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Urinary catheterisation is a crucial procedure in healthcare, requiring a thorough understanding of the anatomical and physiological differences between males and females to ensure safe and effective care. This guide explores the anatomy of the urinary system, detailing the kidneys, ureters, bladder, and urethra, and highlights key differences in catheterisation techniques for men and women. Emphasising evidence-based practices, it discusses recent advancements, such as antimicrobial catheters, and underscores the importance of comprehensive training and competency assessments for healthcare providers. Additionally, the guide advocates for patient-centred approaches, multidisciplinary collaboration, and adherence to updated policies to reduce complications such as catheter-associated urinary tract infections (CAUTIs). By integrating these critical evaluations and best practices, health professionals can enhance patient outcomes and maintain high standards of care in urinary catheterisation. [ABSTRACT FROM AUTHOR]

Introduction: Mannitol, an osmotic diuretic solution, is commonly utilized in priming cardiopulmonary bypass (CPB) and can impact kidney function. This study was conducted to investigate the impact of mannitol use during CPB on kidney function in patients undergoing coronary artery bypass surgery. Methods: This randomized, double-blind clinical trial studied 90 patients undergoing coronary artery bypass surgery. In the control group (n=45), the prime solution included Ringer's lactate, and in the intervention group (n=45), the prime solution had 200 ml of mannitol 20% and Ringer's lactate. A P -value<0.05 was considered significant. The primary endpoint of this study is renal function. Results: Demographic characteristics and risk factors were not significantly different between the two groups (P >0.05). Additionally, there was no statistically significant difference between two groups in terms of CPB time, aortic cross-clamp time, length of time connected to mechanical ventilation, 30-day mortality, ICU, and hospital stay time (P >0.05). Furthermore, no statistically significant difference was observed between the two groups in serum creatinine levels (P =0.53) or BUN levels (P =0.13). The study also found no statistically significant difference in the diuresis rate between the two groups (P =0.10). Conclusion: The present study has shown that adding mannitol to the prime has no effect on kidney function, length of time connected to mechanical ventilation, length of stay in the ICU, or 30-day mortality. Therefore, it suggests that mannitol cannot be used as a preventative strategy for acute kidney injury after cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: The standard surgical treatment for rectal cancer is total mesorectal excision (TME), which may negatively affect patients' functional outcomes and quality of life (QoL). However, it is unclear how different TME techniques may impact patients' functional outcomes and QoL. This systematic review and meta-analysis evaluated functional outcomes of urinary, sexual, and fecal functioning as well as QoL after open, laparoscopic (L-TME), robot-assisted (R-TME), and transanal total mesorectal excision (TaTME). Methods: A systematic review and meta-analysis, based on the preferred reporting items for systematic reviews and meta-analysis statement, were conducted (PROSPERO: CRD42021240851). A literature review was performed (sources: PubMed, Medline, Embase, Scopus, Web of Science, and Cochrane Library databases; end-of-search date: September 1, 2023), and a quality assessment was performed using the Methodological index for non-randomized studies. A random-effects model was used to pool the data for the meta-analyses. Results: Nineteen studies were included, reporting on 2495 patients (88 open, 1171 L-TME, 995 R-TME, and 241 TaTME). Quantitative analyses comparing L-TME vs. R-TME showed no significant differences regarding urinary and sexual functioning, except for urinary function at three months post-surgery, which favoured R-TME (SMD [CI] –0.15 [− 0.24 to − 0.06], p = 0.02; n = 401). Qualitative analyses identified most studies did not find significant differences in urinary, sexual, and fecal functioning and QoL between different techniques. Conclusions: This systematic review and meta-analysis highlight a significant gap in the literature concerning the evaluation of functional outcomes and QoL after TME for rectal cancer treatment. This study emphasizes the need for high-quality, randomized-controlled, and prospective cohort studies evaluating these outcomes. Based on the limited available evidence, this systematic review and meta-analysis suggests no significant differences in patients' urinary, sexual, and fecal functioning and their QoL across various TME techniques. [ABSTRACT FROM AUTHOR]

Design: A multi‐methods, single‐centre pilot comprising a quasi‐experimental pre‐/post‐test design and an exploratory qualitative study. Setting: A rural Australian hospital and health service. Participants: Men newly diagnosed with localised prostate cancer who were scheduled to undergo, or had undergone, radical or robotic prostatectomy surgery within the previous 3 months. Intervention: The intervention comprised a 12‐week virtual care program delivered via teleconference by a specialist nurse, using a pre‐existing connected care platform. The program was tailored to the post‐operative recovery journey targeting post‐operative care, psychoeducation, problem‐solving and goal setting. Main Outcome Measures: Primary outcome: program acceptability. Secondary outcomes: quality of life; prostate cancer‐related distress; insomnia severity; fatigue severity; measured at baseline (T1); immediately post‐intervention (T2); and 12 weeks post‐intervention (T3). Results: Seventeen participants completed the program. The program intervention showed very high levels (≥4/5) of acceptability, appropriateness and feasibility. At T1, 47% (n = 8) of men reported clinically significant psychological distress, which had significantly decreased by T3 (p = 0.020). There was a significant improvement in urinary irritative/obstructive symptoms (p = 0.030) and a corresponding decrease in urinary function burden (p = 0.005) from T1 to T3. Conclusions: This pilot has shown that a tailored nurse‐led virtual care program, incorporating post‐surgical follow‐up and integrated low‐intensity psychosocial care, is both acceptable to rural participants and feasible in terms of implementation and impact on patient outcomes. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Bladder exstrophy-epispadias complex is a rare condition that necessitates numerous surgical procedures during a patient's youth to achieve adequate urine storage and continence. This study aimed to identify the specific needs and functional challenges faced by adults who underwent pediatric bladder exstrophy reconstructions and assess the management of these issues in an adult population. METHODS: A retrospective chart review was conducted for all bladder exstrophy complex patients who underwent surgery at a young age and were subsequently referred to our center between 2005 and 2020. Inclusion criteria included patients with cloacal or classical bladder exstrophy older than 18 years. We recorded the reasons for referral, management of contemporary complaints, types of past and present urinary reconstructions, and their current functional status. RESULTS: The study included 38 patients. The primary reasons for referral were incontinence (39%) and catheterization difficulties (24%). Management typically involved partial or complete surgical revision of their urinary reservoir, occasionally combined with a bladder neck procedure. Ultimately, only three patients continued to experience incontinence, while none reported catheterization issues after undergoing treatment at our center. Long-term exstrophy-related reconstruction complications included urinary tract infections (39%), stones (29%), stenosis (24%), fistulas (13%), chronic renal disease (16%), metabolic abnormalities (3%), and cancer (3%). CONCLUSIONS: Adults who have previously undergone bladder exstrophy reconstruction exhibit a wide range of urologic reconstructions. Their needs often revolve around continence and catheterization concerns. Most patients with satisfactory functional outcomes perform self-catheterization through a continent cutaneous channel and have either a continent pouch or an augmented bladder. [ABSTRACT FROM AUTHOR]

