Difficult Urination Research Articles

Abstract LB-359: Knowledge of prostate cancer and screening attitude of residents of a Nigerian community

Abstract This study assessed the level of awareness and knowledge of prostate cancer amongst the residents of a Nigerian University and its environs. A cross-sectional descriptive study using self-administered questionnaires was carried out among 443 people, aged 20 to 80 residing in Covenant University, Nigeria and its environs. Data analysis was done with SPSS version 15.0. The level of significance was set at p <0.05. The majority (45.1%) of respondents was aged between 31 - 40 years and only 41.3% were aware of the existence of Prostate cancer. Educational background, occupation and religion were observed to significantly increase (p <0.05) awareness of prostate cancer while gender and age did not. The awareness and previous participation in prostate cancer screening negatively (p <0.05) influenced respondents’ decision to participate in future screening. Electronic media via radio and television was the commonest source of awareness for prostate cancer. Only 13.4% became aware through health facility or personnel. Only 30.5% correctly identified the location of the prostate. Most of the respondents identified poor diet and environmental conditions as risk factors while 13.7%, 2.0% and 5.9% identified aging, race and genetics respectively as the causes of prostate cancer. Most of the respondents (31.2%) correctly identified difficult urination as a symptom of prostate cancer. About 30.8% have a relative, family or friend that had prostate cancer out of which 18.5% resulted in deaths. Only one respondent had been previously diagnosed with an enlarged prostate. Majority of the respondents were unaware of a possible cure or therapy. Only 9.9%, of the respondents strongly agreed that prostate cancer was peculiar to all men while a low percentage (4.1%) of respondents strongly agreed that it is a health disparity issue among black men. Over all a very low percentage of 37.9% of the respondents considered prostate cancer to be a serious ailment. The study showed a generally poor knowledge and wrong conceptions about prostate cancer, screening and treatment. This suggests the need for public health education and screening programs on prostate cancer for this population and others. Citation Format: Emeka E.J Iweala, Conrad A. Omonhinmin, Dominic E. Azuh, Isioma J. Okwudi. Knowledge of prostate cancer and screening attitude of residents of a Nigerian community. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-359.

A Novel Application of Three Phase Hollow Fiber Based Liquid Phase Microextraction (HF-LPME) for the HPLC Determination of Tamsulosin from Biological Fluids

Background: Tamsulosin is used for the treatment of difficult urination, a common symptom of an enlarged prostate. Objective: In the present paper, for the first time a microextraction technique was introduced for the detection and determination of tamsulosin in urine and plasma samples. Method: Procedure for extraction of tamsulosin consists of hollow ber based liquid phase microextraction (HF-LPME) followed by high performance liquid chromatography (HPLC) coupled with ultraviolet (UV) detection. The organic liquid membrane consists of 1-Octanol immobilized in the pores of a hollow fiber. A pH gradient was applied to migrate analytes from the sample solution with pH 10.5, through the organic liquid membrane into an acidic acceptor solution with pH 3.0 which was located inside the lumen of hollow fiber. Results: Extraction recoveries greater than 80% were obtained in different biological matrices which resulted in preconcentration factors greater than 102 and acceptable repeatability (2.5 < RSD% <3.5). Conclusion: The method offers good linearity with estimation of coefficacy higher than 0.9990. Finally, it was applied for the determination and quantification of tamsulosin in human plasma and urine samples. Keywords: Tamsulosin, high performance liquid chromatography, hollow ber based liquid phase microextraction, Microextraction.

Acceptability and Satisfaction Associated With the Introduction of the PrePex Circumcision Device in Maputo, Mozambique.

