Guidelines on Paediatric Urology
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Urinary Incontinence: Impact on Long Term Care
Urinary Incontinence: Impact on Long Term Care Muhammad S. Choudhury, MD, FACS Professor and Chairman Department of Urology New York Medical College Director of Urology Westchester Medical Center 1 Urinary Incontinence: Overview • Definition • Scope • Anatomy and Physiology of Micturition • Types • Diagnosis • Management • Impact on Long Term Care 2 Urinary Incontinence: Definition • Involuntary leakage of urine which is personally and socially unacceptable to an individual. • It is a multifactorial syndrome caused by a combination of: • Genito urinary pathology. • Age related changes. • Comorbid conditions that impair normal micturition. • Loss of functional ability to toilet oneself. 3 Urinary Incontinence: Scope • Prevalence of Urinary incontinence increase with age. • Affects more women than men (2:1) up to age 80. • After age 80, both women and men are equally affected. • Urinary Incontinence affect 15% to 30% of the general population > 65 years. • > 50% of 1.5 million Long Term Care residents may be incontinent. • The cost to care for this group is >5 billion per year. • The total cost of care for Urinary Incontinence in the U.S. is estimated to be over $36 billion. Ehtman et al., 2012. 4 Urinary Incontinence: Impact on Quality of Life • Loss of self esteem. • Avoidance of social activity and interaction. • Decreased ability to maintain independent life style. • Increased dependence on care givers. • One of the most common reason for long term care placement. Grindley et al. Age Aging. 1998; 22: 82-89/Harris T. Aging in the eighties. NCHS # 121 1985. Noelker L. Gerontologist 1987; 27: 194-200. 5 Health related consequences of Urinary Incontinence • Increased propensity for fall/fracture. -
Urinary Incontinence
GLICKMAN UROLOGICAL & KIDNEY INSTITUTE Urinary Incontinence What is it? can lead to incontinence, as can prostate cancer surgery or Urinary incontinence is the inability to control when you radiation treatments. Sometimes the cause of incontinence pass urine. It’s a common medical problem. As many as isn’t clear. 20 million Americans suffer from loss of bladder control. The condition is more common as men get older, but it’s Where can I get help? not an inevitable part of aging. Often, embarrassment stops Talking to your doctor is the first step. You shouldn’t feel men from seeking help, even when the problem is severe ashamed; physicians regularly help patients with this prob- and affects their ability to leave the house, spend time with lem and are comfortable talking about it. Many patients family and friends or take part in everyday activities. It’s can be evaluated and treated after a simple office visit. possible to cure or significantly improve urinary inconti- Some patients may require additional diagnostic tests, nence, once its underlying cause has been identified. But which can be done in an outpatient setting and aren’t pain- it’s important to remember that incontinence is a symp- ful. Once these tests have determined the cause of your tom, not a disease. Its cause can be complex and involve incontinence, your doctor can recommend specific treat- many factors. Your doctor should do an in-depth evaluation ments, many of which do not require surgery. No matter before starting treatment. how serious the problem seems, urinary incontinence is a condition that can be significantly relieved and, in many What might be causing my incontinence? cases, cured. -
Late Complications of Duplex System Ureterocele; Acute Urinary Retention, Stone Formation and Renal Atrophy Sipal Timucin¹*, Akdere Hakan² and Bumin Ors¹
