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1
Lambert, Heather. Primary vesicoureteric reflux and reflux nephropathy. Edited by Adrian Woolf. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0355_update_001.
Full textAbstract:
Vesicoureteric reflux (VUR) describes the flow of urine from the bladder into the upper urinary tract when the ureterovesical junction fails to perform as a one-way valve. Most commonly, VUR is primary, though it can be secondary to bladder outflow obstruction and can occur in several multiorgan congenital disorders. There is good evidence of a genetic basis with a greatly increased risk of VUR in children with a family history of VUR. VUR is a congenital disorder, which largely shows improvement or complete resolution with age. Fetal VUR may be associated with parenchymal developmental defects (dysplasia). Postnatally non-infected, non-obstructed VUR does not appear to have a detrimental effect on the kidneys. However there is an association of VUR with urinary tract infection and acquired renal parenchymal defects (scarring). The parenchymal abnormalities detected on imaging, often termed reflux nephropathy, may be as a result of reflux-associated dysplasia or acquired renal scarring or both. It is difficult to distinguish between the two on routine imaging. Higher grades of VUR are associated with more severe reflux nephropathy. The precise role of VUR in pyelonephritis and scarring is not clear and it may be that VUR simply increases the risk of acute pyelonephritis. Whilst most VUR resolves during childhood, it is associated with an increased risk of urinary tract infection and burden of acute disease. Investigation strategies vary considerably, related to uncertainties about the natural history of the condition and the effectiveness of various interventions. The long-term prognosis is chiefly related to the morbidity of reflux nephropathy leading in some cases to impairment of glomerular filtration rate, hypertension, proteinuria, and pregnancy-related conditions including hypertension, pre-eclampsia, and recurrent urinary tract infection. Management is controversial and ranges from simple observation with or without provision of rapid access to diagnosis and treatment of urinary tract infections; to long-term prophylactic antibiotics or various antireflux surgical procedures.
2
Kogevinas, Manolis, Jonine Figueroa, Montserrat Garcia-Closas, and Lorelei Mucci. Urinary Bladder Cancer. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190676827.003.0022.
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Bladder cancer is the ninth most common cancer worldwide, resulting in 430,000 new cases in 2012, and its incidence is substantially higher in men than women. Urothelial cell carcinoma, also known as transitional cell carcinoma, is the predominant histopathologic type. Bladder cancer occupies an important place in occupational epidemiology, in which associations with occupations exposed to aromatic amines were first identified in the 1950s. It is also among the first cancers for which an infectious etiology was identified, through parasitic infection with Schistosoma haematobium, which occurs in Africa and the eastern Mediterranean. Smokers have a two- to threefold increased risk of bladder cancer, and a fivefold higher risk for heavy smokers. Specific medical conditions, including urinary stones and diabetes, are positively associated with risk. Finally, bladder cancer is one of the few examples with consistent evidence of interactions between environmental exposures and genetic polymorphisms in cancer epidemiology.
3
Ali, Ased. Pathogenesis of urinary tract infection. Edited by Rob Pickard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0001.
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The realization of the harms resulting from indiscriminate use of antibiotics for minor infection has added impetus to the need to understand better the interaction between urogenital tract epithelium and invading bacteria during the initial stages of urinary tract infection (UTI). It is thought that uropathogenic Escherichia coli clones develop in the gut and migrate across the perineum to the urethra and up into the bladder. The response of the epithelium to bacterial adherence and the evolution of the invading bacteria will then govern the clinical consequences. These can vary between rapid invasion and further migration to produce systemic sepsis to tolerance of the bacteria in a planktonic state in asymptomatic bacteriuria. The key to these differences is the activation of epithelial pathogen-associated molecular pattern receptors by expressed proteins on the bacterial cell wall. Increased understanding of these interactions will lead to non-antibiotic-based strategies for clinical management of urinary infection.
4
Goossens, Maria E., Frank Buntinx, and Maurice P. Zeegers. Bladder and upper urinary tract cancer. Edited by James W. F. Catto. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0070.