Background:Adult device circumcision may potentially reach more men in Sub-Saharan Africa, with fewer human resource and capacity needs than surgical procedures. Despite these advantages, little is known about device acceptability, including pain and maintaining the device in situ.Methods:Healthy, HIV-negative men, between 18 and 49 years, in a Maputo clinic, were consecutively asked to participate in a circumcision device study that included assessing acceptability. Clinical forms and self-administered surveys were used to collect data at various times during the circumcision process for consenting men. Data were entered into a central database and analyzed using statistical software.Results:Between May and July, 2013, 504 men received device circumcision. Placement was painless for 98.2% of the male population, but the pain was more common during removal with 38.3% reporting severe or unbearable and 21.5% moderate pain. Satisfaction was high at both time points with 88.8% and 92.6% of men being very or somewhat satisfied at placement and removal, respectively. Half of the male population (50.2%) was very or somewhat comfortable with the device in situ; whereas, 36.8% were somewhat or very uncomfortable. Common device difficulties experienced were painful erections (38.5%) and difficult urination (21.8%) and hygiene (21.4%). By the final clinic visit at day 49, 90.4% of them were very or somewhat satisfied with the procedure.Discussion:High levels of satisfaction were reported for device circumcision, despite the pain noted during removal and some challenges with the device in situ. Given the advantages and acceptability among Mozambican men in this study, device circumcision could be offered, when clinically appropriate, as an alternative to surgery.

Posterior urethral valve presenting with urethral stone: a challenging diagnosis

Posterior urethral valve is one of the most common causes of urethral obstruction in male neonates. Posterior urethral valve is now a day commonly diagnosed in prenatal USG. PUV can cause symptoms ranging from pulmonary hypoplasia to renal insufficiency. We are presenting a case report of a rare association of a large urethral calculus secondary to Posterior urethral valve in a 4 years old child who presented with difficulty while micturition. PUV is common finding in male children, which mainly presents with difficult micturition. This case was a rare association of urethral calculi secondary to valves presenting with painful micturition.

Rare giant bladder stone with the size of an adults' fist in healthy young male

Rare giant bladder stone with the size of an adults' fist in healthy young male

Nutritional Status and Dietary Habits of Subjects with Urolithiasis

The lifestyle, environmental factors, nutritional status and dietary habits of patients with Urolithiasis, visiting the major hospitals in Mysore city was studied. The mean age of onset of the disease was &gt; 20 y. A higher incidence was found in men belonging to younger age group. Subjects exhibited a positive urinary tract infection, difficult urination and pain. Somatic assessment indicated a low protein status. Urea, creatinine and other biochemical parameters were within the normal range for majority of subjects. Subjects were involved in heavy activity as they were agricultural laborers. Dietary were mixed types, with the cereals being the predominant items of the daily meals. Consumption of green leafy vegetables/ fruits was very low. The energy intake was lower than RDA. Higher intake of finger millet and horsegram, which are rich sources of calcium, oxalate and dietary fiber, and low fluid intake was reported by the subjects. Research is needed to identify risk factors specific to different geographical regions.

Cystopexy to Treat Urinary Incontinence Due to Urethral Sphincter Mechanism Incompetence in a Male Dog

A castrated male Yorkshire Terrier dog was presented for urinary incontinence and constipation. On physical examination, the dog showed difficult urination. There were no neurological abnormalities and no bacterial detection on urinalysis. Rectal examination revealed a regular, normal-sized prostate. Urethral catheterization was performed easily. Excretory urography and retrograde positive contrast urethrocystography showed displacement of the urinary bladder to the intrapelvic region. There was no evidence of an ectopic ureter. A tentative diagnosis of urethral sphincter mechanism incompetence accompanied with a pelvic bladder was made. Cystopexy was decided to place the urinary bladder to its normal position. The neck of the urinary bladder was anchored to the body wall and prepubic tendon using mattress sutures. Additional sutures were placed to appose the lateral part of the urinary bladder and abdominal wall. A simple interrupted suture was placed to tack the apex of the urinary bladder on the abdominal incision line. A urinary catheter was placed in the urinary bladder to provide post-operative evacuation. The catheter was removed when the dog was able to urinate with minimal straining at 3 days post-operatively. The owner reported that the dogs showed normal urination without straining at 3 days after the catheter was removed. Excretory urography revealed that the urinary bladder was located on its normal position at 2 months post-operatively. Subsequent communication with the owner by telephone revealed that the dog was in good urination at 3 years 11 months post-operatively.

