ABSTRACT

Foreign objects in the urinary bladder may result from urethral passage by the patient, extraneous trauma or ballistic injury, or even more rarely as a result of spontaneous migration of retained metal fragments from prior trauma. In the former acute trauma settings, the patient usually presents for prompt evaluation and treatment. In the latter setting, the patient may present in a delayed fashion with nonspecific urologic complaints. We present an unusual case report involving the extremely delayed migration of a retained piece of shrapnel into the urinary bladder.

Keywords: Bladder, Extravesical, Trauma, Shrapnel

Correspondence: Amir Arsanjani, Department of Urology, New York Medical College, Munger Pavilion, Room 457, Valhalla, NY, 10595,

ABSTRACT

Since the pathophysiology of Lower Urinary Tract Symptoms/Overactive Bladder (LUTS/OAB) is multifactorial, there are many potential targets for future drugs, as identified in preclinical investigations. However, it is difficult to predict what principles can be applied clinically. The mere finding that a drug affects the LUT in a desirable direction seldom motivates speculations like “this may be a new way of treating LUTS/OAB”. For several of the potentially useful drugs, published clinical studies have demonstrated the proof of principle. This review will discuss the pharmacology of and clinical experiences with some of these drugs.

Correspondence: K-E Andersson, Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA,

ABSTRACT

Background: The development of computer-based equipment for diagnostic and therapeutic purposes has evolved considerably in the past few decades. The ability to remotely operate various devices has led physicians to provide off-site assistance in different areas of medicine.

Objectives: The aim of this paper is to share the authors’ initial experience with remote-access urodynamic telementoring. The main focus is in the possibility of using this method for teaching purposes.

Methods: A combination of software installed in both the equipment and the remote computer allowed mentors to participate in the test both peri- and post-procedurally. The use of a webcam allowed visualization and dialog with the patient, and more than one observer could monitor technicians performing the test. Password-protected access warranted patient privacy.

Results: The authors remotely monitored over one hundred urodynamic studies performed in two centers during the past 6 months. The results were satisfactory concerning remote visualization and reporting of tests. The use of this technology adds very little cost in terms of both equipment and operating procedures.

Conclusions: Telementoring in urodynamics may open new possibilities for the teaching and spreading of this important urologic diagnostic tool.

KEYWORDS: Telementoring, Urodynamics, Diagnostic, Urinary incontinence

CORRESPONDENCE: Salvador Vilar Correia Lima, Department of Urology, Federal University of Pernambuco, Av. Parnamirim, 95, Recife, Brazil,

ABSTRACT

Background: Of adults 50 to 80 years old, 29% of men in Europe and 34% of men in the United States have moderate to severe lower urinary tract symptoms. Alpha-blocker medications are the first line of therapy for men with these urinary symptoms. Among this population, cataracts are similarly common. The “intra-operative floppy iris syndrome” cataract surgery complication has been reported in men using alpha-blockers.

Objective: To assess the frequency of cataract surgery complications arising from alpha-blocker therapy in a large patient population.

Design, Setting, and Participants: We retrospectively reviewed the outcomes of 2666 consecutive adults who underwent elective unilateral cataract surgery. The surgeries took place between 2000 and 2005 at both a large university hospital system and a Veteran’s Association medical center. Medical records were assessed for medication use, and operative records were reviewed for evidence of difficult procedures.

Results: The risk of complicated cataract surgery was 14.9% in patients using alpha-blockers, approximately 50% higher than those not receiving this medication (9.5%) (p=0.003). The increased rate of complicated surgeries was restricted primarily to patients over 65 years of age, as 15.6% of surgeries performed on these patients resulted in complicated surgery (p=0.03). There was no statistically significant increase in the rate of complicated surgeries in patients under age 65 who were using alpha-blockers (p>0.05).

Conclusions: If possible, alpha blocker medications should be discontinued prior to eye surgery in older patients.

Keywords: Alpha-Blocker Medications, Lower Urinary Tract Symptoms, Intra-Operative Floppy Iris Syndrome, Cataract Surgery

Correspondence: Thomas A. Rozanski, Department of Urology, MC 7845, UTHSCSA, 7703 Floyd Curl Drive, San Antonio, Texas, USA, 78229,

ABSTRACT

Background: Atypical adenomatous hyperplasia (AAH) is a small, glandular proliferation that has histological similarities to Gleason grade 1 and 2 prostatic adenocarcinoma (PACG 1, 2). There are no distinct histomorphological criteria distinguishing these two lesions from each other and other small glandular proliferations. It is necessary to define histological criteria, as treatment approaches are different for these lesions.

