Renal renin-angiotensin system dysregulation caused by partial bladder outlet obstruction in fetal sheep.
BACKGROUND: To determine whether fetal renal obstruction activates the renal renin-angiotensin system (RAS), an important mediator in normal kidney development and obstructive nephropathy, we used a model of fetal partial bladder outlet obstruction (PBOO). METHODS: Total RNA and protein was extracted from kidney of sheep fetuses with partial bladder outlet obstruction created at 95 days gestation, after 2 (N = 6) and 5 weeks of obstruction (term; N = 6), and from normal fetal sheep at various time points between 60 and 135 days of gestation (total N = 19). Relative levels of mRNA for renin, angiotensinogen, type 1 and 2 angiotensin II (Ang II) receptors (AT-1 and AT-2), and transforming growth factor-beta1 (TGF-beta1) were assessed by semiquantitative reverse transcription-polymerase chain reaction. Expression levels of AT-2 receptor protein were measured by Western blot analysis. RESULTS: Renin mRNA expression was increased (250%) after two weeks of obstruction. In normal fetuses, AT-1 expression was low at 60 to 75 days of gestation and increased toward the end of gestation, whereas AT-2 expression showed a reversed pattern. At 109 days, PBOO caused an increased expression of AT-2 mRNA compared with normals (400%). Correspondingly, AT-2 receptor protein was more abundant in obstructed kidneys. TGF-beta1 mRNA expression was significantly increased in obstructed kidneys at 109 days gestation. CONCLUSIONS: These observations confirm the reciprocal developmental regulation of AT-1 and AT-2 receptors' expression, suggesting their functional role in renal development. Partial bladder outlet obstruction produces specific alterations: increased renin expression and altered balance of receptor subtypes, which may induce altered functional and vascular regulation of the obstructed fetal kidney. TGF-beta1, a mediator of Ang II-induced fibrosis, may play a role in inducing and propagating interstitial fibrosis. (+info)
The diagnostic yield of intravenous urography.
BACKGROUND: Intravenous urography (IVU) is considered an integral imaging component of the nephro-urological work-up in a wide array of clinical settings. At our institution there is an open-access policy with regard to requesting IVU studies. METHODS: In a prospective, blinded observational study we undertook to assess the diagnostic yield of IVU with respect to the source of referral (i.e. Urology, Nephrology, GP, A & E, other speciality) and the presenting features, such as renal colic, haematuria, bladder outflow obstruction, recurrent urinary tract infection (UTI) etc. Two hundred consecutive patients were evaluated. RESULTS: Overall, 23% of tests were positive. There was a highly significant difference in diagnostic yield between the groups (P<0.001 for both referral source and test indication). A positive result was most likely after referral by a kidney specialist (37.1%) and when the test indication was renal colic (42%) or haematuria (32%). The yield was <15% in all other circumstances, with 94.9% and 92.1% of GP- and other hospital speciality-initiated IVUs being negative. When investigating recurrent UTI, 91.7% of tests were negative and 86.2% were negative when the indication was bladder outflow obstruction. CONCLUSIONS: It is suggested that an open access policy for IVU is not justified, especially when cost and the risk associated with contrast media and radiation exposure are taken into account. Our study supports the abandonment of routine IVU in the investigation of UTI and bladder outflow obstruction. (+info)
Fetal penile length.
OBJECTIVE: To construct a reference range for fetal penile length. METHODS: The length of the penis was measured during ultrasound assessment of 95 structurally normal male fetuses of gestational ages 16-38 weeks. Two fetuses with bladder outflow obstruction were also examined. RESULTS: Fetal penile length increases significantly with gestational age, from a mean value of 6.0 mm at 16 weeks to 26.4 mm at 38 weeks. One fetus with urethral agenesis had a penile length on the 0.3rd centile. CONCLUSIONS: Measurement of the fetal penis is easy and not time-consuming. In cases of bladder outflow obstruction, assessment of penile length assists in the differentiation between urethral agenesis and posterior urethral valves. (+info)
Bladder outflow obstruction masquerading as pelviureteric junction (PUJ) obstruction.
We report a case of bladder outflow obstruction presenting with upper tract dilatation mistaken initially as pelviureteric junction (PUJ) obstruction. The lower tract obstruction ought to be dealt with first before upper tract obstruction is assessed because the renal pelvic pressure is significantly affected by vesical filling and high bladder pressure. (+info)
Use of the uroflow study in the diagnosis of bladder outlet obstruction in elderly men.
