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Objective: Recently, there has been considerable research on the origins of childhood conduct problems (CP) and callous-unemotional (CU) behaviors. This study examined associations between children's attachment representations and CP and CU behaviors during middle childhood. Method: At 1st grade, 1,292 children (57% European American, 42.5% African American, 0.5% other race; 50.9% girls) completed a drawing of their family, which was coded by trained raters to assess attachment representations. Primary caregivers reported on children's CP and CU behaviors. Results: Children with disorganized representations showed more CP and CU behaviors than children with secure and resistant representations. They were also more likely than those with secure representations to show elevated CP without CU behaviors, CU behaviors only, and co-occurring CP and CU behaviors. Conclusion: These findings provide support for attachment disorganization as a correlate of CP and CU behaviors and suggest that attachment representations are likely important proximal influences on children's behavior. [ABSTRACT FROM AUTHOR]

Adolescents in 21st century America are experiencing the emergence of their sexual and gender identities in a heteronormative society that is steadily adopting more progressive views and policies related to sexual orientation and gender. However, despite these sociocultural changes, parent–child relationships remain as one of the strongest predictors of LGBT adolescent adjustment. This article reviews the extant literature on this topic from family systems and attachment perspectives while highlighting the significance of family experiences within a minority stress framework. The presentation is oriented around the coming out process, including factors influencing this experience and how postdisclosure parenting affects the health and well‐being of LGBT adolescents. We end by discussing future directions and the challenges inherent to this research. [ABSTRACT FROM AUTHOR]

Deficits in emotion recognition have been associated with psychopathic and callous-unemotional (CU) behaviors among adults, adolescents, and children. However, few previous studies have examined such associations exclusively during early and middle childhood, or demographic differences in emotion recognition that may result from early emotion socialization experiences. The current study used a large, population-stratified, randomly-selected sample of 2nd grade children living in areas of high rural poverty to examine group differences in emotion recognition among children showing no conduct problems or CU behaviors (typical), conduct problems without CU behaviors (CP-only), and both CP and CU behaviors (CP + CU). Primary caregivers reported on children’s conduct problems and callous-unemotional behaviors at 1st grade and children completed a computerized facial emotion recognition task at 2nd grade. Results indicated that CP/CU group differences in emotion recognition accuracy were moderated by child race, with children in the typical group showing better overall accuracy and better recognition of fearful and happy faces among European American children, whereas no group differences were found among African American children. Implications for emotion socialization, etiology of CP and CU behaviors, and future directions for research and treatment are discussed. [ABSTRACT FROM AUTHOR]

The proximal urethral bulb in men is enlarged, surrounds the bulbous urethra, and extends dorsally towards the perineum. During intercourse engorgement takes place due to increased blood flow through the corpus spongiosum. Antegrade ejaculation is facilitated by contraction of the bulbospongiosus muscles during climax. Micturition during sexual stimulation is functionally inhibited. Supporting the bulb may indirectly facilitate continence in a certain subset of patients with postprostatectomy incontinence. During physical activity with increased abdominal pressure, reflex contraction of the pelvic floor muscles as well as the bulbospongiosus muscles occurs to support sphincter function and limit urinary incontinence. Operations to the prostate may weaken urinary sphincter function. It is hypothesized that the distal urinary sphincter may be supported indirectly by placing a hammock underneath the urethral bulb. During moments of physical stress the “cushion” of blood within the supported corpus spongiosum helps to increase the zone of coaptation within the sphincteric (membranous) urethra. This may lead to urinary continence in patients treated by a transobturator repositioning sling in patients with postprostatectomy incontinence. This paper describes the possible role of the urethral bulb in male urinary continence, including its function after retroluminal sling placement (AdVance, AdVance XP® Male Sling System, Minnetonka, USA). [ABSTRACT FROM AUTHOR]

The question is whether the urethral sphincter may be reconstructed after longitudinal injury similar to anal sphincter injuries. Analogue to obstetric, anal sphincter repair, an approximation repair of the sphincter may be feasible. An overlap repair is possible in anal sphincter repair, but because of the little tissue available in the urethral sphincter this is not an option. We describe three cases of urethral sphincter injury of different aetiologies. All resulted in a total longitudinal disruption of the muscular components of the urethral sphincter complex. After making the diagnosis of urethral sphincter injury, a primary approximation repair was done. Follow-up of at least two and up to three years is promising with one male patient being completely continent and the two female patients needing one safety pad per day. Longitudinal disruption of the muscular elements of the sphincteric urethra may be primarily reconstructed with good success using an approximation technique with simple interrupted sutures. [ABSTRACT FROM AUTHOR]

Abstract: Background: The AdVance male sling (American Medical Systems, Minnetonka, MN, USA) has been shown to be an efficacious device in short-term studies for postprostatectomy incontinence (PPI), but long-term studies are lacking. Objective: Examine the intermediate-term outcome with the AdVance sling for PPI management. Design, setting, and participants: A multicentre prospective evaluation was conducted on consecutive patients treated for PPI in three European tertiary reference centres. Intervention: Patients were implanted with the AdVance male sling with no associated surgery. Outcome measurements and statistical analysis: Measurements included daily pad usage, maximum flow rate (Qmax), postvoid residual urine (PVR), the International Consultation on Incontinence Questionnaire–Short Form, the Incontinence Quality of Life questionnaires, and complications of surgery. Paired Wilcoxon signed rank test univariable and multivariable analyses were used. Results and limitations: Follow-up was available for 156 patients for the majority of parameters. Pad usage was significantly decreased compared with baseline at 12 mo and 3 yr (p <0.0001). At 12 mo, 76.9% of patients could be classified as cured or improved; this percentage was maintained at 3 yr (76.8%). Cure rates (58.6% vs 42.3%) and improvement rates (23.2% vs 25.0%) were higher in patients with mild or moderate incontinence compared with severe incontinence. Univariable analysis showed that pretreatment pad usage and severity of incontinence were both significant predictors of success (p =0.0355 and p =0.0420, respectively). However, in multivariable analysis, only pad usage was an independent predictor of success. There were no perioperative or severe postoperative complications. Most complications were Dindo grade I. Seven patients required a second treatment for stress urinary incontinence. There was no worsening over time. Limitations of this study included no comparator group, quality of life questionnaires in only two centres, and no 24-h pad test. Conclusions: The transobturator retroluminal repositioning sling suspension is effective and safe in the longer term for treating PPI. [Copyright &y& Elsevier]