Objectives: This study’s aim was to evaluate the differences in the secretory properties of AAH and PACG 1, 2. We searched for intraluminal crystalloids, corpora amylacea, mucin, and eosinophilic material.

Subjects and Methods: 105 totally embedded radical prostatectomy specimens containing 11 AAH (22 foci) and 15 PACG 1, 2 (22 foci) lesions were evaluated. Basal cell specific antikeratin was applied. We accepted that PACG 1, 2 lesions do not contain basal cells, and we grouped lesions as AAH and PACG 1, 2 based on this opinion. The luminal contents were evaluated by PASAB2, 5 and PTAH.

Results: We found differences between the AAH and PACG 1, 2 lesions for some parameters, including crystalloids, corpora amylacea, and mucin. We found similar properties between the two lesions for eosinophilic material.

Conclusion: In a difficult case, evaluation of the luminal content features may be helpful, but the diagnosis must be supported by immunohistochemistry.

Key Words: Adenosis, Small Glandular Proliferations, Low-Grade Cancer, Prostate, Crystalloids

Correspondence: Ahmet Midi, Pathology Laboratory, Maltepe University, Atatürk cad. Çam sok. No 3, Maltepe, Istanbul, 34882,

ABSTRACT

Intractable dysuria several months after Greenlight™ laser transurethral resection of prostate (PVP) is a well-known occurrence that may affect some men. We present a patient who suffered dysuria for four months after Greenlight™ vaporization but had prompt resolution after undergoing holmium laser ablation of the prostatic fossa. A possible explanation is discussed.

KEYWORDS: Benign Prostatic Hyperplasia, Laser, Dysuria

CORRESPONDENCE: Steve Y Chung, 3068 E. 1825th Road, Ottawa, IL, 61350,

Dear Colleagues,

I would like to announce the launch of the UroToday International Journal® (UIJ) (http://www.urotodayinternationaljournal.com), a new online, peer-reviewed, fast-tracked urology and urologic oncology publication. UIJ focuses specifically on the professional global urology and urologic oncology community. It will elevate the access to relevant urology and oncology science to professionals around the world. UIJ will make the scientific information available to a much wider audience than that reached by other journals, including potential readers who do not have access to a research library that can afford to pay for journal subscriptions. There is no charge to register, submit or publish an article in the UIJ. Additionally there are no charges for color figures. There is no other urology journal offering this unique approach to achieve peer-review publication.

UIJ reaches currently over 55,000 professionals in urology. UIJ will open for general submission of manuscripts on May 31st, 2008 for the July issue.

All manuscripts will be subject to rigorous peer-review. All accepted articles will be given Digital Object Identifier (DOI) numbers so that they can be retrieved and indexed by Pubmed as soon as the pending application from UroToday International Journal has been accepted.

The UroToday International Journal® has an international editorial board headed by myself, Professor at the Institute for Regenerative Medicine at Wake Forest University. The Section/Associate Editors are; Christopher P. Evans, Christian Gratzke and Yasuhiko Igawa. Christopher P. Evans MD, FACS is the Chair of the Department of Urology and Professor & Chairman of Urologic Surgical Oncology University of California, Davis, School of Medicine. Christian Gratzke is an Urologist in the Department of Urology, at the University of Munich in Germany and Yasuhiko Igawa, MD, PhD, is Professor in the Department of Urology at Shinshu University School of Medicine, Japan.Gina B. Carithers is the Publisher of both the UroToday International Journal® and www.urotoday.com. The Managing Editor is Tracy Ireland.

