Search

Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sepsis may lead to multi-organ dysfunction as a result of an inflammatory response. If untreated or if treatment is delayed, it can be fatal. A case presentation on sepsis and septic shock is provided to aid nurses in delivering safe, quality patient care. Implications for nursing are discussed. [ABSTRACT FROM AUTHOR]

Disorders of sex development (DSD) result from intrauterine defects in sex discrimination. The clinical phenotype differs based on the disease type. Cases with ambiguous external genitalia are diagnosed at birth. However, diagnosis of cases with normal-appearing external genitalia may be delayed until puberty. Here, we report a patient with a pelvic mass and a small uterus that was diagnosed by abdominal ultrasound, in addition to the history of primary amenorrhea and physical examination suggested Swyer syndrome, confirmed by genetic karyotyping. Pathological examination of the surgically removed mass revealed dysgerminoma. Until the age of 19, the patient did not have any idea about 46, XY karyotype, and assumed to be a female. The development of dysgerminoma (as a result of the simultaneous presence of gonadal dysgenesis and Y-chromosome) was another challenge that the patient had to deal with. The diagnosis of this patient at an earlier age could have prevented the development of gonadoblastoma, by removal of the streak gonads. By the presentation of this case, we intend to increase the physician's awareness about DSDs; earlier diagnosis may help the patient deal with her disease better and reduce the risk of further complications. [ABSTRACT FROM AUTHOR]

Background: Schistosomiasis affects approximately 230 million people worldwide. There is an increased incidence of schistosomiasis cases in France acquired from outside the country. This increases the risk of schistosomiasis outbreaks as observed in Corsica. Clinicians from non-endemic regions are not accustomed to diagnosing and managing this pathology. The objective of this study is to provide a better description of the clinical and paraclinical characteristics and disease evolution of affected children. Methods: Through the French Pediatric Nephrology Society and the Pediatric Infectious Pathology Group, we contacted all French pediatric centers that may have treated children with urinary schistosomiasis between 2013 and 2019. Age, sex, comorbidities, and clinical, biological, and radiological data (at discovery and follow-up) were collected retrospectively. Results: A total of 122 patients from 10 different centers were included. The median age was 14 years and the sex ratio M/F was 4:1. Hematuria was present in 82% of the patients while urinary tract abnormality was found in 36% of them. Fourteen patients (11%) displayed complicated forms of urinary schistosomiasis including 10 patients with chronic kidney disease. A total of 110 patients received treatment with praziquantel, which was well-tolerated and led to clinical resolution of symptoms in 98% of cases. Conclusion: Patients with schistosomiasis present frequent kidney, urinary, or genital involvement. Systematic screening of patients returning from endemic areas is therefore recommended, especially since treatment with antiparasitic drugs is effective and well-tolerated. Enhancing medical knowledge of this pathology among all practitioners is essential to improve care and outcomes. [ABSTRACT FROM AUTHOR]

Immunogenetic diagnostics allows identifying individuals with a high degree of risk of developing certain diseases, and associative connections with the cytokine link of immunity to expand ideas about their immunogenesis to determine prognostic markers and its course. The objective: to evaluate the associative relationships between the HLA-phenotype of patients with pathology of the genitourinary system and the cytokine link in order to determine the role in immunogenesis, improve prognosis and treatment. Materials and methods. The study was carried out within the framework of the NDP "Evaluate the effectiveness and safety of various methods of treatment of men suffering from chronic calculous prostatitis". The distribution of HLA-antigens in 464 patients with chronic cystitis (ChC), including proliferative cystitis (ChPC) and chronic prostatitis (ChP), sclerosis (SP), benign hyperplasia (HP) and prostate cancer (PC) was studied using the standard microlymphocytotoxic test (Terasaki). The reference group consisted of 350 healthy donors. Relative risk (RR≥2) and absolute (attributive) risk of the disease were determined. Levels of TNF-α, IL-18, MCP-1, IL-17, IL-4, VEGF were studied in blood serum by ELISA on the SunRise TouchScreen analyzer (Invitrogen, USA; Vector Best, Ukraine). Results. The connection of the most common diseases of the genitourinary system with certain histocompatibility antigens (RR≥2) is shown. The causal role of HLA with a reliable absolute risk of developing chronic cystitis (including proliferative) (A10, B14, B16), as well as chronic prostatitis (A24, B8, B52), prostate sclerosis (A24, A28), benign hyperplasia (A29, B38) and prostate cancer (A25, A29, B40, B44, B49) was determined. Protective antigens - A25, A26, B5, B14, B16, B17 for chronic prostatitis, as well as A10, B15, B17 for sclerosis, A9, A10, B17 for bening prostatic hyperplasia and A1, B5, B13, B15 for-prostate cancer. Associations of high production of cytokines were found for pro-inflammatory: TNF-α with HLA-A10, A11, A28, B14, B44; IL-18 - A10 and A24; MSR-1 - A28, B8, B41; IL-17 - A24, A28, B14; anti-inflammatory IL-4 - A24 and A28 (A2, B8, B14 are associated with a lower level of the production, and A10 determines the tendency); and VEGF growth factor - A9, A25 and B8. Conclusions. Associations of predictors of pathology and features of cytokines negative for its course determine additional risks for patients and act as markers for prediction and individualization of treatment. [ABSTRACT FROM AUTHOR]

Warning: This article contains terms, descriptions and opinions that may be culturally sensitive for Aboriginal and Torres Strait Islander peoples. Background: Pelvic health conditions among Aboriginal and Torres Strait Islander women and men are under-recognised and under-reported despite indication of the significant burden of these conditions. Access to effective management provided in a culturally safe manner appears lacking. The study aims were to: (1) summarise the burden of pelvic health conditions among Aboriginal and Torres Strait Islander peoples; (2) explore barriers and enablers to Aboriginal and Torres Strait Islander peoples accessing pelvic healthcare services; and (3) provide considerations on how to implement culturally safe pelvic healthcare services for Aboriginal and Torres Strait Islander peoples. Methods: This study involved a systematic literature search informing a narrative review. Results: Fourteen specific articles were identified. Burden related to pelvic health conditions was identified for both women and men, noting high likelihood of under-reporting. Barriers to effective culturally safe treatment included racism, shame and stigma associated with women's and men's business, lack of culturally safe services and geographical distance. Enablers included building trust with local communities, using yarning principles and codesign of pelvic health services with Aboriginal health workers and services. Strategies to improve pelvic health care for Aboriginal and Torres Strait Islander peoples were described at the systems, health service and clinician levels. Conclusion: Efforts are needed to improve the diagnosis and management of pelvic health conditions for Aboriginal and Torres Strait Islander peoples. Actions are required to engage with local Aboriginal Community Controlled Aboriginal Community Controlled Health Organisations, professionals overseeing service provision and healthcare providers to address the burden of these conditions among Aboriginal and Torres Strait Islander peoples. Warning: This article contains terms, descriptions and opinions that may be culturally sensitive for Aboriginal and Torres Strait Islander peoples. Pelvic health conditions are under-recognised and under-reported by Aboriginal and Torres Strait Islander peoples. Access to effective conservative (non-surgical) management options provided in a culturally safe manner appear to be lacking. We provide strategies to improve pelvic health care of Aboriginal and Torres Strait Islander women and men by highlighting considerations that facilitate culturally safe pelvic health care at the systems, health service and clinician levels. [ABSTRACT FROM AUTHOR]