Subpubic Cartilaginous Pseudocyst: Orthopedic Feature with Urological Consequences

Introduction. Masses arising from structures adjacent to the female urethra can cause obstructive urinary symptoms. Subpubic cartilaginous pseudocyst is a rare degenerative lesion of pubic symphysis that may cause these symptoms. Materials and Methods. A 61-year- and 57-year-old women presented with symptoms of difficult micturition and dyspareunia. Physical examination revealed a painless smooth, rounded, firm, and cystic mass, at the anterior vaginal wall of about 4 cm width. The mass caused inward deviation of the external urethral meatus. Cystoscopy and MRI were done. Results. Cystoscopy of case 1 (61 y) demonstrated anterior external urethral compression with normal urethral mucosa. Cystoscopy was not possible in case 2 (57 y) because the urethra could not be entered under local anesthesia. MRI showed almost the same findings in both cases: midline, rounded, and cystic mass ~3 × 3 × 4 cm, anterosuperior to the urethra, and posteroinferior to the pubic symphysis, with normal features of the urinary bladder. Open surgical excision of theses lesions was performed in both patients. Histopathologic assessment of the specimen obtained from both patients showed degenerated hyaline with areas of fibrinous and mucoid degeneration, a picture suggestive of cartilaginous subpubic pseudocyst. After 11-month and 4-month followup of patients numbers 1 and 2, respectively, there is no evidence of local recurrence of the lesion, either clinically or radiologically and both patients void empty. Conclusions. Subpubic cartilaginous pseudocysts are rare benign lesions with only 13 cases were reported in the literature. Patients present with a spectrum of gynecological and/or urological manifestations. Sizable lesions severely compressing the urethra need surgical excision to restore the voiding function.

Intervenção coronária percutânea pelas vias radial e femoral: comparação entre desconfortos relacionados ao procedimento e custos

INTRODUCAO: Escassos sao os estudos a respeito da Qualidade de Vida pos-intervencao coronaria percutânea (ICP), pelas vias radial e femoral, e dos gastos comparando as duas vias de acesso. Comparamos os desconfortos relacionados ao procedimento e os custos da ICP pelos acessos radial e femoral na fase hospitalar. METODOS: Registro prospectivo, unicentrico, que incluiu pacientes submetidos a ICP eletiva. As queixas relacionadas ao procedimento foram avaliadas ao final do periodo de repouso no leito, por meio de um questionario especifico. Foram computados os custos por unidade de todo o material utilizado na ICP. RESULTADOS: Os pacientes tratados por via radial eram mais jovens, do sexo masculino e a angina estavel foi o quadro clinico mais frequentemente tratado nos dois grupos. O tempo de exame, o numero de vasos tratados e stents por paciente foram semelhantes entre os grupos. Nao ocorreram complicacoes vasculares maiores apos a ICP. Observamos maior desconforto geral associado ao procedimento (60,3% vs. 81,0%; P = 0,01), dor nas costas (1,7% vs. 17,2%; P < 0,01), dificuldade para urinar (1,7% vs. 12,1%; P = 0,03) e dependencia do paciente para desempenhar atividades basicas (70,7% vs. 98,3%; P < 0,01) durante o periodo de observacao no grupo femoral. Na comparacao dos gastos, nao foram notadas diferencas significantes entre os grupos, com ou sem a inclusao dos custos dos stents. CONCLUSOES: A ICP por via radial demonstrou trazer maior conforto para o paciente comparada a via femoral, durante a fase hospitalar. Os custos dos procedimentos pelas duas vias de acesso foram semelhantes.

Therapeutic outcome and quality of life between urethral and detrusor botulinum toxin treatment for patients with spinal cord lesions and detrusor sphincter dyssynergia

Patients with spinal cord lesions and detrusor sphincter dyssynergia (DSD) may be treated with urethral sphincter botulinum toxin A (BoNT-A) injection for difficult urination or detrusor BoNT-A injection for incontinence. Although objective data showed improvement, patients might not be satisfied with the result especially in quality of life (QOL) issue. This study investigated the therapeutic results and QOL and patients' satisfaction to these two treatments. Patients with spinal cord lesion and DSD were treated with urethral sphincter injection of 100 U of BoNT-A for main symptoms of difficult urination and detrusor injection of 200 U of BoNT-A for main symptom of incontinence. The urodynamic parameters, QOL scores using UDI-6 and IIIQ-7 and general satisfaction were compared between two groups. The overall satisfactory result was perceived in 60.6% and 77.3% in patients who received urethral and detrusor BoNT-A injection, respectively. Urodynamic parameters showed significant improvement in both groups. Urethral injection group had improvement in IIQ-7, but not in UDI-6 scores whereas detrusor injection group had improvement in all scores. The improvement of UDI-6 and IIQ-7 was significantly greater in detrusor than urethral injection group. Increase in incontinence grade was the major cause of dissatisfaction in urethral injection group, whereas increase in difficult urination and needing catheterisation were the main dissatisfaction causes in detrusor injection group. There was discrepancy between the objective urodynamic results and patient satisfaction in treatment of DSD by BoNT-A injection. Patients with DSD and treated with detrusor BoNT-A had greater QOL improvement than those treated with urethral injection.

