Emerging Role of Microbiome in the Prevention of Urinary Tract Infections in Children

The microbiome of the urinary tract plays a significant role in maintaining health through the impact on bladder homeostasis. Urobiome is of great importance in maintaining the urothelial integrity and preventing urinary tract infection (UTI), as well as promoting local immune function. Dysbiosis in this area has been linked to an increased risk of UTIs, nephrolithiasis, and dysfunction of the lower urinary tract. However, the number of studies in the pediatric population is limited, thus the characteristic of the urobiome in children, its role in a child’s health, and pediatric urologic diseases are not completely understood. This review aims to characterize the healthy urobiome in children, the role of dysbiosis in urinary tract infection, and to summarize the strategies to modification and reshape disease-prone microbiomes in pediatric patients with recurrent urinary tract infections.

Stakeholders' Perception of the Introduction of Specialized Hospitals for Urologic Diseases: Qualitative Study

Purpose: The purpose of this study is to seek in-depth perspectives of stakeholders on the necessity and specific criteria for designating a specialized hospital for urologic diseases.Methods: Eight participants experts in urology medicine and specialized hospital system were divided into four groups. Following the semi-structured guidelines, an in-depth interview was conducted twice and a focus group discussion was conducted three times. All the interviews were transcribed verbatim and analyzed.Results: The majority of participants predicted that there would be demand for specialized hospitals for urologic diseases. The criteria of designating a specialized hospital, such as the number of hospital beds and quality of health care, have to be modified in consideration of the specificity of urology. The introduction of a specialized hospital would improve the healthcare delivery system, positively affecting hospitals and patients. Furthermore, government support is essential for the maintenance of specialized hospital systems as urology hospitals experience difficulties in generating profits.Conclusion: This study is expected to be used as base data for introducing and operating a specialized hospital for urologic diseases. In addition, it is expected that the methodology and results of this study would encourage follow-up studies on specialized hospitals and provide guidelines to evaluate the effectiveness of such hospitals in other medical fields.

Attributable risks of hospitalizations for urologic diseases due to heat exposure in Queensland, Australia, 1995–2016

Background Heat exposure is a risk factor for urologic diseases. However, there are limited existing studies that have examined the relationship between high temperatures and urologic disease. The aim of this study was to examine the associations between heat exposure and hospitalizations for urologic diseases in Queensland, Australia, during the hot seasons of 1995–2016 and to quantify the attributable risks. Methods We obtained 238 427 hospitalized cases with urologic diseases from Queensland Health between 1 December 1995 and 31 December 2016. Meteorological data were collected from the Scientific Information for Land Owners—a publicly accessible database of Australian climate data that provides daily data sets for a range of climate variables. A time-stratified, case-crossover design fitted with the conditional quasi-Poisson regression model was used to estimate the associations between temperature and hospitalizations for urologic diseases at the postcode level during each hot season (December–March). Attributable rates of hospitalizations for urologic disease due to heat exposure were calculated. Stratified analyses were performed by age, sex, climate zone, socio-economic factors and cause-specific urologic diseases. Results We found that a 1°C increase in temperature was associated with a 3.3% [95% confidence interval (CI): 2.9%, 3.7%] increase in hospitalization for the selected urologic diseases during the hot season. Hospitalizations for renal failure showed the strongest increase 5.88% (95% CI: 5.25%, 6.51%) among the specific causes of hospital admissions considered. Males and the elderly (≥60 years old) showed stronger associations with heat exposure than females and younger groups. The sex- and age-specific associations with heat exposure were similar across specific causes of urologic diseases. Overall, nearly one-fifth of hospitalizations for urologic diseases were attributable to heat exposure in Queensland. Conclusions Heat exposure is associated with increased hospitalizations for urologic disease in Queensland during the hot season. This finding reinforces the pressing need for dedicated public health-promotion campaigns that target susceptible populations, especially for those more predisposed to renal failure. Given that short-term climate projections identify an increase in the frequency, duration and intensity of heatwaves, this public health advisory will be of increasing urgency in coming years.

Past, Present and Future of Urology in Pakistan

There is little published literature on urologic diseases before 1947 from areas now constituting Pakistan. From 1947 to 1970s, urology was part of surgery practiced by general surgeons except for two urology units in 1960s. The real take off of urology began with introduction of transurethral resection of prostate in 1980s, ushering the era of endourology; the second era of which began with ureteroscopy along with extracorporeal shockwave lithotripsy in 1987-1989, percutaneous nephrolithotomy in 1992 and introduction of percutaneous nephrostomy in 1997. Renal transplantation was started in 1979 and currently, there are 19 renal transplant centres. At present, there are 11 specialized kidney centers in the country. Urology has undergone marked metamorphosis during the new millennium with many sub-specialities. Over past few decades, the classical surgical training has shifted toward adaptation of surgical simulation labs. Continuous...

