Common Urological Conditions in the Female

Stress incontinence, urge incontinence, and pyelitis of pregnancy are common urological conditions in the female. Poor therapeutic results in the treatment of stress incontinence may be traced to errors in diagnosis. Accurate diagnosis is based on an accurate history, residual urine test, the stress test, cystometric studies (to rule out neurogenic disturbances), cystourethroscopy and cystourethrography. The most important factor in the production of urge incontinence is infection. Some pathological conditions which may be associated with urge incontinence are urethritis, cystitis, urethral stricture, bladder-neck obstruction, urethral diverticula, urethral caruncle and the urgencyfrequency syndrome. Therapy is directed toward the eradication of infection and treatment of the specific lesion. In pyelitis of pregnancy it is urged that, in cases of unusual bacterial virulence and poor ureteral drainage, early cystoscopic ureteral catheter drainage should be instituted in order to prevent permanent kidney damage. The closest co-operation of urologist, gynecologist and general physician is necessary for clarification of some of the more complex problems.     

Nonspecific Urethritis in Females

The possibility of nonspecific urethritis must be considered in females with persistent irritative symptoms of the lower urinary tract despite “negative” urine cultures. The diagnosis can be made only by the proper collections of urine specimens from both the urethra and the bladder. These specimens will reveal the presence of white blood cells in the urethral washings, while the midstream (bladder) specimen will be free of cells.     

PCR for diagnosis of male Trichomonas vaginalis infection with chronic prostatitis and urethritis

The aim of this study was to assess the usefulness of PCR for diagnosis of Trichomonas vaginalis infection among male patients with chronic recurrent prostatitis and urethritis. Between June 2001 and December 2003, a total of 33 patients visited the Department of Urology, Hanyang University Guri Hospital and were examined for T. vaginalis infection by PCR and culture in TYM medium. For the PCR, we used primers based on a repetitive sequence cloned from T. vaginalis (TV-E650). Voided bladder urine (VB1 and VB3) was sampled from 33 men with symptoms of lower urinary tract infection (urethral charge, residual urine sensation, and frequency). Culture failed to detect any T. vaginalis infection whereas PCR identified 7 cases of trichomoniasis (21.2%). Five of the 7 cases had been diagnosed with prostatitis and 2 with urethritis. PCR for the 5 prostatitis cases yielded a positive 330 bp band from bothVB1 and VB3, whereas positive results were only obtained from VB1 for the 2 urethritis patients. We showed that the PCR method could detect T. vaginalis when there was only 1 T. vaginalis cell per PCR mixture. Our results strongly support the usefulness of PCR on urine samples for detecting T. vaginalis in chronic prostatitis and urethritis patients.     

Asymptomatic gonorrhoea and chlamydial infection in rural Tanzanian men.

OBJECTIVE: To measure the prevalence of urethritis due to Neisseria gonorrhoeae and Chlamydial infection trachomatis in rural Tanzanian men DESIGN: About 500 men aged 15-54 years were selected from each of 12 rural communities by random cluster sampling; interviewed concerning past or present symptoms of sexually transmitted diseases; and asked to provide a first catch urine specimen, which was tested for pyuria with a leucocyte esterase dipstick test. Subjects with symptoms or with a positive result on testing were examined, and urethral swabs were taken for detection of N gonorrhoeae by gram stain and of C trachomatis by antigen detection immunoassay. SETTING: Mwanza region, north western Tanzania. SUBJECTS: 5876 men aged 15-54 years. MAIN OUTCOME MEASURES: Prevalence of urethral symptoms, observed urethral discharge, pyuria, urethritis ( > 4 pus cells per high power field on urethral smear), N gonorrhoeae infection (intracellular gram negative diplococci), and C trachomatis infection (IDEIA antigen detection assay). RESULTS: 1618 (28%) subjects reported ever having a urethral discharge. Current discharge was reported by 149 (2.5%) and observed on examination in 207 (3.5%). Gonorrhoea was found in 128 subjects (2.2%) and chlamydial infection in 39 (0.7%). Only 24 of 158 infected subjects complained of urethral discharge at the time of interview (15%). CONCLUSION: Infection with N gonorrhoeae and C trachomatis is commonly asymptomatic among men in this rural African population. This has important implications for the design of control programmes for sexually transmitted disease.     

