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Urologia 2015Renal transplant (RT) represents the treatment of choice for end-stage renal disease (ESRD) but harbours a wide range of possible complications and therapeutic... (Review)
Review
Renal transplant (RT) represents the treatment of choice for end-stage renal disease (ESRD) but harbours a wide range of possible complications and therapeutic challenges of urological competence. Dialysis years and clinical medical background of these patients are risk factors for sexual dysfunction and lower urinary tract symptoms (LUTS). On the contrary, RT itself may have a number of possible surgical complications such as ureteral stenosis and urinary leakage, while immunosuppressive treatment is a known risk factor for de-novo malignancies.The present review describes the main urologic problems of RT patients and their up-to-date treatment options according to the most recently available literature evidences.
Topics: Humans; Kidney Calculi; Kidney Transplantation; Postoperative Complications; Urologic Diseases; Urologic Neoplasms
PubMed: 26350048
DOI: 10.5301/uro.5000132 -
Nature Reviews. Nephrology Dec 2017Urine is a valuable diagnostic medium and, with the discovery of urinary extracellular vesicles, is viewed as a dynamic bioactive fluid. Extracellular vesicles are... (Review)
Review
Urine is a valuable diagnostic medium and, with the discovery of urinary extracellular vesicles, is viewed as a dynamic bioactive fluid. Extracellular vesicles are lipid-enclosed structures that can be classified into three categories: exosomes, microvesicles (or ectosomes) and apoptotic bodies. This classification is based on the mechanisms by which membrane vesicles are formed: fusion of multivesicular bodies with the plasma membranes (exosomes), budding of vesicles directly from the plasma membrane (microvesicles) or those shed from dying cells (apoptotic bodies). During their formation, urinary extracellular vesicles incorporate various cell-specific components (proteins, lipids and nucleic acids) that can be transferred to target cells. The rigour needed for comparative studies has fueled the search for optimal approaches for their isolation, purification, and characterization. RNA, the newest extracellular vesicle component to be discovered, has received substantial attention as an extracellular vesicle therapeutic, and compelling evidence suggests that ex vivo manipulation of microRNA composition may have uses in the treatment of kidney disorders. The results of these studies are building the case that urinary extracellular vesicles act as mediators of renal pathophysiology. As the field of extracellular vesicle studies is burgeoning, this Review focuses on primary data obtained from studies of human urine rather than on data from studies of laboratory animals or cultured immortalized cells.
Topics: Biomarkers; Extracellular Vesicles; Humans; Kidney; Lipid Metabolism; Proteome; Transcriptome; Urinalysis; Urologic Diseases
PubMed: 29081510
DOI: 10.1038/nrneph.2017.148 -
Medicine Jan 2020Urinary obstruction may be a complicating factor in critically ill patients with urinary tract infections (UTIs) and requires efforts for identifying and controlling the...
Urinary obstruction may be a complicating factor in critically ill patients with urinary tract infections (UTIs) and requires efforts for identifying and controlling the infection source. However, its significance in clinical practice is uncertain. This retrospective study investigated the overall hospital courses of patients in the intensive care unit (ICU) with UTIs from the emergency department.Baseline severity was assessed by the sequential organ failure assessment (SOFA) score; outcomes included probability and inotropic-, ventilator-, renal replacement therapy (RRT)-, and ICU-free days and 28-day mortality.Of 122 patients with UTIs, 99 had abdominal computed tomography scans. Patients without computed tomography scans more frequently had quadriplegia and a urinary catheter than those without scans (P = .001 and .01). Urinary obstruction was identified in 40 patients who had higher SOFA scores and lactate levels (P = .01 and P < .001). The use and free days of inotropic drugs and ventilator did not differ between the groups. However, patients with obstruction were more likely to require RRT and had shorter durations of RRT-free days (odds ratio 3.8; P = .06 and estimate -3.0; P = .04). Durations of ICU-free days were shorter, but it disappeared after adjustment for initial SOFA scores (estimate -2.3; P = .15). Impact of the timing of urinary drainage on outcomes was evaluated, demonstrating that an intervention within 72 hours lengthened the duration of RRT-free days compared with that after 72 hours (estimate -6.0 days; P = .03). On the other hand, the study did not find the association between other outcomes including 28-day mortality and the timing of urinary drainage.Urinary obstruction can be a complicating factor, resulting in a higher probability of RRT implementation and shorter durations of RRT- and ICU-free days in critically ill patients with UTIs. Furthermore, delayed intervention for urinary drainage may result in longer durations of RRT. Efforts should be warranted to find the presence of urinary obstruction and to control infection source in critically ill patients with UTIs.