Urinary bladder spindle-cell neoplasm concomitant with urothelial cancer

A postoperative spindle-cell neoplasm of the urinary bladder is an extremely uncommon lesion. The previous literature indicated that the neoplasm is an indolent, benign tumor and rarely exhibits clinically aggressive behavior. We report a 68-year-old male patient who underwent cystolithotomy for a huge urinary bladder stone. Two months later, he complained of progressively difficult micturition. Imaging studies revealed a huge invasive urinary bladder tumor, and a radical cystoprostatectomy with ileal conduit diversion was performed. The pathology report confirmed a spindle-cell tumor concomitant with a high-grade, papillary urothelial carcinoma. The patient recovered uneventfully, and there has been no tumor recurrence during ongoing follow-up (12 months).

Depression, Anxiety and the Bladder.

Depression and anxiety are common mental illnesses. It is recognized that depression/anxiety causes physical changes, including insomnia, anorexia, and bladder dysfunction. We aimed to delineate bladder dysfunction in patients with depression/anxiety by reviewing the literature. We performed a systematic review of the literature to identify the frequency, lower urinary tract symptoms (LUTS), urodynamic findings, putative underlying pathology, and management of bladder dysfunction in patients with depression/anxiety. From a recent survey of a depression cohort (at a psychiatry clinic), the frequency of bladder dysfunction in depression is lower (up to 25.9%) than that in Parkinson's disease (up to 75%) and stroke (up to 55%), whereas it is significantly higher than that in age-matched controls (around 10%). In both the depression cohort and the psychogenic bladder dysfunction cohort (at a urology clinic), the most common LUTS was overactive bladder (OAB), followed by difficult urination and infrequent voiding. Compared with severe LUTS, urodynamic findings were dissociated; i.e. urodynamic findings were normal except for increased bladder sensation without detrusor overactivity for OAB (50% of all patients), followed by underactive detrusor without post-void residual for difficult urination. The effectiveness of serotonergic or anti-cholinergic medication for ameliorating OAB in the patients awaits further study. In conclusion, although the frequency of LUTS among the depression cohort is not elevated, depression/anxiety is obviously a risk factor for OAB. This finding presumably reflects that the bladder is under emotional control. Amelioration of bladder dysfunction is an important target in treating patients with depression/anxiety.

Urodynamic characteristics of voiding dysfunction in patients with a cerebrovascular accident

Cerebral vascular disease is the sudden onset brain tissue damage and subsequent loss of brain function due to ischemia (white infarct) or hemorrhage (red infarct). Voiding dysfunction is a common sequela after a cerebrovascular accident (CVA). Urinary incontinence occurs in 43.5% of CVA patients within 3 months of the event.1 Incontinence is not life-threatening, and the degree of morbidity often declines over time. Twelve months after CVA, 37.7% of patients continue to have symptoms of urge incontinence.1 The severity and trend of incontinence are dependent on the severity of the stroke and the patient’s age.1 Lower urinary tract symptoms (LUTSs), especially storage symptoms such as frequency and urgency with or without urge incontinence, are commonly present in the 3 months following a CVA.2e4 Pathophysiological conditions other than CVA can cause LUTSs in old age, such as bladder outlet obstruction (BOO), and might lead to confusion in diagnosing and treating voiding dysfunction in older men with a history of CVA.5,6 Foley catheter insertion is the most common method of addressing this problem. Involuntary detrusor muscle contractions are the most common urodynamic finding in patients after a CVA; however, patients with chronic CVA may have both detrusor overactivity (DO) during the storage phase and loss of coordination of urethral sphincter relaxation during voiding that causes urinary incontinence or difficult urination.7,8 Detrusor underactivity (DU) and detrusor hyperreflexia with impaired contractility (DHIC) are other problematic issues that can occur in elderly patients with multiple CVAs or in the acute

