Urinary frequency [keywords]
- Evaluation of feasibility and safety of changing body position after transfemoral angiography: A randomized clinical trial. [JOURNAL ARTICLE]
- J Vasc Nurs 2016 Sep; 34(3):106-115.
Considering the growing number of patients who suffer from cardiovascular and coronary artery disease and the significant importance of angiography in the diagnosis of coronary artery disease, this study investigated the effects of position change on the acute complications of coronary angiography.This study was a randomized clinical trial. Sixty patients undergoing coronary angiography, which was performed by a single operator were selected by convenience sampling method and were assigned to intervention or control groups by randomized block design (30 cases in each group). Intervention group patients' position was changed according to schedule, whereas patients in the control group remained in the supine position in complete bed rest. At the entrance hours, 3, 6, 8, and 24 hours after the angiography, patients in both groups were evaluated in terms of vascular complications, urinary retention, low back pain, groin pain, and comfort. Data were analyzed by repeated measures, Friedman, Mann-Whitney, chi-square, independent t-test, and Kolmogorov-Smirnov tests with SPSS-22.The two groups did not show any significant difference in terms of demographic, clinical, and preinterventional catheterization characteristics (P > 0.05). There was no significant difference with regard to vascular complications including hematoma (P = 0.149), bleeding (P > 0.01), bruise (P = 0.081), and thrombosis in the two groups of patients during 5 consecutive reviews. However, there was a significant statistical difference regarding low back pain (P < 0.001), groin pain (P < 0.001), urinary retention (P = 0.02), and comfort (P < 0.001).The results of this study showed that changing the positions of patients after angiography based on the provided program created no change in the incidence of vascular complications (hematoma, bleeding, thrombosis, and bruise) but resulted in reduced severity of back pain, groin pain, urinary retention, and increased patients' comfort.
- Prevalence and bother of patient-reported lower urinary tract symptoms in the muscular dystrophies. [JOURNAL ARTICLE]
- J Pediatr Urol 2016 Jul 12.
Duchenne muscular dystrophy (DMD) and the less severe Becker muscular dystrophy (BMD) are characterized by progressive muscle weakness and eventual loss of ambulation, and result from mutations in the dystrophin gene. Dystrophin is essential for skeletal muscle functioning but its role in smooth muscle function is not as well established. In a retrospective review, our group previously demonstrated that roughly half of these patients have at least one documented urologic diagnosis, most commonly being lower urinary tract symptoms (LUTS) and nephrolithiasis. To better understand the frequency of LUTS and the degree to which they impact quality of life in this patient population, we performed a cross-sectional evaluation.Following IRB approval, a survey modified from multiple validated surveys was distributed to DMD and BMD patients. The survey contained questions derived from multiple validated questionnaires, including the American Urological Association Symptom Score and the Dysfunctional Voiding Symptoms Score, which assessed both the frequency of lower urinary tract symptoms (i.e. urinary urgency, frequency, enuresis, dysuria, and bowel function) as well as how bothersome patients found these symptoms.Of the 56 respondents (mean age 15.3; range 4-33), 40 (71.4%) reported at least one LUTS, most commonly urgency (n = 31, 55%) and hesitancy of stream (n = 32, 57%) (Figure). Although the majority of the patients reported being happy with their symptoms, 16% (n = 9) expressed dissatisfaction. We did not find any correlation between LUTS and disease progression, as measured by years non-ambulatory, on chi-square analysis.In this cross-sectional study of the frequency and degree of bother of LUTS in D/BMD patients, we found that a high percentage experience LUTS. Despite this high prevalence, the majority report that they are not especially bothered by these symptoms; however, over 16% express dissatisfaction with their current LUTS. With this patient population now living longer, this may become even more prevalent. Screening for bothersome LUTS in patients with DMD and BMD should be a part of disease management, with appropriate treatment or referral to a urologist for those bothered by their symptoms to positively impact their quality of life.
- Inter-rater reliability of the APD, SFU and UTD grading systems in fetal sonography and MRI. [JOURNAL ARTICLE]
- J Pediatr Urol 2016 Jul 27.
