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urinary retention [keywords]
- Salvage cryotherapy for local recurrence after radiotherapy for prostate cancer. [JOURNAL ARTICLE]
- Scand J Urol 2014 Nov 27.:1-5.
Abstract Objective. The aim of this study was to present the outcome of patients treated with salvage cryotherapy after radiotherapy for prostate cancer at one institution. Materials and methods. Consecutive patients treated between 2007 and 2013 with transperineal cryotherapy for biopsy-verified local recurrence after radiotherapy were investigated. An external reviewer retrieved outcome data retrospectively from medical records. Complications were graded according to the Clavien classification. One patient with less than 1 year of follow-up was excluded from the analysis of side-effects. Results. Thirty patients were included, 29 of whom had a follow-up of at least 1 year. The median follow-up was 2.7 years (range 1-6.5 years). Eleven of the 23 patients without hormonal treatment at the time of cryotherapy reached a prostate-specific antigen (PSA) nadir of less than 0.5 ng/ml. At the end of follow-up five of these 23 patients still had a PSA below 0.5 ng/ml and 10 were free from recurrence according to the Phoenix definition. Clinical recurrence (verified with imaging or biopsies) was detected in 13 patients, six of which were local. One patient died from prostate cancer. Eleven patients had urinary incontinence grade 1-2 and three had grade 3-4, seven had pelvic pain, three had severe but transitory tissue sloughing, three developed a urethral stricture or had prolonged urinary retention, and one developed a urinary fistula 4.5 years after cryotherapy. Conclusions. Salvage cryotherapy should be considered as an alternative to hormonal treatment and surgery for local recurrence after radiotherapy for prostate cancer. The results compare well to those reported from centres with longer experience.
- Ambulatory haemorrhoidal surgery: systematic literature review and qualitative analysis. [JOURNAL ARTICLE]
- Int J Colorectal Dis 2014 Nov 28.
The aims of this study are to review the advantages and drawbacks of the ambulatory management of patients scheduled for haemorrhoidal surgery and to highlight the reasons for unplanned hospital admission and suggest preventive strategies.We conducted a systematic review of the literature from January 1999 to January 2013 using MEDLINE and EMBASE databases. Manuscripts were specifically analysed for failure and side effects of haemorrhoidal surgery in ambulatory settings.Fifty relevant studies (6082 patients) were retrieved from the literature review. The rate of ambulatory management failure ranged between 0 and 61 %. The main reasons for failure were urinary retention, postoperative haemorrhage and unsatisfactory pain control. Spinal anaesthesia was associated with the highest rates of urinary retention. Doppler-guided haemorrhoidal artery ligation has less frequent side effects susceptible to impair ambulatory management than haemorrhoidectomy and stapled haemorrhoidopexy. However, the fact that haemorrhoidopexy is less painful than haemorrhoidectomy may allow ambulatory management.Day-case haemorrhoidal surgery can be performed whatever the surgical procedure. Postoperative pain deserves special prevention measures after haemorrhoidectomy, especially by using perineal block or infiltrations. Urinary retention is a common issue that can be responsible for failure; it requires a preventive strategy including short duration spinal anaesthesia. Doppler-guided haemorrhoidal artery ligation is easy to perform in outpatients but deserves more complete evaluation in this setting.
- Wound healing potential of scaffolds prepared from porcine jejunum and urinary bladder by a non-detergent/enzymatic method. [JOURNAL ARTICLE]
- J Biomater Appl 2014 Nov 25.
Scaffolds prepared using extracellular matrices of mammalian organs/tissues, when used as grafts, have wound healing potential. This paper evaluated the physical properties and in vivo wound healing potential of jejunum-derived scaffold (JDS) and urinary bladder-derived scaffold (UDS) of porcine origin prepared by a non-detergent/enzymatic method. The former had higher flexural rigidity and suture retention strength compared to the latter, but both of them had the essential flexural rigidity and suture retention strength required for skin grafts. Full thickness skin-wounds on rabbit dorsum were treated with these scaffolds and the wound healing ability was compared by studying histomorphology parameters such as re-epithelialisation, collagen deposition, angiogenesis, proliferation of cells, mesenchymal cell infiltration and myofibroblast response. The extent of these reactions was assessed using histomorphometry. The results indicated that both grafts initiated healing faster than those wounds without any graft, as evidenced by the extent of cell proliferation and mesenchymal cell infiltration. The myofibroblast response persisted longer in the non-graft assisted wound healing reaction compared to the healing in the graft assisted wounds. Moreover, the JDS induced higher cell proliferation and greater angiogenesis than UDS probably indicating better healing by the former. The results suggested that JDS and UDS prepared by non-detergent/enzymatic method have potential clinical applications.
