Idiopathic Bladder Research Articles

Robot-assisted continent urinary diversion according to the Mitrofanoff principle: results of a bicentric study.

To assess the outcomes of continent urinary diversion according to the Mitrofanoff principle by robot-assisted laparoscopic surgery in terms of continence, catheterization and repeat surgery. All adult patients who underwent procedures for continent urinary diversion via a robot-assisted laparoscopic route between October 2014 and November 2018 were enrolled retrospectively. Abdominal continence and clean intermittent catheterization ability were noted, as well as patient characteristics, details of the technique, intra- and perioperative parameters, and complications. Ten patients were included. Bladder-sphincter disorders were due to neurological causes in nine patients, and one patient had idiopathic bladder sphincter dyssynergia. A continent catheterizable channel was created using the appendix in six cases and the ileum in four cases. The median operative duration was 245min (IQR 228-370). Two patients had a Clavien 3 complication requiring laparoscopy to separately drain a haematoma and a pelvic abscess. The median follow-up was 21months (IQR 17-27). Abdominal continence without further intervention was obtained in 6/10 patients (60%). Two patients needed an open revision of the continent urinary diversion, one required injection of Deflux® and one an intradetrusorian injection of botulinum toxin type A (Botox®). Further surgery was needed for two patients to improve urethral continence. At the end of follow-up, all patients were continent and clean intermittent catheterization was possible. Continent urinary diversion performed according to the Mitrofanoff principle is possible via a robot-assisted laparoscopic route and yields good outcomes on abdominal continence in the short term in patients with clean intermittent catheterization ability.

Abobotulinumtoxin A in Idiopathic Hyperactive bladder – ethical issues

Abobotulinumtoxin A in Idiopathic Hyperactive bladder – ethical issues

Modern non-cosmetic treatment with botulinum toxins

Botulinum toxin has been known in medical history for along time. The first scientific investigations and thoughts on possible indications in the treatment of muscular disorders were published by the German physician and poet Justinus Kerner in 1822. The physiological effect of botulinum toxin was identified in the middle of the twentieth century and the first clinical use was reported in 1977. It was first used in ophthalmology for the correction of strabismus and some years later the therapy of blepharospasm and cervical dystonia was established. Further indications, all supported by randomized controlled studies, are spastic tone increase of the limbs after lesions of the central nervous system, idiopathic axillar hyperhidrosis, chronic migraine and neurogenic or idiopathic bladder hyperactivity. In addition to these indications, alarge number of further possible options have been published in the literature. Beside its effect on transmission at the neuromuscular synapses, botulinum toxin has also been shown to affect the sensory transmission of nociceptive fibers.

Long-term follow-up of intravesical botulinum toxin-A injections in women with idiopathic overactive bladder symptoms.

Intravesical botulinum toxin (BoNT-A) is a safe and effective treatment for overactive bladder syndrome. There are many reports on the clinical experience with BoNT-A, especially in patients with neurogenic detrusor overactivity. The US Food and Drug Administration has recently approved its use for idiopathic overactive bladder (iOAB). Various studies have reported positive results for iOAB in the short-term. Yet little is known about the results after repeated BoNT-A injections. In this study, we evaluated the long-term results of botulinum toxin (BoNT-A) in women with iOAB. Patients treated with BoNT-A from 2004 until 2009 were evaluated in a non-academic teaching hospital (Zuyderland MC, Heerlen, the Netherlands). All female patients with a follow-up of >5years with idiopathic bladder dysfunction were included. All patients received 200U of onabotulinum toxin-A in 20 intradetrusor injections. In some patients, we applied a dose adjustment for repeated injections. Patients were instructed how to use clean intermittent self-catheterization (CISC) before the treatment. We advised patients to commence CISC if post-void residual exceeded 150ml. A total of 128 women were included. All patients had at least 5-year follow-up after their first injection. The mean follow-up was 97 (60-125) months. The mean age was 67 (46-88) years. Of all patients, 30% were still on BoNT-A treatment at the last follow-up visit. Of the 70% that discontinued treatment, 27% had insufficient effect and 43% had tolerability issues. Most patients discontinued treatment after the first (79%) and second (19%) injections. Only 2% of patients discontinued treatment after more than two injections during follow-up. Intravesical BoNT-A is an effective treatment for women with idiopathic OAB. However, in time, almost two-thirds of patients in our study discontinued therapy. Most patients discontinue treatment after one or two injections and mainly due to tolerability issues.

