Uso y complicaciones del cateterismo urinario en salas de cuidados moderados de un hospital universitario

Introducción: El cateterismo urinario es un procedimiento frecuente y en ocasiones es utilizado por fuera de las indicaciones aceptadas para el mismo. Esto aumenta el riesgo de complicaciones vinculadas a su uso, por lo que pueden ser prevenibles. El objetivo del estudio es conocer las características del uso de cateterismo urinario en pacientes ingresados en salas de cuidados moderados de un hospital universitario del tercer nivel de atención, determinar la frecuencia, duración e indicaciones más frecuentes, así como evaluar la presencia de complicaciones asociadas al mismo Metodología: Estudio de corte transversal, realizado en salas de cuidados moderados de un hospital terciario y universitario de Montevideo, Uruguay, el 21 de diciembre de 2022. Se incluyeron pacientes hospitalizados que presentaban o presentaron catéter vesical en la presente internación y se completó la recolección de variables mediante la revisión de la historia clínica. Resultados: De 155 pacientes ingresados en salas de cuidados moderados, a 26 (16,7%) les fue colocado un catéter urinario. La mediana de edad fue 61 años, 80% eran de sexo masculino. La mediana de internación fue de 22 días. En todos los pacientes se utilizó sonda vesical y el 54% fue colocado en el Departamento de Emergencia. En el 46% de los pacientes no se encontró indicación escrita de colocación en la historia clínica. En 50% de los casos no está especificado el motivo de indicación de sonda vesical, mientras que las indicaciones identificadas más frecuentes fueron el control de diuresis (27%) y la desobstrucción de vía urinaria baja (23%). La duración de cateterismo fue de una mediana de 13,5 días, mientras que el 27% de los pacientes la usaron más de 30 días. 35% de los pacientes presentaron complicaciones vinculadas a la sonda vesical, en su mayoría no infecciosas (27%) y 15% presentaron infección urinaria. Estos pacientes tuvieron una duración de cateterismo mayor a los que no presentaron complicaciones (23 vs 10 días, p=0,411). Conclusiones: El catéter vesical fue utilizado en un porcentaje no despreciable de pacientes ingresados en salas de cuidados moderados, de forma prolongada y frecuentemente sin indicación precisa, lo cual expone a un riesgo aumentado de complicaciones vinculadas.

Introduction: Urinary catheterization is a frequent procedure and is sometimes used outside of its accepted indications. This increases the risk of complications related to its use, so they may be preventable. The objective of this study is to know the characteristics of the use of urinary catheterization in patients admitted to moderate care wards of a tertiary care university hospital, to determine the frequency, duration and most frequent indications, as well as to evaluate the presence of associated complications. Methodology: Cross-sectional study, carried out in moderate care wards of a tertiary care and university hospital in Montevideo, Uruguay, on December 21, 2022. Hospitalized patients who present or presented a bladder catheter during the present hospitalization were included, and the collection of variables was completed by reviewing the medical history. Results: Of 155 patients admitted to moderate care wards, 26 (16.7%) had a urinary catheter placed. The median age was 61 years, 80% were male. The median hospitalization was 22 days. In all patients a bladder catheter was used and 54% were placed in the Emergency Department. In 46% of the patients, no written indication for placement was found in the clinical history. In 50% of cases, the reason for indicating the bladder catheter is not specified, while the most frequent indications identified were diuresis control (27%) and lower urinary tract obstruction (23%). The duration of catheterization was a median of 13.5 days, while 27% of the patients used it for more than 30 days. 35% of the patients presented complications related to the bladder catheter, mostly non-infectious (27%) and 15% presented urinary tract infection. These patients had a longer duration of catheterization than those without complications (23 vs 10 days, p=0,411). Conclusions: The bladder catheter was used in a non-negligible percentage of patients admitted to moderate care wards, for a long time and often without a precise indication, which exposes them to an increased risk of related complications.