Abstract: A number of anatomic components work in concert to produce precise control of micturition in the healthy male, including the sphincter with its striated and smooth muscle components, the surrounding muscular and ligamentous support structures, neural components, and the urothelium. Radical prostatectomy is often associated with injury to one or more of these tissues, culminating in stress urinary incontinence (SUI). Although the causes of urinary incontinence can vary, among patients with residual urethral sphincter function, the increased laxity and reduced functional length of the membranous urethra are thought to play key roles in incontinence. Most surgical treatments for urinary incontinence, such as the artificial urinary sphincter and various slings, achieve continence via compression of the urethra, but the AdVance® transobturator retrourethral sling (American Medical Systems, Minnetonka, MN, USA) repositions the urethral sphincter complex back into the pelvis and increases the functional membranous urethral length. Emerging reports on the AdVance® sling suggest favourable cure rates and few complications. Thus, the AdVance® sling provides an alternative approach to treating postprostatectomy SUI that is both less obstructive and more dynamic. [Copyright &y& Elsevier]

Abstract: The AdVance® male sling (American Medical Systems, Minnetonka, MN, USA) is a retrourethral transobturator sling that offers an effective surgical approach for the treatment of postprostatectomy stress urinary incontinence (SUI). Clinical studies have demonstrated success rates of 80–90% at 1-yr follow-up. The most appropriate candidate patients for the AdVance® sling may be those with mild to moderate incontinence, but success rates may not be markedly lower in patients with severe incontinence. Clinical experience with the AdVance® sling suggests that cystoscopically confirmed residual sphincter function is an important requirement for good outcome. Assessment of SUI should be modified to include a consideration of sphincter function in addition to the currently accepted definitions of incontinence severity (pad weight and number). The AdVance® male sling may be considered a first-line surgical treatment as well as a salvage treatment for some patients who have failed previous surgical treatment. More data are needed to better understand the patient-related factors that affect the short- and long-term outcomes of this minimally invasive treatment for male SUI. [Copyright &y& Elsevier]

OBJECTIVE To evaluate the efficacy and safety of a transobturator retroluminal repositioning sling suspension in the treatment of male stress urinary incontinence (SUI) after prostate surgery. PATIENTS AND METHODS In 118 men with SUI after prostatic surgery, a transobturator retroluminal repositioning sling suspension was implanted. Patients were evaluated including: complete history and physical examination, 24-h pad test, a questionnaire (International Consultation on Incontinence Questionnaire, Short-Form), urodynamic evaluation and endoscopy. The surgical technique was described previously. The findings before and at 1 year after sling placement were compared. RESULTS At the 12-month follow-up, 73.7% of the men were cured, 16.9% were improved, and 9.3% were still incontinent. After sling placement the daily pad use decreased significantly ( P < 0.001), while the ICIQ-SF improved significantly ( P < 0.01). The detrusor voiding pressure, postvoid residual urine volume and maximal flow rates remained unchanged, while the Valsalva leak-point pressure improved significantly ( P < 0.01). In 19.5% of the men, there was transient scrotal pain or perineal discomfort. 5.1% of the men, postoperative urinary retention occurred but resolved spontaneously after a few weeks of catheter placement. In 1.7% of the men adductor pain was reported, which resolved spontaneously. There were no major complications. CONCLUSION The transobturator retroluminal repositioning sling suspension for the treatment of male SUI is effective and safe with a low complication rate after 1 year of follow-up. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (case series) Level of Evidence 4 OBJECTIVE To report a new dorsal labia minora skin-graft urethroplasty as a simple, safe and effective therapeutic alternative for female urethral strictures, as although distal urethral strictures can be treated by meatoplasty, proximal and mid-urethral strictures need appropriate urethroplasty. PATIENTS AND METHODS Eight women with a confirmed proximal or mid-urethral stricture had indications for urethroplasty with the use of a thin free labia minora skin graft using a dorsal (6 o'clock position) urethroplasty technique. Full informed consent was obtained. From the inner aspect of one labium minora a thin free skin flap was prepared. The strictured urethra and the anterior vaginal wall were transected and the graft sutured into the defect. All scar tissue was removed and the anterior vaginal wall closed in two layers over the area of the urethroplasty. Continence was evaluated by a stress test with a full bladder. RESULTS All patients were operated on with no complications during or after surgery. After 1 and 2 years of follow-up seven and six of the eight patients had no recurrence of stricture disease. All patients remained continent. CONCLUSION The urethroplasty using an inlay of free thin genital skin graft was safe, uncomplicated and effective. [ABSTRACT FROM AUTHOR]

This is a report of a case of a 26-year-old patient suffering from progressive renal insufficiency with a neurogenic bladder disorder due to a lipomyelomeningocele. She had renal agenesis on the left side and grade III hydronephrosis of both segments of a right duplex kidney with a bifid ureter joining further distal to the kidney. Both ureters were dilated. The cause was found to be a yo-yo reflux between the two halves of the kidney. Following bladder augmentation and pyelopyelostomy, renal insufficiency improved to stage III and has now been stable for four years. Due to the contralateral renal agenesis, the case is a unique illustration of the functional effect of the yo-yo reflux and pyelopyelostomy. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To study the anatomical effects of placing a transobturator tape (TOT) in cadavers as well as determining the clinical outcome in men with urinary incontinence. Methods: The study was a two stage study. The first phase was a cadaver study to examine the placement of the sling. The second part involved the placement of the sling in 20 men with incontinence, which occurred post-radical prostatectomy in 15 men. All patients had pre-operative and post-operative videourodynamics, maximum flow rate (Qmax) and residual urine measurement. Urethral pressure profiles and membranous urethral length were measured in five patients pre- and postoperatively. Incontinence was assessed on the basis of pad usage. Patients’ satisfaction was recorded using a non-validated patient questionnaire at 6 weeks post-operatively. Results: The cadaver study revealed that a leak point pressure of 60cmH2O was achieved on tensioning of the tape. In the clinical series, the mean (range) urethral closure pressure improved from 13.2 (8–22) to 86.4 (70–100) cmH2O following placement of the TOT. The membranous urethral length increased from a mean (range) of 3 (0–7) to 17.2 (10–22) mm following tensioning of the tape. No significant differences in Qmax pre- and postoperatively were observed. Incontinence cure rate (no pad usage) was 40% and improved rate (1–2 pads per day) was 30%. The majority of patients (12/20) were very satisfied with the procedure. Conclusions: The TOT, a novel procedure for treatment of post-radical prostatectomy incontinence, was shown to be effective and well accepted by patients. [Copyright &y& Elsevier]

The author reflects on the study by Ricarda M. Bauer and colleagues which reports medium-term stable outcomes following the implantation of retroluminar functional transobturator sling suspension in patients with post-prostatectomy urinary incontinence.

