Platelet Count And Mean Platelet Volume As Prognostic Markers of Urospsis

Objective: To know and determine platelet count (PLT) and mean platelet volume (MPV) as prognostic factor for outcome in patients with urosepsis. Materials & Methods: This was an analytic observational study. Thirty patients were assigned to the test for PLT and MPV at the day of admission, 36 hours and 72 hours after admission. All subjects were managed according to standard urosepsis therapy. At the 28th day of treatment, patients were evaluated and classified the outcome as survivors and non-survivors. The statistical analysis was performed using multivariate logistic regression with software SPSS 21. In all tests, p<0.05 was considered to indicate significance. Results: The mean of PLT in non-survivors was lower than that in survivors at the day of admission (420 ± 343.57 x103/mm3 vs 423.04 ± 220.15 x103/mm3, p=0.838). Decrease in PLT during the first 72 hours after hospitalization in non-survivors (Δ PLT72h) was greater than that in survivors (-143.43 ± 154.15 x103/mm3 vs -51 ± 121.77 x103/mm3, p=0.050). The mean of MPV in non-survivors was lower than that in survivors at the day of admission (6.30 ± 0.53 fL vs 7.25 ± 1.78 fL, p=0.333). Increase in MPV during the first 72 hours after hospitalization in non-survivors (Δ MPV72h) was greater than that in survivors (3.51 ± 0.86 x103/mm3 vs 1.48 ± 1.54 x103/mm3, p=0.028). In multivariate analysis, Δ MPV72h was an independent predictor of 28-day mortality [OR 9.41 (95% CI, 1.27 – 69.81)]. Conclusion: An increase in MPV during the first 72 hours after hospitalization can be used as poor prognostic in urosepsis patients

Novel implantable pressure and acceleration sensor for bladder monitoring

Objectives To test the hypothesis that an implantable sensing system containing accelerometers can detect small‐scale autonomous movements, also termed micromotions, which might be relevant to bladder physiology. Methods We developed a 6‐mm submucosal implant containing a pressure sensor (MS5637) and a triaxial accelerometer (BMA280). Sensor prototypes were tested by implantation in the bladders of Gottingen minipigs. Repeated awake voiding cystometry was carried out with air‐charged catheters in a standard urodynamic set‐up as comparators. We identified four phases of voiding similar to cystometry in other animal models based on submucosal pressure. Acceleration signals were separated by frequency characteristics to isolate linear acceleration from the baseline acceleration. The total linear acceleration was calculated by the root mean square of the three measurement axes. Acceleration activity during voiding was investigated to adjacent 1‐s windows and was compared with the registered pressure. Results We observed a total of 19 consecutive voids in five measurement sessions. A good correlation (r > 0.75) was observed between submucosal and catheter pressure in 14 of 19 premicturition traces. The peak‐to‐peak interval between maximum total linear acceleration was correlated with the interval between submucosal voiding pressure peaks (r = 0.760, P < 0.001). The total linear acceleration was higher during voiding compared with pre‐ and postmicturition periods (start of voiding/phase 1). Conclusions To the best of our knowledge, this is the first report of bladder wall acceleration, a novel metric that reflects bladder wall movement. Submucosal sensors containing accelerometers can measure bladder pressure and acceleration

Novel implantable pressure and acceleration sensor for bladder monitoring

Abstract Objectives To test the hypothesis that an implantable sensing system containing accelerometers can detect small-scale autonomous movements, also termed micromotions, which might be relevant to bladder physiology. Methods We developed a 6-mm submucosal implant containing a pressure sensor (MS5637) and a triaxial accelerometer (BMA280). Sensor prototypes were tested by implantation in the bladders of Gottingen minipigs. Repeated awake voiding cystometry was carried out with air-charged catheters in a standard urodynamic set-up as comparators. We identified four phases of voiding similar to cystometry in other animal models based on submucosal pressure. Acceleration signals were separated by frequency characteristics to isolate linear acceleration from the baseline acceleration. The total linear acceleration was calculated by the root mean square of the three measurement axes. Acceleration activity during voiding was investigated to adjacent 1-s windows and was compared with the registered pressure. Results We observed a total of 19 consecutive voids in five measurement sessions. A good correlation (r > 0.75) was observed between submucosal and catheter pressure in 14 of 19 premicturition traces. The peak-to-peak interval between maximum total linear acceleration was correlated with the interval between submucosal voiding pressure peaks (r = 0.760, P < 0.001). The total linear acceleration was higher during voiding compared with pre- and postmicturition periods (start of voiding/phase 1). Conclusions To the best of our knowledge, this is the first report of bladder wall acceleration, a novel metric that reflects bladder wall movement. Submucosal sensors containing accelerometers can measure bladder pressure and acceleration

