To Save or not to Save the Kidney: Relieving Unilateral Obstruction May Significantly Improve an Initially Low Split Renal Creatinine Clearance

Objective The aim of this study was to evaluate the change in acute/subacute unilateral renal function after the relief of complete unilateral ureteral obstruction by nephrostomy. Materials and Methods Thirty patients were prospectively enrolled in the study. All had ureteral stone, which were located in the upper ureter in 24 (80%) and in the middle ureter in 6 (20%) patients. As all patients had high-grade hydronephrosis, a percutaneous nephrostomy catheter was placed for the relief of obstruction. At the first week of urinary diversion, 24-hour creatinine clearance (CC) of both affected and normal kidneys were evaluated. In order to determine the difference, same evaluation was performed on the fourth week of nephrostomy placement. Results The mean age of the patients was 44.6 (36-54) years. The mean CC of the affected kidney was 38.8 similar to 4.9 ml/min in the first week of urinary diversion and increased to 42.5 similar to 5.4 ml/min at the end of the fourth week (p<0.001). All patients showed an improvement in CC levels ranging between 2.3% and 17.3% with a mean rate of 8.5 similar to 4.7%. Conclusion According to our results, kidney function may improve during the first month after the relief of obstruction. This improvement may be significant for borderline renal function to determine the curative treatment of an obstructed kidne

Assessment of Voiding Dysfunction and Nocturnal Enuresis Rates in Primary School Children in an Anatolian City with a Validated Dysfunctional Voiding Scoring System Questionnaire

Objective:To investigate the prevalence of voiding dysfunction (VD) and nocturnal enuresis (NE) in Turkish primary school children using a previously validated Dysfunctional Voiding Scoring System (DVSS) questionnaire and a self-administered questionnaire.Materials and Methods:The previously validated DVSS questionnaire was completed by the parents of 3015 randomly selected children. Another questionnaire was also administered for studying VD and NE rates, demographic characteristics, and learning or behavioral problems of children.Results:Of all children, 6.6% (n=199) had a score suggesting VD and 6.1% (n=185) had NE. No significant differences were found between children with and without VD in terms of age, gender, and fluid intake. Children with VD had significantly high rates of constipation (19.7% vs 5.2%; p<0.001) and fecal soiling (32.1% vs 5.1%; p<0.01) compared with children without VD. Children with a higher DVSS score had more frequent behavioral or psychological problems (20.7% vs 4.7%; p<0.01) and learning disabilities (14.7% vs 5.5%; p<0.01). VD had no correlation with overall maternal education level and the type of school (government or private).Conclusion:VD and NE are highly frequent in early childhood and positively correlated with children’s learning disabilities and psychological problems

Upper urinary tract deterioration and possible etiologies in intractable voiding dysfunction: Role of occult spinal malformation

Objectives: To evaluate the presence of upper urinary tract deterioration (UUTD) and accompanying pathologies in children treated with the diagnosis of non-neurogenic bladder-sphincter dysfunction (NNBSD). Patients and Methods: We retrospectively reviewed the medical records of 316 consecutive patients with NNBSD who were treated. All cohort were grouped into two: Group I (Treatment success; n=284), Group II (Treatment failure with any form of occult spinal pathology; n=32). Thirty-four children with treatment-failure and normal magnetic resonance imaging (MRI) findings were excluded. Groups were compared for pre- and posttreatment pediatric lower urinary tract symptom score (PLUTSS), presence of UUTD and urodynamic findings. Results: The mean PLUTSS was significantly less in Group I compared with Group II at pre-treatment and 3 months thereafter the initial treatment (12.20 ± 5.90 and 5.20 ± 4.90 vs 20.3 ± 2.14 and 18 ± 3.4, respectively p<0.01). The mean cystometric capacities and detrusor leak point pressure (DLPP) of Group II prior to initial treatment and after 6 months of the untethering surgery were found to be 194, 267 mL and 28, 12cm H2O, respectively (p<0.05). Presence of UUTD was significantly correlated with DLPP >20 cm H2O and presence of vesicoureteral reflux (VUR)

A Survey Study on Evaluation and Management of Nocturnal Enuresis in Pediatricians and Family Physicians

Objective:Nocturnal enuresis (NE) is one of the most common disorders in pediatric urology, and patients often turn to family physicians (FP) and pediatricians (P) initially. The aim of this study was to understand the awareness, self-confidence and suggestions of physicians regarding the management of NE.Materials and Methods:In this study, 360 FP and family medicine residents (FMR), as well as 280 P and pediatrics residents (PR), were contacted through a cellular phone texting system. A simple multiple-choice questionnaire (Surveymonkey®) consisting of 10 questions was used to gather data. The survey included questions about their experience, training, evaluation, and management of NE.Results:A total of 119 FPs and Ps (18.5%) filled the questionnaire. Thirty (25.21%) of the participants were P, 27 (22.69%) PR, 3 (2.52%) FP and 59 (49.58%) FMR. The rate of physicians who encounter at least 5 children with NE per month is 31.33%. The mean self-confidence in the management of NE was 4.5 out of 10. The self-confidence of pediatricians was significantly higher than that of PR and FMR (p<0.001, p<0.001). Most (n=78, 65.55%) of the participants stated that they received training on EN during medical faculty and 62 (52.10%) during residency. Psychological problems (89.92%), sleep disorders (78.15%), and excessive fluid intake (75.63%) were the most frequently considered factors in etiology. While most responders (75.63%) considered dietary regulation and behavioral interventions as the first-line treatment, 25.21% consult a pediatric urologist and only 1.6% recommend medical treatment.Conclusion:Although FP and P admit they had training on NE, they mostly felt incompetent to manage NE and exclusively avoided pharmacological treatment

