Review

Authors: Samantha Taylor, Søren Boysen, Tony Buffington...

PRACTICAL RELEVANCE

Lower urinary tract signs (LUTS) such as dysuria, haematuria, periuria, pollakiuria and stranguria can occur as the result of a variety of underlying conditions and diagnostic investigation is required to uncover the underlying cause and select appropriate treatment.

AIM

The '2025 iCatCare consensus guidelines on the diagnosis and management of lower urinary tract diseases in cats' provide an overview of the common presenting signs caused by underlying feline lower urinary tract (LUT) diseases in cats, which often are indistinguishable between different underlying causes. The Guidelines set out a diagnostic approach to affected cats before focusing on the most common causes of LUTS: feline idiopathic cystitis (FIC), urolithiasis, urinary tract infection and urethral obstruction. The aim is to provide practitioners with practical information on these problematic conditions.

CLINICAL CHALLENGES

The fact that LUTS are similar despite different underlying causes creates a diagnostic challenge. The most common cause of LUTS, FIC, is challenging to manage due to a complex pathogenesis involving organs outside the LUT. Urethral obstruction is a life-threatening complication of various underlying LUT diseases and recurrent LUTS can lead to relinquishment or euthanasia of affected cats.

EVIDENCE BASE

These Guidelines have been created by a panel of experts brought together by International Cat Care (iCatCare) Veterinary Society (formerly the International Society of Feline Medicine [ISFM]). Information is based on the available literature, expert opinion and the panel members' experience.

Topics: Animals; Cats; Cat Diseases; Urologic Diseases; Veterinary Medicine; Consensus; Cystitis; Urethral Obstruction

PubMed: 39935081
DOI: 10.1177/1098612X241309176

Authors: Akshay Sood, Craig Rogers

Topics: Abdominal Pain; Adult; Diagnosis, Differential; Female; Humans; Kidney; Laparoscopy; Posture; Robotic Surgical Procedures; Urography; Urologic Diseases

PubMed: 29666105
DOI: 10.1136/bcr-2018-224921

Review

Authors: Piernicola Pelliccia, Simone Sferrazza Papa, Federica Cavallo...

Urinary tract dilatation is identified sonographically in 1-2% of fetuses and reflects a spectrum of possible nephro-uropathies. There is significant variability in the clinical management of individuals with prenatal urinary tract dilatation to postnatal urinary pathologies, because of a lack of consensus and uniformity in defining and classifying urinary tract dilation. Ultrasonography is the first step to screen and diagnose kidneys and the urinary tract diseases of the children. The need for a correct ultrasound approach led to the realization of algorithms aimed at standardizing the procedures, the parameters and the classifications. Our objective was to highlight the strengths of the Classification of Urinary Tract Dilation (UTD) suggested by the Consensus Conference which took place in 2014 with the participation of eight Scientific Societies and was subsequently published on the Journal of Pediatric Urology. Before its spread out, the definition of UTD was not uniform and the ultrasonographic measurements were not clearly defined, leading to misunderstandings between physicians. The Classification by the Consensus Conference of 2014 represents a revolutionary tool for the diagnosis and management of UTD. Furthermore, the parameters suggested by the classification proposed are applicable for both prenatal and postnatal classification, ensuring a correct follow-up in children with UTD whose diagnosis had been already made during pregnancy.

Topics: Consensus Development Conferences as Topic; Contrast Media; Dilatation, Pathologic; Female; Humans; Pregnancy; Ultrasonography; Urinary Tract; Urologic Diseases

PubMed: 30484141
DOI: 10.1007/s40477-018-0340-3

Review

Authors: Yohan Santin, Philippe Lluel, Pascal Rischmann...

Cellular senescence is a state of cell cycle arrest induced by repetitive cell mitoses or different stresses, which is implicated in various physiological or pathological processes. The beneficial or adverse effects of senescent cells depend on their transitory or persistent state. Transient senescence has major beneficial roles promoting successful post-injury repair and inhibiting malignant transformation. On the other hand, persistent accumulation of senescent cells has been associated with chronic diseases and age-related illnesses like renal/urinary tract disorders. The deleterious effects of persistent senescent cells have been related, in part, to their senescence-associated secretory phenotype (SASP) characterized by the release of a variety of factors responsible for chronic inflammation, extracellular matrix adverse remodeling, and fibrosis. Recently, an increase in senescent cell burden has been reported in renal, prostate, and bladder disorders. In this review, we will summarize the molecular mechanisms of senescence and their implication in renal and urinary tract diseases. We will also discuss the differential impacts of transient versus persistent status of cellular senescence, as well as the therapeutic potential of senescent cell targeting in these diseases.

