Pub Date : 2023-01-30DOI: 10.3389/fruro.2023.1103915
A. Rensing, Abdul Qadar, Clark Higganbotham*, D. Frimberger, B. Meenakshi‐Sundaram
Background While undescended testes are relatively common, the nonpalpable testis remains a challenging problem. The gold standard treatment remains the laparoscopic orchiopexy. However, today robot-assisted surgery has challenged traditional laparoscopy in many areas of urology. Yet the value of this new approach remains controversial, given concerns with operative time and cost. We reviewed our contemporary results of both robot-assisted orchiopexy (RALO) and traditional laparoscopic orchiopexy (TLO). Our primary aims were to retrospectively compare success rates, and operative time. Our secondary aims were to compare costs and complications related to each method. Methods In this study, all patients treated with laparoscopic and robot-assisted laparoscopic orchiopexy from April 2017 to January 2022 were reviewed using CPT code 54692. Exclusion criteria included bilateral concomitant orchiopexy or concomitant “major surgery,” or follow up less than 6 months. Also excluded were 1st stage orchiopexies. For the purposes of comparison, 1-stage and 2nd stage orchiopexies were included in the analysis. Patient demographics, surgical operative notes and documentation were all reviewed. Results After exclusion criteria was applied, 16 and 17 remained in the laparoscopic and robot-assisted cohorts, respectively. Upon follow up, all patients in both the laparoscopic and robot-assisted cohorts were noted to have a healthy testicle palpable in the dependent portion of the scrotum. The median operative time in the TLO group was 71 minutes, compared to 101 minutes in the RALO group (p>0.0001). When comparing median hospital charges, the TLO group was lower at $38,813, compared to $46,455 in the RALO group (p = 0.0069). There was one postoperative complication in the TLO group (localized wound infection), compared to zero in the RALO group. Conclusions The robot-assisted orchiopexy is safe and effective. However, at this time it remains more costly in terms of time and resources.
{"title":"Robot-assisted laparoscopic orchiopexy: A comparative analysis with laparoscopic orchiopexy","authors":"A. Rensing, Abdul Qadar, Clark Higganbotham*, D. Frimberger, B. Meenakshi‐Sundaram","doi":"10.3389/fruro.2023.1103915","DOIUrl":"https://doi.org/10.3389/fruro.2023.1103915","url":null,"abstract":"Background While undescended testes are relatively common, the nonpalpable testis remains a challenging problem. The gold standard treatment remains the laparoscopic orchiopexy. However, today robot-assisted surgery has challenged traditional laparoscopy in many areas of urology. Yet the value of this new approach remains controversial, given concerns with operative time and cost. We reviewed our contemporary results of both robot-assisted orchiopexy (RALO) and traditional laparoscopic orchiopexy (TLO). Our primary aims were to retrospectively compare success rates, and operative time. Our secondary aims were to compare costs and complications related to each method. Methods In this study, all patients treated with laparoscopic and robot-assisted laparoscopic orchiopexy from April 2017 to January 2022 were reviewed using CPT code 54692. Exclusion criteria included bilateral concomitant orchiopexy or concomitant “major surgery,” or follow up less than 6 months. Also excluded were 1st stage orchiopexies. For the purposes of comparison, 1-stage and 2nd stage orchiopexies were included in the analysis. Patient demographics, surgical operative notes and documentation were all reviewed. Results After exclusion criteria was applied, 16 and 17 remained in the laparoscopic and robot-assisted cohorts, respectively. Upon follow up, all patients in both the laparoscopic and robot-assisted cohorts were noted to have a healthy testicle palpable in the dependent portion of the scrotum. The median operative time in the TLO group was 71 minutes, compared to 101 minutes in the RALO group (p>0.0001). When comparing median hospital charges, the TLO group was lower at $38,813, compared to $46,455 in the RALO group (p = 0.0069). There was one postoperative complication in the TLO group (localized wound infection), compared to zero in the RALO group. Conclusions The robot-assisted orchiopexy is safe and effective. However, at this time it remains more costly in terms of time and resources.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44202471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-27DOI: 10.3389/fruro.2023.1104597
Natalie Armon, Nora Thompson, D. DaJusta, M. Fuchs, C. Ching
Purpose Gender inequities in medicine exist. Urology is a male dominated surgical specialty, with recent census data showing females represent only 10.9% of the workforce. We aimed to characterize the composition of female pediatric urologists across the Societies for Pediatric Urology (SPU) pediatric urology fellowship accredited programs, with particular attention to academic promotion and leadership positions. Methods In January 2023, we reviewed the official websites of the 27 pediatric urology programs listed on the SPU website as fellowship accredited programs. We identified pediatric urology surgery attendings, their gender, academic title, and if they were named a director of an internal program or had a hospital leadership position. We identified the program chief and fellow/resident program director. This data was associated with years in practice. Results Females represented 27.4% of pediatric urology surgical attendings. Four programs (14.8%) had no female attendings. Female staff were in practice a median shorter time than that of males (6 vs. 16 years, p<0.0001). A significantly higher proportion of females were assistant professors (62.2 vs. 35.2%; p=0.0041) while a significantly higher proportion of men were professors (37.0 vs. 18.9%; p=0.0421). Only one program (3.7%) had a female department/division chief. There was no difference between genders regarding being named a director of a program and/or having an identified hospital position of leadership. Female professors had been in practice a significantly shorter time than male professors (p=0.0003); women with an internal or hospital leadership position had also been in practice a significantly shorter time than males (p<0.001). Conclusions Females are represented more in SPU pediatric urology fellowship accredited programs than the overall urology workforce. Fewer female attendings are professors compared to male attendings; however, differences in promotion could be impacted by female attendings being earlier in their career. Hopefully with time, we will see more equal representation amongst genders in pediatric urology programs overall, but especially where we are training the next generation.
