Urogenital function following robotic and laparoscopic rectal cancer surgery: meta-analysis

BACKGROUND

Mixed results are reported on clinical and cancer outcomes in laparoscopic rectal cancer surgery (LRCS) compared with robotic rectal cancer surgery (RRCS). However, more favourable functional outcomes are reported following RRCS. This study compared urinary and sexual function following RRCS and LRCS in male and female patients.

METHODS

A systematic review and meta-analysis of urinary and sexual function after RRCS and LRCS was performed following PRISMA and MOOSE guidelines, and registered prospectively with PROSPERO (ID:CRD42020164285). The functional outcome reporting tools most commonly included: the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI). Mean scores and changes in mean scores from baseline were analysed using RevMan version 5.3.

RESULTS

Ten studies were included reporting on 1286 patients. Some 672 patients underwent LRCS, of whom 380 (56.5 per cent) were men and 116 (17.3 per cent) were women (gender not specified in 176 patients, 26.2 per cent). A total of 614 patients underwent RRCS, of whom 356 (58.0 per cent) were men and 83 (13.5 per cent) were women (gender not specified in 175 patients, 28.5 per cent). Regarding urinary function in men at 6 months after surgery, IPSS scores were significantly better in the RRCS group than in the LRCS group (mean difference (MD) -1.36, 95 per cent c.i. -2.31 to -0.40; P = 0.005), a trend that persisted at 12 months (MD -1.08, -1.85 to -0.30; P = 0.007). ΔIIEF scores significantly favoured RRCS at 6 months [MD -3.11 (95%CI -5.77, -0.44) P <0.021] and 12 months [MD -2.76 (95%CI -3.63, -1.88) P <0.001] post-operatively. Mixed urinary and sexual function outcomes were reported for women.

CONCLUSION

This meta-analysis identified more favourable urinary and erectile function in men who undergo robotic compared with conventional laparoscopic surgery for rectal cancer. Outcomes in women did not identify a consistently more favourable outcome in either group. As robotic rectal cancer surgery may offer more favourable functional outcomes it should be considered and discussed with patients.

Temporal trend and survival impact of infection source among patients with sepsis: a nationwide study

BACKGROUND

To determine the temporal trends of incidence and outcome based on different sources of sepsis using a nationwide administrative database.

METHODS

From 2002 to 2012, the entire Taiwan's health insurance claims data of emergency-treated and hospital-treated sepsis were analysed for incidence and mortality trends. The information about patients with sepsis and sources of sepsis was identified using a set of validated International Classification of Diseases, ninth revision, clinical modification (ICD-9-CM) codes. The 30-day all-cause mortality was verified by linked death certificate database.

RESULTS

A total of 1 259 578 episodes of sepsis were identified during the 11-year study period. Lower respiratory tract infection is the most common source of sepsis in patients, with the highest mortality rate. The incidence of genitourinary tract infection has the fastest growing rate. The sepsis mortality was declining at different rates for each source of sepsis. Co-infections in patients with sepsis are associated with higher mortality rate.

CONCLUSION

The temporal trends of sepsis incidence and mortality varied among different sources of sepsis, with lower respiratory tract being the highest burden among patients with sepsis. Furthermore, sources of sepsis and the presence of co-infection are independent predictors of mortality. Our results support source-specific preventive and treatment strategies for future sepsis management.

DNA repair gene polymorphisms, tumor control, and treatment toxicity in prostate cancer patients treated with permanent implant prostate brachytherapy

BACKGROUND

Radiotherapy and brachytherapy are common treatments for localized prostate cancer (PCa). However, very few studies evaluated the association of variations in DNA damage response genes and treatment outcomes and toxicity in brachytherapy-treated patients.

PURPOSE

To evaluate the association of inherited germline variations in DNA repair-associated genes with tumor control and treatment toxicity in patients treated with low-dose-rate prostate brachytherapy (LDRB).

MATERIAL AND METHODS

The cohort consists of 475 I-125 LDRB patients with a median follow-up of 51 months after seed implantation. Patients were genotyped for 215 haplotype tagging single nucleotide variations (htSNPs) in 29 candidate genes of DNA damage response and repair pathways. Their association with biochemical recurrence (BCR) was assessed using Cox regression models and Kaplan-Meier survival curves. Linear regressions and analysis of covariance (ANCOVA) between early and late International Prostate Symptom Score (IPSS) with htSNPs were used to evaluate the association with urinary toxicity.

RESULTS

After adjustment for the established risk factors, six htSNPs in five genes were found to be significantly associated with an altered risk of BCR, with adjusted hazard ratios (HR_adj. ) ranging between 3.6 and 11.1 (P < .05). Compared to carriers of the ERCC3 rs4150499C allele, patients homozygous for the T allele (n = 22) had a significant higher risk of BCR with a HR of 11.13 (IC₉₅  = 3.9-32.0; P < .0001; q < 0.001). The Kaplan-Meier survival curve revealed a mean BCR-free survival time reduced from 213 ± 7 to 99 ± 12 months (log-rank P < .0001) for homozygous T carriers compare to noncarriers. For late IPSS (>6 months after treatment), htSNP rs6544990 from MSH2 showed a statistically significant b-coefficient of 1.85 ± 0.52 (P < .001; q < 0.1). Homozygous carriers of the MSH2 rs6544990C allele (n = 62) had a mean late IPSS 3.6 points higher than patients homozygous for the A allele (n = 132). This difference was significant when tested by ANCOVA using pretreatment IPSS as a covariate (P < .01).

CONCLUSIONS

This study suggests an association of the intronic variants of the DNA nucleotide excision repair ERCC3 and DNA mismatch repair MSH2 genes with elevated risk of BCR and late urinary toxicity respectively after LDRB. Further validation is required before translational clinical advances.

Association between Mental Disorders and Subsequent Medical Conditions

BACKGROUND

Persons with mental disorders are at a higher risk than the general population for the subsequent development of certain medical conditions.

METHODS

We used a population-based cohort from Danish national registries that included data on more than 5.9 million persons born in Denmark from 1900 through 2015 and followed them from 2000 through 2016, for a total of 83.9 million person-years. We assessed 10 broad types of mental disorders and 9 broad categories of medical conditions (which encompassed 31 specific conditions). We used Cox regression models to calculate overall hazard ratios and time-dependent hazard ratios for pairs of mental disorders and medical conditions, after adjustment for age, sex, calendar time, and previous mental disorders. Absolute risks were estimated with the use of competing-risks survival analyses.

RESULTS

A total of 698,874 of 5,940,299 persons (11.8%) were identified as having a mental disorder. The median age of the total population was 32.1 years at entry into the cohort and 48.7 years at the time of the last follow-up. Persons with a mental disorder had a higher risk than those without such disorders with respect to 76 of 90 pairs of mental disorders and medical conditions. The median hazard ratio for an association between a mental disorder and a medical condition was 1.37. The lowest hazard ratio was 0.82 for organic mental disorders and the broad category of cancer (95% confidence interval [CI], 0.80 to 0.84), and the highest was 3.62 for eating disorders and urogenital conditions (95% CI, 3.11 to 4.22). Several specific pairs showed a reduced risk (e.g., schizophrenia and musculoskeletal conditions). Risks varied according to the time since the diagnosis of a mental disorder. The absolute risk of a medical condition within 15 years after a mental disorder was diagnosed varied from 0.6% for a urogenital condition among persons with a developmental disorder to 54.1% for a circulatory disorder among those with an organic mental disorder.

CONCLUSIONS

Most mental disorders were associated with an increased risk of a subsequent medical condition; hazard ratios ranged from 0.82 to 3.62 and varied according to the time since the diagnosis of the mental disorder. (Funded by the Danish National Research Foundation and others; COMO-GMC ClinicalTrials.gov number, NCT03847753.).

