Search

While there has been widespread recent interest in men's health issues, and prostate cancer in particular, there have been few studies to determine which issues are important from the viewpoint of men themselves. This study was undertaken to identify genitourinary issues of concern to older men. A series of 19 focus groups involved 137 men and 14 women from a broad demographic background. Men expressed consistent concern about urinary symptoms, prostate cancer and sexual function. They revealed misunderstanding and a desire for more information about all issues. Urinary symptoms had a high impact on quality of life that could be made worse by environmental constraints such as working conditions and availability of toilets. Prostate cancer was a concern in all groups, even those at low risk, and men believed that screening for prostate cancer should be offered. Men believed sexuality was not recognised as an issue of concern to older people. Potential barriers to health action included stoicism, not talking about health issues and poor relationships with doctors. The study suggests a substantial need for community and professional education and for health promotion focused on preventable morbidity.

A randomized, double-blind, placebo-controlled clinical trial was conducted to determine the effects of a low-dose (< 2 times the Recommended Dietary Allowance) micronutrient supplement containing trace minerals (zinc and selenium) and/or vitamins/provitamins (vitamin C, alpha-tocopherol, and beta-carotene) on the incidence of respiratory and urogenital infections in institutionalized elderly. After 2 years, there was a significant decrease in the mean number of infections in elders given trace elements (p < 0.01) but not vitamins.

Purpose: We sought to determine whether the neonatal institution of treatment of neurogenic bladder dysfunction in myelomeningocele patients at high risk for urinary tract deterioration improves renal and bladder outcome., Materials and Methods: We reviewed the records of patients with bladder dysfunction believed to be at high risk for renal deterioration based on urodynamic studies. All patients were treated with clean intermittent catheterization. We compared rates of urinary infection, hydronephrosis, reflux, continence and surgical intervention in 46 patients in whom treatment was started in year 1 of life and 52 treated after age 4 years., Results: Renal outcome was similar in both groups with persistent hydronephrosis in 6 of 46 patients (13%) and 7 of 52 (14%), respectively. However, significantly fewer bladder augmentation procedures were required in patients started on treatment during year 1 of life (5 of 46, 11% versus 14 of 52, 27%, p < 0.05)., Conclusions: In addition to any psychological benefit, early intervention with clean intermittent catheterization in children with neurogenic bladder dysfunction may help to prevent irreversible bladder dysfunction and limit the need for bladder augmentation.

Urinary tract malformations have a 1-2% incidence. An early diagnosis of these defects allows to realize as fast as possible the best medical and/or surgical treatment, preventing or at least slowing down the evolution toward chronic renal failure. Urinary tract malformations are particularly suitable for a "prevention" program due to their elevated incidence, to the "silent period" preceding complications and to the therapeutic possibilities strictly related to an early diagnosis. Ultrasound screening can easily identify congenital urinary tract abnormalities, especially obstructive ones, but unfortunately almost half of the cases escape even the most expert "eye". It is necessary a complete check-up right after birth. We tried to compare the method and the results of prenatal screening with the postnatal one, already used in many hospitals. We believe, even following our experience, that the screening for urinary tract malformations of all the neonatal population is a goal to pursue and achieve as soon as possible for its high sensitivity and specificity.

The objective in the Hungarian randomised double-blind controlled trial was to study the preventive effect of periconceptional multivitamin supplementation on neural tube-defects and other congenital abnormalities. There were 2,471 and 2,391 informative offspring (prenatally diagnosed and terminated malformed fetuses, stillborn fetuses, and liveborn infants) in the multivitamin and placebo-like trace element groups, respectively. A single tablet either of a multivitamin containing 0.8 mg of folic acid or trace element supplement was given daily for at least one month before conception and at least until the date of the second missed menstrual period. The total rate of major congenital abnormalities was 20.6/1,000 in the multivitamin and 40.6/1,000 in the trace element group. After the exclusion of six cases of neural-tube defects in the trace element group the difference was very highly significant [P = 0.0003; relative risk of 0.54 (95% CI 0.39, 0.76)]. Multivitamin supplementation appeared to result in a significant reduction in the rate of urinary tract abnormalities, mainly obstructive defects, and in the rate of sporadic cardiovascular malformations, mainly ventricular septal defects. This report is regarded as a hypothesis-generating study encouraging others to see if the result can be repeated.

Objectives: To determine: (1) the incidence in newborns of both significant urinary anomalies and mild hydronephrosis; (2) the degree of inaccuracy of prenatal sonography in our area, and (3) the evolution of neonatal hydronephrosis., Methods: Using ultrasound, we examined 4,130 consecutive newborns, of which only 12 had a positive prenatal sonography. We distinguished 2 grades of hydronephrosis: mild (pelvic diameter between 5 and 15 mm), and significant (pelvic diameter > 15 mm)., Results: In the 'normal' newborns (with negative prenatal sonography), we found 0.9% significant urinary anomalies and 5.2% mild hydronephroses. Mild hydronephroses improved or disappeared spontaneously in 82% of the cases. 50% with significant dilatation required surgical correction., Conclusions: Neonatal ultrasound screening is essential for the early detection of uropathies missed on prenatal examination. The majority of mild hydronephroses detected in the newborn improve or disappear spontaneously. We hypothesize a relationship between the degree of dilatation, obstruction and evolution.

Purpose: Urinary tract management in children with myelodysplasia is controversial. Some advocate observation alone, while others believe that the prophylactic institution of intermittent catheterization and anticholinergic therapy may help to prevent deterioration., Materials and Methods: A nonrandomized prospective study was instituted to compare the urological outcomes of a cohort of children who were at risk for urological deterioration on the basis of bladder-sphincter dyssynergia and/or high filling or voiding pressures. Those at risk were observed until deterioration occurred, or were placed on prophylactic intermittent catheterization with or without anticholinergic medication., Results: Of 44 children at risk 35 followed by observation alone had urinary tract deterioration, whereas only 3 of 20 at risk treated with prophylactic intermittent catheterization had deterioration with time., Conclusions: Proactive bladder treatment significantly reduced the incidence of upper urinary tract deterioration and need for surgical intervention.

To study the relation of maternal periconceptional vitamin use to the risk of a congenital urinary tract anomaly (CUTA), we conducted a case-control study using the Washington State Birth Defect Registry. We identified CUTA cases with no known chromosomal abnormality in seven counties in western Washington State occurring between January 1, 1990, and December 31, 1991. We randomly selected a sample, as controls, of all infants delivered in five large hospitals in King County who did not have a birth defect and who were born in the same year as the cases. About 55% of all infants in King County and a smaller proportion of infants in the other six counties are delivered in these five hospitals. We interviewed mothers of 118 cases and 369 controls to obtain information about their vitamin use during the pregnancy and during the year before the conception. After adjustment for maternal race, family income, county of maternal residence, and birth year, we found that women who used multivitamins during the first trimester had only 15% the risk of bearing a child with a CUTA compared with women who did not take vitamins [odds ratio (OR) = 0.15; 95% confidence interval (CI) = 0.05-0.43]. The reduction was smaller for use restricted to the second or third trimesters (OR = 0.31; 95% CI = 0.09-1.02). Among women who used vitamins during the first trimester, vitamin use before conception was not associated with any further reduction in the risk, nor did there appear to be an association with the amount or brand of vitamin used.(ABSTRACT TRUNCATED AT 250 WORDS)

We assessed the ability of reagent strip screening to predict the finding of blood cells and bacteria using an automated urinalysis workstation (The Yellow IRIS, International Remote Imaging Systems, Chatsworth, Calif) in 427 specimens submitted for urine culture. The sensitivities of leukocyte esterase, hemoglobin, and nitrite detection on reagent strips were 71.9%, 70.8%, and 56.7%, respectively, at 5 or more white blood cells per high-power field, at 3 or more red blood cells per high-power field and bacteria observed using the IRIS. Screening results for leukocyte esterase associated with negative results using the IRIS for white blood cells represented mostly false-positive screening test results based on chart review. Positive screening test results for hemoglobin associated with negative results obtained with the IRIS for red blood cells consisted of equal numbers of false-positive screening test results and IRIS test results based on chart review. A common screening algorithm using a combination of these three reagent strip variables exhibited a false-negative rate of 30.1%: review of medical records found clinical evidence of urinary tract infection in 14 patients and genitourinary or renal disease or hypertension in another 13 patients. Adding more variables to the algorithm increases the sensitivity and decreases the specificity. Both microscopic examination and reagent strip testing of urine are necessary for the detection of abnormalities associated with disease.

Surgical complications of renal transplantation, rejection and infectious diseases are factors contributing to poor renal graft survival. Factors directly concerning the donor can be involved in graft failure: age, medical history, causes of donor brain death. Urologic or arterial anatomic variations are often the source of difficult surgical conditions during renal transplantation. Technical errors during graft procurement must be avoided such as excess of traction or coagulation. Failure in perfusion preservation. As few renal grafts are available, it is thus essential to obtain optimal conditions to avoid failure in cadaver donor graft linked to technical errors during organ procurement.

Ifosfamide is a cyclophosphamide analogue synthesized in the 1960s with antineoplastic activity demonstrated in early broad-ranging phase I studies conducted in Germany in the 1970s. Because of significant urothelial toxicity, phase II studies in ovarian cancer in this country were delayed until the urinary epithelial protector mesna became available in 1985. Since that time, two well-executed prospective trials have shown that this agent produces measurable responses in about 20% of women with ovarian epithelial cancer recurring after primary chemotherapy and in 12% of those with tumors refractory to first-line therapy with regimens including cisplatin. Toxicity includes moderate to severe hematologic toxicity, renal dysfunction which is usually reversible, and CNS abnormalities including lethargy, somnolence, and disorientation. The risk of toxicity may be increased in patients with compromised hepatic or renal function and in those with hydronephrosis or hypoalbuminemia.

The response of ifosfamide-based chemotherapeutic regimens was retrospectively analyzed in adult patients with advanced soft-tissue sarcoma who were treated at the West German Tumor Center, Essen, between 1978 and 1990. Single-agent ifosfamide was given either in split doses of 60-80 mg/kg by 4-h infusion over 5 days or as a continuous 24-h infusion of 5 g/m2. Ifosfamide was given either in split doses of 40-50 mg/kg over 5 days or as a continuous infusion of 5 g/m2 in combination with doxorubicin (40-60 mg/m2, day 1), cisplatin (20 mg/m2, days 1-5), or etoposide (100 mg/m2, days 1, 3, and 5). Mesna was given to all patients as prophylaxis against urotoxicity. Of 54 evaluable patients receiving single-agent ifosfamide, 5 achieved a complete response (CR) and 10 showed a partial response (PR), for an overall response rate of 28%. Objective responses were more frequent in previously untreated patients (47%) than in pretreated patients (15%; P < 0.01). The addition of doxorubicin (n = 41) or cisplatin (n = 29) to ifosfamide did not significantly increase the response rate (29% and 41%, respectively) or median duration of remission as compared with ifosfamide alone. In addition, no significant difference was observed between the two ifosfamide regimens used: the 24-h continuous-infusion schedule (5 g/m2 per course, 27% response rate) and the 5-day fractionated regimen (10-15 g/m2 per course, 19% response rate). We conclude that the response and the median duration of remission produced by single-agent ifosfamide compare favorably with the results achieved using single-agent doxorubicin and the usually more toxic combination regimens.

Two trials using ifosfamide-based combination chemotherapy for advanced soft-tissue sarcoma have been completed. In the first study, 50 evaluable patients received ifosfamide (5 g/m2) with mesna (5 g/m2) and doxorubicin (40 or 60 mg/m2) intravenously (i.v.) every 3 weeks. In all, 11 patients (22%) achieved an objective response [3 complete responses (CRs) and 8 partial responses (PRs)]. Toxicities included leukopenia, febrile neutropenia, nausea and vomiting, and alopecia. The overall median survival was 12 months. In the second study, 51 evaluable patients received ifosfamide (3 g/m2) with mesna (3 g/m2), both being given i.v. on day 1, together with etoposide (100 mg/m2) infused i.v. daily for 3 days. Six patients (12%) achieved objective responses (1 CR, 5 PRs). Toxicities included leukopenia, nausea and vomiting, and alopecia. The overall median survival was 7.4 months. Neither of these combination regimens appears to be more effective in advanced soft-tissue sarcoma than single-agent therapy with either ifosfamide or doxorubicin. If the results of chemotherapy in the management of these tumors are to be improved a new approach to therapy is clearly required.

