Urology

Urinary Lignans Are Associated With Decreased Incontinence in Postmenopausal Women

Thu, 01 Oct 2015 10:44:44 +0000

Publication date: October 2015
Source:Urology, Volume 86, Issue 4
Author(s): Evgeniy I. Kreydin, Michelle M. Kim, Glen W. Barrisford, Dayron Rodriguez, Alejandro Sanchez, Yahir Santiago-Lastra, Dicken S.C. Ko
Objective To examine the association between urinary phytoestrogens and self-reported urinary incontinence in postmenopausal women in the United States using a large, cross-sectional, population-based cohort survey. Methods Data were analyzed for 1789 postmenopausal women aged 50 years or older who participated in one of the 2001-2010 cycles of National Health and Nutrition Examination Survey and underwent measurement of 4 isoflavone (soy derived) and 2 lignan (flax derived) phytoestrogens in their urine. Incontinence was defined as self-reported stress, urge, other, or mixed incontinence. Urine phytoestrogen concentrations were examined in weighted, multivariate logistic regression models for association with each of the lower urinary tract symptoms. All models were adjusted for age, body mass index, diabetes, race, smoking, and parity. Results Increasing urine concentrations of the lignan phytoestrogen enterodiol was associated with decreased likelihood of urge (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.85-0.99), mixed (OR, 0.90; 95% CI, 0.82-0.98), and other (OR, 0.90; 95% CI, 0.81-0.99) incontinence, whereas increasing urine concentrations of the lignan phytoestrogen enterolactone was associated with decreased likelihood of urge (OR, 0.92; 95% CI, 0.86-0.99) and mixed (OR, 0.91; 95% CI, 0.84-0.99) incontinence. No association was observed between any isoflavone phytoestrogens and types of incontinence. Conclusion This study demonstrates that lignan phytoestrogens may have a protective effect against incontinence in postmenopausal women. Prospective clinical and laboratory studies are warranted to investigate the mechanism of this relationship.

An Unusual Etiology for Hematospermia and Treatments That Were Successful

Thu, 01 Oct 2015 10:44:44 +0000

Publication date: October 2015
Source:Urology, Volume 86, Issue 4
Author(s): Hu Han, Xiao-guang Zhou, Dong-dong Fan, Long Tian, Xiao-dong Zhang
Objective To describe the unusual etiology and effective treatments of intractable hematospermia from posterior urethral hemangioma. Methods The ages, disease duration, syndromes, urinary routine, pathologic findings, immunohistochemical staining results, and postoperative complications of 5 patients were recorded. Four patients had a transurethral resection for total removal of lesions, and 1 patient was treated with transurethral fulguration. Results The 5 patients involved were middle aged with an average age of 46.2 years and average disease duration of 8.8 years. The clinical features of their hematospermia were as follows: break outs repeatedly after ejaculation in large quantities, no obvious mixing with the seminal plasma, urine after the first ejaculation or second in the morning is hematuria and is even accompanied by blood clots, and urethrorrhagia after sexual excitation, and there is no significant effect of various positive anti-inflammatory treatments. Cystourethroscopy found that the solitary varicosities were located between the distal end of the verumontanum and the external urethral sphincter. The varicose lesion was removed by transurethral resection for posterior urethral lesions, and the surrounding tissue was removed with fulguration. Vessel formation was confirmed by CD31 and CD34 immunohistochemical staining. Finally, the presence of posterior urethral hemangioma was verified in 4 patients by pathologic examination combined with immunohistochemistry, but 1 patient did not have any specimens available. Conclusion The possibility of posterior urethral hemangioma should be considered for patients with repeated intractable hematospermia. Cystourethroscopy is recommended for examination throughout patient services, and transurethral resection, fulguration, or laser cutting methods can also be performed.

Urinary Bother as a Predictor of Postsurgical Changes in Urinary Function After Robotic Radical Prostatectomy

Thu, 01 Oct 2015 10:44:44 +0000

Publication date: October 2015
Source:Urology, Volume 86, Issue 4
Author(s): Gregory Murphy, Peter Haddock, Hoyt Doak, Max Jackson, Ryan Dorin, Anoop Meraney, Stuart Kesler, Ilene Staff, Joseph R. Wagner
Objective To characterize changes in indices of urinary function in prostatectomy patients with presurgical voiding symptoms. Methods A retrospective analysis of our prostate cancer database identified robot-assisted radical prostatectomy patients between April 2007 and December 2011 who completed pre- and postsurgical (24 months) Expanded Prostate Cancer Index Composite-26 surveys. Gleason score, margins, D'Amico risk, prostate-specific antigen, radiotherapy, and nerve-sparing status were tabulated. Survey questions addressed urinary irritation/obstruction, incontinence, and overall bother. Responses were averaged to calculate a urinary sum (US) score. Patients were stratified according to the severity of their baseline urinary bother (UB), and changes in urinary indices determined at 24 months. Results A total of 737 patients were included. Postsurgical improvement in urinary obstruction, bother, and sum score was related to baseline UB ( P <.001). Men with severe baseline bother had the greatest improvement in US (+9.3), whereas those with asymptomatic baseline UB experienced a decline in US (−2.8). All patients experienced a decline in urinary incontinence of 6.3-8.3 that was independent of baseline bother ( P = .507). Patients with severe UB experienced positive outcomes, whereas those at asymptomatic baseline experienced negative US outcomes. Negative urinary incontinence outcomes were unrelated to baseline UB. Age, radiotherapy, and nerve-sparing status were not associated with improved UB ( P = .029). However, baseline UB was significantly associated with improvement in postsurgical UB ( P = .001). Conclusion Baseline UB is a predictor of postsurgical improvement in urinary function. These data are helpful when counseling a subset of robot-assisted laparoscopic radical prostatectomy patients with severe preoperative urinary symptoms.