Coinheritance of alpha-thalassemia-1 and hemoglobin E/beta zero-thalassemia: practical implications for neonatal screening and genetic counseling

OBJECTIVES: To establish the urologic status of men with Behcet's syndrome, because studies assessing the urologic aspect of Beh?et's syndrome are rare. METHODS: During a 2.5-year period, we evaluated 104 male patients with Beh?et's syndrome, 16 to 50 years old (mean 31+/-7), using a urologic questionnaire and modified Boyarsky symptom score; 44 healthy men, 20 to 46 years old (mean 29+/-7), were used as control subjects. RESULTS: The frequency of epididymitis in patients with Beh?et's syndrome was 19.2% in this study. The mean irritative symptom score was 1.22+/-1.37 (significantly higher than the control group). The frequency of lower urinary tract symptoms (eg, dysuria, urgency, nocturia, terminal dribbling, and intermittency) was significantly higher in patients with Behcet's syndrome. CONCLUSIONS: In this study, the frequency of epididymitis in men with Behcet's syndrome was much higher than previously reported. Because some lower urinary tract symptoms were significantly more frequent in these patients, we conclude that screening of such patients with urologic questionnaire and symptom scoring is essential to identify those who need further urologic evaluation.     

Urologic complications after simultaneous pancreas-kidney transplantation: hand-sewn versus stapled duodenocystostomy

Pancreas transplantation with bladder drainage of exocrine secretions may be associated with significant urologic complications. Stapled and hand-sewn duodenocystostomies were compared in 61 recipients of simultaneous pancreas-kidney transplants. Both methods resulted in similar urologic complication and allograft survival rates. Duodenal segment leaks were associated with significant morbidity and decreased patient and allograft survival.     

Efficacy of lomefloxacin in treatment of nonspecific inflammatory diseases and in prophylaxis of postoperative complications in urology

Clinical and bacteriological efficacies of lomefloxacin and ofloxacin were comparatively estimated in the treatment of 104 urologic patients with nonspecific inflammatory diseases and in 36 urologic patients for prophylaxis of inflammatory complications after surgical interventions. The majority of the urinary tract pathogens i.e. Enterobacteriaceae spp. and gramnegative nonfermenting bacteria were highly susceptible to both the fluoroquinolones. The clinical and bacteriological efficacies of lomefloxacin amounted to 94.4 and 80.7 per cent and those of ofloxacin to 92 and 79.2 per cent respectively. The prophylactic use of lomefloxacin and ofloxacin was efficient in 94.7 and 94.1 per cent of the cases respectively. The antibacterial prophylaxis in urologic patients should be applied not only at the period of surgical interventions but also during the early postoperative period.     

Formative years of the Urodynamics Society: reminiscences

This paper traces the roots and foundations of the Urodynamics Society as a scientific urologic research society back to the postwar information explosion of the 1950s and 1960s. It describes the then-separate islands of science and urologic practice which gradually became amalgamated through interdisciplinary and crossprofessional collaborations and networks, aided by generous government subsidies and wise university policies.     

Effect of Er:YAG laser treatment on the root canal walls of human teeth: an SEM study

The purpose of the study was to assess the applicability of a new ITKA GSD Basic 250 electrosurgical unit (ESU) to urologic endoscopic surgery, laparoscopic surgery and open urologic surgery, its possible interference with videorecording and stray currents in healthy tissues. A new ITKA GSD Basic 250 ESU (test ESU) was used and compared to conventional ESU (Berchtold Elektrotom 390 as reference ESU). Experimental surgery was carried out on three female pigs, which underwent endoscopic, laparoscopic and open surgery. Altogether 29 patients underwent either endoscopic or open surgery with the test ESU. In experimental surgery, the ideal cutting and coagulation settings of the test ESU were in the range 15-25% for endoscopic surgery. In laparoscopic surgery, tissues were ideally resected and removed at 10-15% power settings. In open experimental surgery, the ideal power settings were 25-30%. In human surgery, the test ESU operated well at 25-35% power settings in endoscopic surgery, while in open surgery on humans the ideal settings were 25-35% in monopolar use and 20-25% in bipolar use. When used for endoscopic operations, the test ESU did not interfere with videorecording. Nor were any adverse effects seen in the surrounding tissues. The patients had neither early nor late complications. Histopathological findings revealed no differences in healing between the test ESU and reference ESU. Experimental and patient surgery showed the test ESU to be both safe and effective. It is suitable to be used in urologic endoscopic surgery, laparoscopic surgery and open urologic surgery. It does not interfere with videorecording or cause harmful stray currents in surrounding tissues. Power can be adjusted linearly and precisely. Low-power operation is also possible.     