Are serum levels of 25-hydroxy vitamin D reduced following orchiectomy in testicular cancer patients?

Background The testis represents one place where the progenitor of vitamin D is converted into its active form. Loss of one testis was suggested to result in reduced vitamin D serum levels. Vitamin D deficiency would represent a significant health problem in the long-term course of patients with testicular germ cell tumors (GCTs) since most of them survive. The purpose of this study was to look to the serum 25(OH)-Vitamin D (25OHD) levels in patients with GCTs before and after orchiectomy. A total of 177 GCT patients underwent measurements of serum 25OHD levels, thereof 83 with preoperative measurements and 94 with measurements at six particular time-points from immediate postoperatively to >24 months. Longitudinal assessments of 25OHD serum levels were performed in individual patients with repeated measurements. A second analysis involved patient cohorts with measurements at six postoperative time-points. Serum levels of patients were also compared with 2 control groups, one consisting of 84 patients with non-neoplastic testicular diseases and another with 237 patients with non-neoplastic urologic diseases. We also looked to associations of 25OHD levels with levels of testosterone, follicle stimulating hormone (FSH), age, histology of GCT and season. Descriptive statistical methods were employed to compare groups and to analyze changes over time. Results Normal serum levels of 25OHD were found in 21.7%, 23.1%, 20.2%, 21.9% in GCT patients preoperatively, after >2 years, in control group 1 and control group 2, respectively. Levels were significantly higher in spring and summer, but no association was found with other parameters. We found a significant transient decrease of 25OHD levels with a nadir at 6-12 months after orchiectomy and a recovery thereafter. Conclusion Contrasting with previous studies we found no permanent reduction of serum 25OHD levels after orchiectomy but transient postoperative drop of 25OHD levels. There were no associations of 25OHD levels with age, and levels of testosterone or FSH. Our results may point to a particular role of the testis in vitamin D metabolism and may thus enhance the understanding of the diverse physiological roles of the testis.

The burden of illness in initiating intermittent catheterization: an analysis of German health care claims data

Background Intermittent catheterization (IC) is a common medical technique to drain urine from the bladder when this is no longer possible by natural means. The objective of this study was to evaluate the standard of care and the burden of illness in German individuals who perform intermittent catheterization and obtain recommendations for improvement of care. Methods A descriptive study with a retrospective, longitudinal cohort design was conducted using the InGef research database from the German statutory health insurance claims data system. The study consisted of individuals with initial IC use in 2013–2015. Results Within 3 years 1100 individuals with initial IC were identified in the database (~ 19,000 in the German population). The most common IC indications were urologic diseases, spinal cord injury, Multiple Sclerosis and Spina Bifida. Urinary tract infections (UTI) were the most frequent complication occurring 1 year before index (61%) and in follow-up (year 1 60%; year 2 50%). Resource use in pre-index including hospitalizations (65%), length of stay (12.8 ± 20.0 days), physician visits (general practitioner: 15.2 ± 29.1), prescriptions of antibiotics (71%) and healthcare costs (€17,950) were high. Comorbidities, complications, and healthcare resource use were highest 1 year before index, decreasing from first to second year after index. Conclusions The data demonstrated that prior to initial catheterization, IC users experienced UTIs and high healthcare utilization. While this demonstrates a potential high burden of illness prior to initial IC, UTIs also decreased over time, suggesting that IC use may have a positive influence. The findings also showed that after the first year of initial catheterization the cost decreased. Further studies are needed to better understand the extent of the burden for IC users compared to non-IC users.

