Association between serum ferritin level and lipid profile among diabetic patients: A retrospective cohort study.

High serum ferritin (SF) levels have been linked to obesity, metabolic syndrome, atherosclerosis, diabetes, dyslipidemia, and cancer. This study aimed to investigate the association between SF and dyslipidemia in adults diagnosed with diabetes mellitus. This cross-sectional study retrospectively analyzed the electronic medical records of eligible patients from 3 primary locations in Saudi Arabia namely - Abha, Khamis Mushyt, and Jeddah - from 2010 to 2020. The study included adult patients aged 18 years or older who were diagnosed with diabetes mellitus and identified with an HbA1c level of ≥6.5. This study involved 3674 participants, with males accounting for 26.6% of the total. The mean age of the studied population was 48.0 ±â€…18.4 years. The median [interquartile range] of SF among males was higher than females, however, this difference was not statistically significant (60.0 [23.4-125.8] vs 55.4 [24.0-113.4], P = 0.204). On the other hand, age and region were significantly associated with SF (P = .032 and 0.035). SF had a significant positive correlation with cholesterol (r = 0.081, P < .001), low-density lipoprotein cholesterol (r = .087, P < .001), and triglycerides (r = 0.068, P < .001) and negative correlation with high-density lipoprotein cholesterol (r = -0.13, P < .001). Multivariate analysis revealed that age, sex, residence, and HbA1c were significantly affecting the lipid profile. Clinicians should consider including SF testing as part of the comprehensive evaluation of patients with diabetes and dyslipidemia.

Exploring the self-efficacy of patients with diabetes: its role as a predictor of diabetes management and well-being.

Background: Self-efficacy is a popular psychological concept that refers to an individual's perception or belief in his ability to perform specific actions. This study aimed to assess the predictive value of self-efficacy, measured using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEM6S) questionnaire, for diabetes management and overall well-being in patients with diabetes. Subject and methods: An anonymous online cross-sectional study was conducted to evaluate the self-efficacy of diabetic patients in the Asser region of Saudi Arabia. The participants were requested to upload their most recent glycated hemoglobin A1C (HbA1C) measurements taken in the last three months, which helped in the accurate categorization of their diabetes as either controlled or uncontrolled. We used the valid Arabic version of the SEM6S and WHO-5 well-being questionnaires to assess patient self-efficacy and well-being. Results: A cohort of 342 patients was enrolled in the study, 67.25% were married, their mean age was 43.17 ± 17.61 years, and 52.69% had university-level or higher education. Among the participants, 46.0% exhibited well-being, while 24.9% reported poor well-being, including 9.4% who were identified as experiencing depression. The mean scores of self-efficacy and well-being were significantly higher among those with controlled diabetes versus uncontrolled diabetes (40.86 ± 13.26 vs. 36.48 ± 13.26) and (67.35 ± 21.22 vs. 60.93 ± 25.05), respectively. The predictors of glycemic control were self-efficacy [Odds ratio (OR)=1.03 (95%CI, 1.01-1.06, P=0.002], having other chronic diseases [OR=3.25 (95%CI), P<0.001], having type 1 diabetes [OR=7.16, 95%CI, P=0.005], being Saudi [OR=7.67, (95%CI, P=0.027], working in a public sector [OR=0.15, (95%CI, 0.05-0.44), P=0.005], being unemployed [OR=0.19, (95%CI, 0.06-0.59), P=0.005], being a smoker [OR=0.44, 95%CI, 0.19-0.98, P=0.048], and duration of diabetes between 6-10 years [OR= 0.33, 95%CI, 0.11-0.95), P=0.043] or more than 10 years OR=0.32, 95%CI, 0.12-0.86), P=0.026]. The main determinants of well-being were having self-efficacy [OR=1.07 (95%CI, 1.04-1.09), P = 0.0001], having public health insurance [OR=4.36 (95%CI, P=0.015], and education level (read and write) [OR=0.13 (95%CI,.02-.70), P=0.021]. Conclusions: The study reveals that non-modifiable and modifiable factors, including self-efficacy, play a crucial role in diabetes control. The study recommends providing targeted educational interventions, using different social media platforms, psychosocial support programs, and inclusive healthcare policies to improve diabetes control and mental well-being among diabetic patients.

Lipid profiles and their relation to glycemic control in Saudi Arabia: The role of altitudes and environmental factor.