Introdução: O cateterismo urinário é um procedimento frequente e às vezes é usado fora de suas indicações aceitas. Isso aumenta o risco de complicações relacionadas ao seu uso, portanto, podem ser evitáveis. O objetivo deste estudo é conhecer as características do uso do cateterismo urinário em pacientes internados em enfermarias de cuidados moderados de um hospital universitário terciário, determinar a frequência, duração e indicações mais frequentes, bem como avaliar a presença de complicações associadas ao mesmo. Metodologia: Estudo transversal, realizado em quartos de cuidados moderados de um hospital terciário e universitário em Montevidéu, Uruguai, em 21 de dezembro de 2022. Foram incluídos pacientes que apresentaram ou apresentaram sonda vesical durante a internação atual e a coleta de variáveis ​​foi concluída .revisando o histórico médico. Resultados: Dos 155 pacientes admitidos em enfermarias de cuidados moderados, 26 (16,7%) tiveram um cateter urinário colocado. A idade média foi de 61 anos, 80% eram do sexo masculino. A mediana de internação foi de 22 dias. Em todos os doentes foi utilizada sonda vesical e 54% foram internados no Serviço de Urgência. Em 46% dos pacientes, nenhuma indicação escrita para colocação foi encontrada na história clínica. Em 50% dos casos não é especificado o motivo da indicação da sonda vesical, enquanto as indicações mais frequentes identificadas foram controle da diurese (27%) e desobstrução do trato urinário inferior (23%). A duração do cateterismo foi em média de 13,5 dias, enquanto 27% dos pacientes o utilizaram por mais de 30 dias. 35% dos pacientes apresentaram complicações relacionadas ao cateter vesical, em sua maioria não infecciosas (27%) e 15% apresentaram infecção urinária. Esses pacientes tiveram uma duração mais longa de cateterismo do que aqueles sem complicações (23 vs 10 dias, p=0,411). Conclusões: A sonda vesical foi utilizada em percentual não desprezível de pacientes internados em quartos de cuidados moderados, por tempo prolongado e muitas vezes sem indicação precisa, o que os expõe a um risco aumentado de complicações associadas.

Human HPSE2 gene transfer ameliorates bladder pathophysiology in a mutant mouse model of urofacial syndrome.

Rare early-onset lower urinary tract disorders include defects of functional maturation of the bladder. Current treatments do not target the primary pathobiology of these diseases. Some have a monogenic basis, such as urofacial, or Ochoa, syndrome (UFS). Here, the bladder does not empty fully because of incomplete relaxation of its outflow tract, and subsequent urosepsis can cause kidney failure. UFS is associated with biallelic variants of HPSE2, encoding heparanase-2. This protein is detected in pelvic ganglia, autonomic relay stations that innervate the bladder and control voiding. Bladder outflow tracts of Hpse2 mutant mice display impaired neurogenic relaxation. We hypothesized that HPSE2 gene transfer soon after birth would ameliorate this defect and explored an adeno-associated viral (AAV) vector-based approach. AAV9/HPSE2, carrying human HPSE2 driven by CAG, was administered intravenously into neonatal mice. In the third postnatal week, transgene transduction and expression were sought, and ex vivo myography was undertaken to measure bladder function. In mice administered AAV9/HPSE2, the viral genome was detected in pelvic ganglia. Human HPSE2 was expressed and heparanase-2 became detectable in pelvic ganglia of treated mutant mice. On autopsy, wild-type mice had empty bladders, whereas bladders were uniformly distended in mutant mice, a defect ameliorated by AAV9/HPSE2 treatment. Therapeutically, AAV9/HPSE2 significantly ameliorated impaired neurogenic relaxation of Hpse2 mutant bladder outflow tracts. Impaired neurogenic contractility of mutant detrusor smooth muscle was also significantly improved. These results constitute first steps towards curing UFS, a clinically devastating genetic disease featuring a bladder autonomic neuropathy.

Factors associated with persistent sexual dysfunction and pain 12 months postpartum.

