Current Urology

Patra, Phani B.; Patra, Sayani

2015 Current Urology

doi: 10.1159/000365682pmid: 26195957

Several physiopathologic conditions lead to the manifestation of overactive bladder (OAB). These conditions include ageing, diabetes mellitus, bladder outlet obstruction, spinal cord injury, stroke and brain injury, Parkinson's disease, multiple sclerosis, interstitial cystitis, stress and depression. This review has discussed research findings in human and animal studies conducted on the above conditions. Several structural and functional changes under these conditions have not only been observed in the lower urinary tract, but also in the brain and spinal cord. Significant changes were observed in the following areas: neurotransmitters, prostaglandins, nerve growth factor, Rho-kinase, interstitial cells of Cajal, and ion and transient receptor potential channels. Interestingly, alterations in these areas showed great variation in each of the conditions of the OAB, suggesting that the pathophysiology of the OAB might be different in each condition of the disease. It is anticipated that this review will be helpful for further research on new and specific drug development against OAB.

Lee, Min Y.; Dalpiaz, Amanda; Schwamb, Richard; Miao, Yimei; Waltzer, Wayne; Khan, Ali

2015 Current Urology

doi: 10.1159/000365683pmid: 26195958

The Bartholin's glands are located symmetrically at the posterior region of the vaginal opening and play an important role in the female reproductive system. These two pea-sized glands are involved in mucus secretion and vaginal lubrication. Cyst formation in the glands is common and results from mucus build-up in gland ducts. It is important to monitor such cysts because they may occur in the form of carcinomas. Larger cysts and abscesses are found in the lower vestibular region and typically present with erythema and edema. Biopsy is an effective method for distinguishing between Bartholin's gland cysts and differential diagnosis. While smaller cysts may be asymptomatic and may be left untreated, larger cysts require medical attention. Several treatment options are available, including marsupialization and CO₂ laser. Healing and recovery depend on the severity of infection and course of treatment.

Nason, Gregory J.; Headon, Rebecca; Burke, Matthew J.; Aslam, Asadullah; Kelly, Michael E.; Giri, Subhasis K.; Flood, Hugh D.

2015 Current Urology

doi: 10.1159/000365684pmid: 26195959

Introduction: Debate remains regarding the optimal caliber of ureteroscopes in the management of pediatric urolithiasis, ranging from pediatric scopes to standard scopes. The aim of this study was to assess the safety and efficacy of stone management in a pediatric population using standard adult ureteroscopes. Methods: A retrospective review of all ureteroscopic procedures in patients under the age of 16 years was carried out. Standard adult 7.5 French semi-rigid and 6 French flexible ureteroscopes were used. Results: During the study period, 8 patients underwent 21 ureteroscopic procedures. Two patients had rigid ureteroscopy, seven had flexible ureterorenoscopy and one had a subsequent open procedure. No patients required ureteric dilation. Double J ureteric stents were utilized in 7 patients. There were no complications. All patients required extra corporeal shock wave lithotripsy. Stone clearance was achieved in all patients. Conclusion: Our series demonstrates that, in skilled hands, adult ureteroscopes can be use safely for the treatment of urolithiasis in pediatric patients.

Elzanaty, Saad; Johansen, Claus Erik

2015 Current Urology

doi: 10.1159/000365685pmid: 26195960

Introduction: The aim of the present study was to evaluate the effectiveness of microsurgical varicocele repair in patients with grade III lesions and chronic dull scrotal pain. Materials and Methods: The study was based on 8 patients with grade III left-sided varicocele and chronic dull scrotal pain for whom a microsurgical subinguinal varicocele repair was performed. The 1-year follow-up included pain assessment and scrotal examination. Results: Of the 8 patients, 7 (88%) reported complete resolution of pain with no palpable varicocele on scrotal examination. No cases of testicular atrophy or hydrocele formation were reported. Conclusion: These results indicated that microsurgical varicocele repair may benefit patients with grade III lesions and chronic dull scrotal pain.

Redmond, Ciaran E.; Nason, Gregory J.; Kelly, Michael E.; McMahon, Colm; Cantwell, Colin P.; Quinlan, David M.

2015 Current Urology

doi: 10.1159/000365686pmid: 26195961

Background/Aims: To evaluate the accessibility, usability, reliability and readability of Internet information regarding transrectal ultrasound (TRUS) guided biopsy of the prostate. Materials and Methods: The terms “prostate biopsy”, “TRUS biopsy” and “transrectal ultrasound guided biopsy of the prostate” were separately entered into the each of the top 5 most accessed Internet search engines. Websites were evaluated for accessibility, usability and reliability using the LIDA tool - a validated tool for the assessment of health related websites. Website readability was assessed using the Flesch Reading Ease Score and the Flesch Kincaid Grade Level. Results: Following the application of exclusion criteria, 82 unique websites were analyzed. There was a significant difference in scores depending on authorship categories (p ≤ 0.001), with health related charity websites scoring highest (mean 122.29 ± 13.98) and non-academic affiliated institution websites scoring lowest (mean 87 ± 19.76). The presence of advertisements on a website was associated with a lower mean overall LIDA tool score (p = 0.024). Only a single website adhered to the National Institutes for Health recommendations on readability. Conclusions: This study demonstrates variability in the quality of information available to Internet users regarding TRUS biopsies. Collaboration of website design and clinical acumen are necessary to develop appropriate websites for patient benefit.