Full textAbstract:
Urinary bladder cancer (UBC) ranks ninth in worldwide cancer incidence. The most common histological type in Western countries is transitional cell carcinoma (TCC), while in Africa, a substantial proportion of squamous cell carcinomas (SCC) are observed related to the prevalence of infection with Schistosoma haematobium (bilharziasis). UBC has the highest per-patient lifetime cost for cancer in terms of healthcare expenditure compared to all other types of cancer. It is more frequent in men than in women and age is now widely accepted as the greatest single risk factor for developing UBC. The median age at diagnosis is 70 years. Cigarette smoking and specific occupational exposures, such as carcinogenic dyes for painters, are the main known causes of UBC.
5
Török, M. Estée, Fiona J. Cooke, and Ed Moran. Urinary tract infections. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199671328.003.0017.
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This chapter covers cystitis (an infection of the bladder, characterized by dysuria), acute pyelonephritis (an infection of the kidney), chronic pyelonephritis (which is a chronic diffuse interstitial inflammation), renal abscesses (such as perinephric abscess, renal corticomedullary abscess, and renal cortical abscess), catheter-associated urinary tract infections, prostatitis (including granulomatous prostatitis and prostatic abscess), epididymitis, and orchitis.
6
Bryant, Jason. Bladder Exstrophy. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0040.
Full textAbstract:
Bladder exstrophy is a rare condition in which there is an error in fetal development leaving the bladder and pelvic structure malformed. The bladder, pelvic girdle, and external genitalia are often split, requiring repair. The goals of this repair are to improve quality of life in terms of urinary continence, aesthetics, pelvic stabilization, and sexual function. This repair often requires prolonged traction and external fixation to adequately fuse the pelvic girdle. To aid in the healing and tolerance of this, a prolonged epidural catheter is often used. The pharmokinetics and risk of infection are major considerations during the prolonged use of a caudal catheter.
7
Chanmugam, Arjun S., and Gino Scalabrini. Urinary Tract Infections in Women. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0037.
Full textAbstract:
Urinary tract infections (UTIs) refer to a urine culture yielding a minimum of 100 to 10,000 bacteria units/mm of urine usually from a clean catch midstream sample. This can result from infection of the lower urinary tract involving the bladder (cystitis) or an infection of the upper urinary tract involving the kidneys (pyelonephritis). Uncomplicated UTIs occur in healthy, pre-menopausal, non-pregnant women with a normal urinary tract who have a high likelihood to respond favorably to treatment, but consider local antibiotic resistance patterns. Complicated UTIs occur in women with coexisting pathology, anatomical abnormality, underlying comorbidity, or immunocompromise. Untreated UTIs can progress to pyelonephritis and urosepsis. Asymptomatic bacteriuria for pregnant women can progress very quickly; pyelonephritis carries increased risk of perinatal and neonatal mortality. Pregnant patients should be treated with cephalexin, amoxicillin, or amoxicillin-clavulanic acid (avoiding fluoroquinolones).
8
Watson, Max, Caroline Lucas, Andrew Hoy, and Jo Wells. Genitourinary problems. Oxford University Press, 2010. http://dx.doi.org/10.1093/med/9780199234356.003.0018.
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This chapter focuses on the anatomy and physiology of the bladder and micturition. It covers bladder wall, sphincter active urethra, nerve supply, bladder pain and its treatment, blood supply of the bladder, urinary tract infection (UTI), renal pain, ureteric colic, pelvic pain, urinary retention, ureteric obstruction, urinary incontinence, haematuria, catheterization, genitourinary fistulae, vesicoenteric fistulae, vesicovaginal fistulae, and sexual health in advanced disease.
9
Gardiner, Matthew D., and Neil R. Borley. Urology. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199204755.003.0006.
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This chapter begins by discussing the basic principles of renal and urinary tract physiology, before focusing on the key areas of knowledge, namely congenital urological conditions, urinary retention, lower urinary tract symptoms and disorders, urinary incontinence and neuropathic bladder, iInflammation and infection of the urinary tract, urinary tract calculi, scrotal conditions, penile conditions, renal cancer, bladder cancer, prostate cancer, and testicular cancer. The chapter concludes with relevant case-based discussions.