The Global Online Sexuality Survey (GOSS): The United States of America in 2011. Chapter I: Erectile Dysfunction Among English‐Speakers

The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders, based on validated questionnaires and applying age adjustment to the World Standard Population (WSP) by the World Health Organization. In 2010, the first report of GOSS came from the Middle East, describing an erectile dysfunction (ED) prevalence rate of 47%. This report studies the prevalence rate of ED in the United States as of 2011-2012 and evaluates risk factors for ED. Prevalence of ED. GOSS was randomly deployed to English-speaking male web surfers in the United States via paid advertising on Facebook, comprising 146 questions including the abbreviated 5-item International Index of Erectile Function. Two thousand twenty-two males participated; with a mean age was 52.38 years ± 14.5. Prevalence of ED was 37.7%, adjusted to 33.7% according to WSP, comparable across ethnic groups. The following risk factors were associated with higher risk for ED: diabetes mellitus, hypertension with and without antihypertensive treatment, coronary heart disease, obesity (defined by body mass index), difficult micturition, subjectively reported depression, interpersonal distress, subjectively reported impotence, in addition to novel factors such as subjectively reported premature ejaculation (PE) and concerns over genital size (not a smaller penis per se), low libido, and irregular coitus. Frequency of smoking and alcohol were not associated with higher prevalence of ED, although duration of smoking was. Adjusted to WSP, prevalence rate of ED in the United States of America is 33.7% in the year 2011, in contrast to the adjusted prevalence in the Middle East (47%). Most of the classical risk factors for ED play the same role in the United States and the World, including diabetes, hypertension, and aging. Concerns over genital size and PE are emerging risk factors for ED.

Psychogenic Urinary Dysfunction in Children and Adults

This paper reviews current concepts of psychogenic urinary dysfunction (PUD) in children and adults from a uro-neurologist’s point of view. Although it is not common in urodynamic practice, PUD is an important category that all urologists have to consider. Regarding urologic aspects, PUD is basically a diagnosis of exclusion, particularly from urologic, gynecologic, and neurologic causes. In our patients, the characteristics of lower urinary tract symptoms in PUD are the situational occurrence of overactive bladder and/or difficult urination and, in some patients, extremely infrequent toileting. The characteristics of urodynamics in PUD are increased bladder sensation during bladder filling and underactive/acontractile detrusor during voiding. Regarding neuropsychiatric aspects, PUD is usually accompanied by more obvious psychologic/psychiatric features. In fact, the majority of our patients had hysterical neurosis/conversion disorder and anxiety disorders. Alteration in both emotion and micturition under such conditions most probably originates from the brain, which may reflect functional alteration in γ-aminobutyric acid (GABA)ergic, serotonergic, and corticotropin-releasing factor (CRF)ergic neuronal circuits. In addition, even in cases suggestive of PUD, a possible non-PUD pathology behind the symptoms should always be explored.

Videourodynamic differential diagnosis of voiding dysfunction in Taiwanese women

ObjectiveVoiding dysfunction in women is common, but the differential diagnosis of the underlying pathophysiology is not easy. This study analyzed lower urinary tract dysfunction in women with voiding dysfunction based on videourodynamic study (VUDS). Patients and MethodsA total of 781 consecutive women with complaints of difficult urination were included. All patients underwent VUDS and a final diagnosis was made. The clinical symptoms and video urodynamic characteristics were analyzed. ResultsDifficult urination was the main symptom in 446 patients and an associated symptom in 335. A normal VUDS tracing was found in 96, detrusor overactivity in 112, bladder oversensitivity in 128, and interstitial cystitis in 40. The other 405 women were classified as having voiding dysfunction, including 178 with detrusor underactivity, 55 with detrusor overactivity and inadequate contractility, 88 with dysfunctional voiding, 20 with bladder neck dysfunction, 10 with urethral stricture, and 54 with poor pelvic floor muscle relaxation. Difficult urination was the main symptom in 62%, urinary retention in 11.2%, and frequency, urgency, or urgency incontinence in 24.6% of all patients with voiding dysfunction. A total of 93.8% of patients had both storage and empty symptoms, whereas only 6.2% had empty symptoms alone. Urodynamic parameters could only differentiate bladder outlet obstruction and detrusor underactivity based on voiding detrusor pressure in all patients with voiding dysfunction. ConclusionStorage and voiding symptoms are common in women with voiding dysfunction. VUDS is the best diagnostic tool in the differential diagnosis of female voiding dysfunction.