Background: The height from sea levels, environmental factors, human-environment interactions, and lifestyle significantly influence the lipid profile and glycemic control of a population. Objective: This study aims to explore the influence of altitude on lipid profiles and glycemic control among the Saudi population at sea level and high altitude. Methods: In this retrospective cross-sectional study, a large dataset of patients of both gender and over 30 years old attending internal medicine clinics from two different regions at different heights from sea level, Jeddah (sea level) and Asir region (high altitudes) and referred to commercial laboratories for glycated haemoglobin (HbA1c) and lipids profile. Results: Compared to the Asir region, the Jeddah region had significantly higher mean values for fasting blood sugar (FBG), total cholesterol (TC), low-density lipoprotein (LDL-C), and triglycerides (TG) (P < 0.05). Every 1 mg/dL increase in FBG results in a 0.662 mg/dL increase in TG from the Jeddah region. However, it was a 0.318 mg/dL increase in TG from the Asir region. HbA1c demonstrated a significant (P < 0.05) strong positive correlation with TC, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and lipid ratio. FBG levels were also associated with a high level of TC/HDL-C (ß = 0.137 95% confidence interval [CI]: 0.11-0.21; P < 0.05), LDL-C/high-density lipoprotein cholesterol (HDL-C) (ß = 0.50; 95% CI: 0.31-1.49; P < 0.05), and TG/HDL-C (ß = 0.14; 95% CI = 0.12-0.15; P < 0.05) in Jeddah region. However, significantly high blood pressure was observed in the population from high altitudes. Conclusion: Our results demonstrated a significant positive correlation between lipid profile and glycemic control with high prevalence at sea level.

Prediction of COVID-19 severity from clinical and biochemical markers: a single-center study from Saudi Arabia.

OBJECTIVE: It is known that the severity of COVID-19 is linked to the prognosis of patients; therefore, an early identification is required for patients who are likely to develop severe or critical COVID-19 disease. The purpose of this study is to propose a statistical method for identifying the severity of COVID-19 disease by using clinical and biochemical laboratory markers. PATIENTS AND METHODS: A total of 48 clinically and laboratory-confirmed cases of COVID-19 were obtained from King Fahad Hospital, Medina (KFHM) between 27th April 2020 to 25th May 2020. The patients' demographics and severity of COVID-19 disease were assessed using 39 clinical and biochemical features. After excluding the demographics, 35 predicting features were included in the analysis (diabetes, chronic disease, viral and bacterial co-infections, PCR cycle number, ICU admission, clot formation, cardiac enzymes elevation, hematology profile, sugar levels in the blood, as well as liver and kidney tests, etc.). Logistic regression, stepwise logistic regression, L-2 logistic regression, L-2 stepwise logistic regression, and L-2 best subset logistic regression were applied to model the features. The consistency index was used with kernel Support-Vector Machines (SVM) for the identification of associated markers. RESULTS: L-2 best subset logistic regression technique outperformed all other fitted models for modeling COVID-19 disease severity by achieving an accuracy of 88% over the test data. Consistency index over L-2 best subset logistic regression identified 14 associated markers that can best predict the COVID-19 severity among COVID-19 patients. CONCLUSIONS: By combining a variety of laboratory markers with L-2 best subset logistic regression, the current study has proposed a highly accurate and clinically interpretable model of predicting COVID-19 severity.

Association between serum uric acid with diabetes and other biochemical markers.

Objective: This study aimed to decipher the association between serum uric acid (UA) and glycated hemoglobin (HbA1c) in the population from the southern region of Saudi Arabia. Method: In this retrospective cross-sectional investigation, clinical data obtained from the different commercial laboratories in the Asir region of Saudi Arabia were screened over 2 years. Data were analyzed using standard statistical methods. Results: A total of 1984 laboratory investigations with 1215 females (61.2%) and 769 males (38.6%) were included in the data analysis. In our investigation, the prevalence of hyperuricemia in the study population was 53.5% (41.2% females and 12.3% males) and in the diabetic population was 12.7% (9.47% females and 3.23% males), in prediabetics was 12.65% (9.8% females and 2.85% males), respectively. Prediabetic subjects had higher UA levels than people with diabetes or healthy people. Higher UA quartiles were associated with a high level of urea, blood urea nitrogen (BUN) creatinine, HbA1c, fasting blood sugar (FBS), and total cholesterol (TC) (P < 0.05). High UA (OR = 1.33 for diabetes; OR = 2.676 for prediabetes), high BUN (OR = 3.05 for diabetes; OR = 2.293 for prediabetes), high TC (OR = 3.75 for diabetes; OR = 1.098 for prediabetes), and high TG (OR = 2.67 for diabetes; OR = 1.943 for prediabetes) parameters are the most influential risk factor in diabetic and prediabetic patients than the people who have normal UA, BUN, TC, and TG value. Conclusion: High UA levels are significantly associated with prediabetes as defined by HbA1c criteria, indicating that UA has a significant role in the disturbance of glucose metabolism. A significant positive association was observed between dyslipidemia and serum UA in the study population.

