Laparoscopic Dismembered Repair in Two Patients with Retrocaval Ureter

AbstractRetrocaval ureter (RCU) or circumcaval ureter is a rare cause of congenital hydronephrosis. The surgical correction of RCU should be performed in all patients with obstruction and hydronephrosis symptoms, lumbar pain, urinary tract infections, hematuria, or urolithiasis. Traditionally, an open surgical approach was used for the treatment of RCU. Nowadays, surgical correction of these anomalies is performed using minimally invasive techniques. We report on two cases treated with our standardized laparoscopic technique using only three 5-mm trocars. The proposed approach could be considered as the first-line treatment for RCU.

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Open removal as a first-line treatment of magnetic intravesical foreign bodies

Canadian Urological Association Journal ◽

10.5489/cuaj.190 ◽

2013 ◽

Vol 7 (1-2) ◽

pp. 25 ◽

Cited By ~ 4

Author(s):

Max A. Levine ◽

Howard Evans

Keyword(s):

Urinary Bladder ◽

Minimally Invasive ◽

Foreign Bodies ◽

Magnetic Beads ◽

Minimally Invasive Techniques ◽

Line Treatment ◽

First Line ◽

The Third ◽

Invasive Techniques ◽

First Line Treatment

Intravesical foreign bodies are an uncommon, but significant, cause of urologic consultation. We present 3 patients who all inserted magnetic beads per urethra into the urinary bladder, which subsequently became retained. Endoscopic attempts were unsuccessfully tried in the first 2 cases, necessitating open cystotomy to remove the beads. The third went straight to open removal. Given the failure of minimally invasive techniques, we believe that open removal should be the first-line treatment for these types of foreign bodies.

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Biofeedback as single first-line treatment for non-neuropathic dysfunctional voiding in children with diurnal enuresis

Canadian Urological Association Journal ◽

10.5489/cuaj.5209 ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 2

Author(s):

Fahad Alyami ◽

Tamer Ewida ◽

Hamdan Alhazmi ◽

Mahmoud Trbay ◽

Mostafa Arafa ◽

...

Keyword(s):

Urine Analysis ◽

Line Treatment ◽

Dysfunctional Voiding ◽

First Line ◽

Long Term Outcome ◽

Presenting Symptoms ◽

The Mean ◽

Tract Infections ◽

Diurnal Enuresis ◽

First Line Treatment

Introduction: Non-neurogenic dysfunctional voiding (NDV) accounts for a significant portion of pediatric urology outpatient clinic visits. Biofeedback (BF) is a promising, non-invasive modality for treating children with DV and daytime wetting. Our objective was to investigate BF’s efficacy as a single first-line treatment for children with NDV and diurnal enuresis. Methods: A retrospective cohort study was conducted with a total of 61 consecutive patient records from January 2009 to March 2016. All children with NDV who had BF as first-line treatment were included. Full urological histories, physical examinations, dysfunctional voiding symptom score (DVSS), urine analysis, ultrasound (US), and uroflowmetry (UFM), and electromyogram (EMG) were performed and recorded for all patients before and after finishing the last BF cycle. The patient’s satisfaction scale was also obtained. Results: The mean age was 10±2.6 years. Most patients (80.3%) were females. The presenting symptoms were diurnal enuresis, urinary tract infections, and voiding discomfort in 52 (85.2%), 16 (26.2%), and 38 (62.3%) patients, respectively. Six months after the last BF cycle, there was a statistically significant objective improvement in US and UFM+EMG findings, with the disappearance of EMG signals in 40 of 61 (65.5%) patients. There was also a significant subjective symptomatic improvement, as the mean DVSS had decreased from 14 to 7.9 (p=0.003). Forty-seven patients (77%) were satisfied, while only eight (13.1%) were not. Conclusions: BF is considered a potentially effective, single firstline treatment modality for children with DV and diurnal enuresis. Long-term outcome assessments are needed to assess the children’s compliance and symptom recurrence.

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The Amino Acid Changes T55A, A273P and R277C in the Beta-Lactamase CTX-M-14 Render E. coli Resistant to the Antibiotic Nitrofurantoin, a First-Line Treatment of Urinary Tract Infections

Microorganisms ◽

10.3390/microorganisms8121983 ◽

2020 ◽

Vol 8 (12) ◽

pp. 1983

Author(s):

Yasir Edowik ◽

Thomas Caspari ◽

Hugh Merfyn Williams

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Adult Women ◽

Line Treatment ◽

First Line ◽

Gram Negative ◽

E Coli ◽

Tract Infections ◽

M 14 ◽

First Line Treatment

The antibiotic nitrofurantoin is a furan flanked by a nitro group and a hydantoin ring. It is used to treat lower urinary tract infections (UTIs) that have a lifetime incidence of 50−60% in adult women. UTIs are typically caused by uropathogenic Escherichia coli (UPEC), which are increasingly expressing extended-spectrum beta-lactamases (ESBL), rendering them multi-drug resistant. Nitrofurantoin is a first-line treatment for gram-negative ESBL-positive UTI patients, given that resistance to it is still rare (0% to 4.4%). Multiplex PCR of β-lactamase genes of the blaCTX-M groups 1, 2, 9 and 8/25 from ESBL-positive UTI patients treated at three referral hospitals in North Wales (UK) revealed the presence of a novel CTX-M-14-like gene harbouring the missense mutations T55A, A273P and R277C. While R277 is close to the active site, T55 and A273 are both located in external loops. Recombinant expression of CTX-M-14 and the mutated CTX-M-14 in the periplasm of E. coli revealed a significant increase in the Minimum Inhibitory Concentration (MIC) for nitrofurantoin from ≥6 μg/mL (CTX-M-14) to ≥512 μg/mL (mutated CTX-M-14). Consistent with this finding, the mutated CTX-M protein hydrolysed nitrofurantoin in a cell-free assay. Detection of a novel nitrofurantoin resistance gene indicates an emerging clinical problem in the treatment of gram-negative ESBL-positive UTI patients.

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