Timucin et al. Int Arch Urol Complic 2015, 1:2 ISSN: 2469-5742 International Archives of Urology and Complications Case Report: Open Access Late Complications of Duplex System Ureterocele; Acute Urinary Retention, Stone Formation and Renal Atrophy Sipal Timucin¹*, Akdere Hakan² and Bumin Ors¹ 1Department of Urology, Cerkezkoy State Hospital, Turkey 2Trakya University Health Center for Medical Research and Practic, Turkey *Corresponding author: Sipal Timucin, Department of Urology, Cerkezkoy State Hospital, Tekirdag, Turkey, Tel: +905548430218, E-mail: [email protected] Abstract A 49- year-old woman was admitted to emergency department with a complaint of acute urinary retention. The investigation of the patient revealed right duplex system anomaly, ureterocele containing multiple stones and atrophic right kidney. After reliefing her urinary retention, endoscopic ureterocele de-roofing, two dj stents insertion and stones extraction were performed. The symptoms of the patient were relieved after treatment. The patient was asymptomatic at six month follow-up visit. Keywords Duplex system ureter, Multiple calculi, Transurethral ureterocele incision, Ureterocele, Renal atrophy Introduction Ureterocele is cystic dilation of the terminal ureter and its incidence among newborns was reported 1/500 – 1/4000 [1]. It may be associated with tissue defect of bladder, bladder neck and posterior urethra. Eighty percent of ureteroceles are seen in the ureter draining the upper pole of a complete ureteral duplication. The cases whose diagnoses are omitted in early ages may suffer from recurrent urinary Figure 1: KUB graphy revealed multiple stones in right lower quadrant tract infection, stone formation, septicaemia and renal failure in later years. They generally break out in single system, orthotropic and intravesical in adults [2]. -
Mimickers of Urothelial Carcinoma and the Approach to Differential Diagnosis
Review Mimickers of Urothelial Carcinoma and the Approach to Differential Diagnosis Claudia Manini 1, Javier C. Angulo 2,3 and José I. López 4,* 1 Department of Pathology, San Giovanni Bosco Hospital, 10154 Turin, Italy; [email protected] 2 Clinical Department, Faculty of Medical Sciences, European University of Madrid, 28907 Getafe, Spain; [email protected] 3 Department of Urology, University Hospital of Getafe, 28905 Getafe, Spain 4 Department of Pathology, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, 48903 Barakaldo, Spain * Correspondence: [email protected]; Tel.: +34-94-600-6084 Received: 17 December 2020; Accepted: 18 February 2021; Published: 25 February 2021 Abstract: A broad spectrum of lesions, including hyperplastic, metaplastic, inflammatory, infectious, and reactive, may mimic cancer all along the urinary tract. This narrative collects most of them from a clinical and pathologic perspective, offering urologists and general pathologists their most salient definitory features. Together with classical, well-known, entities such as urothelial papillomas (conventional (UP) and inverted (IUP)), nephrogenic adenoma (NA), polypoid cystitis (PC), fibroepithelial polyp (FP), prostatic-type polyp (PP), verumontanum cyst (VC), xanthogranulomatous inflammation (XI), reactive changes secondary to BCG instillations (BCGitis), schistosomiasis (SC), keratinizing desquamative squamous metaplasia (KSM), post-radiation changes (PRC), vaginal-type metaplasia (VM), endocervicosis (EC)/endometriosis (EM) (müllerianosis), -
Rare Case of Female Behçet's Disease with Urological Involvement
CASE REPORTS Ref: Ro J Rheumatol. 2019;28(2) DOI: 10.37897/RJR.2019.2.6 RARE CASE OF female Behçet’s disease WITH UROLOGICAL INVOLVEMENT Claudia Cobilinschi1,2, Catalin Belinski3, Daniela Opris-Belinski1,2 1„Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania 2„St. Maria“ Clinical Hospital, Bucharest, Romania 3„Prof. Dr. Dimitrie Gerota“ Emergency Hospital, Bucharest, Romania Abstract Behçet’s disease is a systemic vasculitis with several well-defined organ manifestations, including various mu- cocutaneous features. Among them, the urinary tract involvement is rarely cited, most data focusing on bladder dysfunction due to neuroBehçet. This article presents a rare case of a young female patient with urological complaints that was diagnosed with right ureteral ulceration, later confirmed as vasculitis at the histopathological examination. Urological intervention together with adequate immunosuppression let to the healing of the ulcer- ative lesion. The unusual vasculitic lesion site indicates the complexity of Behçet’s disease that requires careful investigation and treatment. Keywords: Behçet’s disease, ureteral ulceration, ureteral stent, immunosuppressant INTRODUCTION The onset of the disease was in 2013 when the patient presented to her general practitioner (GP) for Behçet’s disease (BD) is a variable size vasculitis repeated febrile episodes that were essentially ves- that can affect both arteries and veins characterized peral, occurring in the afternoon followed by odyno- by recurrent episodes of orogenital ulcers, eye and phagia and painful aphthae on her oral mucosa. Due skin involvement, neurologic manifestations accom- to her prominent ENT symptoms, her GP referred panied by a positive patergy test (1). The genetic the patient to a specialist who prescribed multiple background is best described by HLA B51 positivity antibiotic schemes because of the high suspicion of which associates with a more extensive clinical ex- streptococcal infection. -