OBJECTIVE: Identify factors associated with persistent sexual dysfunction and pain 12-months postpartum in an underserved population. METHODS: Extending Maternal Care After Pregnancy (eMCAP) is a program addressing health needs/disparities of patients at risk for worse perinatal outcomes. Participants completed the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and Urinary Distress Index (UDI-6) 12-months postpartum. The PISQ-12 was dichotomized with scores < 32.5 indicating sexual dysfunction. Urinary incontinence (UI) was defined as at-least-somewhat bothersome (vs. none or not-at-all bothersome) urgency urinary incontinence (UUI) or stress urinary incontinence (SUI). Screening for anxiety and depression was completed using Generalized Anxiety Disorder-7 (GAD-7) and Edinburgh Postnatal Depression Scale (EPDS). Bivariate and multivariable logistic regression analyses were performed for sexual dysfunction vs. normal-function, and pain vs. no-pain, using demographic, peri/postpartum, and social-determinant-of-health variables as correlating factors. RESULTS: 328 sexually active patients provided data. On bivariate analysis, sexual dysfunction (n = 31, 9.5%) vs. normal function (n = 297, 90.5%) groups showed no differences in age, BMI, parity, mode of delivery, episiotomy/laceration types, or breastfeeding. Sexual dysfunction was significantly associatedwith both UUI and SUI: 12 (39%) vs. 46 (15%) had UUI, p = 0.001, and 20 (65%) vs. 97 (33%) had SUI, P < 0.001; the dysfunction group also had higher GAD-7 and EPDS scores and greater overall stress levels. On multivariable analysis, SUI and stress remained significantly associated: OR (95% CI) 2.45 (1.02-6.03) and 1.81 (1.32-2.49), respectively. Comparing pain (n = 45, 13.7%) vs. no-pain (n = 283, 86.2%), dyspareunia patients endorsed greater stress levels. CONCLUSION: The interplay between sexual health, incontinence, and mental health deserves further study, and all three should be routinely addressed in postpartum care.

Identification of mechanisms modulating chlorhexidine and octenidine susceptibility in Proteus mirabilis.

AIMS: We aimed to identify mechanisms underlying the tolerance of P. mirabilis-a common cause of catheter associated urinary tract infection-to the clinically used biocides chlorhexidine (CHD) and octenidine (OCT). METHODS AND RESULTS: We adapted three clinical isolates to grow at concentrations of 512 µg ml-1 CHD and 128 µg ml-1 OCT. Genetic characterisation and complementation studies revealed mutations inactivating the smvR repressor and increasing smvA efflux expression were associated with adaptation to both biocides. Mutations in mipA (encoding the MltA interacting protein) were less prevalent than smvR mutations and only identified in CHD adapted populations. Mutations in the rppA response regulator were exclusive to one adapted isolate and were linked with reduced polymyxin B susceptibility and a predicted gain of function after biocide adaptation. Biocide adaptation had no impact on crystalline biofilm formation. CONCLUSIONS: SmvR inactivation is a key mechanism in both CHD and OCT tolerance. MipA inactivation alone confers moderate protection against CHD, and rppA showed no direct role in either CHD or OCT susceptibility.

A histopathological and epidemiological study of urothelial carcinoma at a tertiary care centre in Peshawar, Pakistan.

Bladder cancer is the ninth leading cause of death worldwide and 14th leading cause of death in Pakistan. The objective of this study was to determine the frequency of urothelial carcinoma in various age groups, its gender distribution, and grades. A total of 131 cases of urothelial carcinoma, received at Department of Pathology, Peshawar Medical College, Peshawar, between January 2017 to December 2022, were included in the study; of them 107 (81.6%) were males while 24 (18.3%) were females with a mean age of 62±13 years. The most common histological subtype was papillary urothelial carcinoma in 117(89.3%) cases, followed by Squamous and Glandular in 5(3.8%) cases. Majority of the urothelial carcinoma with high grade showed a statistically significant relation with muscle invasion 38 (50.66%). Males were four times more likely to have urothelial carcinoma while older age groups were more likely to have high grade urothelial carcinoma.

Genitourinary infection and gastroschisis: A systematic review and meta-analysis.

BACKGROUND: Gastroschisis is a congenital anomaly of the umbilical ring with increasing prevalence, especially amongst younger mothers. There is increasing evidence that exposure to genitourinary infections (GUTI) may play an important role in the etiology of gastroschisis. This systematic review and meta-analysis aimed to identify, appraise, and summarize the literature on exposure to GUTI and gastroschisis. METHODS: Six electronic databases (MEDLINE, EMBASE, Web of Science, Scopus, Cochrane Library electronic databases, and Prospero) were searched using a comprehensive search strategy. Citations and cited articles for all included studies were searched. Peer-reviewed, quantitative studies reporting an association of urinary tract infections (UTI) and/or sexually transmitted infections (STI) with gastroschisis were included. Prospero registration CRD42022377420. RESULTS: A total of 2392 papers were identified via the searches of which 15 met our inclusion criteria and were included after title and abstract and full text screening. The study period for included studies ranged from 1995 to 2016, most were from the USA. Four studies considering exposure to STIs and five to UTIs were eligible to progress to meta-analysis. Meta-analysis identified a significantly increased risk of gastroschisis in association with periconceptional exposure to UTI [OR 1.54 (95% CI 1.29, 1.8)], STI [OR 1.4 (95% CI 1.01, 1.79)]. CONCLUSIONS: Periconceptional exposure to GUTI is associated with an increased risk of gastroschisis. The prevention and timely treatment of GUTI amongst women of childbearing age may help to reduce the occurrence of gastroschisis.

