Letter from the Editor - August 2009

Dear Colleagues,

Progress in urology, like in any medical field, is dependent on a continuous accumulation of new knowledge. Every piece of new information, from brief case studies to large clinical trials, adds to our knowledge base and helps the profession grow. The editorial team of UroToday International Journal is grateful to the authors who shared their work in this issue and to the reviewers who ensured its scholarship.

Clinical trials of medications are among the most essential types of research, because they help to dictate treatment standards. Olshansky and his colleagues (Validation of the Differential Cardiovascular Effects of the Antimuscarinic Agents Darifenacin and Tolterodine in a Randomized, Placebo-Controlled, 3-Way Crossover Study) share the results of a well-designed investigation. They validated the results of a previous study showing that tolterodine caused an increase in heart rate (HR) and decrease in heart rate variability (HRV) in healthy older adults, whereas darifenacin did not. Both increased HR and decreased HRV have been associated with increased mortality rates in the general population, particularly in patients with cardiovascular morbidities. Because antimuscarinics are the recommended treatment of patients with the overactive bladder (OAB) syndrome, and these patients have a high prevalence of cardiovascular morbidity, a difference of 2-5 beats per minute in mean HR over 24 hours and a decrease in HRV may be of clinical importance. Physicians who prescribe antimuscarinics will be interested in these findings.

Review articles can provide useful updates on current clinical practice. Westerling’s review (Bladder Pain: Clinical Assessment and Treatment) provides thorough, practical information for any professional involved in the physiology, assessment, and pharmacological or nonpharmacological treatment of bladder pain. Patients with long-term bladder pain often have comorbidities and medications that can complicate management. They may benefit from a multi-disciplinary team approach. Westerling reminds us that quality of life may improve dramatically if these patients are seen by a pain specialist early in the treatment sequence, rather than waiting until the pain is out of control.

The August issue contains many other articles of interest, including: (1) the very timely topic of a gene expression test for prostate cancer, written by Guyon and colleagues; (2) the continuous bladder irrigation model developed by Norman and Connor that shows urethral outflow with and without the addition of suprapubic inflow, using suprapubic catheters of different size combinations; and (3) the use of bacillus Calmette-Guerin therapy with cauterization of 10 mm of the tumor margin in patients with bladder cancer−a management protocol that showed promising results for Falahatkar and colleagues. Finally, Al-Sameraaii and Bowkett remind us of dangers to our children that may reside in the most unlikely places, including their toys.

Kind regards,

K-E Andersson