Behavioral risk factors for urinary tract infections in women

Well-designed epidemiologic studies have shown two behavioral factors to be associated, both significantly and independently, with bacterial urinary tract infection in women: sexual intercourse and use of the diaphragm as a contraceptive method. Less convincing evidence points to a protection afforded by post-intercourse micturition. No other habits were found to increase the risk of urinary infection.     

The effect of traditional risk factors for stone disease on calcium oxalate crystal adherence in the rat bladder

Crystal adherence in the urinary tract has been studied using the chemically injured rat bladder and cell cultures. These studies have provided evidence that mucin prevents adherence and have studied various compounds for their ability to promote or inhibit crystal adherence. Little work has been done examining the effect on crystal adherence of traditional risk factors for stone disease. The study reported here examined the effect hypercalciuria, hyperoxaluria and pH on calcium oxalate crystal adherence using the intact rat bladder model. Calcium at levels seen in hypercalciuric stone formers was associated with increased adherence. Oxalate at levels seen in stone formers had no effect on adherence. There was a tendency to increased crystal adherence at higher pH values only when phosphorus was present as the buffer. Hypercalciuria is a risk factor for stone disease by increasing the level of saturation of calcium oxalate and calcium phosphate in the urine and by decreasing inhibitor function. This study suggests that it may also play a role by increasing crystal adherence within the urinary tract.     

Increased prevalence and analysis of risk factors for indinavir nephrolithiasis

PURPOSE: Indinavir is a protease inhibitor used for treating HIV-1. The drug is lithogenic and was thought to cause a 3% incidence of kidney stones. We evaluated a cohort of patients positive for HIV on indinavir to determine the incidence of indinavir nephrolithiasis and identify risk factors for indinavir stone formation. MATERIALS AND METHODS: Our cohort study of the prevalence of indinavir nephrolithiasis included 155 patients with HIV for 5,732 patient-weeks. The same cohort was then used for a retrospective chart review to assess patient age, weight, duration of drug use, time to stone formation, CD4 count, creatinine, alanine transaminase, and urinary pH and specific gravity as risk factors for stone formation. RESULTS: We estimated the cumulative incidence of indinavir stone formation by the Kaplan-Meier product limit estimator method. At 78 weeks 43.2% of patients had stones (95% confidence interval [CI] 0.292 to 0.543). Increasing age was the only variable that was a statistically significant predictor of indinavair urolithiasis (relative risk 0.955, 95% CI 0.918 to 0.993, p = 0.0159). The mean duration plus or minus standard deviation of indinavir use was statistically the same in each group (42.5 +/- 27. 2 and 40.3 +/- 27.1 weeks in those without and with stones, respectively) despite the observed mean time to stone formation of 23.0 +/- 19.8 weeks. CONCLUSIONS: The clinical prevalence of indinavir nephrolithiasis is much greater than initially reported. Nephrolithiasis during indinavir use does not appear to induce patients to withdraw from the drug.     

A new animal model of hyperoxaluria and nephrolithiasis in rats with small bowel resection

An association between small bowel resection and stone disease has been noted, which is primarily due to increased gut oxalate absorption and resulting excretion by the kidney. In order to better understand the factors affecting both oxalate absorption and renal excretion, and the resulting renal lesions, we have developed a rodent model of small bowel resection and hyperoxaluria. Using this model, we have studied the renal histology in animals with hyperoxaluria over time spans from 2 weeks to 7 months. The initial lesion appears to be crystal formation along the brush border of the proximal tubule, with eventual crystal deposition in collecting ducts and papillary interstitium, and eventual tubule obstruction, interstitial inflammation and fibrosis. Crystal formation appears to dissociate from urinary supersaturation. We hypothesize that oxalate transporters in the proximal tubule may increase local saturations, leading to crystal formation at this site initially. Further studies are required to better characterize the causes and consequences of hyperoxaluria in this animal model.     

