Objectives Overview of Stone Disease
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Leukocyte Esterase Activity in Vaginal Fluid of Pregnant and Non-Pregnant Women with Vaginitis/Vaginosis and in Controls
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by PubMed Central Infect Dis Obstet Gynecol 2003;11:19–26 Leukocyte esterase activity in vaginal fluid of pregnant and non-pregnant women with vaginitis/vaginosis and in controls Per-Anders Mårdh 1, Natalia Novikova 1, Ola Niklasson 1, Zoltan Bekassy 1 and Lennart Skude 2 1Department of Obstetrics and Gynecology, University Hospital, Lund and 2Department of Clinical Chemistry, County Hospital, Halmstad, Sweden Objectives: Todeterminethe leukocyteesterase (LE) activity invaginal lavage fluid ofwomen with acuteand recurrentvulvovaginal candidosis (VVC and RVVC respectively), bacterial vaginosis(BV), and in pregnant and non-pregnantwomen without evidenceof the threeconditions. Also tocompare the resultof LEtestsin women consultingat differentweeks inthe cycle andtrimesters of pregnancy.The LEactivity was correlatedto vaginal pH, numberof inflammatory cells instained vaginal smears,type of predominatingvaginal bacteria andpresence of yeast morphotypes. Methods: Onehundred and thirteen women with ahistoryof RVVC,i.e. with at least fourattacks of the conditionduring the previousyear and who had consultedwith anassumed new attack ofthe condition,were studied.Furthermore, we studied16 women with VVC,15 women with BV,and 27 women attendingfor control of cytological abnormalities, who all presentedwithout evidenceof either vaginitisor vaginosis. Finally, 73 pregnantwomen wereinvestigated. The LEactivity invaginal fluid duringdifferent weeks inthe cycle of 53 of the women was measured. Results: Inthe non-pregnantwomen, anincreased LE activity was foundin 96, 88, 73 and56% of those with RVVC,VVC and BV andin the non-VVC/BVcases,respectively. In 73% of pregnantwomen inthe second trimester,and 76% of thosein the third,the LEtestwas positive.In all groupsof non-pregnantwomen tested, the LEactivity correlatedwith the numberof leukocytesin vaginal smears,but it didnot in those who were pregnant.There was nocorrelation between LE activity andweek incycle. -
Ileal Neobladder: an Important Cause of Non-Anion Gap Metabolic Acidosis
The Journal of Emergency Medicine, Vol. 52, No. 5, pp. e179–e182, 2017 Ó 2017 Elsevier Inc. All rights reserved. 0736-4679/$ - see front matter http://dx.doi.org/10.1016/j.jemermed.2016.12.036 Clinical Communications: Adult ILEAL NEOBLADDER: AN IMPORTANT CAUSE OF NON-ANION GAP METABOLIC ACIDOSIS Jesse W. St. Clair, MD and Matthew L. Wong, MD, MPH Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts Reprint Address: Matthew L. Wong, MD, MPH, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Rosenberg Building, 2nd Floor, 1 Deaconess Road, Boston, MA 02446 , Abstract—Background: The differential diagnosis for a disease, or medications such as acetazolamide. non-anion gap metabolic acidosis is probably less well Commonly used mnemonics to remember the differential known than the differential diagnosis for an anion gap for the non-anion gap metabolic acidosis include metabolic acidosis. One etiology of a non-anion gap acidosis ‘‘ABCD’’ for ‘‘Addison’s, Bicarbonate loss, Chloride is the consequence of ileal neobladder urinary diversion (administration), and Drugs,’’ as well as ‘‘HARDUP’’ for the treatment of bladder cancer. Case Report: We pre- for ‘‘Hyperchloremia, Acetazolamide and Addison’s, sent a case of a patient with an ileal neobladder with a severe non-anion gap metabolic acidosis caused by a Renal Tubular Acidosis, Diarrhea, Ureteroenterostomies, urinary tract infection and ureteroenterostomy. Why and Pancreaticoenterostomies’’ (Table 1) (1). Should an Emergency Physician Be Aware of This?: Part Ureteroenterostomies are when the ureter has an of the ileal neobladder surgery includes ureteroenteros- abnormal connection with a segment of intestine. -
Bladder Stones in Dogs & Cats By: Dr
