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urinary retention [keywords]
- Toxicodynamic and Toxicokinetic Descriptors of Combined Chromium (VI) and Nickel Toxicity. [JOURNAL ARTICLE]
- Int J Toxicol 2014 Oct 28.
After repeated intraperitoneal injections of nickel and chromium (VI) salts to rats, we found, and confirmed by mathematical modeling, that their combined subchronic toxicity can either be of additive type or depart from it (predominantly toward subadditivity) depending on the effect assessed. Against the background of moderate systemic toxicity, the combination under study proved to possess a marked additive genotoxicity assessed by means of the random amplification of polymorphic DNA test. We also demonstrated that chromium and nickel reciprocally influenced the retention of these metals in some organs (especially in the spleen) but not their urinary excretion in this study.
- [Elsberg syndrome.] [JOURNAL ARTICLE]
- Ugeskr Laeger 2013 Dec 16; 175(51)
A syndrome involving acute urinary retention in combination with sacral radiculitis and cerebrospinal fluid pleocytosis was first described by the American neurosurgeon Charles Elsberg in 1931. In many instances the aetiology is herpes simplex virus type 2 (HSV-2) reactivation from sensory neurons. In this case report we present a 34-year-old pregnant woman with previous undiagnosed sensory lumbosacral symptoms. She was hospitalized with HSV-2 meningitis and lumbosacral radiculitis but no genital rash. A week after the onset of symptoms she developed acute urinary retention, thus indicating Elsberg syndrome.
- [5ARI and PSA: open questions.] [JOURNAL ARTICLE]
- Urologia 2014 Sep 23; 81(Suppl. 24):12-16.
No consensus has ever been reached on the predictive value of serum prostate specific antigen(PSA) for the diagnosis of prostate cancer. Limitations of PSA testing in clinical practice have beenoften discussed in the peer-reviewed literature following data derived from clinical trials such as theProstate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events(REDUCE) study that showed a linear rise in the risk of prostate cancer with increasing PSA levels.Benign prostatic hyperplasia is a known confounding factor for the use of PSA as a marker of prostatecancer. Increased prostate volume observed with ageing, urinary retention, acute and chronicinflammatory conditions of the prostate, sexual activity and digital rectal examination may all cause anincrease of PSA values. Both finasteride and dutasteride, 5-alpha reductase inhibitors (5ARI) used inthe treatment of BPH, are known to induce a significant decrease of serum PSA levels close to 50%.The observed change in PSA values following 5ARI treatment has raised questions about the accuracyof PSA testing for the early diagnosis of prostate cancer in patients on finasteride/dutasteride treatment.Careful analysis of data from various clinical trials on pharmacological treatment of LUTS due toBPH suggested that the accuracy of PSA testing is not just maintained but rather increased following5ARI use. Then, the question of PSA accuracy during 5ARI treatment can be considered closed.
- Micturition Problems After Bladder Distension During Hospitalization in Sweden: "I'm Not Ill, Just Damaged for the Rest of My Life" [JOURNAL ARTICLE]
- Nurs Res 2014 November/December; 63(6):418-425.
Urinary retention is a common complication following hospital care, which can result in overdistension of the bladder and, at worst, chronic bladder damage and persistent micturition difficulties.The purpose of this study was to explore patients' experiences of micturition problems after bladder distension and their effects on the patients' everyday lives.The Swedish Patient Insurance LÖF was used to identify patients from January 2007 to June 2010 who have reported micturition problems after hospital care and have had their injuries classified as avoidable bladder damage due to overdistension. Narrative interviews were conducted with 20 volunteers and analyzed by qualitative content analysis.The micturition problems affected everyday life through constraints (dependence on disposables and access to toilets, clothing restrictions, limitations on social life and career), suffering (pain, infections, impaired sex life, leakage), and concerns for the future (fear of worsening symptoms and fear of losing control with age). Aspects related to having been harmed by the healthcare system were the harm could have been avoided (lack of knowledge, insufficient routines, mistrust), obstacles to overcome when reporting an injury (difficulties in obtaining knowledge about the possibility of reporting an injury, ambivalence toward reporting their healthcare providers), and a wish to improve care (raise awareness, prevent harm to others).Bladder distension is a healthcare-related injury that can cause suffering and practical, emotional, and psychosocial problems with a great impact on the life of the person affected and anxiety for the future. The healthcare system must, therefore, raise awareness and improve preventive routines.