Inconsistent engagement in pelvic floor muscle exercise (PFME) among patients with prostate cancer (PC) following radical prostatectomy may have contributed to varying effectiveness in improving urinary incontinence across studies. Identifying factors influencing engagement can help develop effective interventions to maximize participation, enhance urinary function and improve quality of life (QoL). This scoping review aims to systematically search for factors influencing PFME engagement among post radical prostatectomy patients managing urinary incontinence. Eligible publications in English were identified from various databases, including PubMed, CINAHL, ProQuest, PsycINFO and Scopus. A health science librarian was consulted to assist in formulating search terms, encompassing PC, PFME terms and influencing factors terms. We employed Colandrapp™ for data extraction, focusing on key themes such as study characteristics, PFME education and training, recommended sessions, engagement rates and factors influencing PFME engagement following radical prostatectomy. Results were presented in tables and supplemented by a narrative discussion addressing gaps in research knowledge. The synthesis drew from a diverse body of literature, blending quantitative and qualitative approaches, to contribute to a comprehensive understanding of PFME engagement factors. Twelve papers, based on 10 studies published between 2011 and 2018, met our inclusion criteria. The reviewed studies primarily employed longitudinal quantitative designs, except for one study that utilized a mixed‐method design. Only three studies incorporated theories to guide the selection of potential factors influencing PFME engagement. The factors examined across the reviewed studies encompassed aspects related to the patient–partner relationship, patient's action control, planning (dyadic or individual), self‐efficacy, perceived urinary incontinence and the patient–provider relationship. We observed conflicting findings regarding the factors influencing PFME engagement across studies. Our review underscores the importance of theory‐informed studies using rigorous methodology and precise theoretical and operational definitions of potential factors. Such studies can help pinpoint the most influential factors to enhance PFME engagement and, ultimately, improve symptoms and QoL for PC patients. The scoping review also showed critical implications for nursing practice. Nurses should develop individualized and culturally sensitive interventions, integrate health behaviour change theories, assess patient–partner relationships and action control and consider intention's mediating role in the enhancement of PFME engagement following radical prostatectomy. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is increasing in the pediatric population and, as in adults, symptoms vary among patients. In children the first manifestations can sometimes overlap with acute neurological symptoms. Urological symptoms have not been much studied in childhood. We shared our experience with MS urological manifestation in children. Methods: This article is a retrospective evaluation of all children with MS, according to the Krupp criteria, who also present with urological symptoms. We collected demographic and clinical history, the MR localization of demyelinating lesions, urological symptoms, and exams. Results: We report on six MS pediatric cases with urological manifestation. Urinary symptoms, characterized by urinary incontinence in five patients and urinary retention in one patient, appeared in a different time frame from MS diagnosis. Urodynamic exams showed both overactive and underactive bladder patterns. Treatment was defined according to lower urinary tract dysfunction, using clean intermittent catheterization, oxybutynin, and intradetrusor Onabotulinum Toxin-A injection. A low acceptance rate of invasive evaluation and urological management was observed. Conclusions: The MS diagnosis was traumatic for all our patients. We believe it is important to address urological care in young people from the time of diagnosis for prompt management; it could be useful to include a pediatric urologist in multidisciplinary teams. [ABSTRACT FROM AUTHOR]

Introduction: Acute poststreptococcal glomerulonephritis (APSGN) remains a significant public health concern, especially in pediatric populations. This decadelong observational study aims to provide a comprehensive exploration of pediatric APSGN, emphasizing on factors those influencing glomerular filtration rate (GFR) and also contributing to prolonged hospitalization. Materials and Methods: The single-center, observational, retrospective study was conducted from January 2010 to December 2020 and included children aged 3-18 years diagnosed with APSGN. Diagnostic criteria included hematuria, decreased serum complement-3 levels, and evidence of recent streptococcal infection. Data extracted from medical records encompassed demographic details, clinical features, and a range of laboratory parameters. Results: Forty-four patients with APSGN were included (mean age: 8.65±3.31 years), 54.55% of whom were male. Hematuria was present in all cases (macroscopic hematuria in 77.27% of patients), edema in 63.64% of cases, and hypertension in 50.00% of cases. There was a negative correlation between inflammatory markers (C-reactive protein, neutrophil count, and neutrophil-tolymphocyte ratio) and GFR (r: -0.511, r: -0.302, r: -0.380; p :< 0.05 respectively). Decreased GFR, albumin, and complement-3 levels (r: -0.361, r: -0.442, r: -0.315; p :< 0.05, respectively), and increased urine density and urinary protein excretion, correlated significantly with prolonged hospitalization r: 0.413, r: 0.362; p:< 0.05, respectively). Conclusion: Despite the generally favorable prognosis of pediatric APSGN, this study highlights the potential for severe complications. Elevated inflammatory markers signal severe renal involvement, while decreased GFR, albumin, and complement-3 levels, as well as increased urine density and protein excretion, lead to extended hospital stays. These findings may be used for anticipating patient outcomes and optimizing resource utilization in pediatric APSGN care. [ABSTRACT FROM AUTHOR]

Simple Summary: In this research, we explore the effectiveness of a unique home-based 6-month comprehensive program designed to empower prostate cancer patients during their treatment. The Prostate Cancer-Patient Empowerment Program (PC-PEP) aims to enhance the quality of life for men undergoing curative treatment for prostate cancer, focusing on improving urologic function. Through a blend of physical activities, dietary education and recommendations, stress management, and social support, PC-PEP offers an innovative approach to patient care. This study rigorously assesses the impact of PC-PEP through a detailed 6-month comparison with standard care, evaluating its potential to significantly improve patient-reported outcomes. Our findings hold the promise of reshaping patient care strategies, presenting a potentially valuable addition to clinical practices for men battling prostate cancer, with the hope of improving not just their physical well-being but also their overall quality of life. Purpose: This is a secondary analysis examining a six-month home-based Prostate Cancer-Patient Empowerment Program (PC-PEP) on patient-reported urinary, bowel, sexual, and hormonal function in men with curative prostate cancer (PC) against standard of care. Methods: In a crossover clinical trial, 128 men scheduled for PC surgery (n = 62) or radiotherapy with/without hormones (n = 66) were randomized to PC-PEP (n = 66) or waitlist-control and received the standard of care for 6 months, and then PC-PEP to the end of the year. PC-PEP included daily emails with video instructions, aerobic and strength training, dietary guidance, stress management, and social support, with an initial PFMT nurse consultation. Over 6 months, participants in the PC-PEP received optional text alerts (up to three times daily) reminding them to follow the PFMT video program, encompassing relaxation, quick-twitch, and endurance exercises; compliance was assessed weekly. Participants completed baseline, 6, and 12-month International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite (EPIC) questionnaires. Results: At 6 months, men in the PC-PEP reported improved urinary bother (IPSS, p = 0.004), continence (EPIC, p < 0.001), and irritation/obstruction function (p = 0.008) compared to controls, with sustained urinary continence benefits at 12 months (p = 0.002). Surgery patients in the waitlist-control group had 3.5 (95% CI: 1.2, 10, p = 0.024) times and 2.3 (95% CI: 0.82, 6.7, p = 0.11) times higher odds of moderate to severe urinary problems compared to PC-PEP at 6 and 12 months, respectively. Conclusions: PC-PEP significantly improves lower urinary tract symptoms, affirming its suitability for clinical integration alongside established mental health benefits in men with curative prostate cancer. [ABSTRACT FROM AUTHOR]

INTRODUCTION: This is the first North American clinical evidence for MV140, a novel bacterial sublingual vaccine, developed for prevention of recurrent urinary tract infection (UTI) in women. METHODS: Female subjects with ≥3 documented UTIs/year underwent three-month vaccination treatment, nine-month efficacy period, and optional three-month followup (total 15 months). Primary outcome was no clinically diagnosed UTI following vaccination (UTI-free rate). Secondary outcomes included absolute, mean, and median overall reduction in UTI compared to pre-vaccination, quality of life, global response assessment, patient satisfaction, microbiology, and safety. RESULTS: Sixty-seven subjects (mean age 56 years, range 18-80) were enrolled; 64 completed the vaccination period and at least one post-vaccination assessment. Prior to vaccination, subjects reported a mean 6.8 UTIs/year. The UTI-free rate for the nine-month efficacy period was 40.6%. Compared to the infection rate in the year prior to vaccination, the reduction was 75.3% for the nine-month efficacy period post-vaccination. At 12-month followup, 80.3% reported that they were moderately/markedly improved; 58.1% were mostly satisfied, pleased, or delighted, while mean quality of life score improved by 1.5 points. Fourteen of the adverse events in nine subjects were potentially related to the vaccine -- all mild and resolved by three months. None of the 13 serious adverse events were related to vaccine. CONCLUSIONS: This first-in-North-America, prospective case series with the sublingual vaccine, MV140, adds further clinical evidence to its safety and effectiveness in reducing recurrent UTIs in women. [ABSTRACT FROM AUTHOR]