Topics: Animals; Cellular Senescence; Humans; Kidney Diseases; Organ Specificity; Signal Transduction; Urologic Diseases

PubMed: 33167349
DOI: 10.3390/cells9112420

Review

Authors: Geoffrey Burnstock

Purinergic signalling is involved in a number of physiological and pathophysiological activities in the lower urinary tract. In the bladder of laboratory animals there is parasympathetic excitatory cotransmission with the purinergic and cholinergic components being approximately equal, acting via P2X1 and muscarinic receptors, respectively. Purinergic mechanosensory transduction occurs where ATP, released from urothelial cells during distension of bladder and ureter, acts on P2X3 and P2X2/3 receptors on suburothelial sensory nerves to initiate the voiding reflex, via low threshold fibres, and nociception, via high threshold fibres. In human bladder the purinergic component of parasympathetic cotransmission is less than 3 %, but in pathological conditions, such as interstitial cystitis, obstructed and neuropathic bladder, the purinergic component is increased to 40 %. Other pathological conditions of the bladder have been shown to involve purinoceptor-mediated activities, including multiple sclerosis, ischaemia, diabetes, cancer and bacterial infections. In the ureter, P2X7 receptors have been implicated in inflammation and fibrosis. Purinergic therapeutic strategies are being explored that hopefully will be developed and bring benefit and relief to many patients with urinary tract disorders.

Topics: Adenosine Triphosphate; Animals; Health Status; Humans; Receptors, Purinergic; Signal Transduction; Ureter; Urinary Bladder; Urinary Bladder, Neurogenic; Urinary Tract; Urologic Diseases

PubMed: 24265069
DOI: 10.1007/s11302-013-9395-y

Review

Authors: Kwang Woo Lee, Ho Yeon Song, Young Ho Kim...

Due to the rapid development of next-generation sequencing, it has become possible to obtain information on the sequences of all genes in a specific microbiome. The detection of bacteria in patients with no urinary tract infections indicated that the dogma that "urine is sterile" was false, leading to active research regarding the roles of the urinary microbiome in the human urinary tract. Here, we present a review of the current literature regarding the role of the microbiome in urology.

Topics: Humans; Microbiota; Urologic Diseases; Urologic Neoplasms

PubMed: 32665990
DOI: 10.4111/icu.2020.61.4.338

Review

Authors: Imad Bentellis, Gérard Amarenco, Xavier Gamé...

PURPOSE

We aimed to review the current knowledge on the epidemiology, diagnosis, and management of urinary and sexual dysfunction in patients with TTR amyloidosis (ATTR).

METHODS

We performed a review of the literature, screening for randomized controlled trials, prospective and retrospective series, position papers, and guidelines on urinary and sexual dysfunction in ATTR patients published in PubMed and Embase.

RESULTS

Lower urinary tract dysfunction is present in up to 83% of patients with ATTR. Voiding symptoms are the most common, reported in 34.8-87.5% of patients, while urinary tract infections are reported in up to 50%. Urinary incontinence is observed in 16.7-37.5% of the ATTR population, mostly due to decreased urethral resistance. Sexual dysfunction affects over 40% of ATTR patients, with erectile dysfunction and sexual arousal disorder being the most common symptoms in male and female patients, respectively. In addition to a thorough clinical examination, invasive pressure-flow urodynamic testing is a cornerstone in the assessment of ATTR lower urinary tract dysfunction. The most common finding is detrusor underactivity and intrinsic sphincter deficiency. Poor bladder compliance can also be observed in patients, due to amyloid deposits on the bladder wall. Urinary tract imaging may be of interest to rule out upper urinary tract deterioration. Given the paucity of data in the ATTR population, treatment should be tailored to the individual patient.

CONCLUSION

Urinary and sexual dysfunction are highly prevalent in ATTR patients. Comprehensive assessment and multidisciplinary management are keys to avoiding upper urinary tract damage and improving patients' quality of life.