Navarro Small Animal Clinic 5009 Country Club Dr. Victoria, TX 77904 361-573-2491 www.navarrosmallanimalclinic.com Bladder Stones in Dogs & Cats By: Dr. Shana Bohac Dogs, like people, can develop a variety of bladder stones. These stones are rock-like structures that are formed by minerals. Some stones form in alkaline urine, whereas others form when the urine is more acidic. Bladder stones are very common in dogs, particularly small breed dogs. The most common signs that a dog or cat has bladder stones include blood in the urine, and straining to urinate. Blood is seen due to the stones bouncing around and hitting the bladder wall. This can irritate and damage the tissue and can cause cystitis (inflammation of the bladder). Straining to urinate occurs because of the inflammation and irritation of the bladder walls or urethra or muscle spasms. The stone itself can actually obstruct the flow of urine if it blocks the urethra. Small stones can get stuck in the urethra and cause a complete obstruction. This can be life threatening if the obstruction is not relieved since the bladder can rupture as more urine is produced with nowhere to go. Bladder stones form because of changes in the urine pH. Normal dog urine is slightly acidic and contains waste products such as dissolved minerals and enzymes such as urease. Urease breaks down excess ammonia in urine. An overload of ammonia in urine can cause bladder inflammation and thickening known as cystitis. There are a variety of stones that can form in the bladder, some that form in acidic urine, while others form in alkaline urine. -
EAU Guidelines on Bladder Stones 2019
EAU Guidelines on Bladder Stones C. Türk (Chair), A. Skolarikos (Vice-chair), J.F. Donaldson, A. Neisius, A. Petrik, C. Seitz, K. Thomas Guidelines Associate: Y. Ruhayel © European Association of Urology 2019 TABLE OF CONTENTS PAGE 1. INTRODUCTION 3 1.1 Aims and Scope 3 1.2 Panel Composition 3 1.3 Available Publications 3 1.4 Publication History and Summary of Changes 3 1.4.1 Publication History 3 2. METHODS 3 2.1 Data Identification 3 2.2 Review 4 3. GUIDELINES 4 3.1 Prevalence, aetiology and risk factors 4 3.2 Diagnostic evaluation 4 3.2.1 Diagnostic investigations 5 3.3 Disease Management 5 3.3.1 Conservative treatment and Indications for active stone removal 5 3.3.2 Medical management of bladder stones 5 3.3.3 Bladder stone interventions 5 3.3.3.1 Suprapubic cystolithotomy 5 3.3.3.2 Transurethral cystolithotripsy 5 3.3.3.2.1 Transurethral cystolithotripsy in adults: 5 3.3.3.2.2 Transurethral cystolithotripsy in children: 6 3.3.3.3 Percutaneous cystolithotripsy 6 3.3.3.3.1 Percutaneous cystolithotripsy in adults: 6 3.3.3.3.2 Percutaneous cystolithotripsy in children: 6 3.3.3.4 Extracorporeal shock wave lithotripsy (SWL) 6 3.3.3.4.1 SWL in Adults 6 3.3.3.4.2 SWL in Children 6 3.3.4 Treatment for bladder stones secondary to bladder outlet obstruction (BOO) in adult men 7 3.3.5 Urinary tract reconstructions and special situations 7 3.3.5.1 Neurogenic bladder 7 3.3.5.2 Bladder augmentation 7 3.3.5.3 Urinary diversions 7 4. -
Evaluation of Gross and Microscopic Hematuria
EVALUATION OF GROSS AND MICROSCOPIC HEMATURIA APRIL GARDNER, MSBS, PA - C ASSOCIATE PROGRAM DIRECTOR THE UNIVERSITY OF TOLEDO PA PROGRAM OBJECTIVES • Define the terms gross hematuria and microscopic hematuria. • Identify etiologies of hematuria. • Identify risk factors for a urologic cancer in a patient with gross or microscopic hematuria. • Define the term “full evaluation.” • Identify indications for a full evaluation. • Identify labs and diagnostics to evaluate hematuria. • Identify the appropriate follow-up for patients with hematuria. 2 CASE #1 Ms. T is a healthy 50 year-old female, s/p TAH/BSO 15 years ago for severe endometriosis. She presents today for her annual physical exam required by her employer. She has no new complaints and there is no history of any urologic complaints. Physical exam is completely normal Urine dipstick shows 1+ blood, pH 6.0, negative for ketones, glucose, nitrites and leukocyte esterase Microscopic evaluation shows 8 RBCs, no WBCs, bacteria, yeast, crystals, or casts CASE #1 • Should you prescribe an antibiotic for Ms. T today? • Does she need any further follow-up? • If yes, what would follow-up include? CASE #2 Mr. D is a 38 year-old healthy, monogamous married male with 4 children, presenting for a vasectomy consultation. He denies any complaints, including urologic complaints. He takes no medications. He tells you he ran a marathon 2 days ago and then finished building a deck in his backyard yesterday. Physical exam is completely normal Urine dipstick shows 1+ blood, pH 6.0, negative for protein, ketones, glucose, nitrites and leukocyte esterase Microscopic evaluation shows 3 RBCs, no WBCs, bacteria, yeast, crystals, or casts CASE #2 • Should you prescribe an antibiotic for Mr. -