Unexpected candidemia complicating ureteroscopy and urinary stenting

Two elderly patients with obstructive renal calculi who developed Candida albicans bloodstream infection within 12 h following ureteroscopy and ureteral stenting are described. Both patients were treated with prolonged courses of broad-spectrum antibiotics and were found to have urine cultures positive for Candida albicans prior to the urologic procedures. One patient also developed bilateral candidal endophthalmitis. The clinical presentation was indistinguishable from bacteremia complicating manipulation of the urinary tract. The patients were successfully treated with systemic antifungal therapy. Candiduria may present a risk for dissemination during invasive, relatively simple urologic procedures.     

Influence of urinary management on urologic complications in a cohort of spinal cord injury patients

OBJECTIVE: To study urologic complications in patients with spinal cord injury (SCI) in relation to their bladder management. DESIGN AND SETTING: A cohort study of patients with SCI in a rehabilitation center. PARTICIPANTS: One hundred eighty-two patients were studied; demographic data, disease characteristics, and urologic history were obtained for each. INTERVENTION: Patients responding to a questionnaire were given a clinical exam. Their medical records were reviewed, with particular attention given to the following urologic complications: lithiasis, urinary infections, orchiepididymitis, urethral trauma, vesicorenal reflux, and renal failure. RESULTS: Results are reported for 123 patients. Time since SCI was 8 years. Intermittent catheterization was the main method of bladder management. Only 32 patients had changed their method of vesical voiding. Urinary complications had developed in 75% of patients. The most common complication was urinary infection. Vesicoureteral reflux occurred in 26% of patients using percussion. Trauma related to catheterization was the main problem with intermittent catheterization, responsible for a high rate of orchiepididymitis. CONCLUSION: Intermittent catheterization is the most-used method of bladder management, but with a nonnegligible rate of urethral trauma in men. Percussion and Credé maneuver appear to be acceptable techniques of bladder management if the patient is closely monitored.     

Effect of hyperbaric oxygen therapy on testicular ischemia-reperfusion injury

PURPOSE: Testicular torsion is a urologic emergency representing a form of ischemia-reperfusion (IR) injury that requires prompt care to achieve tissue salvage and a reduction in post-torsion morbidity. Hyperbaric oxygen (HBO) has shown benefits in previous musculoskeletal models of IR. We evaluated the efficacy of HBO treatment in a rat testicular torsion model. MATERIALS AND METHODS: Four groups of male Wistar rats were included in this study: 1) Sham (n=16), spermatic cords exposed but not occluded; 2) Control (n=16), 4 hours of bilateral spermatic cord occlusion; 3) HBO during ischemia (n=18), 4 hours of occlusion and administration of HBO during the last 90 minutes of ischemia; and 4) HBO on reperfusion (n=8), HBO administered immediately upon reperfusion of the testes. The animals were sacrificed at two weeks and architecture and germinal epithelial cell thickness were determined by histological examination on each testicle. Average thickness (in cell layers) of each group was compared with control using Student's t test. RESULTS: Control testicles showed a significant reduction in germinal cell thickness compared with sham (1.7 versus 6.3, p <0.05). The animals treated with HBO during ischemia showed a significant increase in epithelial cell thickness compared with control (2.8 versus 1.7, p <0.05). Hyperbaric oxygen treatment during reperfusion had the greatest beneficial effect compared with control (5.1 versus 1.7, p <0.05). CONCLUSIONS: Adjunctive HBO therapy administered during ischemia or reperfusion significantly reduced injury to the testicle in this animal model. These results suggest a potential benefit of HBO treatment in clinical situations of testicular torsion.     

On the use of Pantopaque in renal cysts

Local Pantopaque instillation receives continued support in the urologic and radiologic literature as a method for treating benign renal cysts. If benign renal cysts are a common lesion with an exceedingly small complication rate, what is the rationale for such treatment with a potentially hazardous substance?     