Ended Megaureter in a 23-Year-Old Woman Causing Chronic Pain
341 Central European Journal of Urology CASE REPORT URINARY TRACT INFECTIONS The remnant of a congenital, blind- ended megaureter in a 23-year-old woman causing chronic pain and urinary infections Tomislav Pejcic1, Biljana Markovic2, Zoran Dzamic1, Milan Radovanovic1, Jovan Hadzi-Djokic3 1Clinical Center of Serbia, Urological Clinic, Belgrade, Serbia 2Clinical Center of Serbia, Institute of Radiology, Belgrade, Serbia 3Serbian Academy of Sciences and Arts, Belgrade, Serbia Article history Multicystic dysplastic kidney (MCDK) is a congenital anomaly as the result of abnormal interaction be- Received: March 31, 2103 tween the ureteric bud and metanephric mesenchyme. Unilateral MCDK can be associated with other Accepted: May 19, 2013 anomalies of the genitourinary tract. Relatively rare associated anomaly is the presence of ipsilateral Correspondence refluxing blind megaureter. Tomislav Pejcic The patient reported herein is a 23–years–old woman with involuted MCDK and ipsilateral blind mega- 129/9, Bulevar Zorana ureter causing chronic urinary infection and chronic abdominal pain. Preoperative and intraoperative Djindjica 11070 Belgrade, Serbia examination failed to detect the communication between megaureter and the urinary bladder. phone: +38 111 212 1616 [email protected] Key Words: multicystic dysplastic kidney ‹› refluxing blind megaureter INTRODUCTION CASE REPORT Multicystic dysplastic kidney (MCDK) is a congeni- A 23–year–old woman from a small village was sent tal anomaly that is the result of abnormal interac- to the urologist from the gynecologist, due to solitary tion between the ureteric bud and metanephric right kidney, cystic mass on the left side of the uri- mesenchyme, early ureteral obstruction, or ureteral nary bladder and the presence of chronic pain and atresia. -
Urinary Incontinence Embarrassing but Treatable 2015 Rev
This information provides a general overview on this topic and may not apply to Health Notes everyone. To find out if this information applies to you and to get more information on From Your Family Doctor this subject, talk to your family doctor. Urinary incontinence Embarrassing but treatable 2015 rev. What is urinary incontinence? Are there different types Urinary incontinence means that you can’t always of incontinence? control when you urinate, or pee. The amount of leakage Yes. There are five types of urinary incontinence. can be small—when you sneeze, cough, or laugh—or large, due to very strong urges to urinate that are hard to Stress incontinence is when urine leaks because of control. This can be embarrassing, but it can be treated. sudden pressure on your lower stomach muscles, such as when you cough, sneeze, laugh, rise from a Millions of adults in North America have urinary chair, lift something, or exercise. Stress incontinence incontinence. It’s most common in women over 50 years usually occurs when the pelvic muscles are weakened, of age, but it can also affect younger people, especially sometimes by childbirth, or by prostate or other pelvic women who have just given birth. surgery. Stress incontinence is common in women. Be sure to talk to your doctor if you have this problem. Urge incontinence is when the need to urinate comes on If you hide your incontinence, you risk getting rashes, too fast—before you can get to a toilet. Your body may only sores, and skin and urinary tract (bladder) infections. -
Guidelines on Paediatric Urology S