The Use of the Bladder Wash-Out Test in Patients with Spinal Cord Lesions Who Have Urinary Tract Infection*
Paraplegia 2I (1983) 294-300 © 1983 International Medical Society of Paraplegia THE USE OF THE BLADDER WASH-OUT TEST IN PATIENTS WITH SPINAL CORD LESIONS WHO HAVE URINARY TRACT INFECTION* By J. J. WYNDAELE, M.D., W. OOSTERLINCK, M.D., W. A. DE Sy, M. D. and H. CLAESSENS, M. D. Department of Urology and Rehabilitation Centre, University of Ghent, Belgium Summary. In 42 patients with a spinal cord lesion and chronic urinary tract infection the bladder wash-out test was performed to locate the site of infection. The test was easy to perform and no complications occurred. The test could not be performed in only one patient. Differentiation between upper and lower urinary tract infection was possible in 36 patients (43 tests). By using the test, precise treatment was possible for 23 patients, of whom 17 were cured. Key words: Spinal cord lesions; Bladder wash-out test; Urinary tract infection. Introduction To KNOW the exact site of infection may be a very important factor in the correct management of patients with urinary tract infection. Chronic or recurrent urinary tract infections are frequent in patients with spinal cord lesions. Localisation of the infection in these patients may be the clue to a definite diagnosis, and proper treatment. Among other, procedures, the bladder wash-out test has been pro posed as a technique which makes differentiation between upper and lower urinary tract infection possible. The purpose of this study is to evaluate its usefulness in patients with spinal cord lesions and chronic or recurrent urinary tract infection. Methods We perform the bladder wash-out test approximately as described by Fairley and associates (Fairley et al., 1967). -
Storm in a Pee Cup: Hematuria and Proteinuria
Storm in a Pee Cup: Hematuria and Proteinuria Sudha Garimella MD Pediatric Nephrology, Children's Hospital-Upstate Greenville SC Conflict of Interest • I have no financial conflict of interest to disclose concerning this presentation. Objectives • Interpret the current guidelines for screening urinalysis, and when to obtain a urinalysis in the pediatric office. • Interpret the evaluation of asymptomatic/isolated proteinuria and definitions of abnormal ranges. • Explain the evaluation and differential diagnosis of microscopic hematuria. • Explain the evaluation and differential diagnosis of gross hematuria. • Explain and discuss appropriate referral patterns for hematuria. • Racial disparities in nephrology care 1. APOL-1 gene preponderance in African Americans and risk of proteinuria /progression(FSGS) 2. Race based GFR calculations which have caused harm 3. ACEI/ARB usage in AA populations: myths and reality Nephrology Problems in the Office • Hypertension • Proteinuria • Microscopic Hematuria • Abnormal Renal function The Screening Urinalysis • Choosing Wisely: • Don’t order routine screening urine analyses (UA) in healthy, asymptomatic pediatric patients as part of routine well child care. • One study showed that the calculated false positive/transient abnormality rate approaches 84%. • Population that deserves screening UA: • patients who are at high risk for chronic kidney disease (CKD), including but not necessarily limited to patients with a personal history of CKD, acute kidney injury (AKI), congenital anomalies of the urinary tract, acute nephritis, hypertension (HTN), active systemic disease, prematurity, intrauterine growth retardation, or a family history of genetic renal disease. • https://www.choosingwisely.org/societies/american-academy-of-pediatrics-section-on- nephrology-and-the-american-society-of-pediatric-nephrology/ Screening Urinalysis: Components A positive test for leukocyte esterase may be seen in genitourinary inflammation, irritation from instrumentation or catheterization, glomerulonephritis, UTIs and sexually transmitted infections. -
Treatment and Prevention of Calcium Oxalate Kidney and Bladder Stones