Giant Benign Prostatic Hyperplasia: A Case Report.

We present the case of a 69-year-old man experiencing lower urinary tract symptoms (LUTS), notably difficulties with urination. His total prostate-specific antigen level was measured at 3.52 ng/ml, accompanied by an International Prostate Symptom Score of 32. Transrectal ultrasound revealed a prostate volume of 268 cm3. Benign prostatic hyperplasia (BPH) is a common condition among aging men, often manifesting as LUTS. However, in rare instances, BPH can progress pathologically to giant prostatic hyperplasia, characterized by a prostate gland exceeding 500 g in weight. This report documents the successful enucleation of the giant BPH without significant complications, utilizing a transvesical prostatectomy technique. Our case underscores the importance of early diagnosis and appropriate management strategies.

The Treatment Selection for a 36-Year-Old Woman With Stress Urinary Incontinence Using a Discrete Mathematical Approach: A Case Report.

This case report describes the treatment selection process for a 36-year-old woman with stress urinary incontinence (SUI) and an overactive bladder (OAB) who desired pregnancy. The patient had comorbidities of hypertension and type 2 diabetes, which required consideration to improve her quality of life and reproductive health. A recently developed decision support tool using a discrete mathematical approach was used to select a treatment method tailored to the patient's individual situation. The analysis determined that vaginal erbium laser (VEL) treatment (Renovalase SP Dynamis Fotona d.o.o, Ljubljana, Slovenia) was the most suitable for this patient. VEL treatment significantly improved both SUI and OAB and changing antihypertensive medication eliminated nocturia. This case suggests the potential application of graph theory in treatment selection for SUI patients.

Surgical Management of Bilateral Single-System Ectopic Ureters (BSSEUs) in a Pediatric Patient: A Report of a Rare Case and Literature Review.

Bilateral single-system ectopic ureters (BSSEUs) are among the rarest entities encountered in pediatric urology. A BSSEU occurs when the ureteric buds originate cranially from the mesonephric ducts, causing a delay in their integration into the urogenital sinus. It presents as continuous incontinence in females, whereas symptoms like infection and discomfort are present in males. We describe a case involving a BSSEU opening into the vagina and urethra, with the patient experiencing continuous urinary incontinence, and its diagnosis and management. Here, We discuss a rare case of a four-year-old girl exhibiting continuous urinary incontinence or dribbling associated with recurrent urinary tract infections (UTIs) attributed to bilateral ectopic ureters. Imaging modalities, including contrast-enhanced computed tomography(CECT) and MRI, revealed the presence of BSSEUs accompanied by hydroureteronephrosis. The condition was managed with prompt surgical intervention involving bilateral ureteric reimplantation. Subsequent to the procedure, the patient experienced a significant improvement in continence mechanism and bladder capacity, obviating the requirement of urinary diversion procedure appendicovesicostomy or bladder neck reconstruction. Notably, while BSSEUs are an uncommon presentation, their timely and appropriate management is paramount in preventing potential renal damage. This case underscores the significance of vigilant monitoring and proactive intervention in addressing such complex urological anomalies in pediatric patients.

Navigating Treatment Choices for Stress and Urgency Urinary Incontinence Using Graph Theory in Discrete Mathematics.

