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Journal of Feline Medicine and Surgery Feb 2023The aim of this study was to investigate a potential association between the COVID-19 pandemic stay-at-home orders and the prevalence of emergency room presentations for...
OBJECTIVES
The aim of this study was to investigate a potential association between the COVID-19 pandemic stay-at-home orders and the prevalence of emergency room presentations for urethral obstruction (UO) in feline patients.
METHODS
Medical records and hospital census were retrospectively searched to identify the total number of cats and total number of male cats with UO presenting to two academic veterinary medical centers from 22 March to 10 August in the years 2018 (123), 2019 (137) and 2020 (175). Cats were grouped based on the year of presentation and the proportions of UO cases relative to all cats presenting to the emergency rooms during the same time frame. Absolute (year of interest - reference year) and relative ([year of interest - reference year]/[reference year]) change in prevalence was determined. These were compared for each year using a two-sample -test.
RESULTS
The absolute and relative prevalence of UO presentations across the combined population increased significantly during the COVID-19 pandemic in comparison with 2018 (2.2% and 59%, respectively; = 0.0003) and 2019 (1.9% and 48%, respectively; = 0.0021). For the individual institutions, a significant increase in UO presentations was found for institution A when comparing 2020 with both 2018 ( = 0.0072) and 2019 ( = 0.0073), but not for institution B ( = 0.057 and = 0.18, respectively). No significant differences were found when 2018 and 2019 were compared across the combined population or within institutions.
CONCLUSIONS AND RELEVANCE
The results of this study demonstrate an increased prevalence of UO during the initial months of the COVID-19 pandemic, which may be related to environmental change and stress imposed by stay-at-home orders.
Topics: Cats; Animals; Male; Retrospective Studies; Pandemics; Prevalence; Universities; COVID-19; Urethral Obstruction; Cat Diseases
PubMed: 36779411
DOI: 10.1177/1098612X221149377 -
BMJ Case Reports Apr 2022Combination of posterior urethral valves and urachus remnants has been described as rare occurrence. We report a case of a baby boy with normal antenatal scans, in whom...
Combination of posterior urethral valves and urachus remnants has been described as rare occurrence. We report a case of a baby boy with normal antenatal scans, in whom the presence of large urachal cyst and posterior urethral valves causing high pressure bladder and chronic kidney disease was found. The patient underwent ablation of posterior urethral valves at 23 days of life and urachal cyst removal at age of 4 and a half months.
Topics: Female; Humans; Infant; Male; Pregnancy; Urachal Cyst; Urachus; Urethral Obstruction; Urinary Bladder; Urinary Tract
PubMed: 35418380
DOI: 10.1136/bcr-2021-248460 -
The Journal of Urology Jan 2015Anterior urethral stricture disease most commonly presents as urinary obstruction. Lower urinary tract pain is not commonly reported as a presenting symptom. We...
PURPOSE
Anterior urethral stricture disease most commonly presents as urinary obstruction. Lower urinary tract pain is not commonly reported as a presenting symptom. We prospectively characterized lower urinary tract pain in association with urethral stricture disease and assessed the effects of urethroplasty on this pain.
MATERIALS AND METHODS
Men (18 years old or older) with anterior urethral stricture disease were prospectively enrolled in a longitudinal, multi-institutional, urethral reconstruction outcomes study from June 2010 to January 2013 as part of TURNS (Trauma and Urologic Reconstruction Network of Surgeons). Preoperative and postoperative lower urinary tract pain was assessed by the validated CLSS. Voiding and sexual function was assessed using validated patient-reported measures, including I-PSS.
RESULTS
Preoperatively 118 of 167 men (71%) reported urethral pain and 68 (41%) reported bladder pain. Age was the only predictor of urethral pain with men 40 years or younger reporting more pain than those 60 years old or older (81% vs 58%, p = 0.0104). Lower urinary tract pain was associated with worse quality of life and overall voiding symptoms on CLSS and I-PSS (each p <0.01). Postoperatively lower urinary tract pain completely resolved in 64% of men with urethral pain and in 73.5% with bladder pain. There were no predictive factors for changes in lower urinary tract pain after urethral reconstruction.
CONCLUSIONS
Lower urinary tract pain is common in urethral stricture disease, especially in younger men. It is associated with worse quality of life and voiding function. In most men lower urinary tract pain resolves after urethral reconstruction.