Prosztatarákkal diagnosztizált betegek egészségmagatartásának vizsgálata

Összefoglaló. Bevezetés: A férfiakat érintő egyik leggyakoribb malignus ráktípus a prosztatarák. A Nemzeti Rákregiszter adatai alapján hazánkban évente több mint 4600 új eset kerül diagnosztizálásra. Célkitűzés: A rákbetegek pszichoszociális háttere napjainkig alulvizsgált terület Magyarországon. A szerzők célja a magyar prosztatarákos férfiak szociodemográfiai, egészségi, mentális állapotának vizsgálata volt. Módszer: A vizsgálatban 100 prosztatarákos férfi vett részt, akiknek más urológiai betegsége nem volt, továbbá más daganatos betegségből kifolyó kezelésben nem részesültek a kérdőív kitöltésekor. A részvétel anonim és önkéntes volt. A standard validált tesztek mellett – mint a Beck Depresszió Kérdőív, Rosenberg Önértékelés Skála – szociodemográfiai, egészségmagatartás- és életmód-kérdéscsoportokat tartalmazott kérdőívünk. Statisztikai analízis: Leíró statisztikát, khi-négyzet-próbát, lineáris regresszió analízist, Fisher-egzakt tesztet, kétmintás t-próbát végeztünk 95%-os valószínűségi szinten az SPSS 20.0 és a Microsoft Excel 2016-os programban. Eredmények: Az egészségi állapotot a lakhely településcsoportja (p = 0,024), az anyagi helyzet (p = 0,001), a krónikus betegség (p = 0,000), a fizikai aktivitás (p = 0,000) és az alkoholfogyasztás (p = 0,001) befolyásolta. A társas támogatás (p = 0,726) ellenben nem bizonyult befolyásoló tényezőnek. A megkérdezettek 66%-a volt elhízott a BMI alapján. Helyesen csupán a megkérdezettek egyharmada táplálkozott a ma érvényes MDOSZ-ajánlás alapján. 62%-uk enyhén depressziósnak volt mondható a Beck Depresszió Kérdőív alapján, 73%-uk önértékelése azonban a Rosenberg Önértékelés Skála alapján átlagosnak volt mondható. Az életkorral nem nőtt sem a Depresszió Kérdőív pontszáma, sem az Önértékelés Skála pontszáma. Következtetés: Eredményeink alátámasztják, amit a hazai és a külföldi szakirodalom is mutat: az egészséget befolyásoló tényezőknek meghatározó szerepük van a daganatos megbetegedéssel élőknél is. A depresszió és az önértékelés közti összefüggés nem igazolódott a mintánkban. Orv Hetil. 2021; 162(10): 383–391. Summary. Introduction: Prostate cancer is one of the most common malignant cancers amongst men. More than 4600 men are diagnosed with prostate cancer every year in Hungary. Objective: The psychosocial background of cancer patients is an underexamined area in Hungary. The aim of the authors was to obtain information on the sociodemographic status, health and mental status of Hungarian men with prostate cancer. Method: 100 prostate cancer patiens were included in the study who did not have any urologic diseases and did not go under any therapy due to any other type of cancer. The applied questionnaire was put together by the authors about sociodemographic and health status, lifestyle. The Beck’s Depression Inventory and the Rosenberg Self-Esteem Scale were also used. Statistical analysis: We used descriptive statistics, chi-square test, linear regression, Fisher’s exact test, independent t-sample test on a 95% probability level in the SPSS 20.0 and Microsoft Excel 2016 softwers. Results: The settlement classification (p = 0.024), financial status (p = 0.001), chronic illnesses (p = 0.000), physical activity (p = 0.000) and alcohol consumption (p = 0.001) affected the health status. Only one third of the respondents ate healthy according to the recommendations of the MDOSZ. 66% of the respondents were overweight. 62% of the respondents were depressed according to the Beck’s Depression Inventory, however, 73% of them had average self-esteem measured by the Rosenberg Scale. We proved that with age either the depression score or the self-esteem score did not increase. Conclusion: Our results roughly mirror the national and international literature about health behavior. No connection was found between self-esteem and depression. Orv Hetil. 2021; 162(10): 383–391.

Accuracy of Urologic Conditions Portrayed on Grey’s Anatomy

Despite the common prevalence of urologic diseases, studies have demonstrated that the general public often has little knowledge or insight into the field of urology or the role of an urologist. In this study, we investigated the context, frequency, and accuracy of urologic conditions on the television series Grey’s Anatomy. We reviewed episodes from the first 15 seasons. Episodes with urologic references were then screened and the urologic conditions, outcomes, and treatments were recorded. We identified a total of only 21 urologic events across 15 seasons and 342 episodes of Grey’s Anatomy. A total of 52% (11/21) of the conditions were related to external male genitalia. The portrayal of these conditions and the associated treatments were considered to be medically accurate within reason 62% (13/21) of the time. There is significant room for improvement to increase the portrayal of common urologic conditions and malignancies to improve the public’s awareness and perception of our specialty.

Pharmacotherapeutic approach toward urological medications and vaccination during COVID-19: a narrative review

One year after the prevalence of the novel coronavirus pandemic, some aspects of the physiopathology, treatment and progression of coronavirus 2019 disease (COVID-19) have remained unknown. Since no comprehensive study on the use of urological medications in patients with COVID-19 has been carried out, this narrative review aimed to focus on clinically important issues about the treatment of COVID-19 and urologic medications regarding efficacy, modifications, side effects and interactions in different urologic diseases. In this review, we provide information about the pharmacotherapeutic approach toward urologic medications in patients with COVID-19 infection. This study provides an overview of medications in benign prostatic hyperplasia, prostate cancer, impotence and sexual dysfunction, urolithiasis, kidney transplantation and hypertension as the most frequent diseases in which the patients are on long-term medications. Also, the effect of urologic drugs on the efficacy of vaccination is briefly discussed.