The objective: is to evaluate the effectiveness of the treatment of muscle-invasive bladder cancer (MIBC) by creating an artificial reservoir for the derivation of urine from segments of the small intestine of patients and to study urination and other functions of the urinary system in the postoperative period. Material and methods. During 2019-2020, the SI «Academician O.F. Vozianov Institute of Urology National Academy of Sciences of Ukraine» conducted examinations and treatments on nine patients diagnosed with MIBC at clinical stages T2aN0M0-T3bN0M0. All patients underwent laparoscopic cystectomy and lymphadenectomy, while a third of them underwent open bladder resection at other medical facilities. Among these, three patients received intracorporeal ileoneocystoplasty, whereas in six patients, the procedure involved a change in access from a median laparotomy. The implemented method of orthotopic ileoneocystoplasty during radical cystectomy involves creating an orthotopic artificial bladder from a previously resected segment of the ileum and anastomosing it with the proximal part of the urethra and the distal segments of the ureters. Notably, this method introduces several innovations: firstly, it allows for instrumental intestinal suturing in cases of endoscopic variants of radical cystoprostatectomy, and reduces the necessary length of the ileo-intestinal fragment to 50 cm. Secondly, it involves complete detubularization of the intestine fragment, asymmetrically during its middle 5 cm to form a cervical flap, and symmetrically along the contramesenteric edge for the remaining length. Thirdly, the medial edges of the right and left intestinal segments are initially fixed to the upper edge of the middle segment. Fourthly, after creating the eye of the neck of the future reservoir, the upper and middle thirds of the lateral edge of the right and left intestinal segments are fastened together. Fifthly, the original neck of the intestinal bladder is formed by performing vertical incisions of the pre-created eye of the neck of the reservoir at 12 and 6 o'clock to expand its diameter to 1.0-1.5 cm, followed by eversion and tubularization of the formed semicircles on the urethral catheters using 3-5 nodal sutures and a neck duplication maneuver with two nodal, superimposed parallel to the axis of the neck, sero-muscular sutures with a step between injection and needle puncture of 0.3-0.5 cm. Sixth, after forming the vesico-urethral anastomosis, the free edge of the cervical flap and the lower thirds of the lateral edge of the right and left intestinal segments are sutured, the adoral nd aboral intestinal openings are sealed, a cystostomy drainage is installed through the latter, and a reversible peritonization maneuver is performed. Results. According to the type of intervention, patients were divided into 2 groups: 1 group of open ileoneocystoplasty - 6 patients, 2 group of intracorporeal ileoneocystoplasty - 3 patients. According to the results of the operation, the average volume of the artificial reservoir immediately after the operation was: in group 1 - 180 ml ± 23 ml, in group 2 160 ml ± 50 ml. After 6 months, this volume increased and was 420 ± 68 ml in group 1, 380 ± 50 ml in group 2, which allowed patients to urinate 6-8 times a day and 2-3 times a night in some cases. The postoperative bed-day in group 2 was shorter on average by 7 days (7.2 ± 1.5 vs. 14.2 ± 4.2). In this study, there were no registered cases of leakage of the vesico-urethral anastomosis or its stenosis. Conclusions. Application of the proposed method of orthotopic ilioneocystoplasty during radical cystectomy will allow: - to reduce the total time of the operation in connection with the use of modern methods of intestinal suture provided for in its framework; - to compensate for the possible tension of the vesico-urethral anastomosis, which will lead to a decrease in the frequency and intensity of such postoperative complications and negative consequences as: leakage of the vesico-urethral anastomosis or its stenosis, as well as urinary incontinence at night; - thanks to the original maneuver of forming the neck of the ileal reservoir, reduce the hypermobility of the reconstructed bladder-urethral segment; - reduce the likelihood of metabolic disorders in the postoperative period due to the reduction of the length of the ileal segment removed from the patient; - to unify the technology of orthotopic ilioneocystoplasty within the framework of various approaches to performing radical cystectomy, among them: traditional «open», laparoscopic or robot-assisted. [ABSTRACT FROM AUTHOR]

Background: Phalloplasty in transgender men is performed with or without Urethral Lengthening (UL). To create clear expectations in the choice of UL, an overview and comparison of outcomes is useful. Aims: To provide and compare surgical outcomes and urinary functioning after phalloplasty with versus without UL in transgender men. Methods: A single-center, retrospective chart review was conducted among transgender men who underwent phalloplasty with or without UL between 01-2013 and 10-2020. Primary outcomes were differences in complication and reoperation rates. Secondary outcomes were end-stages of voiding at last follow-up and differences in voiding analyses pre- and postoperatively. Results: Of 136 men, 91 (67%) underwent phalloplasty with, and 45 (33%) without UL. Wound infection (31 vs. 16%, p = 0.06) and partial flap loss (35 vs. 13%, p = 0.008) were predominately seen after UL. In the UL group, 43% urethral fistulas and 60% urethral strictures were observed, relative to one man without UL who had a urethral fistula (both p < 0.001). Meatal or perineal orifice stenosis was seen in 29% with versus 11% without UL (p = 0.02). Reoperation was needed in 81% with versus 27% without UL (p < 0.001). At follow-up, 80/91 (88%) after UL reached end-stage of voiding, with 60/80 (75%) able to void while standing and 20/80 (25%) having a definitive urethrostomy. The remaining 11/91 (12%) men were awaiting further treatment for urological complications. The men able to void while standing had a median of one reoperation (range 0–6), and a significant decrease in maximum flow rate on postoperative uroflowmetry (21.4 vs. 29.8 mL/s, p < 0.001). After phalloplasty without UL, all men had a definitive perineostomy without changes in voiding analyses. Discussion: The choice for or against UL during phalloplasty has become more relevant over the years. This comparison of surgical outcomes and urinary functioning can be useful in the shared decision-making process to come to the most suitable choice of phalloplasty. [ABSTRACT FROM AUTHOR]

The objective: to determine the activity levels of total N-acetyl-β-D-glucosaminidase (NAG), its heat-stable isoenzyme NAG B and β-galactosidase (β-Gal) as enzymological criteria of the functional state of the kidney parenchyma, in particular its tubular part, in the urine of younger children age group with congenital megaureter (MU) depending on the degree of suppression of the urodynamics of the upper urinary tract (UUT). Materials and methods. Before reconstructive treatment 103 children aged 0.5 to 15 years with various clinical variants of congenital MU were examined. According to the degree of suppression of urodynamics of the UUT, the patients were divided into three groups: 1st group - 32 patients with I degree (initial degree), 2nd group - 41 children with II degree (medium one), 3rd group - 30 patients with III degree (expressed one). The control group included 25 practically healthy children. Patients were divided into two subgroups by age. Subgroup "a" included 29 patients aged from 0.5 to 3 years (average age - 1.4±0.5 years), of which 9 patients were examined in the 1st group, 13 persons - in the 2nd group, in 3d group - 7 patients. Subgroup "b" included 74 children aged 4 to 15 years (average age - 8.3±1.5 years). Enzymological activity of the morning portion of urine in patients was determined by the colorimetric method. Statistical processing of data was performed after analyzing the conformity of their distribution to normality. Results. It was established that the total activity of NAG and the activity of NAG B in the urine of all patients with congenital MU with the I degree of suppression of urodynamics of the UUT, regardless of age, probably exceeded the average data of similar indicators in the control group (p<0.05-0.001). In children with congenital MU with II degree suppression of urodynamics of the UUT, regardless of age, a similar trend of changes in the activity levels of all the studied enzymes was determined, compared to patients of the 1st group (р<0.02-0.001). The total activity of NAG, the activity of NAG B and β-Gal in the urine of patients with III degree of suppression of urodynamics of the UUT probably exceeded similar indicators compared to patients of the 2nd group regardless of the age (p<0.001). The results of the study showed that in patients with the I degree of suppression of urodynamics of the UUT between age groups there was no statistical probability of changes in the activity levels of the studied enzymes. In children under 3 years of age with III degree of inhibition of urodynamics of the UUT the levels of enzyme activity probably exceeded similar indicators in the group of patients of 3 years old and over (р<0.05-0.001). Enzyme activity levels of NAG and NAG B in the urine of patients under 3 years old with II degree of suppression of urodynamics of the UUT also statistically significantly exceeded the similar indicators of sick children over 3 years old (p<0.01). Conclusions. The intensity of the increase in the urinary activity of NAG, its thermostable isoenzyme NAG B and β-Gal in patients under 3 years old compared to the group of patients over the age of 3 years growths with an increase in the degree of suppression of the urodynamics of the UUT, which should be taken into account during treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Parabens, found in everyday items from personal care products to foods, are chemicals with endocrine-disrupting activity, which has been shown to influence reproductive function. OBJECTIVES: This study investigated whether urinary concentrations of methylparaben, propylparaben, or butylparaben were associated with the urinary metabolome during the periconceptional period, a critical window for female reproductive function. Changes to the periconceptional urinary metabolome could provide insights into the mechanisms by which parabens could impact fertility. METHODS: Urinary paraben concentrations were measured in paired pre- and postconception urine samples from 42 participants in the Early Pregnancy Study, a prospective cohort of 221 women attempting to conceive. We performed untargeted and targeted metabolomics analyses using ultrahigh-performance liquid chromatography quadrupole time-of-flight mass spectrometry. We used principal component analysis, orthogonal partial least-squares discriminant analysis, and permutation testing, coupled with univariate statistical analyses, to find metabolites associated with paraben concentration at the two time points. Potential confounders were identified with a directed acyclic graph and used to adjust results with multivariable linear regression. Metabolites were identified using fragmentation data. RESULTS: Seven metabolites were associated with paraben concentration (variable importance to projection score >1, false discovery rate-corrected 푞-value<0.1). We identified four diet-related metabolites to the Metabolomics Standards Initiative (MSI) certainty of identification level 2, including metabolites from smoke flavoring, grapes, and olive oil. One metabolite was identified to the class level only (MSI level 3). Two metabolites were un-identified (MSI level 4). After adjustment, three metabolites remained associated with methylparaben and propylparaben, two of which were diet-related. No metabolomic markers of endocrine disruption were associated with paraben concentrations. DISCUSSION: This study identified novel relationships between urinary paraben concentrations and diet-related metabolites but not with metabolites on endocrine-disrupting pathways, as hypothesized. It demonstrates the feasibility of integrating untargeted metabolomics data with environmental exposure information and epidemiological adjustment for confounders. The findings underscore a potentially important connection between diet and paraben exposure, with applications to nutritional epidemiology and dietary exposure assessment [ABSTRACT FROM AUTHOR]