Topics: Adult; Humans; Lower Urinary Tract Symptoms; Male; Middle Aged; Pain; Prevalence; Prospective Studies; Urethra; Urethral Stricture; Urologic Surgical Procedures
PubMed: 25046621
DOI: 10.1016/j.juro.2014.07.007 -
Journal of the American Veterinary... May 2022Urolithiasis is the most common cause of urinary tract disease in small ruminants and has significant economic and production impacts worldwide. Urolithiasis is...
Urolithiasis is the most common cause of urinary tract disease in small ruminants and has significant economic and production impacts worldwide. Urolithiasis is multifactorial in origin and generally begins with the formation of cystoliths followed by urethral obstruction. The condition is most common in males. Clinical signs are variable depending on the severity of the obstruction. Uroliths can be calcium, struvite, or silicate based; however, struvite and amorphous magnesium calcium phosphate are the most common urolith types observed in small ruminants. Although urethral process (vermiform appendage) amputation is widely considered the first line of treatment, reobstruction is common within the first 36 hours. Surgical interventions such as temporary tube cystostomy, perineal urethrostomy (PU), modified proximal perineal urethrostomy, vesico-preputial anastomosis (VPA), and urinary bladder marsupialization (BM) are reported to carry an improved prognosis for long-term survival. PU carries a lower proportion of long-term success (> 12-month survival time) when compared with VPA and BM. Stoma stricture and urine scald are the most commonly observed surgical complications. Currently, the literature provides minimal direction for clinician decision-making in managing these cases while accounting for patient history, client financial ability, composition of calculi, and potential treatment complications. Small ruminant urinary obstructions are challenging and complicated conditions to treat, due to their multifactorial etiology, ruminant urogenital anatomy, and the variety of imperfect treatment options available. The purpose of this article this article is to provide veterinary practitioners with decision trees to guide management and treatment of urolithiasis in small ruminants.
Topics: Animals; Decision Trees; Goat Diseases; Goats; Male; Ruminants; Struvite; Urethral Obstruction; Urinary Bladder Calculi; Urinary Calculi; Urolithiasis
PubMed: 35442905
DOI: 10.2460/javma.22.02.0071 -
Urology Aug 1993The measurement of detrusor pressure and flow rate during voiding is the only way to objectively measure or grade infravesical obstruction. The resulting data cannot be... (Comparative Study)
Comparative Study Review
The measurement of detrusor pressure and flow rate during voiding is the only way to objectively measure or grade infravesical obstruction. The resulting data cannot be interpreted easily. Manual as well as automatic methods have been introduced to derive one or several factors or parameters to quantify urethral resistance. A number of these methods are described in this overview. Since automatic methods involving computers guarantee uniform, unbiased, and objective processing of data, besides enabling the use of (statistical) methods that take into account more than one or two of the measured pressure and flow rate values, emphasis is on these methods. Some clinical results obtained with such automatic methods are discussed to illustrate the clinical value and possible impact on diagnosis and evaluation of treatment of lower urinary tract disorders.
Topics: Diagnosis, Computer-Assisted; Humans; Mathematics; Pressure; Urethral Obstruction; Urodynamics
PubMed: 8367933
DOI: 10.1016/0090-4295(93)90652-q -
Canadian Family Physician Medecin de... May 2000To review the clinical classification of childhood diurnal enuresis, to describe the evaluation process, and to discuss principles of management. (Review)
Review
OBJECTIVE
To review the clinical classification of childhood diurnal enuresis, to describe the evaluation process, and to discuss principles of management.
QUALITY OF EVIDENCE
An extensive literature review was performed with a MEDLINE search. Articles were selected according to date of publication, clinical relevance, and availability. Recent articles, cohort studies of at least 50 patients, and randomized clinical trials were preferred. Recent editions of classic textbooks were consulted. Evaluation and management activities discussed in this article are supported by original and relevant literature.
MAIN MESSAGE
Most causes of childhood diurnal enuresis can be determined by a thorough history coupled with a complete physical examination and urinalysis and culture. Supplementary investigations include ultrasonography of the kidneys and bladder to screen for neurogenic bladder and urethral obstruction. When obstruction, ectopic ureter, or bladder dysfunction is suspected, voiding cystourethrography and urodynamic studies are needed. Evaluation of neurogenic bladder includes magnetic resonance imaging of the spine. Treatment is aimed at correcting poor toilet habits, preventing or treating urinary tract infections, and using appropriate medication.