Background: Current guidelines recommend repeat computed tomography (CT) imaging in high-grade blunt renal injury within 48–96 h, yet diagnostic value and clinical significance remain controversial. The aim of this work was to determine the possible gain of CT re-imaging in uncomplicated patients with blunt renal trauma at 48 h after injury, presenting one of the largest case series. Methods: A retrospective database of patients admitted to our centre with isolated blunt renal trauma due to sporting injuries was analysed for a period of 20 years (2000–2020). We included only patients who underwent repeat imaging at 48 h after trauma irrespective of AAST renal injury grading (grade 1–5) and initial management. The primary outcome was intervention rates after CT imaging at 48 h in uncomplicated patients versus CT scan at the time of clinical symptoms. Results: A total of 280 patients (mean age: 37.8 years; 244 (87.1%) male) with repeat CT after 48 h were included. 150 (53.6%) patients were classified as low-grade (grade 1–3) and 130 (46.4%) as high-grade (grade 4–5) trauma. Immediate intervention at trauma was necessary in 59 (21.1%) patients with high-grade injuries: minimally invasive therapy in 48 (81.4%) and open surgery in 11 (18.6%) patients, respectively. In only 16 (5.7%) cases, intervention was performed based on CT re-imaging at 48 h (low-grade vs. high-grade: 3.3% vs. 8.5%; p = 0.075). On the contrary, intervention rate due to clinical symptoms was 12.5% (n = 35). Onset of clinical progress was on average (range) 5.3 (1–17) days post trauma. High-grade trauma (odds ratio [OR]grade 4 vs. grade 3, 14.62; p < 0.001; ORgrade 5 vs. grade 3, 22.88, p = 0.004) and intervention performed at the day of trauma (OR 3.22; p = 0.014) were powerful predictors of occurrence of clinical progress. Conclusion: Our data suggest that routine CT imaging 48 h post trauma can be safely omitted for patients with low- and high-grade blunt renal injury as long as they remain clinically stable. Patients with high-grade renal injury have the highest risk for clinical progress; thus, close surveillance should be considered especially in this group. [ABSTRACT FROM AUTHOR]

OBJECTIVE • To evaluate the success of endoscopic dextranomer/hyaluronic acid copolymer (DHAC) application in the treatment of patients with recurrent urinary tract infections (UTIs) and vesico-ureteric reflux (VUR) into the transplanted graft after renal transplantation. PATIENTS AND METHODS • Between January 2008 and April 2009, 19 patients with recurrent UTIs presented VUR proven by voiding cystourethrography. • To correct VUR of the transplanted ureter, DHAC was injected endoscopically using hydrodistention technique. • Pre- and postoperative serum creatinine levels, the number of pre- and postoperative UTIs, postoperative complications and reflux resolution rate were recorded. The mean follow-up was 6.5 months. RESULTS • The average number of UTIs was reduced significantly from 4.89 (range 2-14) to 1.31 (range 0-4) on pre- and postoperative follow-up, respectively, of 6 months ( P < 0.001). The success rate increased from 57.9% after the first injection to 78.9% after the second injection. • The remaining four patients with residual VUR received long-term low dose antibiotic prophylaxis. In total, two (10.5%) patients developed increasing creatinine levels postoperatively as a result of distal ureteral obstruction, and temporary urinary drainage was necessary in both patients. CONCLUSIONS • DHAC appears to be an efficient and minimal invasive method for treating VUR after renal transplantation with respect to short-term success. • Further investigation with a larger group of patients and longer follow-up is needed to evaluate the prolonged effect, as well as any potential side effects. [ABSTRACT FROM AUTHOR]

Background. Whether living with reduced nephron mass (RNM) poses a risk to humans is the subject of ongoing controversy. The aim of this study was to discover whether or not RNMs are associated with greater atherosclerotic plaque burdens.Methods. Using the post-operative abdominal CT scans of 739 nephrectomized patients [NP; 315 women and 424 men; mean age 64.5 ± 15.0 years; observation period 4.9 ± 5.7 years (3675.9 patient-years)] and of an age- and a gender-matched control group, a retrospective observational and case–control study was conducted. The V600 calcium scoring method was used to determine the aortic calcium volume score (ACS) and thus the APB.Results. The ACS was 0.47 ± 0.77 mm3 in the NPs compared with 0.41 ± 0.69 mm3 in the control group (P <0.0001). The ACS and the glomerular filtration rate (GFR using the CKD-EPI formula) after nephrectomy correlated inversely (P = − 0.3652; P <0.0001), and the ACS and the time since nephrectomy correlated positively (P = 0.2919; P <0.0001). In linear regression models, age, time interval and GFR after nephrectomy proved to be independent factors of influence on ACS (P <0.05 each). Including the control group, age, GFR after nephrectomy and nephrectomy were independent factors of influence on the ACS. The factor GFR after nephrectomy explains ~ 10.7% in NPs, and 28% of the variance of the ACS in all patients.Conclusions. The factors ‘low GFR’ and RNM are risk factors for greater atherosclerotic plaque burden. Patients with RNM should undergo regular control examinations to monitor arterial blood pressure and treat hypertension if it occurs. [ABSTRACT FROM AUTHOR]

AbstractPurpose:To describe the current and new developments in transrectal ultrasound (US) imaging of the prostate.Patients and Methods:Grayscale imaging of the prostate is the standard method for diagnostic evaluation and biopsy guidance. Color Doppler (CD) imaging, including CD and power Doppler US, allows for detection of macrovascularity and may therefore be helpful for assessment of prostatic blood flow. The use of US microbubbles for CD imaging and new contrast-specific techniques enable assessment of prostate microvascularity associated with prostate cancer (PCa). Recently, real-time elastography has been introduced to improve detection of cancer based upon changes in tissue stiffness.Results:Contrast-enhanced CD imaging has shown to enable PCa detection by performing targeted biopsies into suspicious areas. Comparisons between systematic and contrast-enhanced targeted biopsies have shown that the targeted approach detects more cancers and cancers with higher Gleason scores with a reduced number of biopsy cores. New microbubble-specific US techniques can improve sensitivity and specificity of US imaging for PCa detection. Real-time elastography has been demonstrated to be useful for the detection of PCa, and may further improve PCa staging.Conclusions:The new US techniques seem to have the potential to improve PCa detection, and also PCa grading and staging. As these diagnostic methods improve, the ultimate hope is to eliminate biopsy in patients without cancer. [ABSTRACT FROM AUTHOR]