Genitourinary Complications Are a Leading and Expensive Cause of Emergency Department and Inpatient Encounters for Persons With Spinal Cord Injury

OBJECTIVES

To determine the rates of emergency department (ED) visits and inpatient hospitalizations for genitourinary (GU) complications after spinal cord injury (SCI) using a national sample; to examine which patient and facility factors are associated with inhospital mortality; and to estimate direct medical costs of GU complications after SCI.

DESIGN

Retrospective cross-sectional and cost analysis of the 2006 to 2015 National Inpatient Sample and National Emergency Department Sample from the Healthcare Cost and Utilization Project.

PARTICIPANTS

SCI-related encounters using various International Classification of Disease, Ninth Edition, Clinical Modification diagnosis codes. The inpatient sample included 1,796,624 hospitalizations, and the ED sample included 618,118 treat-and-release visits.

MAIN OUTCOME MEASURES

The exposure included a GU complication, identified by International Classification of Disease, Ninth Edition, Clinical Modification codes 590-599. The outcomes then included an ED visit or hospitalization, death prior to discharge, and direct medical costs estimated from reported hospital charges.

RESULTS

For the inpatient sample, we observed a 2.5% annual increase (95% confidence interval [CI], 1.8-3.2) in the proportion of SCI-related hospitalizations with any GU complication from 2006 to 2011, and a lesser rate of increase of 0.9% (95% CI, 0.4-1.4) each year from 2011 to 2015. Age, level of injury, and payer source were correlated to inhospital mortality. The costs of GU-related health care use exceeded $4 billion over the study period.

CONCLUSIONS

This study shows the rates and economic burden of health care use associated with GU complications in persons with SCI in the United States. The need to develop strategies to effectively deliver health care to the SCI population for these conditions remains great.

A prospective audit of the 10-year outcomes from low dose-rate brachytherapy for early stage prostate cancer

AIM

New Zealand men diagnosed with early stage prostate cancer need to know what outcomes to expect from management options.

METHODS

Between 2001 and 2016, 951 men were treated with low dose-rate brachytherapy (permanent iodine-125 seed implantation) by the Wellington Prostate Brachytherapy Group based at Southern Cross Hospital, Wellington. At follow up after treatment, men had their PSA measured and were scored for urinary, bowel and sexual side effects. RESULTS: Median follow-up of men was 7.9 years (range 2.0-16.3 years). Ten-year PSA control was 95% for the 551 men with low-risk prostate cancer and 82% for the 400 men with intermediate-risk prostate cancer. Adverse effects were generally minor and short-term only. Temporary urinary obstruction developed soon after the implant in 2.6% men, and the 10-year cumulative risk of urethral stricture was 2.6%. Erectile dysfunction developed in 29% men, two-thirds of whom had a good response to a PDE5 inhibitor. Most men returned to a normal routine within four days of the implant.

CONCLUSION

LDR brachytherapy is a highly effective low-impact treatment option for New Zealand men with early stage prostate cancer.

The Effect of Shift Work on Urogenital Disease: a Systematic Review

PURPOSE OF REVIEW

Non-standard shift work schedules negatively impact the overall health of shift workers, and several studies have shown that shift work, specifically, is detrimental to urogenital health. The aims of this study are to systematically review the literature and determine the effect of shift work on the outcomes of hypogonadism, male infertility, lower urinary tract symptoms, and urogenital cancers.

RECENT FINDINGS

Recent evidence supports associations between non-standard shift work and an increase in the frequency of prostate cancer and the severity of erectile dysfunction, lower urinary tract symptoms, and hypogonadal symptoms, as well as worsening of semen parameters and fertility. These associations are strengthened by the presence of shift work sleep disorder (SWSD) which affects up to 20% of shift workers. No studies have assessed the impact of shift work on the frequency or severity of nephrolithiasis, interstitial cystitis, pelvic pain, prostatitis, or urinary tract infections. Non-standard shift work has been associated with a variety of negative health outcomes and urologic complications, especially with concurrent shift work sleep disorder. Recognition of these elevated risks among shift workers can aid in more effective screening for urologic conditions.

Treatment-related toxicity in men who received Intensity-modulated versus 3D-conformal radiotherapy after radical prostatectomy: A national population-based study

BACKGROUND AND PURPOSE

In the post-prostatectomy setting the value of Intensity-modulated (IMRT) relative to 3D-conformal radiotherapy (3D-CRT) in reducing toxicity remains unclear. We compared genitourinary (GU) and gastrointestinal (GI) toxicity after post-prostatectomy IMRT or 3D-CRT.

MATERIALS AND METHODS

A population-based study of all patients treated with post-prostatectomy 3D-CRT (n = 2422) and IMRT (n = 603) was conducted between January 1 2010 and December 31 2013 in the English National Health Service. We identified severe GI and GU toxicity using a validated coding-framework and compared IMRT and 3D-CRT using a competing-risks proportional hazards regression analysis.

RESULTS

There was no difference in GI toxicity between patients who received IMRT and 3D-CRT (3D-CRT: 5.8 events/100 person-years; IMRT: 5.5 events/100 person-years; adjusted HR: 0.85, 95%CI: 0.63-1.13; p = 0.26). The GU toxicity rate was lower with IMRT but this effect was not statistically significant (3D-CRT: 5.4 events/100 person-years; IMRT: 3.8 events/100 person-years; adjusted HR: 0.76, 95%CI: 0.55-1.03; p = 0.08).

CONCLUSIONS

The use of post-prostatectomy IMRT compared to 3D-CRT is not associated with a statistically significant reduction in rates of severe GU and GI toxicity, although there is some evidence that GU toxicity is lower with IMRT. We would caution against rapid transition to post-prostatectomy IMRT until further evidence is available supporting its superiority.

Demographic and behavioural risk factors associated with Trichomonas vaginalis among South African HIV-positive men with genital ulcer disease: a cross-sectional study

OBJECTIVES

Demographic and risky sexual behaviours may increase the risk for Trichomonas vaginalis (TV) infection and, thus, enhance HIV transmission to uninfected partners. We assessed the demographic and behavioural risk factors associated with TV among South African HIV-positive men with genital ulcer disease.

METHODS

We conducted a cross-sectional study with data from a randomised controlled trial conducted by the Centers for Disease Control and Prevention and the London School of Hygiene and Tropical Medicine. The data were obtained from three primary healthcare clinics in South Africa. At baseline (n=387), participants reported on demographics, sexual behaviour, history of sexually transmitted infections and clinical ulcers. The outcome TV was measured using real-time multiplex PCR assays and a Rotor-gene 3000 platform from the first and past urine samples of all participants. Logistic regression model estimated ORs and 95% CIs adjusted for demographics, sexual risk behaviours and ulcer conditions.

RESULTS

An estimated 11.4% of TV was detected among the men. The odds of TV infection were significantly associated with high blister counts (OR 4.0, 95% CI 1.6 to 28, p=0.01), ulcer pain (OR 0.4, 95% CI 0.2 to 0.7, p=0.003), number of days with ulcers (OR 0.4, 95% CI 0.2 to 0.8, p=0.006), sought treatment before coming into clinics (OR 0.07, 95% CI 0.002 to 0.7, p=0.005) and being unqualified worker (OR 2.5, 95% CI 0.9 to 6.7 p=0.05). Multivariate analyses revealed that increased days with ulcers (OR 0.1, 95% CI 0.04 to 0.5, p=0.002) and ulcer pain intensity (OR 0.08, 95% CI 0.007 to 1.1, p=0.05) remained significantly associated with decreased odds of TV infection. Men from the Sotho ethnic group were eight times more likely to have TV infection (OR 8.6, 95% CI 1.3 to 55.7, p<0.02) than men from the other ethnic groups.