Kind regards,
Karl-Erik Andersson, MD, PhD

Editor-In-Chief

ABSTRACT

Introduction: Stress urinary incontinence (SUI) is the involuntary leakage of urine during periods of increased abdominal pressure (e.g., coughing, running or lifting). It is caused by an incompetent urethral sphincter which may arise as a consequence of damage to the pelvic floor muscles sustained during pregnancy and childbirth. Pharmacological therapy includes the off-label use of sympathomimetic medication (alpha-adrenergic agonists), to enhance urethral tone and alleviate symptoms, however their associated cardiovascular side effects (e.g. hypertension) limits their utility. PSD503 (Plethora Solutions Ltd, London, UK) is a controlled dose topical gel, which contains the alpha-adrenergic agonist phenylephrine (20% w/w). It has been developed as a locally administered treatment for SUI, to increase urethral tone and provide symptomatic relief, in the absence of systemic side effects.

Background

Obesity is an established and modifiable risk factor for urinary incontinence (UI) but conclusive evidence for a beneficial effect of weight loss on UI is lacking.

Introduction: We present a retrospective study involving 48 patients, who underwent transurethral resection of the prostate (TURP) for bladder outflow obstruction due to prostatic enlargement [4]. The aim of the study was to compare the safety of 2-way catheters post-TURP in relation to the 3-way catheter.

ABSTRACT

Introduction: Lower urinary tract dysfunction (LUTD) following neurological illness depends upon the level of lesion in the nervous system, causing a characteristic pattern of lower urinary tract symptoms (LUTS). However, a subset of patients may have symptoms that are at variance from the expected pattern.

Background

Obesity is an established risk factor for urinary incontinence (UI).

ABSTRACT

Introduction and Objectives: Faecal incontinence is a devastating social and physical handicap affecting 2% of the general population. It is 8 times more common in females than males, largely due to the adverse effects of childbirth on vulnerable pudendal nerves. Our laboratory created 2 rat models simulating faecal incontinence in which the inferior rectal nerve (a terminal branch of the pudendal nerve that supplies the external anal sphincter) is either crushed or compressed. We aimed to determine the effects of these injuries on inferior rectal-nerve axonal counts and cross-sectional areas in our rat models, and to correlate these findings with somatosensory evoked potentials (SSEPs) from the same animals.

Introduction and Objectives

The objectives of this clinical study were to demonstrate non-inferiority of oral trospium chloride (TC) in comparison to oxybutynin (OXY), and to evaluate efficacy, safety, and quality of life parameters when using either substance in the treatment of patients with urge urinary incontinence.

Introduction and Objectives

Since the initial description by Ulmsten, the wide use of TVT was associated with per and post operative complications.

ABSTRACT

Introduction and Objectives: Suburethral synthetic sling procedures have become widely used as surgical treatment for female urinary stress incontinence. However synthetic slings are expensive. Since 2002, we have used in a non- randomized fashion, Composix-based slings, tension-free vaginal tapes TVT and transobturator tapes TVT-O. The Composix sling was cut from a large sheet used for ventral hernia repair and resterilized. The Composix sling was fitted with 0 Maxon resorbable sutures on each side and positionned suburethrally with a Raz needle introduced though a small suprapubic incision. The goals of this prospective study are to compare the success rate, the durability, the complications and the cost of the three different approaches.

ABSTRACT

Introduction and Objectives: The objectives of this clinical study were to demonstrate non-inferiority of oral trospium chloride (TC) in comparison to oxybutynin (OXY), and to evaluate efficacy, safety, and quality of life parameters when using either substance in the treatment of patients with urge urinary incontinence.

ABSTRACT

Objective: To evaluate changes in bowel symptoms after sacrocolpopexy (SC).

 ABSTRACT

Introduction and Objectives: Since the initial description by Ulmsten, the wide use of TVT was associated with per and post operative complications. Alternative routes were later described and more recently mini slings procedures without skin exit. We recently developed the Sub Pubic TVT route (TSP) using a small sub urethral sling. Anatomical considerations and short term results are presented.

Introduction and Objectives: Suburethral synthetic sling procedures have become widely used as surgical treatment for female urinary stress incontinence. However synthetic slings are expensive. Since 2002, we have used in a non- randomized fashion, Composix-based slings, tension-free vaginal tapes TVT and transobturator tapes TVT-O. The Composix sling was cut from a large sheet used for ventral hernia repair and resterilized. The Composix sling was fitted with 0 Maxon resorbable sutures on each side and positionned suburethrally with a Raz needle introduced though a small suprapubic incision. The goals of this prospective study are to compare the success rate, the durability, the complications and the cost of the three different approaches.