Urogenital emergencies demand immediate attention within the field of emergency medicine, encompassing a range of critical conditions from ectopic pregnancies to kidney stones. Timely diagnosis and treatment are vital to prevent potential mortality and morbidity. However, due to the sensitive nature of these disorders and the cultural taboos surrounding them, accessing prompt medical care can be challenging. To bridge this gap, innovative gamification-based learning techniques, such as the Learning Urogenital Diseases in Oddity (LUDO), have been introduced for emergency medicine residents (Chou, What is gamification? Yukai Chou: Gamification and behavioral design, n.d.; Gamification '13: Proceedings of the first international conference on gameful design, research, and applications, 2013). LUDO is a timed, gamified exercise that offers residents an interactive and engaging platform to enhance their clinical knowledge related to urogenital disorders. Adapted from the well-known board game, LUDO fosters learning, collaboration, and cooperation among residents. This format is highly customizable and can be utilized by various learning groups. Participants, emergency medicine residents from different academic years, formed four teams, each distinguished by a unique color. The exercise utilized simple and accessible materials, including a LUDO board, LED stopwatch, laptop, colored hats, and a desk bell. Teams advanced their tokens through the board by correctly answering urogenital disorder-related questions within a specified time frame. LUDO's objectives extended beyond token movement, assessing essential skills such as teamwork, time management, resource utilization, and strategic decision-making. The option to seek external resources, limited to five times per team, added an element of strategy. Facilitators evaluated participants' performance through questionnaires and Likert scales. The results revealed that LUDO effectively promoted teamwork, communication, leadership, and problem-solving among emergency medicine residents. Resident feedback was overwhelmingly positive, with interest in adopting this format for other educational modules. The gamified approach encouraged engagement and motivation, with immediate feedback ensuring continuous learning. In conclusion, the incorporation of the LUDO gamified format provides an enjoyable and interactive learning experience for emergency medicine residents. It enhances engagement, fosters teamwork, and facilitates the rapid assimilation of crucial knowledge related to urogenital diseases. This adaptable approach holds promise for improving resident training in various clinical scenarios. [ABSTRACT FROM AUTHOR]

Introduction: The association between Mycobacterium tuberculosis and the Human Immunodeficiency Virus can accelerate the deterioration of immunological functions. The risks are even more accentuated in the situation of a Non-tuberculous Mycobacterium and Mycobacterium tuberculosis co-infection. Case presentation: We present the case of a 59-year-old male patient, who was admitted at the hospital with non-specific symptoms. Further investigations reveal a remarkable particularity about the case: The infection with Mycobacterium tuberculosis was urogenital, whereas the one with Non-tuberculous mycobacteria was pulmonary. Conclusion: Both Mycobacterium tuberculosis and Non-tuberculous strains can exist within the same infection, posing great difficulties for diagnosis, as well as the treatment scheme. [ABSTRACT FROM AUTHOR]

Background: Although aspirin is increasingly utilized to reduce the event of severe perioperative complications, the effect of long-term aspirin use (L-AU) on perioperative complications in patients undergoing shoulder arthroplasty (SA) has not been well studied. The goal of the present study is to identify the influence of L-AU on perioperative complications in individuals undergoing SA. Methods: We selected data from the National Inpatient Sample database between 2010 and 2019, to identify adult patients with SA. Patients were subsequently categorized into L-AU and whole non-L-AU cohorts according to the presence of aspirin use. The demographic and comorbidity characteristics were matched using propensity score matching (PSM). The Pearson chi-square test, Wilcoxon rank test and logistic regression were utilized to assess the association of L-AU with perioperative complications. Results: From 2010 to 2019, a total of 162,418 SA patients satisfied the inclusion criteria, with 22,659 (13.95%) using aspirin on a long-term basis. The vast majority of the patients with pre-existing L-AU were aged 65–74 years, female, White and had Medicare insurance. L-AU before surgery was linked to increased risks of perioperative complications, such as blood transfusion (adjusted odds ratio [aOR]: 1.339), genitourinary disease (aOR: 1.349), acute renal failure (aOR: 1.292), acute myocardial infarction (aOR: 1.494), higher total charge (L-AU vs. the whole non-L-AU vs. matched non-L-AU: $66,727.15 vs. $59,697.08 vs. $59,926.32), and prolonged hospitalization stay (LOS) (aOR: 0.837). However, L-AU was considered a protective factor of acute cerebrovascular disease (aOR: 0.722) and stroke (aOR: 0.725). Conclusions: Our study is based on the largest open-access all-payer inpatient database, revealing a noteworthy finding of aspirin's protective and adverse impact on different postoperative complications in the US population, such as acute cardiovascular disease, and stroke, etc. Further studies assessing the optimum preoperative aspirin duration and dosage to meet the best benefit quantity for patients with planned joint arthroplasties are suggested. [ABSTRACT FROM AUTHOR]

Background: Aortic–esophageal fistula (AEF) after thoracic endovascular aortic repair (TEVAR) has a high fatality rate and is difficult to treat. Endoluminal vacuum therapy (EVT) has recently appeared and proven to be a useful method for anastomotic leakage. Case presentation: A 76-year-old man underwent aortic arch replacement for a stent graft infection after TEVAR. Persistent mediastinitis and pyothorax were observed after aortic arch replacement, and further examination revealed an esophageal–mediastinal fistula (EMF). Over-the-scope clip (OTSC®) closure was performed to treat EMF but achieved no cure. Then, the patient was referred to our hospital. First, we removed the OTSC® that interfered with the treatment using the remOVE System® and started EVT using a double-lumen elemental diet tube (W–EDT®). The vacuum sponge was affixed to the vacuum side of W–EDT®, and enteral nutrition administered through W–EDT was combined with EVT. EMF was cured 11 days after EVT, and the patient was able to feed himself. Conclusion: The combination of EVT and enteral nutrition feeding using W–EDT® is a successful novel procedure to treat refractory EMF. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a communicable disease that is a major cause of ill health. Urogenital TB was a frequent urological disease in the pre-antibiotic era: about 20% of patients in urological hospitals had renal TB, mostly in the form of pyonephrosis. We composed a narrative review of the literature with keywords "urogenital tuberculosis', "prostate tuberculosis" "kidney tuberculosis", "treatment of tuberculosis". Urogenital TB (UGTB) includes TB of the kidney and the urinary tract and male and female genital TB. Each clinical presentation requires tailored antibiotic therapy depending on stage and general management. Anti-TB therapy should be multicomponent, continuous, long-lasting and controlled with a follow-up for 2-3 years. Otherwise, the risks of development of drug-resistance and relapse increase. Index of suspicion on UGTB is generally low, causing a delay in diagnosis; consequently, complicated forms of UGTB respond poorly to anti-TB therapy, while timely diagnosed "minor" forms are curable medically without surgery. Even with timely diagnosed UGTB, non-optimal therapy may result in over-fibrosis, scarring and strictures of the urinary tract, making surgical repair inevitable. Nevertheless, we have a wide enough spectrum of anti-TB drugs to cure urogenital TB. [ABSTRACT FROM AUTHOR]