Nefrolitotomi Perkutan P.C.N.L. (Percutaneous Nephrolithotomy)

Nefrolitotomi terbuka adalah salah satu pembedahan terbuka yang paling traumatik dalam ilmu bedah. Pembedahan terbuka nefrolitotomi masih dapat dipertanggungjawabkan pada kasus-kasus batu ginjal yang besar atau batu staghorn. Akan tetapi untuk mengeluarkan batu yang lebih kecil dari 2 cm, tindakan bedah terbuka tampaknya tidak begitu tepat dilakukan pada saat ini. Oleh karena itu tidaklah mengherankan bila para ahli urologi berusaha mencari pemecahan bedah invasif minimal untuk mengeluarkan batu

Post-vasectomy semen analysis: Optimizing laboratory procedures and test interpretation through a clinical audit and global survey of practices

Purpose: The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. Materials and Methods: We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic’s Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. Results: Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unprotected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the majority of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA’s. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. Conclusions: Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compliance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy.American Center for Reproductive Medicin

Novel Assessment Techniques for in vivo Bladder Physiology

Neurological and functional bladder disorders cause significant morbidity and detriment to the quality of life. These disorders cause lower urinary tract symptoms which affect up to 45.7% of the world population. Neurological bladder disorders due to spinal cord injury and multiple sclerosis in some cases cause life-threatening urological complications. Functional bladder disorders in the absence of nervous system pathology present with moderate-to-severe symptoms in 34.9% of patients. Assessment of these disorders are often challenging, with various examination methods employed including symptom scores, bladder diary, uroflowmetry and urodynamics. Urodynamics is commonly used to describe a combination of tests aimed to elucidate the underlying pathophysiology of the lower urinary tract disorder. One routine urodynamic test, filling cystometry, continuously measures bladder pressure in response to filling of the bladder. Another test, pressure flow study, records this pressure during voiding along with other parameters. Urodynamics using telemetry from implanted sensors in primates provides recording for long periods without anesthesia. Surgery to implant the telemetric sensors precludes usage in humans, therefore ambulatory urodynamics in patients for clinical problems is still limited to urethral catheters. To further clarify bladder (dys)function, pressure measurements are combined with measurement of electrical muscle activity (electromyography) and x-ray bladder imaging. This investigation is commonly referred to as video urodynamics. However, measurements with this method only reflect summation of total bladder activity, and is unable to discern differential contribution from various parts of the bladder. The bladder has contrasting roles in voiding and storage phases of the micturition cycle. During voiding, bladder contraction is observed as a synchronous contraction of the entire organ. In contrast, during the storage phase the bladder functions as a flexible compliant vessel for urine storage. Studies during this phase have shown that separate parts of the bladder exhibit localized contractions and elongations with variable propagation. This autonomous activity of the bladder has been observed in ex-vivo animal models. Furthermore, in-vivo studies have shown alterations in autonomous myogenic activity may play a role in the pathogenesis of urgency symptoms. Two different sensors will be used to study the bladder in this project. A miniature sensor in form of a pill, which can be implanted through minimally invasive endoscopy (cystoscopy) has been developed. This sensor allows ambulatory monitoring without surgical implantation. The newest design of this sensor will feature wireless powering and communication system thus reducing the components on the pill and consequently its size. The second sensor is an accelerometer in biocompatible packaging implantable in the bladder submucosa. This sensor has successfully been used to acquire acceleration signals of the heart. Therefore, we expect application of this sensor in the bladder will provide mechanical insight into bladder wall motion with 3 dimensional data. A suitable animal model for testing these microelectronic sensors should closely resemble the human lower urinary tract. Gottingen minipigs are purpose bred and widely used in research. Micturition volume of these animals closely resemble human data. The aim of this thesis is to study the application of the wireless pressure sensor and acceleration sensor in animal models of normal physiology and pathological conditions.status: publishe

