Global Journal of Urology and Nephrology

  • UTIs in Chronic Health Situations

    UTIs are a severe public health problem and are caused by a range of pathogens, but most commonly by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus. High recurrence rates and increasing antimicrobial resistance among uropathogens threaten to greatly increase the economic burden of these infections. UTIs typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. If left untreated, a urinary tract infection can have serious consequences. Adult women are 30 times more likely than men to develop a UTI, with almost half of them experiencing at least one episode of UTI during their lifetime. Uncomplicated lower UTI remains one of the most commonly treated infections in primary care. A complicated UTI is an infection associated with a condition, such as a structural or functional abnormality of the genitourinary tract, or the presence of an underlying disease. Diagnosis of a UTI is based on a focused history, with appropriate investigations depending on individual risk factors. The paper reviews several chronic conditions that are risk factors for UTIs in human being.

  • Impact of components of metabolic syndrome on the prostatic volume and lower urinary tract symptoms in a sample of patient with benign prostatic hyperplasia in Iraq

    Objective To evaluate the association between the components of metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) focusing at their effects on prostatic volume and on the severity of LUTS . Patients & Methods From October 2016 to January 2018, eighty patients presented with LUTS due to the BPH. LUTS were assessed using the international prostatic symptoms score (IPSS) and MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III guidelines. Patients were randomly collected into two categories: A (48 patients) had MetS and B (32 patients) without MetS. Results The mean age was 64.3 years, statistically significant variation was identified between the two categories regarding the moderate and severe IPSS, S.PSA, prostatic size and post voiding residue (PVR), the P value (

  • Lifestyle Issues and Prevention of Recurrent UTIs

    UTI is one of the most prevalent diseases with diverse etiological agents annually affecting 250 million and causes death of 150 million people worldwide [1,2]. Adult women are 30 times more likely than men to develop a UTI [3]. Although the estimated mortality rate is generally lower than with RTIs, it may rise up to 26% if complicated with bacteremia or septic shock [4]. Financial burden of UTIs exceeds $3.5 billion in US alone [5] whereas more than 50% of the antibiotics prescribed for a suspected UTI in older adults being considered unnecessary [6]. More interestingly, nosocomial UTIs account for nearly 40% of all hospital acquired infections [7] and around 50% of UTI in children are missed [8]. Recurrent UTIs (RUTIs) are mostly caused by frequent sexual intercourse, heterosexual lack of circumcision receptive anal intercourse (without a condom), multiple sexual partners (each sex partner shares his/her UGT microbiota with the other), use of spermicide and a new sexual partner, sexual intercourse with addicted partners, sexual intercourse with sex workers, sexual intercourse with online dating friends, sexual intercourse with a new sex partner within less than 2 months [9-20]. Traditional lifestyle factors such as fluid intake and diet are not considered independent risk factors now [15]. UTIs account for nearly 25% of all infections [16]. Sexual intercourse ≥3 times/week was associated with greater frequency of UTI [21]. Close proximity of the urethral meatus to the anus and shorter urethra, is a likely factor [22-26]. Many other factors have been thought to predispose women to RUTIs, such as voiding patterns pre- and post-coitus, wiping technique, wearing tight undergarments, deferred voiding habits and vaginal douching; nevertheless, there has been no proven association [16]. Although, genital hygiene practices such as frequency of coitus, urinating after coitus, washing genitals precoitus, male partner washing genitals precoitus,…

  • Alternative Management of Uncomplicated UTIs in Women

    UTIs typically cause women to have a severe urge to urinate, and to do so frequently. It’s also often very painful when they do, and many experiences a burning sensation in their bladder or urethra. Two common factors emerged in urine that had a better ability to resist bacterial growth: it had a high pH—one that’s more alkaline, in other words—and higher levels of certain metabolites formed by gut microbes. Physicians already know how to raise urinary pH with things like calcium supplements, and alkalizing agents are already used in the U.K. as over-the-counter UTI treatments. However, early on in an infection, cells produce a protein called siderocalin that blocks bacterial growth, including the growth of E. coli. Uncomplicated UTIs usually go away with drugs within two to three weeks, but in some cases, women may take antibiotics for 6 months or longer if their UTIs keep coming back. Most UTIs are caused by the bacteria Escherichia coli (E. coli), and recent surveillance data shows a significant rise in cases of UTIs caused by E. coli that are resistant to the antibiotics most commonly used to that treat them. Doctors say “It’s uncomfortable but not life-threatening, so women don’t go in”.