Quality of life following bladder training in older women with urinary incontinence

This study investigated the changes in quality of life following a randomized controlled 6-week trial of bladder training in 123 older women with urinary incontinence. Both clinical (diary, pad test) and quality of life measures (Incontinence Impact Questionnaire (IIQ), Center for Epidemiological Studies-Depression Scale (CES-D)) and visual analog scales on symptom burden were obtained at baseline, 6 weeks and 6 months following treatment. All subscales and the composite scale of the IIQ and the visual analog scales were significantly improved following bladder training, with effects maintained 6 months later. No changes were observed in CES-D scores. Women with genuine stress incontinence and those with detrusor instability with or without concomitant stress incontinence had similar improvements. We conclude that bladder training is effective in improving the quality of life of incontinent women regardless of urodynamic diagnosis. EDITORIAL COMMENT: This is a well designed investigation looking at the impact of bladder training on the quality of life of elderly women with urinary incontinence. The results are as would be expected: bladder training significantly improves the quality of life of such women. It is, however, surprising that the effect is equally positive in patients with pure stress incontinence and those with detrusor instability. Given the short-term improvement in patients with pure stress incontinence (there was deterioration in quality of life 6 months after treatment), perhaps the only reason for the positive change in quality of life and continence lay in the increased frequency of urination and the regimented voiding habits, which were not maintained post-treatment.     

Urinary glycosaminoglycan excretion in healthy and stone-forming children

Both in vivo and in vitro studies suggest that macromolecules excreted in the urine, e. g. glycosaminoglycans (GAGs) may be inhibitors of kidney stone formation. We evaluated urinary GAG excretion in 22 children with calcium oxalate stones [8 with absorptive hypercalciuria, 6 with renal hypercalciuria (RH), 8 with normocalciuria], and in 20 age-matched controls. There was no significant difference between the two groups in the total urinary GAG level. In terms of the various GAG fractions, patients with RH excreted considerably less keratan sulphate and considerably more dermatan sulphate than the other patients and healthy controls. There was no difference between the two groups in condroitin sulphate, heparan sulphate and hyaluronic acid excretion. We conclude that there is no significant correlation between the formation of calcium oxalate stones and urinary GAG excretion. Received January 31, 1995; received in revised form and accepted February 6, 1996     

部分胃体-窦部代膀胱术的临床应用及长期随访

目的探讨部分胃体-窦部代膀胱术的临床应用价值。方法回顾性分析30例胃代膀胱术患者的临床资料、实验室检查、影像学检查、膀胱镜及尿动力学检查结果。男17例，女13例。年龄21—69岁，平均55岁。原发病为膀胱癌24例，结核性膀胱挛缩6例。结果术后新膀胱贮尿功能良好，患者经尿道排尿，膀胱容量280—580ml，平均385ml；最大尿道压20—60cm H2O，平均49cm H2O；充盈期膀胱压5—15cm H2O，平均12cmH2O；最大膀胱压35—65cm H2O，平均55cmH2O；排尿期最大膀胱压28—60cm H2O，平均46cm H2O；最大尿流率10～28ml／s，平均18ml／s；剩余尿量5～85ml，平均20ml。随访9个月一24年，平均8．2年，无水、电解质代谢紊乱，无输尿管返流，无尿失禁及肾功能损害。4例出现会阴部、膀胱区疼痛；5例出现遗尿，术后3—6个月逐渐缓解；1例因膀胱结石再次手术。术后3．5年膀胱肿瘤复发1例，行经尿道膀胱肿瘤电切术。结论部分胃体一窦部代膀胱术后并发症少，相关生理指标接近正常。     

Increased risk of median nerve dysfunction in floor cleaners: a controlled clinical and neurophysiological study

We studied median nerve involvement in a group of asymptomatic handworkers at risk for carpal tunnel syndrome, and we evaluated damage to thin and thick nerve fibres in the distribution area of the median nerve. Considering floor cleaners as workers at high risk of developing cumulative traumatic disorders in the wrist, we included 42 cleaners and 41 controls. We assessed nerve conduction studies, vibration threshold, and temperature and pain thresholds of the median nerve. The cleaners had significantly impaired motor nerve conduction velocity (p = 0.006), longer sensory distal latency (p = 0.01), lower sensory amplitude (p = 0.0005), and increased difference in heat and cold threshold of the median nerve (p = 0.0002). Increased temperature threshold was associated with prolonged sensory distal latency of the median nerve in the cleaners. In conclusion, impaired neurophysiological variables in the median nerve in floor cleaners compared with controls confirm the hypothesis that those workers are at risk of developing median nerve dysfunction. Sensory nerves seem to be more susceptible to injury than motor branches.     