Male infertility is a concern affecting approximately 8% of couples worldwide, with ejaculatory duct obstruction contributing to about 5% of male infertility cases. Prostatic utricle cysts are a rare but surgically correctable cause of ejaculatory duct obstruction. While often asymptomatic, these cysts can manifest as azoospermia with low ejaculate volume, necessitating intervention for fertility restoration. We present the case of a 22‑year‑old newly married male with azoospermia and otherwise unremarkable medical history. Clinical examination revealed normal bilateral vas deferens and epididymis, along with low ejaculate volume. Testicular size, follicle‑stimulating hormone, and testosterone levels were within the normal range. Transabdominal ultrasound uncovered a midline cystic structure within the prostate. Bilateral testicular fine‑needle aspiration confirmed the presence of spermatozoa at various stages of development. The patient underwent urethroscopy, bilateral retrograde seminal vesiculography, and transurethral resection of the midline prostatic cyst. At 3 months, the follow‑up revealed normal semen analysis. Transurethral resection of the roof of the midline prostatic cyst can effectively restore fertility in cases of ejaculatory duct obstruction. Precise resection technique is crucial to prevent damage to the urethral sphincter and subsequent incontinence. This approach offers a favorable prognosis for fertility restoration in patients with prostatic utricle cysts and associated azoospermia. [ABSTRACT FROM AUTHOR]

Simple Summary: This retrospective study presents the clinical outcomes of the largest cohort of patients (853 patients) with low-, favorable intermediate-, and unfavorable intermediate-risk prostate cancer treated with ultra-hypofractionated proton beam radiotherapy (36.25 GyE/five fractions). The median follow-up time was 62.7 months. Ultra-hypofractionated proton beam radiotherapy is an effective treatment for low- and favorable intermediate-risk prostate cancer, with long-term bDFS rates comparable to other techniques. It is promising for unfavorable intermediate-risk prostate cancer and has acceptable long-term GI and favorable GU toxicity. Background: We retrospectively analyzed the 5-year biochemical disease-free survival (bDFS) and occurrence of late toxicity in prostate cancer patients treated with pencil beam scanning (PBS) proton radiotherapy. Methodology: In the period from January 2013 to June 2018, 853 patients with prostate cancer were treated with an ultra-hypofractionated schedule (36.25 GyE/five fractions). The mean PSA value was 6.7 (0.7–19.7) µg/L. There were 318 (37.3%), 314 (36.8%), and 221 (25.9%) patients at low (LR), favorable intermediate (F-IR), and unfavorable intermediate risk (U-IR), respectively. Neoadjuvant hormonal therapy was administered to 197 (23.1%) patients, and 7 (0.8%) patients had adjuvant hormonal therapy. The whole group of patients reached median follow-up time at 62.7 months, and their mean age was 64.8 (40.0–85.7) years. The bDFS rates and late toxicity profile were evaluated. Results: Median treatment time was 10 (7–38) days. Estimated 5-year bDFS rates were 96.5%, 93.7%, and 91.2% for low-, favorable intermediate-, and unfavorable intermediate-risk groups, respectively. Cumulative late toxicity (CTCAE v4.0) of G2+ was as follows: gastrointestinal (GI)—G2: 9.1%; G3: 0.5%; genitourinary (GU)—G2: 4.3%, and no G3 toxicity was observed. PSA relapse was observed in 58 (6.8%) patients: 16 local, 22 lymph node, 4 bone recurrences, and 10 combined sites of relapse were detected. Throughout the follow-up period, 40 patients (4.7%) died, though none due to prostate cancer. Conclusion: Ultra-hypofractionated proton beam radiotherapy is an effective treatment for low- and favorable intermediate-risk prostate cancer, with long-term bDFS rates comparable to other techniques. It is promising for unfavorable intermediate-risk prostate cancer and has acceptable long-term GI and favorable GU toxicity. [ABSTRACT FROM AUTHOR]

The present century faces developmental fallout as vulnerability and risk mount on the global systems due to climate change, urbanisation, and population ageing. Moreover, population ageing is gaining a stronger hold in urban areas, and so are climate change and related shocks and stresses. Consequently, repercussions for the weakest sections of society – including the elderly – remain under academic consideration. In this context, the paper aims to understand the perilous predicament of older people due to the occurrence and interaction between climate change, urbanisation, and population ageing. This review investigates the underpinnings of the nature of the interaction among the three phenomena; and discerns how as a result of the interaction, various climate change related shocks and stresses affect older people in urban settings. It emerges that these three phenomena exhibit: concurrence; a positive trend of growth; and a cyclic pattern of interaction with four linkages, implying (i) rapid urbanisation is fuelling climate change, (ii) climate change is impacting urban areas, (iii) older people are increasing in urban areas, and (iv) urbanisation provides opportunities and barriers for older people. This interplay further discloses that older people stand vulnerable and at heightened risk from climate change related stressors in urban areas. These understandings highlight the need to ensure that urban environments remain age-friendly even in the face of climate change. [ABSTRACT FROM AUTHOR]

Aims: To describe and synthesize non‐pharmacological and nonsurgical interventions for male urinary incontinence from the existing literature. Methods: A scoping review was conducted following the methodology suggested by Arksey and O'Malley: (1) identification of the research questions; (2) identification of relevant studies using a three‐step search recommended by JBI: an initial search within PubMed and CINAHL, a comprehensive literature search within PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library, and literature search of references lists; (3) study selection; (4) data extraction and charting; (5) collation, summarization, and reporting of the results. The PRISMA‐ScR Checklist was used to report. Results: A total of 4602 studies were identified, of which 87 studies were included. Approximately 78% were randomized controlled trials. More than 88% of the participants were men with prostate cancer. Exercising pelvic floor muscles 30 times per day for 12 weeks was the most frequently reported. Parameters of electrical stimulation were typically set up to 50 Hz and 300 μs for frequency and width of pulse, respectively, and lasted for 15 min. Pure pelvic floor muscle training, Pilates, Yoga, whole body vibration, diaphragm/abdominal muscle training, micturition interruption exercise, acupuncture, and auriculotherapy showed positive effects on reducing urinary incontinence. Conclusion: The findings suggested implementing pelvic floor muscle training alone before or after surgery can both prompt the recovery of continence in men after prostate cancer surgery. The decision to use biofeedback or electrical stimulation to enhance the therapeutic effect of pelvic floor muscle training should be approached with caution. More rigorous designed studies are needed to validate the effectiveness of Traditional Chinese Medicine techniques and diverse novel methods. Relevance to clinical practice: Physicians and nurses need to be up to date on the latest evidence‐based non‐pharmacological and nonsurgical interventions in male urinary incontinence and select appropriate interventions based on available medical resources and patient preferences. [ABSTRACT FROM AUTHOR]

Introduction: Tissue plasminogen activator (tPA), commonly used for treatment of acute ischemic stroke, is associated with life-threatening bleeding intracranially as well as surrounding the airway. Case Report: A 78-year-old year old male who presented with stroke symptoms and after tPA administration developed a retropharyngeal hematoma requiring intubation and surgical intervention. Conclusion: Numerous threats to the patient's airway can develop after tPA administration. While angioedema is the most common cause, it is important to be prepared for other causes related to hemorrhage. [ABSTRACT FROM AUTHOR]