运用PCR 扩增技术检测解脲脲支原体生物群的临床应用

目的:探讨运用酶链聚合反应(PCR)技术检测泌尿生殖道解脲脲原体(Uu)的生物群,分析Uu生物群与临床症状的相关性。方法:以支原体16S rRNA保守区域基因为扩增靶序列设计引物,采用PCR方法扩增Uu 16S rRNA基因检测125例临床标本,并将检测结果与临床症状进行相关性分析。结果:PCR法检出Uu阳性率44.8%,其中35例Uu生物1群阳性,其中有16例有症状;27例Uu生物2群阳性,其中有18例有症状。Uu生物1群感染与症状的相关性无统计学差异(P>0.05),而Uu生物2群感染与症状相关性有统计学差异(P<0.05)。结论:PCR检测Uu 16S rRNA基因可用于Uu生物群的检测,Uu生物2群可能是非淋菌性尿道炎(NGU)的一个致病菌,而Uu生物1群与NGU无明显相关性。     

解脲脲原体药物敏感性变迁研究

目的:探讨上海地区2008与2012年泌尿生殖道解脲脲原体(Ureaplasma urealyticum,UU)耐药性变化,为临床合理用药提供参考。方法:采用自制UU药物敏感检测试剂对2008年450例和2012年459例患者的标本进行检测,观察UU阳性情况及UU对交沙霉素、氧氟沙星、阿奇霉素和强力霉素的药物敏感性。结果:2008年分离到150例UU阳性标本和2012年分离到134例UU阳性标本分别对交沙霉素、强力霉素、氧氟沙星和阿奇霉素等4种抗菌素的敏感率有显著性差异;2008年46例和2012年38例男性患者阳性标本中分离的UU分别对交沙霉素和阿奇霉素敏感率有显著性差异;对强力霉素和氧氟沙星敏感率无显著性差异。2008年104例和2012年96例女性患者阳性标本中分离的UU分别对交沙霉素、强力霉素、氧氟沙星和阿奇霉素等4中抗菌素的敏感率都有显著性差异。结论:5年间UU药物敏感性发生了变迁;临床医师应该关注本地区药物敏感性变迁,合理选用抗生素。     

Role of Chlamydia trachomatis and HLA-B27 in sexually acquired reactive arthritis.

Inflammatory arthritis, tendinitis, and fasciitis after non-specific urethritis ("sexually acquired reactive arthritis" (SARA)) was studied prospectively in 531 men with non-specific urethritis, with particular reference to the frequency of isolation of Chlamydia trachomatis and the presence of HLA-B27. Satisfactory cultures were obtained from the urethral swabs from 384 patients; and HLA typing was performed on 482, of whom 30 (6%) were HLA-B27-positive. Arthritis developed in 16 patients, and five of the 14 (36%) with satisfactory cultures were positive for C trachomatis; 135 of the patients without arthritis were also positive for C trachomatis, an identical proportion. Seven of the 15 patients (40%) with arthritis who were HLA-typed were HLA-B27-positive. Six of the 30 patients with HLA-B27 developed peripheral arthritis in contrast to only nine of the 452 patients lacking the antigen, suggesting a tenfold increase susceptibility. C trachomatis, however, was no more prevalent in cultures from HLA-B27-positive men than from the others. Thus carriage of C trachomatis is unlikely to be influenced by HLA-B27. C trachomatis may be an important pathogen in some cases of SARA but does not appear to be an exclusive trigger factor for this condition.     

阴道消毒治疗护理器的临床应用

目的:探讨妇科手术后病人的阴道护理的新方法、新手段,旨在提高临床疗效。方法:随机选取398例妇科手术后的病人做常规会阴护理,对其中172例使用阴道消毒治疗器做阴道护理。结果:试验组的172例术后病人在尿路感染率、阴道炎、宫颈炎、息肉发生率明显低于常规组。结论:妇科手术后病人在应用新式阴道消毒治疗器后,不但能弥补传统阴道护理方法的不足,还明显扩大了会阴护理的消毒范围,减少妇科手术后阴道、尿道逆行感染的发生率,有效的提高临床疗效。新式阴道消毒护理器应是目前临床应用中的较理想的护理方法和手段。     

Struvite penile urethrolithiasis in a pygmy sperm whale (Kogia breviceps)

Massive urolithiasis of the penile urethra was observed in an adult pygmy sperm whale (Kogia breviceps) stranded on Topsail Island, North Carolina, USA. Calculi occupied the urethra from just distal to the sigmoid flexure to the tip of the penis for a length of 43 cm. A urethral diverticulum was present proximal to the calculi. The major portion of the multinodular urolith weighed 208 g and was 16 cm long x 3.7 cm diameter at the widest point. The urolith was composed of 100% struvite (magnesium ammonium phosphate) and on culture yielded Klebsiella oxytoca, a urease-positive bacterium occasionally associated with struvite urolith formation in domestic animals. Reaction to the calculi was characterized histologically by moderate multifocal to coalescing plasmacytic balanitis and penile urethritis. Role of the urethrolithiasis in the whale's stranding is speculative but could have involved pain or metabolic perturbations such as uremia or hyperammonemia.     