Topics: Aged; Aged, 80 and over; Critical Illness; Female; Humans; Intensive Care Units; Male; Odds Ratio; Organ Dysfunction Scores; Renal Replacement Therapy; Retrospective Studies; Time Factors; Urinary Tract Infections; Urologic Diseases
PubMed: 31895786
DOI: 10.1097/MD.0000000000018519 -
Nature Reviews. Nephrology Nov 2020Although often considered a single-entity, chronic kidney disease (CKD) comprises many pathophysiologically distinct disorders that result in persistently abnormal... (Review)
Review
Although often considered a single-entity, chronic kidney disease (CKD) comprises many pathophysiologically distinct disorders that result in persistently abnormal kidney structure and/or function, and encompass both monogenic and polygenic aetiologies. Rare inherited forms of CKD frequently span diverse phenotypes, reflecting genetic phenomena including pleiotropy, incomplete penetrance and variable expressivity. Use of chromosomal microarray and massively parallel sequencing technologies has revealed that genomic disorders and monogenic aetiologies contribute meaningfully to seemingly complex forms of CKD across different clinically defined subgroups and are characterized by high genetic and phenotypic heterogeneity. Investigations of prevalent genomic disorders in CKD have integrated genetic, bioinformatic and functional studies to pinpoint the genetic drivers underlying their renal and extra-renal manifestations, revealing both monogenic and polygenic mechanisms. Similarly, massively parallel sequencing-based analyses have identified gene- and allele-level variation that contribute to the clinically diverse phenotypes observed for many monogenic forms of nephropathy. Genome-wide sequencing studies suggest that dual genetic diagnoses are found in at least 5% of patients in whom a genetic cause of disease is identified, highlighting the fact that complex phenotypes can also arise from multilocus variation. A multifaceted approach that incorporates genetic and phenotypic data from large, diverse cohorts will help to elucidate the complex relationships between genotype and phenotype for different forms of CKD, supporting personalized medicine for individuals with kidney disease.
Topics: Chromosome Mapping; Genotype; High-Throughput Nucleotide Sequencing; Humans; Phenotype; Precision Medicine; Renal Insufficiency, Chronic; Urologic Diseases
PubMed: 32807983
DOI: 10.1038/s41581-020-0325-2 -
Open Veterinary Journal 2022Feline lower urinary tract disease (FLUTD) is a common disorder associated with the dysfunction of the urinary bladder or urethra in tomcats.
BACKGROUND
Feline lower urinary tract disease (FLUTD) is a common disorder associated with the dysfunction of the urinary bladder or urethra in tomcats.
AIM
A prospective study was carried out on the point prevalence and odds ratio (OR) of the FLUTD in Shirazi and Baladi tomcats at Ismailia Governorate, Egypt, recording the prominent clinical manifestation and identifying the antibiogram, virulence, and antimicrobial resistance genes of the causative microorganisms.
METHODS
A total number of 420 tomcats admitted to the veterinary clinics of Ismailia during the period June 2020 to May 2021 were examined for FLUTD. A total of 1,260 urine samples were collected and analyzed.
RESULTS
Hematuria, dysuria, and pollakiuria were the most evident signs recorded in a total of 120 tomcats diagnosed with FLUTD. The diagnosed cases of FLUTD were associated with causes like crystals (35.83%), pyogenic microorganisms (19.16%), and mixed cases (45.00%). The prevalence revealed highly significant ( < 0.01) increases in the cases caused by , mixed cases, and calcium oxalate at >4 years; at ≤ 2 years; amorphous urate and phosphate at 2-4 and >4 years in Shirazi and ≤2 years in Baladi; triple phosphate at ≤2 years in Shirazi and >4 years in Baladi; and mixed cases at ≤2 years. The OR of FLUTD revealed higher odds of associations with , mixed cases, , amorphous urate, and triple phosphate, as well as lower odds with , calcium oxalate, amorphous phosphate, and mixed cases. Isolated revealed higher resistance to amoxicillin (AMX, 83.4%), ceftriaxone (83.4%), ceftazidime (CAZ, 75.0%), and cefoxitin (FOX, 50.0%), and to oxacillin (100%), FOX (100%), AMX (85.8%), CAZ (76.2%), and FOX (50.0%). -detected virulence genes were , , , and , and were , , , , , , and . About 100% of and 76.1% of isolates exhibited multidrug resistance.