CONCLUSION

HIV-positive men with severe ulceration should be screened and treated for TV to minimise HIV transmission to uninfected partners.

Genito-urinary sequelae after carcinological rectal resection: What to tell patients in 2017

Although we have seen revolutionary changes with multi-disciplinary management of patients with rectal cancer, the evaluation of genito-urinary sequelae remains of great concern. Precise pre-operative evaluation with validated scores allows detection of urinary disorders in 16 to 23% of patients, and sexual disorders in nearly 35% of men and 50% of women. Regardless of the surgical approach, it is fundamental to respect the autonomic innervation during total mesorectal excision in order to prevent these sequelae. Identification of these nerves can be facilitated by intra-operative neuro-stimulation. In spite of these precautions, de novo urinary sequelae are observed in nearly 33% of patients and bladder evacuation disorders in 25% of patients. Advanced age, pre-operative urinary disorders, female gender, and abdomino-perineal resection are independent risk factors for urinary sequelae. Early post-operative urodynamic abnormalities might be predictive of these sequelae and justify early physiotherapy. Likewise, sexual sequelae such as erectile and/or ejaculatory disorders, dyspareunia and lubrication deficits result in de novo cessation of sexual activity in 28% of men and 18% of women. Advanced age, neo-adjuvant radiation therapy, and abdomino-perineal resection are independent risk factors for sexual dysfunction. Pharmacotherapy with sildenafil has proven useful in the treatment of erectile disorders. Genito-urinary and ano-rectal sequelae occur concomitantly in more than one of ten patients, suggesting a potential common pathophysiology.

Genitourinary Complications of Diabetes Mellitus: An Overview of Pathogenesis, Evaluation, and Management

BACKGROUND

Diabetes mellitus is a vastly prevalent metabolic disorder with escalating global health concerns. Particularly when mismanaged, chronic micro- and macrovascular complications may highly impair physiological systems while immunodeficiency disposes us to infection.

OBJECTIVE

We investigate infections, localized complications, and neoplasms of the genitourinary system secondary to the chronic complications of diabetes mellitus in males and females.

METHOD

A comprehensive MEDLINE® search was guided using key words relevant to diabetes mellitus and the genitourinary system.

RESULTS

Pathogen-friendly environments may implicate the sequelae of urinary tract and genital mycotic infections, potentially generating necrosis, abscess, and other inflammatory complications, which may present concomitantly with neurogenic and/or vasculogenic dysfunction to further exacerbate an existing genitourinary condition. Manifestations of the adrenal, renal, and genital organs and tissues are discussed as they relate to vascular, immunodeficient, and other hyperglycemic complications of the diabetic state. Among those, chronic kidney disease and cystopathy are the most prevailing and detrimental. Though studies have connected diabetes to either an increased risk of developing or poor prognosis of bladder, renal, prostate, endometrial, and cervical cancers, the explicit biological relationships are as of yet inconclusive.

CONCLUSION

Despite the availability of precise treatments to ameliorate most presently reviewed conditions, particularly urinary tract and genital mycotic infection-related sequelae, reversing permanent vascular damage remains a great challenge. Leading a healthier lifestyle and managing diabetes mellitus with a patient-centric approach from the outset are the most putative methods for preventing critical long-term genitourinary manifestations of diabetes mellitus.

Current Practice Patterns Among Members of the American Urological Association for Male Genitourinary Lichen Sclerosus

OBJECTIVE

To determine the practice patterns of urologists who treat male genitourinary lichen sclerosus (MGU-LS) via a national web-based survey distributed to American Urological Association members.

METHODS

A 20-question survey was collected from a random sample of American Urological Association members. Respondents answered questions on their practice patterns for MGU-LS diagnosis, treatment of symptomatic urethral stricture disease, surveillance, and follow-up.

RESULTS

In total, 309 urologists completed the survey. The majority of respondents reported practicing more than 20+ years (37.5%) within an academic (31.7%) or group practice (31.1%) setting. The majority of respondents saw 3-5 men with MGU-LS per year (32.7%). The most common locations of MGU-LS involvement included the glans penis (66.2%), foreskin (26.3%), and/or the urethra (5.8%). Respondent first-line treatment for urethral stricture disease was direct visual internal urethrotomy (26.6%) and second-line treatment was referral to subspecialist (38.4%). After controlling for the number of patients evaluated with MGU-LS per year, those with reconstructive training were more likely to perform a primary urethroplasty for men with symptomatic urethral stricture disease (adjusted odds ratio 13.1, 95% confidence interval 5.1-33.8, P < .001). They were also more likely to counsel men on the associated penile cancer risks (adjusted odds ratio 4.6, 95% confidence interval 1.7-12.5, P < .01).

CONCLUSION

Reconstructive urologists evaluate the most number of patients with MGU-LS and are more likely to perform primary urethroplasty for urethral stricture disease. Men with MGU-LS should be referred to a reconstructive urologist to understand the full gamut of treatment options.

[Urological Diseases in Men and their Prevention]

The late-onset hypogonadism is defined as a reduction of blood testosterone values in aging males in combination with sexual symptoms. A hormone substitution is only necessary if desired by the patient. Erectile dysfunction is often caused by vasculopathy. Therefore, vascular risk factors should be evaluated. In case of cardiovascular disease a cardiologist should be addressed before initiating treatment. First line therapy consists of phosphodiesterase inhibitors. In lower urinary tract symptoms prostatic enlargement is the likely cause, but other causes have to be ruled out. Symptomatic therapy can be initiated if the patient is bothered. If voiding symptoms are predominant, alpha blockers or alpha reductase inhibitors are the treatment of choice. In case of storage symptoms, treatment can be started with muscarin receptor antagonists.

Carbon-ion Radiotherapy for Prostate Cancer: Analysis of Morbidities and Change in Health-related Quality of Life

AIM

To prospectively evaluate the feasibility of carbon-ion radiotherapy (C-ion RT) for prostate cancer using a new compact-sized accelerator.

PATIENTS AND METHODS

Seventy-six patients underwent C-ion RT at our center using a recommended dose fractionation of 57.6 GyE in 16 fractions established at the National Institute of Radiological Sciences. Health-related Quality of Life (HRQOL) assessment was also performed using the Medical Outcome Study 8-items Short Form Health Survey (SF-8) questionnaire.

RESULTS

The median follow-up time was 51 months (range=8-58 months). Grade 2 gastrointestinal and genitourinary complications developed in 1 (1.3%) and 5 (6.6%) patients, respectively. Recurrences occurred in 4 patients, and the 4-year biochemical relapse-free rate was 94.6%. The HRQOL scores after C-ion RT were objectively well-maintained.

CONCLUSION

Irrespective of the small number of patients of the study, C-ion RT for prostate cancer using the first commercial-based accelerator reproduced the toxicity outcomes at the NIRS.

Calcification of the vas deferens and seminal vesicles: a review

INTRODUCTION

Calcification of the vas deferens and seminal vesicles is a rare condition of unknown incidence. It has been described in association with diabetes, hyperparathyroidism and genitourinary tuberculosis, amongst other conditions. Little is known about the clinical significance and management of this condition. We review the literature in an effort to find answers about an entity that is frequently appreciated as an incidental finding.

MATERIALS AND METHODS

An electronic database search was performed (Medline) using the key words: vas deferens; seminal vesicles; calcification, alone or in combination. Articles were selected according to relevance and quality of evidence.

RESULTS

The search included published manuscripts between 1960 and 2012. A total of 17 relevant publications were identified. The majority were written in the English language and mostly consisted of case presentations and reports of radiologic findings.

CONCLUSION

Calcification of the vas deferens and seminal vesicles is a rare condition. However, it may be implicated in male factor infertility and symptoms from the urogenital tract. Treatment should be directed towards the underlying cause on an individual basis. It is unknown whether control of the primary process has any effects on the histopathological appearance of the ducts and/or their improvement of function.