The uroflow and pressure-flow data of 67 men aged 65 years or more were compared. At best, the uroflow study applying the Liverpool nomogram (25th percentile) and Bristol nomogram (OSD) diagnosed bladder outlet obstruction with sensitivity of 62.5% and 62.5% and specificity of 48.8% and 74.4% respectively. Using the 50th percentile of the Liverpool nomogram as the cut-off resulted in a negative predictive value of 100.0% allowing about 10% of men to have this diagnosis ruled out. We conclude that the uroflow study is inaccurate in diagnosing bladder outlet obstruction in elderly men. However, it can be used to rule out this condition in the small subset of men with maximum flow rates above the 50th percentile of the Liverpool nomogram. (+info)
Evaluation for Madigan's prostatectomy in patients with benign prostatic hyperplasia.
AIM: To comparatively evaluate the efficacy and post-operative complications of the Madigan's prostatectomy (MPC) and suprapubic prostatectomy (SPPC). METHODS: A total of 43 patients with benign prostatic hyperplasia were divided into two groups: 21 underwent MPC and 22, SPPC. In all the patients, the international prostate symptom score (IPSS) and urinary pressure-flow studies were assessed before and 6 months after operation. The International Continence Society (ICS) nomogram, Abrams-Griffiths (AG) number and linear passive urethral resistance relation analysis (L-PURR) were used to diagnose and grade bladder outlet obstruction (BOO). The IPSS and the urodynamic parameters before and after operation, as well as the advantages and post-operative complications were recorded and compared. RESULTS: Patients of both the MPC and SPPC groups had a significant improvement in IPSS and urodynamic parameters. Obstruction was relieved in 81.0% of MPC and 86.4% of SPPC patients. MPC has the advantages of the absence of postoperative hematuria and post-catheter stricture, a shorter period of hospitalization, and lower incidence of retrograde ejaculation and erectile dysfunction. CONCLUSION: Both MPC and SPPC can effectively relieve BOO. MPC has certain advantages and a lower incidence of complications as compared with SPPC. (+info)
The effectiveness of reducing the daily dose of finasteride in men with benign prostatic hyperplasia.
BACKGROUND: Finasteride, a 5 alpha reductase inhibitor, is an established treatment for benign prostatic hyperplasia. The recommended dosage is 5 mg a day, however case reports have show effectiveness with lower doses. The objective of the current study was to determine in men with benign prostatic hyperplasia, previously treated for at least one year with finasteride 5 mg daily, if they will maintain subjective and objective improvements in urinary obstruction when treated with 2.5 mg of finasteride daily for one year. METHODS: In an open label, prospective study, 40 men with benign prostatic hyperplasia, previously treated for at least one year with 5 mg of finasteride, took 2.5 mg of finasteride daily for one year. Measurements included AUA symptom score, maximum flow rate, voided volume and PSA. RESULTS: There were no significant changes in maximum flow rate, voided volume, or AUA symptom score after one year of finasteride 2.5 mg daily therapy. PSA increased significantly, p <.01, after one year of finasteride 2.5 mg daily, 2.0 +1.4 ng/ml, when compared to finasteride 5 mg daily, 1.4+ 1.0 ng/ml. CONCLUSIONS: The daily dose of finasteride can be reduced to 2.5 mg daily without significant effect on subjective and objective measures of urinary obstruction. Although statistically significant increases in PSA are noted when reducing the daily finasteride dose from 5 mg to 2.5 mg, the clinical significance of a mean.6 ng/ml increase in PSA is questionable. (+info)
Fetal, perinatal, and infant death with congenital renal anomaly.
AIMS: To ascertain why 19.6% of pregnancies in which a fetal renal anomaly has been detected fail to produce a surviving child, and whether antenatal diagnostic accuracy has altered since specialised fetal medicine units were established in 1995. METHODS: An analysis of deaths was conducted among fetuses and babies with a congenital abnormality in the urinary tract notified to the Northern Region Congenital Abnormality Survey (NorCAS). There were 560 deaths among 2857 cases with an anomaly in the urinary tract delivered between 19 February 1984 and 21 March 2000. RESULTS: Renal anomaly was the cause of death in 323 (57.7%) cases. Excluding 10 which were not screened, 126 (60%) of 210 pre-1995 had been suspected antenatally and 81 (78.6%) of 103 post-1995. No abnormality had been suspected in 39 (18.6%) cases pre-1995 and four (3.9%) post-1995. Postnatal death occurred in 89 (41.4%) pre-1995 and in 13 (12%) post-1995. There were 209 cases of death caused by anomalies in other systems but with a renal anomaly present, of which 66 (31.6 %) were chromosomal and 36 (54.5%) had a horseshoe kidney. Of the cases with a horseshoe kidney, 56.3% had a chromosomal anomaly. CONCLUSIONS: The antenatal diagnosis of renal anomalies which cause death did not improve significantly in the second period of this study. However, the number of false positive antenatal diagnoses and the number of postnatal deaths were significantly lower and the number of pregnancy terminations were significantly higher. This reduced the risk of delivering a live baby with an unexpected fatal renal anomaly. (+info)