{"title":"Current state of female pediatric urologists at Societies for Pediatric Urology fellowship accredited programs","authors":"Natalie Armon, Nora Thompson, D. DaJusta, M. Fuchs, C. Ching","doi":"10.3389/fruro.2023.1104597","DOIUrl":"https://doi.org/10.3389/fruro.2023.1104597","url":null,"abstract":"Purpose Gender inequities in medicine exist. Urology is a male dominated surgical specialty, with recent census data showing females represent only 10.9% of the workforce. We aimed to characterize the composition of female pediatric urologists across the Societies for Pediatric Urology (SPU) pediatric urology fellowship accredited programs, with particular attention to academic promotion and leadership positions. Methods In January 2023, we reviewed the official websites of the 27 pediatric urology programs listed on the SPU website as fellowship accredited programs. We identified pediatric urology surgery attendings, their gender, academic title, and if they were named a director of an internal program or had a hospital leadership position. We identified the program chief and fellow/resident program director. This data was associated with years in practice. Results Females represented 27.4% of pediatric urology surgical attendings. Four programs (14.8%) had no female attendings. Female staff were in practice a median shorter time than that of males (6 vs. 16 years, p<0.0001). A significantly higher proportion of females were assistant professors (62.2 vs. 35.2%; p=0.0041) while a significantly higher proportion of men were professors (37.0 vs. 18.9%; p=0.0421). Only one program (3.7%) had a female department/division chief. There was no difference between genders regarding being named a director of a program and/or having an identified hospital position of leadership. Female professors had been in practice a significantly shorter time than male professors (p=0.0003); women with an internal or hospital leadership position had also been in practice a significantly shorter time than males (p<0.001). Conclusions Females are represented more in SPU pediatric urology fellowship accredited programs than the overall urology workforce. Fewer female attendings are professors compared to male attendings; however, differences in promotion could be impacted by female attendings being earlier in their career. Hopefully with time, we will see more equal representation amongst genders in pediatric urology programs overall, but especially where we are training the next generation.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47989487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-26DOI: 10.3389/fruro.2023.1113054
C. Chan, C. Ng, S. Yuen, B. Lau, C. Yee, J. Teoh, P. Chiu, S. Kwok
Objectives To study the association between nocturia and brachial-ankle pulse wave velocity (baPWV) [surrogate of central arterial stiffness (CAS)] in men and to explore this association on predicting major adverse cardiovascular events (MACE). Methods 246 consecutive men (mean age:68.1 ± 8.4, range 36-88) newly referred to urology clinic for male-lower urinary tract symptoms(mLUTS)/nocturia were recruited. Their bilateral baPWV were measured by automatic pulse waveform analyzer. The associations between baseline characteristics, mLUTS/nocturia and baPWV(>1800cm/sec) [significant CAS] were analyzed by multivariate logistic regression. We followed the cohort for a median period of 27.5 months. Cox proportional hazard regression analysis and Kaplan-Meier method were used to study factors predicting MACE. Results The mean ( ± SE) baPWV of our cohort was 1820 ± 16cm/sec. For comparison, the reported value of the general population of similar age structure was~1650cm/sec. IPSS (total) was not associated with baPWV, whereas IPSS-Question.7(nocturia) was significantly increased with baPWV in men<70yo [nocturia=1.6 ± 1.14, 2.1 ± 1.08, 2.67 ± 1.33) for baPWV(cm/sec) <1400, 1400-1800, >1800 respectively] (P-trend=0.002). Age≥70yo (OR:2.70, 95%CI:1.52-4.76), diabetes mellitus (OR:2.26, 95%CI:1.06-4.83), hypertension (OR:1.95, 95%CI:1.10-3.45) and nocturia≥3x/night (OR:1.75, 95%CI:1.02-3.12) independently determined baPWV>1800cm/sec. The cumulative incidence rate of MACE was 46.8/1000 man-years(95%CI:30.96-68.16/1000). The addition of nocturia≥3x/night and baPWV>1800 cm/sec to the basic model improved the prediction of the development of MACE (difference in -2 log likelihood value: 11.219, p<0.001). Past history of ischemic heart (HR:5.67, 95%CI:2.02-15.88), nocturia≥3x/night (HR:2.87, 95%CI: 0.94-8.76) and baPWV>1800cm/sec (HR:5.16, 95%CI:1.79-14.90) independently predicted MACE in men. Conclusion Men attending the urology clinic for male-LUTS/nocturia had higher baPWV. This association was more pronounced in men<70yo. Men presented with both nocturia≥3x/night and baPWV>1800cm/sec showed significant predilection for developing MACE.