Transitioning from conventional radiotherapy to intensity-modulated radiotherapy for localized prostate cancer: changing focus from rectal bleeding to detailed quality of life analysis

With the advent of modern radiation techniques, we have been able to deliver a higher prescribed radiotherapy dose for localized prostate cancer without severe adverse reactions. We reviewed and analyzed the change of toxicity profiles of external beam radiation therapy (EBRT) from the literature. Late rectal bleeding is the main adverse effect, and an incidence of >20% of Grade ≥2 adverse events was reported for 2D conventional radiotherapy of up to 70 Gy. 3D conformal radiation therapy (3D-CRT) was found to reduce the incidence to ∼10%. Furthermore, intensity-modulated radiation therapy (IMRT) reduced it further to a few percentage points. However, simultaneously, urological toxicities were enhanced by dose escalation using highly precise external radiotherapy. We should pay more attention to detailed quality of life (QOL) analysis, not only with respect to rectal bleeding but also other specific symptoms (such as urinary incontinence and impotence), for two reasons: (i) because of the increasing number of patients aged >80 years, and (ii) because of improved survival with elevated doses of radiotherapy and/or hormonal therapy; age is an important prognostic factor not only for prostate-specific antigen (PSA) control but also for adverse reactions. Those factors shift the main focus of treatment purpose from survival and avoidance of PSA failure to maintaining good QOL, particularly in older patients. In conclusion, the focus of toxicity analysis after radiotherapy for prostate cancer patients is changing from rectal bleeding to total elaborate quality of life assessment.

The anti-oxidant effects of ginger and cinnamon on spermatogenesis dys-function of diabetes rats

BACKGROUND

Diabetes rats have been linked to reproductive dysfunction and plant medicine has been shown to be effective in its treatment. Antioxidants have distinctive effects on spermatogenesis, sperm biology and oxidative stress, and changes in anti-oxidant capacity are considered to be involved in the pathogenesis of chronic diabetes mellitus. Ginger and cinnamon are strong anti-oxidants and have been shown to reduce oxidative stress in the long-term treatment of streptozotocin (STZ)-induced diabetes in animal models. The present study examined the influence of combined ginger and cinnamon on spermatogenesis in STZ-induced diabetes in male Wistar rats.

MATERIALS AND METHODS

Animals (n = 80) were allocated randomly into eight groups, 10 each: Group 1: Control rats given only 5cc Normal saline (0.9% NaCl) daily;Group2: rats received ginger (100mg/kg/rat) daily; Group 3: rats received cinnamon (75mg/kg) daily; Group 4: rats received ginger and cinnamon, (100mg/kg/rat ginger and 75mg/kg cinnamon) daily; Group 5: Diabetic control rats received only normal saline. Group 6: Diabetic rats received 100mg/kg/day ginger; Group 7: Diabetic rats received 75mg /kg/ day cinnamon; Group 8: Diabetic rats received ginger and cinnamon (100mg/kg/day and 75mg/kg /day). Diabetes was induced with 55 mg/kg, single intra-peritoneal injection of STZ in all groups. At the end of the experiment (56th day), blood samples were taken for determination of testosterone, LH,FSH, total anti-oxidant capacity, and levels of malondialdehyde, SOD, Catalase and GPX. All rats were euthanized, testes were dissected out and spermatozoa were collected from the epididymis for analysis.

RESULTS

Sperm numbers, percentages of sperm viability and motility, and total serum testosterone increased in ginger and cinnamon and combined ginger and cinnamon treated diabetic rats compared with control groups. Serum testosterone, LH and FSH were higher compared to control group and also serum anti-oxidants (TAC, SOD, GPX and catalase) all were increased at the end of treatment. Combined ginger and cinnamon showed more intense increase in all parameters compare to ginger and cinnamon alone. Most of the results were significant (P<0.05).

CONCLUSION

We concluded that combined ginger and cinnamon have significant beneficial effects on the sperm viability, motility, and serum total testosterone, LH,FSH and serum anti-oxidants' level and could be effective for maintaining healthy sperm parameters and male reproductive function in diabetics.

Canine theriogenology for dog enthusiasts: teaching methodology and outcomes in a massive open online course (MOOC)

A massive open online course (MOOC) in canine theriogenology was offered for dog owners and breeders and for veterinary professionals as a partnership between the University of Minnesota and Coursera. The six-week course was composed of short video lectures, multiple-choice quizzes with instant feedback to assess understanding, weekly case studies with peer evaluation to promote integration of course materials, and discussion forums to promote participant interaction. Peak enrollment was 8,796 students. The grading policy for completion was strict and was upheld; completion rate for all participants was 7.5%. About 12% of participants achieved a grade of over 90% in the course, with those who had any deficiency mostly missing one quiz or assignment. Ninety-nine individuals were enrolled in a for-cost, credentialed pathway, and 50% of those individuals completed all required course components. Pre- and postcourse surveys were used to demonstrate that learning objectives were met by the participants and to identify that lack of time to commit to study was the biggest impediment to completion. Positive aspects of the course were active engagement by participants from all over the world and the ability of this university and instructor to reach those learners. Negative aspects concerned technical support and negative feedback from some participants who were unable to meet course requirements for reasons beyond the control of the instructor.

Dose-adapted salvage radiotherapy after radical prostatectomy based on an erMRI target definition model: toxicity analysis

BACKGROUND

To assess treatment tolerance by patients treated with a dose-adapted salvage radiotherapy (SRT) protocol based on an multiparametric endorectal magnetic resonance imaging (erMRI) failure definition model after radical prostatectomy (RP).

MATERIAL AND METHODS

A total of 171 prostate cancer patients recurring after RP undergoing erMRI before SRT were analyzed. A median dose of 64 Gy was delivered to the prostatic bed (PB) with, in addition, a boost of 10 Gy to the suspected relapse as visualized on erMRI in 131 patients (76.6%). Genitourinary (GU) and gastrointestinal (GI) toxicities were scored using the RTOG scale.

RESULTS

Grade ≥ 3 GU and GI acute toxicity were observed in three and zero patients, respectively. The four-year grade ≥ 2 and ≥ 3 late GU and GI toxicity-free survival rates (109 patients with at least two years of follow-up) were 83.9 ± 4.7% and 87.1 ± 4.2%, and 92.1 ± 3.6% and 97.5 ± 1.7%, respectively. Boost (p = 0.048) and grade ≥ 2 acute GU toxicity (p = 0.008) were independently correlated with grade ≥ 2 late GU toxicity on multivariate analysis.

CONCLUSIONS

A dose-adapted, erMRI-based SRT approach treating the PB with a boost to the suspected local recurrence may potentially improve the therapeutic ratio by selecting patients that are most likely expected to benefit from SRT doses above 70 Gy as well as by reducing the size of the highest-dose target volume. Further prospective trials are needed to investigate the use of erMRI in SRT as well as the role of dose-adapted protocols and the best fractionation schedule.