In this study, we propose a method for navigating the choice of treatment for stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) using graph theory in discrete mathematics. Our previous study accumulated data from 150 patients who underwent tension-free vaginal tape (TVT), transobturator tape (TOT), and vaginal non-ablation Erbium YAG laser (VEL) surgeries between 2014 and 2016. Network diagrams were created using this data. The treatments TVT, TOT, and VEL, along with patient characteristics (1-hour pad test: 1-hrPadTest, Overactive Bladder Symptom Score: OABSS), were represented as nodes and edges in the network diagram. We then employed a heuristic function to select the optimal treatment method for the patients with SUI and UUI. This process enables medical professionals to easily navigate the data for patients with both SUI and UUI concerns by calculating the shortest path connecting the 1-hrPadTest and OABSS. These results, which are consistent with those of previous studies, suggest that VEL is the optimal treatment. Unlike previous studies that employed statistical knowledge that is challenging for patients to understand, our study aids patients in visually comprehending and developing a customized treatment plan. This approach introduces a novel perspective for clinical decision-making in the treatment of urinary incontinence. To the best of our knowledge, this is the first study to apply discrete mathematics to patient decision-making for urinary incontinence treatment.

Radical total pelvic exenteration with concomitant right nephrectomy in the management of recurrent endometrioid ovarian adenocarcinoma: A case report and literature review.

Endometrioid ovarian adenocarcinoma is a common subtype of epithelial ovarian cancer that can arise on a background of endometriosis. Maximal cytoreductive effort with an aim to remove all macroscopic disease (achieve R0) is the single independent prognostic factor for survival. Complex multidisciplinary surgeries may be required in order to achieve this.

Urinary polycyclic aromatic hydrocarbons and adult obesity among the US population: NHANES 2003-2016.

Polycyclic aromatic hydrocarbons (PAHs) are naturally occurring environmental pollutants that may contribute to obesity in the adult population. To investigate the relationship between the urinary concentrations of PAH metabolites and adult obesity among the US population, the National Health and Nutritional Examination Survey (NHANES, 2003-2016) was used as a data source for this study. As many as 4464 participants in the NHANES 2003-2016 were included in the final analyses. We used logistic regression to look at the link between urinary PAH metabolites and obesity, using odds ratios (ORs) and 95% confidence intervals (CIs). The study sample comprised 4464 individuals aged ≥18 years, 2199 were male and 2265 were female. The study characteristics for four different quartiles were analyzed, and the average ages of the four urinary PAH quartiles were 49.61 ± 20.01, 46.63 ± 20.33, 44.28 ± 19.19, and 43.27 ± 17.68 years, respectively. In the quartile analysis of all participants, the third quartile was significantly associated with an increased prevalence of obesity (OR = 1.33, 95% CI = 1.12-1.59) with p-values <.05. In addition, females, but not males, had a strong link between the second, third, and fourth quartiles of urinary PAH and a higher risk of obesity (OR = 1.27, 95% CI = 1.00-1.61; OR = 1.52, 95% CI = 1.19-1.94; and OR = 1.39, 95% CI = 1.09-1.78). In conclusion, the study observed that urinary PAH metabolites were associated with the prevalence of obesity among the US population.

Urinary microbiome dysbiosis is associated with an inflammatory environment and perturbed fatty acids metabolism in the pathogenesis of bladder cancer.

BACKGROUND: Bladder cancer is a common malignancy with high recurrence rate. Early diagnosis and recurrence surveillance are pivotal to patients' outcomes, which require novel minimal-invasive diagnostic tools. The urinary microbiome is associated with bladder cancer and can be used as biomarkers, but the underlying mechanism is to be fully illustrated and diagnostic performance to be improved. METHODS: A total of 23 treatment-naïve bladder cancer patients and 9 non-cancerous subjects were enrolled into the Before group and Control group. After surgery, 10 patients from the Before group were further assigned into After group. Void mid-stream urine samples were collected and sent for 16S rDNA sequencing, targeted metabolomic profiling, and flow cytometry. Next, correlations were analyzed between microbiota, metabolites, and cytokines. Finally, receiver operating characteristic (ROC) curves of the urinary biomarkers were plotted and compared. RESULTS: Comparing to the Control group, levels of IL-6 (p < 0.01), IL-8 (p < 0.05), and IL-10 (p < 0.05) were remarkably elevated in the Before group. The α diversity of urine microbiome was also significantly higher, with the feature microbiota positively correlated to the level of IL-6 (r = 0.58, p < 0.01). Significant differences in metabolic composition were also observed between the Before and Control groups, with fatty acids and fatty acylcarnitines enriched in the Before group. After tumor resection, cytokine levels and the overall microbiome structure in the After group remained similar to that of the Before group, but fatty acylcarnitines were significantly reduced (p < 0.05). Pathway enrichment analysis revealed beta-oxidation of fatty acids was significantly involved (p < 0.001). ROC curves showed that the biomarker panel of Actinomycetaceae + arachidonic acid + IL-6 had superior diagnostic performance, with sensitivity of 0.94 and specificity of 1.00. CONCLUSIONS: Microbiome dysbiosis, proinflammatory environment and altered fatty acids metabolism are involved in the pathogenesis of bladder cancer, which may throw light on novel noninvasive diagnostic tool development.