Urinary ascites from spontaneous bladder perforation in female neonate

Urinary ascites from bladder perforation in neonate is a rare event reported to occur more commonly following umbilical artery catheterization. Other causes include bladder perforations in neonates with bladder abnormalities, following bladder instrumentation or idiopathic bladder perforations. The present manuscript describes a full-term female neonate with spontaneous bladder perforation who was successfully managed with early operative intervention. We also present a review of the current literature and also discuss the pathogenesis, diagnosis and management of this rare entity.

Long-Term Outcome of the Pippi Salle Procedure for Intractable Urinary Incontinence in Patients with Severe Intrinsic Urethral Sphincter Deficiency

We evaluated the long-term outcome of the Pippi Salle procedure in patients with severe intrinsic urethral sphincter deficiency. We performed the Pippi Salle procedure in 6 males and 6 females with severe intrinsic sphincter deficiency between March 2003 and August 2013. Median patient age was 15 years (range 6 to 45). Mean followup was 75 months (range 17 to 142). Six males and 3 females had neurogenic intrinsic sphincter deficiency (spina bifida in 8 and spinal cord injury in 1). Three females had anatomical intrinsic sphincter deficiency (idiopathic bladder hypoplasia in 2 and pseudo-ureterocele in 1). Four patients had previously undergone bladder neck surgery, 3 had been treated with endoscopic injection of collagen, 2had undergone fascial sling and 1 had been treated with tension-free vaginal tape surgery. The Pippi Salle procedure was performed alone (2 patients), or in combination with bladder augmentation (4) or catheterizable abdominal stoma (1), or both (5). Complete dryness was achieved in 7 patients (58%). Of 9 patients with neurogenic intrinsic sphincter deficiency 7 (78%) achieved complete dryness. Eight patients experienced complications, including continued urinary incontinence (5), difficulty catheterizing per urethra (3) and urinary calculi (1). These 8patients were successfully treated with additional endoscopic interventions, including injection of collagen in 4, injection of dextranomer-hyaluronic acid in 1,transurethral incision of urethral kink in 3 and vesicolithotripsy in 1. After these simple interventions complete dryness was achieved in all 12 patients. Although we experienced some minor complications in the short term, most patients were simply and successfully treated with endoscopic surgery. The long-term results of the Pippi Salle procedure are promising.

CLINICAL BACKGROUND ANALYSIS ABOUT TRANSURETHRAL ELECTROCOAGULATION

Transurethral electrocoagulation (TUC) is a rare event but occurs in a constant manner with various causes or disorders and reduces patient quality of life. So far there have been no reports focusing on the details of TUC. We focused on the clinical background and related causes in cases of TUC in our institution. We identified 76 cases (65 patients) who underwent TUC at Keio University Hospital between April 2001 and March 2011. We focused on patient background, especially with respect to the primary disease, treatment modality, use of antiplatelet or anticoagulant agent, timing of TUC, type of electrosurgical device, and the incidence of transfusion. The primary disease for TUC included bladder tumor (BT) in 31 cases, benign prostate hyperplasia (BPH) in 13, prostate cancer (PCa) in 13, idiopathic bladder bleeding in 4, periarteritis nodosa in 3, uterine cervical cancer in 3, and others in 9. TUC after transurethral resection (TUR) was found in 38 cases, including transurethral resection of bladder tumor (TURBT) in 26 of 31 BT cases and transurethral resection of prostate (TURP) in 12 of 13 BPH cases. After TURBT, TUC was performed before removal of a urethral catheter in 7 cases, and after removal of a urethral catheter in 19 cases. With regard to TUC associated with TURP, the average estimated prostate volume in TUC cases before removal of the urethral catheter was 66.2 ml, which was significantly larger than that in TUC cases after removal of the urethral catheter (46.1 ml, p = 0.045). TUC after the radiation therapy was observed in 21 cases, and the average time from the radiation therapy to TUC was 3.4 years (7 months-10 years). TUC was caused by multiple causes or disorders, and 75% of our TUC was associated with BT, BPH or PCa. TUC associated with TURBT frequently occurred within 1 week after TURBT but was still observed after 1 month following the operation. All TUC associated with TURP occurred within 3 weeks after operation. The average period from radiation therapy to TUC was 3.4 years (7 months-10 years) and TUC associated with radiation cystitis could occur beyond 5 years after radiation.

