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Background: The aim of this study was to compare the performance of the new flow cytometer UF-5000 with the UF-1000i and Gram staining for determining bacterial patterns in urine samples., Methods: Women who attended our clinic with symptoms suggestive of urinary tract infection were enrolled in the study. Mid-stream urine samples were collected for gram staining, urine analysis and urine cultures. Bacterial patterns were classified using the UF-1000i (none, cocci bacteria or rods/mixed growth), the UF-5000 (none, cocci, rods or mixed growth) and Gram staining., Results: Among the 102 included samples, there were 10 g-positive cocci, 2 g-positive bacilli, 66 g-negative rods, and 24 mixed growth. The sensitivity/specificity of the UF-1000i was 81.8/91.1% for gram-negative rods and 23.5/96.9% for cocci/mixed. The sensitivity/specificity of the UF-5000 was 80.0/88.2% for gram negative rods and 70.0/86.5% for gram-positive cocci., Conclusions: The UF-5000 demonstrated good sensitivity and specificity for Gram-negative bacilli and demonstrated an improved sensitivity for detecting Gram-positive cocci compared with the UF-1000i.

Objectives: Urinary tract infection (UTI) symptoms recurrence is common with estimated rate of 30%–50% within 1 year. The study aimed to evaluate the potential risk factors for symptoms UTI recurrence in women at outpatient clinic in a prospective fashion. Materials and Methods: This study was conducted from July 1, 2016, to June 30, 2019. Women who visited urological clinics with symptoms suggestive of UTI were invited to fill the questionnaire including baseline characteristics and Urinary Tract Infection Symptom Assessment questionnaire. Mid-stream urine samples of the participants were collected for urine analysis and urine culture. Phone interviews were done at 12 months' postclinic visit to inquire if the participants have any episode of UTI symptoms recurrence during the period of time. Results: Among the 188 eligible patients, 183 patients (age = 50.0 ± 15.3 years old) were included in the analysis. There were 44 (24%) participants had UTI symptoms recurrent episodes during the 12-month follow-up. Further multivariate analysis revealed that menopause (odds ratio [OR] = 4.89, 95% confidence interval [CI] = 1.63–14.68, P = 0.005), history of UTI-related symptoms within 1 year before the episode OR = 3.79, 95% CI = 1.29–11.15, P = 0.016) and Escherichia coli infection (OR = 4.81, 95% CI = 1.51-15.28, P = 0.008) were significant risk factors for UTI symptoms recurrence during the 12 months' follow-up. Conclusion: Menopause, history of UTI-related symptoms within 1 year before this episode of UTI and E. coli infection in 12 months were potential risk factors for UTIs symptoms recurrence in women. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine whether toilet-trained children with a history of febrile urinary tract infection (fUTI) and elevated postvoid residual (PVR) urine volume according to a recently published PVR nomogram were at greater risk of UTI recurrence. Materials and methods: One month after recovery from febrile UTI, constipation was diagnosed according to the Rome III criteria, and lower urinary tract (LUT) function was evaluated with two sets of uroflowmetry and PVR by ultrasonography. For children aged ≦6 and ≧7 years, elevated PVR is defined as >20 and >10 ml, respectively. Cox proportion hazards regression was used to evaluate the risk factors for recurrence of UTI. Results: Between 2005 and 2011, 60 children aged 6.5 ± 2.5 years (boy:girl ratio 27:33) were enrolled for analysis. Univariate analysis showed that recurrent febrile UTI was more commonly observed in children with elevated PVR [repetitive elevated PVR: hazard ratio (HR) 5.75, 95 % confidence interval (CI) 1.41-23.4; one elevated PVR: HR 4.53, 95 % CI 1.01-20.2] and high-grade vesicoureteral reflux (VUR; HR 4.53, 95 % CI 1.46-14.07). Multivariate analysis showed that younger age (HR 1.37, 95 % CI 1.03-1.82, p < 0.01) and elevated PVR (HR 2.88, 95 % CI 1.44-5.73, p = 0.01) were significant, independent risk factors for recurrent febrile UTI-but not gender, presence of high-grade VUR and constipation. Conclusion: Elevated PVR defined by the new PVR nomogram predicted recurrent UTI in children with history of febrile UTI. Care should be taken to manage children with elevated PVR. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the inter-observer, intra-observer and intra-individual reliability of uroflowmetry and post-void residual urine ( PVR) tests in adult men. Methods Healthy volunteers aged over 40 years were enrolled. Every participant underwent two sets of uroflowmetry and PVR tests with a 2-week interval between the tests. The uroflowmetry tests were interpreted by four urologists independently. Uroflowmetry curves were classified as bell-shaped, bell-shaped with tail, obstructive, restrictive, staccato, interrupted and tower-shaped and scored from 1 (highly abnormal) to 5 (absolutely normal). The agreements between the observers, interpretations and tests within individuals were analyzed using kappa statistics and intraclass correlation coefficients. Generalizability theory with decision analysis was used to determine how many observers, tests, and interpretations were needed to obtain an acceptable reliability (> 0.80). Results Of 108 volunteers, we randomly selected the uroflowmetry results from 25 participants for the evaluation of reliability. The mean age of the studied adults was 55.3 years. The intra-individual and intra-observer reliability on uroflowmetry tests ranged from good to very good. However, the inter-observer reliability on normalcy and specific type of flow pattern were relatively lower. In generalizability theory, three observers were needed to obtain an acceptable reliability on normalcy of uroflow pattern if the patient underwent uroflowmetry tests twice with one observation. Conclusions The intra-individual and intra-observer reliability on uroflowmetry tests were good while the inter-observer reliability was relatively lower. To improve inter-observer reliability, the definition of uroflowmetry should be clarified by the International Continence Society. [ABSTRACT FROM AUTHOR]