Prevalence and Characteristics of Thyroid Abnormalities and Its Association with Anemia in ASIR Region of Saudi Arabia: A Cross-Sectional Study.

The thyroid gland plays a significant role in the metabolism and proliferation of blood cells; hematological disorders are frequently observed in patients with thyroid disorders, and the most frequent problem is anemia. The main objective of this research work is to evaluate the prevalence and types of thyroid dysfunction and their association with anemia in different gender stratified by age in the Asir region of Saudi Arabia. Four years of data from July 2016 to July 2020 for 9992 study subjects were collected. Statistical analysis was performed based on thyroid disorder and anemia stratified by gender and age subgroup. The mean age of the study subject was 43.4 ± 15.8 years, and females constituted 61.7% of cases. Thyroid dysfunction was observed in 49.76% (4973), and subclinical hypothyroidism was the most prevalent type (3922/9992), followed by primary hypothyroidism (530/9992). Females have a significantly higher overall prevalence of thyroid dysfunction than males (p < 0.05). Anemia was detected in 1344 females and 465 males with a thyroid disorder, and also, the prevalence was significantly higher (p < 0.05), compared to the normal thyroid group. Thyroid disorders are a common problem in our population, more prevalent in females than males, with the peak age of above 30 years, and are associated with an increased prevalence of anemia.

Clinical utility of genotypic resistance tests for HIV-1-infected patients with low-level virological failure.

The usefulness of genotypic resistance tests (GRT) among HIV-1 patients with low-level virological failure (LLVF) was evaluated. Up to 78% of samples with <1,000 copies/ml were sequenced successfully. For samples with 50 to 200 copies/ml, the success rate was as high as 69%. LLVF should not deter clinicians from requesting GRT.

Morphometric and molecular differentiation of Phlebotomus (Phlebotomus) sandflies.

The closely related sandfly species of the subgenus Phlebotomus namely, Phlebotomus papatasi (Scopoli, 1786), Phlebotomus duboscqi Neveu-Lemair, 1906 and Phlebotomus bergeroti Parrot, 1934 (Diptera: Psychodidae), are major vectors of Leishmania major (Kinetoplastida: Trypanosomatidae), the causative agent of cutaneous leishmaniasis in the Old World. Although allopatric in most of their distribution, the three species exist sympatrically in many places in central and eastern Sudan. Males of the three species can be distinguished using morphological characters; however, females are much harder to identify, thus complicating epidemiological studies. We carried out a morphometric and a molecular study to determine reliable morphological features and develop a polymerase chain reaction (PCR) assay for distinguishing females of these species. Males and females from each species were collected from sites in Sudan, East Africa and from one site in Mali, West Africa. Males were analysed morphologically and 20 characters and 10 character ratios were used in a stepwise discriminant analysis. This led to the identification of four characters with high discriminant loading scores sufficient for accurate male species identification. Male DNA was then used for the development of a PCR-based species diagnostic based on the second internal transcribed spacer (ITS2) of the ribosomal DNA. A set of four primers was developed to generate fragment sizes that are specific to each species and can reliably identify females as well as hybrid DNA. Both the morphometric and the molecular findings of this study have important applications for studies of the epidemiology of cutaneous leishmaniasis.

Cardiovascular risk evaluation and antiretroviral therapy effects in an HIV cohort: implications for clinical management: the CREATE 1 study.