Sling Surgery for Female Incontinence

The pelvic floor is at an increased risk of damage during the lifespan of women. Pregnancy, vaginal delivery, aging, menopause, previous pelvic surgery, and lifestyle factors have a negative influence on the connective tissue and muscular components of the pelvic floor leading to urinary incontinence (UI). Pregnancy and vaginal delivery have been identified as the most important risk factors for incontinence. Cystocele, rectocele, uterine, vault prolapse, and/or incontinence can occur due to lacerations of the connective tissue support at different levels. Moreover, muscular damage of the levator complex can lead to widening of the levator hiatus, giving way to the descent of pelvic organs resulting in UI. Although some genetic abnormalities have been identified, their clinical implications remain unclear. Diagnostic evaluations should be performed in accordance with established evidence-based guidelines. Although short-term results of single-incision midurethral slings indicate similar efficacy to conventional midurethral slings, their long-term outcome is still not determined. Scientists continue to investigate the exact causes of stress UI as well as the optimum substitute material using the best surgical reconstructive approach. The recent European Association of Urology consensus statement underlines an imperative requirement for an optimal solution using minimal amount of material related to the indication and higher competence of surgeons for this surgery. High-quality trials with a longer follow-up are currently an unmet need. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved

What developments are needed to achieve less-invasive urodynamics? ICI-RS 2019

Aims To assess the state of technologies for urodynamics that are less invasive than standard cystometry and pressure-flow studies and to suggest areas needing research to improve this. Methods A summary of a Think Tank debate held at the 2019 meeting of the International Consultation on Incontinence Research Society is provided, with subsequent analysis by the authors. Less-invasive techniques were summarized, classified by method, and possible developments considered. Discussions and recommendations were summarized by the co-chairs and edited into the form of this paper by all authors. Results There is a full spectrum of technologies available for less-invasive assessment, ranging from simple uroflowmetry through imaging techniques to emerging complex technologies. Less-invasive diagnostics will not necessarily need to replace diagnosis by, or even provide the same level of diagnostic accuracy as, invasive urodynamics. Rather than aiming for a technique that is merely less invasive, the priority is to develop methods that are either as accurate as current invasive methods, or spare patients from the necessity of invasive methods by improving early triaging. Conclusions Technologies offering less-invasive urodynamic measurement of specific elements of function can be potentially beneficial. Less-invasive techniques may sometimes be useful as an adjunct to invasive urodynamics. The potential for current less-invasive tests to completely replace invasive urodynamic testing is considered, however, to be low. Less-invasive techniques must, therefore, be tested as screening/triaging tools, with the aim to spare some patients from invasive urodynamics early in the treatment pathway

Do the definitions of the underactive bladder and detrusor underactivity help in managing patients: International Consultation on Incontinence Research Society (ICI-RS) Think Tank 2017?

AimsThe Think Tank aimed to discuss the pitfalls and advantages of current definitions in terms of research and management of underactive bladder (UAB). UAB broadly defines a symptom complex of bladder emptying problems and does not indicate a specific pathology. Detrusor underactivity (DU) is a urodynamic diagnosis from pressure-flow studies. The correlation of UAB with DU remains to be precisely determined. MethodsThe presentations and subsequent discussion, leading to research recommendations during the Think Tank of the International Consultation on Incontinence Research Society in Bristol, 2017, are summarized. ResultsTo develop more specific individualized management strategies, the Think Tank panel proposed (i) that, since defining a single type of index patient to represent all UAB will not fulfill all clinical research needs, several index patients should be defined by phenotyping of patients with UAB, including, children, young men and women, elderly male and female patients with co-existing DU and detrusor overactivity, and neurological patients with UAB; (ii) prospective longitudinal studies to assess the natural history of UAB, in the different target populations, based on different UAB phenotypes, should be initiated; (iii) DU should be precisely defined by urodynamic parameters; and (iv) work to develop validated specific questionnaires combined with non-invasive tests for screening, diagnosis and follow up, needs to be continued. ConclusionsThe precise relationship of UAB to DU remains to be defined. Phenotyping patients with UAB/DU, performing prospective trials of natural history, and developing symptom questionnaires and diagnostic investigations will improve our ability to identify and treat UAB/DU