CONCLUSION
FLUTD in tomcats is associated with higher odds in , mixed cases, and triple phosphate at older ages (>4 years) with high antimicrobial resistance in the microbial isolates contributing to the disease.
Topics: Animals; Calcium Oxalate; Cat Diseases; Cats; Egypt; Escherichia coli; Phosphates; Prospective Studies; Staphylococcus aureus; Uric Acid; Urologic Diseases
PubMed: 35603074
DOI: 10.5455/OVJ.2022.v12.i2.18 -
PloS One 2012Human cystic echinococcosis (CE) is caused by flatworm larvae of Echinococcus granulosus and is endemic in many parts of the world. In humans, CE cysts primarily affect...
BACKGROUND
Human cystic echinococcosis (CE) is caused by flatworm larvae of Echinococcus granulosus and is endemic in many parts of the world. In humans, CE cysts primarily affect the liver and pulmonary system, but can also affect the renal system. However, the clinical manifestations of renal CE can be subtle, so healthcare professionals often overlook renal CE in differential diagnosis. In this study, we examined the clinical and demographic characteristics of patients with urinary tract CE and analyzed the diagnosis and treatment procedures for this disease.
METHODS
The records of 19 consecutive renal CE patients who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 1983 to April 2011 were retrospectively reviewed. In all cases, CE of the urinary tract was confirmed by pathological examination and visual inspection during surgery.
RESULTS
Fifteen patients were males and 4 were females. The most common symptoms were non-specific lower back pain and percussion tenderness on the kidney region. All patients were followed up for 9-180 months after surgery. None of the patients experienced a recurrence of renal CE, but 4 patients experienced non-renal recurrence of hydatid disease.
CONCLUSIONS
Hydatid cysts from E. granulosus are structurally similar in the liver and urinary tract. Thus, the treatment regimen for liver CE developed by the World Health Organization/Informal Working Group on Echinococcosis (WHO/IWGE) could also be used for urinary tract CE. In our patients, the use of ultrasound, computed tomography, serology, and clinical characteristics provided a diagnostic accuracy of 66.7% to 92.3%.
Topics: Adolescent; Adult; Animals; Antibodies, Helminth; Echinococcosis; Echinococcus granulosus; Female; Humans; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Urologic Diseases; Urologic Surgical Procedures
PubMed: 23133601
DOI: 10.1371/journal.pone.0047667 -
Urology Journal Aug 2020Novel coronavirus Disease (Covid-19) has emerged in Wuhan, China in December 2019 and became a pandemic in a few weeks. In this review, we aimed to summarize the... (Review)
Review
INTRODUCTION
Novel coronavirus Disease (Covid-19) has emerged in Wuhan, China in December 2019 and became a pandemic in a few weeks. In this review, we aimed to summarize the current urologic practice trends worldwide to help urologist in decision making in disasters particularly in Covid-19 pandemic.
MATERIAL AND METHOD
We have performed a PubMed and Internet search by using the keywords: 'Covid', 'new coronavirus', 'coronavirus urology, 'covid urology' without a date restriction. Results: All elective surgeries for benign urological conditions such as urinary tract stone disease that not caused complicated obstruction, benign prostate enlargement, infertility, incontinence and genitourinary prolapse, erectile dysfunction undescendent testis, vesico-ureteral reflux should be postponed till the lasting of Covid-19 outbreak. In obstructing ureteral stone both nephrostomy tube and double-J stent insertion are valid management options. However, one must consider that these procedures must be performed under local anesthesia when possible to spare a ventilator. When deferring urooncological operations and treatments oncological outcomes must be considered. Aggressive cessation or reducing the dosage of immunosuppressant therapy might be an option in renal transplanted patients with severe pneumonia or acute respiratory distress syndrome.