[The spread of ecology-dependent diseases of the genitourinary system in bioclimatic zones of the Primorskiĭ region]

The estimation of the prevalence of a class of diseases of the genitourinary system (ICD-10) of the population in the bioclimatic zones of the Primorsky Krai, with taking into account the environmental situation has been performed. The study of the prevalence of diseases of the genitourinary system was carried out with the use of the classical method of data analysis--descriptive statistics. To determine the impact of water quality correlation and regression analysis of the statistical software package SPP has been applied. The study revealed that the diseases of the genitourinary system occupy in the structure of ecology-dependent morbidity in adults--14.9%, in adolescents--13.1% and in children--5.2%, respectively. During the period of 2000-2011 there is noted a trend of the growth of the level of pathology of the genitourinary system. Over the past 5 years, the number of uronefrological patients doubled. Using the a chi-square test for independence, we found that there is a statistically significant correlation (p < or = 0.001) between the level of diseases of the genitourinary system, the bio-climatic zones and zones of ecological situation in all age groups. The use of regression analysis (multiple regression equation) allowed to determine the main parameters of the water module affecting the rate of spread of diseases of the genitourinary system in different bioclimatic zones. The prevalence level of diseases of the genitourinary system in each age group and bioclimatic zone is affected by a certain combination of parameters of the chemical composition of drinking water. The priority of them are by microbial number, Cl-, Fe sum, NO3-, HCO3-, PH, Mg2+, Ca2+. Ranking of the territory in terms of morbidity permitted to determine the problematic situation in the administrative bodies that was taken into account in the development of the program on the prevention of the ecology-dependent diseases of the genitourinary system.

Common and unusual urogenital Crohn's disease complications: spectrum of cross-sectional imaging findings

Involvement of the urinary tract and genital organs is not uncommon in patients affected with Crohn's disease (CD). Occurring in both sexes, uro-gynecological complications are often clinically unsuspected because of the dominant intestinal or systemic symptoms. Knowledge of their manifestations and cross-sectional imaging appearances is necessary to recognize and report them, since correct medical or surgical treatment choice with appropriate specialist consultation allows to prevent further complications. Besides uncomplicated urinary tract infections that usually do not require imaging, urolithiasis and pyelonephritis represent the most commonly encountered urinary disorders: although very useful, use of computed tomography (CT) should be avoided whenever possible, to limit lifetime radiation exposure. Hydronephrosis due to ureteral inflammatory entrapment and enterovesical fistulization may result from penetrating CD, and require precise imaging assessment with contrast-enhanced CT to ensure correct surgical planning. Representing the majority of genital complication, ano- and rectovaginal fistulas and abscesses frequently complicate perianal inflammatory CD and are comprehensively investigated with high-resolution perianal MRI acquired with phased-array coils, high-resolution T2-weighted sequences and intravenous contrast. Finally, rare gynecological manifestations including internal genital fistulas, vulvar and male genital involvement are discussed.

The association between diurnal temperature range and emergency room admissions for cardiovascular, respiratory, digestive and genitourinary disease among the elderly: a time series study

OBJECTIVES

To evaluate the short-term effect of diurnal temperature range (DTR) on emergency room (ER) admissions among elderly adults in Beijing.

METHODS

After controlling the long-time and seasonal trend, weather, air pollution and other confounding factors, a semi-parametric generalized additive model (GAM) was used to analyze the exposure-effect relationship between DTR and daily ER admissions among elderly adults with different lag structures from 2009 to 2011 in Beijing. We examined the effects of DTR for stratified groups by age and gender, and conducted the modifying effect of season on DTR to test the possible interaction.

RESULTS

Significant associations were found between DTR and four major causes of daily ER admissions among elderly adults in Beijing. A 1 °C increase in the 8-day moving average of DTR (lag 07) corresponded to an increase of 2.08% (95% CI: 0.88%-3.29%) in respiratory ER admissions and 2.14% (95% CI: 0.71%-3.59%) in digestive ER admissions. A 1 °C increase in the 3-day and 6-day moving average of DTR (lag 02 and lag 05) corresponded to a 0.76% (95% CI: 0.07%-1.46%) increase in cardiovascular ER admissions, and 1.81% (95% CI: 0.21%-3.45%) increase in genitourinary ER admissions, respectively. The people aged 75 years and older were associated more strongly with DTR than the 65-74 age group. The modifying effect of season on DTR was observed and it was various in four causes.

CONCLUSIONS

This study strengthens the evidence that DTR is an independent risk factor for ER admissions among elderly persons. Some prevention programs that target the elderly and other high risk subgroups for impending large temperature changes may reduce the impact of DTR on people's health.

Urogenital complications of obesity

We performed a critical review focused on the main non-oncologic disorders that have a strong, direct association with obesity: chronic kidney disease, kidney stones and female and male lower urinary tract symptoms/disorders. We discuss the epidemiology, pathogenesis and therapeutic aspects regarding the association between obesity and non-diabetic and non-hypertensive forms of chronic kidney disease directly caused or worsened by weight excess, with particular attention on obesity-related glomerulopathy (ORG), which is typical of severe obesity, and the consequences of intentional weight loss on proteinuria and glomerular filtration rate. The associations of obesity with kidney stones and lower urinary tract conditions are also discussed from the epidemiological, physiopathological and therapeutical points of view, with emphasis on the principal concerns raised by the heterogeneity of study designs and outcome definitions typical of research in these fields. We also call attention to important clinical and scientific questions that should be addressed by future research.

[Incidence of non-communicable diseases and health risks due to potable water quality]

Iron and fluorine concentrations and water mineralization and hardness, which exceeded the maximum allowable concentrations, were found to cause an increase in overall morbidity and morbidity from skeletal-and-muscular, urogenital, and digestive system involvement in the population of the Krasnoyarsk Region. A quantitative relationship were found between the concentrations of iron, the hardness and dry residue of water and the incidence rates of urogenital, skeletal-and-muscular and digestive diseases. The consumption of potable water contaminated with chloroform and methane tetrachloride presents unacceptable carcinogenic risks to the population of the Krasnoyarsk Region.

Acute toxicity of combined photon IMRT and carbon ion boost for intermediate-risk prostate cancer - acute toxicity of 12C for PC

BACKGROUND

Carbon ion ((12)C) therapy in the treatment of prostate cancer (PC) might result in an improved outcome as compared to low linear energy transfer irradiation techniques. In this study, we present the first interim report of acute side effects of the first intermediate-risk PC patients treated at the GSI (Gesellschaft für Schwerionenforschung) and the University of Heidelberg in an ongoing clinical phase I/II trial using combined photon intensity modulated radiation therapy (IMRT) and (12)C carbon ion boost.

MATERIAL AND METHODS

Fourteen patients (planned accrual: 31 pts) have been treated within this trial so far. IMRT is prescribed to the median PTV at a dose of 30 × 2 Gy; (12)C boost is applied to the prostate (GTV) at a dose of 6 × 3 GyE using raster scan technique. Safety margins added to the clinical target volume were determined individually for each patient based on five independent planning computed tomography (CT)-scans. Acute gastrointestinal (GI) and genitourinary (GU) toxicity was assessed and documented according to the CTCAE Version 3.0.

RESULTS

Radiotherapy was very well tolerated without any grade 3 or higher toxicity. Acute anal bleeding grade 2 was observed in 2/14 patients. Rectal tenesmus grade 1 was reported by three other patients. No further GI symptoms have been observed. Most common acute symptoms during radiotherapy were nocturia and dysuria CTC grade 1 and 2 (12/14). There was no severe acute GU toxicity.

CONCLUSION

The combination of photon IMRT and carbon ion boost is feasible in patients with intermediate-risk PC. So far, the treatment has been well tolerated. Acute toxicity rates were in good accordance with data reported for high dose IMRT alone.

Urologic aspects of HIV infection

Although lifespan has dramatically improved in the human immunodeficiency virus-positive (HIV+) population, HIV and its treatment continue to be a source of substantial morbidity in many organ systems, including the genitourinary tract. As the number of long-term survivors increases with advances in antiretroviral therapy, age-associated urologic symptoms are also becoming increasingly relevant considerations for people living with HIV. Primary care physicians have a major role to play in maintaining the genitourinary health of their HIV+ patients. This role is of great importance not just for the well-being of the individual patient but for the public health, as the genitourinary tract is a common vector for HIV transmission. In this article the authors review the management of the genitourinary system in patients with HIV infection. Particular consideration is given to urinary tract infections, lower urinary tract symptoms, renal insufficiency, sexual and fertility problems, and cancers of the genitourinary tract. Management algorithms are outlined and indications for referral to a urologist are emphasized.