  • Turning complexity into clarity: polyuria and hypernatremia

    Case history The patient is 65-year old African American male with history of hypertension. He was admitted to hospital with lethargy, disorientation, and confusion. His clinical evaluation and CT of the head revealed subarachnoid hemorrhage. He had h/o stroke 5 years ago. The patient didn’t have fever, but did have a diarrhea of 1-day duration. He is receiving parenteral feeding and his urine output is 4L/day. His physical examination revealed blood pressure of 100/70mmHg, with heart rate of 100 BPM. He has dry mucous membranes and the rest of examination was unremarkable. His laboratory investigation showed sodium 159meg/L, K+ 4.6meg/L, chloride 114mEq/L, HCO3 26mEq/L, creatinine 1.9mg/L, Blood urea nitrogen 64mg/L, and glucose 200mg/L His urine sodium 70mEq/L, and urine osmolality 380mOsm/Kg H2O. His volume status is slightly dry, and he weighs 70Kg. Case discussion This case illustrated several information including polyuria with parenteral nutrition, low blood pressure and dry mucous membranes denoting low extracellular fluids volume. High serum sodium, and high urine osmolality in the face of hypovolemia and hypernatremia. As a consequence of his illness he suffered from low perfusion to the kidneys with worsening kidney function. Hypernatremia is a common electrolyte abnormality and defined as a serum sodium >145mEq/L (1,2,3). Hypernatremia is hyperosmolar state caused by a decrease in total body water (TBW), relative to electrolytes content (4). Therefore, hypernatremia is a water problem not sodium problem. It often occurs in elderly and hospitalized patients with restricted access to water and in those with impaired thirst mechanism (hypodipsia/adepsia) or mental status changes. Developing hypernatremia is virtually impossible if the thirst mechanism is intact and water is available. Hyper-osmolality caused by hypernatremia and water loss can lead to neurological cell shrinkage and brain injury. Loss of volume also can leads to circulatory collapse and organ failure. Hypernatremia is considered…

  • Two Options the sweetest among them is bitter: Fournier-gangrene associated with sodium-glucose co-transporter 2-inhibitors

    The authors discuss a case of sodium-glucose co-transporter 2 inhibitor associated with Fournier-gangrene in a patient with type-2 diabetes millets. The patient had extensive surgical intervention and skin graft but succumbed to her disease.

  • Large urinary bladder leiomyoma causing right hydronephrosis, a rare case report: diagnosis and management

    Background Leiomyoma of the urinary bladder is a rare tumor despite the routine use of ultrasonography. These tumors are typically asymptomatic, sometimes present with hematuria, dysuria, and bladder outlet obstruction. Leiomyoma is a benign tumor which is detected incidentally and rarely causes upper urinary tract changes. (1, 2) We present an extremely rare case of leiomyoma in urinary bladder causing right hydronephrosis and presenting with flank pain. Case summary A 42 years female presented with flank pain in the emergency room as result of hydronephrosis in the right kidney. Imaging of urinary tract revealed 6 x 6.5 cm, a well-circumscribed tumor with right hydroureteronephrosis suggestive of leiomyoma of the urinary bladder. Excision of leiomyoma was done intravesically with preservation of bilateral ureteral orifices’. Conclusion Our case highlights despite being a large tumor there was no ureteral involvement. The hydronephrosis was the result of compression from large sized leiomyoma which was successfully managed by excision of leiomyoma.

  • Mineral-Bone Disorders in Chronic Hemodialysis Patients in Sub-Saharan Africa: Dakar Experience (Senegal West Africa)