{"title":"Nocturia is associated with stiffer central artery and more likely development of major adverse cardiovascular events in men","authors":"C. Chan, C. Ng, S. Yuen, B. Lau, C. Yee, J. Teoh, P. Chiu, S. Kwok","doi":"10.3389/fruro.2023.1113054","DOIUrl":"https://doi.org/10.3389/fruro.2023.1113054","url":null,"abstract":"Objectives To study the association between nocturia and brachial-ankle pulse wave velocity (baPWV) [surrogate of central arterial stiffness (CAS)] in men and to explore this association on predicting major adverse cardiovascular events (MACE). Methods 246 consecutive men (mean age:68.1 ± 8.4, range 36-88) newly referred to urology clinic for male-lower urinary tract symptoms(mLUTS)/nocturia were recruited. Their bilateral baPWV were measured by automatic pulse waveform analyzer. The associations between baseline characteristics, mLUTS/nocturia and baPWV(>1800cm/sec) [significant CAS] were analyzed by multivariate logistic regression. We followed the cohort for a median period of 27.5 months. Cox proportional hazard regression analysis and Kaplan-Meier method were used to study factors predicting MACE. Results The mean ( ± SE) baPWV of our cohort was 1820 ± 16cm/sec. For comparison, the reported value of the general population of similar age structure was~1650cm/sec. IPSS (total) was not associated with baPWV, whereas IPSS-Question.7(nocturia) was significantly increased with baPWV in men<70yo [nocturia=1.6 ± 1.14, 2.1 ± 1.08, 2.67 ± 1.33) for baPWV(cm/sec) <1400, 1400-1800, >1800 respectively] (P-trend=0.002). Age≥70yo (OR:2.70, 95%CI:1.52-4.76), diabetes mellitus (OR:2.26, 95%CI:1.06-4.83), hypertension (OR:1.95, 95%CI:1.10-3.45) and nocturia≥3x/night (OR:1.75, 95%CI:1.02-3.12) independently determined baPWV>1800cm/sec. The cumulative incidence rate of MACE was 46.8/1000 man-years(95%CI:30.96-68.16/1000). The addition of nocturia≥3x/night and baPWV>1800 cm/sec to the basic model improved the prediction of the development of MACE (difference in -2 log likelihood value: 11.219, p<0.001). Past history of ischemic heart (HR:5.67, 95%CI:2.02-15.88), nocturia≥3x/night (HR:2.87, 95%CI: 0.94-8.76) and baPWV>1800cm/sec (HR:5.16, 95%CI:1.79-14.90) independently predicted MACE in men. Conclusion Men attending the urology clinic for male-LUTS/nocturia had higher baPWV. This association was more pronounced in men<70yo. Men presented with both nocturia≥3x/night and baPWV>1800cm/sec showed significant predilection for developing MACE.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42410328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-24DOI: 10.3389/fruro.2023.1105513
Katharina Mitchell, Chad Morley, J. Barnard
While only 20% of the nation’s population lives in rural areas, 40% of the Appalachian population resides in rural areas. Due to the rural nature of this region we hypothesized this may have implications regarding the outcomes of traumatic testicular injuries (TTI), such as increased rate of organ loss. Here in, we report the findings of our 10-year retrospective study analyzing patients presenting with TTI to our rural tertiary care facility in comparison to an 8-year review of 8,030 TTI from the National Trauma Data Bank (NTDB®). Of the 34,000 trauma patients reviewed, 23 (0.07%) had TTI which concurs with the NTDB® value of 0.2%. Blunt trauma accounted for 91.3% of TTI contrasting with NTDB® data suggesting 50.5% attributable to penetrating mechanisms. Firearm related injuries comprised 4.3% of TTI, but 38.3% of NTDB®’s. Motor vehicle collision/motor cycle crash (MVC/MCC) accounted for 26.0%, similarly NTDB® data showed 26.6%. Median length of stay (LOS) was 1 day, and 3 for NTDB®. Scrotal exploration occurred in 90.4% of cases with 52.4% requiring orchiectomy, whereas NTDB® data suggested 48.3% and 23.4% respectively. In conclusion, compared to the NTDB® TTI data, Appalachia has a higher incidence of blunt mechanism, scrotal exploration rate, and testicular loss.
