Persistence of uropathogenic Escherichia Coli in the bladders of female patients with sterile urine after antibiotic therapies.

This study aimed to provide evidence of persistent uropathogenic Escherichia coli (UPEC) in female patients with recurrent urinary tract infection (UTI) after antibiotic therapy. We collected biopsies of the bladder, and clean-catch urine samples from 32 women who had episodes of recurrent UTI and were given antibiotic therapy. Urine samples and biopsies were analyzed by conventional bacteriological techniques. Phylogenetic group and 16 virulence factors (VFs) of UPEC were determined using polymerase chain reaction (PCR). The infection capability of UPEC was confirmed in a mouse model. Immunofluorescence and electron microscopy were used to detect intracellular bacterial communities (IBCs) in the mouse model. The results showed that all urine specimens were detected sterile. E. coli was found in 6 of 32 biopsies (18.75%), and was identified to be UPEC by PCR. Different VFs associated with the formation of IBCs were identified in all six UPEC isolates. Each UPEC isolate was capable of forming IBCs within the bladder epithelial cells of mice. In conclusion, UPEC with distinctive pathological traits and the capability of IBC formation was first found in the bladders of women after antibiotic therapy, suggesting that the IBC pathogenic pathway may occur in humans and it plays an important role in UTI recurrence.

[Application of one-stop diagnosis and treatment plan in percutaneous nephrolithotomy for patients with complex renal calculi].

OBJECTIVE: To evaluate the safety and efficacy of preoperative computed tomography urography (CTU) three-dimensional reconstruction, intraoperative radiology and ultrasound guidance followed by percutaneous nephrolithotomy (PCNL) in the treatment of complex renal calculi. METHODS: We summarized the clinical data of 210 patients with complex renal calculi treated at our hospital from December 2008 to December 2011 in this retrospective study. In the one-stop diagnosis and treatment group (n = 119), the optimal puncture approach was designed according to CTU imaging and three-dimensional reconstruction. Percutaneous track was established by ultrasound and radiology guided puncture. PCNL was performed with EMS system. The control group (n = 91) underwent PCNL without radiological guidance. The success rate of puncture, mean accessing time, mean operative duration, intraoperative volume of blood loss and stone-free rate after one operative session were observed. Post-operative follow-ups were conducted until June 2012. RESULTS: Compared to the control group, the one-stop diagnosis and treatment group showed a higher success rate of puncture [98.3% (117/119) vs 92.3% (84/91), P = 0.037], a shorter operative duration [97.8 ± 13.20 vs 110.0 ± 14.73 min, P = 0.043] and a higher stone-free rate after one operative session [92.4% (110/119) vs 83.5% (76/91), P = 0.037]. No significant difference was detected in the mean accessing time[15.3 ± 3.7 vs 13.9 ± 3.9 min, P = 0.398] or intraoperative volume of blood loss [195.8 ± 84.15 vs 263.3 ± 82.06 ml, P = 0.059]. No severe complications occurred. No recurrence of calculi was noted during the follow-up period. CONCLUSION: One-stop diagnosis and treatment plan (CTU 3-D reconstruction plus radiology, ultrasound guidance followed by PCNL) may identify the puncture path, improve the successful rate of puncture and stone-free rates and reduce the complications of PCNL.

Urodynamic investigation of cyclophosphamide-induced overactive bladder in conscious rats.

BACKGROUND: Overactive bladder (OAB) can be caused by many factors such as inflammation, bladder outlet obstruction, neurogenic factors. We performed an intraperitoneal (ip) injection of cyclophosphamide to induce cystitis in rats, which causes their detrusors to overact, to provide a valuable disease model for discussing OAB pathogenesis and to study effective curing methods. METHODS: Female Sprague-Dawley rats were induced to form cystitis by cyclophosphamide (200 mg/kg, ip). The day after the injection, two catheters were inserted into each rat's bladder to study its urodynamics. The BL-410 model bio-function experimental system was used to monitor bladder pressure while the rats were conscious. Unstable detrusor contractions appear in the urine storage period as a standard to determine OAB, and the positive rate was calculated. Urodynamic parameters such as bladder basal pressure (BP), maximum voiding pressure (MVP), intercontraction interval (ICI), spontaneous activity (SA), maximum cystometric capacity (MCC), and bladder compliance (BC) were recorded in each group, and a light microscope was used to observe the pathological changes in the rat bladder tissue. RESULTS: The detrusor instability rate of the model group was 83.33%. The MVP, MCC and BC of rats in the model group were lower than the control group (P < 0.01), and the BP, ICI and SA of the model group rats were higher than the control group (P < 0.01). The difference between the control group and the model group is statistically significant. The model group rats' bladder walls swelled and bled, the submucosa thickened and leukocyte infiltration became serious. CONCLUSIONS: Acute cystitis and OAB symptoms can be induced by ip injections of cyclophosphamide in rats. This can provide a valuable animal model to study OAB in human beings.