CONCLUSIONS
In most instances, diurnal enuresis in childhood is a benign condition with an easily identifiable cause and an excellent prognosis with time and appropriate treatment.
Topics: Child; Circadian Rhythm; Enuresis; Humans; Magnetic Resonance Imaging; Physical Examination; Prognosis; Urethral Obstruction; Urinary Bladder Diseases
PubMed: 10845137
DOI: No ID Found -
Journal of the American Veterinary... Feb 2019OBJECTIVE To evaluate the effect of urinary bladder lavage on in-hospital recurrence of urethral obstruction (UO) and durations of urinary catheter retention and...
OBJECTIVE To evaluate the effect of urinary bladder lavage on in-hospital recurrence of urethral obstruction (UO) and durations of urinary catheter retention and hospitalization for male cats. DESIGN Randomized controlled clinical trial. ANIMALS 137 male cats with UO. PROCEDURES Following random allocation, cats either did (flush group; n = 69) or did not (no-flush group; 68) undergo urinary bladder lavage with saline (0.9% NaCl) solution after alleviation of the obstruction and placement of a urethral catheter. Signalment, prior history of UO, presence of crystalluria, difficulty of urinary tract catheterization, in-hospital UO recurrence rate, and durations of urinary catheter retention and hospitalization were compared between the flush and no-flush groups. RESULTS Baseline characteristics did not differ significantly between the 2 treatment groups. The in-hospital UO recurrence rate (9/69 [13%]) and median durations of urinary catheter retention (37 hours; range, 3 to 172 hours) and hospitalization (3 days; range, 0.5 to 12 days) for the flush group did not differ significantly from the in-hospital UO recurrence rate (13/68 [19%]) and median durations of urinary catheter retention (36 hours; range, 1 to 117 hours) and hospitalization (3 days; range, 1 to 9 days) for the no-flush group. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that, for male cats with UO, urinary bladder lavage at the time of urethral catheterization had no significant effect on in-hospital recurrence rate of the condition, duration of urinary catheter retention, or duration of hospitalization; however, additional studies are necessary to validate or refute these findings.
Topics: Animals; Cat Diseases; Cats; Hospitalization; Male; Recurrence; Therapeutic Irrigation; Urethral Obstruction; Urinary Bladder; Urinary Catheterization; Urinary Retention
PubMed: 30714866
DOI: 10.2460/javma.254.4.483 -
Chirurgia (Bucharest, Romania : 1990) 2020Obstructive uropathy is defined the clinical entity that is characterized by changing the structural and functional feature of the urinary system due to interruption of... (Review)
Review
Obstructive uropathy is defined the clinical entity that is characterized by changing the structural and functional feature of the urinary system due to interruption of normal urinary runoff. Gynecological benignities could rarely cause obstructive uropathy. Material and In this study the incidence and the severity of obstructive uropathy caused by gynecological benignities, was investigated. Additionally, we examined the spectrum of the contigent therapeutical procedures, in order to contend with this severe clinical entity, as well as the dangerous for life complication of urosepsis. Gynecological benignities can cause obstructive uropathy. These conditions are rarely faced, composing a challenging problem for physicians. In the spectrum of these conditions are included adnexal masses, leiomyomas, pelvic inflammatory disease and endometriosis. Obstructive uropathy due to gynecological benignities is a very rare, difficult and challenging condition and physicians should always consider the existence of uropathy in such cases.
Topics: Female; Genital Diseases, Female; Humans; Incidence; Treatment Outcome; Ureteral Obstruction; Urethral Obstruction
PubMed: 33138894
DOI: 10.21614/chirurgia.115.5.579 -
BMC Urology Oct 2019The association between surgical outcome of hypospadias repair and long-term male reproductive function has not been documented. The purpose of this study was to clarify...
BACKGROUND
The association between surgical outcome of hypospadias repair and long-term male reproductive function has not been documented. The purpose of this study was to clarify association between paternity in adult hypospadias patients and reoperation for urethral obstruction after two-stage repair during childhood.