Antenatal hydronephrosis (ANH) is frequently detected on screening obstetric ultrasonography. Common ANH grading systems include the anterior-posterior diameter (APD) and the Society for Fetal Urology (SFU) grading system. Recent developments in the management of ANH include the use of fetal magnetic resonance imaging (MRI), and a new grading system - Urinary Tract Dilation (UTD). This study reviewed patients who underwent fetal MRI and ultrasound, and compared the grading systems across these imaging modalities.Patients who underwent paired fetal MRI and ultrasound studies between January 2012 and January 2014 were included. Two pediatric urologists and a pediatric radiologist reviewed the studies. Data collected included APD, SFU grade, and UTD grade. Fleiss' kappa statistic determined the inter-rater reliability (IRR) of the SFU and UTD grading within each imaging modality. Intra-class correlation assessed the consistency of the APD measurements.Forty-seven patients and 88 renal units were evaluated. Median gestational age was 22 weeks. Kappa values of the SFU grading system indicated fair IRR for ultrasound imaging and moderate IRR for MRI imaging, while the UTD grading system reached moderate IRR for both. The IRR of the SFU grading system was improved with the use of MRI, while the UTD grading system was no different. The APD intraclass correlation coefficient improved significantly when measured by MRI. As the ultrasound SFU grade increased, the odds of the MRI SFU grade being scored higher increased by a factor of 3.7. There was no difference between ultrasound and MRI when using the UTD grading system.This study was the first to assess the UTD system in a cohort of patients who underwent paired ultrasound and MRI studies. The results suggested that the UTD system might improve IRR, compared with the SFU system. The use of fetal MRI may improve the IRR of the SFU grading system. It also found that the proportion of SFU grades was affected by the imaging modality, raising the possibility that MRI 'overcalls' the SFU grade, compared with ultrasound. This difference was not observed using the UTD grading system. The most important limitation was the selection bias favoring complex pathology with severe ANH diagnosed at an early gestational age.In this unique cohort, the UTD system improved IRR when compared to the SFU grading system. Fetal MRI improved the IRR of the SFU grading system, and improved the APD intraclass correlation. The SFU grading was likely to be higher when assessed by MRI vs ultrasound, but the UTD grade was not affected by the imaging modality.
- First trimester phthalate exposure and male newborn genital anomalies. [JOURNAL ARTICLE]
- Environ Res 2016 Aug 18.
Anti-androgenic phthalates are environmental chemicals that affect male genital development in rodents leading to genitourinary birth defects. We examined whether first trimester phthalate exposure may exert similar effects in humans leading to an increased incidence of newborn male genital anomalies in a multi-center cohort study.We recruited first trimester pregnant women within The Infant Development and the Environment Study (TIDES) from 2010 to 2012 from four study centers and limited analyses to all mother/male infant dyads who had complete urinary phthalate and birth exam data (N=371). We used multivariate logistic regression to determine the odds of having a genital anomaly in relation to phthalate exposure.Hydrocele was the primary abnormality observed in the cohort (N=30) followed by undescended testes (N=5) and hypospadias (N=3). We observed a statistically significant 2.5 fold increased risk (95% CI 1.1, 5.9) of having any anomaly and 3.0 fold increased risk (95% CI 1.2, 7.6) of isolated hydrocele in relation to a one log unit increase in the sum of di-ethylhexyl phthalate (DEHP) metabolites.First trimester urinary DEHP metabolite concentrations were associated with increased odds of any newborn genital anomaly, and this association was primarily driven by isolated hydrocele which made up the majority of anomalies in newborn males. The association with hydrocele has not been previously reported and suggests that it may be an endpoint affected by prenatal phthalate exposures in the first trimester of development. Future human studies should include hydrocele assessment in order to confirm findings.
- Variability and exposure classification of urinary phenol and paraben metabolite concentrations in reproductive-aged women. [JOURNAL ARTICLE]
- Environ Res 2016 Aug 24.:513-520.
Human exposure to phenols and parabens is widespread. Within-person variability of urinary concentrations in healthy women is not well characterized.To characterize the variability of urinary phenol and paraben concentrations across two months and evaluate the ability of a single spot urine sample to characterize exposure.143 women provided 509 spot urine samples collected across two months of study (3-5 samples/woman). We measured urinary concentrations of 8 phenols: bisphenol A (BPA), benzophenone-3 (BP-3), benzophenone-1 (BP-1), 2,4-dichlorophenol (2,4-DCP), 2,5-dichlorophenol (2,5-DCP), 2,4,5-trichlorophenol (2,4,5-TCP), 2,4,6-trichlorophenol (2,4,6-TCP), triclosan (TCS); and 8 parabens and their metabolites (benzyl (BzP), butyl (BuP), ethyl (EtP), heptyl (HeP), methyl (MeP), propyl (PrP), 4-hydroxybenzoic acid (4-HB), 3,4-dihydroxybenzoic acid (3,4-DHB)). Biomarker variability was characterized using the intraclass correlation coefficient (ICC) and surrogate category analyses were conducted.ICCs ranged from very low for BPA (0.04) to moderate for BP-3, BP-1, TCS, BzP, and MeP (0.66, 0.58, 0.55, 0.54, and 0.62, respectively). Surrogate analyses suggested that BP-1, BP-3, TCS, 2,4-DCP, BuP, and PrP may be characterized by a single spot sample (sensitivity range 0.76-0.86) but that additional samples were necessary for BPA, HeP, 4-HB, and 3,4-DHB (sensitivity range 0.47-0.61).Urinary phenol and paraben metabolite concentrations were variable across two months in healthy women but the degree of reliability differed by the specific biomarker. A small number of samples may sufficiently characterize typical concentrations for BP-3, BP-1, TCS, BuP, and PrP; but additional biospecimens may be necessary to characterize exposure for other compounds, including BPA.