MP38-20 THE EFFICACY OF BOTULINUM TOXIN A FOR CONTROL OF URINARY INCONTINENCE IN PATIENTS WITH A SUPRAPUBIC CATHETER

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy II1 Apr 2014MP38-20 THE EFFICACY OF BOTULINUM TOXIN A FOR CONTROL OF URINARY INCONTINENCE IN PATIENTS WITH A SUPRAPUBIC CATHETER Bashir Mukhtar, Shafiul Chowdhury, Mahreen Pakzad, Julian Shah, Jeremy Ockrim, Tamsin Greenwell, and Rizwan Hamid Bashir MukhtarBashir Mukhtar More articles by this author , Shafiul ChowdhuryShafiul Chowdhury More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Julian ShahJulian Shah More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , and Rizwan HamidRizwan Hamid More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1277AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are a variety of methods for bladder drainage in disease state including suprapubic catheterisation (SPC). A proportion of these patients continue to have urgency related urinary incontinence refractory to antimuscarinics. Intradetrusor Botulinum toxin A (BTX) is an accepted treatment for control of detrusor overactivity (DO). However, the efficacy of BTX in controlling incontinence in patients with SPC is not well documented. We present our experience with BTX in this setting. METHODS We compiled a retrospectively collated database of patients that between September 2012 and September 2013 had undergone intradetrusor injections of BTX into multiple sites of the bladder wall at our institution. 206 patients were identified, of which 16 had SPC as a method of bladder drainage. All but one had urodynamic proven DO with urinary incontinence. 12 had a pre-treatment diagnosis of neuropathic bladder dysfunction, with the majority of these being secondary to multiple sclerosis. 3 had idiopathic bladder dysfunction and 1 had a diagnosis of chronic pelvic pain syndrome. Data on urodynamics results, including evidence of DO, leakage, BTX dose and further treatment, was collected from the trust computer database. Associated complications, improvement in symptoms, duration of cessation of leakage and if subsequent BTX treatment was effective, was collected via clinic letters, repeat urodynamics and subjectively via a telephone interview. RESULTS The mean age of the cohort was 59 years (range; 34-77 years). Gender ratio was 12 females to 4 males (3:1). From our cohort of 16 patients, 10 reported significant improvement in symptoms with quality-of-life improving effects. 3 had no discernable improvement in symptoms. In 3 the result could not be established. 6/10 patients with improvements were cured of incontinence. Indeed, at the time of follow-up, only one had reported a relapse (at 7 months). The others were within 3,3,5,5 and 9 months of their treatment and still asymptomatic for leakage. In those that had repeat BTX within the study time, all (5/5) reported excellent efficacy. Only 1 patient experienced significant discomfort from the treatment, which resulted in cessation of the procedure. No others reported any peri-operative difficulties (15/16). CONCLUSIONS In patients with urodynamic diagnosed DO who have SPC as a means of bladder drainage, and who experience urinary incontinence that is refractory to antimuscuranics, BTX is an effective treatment option, with good tolerability and beneficial effects that appear to be sustained with repeated injections. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e410 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Bashir Mukhtar More articles by this author Shafiul Chowdhury More articles by this author Mahreen Pakzad More articles by this author Julian Shah More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Rizwan Hamid More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluation of the patients quality of life with diabetic and idiopathic bladder hyperactivity

The research of the quality of life of 75 patients with diabetic bladder hyperactivity (BH) and 349 patients with idiopathic BH. For the assessment of quality of life the questionnaire KHQ was used. There has been a significant decline in the life quality of the patients of both groups. At the same time the specificies of influence of two forms of BH on some particular aspects of quality of life were marked. When diabetic BH compare to idiopathic BH revealed more severe limitations in daily activities and reducing of emotional status, but less strong influence on personal relationships.

