Issue 2: August 2008

UIJ Volume 1 Issue 2 August 2008

Letter from the Editor - June 2008

Dear Colleagues,

The 4th International Consultation on Incontinence (ICI) will be held in Paris July 5-8, 2008. The organizers of this workshop have summoned the world´s leading experts in urology, gynecology and urodynamics to present and discuss the most recent advances in the field, including epidemiology, basic science, and treatment. However, the purpose is not only to review the current state of knowledge on incontinence, but also to propose strategies for the practical diagnostic and therapeutic management of the disorders following the evidence based medicine principles. Additionally the purpose is to propose validated standard international instruments to evaluate incontinence, and to help standardize response criteria and recommendations for clinical research on incontinence.

This broad scope of the workshop is reflected in the abstracts of the posters that will be presented at the meeting and which this first issue of Urotoday International Journal (UIJ) is proud to publish with exclusivity. The abstracts comprise not only different aspects of the overactive bladder such as treatment, epidemiology, basic science, but also summarize recent advances in the areas of stress incontinence, pelvic floor disorders and prolapse. Methods, technical and diagnostic aspects of incontinence, as well as of treatment, are also covered. The aim of UIJ is to elevate the access to relevant urology science to professionals around the world and to make this scientific information available to a wide audience. We believe that there is a good chance that this aim will be fulfilled for these abstracts, since UIJ currently reaches over 60,000 professionals in urological diseases.

It is our hope that all professionals in the fields of incontinence research and management, both experienced and newcomers, will benefit from these abstracts, and become inspired towards further efforts.

Kind regards,
Karl-Erik Andersson
Editor-in-Chief

 

Delayed Extravesical Shrapnel Migration into the Urinary Bladder: A Case Report and Review of a Rare Clinical Entity

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,

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Bladder Pharmacology and Treatment of Lower Urinary Tract Symptoms: Recent Advances

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,

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Telementoring in Urodynamics: Initial Experience

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,

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Complicated Cataract Surgery in Patients Receiving Alpha-Blockers for Benign Prostatic Hyperplasia

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,

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Differences in the Secretory Activity of the Atypical Adenomatous Hyperplasia and Low-Grade Prostatic Adenocarcinoma

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,

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Chronic Dysuria Associated With GreenLight Laser Vaporization of the Prostate and its Prompt Resolution After Holmium Laser Ablation of Prostatic Fossa

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,

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