Abstract: The objective of the article is to summarize the results of our previous reports with regard to uroflowmetry, postvoid residual urine (PVR), and lower urinary tract symptoms in healthy children in Xindian, New Taipei, Taiwan. Healthy children aged 4–12 years were enrolled and their PVR was evaluated with two sets of uroflowmetry. Those with a voided volume (VV) < 50 mL were excluded from further analysis. Bladder capacity (BC) was defined as the VV + PVR and the expected BC was defined as (age in years + 1) × 30 mL. Uroflowmetry curves were interpreted independently by two pediatric urologists. The lower value of two consecutive PVRs and the higher value of two consecutive peak flow rates (Qmax) were used to construct dual-PVR and dual-Qmax nomograms, respectively. One parent of each child completed a questionnaire on bedwetting and the dysfunctional voiding symptoms score (DVSS). A total of 1128 children (583 boys and 545 girls) with a mean age of 7.7 ± 2.2 years were eligible for analysis and construction of nomograms. On the first uroflowmetry, 960 (85.1%) children were classified as having a normal bell-shaped curve and 168 (14.9%) had a non–bell-shaped curve. An abnormal uroflow pattern was frequently observed at VV ≥ 100% or BC ≥ 115% of the expected BC. Multivariate analysis revealed that the Qmax value was significantly affected by age, VV, and sex (all p < 0.01). The minimally acceptable Qmax, around the 10th percentile of the dual-Qmax nomogram, was > 11.5 mL/second in children aged ≤ 6 years and > 15.0 mL/second in children aged ≥ 7 years. Significant variations in the PVR were observed in each individual. Multivariate studies showed that the PVR was positively associated with bladder capacity and negatively associated with age, was higher in boys than in girls, and was higher in children with abnormal uroflow patterns. For children aged ≤ 6 years, repetitive PVR > 20 mL or > 10% BC can be regarded as an elevated PVR. For children aged ≥ 7 years, repetitive PVR > 10 mL or 6% BC can be redefined as elevated. A DVSS ≥ 6.66 is highly suggestive of lower urinary tract dysfunction in both sexes with good sensitivity and specificity. New nomograms for uroflowmetry, PVR, and DVSS were established for the noninvasive assessment of pediatric lower urinary tract function. Repeat tests are recommended if a single test is abnormal. Invasive videourodynamic study is recommended in cases of refractory lower urinary tract symptoms and repeat abnormal tests. [Copyright &y& Elsevier]