{"title":"Traumatic testicular injuries in appalachia: A ten-year review from a level 1 trauma center and comparison to the national trauma data bank®","authors":"Katharina Mitchell, Chad Morley, J. Barnard","doi":"10.3389/fruro.2023.1105513","DOIUrl":"https://doi.org/10.3389/fruro.2023.1105513","url":null,"abstract":"While only 20% of the nation’s population lives in rural areas, 40% of the Appalachian population resides in rural areas. Due to the rural nature of this region we hypothesized this may have implications regarding the outcomes of traumatic testicular injuries (TTI), such as increased rate of organ loss. Here in, we report the findings of our 10-year retrospective study analyzing patients presenting with TTI to our rural tertiary care facility in comparison to an 8-year review of 8,030 TTI from the National Trauma Data Bank (NTDB®). Of the 34,000 trauma patients reviewed, 23 (0.07%) had TTI which concurs with the NTDB® value of 0.2%. Blunt trauma accounted for 91.3% of TTI contrasting with NTDB® data suggesting 50.5% attributable to penetrating mechanisms. Firearm related injuries comprised 4.3% of TTI, but 38.3% of NTDB®’s. Motor vehicle collision/motor cycle crash (MVC/MCC) accounted for 26.0%, similarly NTDB® data showed 26.6%. Median length of stay (LOS) was 1 day, and 3 for NTDB®. Scrotal exploration occurred in 90.4% of cases with 52.4% requiring orchiectomy, whereas NTDB® data suggested 48.3% and 23.4% respectively. In conclusion, compared to the NTDB® TTI data, Appalachia has a higher incidence of blunt mechanism, scrotal exploration rate, and testicular loss.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46341277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-19DOI: 10.3389/fruro.2022.1092192
Daniel Inouye, Zoe Baker, Adam Peña, Evalynn Vasquez
Introduction Epididymitis, orchitis, and epididymo-orchitis (EO) are common disorders in pediatric patients which may be caused by infection, trauma, or inflammation. SARS-CoV-2 associated EO has been previously described, particularly in adults. However, no systematic reviews of these manifestations in pediatric patients yet exist. We present a systematic literature review of epididymitis, orchitis, and EO associated with SARS-CoV-2 in pediatric patients to shed light on these relatively rare, yet potentially severe, conditions to understand presentation, course of illness, management options, and outcomes. Materials and Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed using specified key terms to search PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Embase. Articles were independently screened by two reviewers. Manuscripts with detailed descriptions of SARS-CoV-2 associated epididymitis, orchitis, or EO in pediatric patients were included. Exclusion criteria included: no clear diagnosis of the target diseases and no detailed clinical course described. Quality and bias were assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. Results 60 records were initially identified, with 6 case reports included in the systematic review. All 6 patients included presented with fever and genitourinary symptoms. Four patients were also diagnosed with multisystem inflammatory syndrome in children (MIS-C). One patient underwent surgical exploration for presumed testicular torsion, though intraoperatively there was no evidence of torsion. All patients recovered without documented long-term sequelae. Discussion While observational studies are prone to bias, this systematic review suggests that epididymitis, orchitis, and EO are significant manifestations of SARS-CoV-2 that may mimic urologic emergencies (i.e., testicular torsion). Providers should suspect these conditions in pediatric COVID-19 patients with scrotal symptoms, particularly with associated MIS-C. The long-term genitourinary sequelae of SARS-CoV-2 should be investigated, including the effects on pediatric patients undergoing reproductive development.
