Lower urinary tract symptoms (LUTS) commonly affecting ageing men and is thought to be linked with other comorbidities and unhealthy lifestyles. This study was performed to report the prevalence of LUTS and its association with quality of life (QOL) in urination and other related factors. The study was part of the National Health and Morbidity Survey (NHMS) 2019, a cross-sectional community-based survey in Malaysia. Validated self-administered bilingual International Prostate Symptom Score (IPSS) was used to assess the LUTS. Other comorbidities and unhealthy lifestyles were recorded using face-to-face interview and in-situ measurements such as anthropometry assessment and blood measurement. There were a total of 2251 respondents. 16.3% of the respondents had clinically significant LUTS (IPSS ≥ 8). LUTS was found to be significantly associated with QOL, age and inactive physical activities. Nocturia was the most prevalent and bothersome symptom. LUTS is a common condition and adversely affect QOL. Ageing and physically inactive males are associated with the development of LUTS. It is recommended to increase public awareness of the condition and availability of treatment options for LUTS. Any upcoming survey should have a more in-depth investigation such as clinical profiling of subjects.
Purpose: We compared the patency and the suitability of arteriovenous fistula (AVF) created for vascular access by two approaches: (a) physical examination with preoperative vascular mapping and (b) physical examination alone.Methods: We compared the patency and the suitability of AVF created in patients for dialysis. There were two cohorts of patients of 79 patients each: (a) patients with AVF created based on the combination of physical examination and preoperative vascular mapping (PE+VM) and (b) patients with AVF created based on physical examination (PE) alone. Fistula patency is defined as clinical detection of thrill (or auscultation) of murmur over the fistula and coded as having thrills (patent) versus not having thrills (not patent). Suitability of fistula is defined as functioning AVF (AVF can be adequately used via 2-needle cannulation for dialysis) and coded as suitable versus not suitable.Results: AVF created after the preoperative vascular mapping (PE+VM) has 5.70 (at six weeks) and 3.76 (at three months) times higher chance for patency, and 3.08 times higher chance for suitable AVF for dialysis than AVF created after the physical examination (PE) alone.Conclusion: Physical examination with preoperative ultrasound mapping (PE+VM) significantly improves the short term patency and the suitability of AVF for dialysis. Keywords: arteriovenous fistula, hemodialysis, ultrasound, sonography, vascular patency
Background Testicular infarction/gangrene is usually caused by testicular torsion. Strangulated inguinal hernia complicated with testicular infarction is unusual in adults in contrast to many reported cases involving pediatric patients. Case presentation We report an unusual case of testicular gangrene in an elderly man presented with abandoned right obstructed inguinoscrotal hernia. He had right open hernioplasty with right orchidectomy. Conclusion Obstructed adult inguinoscrotal hernia potentially leading to testicular gangrene, despite being uncommon sequalae. The surgeon should always routinely examine the testis during surgery for complicated hernia to prevent missed gangrenous testis behind.
Colorectal carcinoma (CRC) rarely metastasizes to the urinary system in isolated form. It usually spreads through direct invasion with intra-ureteric growth or local ureter mucosal metastasis without involving the muscular layer. We present a case of a 63-year-old man who came with uraemic symptoms and a ballotable right kidney. Laboratory and imaging showed acute renal failure with right renal mass suspicious of malignancy and left ureteric stricture causing hydronephrosis. He underwent right radical nephrectomy and left open ureteric stenting plus biopsy sampling. Adenocarcinoma was detected through the evaluation of the specimen. In view that adenocarcinoma rarely occurs in the urinary system, an investigation was carried out to search for the primary source. Colonoscopy was performed, which later showed adenocarcinoma of the rectum. Adenocarcinoma in the renal system should always raise the suspicion of another primary source of malignancy, especially colorectal origin. The advanced stage of this cancer should be managed with the best palliative treatment rather than aggressive surgical intervention.
Background Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of bleeding from the procedure and the hypercoagulable state in hypoalbuminemia. The management of a patient with venous thrombosis with perinephric hematoma post renal biopsy can be difficult if occurred. Case presentation We are presenting a case of perinephric hematoma following percutaneous renal biopsy in a 23-year-old man with lupus nephritis, nephrotic syndrome, and lower limbs deep vein thrombosis (DVT). The patient developed persistent frank haematuria, flank pain and acute urinary retention post-procedure. We have withheld his oral warfarin three days before the procedure, and no anticoagulation was given subsequently. Initial CT Angiography (CTA) renal showing stable hematoma and no visible evidence of vascular injury. Three weeks later, the patient still has persistent frank haematuria and a repeated CTA renal revealed new bilateral renal vein thrombosis. Considering the high risk of worsening symptomatic venous thrombosis, we gave subcutaneous enoxaparin sodium and restart oral warfarin despite ongoing haematuria. The frank haematuria resolved within two days of anticoagulation with no radiological evidence of worsening of the perinephric hematoma. The follow-up ultrasonography a month later showed resolution of the hematoma and renal vein thrombosis with no adverse effect. Conclusion Our experience, in this case, highlighted the importance of case selection for percutaneous renal biopsy among high-risk patients. Additionally, a prolonged frank haematuria in post-renal biopsy with nephrotic syndrome warranted a reassessment, as a clinical presentation of post-procedure perinephric hematoma and renal vein thrombosis can overlap. We also demonstrated that restarting anticoagulation earlier than four weeks in a patient with renal vein thrombosis and post-renal biopsy perinephric hematoma can be safe in the selective case.
Primary obstructed Megaureter (POM) defined as dilatation of ureter bigger than the normal size with or without renal pelvis dilatation. POM was first described in 1923 by Clark [1]. This is the second most common aetiology causing hydronephrosis in infant and it more prevalence in boys compared with girls. Early detection of POM is important to guide us in the long management of the patient and better outcome. Surgical intervention still mainstay treatment for POM in failure of conservative management.
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