- Fructan supplementation of senior cats affects stool metabolite concentrations and fecal microbiota concentrations, but not nitrogen partitioning in excreta. [Journal Article]
- J Anim Sci 2014 Nov; 92(11):4964-71.
Fructan supplementation of a commercially available canned cat food was evaluated using senior (≥ 9 yr) cats to assess nitrogen (N) partitioning in excreta and stool metabolite and microbiota concentrations. Oligofructose (OF) or SynergyC (OF+IN) were added to the diet individually at 1% (dry weight basis). Cats were acclimated to the control diet for 7 d and then were randomly assigned to 1 of 3 treatment groups for 21 d (n = 6). Feces and urine were collected on d 22 through 28. No differences were observed in food intake; fecal output, DM percentage, score, pH, or short- or branched-chain fatty acids, fecal and urinary ammonia output, urinary felinine concentrations, or N retention. Supplemental OF+IN tended to decrease N digestibility (P = 0.102) and Bifidobacteria spp. (P = 0.073) and decrease fecal indole (P < 0.05), tyramine (P < 0.05), and Escherichia coli (P < 0.05) concentrations. Both fructan-supplemented treatments decreased (P < 0.05) fecal histamine concentrations. The tendency to a lower apparent N digestibility was likely due to increased colonic microbial protein synthesis of fructan-supplemented cats. Fructan supplementation may benefit senior cats as it modulates stool odor-forming compounds and decreases some protein catabolites and pathogenic gut microbiota concentrations without affecting N retention.
- The massively enlarged prostate: Experience with photoselective vaporisation of the ≥100cc prostate using the 180W Lithium Triborate Laser. [JOURNAL ARTICLE]
- J Endourol 2014 Oct 24.
Objectives: To determine if there is a role for high powered photoselective vaporisation of the prostate (PVP) in large prostates for the management of bladder outlet obstruction. This study aims to evaluate the safety and efficacy of PVP in prostates ≥ 100 cc. Materials and Methods: A retrospective analysis of a prospectively maintained database (ethics approved) single surgeon, single centre series between November 2010 and February 2013 of males with ≥ 100cc prostates who underwent PVP. Perioperative and functional outcomes at baseline, 3 and 6 months were evaluated. Results: 35 males were identifed, median age 70 (IQR 66-79) with prostates ≥ 100cc (median 132, IQR 118-157). Preoperatively, 11/35 (31%) were in urinary retention and 11/35 (31%) were anticoagulated. Perioperative outcomes showed median laser time 75 mins, operating time 103 mins and energy use 750 kJ. Median post-operative length of stay was 20 hours, catheterisation 12 hours and 33/35 (94%) were discharged catheter free. 12 adverse events in 11 men were recorded, all Clavien Dindo Grade I-II with 1 Grade IIIa complication. Paired functional outcomes showed statisticially significant (p<0.05) improvements in median IPSS (20, 6, 6), QoL (4, 1, 1), Qmax (9.5, 20.5, 19.5 mL/s) and PVR (149, 40, 41 mls) (baseline, 3, 6 months). Conclusion: PVP using the 180W LBO laser in large prostates appears feasible and efficacious, with short duration of catheterisation and post-operative length of stay. Acceptable morbidity was recorded. Enormous energy utilisation was delivered within acceptable operating times. Early results indicate excellent functional outcomes at 3 and 6 months following PVP.
- Factors that Delay Treatment of Symptomatic Metastatic Extradural Spinal Cord Compression. [JOURNAL ARTICLE]
- J Palliat Med 2014 Oct 24.