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Purpose: The aim of this study is to determine nitrofurantoin exposure in female patients with different age and renal function with complaints of an uncomplicated UTI. Also the nitrofurantoin exposure in relation to the dosage regimen will be studied. Methods: Eight general practitioners (GP) participated in the study and included 38 patients with symptoms of an uncomplicated UTI, treated either with a dose of 50 mg q6h or 100 mg q12h, upon the discretion of the GP. Nitrofurantoin exposure was quantified in the patient's 24-h urine samples by UHPLC-UV and the area under the curve was calculated. Results: The 38 patients provided a range of 2–17 urine samples. The urine nitrofurantoin exposure was 1028 mg h/L for the patients receiving 50 mg q6h and 1036 mg h/L for those treated with 100 mg q12h (p = 0.97) and was not affected by age and eGFR (p = 0.64 and p = 0.34, respectively). Conclusion: The data obtained do not support the discouragement of nitrofurantoin use in the elderly and in patients with impaired renal function. Since only a small number of patients were included, a larger study with more patients is warranted to evaluate nitrofurantoin exposure and adverse effects. [ABSTRACT FROM AUTHOR]

Background: This randomized, double-blind, placebo-controlled study aimed to investigate the effects of γ-tocopherol (Toc) supplementation on premenstrual symptoms and natriuresis. Methods: We enrolled 51 Japanese women with premenstrual symptoms, particularly those who showed increased symptoms induced by water retention during the luteal phase compared with the follicular phase. Premenstrual symptoms were recorded in the first cycle's postmenstrual follicular phase; physical measurements and urine collection were conducted during the 48-h run-in period. The test supplement, which contained 180 mg of γ-Toc or placebo, was orally administered twice a day for 7 days during the luteal phase of the first and second cycles in a crossover manner. The same evaluation was conducted during the luteal phase, beginning in the morning of the sixth day of supplement administration. Results: Compared with placebo intake, γ-Toc intake significantly reduced "fatigue" and "irritability/anger" symptoms. Furthermore, compared with placebo intake, γ-Toc intake significantly reduced the thigh circumference. Regarding the "swelling of the legs" and "heavy legs" symptoms and the thigh circumference, the biphasic trend of increasing and decreasing values in the daytime and morning, respectively, during the follicular phase was not observed at the luteal phase with placebo intake. Contrastingly, γ-Toc intake resulted in significantly lower values in the morning than placebo intake. The mean difference in 24-h urinary sodium excretion between γ-Toc and placebo intake was 10.6 mEq (95% confidence interval (CI): -0.1, 21.4, p = 0.05, power 55%). Plasma γ-Toc and its metabolite γ-carboxyethyl hydroxychroman (CEHC) levels were significantly higher with γ-Toc intake than with placebo intake. There were no significant between-supplement differences in serum electrolyte levels or cumulative urinary potassium excretion. Conclusion: γ-Toc intake could effectively alleviate certain premenstrual syndrome symptoms, particularly those related to water retention during the luteal phase. Furthermore, the underlying mechanism may involve the diuretic effect of γ-CEHC, which is a γ-Toc metabolite. Trial registration: UMIN000047989; registration date: 10/06/2022, retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: Long-term patient-reported outcomes are needed to inform treatment decisions for localized prostate cancer. Methods: Patient-reported outcomes of 1643 randomly assigned participants in the ProtecT (Prostate Testing for Cancer and Treatment) trial were evaluated to assess the functional and quality-of-life impacts of prostatectomy, radiotherapy with neoadjuvant androgen deprivation, and active monitoring. This article focuses on the outcomes of the randomly assigned participants from 7 to 12 years using mixed effects linear and logistic models. Results: Response rates exceeded 80% for most measures. Among the randomized groups over 7 to 12 years, generic quality-of-life scores were similar. Among those in the prostatectomy group, urinary leakage requiring pads occurred in 18 to 24% of patients over 7 to 12 years, compared with 9 to 11% in the active monitoring group and 3 to 8% in the radiotherapy group. In the prostatectomy group, 18% reported erections sufficient for intercourse at 7 years, compared with 30% in the active monitoring and 27% in the radiotherapy groups; all converged to low levels of potency by year 12. Nocturia (voiding at least twice per night) occurred in 34% in the prostatectomy group compared with 48% in the radiotherapy group and 47% in the active monitoring group at 12 years. Fecal leakage affected 12% in the radiotherapy group compared with 6% in the other groups by year 12. The active monitoring group experienced gradual age-related declines in sexual and urinary function, avoiding radical treatment effects unless they changed management. Conclusions: ProtecT provides robust evidence about continued impacts of treatments in the long term. These data allow patients newly diagnosed with localized prostate cancer and their clinicians to assess the trade-offs between treatment harms and benefits and enable better informed and prudent treatment decisions. (Funded by the UK National Institute for Health and Care Research Health Technology Assessment Programme projects 96/20/06 and 96/20/99; ISRCTN number, ISRCTN20141297; ClinicalTrials.gov number, NCT02044172.) [ABSTRACT FROM AUTHOR]

The NHS England Radiotherapy Service Specification calls for routine use of patient-reported outcome measures (PROMs). However, barriers exist at patient, healthcare professional and service levels. The aim of the present study was to determine the current use of PROMs within radiotherapy services in England. The current attitudes, barriers and enablers to the implementation of PROMs in radiotherapy practice were evaluated and practical recommendations to inform future implementation were developed. A mixed-methods approach was adopted to obtain quantitative and qualitative data. An online questionnaire was developed and disseminated to all radiotherapy operational delivery network managers across England. The questionnaire consisted of 12 open and closed questions relating to PROMs use, with the option to provide free-text responses. Inductive thematic analysis was conducted on free-text comments, whereas descriptive statistics were used to analyse quantitative data. In total, 182 responses were received from 40 of the 50 radiotherapy providers, resulting in a response rate of 84%. The current use of PROMs was analysed, including rationale for use, tools used, format of PROMs collection and timing within the radiotherapy pathway. Most respondents indicated that PROMs were used in the context of clinical trials only. Through thematic analysis, four identical key themes were identified relating to both barriers and enablers to PROMs use; these included IT infrastructure, time, human/financial resources and training/education. A fifth theme, standardisation, was identified as a key enabler to PROMs use. Our findings show that outside of clinical trials, PROMs are not routinely used in radiotherapy services due to barriers identified at professional and service levels. Here we provide recommendations to mitigate the barriers identified and implement PROMs in radiotherapy, including training for healthcare professionals and standardisation of PROMs tools and storage. This study provides a key first step in driving PROMs implementation within radiotherapy services across England. • Outside of clinical trials, PROMs were not widely used within radiotherapy services. • Common PROMs used included QOL, anxiety/depression and urinary/bowel function tools. • PROMs are completed using either paper or electronic forms, by staff or patients. • Barriers include IT infrastructure, time, resources (staff/finances) and training. • Enablers included IT, time, resources, training and standardisation. [ABSTRACT FROM AUTHOR]