Current state and novel outlook on prevention and treatment of rising antibiotic resistance in urinary tract infections.

Antibiotic-resistant bacteria are currently an important public health concern posing a serious threat due to their resistance to the current arsenal of antibiotics. Uropathogens Escherichia coli (UPEC), Proteus mirabilis, Klebsiella pneumoniae and Enterococcus faecalis, antibiotic-resistant gram-negative bacteria, cause serious cases of prolonged UTIs, increasing healthcare costs and potentially even leading to the death of an affected patient. This review discusses current knowledge about the increasing resistance to currently recommended antibiotics for UTI therapy, as well as novel therapeutic options. Traditional antibiotics are still a part of the therapy guidelines for UTIs, although they are often not effective and have serious side effects. Hence, novel drugs are being developed, such as combinations of ß-lactam antibiotics with cephalosporins and carbapenems. Siderophoric cephalosporins, such as cefiderocol, have shown potential in the treatment of individuals with significant gram-negative bacterial infections, as well as aminoglycosides, fluoroquinolones and tetracyclines that are also undergoing clinical trials. The use of cranberry and probiotics is another potential curative and preventive method that has shown antimicrobial and anti-inflammatory effects. However, further studies are needed to assess the efficacy and safety of probiotics containing cranberry extract for UTI prevention and treatment. An emerging novel approach for UTI treatment is the use of immuno-prophylactic vaccines, as well as different nanotechnology solutions such as nanoparticles (Nanoparticles). Nanoparticles have the potential to be used as delivery systems for drugs to specific targets. Furthermore, nanotechnology could enable the development of nano antibiotics with improved features by the application of different Nanoparticles in their structure, such as gold and copper Nanoparticles. However, further high-quality research is required for the synthesis and testing of these novel molecules, such as safety evaluation and pharmacovigilance.

The relationships between blood lead levels and nocturia prevalence in adults: A retrospective study.

PURPOSE: The purpose of this study was to examine the association between blood lead levels and the prevalence of nocturia in American adults. METHODS: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2020, focusing on individuals aged 20 years or older (n = 11,919). Blood lead levels were categorized into two groups (<2 µg/dL and ≥2 µg/dL), and the presence of nocturia was assessed based on questionnaire responses. We used multivariable logistic regression models to explore the association between blood lead levels and nocturia while adjusting for various covariates, including sex, ratio of family income to poverty (RIP), lipid profile, age, body mass index (BMI), race, citizenship, sleep trouble, diabetes, and hypertension. To verify whether certain covariates influence blood lead levels and the risk of nocturia, we conducted subgroup analyses. RESULTS: Of the study participants, 31.70% reported experiencing nocturia. Individuals with higher blood lead levels (≥2 µg/dL) exhibited a higher likelihood of experiencing nocturia compared to those with lower levels (<2 µg/dL) in all three models (Model 1: OR 1.46, 95% CI 1.29-1.66, p < 0.0001; Model 2: OR 1.25, 95% CI 1.09-1.44, p = 0.002; Model 3: OR 1.22, 95%CI 1.06-1.41, p = 0.01). Subgroup analyses revealed that factors such as age, sex, sleep trouble, diabetes, hypertension, BMI, RIP, and race did not affect the association between blood lead levels and the risk of nocturia (P for interaction >0.05). CONCLUSIONS: This study reported the correlation between blood lead levels and nocturia. We found that compared to blood lead levels below 2 µg/dL, when lead levels reached or exceeded 2 µg/dL, the risk of nocturia occurrence increased by 22%. CLINICAL TRIAL REGISTRATION: This study is based on existing data from a public database and not from a specific clinical trial; hence, clinical registration information is not provided.

Efficacy and safety of onabotulinumtoxinA for the treatment of overactive bladder in men and women: A pooled analysis.

