Current Issue : April - June Volume : 2016 Issue Number : 2 Articles : 8 Articles
The proximal urethral bulb in men is enlarged, surrounds the bulbous urethra, and extends dorsally towards the perineum.\nDuring intercourse engorgement takes place due to increased blood flow through the corpus spongiosum. Antegrade ejaculation is\nfacilitated by contraction of the bulbospongiosus muscles during climax. Micturition during sexual stimulation is functionally\ninhibited. Supporting the bulb may indirectly facilitate continence in a certain subset of patients with post prostatectomy\nincontinence. During physical activity with increased abdominal pressure, reflex contraction of the pelvic floor muscles as well\nas the bulbospongiosus muscles occurs to support sphincter function and limit urinary incontinence. Operations to the prostate\nmay weaken urinary sphincter function. It is hypothesized that the distal urinary sphincter may be supported indirectly by placing\na hammock underneath the urethral bulb. During moments of physical stress the ââ?¬Å?cushionââ?¬Â of blood within the supported corpus\nspongiosum helps to increase the zone of coaptation within the sphincteric (membranous) urethra. This may lead to urinary\ncontinence in patients treated by a transobturator repositioning sling in patients with post prostatectomy incontinence. This paper\ndescribes the possible role of the urethral bulb in male urinary continence, including its function after retroluminal sling placement\n(AdVance, AdVance XPââ??â?¡ Male Sling System, Minnetonka, USA)....
Objectives.The aim was to compare demographics and pathological features of bladder carcinoma treated in a urology unit with\nfindings of previous studies done in Sri Lanka. Materials and Methods. Data of newly diagnosed patients with bladder cancer in a\ntertiary referral centre from 2011 to 2014 were analysed. Data on bladder cancers diagnosed from 1993 to 2014 were obtained from\nprevious publications and Sri Lanka Cancer Registry. Results.There were 148 patients and mean age was 65 years. Male to female\nratio was 4.1 : 1. Urothelial carcinoma (UC) was found in 89.2% of patients.Muscle invasion was noted in 35% of patients compared\nto 48.4% two decades ago. In patients with UC, 16.5% were found to have pT1 high grade tumour. It was 5.3% from 1993 to 2000.\nPure squamous cell carcinoma was found in 8.1% of patients while primary or de novo carcinoma in situ (not associated with high\ngrade pT1 tumours)was seen in one patient only. Conclusions.The percentage of squamous carcinoma is higher among Sri Lankan\npatients while primary carcinoma in situ is a rarity. The percentage of muscle invasive disease has decreased while the percentage\nof pT1 high grade tumours has increased during the last two decades in Sri Lanka...
Background. Predicting the progression of kidney failure in patients with chronic kidney disease is difficult. The aim of this study\nwas to assess the predictors of rapid kidney decline in a cohort of patients referred to a single outpatient nephrology clinic. Design.\nLongitudinal, prospective cohort study with a median follow-up of 3.39 years. Methods. Data were obtained from 306 patients\nwith chronic renal failure based on serum creatinine-estimated glomerular filtration rate (eGFRcreat) < 90 mL/min/1.73m2. After\nexcluding patients who died (...
Background: Treatment of end stage renal disease has an impact on patients� physical and psychological health,\nincluding quality of life (QoL). Nowadays, it is known that reducing the dialysis period has many advantages\nregarding QoL and medical outcomes. Although preemptive transplantation is the preferred strategy to prevent\npatients undergoing dialysis, its psychological impact is unknown. Moreover, transplantation can be experienced\nin a completely different manner among patients who were on dialysis and those who still had a functioning\nkidney at the time of surgery. Longitudinal data are often collected to allow analyzing the evolution of patients�\nQoL over time using questionnaires. Such data are often difficult to interpret due to the patients� changing standards,\nvalues, or conceptualization of what the questionnaire is intended to measure (e.g. QoL). This phenomenon is referred\nto as response shift and is often linked to the way the patients might adapt or cope with their disease experience.\nWhether response shift is experienced in a different way among patients who were on dialysis and those who still had\na functioning kidney at time of surgery is unknown and will be studied in the PreKit-QoL study (trial registration\nnumber: NCT02154815). Understanding the psychological impact of pre-emptive transplantation is an important\nissue since it can be associated with long-term patient and graft survival. Methods/Design: Adult patients with a pre-emptive transplantation (n = 130) will be prospectively included\nalong with a control group of patients with a pre-transplant dialysis period < 36 months (n = 260). Only first\nand single kidney transplantation will be considered. Endpoints include: comparison of change between\ngroups in QoL, anxiety and depressive disorders, perceived stress, taking into account response shift. These\ncriteria will be evaluated every 6 months prior to surgery, at hospital discharge, at three and six months, one\nand two years after transplantation.\nDiscussion: The PreKit-QoL study assesses and compares the evolution of QoL and other psychological criteria in\npreemptive and dialyzed patients taking patients� adaptation into account through response shift analyses. Our study\nmight help to conceive specific, adapted educational programs and psychological support to prevent a possible\npremature loss of the kidney as a consequence of non-compliance in patients that may be insufficiently prepared\nfor transplantation....