Abstract Background: Treatment delays of metastatic extradural spinal cord compression (MESCC) sometimes have been reported, but reasons for its delay have remained unclear. The purpose of this study was to assess which clinical factors are associated with treatment delays in neurologically symptomatic MESCC in the hospital settings. Methods: We reviewed medical records of MESCC patients in our institute who had at least one progressive neurological symptom (weakness, sensory changes, urinary retention, or nerve root pain), were diagnosed by magnetic resonance imaging (MRI), and were treated with at least radiotherapy. The number of days prior to treatment initiation were counted and defined as follows: from the patients' first physician visit to our hospital until MRI diagnosis [T1 (days)], from MRI diagnosis to treatment [T2 (days)], and from patients' first visit to treatment [T1+2 (days)]. Nine clinical factors that could potentially delay treatment were analyzed for each period. Results: Forty-three episodes of MESCC met the inclusion criteria. Median days in T1+2 was 3 days (range: 0-22). T1 and T1+2 were significantly higher in patients with normal walking status than in those with deterioration or inabilities to walk (T1+2, 7 days versus 3 days, median, p<0.001). The number of days was higher in all periods when it included weekends (T1+2, 7 days versus 2 days, median, p<0.001). Conclusions: Our findings suggest that normal walking status at the first physician visit and inclusion of weekends during the pretreatment periods were factors that resulted in treatment delays even for MESCC patients with emergency neurological symptoms.
- Anesthesia-free procedures for benign prostate obstruction: worth it? [JOURNAL ARTICLE]
- Curr Opin Urol 2014 Oct 21.
Perhaps, 30% of patients with benign prostate obstruction experience no symptom relief with drug therapy, necessitating surgical intervention. General anesthesia can be too dangerous for elderly or frail men, making local anesthesia desirable. Such minimally invasive procedures may offer time-saving, effective, gentle, and well tolerated alternatives.Recent interest has focused on the mechanical devices and intraprostatic injections. The commercially available UroLift system demonstrates promising short-term data in randomized multicenter trials. Rezum steam injection therapy is intriguing, although currently study-based with limited data. NX1207 and PRX302 are new intraprostatic injection drugs demonstrating interesting results in phase I and II studies, whereas conflicting results surround the prostatic injection of botulinum toxin A. For transurethral microwave therapy, definitive evaluations regarding the treatment of chronic urinary retention in nonsurgical patients are ongoing.Although none of these minimally invasive procedures must be performed under general anesthesia, all require local anesthesia with possible sedation. In most studies, pain therapy management is rudimentary or not described. Although good short-term results are described, no long-term data are available.
- Mini-slings can cause complications. [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Oct 23.
Single-incision mini-slings (SIMS) have been advocated to avoid the complications of transobturator and retropubic midurethral slings. We present a series of SIMS complications and their outcome after vaginal removal at a tertiary care center.Following Institutional Review Board approval, a prospective database of consecutive women who underwent SIMS removal for complications and had a minimum follow-up of 6 months was reviewed. Patient-reported outcomes were assessed by main symptom category. In addition, an ideal outcome or cure was defined as continent, pain-free, sexually active if active preoperatively, and not requiring additional medical or surgical therapy.Of 23 women, 17 met inclusion criteria. Presenting symptoms were varied but dominated by incontinence (14), pelvic pain (11), dyspareunia (10), and obstructive urinary symptoms/urinary retention (5), with 76 % presenting with more than one complaint. Type of SIMS included MiniArc™ (11), Solyx™ (4), and TVT-Secur™ (2). At a mean follow-up of 17 ± 9 (range 7-44) months after SIMS removal, six (35 %) women were cured of their presenting complaint. Among the 11 women with pelvic pain, 6 had resolution of pain, 2 improvement, and 3 persistent pain. Six of seven women who were sexually active beforehand resumed sexual activity. Dyspareunia persisted in three women. Of 14 with incontinence, 8 had cure or improvement, and obstructive symptoms resolved in 4 of 5.This series outlines several complications with SIMS, similar to what has been reported with other suburethral synthetic tapes. Therefore, caution is required and patient counseling is important.
- Testosterone and benign prostatic hyperplasia. [JOURNAL ARTICLE]
- Asian J Androl 2014 Oct 21.
The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in particular any possible effect on the risk of prostate cancer have prompted further research in this regard. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms (LUTS) in patients treated with testosterone. The exact mechanism of this improvement is still debated but may have a close relationship to metabolic syndrome. For the clinician, the results of these studies are promising but do not constitute high levels of evidence. A thorough clinical examination (including history, examination and laboratory testing of testosterone) should be undertaken before considering the diagnosis of late-onset hypogonadism or instigating treatment for it. Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients.