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Effective treatment for mixed urinary incontinence with a pubovaginal sling.

PURPOSE: We assessed the results of autologous fascia pubovaginal sling (PVS) in women with mixed incontinence using a validated outcome sco … nce (MUI). Patients completed a urological questionnaire, 24-hour voiding diary, pad test, VUDS and cystoscopy preoperatively. The diagnosis of SUI and UUI was further confirmed by physician interview. In patients with MUI detrusor overactivity was classified according to urodynamic criteria. At least 1 year postoperatively the validated Urinary Incontinence …

[Pathology of the gynecologic ureter].

OBJECTIVE: Ureteral lesions due to pelvic endometriosis, gynecological surgery and post-actinic are common findings in urology. Pelvic endom … ynecological surgery are present in every surgical study. Most authors describe that intraoperative cystoscopy can immediately enhance the problem avoiding a re-operation. The laparoscopic risk seems to be for the cardinal ligaments when they divide beneath the uterine veins. Most authors seem to agree with the immediate need for a nephrostomic drainage foll …

Pathophysiology of autonomic dysreflexia: long-term treatment with terazosin in adult and paediatric spinal cord injury patients manifesting recurrent dysreflexic episodes.

INTRODUCTION: Spinal cord injury (SCI) results in disruption of synaptic influences on the sympathetic preganglionic neurones. Remodelling o … nce of an acute predisposing factor for dysreflexia eg performance of an invasive procedure such as cystoscopy, digital evacuation of bowels, or acute urinary retention, were enrolled in this study. INTERVENTION: After discussion with the patients and their carers, terazosin was prescribed with a starting dose of 1 mg in an adult and 0.5 mg in a child admin …

Transurethral fulguration of the prostate with the roller ball.

OBJECTIVES: To assess the histologic changes in the prostate and the clinical outcome in men with symptomatic benign prostatic hyperplasia ( … ultrasound of the prostate, serum prostate-specific antigen, serum hemoglobin and electrolytes, and cystoscopy. The procedure was performed under general or spinal anesthesia using standard equipment and 3-mm roller ball. The patients were seen in follow-up at 1, 3, 6, 9, and 12 months. RESULTS: The results of the first phase of the study indicate that the …

Lower risk of pelvic metalware infection with operative repair of concurrent bladder rupture.

BACKGROUND: Patients with traumatic bladder rupture frequently have associated pelvic fracture. With increasing numbers of pelvic fractures fixed internally, there are concerns that conservative management of bladder rupture may increase the risk of pelvic metalware infection. This study aims to determine if operative repair of bladder rupture in comparison to conservative management with catheter drainage alone is associated with a lower rate of infection of internal fixation device for concurrent pelvic fracture. METHODS: This is a retrospective cohort study of level IV evidence. From July

Prospective multi-center study elucidating patient experience after prostatic urethral lift.

INTRODUCTION: The prostatic urethral Lift (PUL) procedure offers a novel treatment for men with lower urinary tract obstructive symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Most patients who seek LUTS/BPH treatment choose the intervention that offers the expectations of a significant improvement in quality of life and the least chance of short or long term morbidity. We report the results of a prospective, non-randomized study designed to further characterize the perioperative subject experience with the PUL procedure. MATERIALS AND METHODS: The PUL procedure employs perma

Twelve-year follow up of a randomized prospective trial comparing bacillus Calmette-Guerin and epirubicin as adjuvant therapy in superficial bladder cancer.

AIM: To compare bacillus Calmette-Guerin (BCG) with epirubicin in adjuvant therapy of superficial bladder transitional cell carcinoma, with respect to recurrence, progression and survival. Prognostic factors are also evaluated. METHODS: Between October 1991 and September 1999, all patients harboring superficial bladder cancers (Ta or T1) with any of the relevant criteria (stage>a, grade>1, size>1 cm, multiple or recurrent tumors), after complete transurethral resection were randomized to receive either 81 mg Connaught strain BCG or 50 mg epirubicin. Patients with recurrences were eligible to

An increased body mass index is associated with a worse prognosis in patients administered BCG immunotherapy for T1 bladder cancer.

PURPOSE: The body mass index (BMI) may be associated with an increased incidence and aggressiveness of urological cancers. In this study, we aimed to evaluate the impact of the BMI on survival in patients with T1G3 non-muscle-invasive bladder cancer (NMIBC). METHODS: A total of 1155 T1G3 NMIBC patients from 13 academic institutions were retrospectively reviewed and patients administered adjuvant intravesical Bacillus Calmette-Guérin (BCG) immunotherapy with maintenance were included. Multivariable Cox regression analysis was performed to identify factors predictive of recurrence and progressi

[Diagnosis and treatment of interstitial cystitis].

Interstitial Cystitis, first described in 1887 as an inflammatory disease of the bladder wall, is now regarded as a very common disease with an estimated number of unreported cases. Reasons for underdiagnosis is the widespread use of strict exclusion criteria. The disease can already be suspected by a careful medical history and physical examination in an early stage and then be treated with promising multimodal therapeutic approaches. In addition to a symptomatic oral therapy, local instillations with constituents of the protective glycosaminoglycan-layer are the most common therapeutic appro

Transurethral microwave thermotherapy: clinical results after 11 years of use.

PURPOSE: To evaluate the durability of the effect of transurethral microwave thermotherapy (TUMT) for lower urinary-tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO). PATIENTS AND METHODS: A total of 841 patients with LUTS received TUMT using the Prostatron device at Sahlgrenska University Hospital, Sweden. Two treatment programs were used: low-energy Program 2.0 and high-energy Program 3.5. A questionnaire, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, and questions about general health status, was sent to all the patients. The mean fo

Multi-Institution Evaluation of Sequential Gemcitabine and Docetaxel as Rescue Therapy for Nonmuscle Invasive Bladder Cancer.