We have received 147 patients with an antenatal diagnosis of uropathy confirmed after birth. Surgery during the first 3 months of life was necessary for 78 (54%) of them. The procedures included partial or total exeresis of the kidney in 9 cases, and reconstruction of the excretory pathway in 69 (88%). The renal function is normal in all cases, and one failure of surgery only was noted. Four children with pelviureteral obstruction had infections in spite of the antenatal screening, as did one child with reflux. One child remained with a postoperative urinary infection, which can be attributed to contralateral reflux. In surgery of the renal pelvis, as well as in the reimplantation of thin ureters, no tube was left in place, thus reducing the stay in hospital and the risk of post-operative infection. The children were admitted to hospital with their mothers in 95% of all cases.

One-year screening of urological diseases in preschool and schoolboys under 17 years of age identified relevant affections in 264 (10.13%) of the examinees. Phimosis and varicocele were the most frequent findings. Urological examinations of 3-, 7- and 14-year-old boys are suggested to be included into routine prophylactic check-ups.

Sickle cell disease (SCD) is an inherited, chronic, painful condition seen primarily in blacks and populations from the Mediterranean and Caribbean areas. The crescent or sickle shaped red blood cells have a shorter lifespan causing severe anemia; they are sticky and easily clump together causing intravascular occlusions which eventually damage vital organs. Providing nursing care for patients with sickle cell disease can be very challenging because of the chronic nature of the illness. Understanding the disease phenomena can facilitate nursing assessments and help nurses individualize care for these clients.

During a 3-year period, 93 prenatal diagnoses of kidney or urinary tract abnormalities were carried out in the French district of Puy-de-Dôme. Sixty-nine mothers were resident in this area giving an incidence of 2.8 out of 1000 births. The pregnancy was interrupted in 10 cases, there were 2 stillbirths and three infants died within two months of life. The most frequent abnormalities were: hydronephrosis (48% of cases), megaureter with or without ureter duplication (19%) and multicystic dysplasia (16%). The prenatal diagnosis was confirmed after birth in 82% of cases. Of the 56 infants with obstructive uropathies, 17 underwent a pyeloplasty within three months of life, 32 had conservative treatment, of whom 4 were operated on afterwards, and seven could not be traced. Of the seven infants who had normal ultrasound scan at birth, three had abnormal scan during the follow-up one of whom was operated on. Nephrectomy was not performed in any of the 11 cases of multicystic dysplasia: one patient was lost to follow up, three had stable lesions and in seven cases, the size of the cysts decreased.

In a 10 year series of 350 consecutive renal transplant operations, the overall urological complication rate was 7.7%. During this period double J stents were introduced and were used either in the treatment of actual urological complications or as a prophylactic measure to protect ureters which had been damaged at retrieval. A total of 34 double J stents were used in 33 patients. The indications were: ureteric obstruction (n = 13), urinary leak (n = 5), short transplant ureter anastomosed using an extravesical ureteroneocystostomy (n = 10) and ureteric injury at the time of organ retrieval (n = 6). Thirty-two double J stents were inserted at open operation and two were inserted by an antegrade method after percutaneous nephrostomy. Improvement in renal function occurred in 16 out of the 18 cases of urological complications. No kidneys were lost and there were no deaths as a direct result of these complications. In a number of cases the insertion of a double J stent was the only treatment, thus eliminating the need for more complex surgery. All 16 patients who had a ureteric stent inserted as a prophylactic measure at the time of transplantation made uncomplicated postoperative recoveries. Urinary tract infection was relatively common (27%) after double J stent insertion, but other complications were rare. In conclusion, double J stents have proved to be a useful adjunct in the management of renal transplant related urological complications.