Idiopathic Infantile Bladder Lithiasis from Roman Antiquity

Idiopathic Infantile Bladder Lithiasis from Roman Antiquity

Effect of the SK/IK channel modulator 4,5‐dichloro‐1,3‐diethyl‐1,3‐dihydro‐benzoimidazol‐2‐one (NS4591) on contractile force in rat, pig and human detrusor smooth muscle

• To investigate the importance of small (SK)- and intermediate (IK)-conductance Ca2(+) -activated K(+) channels on bladder function, by studying the effects of 4,5-dichloro-1,3-diethyl-1,3-dihydro-benzoimidazol-2-one (NS4591), a new modulator of SK/IK channels, on contractions induced by electrical field stimulation (EFS) and carbachol in rat, pig and human detrusor. • Detrusor biopsies were obtained from rats, pigs and male patients undergoing cystectomy because of bladder cancer. • Force was recorded using myographs. • Intracellular free Ca(2+) was measured in myocytes using microfluorimetry. • In rat bladder rings subjected to EFS, cumulative addition of NS4591 (0.1-30 µM) decreased force by 82 ± 2.9% (n = 6).This effect was reduced by 64 ± 5.2% in the presence of 0.3 µM apamin, a specific inhibitor of SK channels. Apamin increased the force evoked by EFS significantly: force was increased by 14.2 ± 3.4% (n = 5) and 10.1 ± 2.6% (n = 7) in pig and human detrusor strips, respectively (P = 0.04 and P = 0.02). • The cumulative addition of NS4591 (0.3-30 µM) significantly reduced the amplitude of carbachol-induced rhythmic oscillations by 62.0 ± 12.0% (n = 12) and the minimum force between oscillations by 30 ± 5% (n = 9) in pig detrusor strips (P < 0.005). In the presence of 10 µM NS4591, carbachol (1 µM) induced rhythmic contractions with an amplitude and normalized mean power frequency (nmeanPF) of 8.4 ± 5.1% and 0.11 ± 0.06 mN root mean square (rms) Hz (n = 12), respectively, vs. 21 ± 3.4% and 0.17 ± 0.04 mN rms Hz in control strips (n = 13). Apamin induced 6- and 11-fold increases in amplitude and nmeanPF vs. 1.3- and 2-fold increases in control strips. • In human detrusor strips (n = 15), the cumulative addition of NS4591 (1-30 µM) significantly reduced the amplitude by 69 ± 11%, the nmeanPF by 78 ± 6% and the minimum force between carbachol-induced oscillations by 59 ± 5% (P < 0.008). The addition of apamin (0.3 µM) before application of 1 µM carbachol abolished the effects of NS4591 on amplitude and partially abolished its effect on nmeanPF by 41 ± 7%, vs. a 78 ± 6% reduction in the absence of apamin (n = 8). • In spontaneously active detrusor preparations, NS4591 reduced or abolished contractions. • Furthermore, NS4591 (10 µM) decreased the carbachol-induced increase in the fura-2 ratio by 43 ± 3% compared with control (n = 12) (P < 0.03). • The SK/IK channel modulator NS4591 inhibits EFS- and carbachol-induced contractions in rat, pig and human detrusor muscle. • NS4591 may have therapeutic potential for treatment of detrusor overactivity.

New Aspects in the Differential Diagnosis and Therapy of Bladder Pain Syndrome/Interstitial Cystitis

Diagnosis of bladder pain syndrome/interstitial cystitis (BPS/IC) is presently based on mainly clinical symptoms. BPS/IC can be considered as a worst-case scenario of bladder overactivity of unknown origin, including bladder pain. Usually, patients are partially or completely resistant to anticholinergic therapy, and therapeutical options are especially restricted in case of BPS/IC. Therefore, early detection of patients prone to develop BPS/IC symptoms is essential for successful therapy. We propose extended diagnostics including molecular markers. Differential diagnosis should be based on three diagnostical “columns”: (i) clinical diagnostics, (ii) histopathology, and (iii) molecular diagnostics. Analysis of molecular alterations of receptor expression in detrusor smooth muscle cells and urothelial integrity is necessary to develop patient-tailored therapeutical concepts. Although more research is needed to elucidate the pathomechanisms involved, extended BPS/IC diagnostics could already be integrated into routine patient care, allowing evidence-based pharmacotherapy of patients with idiopathic bladder overactivity and BPS/IC.