AIMS: The aim of this study is to determine the cardiovascular disease (CVD) risk profile of a large UK HIV cohort and how highly active antiretroviral therapy (HAART) affects this. METHODS: It is a cross-sectional study within a large inner city hospital and neighbouring district hospital. A total of 1021 HIV positive outpatients representative of the complete cohort and 990 who had no previous CVD were included in CVD risk analysis. We recorded demographics, HAART history and CVD risk factors. CVD and coronary heart disease (CHD) risks were calculated using the Framingham (1991) algorithm adjusted for family history. RESULTS: The non-CVD cohort (n = 990) was 74% men, 51% Caucasian and 73.1% were on HAART. Mean age was 41 +/- 9 years, systolic blood pressure 120 +/- 14 mmHg, total cholesterol 4.70 +/- 1.05 mmol/l, high-density lipoprotein-C 1.32 +/- 0.48 mmol/l and 37% smoked. Median CVD risk was 4 (0-56) % in men and 1.4 (0-37) % in women; CHD risks were 3.5 (0-36) % and 0.6 (0-16) %. CVD risk was > 20% in 6% of men and 1% of women and > 10% in 12% of men and 4% of women. CVD risk was higher in Caucasians than other ethnicities; the risk factor contributing most was raised cholesterol. For patients on their first HAART, increased CHD risk (26.2% vs. 6.5%; odds ratio 4.03, p < 0.001) was strongly related to the duration of therapy. CONCLUSIONS: Modifiable risk factors, especially cholesterol, and also duration of HAART, were key determinants of CVD risk. DISCUSSION: Regular CHD and/or CVD risk assessment should be performed on patients with HIV, especially during HAART therapy. The effect of different HAART regimens on CHD risk should be considered when selecting therapy.

Ultramicrosurgery: A new approach to treat primary male genital lymphedema.

BACKGROUND: Lymphedema is a chronic pathology characterized by progressive swelling due to lymphatic dysfunction (1). Literature contains few studies that focus on male genital lymphedema. A variety of surgical techniques as part of the male genital lymphedema therapeutic strategy has been described. Supramicrosurgical lymphatico-venular anastomosis s-LVA, based on connecting lymphatic collectors to venules, has evidenced efficient outcomes thus far. However, the peculiarity of the genital area may lead to an innovative and even more accurate surgical technique as a treatment of male genital lymphedema: lymphatic pre-collectors located superficially over the fascial layer can be used to perform the ultramicrosurgical anastomosis. PURPOSE OF THE STUDY: In this paper, the authors report their experience of this new surgical concept based on anastomosing lymphatic precollectors to venules. METHODS: We performed a retrospective study from 2014 to 2016. Six male patients with primary genital lymphedema underwent ultramicrosurgical lymphatico-venular anastomosis in Siena University Hospital, Italy. RESULTS: Ultramicrosurgical lymphatico-venular anastomosis has evidenced positive outcomes in terms of prognosis, infectious complications, volume reduction, and quality of life. The average cellulitis rate dropped from 2.5 episodes a year to 0.5 episodes after surgical intervention. The mean satisfaction index passed from 1.33 before the intervention to 2.83. CONCLUSION: Ultramicrosurgical lymphatico-venular anastomosis represents a challenging physiological approach for male genital lymphedema with promising outcomes.

Reduced fibrinolysis and increased fibrin generation can be detected in hypercoagulable patients using the overall hemostatic potential assay.

BACKGROUND: Routinely available coagulation assays are not capable of detecting clinically defined hypercoagulable states. A number of global coagulation assays have been developed with the potential to evaluate hypercoagulability, which predisposes to the common clinical events of arterial and venous thromboembolism (VTE). OBJECTIVES: We hypothesized that the overall hemostatic potential (OHP) assay would show abnormal fibrin generation and lysis in patients with clinically defined hypercoagulable states. METHODS: We used the OHP assay as described by Blombäck and colleagues [1,2] in 161 clinically hypercoagulable patients with arterial or VTE, pregnancy complications or autoimmune disease. Eighty patients had associated antiphospholipid antibodies (APLA). Ninety-eight normal plasma donors were tested for comparison. RESULTS: We derived three new assay parameters for correlation with hypercoagulable states: the maximum optical density, maximum slope, and delay in onset of fibrin generation. We found significantly different assay results for all patients' parameters examined when compared with controls, indicating both increased fibrin generation and reduced fibrinolysis in hypercoagulable patients. The findings were similar whether samples were collected in association with an acute thrombotic event or not. Estimated assay sensitivity for detection of a clinically defined hypercoagulable state was 96%. CONCLUSIONS: The OHP assay is a simple, inexpensive global test that is useful for assessing patients with hypercoagulable states including APLA. OHP results are significantly abnormal in hypercoagulable groups compared with controls, indicating that both increased fibrin generation and reduced fibrinolysis contribute to hypercoagulable states. The assay may ultimately assist in tailoring clinical management to patients' individual requirements.