Treatment and prevention of calcium oxalate Leslie Bean with Fuzzerbear kidney and bladder stones Adapted from an article by CJ Puotinen and Mary Straus, published in the Whole Dog Journal, May 2010 Bladder and kidney stones are serious problems in dogs as well as people. These conditions – which are also known as uroliths or urinary calculi – can be excruciatingly painful as well as potentially fatal. Fortunately, informed caregivers can do much to prevent the formation of stones and in some cases actually help treat stones that develop. In this article, we examine calcium oxalate or CaOx stones. CaOx stones occur in both the bladder (lower urinary tract) and kidneys (upper urinary tract) of male and female dogs. Most calcium oxalate uroliths are nephroliths (found in the kidney), and most of the affected patients are small-breed males. CaOx uroliths are radiopaque, meaning that they are easily seen on radiographs (X- rays). Twenty-five years ago, struvites were the most common uroliths collected from canine patients, representing almost 80 percent of the total, while only 5 percent were calcium oxalate stones. The percentage of struvite uroliths found has declined while that of CaOx stones has risen, so that nearly half of all canine uroliths analyzed today are calcium oxalate stones. It’s unknown whether the incidence of struvite stones has decreased or if the change is due solely to an increase in calcium oxalate uroliths. Similar changes have occurred in cats, but in that case, we have a good idea why. Twenty years ago, calcium oxalate stones were virtually unheard of in cats, who commonly formed sterile struvites. -
Ultrasound Findings of the Urinary Tract in Patients with Spinal Cord
Spinal Cord (2015) 53, 139–144 & 2015 International Spinal Cord Society All rights reserved 1362-4393/15 www.nature.com/sc ORIGINAL ARTICLE Ultrasound findings of the urinary tract in patients with spinal cord injury: a study of 1005 cases Ü Güzelküçük, Y Demir, S Kesikburun, B Aras, E Yaşar and AK Tan Study design: Retrospective chart review. Objectives: To document urinary tract abnormalities (UTAs) in patients with spinal cord injury (SCI) and to assess demographic and clinical features associated with UTA detected via ultrasound (US). Setting: Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. Methods: The medical and radiological records of all patients with SCI were screened. Variables in each patient with SCI, including age at the time of the US examination, gender, etiology, level and severity of SCI, time since injury, bladder management methods and findings of urinary tract US, were reviewed and analyzed. Results: Data were obtained from 1005 patients during the 6-year study period (2008–2013). The mean age was 35.67 ± 14.79 years and the male–female ratio was 2.84:1. Trabeculated bladder (TB) was observed in 35.1% of the patients, bladder calculi in 6%, renal calculi in 6%, hydronephrosis in 5.5% and renal atrophy in 1.2%. Bladder calculi, renal calculi and renal atrophy were observed in patients with TB at higher rates than in those without TB (P = 0.001, 0.036 and 0.004, respectively). The association of TB with hydronephrosis was very close to significance level (P = 0.052). Conclusion: A large number of SCI patients had UTAs including TB, renal and bladder calculi, hydronephrosis and renal atrophy. -
Oxalate Bladder Stones (Canine) - Veterinarypartner.Com - a VIN Company! Page 1 of 3
01 Oxalate Bladder Stones (Canine) - VeterinaryPartner.com - a VIN company! Page 1 of 3 Home » Oxalate Bladder Stones (Canine) THE PET HEALTH LIBRARY By Wendy C. Brooks, DVM, DipABVP Educational Director, VeterinaryPartner.com Oxalate Bladder Stones (Canine) Oxalate Bladder Stones in Dogs • 73% of calcium oxalate patients are male. This stone type is unusual in females. • Breeds at especially high risk include: miniature schnauzers, Lhasa Apsos, Yorkshire terriers, miniature poodles, shih tzus, and Bichon frises. • Most cases occur in dogs between ages 5 and 12 years of age. How do we know these are Calcium Oxalate Stones? Although a urinalysis can provide a clue, the only way to know for sure that a dog’s bladder stone is an oxalate stone is to retrieve a stone and have a laboratory analyze it. If the stones are very small, flushing the urinary bladder and forcefully expressing it may produce a stone sample for testing. The only other way to obtain a sample is to surgically open the bladder and remove the stones. The surgical method is invasive but provides the most rapid resolution of the bladder stone issue. Calcium oxalate stones cannot be made to dissolve over time by changing to a special diet, as can be done with struvite or uric acid bladder stones. Each division of these bladder stones Why would my Dog Form Calcium Oxalate Stones? = 1 millimeter It shouldn’t be too surprising that there is a strong hereditary component to the formation of oxalate bladder stones. This is also true in humans. There is a substance called nephrocalcin in urine that naturally inhibits the formation of calcium oxalate stones. -