PURPOSE: Rescue intravesical therapies for patients with bacillus Calmette-Guérin failure nonmuscle invasive bladder cancer remain a critical focus of ongoing research. Sequential intravesical gemcitabine and docetaxel therapy has shown safety and efficacy in 2 retrospective, single institution cohorts. This doublet has since been adopted as an intravesical salvage option at multiple institutions. We report the results of a multi-institutional evaluation of gemcitabine and docetaxel. MATERIALS AND METHODS: Each institution retrospectively reviewed all records of patients treated with intraves

Diagnosis and management of superficial bladder cancer.

Bladder cancer is the fourth leading cause of cancer in American men, accounting for more than 12,000 deaths annually. It was one of the fir … dvocated by some. These radiologic studies are unable to provide adequate bladder imaging, and thus cystoscopy is required for the diagnosis of bladder cancer. Most bladder cancers present as "superficial" disease, confined to the bladder mucosa or submucosal layer, without muscle invasion. Superficial tumors consist of papillary tumors that are mucosally co …

Treatment of superficial bladder tumors: achievements and needs. The EORTC Genitourinary Group.

OBJECTIVE: The therapeutic objectives in the initial treatment of superficial tumors are to remove completely the tumor, to assess the need … als. The follow-up of patients with all types of superficial tumors must be lifelong; unfortunately cystoscopy cannot be replaced yet by the control of any markers present or not in the urine. There is hope this may change in the near future.

[Radical hysterectomy with pelvic lymphadenectomy in patients with carcinoma of the uterine cervix--3 years' experience].

INTRODUCTION: Almost all patients with invasive cervical carcinoma can be treated with either primary irradiation therapy or primary surgery … adiography, blood and urine analyses. In some cases we had to make other examinations (cystography, cystoscopy, intravenous pyelography, sygmoidoscopy, rectoscopy, CT scanning and magnetic resonance). The surgical treatment of invasive carcinoma of the cervix was limited to those patients in whom the disease was confined to the cervix or vaginal fornix (stag …

The clinical toxicology of ketamine.

INTRODUCTION: Ketamine is a pharmaceutical drug possessing both analgesic and anaesthetic properties. As an anaesthetic, it induces anaesthe … giopathy and cystitis, which can be confirmed by endoscopic retrograde cholangiopancreatography and cystoscopy, respectively. MANAGEMENT: Treatment of acute clinical toxicity is predominantly supportive with empiric management of specific adverse effects. Benzodiazepines are recommended as initial treatment to reduce agitation, excess neuromuscular activity …

Efficacy of sodium hyaluronate in the management of chemical and radiation cystitis.

Onset of cystitis in patients receiving immuno-chemotherapeutic agents by intravesical instillation for non-muscle invasive transitional cel … responded a little better than those who had received radiotherapy. Subsequent urinary cytology and cystoscopy ruled out bladder cancer progression in these cases after temporary postponement of the oncological treatment. Intravescical sodium hyaluronate seems a valid and quick therapeutic solution for iatrogenic cystitis from chemo or radiotherapy. After re …

Perioperative complications and early follow-up with 100 TVT-SECUR procedures.

Our objective was to evaluate the complications and early follow-up of the tension-free vaginal tape (TVT)-SECUR, a new minimally invasive a … yet with no skin incisions, required neither bladder catheterization nor intraoperative diagnostic cystoscopy. The clinical and surgical data of 100 consecutive patients with TVT-SECUR were collected prospectively. Two patients had urinary obstructions and needed surgical tape-tension relief. One patient had a 50 mL paravesical self-remitting hematoma. At t …

A Rare Case of Bladder Cancer With Squamous Differentiation Causing Hypercalcemia and Leukocytosis.

The most common cause of humoral hypercalcemia of malignancy is excessive secretion of parathyroid hormone-related peptide (PTHrP), which can include solid tumors, most commonly squamous cell carcinoma (SCC). It is unusual to see hypercalcemia associated with bladder cancer and local tumor-related secretion of PTHrP from SCC of the bladder. In addition to hypercalcemia, leukocytosis can be a concomitant neoplastic syndrome resulting from cytokine production of granulocyte colony-stimulating factor (G-CSF) from poorly differentiated cells. We discuss a case of a 62-year-old male who came to med

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… He underwent an outpatient CT urogram, which revealed a large 7 cm bladder diverticulum with the entirety filled with tumor, followed by cystoscopy with cytopathology of the bladder wash, raising concerns for malignancy. … Urology believed that although the tumor appeared low grade on cystoscopy, due to the large tumor burden, transurethral resection of bladder tumor (TURBT) could cause risk of perforation, would unlikely to be curative, and require greater than five hours of operation time. …

Bladder neck incision for female bladder neck obstruction: long-term outcomes.

OBJECTIVE: To evaluate the long-term outcomes of bladder neck incision (BNI) for primary bladder neck obstruction in women. METHODS: Eighty-four women were diagnosed on the basis of videourodynamic study. BNI was performed for each patient, with incisions made at 2 different sites on the bladder neck. RESULTS: Follow-up data were available for 6-78 months (average, 27.4), postoperatively. Successful recovery after BNI without serious complications was achieved in 71 of 84 (84.5%) patients. During follow-up, the mean International Prostate Symptom Score decreased from 22.9 to 7.9 (P <.01). Qu