{"title":"Epididymitis, orchitis, and epididymo-orchitis associated with SARS-CoV-2 infection in pediatric patients: A systematic review","authors":"Daniel Inouye, Zoe Baker, Adam Peña, Evalynn Vasquez","doi":"10.3389/fruro.2022.1092192","DOIUrl":"https://doi.org/10.3389/fruro.2022.1092192","url":null,"abstract":"Introduction Epididymitis, orchitis, and epididymo-orchitis (EO) are common disorders in pediatric patients which may be caused by infection, trauma, or inflammation. SARS-CoV-2 associated EO has been previously described, particularly in adults. However, no systematic reviews of these manifestations in pediatric patients yet exist. We present a systematic literature review of epididymitis, orchitis, and EO associated with SARS-CoV-2 in pediatric patients to shed light on these relatively rare, yet potentially severe, conditions to understand presentation, course of illness, management options, and outcomes. Materials and Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed using specified key terms to search PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Embase. Articles were independently screened by two reviewers. Manuscripts with detailed descriptions of SARS-CoV-2 associated epididymitis, orchitis, or EO in pediatric patients were included. Exclusion criteria included: no clear diagnosis of the target diseases and no detailed clinical course described. Quality and bias were assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. Results 60 records were initially identified, with 6 case reports included in the systematic review. All 6 patients included presented with fever and genitourinary symptoms. Four patients were also diagnosed with multisystem inflammatory syndrome in children (MIS-C). One patient underwent surgical exploration for presumed testicular torsion, though intraoperatively there was no evidence of torsion. All patients recovered without documented long-term sequelae. Discussion While observational studies are prone to bias, this systematic review suggests that epididymitis, orchitis, and EO are significant manifestations of SARS-CoV-2 that may mimic urologic emergencies (i.e., testicular torsion). Providers should suspect these conditions in pediatric COVID-19 patients with scrotal symptoms, particularly with associated MIS-C. The long-term genitourinary sequelae of SARS-CoV-2 should be investigated, including the effects on pediatric patients undergoing reproductive development.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43501706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-09DOI: 10.3389/fruro.2022.1028778
Kristian Stærk, L. Langhorn, L. Nielsen, Thomas Andersen
Urinary tract infections (UTIs) are one of the most common bacterial infections worldwide. The diagnosis is mainly dependent on the quantitative identification of uropathogens in urine from suspected patients and therefore, it is essential that bacterial count in urine specimens accurately reflects the bacterial population inside the bladder. In this study, we collected the first- and last urine specimens during a single full voiding from pigs with experimentally induced UTI and compared the urine density and bacterial counts of the collected specimens. We found that specimens from the same voiding varied in density and in bacterial counts by up to a thousand-fold with significant impact on diagnostic sensitivity. In conclusion, the porcine bladder can simultaneously contain intravesical compartments of varying density and bacterial counts that greatly influences microbiological analysis. The distribution of bacteria in intravesical compartments is critical to consider when using pigs as biomedical models of UTI. Furthermore, the similarities of porcine and human anatomy and physiology, suggest that the results are likely to be translatable to human, in which case potential UTIs could be overlooked by today’s diagnostic procedures.
{"title":"Intravesical compartments in the bladder can affect microbiological culturing outcome: An experimental study in pigs","authors":"Kristian Stærk, L. Langhorn, L. Nielsen, Thomas Andersen","doi":"10.3389/fruro.2022.1028778","DOIUrl":"https://doi.org/10.3389/fruro.2022.1028778","url":null,"abstract":"Urinary tract infections (UTIs) are one of the most common bacterial infections worldwide. The diagnosis is mainly dependent on the quantitative identification of uropathogens in urine from suspected patients and therefore, it is essential that bacterial count in urine specimens accurately reflects the bacterial population inside the bladder. In this study, we collected the first- and last urine specimens during a single full voiding from pigs with experimentally induced UTI and compared the urine density and bacterial counts of the collected specimens. We found that specimens from the same voiding varied in density and in bacterial counts by up to a thousand-fold with significant impact on diagnostic sensitivity. In conclusion, the porcine bladder can simultaneously contain intravesical compartments of varying density and bacterial counts that greatly influences microbiological analysis. The distribution of bacteria in intravesical compartments is critical to consider when using pigs as biomedical models of UTI. Furthermore, the similarities of porcine and human anatomy and physiology, suggest that the results are likely to be translatable to human, in which case potential UTIs could be overlooked by today’s diagnostic procedures.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48372803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-06DOI: 10.3389/fruro.2022.1089135
J. Yang, Zoe Baker, Hannah Dillon, Arthi Hannallah, Irene Klecha, Michelle M. Soohoo, J. Ko, R. D. De Filippo, Evalynn Vasquez
Introduction Fetal anomalies detected on prenatal ultrasound can elicit maternal psychological distress and may be associated with increased risk of adverse fetal outcomes. Prenatal consultation with pediatric specialists may allay parental worries by improving clarity surrounding a fetal diagnosis, establishing a postnatal management plan, and providing expert advice. We sought to determine whether maternal anxiety and worry decreased following prenatal pediatric urology consultations among a cohort of pregnant women whose fetuses were diagnosed with urologic anomalies. Methods Pregnant women referred to pediatric urologists for prenatal consultation through our Fetal Maternal Center following detection of a urologic anomaly were recruited from February 2021 to March 2022 inclusive. Participants completed questionnaires before and after prenatal pediatric urology consultation assessing maternal current state anxiety (S-Anxiety) on the State-Trait Anxiety Inventory (STAI) and self-reported worry surrounding the fetal diagnosis. Differences in anxiety and worry before versus after prenatal consultation were analyzed using paired t-tests and McNemar’s tests. Results 26 pregnant women completed pre- and post-visit questionnaires. Most participants (92.3%) received prenatal pediatric urology consultation for anomalies of the fetal kidney(s), including hydronephrosis and suspected multicystic dysplastic kidney. The proportion of participants reporting extreme or moderate levels of worry surrounding the fetal diagnosis significantly decreased from 69.2% prior to prenatal pediatric urology consultation, to 30.8% after consultation (p=0.02). Reductions in worry after prenatal consultation were reported among 80.8% of participants. Average state anxiety on the STAI similarly significantly decreased from 35.2 ( ± 9.4) before prenatal consultation to 31.4 ( ± 11.1) after consultation. Differences in reductions in anxiety and worry did not significantly differ among participants attending prenatal consultations in-person or via telehealth. Conclusions Among a cohort of pregnant women diagnosed with fetal anomalies of the urinary tract, anxiety and worry surrounding the fetal diagnosis significantly decreased after prenatal in-person or telehealth consultations with pediatric urologists.