Purpose: We report intra-individual variability, related factors and the normal reference value of post-void residual urine in children. Materials and Methods: Healthy kindergarteners were enrolled for the evaluation of post-void residual urine, which was assessed by ultrasound within 5 minutes after voiding when voided volume was greater than 50 ml. Bladder over distention was arbitrarily defined as a bladder capacity (voided volume plus post-void residual urine) of 115% or greater of expected bladder capacity. The Pearson correlation method was used to evaluate the correlation between post-void residual urine and related factors. Results: More than 1 post-void residual urine value was recorded in 219 children with a mean ± SD age of 4.9 ± 0.9 years. Mean post-void residual urine was 12.2 ± 20.3 ml (median 5.5). The correlation for consecutive post-void residual urine was low in all children and negligible in the 129 without bladder over distention (r = 0.34 and 0.13, respectively). Repeat post-void residual urine greater than 20 ml and greater than 10% bladder capacity was observed in 2.3% and 7.8% of children, respectively, without bladder over distention. Post-void residual urine increased as bladder capacity increased (r = 0.38, p <0.01). Excluding those with bladder over distention, post-void residual urine decreased as the age of the child increased. Children who drank more fluids before voiding had a higher rate of bladder over distention for each micturition than those who drank regularly (13.8% vs 4.9%, p = 0.04). Conclusions: Because of the significant intra-individual variability of post-void residual urine, a single post-void residual urine test is not reliable for assessing pediatric voiding function. Two post-void residual urine tests are recommended. Post-void residual urine is affected by bladder over distention, age of the child and possibly extra hydration before assessment. Abnormal post-void residual urine could be defined as post-void residual urine greater than 20 ml, rather than as greater than 10% bladder capacity, on repeat micturitions without bladder over distention. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate the inter-observer and intra-observer agreement on the interpretation of uroflowmetry curves of children. Materials and methods: Healthy kindergarten children were enrolled for evaluation of uroflowmetry. Uroflowmetry curves were classified as bell-shaped, tower, plateau, staccato and interrupted. Only the bell-shaped curves were regarded as normal. Two urodynamists evaluated the curves independently after reviewing the definitions of the different types of uroflowmetry curve. The senior urodynamist evaluated the curves twice 3months apart. The final conclusion was made when consensus was reached. Agreement among observers was analyzed using kappa statistics. Results: Of 190 uroflowmetry curves eligible for analysis, the intra-observer agreement in interpreting each type of curve and interpreting normalcy vs abnormality was good (kappa=0.71 and 0.68, respectively). Very good inter-observer agreement (kappa=0.81) on normalcy and good inter-observer agreement (kappa=0.73) on types of uroflowmetry were observed. Poor inter-observer agreement existed on the classification of specific types of abnormal uroflowmetry curves (kappa=0.07). Conclusions: Uroflowmetry is a good screening tool for normalcy of kindergarten children, while not a good tool to define the specific types of abnormal uroflowmetry. [Copyright &y& Elsevier]

Purpose: To report the effects of the age initiating toilet training on urinary continence and voiding function in children. Material and Methods: In three years, we enrolled 318 healthy kindergarteners. One of the parents completed the questionnaire including the age initiating and the duration of toilet training, the current status of daytime and nighttime continence, the age of attaining daytime and nighttime continence, Dysfunctional Voiding Symptom Score (10 parameters, score 0–3), and Bristol Stool Scale. All children underwent uroflowmetry and post-void residual urine (PVR) tests. Results: Finally, 235 respondents (106 boys/129 girls, mean age = 4.8 ± 0.9 years) were eligible for analysis. The mean age initiating toilet training was 24.4±8.4 months. Based on the age initiating toilet training, children were classified as Early (≦18months, n=67) or Late Group (>18 months, n=168). Early Group had higher rates of daytime and nighttime continence before 30 months of age than Late Group (89.6% vs. 42.9%, p<0.001 and 63% vs. 18.3%, p<0.001, respectively). Of 169 children achieved nighttime continence, the age attaining nighttime continence significantly correlated with the age initiating daytime and nighttime training. A trend of lower DVSS was observed in the Early Group. (3.8±3.6 vs. 4.7±3.3, p=0.08). There were no significant difference in the prevalence of repeat abnormal flow patterns and increased PVR (>20ml) between two Groups. Conclusions: Early toilet training was associated with early attainment of both daytime and nighttime continence. The children with early toilet training had normal voiding function and a trend of lower DVSS. [Copyright &y& Elsevier]

Purpose: To evaluate the ability of bacterial scatter diagrams generated from the automated urine particle analyzer (UF-1000i, Sysmex, Kobe, Japan) to pre-estimate the treatment efficacy of oral cefalexin in treating women with uncomplicated urinary tract infection (uUTI).Materials and Methods: Over 3 years, women 20-80 years old with symptoms suggestive of uUTI (Urinary Tract Infection Symptoms Assessment symptom score, ,UTISA > 3) and bacteriuria (bacterial count ≥ 100/uL) were enrolled. After informed consent, patients took cephalexin 500mg 4 times/day for 7 days. The voided urine specimens were classified into rods or cocci/mixed group automatically through the built-in software of the UF1000i. Patients were followed up with UTISA on the 3rd day after treatment and returned to the clinic on the 7th day and followed for additional UTISA and urine analysis. Symptom and laboratory improvement were defined as UTISA < 4 and bacterial count < 100/uL, respectively, on the 7th day.Results: Of 99 women (age: 49.91 ±15.32 years) eligible for analysis, 80 were classified as having urine that contained rods and 19 as cocci/mixed. Symptom improvement was observed in 62 women in the rods group and 11 women in the cocci/mixed group (p = 0.08). Laboratory improvement was noted in 64 women in the rods group and 10 women in the cocci/mixed group (p = 0.01). On day 7, treatment success with both symptom and laboratory improvement was more observed in rods than in cocci/mixed group (61.3% vs. 26.3%, p < 0.01).Conclusion: The automatic urine particle analyzer can pre-estimate the treatment response of antibiotics in women with uUTI. [ABSTRACT FROM AUTHOR]