- Efficacy of sling procedures for treatment of female stress urinary incontinence. [Journal Article]
- Coll Antropol 2014 Sep; 38(3):1063-9.
The aim of this study was to determine the efficacy and surgical outcome of the sling procedures in stress incontinent women in comparison to conventional anterior colporrhaphy. Total of 56 patients with stress urinary incontinence (SUI) were treated with sling procedure between November 2011 and March 2013, 39/56 (69.6%) with suprapubic arc (SPARC) and 17/56 (30.4%) with MiniArc method. During the same period total of 49 patients with SUI were treated with traditional anterior colporrhaphy according to Bagovid method as the control group. All patients were prospectively clinically assessed over aperiod of 3, 6 and l2 months after surgery. The objective cure rate after the follow-up was 92.9% (52/56) in observed group of patients and 79.6% (39/49) in control group and improvement was occurred in rest of 5.4% (3/56) and 18.4% (9/49), respectively (p < 0.05). The overall complications rate was significantly lower in the observed group of patients than in the control group, 12.5% (7/56) vs. 28.6% (14/49), (p < 0.05). In the sling group was postoperatively noticed slightly higher rate of urinary incontinence, but in the colporrhaphy group was emphasized rate of urinary retention. Only one from the each group of patients failed the surgical procedure and required additional correction for SUI. The mean operating time for SPARC and MiniArc procedure was 19 +/- 7 and 9 +/- 5 minutes, respectively (p < 0.0001). Mean duration of hospitalization was significantly shorter in the sling group of patients (2.6 +/- 1.0, range 2-7) days than in the control group of (9.6 +/- 1.8, range 6-18), (p < 0.001 < 0.0001). According to presented results, sling is a highly effective method in patients with SUI with low incidence of perioperative complications, promising long-term results and high patient's satisfaction.
- Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis. [Journal Article]
- BMJ Open 2014; 4(11):e006316.
Worldwide, an estimated 125 million girls and women live with female genital mutilation/cutting (FGM/C). We aimed to systematically review the evidence for physical health risks associated with FGM/C.We searched 15 databases to identify studies (up to January 2012). Selection criteria were empirical studies reporting physical health outcomes from FGM/C, affecting females with any type of FGM/C, irrespective of ethnicity, nationality and age. Two review authors independently screened titles and abstracts, applied eligibility criteria, assessed methodological study quality and extracted full-text data. To derive overall risk estimates, we combined data from included studies using the Mantel-Haenszel method for unadjusted dichotomous data and the generic inverse-variance method for adjusted data. Outcomes that were sufficiently similar across studies and reasonably resistant to biases were aggregated in meta-analyses. We applied the instrument Grading of Recommendations Assessment, Development and Evaluation to assess the extent to which we have confidence in the effect estimates.Our search returned 5109 results, of which 185 studies (3.17 million women) satisfied the inclusion criteria. The risks of systematic and random errors were variable and we focused on key outcomes from the 57 studies with the best available evidence. The most common immediate complications were excessive bleeding, urine retention and genital tissue swelling. The most valid and statistically significant associations for the physical health sequelae of FGM/C were seen on urinary tract infections (unadjusted RR=3.01), bacterial vaginosis (adjusted OR (AOR)=1.68), dyspareunia (RR=1.53), prolonged labour (AOR=1.49), caesarean section (AOR=1.60), and difficult delivery (AOR=1.88).While the precise estimation of the frequency and risk of immediate, gynaecological, sexual and obstetric complications is not possible, the results weigh against the continuation of FGM/C and support the diagnosis and management of girls and women suffering the physical risks of FGM/C.This study is registered with PROSPERO, number CRD42012003321.
- Permanent prostate brachytherapy using high V150. [JOURNAL ARTICLE]
- Pract Radiat Oncol 2014 Oct 7.
Prostate brachytherapy sometimes requires the volume receiving >150% of the prescribed dose (V150) to be >50% to obtain satisfactory coverage. There has been concern expressed that high V150 may be associated with higher rates of urinary retention and morbidity.We reviewed 207 consecutive cases of prostate brachytherapy treated with palladium 103 ((103)Pd; n = 140) or iodine 125 ((125)I; n = 67). Prescribed doses for (103)Pd monotherapy and boost were 124 and 90 Gy, respectively; for (125)I, the corresponding doses were 160 and 120 Gy. Patients were evaluated at baseline, 1 month, 3 months, and every 6 months thereafter.Median follow-up at the time of analysis was 18 months. For (103)Pd, the mean intraoperative volume and V150 were 30.3 cm(3) and 72%, respectively; corresponding values for (125)I were 38.3 cm(3) and 59%, respectively. Two of the patients treated with iodine and 9 treated with palladium experienced acute urinary retention, which was not statistically significant (P = .48). The rectal V100 for (103)Pd was significantly less than that for (125)I (P < .001). The mean baseline, 1-month, and 12-month American Urologic Association (AUA) scores for (103)Pd were 8.5, 19.7, and 8.2, respectively; for (125)I, the values were 7.4, 17.1, and 13.4, respectively. At 12 months, the AUA scores returned to baseline in the (103)Pd-treated patients, whereas scores in (125)I-treated patients remained elevated (P = .005). High V150 did not appear to cause undue risk of urinary retention or morbidity based on logistic regression analysis of patients treated with monotherapy performed with either isotope.The risk of urinary retention was low, despite high V150 values for both isotopes. In patients treated with brachytherapy alone, no significant increase in urinary morbidity was seen in relation to V150. AUA scores returned to baseline in (103)Pd-treated patients at 1 year, whereas (125)I-treated patients demonstrated continued elevation.