Combination of IG-IMRT and permanent source prostate brachytherapy in patients with organ-confined prostate cancer: GU and GI toxicity and effect on erectile function

PURPOSE

To assess toxicity outcomes of image-guided intensity-modulated radiation therapy (IG-IMRT) combined with permanent prostate seed implant in a cohort of patients with localized prostate cancer.

METHODS AND MATERIALS

A retrospective analysis was performed on 67 patients with the median pretreatment prostate-specific antigen level of 5.4. The Gleason score was less than 7 in 7 patients, 7 in 52 patients, and greater than 7 in 8 patients. The median followup was 28.2 months (range, 12-89.5 months). Treatment consisted of 45 (n=65) or 50.4 Gy (n=2) at 1.8 Gy/fraction of IG-IMRT to the prostate and seminal vesicles. Eight patients had simultaneous irradiation of pelvic lymph nodes to 45 (n=65) or 50.4 Gy (n=2). After IG-IMRT, patients received transperineal prostate implant boost with either (103)Pd (n=65, the prescribed D(90) of 100 Gy) or (125)I (n=2, D(90) of 110 Gy). Eleven patients received androgen deprivation therapy with radiotherapy.

RESULTS

Toxicity higher than Grade 3 was not observed. The combined incidence of acute and late Grade 3 genitourinary toxicity was 6%. The combined incidence of acute and late Grade 3 gastrointestinal toxicity was 3%. At least one episode of gastrointestinal bleeding on followup, which could be attributed to radiation, was recorded in 14.9% of patients. For patients achieving erections before radiation, the 3-year Kaplan-Meier potency preservation rate was 66.5%.

CONCLUSIONS

The early toxicity of the combination of IG-IMRT and low-dose rate brachytherapy boost in this study was favorable.

Recognition and treatment of genitourinary complications in paediatric Crohn's disease using Infliximab

Although genitourinary complications of Crohn's are well recognized, available information regarding their clinical course and management is sparse especially in the paediatric population. We report a myriad of urological complications in five paediatric cases, our experience from a tertiary paediatric urological and gastroenterological centre. All children with urological complications had severe Crohn's disease which necessitated the use of immuno-suppressants including Infliximab. Three of four children healed and closed their fistulas after treatment, although failed to avoid future surgery, albeit for other reasons.

CONCLUSION

We suggest Infliximab should be considered as a treatment option but in the absence of a common consensus, treatment be tailored to individual cases.

[Management of urological patients with HIV infection]

The analysis of urological care for HIV infected patients treated in Moscow city clinical hospital N 47 covers 12-year trends in hospitalization of HIV-infected urological patients, their nosological distribution, statistics of surgical outcomes. The highest efficacy of empiric antibacterial therapy of acute pyelonephritis in HIV-infected patients was seen in combined administration of fluorofloxacin of the second generation (ofloxacin) and nitroimidasol (metronidasol). Specific features of pharmacokinetics and interaction of antiretroviral drugs with medicines used in urological practice are analysed.

Late pelvic toxicity after bladder-sparing therapy in patients with invasive bladder cancer: RTOG 89-03, 95-06, 97-06, 99-06

PURPOSE

In selected patients with muscle-invasive bladder cancer, combined-modality therapy (transurethral resection bladder tumor [TURBT], radiation therapy, chemotherapy) with salvage cystectomy, if necessary, can achieve survival rates similar to radical cystectomy. We investigated late pelvic toxicity after chemoradiotherapy for patients treated on prospective protocols.

PATIENTS AND METHODS

Between 1990 and 2002, 285 eligible patients enrolled on four prospective protocols (Radiation Therapy Oncology Group [RTOG] 8903, 9506, 9706, 9906) and 157 underwent combined-modality therapy, surviving >or= 2 years from start of treatment with their bladder intact. Rates of late genitourinary (GU) and GI toxicity were assessed using the RTOG Late Radiation Morbidity Schema, with worst toxicity grade (scale 0 to 5) occurring >or= 180 days after start of consolidation therapy reported for each patient. Persistence of toxicity was defined as grade 3+ toxicity not decreasing by at least one grade. Logistic and Cox regression analyses were performed to evaluate relationship between clinical characteristics, frequency, and time to late grade 3+ pelvic toxicity. Covariates included age, sex, stage, presence of carcinoma in situ, completeness of TURBT, and protocol.

RESULTS

Median follow-up was 5.4 years (range, 2.0 to 13.2 years). Seven percent of patients experienced late grade 3+ pelvic toxicity: 5.7% GU and 1.9% GI. In only one of nine patients did a grade 3+ GU toxicity persist. Notably there were no late grade 4 toxicities and no treatment-related deaths. None of the clinical variables studied predicted for late grade 3+ pelvic toxicity.

CONCLUSION

Rates of significant late pelvic toxicity for patients completing combined-modality therapy for invasive bladder cancer and retaining their native bladder are low.

[Unbalanced nutrition is a universal factor in the occurrence of visceral diseases]

Nutrition is one of the most important determinants of human health. The investigation has determined the pattern of actual nutrition of the Samara Region, its influence on the occurrence of cardiovascular, endocrine, urogenital, and musculoskeletal, and digestive diseases. Emphasis is placed on unbalanced diets excluding meat, by increasing the consumption of bread and cereals, which is a universal factor for the development of visceral diseases. Balanced nutrition using full-value natural products in the optimum ratio is a major condition for health preservation and a means for prevention of the development of various diseases.

[Visceral diabetic neuropathy of the urogenital tract]

The article deals with issues of diabetic autonomous neuropathy (DAN) in the urogenital tract (UGT), and brings attention to the ethiopathogenesis of diabetic polyneuropathy. It provides a synopsis of autonomous neuropathy and deals, in more detail, with its manifestations in the UGT. The different symptoms of the disorder are addressed, the need for timely diagnosis is pointed out as the prerequisite for a successful therapy, and the necessity for interdisciplinary cooperation in dealing with this health issue is exposed.

Identification of novel risks for nonulcerative sexually transmitted infections among young men in Kisumu, Kenya

OBJECTIVES

STI prevention interventions often aim to reduce HIV incidence. Understanding STI risks may lead to more effective HIV prevention.

GOAL

To identify STI risks among men aged 18-24 in Kisumu, Kenya.

STUDY DESIGN

We analyzed baseline data from a randomized trial of male circumcision. Participants were interviewed for sociodemographic and behavioral risks. Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were diagnosed by polymerase chain reaction assay and Trichomonas vaginalis (TV) by culture. The outcome for logistic regression analysis was infection with NG, CT, or TV.

RESULTS

Among 2743 men, 214 (7.8%; 95% CI: 6.8%-8.8%) were infected with any STI. In multivariable analysis, statistically significant risks for infection were: living one's whole life in Kisumu (OR = 1.50; 95% CI: 1.12-2.01), preferring "dry" sex (OR = 1.47; 95% CI: 1.05-2.07), HSV-2 seropositivity (OR = 1.37; 95% CI: 1.01-1.86), and inability to ejaculate during sex (OR = 2.04; 95% CI: 1.15-3.62). Risk decreased with increasing age and education, and cleaning one's penis less than 1 hour after sex (OR = 0.51; 95% CI: 0.33-0.80).

CONCLUSION

Understanding how postcoital cleaning, "dry" sex, and sexual dysfunction relate to STI acquisition may improve STI and HIV prevention.