Cadmium (Cd) is a toxic heavy metal, exposure to which leads to adverse health effects including chronic kidney damage. Tremendous efforts have been explored in identifying safe chelating agents for removing accumulated Cd from kidney, but with limited success owing to their associated side effects and the ineffectiveness in eliminating Cd. A newly developed chelating agent, sodium (S)-2-(dithiocarboxylato((2S,3 R,4R,5 R)-2,3,4,5,6-pentahydroxyhexyl) amino)-4(methylthio)butanoate (GMDTC), has been shown to effectively mobilize Cd from kidney. However, the mechanism(s) of removal are unclear, while it has been hypothesized that renal glucose transporters potentially play key roles mainly because GMDTC contains an open chain glucose moiety. To test this hypothesis, we utilized the CRISPR/Cas9 technology and human kidney tubule HK-2 cells, and constructed sodium-dependent glucose transporter 2 (SGLT2) or glucose transporter 2 (GLUT2) gene knockout cell lines. Our data showed that GMDTC's ability in removing Cd from HK-2 cells was significantly reduced both in GLUT2 −/− or SGLT2 −/− cells, with a removal ratio reduced from 28.28% in the parental HK-2 cells to 7.37% in GLUT2 −/− cells and 14.6% in SGLT2 −/− cells. Similarly, knocking out the GLUT2 or SGLT2 led to a compromised protective effect of GMDTC in reducing cytotoxicity of HK-2 cells. This observation was further observed in animal studies, in which the inhibition of GLUT2 transporter by phloretin treatment resulted in reduced efficiency of GMDTC in removing Cd from the kidney. Altogether, our results show that GMDTC is safe and highly efficient in removing Cd from the cells, and this effect is mediated by renal glucose transporters. [ABSTRACT FROM AUTHOR]

Objective: The goal of this research was to determine if dye can be omitted without affecting the accuracy of urinary-tract injury assessment during cystoscopy at the time of hysterectomy. Materials and Methods: This prospective randomized study was performed at a gynecologic oncology service in a tertiary-care center from July 2018 to June 2019. All patients undergoing hysterectomy for either benign and malignant indications were included. The study focused on the routine cystoscopy given to each patient per protocol. Patients were randomized into 2 main groups: (1) dye versus (2) no-dye, and then into 4 subgroups based on the distending media that was used (water or saline). A linear, continuous visual scale was used to grade ureteral jet strength. The time to visualization of ureteral jets was documented. The primary outcome measure was the degree of agreement between 2 observers' ratings of ureteral jet strengths when urinary dye was used or when it was not used. Results: According to Cronbach's α, the correlation between 2 observers was 85.3% agreement for the strength of the right-side ureteral jets and 85.8% for the left side ureteral jets. The difference in jet strength between the dye and no-dye groups was statistically significant for evaluation of the right-side ureter but not clinically significant. No statistical significance for assessment of ureteral jet strength was noted between water and saline distension media nor was there a difference between the groups for time until first jet visualization. Conclusions: Cystoscopy can be performed without using dye for ureter and bladder assessment during gynecologic surgeries. (J GYNECOL SURG 38:348) [ABSTRACT FROM AUTHOR]

During the past decades, remarkable progress has been made in our understanding of the molecular basis of kidney diseases, as well as in the ability to pinpoint disease-causing genetic changes. Congenital anomalies of the kidney and urinary tract (CAKUT) are remarkably diverse, and may be either isolated to the kidney or involve other systems, and are notorious in their variable genotype–phenotype correlations. Genetic conditions underlying CAKUT are individually rare, but collectively contribute to disease etiology in ~ 16% of children with CAKUT. In this review, we will discuss basic concepts of kidney development and genetics, common causes of monogenic CAKUT, and the approach to diagnosing and managing a patient with suspected monogenic CAKUT. Altogether, the concepts presented herein represent an introduction to the emergence of nephrogenetics, a fast-growing multi-disciplinary field that is focused on deciphering the causes and manifestations of genetic kidney diseases as well as providing the framework for managing patients with genetic forms of CAKUT. [ABSTRACT FROM AUTHOR]

The use of sodium-glucose co-transporter 2 (SGLT2) inhibitors has evolved over the past decade, from their initial indication as an adjunctive oral medication to treat hyperglycaemia in diabetics, to becoming part of guideline-directed therapy for the treatment of chronic kidney disease, heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. This transition was driven by data from large cardiovascular and renal outcome trials, which repeatedly demonstrated that SGLT2 inhibitors improve important endpoints in chronic kidney disease and heart failure. In chronic kidney disease, SGLT2 inhibition reduces decline in glomerular filtration rate, risk of progression to end-stage renal disease and death from renal causes. With respect to their use in heart failure, SGLT2 inhibitors decrease risk of major adverse cardiac events, hospitalisation for heart failure and death from cardiovascular causes. While the benefits of these medications have been demonstrated, the mechanisms by which they are conferred are less clear. Extensive investigation into potential mechanisms of benefits has been pursued internationally and current hypotheses include increased natriuresis and osmotic diuresis, improved glomerular haemodynamic, reduced body mass and reduced adipose tissue mediated inflammation, in addition to others. This review discusses the physiology underlying the therapeutic benefit of SGLT2 inhibition in chronic kidney disease and heart failure. [ABSTRACT FROM AUTHOR]

Background: Acupuncture (AP) has been empirically used to relieve post-canine distemper virus (CDV) infection neurological signs in veterinary clinics. Objectives: This clinical study aimed to investigate the effects of AP combined with electroacupuncture (EA) on neurological function in dogs infected by CDV. Methods: Twenty-four CDV-infected dogs with neurological sequelae were recruited to receive weekly AP/EA sections for 24 weeks. Neurological improvements were assessed before each AP/EA session using a modified scoring system. Data were analyzed using the McNemar test, Friedman test, Fisher's exact test, and Kaplan-Meier curves (p < 0.05). Results: Neurological scores improved from seven to 24 weeks after AP/EA treatment compared with pretreatment scores (p < 0.001). Significant improvements were recorded over time for functional limb recovery, cranial nerve deficits, mental status (p = 0.025 - 0.014), and urinary function (p < 0.001). Myoclonus was improved and entirely reversed in 75% and 25% of the dogs, respectively. At the end of treatment, the proportion of dogs with normal proprioception, posture, hopping (p < 0.001), and superficial pain sensation responses (p = 0.004) was greater than pretreatment values. Conclusion: AP/EA therapy promoted significant neurological recovery in CDV-infected dogs and may be considered within the chronic phase of the disease to improve motor and sensory rehabilitation. However, these results are preliminary and must be confirmed by further investigations. [ABSTRACT FROM AUTHOR]

Background. Urinary podocyte excretion is related to a reduction in glomerular podocyte numbers, glomerulosclerosis, and urinary protein selectivity. To elucidate the role of urinary podocytes in proteinuria and renal prognosis and to identify the factors that cause podocyte detachment, we examined urinary podocytes in 120 renal biopsy patients. Methods. Podocytes were identified in urinary sediments stained with fluorescent-labeled anti-podocalyxin antibodies in ten high power fields. The amounts of protein bands, separated by SDS-polyacrylamide gel electrophoresis, were calculated using an image software program and the correlation with urinary podocytes was analyzed. Podocyte surface pores were observed using a low-vacuum scanning electron microscope. The renal prognosis, including induction of hemodialysis or 30% reduction in eGFR, was investigated. Results. Urinary podocyte excretion showed a higher positive correlation with albumin excretion compared to IgG, prealbumin, and transferrin. There were no significant correlations between urinary podocyte count and low molecular weight proteins, including β2-microglobulin and α1-microglobulin. The number of podocyte surface pores was positively correlated with proteinuria, suggesting enhanced albumin transcytosis. The hemodynamic pressure on the glomerular capillary wall, including products of pulse pressure and pulse rate (water hammer pressure), was positively correlated with urinary podocyte excretion. Urinary podocyte excretion and Tamm–Horsfall protein (THP) were independent risk factors for renal prognosis but were not related to response to treatment. Conclusion. Urinary podocyte excretion was correlated with urinary albumin excretion, indicating specific albumin transport by podocytes. Podocytes were detached from the glomerular capillaries by water hammer pressure and THP was involved in the renal prognosis. [ABSTRACT FROM AUTHOR]