2314 BASELINE URODYNAMIC PARAMETERS DO NOT AFFECT THE TREATMENT OUTCOME OF INTRAVESICAL 100U ONABOTULINUMTOXINA INJECTION FOR PATIENTS WITH IDIOPATHIC DETRUSOR OVERACTIVITY

INTRODUCTION AND OBJECTIVES: Intravesical injection of onabotulinumtoxinA (BoNT-A) provides effective treatment for idiopathic detrusor overactivity (IDO). However, not all patients have successful long-term therapeutic effect. This study investigated the affect of baseline urodynamic parameters on the therapeutic effect and adverse events after injecting 100U onabotulinumtoxinA in patients with IDO refractory to antimuscarinics. METHODS: A total of 174 patients who received the first single intravesical BoNT-A 100U injection for refractory IDO were included. The success rate was determined based on patient perception of bladder condition (PPBC) improved by 2 scales. The short-term (3 months) and long-term (up to 24 months) success rates were analyzed according to the baseline urodynamic parameters including cystometric bladder capacity, maximum flow rate, postvoid residual, voiding efficiency, and DO subtypes. The BoNT-A related adverse events were also reported. RESULTS: A successful outcome was reported by 138 (79.3%) patients at 3 months. The baseline urodynamic parameters did not affect the success rates except that patients with phasic DO had a significantly higher success rate at 3 months than patients with terminal DO. Patients with a baseline PVR 100ml had a higher rate of acute urinary retention and needed straining to void. However, long-term success rates upto 24 months showed no significant difference between patients with different urodynamic parameters. CONCLUSIONS: Except for patients with phasic DO, the baseline urodynamic parameters did not affect the treatment outcome of intravesical injection of 100U onabotulinumtoxinA for IDO. However, the occurrence of AUR and difficult urination were significantly greater in patients with baseline PVR of 100ml.

Do baseline urodynamic parameters affect the treatment outcome after intravesical 100 U onabotulinumtoxinA injection in patients with idiopathic detrusor overactivity?

ObjectivesIntravesical injection of onabotulinumtoxinA (BoNT-A) provides effective treatment for idiopathic detrusor overactivity (IDO). However, not all patients have successful long-term therapeutic effects. This study investigated the effects of baseline urodynamic parameters on the therapeutic outcome, after injecting 100 U BoNT-A in patients with IDO. Materials and MethodsA total of 174 patients who received a first single intravesical BoNT-A 100 U injection for refractory IDO were included. A successful outcome was defined as an improvement of at least two points on a patient perception of bladder condition scale, which was scored from 0 to 6. The short-term (3 months) and long-term (up to 24 months) success rates were analyzed according to baseline urodynamic parameters, including cystometric bladder capacity, maximum flow rate, postvoid residual, voiding efficiency, and detrusor overactivity (DO) subtypes. BoNT-A- related adverse events were also reported. ResultsA successful outcome was reported by 138 (79.3%) patients at 3 months. The baseline urodynamic parameters did not affect the success rates, except that patients with phasic DO had a significantly higher success rate at 3 months than patients with terminal DO. Patients with a baseline postvoid residual (PVR) > 100mL, had higher rates of acute urinary retention and need to strain to void. However, long-term success rates up to 24 months showed no significant differences between patients with different urodynamic parameters. ConclusionsExcept for patients with phasic DO, the baseline urodynamic parameters did not affect the treatment outcome of intravesical injection of 100 U BoNT-A for IDO. However, acute urinary retention and difficult urination occurred more often in patients with a baseline PVR of > 100mL.