- Effects of dietary glycerin inclusion at 0%, 5%, 10%, and 15% of dry matter on energy metabolism and nutrient balance in finishing beef steers. [JOURNAL ARTICLE]
- J Anim Sci 2014 Nov 20.
Expansion of the biodiesel industry has increased the glycerin ( GLY: ) supply. Glycerin is an energy-dense feed that can be used in ruminant species; however, the energy value of GLY is not known. Therefore, the effects of GLY inclusion at 0%, 5%, 10%, and 15% on energy balance in finishing cattle diets were evaluated in 8 steers (BW = 503 kg) using a replicated Latin square design. Data were analyzed with the fixed effects of dietary treatment and period and random effects of square and steer within square were included in the model. Contrast statements were used to separate linear and quadratic effects of GLY inclusion. Glycerin replaced dry-rolled corn ( DRC: ) at 0% ( GLY-0: ), 5% ( GLY-5: ), 10% ( GLY-10: ), and 15% ( GLY-15: ) of dietary dry matter. Dry matter intake decreased linearly (P = 0.02) as GLY increased in the diet. As a proportion of GE intake, fecal energy loss tended to decrease linearly (P < 0.07), and DE also tended to increase linearly (P = 0.07) as dietary level of GLY increased. Urinary energy loss was not different (P > 0.31) as a proportion of GE as GLY increased in the diet. Methane energy loss as a proportion of GE intake tended to respond quadratically (P = 0.10) decreasing from 0% to 10% GLY inclusion and increasing thereafter. As a proportion of GE intake, ME tended to respond quadratically (P = 0.10), increasing from 0% GLY to 10% GLY and then decreasing. As a proportion of GE intake, heat production increased linearly (P = 0.02) as GLY increased in the diet. Additionally, as a proportion of GE intake, retained energy ( RE: ) tended to respond quadratically (P = 0.07) increasing from 0% to 10% GLY inclusion and decreasing thereafter. As a proportion of N intake, urinary and fecal N excretion increased linearly (P < 0.04) as GLY increased in the diet. Furthermore, g of N retained and N retained as a % of N intake both decreased linearly (P < 0.02) as GLY increased in the diet. Total dry matter digestibility tended (P < 0.10) to respond quadratically increasing at a decreasing rate from 0% to 5% GLY inclusion. Overall, RE tended to decrease as GLY increased in the diet in conjunction with a decrease in N retention, which could indicate an increased metabolic cost to the animal associated with feeding GLY. Based on RE, the feeding value of GLY in high-concentrate diets is greater than DRC at 5% and 10% of DM, but less at 15% of DM.
- Role of Renal Sensory Nerves in Physiological and Pathophysiological Conditions. [JOURNAL ARTICLE]
- Am J Physiol Regul Integr Comp Physiol 2014 Nov 19.:ajpregu.00351.2014.
Whether activation of afferent renal nerves contributes to the regulation of arterial pressure and sodium balance has been long overlooked. In normotensive rats, activating renal mechanosensory nerves decreases efferent renal sympathetic nerve activity (ERSNA) and increases urinary sodium excretion, an inhibitory renorenal reflex. There is an interaction between efferent and afferent renal nerves whereby increases in ERSNA increase afferent renal nerve activity (ARNA) leading to decreases in ERSNA by activation of the renorenal reflexes to maintain low ERSNA to minimize sodium retention. High sodium diet enhances and low dietary sodium reduces the responsiveness of the renal sensory nerves, thus producing physiologically appropriate responses to maintain sodium balance. Increased renal angiotensin II reduces the responsiveness of the renal sensory nerves in physiological and pathophysiological conditions, including hypertension, congestive heart failure and ischemia-induced acute renal failure. Impairment of inhibitory renorenal reflexes in these pathological states would contribute to the hypertension and sodium retention. When the inhibitory renorenal reflexes are suppressed, excitatory reflexes may prevail. Renal denervation reduces arterial pressure in experimental hypertension and in treatment resistant hypertensive patients. The fall in arterial pressure is associated with a fall in muscle sympathetic nerve activity suggesting increased ARNA contributing to increased arterial pressure in these patients. Although removal of both renal sympathetic and afferent renal sensory nerves most likely contributes to the arterial pressure reduction initially, additional mechanisms may be involved in long-term arterial pressure reduction since sympathetic and sensory nerves reinnervate renal tissue in a similar time dependent fashion following renal denervation.