IMPACT OF COVID – 19 ON UROLOGICAL INTERVENTIONS AT TERTIARY REFERRAL HOSPITAL

Objective: This study aims to identify and evaluate the impact of COVID-19 on urological interventions at Soetomo general-academic hospital as the tertiary referral center. Material & Methods: This study is a descriptive-retrospective, single-center study that included all confirmed cases of COVID-19 in urological patients from March 1, 2020 until December 31, 2021 at Soetomo general-academic hospital. We investigated these patients' characteristics, focusing on the demography, clinical data, and eventual outcome. Patient's gender, age, primary urological presentation, COVID-19-related symptom, comorbidity, chest x-ray result, and laboratory value were among the involved variables. The patient's outcome was categorized into death, delayed intervention, or intervention as scheduled.  Results: Seventy-seven patients were enrolled, with a mean age of 44.2 years. Fever was found in 42 (54%) patients and respiratory symptoms in 32 (41.5%) patients. An NLR value of >6 was found in 55.8% of patients. A total of 18 patients experienced LUTS (23.4%), 33 patients presented with hematuria (42.9%), and 30 patients had urinary tract infections (39%). Nineteen out of 77 patients (27.3%) died before intervention. On the other hand, surgical intervention in 37 (66%) patients were delayed due to self-isolation, while intervention in 19 (34%) patients was performed as scheduled due to their emergency nature. Conclusion: Urological patients infected with COVID-19 were impacted by the delay of surgical procedures and mortality in the first 22 months of the pandemic.

URINARY NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN AND CREATININE SERUM BPH PATIENTS WITH ACUTE URINE RETENTION TO DETECT KIDNEY FUNCTION DISORDERS

Objective: The main objective of this study was to determine renal function in patients with Benign Prostate Hyperplasia (BPH) in acute urinary retention period and two weeks after catheter insertion using creatinine serum and urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) biomarker parameters.Materials &amp; Method:This is an observational co-hort study conducted in patients with BPH with acute urinary retention who came to Soetomo General Hospital, Surabaya. All the patients underwent laboratory investigation that were urinary NGAL and creatinine serum, marker of renal function.Result: The mean creatinine serum of 31 samples when retention phase was 1.6 ± 0.9 mg/dL and it decreased after 2 weeks of urinary catheter insertion (1.46 ± 0.89 mg/dL). Mean urinary NGAL level when retention phase was 308.1 ± 244.8 ng/dL, and after 2 weeks after urinary catheter insertion it decreased to 158.5 ± 123.3 ng/dL. There was significant decreasing creatinine serum and urinary NGAL levels in patients with BPH and acute urinary retention in the retention phase 2 weeks after urinary catheter insertion, with p value &lt; 0.006 and &lt; 0.0001, respectively. There was no significant correlation between the duration of retention and urinary retention volume (p&gt;0.05).Conclusion: There was a significant decreasing creatinine serum and urinary NGAL levels in patients with BPH and acute urinary retention in retention phase and two weeks after urinary catheter insertion. There was no significant correlation between the urinary NGAL and creatinine serum and the duration of retention and urinary retention volume

The bladder pill: Towards continuous bladder pressure monitoring via wireless power and communication

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In-Vivo Implantable Sensor System for Measuring Bladder Wall Movements

The design and implementation of a medical implantable device for bladder monitoring is presented. A network of accelerometers is to be implanted in-between the outside bladder muscle and the mucous membrane. A pressure sensor is also implanted in this submucosal layer to obtain intraluminal pressure readings. The sensor system is powered by an implanted battery and provides a wireless communication link for data and control. A smart measurement protocol allows the system to be operational for several weeks. The sensors are mounted on a flexible printed circuit board that can be elongated up to 250%, to accommodate the natural stretching of the bladder organ tissue during filling.status: publishe