Tissue engineering in urethral reconstruction

Tissue engineering is an exciting and rapidly evolving technology. In this review, we discuss the recent progress made in the field of urethral reconstruction and consider the clinical implications and further advancement of these endeavours

A consensus statement on when to start clean intermittent self‐catheterization: An untapped resource?

Background Clean intermittent self-catheterisation (CISC or ISC) is used by patients/carers to empty the bladder if needed. Sometimes the urethral lumen leading out of the bladder is blocked; sometimes, the bladder (detrusor) muscle itself or the autonomic motor nerves innervating the bladder are damaged, resulting in a failure of the detrusor muscle to work, leading to a failure of the bladder being able to empty adequately. Prior consensus as to the indications and timing of CISC has yet to be provided. This article aims to provide a multidisciplinary consensus view on this subject. Conclusion It is evident that every patient needs to be considered individually, bearing in mind the symptoms and investigations to be considered. We emphasise the importance of considering the term Bladder Voiding Efficiency (BVE). One group of patients who might find CISC helpful are those with a neurological disorder; these include spinal injury patients, multiple sclerosis, Parkinson's, and a condition called cauda equina. Sometimes bladder problems are treated with anticholinergics, and others may be treated with Botox. These may cause the bladder not to empty at all, which is good for leaks but needs self-catheterisation to empty the bladder. In the past, hospitals used a permanent catheter called an ‘indwelling’ or a ‘suprapubic’ catheter. These can have side effects, including infections, stones, and pain. For CISC, disposable catheters are the best option for patients as they come in different sizes and styles to provide individualised care. In conclusion, we would like hospitals to consider each patient separately and not use a general ‘one-size-fits-all’ bladder function for these patients

Systematic review and metaanalysis of genetic association studies of urinary symptoms and prolapse in women

Peer reviewe

The Impact of Nocturia on Mortality: A Systematic Review and Meta-Analysis

Purpose: Nocturia (waking from sleep at night to void) is a common cause of sleep disruption associated with increased comorbidity and impaired quality of life. However, its impact on mortality remains unclear. We performed a systematic review and meta-analysis to evaluate the association of nocturia with mortality as a prognostic factor and a causal risk factor. Materials and Methods: We searched PubMed (R), Scopus (R), CINAHL (R) (Cumulative Index of Nursing and Allied Health Literature) and major conference abstracts up to December 31, 2018. Random effects meta-analyses were done to address the adjusted RR of mortality in people with nocturia. Metaregression was performed to explore potential determinants of heterogeneity, including the risk of bias. We applied the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) framework to rate the quality of evidence for nocturia as a prognostic risk factor for mortality and separately as a cause of mortality. Results: Of the 5,230 identified reports 11 observational studies proved eligible for inclusion. To assess nocturia 10 studies used symptom questionnaires and 1 used frequency-volume charts. Nocturia was defined as 2 or more episodes per night in 6 studies (55%) and as 3 or more episodes per night in 5 (45%). Pooled estimates demonstrated a RR of 1.27 (95% CI 1.16-1.40, I-2=48%) with an absolute 1.6% and 4.0% 5-year mortality difference in individuals 60 and 75 years old, respectively. The pooled estimates of relative risk did not differ significantly across varying age, gender, followup, nocturia case definition, risk of bias or study region. We rated the quality of evidence for nocturia as a prognostic factor as moderate and as a cause of mortality as very low. Conclusions: Nocturia is probably associated with an approximately 1.3-fold increased risk of death.Peer reviewe

Yövirtsaamisen ennuste – meta-analyysista tukea päätöksentekoon

Incidence and remission of nocturia: a systematic review and meta-analysis Eur Urol, julkaistu verkossa 19.2.201

Back to Analogue: Self-Reporting for Parkinson’s Disease.