In practice, trauma and orthopedic surgery during spinal anesthesia are often performed with routine urethral catheterization of the bladder to prevent an overdistention of the bladder. However, use of a catheter has inherent risks. Ultrasound examination of the bladder (Bladderscan®) can precisely determine the bladder volume. Thus, the aim of this study was to identify parameters indicative of urinary retention after low-dose spinal anesthesia and to develop a simple algorithm for patient care. This prospective pilot study approved by the Ethics Committee enrolled 45 patients after obtaining their written informed consent. Patients who underwent arthroscopic knee surgery received low-dose spinal anesthesia with 1.4 ml 0.5% bupivacaine at level L3/L4. Bladder volume was measured by urinary bladder scanning at baseline, at the end of surgery and up to 4 h later. The incidence of spontaneous urination versus catheterization was assessed and the relative risk for catheterization was calculated. Mann–Whitney test, χ² test with Fischer Exact test and the relative odds ratio were performed as appropriate. * P < 0.05. Seventy percent of the patients were able to void spontaneously; in 30%, a Foley catheter had to be inserted because bladder volume exceeded 500 ml and/or urination was insufficient ( P < 0.01). Bladder volume differed independently of the fluid infused. Additionally, patients with a bladder volume >300 ml postoperatively had a 6.5-fold greater likelihood for urinary retention. In the management of patients with short-lasting spinal anesthesia for arthroscopic knee surgery we recommend monitoring bladder volume by Bladderscan® instead of routine catheterization. Anesthesiologists or nurses under protocol should assess bladder volume preoperatively and at the end of surgery. If bladder volume is >300 ml, catheterization should be performed in the OR. Patients with a bladder volume of <300 ml at the end of surgery may be transferred to the ward or recovery room. In these patients, bladder volume must be checked at least every 60 min for a maximum of 3 h or until spontaneous voiding is possible or bladder volume is >500 ml. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare the effect of incontinence surgery and pelvic floor training on quality of life (QOL), anxiety and depression in patients with stress urinary incontinence (SUI). Methods: In a prospective longitudinal study, females with proven SUI were asked to complete a set of standardized questionnaires (sociodemographic data sheet, FACT-G, I-QOL, HADS) before and eight weeks after treatment. The comparison groups consisted of a surgical treatment group and a conservative group that underwent supervised pelvic floor training for eight weeks. Results: From the 67 female patients included in the study a number of 53 patients completed both assessment time points (mean age 57.4, mean years of SUI 7.6). The surgical treatment group consisted of 32 patients of which 21 patients received a modified Burch colposuspension and 11 patients a tension-free mid-urethral tape suspension. The 21 patients in the conservative group attended eight once-weekly supervised pelvic floor training sessions. After treatment the surgical intervention group showed a significantly higher improvement of QOL (FACT-G and I-QOL) and anxiety (HADS) than the pelvic floor training group. Conclusion: For female patients with SUI surgery yielded a better outcome than pelvic floor training with regard to quality of life and anxiety. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the security, value, and efficacy of the second-generation AdVance male sling XP (Boston Scientific®), after implementation in 2010 with advantageous modifications in the sling structure and needle shape, in a prospective multicenter long-term follow-up study. Methods: In total, 115 patients were included. Exclusion criteria were earlier incontinence (UI) surgery, nocturnal UI, former radiotherapy, or night-time incontinence. We also excluded patients with a functional urethra <1 cm in a preoperatively performed repositioning test. A consistent 24-h pad test, International Quality of Life (IQOL) score, visual analog pain scale (VAS), International Consultation-Incontinence Questionnaire (ICIQ-UI SF), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), and Patient Global Impression of Improvement (PGI-I) scores were requested postoperatively. Results: The 24-month follow-up (114 patients) revealed 64.0% cured and 28.8% improved patients. Mean urine loss was reduced significantly to 19.0 g (p < 0.001). A mean PGI score of 1.5 and a mean VAS score of 0.2 were obtained. The 60-month follow-up (59 patients) revealed 57.6% cured and 25.4% improved patients. Mean urine loss was reduced significantly to 18.3 g (p < 0.001). A mean PGI score of 1.6 and a mean VAS score of 0.2 were obtained. Conclusions: The AdVance XP displays excellent continence results and secure effectiveness over a 5-year period. Moreover, these data are demonstrating low complication rates and improved quality of life in the long-term use of AdVance XP. [ABSTRACT FROM AUTHOR]

Urological endometriosis as the primary and sole form of presentation is rare. With ultrasound being available at routine examinations by the urologist and gynecologist, asymptomatic and incidental hydronephrosis is picked up far more than before. The behavior of endometriosis may be very aggressive in terms of ingrowth and fibrosis of the ureter, the periureteral structures and the bladder. It is important to get to an accurate and timely diagnosis to prevent loss of renal function. We report 2 cases who presented with asymptomatic hydronephrosis. Because of severe ureteric obstruction and infiltration of the ureters and/or bladder, surgery was selected as treatment option. Ureteric stenting was not possible because of severe fibrosis and stricture formation of the distal ureter. Primary surgery gave satisfactory results at more than 1 year of follow-up. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

• Poverty is associated with HPA-axis activity in young children. • Theory suggests caregiving behaviors mediate this association. • We review the literature linking caregiving behaviors to HPA-axis activity. • We focus on caregiving behaviors in the context of poverty. • Our review includes both parental and non-parental caregiving behaviors. The association between poverty and the activity of the hypothalamic pituitary adrenal (HPA) axis in early childhood is well established. Both ecological and transactional theories suggest that one way in which poverty may influence children's HPA-axis activity is through its effects on parents' behaviors, and over the past three decades a substantial literature has accumulated indicating that variations in these behaviors are associated with individual differences in young children's HPA-axis activity. More recent research suggests that non-parental caregiving behaviors are associated with HPA-axis activity in early childhood as well. Here we systematically review the literature on the association between both parental and non-parental caregiving behaviors in the context of poverty and the activity of the HPA-axis in early childhood. We conclude by noting commonalities across these two literatures and their implications for future research. [ABSTRACT FROM AUTHOR]

Aim: Prostate biopsies are usually done with transrectal ultrasound (TRUS) in B-mode (B TRUS) but multiparametric MRI (mpMRI) is the gold imaging standard for the visualization of clinically significant prostate cancer (PCa), since a lowPCa detection rate is reported for B TRUS. The aim of this study was to assess the visibility of MRI lesions on B TRUS and to determine which factors may influence the visibility on B TRUS.Material and Methods: 142 men with 148 lesions reported on mpMRI underwent a B TRUS/mpMRI fusion targeted biopsy of the prostate and were included in this retrospective study. During the biopsy, images were obtained and stored in the institution's PACS. These images were reviewed by two radiologists to determine, whether an mpMRI lesion was or was not visible on B TRUS.Results: Overall 92 from 148 mpMRI lesions (62.2%) were visible on B TRUS. The location of the lesion in the prostate, the PIRADS classification of the lesions and the size of the lesion had no significant influence on the visibility on B TRUS. Only the prostate volume had a significant influence on visibility: in smaller prostates significantly more lesions were visible on B TRUS than in large glands (p+0.041; 45.1 ml vs 54 ml).Conclusion: The use of newer high-end ultrasound units as well as experience gained from fusion biopsies enables us to see 62.2 % of all suspicious mpMRI lesions on B TRUS. B TRUS images merit a thorough examination during a conventional biopsy setting. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the efficacy and safety of the AdVance XP® sling (Boston Scientific, formerly American Medical Systems) in male stress urinary incontinence ( SUI) after radical prostatectomy in a prospective multicentre study, as in recent years several studies have shown the effectiveness and safety of the AdVance sling for treating male SUI and in 2010 the second-generation AdVance XP was introduced with several changes in the sling design and a new needle shape. Patients and Methods In all, 115 patients were included. Patients with nocturnal UI, previous UI surgery, previous radiotherapy and a coaptive zone of <1 cm in the preoperative repositioning test were excluded. Postoperatively, a standardised 24-h pad test, quality-of-life scores [International Quality of Life score ( IQOL) and International Consultation on Incontinence Questionnaire short form ( ICIQ- UI SF)], visual analogue scale ( VAS) for pain, five-item version of the International Index of Erectile Function ( IIEF-5), International Prostate Symptom Score ( IPSS) and Patient Global Impression of Improvement ( PGI-I) score, were performed. All patients with a 0-5 g pad test were defined as cured and improved with a reduction of urine loss of >50%. All others were classified as failures. Significance analysis was performed using the Wilcoxon test. Results The mean (median) preoperative urine loss in the 24-h pad test was 272.0 (272.0) g. After a follow-up of 3 months (114 patients), 64.9% of the patients were cured and 31.6% had an improved continence status. The mean urine loss decreased significantly to 34.9 g ( P < 0.001), with a mean VAS score of 0.5, and mean PGI-I of 1.5. After a follow-up of 24 months (80 patients), 68.8% of the patients were cured and 22.5% had improved. The mean urine loss decreased significantly to 19.1 g ( P < 0.001), with a mean VAS score of 0.3, and mean PGI-I of 1.5. After a follow-up of 36 months (47 patients), 66.0% of the patients were cured and 23.4% had improved. The mean urine loss decreased significantly to 21.8 g ( P < 0.001), with a mean VAS score of 0.0, and mean PGI-I of 1.6. The mean IQOL and ICIQ- UI SF improved significantly (both P < 0.001) after 36 months. There were no significant postoperative changes in IIEF-5 and IPSS. No intraoperative and no long-term complications occurred. No erosion or explanations occurred. Conclusion The AdVance XP shows good and stable effectiveness and low complication rates even at a mid-term follow-up of up to 36 months. [ABSTRACT FROM AUTHOR]