10
Lee, Olivia T., Jennifer N. Wu, Frederick J. Meyers, and Christopher P. Evans. Genitourinary aspects of palliative care. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0084.
Full textAbstract:
Genitourinary tract diseases in the palliative care setting most commonly involve urinary tract obstruction, intractable bleeding, fistulae, and bladder-associated pain. Sources of obstruction in the lower urinary tract include benign prostatic hyperplasia, invasive prostate or bladder cancer, urethral stricture, or bladder neck contracture. Upper tract obstruction includes intraluminal or extraluminal blockage of the renal collecting system and ureters, such as transitional cell carcinoma, fibroepithelial polyps, stricture, stones, pelvic or retroperitoneal malignancy, fibrosis, or prior radiation. Untreated, obstructive uropathy leads to elevated bladder, ureter, and kidney pressures, bladder dysfunction, urolithiasis, renal failure, pyelonephritis, or urosepsis. Intractable haematuria can cause problematic anaemia, frequent transfusions, clot retention, haemorrhagic shock, and death. In addition, urinary tract fistulae such as vesicovaginal and vesicoenteric fistulae are common in patients who have had prior pelvic surgery or radiation especially in the setting of immunocompromise, poor nutrition, and infection. Untreated, these symptoms lead to rash, skin breakdown, ulcers, chronic infection, and sepsis. Lastly, pelvic and bladder pain, depending on aetiology can be treated with oral medications, intravesical therapies, or surgical therapies such as palliative resection or urinary diversion. Selection of tests and treatment modalities in the palliative care setting should be based on using the least invasive means to achieve the most relief in suffering. Some genitourinary conditions are potentially fatal, and in the acute or subacute setting, require re-evaluation of the end-of-life goals and wishes of the patient and family.
11
Hutton, Kim, and Ashok Daya Ram. Disorders of the urethra. Edited by David F. M. Thomas. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0117.
Full textAbstract:
Most disorders of the urethra in children are congenital in origin and affect boys more commonly than girls. They include; posterior urethral valves (PUV), anterior urethral valves, anterior urethral diverticulum, syringocele, urethral atresia, megalourethra, urethral web, urethral polyp, and urethral duplication. Urethral strictures may be congenital or acquired. Most cases of PUV are now diagnosed prenatally. Postnatal management comprises bladder drainage, correction of any metabolic disturbance, prevention of infection (UTI), and endoscopic valve ablation. Careful follow up is required with the aim of preventing urosepsis and preserving renal function. Persisting bladder dysfunction (‘valve’ bladder) can threaten renal function and should be managed aggressively. Chronic renal failure ultimately affects a third of boys with PUV, of whom 10–20% require renal transplantation during the course of childhood. PUV may also present clinically with recurrent UTI, urinary incontinence, or unexplained lower urinary tract symptoms.
12
Dodds, Chris, Chandra M. Kumar, and Frédérique Servin. Urological and gynaecological surgery in the elderly. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198735571.003.0010.
Full textAbstract:
Urological and gynaecological procedures are commonly performed in the elderly. Usually, urinary tract endoscopy and surgery should only be performed if the urine is made sterile. Infection of the urinary tract is always a threat, specifically in obstructive diseases and in patients with permanent bladder catheters. Simple measures may prevent most of the transurethral resection of the prostate (TURP) syndrome cases. The elderly patient taking anti-platelet or anticoagulant drugs and presented for endoscopic urological surgery are at special risk because these may lead to life-threatening haemorrhage, and stopping these drugs can lead to life-threatening cardiovascular and embolic phenomenon. For most of these procedures, the choice between general and regional (mainly spinal) anaesthesia must be influenced by the specific medical condition of the patient, his/her wishes, and the planned procedure.
13
Barsoum, Rashad S. Schistosomiasis. Edited by Vivekanand Jha. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0194_update_001.