Use of a functional assay to diagnose protein S deficiency; inappropriate testing yields equivocal results.

Inherited deficiency of protein S (PS) is a rare but accepted risk factor for venous thromboembolism. There is accumulating evidence that inherited PS deficiency may be associated with a variety of adverse obstetric events. Acquired PS deficiency may be caused by a variety of clinical states including normal pregnancy. We conducted a retrospective audit of the results of screening for PS deficiency through our reference laboratory. The majority of patients in this audit with significantly reduced (<50%) free functional PS levels had a major confounding factor likely to cause acquired PS deficiency, most frequently pregnancy. Recommendations for PS testing for the diagnosis of hereditary PS deficiency include deferring testing until at least 40 days post-partum. It appears that these recommendations are not being adhered to leading to difficulty in the interpretation of results.

Relationship between human T cell leukemia virus-II and atypical hairy cell leukemia: a serologic study of hairy cell leukemia patients.

Human T cell leukemia virus (HTLV-II) is an infrequently encountered human T cell leukemia virus first isolated from a patient with atypical hairy cell leukemia. Recently, we identified a second patient infected with HTLV-II who had a similar clinical syndrome of atypical hairy cell leukemia associated with peripheral T cell lymphocytosis. HTLV-II was detected by molecular hybridization studies, and more recently, by electron microscopy, in cell lines derived from the patient. Both patients came from the Los Angeles area and had spent several years in Alaska. As opposed to our two patients, 21 patients with more typical cases of hairy cell leukemia were seronegative for HTLV-II. Two additional cases of unusual T cell malignancy linked to HTLV-II have been described by other investigators and bear limited similarity to our index cases. Further studies are necessary to define the spectrum of malignancies linked to HTLV-II and to identify infected individuals for prospective study.

Evidence that protein kinase A activity is required for the basal and tax-stimulated transcriptional activity of human T-cell leukemia virus type-I long terminal repeat.

The present study was undertaken to investigate the role of protein kinase A (PKA) in the control of human T-cell leukemia virus type-I (HTLV-I) long terminal repeat (LTR) expression, since this issue is still controversial. For this purpose we employed two human T-cell lines; the Jurkat cells in which long exposure to diBu-cAMP severely down-regulated the catalytic subunit of PKA (PKA-C), and H-9 cells in which such exposure markedly increased PKA-C level. Transient transfection assays revealed that addition of diBu-cAMP 1 h before or after transfection profoundly increased HTLV-I LTR directed CAT expression and synergistically enhanced its stimulation by the viral transactivator tax gene product in both cell lines. However longer exposure to diBu-cAMP before transfection reduced LTR-CAT expression to below its basal level and completely abolished its stimulation by tax in Jurkat cells, and this diBu-cAMP inhibitory effect could be abrogated by co-transfection of a PKA-C expressing vector. By contrast, in H-9 cells, this long exposure to diBu-cAMP continued enhancing LTR-CAT expression and its tax-mediated transactivation, and this stimulatory effect of diBu-cAMP could be diminished by the PKA-specific inhibitor N-12-(p-bromocinnamylamine)ethyll-5-isoquinolinsulfonamid e (H-89). Notably, in the absence of diBu-cAMP treatment H-89 reduced LTR-CAT expression to below its basal level and prevented its stimulation by tax in both cell lines. Together these findings indicate not only that cAMP-activated PKA stimulates HTLV-I LTR expression and its transactivation by tax, but even in the absence of PKA activating signals the basal HTLV-I LTR expression as well as its stimulation by tax are both dependent on a basal PKA activity.

DNA binding properties of the zinc-bound and zinc-free HIV nucleocapsid protein: supercoiled DNA unwinding and DNA-protein cleavable complex formation.