COMMON LESIONS OF THE URETHRA IN WOMEN

Urethral disease in women and girls often is overlooked. As the urine may seem to be normal as determined by repeated urinalysis, the symptoms—urinary frequency and burning—may be attributed entirely to other pelvic disease or to functional disorder. Since erroneous diagnosis may lead to unnecessary procedures or to neglect of treatment with consequent development of severe disease in the kidneys or ureters, it is important to consider urethral lesions as a possible cause in any case of abdominal discomfort in women.The most common lesions of the urethra in women are urethritis, stricture, caruncle, inflammatory polyps and cysts, prolapse of the urethra, and diverticulum. In some cases diagnosis can be made simply on the basis of inspection and palpation. In others more extensive diagnostic procedures must be carried out in order that treatment may be definitive.The methods of treatment, varying with the nature of the lesion, are outlined herein.     

Inapparent genital infection with Chlamydia trachomatis and its potential role in the genesis of Reiters syndrome.

An infectious etiology has been suggested for Reiter's syndrome (RS) because the disease has often been observed to follow episodes of urethritis or dysentery. Despite demonstrations of bacterial antigens in the synovial tissues of RS patients, it is not clear whether viable organisms are present in the synovium in any particular stage of this disease. Furthermore, it is not clear how either viable organisms or their product(s) might reach the joints. Infection with the bacterium Chlamydia trachomatis is the most common sexually transmitted disease in the United States, and as such this organism has emerged as a primary pathogen associated with RS. Previous work from our group has shown that synovial biopsy tissues from a majority of RS patients studied show significant levels of apparently intact chlamydial RNA, even when synovial or urethral cultures from the same patients are unequivocally negative for the organism. We show here that inapparent urethral infection with chlamydia occurs with high prevalence in men, and that inapparent cervical infection with the organism occurs at high prevalence in women. These data provide an important link in the relationship between initial chlamydial infection and possible subsequent genesis of RS, and they may give useful insight into mechanisms by which chlamydial infection can lead to development of this disease. Our data argue further that inapparent infection may be a significant factor in pathogenesis for all chlamydia-related diseases, and they suggest that, contrary to current ideas, C. trachomatis can generate disseminated infection.     

Infectious Urethritis in Men and Women: Diagnosis and Treatment

Acute and recurrent infectious urethritis in men and women is commonly seen by physicians. Since specific therapy varies widely with the type of urethritis present, the proper diagnosis must be clearly established if curative drug therapy is to be selected. It is valuable, therefore, to review the diagnosis and therapy of the various forms of infectious urethritis that are recognized today in both men and women.     

Surface localized glyceraldehyde-3-phosphate dehydrogenase of Mycoplasma genitalium binds mucin

Mycoplasma genitalium is the smallest known self-replicating cell. It was first isolated from urethral specimens in individuals with non-gonococcal urethritis and, more recently, from respiratory and synovial sites. Our laboratory has been interested in defining the mechanisms by which M. genitalium adheres to and colonizes host cell surfaces. In order to determine potential targets of adherence, we examined the interaction of M. genitalium with a primary component of the mucosal epithelial lining, mucin (Mn). Three Mn-binding proteins (MnBPs) of M. genitalium were isolated by affinity chromatography. One of these proteins was identified by N-terminal sequencing as glyceraldehyde-3-phosphate dehy-drogenase (GAPDH). Antiserum raised against recombinant GAPDH blocked binding of intact biosynthetically labelled mycoplasmas to mucin by approximately 70%. Whole cell radioimmunoprecipitation indicated that GAPDH was surface-accessible and surface localization of GAPDH was further verified by membrane fractionation and immunoelectron microscopy. The role of GAPDH as an adhesin to Mn not only provides insights into the organism's mechanisms of adherence and colonization but also into its ability to maximize its limited genome.     

Diagnosis and treatment of urethritis in men.

Gonococcal and nongonococcal urethritis are the most common sexually transmitted diseases in men. Failure to control these infections is a result of improper treatment of index cases and their sexual contacts. The proper management of urethritis in men is reviewed.     

Arterial Hypertension and Ischemic Heart Disease: Comparison in Epidemiological Studies

Forty cases of gonococcal urethritis were treated with oxytetracycline using various dosage schedules; there were 37 cures and three failures. The most convenient and most effective dosage was found to be 250 mg. oxytetracycline, given as a single intramuscular injection of 5 c.c.A series of 40 patients with non-gono-coccal urethritis was also collected. Two cases of urethritis due to Trichomonas vaginalis and two due to Candida albicans were removed from the series. Of the 36 cases which remained, cure was obtained with the use of oxytetracycline in different dosages in 30 cases; six cases were failures. The dosage which gave the best result in the therapy of non-gonococcal urethritis was 250 mg. oxytetracycline (5 c.c.), given as a single intramuscular injection, plus 250 mg. orally, four times a day for four days.The effectiveness of oxytetracycline in the treatment of urethritis has not decreased.     