Spontaneous Bladder Rupture From Pushing a Heavy Object

Bladder rupture due to major abdominal trauma is common. Idiopathic bladder rupture without trauma and without injury-associated evidence is rare. It can mimic other causes that result in acute abdomen, such as appendicitis or peritonitis. We present the case of a 50-year-old male with right lower quadrant abdominal pain with peritoneal sign and acute urine retention. He had a history of benign prostatic hyperplasia and denied any previous trauma. Pushing a huge freezer after drinking much beer was mentioned. Series survey led to the suspicion of appendix rupture and benign prostatic hyperplasia with acute urine retention. However, laparoscopic exploration revealed intraperitoneal bladder rupture. Laparoscopic cystorrhaphy was performed with interrupted two-layer sutures. The patient recovered quickly and was discharged from hospital on the 3rd postoperative day. Spontaneous bladder rupture may result from abruptly elevated intraperitoneal pressure while the bladder is distended when pushing heavy objects or during Valsalva maneuvers. We also present the diagnostic and therapeutic value of laparoscopy for bladder rupture.

1595 “TWO-STAGE-IMPLANTATION” VS. “CONVENTIONAL” PERIPHERAL NERVE EVALUATION - COMPARISON OF RESPONSE RATES IN SACRAL NERVE STIMULATION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy II1 Apr 20101595 “TWO-STAGE-IMPLANTATION” VS. “CONVENTIONAL” PERIPHERAL NERVE EVALUATION - COMPARISON OF RESPONSE RATES IN SACRAL NERVE STIMULATION Andreas Bannowsky, Shuji Sugimoto, Georg Böhler, Raina van Ahlen, Hermann van Ahlen, and Klaus-Peter Jünemann Andreas BannowskyAndreas Bannowsky Osnabrück, Germany More articles by this author , Shuji SugimotoShuji Sugimoto Tokyo, Japan More articles by this author , Georg BöhlerGeorg Böhler Kiel, Germany More articles by this author , Raina van AhlenRaina van Ahlen Osnabrück, Germany More articles by this author , Hermann van AhlenHermann van Ahlen Osnabrück, Germany More articles by this author , and Klaus-Peter JünemannKlaus-Peter Jünemann Kiel, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1373AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prior to implantation of a chronical sacral neurostimulator, it is important to establish which patients might profit from this kind of therapy in order to ensure, by means of a PNE (peripheral nerve evaluation) test, that the implantation of a permanent stimulating device is effective. In a retrospective study we compared the two different techniques used in our department (implantation of the permanent neurostimulation electrodes so-called ‘two-stage-implantation‘ vs. conventional PNE). METHODS We performed a sacral nerve stimulation in 53 patients (mean age: 49.7 yrs (14-75 yrs); 31 with neurogenic or ideopathic urinary retention, 13 with a hyperactive detrusor and 9 with sensory urge or pelvic pain) over a minimum of 5 days. In 42 patients we performed a conventional PNE, 11 patients received ‘two-stage-implantation‘ with implantation of the permanent electrodes. RESULTS 52 of 53 patients received bilateral test stimulation (9% at S2, 91% at S3). One patient underwent unilateral PNE (S3) because of anatomical deformity of the os sacrum. In 20 cases the conventional PNE-test (cPNE) was successful according to standard criteria (47.6% of all cPNE). 12 of these patients suffered from a neurogenic bladder dysfunction, in 8 cases the causes were idiopathic; 9 patients suffered from retention, 7 from overactive bladder symptoms and 4 patients from sensory urge or pelvic pain. The response rate of ‘two-stage-implantation‘ with implantation of the permanent electrodes was 81.8% (9 of 11 patients). 7 patients with neurogenic and 2 with idiopathic bladder dysfunction; 3 patients suffered from retention, 4 from overactive bladder symptoms and 2 patients from sensory urge. CONCLUSIONS Success rate of implantation of permanent neurostimulation electrodes in selecting patients for the permanent implant is significantly higher than the conventional PNE. In this group patients with neurogenic and overactive bladder dysfunctions showed the highest response rates to sacral nerve stimulation and are the most likely to benefit from sacral neuromodulation. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e616 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andreas Bannowsky Osnabrück, Germany More articles by this author Shuji Sugimoto Tokyo, Japan More articles by this author Georg Böhler Kiel, Germany More articles by this author Raina van Ahlen Osnabrück, Germany More articles by this author Hermann van Ahlen Osnabrück, Germany More articles by this author Klaus-Peter Jünemann Kiel, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Neonatal urinary ascitis from idiopathic rupture of bladder.