There is a paucity of data on research funding levels for male reproductive health (MRH). We investigated the research funding for MRH and infertility by examining publicly accessible web-databases from the UK and USA government funding agencies. Information on the funding was collected from the UKRI-GTR, the NIHR's Open Data Summary, and the USA's NIH RePORT web-databases. Funded projects between January 2016 and December 2019 were recorded and funding support was divided into three research categories: (i) male-based; (ii) female-based; and (iii) not-specified. Between January 2016 and December 2019, UK agencies awarded a total of £11,767,190 to 18 projects for male-based research and £29,850,945 to 40 projects for female-based research. There was no statistically significant difference in the median funding grant awarded within the male-based and female-based categories (p = 0.56, W = 392). The USA NIH funded 76 projects totalling $59,257,746 for male-based research and 99 projects totalling $83,272,898 for female-based research Again, there was no statistically significant difference in the median funding grant awarded between the two research categories (p = 0.83, W = 3834). This is the first study examining funding granted by main government research agencies from the UK and USA for MRH. This results should stimulate further discussion of the challenges of tackling male infertility and reproductive health disorders and formulating appropriate investment strategies. [ABSTRACT FROM AUTHOR]

Objective The goal of this scoping review was to determine the types and rates of pain and dysfunction outcomes reported after gender-affirming surgical procedures. In addition, a summary of the involvement of conservative care reported in the literature was produced. Methods A research librarian conducted searches through multiple databases from inception to 2021. Abstracts and full texts were reviewed by a team of at least 2 reviewers. Data were extracted from a custom survey and exported for summary. Results Thirty-one papers discussed masculinizing interventions, and 87 papers discussed feminizing procedures. Most of the studies emphasized surgical outcomes. Of the studies reporting pain or dysfunction, few standardized outcomes were used to collect information from patients. The pain was experienced across body regions after surgery for both feminizing and masculinizing procedures. Vaginal stenosis and incontinence were the most common complications reported. Patients were most often managed by physical therapists for vaginal stenosis or dyspareunia. Conclusion Many published studies do not systematically collect specific or standardized information about pain and dysfunction after gender-affirming surgery. Of those studies that do report these outcomes, few detail the involvement of physical therapists in the recovery after surgery. Impact Pain and urogenital dysfunction, often managed by physical therapists, occur after gender-affirming surgery, suggesting that physical therapists could have a larger role in the recovery of this patient population after surgery. The extent to which interventions used to manage these conditions in cisgender people will be equally effective in transgender people is unknown at this time. Future studies should use recognized measures to characterize patients' experiences with pain and dysfunction after surgery. [ABSTRACT FROM AUTHOR]

Background: Post-evacuation return after mandatory hospital evacuation due to complicated disasters is often overlooked and not well-discussed. Aims: In this study, we explored the factors which are related to the ease or difficulty of the post-evacuation return to Fukushima prefecture of psychiatric inpatients who had been evacuated to hospitals outside the prefecture because of the Great East Japan Earthquake (GEJE) and subsequent Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. Method: This retrospective cohort study included evacuated psychiatric hospital inpatients who were registered in the Matching Project for Community Transition (MPCT) and had been traced until July 31, 2019. A total of 531 patients were included for the analyses. Univariable and multivariable analysis were conducted to detect the patients' traits including their psychiatric/physical backgrounds which were associated with their outcome – the time from GEJE to the date of return to Fukushima. Results: Over half of the patients returned to Fukushima. In the multivariable analysis, the patients' gender (male), age (older), and psychiatric diagnoses of schizophrenia, schizotypal and delusional disorders (ICD-10, F20–29) showed lower hazard ratio (HR) and statistically significant association with the difficulties of post-evacuation return. Meanwhile, disorders of psychological development (F80–89), diseases of the nervous (G00–99, except G40–41) and genitourinary (N00–99) systems showed higher HR and statistically significant association with the ease of return. Conclusions: The specific characteristics of the psychiatric inpatients including their psychiatric and physical status are associated with their post-evacuation return to their hometown. These results indicated that the evacuated hospitals' practitioners and staffs from the MPCT understood the necessity of the earlier return of inpatients to their hometown. Moreover, clinicians should pay more attention to some symptoms unique to psychiatric patients which contributed to their difficulties in returning safely or expressing their hope to return. [ABSTRACT FROM AUTHOR]

Resveratrol is a polyphenol found naturally in fruits and plants. Recently, studies in humans and animal models have suggested beneficial properties of this polyphenol, such as improvements to metabolic and lipid profiles, along with antioxidant, anti-inflammatory and anti-proliferative effects. In the urogenital tract (UGT), resveratrol has also been tested clinically and experimentally as a therapeutic drug in several diseases; however, the translational efficacy of resveratrol, especially in UGT, is still a matter of debate. In the present review, we address the pre-clinical efficacy of resveratrol in UGT-related dysfunctions, focusing on lower urinary tract symptoms, non-cancerous prostatic disease (benign prostatic hyperplasia and prostatitis) and erectile dysfunction. In vitro studies indicate that resveratrol reduces inflammatory markers and oxidative stress, and improves endothelial function in UGT organs and cells isolated from humans and animals. Despite displaying low oral bioavailability, in vivo administration of resveratrol largely improves erectile dysfunction, benign prostatic hyperplasia, prostatitis and voiding impairments, as evidenced in different animal models. Resveratrol also acts as a microbiota modulator, which may explain some of its beneficial effects in vivo. In contrast to the large amount of pre-clinical data, there are insufficient clinical trials to establish resveratrol treatment efficacy in human UGT-related diseases. In summary, we provide an overview of the in vivo and in vitro efficacy of resveratrol in animal and human UGT dysfunctions, which may support future clinical trials. [ABSTRACT FROM AUTHOR]

Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Psoriasis is a chronic inflammatory disease which has multisystem involvement, predominantly skin and joints. It affects quality of life and leads to psychological distress in patients leading to poor self-esteem and depression, ultimately affecting interpersonal relationships. Homoeopathy believes in a holistic approach and, when prescribed on a constitutional basis, helps to cure the condition from its root cause. A diagnosed case of psoriasis in a 23-year-old male came into the Homoeopathic OPD with complaints of psoriatic patches on the face and scalp. Routine investigations were done to rule out other disorders. In this case, Sulphur was prescribed on a constitutional basis and proved to be beneficial. Considering the extent of psoriasis in this patient, the Homoeopathic approach relieved the case in a short period of time with prolonged treatment response, suggesting that this may represent the ideal cure in Homoeopathy. [ABSTRACT FROM AUTHOR]

Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium are the three most commonly reported sexually transmitted bacteria. The present study aimed to investigate the presence of C. trachomatis, N. gonorrhoeae, and M. genitalium in urogenital samples collected from 18–68-year-old Turkish patients who were admitted to the hospital with various urogenital symptoms. A total of 360 patients with symptoms of STD were included in the study. Following DNA extraction by QIAamp Mini Kit, the presence of C. trachomatis, N. gonorrhoeae, and M. genitalium were investigated using multiplex real-time PCR. Causative organisms were identified in 68 (18.9%) of 360 patients. C. trachomatis, N. gonorrhoeae, and M. genitalium were detected in 40 (11.1%), 14 (3.9%), and 28 (7.8%) of the patients, respectively. Patients 21–30 years of age represented more than one-third (37.8%) of positive patients. Of all patients, dual infections of C. trachomatis–M. genitalium, N. gonorrhoeae–C. trachomatis, N. gonorrhoeae–M. genitalium, and triple infection of C. trachomatis–N. gonorrhoeae–M. genitalium were determined in 1.6% (6/360), 1.3% (5/360), 0.2% (1/360), and 0.2% (1/360) of the patients, respectively. In CT-, NG-, and MG-positive patients, different STI agents were also found such as HIV, HBV, HPV, HSV2, T. pallidum, and T. vaginalis. In conclusion, among C. trachomatis, N. gonorrhoeae, and M. genitalium, CT was the most frequently detected bacterial cause of STDs in our hospital at Istanbul. Co-infections, which comprise more than one-fifth of the cases, should not be underestimated. Regular screening and following up of STD agents using multiplex real-time PCR-based diagnostic methods enabling the immediate detection of co-infections are essential for the treatment and primary prevention of STDs. [ABSTRACT FROM AUTHOR]

The military situation in Ukraine significantly worsened the quality of medical care for the population. Of all Ukrainian men the age category from 30 to 60 years old who take part in military operations is the most effective one. Another, no less important part of the male population is the old persons, who, as a result of military operations, have limited opportunities to receive medical care. Currently, observing by urologist, required for benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) due to combat operations in the country, is often performed via distance curation. The doctor needs a clear understanding of the patient's medical history, taking into account his psychological and somatic status, the use of medicines. Stress negatively affects men's health, worsening the hormonal background, mental state and aggravating problems of the genital and urinary systems. Psychological stress is a factor in the exacerbation or occurrence of urological complaints, which can lead to the pathological activation of certain parts of the sympathetic nervous and hormonal systems, the development of LUTS by BPH. Tamsulosin is considered to be the most recognized and widely used treatment for LUTS in patients with BPH. The classic medicament approach of BPH monotherapy is the use of Serenoa repens extract. The distance appointment of selective α-adrenoblockers, both in monotherapy and in combinations, is an important measure of providing specialized urological care to the population. [ABSTRACT FROM AUTHOR]

The increase in uranium mining in Kazakhstan has brought with it a number of problems. Reducing the negative impact of radiation-toxic factors on the health of workers and the population in uranium mining regions is one of them. This article presents a pilot population health study in which we developed approaches to support residents living near an operating uranium mining enterprise. The purpose of the current study was to assess the impact of technogenic factors on the health of those living near the Syrdarya uranium ore province. Data collected from 5605 residents from the village of Bidaykol (the main group)—which is located 4 km from the uranium mining enterprise—and the village of Sunakata (the control group), which is located in the Kyzylorda region, were analyzed. A bidirectional cohort study was conducted. The prevalence of acute and chronic diseases among the residents of Bidaykol was 1.3 times higher than that in the control group. The structure of morbidity was dominated by pathologies of the genitourinary system (27%), the circulatory system (14.4%), and the respiratory system (11.9%). Relative risks (RR > 1) were identified for most classes of diseases, the highest being for diseases of the blood (RR = 2.6), skin (RR = 2.3), and genitourinary system (RR = 1.9). In the main group, renal pathologies were the most frequent class in the age group of 30–40 years, occurring mainly in women. In addition, they had a direct dependence on the duration of residence in the territory of the uranium ore province. Further studies into the interaction between the technogenic factors associated with uranium mining enterprises and the development of diseases of the urinary system are needed. This will make it possible to determine ways to prevent these pathologies in the population. [ABSTRACT FROM AUTHOR]

46, XX testicular differences of sex development (DSD) is a rare cause of DSD presenting as a phenotypical male with chromosomal sex of 46, XX. Sex-determining region of the Y chromosome (SRY)-positive 46, XX DSDs have a well-characterized pathogenetic mechanism, whereas in SRY-negative 46, XX DSDs, the pathogenesis is not clearly delineated. Herein, we present a case of a 3 1/2-year-old child who presented with ambiguous genitalia and bilateral palpable gonads. On the basis of a karyotype and fluorescent in situ hybridization, we arrived at a diagnosis of SRY-negative 46, XX testicular DSD. Basal serum estradiol and human menopausal gonadotrophin stimulated estradiol levels and inhibin A blood levels were against the presence of any ovarian tissue. Imaging of the gonads showed bilateral normal-looking testis. A clinical exome sequencing revealed a heterozygous missense variant NR5A1:c275G>A (p. Arg92gln) located at exon 4 in the affected child. Protein structure analysis was further performed, and the variant was found to be highly conserved. Sanger's sequencing showed that the mother was heterozygous for the variant detected in the child. This case highlights the rarity of SRY-negative 46, XX testicular DSD with a unique variant. Largely under characterized, this group of DSDs needs to be reported and analyzed to add to the spectrum of presentation and genetic characteristics. Our case is expected to add to the database, knowledge, and approach to cases of 46, XX testicular DSD. [ABSTRACT FROM AUTHOR]

Duplication of appendix including horseshoe appendix (HA) is well reported. We present the case of acute appendicitis in a 19-year-old male where we found the appendicular base was doubly inserted into the cecum, and the tip was attached to the cecum at sagittal disposal. Ligation and transection of both bases and tip individually were carried out. This is a previously undescribed variety of appendiceal anomalies in the form of HA with double insertion of the base. This report will be a step toward broadening the horizon of knowledge regarding appendiceal anomalies and better delineation of such anomalies. [ABSTRACT FROM AUTHOR]

A cavernosal abscess is a rare urological condition to occur. It is classified as primary and secondary. The primary is mostly idiopathic, whereas the secondary is associated with some precipitating factors. Most of the cases were diagnosed clinically. In some cases, imaging such as an ultrasound of the local region or magnetic resonance imaging may be required. Cavernosal abscesses can be treated using a minimally invasive procedure such as image-guided drainage or incision and drainage along with systemic antibiotics. A 52-year-old uncircumscribed uncontrolled diabetic patient presented with a complaint of swelling in the penile region for the 1-week duration. He also complains of pain in the penile region for a 5-day duration. He is a known case of type 2 diabetes on oral hypoglycemic drugs for the past 2 years. Clinical examination confirmed the diagnosis of cavernosal abscess. The patient underwent circumcision with incision and drainage of abscess under higher antibiotic coverage (vancomycin and metronidazole). The patient underwent local excision of primary scrotal calcinosis after 1 month. The patient is followed up for more than 2 years without any evidence of recurrence or impotence. The cavernosal abscess is one of the rare urological conditions, which needs immediate surgical intervention to reduce future complications such as erectile dysfunction and recurrent abscess. Uncontrolled diabetes has a high chance of developing cavernosal abscesses even without precipitating factors. [ABSTRACT FROM AUTHOR]