Full textAbstract:
The urinary system is the primary target of Schistosoma haematobium infection, which leads to granuloma formation in the lower urinary tract that heals with fibrosis and calcification. While the early lesions may be associated with distressing acute or subacute symptoms, it is the late lesions that constitute the main clinical impact of schistosomiasis. The latter include chronic cystitis, ureteric fibrosis, ureterovesical obstruction or reflux which may lead to chronic pyelonephritis. Secondary bacterial infection and bladder cancer are the main secondary sequelae of urinary schistosomiasis.The kidneys are also a secondary target of S. mansoni infection, attributed to the systemic immune response to the parasite. Specific immune complexes are responsible for early, often asymptomatic, possibly reversible, mesangioproliferative lesions which are categorized as ‘class I’. Subsequent classes (II–VI) display different histopathology, more serious clinical disease, and confounding pathogenic factors. Class II lesions are encountered in patients with concomitant salmonellosis; they are typically exudative and associated with acute-onset nephrotic syndrome. Classes III (mesangiocapillary glomerulonephritis) and IV (focal segmental sclerosis) are progressive forms of glomerular disease associated with significant hepatic pathology. They are usually associated with immunoglobulin A deposits which seem to have a significant pathogenic role. Class V (amyloidosis) occurs with long-standing active infection with either S. haematobium or S. mansoni. Class VI is seen in patients with concomitant HCV infection, where the pathology is a mix of schistosomal and cryoglobulinaemic lesions, as well as amyloidosis which seems to be accelerated by the confounded pathogenesis.Early schistosomal lesions, particularly those of the lower urinary tract, respond to antiparasitic treatment. Late urological lesions may need surgery or endoscopic interventions. As a rule, glomerular lesions do not respond to treatment with the exception of class II where dual antiparasitic and antibiotic therapy is usually curative. Patients with end-stage kidney disease may constitute specific, yet not insurmountable technical and logistic problems in dialysis or transplantation. Recurrence after transplantation is rare.
14
Osman, Nadir I., and Christopher R. Chapple. Urethral diverticula. Edited by Christopher R. Chapple. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0042.
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Urethral diverticula (UD) are not uncommon, affecting up to 6% of the female population, but are in the majority of cases asymptomatic and of no clinical significance. They are thought to arise as a consequence of infection, obstruction, and subsequent rupture of a periurethral gland. UD often pose a significant diagnostic challenge, as symptoms are largely non-specific and easily confused with other conditions such as bladder pain syndrome and recurrent urinary tract infection. As such, both misdiagnosis and delayed diagnosis are common, to the frustration of both patients and surgeons. Traditional methods of diagnosis, such as voiding cystourethrogram, relied upon urethral catheterization and contrast instillation, and were associated with poor anatomical detail. Recent advances in imaging, particularly magnetic resonance imaging, have improved the diagnosis and staging of UD, and have allowed for more accurate preoperative planning.
15
Eastwood, John, Cathy Corbishley, and John Grange. Mycobacterial infections. Edited by Vivekanand Jha. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0196.
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The genus Mycobacterium contains over a hundred species including the M. tuberculosis complex and M. leprae, the causative agents of, respectively, tuberculosis and leprosy. The many other species are environmental saprophytes, present particularly in free and piped water sources, and some species are causes of opportunist disease in humans, especially in those who are immune compromised.The genitourinary tract is a common site of both primary and post-primary tuberculosis. In most cases of renal tuberculosis there are gross lesions consisting of caseating granulomas from which tubercle bacilli enter the urinary tract, often with the development of secondary lesions in the ureters, bladder, epididymis, and testis. Tuberculous interstitial nephritis is a less common condition with an insidious course and may result in renal failure. The urine is often negative for tubercle bacilli, emphasizing the need for biopsy in those with renal insufficiency.The risk of developing pulmonary or disseminated tuberculosis after infection is greatly enhanced by any form of immune compromise including renal failure and post-renal transplant immunosuppression.