Guidelines on Paediatric Urology S. Tekgül (Chair), H.S. Dogan, E. Erdem (Guidelines Associate), P. Hoebeke, R. Ko˘cvara, J.M. Nijman (Vice-chair), C. Radmayr, M.S. Silay (Guidelines Associate), R. Stein, S. Undre (Guidelines Associate) European Society for Paediatric Urology © European Association of Urology 2015 TABLE OF CONTENTS PAGE 1. INTRODUCTION 7 1.1 Aim 7 1.2 Publication history 7 2. METHODS 8 3. THE GUIDELINE 8 3A PHIMOSIS 8 3A.1 Epidemiology, aetiology and pathophysiology 8 3A.2 Classification systems 8 3A.3 Diagnostic evaluation 8 3A.4 Disease management 8 3A.5 Follow-up 9 3A.6 Conclusions and recommendations on phimosis 9 3B CRYPTORCHIDISM 9 3B.1 Epidemiology, aetiology and pathophysiology 9 3B.2 Classification systems 9 3B.3 Diagnostic evaluation 10 3B.4 Disease management 10 3B.4.1 Medical therapy 10 3B.4.2 Surgery 10 3B.5 Follow-up 11 3B.6 Recommendations for cryptorchidism 11 3C HYDROCELE 12 3C.1 Epidemiology, aetiology and pathophysiology 12 3C.2 Diagnostic evaluation 12 3C.3 Disease management 12 3C.4 Recommendations for the management of hydrocele 12 3D ACUTE SCROTUM IN CHILDREN 13 3D.1 Epidemiology, aetiology and pathophysiology 13 3D.2 Diagnostic evaluation 13 3D.3 Disease management 14 3D.3.1 Epididymitis 14 3D.3.2 Testicular torsion 14 3D.3.3 Surgical treatment 14 3D.4 Follow-up 14 3D.4.1 Fertility 14 3D.4.2 Subfertility 14 3D.4.3 Androgen levels 15 3D.4.4 Testicular cancer 15 3D.5 Recommendations for the treatment of acute scrotum in children 15 3E HYPOSPADIAS 15 3E.1 Epidemiology, aetiology and pathophysiology -
Renal Agenesis, Renal Tubular Dysgenesis, and Polycystic Renal Diseases
Developmental & Structural Anomalies of the Genitourinary Tract DR. Alao MA Bowen University Teach Hosp Ogbomoso Picture test Introduction • Congenital Anomalies of the Kidney & Urinary Tract (CAKUT) Objectives • To review the embryogenesis of UGS and dysmorphogenesis of CAKUT • To describe the common CAKUT in children • To emphasize the role of imaging in the diagnosis of CAKUT Introduction •CAKUT refers to gross structural anomalies of the kidneys and or urinary tract present at birth. •Malformation of the renal parenchyma resulting in failure of normal nephron development as seen in renal dysplasia, renal agenesis, renal tubular dysgenesis, and polycystic renal diseases. Introduction •Abnormalities of embryonic migration of the kidneys as seen in renal ectopy (eg, pelvic kidney) and fusion anomalies, such as horseshoe kidney. •Abnormalities of the developing urinary collecting system as seen in duplicate collecting systems, posterior urethral valves, and ureteropelvic junction obstruction. Introduction •Prevalence is about 3-6 per 1000 births •CAKUT is one of the commonest anomalies found in human. •It constitute approximately 20 to 30 percent of all anomalies identified in the prenatal period •The presence of CAKUT in a child raises the chances of finding congenital anomalies of other organ-systems Why the interest in CAKUT? •Worldwide, CAKUT plays a causative role in 30 to 50 percent of cases of end-stage renal disease (ESRD), •The presence of CAKUT, especially ones affecting the bladder and lower tract adversely affects outcome of kidney graft after transplantation Why the interest in CAKUT? •They significantly predispose the children to UTI and urinary calculi •They may be the underlying basis for urinary incontinence Genes & Environment Interact to cause CAKUT? • Tens of different genes with role in nephrogenesis have been identified. -
Surgical Treatment of Urinary Incontinence in Men
Committee 13 Surgical Treatment of Urinary Incontinence in Men Chairman S. HERSCHORN (Canada) Members H. BRUSCHINI (Brazil), C.COMITER (USA), P.G RISE (France), T. HANUS (Czech Republic), R. KIRSCHNER-HERMANNS (Germany) 1121 CONTENTS I. INTRODUCTION VIII. TRAUMATIC INJURIES OF THE URETHRA AND PELVIC FLOOR II. EVALUATION PRIOR TO SURGICAL THERAPY IX. CONTINUING PEDIATRIC III. INCONTINENCE AFTER RADICAL PROBLEMS INTO ADULTHOOD: THE PROSTATECTOMY FOR PROSTATE EXSTROPHY-EPISPADIAS COMPLEX CANCER X. DETRUSOR OVERACTIVITY AND IV. INCONTINENCE AFTER REDUCED BLADDER CAPACITY PROSTATECTOMY FOR BENIGN DISEASE XI. URETHROCUTANEOUS AND V. SURGERY FOR INCONTINENCE IN RECTOURETHRAL FISTULAE ELDERLY MEN VI. INCONTINENCE AFTER XII. THE ARTIFICIAL URINARY EXTERNAL BEAM RADIOTHERAPY SPHINCTER (AUS) ALONE AND IN COMBINATION WITH SURGERY FOR PROSTATE CANCER XIII. SUMMARY AND RECOMMENDATIONS VII. INCONTINENCE AFTER OTHER TREATMENT FOR PROSTATE CANCER REFERENCES 1122 Surgical Treatment of Urinary Incontinence in Men S. HERSCHORN, H. BRUSCHINI, C. COMITER, P. GRISE, T. HANUS, R. KIRSCHNER-HERMANNS high-intensity focused ultrasound, other pelvic I. INTRODUCTION