Extant literature suggests that oppositional defiant disorder (ODD) and callous-unemotional (CU) behaviors in childhood and adolescence are associated with distinct patterns of psychophysiological functioning, and that individual differences in these patterns have implications for developmental pathways to disorder. Very little is known about the associations between psychophysiological functioning in infancy and later ODD and CU behaviors. This study examined associations between basal autonomic nervous system (ANS) functioning in infancy and ODD and CU behaviors in later childhood. Using longitudinal heart period (HP) and respiratory sinus arrhythmia (RSA) data from the Durham Child Health and Development Study (N = 206), the current study tested associations within a structural equation modeling framework, between continuous measures of HP and RSA across the first 2 years of life, and later ODD and CU behaviors at first grade. Results indicate that ODD and CU behaviors in childhood are associated with lower baseline RSA, but not HP, across infancy. The implications of these findings for developmental models of ODD and CU behaviors are discussed. [ABSTRACT FROM AUTHOR]

Purpose: For the treatment of persistent post-prostatectomy incontinence (PPI), several surgical treatment options including male slings are available. In 2010, the second generation of the retrourethral male sling Advance, AdVanceXP, was introduced. Aim of the study was to examine in a prospective multicentre study the outcome of AdVanceXP in the treatment of PPI. Methods: Ninety-four patients were treated with AdVanceXP. Patients with nocturnal incontinence, previous incontinence surgery, with coaptive zone <1 cm and irradiated patients were excluded. Measurements included: daily pad usage, 24-h pad weight test, post-operative pain in the visual analogue scale, International Quality of Life questionnaire, International Consultation on Incontinence Questionnaire short form, IEEF5 and Patient Global Impression of Improvement. Adverse events were recorded. All patients with no pads and 0-5 g in the 24-h pad test were defined as cured and those with a reduction in urine loss >50 % as improved. Results: Preoperatively, the median 24-h pad weight test was 274 g and daily pad usage was 3. At 1-year follow-up, 66.3 % of patients could be classified as cured and 25.3 % as improved. After 2 years, 73.1 % could be classified as cured and 19.6 % as improved. Urine loss decreased ( p < 0.001), and quality of life improved significantly ( p < 0.001). Mean PGI was 1.5 after 1 year and 1.4 after 2 years. Majority of complications were minor. No intraoperative complications and five serious post-operative events occurred (grade IIIB complications). No explantation was necessary. Conclusions: AdVanceXP, when correctly indicated, shows good effectiveness and low complication rates after up to 2 years. [ABSTRACT FROM AUTHOR]

Objective: The incidence of urethral injuries in children is rare due to the fact that the urethra is short, mobile and protected by the pubic bone. The management of urethral trauma in childhood remains controversial because of the limited expertise of most urologists. Material and Methods: We performed a literature review by searching the Medline database for articles published between 1975 and 2010 based on clinical relevance. Electronic searches were limited to the keywords 'pediatric', 'urethral injury', 'trauma' and 'reconstruction'. Results: Retrograde urethrography is considered the gold standard for diagnosis of urethral injuries. The initial management should ensure drainage of the bladder either by suprapubic cystostomy or urethral realignment if possible: in complete anterior urethral disruption as well as in children with life-threatening pelvic and intra-abdominal injuries after posterior urethral injuries, a deferred repair after 3 months is necessary. Immediate primary suturing of disrupted and dislocated urethral ends should be avoided because of high complication rates. Primary repair, however, of the defect is possible in girls avoiding a 2-stage approach. Conclusion: The aim of therapy is minimizing remote damages such as urethrocutaneous fistulae, periurethral diverticulae, strictures, incontinence and impotence with different therapeutic management depending on classification of the injury and the presence of life-threatening injuries. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: The incidence of urethral injuries in children is rare due to the fact that the urethra is short, mobile and pro-tected by the pubic bone. The management of urethral trau-ma in childhood remains controversial because of the limit-ed expertise of most urologists. Material and Methods: We performed a literature review by searching the Medline da-tabase for articles published between 1975 and 2010 based on clinical relevance. Electronic searches were limited to the keywords 'pediatric', 'urethral injury', 'trauma' and 'recon-struction'. Results: Retrograde urethrography is considered the gold standard for diagnosis of urethral injuries. The initial management should ensure drainage of the bladder either by suprapubic cystostomy or urethral realignment if possi-ble: in complete anterior urethral disruption as well as in chil-dren with life-threatening pelvic and intra-abdominal inju-ries after posterior urethral injuries, a deferred repair after 3 months is necessary. Immediate primary suturing of dis-rupted and dislocated urethral ends should be avoided be-cause of high complication rates. Primary repair, however, of the defect is possible in girls avoiding a 2-stage approach. Conclusion: The aim of therapy is minimizing remote damages such as urethrocutaneous fistulae, periurethral diver-ticulae, strictures, incontinence and impotence with differ-ent therapeutic management depending on classification of the injury and the presence of life-threatening injuries. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To establish a method for estimating the probability of renal artery stenosis (RAS) based on the calcium volume score of the aorta (ACS). Materials and Methods: In a retrospective observation study, CT angiographies acquired on a 64-slice MDCT scanner were analyzed for 1351 patients (female: 531; male 826; mean age 60.9±17.7years). A volumetric scoring method was used, detecting plaques with a density of more than 600 HU. Results: 13.8% of the patients showed a stenosis >50%, 4.1% a stenosis >70%. The ACS was 0.61±1.01ml calcium. The sensitivity for detection of RAS >50% and RAS >80% was 0.9572 and 1.0, respectively. The negative predictive value (NPV) of a lack of calcification for excluding RAS >50% and RAS >80% was 0.9752 and 1, respectively. As ACS increased, the specificity for RAS >50% increased to 0.9390. With an ACS of 0.380ml, accuracy reached a maximum of 0.6585. ROC analyses yielded an area under the curve of 0.88 (p <0.0001). Sensitivity, specificity, NPV and PPV are indicated in relation to the degree of RAS, as well as the diagnostic yield of the method, which is valuable in patients older than 50years. Conclusion: Due to its extremely high sensitivity and NPV, the ACS is a very useful screening method for RAS. The validity of the method, as well as its diagnostic value is equivalent to that of coronary artery calcium scoring. Lack of calcifications of the aorta renders atherosclerotic RAS highly improbable. [Copyright &y& Elsevier]