Simple Summary: Prostate cancer is one of the most dominant cancers in the Western world. In recent years, the use of positron emission tomography (PET) targeting prostate-specific membrane antigen (PSMA) to image prostate cancer allows accurate diagnosis and staging. Compared to the recently registered PET tracers [68Ga]Ga-PSMA-11 and [18F]DCFPyL, [18F]PSMA-1007 is predominantly excreted by the hepatobiliary tract, resulting in much lower urinary uptake. This allows for an improved evaluation of the pelvic area. However, on some occasions, clinicians do observe high excretion of [18F]PSMA-1007 by the renal system. Yet, this sudden differential metabolism of [18F]PSMA-1007 remains poorly understood. In this retrospective study, we aimed to elucidate the incidental high urinary uptake of [18F]PSMA-1007 by assessing the individual patient characteristics, scan (data) and peptide batches. Positron emission tomography (PET) of prostate-specific membrane antigen (PSMA) allows for accurate diagnosis and staging of prostate cancer (PCa). Compared to other PSMA PET tracers available, [18F]PSMA-1007 is predominantly excreted via the hepatobiliary tract resulting in low renal excretion which improves evaluation of the pelvic area. However, some patients do show high urinary uptake of [18F]PSMA-1007. The present study aimed to investigate this sudden high urinary uptake of [18F]PSMA-1007 by evaluating [18F]PSMA-1007 PET scans from PCa patients. In this single-center retrospective study, patients that underwent [18F]PSMA-1007 PET imaging between July 2018 and January 2021 were included. Data regarding the individual patient characteristics, scan acquisition and batch production were analyzed. To determine the urinary excretion of [18F]PSMA-1007, a region of interest was drawn in the bladder, and standardized uptake values (SUVs) were calculated and compared to SUVs in the prostate. An SUVmax of >10 was considered high urinary excretion, an SUVmax 7.5–10 intermediate and an SUVmax < 7.5 low urinary excretion. A total of 344 patients underwent [18F]PSMA-1007 PET/CT imaging, with 37 patients receiving three or more [18F]PSMA-1007 PET/CT scans. The mean SUVmean and SUVmax of the bladder were 3.9 (SD 2.9) and 5.9 (SD 4.2), respectively. Fourteen percent of patients showed high urinary uptake of [18F]PSMA-1007. Twelve of the thirty-seven patients (32.4%) that had multiple scans showed a varying urinary uptake of [18F]PSMA-1007 per PSMA PET/CT scan. In terms of patient characteristics, risk factors, medication and blood laboratory results, no significant influencing variables were found. Nor was there a difference observed in the batch size and the mean radiochemical purity of PSMA-1007 for high- and low-excreting patients. However, the bladder volume affected the mean SUVmax in the bladder significantly, with higher SUVs in lower bladder volumes. In this study, we observed that a higher SUV in the urinary tract seemed to occur in patients with low bladder volume. A prospective study is needed to corroborate this hypothesis. [ABSTRACT FROM AUTHOR]

Micturition is an involuntary process based on spinal arcs in infants and children until a defined age. The awareness and voluntary control of voiding depends on specific areas in the central nervous system, especially cortical regions. The cells and connections between these areas develop over time and regulate the voiding process. The ability to maintain continence and to adjust physiological needs to appropriate environmental conditions is considered to be acquired through systematic behavioral education, especially toilet training. The recommendations specify the age at which to start establishing the relevant habits. The purpose of these guidelines is to achieve proper micturition control development and to avoid functional lower urinary tract (LUT) disorders. We present a case of a patient who underwent complete urinary diversion in infancy and reconstruction of the urinary tract eleven years later. For eleven years, she had an empty bladder and no toilet training. After undiversion, she regained full continence in a short space of time. The presence of proper LUT function and a controlled micturition process raises the question of the standard toilet training recommendations' validity. The aim of our work focuses on the following question: Is toilet training the only way to achieve micturition skills and proper urinary tract function? The history of our patient and the literature reveal that voluntary micturition may develop without stimulating signals of filling from bladder receptors and independently of recommended behavioral education, so toilet training seems to not be necessary. [ABSTRACT FROM AUTHOR]

The goal of functional renal imaging is to identify and quantitate irreversible renal damage and nephron loss, as well as potentially reversible hemodynamic changes. MR urography has evolved into a comprehensive evaluation of the urinary tract that combines anatomical imaging with functional evaluation in a single test without ionizing radiation. Quantitative functional MR imaging is based on dynamic contrast-enhanced MR acquisitions that provide progressive, visible enhancement of the renal parenchyma and urinary tract. The signal changes related to perfusion, concentration and excretion of the contrast agent can be evaluated using both quantitative and qualitative measures. Functional evaluation with MR has continued to improve as a result of significant technical advances allowing for faster image acquisition as well as the development of new tracer kinetic models of renal function. The most common indications for MR urography in children are the evaluation of congenital anomalies of the kidney and urinary tract including hydronephrosis and renal malformations, and the identification of ectopic ureters in children with incontinence. In this paper, we review the underlying acquisition schemes and techniques used to generate quantitative functional parameters including the differential renal function (DRF), asymmetry index, mean transit time (MTT), signal intensity versus time curves as well as the calculation of individual kidney glomerular filtration rate (GFR). Visual inspection and semi-quantitative assessment using the renal transit time (RTT) and calyceal transit times (CTT) are fundamental to accurate diagnosis and are used as a basis for the interpretation of the quantitative data. The importance of visual assessment of the images cannot be overstated when analyzing the quantitative measures of renal function. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be able to identify the various types of lower urinary tract symptoms in older women • To confidently assess and treat lower urinary tract symptoms in older women • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Lower urinary tract symptoms (LUTS) are prevalent in older women. These symptoms are often under-reported due to the potentially embarrassing nature of the symptoms and a belief that they are an inevitable consequence of ageing. LUTS such as urinary incontinence have a significant negative effect on people's quality of life; however, with the appropriate assessment and management, improvements can be achieved. This article reviews the different types of LUTS and their causes, assessment and treatment, focusing on older women. It aims to provide nurses with an understanding of LUTS so that they can identify appropriate interventions. [ABSTRACT FROM AUTHOR]

PURPOSE: To characterize common clinical indications for urodynamic, a bladder function test, in adults with spina bifida. METHODS: A retrospective chart review was performed for 215 patients seen in an adult multidisciplinary spina bifida clinic who were registered with the National Spina Bifida Patient Registry from October 2011 to October 2018. Descriptive statistics were used for statistical comparisons. RESULTS: A total of 52 of 215 patients developed a clinical indication for urodynamics. Of these, 71 (33%) patients (8 of whom underwent testing twice) had urodynamics performed, resulting in a total of 79 urodynamic study encounters that were analyzed. Thirty-four (43%) urodynamic testing cases were performed due to a symptomatic change in lower urinary tract function; 14 (18%) were due to declining renal function or concern for upper tract deterioration based on imaging. The data obtained from urodynamic investigation led to new recommendations for urinary tract management in 59 (75%) of the urodynamic studies performed. A total of 32 of the 90 (35%) recommendations made were surgical interventions and 30 (33%) were for a change in medical management. Interestingly, 8 of the 18 (44%) routine or baseline urodynamic tests performed led to new recommendations in urinary tract management. CONCLUSION: A total of 24%of patients in the multidisciplinary spina bifida clinic developed an indication for urodynamic testing over a 7-year period which resulted in new recommendations for urinary tract management in most. As more patients with spina bifida enter adulthood, the indications for urodynamic evaluation may become more defined, since the results often lead to alterations in bladder management. [ABSTRACT FROM AUTHOR]

The effective storage of urine and its expulsion relies upon the coordinated activity of parasympathetic, sympathetic, and somatic innervations to the lower urinary tract (LUT). At birth, all mammalian neonates lack the ability to voluntary regulate bladder storage or voiding. The ability to control urinary bladder activity is established as connections to the central nervous system (CNS) form through development. The neural regulation of the LUT has been predominantly investigated in adult animal models where comparatively less is known about the neonatal and postnatal neurophysiological development that facilitate urinary continence. Furthermore, congenital neurological or anatomical defects can adversely affect both storage and voiding functions through postnatal development and into adulthood, leading to secondary conditions including vesicoureteral reflux, chronic urinary tract infections, and end-stage renal disease. Therefore, the aim of the review is to provide the current knowledge available on neurophysiological regulation of the LUT through pre- to postnatal development of human and animal models and the consequences of congenital anomalies that can affect LUT neural function. [ABSTRACT FROM AUTHOR]