小儿神经源性膀胱与上尿路损害

目的：探讨脊髓发育不良致神经源性膀胱造成上尿路损害的尿动力学危险因素,方法：对32例脊髓发育不良患儿行尿动力学和影像学检查。结果：18例（56％）有肾和输尿管积水,其中4例伴IV－V级膀胱输尿管返液,19例逼尿肌漏尿点压力大于等于40cmH2O(1cmH2O=0.098kPa)且膀胱顺应性小于等于40ml/cmH2O的患儿中,17例合并上尿路损害,13例逼尿肌漏尿点压力＜40cmH2O且膀胱顺应性＞40ml/c mH2O的患儿中,仅1例有双侧输尿管扩张,差别有非常显著性意义（P＜0．001）,结论：对脊髓发育不良致神经源性膀胱的患儿应行尿动力学检查,了解逼尿肌漏尿点压力和膀胱顺应性,确定与上尿路损害有关的危险因素,有助于避免上尿路进一步损害。     

滥用氯胺酮引起膀胱功能障碍患者膀胱组织中P2X1受体的表达及其意义

目的 研究P2X1受体在滥用氯胺酮导致膀胱功能障碍患者膀胱组织中的表达及其临床意义.讨论P2X1受体在滥用氯胺酮引起膀胱功能障碍中的作用.方法 采用免疫组织化学方法分别检测36例滥用氯胺酮引起膀胱功能障碍患者(实验组)和36例正常膀胱组织(对照组)中P2X1受体、M2受体、M3受体的表达情况,利用全自动显微镜及图像分析系统对免疫组化染色结果进行图像采集分析、测量其平均灰度值,同时比较两组间P2X1受体、M2受体、M3受体表达的差异.结果 P2X1受体主要在膀胱黏膜移行上皮细胞表达,实验组P2X1受体表达明显增强,与对照组比较差异有统计学意义(P＜0.01),而M2受体、M3受体表达与对照组比较无明显差异(P＞0.01).结论 滥用氯胺酮引起膀胱功能障碍患者膀胱组织中P2X1受体表达显著增强,而M2受体、M3受体并未异常表达,提示P2X1受体上调可能在滥用氯胺酮导致膀胱过度活动中发挥关键作用.     

Hypocitraturia as a risk factor for nephrocalcinosis after kidney transplantation

Calcium-oxalate crystal deposition in kidney transplant biopsy specimen led us to investigate the impact of calcineurin inhibitor treatment on urinary excretion of lithogenic and stone inhibitory substances in 53 children after successful kidney transplantation (KTx) receiving cyclosporine A (CsA) or tacrolimus. We compared the values obtained with those of 12 patients with recurrent nephrotic syndrome under CsA and of 6 patients with Rasmussen encephalitis (RE) under tacrolimus therapy. Renal ultrasound examinations were repeatedly performed. Hypocitraturia was found in 69% of patients, with KTx patients having a significantly lower urinary citrate excretion than those receiving calcineurin inhibitors for other reasons. Secondly, we found hyperoxaluria in 35% of patients, again especially in those after KTx. No significant difference in urinary substances was seen comparing CsA with tacrolimus treatment. Urolithiasis was found in one and calcium-oxalate crystal deposition in biopsy specimen of three KTx patients. Calcineurin inhibitor treatment can lead to significant hypocitraturia, especially in patients after KTx receiving the highest dose of medication. Hyperoxaluria is primarily the result of a removal of significant body oxalate stores, deposited during dialysis, but may not be suspected as a specific side effect of calcineurin inhibitor therapy. Both findings can increase the risk for urolithiasis or nephrocalcinosis.     

A prospective study of risk factors for erectile dysfunction

PURPOSE: We examined the impact of obesity, physical activity, alcohol use and smoking on the development of erectile dysfunction. MATERIALS AND METHODS: Subjects included 22,086 United States men 40 to 75 years old in the Health Professionals Followup Study cohort who were asked to rate their erectile function for multiple periods on a questionnaire mailed in 2000. Men who reported good or very good erectile function and no major chronic disease before 1986 were included in the analyses. RESULTS: Of men who were healthy and had good or very good erectile function before 1986, 17.7% reported incident erectile dysfunction during the 14-year followup. Obesity (multivariate relative risk 1.9, 95% CI 1.6-2.2 compared to men of ideal weight in 1986) and smoking (RR 1.5, 95% CI 1.3-1.7) in 1986 were associated with an increased risk of erectile dysfunction, while physical activity (RR 0.7, 95% CI 0.7-0.8 comparing highest to lowest quintile of physical activity) was associated with a decreased risk of erectile dysfunction. For men in whom prostate cancer developed during followup, smoking (RR 1.4, 95% CI 1.0-1.9) was the only lifestyle factor associated with erectile dysfunction. CONCLUSIONS: Reducing the risk of erectile dysfunction may be a useful and to this point unexploited motivation for men to engage in health promoting behaviors. We found that obesity and smoking were positively associated, and physical activity was inversely associated with the risk of erectile dysfunction developing.     