Rare urologic pathology presenting as abdominal masses in children

The key to correct diagnosis of abdominal masses in children is awareness of all the possibilities. Three children with abdominal masses of uncommon urologic origin are described. The lesions were adrenal cortical carcinoma, a pancake pelvic kidney and a non-functioning hydronephrotic segment of a horseshoe kidney. Management of these patients is discussed and the literature is reviewed.     

Patient perspective of long-term outcome of augmentation cystoplasty for neurogenic bladder

OBJECTIVES: Although the urologic outcomes of augmentation cystoplasty for neurogenic bladder dysfunction are well known, additional information about the patient perspective is needed. The aim of this study was to assess patient perspective using a standardized questionnaire. METHODS: Fifty-nine patients, who had undergone augmentation enterocystoplasty as part of reconstruction mainly to correct hyperactive bladders and incontinence, were subjected to a questionnaire after a median of 76.1 postoperative months. The questionnaire addressed medications, catheterization, incontinence, bowel dysfunction, and satisfaction with urinary tract management. The urologic outcomes regarding upper and lower tract changes, complications, and reinterventions were documented as well. RESULTS: The patients experienced a significant increase in bladder capacity and decrease in pressure at capacity (P < 0.0001). Normal upper tracts remained normal and there was either improvement or stabilization of hydronephrosis. Twenty-four patients (40.6%) had one or more complications, with 21 requiring reinterventions. Twenty-five percent of patients required the reintervention within the first 25 months, and the median time to reintervention was almost 10 years. Thirty-five patients took medications such as anticholinergics, antidiarrheals, or antibiotics. Fifty-six patients were treated with clean intermittent catheterization (CIC) at a mean interval of 4.6 hours. Seven patients had some difficulty with CIC. Thirty-nine patients (67%) were dry, and 17 had mild and 3 severe incontinence. Eleven patients (18.6%) reported bowel dysfunction, although 7 had it preoperatively. Almost all patients were very satisfied with their urologic management. CONCLUSIONS: The high degree of patient satisfaction attests to the value of the procedure. The complication and reintervention rates underscore the importance of long-term follow-up.     

Length of stay for specialized pediatric urologic care

BACKGROUND: Pediatric urologic specialists have been excluded from many recent managed care contracts because they are believed to be more expensive and of no better quality than general urologists in managing common urologic problems in children. We believed this to be inaccurate. OBJECTIVES: To compare the length of stay at the University of California, San Francisco Medical Center for 2 common pediatric urologic operative procedures with data from other northern California hospitals and to document our results and patient satisfaction. DESIGN: Retrospective analysis of HCIA statewide database (HCIA Inc, Orange, Conn). SETTING: Northern California, 1995. SUBJECTS: Children younger than 12 years undergoing surgery for repair of an obstruction of the ureteropelvic junction or vesicoureteral reflux. MAIN OUTCOME MEASURE: Length of stay. RESULTS: The length of stay in our hospital was similar to that observed in other hospitals in which other full-time pediatric urologic specialists practiced and was significantly less than that observed in other northern California hospitals, even when adjusted for risk. In fact, a savings of 279 hospital days would have been realized if all patients had the same length of stay as that achieved at University of California, San Francisco Medical Center. In the 38 patients operated on at our center, there was uniform surgical success. Of the parents, 92% (11/ 12) were satisfied with their child's care and 92% (11/ 12) believed they received enough information to know what to expect and how to care for their child at home. There were no data available evaluating quality from other northern California hospitals for comparison. CONCLUSIONS: Our finding that actual and risk-adjusted length of stay were shorter when patients were treated by full-time pediatric urologists, while excellent quality was maintained, suggests that these specialists achieve their results with more efficiency and lower resource utilization than do general urologists. The implication of these results is that exclusive contracting that prevents patients from receiving care from full-time specialists results in overuse of valuable resources and possibly reduced quality. If our results are generalizable, they have important implications for health care reform in the United States.     

Hemangioma of bladder

A twenty-nine-year-old woman had a history of recurring gross, total painless hematuria. The past history and urologic studies supported the diagnosis of hemangioma of the bladder. A partial cystectomy was performed. The pertinent literature is reviewed.     

Carcinoma of the prostate diagnosed initially as carcinoma of the rectum

Carcinoma of the prostate appearing as a primary rectal tumor is more common than generally realized. Multiple biopsies with special stains and complete urologic investigation may be necessary before its prostatic origin can be established. The importance of making the proper diagnosis is underlined by the differences in treatment for the two lesions.     