Urinary, sexual, and bowel dysfunction and bother after radical prostatectomy

INTRODUCTION

Radical prostatectomy results in greater persistence of urinary and sexual dysfunction (and to a minor degree, bowel dysfunction) than other forms of prostate cancer treatment. These physical side effects create bother, which is the degree of annoyance, dysfunction, or discomfort associated with treatment aftermath.

OBJECTIVE

The purpose of this study was to assess the relationships between post-radical prostatectomy urinary, sexual, and bowel dysfunction, and the resultant bother to determine which of the physical dysfunctions bothers men the most.

METHOD

Seventy-two men were recruited and surveyed 6 weeks after radical prostatectomy. Outcome measures included self-efficacy (Stanford Inventory of Cancer Patient Adjustment), social support (Modified Inventory of Socially Supportive Behaviors), uncertainty (Uncertainty in Illness Scale), and physical function and bother (UCLA Prostate Cancer Index).

RESULTS

Sexual dysfunction had the highest prevalence among treatment side effects caused by radical prostatectomy. However, it was urinary dysfunction in terms of incontinence that was the most bothersome.

CONCLUSIONS

Given various treatment options for prostate cancer, men who undergo radical prostatectomy initially decide that the physical dysfunction is worth the benefits of improved likelihood of survival; however, they do so without firsthand knowledge of the associated bother. Patients should be informed of the transient and unrelenting physical symptoms and associated bother that are produced after radical prostatectomy.

Psychometric properties of the Male Urogenital Distress Inventory (MUDI) and Male Urinary Symptom Impact Questionnaire (MUSIQ) in patients following radical prostatectomy

INTRODUCTION

Research instruments can be used to assess the impact of lower urinary tract symptoms on health-related quality of life. Evaluating the reliability, validity, and sensitivity of two of these instruments provides evidence concerning their readiness for use in research and clinical settings.

OBJECTIVE

The researchers evaluated psychometric properties of the Male Urogenital Distress Inventory and Male Urinary Symptom Impact Questionnaire in men suffering from lower urinary tract symptoms following radical prostatectomy.

METHOD

The internal consistency reliability, concurrent validity, construct validity, and sensitivity of both instruments were evaluated in a cohort of men who participated in a larger study of nursing's impact on quality of life post-prostatectomy.

RESULTS

The reliability, validity, and sensitivity of both instruments were supported in this population.

CONCLUSIONS

Initial support is provided for use of the instruments to measure the effect of interventions for lower urinary tract symptoms and urine leakage on health-related quality of life during the first 6 months of recovery from radical prostatectomy; however, further research with a larger and more diverse sample is needed prior to using the instruments in clinical settings.

Quality of life before and after prostatectomy as treatment for localized cancer

INTRODUCTION

Treatment for prostate cancer is known to affect quality of life. Comparison of treatment options needs to include quality of life data, preferably obtained directly from the person who underwent treatment.

OBJECTIVE

This study allowed men, diagnosed with localized prostate cancer, who elected to undergo a prostatectomy as treatment, to self-evaluate their quality of life before and after treatment.

METHODS

Using the Functional Assessment of Cancer Therapy - Prostate (FACT-P) instrument, longitudinal data were collected from 56 participants and demographic data were self-disclosed. Data collection intervals were prior to surgery, 1, and 6 months after surgery.

RESULTS

These results demonstrate a statistical decrease within the domains of social well-being and concerns specific to those with prostate cancer. These effects remain apparent 6 months after treatment. The primary cause of this effect is related to satisfaction with the ability to perform sexual activity.

CONCLUSIONS

Individuals electing to undergo a prostatectomy for treatment of their localized prostate cancer should be aware of the impact this treatment has on quality of life. Knowledge of these results may be used to assist patients in selecting the appropriate treatment.

Population-Based Outreach for Chlamydia Screening in Men: Results From a Randomized Trial

OBJECTIVE

To evaluate the feasibility and efficacy of population-based outreach strategies to improve genital Chlamydia trachomatis (CT) screening in men.

STUDY DESIGN

In a randomized trial, male enrollees ages 21-25 (n = 8820) were selected from the automated files of Group Health Cooperative and randomized to: a letter + test-request card for a CT urine home sampling kit (arm 1, n = 2940); a letter + mail-back sampling kit (arm 2, n = 2940); or a usual care control (arm 3, n = 2940). One reminder was sent to arms 1 and 2. The outcome was CT testing rates in the 4 months postrandomization.

RESULTS

105 of 2940 (3.6%) men in arm 1 and 230 of 2940 (7.8%) in arm 2 returned mailed specimens. All 335 respondents were sexually experienced, 43% had >2 sex partners in the past year, and 80% reported no genitourinary symptoms. Compared to arm 3, the relative risk of being tested was 5.6 (95% confidence interval (CI) 3.6-8.7) for arm 1 and 11.1 (95% CI 7.3-16.9) for arm 2. Arm 2 was significantly more likely to be tested than arm 1. CT prevalence for mailed-back specimens was 1.0% (1 of 105) for arm 1 and 2.6% (6 of 230) for arm 2; 70% of all positive intervention tests were from mailed samples.

CONCLUSIONS

Both strategies resulted in significantly higher CT testing than usual care, but the intervention response rate was low (5.7% overall). Direct kit mailing performed best. In US populations, the value of mailed outreach strategies to men must be considered in the context of other CT screening priorities.

Urogenital Disorders Associated With Gut Failure and Intestinal Transplantation

PURPOSE

Intestinal transplantation has been increasingly performed in patients with short bowel syndrome and irreversible gut failure with successful outcomes. In parallel a common association was observed between gut failure and different urological disorders. To our knowledge this study is the first to address such an important clinical observation with special reference to the underlying disease.

MATERIALS AND METHODS

The medical records of 175 consecutive adult intestinal recipients were reviewed. Data were compiled and described according to the documented urogenital disorder, cause of intestinal failure and treatment modality, including transplantation.

RESULTS

Of the patients 43 experienced a total of 53 urogenital disorders for an overall incidence of 25%, including 24 (56%) who had the disorder before referral and 19 (44%) in whom the morbidity developed as a result of transplantation. Interestingly hypercoagulability, pseudo-obstruction, Crohn's disease and Gardner's syndrome were the underlying urogenital and intestinal disorder pathologies in 6.3% of the study patients. Treatment for prior urogenital disorders, including malignancy, precipitated intestinal failure in 3.4% of the referred patients. Reciprocally surgical treatment for the primary intestinal disease and management of gut failure by total parenteral nutrition, followed by transplantation, resulted in different urogenital complications in 17.7% of the total population with an 8.6% incidence of chronic renal failure.

CONCLUSIONS

Gut failure and intestinal transplantation are commonly associated with different urogenital disorders. Accordingly a designated urological service should be considered part of the multidisciplinary team required for treating this unique population.

Genitourinary problems in bicyclists

Genitourinary complaints are common in cyclists. Bicycle fit, improper saddle type, and individual anatomic factors are important evaluation criteria to consider when diagnosing symptoms and determining treatment options. By learning how to recognize and treat contributing factors, as well as learning a few simple bike-fitting techniques, physicians can treat and prevent many common problems associated with bicycling.

Ejaculatory duct obstruction caused by a right giant seminal vesicle with an ipsilateral upper urinary tract agenesia: an embryologic malformation

OBJECTIVE

To report our experience with TURED in infertile men with EDO associated with abnormal development of the mesonephric or Wolffian duct, causing a contemporary malformation of the ipsilateral upper urinary tract.

DESIGN

Retrospective clinical study.

SETTING

Infertile men in an hospital environment.

PATIENT(S)

Seven patients affected by Zinner syndrome, from March to September 2005, were selected.

INTERVENTION(S)

Underwent TURED.

MAIN OUTCOME MEASURE(S)

Semen analysis, endocrine profile, transrectal ultrasonography and seminal vesicles aspiration, excretory urography, computerized tomography (CT), or magnetic resonance imaging (MRI).