Objectives: We evaluated whether real-time 3D ultrasound (4D-US) together with clinical evaluation is an alternative to voiding cystourethrography (VCUG) after endoscopic treatment of vesicoureteral reflux (VUR) in children at postoperative follow-up. Material and Methods: We reviewed 178 children who underwent endoscopic therapy with dextranomer/hyaluronic acid copolymer in grade II or III VUR between 2002 and 2005. 4D-US was performed in all patients 1 day and 3, 9 and 18 months after endoscopic therapy. Only children with postoperative urinary tract infections (UTIs) and/or nonorthotopic position of the bulking agent were referred for VCUG. Results: In 93% of the ureteral units, the depot could be detected in the orthotopic position after 3, 9 and 18 months. None of these children developed UTIs in the postoperative follow-up. Twelve children demonstrated a shifting of the depot, indicating a possible therapy failure. Eight of these 12 patients (66.7%) presented a positive VCUG, and 50% of them sustained UTIs. Conclusions: 4D-US seems to be a sufficient protocol in the follow-up of children after endoscopic treatment of low-grade VUR. VCUG should be performed in cases of a shifted position of the depot; invasive investigations are unnecessary in asymptomatic children with orthotopic bulk. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Unilateral renal agenesis with an absence of the seminal vesicle, epididymis and ductus deferens is rare and is the result of a developmental disorder of the mesonephric or Wolffian duct. We report the case of a 22-year-old man who presented with testicular pain on the left side of 3 weeks' duration. During the clinical investigation of the scrotum a nonpalpable ductus deferens on the left side was found incidentally. As a result of the urological ultrasound the diagnosis of renal, epididymal, seminal vesicle and ductus deferens agenesis on the left was confirmed. As a vascular variety the CT demonstrated 2 renal veins and 2 renal arteries on the right originating from the superior mesenteric artery together with the right hepatic artery. The testicular artery was placed on both sides. Further diagnostic investigations including a spermiogram, hormone analysis and kidney function tests were normal. Congenital urogenital malformations can be found in various combinations even in adults. Unilateral absence of the vas deferens during clinical examination should alert the clinician to an underlying renal, seminal vesicle and epididymal anomaly; further urological investigation is mandatory. A genetic investigation of the CFTR gene is not necessary in the absence of both ductus deferentes with renal agenesis. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Study Type - Diagnosis (exploratory cohort) Level of Evidence 2b OBJECTIVE To correlate a subjective blood-flow rating scale from contrast-enhanced colour Doppler (CECD) transrectal ultrasonography-targeted prostate biopsy with the histopathological outcome of the biopsy. PATIENTS AND METHODS In all, 760 men with a serum total prostate-specific antigen (PSA) level of ≥1.25 ng/mL and a free-to-total PSA ratio of <18% were included. CECD-targeted biopsies with five cores were taken only in hypervascular areas of the peripheral zone using a second-generation ultrasonography contrast agent, followed by a 10-core systematic biopsy. Prostate blood flow was scored using a subjective 5-point scale in which 1 indicated 'benign', 2 'probably benign', 3 'indeterminate', 4 'probably malignant' and 5 'malignant'. RESULTS Overall 37% (283 of 760) patients had prostate cancer in the biopsy. All 100 patients with a score of 5 had cancer; 153 had a score of 4, of whom 130 (85%) had cancer and 23 had benign histology (15%); 131 had a score of 3, of whom 34 (26%) had cancer and 97 (74%) had benign histology; 284 had a score of 2, of whom 17 (6%) had cancer and 267 (94%) had benign histology; 92 had a score of 1, of whom two (2%) had cancer and 90 (98%) had benign tissue. Statistical evaluation showed that the subjective blood-flow rating scale correlated strongly and significantly ( r= 0.75, P < 0.01) with the histopathological outcome of the biopsy. CONCLUSION The present study shows that a subjective CECD blood-flow rating scale is a reliable tool to predict the pathological outcome of biopsy cores. [ABSTRACT FROM AUTHOR]

Abstract: The treatment of patients presenting with severe symptoms of obstruction due to benign prostatic hyperplasia and a history of previous surgery for long urethral stricture is still a matter of discussion. We report on 3 patients in whom resection of the prostate was performed using a dilated cystostomy approach under spinal anesthesia. All men had undergone dorsal onlay urethroplasty for long urethral stricture before prostate resection. The good outcome demonstrated the feasibility and safety of prostate resection using a suprapubic approach, which may become a treatment option in this group of patients. [Copyright &y& Elsevier]

OBJECTIVE To analyse the morphological appearance of horseshoe kidneys (HKs) and crossed fused ectopia (CFE) and to assess the frequency and clinical significance of associated anomalies and diseases. PATIENTS AND METHODS The findings and images of 209 patients with fused kidneys (FKs) were reviewed; in all, 244 scans from computed tomography (CT), 233 ultrasonograms and 89 micturition cysto-urethrograms, urograms, magnetic resonance images and angiograms were taken. RESULTS HKs (found in one of 474 abdominal CT scans) and CFEs (found in one of 3078 CT scans) showed a high variability of vasculature that could not be classified. However, some generalized conclusions were possible about the renal vasculature (430 arteries in 103 kidneys). Variants of the most cephalad artery of both sides were rare. The second artery on the right had a pre-caval course. The origins of vessels located further caudal were more ventral. CFEs were anatomically different from HKs with respect to lower position, greater axial rotation, smaller pelvic width, more caudal origin, and fewer vessels, but not in accompanying anomalies. Severe anomalies or malformations were found in 23% of patients, with half of them in the urogenital system. Malformations were found considerably more often in children than in adults. There was no increased incidence of diseases such as stones or inflammation of the renal pelvis. CONCLUSION Concomitant anomalies and diseases were equally frequent for HK and CFE, but less frequent than generally assumed. Individual cases of complex anatomical situations require special examination strategies, and CT appears to be the most reliable imaging method. [ABSTRACT FROM AUTHOR]