Samplaski, Mary K.; Bachir, Bassel G.; Lo, Kirk C.; Grober, Ethan D.; Lau, Susan; Jarvi, Keith A.

2015 Current Urology

doi: 10.1159/000365687pmid: 26195962

Introduction: We sought to evaluate the incidence and effect of cocaine use in the infertile male population. Materials and Methods: Men presenting for fertility evaluation reporting cocaine usage were identified via prospectively collected database. Data were analyzed for usage patterns, reproductive history, associated drug use and medical conditions, hormonal and semen parameters. Results: Thirty-eight out of 4,400 (0.9%) men reported cocaine use. Most used cocaine every 3 months or less. Compared with non-cocaine using men, cocaine users reported more recreational drug use (89 vs. 9.2%), marijuana use (78.9 vs. 11.4%), chlamydia (10.5 vs. 3%), herpes (7.9 vs. 2.5%), and tobacco use (55.3 vs. 19.5%). After excluding men with causes for azoospermia, the mean semen parameters for cocaine users were: volume 2.47 ± 1.02 ml; concentration 53.55 ± 84.04 × 10⁶/ml; motility 15.72 ± 12.26%; total motile sperm count 76.67 ± 180.30 × 10⁶. Conclusions: Few (< 1%) men in our infertile population reported the use of cocaine, and the frequency of use was low. Given the low use rates and limitations of reporting bias, it is difficult to determine the direct effect of cocaine use on male fertility. However, while infrequent cocaine use seems to have limited impact on semen parameters, men reporting cocaine use represent a different cohort of men than the overall infertile population, with higher rates of concurrent substance abuse, tobacco use and infections, all of which may negatively impact their fertility. Reported cocaine users should be screened for concurrent drug use and infections.

Alan, Cabir; Eren, Ali E.; Ersay, Ahmet R.; Kocoglu, Hasan; Basturk, Gokhan; Demirci, Emrah

2015 Current Urology

doi: 10.1159/000365688pmid: 26195963

Aim: To evaluate the efficacy of early duloxetine therapy in stress urinary incontinence occurring after radical prostatectomy (RP). Material and Method: Patients that had RP were randomly divided into 2 groups following the removal of the urinary catheter. Group A patients (n = 28) had pelvic floor exercise and duloxetine therapy. Group B patients (n = 30) had only pelvic floor exercise. The incontinence status of the patients and number of pads were recorded and 1-hour pad test and Turkish validation of International Consultation on Incontinence Questionnaire-Short Form test were applied to the patients at the follow-up. Results: When the dry state of the patients was evaluated, 5, 17, 3, and 2 of 28 Group A patients stated that they were completely dry in the 3rd, 6th, 9th and 12th month respectively and pad use was stopped. There was no continence in 30 Group B in the first 3 months. Twelve, 6, and 8 patients stated that they were completely dry in the 6th, 9th and 12th month, respectively. But 3 of 4 patients in whom dryness could not be provided were using a mean of 7.6 pads in the first day and a mean of 1.3 pads after 1 year. When pad use of the patients was evaluated, the mean monthly number of pad use was determined to be 6.2 (4-8) in the initial evaluation, 2.7 (0-5) in the in 3rd month, 2 (0-3) in the 6th month and 1.6 (0-2) pad/d in the 9th month in the group taking medicine. The mean monthly number of pads used was determined to be 5.8 (4-8) in the initial evaluation, 4.3 (3-8) in the 3rd month, 3 (0-6) in the 6th month and 1.6 (0-6) pad/d in the 9th month in the group not taking medicine. Conclusion: According to the results, early duloxetine therapy in stress urinary incontinence that occurred after RP provided early continence.

Nordsiek, Michael; Ross, Curtis; Metro, Michael

2015 Current Urology

doi: 10.1159/000365689pmid: 26195964

The Buschke-Lowenstein tumor (BLT) is a slow-growing, locally destructive verrucous plaque that typically appears on the penis but may occur elsewhere in the anogenital region. It most commonly is considered to be a regional variant of verrucous carcinoma. It is rare but accounts for 5-24% of all penile cancers. It can also affect the perineum and other portions of the genitalia. It was first described by Buschke and Löwenstein in 1925, and is also known as giant condyloma acuminatum (GCA). Regardless of the treatment modality, careful follow-up is recommended because of the high risk of recurrence and the possibility for malignant transformation in 30-56% of patients. We present a case of a 47-year-old Hispanic female that presented to the urology clinic for dysuria and upon work-up was found to have a GCA. GCA typically affects the penis, although the perianal region, vulva, vagina, rectum, scrotum, perineum and bladder may be involved. To date, we believe this is the only reported case of GCA in the urethra of a female patient with sparing of the bladder. This lesion was successfully removed with wide local excision. We believe that further studies are needed to define this disease, identify its pathogenesis, and the most successful treatment protocol.

Kivlin, Dana; Ross, Curtis; Lester, Kyle; Metro, Michael; Ginsberg, Philip

2015 Current Urology

doi: 10.1159/000365690pmid: 26195965

We report 2 cases of spontaneous bladder rupture related to chronic outlet obstruction and urinary retention. In both cases, focal perforation was identified within diverticula. Bladder rupture in the absence of trauma is a rare and serious event with a mortality rate approaching 50%. These injuries are often initially misdiagnosed and it is our goal to provide insight to the presentation, management and treatment of this rare event.