Bladder rupture in the neonate is an uncommon event, and mostly occurs as a rare complication of umbilical artery catheterization. The usual manifestations include low urine output, ascites, respiratory distress, and rising serum, urea and creatinine. Another cause is observed in premature infants who are managed in the neonatal intensive care unit by minimal stimulation therapy and mechanical ventilation. We are presenting a case of idiopathic bladder rupture in neonate. The management of such case is discussed with review of literature.

Intravesical botox injections in children with a therapy resistant idiopathic overactve bladder

Purpose In general, the first choice of treatment of an overactive bladder is urotherapy combined with with anticholinergics. If this therapy fails, intravesical Botulinum toxin injections (Botox®) (IBI) might be an option. In the Netherlands, Botox® is not yet registrated for this indication. We prospectively studied the effect of IBI in combination with urotherapy in children with a therapy resistant idiopathic overactive bladder. Material and methods 18 patients with a mean age of 9.8 years received submucosal 200 IU Botox dissolved in 20 ml of 0.9% saline and a few drops methylene blue in the bladderwall. Patients were discharged when postvoiding residu was acceptable. After 6 and 12 weeks urodynamics were performed together with a voiding diary. Changes in the mean maximal bladder capacity (from voiding dairy), the number of children with incontinence (day and night) and the mean maximal detrusor pressure during voiding were noted as well as observed side effects. Results The mean bladdercapacity increased from 186 ml to 245 ml after 6 weeks (p = 0.001) and to 278 ml after 12 weeks (p = 0.001). Pre-operative diurnal incontinence was seen in 13 patients. This decreased after 6 weeks to 5 children (p = 0.008) and after 12 weeks to 4 children (p = 0.004). Pre-operatively 16 children had nocturnal incontinence. After 6 and 12 weeks this decreased to 11 and 12 children respectively. The mean maximal detrusorpressure (cm H2O) during voiding was not decreased. Conclusions IBI might be effective in children with a therapy resistant overactive bladder with respect to increasing the bladdercapacity and decreasing the number of incontinent children.

NOVEL RECTUS CROSSOVER TECHNIQUE FOR ENHANCING CONTINENCE IN CUTANEOUS URINARY DIVERSION

We evaluated the long-term outcome of the Pippi Salle procedure in patients with severe intrinsic urethral sphincter deficiency.We performed the Pippi Salle procedure in 6 males and 6 females with severe intrinsic sphincter deficiency between March 2003 and August 2013. Median patient age was 15 years (range 6 to 45). Mean followup was 75 months (range 17 to 142). Six males and 3 females had neurogenic intrinsic sphincter deficiency (spina bifida in 8 and spinal cord injury in 1). Three females had anatomical intrinsic sphincter deficiency (idiopathic bladder hypoplasia in 2 and pseudo-ureterocele in 1). Four patients had previously undergone bladder neck surgery, 3 had been treated with endoscopic injection of collagen, 2 had undergone fascial sling and 1 had been treated with tension-free vaginal tape surgery. The Pippi Salle procedure was performed alone (2 patients), or in combination with bladder augmentation (4) or catheterizable abdominal stoma (1), or both (5).Complete dryness was achieved in 7 patients (58%). Of 9 patients with neurogenic intrinsic sphincter deficiency 7 (78%) achieved complete dryness. Eight patients experienced complications, including continued urinary incontinence (5), difficulty catheterizing per urethra (3) and urinary calculi (1). These 8 patients were successfully treated with additional endoscopic interventions, including injection of collagen in 4, injection of dextranomer-hyaluronic acid in 1, transurethral incision of urethral kink in 3 and vesicolithotripsy in 1. After these simple interventions complete dryness was achieved in all 12 patients.Although we experienced some minor complications in the short term, most patients were simply and successfully treated with endoscopic surgery. The long-term results of the Pippi Salle procedure are promising.