Epidemiology of sexually transmitted Chlamydia trachomatis infections in male patients

868 male urethritis patients were studied for the presence of chlamydiae in the 1981-1986 period. 36% of NGU, 31.3% of gonococcal urethritis and 58.8% of PGU urethritis patients presented C. trachomatis infections as detected by cell culture inoculation. Chlamydial infection was recorded more often in the 21-30 years age group (30.8%), in unmarried patients (70.6%), as well as in people with low educational degree (46.6% of cases), 42.3% of the C. trachomatis cases were already confronted with one or more urethritis episodes. 24.7% of patients have been subjected to a previous antichlamydial treatment.     

The transferrin receptor expressed by gonococcal strain FA1090 is required for the experimental infection of human male volunteers

Iron, an essential nutrient for most microorganisms, is sequestered by the host to decrease the concentration of iron available to bacterial pathogens. Neisseria gonorrhoeae , the causative agent of gonorrhoea, can acquire iron by direct interaction with human iron-binding proteins, including the serum glycoprotein, transferrin. Iron internalization from host transferrin requires the expression of a bacterial receptor, which specifically recognizes the human form of transferrin. Two gonococcal transferrin-binding proteins have been implicated in transferrin receptor function, TbpA and TbpB. We constructed a gonococcal transferrin receptor mutant without the introduction of additional antibiotic resistance markers and tested its ability to cause experimental urethritis in human male volunteers. The transferrin receptor mutant was incapable of initiating urethritis, although the same inoculum size of the wild-type parent strain, FA1090, causes urethritis in >90% of inoculated volunteers. To our knowledge, this is the first experimental demonstration that a bacterial iron acquisition system is an essential virulence factor for human infection.     

Experimental Mycoplasma infection of the urogenital tract in monkeys

The possibility of the experimental reproduction of infectious urethritis in monkeys by infecting them with mycoplasma and ureaplasma cultures, newly isolated from human patients, has been shown. In monkeys inoculated with the mixture of mycoplasmas and ureaplasmas, more pronounced infectious urethritis with the symptoms of ascending infection develops. The animals who have had the disease do not develop resistance to repeated infection.     

溶脲脲原体及其两个生物群与非淋菌性尿道炎相关性的研究

目的 阐明溶脲脲原体及其2个生物群与非淋菌性尿道炎的关系。方法 使用通用引物-PCR-毛细管电泳法对淋菌性尿道炎组,非淋菌性尿道炎组和对照组中的溶脲脲原体的2个生物群进行检测。结果 溶脲脲原体生物群2在非淋菌性尿道炎中的检出率高于对照组（P〈0．05）,溶脲脲原体生物群1在淋菌性尿道炎中的检出率低于对照组（P〈0．05）,而在非淋菌性尿道炎和对照组中,溶脲脲原体生物群1的检出率差异无显著性（P〉0．05）。结论 溶脲脲原体生物群2是和非淋菌性尿道炎有一定关系的,溶脲脲原体生物群2可能才是引起非淋尊性尿道炎的病原体之一,而生物群1不引起非淋菌性尿道炎,淋球菌的增殖有可能抑制尿道中的溶脲脲原体生物群1的生长。     

Urethral closure mechanisms during sneezing-induced stress in anesthetized female cats

During stress-induced increase in abdominal pressure, urinary continence is maintained by urethral closure mechanisms. Active urethral response has been studied in dogs and rats. Such an active urethral response is also believed to occur in humans during stress events. We aimed to investigate urethral closure mechanisms during sneezing in cats. Urethral pressures along the urethra (UP1-UP4), with microtip transducer catheters with UP4 positioned in the distal urethra where the external urethral sphincter (EUS) is located, and intravesical pressure were measured, and abdominal wall, anal sphincter (AS), levator ani (LA), and EUS electromyograms (EMGs) were recorded during sneezing under closed-abdomen and open-abdomen conditions in eight anesthetized adult female cats. Proximal and middle urethral response induced by sneezing was not different from bladder response. Distal urethral response was greater compared with proximal and middle urethral and bladder response. In the open-abdomen bladder, proximal and middle urethral responses were similarly decreased and distal urethral response was unchanged compared with the closed-abdomen bladder. Bladder and urethral responses were positively correlated to sneeze strength. EUS, LA, and AS EMGs increased during sneezing. No urine leakage was observed, regardless of the strength of sneeze. In cats urethral closure mechanisms are partly passive in the proximal and middle urethra and involve an active component in the distal urethra that is believed to result from EUS and possibly LA contractions. Because central serotonin exerts similar effects on the lower urinary tract in cats and humans, the cat may represent a relevant model for pharmacological studies on continence mechanisms.