Abstract: Context: The intraprostatic injection of botulinum neurotoxin type A (BoNT-A) is a minimally invasive but still-experimental treatment of lower urinary tract symptoms (LUTS) due to benign prostatic enlargment (BPE) based on an off-label use of the drug. Objective: Report the mechanisms of action of BoNT-A on the prostate as well as the efficacy and safety of intraprostatic BoNT-A injection according to various injection protocols. Evidence acquisition: We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE) database and the abstract volumes of the 2005, 2006, and 2007 European Association of Urology (EAU), American Urological Association (AUA) and International Continence Society (ICS) meetings for studies on intraprostatic BoNT-A injection. Evidence synthesis: Five experimental studies and 10 clinical studies were found. The level of evidence is 1b for one study and 3 for the other studies, with grades of recommendation of A and C, respectively. The experimental studies report induced relaxation of the prostate, atrophy, and reduction of its size through inhibition of the trophic effect of the autonomic system on the prostate gland. In the clinical studies, all patients had LUTS due to BPE and prostate volume varied from <20ml to >80ml. The dose varied from 100U to 300U of Botox®. The injection was performed transperineally, transrectally, or transurethrally under general, local, or without anesthesia. The follow-up period ranged from 3 mo to 19.8 mo. All studies reported an improvement of maximum urinary flow rate, quality-of-life index and reduction of International Prostate Symptoms Score, prostate-specific antigen (PSA) level, post-void residual volume, and prostate volume. Local or systemic side effects were rare. Only patients with retention needed a urethral drainage catheter. Conclusions: BoNT-A intraprostatic injection provides improvement in patients with LUTS due to BPE refractory to medical treatment. However, there is a need for large placebo controlled-studies and long-term results. So far the therapy is still experimental. [Copyright &y& Elsevier]

Authors from Austria present their 1-year follow-up of 117 patients with stress urinary incontinence treated with autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. This detailed study shows that such a procedure is highly effective and safe for treating this condition. OBJECTIVES To investigate the influence of intravesical potassium on pelvic floor activity (PFA) during voiding in women with recurrent urinary tract infections (rUTIs) by using comparative urodynamics (CUD). PATIENTS AND METHODS CUD was conducted in 49 women (mean age 34.6 years, range 15–82) with rUTI. Every patient had two sessions of pressure-flow studies with simultaneous measurement of PFA by perineal surface electromyography (EMG); the first was with 0.9% saline and in the second the bladder was filled with 0.2m KCl solution. All patients had voiding cysto-urethrography, and dysfunctional voiding (DV) was diagnosed when significant PFA was measured by EMG during voiding. RESULTS Overall, DV was diagnosed in 37 patients (76%) using CUD; 16 (32%) had DV with saline on the pelvic floor EMG. In all these patients there were significantly greater EMG signals in the presence of KCL. In 21 patients (43%) DV was only detected using KCL; this improvement in the detection rate of DV was statistically significant ( P = 0.006). Filling with KCl also prompted a statistically significant difference ( P < 0.05) in maximum bladder capacity, maximum and average flow rates and in postvoid residual urine volume. CONCLUSION The present data show that DV is present in most women with rUTI but cannot sufficiently be diagnosed by conventional urodynamics with standard 0.9% saline. The present study suggests that CUD might enhance the detection rates of DV. [ABSTRACT FROM AUTHOR]

OBJECTIVES To assess the influence of intravesical potassium on pelvic floor activity (PFA) during voiding in women with symptoms of overactive bladder (OAB), by using comparative urodynamics (CUD). PATIENTS AND METHODS The study included 175 women who met the criteria of OAB (mean age 52.7 years, range 18–87). CUD included two sessions of pressure-flow studies (0.9% saline vs 0.2m KCl) with simultaneous measurement of PFA using perineal electromyography (EMG) with surface electrodes. Dysfunctional voiding (DV) was diagnosed if significant PFA was measured by EMG during voiding. RESULTS In 44 patients (25%) there was increased EMG activity only in the presence of KCL; in 58 (33%) there was DV with increased PFA during filling with saline. In all these patients PFA was significantly greater in the presence of KCl ( P < 0.001). In patients with DV, filling with KCl prompted a statistically significant difference in maximum bladder capacity, maximum flow rate, mean flow rate and postvoid residual urine volume ( P < 0.05). In summary, 102 patients (58%) had DV. CONCLUSION These findings suggest that DV is associated with epithelial dysfunction of the bladder mucosa, which clinically leads to OAB syndrome and can be revealed by CUD. The detection of DV might elude conventional urodynamics, but can be significantly enhanced by CUD (0.9% saline vs 0.2m KCl). [ABSTRACT FROM AUTHOR]

Objective: To determine if there are areas of major and minor perfusion in a single testicle, and if the quality and quantity of sperm are correlated with the level of perfusion, we collected testicular tissue from areas with different levels of perfusion. Design: Controlled clinical study. Setting: Consecutive patients with azoospermia. Patient(s): Patients with azoospermia undergoing testicular sperm extraction (TESE) biopsy for the retrieval of sperm to be used in an assisted reproduction program. Intervention(s): Perfusion mapping was performed with the use of color Doppler ultrasound. Areas with different levels of perfusion were marked with needles. After incision with radiofrequency cutting, the exposed tissue was examined with a laser Doppler flowmeter, and biopsies were taken for TESE and histology. Sperm were analyzed using World Health Organization criteria, and prepared for intracytoplasmic sperm injection (ICSI). Main Outcome Measure(s): Correlation of sperm quality and quantity in testicular-tissue biopsies, with tissue-perfusion units (TPU) measured by laser Doppler flowmeter. Result(s): From 40 biopsies taken from 20 testicles of 12 patients, tissue was analyzed for sperm quality and quantity. Sperm quality was highest in areas of high tissue perfusion. In areas of 70 TPU, 72.3% progressive sperm were detected, whereas in areas of 10 TPU, only 13.3% progressive sperm and elevated numbers of precursor cells could be observed. The number of motile sperm isolated from tissue samples correlated well with the intensity of tissue perfusion. Conclusion(s): We have shown for the first time that in patients suffering from azoospermia, sperm quality and quantity depend on tissue perfusion within the testicle. [Copyright &y& Elsevier]