- Simultaneous self-created transobturator tape and laparoscopic extraperitoneal vaginal support in patients with stress urinary incontinence and prolapse of the anterior and apical vaginal compartments. [JOURNAL ARTICLE]
- Eur J Obstet Gynecol Reprod Biol 2016 Aug 8.:117-121.
Stress urinary incontinence (SUI) is frequently associated with prolapse of the apical and anterior vaginal compartments. The standard treatment of SUI is transobturator tape (TOT). The usual treatment of prolapse (anterior colporrhaphy) has a high recurrence rate. The aim of this study is to evaluate the results of the treatment of SUI and concomitant anterior and apical prolapse with self-created transobturator tape and simultaneous laparoscopic anterior and apical support.A total of 36 patients with SUI and prolapse of the anterior and apical compartments were underwent operations. The mean follow-up was 18 months. Self-created transobturator tape and laparoscopical support of the anterior and apical compartment prolapse were performed in all patients. The most important symptoms of prolapse and incontinence, the anatomical outcome, and complications were evaluated before and after the surgery.Treatment of incontinence and anterior and apical prolapse was successful in 33/36 (91.7%), 30/36 (83.3%) and 31/36 (86.1%) patients, respectively (p<0.0001). There is a significant reduction of vaginal bulging and pelvic pressure (p<0.0001). Frequency and urgency were significantly reduced (p<0.0007 and p<0.03 respectively). There was no significant deterioration of the posterior compartment. The most important complications were bladder perforation in 2/36 (5.5%) patients and temporary urinary retention in 3/36 (8.3%) patients (Clavien-Dindo grade 3).Simultaneous laparoscopic anterior and lateral extraperitoneal support and transobturator tape are effective in the treatment of patients with both conditions.
- Dietary micronutrient intake and its relationship with arsenic metabolism in Mexican women. [JOURNAL ARTICLE]
- Environ Res 2016 Aug 23.:445-450.
Concentrations of inorganic arsenic (iAs) metabolites in urine present intra- and interindividual variations, which are determined not only by the magnitude of exposure to iAs, but also by differences in genetic, environmental and dietary factors.To evaluate whether differences in dietary intake of selected micronutrients are associated with the metabolism of iAs.The intake of 21 micronutrients was estimated for 1027 women living in northern Mexico using a food frequency questionnaire. Concentration of urinary metabolites of iAs was determined by high performance liquid chromatography inductively coupled plasma mass spectrometry (HPLC-ICP-MS) and the proportion of iAs metabolites was calculated (%iAs, monomethylarsonic acid [%MMA] and dimethylarsinic acid [%DMA]), as well as ratios corresponding to the first (MMA/iAs), second (DMA/MMA) and total methylation (DMA/iAs).After adjustment for covariates, it was found that methionine, choline, folate, vitamin B12, Zn, Se and vitamin C favor elimination of iAs mainly by decreasing the %MMA and/or increasing %DMA in urine.Our results confirm that diet contributes to the efficiency of iAs elimination. Further studies are needed to assess the feasibility of dietary interventions that modulate the metabolism of iAs and the consequent risk of diseases related to its exposure.
- Nocturnal polyuria and hypertension in patients with lifestyle-related diseases and overactive bladder. [JOURNAL ARTICLE]
- J Urol 2016 Aug 23.
