International urology and nephrology
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Randomized Controlled Trial
Urethral pressure measurement in stress incontinence: does it help?
The resting urethral pressure profile (UPP), used for the assessment of women with stress incontinence, is routine in many urodynamic units. It is time- and effort-consuming, and its diagnostic value is controversial, as well as its value in the prediction of outcome of anti-incontinence surgery. Herein, we assessed its value in the prediction of the outcome of surgery. ⋯ The routine use of resting UPP has no added value in terms of the prediction of success of incontinence surgery. It does not help with follow-up and adds to the time and cost of the examination.
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Controlled Clinical Trial
Procalcitonin for the early prediction of renal parenchymal involvement in children with UTI: preliminary results.
In order to establish the most reliable marker for distinguishing urinary tract infections (UTI) with and without renal parenchymal involvement (RPI), we recorded the clinical features and admission leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum procalcitonin (PCT) in 57 children (including 43 girls) aged 2-108 months admitted with a first episode of UTI. RPI was evaluated by Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy within 7 days of admission. To establish cut-off points for ESR, CRP, and PCT, we used receiver operating characteristics curves and compared the area under the curve for ESR, CRP, and PCT. ⋯ PCT was more sensitive and specific for the diagnosis of upper versus lower UTI than ESR and CRP. Using a cut-off value of 0.85 ng/ml, PCT had the best performance, with sensitivity, specificity, and positive and negative predictive values of 89%, 97%, 96%, and 91% respectively. Serum PCT is a better marker than ESR, CRP, and leukocyte count for the early prediction of RPI in children with a first episode of UTI.
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Case Reports
Acute pyelonephritis with renal vein and inferior vena cava thrombosis in a case of hyperhomocysteinemia.
Acute pyelonephritis is not considered a common cause of renal vein (RVT) and inferior vena caval thrombosis (IVCT). Apart from malignancy, RVT is not an uncommon condition amongst patients with nephrotic syndrome, most commonly seen in patients with membranous glomerulonephritis. However, RVT occurring in association to acute pyelonephritis is rare. ⋯ We report a case of acute pyelonephritis with RVT and IVCT with underlying hyperhomocysteinemia. The patient was treated with systemic anticoagulation, antibiotics, and B complex therapy. At 3 months follow-up, there was complete resolution of thrombus but the left kidney was nonfunctioning.
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The objective is to evaluate resistance between community-acquired urinary tract infections (CAUTI), nosocomialy-acquired urinary tract infections (NAUTI), and empirical therapy adequacy. E. coli is the predominant pathogen of both CAUTI and NAUTI, followed by Klebsiella spp. in NAUTI and Pseudomonas spp. in catheter-associated urinary tract infections. ⋯ Absolute or high level resistance for commonly used empirical antimicrobial therapy was found in catheter-associated UTI and NAUTI while resistance among CAUTI was respectable. Patients with NAUTI as well as patients with catheter-associated urinary tract infections have similar resistance and similar microorganisms isolated as a causative agents, and should not be empirically treated unless the clinical emergency requests.
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Functional enuresis is defined as repeated voiding of urine into bed or clothes in children after 5 years of age following the exclusion of major somatic diseases. Autonomic nervous system dysregulation has been proposed as a pathophysiologic mechanism in the etiopathogenesis. The objective of this study was to evaluate autonomic nervous system functions with pupil diameter measurement in enuretic children. ⋯ Pupil diameter measurements were performed under photopic and mesopic lighting conditions by using a pupillometer. Mean photopic pupil diameter was found to be larger in the enuretic children than in the healthy controls (4.47 +/- 0.52 mm vs. 4.03 +/- 0.75 mm; P = 0.03). Autonomic nervous system imbalance of the ocular system is considered to be part of the autonomic nervous system dysregulation in functional enuretic children.