{"title":"Reduction in maternal anxiety following prenatal pediatric urology consultation","authors":"J. Yang, Zoe Baker, Hannah Dillon, Arthi Hannallah, Irene Klecha, Michelle M. Soohoo, J. Ko, R. D. De Filippo, Evalynn Vasquez","doi":"10.3389/fruro.2022.1089135","DOIUrl":"https://doi.org/10.3389/fruro.2022.1089135","url":null,"abstract":"Introduction Fetal anomalies detected on prenatal ultrasound can elicit maternal psychological distress and may be associated with increased risk of adverse fetal outcomes. Prenatal consultation with pediatric specialists may allay parental worries by improving clarity surrounding a fetal diagnosis, establishing a postnatal management plan, and providing expert advice. We sought to determine whether maternal anxiety and worry decreased following prenatal pediatric urology consultations among a cohort of pregnant women whose fetuses were diagnosed with urologic anomalies. Methods Pregnant women referred to pediatric urologists for prenatal consultation through our Fetal Maternal Center following detection of a urologic anomaly were recruited from February 2021 to March 2022 inclusive. Participants completed questionnaires before and after prenatal pediatric urology consultation assessing maternal current state anxiety (S-Anxiety) on the State-Trait Anxiety Inventory (STAI) and self-reported worry surrounding the fetal diagnosis. Differences in anxiety and worry before versus after prenatal consultation were analyzed using paired t-tests and McNemar’s tests. Results 26 pregnant women completed pre- and post-visit questionnaires. Most participants (92.3%) received prenatal pediatric urology consultation for anomalies of the fetal kidney(s), including hydronephrosis and suspected multicystic dysplastic kidney. The proportion of participants reporting extreme or moderate levels of worry surrounding the fetal diagnosis significantly decreased from 69.2% prior to prenatal pediatric urology consultation, to 30.8% after consultation (p=0.02). Reductions in worry after prenatal consultation were reported among 80.8% of participants. Average state anxiety on the STAI similarly significantly decreased from 35.2 ( ± 9.4) before prenatal consultation to 31.4 ( ± 11.1) after consultation. Differences in reductions in anxiety and worry did not significantly differ among participants attending prenatal consultations in-person or via telehealth. Conclusions Among a cohort of pregnant women diagnosed with fetal anomalies of the urinary tract, anxiety and worry surrounding the fetal diagnosis significantly decreased after prenatal in-person or telehealth consultations with pediatric urologists.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44185956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-05DOI: 10.3389/fruro.2022.1069265
A. Choksi, Christopher S. Hayden, S. Rahman, S. Lokeshwar, I. Kim
Introduction Genitourinary pathologies are increasingly common in low and lower-middle Q6 income countries (LMICs) however there is a disproportionate distribution of clinical trials in higher income countries as compared to LMICs. In order for evidence-based practice to be implemented in LMICs with regards to urologic conditions and malignancies, clinical trials need to be performed within LMICs such that the results can be analyzed based on the context of the local environment. Methods We queried ClinicalTrials.gov and the ICTRP for active clinical trials that were related to ‘prostatic neoplasms’, ‘urinary bladder neoplasms’, ‘kidney neoplasms’, ‘urolithiasis’, ‘urinary tract infections’ and ‘lower urinary tract symptoms’. The national incidence and DALYs was obtained from the Global Burden of Disease 2019 to analyze for a correlation between the numbers of clinical trials performed in a country with the burden of disease. Results A total of 4,169 clinical trials were identified based on the search query terms. Ninety percent of the clinical trials are being conducted in 32 countries. A majority of clinical trials are being performed in HICs. The proportion of non-oncologic urologic clinical trials performed in LMICs is greater than the proportion of urologic oncology clinical trials performed in LMICs (p <0.001). Linear regression models demonstrates a weak relationship between the global burden of disease and the number of clinical trials conducted in each country for the individual urologic conditions. Discussion A majority of urologic clinical trials are being conducted in high-income countries which does not coincide with the global burden of disease of urologic conditions.