Angina and atrial fibrillation in a patient with thyrotoxicosis

We report the case of a 50-year-old woman admitted to our Unit with the diagnosis of acute urinary retention due to huge uterine leiomyoma. Total abdominal hysterectomy resulted in resolution of the urologic symptomatology.     

Effects of phospholipid base analogues on the subcellular membrane ether composition of suspension cultured LM cells

Morbidity and mortality from pulmonary complications following urinary tract operations can be reduced by preoperative identification of the high risk patient. Pulmonary function tests and arterial blood gases are necessary to identify these patients and to delineate the severity of their pulmonary disease. Respiratory complications can be prevented in many patients with the proper use of pre- and postoperative chest physical therapy and oxygen therapy. Despite the most careful pulmonary management, some patients develop acute respiratory failure following urologic operations. Respiratory failure results from a combination of physiologic abnormalities which impair alveolar ventilation and oxygenation. Utilizing controlled ventilation, supplemental oxygen, and a physiologic approach to treating the underlying cause of respiratory failure, three fourths of urologic patients in respiratory failure may be expected to survive.     

Prevention of cerebral edema and infarct in cerebral reperfusion injury by an antibody to interleukin-8

BACKGROUND: Indinavir, a protease inhibitor widely used to treat patients with HIV infection, has been associated with nephrolithiasis. Distinctive urinary crystals and a spectrum of urologic disorders were noted in patients receiving indinavir. OBJECTIVE: To determine the composition of urinary crystals and the frequency of asymptomatic crystalluria and urinary tract symptoms in patients receiving indinavir. PATIENTS: Patients with HIV infection who were enrolled in studies conducted at the National Institutes of Health. MEASUREMENTS: Microscopic urinalysis, high-performance liquid chromatography (HPLC) and mass spectrometry of urinary crystals and stones, and clinical evaluation of patients with urologic symptoms. RESULTS: Of 240 patients receiving indinavir, 142 provided urine specimens for analysis. Twenty-nine (20%) had crystals consisting of plate-like rectangles and fan-shaped or starburst forms. Mass spectrometry and HPLC confirmed that these crystals were composed of indinavir. Of 40 patients who were not receiving indinavir, none had similar crystals (P < 0.001). Nineteen of the 240 patients receiving indinavir (8%) developed urologic symptoms. Of these, 7 (3%) had nephrolithiasis and the other 12 (5%) had previously undescribed syndromes: crystalluria associated with dysuria and crystalluria associated with back or flank pain. Four of the patients with the latter syndrome had radiographic evidence of intrarenal sludging. CONCLUSIONS: Indinavir forms characteristic crystals in the urine. This crystalluria may be associated with dysuria and urinary frequency, with flank or back pain associated with intrarenal sludging, and with the classic syndrome of renal colic.     

Making sense of the results of your research

The association of a carcinoid tumour with non-endocrine urologic neoplasms is an infrequent finding. This paper contributes one case of multiple primary neoplasm where a prostatic adenocarcinoma coexists with an intestinal carcinoid tumour in a 63-year old asymptomatic patient. Diagnosis of prostate cancer was achieved during a screening for this conditions whereas the intestinal carcinoid tumour was found in the extension study.     

Self-esteem and depression in men who present with erectile dysfunction

Erectile dysfunction always has a psychologic component in addition to the underlying physical cause. The extent of depression and reduced self-esteem in patients who present with erectile dysfunction are explored in this study. Suggestions are given for how urologic nurses can overcome patients' fears and concerns.     

Acute cauda equina syndrome secondary to lumbar disc herniation mimicking pure conus medullaris syndrome--case report

Chyluria is a urologic manifestation of a lymphatic system disease abnormality and leads to nutritional deficiency. The case of a patient with chyluria is presented, and the results of lymphoscintigraphy with those of contrast lymphangiography are compared. Lymphoscintigraphy very clearly showed the site of the fistulae and was as precise as lymphangiography. Follow-up lymphoscintigraphy 2 months after therapy revealed no radionuclide accumulation. Lymphoscintigraphy is a useful, noninvasive, safe, and simple technique for the diagnosis and follow-up of chyluria.