Urinary incontinence (UI) in women is a common problem worldwide. It has a major impact on the physical and social activities and interpersonal relationships. The societies in the Gulf countries are ...conservative and favours large families, high parity and short inter-pregnancy intervals. Moreover, there is a high prevalence of gestational diabetes with many macrosomic babies. This study aimed to review the published literature on UI among women in this region.
All published literature which investigated the prevalence, social impact and help-seeking behavior in women with UI in the Gulf countries was reviewed.
Nine studies met the criteria and were very heterogeneous. None of them was a true population-based study and all except one, investigated subjects from healthcare facilities. The prevalence of UI ranged from 20.3% to 54.5%. Stress UI was the main type reported. The main predisposing factors were chronic respiratory diseases and constipation. There was a large impact on the quality of life with major interference with prayers (34–90%) and sexual relationships (18–57%). The main reasons for not seeking medical advice were embarrassment to see doctors especially male doctors and the belief that UI is common, normal or incurable disease.
There is a need for true whole population-based studies of UI in this region with the use of validated international questionnaires. UI was shown to have a major impact on the act of prayers and sexual relationships. A large proportion of women are still embarrassed to discuss the issue with doctors especially male doctors.
Research has demonstrated that hypertension can lead to an exaggeration in the renal functional and histological changes caused by ureteral obstruction. These changes were particularly observed ...shortly after the release of a relatively brief period of unilateral ureteral obstruction (UUO). However, the long-term impact of hypertension on the recovery of renal functions has not been investigated beyond the immediate period after UUO reversal. In order to investigate this effect, a group of spontaneously hypertensive rats (G-SHR, n = 11) and a group of normotensive Wistar Kyoto rats (G-NTR, n = 11) were subjected to a 48 h reversible left UUO. The impact of UUO was then examined 45 days after the reversal of obstruction. The glomerular filtration rate, renal blood flow, and the fractional excretion of sodium in the post-obstructed left kidney (POK) showed similarities to the non-obstructed right kidney (NOK) in both groups. However, the changes in the albumin creatinine ratio, renal injury markers, pro-apoptotic markers, and histological changes in the G-SHR were much more pronounced compared to the G-NTR. We conclude that hypertension continues to have a significant impact on various aspects of renal injury and function, even several weeks after UUO reversal.
Injury of the renal collecting system is a well-known complication of percutaneous nephrolithotomy (PNL). Large injuries may cause excessive bleeding and fluid extravasation and require adequate ...drainage using several modalities such placement of JJ stents. Herein, we report on two cases in which the upper coil of the JJ stent got buried in the fibrous tissues which formed due to an injury of the collecting system during PNL.
40 years old male and 32 years old female underwent standard PNL for partial and total staghorn calculi, respectively. During the procedure in both cases, the renal pelvis was injured. In both cases, JJ stent was used to drain the collecting system. Trial to remove the JJ stent 6 weeks following the procedure failed because the upper coils of the stents were embedded in the fibrous tissues at the perforation site. Laser incision of the fibrous tissues and releasing the upper coil of the stents were performed using percutaneous approach in the first case and flexible ureterorenoscopy (fURS) in the second patient. The procedures were uneventful in both cases.
This is the first report of embedded JJ stents which got buried by fibrous tissues at the site of collecting system injury that occurred during PNL. To prevent this complication in such cases, we suggest draining the collecting system using nephrostomy tube instead of JJ stent. Alternatively, the upper coil of the stent should be placed away from the injury site.
Both ureteral obstruction (UO) and hypertension are common conditions that affect kidney functions. Hypertension and chronic kidney disease are closely associated with an overlapping and intermingled ...cause-and-effect relationship. The effect of hypertension on the renal dysfunction following reversible UO has not been studied previously. To study this effect, spontaneously hypertensive (G-HT,
= 10) and normotensive Wistar (G-NT,
= 10) rats underwent 48-h reversible left unilateral UO (UUO), and the effect of UUO was studied 96 h following UUO reversal. The glomerular filtration rate, renal blood flow, and renal tubular functions such as the fractional excretion of sodium in the post-obstructed left kidney (POK) in both groups were significantly altered compared with the non-obstructed right kidney (NOK). However, the alterations in the G-HT were significantly more exaggerated when compared with the G-NT. Similar findings were observed with the histological features, gene expression of kidney injury markers, pro-inflammatory, pro-fibrotic and pro-apoptotic cytokines, and pro-collagen, as well as tissue levels of apoptotic markers. We conclude that hypertension has significantly exaggerated the alterations in renal functions and other parameters of renal injury associated with UUO.
Spontaneous JJ stent fragmentation can occur as early as 3 weeks post‐insertion. This could be due to a hostile urine environment and might be avoided by strict dietary modification, adequate ...hydration, and close follow‐up.
Spontaneous JJ stent fragmentation can occur as early as 3 weeks post‐insertion. This could be due to a hostile urine environment and might be avoided by strict dietary modification, adequate hydration, and close follow‐up.