Prevalence of bladder dysfunction in Parkinsons disease

BACKGROUND AND AIMS: Prevalence of lower urinary tract symptoms (LUTS) in Parkinsons disease (PD) is reported as 27%-39% based on validated questionnaires which do not consider the degree of bother. To estimate the prevalence of LUTS in patients with PD, the severity of symptoms, the volume of postmicturitional urine, and to estimate differences compared to non-PD patients referred for urological evaluation. METHODS: One hundred seven patients with PD were evaluated using two sets of validated questionnaires (Dan-PSS and IPSS) about LUTS; postmicturitional residual urine was recorded, and compared to 61 patients without PD presenting at an urological clinic for examination. RESULTS: Bothersome LUTS measured using Dan-PSS scores correlated significantly with Hoehn and Yahr stage of disease (P = 0.02), but not with duration of disease or age. IPSS scores did not correlate to stage of disease, duration of disease or age. Two arbitrary cut-offs were applied, identifying patients with significant LUTS, Dan-PSS > 10 and IPSS > 10. There were no significant differences between the age or duration of disease of patients with and without significant LUTS. The most frequent symptom was nocturia (IPSS: 86%) followed by frequency (IPSS: 71%) and urgency (IPSS: 68%). The most frequently reported bothersome bladder symptom was urgency (Dan-PSS: 61%), followed by nocturia (Dan-PSS: 50%) and urge incontinence (Dan-PSS: 44%). The prevalence of bothersome frequency is low (Dan-PSS: 37%). The postmicturitional volumes (PMV) did not correlate to stage of disease, duration of disease or age, or to scores on questionnaires. Mean PMV was 34 ml. Seven patients (6%) with PD had a PMV larger then 100 ml. DISCUSSION: The prevalence of severe LUTS was similar with other studies, but the correlation between Dan-PSS and stage of disease, and not IPSS indicates that despite seeing no increase in frequency and severity of LUTS as PD progresses, patients find symptoms more bothersome. This may be due to progression in gait difficulties or a decreasing ability to separate and integrate sensory input, or both.     

Prevalence and risk factors for female sexual dysfunction in Turkish women

PURPOSE: We assessed the prevalence of and risk factors for FSD using the Turkish version of the FSFI in Turkish women. MATERIALS AND METHODS: The study consisted of 518 women 18 to 55 years old living in Ankara, who completed the FSFI for the evaluation of FSD. The women were divided into 3 groups according to age, that is 18 to 30 (273), 31 to 45 (192) and 46 to 55 years (53). Demographic characteristics and risk factors were assessed in all women. Findings were compared between women with and without FSD. RESULTS: According to the FSFI score 48.3% of women reported FSD (FSFI score less than 25). The prevalence of FSD was 41% at ages 18 to 30 years, 53.1% at ages 31 to 45 years and 67.9% at ages 46 to 55 years. FSD was detected as a desire problem in 48.3% of women, an arousal problem in 35.9%, a lubrication problem in 40.9%, an orgasm problem in 42.7%, a satisfaction problem in 45.0% and a pain problem in 42.9%. Risk factors for FSD were age, smoking (OR 2.4, 95% CI 6.8 to 18.1), menopause (OR 1.7, 95% CI 2.7 to 10.2), diet (OR 1.2, 95% CI 1.9 to 5.5) and marital status (OR 0.8, 95% CI 1.5 to 3.2) (each p <0.001). CONCLUSIONS: Overall 48.3% of women in our study had FSD according to the FSFI. Apart from age, the most important risk factors for FSD were smoking, diet based life-style changes, menopause status and marital status.     

糖尿病患者膀胱功能改变的临床研究

目的 :探讨糖尿病患者膀胱功能变化及其机制。方法 :将 70例糖尿病患者按照病程分为早期组和进展期组 ,分别对其初尿意的膀胱容量、最大膀胱容量、最大自由尿流率、最大尿流时的逼尿肌压力 (PQmax)、剩余尿量进行分析。结果 :早期组糖尿病患者产生初尿意的膀胱容量增大至 (15 1.6 7± 2 4 .0 7)ml,进展期糖尿病患者初尿意的膀胱容量进一步增大至 (2 6 8.16± 13.90 )ml,最大膀胱容量增大至 (5 92 .97± 2 5 2 .5 1)ml,最大自由尿流率降低至 (8.6 1± 2 .0 4 )ml/min ,PQmax降低 (3.2 5± 1.94 )kPa ,剩余尿量增加至 (16 9.0 3± 137.2 5 )ml。结论 :早期糖尿病患者膀胱感觉减退可能是逼尿肌兴奋性降低的缘故 ;进展期糖尿病患者的一系列尿动力学改变 ,可能是在逼尿肌兴奋性改变的基础上出现逼尿肌收缩力降低的结果。     