METHODS
Ninety hypospadias patients who underwent the same kind of two-stage repair in our institute by a single surgeon, were initially treated at < 18 years old, and who were ≥ 18 years old during the survey were included in the study. Present physical, social, and life status were evaluated by a mailed self-entry questionnaire, and clinical background and surgical outcome data were evaluated by medical records. National survey data of the general population were used as external control. The paternity rate of the patient groups was evaluated by Kaplan-Meier curve analysis and log-rank tests.
RESULTS
Twenty-six patients (28.9%) underwent 43 reoperations after completion of the initial repair. Twelve patients were reoperated for obstructive complication (Study group) and were compared with 14 patients who were reoperated only for non-obstructive causes and 64 patients who were not reoperated as Study control group (N = 78). The Study group patients showed sexual intercourse rate and marriage rate not statistically different in comparison with the Study control, although marriage rate at 32.5 years old were lower than the general population (p = 0.048, z-test). None of the Study group achieved paternity, which showed a significant difference to the Study control (p = 0.032, log-rank test). The difference was also statistically significant in the analysis among the 31 married patients (p = 0.012, log-rank test). Patients reoperated for obstructive complication documented worsened Quality of Life score in the International Prostate Symptom Score (2.3 ± 2.0 vs. 1.4 ± 1.2, p = 0.031, t-test) and ejaculation problems (66.7% vs. 17.4%, p = 0.003, chi-square test).
CONCLUSIONS
History of reoperation for obstructive complication was associated with lower paternity rate in patients with hypospadias, presumably for multifactorial causes associated with marriage age and ejaculation problems. The present results may implicate importance of uncomplicated urethroplasty during childhood for achieving paternity, although it should be further tested in the future for larger groups of hypospadias patients.
Topics: Adolescent; Adult; Age Factors; Child; Cohort Studies; Fertility; Humans; Hypospadias; Male; Reoperation; Urethral Obstruction; Urologic Surgical Procedures, Male; Young Adult
PubMed: 31585530
DOI: 10.1186/s12894-019-0512-2 -
The Canadian Journal of Urology Oct 2015Lower urinary tract symptoms are a common complaint. Surgery to debulk hyperplastic prostate tissue is indicated for men with symptoms refractory to medical therapy, or... (Review)
Review
INTRODUCTION
Lower urinary tract symptoms are a common complaint. Surgery to debulk hyperplastic prostate tissue is indicated for men with symptoms refractory to medical therapy, or for those who cannot tolerate first-line medications. In recent decades, new endoscopic techniques have been developed to reduce the morbidity of transurethral resection of the prostate (TURP). Nonetheless, complications are still frequently encountered in the immediate, early, and remote postoperative setting.
MATERIALS AND METHODS
In this review, we perform an in-depth examination of contemporary treatment strategies for long term complications of surgical outlet reduction procedures. Complications encountered in the remote postoperative setting such as erectile dysfunction (ED), urethral stricture, refractory incontinence, and bladder neck contracture were identified in the literature.
RESULTS
Treatment strategies for ED after TURP do not differ from algorithms applied for ED due to other causes. Management of urethral stricture following TURP depends on the size and location of narrowing and can range from simple dilation to complex excision with grafting techniques or perineal urethrostomy. Refractory urinary incontinence requires a full diagnostic evaluation, and artificial urinary sphincter placement is efficacious for cases that do not respond to first-line medical therapy. Finally, numerous therapies for bladder neck contracture exist and vary in their invasiveness.
CONCLUSION
Endoscopic reduction of the prostate for the male with benign prostatic obstruction via most contemporary modalities is a safe and effective means to decrease outlet resistance to urinary flow. However, late complications from these procedures still exist. Management of remote morbidity following TURP can be diagnostically and therapeutically complex, necessitating prompt referral to a genitourinary reconstruction specialist.
Topics: Aged; Aged, 80 and over; Disease Management; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Minimally Invasive Surgical Procedures; Postoperative Complications; Prostatic Hyperplasia; Reoperation; Risk Assessment; Transurethral Resection of Prostate; Treatment Outcome; Urethral Obstruction; Urethral Stricture; Urinary Bladder Neck Obstruction; Urinary Incontinence; Urography
PubMed: 26497349
DOI: No ID Found