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PubMed1994

Surgical implications of genitourinary tract anomalies in patients with imperforate anus.

Genitourinary anomalies in patients with imperforate anus are a frequent source of significant morbidity. We report a retrospective study of 64 genitourinary procedures performed on 23 patients. Renal, collecting system, bladder and perineal anomalies were encountered in 65%, 83%, 87% and 65% of these complex cases, respectively. A total of 70% of the patients required intermittent catheterization due to bladder dysfunction. Surgical alternatives, complications of management and functional outcomes are reviewed in detail. Genitourinary reconstruction is best undertaken as an integral part of imperforate anus reconstruction. Failure to do so results in the loss of surgical alternatives, unnecessary reoperative procedures and compromised outcomes.

Abnormalities, Multiple↗
PubMed1996

Indicators of genitourinary tract injury or anomaly in cases of pediatric blunt trauma.

PURPOSE: Microscopic hematuria (> or = 20) RBCs per high-power field [HPF] has been used frequently as an indicator for genitourinary (GU) tract injury in pediatric cases of blunt trauma. The aim of this study was (1) to determine whether a certain threshold of microscopic hematuria was associated with GU tract injury in our patient population, and (2) to identify additional factors warranting evaluation of the GU tract. METHODS: The records of 100 patients under 18 years of age whose discharge diagnosis in the trauma registry included hematuria or GU tract injury were reviewed retrospectively (1989 through 1993). The following data were collected: age, sex, mechanism of injury, physical findings, associated injuries, urinalysis results, radiographic study results, disposition, and outcome. Data were analyzed using the SPSS program. RESULTS: The majority of children were victims of motor vehicle accidents. All but one study patient had an intravenous pyelogram and/or computed tomography scan. Twenty-seven patients had GU tract injuries or previously unrecognized congenital anomalies (9 contusions, 5 lacerations, 1 vascular pedicle injury, 4 bladder injuries, 3 urethral/vaginal tears, 5 anomalies). Twenty-seven percent (3 of 11) of children with minor injuries and 25% (2 of 8) of those with major injuries had microscopic hematuria of less than 20 RBCs/HPF. Mechanism of injury and hypotenison were not associated with GU tract injury. One third of the patients with isolated chest or abdominal injuries, and 50% of those with combined chest/abdominal injuries had GU tract injuries or anomalies identified. Pelvic fracture was associated with GU tract injury or anomaly in 50% of cases (P < 0.02). CONCLUSION: The authors found that (1) a threshold of > or = 20 RBCs/HPF as an indication for radiograph evaluation would have missed 28% of cases with GU tract injuries or occult anomalies, and (2) pelvic fractures and abdominal/chest injuries help to identify patients who require evaluation of the GU tract. The need for GU tract evaluation in pediatric trauma patients is based as much on clinical judgment as on the presence of hematuria.

Adolescent↗
PubMed2002

Epithelial-specific Cre/lox recombination in the developing kidney and genitourinary tract.

Ksp-cadherin is a unique, tissue-specific member of the cadherin family of cell adhesion molecules that is expressed in tubular epithelial cells in the kidney and developing genitourinary (GU) tract. It has recently been shown that a 1341-bp fragment of the 5' flanking region containing the Ksp-cadherin gene promoter can recapitulate the complete expression pattern of the gene in the developing kidney and GU tract. Similar to the endogenous Ksp-cadherin gene, transgenes containing 1341 bp of the 5' flanking region are expressed in developing nephrons, ureteric bud, mesonephric tubules, Wolffian duct, and Müllerian duct. In adult mice, the expression is restricted to renal tubules. In the current study, Ksp1.3/Cre transgenic mice carrying 1329 bp of the Ksp-cadherin 5' flanking region linked to the Cre recombinase gene were produced. Adult transgenic mice expressed Cre recombinase in renal tubules, especially collecting ducts and thick ascending limbs of Henle's loops. Transgenic embryos expressed Cre recombinase in the branching ureteric bud, developing renal tubules, and sex ducts. Ksp1.3/Cre transgenic mice were crossed with mice carrying a lacZ reporter gene that is activated by Cre/lox-mediated genetic recombination. Bitransgenic progeny expressed lacZ exclusively in renal tubules, mesonephric tubules, ureteric bud, developing ureter, and Wolffian duct. These results demonstrate that Ksp1.3/Cre transgenic mice express Cre recombinase exclusively in the kidney and developing GU tract and can mediate epithelial-specific Cre/lox recombination in these tissues. Ksp1.3/Cre transgenic mice should be useful for cell lineage studies and kidney-specific gene targeting.