Topics: Betacoronavirus; COVID-19; Comorbidity; Coronavirus Infections; Delivery of Health Care; Humans; Pandemics; Pneumonia, Viral; SARS-CoV-2; Urologic Diseases; Urology
PubMed: 32808272
DOI: 10.22037/uj.v16i7.6285 -
Cirugia Espanola May 2005The pelvic floor is one of the most complex structures of the human body. Historically, the approach to pelvic floor disease has been "vertical": the anterior... (Review)
Review
The pelvic floor is one of the most complex structures of the human body. Historically, the approach to pelvic floor disease has been "vertical": the anterior compartment was the domain of urologists, the middle compartment was the domain of gynecologists with frequent incursions into the female anterior compartment, and the posterior compartment was reserved for surgeons. In the last few years, a change has occurred in the philosophy underpinning the management of these diseases with the development of an integrative "cross sectional" approach which affects the physiology, physiopathology, and the definition of these diseases as an integrated structure, and which includes urinary and fecal incontinence, pelvic organ prolapse, alterations in the perception of urinary tract emptying, chronic constipation, sexual dysfunctions, and several chronic pain syndromes in the perineal area. We believe that the efforts of the various professionals involved in the treatment of these disorders should be pooled and that pelvic floor units should be created. These units should be characterized by a multidisciplinary approach, since the skills and knowledge necessary for the management of these patients requires teams composed of professionals with a broad range of competencies.
Topics: Female; Genital Diseases, Female; Humans; Pelvic Floor; Urologic Diseases
PubMed: 16420929
DOI: 10.1016/s0009-739x(05)70849-6 -
Urologia Internationalis 2021The COVID-19 pandemic has caused a global health threat. This disease has brought about huge changes in the priorities of medical and surgical procedures. This short... (Review)
Review
The COVID-19 pandemic has caused a global health threat. This disease has brought about huge changes in the priorities of medical and surgical procedures. This short review article summarizes several test methods for COVID-19 that are currently being used or under development. This paper also introduces the corresponding changes in the diagnosis and treatment of urological diseases during the COVID-19 pandemic. We further discuss the potential impacts of the pandemic on urology, including the outpatient setting, clinical work, teaching, and research.
Topics: Ambulatory Care; COVID-19; COVID-19 Testing; Education, Medical, Graduate; Humans; Internship and Residency; Practice Patterns, Physicians'; Predictive Value of Tests; Reproductive Techniques, Assisted; Urologic Diseases; Urologists; Urology
PubMed: 33227808
DOI: 10.1159/000512880 -
European Journal of Obstetrics,... Feb 2017Deep endometriosis, occurring approximately in 1% of women of reproductive age, represents the most severe form of endometriosis. It causes severe pain in the vast... (Review)
Review
Deep endometriosis, occurring approximately in 1% of women of reproductive age, represents the most severe form of endometriosis. It causes severe pain in the vast majority of affected women and it can affect the bowel and the urinary tract. Hormonal treatment of deep endometriosis with progestins, such as norethindrone acetate or dienogest, or estroprogestins is effective in relieving pain in more than 90% of women at one year follow up. Progestins and estroprogestins can be safely administered in the long-term, may be not expensive and are usually well tolerated. Therefore, they should represent the first-line treatment of deep endometriosis associated pain in women not seeking natural conception. However, hormonal treatment is ineffective or not tolerated in about 30% of women, the most common side effects being erratic bleeding, weight gain, decreased libido and headache. Surgical excision of deep endometriosis is mandatory in presence of symptomatic bowel stenosis, ureteral stenosis with secondary hydronephrosis, and when hormonal treatments fail. Surgical treatment is similarly effective as compared to hormonal treatment in relieving dismenorhea, dyspareunia and dyschezia at one year follow up in more than 90% of women with deep endometriosis. Surgical removal of the nodules may require resection of the bowel, ureter or bladder, with possible severe complications such as rectovaginal or ureterovaginal fistula and anastomotic leakage. A thorough counsel with the patient is necessary in order to pursue a therapeutic plan centered not on the endometriotic lesions, but on the patient's symptoms, priorities and expectations.
Topics: Clinical Decision-Making; Disease Management; Endometriosis; Female; Humans; Intestinal Diseases; Physicians; Treatment Outcome; Urologic Diseases
PubMed: 27544308
DOI: 10.1016/j.ejogrb.2016.07.513