Colorectal Burkitt Lymphoma

Purpose: Introduction: Patients with AIDS remain at increased risk for high-grade B cell lymphoma. The incidence of Burkitt lymphoma has dramatically increased since HIV appearance. However, in the era of HAART, only a few cases of colorectal Burkitt lymphoma have been reported these days. Burkitt lymphoma associated with AIDS is characterized by extensive lymphadenopathy and extranodal involvement. Case Presentation: A 32-yearold male with AIDS presented with rectal pain. The patient was noncompliant with HAART, and his last CD4 count was 156 cells per μl 2 months prior. He also admitted suprapubic abdominal pain associated with difficult urination. His vital signs were T 99.1F, HR 110/min, BP 149/85 mmHg, SpO2 98% on room air. Fullness with tenderness was observed in the suprapubic area. Rectal exam revealed a circumferential polypoid mass above the anal junction. Labs were significant for WBC 3800/μl, HGB 10.8 g/dL, PLT 103 K/μl and LDH 1901 U/L. The abdominal CT demonstrated multiple large soft tissue masses throughout the abdomen arising from the small bowel with the largest measuring 8.7 x 15 cm. Right hydronephrosis was also found. CTguided biopsy revealed high-grade B cell lymphoma with Burkitt's feature. Immunohistochemistry was positive for CD45, CD20, CD10, BCL-2, BCL-6, and negative for CD3, CD5, CD23, Cyclin D1. Proliferation index was more than 90%. Colonoscopy showed single large circumferential friable mass in the rectum. The patient was treated with chemotherapy consisting of etoposid, predonisone, vincristine, cyclophosphamide, and doxorubicin (EPOCH) with good clinical response. His rectal/abdominal pain and urinary symptoms improved. Discussion: A majority of AIDS-related lymphomas are high-grade B-cell tumors. Advanced stage at presentation is more frequent in the setting of HIV infection. However, with recent advances in HAART, colorectal involvement with the most aggressive type of B-cell lymphoma, Burkitt lymphoma, is not common. In our case, the patient was noncompliant with HAART and presented with extensive abdominal lymphadenopahy. Generalized lymphadenopathy is one of the main symptoms for Burkitt lymphoma associated with AIDS. Those patients can be presented with bowel obstruction, gastrointestinal bleeding or obstructive uropathy. Therefore, rectal pain or voiding symptoms in HIV patients should raise a suspicion for colorectal involvement of Burkitt lymphoma. In addition, unusual presentation of Burkitt lymphoma warrants an aggressive search for coexisting HIV infection.

Difficult Urination Does Not Affect the Successful Outcome after 100U OnabotulinumtoxinA Intravesical Injection in Patients with Idiopathic Detrusor Overactivity.

Intravesical injection of onabotulinumtoxinA (i.e. Botox) provides effective treatment for overactive bladder. However, treatment-related adverse events (AEs) remain problems. This study investigated the effect of AEs after onabotulinumtoxinA injection on the success rate for idiopathic detrusor overactivity (IDO). A total of 174 patients who received the first single intravesical onabotulinumtoxinA 100U injection for refractory IDO were included. The onabotulinumtoxinA related AEs including acute urinary retention (AUR), large postvoid residual (PVR, ≥150 mL), difficult urination, urinary tract infection, gross hematuria and general weakness were recorded. The success rate was determined based on patient perception of bladder condition improved by two scales. The short-term (3 months) and long-term (up to 24 months) success rates were analyzed according to the occurrence of these AEs. A successful outcome was reported by 138 (79.3%) patients at 3 months. AUR occurred in 12 (6.9%) patients, large PVR developed in 81 (46.6%) and 73 (42%) needed straining to void. Gross hematuria occurred in 17 (9.8%) patients, urinary tract infection developed in 27 (15.5%) and general weakness was noted in 6 (3.4%). The occurrence of AUR did not affect the therapeutic results. Patients having large PVR and difficult urination had a significantly higher success rate at 3 months. Long-term success rates up to 24 months showed no significant difference between patients with and without AEs. AEs after intravesical 100U onabotulinumtoxinA for IDO were frequently encountered. However, the occurrence of AUR, large PVR or difficult urination did not affect the final therapeutic outcome.