- Total plasma clearance versus urinary plasma clearance of (51)Cr-EDTA in patients with cirrhosis with and without fluid retention. [JOURNAL ARTICLE]
- Scand J Clin Lab Invest 2014 Nov 20.:1-9.
Background and aim. In patients with fluid retention, the total plasma clearance of (51)Cr-EDTA (ClP) may overestimate the glomerular filtration rate (GFR). The present study was therefore undertaken in order to compare ClP with the urinary plasma clearance of (51)Cr-EDTA (ClU) in patients with cirrhosis with and without fluid retention. Material and methods. A total of 136 patients with cirrhosis (24 without fluid retention, 112 with ascites) received a quantitative intravenous injection of (51)Cr-EDTA followed by plasma and quantitative urinary samples for 5 hours. ClP was determined from the injected dose relative to the plasma concentration-time area, extrapolated to infinity. ClU was determined as urinary excretion relative to the plasma concentration-time area up to voiding. Results. In patients without fluid retention, the difference between ClP and ClU (ClP - ClU = ClΔ) was mean 4.5 mL/min/1.73 m(2). In patients with ascites, ClΔ was significantly higher (17.6 mL/min/1.73 m(2), p < 0.0001). ClΔ increased with lower values of GFR (r = - 0.458, p < 0.001). Repeated measurements of ClU in a subgroup of patients with fluid retention (n = 25) gave almost identical values. Different types of corrections of one-pool clearance were almost identical with ClP, except for higher clearance values, which were somewhat underestimated by the former. Conclusion. In patients with fluid retention and ascites ClP and corrected one-pool clearance overestimates GFR substantially. Although ClU may underestimate GFR slightly, patients with ascites should collect urine quantitatively in order to obtain a reliable measurement of GFR.
- Effect of dietary protein on intake, nutrients utilization, nitrogen balance, blood metabolites, growth and puberty in growing Bhadawari buffalo (Bubalus bubalis) heifers. [JOURNAL ARTICLE]
- Trop Anim Health Prod 2014 Nov 19.
Fifteen Bhadawari buffalo heifers of 207 ± 9.78 kg mean body weight were randomly distributed into three dietary groups to evaluate the effect of protein level on nutrient utilization, nitrogen (N) balance, growth rate, blood metabolites, and puberty. All animals were offered wheat straw-berseem diets supplemented with concentrate mixtures of similar energy (2.7 Mcal/kg) and different protein levels (14.3-22 %). Animals of standard-protein group (SPG) were offered protein and energy as per requirement, while animals of low-protein group (LPG) and high-protein group (HPG) were fed 20 % less and 20 % more protein, respectively, than SPG. Feed dry matter (DM) and metabolizable energy (ME) intake (% body wt. and g/kg w(0.75)) were similar for all three diets; however, the crude protein (CP) and digestible crude protein (DCP) intake on percent body weight and per kilogram metabolic weight was higher (P < 0.05) in HPG than in SPG or LPG. Digestibility of CP, cellulose, and hemicellulose was higher (P < 0.05) in HPG versus LPG. Fecal N excretion was similar, while urinary N excretion was highest (P < 0.05) in HPG (74.83 g/day) compared with SPG (50.03 g/day) and LPG (47.88 g/day), which resulted in lower N retention in HPG than in the other dietary groups. Level of dietary N had no effect on blood metabolites viz. glucose, urea, and N. Digestible energy (DE) and ME contents of diets were identical, while DCP contents were higher (P < 0.05) in HPG than in LPG. Feed and nutrient (CP and ME) conversion efficiency to produce a unit kilogram weight gain was identical among the dietary groups. Dietary protein level had no effect on the heifer's weight and age at puberty. The mean growth rate of heifers at 240 days was higher (P > 0.05) in SPG (330.8 g/day) than in LPG (296.7 g/day), while the animals gained more weight in January to March months and the lowest weight in May to July months. Protein level had no effect on conception rate of heifers. Results revealed that 20 % higher or less protein than the ICAR requirement had no significant (P > 0.05) on feed intake, nutrient conversion efficiency for weight gain, heifer growth, and puberty; however, 20 % more protein increased urinary N loss.