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Introduction: Topical pharmacotherapy is often practiced in the treatment of adults with phimosis or Lichen Sclerosus (LS). However, it is unclear if it is effective., Areas Covered: The authors review pharmacological treatments in adults with phimosis or LS using the Preferred Reporting of Items for Systematic Reviews and Meta-analysis (PRISMA) methodology. They searched seven databases using key words phimosis, drug treatment, medical, treatment, lichen sclerosis, pharmacological treatment, medications, comparison study for all English language articles from 1962 to 2021. Inclusion criteria were patients >18 yr., and the use of topical medical treatment with outcome data. The article includes the authors' expert opinion and their perspectives for the future., Expert Opinion: There is limited research, with significant heterogeneity, which suggests the probable safety of topical steroids with some potential to reduce the signs and symptoms of LS. However, good quality research, with patient reported outcome data, is required to establish its true role and effectiveness.

Background: Urolithiasis has a significant impact on patients' health-related quality of life (HRQoL)., Objective: To develop a core patient-reported outcome measure (PROM) using modern psychometric methods to quantify the impact of urolithiasis and different treatments., Design, Setting, and Participants: Adult patients with urinary calculi, attending urology departments, covering all index categories and treatment spectrum, participated during different development phases. The pilot instrument was created from potential items (phases 1 and 2) within the conceptual framework. The instrument was pretested (phase 3) and then underwent psychometric evaluation in two parts (phases 4 and 5)., Outcome Measurements and Statistical Analysis: The validity and reliability of the new PROM were assessed using Rasch measurement theory (RUMM 2030 statistical software) and traditional analyses., Results and Limitations: In total, 683 patients (median age 51 yr, range 18-92 yr) participated during different phases. The initial 60-item draft (five scales) was completed by 212 patients (phase 4). A revised 25-item draft was produced after removal of unstable items. In the second field test, the revised version was evaluated by 369 patients. This led to the final Urinary Stones and Intervention Quality of Life (USIQoL; 15 items) with summated logit scores. The PROM includes three scales: pain with physical health (six items), psychosocial health (seven items) and work performance (two items). Lower scores indicate better outcomes. Results demonstrate that USIQoL is reliable (r ≥ 0.8) and internally consistent (α ≥ 0.7), and has good construct validity (good hypothesised correlations, r > 0.3) and satisfactory sensitivity to change (p < 0.01). All scales demonstrated unidimensionality with good item fit and person separation indices. A limitation is that USIQoL was developed in the English language within the UK population., Conclusions: USIQoL is a short, unidimensional, valid, and reliable PROM for assessing the HRQoL impact of urinary calculi and treatments. It is expected to serve as a core PROM across the entire spectrum of urolithiasis., Patient Summary: Kidney stones are a common condition for which various treatment options are available. The condition and treatments have a significant impact on a patient's quality of life. This can be measured objectively using a valid and reliable patient-reported outcome measure (PROM) developed using modern methods. We have developed a PROM that provides helpful and accurate measurement useful for all stakeholders., (Copyright © 2020 European Association of Urology. All rights reserved.)

Introduction: Shock wave lithotripsy (SWL) is a well-established treatment for kidney stone disease (KSD) and despite its decreased popularity in the past, it has now gained renewed interest due to its minimally invasive nature and good outcomes, especially in the face of COVID-19 pandemic. The aim of our study was to perform a service evaluation to analyse and identify quality of life (QoL) changes [using Urinary Stones and Intervention Quality of Life (USIQoL) questionnaire] after repeat SWL treatments. This would enable a greater understanding of SWL treatment and reduce the current gap of knowledge regarding patient specific outcomes in the field., Material and Methods: Patients affected by urolithiasias underwent SWL treatment between September 2021 and February 2022 (6 months), were included in the study. A questionnaire was given to the patients in each SWL session and consisted of three main topic areas: a domain on Pain and Physical Health, on Psycho-social Health and on Work (see appendix below). Patients also completed a Visual Analogue Scale (VAS) in relation to the pain related to the treatment. Data from the questionnaires were collected and analysed., Results: A total of 31 patients filled in two or more surveys, with a mean age of 55.8 years. On repeat treatments, pain and physical health domain was significantly better (p = 0.0046), psycho-social health domain was significantly better (p <0.001), work domain was significantly better (p = 0.009) and a correlation [on Visual Analog Scale (VAS)] was observed between pain decreasing in subsequent SWL procedures., Conclusions: Our study found that the choice of SWL to treat KSD does improve a patient's QoL. This could be related to improvement of physical health, psychological and social wellbeing, and ability to work. Higher QoL and low pain scores are observed in relation to repeat SWL treatment and are not directly associated to stone-free status., Competing Interests: The authors declare no conflicts of interest., (Copyright by Polish Urological Association.)

Locomotor adaptations, as required for community walking, rely heavily on the sense of vision. Little is known, however, about gaze behavior during pedestrian interactions while ambulating in the community. Our objective was to characterize gaze behavior while walking in a community environment and interacting with pedestrians of different locations and directions. Twelve healthy young individuals were assessed as they walked in a shopping mall from a pre-set location to a goal located 20 m ahead. Eye movements were recorded with a binocular eye-tracker and temporal distance factors were assessed using wearable sensors from a full-body motion capture system. Participants exhibited more numerous and longer gaze episodes on pedestrians (GEP) that were walking in the same direction as themselves vs. those that were in the opposite direction. The relative durations of GEPs, however, showed no significant differences between pedestrians walking in the same vs. opposite direction. Longer durations of GEPs were also observed for centrally located pedestrians compared to those located on either side, but this was the case only for pedestrians that were walking in the same direction as participants. In addition, pedestrians in the centre, and even more so those on the right, were fixated at farther distances compared to those on the left. Results indicate that healthy young individuals modulate their gaze behavior as a function of the location and direction of pedestrians when ambulating in a community environment. The observed modulation is interpreted as being caused by an interplay between collision risk, pedestrian visibility, presence of leaders and social conventions (right-sided circulation). Present results also establish baseline measures for the quantification of defective visuomotor strategies in individuals with mobility disorders., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Urinary stone disease is a common, often recurrent disease, that can have a negative impact on patients' health-related quality of life (HRQoL), often effecting working, productive members of society. The literature lacks data from structured, qualitative research which could give unique insight into patients' HRQoL. The objective is to understand the impact of urinary stone disease and treatments on patients' HRQoL, from patients' and their relatives' perspective using qualitative and quantitative methodologies. Semi-structured interviews and a focus group were used to understand the HRQoL issues of patients with urinary stones disease, covering the American Urology Association index stone categories. Thematic analysis was performed (using qualitative data analysis software). Familial impact was assessed using the family-related outcome measure (FROM-16©). 62 patients with stone disease and interventions (mean age 51, range 19-92) participated. Data collection stopped when data saturation was achieved. Analysis revealed negative impact of stone disease and interventions on the patients' HRQoL, affecting domains of pain, physical symptoms, outlook on life, work/career, change in lifestyle/diet, social life, difficulties of daily living, travel/holiday problems, relationships and family member impact (106 themes grouped under ten broad headings). Sub-group analyses revealed similar impact in either sex, ureteric and renal stone groups. Recurrent stones were associated with work/financial concerns and treatment preferences varied accordingly. Our qualitative study presents detailed insights into the multidimensional impact of urinary calculi and their treatments on various domains of the HRQoL, confirming previous findings and adding new observations. The findings are expected to help in the development of patient-centric measures and communication tools.

Introduction: Ureteral stents are frequently used in urology practice and have a significant impact on health-related quality of life (QoL). In 2003 . Joshi et al. developed the specific questionnaire for evaluation of QoL and stent-related symptoms, namely Ureteral Stent Symptoms Questionnaire (USSQ). USSQ consists of 40 questions and 2 visual analog scales (VAS), divided into 6 domains. Over the past decade, this questionnaire has been translated into 9 languages. A Russian version of the questionnaire has not been developed yet., Aim: To perform linguistic validation of the Russian version of the USSQ., Material and Methods: Linguistic validation of the original USSQ was performed through a standard process including translation, back translation and pilot study. A total of 103 patients undergone ureteral stent placement and successfully filled in the Russian USSQ at weeks 1 and 4 after stenting, and at week 4 after stent removal. In addition, 30 healthy people filled in the same questionnaires twice at 3-week intervals, as a control group. To evaluate reliability, validity and sensitivity to change of the Russian USSQ, statistical analysis was performed. External criteria included validated questionnaires (EQ-5D, IPSS and pain VAS)., Results: Content validity was approved by experts and proved during patients interviewing. Reliability test-retest was satisfactory for urinary symptoms, body pain, general health, and work performance domains (p<0,001 between test and retest evaluation). USSQ domains showed good correlations between each other (correlation coefficient was 0,80-0,94). Cronbach's alpha coefficient of internal reliability was 0.73-0.95. Correlation between other instruments and corresponding USSQ domains was good (p<0,001), proving criterial validity. Sensitivity to changes after stenting and stent removal was also good for most domains (p less or equal 0,001)., Conclusion: Russian version of USSQ is a valid, reliable and sensitive instrument for the assessment of QoL and stent-related symptoms and is ready for application in the routine clinical practice.

Ureteric stents are one of the most crucial tools used for various clinical conditions in the urological field. Placement of a ureteric stent, for short- or long-term use, remains one of the commonest urological interventional procedures. In the past few decades, ureteral stents have undergone notable technological advancements. However, an ideal stent without significant side-effects is yet to be engineered. Indwelling ureteric stents are often accompanied by physical distress to the patient and clinical complications, such as bacterial adhesion, encrustation, malpositioning, stent fracture and forgotten stent syndrome, that influence patients' health-related quality of life. In the market, different stent types are available, designed to reduce infections, and improve patient symptoms and tolerance. In this review, we have emphasized the recent developments that have taken place in stent design, size, materials and coating. This overview looks at current practices and problems related to stents, along with clinical and economic considerations. Few trial studies have been enumerated in the context of utilization of a ureteral stent symptom questionnaire and various stent models to compare their effects in patients., (© 2019 The Japanese Urological Association.)

Introduction: In the year 2003, Joshi et al . developed a validated outcome assessment tool to measure the ureteral stent-related symptoms. The original English language Ureteral Stent Symptom Questionnaire (USSQ) has been validated in various languages worldwide. Our objective was to develop the USSQ in Hindi, a commonlyused language in India, by validating it in patients undergoing ureteroscopic lithotripsy., Materials and Methods: A final Hindi version of the USSQ was derived from the original English version to apply to the study population by translation, back translation, and face-to-face interviews. The Hindi and English versions were completed by 70 patients undergoing ureteroscopic lithotripsy with stent in situ , on postoperative days 7 and 8, and 4 weeks after stent removal. Similarly, discriminant validity was checked among 50 healthy individuals. A detailed statistical analysis was used to correlate results (Cronbach's α coefficient, Spearman's correlation, and Mann-Whitney U-test)., Results: A total of 70 patients were enrolled in the study and 61 completed the final assessment. The median age was 35 years (range: 18-60 years). The USSQ domain scores with the stent in situ were higher than poststent status. The test-retest reliability checked by Cronbach's α coefficient (>0.44) and Spearman's correlation coefficient (>0.44) were acceptable to good. We found high discriminant validity of the questionnaire between patients with stent and the healthy controls ( P < 0.05)., Conclusion: Our results demonstrate satisfactory validity for the Hindi version of the USSQ for the assessment of quality of life in patients with stent. This is ready for application in the clinical studies and the future stent-related research in Hindi language., Competing Interests: Conflict of Interest: There are no conflicts of interest.

Purpose: We developed and validated the German version of the Ureteral Stent Symptoms Questionnaire (USSQ) for male and female patients with indwelling ureteral stents., Methods: The German version of the USSQ was developed following a well-established multistep process. A total of 101 patients with indwelling ureteral stents completed the German USSQ as well as the validated questionnaires International Prostate Symptom Score (IPSS) or International Consultation on Incontinence Questionnaire (ICIQ) and the Short Form Health Survey (SF-36). Patients completed questionnaires at 1 and 2-4 weeks after stent insertion and 4 weeks after stent removal. Statistical analyses were performed to assess the psychometric properties of the questionnaire., Results: The German version of the USSQ showed good internal consistency (Cronbach's α = .72-.88) and test-retest reliability [intraclass correlation coefficient (ICC) = .81-.92]. Inter-domain associations within the USSQ showed substantial correlations between different USSQ domains, indicating a high conceptual relationship of the domains. Except from urinary symptoms and general quality of life, German USSQ showed good convergent validity with the corresponding validated questionnaires. All USSQ domains showed significant sensitivity to change (p ≤ .001)., Conclusion: The new German version of the USSQ proved to be a reliable and robust instrument for the evaluation of ureteral stent-associated morbidity for both male and female patients. It is expected to be a valid outcome measure in the future stent research.

Introduction: Urinary stone disease is a common and often recurrent condition that can affect kidney function and requires a range of medical and surgical treatments, all of which can have a significant impact on patients' health-related quality of life (HRQoL) and treatment preferences., Objective: To review the literature systematically for all studies that include HRQoL measurement or patient preferences in the context of urinary stone disease., Methods: Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process, EMBASE, SCOPUS, EconLit, and Web of Science were searched from inception to January 2016. All study designs with adult participants were included. Narrative synthesis was performed., Results: Thirty-five studies met the inclusion criteria (six randomized controlled trials and 29 observational studies) from 15 countries, including 5472 patients. Eleven studies showed that stone formers had worse HRQoL than the general population; it was noted that stone formers were more likely to suffer from depression. Women have significantly lower HRQoL than men. Twenty-six studies used a generic HRQoL measure and six were nonvalidated disease specific. Studies concerning patient preference were heterogeneous and showed that extracorporeal shock wave lithotripsy is still favored above other interventions and that a large number of patients would prefer the treatment pathway to be decided upon by their clinician., Conclusion: Urinary calculi and its treatment can have significant negative patient impact and influence patient preferences. Patients with stone disease tend to have worse physical and mental HRQoL, quantified using generic measures. Structured research with disease-specific measures underpinned by sound methodology would be beneficial and aid in development of patient-centric management., Systematic Review Registration: This review was prospectively registered with the international prospective register of systematic reviews-PROSPERO 2013:CRD42013006084.

Purpose: We compared the relative permeability of upper urinary tract and bladder urothelium to mitomycin C., Materials and Methods: Ex vivo porcine bladder, ureters and kidneys were dissected out and filled with 1 mg ml(-1) mitomycin C. At 60 minutes the organs were emptied and excised tissue samples were sectioned parallel to the urothelium. Sectioned tissue was homogenized and extracted mitomycin C was quantified. Transurothelial permeation across the different urothelia was calculated by normalizing the total amount of drug extracted to the surface area of the tissue sample. Average mitomycin C concentrations at different tissue depths (concentration-depth profiles) were calculated by dividing the total amount of drug recovered by the total weight of tissue., Results: Mitomycin C permeation across the ureteral urothelium was significantly greater than across the bladder and renal pelvis urothelium (9.07 vs 0.94 and 3.61 μg cm(-2), respectively). Concentrations of mitomycin C in the ureter and kidney were markedly higher than those achieved in the bladder at all tissue depths. Average urothelial mitomycin C concentrations were greater than 6.5-fold higher in the ureter and renal pelvis than in the bladder., Conclusions: To our knowledge we report for the first time that the upper urinary tract and bladder show differing permeability to a single drug. Ex vivo porcine ureter is significantly more permeable to mitomycin C than bladder urothelium and consequently higher mitomycin C tissue concentrations can be achieved after topical application. Data in this study correlate with the theory that mammalian upper tract urothelium represents a different cell lineage than that of the bladder and it is innately more permeable to mitomycin C., (Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Intravesical oxybutynin is highly effective in the treatment of overactive bladder. Traditionally the mechanism of action was explained by antagonism of muscarinic receptors located in the detrusor, however evidence now suggests antimuscarinics may elicit their effect by modifying afferent pathways in the mucosal region. This study aimed to investigate the bladder wall distribution of oxybutynin in an ex vivo setting providing tissue - layer specific concentrations of drug achieved after intravesical delivery. Whole ex vivo porcine bladders were intravesically instilled with 0.167 mg mL(-1) oxybutynin solution. After 60 min, tissue samples were excised, serially sectioned parallel to the urothelial surface and extracted drug quantified. Drug distribution into the urothelium, lamina propria and detrusor was determined. Oxybutynin permeated into the bladder wall at a higher rate than other drugs previously investigated (apparent transurothelial Kp = 1.36 × 10(-5) cm s(-1) ). After 60 min intravesical instillation, concentrations achieved in the urothelium (298.69 μg g(-1) ) and lamina propria (43.65 μg g(-1) ) but not the detrusor (0.93 μg g(-1) ) were greater than reported IC50 values for oxybutynin. This work adds to the increasing body of evidence suggesting antimuscarinics elicit their effects via mechanisms other than direct inhibition of detrusor contraction., (© 2015 Wiley Periodicals, Inc. and the American Pharmacists Association.)

One unreported case of extended-spectrum-beta-lactamase (ESBL)-producing Salmonella enterica serovar Typhi was identified, whole-genome sequence typed, among other analyses, and compared to other available genomes of S. Typhi. The reported strain was similar to a previously published strain harboring blaSHV-12 from the Philippines and likely part of an undetected outbreak, the first of ESBL-producing S. Typhi., (Copyright © 2015, American Society for Microbiology. All Rights Reserved.)