We report the process used to create artefacts for self-reporting Parkinson's Disease symptoms. Our premise was that a technology-based approach would provide participants with an effective, flexible, and resilient technique. After testing four prototypes using Bluetooth, NFC, and a microcontroller we accomplished almost full compliance and high acceptance using a paper diary to track day-to-day fluctuations over 49 days. This diary is tailored to each patient's condition, does not require any handwriting, allows for implicit reminders, provides recording flexibility, and its answers can be encoded automatically. We share five design implications for future Parkinson's self-reporting artefacts: reduce participant completion demand, design to offset the effect of tremor on input, enable implicit reminders, design for positive and negative consequences of increased awareness of symptoms, and consider the effects of handwritten notes in compliance, encoding burden, and data quality

Croatia at the International Exhibition of Children\u27s Drawings in Beijing

Context Although family studies have shown that male lower urinary tract symptoms (LUTS) are highly heritable, no systematic review exists of genetic polymorphisms tested for association with LUTS. Objective To systematically review and meta-analyze studies assessing candidate polymorphisms/genes tested for an association with LUTS, and to assess the strength, consistency, and potential for bias among pooled associations. Evidence acquisition A systematic search of the PubMed and HuGE databases as well as abstracts of major urologic meetings was performed through to January 2013. Case-control studies reporting genetic associations in men with LUTS were included. Reviewers independently and in duplicate screened titles, abstracts, and full texts to determine eligibility, abstracted data, and assessed the credibility of pooled associations according to the interim Venice criteria. Authors were contacted for clarifications if needed. Meta-analyses were performed for variants assessed in more than two studies. Evidence synthesis We identified 74 eligible studies containing data on 70 different genes. A total of 35 meta-analyses were performed with statistical significance in five (ACE, ELAC2, GSTM1, TERT, and VDR). The heterogeneity was high in three of these meta-analyses. The rs731236 variant of the vitamin D receptor had a protective effect for LUTS (odds ratio: 0.64; 95% confidence interval, 0.49–0.83) with moderate heterogeneity (I2 = 27.2%). No evidence for publication bias was identified. Limitations include wide-ranging phenotype definitions for LUTS and limited power in most meta-analyses to detect smaller effect sizes. Conclusions Few putative genetic risk variants have been reliably replicated across populations. We found consistent evidence of a reduced risk of LUTS associated with the common rs731236 variant of the vitamin D receptor gene in our meta-analyses. Patient summary Combining the results from all previous studies of genetic variants that may cause urinary symptoms in men, we found significant variants in five genes. Only one, a variant of the vitamin D receptor, was consistently protective across different populations

Development of an autologous fibroblast impregnated tissue for use in urological procedures for stress urinary incontinence and pelvic organ prolapse repair

Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) lead to significant interference in the quality of life of the millions of women affected by them. The treatment options for these women include surgical prostheses which are currently fraught with high failure and complication rates. Our aim was to explore tissue engineering as a solution to the problems of prosthetic failure. The objective was to identify suitable scaffolds that may be used to produce tissue engineered prostheses, with autologous fibroblasts, for use in women with SUI/ POP. Seven candidate scaffolds; Alloderm, cadaveric dermis, polypropylene, porcine dermis, sheep forestomach, porcine small intestinal submucosa and thermoannealed poly(l)lactic acid were investigated. We seeded 800 000 oral fibroblasts to 2cm2 of each scaffold. We assessed the metabolic activity and proliferation of attached cells using AlamarBlue and DAPI staining, contraction using serial photographs, biomechanical properties using a uniaxial tensiometer, collagen production using Sirius red and immunofluorescence staining, and extracellular matrix production using scanning electron microscopy. In addition, the effect of mechanical restraint, simple variable stress and ascorbate-2-phosphate on the above parameters of the tissue engineered prostheses were also investigated. Two scaffolds; porcine small intestinal submucosa and thermoannealed poly(l) lactic acid have been identified as suitable matrices for supporting fibroblast attachment and new extracellular matrix production. Both scaffolds showed cells proliferated and increased their metabolic activity over 14 days of culture. Immunostaining also revealed new collagen I, III and elastin. The mechanical properties of the two scaffolds when cellularised were also close to those of native tissue. We have also shown that mechanical and chemical modulation of the culture environment may be beneficial in producing tissue engineered prostheses with improved properties. Further work will now take these findings in to in vivo models