{"title":"The disparities in clinical trials addressing urologic conditions among lower-income countries","authors":"A. Choksi, Christopher S. Hayden, S. Rahman, S. Lokeshwar, I. Kim","doi":"10.3389/fruro.2022.1069265","DOIUrl":"https://doi.org/10.3389/fruro.2022.1069265","url":null,"abstract":"Introduction Genitourinary pathologies are increasingly common in low and lower-middle Q6 income countries (LMICs) however there is a disproportionate distribution of clinical trials in higher income countries as compared to LMICs. In order for evidence-based practice to be implemented in LMICs with regards to urologic conditions and malignancies, clinical trials need to be performed within LMICs such that the results can be analyzed based on the context of the local environment. Methods We queried ClinicalTrials.gov and the ICTRP for active clinical trials that were related to ‘prostatic neoplasms’, ‘urinary bladder neoplasms’, ‘kidney neoplasms’, ‘urolithiasis’, ‘urinary tract infections’ and ‘lower urinary tract symptoms’. The national incidence and DALYs was obtained from the Global Burden of Disease 2019 to analyze for a correlation between the numbers of clinical trials performed in a country with the burden of disease. Results A total of 4,169 clinical trials were identified based on the search query terms. Ninety percent of the clinical trials are being conducted in 32 countries. A majority of clinical trials are being performed in HICs. The proportion of non-oncologic urologic clinical trials performed in LMICs is greater than the proportion of urologic oncology clinical trials performed in LMICs (p <0.001). Linear regression models demonstrates a weak relationship between the global burden of disease and the number of clinical trials conducted in each country for the individual urologic conditions. Discussion A majority of urologic clinical trials are being conducted in high-income countries which does not coincide with the global burden of disease of urologic conditions.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48440434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-05DOI: 10.3389/fruro.2022.959583
B. Wadie, H. G. Aamer, S. Khater, M. Gabr
Purpose This is an experimental preclinical study testing the applicability of autologous skeletal muscle-derived cells as a treatment of SUI in a canine model. Methods Ten mongrel dogs were included in this study. Skeletal muscle was harvested for biopsy in 4 dogs. One month later, incontinence was induced in 8 dogs through urethrolysis. Biopsied muscle cells were incubated and expanded for 8 weeks. Muscle-derived cells were collected and covered with a polyglycolic acid (PGA) scaffold immersed in culture medium and coated with Matrigel to be used as a sling, which was placed suburethrally in 8 dogs; 4 had cell seeding, and 4 had scaffolds only. Urethral pressure (UP) measurements were performed at baseline and 2 & 6 weeks after sling insertion. The urethra was harvested 4 weeks after sling insertion for histopathology. Results One month, a statistically significant increase of mean urethral pressure values compared to baseline was observed in all dogs with a scaffold inserted. The increase ranged from 5 to 40 cmH2O. Histopathology showed significant periurethral proliferation of skeletal muscles in 4 dogs with cell-seeded scaffolds. These levels were the maximum levels in dogs # 1 & 2. This was not the case in the 4 dogs that had slings only. Conclusion Based on the outcome of this preliminary experience, the use of skeletal muscle-seeded PGA scaffolds seems to be an easy and reproducible procedure which preserves histological differentiation and integrity in a canine model
{"title":"The use of autologous skeletal muscle-derived cells as a sling in the treatment of stress-induced urinary incontinence: An experimental study in dogs","authors":"B. Wadie, H. G. Aamer, S. Khater, M. Gabr","doi":"10.3389/fruro.2022.959583","DOIUrl":"https://doi.org/10.3389/fruro.2022.959583","url":null,"abstract":"Purpose This is an experimental preclinical study testing the applicability of autologous skeletal muscle-derived cells as a treatment of SUI in a canine model. Methods Ten mongrel dogs were included in this study. Skeletal muscle was harvested for biopsy in 4 dogs. One month later, incontinence was induced in 8 dogs through urethrolysis. Biopsied muscle cells were incubated and expanded for 8 weeks. Muscle-derived cells were collected and covered with a polyglycolic acid (PGA) scaffold immersed in culture medium and coated with Matrigel to be used as a sling, which was placed suburethrally in 8 dogs; 4 had cell seeding, and 4 had scaffolds only. Urethral pressure (UP) measurements were performed at baseline and 2 & 6 weeks after sling insertion. The urethra was harvested 4 weeks after sling insertion for histopathology. Results One month, a statistically significant increase of mean urethral pressure values compared to baseline was observed in all dogs with a scaffold inserted. The increase ranged from 5 to 40 cmH2O. Histopathology showed significant periurethral proliferation of skeletal muscles in 4 dogs with cell-seeded scaffolds. These levels were the maximum levels in dogs # 1 & 2. This was not the case in the 4 dogs that had slings only. Conclusion Based on the outcome of this preliminary experience, the use of skeletal muscle-seeded PGA scaffolds seems to be an easy and reproducible procedure which preserves histological differentiation and integrity in a canine model","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47742775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01Epub Date: 2023-03-22DOI: 10.3389/fruro.2023.1079790