In order to evaluate the preventive efficacy, safety and usefulness of mesna (Sodium 2-mercaptoethane sulfonate) against ifosfamide-induced urinary disorders, a placebo-controlled double-blind comparative study was performed. Ifosfamide was administered by intravenous drip infusion at a daily dose of 2 g/m2 for 5 consecutive days, and mesna was intravenously administered at 20% of the ifosfamide dose, three times daily for 5 consecutive days. The results obtained are as follows. (a) Of 101 accrued patients, 91 patients were evaluated consisting of 45 for the mesna group and 46 for the placebo group. There was no intergroup difference in the number of the evaluated cases and patient characteristics. (b) Micturition pain and feeling of residual urine graded as moderate or severe were not observed for the mesna group, but were observed for the placebo group with incidences of 19.6% (9/46) for micturition pain and 15.2% (7/46) for feeling of residual urine; the intergroup differences in the appearance of these urinary symptoms were statistically significant (P = 0.0003 for micturition pain; P = 0.0009 for feeling of residual urine). The incidence of hematuria graded as moderate or severe was 6.7% (3/45) in the mesna group, which was significantly lower than the 32.6% (15/46) in the placebo group (P = 0.0008). (c) No side-effect attributable to mesna was observed. (d) A judgment of "useful" was obtained in 80.0% (36/45) of the patients treated with mesna, which was significantly higher than the 34.8% (16/46) of the patients treated with placebo (P = near 0). On the basis of the above results, we conclude that the preventive efficacy, safety and usefulness of mesna against ifosfamide-induced urinary disorders have been well demonstrated in this study.

From January 1985 to July 1989, 36 children received a renal transplant at our hospital. Their ages ranged from 2 to 18 years. All patients had a standard neoureterocystostomy according to Lich-Grégoir. In the first 18 patients, no transanastomotic stent was placed. In the latter 18, a transanastomotic stent with or without suprapubic bladder drainage was performed. In the nonstented group, six severe urological complications occurred, two of which eventually resulted in loss of the transplant. In the stented group, only one severe urological complication occurred. No kidneys in this group were lost due to urological complications. The number of urinary tract infections in the nonstented group was the same as in the stented group.

Fourteen patients with extensive disease small cell bronchogenic carcinoma (SCBC) received ifosfamide at 2,000 mg/m2/day for 5 consecutive days with simultaneous mesna and vincristine while 26 patients with extensive disease non-small-cell bronchogenic carcinoma (N-SCBC) received the same regimen without vincristine. Eight partial responses (57%) were observed with a 40-week median survival in the case of SCBC and four partial remissions (15%) with a 31-week median survival in N-SCBC. Granulocytopenia was the dose-limiting toxicity, whereas urotoxicity was well controlled with mesna. Neuropsychiatric toxicity consisted of anxiety, agitation, confusion, and hallucination. Neurobehavioral testing detected worsened performance during ifosfamide treatment. Ifosfamide is one of the few active agents in N-SCBC.

A review on the operative methods for prophylaxis of urological complications (fistulas and strictures) due to radical hysterectomy with systemic dissection of lymph nodes is described. The authors recommend the method of T. H. Green as the most effective method. A new method for protection of the ureter with flaps, formed as a "leg" from omentum majus, is proposed. The modification has been used in 20 patients without postoperative complications. The method is recommended in cases, when postoperative stenosis or strictures of the ureters are expected as well as when postoperative irradiation is forthcoming.

We have attempted to address some of the current issues and new trends in the urologic management of SCI patients. Although tremendous progress has been made with these patients, resulting in a significant lowering of renal morbidity and mortality, there is still room for improvement. Newer methods of bladder management and refinements of older techniques are being sought. Progress in treating urinary infections should occur through development of new antibacterials and through improved understanding of host-bacterial interactions. Research into these problems and the general management of the neurologic dysfunction in SCI offers the hope of an even brighter future for these severely disabled patients.