operations and trauma is a particularly challenging problem because of tissue damage outside the lower Surgery for male incontinence is an important aspect urinary tract. The artificial sphincter implant is the of treatment with the changing demographics of society most widely used surgical procedure but complications and the continuing large numbers of men undergoing may be more likely than in other areas and other surgery and other treatments for prostate cancer. surgical approaches may be necessary. Unresolved problems from pediatric age and patients with Basic evaluation of the patient is similar to other areas refractory incontinence from overactive bladders may of incontinence and includes primarily a clinical demand a variety of complex reconstructive surgical approach with history, frequency-volume chart or procedures. -
Acute Onset Flank Pain-Suspicion of Stone Disease (Urolithiasis)
Date of origin: 1995 Last review date: 2015 American College of Radiology ® ACR Appropriateness Criteria Clinical Condition: Acute Onset Flank Pain—Suspicion of Stone Disease (Urolithiasis) Variant 1: Suspicion of stone disease. Radiologic Procedure Rating Comments RRL* CT abdomen and pelvis without IV 8 Reduced-dose techniques are preferred. contrast ☢☢☢ This procedure is indicated if CT without contrast does not explain pain or reveals CT abdomen and pelvis without and with 6 an abnormality that should be further IV contrast ☢☢☢☢ assessed with contrast (eg, stone versus phleboliths). US color Doppler kidneys and bladder 6 O retroperitoneal Radiography intravenous urography 4 ☢☢☢ MRI abdomen and pelvis without IV 4 MR urography. O contrast MRI abdomen and pelvis without and with 4 MR urography. O IV contrast This procedure can be performed with US X-ray abdomen and pelvis (KUB) 3 as an alternative to NCCT. ☢☢ CT abdomen and pelvis with IV contrast 2 ☢☢☢ *Relative Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Radiation Level Variant 2: Recurrent symptoms of stone disease. Radiologic Procedure Rating Comments RRL* CT abdomen and pelvis without IV 7 Reduced-dose techniques are preferred. contrast ☢☢☢ This procedure is indicated in an emergent setting for acute management to evaluate for hydronephrosis. For planning and US color Doppler kidneys and bladder 7 intervention, US is generally not adequate O retroperitoneal and CT is complementary as CT more accurately characterizes stone size and location. This procedure is indicated if CT without contrast does not explain pain or reveals CT abdomen and pelvis without and with 6 an abnormality that should be further IV contrast ☢☢☢☢ assessed with contrast (eg, stone versus phleboliths). -
Urethral Stone: a Rare Cause of Acute Retention of Urine in Men
Open Journal of Urology, 2020, 10, 145-151 https://www.scirp.org/journal/oju ISSN Online: 2160-5629 ISSN Print: 2160-5440 Urethral Stone: A Rare Cause of Acute Retention of Urine in Men Ahmed Ibrahimi*, Idriss Ziani, Jihad Lakssir, Hachem El Sayegh, Lounis Benslimane, Yassine Nouini Department of Urology A, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco How to cite this paper: Ibrahimi, A., Zia- Abstract ni, I., Lakssir, J., El Sayegh, H., Benslimane, L. and Nouini, Y. (2020) Urethral Stone: A Urethral stones are a very rare form of urolithiasis, they most often originate Rare Cause of Acute Retention of Urine in from the upper urinary tract or bladder, and are rarely formed primarily in Men. Open Journal of Urology, 10, 145-151. the urethra, it is formed on a urethral anatomical pathology in the majority of https://doi.org/10.4236/oju.2020.105016 cases. The clinical symptomatology is very variable ranging from simple dy- Received: March 12, 2020 suria with penile pain to acute retention of urine. Smaller stones can be ex- Accepted: April 23, 2020 pelled spontaneously without intervention, but larger stones or complicated Published: April 26, 2020 stones or those developed on an underlying urethral anatomical pathology Copyright © 2020 by author(s) and require surgical treatment. The minimally invasive treatment should be the Scientific Research Publishing Inc. preferred route for the surgical treatment of this disease when feasible. We This work is licensed under the Creative report the case of a young man with no particular pathological history who Commons Attribution International License (CC BY 4.0).