The objective of this multicenter, cross-sectional study was to investigate the relationship of nocturnal polyuria in patients with common lifestyle-related diseases and overactive bladder (OAB), with special attention to hypertension.After baseline assessment, patients recorded their 24-hour urinary frequency/volume, blood pressure, and heart rate for 3 days, and were stratified into 4 groups based on mean blood pressure (no hypertension, controllable, untreated, and uncontrolled hypertension).Eligible patients (n=2,353; urinary urgency ≥once/week, ≥1 nocturnal toilet visit) were enrolled from 543 sites in Japan. Of these, complete data including the 24-hour frequency volume chart was collected from 1,271 patients. Multivariable analyses showed a statistically significant association of nocturnal polyuria with increasing age (Odds ratio [OR] [95% CI]: 1.04 [1.02, 1.05], p<0.001), gender (OR [95% CI]: 0.75 [0.59, 0.96] for women vs men; p=0.02), and hypertension (OR [95% CI]: 1.10 [0.83, 1.46], 2.62 [1.55, 4.45], 1.15 [0.81, 1.62], for controllable, untreated, and uncontrolled hypertension vs no hypertension, respectively, p=0.005). However, when assessed separately for men and women, hypertension and heart rate were significantly associated with nocturnal polyuria in women alone (p=0.01 and 0.03, respectively). Lower urinary tract symptoms suggestive of benign prostatic hyperplasia were significantly associated with nocturnal polyuria in men alone (p<0.001).The current study demonstrated that nocturnal polyuria was significantly associated with age, men, and untreated hypertension in patients with lifestyle-related diseases and OAB, with the association between hypertension and nocturnal polyuria significant in women alone.
- Smoking and prevalence of nocturia in Japanese patients with type 2 diabetes mellitus: a post-hoc analysis of The Dogo Study. [JOURNAL ARTICLE]
- Neurourol Urodyn 2016 Aug 26.
No evidence exists regarding the association between smoking status and nocturia among patients with type 2 diabetes mellitus. We evaluated this association among Japanese patients with type 2 diabetes mellitus by post-hoc analysis.Study subjects were 817 Japanese patients with type 2 diabetes mellitus. Study subjects were considered to have nocturia if they answered "once or more" to the question: "Within one week, how many times do you typically wake up to urinate from sleeping at night until waking in the morning?" We used the following three outcomes: (1) nocturia was ≥1 voids per night; (2) moderate nocturia was ≥2 voids per night; and (3) severe nocturia was ≥3 voids per night. Adjustments were made for age, sex, body mass index, hypertension, dyslipidemia, stroke, glycated hemoglobin, current drinking, use of anti-hypertensive agent, use of insulin, use of oral anti-hyperglycemic agent, and diabetic retinopathy.The prevalence values of one void per night, two voids per night, and three or more voids per night were 39.5%, 27.1%, and 14.8%, respectively. Current smoking was independently inversely associated with severe nocturia compared with never or former smoking; the adjusted PR was 0.47 (95%CI: 0.25-0.89). Among the 443 patients who had ever smoked, compared with former smoking, current smoking was independently inversely related to severe nocturia; the adjusted PR was 0.44 (95%CI: 0.24-0.82).In Japanese patients with type 2 diabetes mellitus, current smoking may be independently inversely associated with severe nocturia.
- Are patients willing to trade cure rate against less pain? Patients' preferences for single incision midurethral sling or transobturator standard midurethral sling. [JOURNAL ARTICLE]
- Neurourol Urodyn 2016 Aug 26.
To quantify to what extent patients are willing to trade their chance of cure of stress urinary incontinence (SUI) against less postoperative groin pain. Randomized, controlled trials show less postoperative pain following single-incision mini-sling (SIMS), but slightly higher cure rates following a transobturator standard midurethral sling (SMUS).A multi-center, interview-based trade-off experiment for treatment preference among 100 women with predominant SUI and undergoing SIMS. A hypothetical cure rate of SIMS was systematically varied from 10% to 70%, while keeping the cure rate of SMUS constant at 70%. The trade-off was assessed for two hypothetical durations of substantial postoperative pain after SMUS-2 days or 2 weeks-while simultaneously assuming the absence of substantial postoperative pain after SIMS.To prevent 2 days of substantial postoperative pain with SMUS, patients were willing to accept a 4.3% mean decrease in cure rate of SIMS, while a 7.1% mean decrease was acceptable to forego 2 weeks of substantial pain. Younger women (P = 0.04) and single women (P = 0.04) were associated with the trade-off limit for 2 days, respectively, 2 weeks of substantial postoperative pain. Single women were willing to accept lower cure rates. No correlations with trade-off limits were found for patients' actual severity, duration, and frequency of SUI.Patients are willing to accept a slightly lower probability of cure to prevent substantial post-operative pain by undergoing a less invasive procedure. These results are relevant for counselling of patients indicated for SUI surgery.