Abstract: Objectives: The present retrospective study was designed to investigate the value of transition zone (TZ) biopsies for prostate cancer (PC) detection rate in a combined contrast enhanced color Doppler targeted (CECD) and gray-scale systematic biopsy (SB) approach. Methods: PSA screening participants totalling 1475 with tPSA of >1.25ng/ml (fPSA≤18%) were assessed. Ten SB and additionally 5 or fewer CECD were performed. The impact of TZ biopsies on the PC detection rate and the biological significance of the detected TZ-cancers were analyzed. Results: Out of 1475 biopsied patients, 395 (26.8%) were identified as PC patients; 5925 biopsy cores from these patients were analyzed. In 86 patients (21.8% of PC), we found 102 PC- positive cores in the TZ, and only in 9 of them solitary TZ-cancers without any other PC-location (2.3% of PC or 0.6% of all investigated patients). Pathologic findings after retropubic prostatectomy (RPE) revealed multifocal adenocarcinoma including involved peripheral zone (PZ) in eight of these nine patients, and solitary TZ-cancer in one patient. There was no positive correlation between prostate volume and TZ-detection rate and no patient with solitary TZ-PC after rebiopsy. Conclusion: Biopsy revealed 9 solitary TZ cancers (1.8%) and RPE revealed only one of them to be truly TZ-confined cancer (0.6%). Furthermore PC-detection did not improve, even in patients with rebiopsy, and there was no correlation between detection of TZ-cancers and prostate volume. A combined use of CECD and SB to investigate participants of a PSA-screening program suggests that TZ-biopsies do not improve PC detection rate and are therefore unnecessary. [Copyright &y& Elsevier]

OBJECTIVE To evaluate the prostate cancer detection rate at low total prostate-specific antigen (tPSA) ranges of 2.6–4 and 4.1–10 ng/mL, according to different percentage free (f/t) PSA levels in a screening population. SUBJECTS AND METHODS In all, 1809 consecutive screening volunteers with a tPSA level of 2.6–10.0 ng/mL were assessed. Ten systematic ultrasonography-guided prostate biopsies and, since 2000, an additional five Doppler-enhanced targeted biopsies were taken on the basis of age-specific tPSA reference ranges. We analysed the detection rate of prostate cancer according to f/tPSA ranges of 0–9%, 10–14%, 15–18% and >18%. RESULTS The detection rates for the subgroups with tPSA levels of 2.6–4.0 and 4.1–10.0 ng/mL were 20.2% and 27.0%, respectively. The cancer detection rate in the first group (2.6–4.0 ng/mL) at 0–10% fPSA was 22.9%, and that in the second group (4.1–10.0 ng/mL) at 0–10% was 36.9%. There were significant differences between these groups. If the f/tPSA was 10–15%, the cancer detection rate for the two groups were 22.6% and 32.5%, respectively ( P < 0.05). There was no statistically significant difference in the cancer detecting rates at an f/tPSA of 15–18% or >18%. CONCLUSION There is a statistically significantly higher cancer detection rate when the f/tPSA is <15% than in groups of men with a f/tPSA of >15% in screening population assessed primarily using tPSA level. [ABSTRACT FROM AUTHOR]

Abstract: Background:: Previous studies have demonstrated the efficacy of local application of estrogen in treating postmenopausal women with recurrent urinary tract infections (RUTI) and urinary incontinence. Younger women under oral contraceptives (OC) can suffer from similar symptoms. The aim of this pilot study was to evaluate the effectiveness of local estrogens on RUTI and the impact of local hormonal supplementation on bladder neck vascularization. Methods:: 30 women (mean age 22.7 years) with a longstanding history of RUTI were included. Pre-treatment investigation included complete clinical history, urinalysis, urine culture and cystoscopy. All subjects completed a questionnaire about onset and duration of disease and quality of life before and after treatment. Local (vaginal) estrogen therapy consisted of 1mg estriol (E3) 7 times a week for two weeks and twice a week for two additional weeks. Sonographic examination of bladder vascularization was performed before and after treatment using transperineal color Doppler ultrasound (6MHz, Acuson Sequoia 512, Mountain View, CA, USA) with a filled bladder. After angle correction, peak systolic blood flow velocity (PSBFV) and end diastolic blood flow velocity (EDBFV) were measured in 2 bladder arteries; and the Resistive Index (RI) was calculated. Flow velocity in each vessel was measured at least four times and the mean value determined. Results:: All patients completed the therapy course without severe side effects. Patients had a mean history of RUTI over 2.3 years; the mean period under OC was 3.2 years. In the follow-up period of 11 months after treatment, 24/30 patients reported no symptoms of cystitis and used no additional medication. Normal bladder epithelium in control cystoscopy after E3 therapy was seen in all patients with trigonal metaplasia and vulnerable, highly vascularized urothelium at the initial investigation. RI decreased from 0.945 to 0.705 after treatment (p<0.001), concomitantly the mean EDBFV increased highly significantly from 0.82cm/sec to 4.45cm/sec after estrogen treatment (p<0.001). Interpretation:: In a majority of young patients under OC and a longstanding history of RUTI, a considerable infection-free period was achieved after local application of estrogen. Decreased RI and increased EDBFV indicate vasodilatation and less peripheral vascular resistance. Responsiveness to local E3 may correspond to improved cystoscopic findings as a consequence of increased bladder perfusion. [Copyright &y& Elsevier]

Study Type – Diagnosis (case series) Level of Evidence 4 OBJECTIVE To compare the results of contrast-enhanced colour Doppler (CECD)-targeted prostate biopsy with a systematic 10-core grey-scale biopsy scheme in patients initially diagnosed with high-grade prostatic intraepithelial neoplasia (HGPIN), as although HGPIN is thought to be a precursor to invasive adenocarcinoma, its diagnosis is no longer considered an indication for repeat prostate biopsy and patients should be followed by prostate-specific antigen levels and a digital rectal examination. PATIENTS AND METHODS In all, 104 patients (aged 45–78 years) diagnosed with HGPIN on initial prostate needle biopsy were referred for a repeat biopsy within 6 months. Two independent examiners evaluated each patient; one used CECD-targeted biopsy (up to five cores) into hypervascular regions in the peripheral zone only, and subsequently the second took a systematic 10-core grey-scale biopsy. Cancer detection rates of both techniques were compared. RESULTS Overall, 26 of the 104 men (25%) had prostate cancer in the repeated biopsy. Using the CECD technique cancer was detected in 21% (22 of 104). The positive re-biopsy rate using the systematic technique was 9.6% (10 of 104; P < 0.001). The total incidence of HGPIN with no evidence of tumour on re-biopsy was 8.7% (nine of 104). The Gleason score in all 22 cancers detected with the CECD technique varied between 6 and 8. The systematic technique detected cancers with Gleason scores of 6 or 7. There were no adverse events or complications. CONCLUSION CECD increased the detection rate of prostate cancer, and using fewer biopsy cores than the systematic biopsy technique in patients previously diagnosed with HGPIN. [ABSTRACT FROM AUTHOR]

Female epispadias without exstrophy is a very rare entity. Symptoms of female epispadias are primary urinary incontinence and anatomical abnormal features. A 24-year-old married women with two children presented with primary urinary incontinence. Due to previous failure of correct diagnosis and ineffective medical treatment, the patient developed psychological problems (anxiety and depression). In the presence of minimal rhabdosphincter function we could achieve socially acceptable urinary continence by bladder neck plication and a Burch colposuspension. The patient did not consent to a major reconstruction. [ABSTRACT FROM AUTHOR]