    Introduction: Mineral bone disorders (BMD) are almost constant complications in chronic hemodialysis patients. The objective of our study was to determine the prevalence and profiles of BMD in chronic hemodialysis patients. Patients and methods: This is a six-year descriptive and analytical retrospective study from January 1st, 2010 to December 31st, 2015, at the hemodialysis department of the University Hospital Center (CHU) Aristide Le Dantec. Were also included patients on chronic hemodialysis for at least 3 months, with at least one prescribed amount of parathyroid (PTH). For each included patient, the epidemiological, dialytic, diagnostic and therapeutic parameters were collected and analyzed. Results: Over 86 patients, 71 (82.5%) had BMD. The average age was 48.92 ± 15.5 years old, with a sex ratio of 0, 65. Nephroangiosclerosis was the most frequent initial nephropathy (56.3%). The dialysis seniority was 5.2 ± 2.9 years old and 93% of patients profited from 3 sessions of 4 hours per week. Eleven patients (15.5%) had previous aluminum intoxication. Fifty-eight patients (81.6%) had secondary hyperparathyroidism, 12.6% had adynamic osteopathy (OA), and 1.4% had osteomalacia. In patients with secondary hyperparathyroidism, the average age was 48.6 ± 15 years old. 37.9% of these patients had articular pains, 22.4% had bone pains and 13.8% had spontaneous fractures. Eleven patients had hypocalcemia and only one patient had mild hypercalcemia. 46.5% of patients had normal phosphatemia; 29.3% had hypophosphatemia and 24.13% had hyperphosphatemia. Average PTH was 913.85 ± 331.65 ng/ml. 73% of patients had 25-OH-Vit D insufficiency; 72.7% of patients had high total PAL. Therapeutically, 91.4% of patients had been treated with calcium carbonate; 25.9% with a treatment based on non-calcium phosphorus chelators; 69% of patients received vitamin D and 15.5%, calcimimetic treatment. 22% of patients under medical treatment normalized their PTH. Parathyroidectomy was performed in 6.9% of patients. The average age in…

  • Illusive Dynamic Nadirs and Masks of Postoperative Hyponatraemia and the TURP Syndrome: Volumetric Overload Over Time (VO/T) Concept for Resolving its Puzzle

    Introduction and Objective Postoperative hyponatraemia (HN) causes serious morbidity and mortality, of which the transurethral resection of the prostate (TURP) syndrome is a unique model. It is an illusive puzzle with unclear definition, unknown aetiology, difficult diagnosis and disputed therapy. Clinical presentation ranges from prodromal symptoms to severe signs of circulatory shock and multiple vital organ dysfunction/ failure (MVOD/F) or death. All severe cases were reported retrospectively and attributed to multiple toxic/ dilution hypotheses interchangeably with recognized clinical conditions. The overlooked VO/T causes dynamic HN nadirs and masks making it a complex clinical/biochemical jigsaw puzzle with false and missing pieces. The objective here is to resolve this puzzle. Patients and Methods: Investigations based on clinical observations, critical literature analysis, physics-physiological and clinical prospective studies done over the past 32 years. Observations and deductive analysis identified VO/T insult, HN nadirs, clinical paradoxical masks of shock and MVOD/F. Documented evidence provided correct puzzle pieces and stepping-stones that led to new understanding, rejecting false and discovering missing ones. Prospective studies verified and quantified VO/T insult causing secondary, tertiary HN nadirs and osmotic gaps. Severity depends on VO over T and fluid type of sodium-free (VO1) and sodium-based (VO2) fluids and tonicity as well as patient’s variables of body weight and hormones. The results of all prospective studies on VO, HN nadirs, and clinical severity grades have contributed to resolving the puzzle that is impossible to resolve using a single prospective study. Results: “VO over T” causes the biochemical and clinical features of HN and the TURP syndrome. Dilutional HN “shock” and “VO” concepts were reported 45 and 11 years ago but VO insult remained invisible. The puzzle was resolved after unraveling the dynamic role of T in HN nadirs, discovering missing pieces and refuting unduly incriminated dilutional and toxic hypotheses. 3.5l of VO1…

  • Epidemiological Profile and Histopathological Aspects of Malignant Tumors of Testicle in Yaounde and Douala (Cameroon)

    Objective: Determine the epidemiological profile and histopathological aspects of testicular cancer in the two major cities of Cameroon, Yaoundé and Douala. Patients and methods: It was a retrospective cross-sectional descriptive study conducted in the reference structures approved for anatomopathological examination in Yaoundé and Douala. The study was conducted over a 17-year period (2001-2017). We included all cases of histologically confirmed testicular tumors. Variables included frequency, year of diagnosis, sociodemographic data, clinical aspects, types of sampling, gross macroscopy, and histological types. Results: We collected 81 cases of testicular tumors (49 benign tumors and 32 malignant tumors), with a mean age of diagnosis of 36.27 ± 18.9 years. For malignant tumors, the mean age was 40.25 ± 25.02 years, the predominant age group was 20-29 years (25%), the predominant type of specimen was the orchidectomy %, the predominant histological types were germ cell tumors with 30% seminomas. Conclusion: Testicular tumoral pathology affects more young man and is dominated by seminoma-type germ tumors.