Topics: Amyloid Neuropathies, Familial; Humans; Sexual Dysfunction, Physiological; Urologic Diseases

PubMed: 31452024
DOI: 10.1007/s10286-019-00627-7

Authors: Catherine S Forster, Prasad Devarajan

Neutrophil gelatinase-associated lipocalin (NGAL) is best known as a non-invasive early marker of acute kidney injury (AKI). However, recent published reports have described additional utility of both plasma NGAL (pNGAL) and urine NGAL (uNGAL) in various pathologic conditions within the pediatric urinary tract, including urinary tract infection, vesicoureteral reflux (VUR), renal scarring, and obstructive uropathy. These two forms of NGAL have different applications related to their mechanisms of upregulation: pNGAL can serve as a marker of systemic inflammatory conditions, whereas uNGAL is specific for insults to the renal epithelium. Therefore, pNGAL has good predictive accuracy in systemic inflammation associated with pyelonephritis and renal damage, while uNGAL is an effective marker for identifying infection within the genitourinary environment as well as subclinical renal damage as a result of scarring or obstruction. Continued work should focus on the effect of trending NGAL values in patients with pyelonephritis, VUR, and hydronephrosis, to determine if longitudinal NGAL patterns have value in predicting adverse outcomes.

Topics: Biomarkers; Child; Humans; Lipocalin-2; Urinary Tract Infections; Urologic Diseases

PubMed: 27785626
DOI: 10.1007/s00467-016-3540-0

Review

Authors: Rachel Shoemaker, Jayoung Kim

The urinary tract likely plays a role in the development of various urinary diseases due to the recently recognized notion that urine is not sterile. In this mini review, we summarize the current literature regarding the urinary microbiome and mycobiome and its relationship to various urinary diseases. It has been recently discovered that the healthy urinary tract contains a host of microorganisms, creating a urinary microbiome. The relative abundance and type of bacteria varies, but generally, deviations in the standard microbiome are observed in individuals with urologic diseases, such as bladder cancer, benign prostatic hyperplasia, urgency urinary incontinence, overactive bladder syndrome, interstitial cystitis, bladder pain syndrome, and urinary tract infections. However, whether this change is causative, or correlative has yet to be determined. In summary, the urinary tract hosts a complex microbiome. Changes in this microbiome may be indicative of urologic diseases and can be tracked to predict, prevent, and treat them in individuals. However, current analytical and sampling collection methods may present limitations to the development in the understanding of the urinary microbiome and its relationship with various urinary diseases. Further research on the differences between healthy and diseased microbiomes, the long-term effects of antibiotic treatments on the urobiome, and the effect of the urinary mycobiome on general health will be important in developing a comprehensive understanding of the urinary microbiome and its relationship to the human body.

Topics: Causality; Humans; Metagenome; Microbiota; Urinary Tract; Urologic Diseases

PubMed: 34729961
DOI: 10.4111/icu.20210312

Review

Authors: A G Rockall, A P Newman-Sanders, M A al-Kutoubi...

Many serious and potentially treatable diseases of the urinary tract may have haematuria as their only manifestation. However, asymptomatic microscopic haematuria detected by dipstick testing may be seen in up to 16% of screening populations. The great majority of such cases will have no sinister underlying cause, particularly in those under 40 years of age, and so the schedule of further investigations, some of which may be invasive, time-consuming and expensive, needs to be rationalised. In addition, the increasing popularity of 'fast track' clinics for the investigation of haematuria enhances the need for a clear strategy of investigation. Analysis of the epidemiology of asymptomatic haematuria and its causes combined with a consideration of the risk-benefit profile of the available investigations, makes it possible to set out an algorithm for the initial management of this common finding. Careful clinical assessment and basic laboratory tests for renal function, analysis of the urinary sediment and cytological examination of the urine are followed by ultrasound and plain radiography of the urinary tract. Flexible cystoscopy under local anaesthetic is central to the algorithm in patients of all ages. The importance of a nephrological opinion and consideration of renal biopsy, especially in younger patients with other evidence of glomerular disease, is stressed. The role of intravenous urography in excluding pathology of the upper urinary tract, especially in patients over the age of 40, is also considered.

Topics: Adult; Aged; Aged, 80 and over; Female; Hematuria; Humans; Male; Middle Aged; Urography; Urologic Diseases

PubMed: 9135826
DOI: 10.1136/pgmj.73.857.129