Canine Kidney Stone and Bladder Stone Prevention | Whole Dog Journal
Canine Kidney Stone and Bladder Stone Prevention | Whole Dog Journal https://www.whole-dog-journal.com/issues/13_4/features/Detecting-Urin... Canine Kidney Stone and Bladder Stone Prevention How to prevent and treat your dog's struvite crystals and stones. By CJ Puotinen, Mary Straus [Updated August 6, 2018] URINARY STONES IN DOGS: OVERVIEW 1. Become familiar with the symptoms of urinary stones and respond quickly if you see them. 2. Request a urine culture and sensitivity test to check for infection even if your veterinarian doesn't think it's necessary. 3. Encourage your dog to drink extra water and give her frequent opportunities to urinate. 4. Don't expect a low-protein diet to cure or prevent struvite stones. 5. Learn how to test your dog's pH to check for recurring urinary tract infections. Humans aren’t the only ones who get kidney and bladder stones. Our dogs develop these painful and dangerous conditions, too. But much of what is said and done about canine urinary tract stone disease (also known as bladder stones, urolithiasis, urinary stones, ureteral stones, urinary calculi, ureteral calculi, or urinary calculus disease), including its causes and treatment, is either incorrect, ineffective, or potentially harmful. Here’s the information you need in order to make informed decisions on behalf of your best friend. Most canine uroliths, or bladder stones, fall into six categories, depending on their mineral composition: • Magnesium ammonium phosphate (also called struvites) • Calcium oxalate • Ammonium urate or uric acid • Cystine • Calcium phosphate • Silica 1 of 13 11/1/2018, 7:58 PM Canine Kidney Stone and Bladder Stone Prevention | Whole Dog Journal https://www.whole-dog-journal.com/issues/13_4/features/Detecting-Urin.. -
Leukocyte Esterase Activity in Vaginal Fluid of Pregnant and Non-Pregnant Women with Vaginitis/Vaginosis and in Controls
Infect Dis Obstet Gynecol 2003;11:19–26 Leukocyte esterase activity in vaginal fluid of pregnant and non-pregnant women with vaginitis/vaginosis and in controls Per-Anders Mårdh 1, Natalia Novikova 1, Ola Niklasson 1, Zoltan Bekassy 1 and Lennart Skude 2 1Department of Obstetrics and Gynecology, University Hospital, Lund and 2Department of Clinical Chemistry, County Hospital, Halmstad, Sweden Objectives: Todeterminethe leukocyteesterase (LE) activity invaginal lavage fluid ofwomen with acuteand recurrentvulvovaginal candidosis (VVC and RVVC respectively), bacterial vaginosis(BV), and in pregnant and non-pregnantwomen without evidenceof the threeconditions. Also tocompare the resultof LEtestsin women consultingat differentweeks inthe cycle andtrimesters of pregnancy.The LEactivity was correlatedto vaginal pH, numberof inflammatory cells instained vaginal smears,type of predominatingvaginal bacteria andpresence of yeast morphotypes. Methods: Onehundred and thirteen women with ahistoryof RVVC,i.e. with at least fourattacks of the conditionduring the previousyear and who had consultedwith anassumed new attack ofthe condition,were studied.Furthermore, we studied16 women with VVC,15 women with BV,and 27 women attendingfor control of cytological abnormalities, who all presentedwithout evidenceof either vaginitisor vaginosis. Finally, 73 pregnantwomen wereinvestigated. The LEactivity invaginal fluid duringdifferent weeks inthe cycle of 53 of the women was measured. Results: Inthe non-pregnantwomen, anincreased LE activity was foundin 96, 88, 73 and56% of those with RVVC,VVC and BV andin the non-VVC/BVcases,respectively. In 73% of pregnantwomen inthe second trimester,and 76% of thosein the third,the LEtestwas positive.In all groupsof non-pregnantwomen tested, the LEactivity correlatedwith the numberof leukocytesin vaginal smears,but it didnot in those who were pregnant.There was nocorrelation between LE activity andweek incycle.