Background: Most acute decompensated heart failure admissions are driven by congestion. However, residual congestion is common and often driven by the lack of reliable tools to titrate diuretic therapy. The authors previously developed a natriuretic response prediction equation (NRPE), which predicts sodium output using a spot urine sample collected 2 h after loop diuretic administration.Objectives: The purpose of this study was to validate the NRPE and describe proof-of-concept that the NRPE can be used to guide diuretic therapy.Methods: Two cohorts were assembled: 1) the Diagnosing and Targeting Mechanisms of Diuretic Resistance (MDR) cohort was used to validate the NRPE to predict 6-h sodium output after a loop diuretic, which was defined as poor (<50 mmol), suboptimal (<100 mmol), or excellent (>150 mmol); and 2) the Yale Diuretic Pathway (YDP) cohort, which used the NRPE to guide loop diuretic titration via a nurse-driven automated protocol.Results: Evaluating 638 loop diuretic administrations, the NRPE showed excellent discrimination with areas under the curve ≥0.90 to predict poor, suboptimal, and excellent natriuretic response, and outperformed clinically obtained net fluid loss (p < 0.05 for all cutpoints). In the YDP cohort (n = 161) using the NRPE to direct therapy mean daily urine output (1.8 ± 0.9 l vs. 3.0 ± 0.8 l), net fluid output (-1.1 ± 0.9 l vs. -2.1 ± 0.9 l), and weight loss (-0.3 ± 0.3 kg vs. -2.5 ± 0.3 kg) improved substantially following initiation of the YDP (p < 0.001 for all pre-post comparisons).Conclusions: Natriuretic response can be rapidly and accurately predicted by the NRPE, and this information can be used to guide diuretic therapy during acute decompensated heart failure. Additional study of diuresis guided by the NRPE is warranted. [ABSTRACT FROM AUTHOR]

The lower urinary tract has the main function of urine storage and voiding. The integrity of the lower urinary tract nerve supply is necessary for its proper function. Neurological disorders can lead to lower urinary tract dysfunction (LUTD) and cause lower urinary tract symptoms (LUTS). Common causes of neurogenic LUTS or LUTD include spinal cord injury, multiple sclerosis, Parkinson's disease, cerebrovascular accidents, cauda equina syndrome, diabetes mellitus, and multiple system atrophy. The pathophysiology is categorized according to the nature of the onset of neurological disease. Assessment requires clinical evaluation, laboratory tests, imaging, and urodynamic studies. Impaired voiding is most often managed by clean intermittent self-catheterization if the postvoid residual urine exceeds 100 ml, whereas storage symptoms are most often managed by antimuscarinic medications. Intradetrusor injection of botulinum toxin type A is emerging as an effective treatment for managing refractory neurogenic detrusor overactivity. This review provides an overview of the clinical characteristics, diagnosis, and management of LUTD in patients with central and peripheral common neurological diseases. [ABSTRACT FROM AUTHOR]

Objective: To compare effects of the dipeptidyl peptidase 4 (DPP-4) inhibitor linagliptin with those of a sulfonylurea on renal physiology in metformin-treated patients with type 2 diabetes mellitus (T2DM).Research Design and Methods: In this double-blind randomized trial, 46 overweight T2DM patients without renal impairment received once-daily linagliptin (5 mg) or glimepiride (1 mg) for 8 weeks. Fasting glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined by inulin and para-aminohippuric acid clearances. Fractional excretions, urinary damage markers, and circulating DPP-4 substrates (among others, glucagon-like peptide 1 and stromal cell-derived factor-1α [SDF-1α]) were measured.Results: HbA1c reductions were similar with linagliptin (-0.45 ± 0.09%) and glimepiride (-0.65 ± 0.10%) after 8 weeks (P = 0.101). Linagliptin versus glimepiride did not affect GFR, ERPF, estimated intrarenal hemodynamics, or damage markers. Only linagliptin increased fractional excretion (FE) of sodium (FENa) and potassium, without affecting FE of lithium. Linagliptin-induced change in FENa correlated with SDF-1α (R = 0.660) but not with other DPP-4 substrates.Conclusions: Linagliptin does not affect fasting renal hemodynamics compared with glimepiride in T2DM patients. DPP-4 inhibition promotes modest natriuresis, possibly mediated by SDF-1α, likely distal to the macula densa. [ABSTRACT FROM AUTHOR]

Aim: In this study, we investigated self-measured voiding time in the Japanese population. Methods: A survey questionnaire was used to determine self-measured voiding time in Japanese participants aged =20 years. In addition to demographic data such as age and sex, relevant medical conditions, including hypertension, diabetes mellitus, renal impairment and other disorders, were also recorded. Voiding time was measured whenever the participant had the urge to void. Results: In total, 2493 healthy individuals (1347 men, mean SD, age 60.50 12.16 years, and 1146 women, 51.16 12.97 years) participated in the survey. Self-measured voiding time was 27.71 20.25 s for men, and 17.49 11.87 s for women. Additionally, 1227 participants with certain diseases were included (1026 men, aged 67.12 9.93 years, and 201 women, 60.26 11.02 years). In this group, self-measured voiding time was significantly longer at P < 0.01 (30.71 20.98 s in men, 21.28 15.56 s in women). In men whose international prostate symptom score (IPSS) was >7, voiding time was significantly longer (healthy men: IPSS =7 n = 868, 23.9 14.88 s, IPSS =8 n = 479, 34.6 26.05 s, P < 0.05, men with comorbidities: IPSS =7: n = 504, 25.64 15.63 s, IPSS =8: n = 522, 35.6 24.11 s, P < 0.05). Conclusions: This self-reported internet survey revealed that self-measured voiding time was longer in men than women regardless of age, and was significantly prolonged with age regardless of sex. Furthermore, self-measured voiding time could be a good screening tool to predict urinary function and health status. Geriatr Gerontol Int 2020; 20: 670-673. [ABSTRACT FROM AUTHOR]

Traces is a series of articles designed to enhance the clinician's ability to prepare the patient for, safely perform, and interpret findings of a single test or multichannel urodynamic testing. This article provides an introduction to urodynamic testing, including a brief overview of urodynamic hardware and software and the testing environment, along with commonly performed urodynamic tests and the most common bundled evaluation, referred to as multichannel urodynamics. Safety issues encountered during urodynamic testing, including infection prevention, avoidance of urethral trauma and hematuria, managing sudden changes in blood pressure, and radiation safety, are discussed in greater detail. [ABSTRACT FROM AUTHOR]

This article is a reported of a study of the relationship between lower urinary tract symptoms and pelvic muscle exercise attitudes as well as effects on the self‐efficacy in childbirth women. Pregnancy and childbirth are normal physiological processes, but their effects on the genitourinary system are great. The enlarged uterus resulting from foetal growth is a major cause of urinary incontinence because it affects the tissues supporting the female pelvis and causes relaxation of the pelvic floor muscle and lower urinary function. A descriptive research study was performed from August to November 2017. Overall, 141 women after childbirth were conducted who living in South Korea. The outcome measure was the lower urinary tract symptoms, attitudes toward pelvic muscle exercise and self‐efficacy for pelvic muscle exercise. In this study, even though the women after childbirth had moderate level of lower urinary tract symptoms, their self‐efficacy for pelvic muscle exercise was low. Also, the gestational diabetes history and exercise duration after birth were identified as variables affecting self‐efficacy for pelvic muscle exercise. The present study showed that nurses should provide knowledge and strategies about pelvic muscle exercise to enhance self‐efficacy for post‐partum women. [ABSTRACT FROM AUTHOR]

The review intends to look into the benefits, impacting factors, preserving strategies especially haemodialysis (HD)- related factors and strategies as well as clinical practice implications of residual renal function (RRF) among patients on HD. Databases of Medline (Ovid), CINAHL Plus with full text (EBESCO), Embase (Ovid) and Pubmed (from January 2000 to December 2018) were searched for relevant study reports and reviews and 78 full articles were included. RRF confers a wide range of benefits for people on HD. It brings a strong survival advantage for HD populations. It provides continuous water and sodium excretion and clears middle molecular weight and protein bound uraemic toxins more efficiently. RRF also brings better management of anaemia, mineral and bone disorder, and leads to lower risk of arteriosclerosis, better nutrition and better quality of life (QOL). Intradialytic hypotension (IDH), inflammation, volume derangement, dialyser bio-incompatibility are important HD-related factors accelerating RRF decline after the initiation of HD. Studies also elucidate that incremental HD, haemodiafiltration (HDF) and peritoneal dialysis (PD) or a combination of PD and HD modality may better preserve RRF. Based on the available evidence, nephrology nurses can improve clinical practice to assist in preserving RRF among HD patients. These clinical practice implications include preventing IDH, improving dry weight assessment and volume control, advocating for incremental HD, promoting HDF, PD modality or the combination of PD and HD, improving infection control to decrease systemic inflammation, using a dialyser with further improved biocompatibility as well as promoting diuretic agents' adherence. [ABSTRACT FROM AUTHOR]