Beatrice M Girard, Susan E Campbell, Margaret A Vizzard
Symptom exacerbation due to stress is prevalent in many disease states, including functional disorders of the urinary bladder (e.g., overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS)); however, the mechanisms underlying the effects of stress on micturition reflex function are unclear. In this study we designed and evaluated a stress-induced symptom exacerbation (SISE) mouse model that demonstrates increased urinary frequency and somatic (pelvic and hindpaw) sensitivity. Cyclophosphamide (CYP) (35 mg/kg; i.p., every 48 hours for a total of 4 doses) or 7 days of repeated variate stress (RVS) did not alter urinary bladder function or somatic sensitivity; however, both CYP alone and RVS alone significantly (p ≤ 0.01) decreased weight gain and increased serum corticosterone. CYP treatment when combined with RVS for 7 days (CYP+RVS) significantly (p ≤ 0.01) increased serum corticosterone, urinary frequency and somatic sensitivity and decreased weight gain. CYP+RVS exposure in mice significantly (p ≤ 0.01) increased (2.6-fold) voiding frequency as we determined using conscious, open-outlet cystometry. CYP+RVS significantly (p ≤ 0.05) increased baseline, threshold, and peak micturition pressures. We also evaluated the expression of NGF, BDNF, CXC chemokines and IL-6 in urinary bladder in CYP alone, RVS alone and CYP+RVS mouse cohorts. Although all treatments or exposures increased urinary bladder NGF, BDNF, CXC and IL-6 content, CYP+RVS produced the largest increase in all inflammatory mediators examined. These results demonstrated that CYP alone or RVS alone creates a change in the inflammatory environment of the urinary bladder but does not result in a change in bladder function or somatic sensitivity until CYP is combined with RVS (CYP+RVS). The SISE model of CYP+RVS will be useful to develop testable hypotheses addressing underlying mechanisms where psychological stress exacerbates symptoms in functional bladder disorders leading to identification of targets and potential treatments.
{"title":"Stress-induced symptom exacerbation: Stress increases voiding frequency, somatic sensitivity, and urinary bladder NGF and BDNF expression in mice with subthreshold cyclophosphamide (CYP).","authors":"Beatrice M Girard, Susan E Campbell, Margaret A Vizzard","doi":"10.3389/fruro.2023.1079790","DOIUrl":"10.3389/fruro.2023.1079790","url":null,"abstract":"<p><p>Symptom exacerbation due to stress is prevalent in many disease states, including functional disorders of the urinary bladder (e.g., overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS)); however, the mechanisms underlying the effects of stress on micturition reflex function are unclear. In this study we designed and evaluated a stress-induced symptom exacerbation (SISE) mouse model that demonstrates increased urinary frequency and somatic (pelvic and hindpaw) sensitivity. Cyclophosphamide (CYP) (35 mg/kg; i.p., every 48 hours for a total of 4 doses) or 7 days of repeated variate stress (RVS) did not alter urinary bladder function or somatic sensitivity; however, both CYP alone and RVS alone significantly (p ≤ 0.01) decreased weight gain and increased serum corticosterone. CYP treatment when combined with RVS for 7 days (CYP+RVS) significantly (p ≤ 0.01) increased serum corticosterone, urinary frequency and somatic sensitivity and decreased weight gain. CYP+RVS exposure in mice significantly (p ≤ 0.01) increased (2.6-fold) voiding frequency as we determined using conscious, open-outlet cystometry. CYP+RVS significantly (p ≤ 0.05) increased baseline, threshold, and peak micturition pressures. We also evaluated the expression of NGF, BDNF, CXC chemokines and IL-6 in urinary bladder in CYP alone, RVS alone and CYP+RVS mouse cohorts. Although all treatments or exposures increased urinary bladder NGF, BDNF, CXC and IL-6 content, CYP+RVS produced the largest increase in all inflammatory mediators examined. These results demonstrated that CYP alone or RVS alone creates a change in the inflammatory environment of the urinary bladder but does not result in a change in bladder function or somatic sensitivity until CYP is combined with RVS (CYP+RVS). The SISE model of CYP+RVS will be useful to develop testable hypotheses addressing underlying mechanisms where psychological stress exacerbates symptoms in functional bladder disorders leading to identification of targets and potential treatments.</p>","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"3 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10558155/pdf/nihms-1929078.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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