Both the spinal cord physician and the spinal surgeon must be fully cognizant of the alterations of functions in multiple systems of the body caused by a spinal cord injury. Complications can easily arise, particularly within the respiratory, urinary, and integumentary systems. Most are preventable if the medical and nursing staff are sufficiently knowledgeable to anticipate them and if the necessary equipment and facilities are available. Regionalization of care with early referral to a spinal cord injury center has become a cost-effective way to manage these patients. Only if their medical needs are met and complications are prevented will surgery, performed to allow early mobilization, really accomplish the desired result. This update reviews the current medical and surgical points of view concerning diagnosis, fracture classification, spinal stability, reduction and stabilization of the fracture deformity, and spinal canal decompression.

Diseases of urinary organs are quite important from the standpoint of public health as the frequent cause of death, disease, defect, disability, discomfort, dissatisfaction and destitution (7D). From 1979 to 1984, 82,071 persons died from diseases of urinary organs in Japan. Of these 14.4, 11.9 and 8.5% were deaths from cancers of prostate, urinary bladder and kidney, respectively. Mortality from these diseases, is on the increase in recent years. Deaths due to kidney insufficiency, both acute and chronic, are also on the increase. Series of epidemiological studies revealed selected risk factors enhancing the risk of occurrence of each of these diseases, e.g., cigarette smoking and meat intake for bladder cancer, drinking of hard liquor and lesser consumption of green-yellow vegetables for prostatic cancer, lesser consumption of soybean paste soup for chronic nephritis. Obviously these diseases are a heavy burden to the nation, the effective planning and implementation of primary and secondary prevention programs are urgently necessary.

This paper is the report of a dosimetric study of 79 urinary complications after radical radiation treatment (1975-1979) of 624 cervical uterine tumors. Treatment consisted of external irradiation (25 MeV linear accelerator) and intracavitary irradiation (Fletcher-Suit-Delclos applicator). Dosimetric-computerized studies were expressed as the maximum bladder dose on the trigone, as proposed by the I.C.R.U. Bladder doses were actually studied as a function of intracavitary irradiation and intracavitary + external irradiation. The results show a significant difference in patients with and without complications based on the dose reaching the bladder. The relative contribution of external therapy and intracavitary irradiation and their value can serve as one of the primary indicators for predicting complications. These values should be determined before placement of intracavitary sources. We found that the dose to the critical organs cannot be defined as a single number. These results argue in favor of adapting individual patient therapy based on rectal and bladder dosimetry and may be adjustable to all treatment modalities.

Our incidence of urological complications in 860 consecutive renal transplants in 3.4 per cent. A further reduction in incidence is demonstrated in the most recent 250 transplants of this series. Urological complications have been kept to a minimum by strict adherence to certain principles in donor nephrectomy, management of multiple and small arteries, and the technique of graft implantation. When urological complications were suspected early and judicious use of 131I hippurate scintiphotographic techniques has proved to be the most helpful method to evaluate patients. If a urological complication did occur prompt recognition and treatment were responsible for a high rate of graft salvage, low incidence of sepsis and absence of patient mortality.

A 4-stage system of mass screening of population for the detection of renal diseases tested in one of the outpatient clinic zones in Moscow (2013 residents), Thelinograd (7091 residents), and Tselinograd Region, Kazakh SSR (880 residents) was presented. The incidence rates of renal diseases per 1000 examined population in Moscow, Tselinograd and Thelinograd Region, Kazakh SSR, were 12.4 +/- 2.5, 10.4 +/- 1.2, 13.6 +/- 3.9, respectively.

A 24-month study assessed the carcinogenic potential of the nephrotoxic mycotoxin ochratoxin A (OA) in B6C3F1 mice. Three groups of 50 males and 50 females were fed 0.1 or 40 ppm OA in the diet. Obstructive urinary tract disease (mouse urological syndrome [MUS]) accounted for the greatest number of spontaneous deaths in the male mice of control (12/50) and 1 ppm (13/50) dose groups, but the disease was not observed in the males fed 40 ppm OA. The earliest age of onset of clinical signs of MUS was 4 months and the average age of onset was 10.1 months. The first death from MUS was observed at 5 months and average age at death was 12.2 months. The mice were caged in groups of five mice per cage and clustering of cases of MUS was observed. Properties of OA which may be important to its preventive effect include inhibition of growth of gram positive bacteria and the production of polyuria as a result of renal proximal tubular damage.