Aging↗
PubMed2002

A minimal Ksp-cadherin promoter linked to a green fluorescent protein reporter gene exhibits tissue-specific expression in the developing kidney and genitourinary tract.

Ksp-cadherin is a unique, tissue-specific member of the cadherin family of cell adhesion molecules that is expressed exclusively in tubular epithelial cells in the kidney and developing genitourinary (GU) tract. Transgenic mice carrying 3425 bp of the Ksp-cadherin 5' flanking region linked to a lacZ reporter gene express beta-galactosidase exclusively in the kidney, although the expression pattern is incomplete (Am J Physiol 277: F599-F610, 1999). To further define the region that mediates tissue-specific expression, transgenic mice carrying 1341 bp or 324 bp of the 5' flanking region linked to a green fluorescent protein (GFP) reporter gene were produced. Transgenic mice carrying 1341 bp of the 5' flanking region expressed GFP in all embryonic tissues that endogenously express Ksp-cadherin, including the ureteric bud, Wolffian duct, Müllerian duct, and developing tubules in the mesonephros and metanephros. In the adult kidney, GFP was highly expressed in thick ascending limbs of Henle's loops and collecting ducts and weakly expressed in proximal tubules and Bowman's capsules. Transgenic mice carrying 324 bp of the 5' flanking region exhibited expression exclusively in tubular epithelial cells in the developing kidney and GU tract. Immunoblot analysis showed that the expression of GFP was restricted to the kidney in adult mice. Taken together, these results demonstrate that 324 bp of the Ksp-cadherin 5' flanking region is sufficient to direct epithelial-specific expression in the developing kidney and GU tract. Transgenic mice that express GFP in the mesonephros, metanephros, ureteric bud, and sex ducts may be useful for cell lineage studies.

Aging↗
PubMed1980

Late genitourinary tract complications associated with severe pelvic injury.

The late urologic complications in certain patients with a severe pelvic injury is inevitable, regardless of the immediate form of therapy instituted to the traumatized lower part of the urinary tract. The three most common late genitourinary complications are deep urethral stricture, urinary incontinence and erectile impotency. The modified posterior urethroplasty for deep urethral stricture used in this series is simple and extremely successful. The genitourinary prosthesis was found quite useful in the surgical management of traumatic urinary incontinence and erectile impotency. These surgical techniques have made it possible to rehabilitate totally the crippling urologic sequelae of pelvic trauma.

Adult↗
PubMed1989

Sarcomas of the retroperitoneum and genitourinary tract.

A total of 62 patients with retroperitoneal or genitourinary sarcoma was treated at our institutions during the last 46 years. Of the patients 51 were followed for at least 5 years or until they died (median followup 11 years); 5 patients were lost to followup. The most common site was the retroperitoneum. Liposarcoma, leiomyosarcoma and malignant fibrous histiocytoma were the most common tumors (74 per cent). Tumors were completely resected in 42 patients (68 per cent) and incompletely resected in 11, while a biopsy only was performed in 9. Some patients also received adjuvant radiation therapy and/or chemotherapy. There were no long-term survivors among patients with unresectable tumors. Over-all 3 and 5-year survival rates were 68 and 39 per cent, respectively. The histological type of the tumor appeared to have prognostic significance. The highest 5-year survivals were for liposarcoma (70 per cent), malignant fibrous histiocytoma (33 per cent) and leiomyosarcoma (13 per cent). The mean survival for patients after adjuvant radiation therapy or chemotherapy was similar to that after a radical operation alone. The primary cause of treatment failure was local recurrence (45 per cent of the patients), which was detected within 3 years of complete resection in most cases (82 per cent). Complete extirpation that provided adequate margins free of tumor was the most effective initial treatment and provided the best chance for cure.

Combined Modality Therapy↗
PubMed1991

Nonvascular intervention in the genitourinary tract.

The past few years have seen significant expansion in interventional genitourinary radiology. Balloon dilatation of the prostate is a new, safe procedure that may be offered as a surgical alternative to high-risk patients as well as to younger patients wishing to avoid surgical complications. The procedure is contraindicated in patients with middle lobe hypertrophy, carcinoma, very large glands, or a history of retention. Because of the lack of large randomized controlled studies, the procedure should still be considered investigational. Transcervical fallopian tube recanalization for proximal tubal occlusion is another new outpatient procedure with low morbidity and cost compared with the more expensive alternatives of in vitro fertilization and tubal microsurgery. Pregnancy rates approach 60% in selected subgroups of patients. Furthermore, selective salpingography may provide diagnostic information not available with conventional hysterosalpingography. The most recent advance in renal parenchymal biopsy has been the development of an automated biopsy gun, which, in conjunction with real-time ultrasonographic monitoring, has increased the ease, speed, and accuracy of the procedure and significantly decreased complications.

Biopsy, Needle↗
PubMed2006

Lower genitourinary tract sources of seminal HIV.

OBJECTIVE: To investigate genital tract sources of HIV-1, we conducted extensive genitourinary sampling of 23 seropositive men without urethritis who shed HIV in their seminal plasma. DESIGN: Semen was collected, then samples were obtained for HIV RNA in blood plasma, urethral fluid, pre-prostate massage fluid/urine (PMF/U) and post-PMF/U, and expressed prostatic secretions. Systematic transrectal ultrasound-guided prostate biopsies obtained from multiple prostate areas were evaluated for HIV RNA and DNA. RESULTS: Seminal HIV RNA levels correlated with HIV RNA levels in urethral fluid and post-PMF/U and with prostate biopsies HIV DNA, but not with expressed prostatic secretions HIV RNA. However, only the HIV RNA level in post-PMF/U independently predicted that in semen (2.77-fold change in semen for each 10-fold change in post-PMF/U; 95% confidence interval, 1.0-7.7) accounting for one third of the seminal HIV RNA level variation, irrespective of adjustment for antiretroviral therapy. CONCLUSIONS: These data indicate that distal genitourinary sources other than the prostate appear to be the major source of seminal HIV in men without clinical urethritis or prostatitis. Because the HIV RNA level in blood plasma is not reliable as an independent clinical predictor of virus levels in seminal plasma, these findings also extend the concept that the male genital tract is a distinct virological compartment from blood.

Adult↗
PubMedDate not supplied

Primary care for women. Assessment and management of genitourinary tract disorders.

This article reviews the basic anatomy and physiology of the genitourinary system and disorders commonly encountered in the primary care setting. The role of the nurse-midwife in the assessment and treatment or referral of complaints of dysuria, hematuria, and incontinence is discussed. The treatment of nonpregnant women with cystitis is addressed; symptoms associated with pelvic relaxation are discussed, and a management scheme for teaching effective pelvic floor exercises is presented.

Female↗
PubMed1981

Transcatheter hemostasis in the genitourinary tract.

Transcatheter hemostasis is applicable in a large variety of causes of genitourinary hemorrhage. The method is particularly useful in the management of trauma since temporary occlusion of the bleeding vessel usually produces cessation of hemorrhage without significant sacrifice of additional parenchyma. Control of arteriovenous fistulas requires an assessment of flow characteristics and careful tailoring of catheter and embolization technique; large emboli or glue is frequently required for occlusion of large fistulas, whereas small ones can be treated with Ivalon. Hemorrhage from renal or pelvic neoplasm is also effectively managed by transcatheter therapy.

Adenocarcinoma↗
PubMed1984

The bowel, the genitourinary tract, and infective endocarditis.

Of 582 episodes of infective endocarditis 75 were attributable to organisms normally resident in the bowel and 12 others were associated with alimentary tract operations, investigations, or disease. The mean age of the 87 patients in this particular group was higher (59.7 years) than that of all the patients with infective endocarditis (51.4 years). As far as could be ascertained 41% had no pre-existing cardiac abnormality, and in a little under a half no predisposing event to initiate the illness was apparent. Where the portal of entry of the organism to the blood stream was evident it was slightly more often in the genitourinary than the alimentary tract. Bowel organisms are no less important than those associated with the teeth in causing infective endocarditis. It is suggested that in all those patients with known cardiac abnormalities and possibly in those over the age of 60 with normal hearts antibiotic cover should be considered when they undergo genitourinary or alimentary tract surgery or instrumentation.

Adolescent↗
PubMed1997

Plexiform neurofibroma involving the genitourinary tract in children: case reports and review of the literature.

We report extensive genitourinary neurofibroma in two children who presented with massive bilateral hydroureteronephrosis and a thick-walled bladder. The best radiologic technique to stage the disease and determine treatment is magnetic resonance imaging. Management of extensive genitourinary neurofibroma is controversial. Based upon our experience and a review of the literature, aggressive surgery should be approached cautiously.

Humans↗
PubMed1999

Assessment of mucosal immune response in genitourinary tract using urine.

A novel method to assess mucosal immune response in the genitourinary mucosa after immunization with a mucosal vaccine has been developed. In this method, secretory IgA antibody is measured by a highly sensitive enzyme immunoassay (immune-complex transfer enzyme immunoassay) using urine as a specimen. The urinary IgA antibody response could be detected by the immune-complex transfer enzyme immunoassay. In contrast, a conventional enzyme immunoassay (enzyme-linked immunosorbent assay (ELISA)) could not detect this response because of its low sensitivity. Because urine samples can be collected easily and nontraumatically, not only from experimental animals but also from humans, both males and females, the present method may be applicable for assessing the protective efficacy of candidates for mucosal vaccines against sexually transmitted microorganisms, such as human immunodeficiency virus. Furthermore, the usefulness of this method for novel mucosal vaccine formulae was shown for a model in which vaccine antigen and Bordetella pertussis adjuvant were adsorbed onto CaCO, and enclosed in enteric coated capsules.

Adjuvants, Immunologic↗
PubMed1985

[A clinical observation of genitourinary tract tuberculosis during the last decade].

Altogether, 92 patients were diagnosed as having genitourinary tuberculosis, and were treated at our clinic from 1972 to 1981. These patients form the basis for our statistical study. The incidence of genitourinary tuberculosis among our new outpatients showed a tendency to decrease and was less than 0.4% during the last five years. The mean age of the genitourinary tuberculosis patients was 42.8, rather higher than ten years ago. Of these, 41% had a history of tuberculosis and 54% chiefly complained of bladder-related symptoms. Tubercle bacilli were detected in 87% of the patients. About 45% of the patients with urinary tuberculosis underwent nephrectomy, which was indicated principally in cases of non-functioning kidneys and severe hydronephrosis. A combination of PAS, INH, and RFP was used most often and was administered in 58 cases. Used second most often was a combination of SM, PAS, and INH (administered in 46 cases).

Adolescent↗
PubMed1996

Environment and the genitourinary tract.

A variety of environmental factors have been associated with conditions that affect the genitourinary system. Chronic lead exposure and halogenated hydrocarbons have been found to affect sperm production and fertility. Heavy metals such as mercury and cadmium have been associated with renal tubular toxicity and kidney failure. Aromatic amines, used in a number of industrial processes and most commonly found in the dye industry, have been associated with development of bladder cancer. The same substances that are metabolites in cigarette smoke have been found to explain the strong association between bladder cancer and cigarette smoking. Chlorination and fluoridation have recently been associated with bladder cancer. In each of these associations, host factors may contribute to the toxicity of these substances either by detoxifying them or by converting them to more active agents. Education and regulation are needed to decrease the environmental risk they create.

Cocarcinogenesis↗