The genetic cause of 46, XY disorder of sex development (DSD) still cannot be determined in about half of the cases. GATA-4 haploinsufficiency is one of the rare causes of DSD in genetic males (46, XY). Twenty-two cases with 46, XY DSD due to GATA-4 haploinsufficiency (nine missense variant, two copy number variation) have been previously reported. In these cases, the phenotype may range from a mild undervirilization to complete female external genitalia. The haploinsufficiency may be caused by a sequence variant or copy number variation (8p23 deletion). The aim of this study was to present two unrelated patients with DSD due to GATA- 4variants and to review the phenotypic and genotypic characteristics of DSD cases related to GATA-4 deficiency. [ABSTRACT FROM AUTHOR]

Objective: Urogenital tuberculosis and disseminated tuberculosis affecting urogenital system are more frequent in developing countries but are often overlooked in developed ones. We aimed to compare clinical characteristics and outcomes of urogenital tuberculosis and disseminated tuberculosis affecting the urogenital system. Material and methods: We retrospectively reviewed data from patients with tuberculosis in the urogenital system, diagnosed in a tertiary center in a European country, from 2008 to 2018. Cases were divided into urogenital tuberculosis and disseminated tuberculosis affecting the urogenital system and compared. Results: We included 172 patients, 31 with urogenital tuberculosis and 141 with disseminated tuberculosis affecting urogenital system. Patients with disseminated tuberculosis affecting the urogenital system were younger (median 45 vs. 64 years, P = .001), more likely to be male (80 vs. 55%, P = .005), or having risk factors for the disease (84 vs. 23%, P = .005) than patients with urogenital tuberculosis. Patients with urogenital tuberculosis presented most commonly with symptoms related to the urinary tract, with 52% complaining of lower urinary tract symptoms attributed to urinary tract infections and 48% of dysuria, while patients with disseminated tuberculosis affecting the urogenital system presented mainly with systemic symptoms, with 89% complaining of malaise, 62% of fever, and 57% of anorexia. Patients with urogenital tuberculosis were more likely to need urological surgery as part of their treatment (71 vs. 5%, P < .001) and patients with disseminated tuberculosis affecting the urogenital system were more likely to die due to tuberculosis (10 vs. 21%, P < .001). Conclusion: Tuberculosis of the urogenital system can have multiple clinical presentations, and a simple diagnostic algorithm does not exist. In the presence of urogenital tuberculosis in injected drug users, immunosuppressed individuals, or patients with systemic symptoms, we should think of disseminated tuberculosis affecting the urogenital system and remember these patients less frequently need surgery but entail a worst outcome. [ABSTRACT FROM AUTHOR]

Aim. An attempt to assess the impact of dual diagnosis -- mental illness and addiction on the occurrence of sexual dysfunctions, and evaluation of problems with sexual functioning in men treated in a psychiatric ward. Material and method. 140 psychiatrically hospitalized men (mean age 40.4 ± 12.7 years) with the diagnosis of schizophrenia, affective disorders, anxiety disorders, addiction and double diagnosis (schizophrenia and addiction) took part in the study. The Sexological Questionnaire, developed by Professor Andrzej Kokoszka, and the International Index of Erectile Function IIEF-5 were used in the study. Results. The occurrence of sexual dysfunctions in the study group was reported in 83.6% of patients. The most common was reduction in sexual needs (53.6%) and orgasm delay (40%). Depending on the research tool used, erectile dysfunction appeared in 38.6% of respondents (according to Kokoszka's Questionnaire) and 61.4% of patients (IIEF-5). Severe erectile dysfunction was more common in the group of patients without a partner (12.4% vs. 0; p = 0.000) compared to people in relationships and in the group with anxiety disorders (p = 0.028) compared to groups with other mental disorders. In the group of people with dual diagnosis (DD), sexual dysfunctions were observed more frequently in comparison to patients with schizophrenia (p = 0.034). Treatment lasting over 5 years was more often associated with sexual dysfunctions (p = 0.007). In the DD group, lack of orgasm and excessive sexual needs were more frequent in comparison to people with one diagnosis (p = 0.0145; p = 0.035). Conclusions. Sexual dysfunctions are more common in patients with DD in comparison to patients diagnosed with schizophrenia. Lack of a partner and the duration of psychiatric treatment over 5 years is associated with more frequent occurrence of sexual dysfunctions. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the development of treatment of primary high-risk prostate cancer in regards to biochemical no evidence of disease (bNED), acute and late gastrointestinal (GI) and genitourinary (GU) side effects. Primary high-risk prostate cancer patients treated between 1994 and 2016 were included. Applied doses ranged from 60 to 80 Gy, with a dose of 1.8 or 2 Gy per fraction. Techniques were either 3D conformal or intensity modulated radiotherapy and volumetric intensity modulated arc therapy. 142 patients were treated with doses up to 70 Gy (median dose 66 Gy; 66 Gy group), 282 with doses between 70 and 76 Gy (median dose 74 Gy; 74 Gy group), and 141 with doses >76 Gy (median dose 78 Gy; 78 Gy group). The median follow-up was 48 months. The bNED rates were 50% after 5 years and 44% after 9 years in the 66 Gy group; 65% and 54%, respectively, in the 74 Gy group; and 83% and 66%, respectively, in the 78 Gy group (p = 0.03 vs. 74 Gy and p < 0.0001 vs. 66 Gy). We found a higher rate of acute GI side effects in the 78 Gy group compared to the other groups, but not in maximum acute GU side effects and late maximum GI and GU effects. High-risk prostate cancer patients treated with doses of 78 Gy had significantly better bNED rates. Compared to the historical 66 Gy group, 50% more patients achieved bNED after a follow-up of 9 years. [ABSTRACT FROM AUTHOR]

Sexual problems are very prevalent among survivors of child sexual abuse (CSA). Yet, various approaches to therapy do not seem to address this issue when treating these individuals. Traditional sex therapy may also not suit the experiences of CSA survivors, as CSA was not considered when the most well-known and frequently used techniques were developed. The present review sought to identify (1) theory-based therapeutic approaches that address sexual problems among CSA survivors and offer treatment protocols (including an outline of specific therapy stages, sessions, or techniques) to treat these sexual problems and (2) identify therapeutic approaches that include a protocol for treating sexual problems among CSA survivors that was empirically tested and validated. In total, six approaches for treating sexual dysfunctions among CSA survivors that provide detailed guidelines for implementing the approach within sex therapy for CSA survivors were identified in the literature. Only two of the studies conducted a randomized controlled trial to test the intervention. This overview concludes with important issues to address when treating sexual problems among CSA survivors and a call for additional evidence-based practices for treating sexual problems among survivors of CSA. [ABSTRACT FROM AUTHOR]

The article offers a perspective on the transformation of urology residency with evolving gender-affirming surgical training by 2040. Emphasis is given on the need for urology programs to provide assessments that track the progress of urology residents who perform gender-affirming surgical procedures. It suggests the development of practices for transvaginal biopsy and preoperative magnetic resonance imaging, as well as the expansion of research and use of prostate cancer screening.

The enzyme 17-β-hydroxysteroid dehydrogenase type 3 (17β-HSD3) catalyzes the biosynthesis of testosterone (T) from Δ4- androstenedione, and plays an important role in the final steps of androgen synthesis. 17β-HSD3 deficiency originates from mutations in the HSD17B gene, causing an autosomal recessive 46,XY sex developmental disorder (DSD). Patients with 46,XY karyotype can exhibit a wide phenotypic spectrum, varying from complete external female genitalia to male genitalia with hypospadias. Here we report a case of 17β-HSD3 deficiency diagnosed in the infantile period who was later found to have a novel HSD17B3 gene variation. The 14-month old patient, who exhibited a female phenotype, presented with a bilateral lump in the inguinal area. Imaging revealed bilateral testicular gonads in the inguinal area. Hormonal evaluation showed low levels of basal and stimulated serum T, a high level of androstenedione (A), and a low T/A ratio. Chromosomal analysis showed 46,XY karyotype. Sequence analysis of the HSD17B3 gene revealed a c.673_1G>C homozygous class 2 (splice site) variation in intron 9. The consanguineous parents were sequenced, and both were heterozygous for the same mutation. This variation has not been previously reported in the literature. In conclusion, a 46,XY DSD should be considered in patients with a female phenotype who exhibit gonad(s) in the inguinal area at an early age. Furthermore, in patients with insufficient T synthesis and high levels of androstenedione, 17β-HSD3 should be considered, and molecular analysis should be done for a definitive diagnosis and subsequent genetic counseling. [ABSTRACT FROM AUTHOR]

Objective: Androgen insensivity syndrome (AIS) and 5α-reductase deficiency (5α-RD) present with indistinguishable phenotypes among the 46,XY disorders of sexual development (DSD) that usually necessitate molecular analyses for the definitive diagnosis in the prepubertal period. The aim was to evaluate the clinical, hormonal and genetic findings of 46,XY DSD patients who were diagnosed as AIS or 5α-RD. Methods: Patients diagnosed as AIS or 5α-RD according to clinical and hormonal evaluations were investigated. Sequence variants of steroid 5-α-reductase type 2 were analyzed in cases with testosterone/dihydrotestosterone (T/DHT) ratio of ≥20, whereas the androgen receptor (AR) gene was screened when the ratio was <20. Stepwise analysis of other associated genes were screened in cases with no causative variant found in initial analysis. For statistical comparisons, the group was divided into three main groups and subgroups according to their genetic diagnosis and T/DHT ratios. Results: A total of 128 DSD patients from 125 non-related families were enrolled. Birth weight SDS and gestational weeks were significantly higher in 5α-RD group than in AIS and undiagnosed groups. Completely female phenotype was higher in all subgroups of both AIS and 5α-RD patients than in the undiagnosed subgroups. In those patients with stimulated T/DHT <20 in the prepubertal period, stimulated T/DHT ratio was significantly lower in AIS than in the undiagnosed group, and higher in 5α-RD. Phenotype associated variants were detected in 24% (n=18 AIS, n=14 5α-RD) of the patients, revealing four novel AR variants (c.94G>T, p.Glu32*, c.330G>C, p.Leu110=; c.2084C>T, p.Pro695Leu, c.2585_2592delAGCTCCTG, p.(Lys862Argfs*16), of these c.330G>C with silent status remained undefined in terms of its causative effects. Conclusion: T/DHT ratio is an important hormonal criterion, but in some cases, T/DHT ratio may lead to diagnostic confusion. Molecular diagnosis is important for the robust diagnosis of 46,XY DSD patients. Four novel AR variants were identified in our study. [ABSTRACT FROM AUTHOR]

Lead primarily affects male reproductive functions via hormonal imbalance and morphological damage to the testicular tissue with significant alteration in sperm profile and oxidative markers. Though, different studies have reported that Cocos nucifera L. oil has a wide range of biological effects, this study aimed at investigating the effect of Cocos nucifera L. oil on lead acetate-induced reproductive toxicity in male Wistar rats. Twenty (20) sexually matured male Wistar rats (55–65 days) were randomly distributed into four groups (n=5). Group I (negative control)—distilled water orally for 56 days, Group II (positive control)—5 mg/kg bwt lead acetate intraperitoneally (i.p.) for 14 days, Group III—6.7 mL/kg bwt Cocos nucifera L. oil orally for 56 days and Group IV—lead acetate intraperitoneally (i.p.) for 14 days and Cocos nucifera L. oil for orally for 56 days. Rats were sacrificed by diethyl ether, after which the serum, testis and epididymis were collected and used for semen analysis, biochemical and histological analysis. The lead acetate significantly increases (p<0.05) testicular and epididymal malondialdehyde (MDA) levels, while a significant reduction (p<0.05) in sperm parameters, organ weight, testosterone and luteinizing hormone was observed when compared with the negative control. The coadministration of Cocos nucifera oil with lead acetate significantly increases (p<0.05) testosterone, luteinizing hormone, sperm parameters and organ weight, with a significant decrease (p<0.05) in MDA levels compared with positive control. Histological analysis showed that lead acetate distorts testicular cytoarchitecture and germ cell integrity while this was normalized in the cotreated group. Cocos nucifera oil attenuates the deleterious effects of lead acetate in male Wistar rats, which could be attributed to its polyphenol content and antioxidant properties. [ABSTRACT FROM AUTHOR]

Objective: A surge in the easy availability of robotic platforms has resulted in numerous surgical procedures, which were previously done using an open or conventional laparoscopic approach, are now being done using robots worldwide. A prospective randomized study was conducted to compare surgical and functional outcomes of conventional laparoscopic pyeloplasty with robotic-assisted pyeloplasty. Materials and Methods: Patients who require pyeloplasty who presented to our institute between June 2015 and March 2018 were randomized into a robot-assisted or conventional laparoscopic pyeloplasty group. Common steps included a lateral trans-peritoneal approach, intraoperative antegrade double-J stent placement, stent removal at 4 weeks postoperative, and Diethylene Triamine Penta Acetate renogram at 4 weeks post stent removal. Records of intraoperative and postoperative variables were maintained for all patients. The comparison of continuous numerical data was done using the Independent t-test and categorical non-numerical data using the chi-square (χ²) test. P-values of <0.05 were considered significant. Results: This study includes 58 patients who were randomized into two groups with 29 patients each. No significant difference was noted for postoperative variables, such as the visual analog score for pain, drain placement duration, hospitalization duration, and time to return to daily activity. Intraoperative variables, such as total operative time (148.56 minute vs. 114.28 minute, p-value=0.001) and intraoperative blood loss (68.4 mL vs. 59.2 mL, p-value=0.001) were significantly lesser and favored robot-assisted pyeloplasty over conventional laparoscopic pyeloplasty. Conclusion: In favor of robot-assisted pyeloplasty, both statistically and clinically intraoperative time was lesser, but intraoperative blood loss was lesser only statically and not clinically. [ABSTRACT FROM AUTHOR]