Prenatal urinary ascites due to the idiopathic bladder rupture

The case of intrauterine idiopathic bladder rupture with consecutive urinary ascites is presented. Conservative management resulted in complete resolution of the lesion.

Role of botulinum toxin-A in management of refractory idiopathic detrusor overactive bladder: Single center experience

Overactive bladder (OAB) is a bothersome condition affecting the quality of life, financial constraint on the individual, and community. Anticholinergic drugs cannot be used for long term due to adverse side effects. Botulinum toxin has recently shown promising and encouraging result in management of OAB. Aim was to study the safety, efficacy, tolerability, and duration of effect of 200 units of botulinum toxin in refractory idiopathic detrusor overactivity. Thirty-nine female patients (average age of 52 years) clinically and urodynamically diagnosed as idiopathic OAB were injected 200 units of botulinum toxin-A mixed with 20 ml of normal saline, intradetrusally at the rate of 1 mL at each site for 20 such sites sparing the trigone and ureteric orifices. Follow up at 3rd, 6th, 9th, and 12th month with clinical and urodynamical questionnaire was done. There were 4 dropouts and 35 patients were evaluated, of which 30 patients (85.7%) showed improvement in clinical features like frequency, urgency, nocturia, and incontinence within 1 week of injection, which lasted for mean period of 7 months (varying from 6 to 9 months). Volume at first desire to void improved from median baseline of 104-204 ml and maximum cystometric capacity of bladder increased from mean baseline value of 205-330 ml. The detrusor pressure decreased by 49% from the baseline and postresidual urine volume increased by 30% of maximum cystometric capacity of bladder. There was no adverse effect on our patient. Intradetrusor injection of Botox-A in management of refractory overactive idiopathic bladder is not only safe and well tolerated, but also very effective with practically no side effects.

Hallazgos urodinámicos en mayores de 65 años: experiencia en el departamento 19 de la Agencia Valenciana de Salud (AVS)

This work tries to analyze the urodynamic studies performed in patients over the age of 65 years in the Department 19 of HCAV with the aim of reviewing our activity in this population segment between January 2001 and September 2006, and to perform a clinical-urodynamic correlation which will help to find a diagnosis avoiding the need to repeat urodynamic tests. We perform a descriptive transversal study with retrospective analysis of data from patients older than 65 years who underwent urodynamic tests. Total population in this age range in our health-care department (HCD) (HCD 19) is 35.260 inhabitants (12% of total population) (Valencia health care agency. Healthcare Management HCD 19. Alicante General University Hospital. May 2005). In this population 41% are males (14.620 people) and 59% females (20.637 people). Among males, the most frequent urodynamic finding is infravesical obstruction in almost half of the cases (48%), followed by bladder hyperactivity in 197%, and idiopathic bladder hyperactivity and urgency incontinence with 10%, respectively. No reproducibilily of the symptoms reaches 9% of the cases. On the other hand, in females the most frequent finding is mixed urinary incontinence in 25% of the cases, followed by bladder hyperactivity 17%, urgency incontinence 14% and stress urinary incontinence 13%. No reproducibility of the symptoms reached 11%. In the opposite extreme are intravesical obstruction and sphincter/detrusor dyssynergia without any case. We find that people between 70 and 75 years old are the population group undergoing a greater number of urodynamic tests in our area. The most frequent urodynamic tests performed at our department was pressure/flow study with evaluation of post void residual. Urethra profile was reserved for recurrent stress urinary incontinence after surgery. Obstructive symptoms in males and mixed urinary incontinence in females were the most frequent causes for the indication of urodynamic tests. Our symptom no-reproduceability rates were below 10% of the cases.