This study investigated the influence of refugee status on the occurrence of enuresis. It was performed among school children aged 6 to 11 years and their parents in the Vukovarsko-srijemska County (eastern Croatia), which had many displaced persons and refugees (mostly women and children) in the 1990s due to the wars in Croatia and Bosnia and Herzegovina. A specially designed questionnaire (about the child’s age and gender, the child’s enuresis history and that of the parents, and data on parental refugee status in childhood) was completed by one of the parents. Adequate data were collected for 3046 children. The prevalence of enuresis among the studied children was quite low (2.3%) but the prevalence distribution according to gender, the decline by age, and the higher odds ratio for paternal enuresis were in line with the results of other studies. The prevalence of parental enuresis in childhood was higher than their children’s enuresis (mothers: 5.8%, fathers: 3.6%, p < 0.001), and significantly higher among parents who had been refugees (mothers: p = 0.001, fathers: p = 0.04). Parental refugee status had no influence on the children’s enuresis. The results suggest that refugee status is a risk factor for the occurrence of enuresis in childhood.
Recurrent urinary tract infections (rUTI) represent a major healthcare and economic burden along with a significant impact on patient’s morbidity and quality of life, even in the absence of well-known risk factors, such as vesicoureteral reflux. Despite numerous attempts to find a suitable therapeutic option, there is no clear benefit of any currently available intervention for prevention of UTI recurrence and its long-term consequences such as hypertension, renal scarring and/or insufficiency. The common treatment practice in many centers around the globe involves the use of continuous low-dose antibiotic prophylaxis, irrespective of various studies indicating increased microbial resistance against the prophylactic drug, leading to prolonged duration and escalating the cost of UTI treatment. Moreover, the rapid appearance of multi-drug resistant uropathogens is threatening to transform UTI to untreatable disease, while impaired host-microbiota homeostasis induced by a long-term use of antibiotics predisposes patients for various autoimmune and infectious diseases. New biomarkers of the increased risk of UTI recurrence could therefore assist in avoiding such outcomes by revealing more specific patient population which could benefit from additional interventions. In this light, the recent findings suggesting a crucial role of urothelial innate immunity mechanisms in protection of urinary tract from invading uropathogens might offer new diagnostic, prognostic and even therapeutic opportunities. Uroepithelial cells detect uropathogens via pattern recognition receptors, resulting in activation of intracellular signaling cascade and transcription factors, which ultimately leads to an increased production and secretion of chemokines, cytokines and antimicrobial peptides into the urinary stream. Emerging evidence suggest that the disturbance of a single component of the urinary tract innate immunity system might increase susceptibility for rUTI. The aim of the current review is to update clinicians and researchers on potential biomarkers of host immune response alterations predisposing for rUTI and propose those well worth exploring further. For this purpose, over a hundred original papers were identified through an extensive PubMed and Scopus databases search. This comprehensive review might enrich the current clinical practice and fill the unmet clinical needs, but also encourage the development of therapeutic agents that would facilitate urinary bacterial clearance by enhancing the host immune response.
Background:The goals of medical intervention in patients with vesicoureteral reflux are to allow normal renal growth, prevent infections and pyelonephritis, and prevent renal failure. We present our experience with endoscopic treatment of vesicoureteral reflux in children by subureteral dextranomer/hyaluronic acid copolymer injection.Methods: Under cystoscopic guidance, dextranomer/hyaluronic acid copolymer underneath the intravesical portion of the ureter in a subureteral or submucosal location was injected in patients undergoing endoscopic correction of vesicoureteral reflux.Results: A total of 282 patients (120 boys and 162 girls) underwent the procedure. There were 396 refluxed ureters altogether. The mean age of patients was 4.9 years. The mean overall follow-up period was 44 months. Among the 396 ureters treated, 76% were cured with a single injection. A second and third injection raised the cure rate to 93% and 94%, respectively. Twenty-two (6%) ureters failed all 3 injections, and were converted to open surgery. Conclusion:Endoscopic treatment of vesicoureteral reflux can be recommended as a first-line therapy for most cases of vesicoureteral reflux, because of the short hospital stay, absence of complications and the high success rate.Contexte : Chez des patients qui présentent un reflux vésico-urétéral, les objectifs de l'intervention médicale sont de permettre une croissance rénale normale, de prévenir les infections, la pyélonéphrite et l'insuffisance rénale. Nous présentons notre expéri-ence du traitement endoscopique du reflux vésico-urétéral par injection infraurétérale du copolymère dextranomère-acide hyaluronique chez des enfants.Méthodes : Sous cystoscopie, le copolymère dextranomère-acide hyaluronique a été injecté sous la portion intravésicale de l'uretère dans la région infra-urétérale ou sousmuqueuse chez des patients qui devaient subir une correction endoscopique pour reflux vésico-urétéral.Résultats : En tout, 282 patients (120 garçons et 162 filles) ont subi l'intervention, pour un total de 396 uretères touchés par le reflux. L'âge moyen des patients était de 4,9 ans. Le suivi global moyen a été de 44 mois. Parmi les 396 uretères traités, 76 % ont été corrigés au moyen d'une simple injection. Une seconde, puis une troisième injection ont porté le taux de guérison à 93 % et à 94 %, respectivement. Vingt-deux uretères (6 %) n'ont pas répondu aux 3 injections et pour ces cas, on a utilisé la chirurgie ouverte. Conclusion :Le traitement endoscopique du reflux vésico-urétéral peut être recommandé en traitement de première intention dans la plupart des cas de reflux vésico-urétéral en raison de la brièveté du séjour hospitalier, de l'absence de complications et du taux de réussite élevé.
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