The HIV nucleocapsid (NC) protein contains, as those of other retroviruses, two Cys-His arrays which function as zinc finger binding domains. The nucleic acid binding properties of retroviral NC have been previously demonstrated. In this study, we characterized the DNA binding ability of the zinc-bound and zinc-free forms of HIV NC. We found that in addition to binding single-stranded DNA, both forms bind and unwind supercoiled plasmid DNA. The binding ability of the zinc-bound form was higher than the zinc-free form. In addition we showed the formation of NC protein-DNA cleavable complex which is the result of a presumably covalent bond formed between the protein and the phosphate moiety of the DNA backbone. The NC unwinding activity and the protein-DNA cleavable complex formation resembles the first step of the relaxing mechanism of DNA topoisomerase. Our results shed light on the possibility of a novel physiological function for the HIV NC protein in the viral life cycle.

Stimulation of HTLV-I expression by subtoxic dose of 3-methylcholanthrene.

In vivo infection by HTLV-I is characterized by the lack of virus expression in the host's infected cells and in most cases it is clinically inapparent. The present study shows that exposure of HTLV-I-infected human T-cells to a maximal non-toxic dose of 3-MC remarkably enhances virus expression. This stimulatory effect was demonstrated by showing elevated levels of viral RNA and proteins within the cells and increased virus release to the culture medium. The enhanced virus expression was found to increase the ability of the treated cells to infect normal human peripheral lymphocytes in co-culture. Such data point to the possibility that initiation of a pathogenic process in HTLV-I-infected individuals might result from activating the expression of the latent provirus by environmental carcinogens.

Effect of mouse interferon on retrovirus production by chronically infected rat cells.

Mouse interferon (IFN) inhibited retrovirus release by both mouse and rat cells with the same efficiency. However, the antiviral state developed more slowly in rat than in mouse cells, and after removal of IFN it also persisted for a longer time in rat than in mouse cells. Under conditions where IFN strongly inhibited virus production it had no effect on cell replication nor on cellular RNA or protein synthesis.

A survey of heparin monitoring in Australasia.

Full dose heparin therapy is monitored by a variety of laboratory methods, of which the activated partial thromboplastin time (APTT) is the most popular. A large number of APTT reagents are currently available, with different sensitivities to heparin evident in many. Within the literature it is apparent that there is a lack of consensus, and indeed some confusion, regarding the therapeutic ranges for the APTT for standard heparin therapy in the treatment of venous thromboembolic disease. Accordingly we conducted an Australasian survey to evaluate current laboratory and clinical practices in monitoring heparin therapy, to determine the extent of variation in the approach and to stimulate the process of standardisation of acceptable procedures and methodology. Results of the survey demonstrate that currently there is no uniform practice used to establish therapeutic ranges for monitoring standard heparin therapy. Furthermore, results suggest that current practice may lead to subtherapeutic anticoagulation in many laboratories.

Urethral mucosa prolapse in young girls.

Two cases of urethral prolapse in young girls are presented. One patient had urethral bleeding and the other presented with acute urinary retention. In Tanzania, to the best of our knowledge, urethral prolapse as a cause of acute urine retention in girls has not been reported. The management is also discussed.

Ureterosigmoidostomy: a useful procedure of internal urinary diversion in selected patients.

OBJECTIVES: To determine the quality of life and complications in patients who underwent ureterosigmoidostomy for various indications. DESIGN: Case series. SETTING: Urological clinic. SUBJECT: Nine patients who had good anal sphincter control and no upper urinary tract dilation, underwent urinary diversion via ureterosigmoidostomy by antireflux ureteral anastomosis. They were followed up for not less than five years. MAIN OUTCOME MEASURES: Incidence of symptomatic urinary tract infections, metabolic derangement; occurrence of upper urinary tract dilation, frequency of emptying the rectum, incidence of soiling and quality of life. RESULTS: The group as whole, experienced a total of 69 years of life with ureterosigmoidostomy diversion. There were no serious post operative complications. There were two incidences of urinary tract infection in the same patients who also had upper urinary tract dilation. Metabolic derangements and gross incontinence did not occur. All patients had satisfactory quality of life. CONCLUSIONS: In under developed nations where patients cannot afford external appliances and the surgeon's skill for continent diversion is lacking, our results show that in properly motivated patients with a good functional anal sphincter and who are free of ureteral dilation, ureterosigmoidostomy can be a successful form of urinary diversion without the psychological and social burdens of a wet cutaneous stoma.