Purpose of ReviewIn this review, we describe the incidence, diagnosis, and management of urethral strictures in women. Recent Findings Definitive repair of urethral strictures in women traditionally utilizes vaginal and labial flaps. Oral mucosal buccal graft urethroplasty also has high success rates, with larger series demonstrating feasibility and durability. Summary Urethral strictures in women are very rare. When they do occur, they are often difficult to diagnose, requiring a high index of suspicion. Women with urethral strictures often present with symptoms of obstructed urinary flow, such as incomplete emptying, straining, and elevated postvoid residual. First line, minimally invasive treatment consists of urethral dilation and urethrotomy, though urethrotomy is rarely performed. Repeat urethral dilation has low success rates compared with urethroplasty, which is a more definitive treatment.
Silver diamine fluoride (SDF) is a dental biomaterial used to arrest dental caries. To better understand SDF’s mechanism of action, we examined the localization of silver within the tissues of SDF-treated teeth. Carious primary teeth fixed within 2 min of SDF application (SDF-minutes, n = 3), at 3 wk after SDF application in vivo (SDF-weeks, n = 4), and at 2 y after multiple SDF applications in vivo (SDF-multiple, n = 1) were investigated in this study. Carious primary teeth without SDF application (no-SDF, n = 3) served as controls. Mineral density and structural analyses were performed via micro–X-ray computed tomography and scanning electron microscopy. Elemental analyses were performed through X-ray fluorescence microprobe and energy-dispersive X-ray spectroscopic techniques. SDF-treated teeth revealed higher X-ray–attenuated surface and subsurface regions within carious lesions, and similar regions were not present in no-SDF teeth. Regions of higher mineral density correlated with regions of silver abundance in SDF-treated teeth. The SDF penetration depth was approximated to 0.5 ± 0.02 mm and 0.6 ± 0.05 mm (mean ± SD) for SDF-minutes and SDF-weeks specimens, respectively. A higher percentage of dentin tubular occlusion by silver or calcium phosphate particles was observed in primary teeth treated with SDF-weeks as compared with SDF-minutes. Elemental analysis also revealed zinc abundance in carious lesions and around the pulp chamber. SDF-weeks teeth had significantly increased tertiary dentin than SDF-minutes and no-SDF teeth. These results suggest that SDF treatment on primary teeth affected by caries promotes pathologic biomineralization by altering their physicochemical properties, occluding dentin tubules, and increasing tertiary dentin volume. These seemingly serendipitous effects collectively contribute to the cariostatic activity of SDF.
To assess the role of core body temperature in urinary stone formation using a large clinical dataset. Patients and Methods We retrospectively collected 14 519 039 individual temperature measurements from 580 416 patients with medical history, laboratory values and medication history between 2013 and 2018 at a single institution. After exclusions and matching 2:1 (controls:cases) to account for confounding variables, 7104 patients with a history of urinary stones were identified. Results Patients with a history of urinary stones (cases) had an elevated mean (SD) oral temperature compared to matched controls, at 36.666 (0.17) vs 36.659 (0.20)°C (P = 0.012). Logistic regression of matched samples showed that higher core body temperature was predictive of a history of nephrolithiasis (odds ratio 1.21, 95% confidence interval 1.04-1.4; P = 0.015). Conclusion Core body temperature was significantly higher in patients with a history of urinary stones compared to matched controls, contrary to the anticipated thermodynamic considerations leading to crystal aggregation. Given that the core body temperature is elevated, rather than decreased, thermodynamic process driving stone formation is unlikely.
Voiding positions and preferences in men are not well characterized. In this study, we aim to understand the interplay of voiding characteristics and their impact on voiding position. Methods: We designed a 27-item survey to assess voiding characteristics and lower urinary tract symptoms (LUTS) severity in men seen in urology and other outpatient clinics. Participants included adult men patients and adult men accompanying patients at our institution's outpatient clinics. Data collected included demographics, International Prostate Symptom Score questionnaire, stream type (single, split, and dribble), voiding behavior, positional stream quality, and voiding bother. Results: We received 195 completed surveys (80% response rate). Of men queried, 18% (35/195) preferred to sit while voiding. Overall, men who sit had a higher proportion of LUTS (66% [23/35] vs. 41% [66/160]; p = .01), more physical limitations affecting voiding choice (20% [7/35] vs. 3% [5/160]; (p = .001), and a lower desire to stand (6% [2/35] vs. 24% [38/160]; p = .02), compared to men who stand. Men who sit while voiding reported nearly double the amount of voiding associated bother (34% [12/35]) compared to men who stand (18% [28/160]; p = .04). Older aged men reported a similar rate of seated urination compared to younger men. The most common reasons to void seated included comfort and avoidance of spraying. Conclusions: Our findings discourage the use of anecdotal beliefs founded on generalizable characteristics, such as age and stream type, to infer a patient's voiding characteristics. Open dialog with patients regarding voiding preferences may garner important information regarding overall urologic health and better inform urologic care.
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