BACKGROUND: This pooled analysis of randomized controlled studies investigated the safety and efficacy of onabotulinumtoxinA in male and female patients with overactive bladder (OAB). METHODS: Data were pooled from four similarly designed trials in North America and Europe. Adults with idiopathic OAB for ≥6 months inadequately managed by at least one anticholinergic were randomized 1:1 or 2:1 to receive onabotulinumtoxinA 100 U or matched placebo in Cycle 1 and could request open-label retreatment with onabotulinumtoxinA 100 U at ≥12 weeks. Efficacy outcomes at Week 12 included the primary endpoint of mean urinary incontinence (UI) episodes per day and other variables, such as the proportion of patients with ≥50% reduction in daily UI episodes. Safety was assessed by monitoring treatment-emergent adverse events (TEAEs). Analyses by sex were descriptive. Males were further analyzed by benign prostatic hyperplasia (BPH) diagnosis status. RESULTS: In the pooled population (N = 1564), there were 194 males (12.4%) and 1370 females (87.6%). Mean number of baseline UI episodes per day was 4.9 in males and 5.5 in females. At Week 12, numerically greater mean reductions from baseline in number of daily UI episodes were observed with the onabotulinumtoxinA 100 U group (females: -3.0; males: -2.2) versus placebo (females: -1.1; males: -1.3). Achievement of ≥50% reduction in daily UI episodes was numerically greater with onabotulinumtoxinA 100 U (females: 64.8%; males: 61.2%) versus placebo (females: 30.6%; males: 44.8%), and numerically higher in males without BPH (onabotulinumtoxinA: 65.1%; placebo: 50.9%) versus with BPH (onabotulinumtoxinA: 54.3%; placebo: 36.6%). A total of 34.7% of males and 39.4% of females experienced at least one TEAE in the first 12 weeks during treatment Cycle 1. Urinary tract infection rate was 13.1% in females and 4.2% in males; incidence of hematuria was 6.8% in males and 1.1% in females. Incidence of urinary retention (defined as incomplete emptying, requiring catheterization) was 2.7% in females and 4.7% in males. CONCLUSION: OnabotulinumtoxinA 100 U was efficacious and well tolerated in men and women with OAB, including in males with and without BPH. No new safety findings were identified when data were analyzed by sex.

Draft genome assemblies of three Klebsiella grimontii strains isolated from catheterized urine samples from the same male participant over the course of 6 months.

Klebsiella grimontii is a newly identified species within the Klebsiella oxytoca complex. Here, we present the draft genome sequence of three K. grimontii strains that were isolated from catheterized urine samples collected from a participant in a longitudinal study over ~6 months.

Dysregulated Urinary Extracellular Vesicle Small RNAs in Diabetic Nephropathy: Implications for Diagnosis and Therapy.

Background: Diabetic nephropathy (DN) represents a major chronic kidney disorder and a leading cause of end-stage renal disease (ESRD). Small RNAs have been showing great promise as diagnostic markers as well as drug targets. Identifying dysregulated micro RNAs (miRNAs) could help in identifying disease biomarkers and investigation of downstream interactions, shedding light on the molecular pathophysiology of DN. In this study, we analyzed small RNAs within human urinary extracellular vesicles (ECVs) from DN patients using small RNA next-generation sequencing. Method: In this cross-sectional study, urine samples were collected from 88 participants who were divided into 3 groups: type 2 diabetes (T2D) with DN (T2D + DN, n = 20), T2D without DN (T2D - DN, n = 40), and healthy individuals (n = 28). The study focused on isolating urinary ECVs to extract and sequence small RNAs. Differentially expressed small RNAs were identified, and a functional enrichment analysis was conducted. Results: The study revealed a distinct subset of 13 miRNAs and 10 Piwi-interacting RNAs that were significantly dysregulated in urinary ECVs of the DN group when compared to other groups. Notably, miR-151a-3p and miR-182-5p exhibited a unique expression pattern, being downregulated in the T2D - DN group, and upregulated in the T2D + DN group, thus demonstrating their effectiveness in distinguishing patients between the 2 groups. Eight driver genes were identified PTEN, SMAD2, SMAD4, VEGFA, CCND2, CDK6, LIN28B, and CHD1. Conclusion: Our findings contribute valuable insights into the pathogenesis of DN, uncovering novel biomarkers and identifying potential therapeutic targets that may aid in managing and potentially decelerating the progression of the disease.