Background: Despite all recent health-related improvements, anemia remains an extensive global public health issue affecting the lives of about one-fourth of the world population in a geographically heterogeneous pattern. We, therefore, aimed to illustrate the prevalence, severity, most common types, and major determinants of anemia among adults in Khuzestan, Iran, from 2016 to 2019.Methods: In a large population-based cross-sectional study comprising of a diverse population, each participant underwent a questionnaire-based interview and laboratory testing for hematological analysis. A hemoglobin (HGB) concentration of < 12 g/dL in non-pregnant women and < 13 g/dL in men were defined anemic. The multivariate logistic regression analysis was performed to explore the association between anemia and its potential determinants.Results: Data on 29,550 (96.87%) males and non-pregnant females between 20-65 years of age (mean age: 41.90 ± 11.88 years; female sex: 63.58%; Arab ethnicity: 48.65%), whose HGB level was available, were included in the study. The mean ± SD HGB concentration was 13.75 ± 1.65 g/dL. The age- and sex-standardized prevalence rate of anemia was 10.86% (95% CI: 10.51-11.23%). The most prevalent degree was mild anemia (7.71%, 95% CI: 7.40-8.03%) and only 0.17% were severely anemic. Of those considered anemic, the highest proportion was related to normochromic/microcytic (50.65%), followed by hypochromic/microcytic (30.29%). In the multiple logistic regression, the parameters of female gender (OR: 3.17, 95% CI: 2.68-3.76), age group of 35-49 years (OR: 1.66, 95% CI: 1.52-1.82), being underweight (OR: 1.58, 95% CI: 1.29-1.93), being unemployed or retired (OR: 1.55, 95% CI: 1.33-1.81), and living in urban areas (OR: 1.18, 95% CI: 1.09-1.29) were major determinants of anemia. Additionally, we observed a minor but significant positive association between anemia status and CKD, older ages, increased night sleep duration, being a housewife and married, as well as a negative association between anemia and factors including hookah smoking, presence of metabolic syndrome, and overweight and obesity.Conclusions: Taken together, the anemia prevalence in this study population was of mild public health significance. The major suspected causes might be iron deficiency and chronic disease anemias. Comparably higher rates of anemia were observed amongst women, individuals aged 35-49 years, underweights, unemployed or retired subjects, and urban residents. [ABSTRACT FROM AUTHOR]

Urological conditions have become increasingly common and early diagnosis is key to achieving better outcomes. This article discusses the importance of having a comprehensive understanding of urological disorders, having the skills to interpret relevant information, and recognising the relationships among given elements to make an appropriate clinical diagnosis. [ABSTRACT FROM AUTHOR]

Xanthoma is a benign lesion characterized by the localized collection of lipid-containing histiocytes. It is mostly observed in patients with hyperlipidemia but can also be found in patients with normal lipid profiles. It is very rarely detected in the bladder. Xanthoma may be associated with bladder tumor or it can be seen isolated. Most of the cases in the literature are elderly patients. Isolated bladder xanthoma is mostly detected incidentally in cystoscopy performed for complaints like hematuria and lower urinary tract symptoms. A large lesion can be detected in radiological imaging and mistaken for a bladder tumor. We present a case of urinary bladder xanthoma incidentally detected in a 38-year-old man. [ABSTRACT FROM AUTHOR]

Significant improvements in the treatment of anal cancer have produced a growing population of anal cancer survivors. These patients often experience late adverse effects related to their treatment. Research has revealed substantial unmet needs because of long-term symptoms and functional impairments after treatment that may negatively affect health-related quality of life. The purpose of the present guidelines is to review the scientific evidence for the management of late adverse effects after (chemo)radiotherapy ([C]RT) for anal cancer and to extrapolate knowledge from other pelvic malignancies treated with pelvic (C)RT so that they may guide the clinical management of late adverse effects. Relevant studies were systematically searched in four databases from their inception to June 2020 (no language limitation) and guidelines were searched in 16 databases, focussing on bowel dysfunction, psychosocial aspects, pain, and sexual and urinary dysfunction. The guidelines were developed by a panel of experts using the Oxford Centre for Evidence-based Medicine, levels of evidence, and grades of recommendations. Late adverse effects after (C)RT for anal cancer are associated with a low overall quality of life among survivors. The most pronounced late adverse effects are bowel dysfunction (present in up to 78%), urinary dysfunction (present in up to 45%), and sexual dysfunction (present in up to 90% of men and up to 100% of women). Only indirect data on adequate treatment options of these late adverse effects for anal cancer are available. Quality of life and late adverse effects should be monitored systematically following treatment for anal cancer to identify patients who require further specialist evaluation or support. Increased awareness of the extent of the problem may serve to stimulate and facilitate multidisciplinary collaboration, which is often required. [ABSTRACT FROM AUTHOR]

Androgen deprivation therapy (ADT) used for prostate cancer (PCa) management is associated with metabolic and anthropometric toxicity. Metformin given concurrent to ADT is hypothesized to counteract these changes. This planned interim analysis reports the gastrointestinal and genitourinary toxicity profiles of PCa patients receiving ADT and prostate/pelvic radiotherapy plus metformin versus placebo as part of a phase 2 randomized controlled trial. Men with intermediate or high-risk PCa were randomized 1:1 to metformin versus placebo. Both groups were given ADT for 18-36 months with minimum 2-month neoadjuvant phase prior to radiotherapy. Acute gastrointestinal and genitourinary toxicities were quantified using CTCAE v4.0. Differences in ≥ grade 2 toxicities by treatment were assessed by chi-squared test. 83 patients were enrolled with 44 patients randomized to placebo and 39 randomized to metformin. There were no significant differences at any time point in ≥ grade 2 gastrointestinal toxicities or overall gastrointestinal toxicity. Overall ≥ grade 2 gastrointestinal toxicity was low prior to radiotherapy (7.9% (placebo) vs. 3.1% (metformin), p = 0.39) and at the end of radiotherapy (2.8% (placebo) vs 3.1% (metformin), p = 0.64). There were no differences in overall ≥ grade 2 genitourinary toxicity between treatment arms (19.0% (placebo) vs. 9.4% (metformin), p = 0.30). Metformin added to radiotherapy and ADT did not increase rates of ≥ grade 2 gastrointestinal or genitourinary toxicity and is generally safe and well-tolerated. [ABSTRACT FROM AUTHOR]

* Context.--Lesions in the genitourinary (GU) organs, both benign and malignant, can demonstrate overlapping morphology, and practicing surgical pathologists should be aware of these potential pitfalls and consider a broad differential diagnosis for each specific type of lesion involving the GU organs. The following summary of the contents presented at the 6th Annual Chinese American Pathologists Association (CAPA) Diagnostic Course (October 10-11, 2020), supplemented with relevant literature review, exemplifies the common diagnostic challenges and pitfalls for mass lesions of the GU system of adults, including adrenal gland, with emphasis on immunohistochemical and molecular updates when relevant. Objective.--To describe the common mass lesions in the GU system of adults, including adrenal gland, with emphasis on the diagnostic challenges and pitfalls that may arise in the pathologic assessment, and to highlight immunohistochemical workups and emerging molecular findings when relevant. Data Sources.--The contents presented at the course and literature search comprise our data sources. Conclusions.--The diagnostic challenges and pitfalls that arise in the pathologic assessment of the mass lesions in the GU system of adults, including adrenal gland, are common. We summarize the contents presented at the course, supplemented with relevant literature review, and hope to provide a diagnostic framework to evaluate these lesions in routine clinical practice. [ABSTRACT FROM AUTHOR]

Isotretinoin is often used in the treatment of severe acne. However, many adverse reactions were reported, including mucocutaneous, metabolic, neurological and psychiatric, ophthalmologic, hematologic side effects and teratogenicity. The mucocutaneous are the most common side effects and often develop in a dose-dependent manner. I present a case of a 20-year-old male with the unusual non-specific dysuria only and review the literature on the urological effects of isotretinoin. [ABSTRACT FROM AUTHOR]