Efforts to decrease the deleterious effects of renal ischemia-reperfusion injury (IRI) are ongoing. Recently, there has been increasing interest in using natural phytochemical compounds as ...alternative remedies in several diseases. Nerolidol is a natural product extracted from plants with floral odors and has been proven to be effective for the treatment of some conditions. We investigated the effect of nerolidol in a rat model of renal IRI. Nerolidol was dissolved in a vehicle and administered orally as single daily dose of 200 mg/kg for 5 days prior to IRI and continued for 3 days post IRI. G-Sham (
= 10) underwent sham surgery, whereas G-IRI (
= 10) and G-IRI/NR (
= 10) underwent bilateral warm renal ischemia for 30 min and received the vehicle/nerolidol, respectively. Renal functions and histological changes were assessed before starting the medication, just prior to IRI and 3 days after IRI. Nerolidol significantly attenuated the alterations in serum creatinine and urea, creatinine clearance, urinary albumin and the urinary albumin-creatinine ratio. Nerolidol also significantly attenuated the alterations in markers of kidney injury; proinflammatory, profibrotic and apoptotic cytokines; oxidative stress markers; and histological changes. We conclude that nerolidol has a renoprotective effect on IRI-induced renal dysfunction. These findings might have clinical implications.
The presence of intra-calcular gas might indicate the coexistence of gas-forming bacterial infections, which are potentially severe and life threatening. Gas-containing renal stones are rare. Herein, ...we present a case of gas-containing renal matrix stone that was associated with emphysematous pyelitis and reflect on its management.
A 30-year-old woman, with no underlying comorbidities, presented at 30 weeks of pregnancy with symptoms of pyelonephritis. Imaging showed no renal stones. Postdelivery, she presented again with similar symptoms in addition to pneumaturia. Imaging showed several large gas-containing renal matrix stones associated with emphysematous pyelitis, pneumoureter, and pneumobladder. She improved with oral antibiotics and underwent percutaneous nephrolithotomy 6 weeks later.
The presence of intra-calcular gas does not necessarily indicate a serious condition and the treatment can be planned according to the patient's symptoms and the presence and type of any emphysematous renal infection.
Flexible ureterorenoscopy (FURS) and holmium laser lithotripsy is currently considered as one of the treatment options for large renal calculi. It has been shown to be safer than percutaneous ...nephrolithotomy. The latter can sometimes be complicated by the formation of intrarenal arteriovenous malformation (AVM). AVM is extremely rare following FURS and laser lithotripsy. Indeed only one case has been reported on reviewing the literature up to June 2018. We report on the second case illustrating the possibility of developing this major complication following this procedure.
A 79 years old diabetic and hypertensive male with stage-4 chronic kidney disease who previously had left extracorporeal shockwave lithotripsy and FURS with Holmium laser lithotripsy, presented with bilateral large renal calculi. He underwent simultaneous bilateral FURS and Holmium laser lithotripsy and was discharged home the following day with almost clear urine. Four days post-discharge, he presented with gross hematuria for which he required hospitalization and blood transfusion. CT scan demonstrated left subcapsular, perinephric and retroperitoneal hematoma. Angiography showed contrast extravasation from pseudoaneurysms in two small branches of left renal artery. Both were selectively embolized with micro-coils and this led to the cessation of the hematuria.
Despite the relative safety of FURS and Holmium laser lithotripsy, it can be associated with major complications like intrarenal AVM. This can probably be prevented by careful and judicious use of laser energy in patients with large stone burden and premorbid conditions.
The healthcare-seeking behaviour of women with pelvic organ prolapse (POP) is affected by several factors including the cultural background. There is limited number of studies which addressed the ...healthcare-seeking behaviour in women with POP. The aim of this study was to determine the degree of bother, social impact and healthcare seeking behaviour of symptoms of POP in one of the Gulf countries and compare the results to published data from other areas.
All women who attended the three family development centres in our city between January 2010 and January 2011 and who had symptoms suggestive of POP were included in the study. The data was collected by well-trained interviewers.
One hundred twenty-seven women reported symptoms of POP (mean age: 38.2 years; range: 18-71). Out of these, 111 (87.4%) had at least one activity (physical, social or prayers) or sexual relationship affected by POP symptoms. In 49 women (38%), the effect on at least one of these activities or relationships has been described as moderate and in 18 women (14%), the effect was severe. Sixty-nine women (54%) did not seek medical advice due to: embarrassment to see medical doctors (51%), the belief that POP is normal among women (51%), hope for spontaneous resolution (48%), embarrassment to see male doctors (33%) and unawareness of the existence of medical treatment (30%). On univariate analysis, the need to insert the finger in the vagina to empty the bladder or bowel and the interference of symptoms with physical activities, had significantly determined healthcare seeking attitude (P < 0.05 for all). However, on multivariate analysis interference with physical activities was the only significant determinant (P = 0.04).
Although POP had affected the quality of life in the majority of the affected women, unlike some other societies, more than half failed to seek healthcare advice mainly due to shyness and embarrassment and lack of proper knowledge about the condition. Interference of symptoms with physical activities was the main significant determinants of healthcare-seeking behaviour. Additional teaching campaigns designed according to cultural backgrounds in each society are required to address these sensitive issues.
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