Background: Many metabolic changes develop in patients with chronic kidney disease which often necessitate\nfrequent biochemical analysis of blood. Saliva analysis as an alternative to blood has many advantages. The aims of\nthis study were to evaluate levels of salivary creatinine and urea in patients with chronic kidney disease in comparison\nto healthy individuals; to determine correlation between salivary creatinine/urea and blood creatinine/urea and to\nevaluate the diagnostic potential of saliva.\nMethods: A case control study, involving 50 patients with late stage chronic kidney disease and 49 healthy individuals\nas control. Blood and saliva samples were analyzed for urea and creatinine levels. Data are presented as median with\ninterquartile range and compared using Independent Samples Mann Whitney U test. Correlation between plasma and\nsalivary creatinine as well as urea was determined using Spearman�s correlation test. Receiver operating characteristics\n(ROC) analysis was done to determine the diagnostic ability of salivary creatinine and urea and cut-off values were\nestablished.\nResults: Median salivary creatinine levels were 2.60 mg/dl and 0.20 mg/dl while median salivary urea levels\nwere 92.00 mg/dl and 20.50 mg/dl in patients with chronic kidney disease and controls respectively. Salivary\nlevels of creatinine and urea were significantly elevated in chronic kidney disease patients (p < 0.001). In addition, there\nwas positive correlation between blood and salivary creatinine as well as urea levels. Total areas under the curve for\nsalivary creatinine and urea were 0.97 and 0.89 respectively. Cut-off values for salivary creatinine and urea were 0.55 mg/dl\nand 27.50 mg/dl respectively which gave sensitivity and specificity of 94 % and 85 % for creatinine; as well as 86 % and\n93 % for urea.\nConclusions: Findings of this study suggest that analysis of salivary creatinine and urea in patients with chronic kidney\ndisease reflects their levels in blood. Hence, salivary creatinine and urea could be used as diagnostic biomarkers of chronic\nkidney disease....
Background: Fibrillary glomerulonephritis (FGN) is a rare primary glomerular disease that seldom coexists with\nother diseases. Membranoproliferative glomerulonephritis is a pathologic finding of renal lesions associated with\nIgM-secreting monoclonal proliferations. We present a case study of a patient with unusual simultaneous FGN and\nIgM-related renal disorder in nonmalignant monoclonal IgM gammopathy.\nCase presentation: A 63-year-old male presented with nephrotic syndrome and elevated serum creatinine levels.\nLaboratory examination revealed elevated levels of serum IgM and low C3 levels. Serum and urine immunofixation\nelectrophoresis showed a monoclonal IgM with a kappa light chain. A bone marrow biopsy revealed less than 5 %\nbone marrow infiltration by lymphoplasmacytic lymphoma, and a renal biopsy revealed mesangiocapillary\nglomerulonephritis on light microscopy. Immunofluorescent and immunohistochemical staining indicated granular\ndeposits of immunoglobulin G in the mesangium and granular deposits of immunoglobulin M and �º light chains\nalong the capillary wall. Electron microscopy revealed randomly arranged nonbranching fibrils of approximately\n15 nm in diameter in the glomerular mesangium and subendothelial electron-dense deposits. According to these\nresults, we confirmed FGN and membranoproliferative glomerulonephritis, which were attributed to monoclonal\nIgM deposits.\nConclusion: To the best of our knowledge, this is the first report of simultaneous FGN and membranoproliferative\nglomerulonephritis in nonmalignant IgM monoclonal gammopathy....
The use of various grafts and flaps plays a critical role in the successful surgical management of urethral stricture disease.A thorough\ncomprehension of relevant anatomy and principles of tissue transfer techniques are essential to understanding the appropriate use\nof grafts or flaps to optimize outcomes. We briefly review these principles and discuss which technique may be best suited for a\ngiven anterior urethral stricture, depending on the location and length of the stricture, the presence or absence of an intact corpus\nspongiosum, and the availability of adequate and healthy penile skin....
Purpose. To determine whether total psoas area (TPA), a simple estimate of muscle mass, is associated with complications after\nradical cystectomy. Materials and Methods. Patients who underwent radical cystectomy at our institution from 2011 to 2012 were\nretrospectively identified. Total psoas area was measured on preoperative CT scans and normalized for patient height.Multivariable\nlogistic regression was used to determine whether TPA was a predictor of 90-day postoperative complications. Overall survival\nwas compared between TPA quartiles. Results. 135 patients were identified for analysis. Median follow-up was 24 months (IQR:\n6ââ?¬â??37 months). Overall 90-day complication rate was 56% (75/135). TPA was significantly lower for patients who experienced\nany complication (7.8 cm2/m2 versus 8.8 cm2/m2, ...
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