RESULT(S)

Before surgery, the patients experienced a decreased intensity and force of ejaculation and a low motile sperm count. The detection of the ipsilateral upper urinary tract malformation by the patients was incidental. After surgery, all patients reported having a projectile ejaculation, an increase in the average postoperative volume, and of the total motile sperm count.

CONCLUSION(S)

A seminal vesicle cyst combined with ipsilateral renal agenesis, described as Zinner syndrome, is a rare urological anomaly. It is frequently asymptomatic or else characterized by infertility, symptoms of bladder irritation, or pain in the scrotum and perineum. In selected patients, TURED can improve semen quality with subsequent ability to impregnate. The upper urinary tract malformation should be treated in symptomatic cases only.

Chronic genitourinary and gastrointestinal toxicity of prostate cancer patients undergoing pelvic radiotherapy with intensity-modulated versus 4-field technique

PURPOSE

To compare chronic GU and GI toxicity of pelvic radiotherapy delivered using intensity-modulated radiotherapy (IMRT) versus conventional 4-field technique.

METHODS

The records of consecutive prostate cancer patients receiving RT at a single institution with a minimum follow-up of 120 days were reviewed; 48 of these patients received a prostate boost preceded by pelvic radiotherapy (PRT), 14 with IMRT (IM-PRT), and 34 with 4-field (4F-PRT). Dosimetric endpoints for the bladder, rectum, composite, and target for the PRT plans were compared using the 2-tailed t test. Late RTOG GU and GI toxicity were compared using the chi test. Ordered logit regression analyses were performed using all major patient, disease, and treatment factors as covariates.

RESULTS

IM-PRT demonstrated superior bladder and rectum dosimetric endpoints over 4F-PRT for the PRT portion of the treatment and for the composite treatment at the expense of higher target inhomogeneity in the PRT portion of the treatment plan. Late GU toxicity was significantly lower in the IM-PRT group (P < 0.001), whereas late GI toxicity was similar in both groups (P = 0.44). When considering a similar follow-up interval in both groups, however, the difference in GU toxicity only reached a trend (P = 0.10). The regression analyses showed that no factor, including IMRT, reached significance in predicting GU or GI toxicity.

CONCLUSION

Use of pelvic IMRT for prostate cancer patients was not associated with reduction of late GI toxicity but was associated with a small reduction of late GU toxicity. This reduction of late GU toxicity warrants further exploration in consortium studies.

Reactive arthritis due to zoophilic (canine) sexual intercourse

Reactive arthritis (ReA) is defined as a joint inflammation triggered by a distant infection, with no cultivable microbes in the joints. Although efforts have been made to characterize the microorganism linked to ReA, no definite common feature has so far emerged. Here we present a case of ReA which occurred after a zoophilic (canine genus) sexual intercourse.

Chlamydia trachomatis among young Norwegian men: sexual behavior and genitourinary symptoms

OBJECTIVE

The study objective was to assess Chlamydia trachomatis (CT) prevalence, risk factors, and genitourinary symptoms among young men.

METHODS

Sexually active men 18 to 30 years old were recruited during April through October 2005 at the student health services and through field work at university campuses in 2 Norwegian cities. A total of 1,032 participants completed a questionnaire on sexual behavior and provided first-void urine for CT testing.

RESULTS

The overall CT prevalence was 7.8% (81 of 1,032). In multivariable analysis, >or=5 lifetime sexual partners (adjusted odds ratio [aOR]: 2.7, 95% confidence interval [CI]: 1.4-5.2), a burning sensation on urination (aOR: 5.7, 95% CI: 3.1-10.5), and penile discharge (aOR: 2.6, 95% CI: 1.1-6.3) were significant risk factors for a positive CT test, whereas condom use (last intercourse) was preventive (aOR: 0.4, 95% CI: 0.2-0.8).

CONCLUSIONS

A CT prevalence of 7.8% was found among male students. Promotion of increased testing among men is important to prevent CT transmission.

Predictive factors for late genitourinary and gastrointestinal toxicity in patients with prostate cancer treated with adjuvant or salvage radiotherapy

PURPOSE

To determine the rate and magnitude of late genitourinary (GU) and gastrointestinal (GI) toxicities after salvage or adjuvant radiotherapy (RT) for prostate cancer, and to determine predictive factors for these toxicities.

METHODS AND MATERIALS

A large multi-institutional database that included 959 men who received postoperative RT after radical prostatectomy (RP) was analyzed: 19% received adjuvant RT, 81% received salvage RT, 78% were treated to the prostate bed only, and 22% received radiation to the pelvis.

RESULTS

The median follow-up time was 55 months. At 5 years, 10% of patients had Grade 2 late GU toxicity and 1% had Grade 3 late GU toxicity, while 4% of patients had Grade 2 late GI toxicity and 0.4% had Grade 3 late GI toxicity. Multivariate analysis demonstrated that adjuvant RT (p = 0.03), androgen deprivation (p < 0.0001), and prostate bed-only RT (p = 0.007) predicted for Grade 2 or higher late GU toxicity. For GI toxicity, although adjuvant RT was significant in the univariate analysis, no significant factors were found in the multivariate analysis.

CONCLUSIONS

Overall, the number of high-grade toxicities for postoperative RT was low. Therefore, adjuvant and salvage RT can safely be used in the appropriate settings.

Klippel-Trenaunay Syndrome: Incidence and Treatment of Genitourinary Sequelae

PURPOSE

Prior reviews regarding genitourinary manifestations of Klippel-Trenaunay syndrome used data acquired from diverse specialty specific articles to define the incidence and sequelae of its genitourinary manifestations. We believe that this resulted in erroneous conclusions regarding the urological complications of Klippel-Trenaunay syndrome.

MATERIALS AND METHODS

Data on genitourinary manifestations in patients with Klippel-Trenaunay syndrome treated at 1 institution from 1970 through 2005 were acquired.

RESULTS

Of 218 patients with Klippel-Trenaunay syndrome 30% (66 of 218) had genitourinary involvement, including 7% (15) with cutaneous genital abnormalities, 7% (15) with visceral genitourinary involvement and 16% (36) with each type. Intermittent bleeding from cutaneous genital abnormalities developed in 65% of patients (33 of 51). Conservative treatment with compression and/or cauterization was attempted in all 33 patients and it was successful in 64% (21 of 33). Intractable hemorrhage resulted in excision of the cutaneous bleeding site in 36% of cases (12 of 33). A total of 39 hospitalizations for gross hematuria occurred in 9% of the patients (19 of 218). Hematuria developed from the bladder in 11 cases, the urethra in 4 and the kidney in 4. Conservative therapy resolved gross hematuria in 21% of the patients (4 of 19). Refractory hematuria was successfully treated with cauterization in 37% of the patients (7 of 19) and by angiographic embolization in 10% (2 of 19). Intractable gross hematuria resulted in open surgical excision of the bleeding site in 32% of the patients (6 of 19).

CONCLUSIONS

The incidence of genitourinary manifestations of Klippel-Trenaunay syndrome is 30%, which is triple the previously reported incidence of 9%. Unlike prior reports stating that the genitourinary abnormalities rarely caused problems, 52% of the patients (34 of 66) with Klippel-Trenaunay syndrome who had urological manifestations eventually required interventional therapy for genitourinary complications.

The late effects of childhood cancer therapy

In this article the difficulties that face survivors of childhood cancer therapy are presented, and the late effects of such therapy, separated into nonmalignant and malignant late effects, are discussed according to organ system. Recommendations for monitoring the late effects are set forth. A table listing radiation-therapy site and chemotherapeutic agents and selected late effects that result from their use is provided. Finally, a brief recommendation regarding the establishment of a late-effects clinic is also presented.