Aim: Diuretics are a cornerstone in treatment of heart failure (HF). Torasemide is a loop diuretic with a potential advantage over other diuretics. We aim to meta‐analyse and compare the effect of torasemide with furosemide in HF patients. Methods: A comprehensive literature search using 12 databases including PubMed, Scopus, and Web of Science was performed. All randomized controlled trials (RCTs) comparing furosemide and torasemide in HF patients were included and meta‐analysed. We assessed the risk of bias using Cochrane Collaboration's tool. The protocol was registered in PROSPERO (CRD42016046112). Results: Eighteen RCTs with 1598 patients were included. There was a significant difference between torasemide 20 mg and furosemide 40 mg in increasing the urine volume (standard difference of the mean (SDM) [95% confidence interval] = −0.78 [−1.52 to −0.053], P =.036). Torasemide 10 mg and 10 to 20 mg have a significant effect on potassium excretion in comparison with furosemide 25 to 40 mg (P =.018 and.023, respectively). In general, torasemide and furosemide have no significant difference in mortality, edema improvement, weight loss, heart rate, and reducing systolic/diastolic blood pressure. However, oral torasemide has a significant lower hospital stay P <.001 and superior effect in improving ejection fraction P =.029. Conclusion: Although not all results are statistically significant, torasemide has potential advantages on multiple aspects of HF management when compared with furosemide. More studies are needed to clarify these effects. [ABSTRACT FROM AUTHOR]

Background: This study examined the effect of serum uric acid (SUA) level and urinary sodium excretion on blood pressure as well as their combined effect on prehypertension in a Korean population.Method: Data from the 7th Korea National Health and Nutrition Examination Survey for adults (≥ 19 years of age) were used. The participants were classified into two groups, normotension and prehypertension, according to the JNC-7 definition. Logistic regression was carried out and adjusted for traditionally regarded confounders of blood pressure. All analyses considered a complex sampling design. A multivariate analysis was performed on subgroups defined according to their SUA level and urinary sodium excretion.Results: The 4200 participants were divided into normotension (n = 2646) and prehypertension (n = 1554) groups. In the univariate analysis, patient age, male sex, concurrent comorbidity (diabetes mellitus, cardiovascular disease, stroke, dyslipidemia, and chronic kidney disease), uric acid, and urinary sodium excretion were associated with prehypertension. After adjusting for baseline covariates, both the SUA level and urinary sodium excretion were significant predictors of incident prehypertension (SUA, per 1 mg/dL increase, odds ratio [OR] 1.216, 95% confidence interval [95% CI] 1.131-1.309; urinary sodium excretion, per 1 g/day increase, OR 1.067, 95% CI 1.019-1.117). Additionally, simultaneously higher tertiles of SUA and urinary sodium excretion resulted in higher ORs for prehypertension.Conclusion: Increased SUA is a significant risk marker for the development of prehypertension in normotensives. Simultaneously high SUA and urinary sodium excretion amplified the effect on the development of prehypertension. Our findings suggest that lowering SUA levels and reducing sodium intake will contribute to preventing hypertension. [ABSTRACT FROM AUTHOR]

Neurogenic bladder (NGB) secondary to spinal cord injury (SCI) is accompanied with several complications such as urinary tract deterioration, urinary incontinence, and consequently lower quality of life (QoL), significant morbidities, and occasionally death. Current therapeutic methods have some side effects and there is no treatment for the upper urinary tract injuries. Stem cell therapy is a promising method for treating this condition. However, the best timing and the best route of its transplantation have not yet been determined. Animal models of SCI, especially in rats, are the most commonly used method for evaluating the efficacy of cell therapy in NGB improvement, and the most common assessment method is the urodynamic studies (UDS). However, there are variations in the range of UDS parameters among the published studies. The current review aimed to discuss the effect of stem cell transplantation on bladder dysfunction recovery based on urodynamic parameters after SCI in rats. For this purpose, the cell source, doses, the route of administration, and the complete UDS equipment and its parameters were summarized in SCI models in rats. In some urodynamic test results, to some extent, an improvement in the lower urinary system function was observed in each treatment group. However, this improvement was far from full functional recovery. The average cell dose was about 1 million cells in every injected site. In most studies, the stem cells (SCs) were transplanted 9 days after the injury using PE-50 and PE-60. Many researchers have recommended further experimental and clinical studies to confirm this treatment modality. [ABSTRACT FROM AUTHOR]

The authors convey their thoughts on a study review about the genetic basis of congenital anomalies of the kidney and urinary tract (CAKUT). Topics mentioned include the role of Hox genes in various developmental stages of the human embryo, the association of homozygous or heterozygous variants in Homeobox A11 (HOXA11) with syndromic and/or isolated CAKUT phenotypes, and the molecular pathogenesis of HOXA11-related disease in humans with CAKUT.

The rapidly expanding field of tissue engineering along with stem cell therapy has a promising future in pediatric urological conditions. The initial struggle seemed difficult in renal regeneration but a functional biounit has been developed. Urine excretion has been demonstrated successfully from stem cell-generated embryonic kidneys. Three-dimensional (3D) stem cell-derived organoids are the new paradigm in research. Techniques to regenerate bladder tissue have reached the clinic, and the urethra is close behind. 3D bioprinted urethras would soon be available. Artificial germ cells produced from mouse pluripotent stem cells have been shown to give rise to live progeny. Myoblast and fibroblast therapy has been safely and effectively used for urinary incontinence. Stress urinary incontinence has been clinically treated with muscle-derived stem cells. Skeletal muscle-derived stem cells have been shown to get converted into smooth muscle cells when implanted into the corpora cavernosa in animal models. This review encompasses the various experimental and clinical developments in this field that can benefit pediatric urological conditions with the contemporary developments in the field. [ABSTRACT FROM AUTHOR]

The aim of this study was investigating to detriment the toxic effects of digoxin on the vital organs of mice like heart, Brain, liver, and kidneys. The experimental animals were categorized into 3 groups (T1, T2& C) each consist of 10 mice divided according to daily treatment with digoxin. T1, T2 groups representing dosing orally with 5, 10 mcg/ kg, respectively. C group acts as a control and treated with distilled water for 21 days. After a study period, animals were sacrificed. Histological samples were prepared by using hematoxylin and eosin stain. The study results of the T1 group show that different effects in liver tissue: degeneration signs, necrosis, low to severe periportal fibrosis and appear septal fibrosis. In Brain samples, perineural oedema with mild ganglion cell degeneration was clear. Kidney slices show enlargement of Bowman space with shrinkage of glomerular tuft and vacuolation of epithelia of lining urinary tubules. The T2 study group: brain slices present perineural and vascular edema, severe ganglion cell degeneration and necrosis. The renal tissue appears few infiltrations of inflammatory cells and vacuolation of urinary tubules. The main histological changes of Heart slices in both groups (T1, T2) were hemorrhage with oedema but the severity of lesion in T2 was higher characterized by hemorrhage with oedema and hyalinization of the myocardium. In conclusion, this study revealed that the digoxin of both doses: 5 mcg/kg and10 mcg/kg has histopathological effects in different vital organs of mice like (liver, brain, kidney and heart tissue), but these effects were severe in T2 group. [ABSTRACT FROM AUTHOR]

Key content: Indications for urodynamic investigations include urinary tract symptoms such as urge incontinence, stress urinary incontinence (SUI) and neurological urinary incontinence.Components of urodynamic testing include a physical assessment along with representative uroflowmetry with post‐void residual (PVR), transurethral cystometry and a pressure‐flow study.It is important for clinicians to understand key physiological measurements and parameters of lower urinary tract function.There are many factors to consider when interpreting results from urodynamic investigations, and it is vital for documentation to be accurate and methodical. Learning objectives: To understand the key indications and components of urodynamics and how to define a clear question prior to starting investigations.To learn accepted physiological parameters for lower urinary tract functions and apply these to a concise method of interpreting urodynamic results.To acknowledge the limitations of an investigation when attempting to reproduce pathology in an artificial environment. Ethical issues: Should all women undergoing an incontinence procedure have urodynamic investigations?Who to believe – the patient or the test? [ABSTRACT FROM AUTHOR]