[Endourological treatment of aged high-risk patients with benign prostate hyperplasia: a report of 283 cases].

OBJECTIVE: To evaluate the safety and effectiveness of endourological techniques in the treatment of benign prostate hyperplasia (BPH) in aged high-risk patients. METHODS: We used endourological techniques in the treatment of 283 BPH patients aged over 70 years and complicated with hydronephrosis, renal failure, heart failure, cerebral infarction, respiratory dysfunction, anemia, diabetes, bladder tumor, or prostate weight over 80 g, TURP (transurethral resection of the prostate) for 112 cases and PKRP (transurethral plasmakinetic resection of the prostate) for the other 171. All the patients were followed up for 1-30 months. RESULTS: In the TURP group, the scores on IPSS and QOL were decreased from 27.5 +/- 2.8, 5.5 +/- 1.0 to 5.8 +/- 1.2, 1.0 +/- 0.5, and the residual urine volume (RUV) from (75.0 +/- 20.0) ml to (8.0 +/- 3.0) ml, but the maximal flow rate (Qmax) increased from (6.5 +/- 2.0) ml/s to (18.5 +/- 1.5) ml/s (P < 0.05), while in the PKRP group, the scores on IPSS and QOL were decreased from 28.2 +/- 2.2, 5.5 +/- 1.0 to 5.4 +/- 1.6, 1.0 +/- 0.5, and RUV from (80.0 +/- 20.0) ml to (7.0 +/- 3.0) ml, and Qmax increased from (6.8 +/- 2.1) ml/s to (20.0 +/- 1.5) ml/s (P < 0.05). There were no statistically significant differences in IPSS, QOL, Qmax and RUV after treatment between the two groups (P > 0.05), but significantly less complications were found in the PKRP than in the TURP group (P < 0.05). CONCLUSION: Endourological treatment, especially PKRP, with comprehensive perioperative preparations, unerring operative skills, well-controlled operation time, and intensive postoperative monitoring and nursing, has the advantages of high safety, less bleeding, fewer complications and definite effectiveness for aged high-risk BPH patients.

[Clinical significance of parameters of prostate volume measured by transabdominal ultrasonography in evaluating bladder outlet obstruction].

OBJECTIVE: To explore the correlation between the parameters of prostate volume (PV) measured by transabdominal ultrasonography and urodynamic results in diagnosing bladder outlet obstruction (BOO). METHODS: 112 BPH patients aged 45-85 underwent transabdominal ultrasonography to measure the superior-inferior diameter (R1) anterior-posterior diameter (R2), and left-right diameter (R3). Urodynamic examination was conducted to record the maximum flow rate (Qmax), detrusor pressure at maximum urinary flow rate (Pdet. Qmax), and detrusor pressure at minimum urinary flow rate (Pdet. Qmin), Schafer grading and international prostate symptom score (IPSS) scores were calculated. Correlation analysis was performed. RESULTS: The PV, R1, R2, and R3 were (48 +/- 29) ml, (4.3 +/- 1.0) cm, (3.7 +/- 0.9) cm, and (5.2 +/- 0.8) cm respectively. The Qmax, Pdet. Qmax, Schafer score, and IPSS score were (6.2 +/- 3.2) ml/s, (56 +/- 41) cm H2O, 3.1 +/- 1.8 (0-6) and 23 +/- 2 (15-31) respectively. Logistic regression analysis showed that R1 (OR = 22.662, P = 0.000), PV (OR = 0.946, P = 0.008) , and Qmax (OR = 0.760, P = 0.013) were positively correlated with Schafer grading value. CONCLUSION: The parameters of PV measured by transabdominal ultrasonography are reliable to diagnose BOO due to BPH.

[Ureteroscopic holmium: YAG laser lithotripsy for managing urinary tract calculi].

OBJECTIVE: To evaluate the effectiveness and safety of ureteroscopic holmium: YAG laser lithotripsy for managing ureteral calculi. METHODS: Ureteroscopic holmium: YAG laser lithotripsy was used in 168 ureteral calculi (proximal 27 cases, middle 33 cases, distal 108 cases). Transurethral cystoscopic holmium: YAG laser lithotripsy in 12 bladder calculi. RESULTS: Four to six weeks after operation, The stone-free rate was 93% (25/27) in the proximal ureteral calculi, 94% (31/33) in the middle ureteral calculi, 94% (102/108) in the distal ureteral calculi, respectively. The complication rate was 5% (8 cases). the stone-free rate of bladder calculi was 100% (12/12), no complication. CONCLUSION: Ureteroscopic holmium: YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.