逼尿肌厚度评估神经源性膀胱患者下尿路功能障碍

目的通过超声检测逼尿肌厚度(DWT)在评估神经源性膀胱(NB)患者下尿路功能障碍的临床价值。方法选取本院2015年7月至2018年7月诊治的78例因脊髓损伤引起的成年NB患者为病例组,以40例正常成年人群为对照组。超声测量DWT、尿动力学检测最大膀胱容量(MCC)、膀胱顺应性(BC)、残余尿量(PVR)及逼尿肌漏尿点压(ALPP)等指标。统计学分析比较DWT与MCC、BC、PVR及ALPP各指标的关系。结果病例组患者膀胱容量分别在50、100、150、200、250、300、400、500 mL时测得的DWT均明显大于对照组人群(P<0.05)。与低DWT组相比,高DWT组BC明显较低,而DLPP明显较高(P<0.05),组间PVR、MCC差异无统计学意义(P>0.05)。Pearson线性相关分析结果表明,DWT与BC呈明显负相关(r=0.635,P=0.001),与DLPP呈明显正相关(r=0.621,P=0.003),而与PVR、MCC无相关性(r=0.422、0.331,P=0.158、0.341)。结论NB患者DWT增加,DWT与膀胱顺应性呈负相关,而与DLPP呈正相关。应用超声评估NB患者DWT有助于反映NB下尿路功能障碍。     

Prevalence and risk factors for urinary and anal incontinence in Tunisian middle aged women

Objectives

To estimate the prevalence of urinary incontinence and anal incontinence in Tunisian women and to identify their risk factors.

膀胱肿瘤患者术后医院感染情况的调查与分析

目的了解膀胱肿瘤患者术后医院感染的发生率、危险因素、病原菌及其耐药率,为预防术后感染提供科学依据。方法用回顾性调查方法,收集2010年1月至2013年12月我院泌尿外科施行膀胱肿瘤手术（包括膀胱肿瘤电切术、膀胱部分切除术和膀胱根治性切除术）患者的临床资料、微生物检查结果,并对相关资料进行统计分析。结果膀胱肿瘤术后医院感染发生率为8.8%,其中泌尿系感染以革兰阴性菌为主（71.1%）,其对三代头孢菌素和喹诺酮类耐药率达40%-50%;术后医院感染与患者年龄、住院时间、术前尿路感染、手术时间、导尿管留置时间、有无糖尿病及是否恶性肿瘤密切相关（Ρ〈0.05）。结论应整合一系列有严格循证医学证据和基础的防控方案,制定出合理的干预策略,并进行早期干预,以期达到有效降低术后感染的目的。     

尿膀胱肿瘤抗原检测诊断膀胱肿瘤的meta分析

目的 系统评价尿液中膀胱肿瘤抗原(BTA stat)检测诊断膀胱肿瘤的临床价值.方法制定原始文献的纳入标准、排除标准及检索策略,在MEDLINE(1966年1月-2008年6月)、EMBASE(1988年1月-2008年6月)、Cochrane图书馆、中国生物医学期刊文献数据库(1979年1月-2008年6月)、CNKl数字图书馆(1979年1月-2008年6月)进行有关尿BTA stat诊断膀胱癌文献的检索、质量评价和资料提取.采用MetaDiScl.4软件进行Meta分析. 结果 共检索到相关研究71篇,排除51篇,符合纳入标准20篇进入Meta分析,涉及研究对象5929例.异质性检验提示存在异质性.按随机效应模型进行Meta分析,BTA stat诊断膀胱癌的准确度指标敏感性、特异性、阳性似然比、阴性似然比以及诊断优势比等汇总值分别为0.64(95%CI 0.62～0.66)、0.72(95%CI 0.70～0.73)、2.33(95%CI 2.03～2.68)、0.48(95%CI 0.42～0.55)及5.12(95%CI 3.88～6.75).其敏感性随肿瘤病理分级和分期的升高而增加,且初发肿瘤的敏感性高于复发肿瘤.综合受试者工作特征曲线下面积为0.7500,Q*=0.6934. 结论 尿BTA stat检测诊断膀胱肿瘤的准确度中等,可以作为膀胱镜检查的重要辅助手段.