Irritative Voiding Symptoms Research Articles

Transmural Vaginal-to-Bladder Injury From an Obstructed Labor Pattern

A vesicovaginal fistula, among other devastating sequelae, is a complication that can arise from obstetric trauma such as prolonged obstructed labor patterns. These are rarely seen as obstetric-related complications in well-developed countries. They are thought to arise from direct ischemic injury that can occur between the fetal head and the adjacent tissues. A patient presented to the emergency room in obstructed labor. Examination revealed a crowning fetal head, no fetal heart tones, and purulent vaginal discharge. Postpartum, the patient experienced irritative voiding symptoms, vaginal stenosis, and cystoscopic evidence of injury to the bladder base. These findings may provide evidence of the transmural vaginal-to-bladder damage that can occur from obstructed labor.

Potential Use of Antiproliferative Factor as a Targeting Therapy in Painful Bladder Syndrome/Interstitial Cystitis

syndrome/interstitial cystitis (PBS/IC) encompasses a major portion of the painful bladder disease complex. Painful comprise a large group of patients with and/or urethral and/or pelvic pain, irritative voiding symptoms (urgency, frequency, nocturia, and dysuria), and sterile urine cultures. conditions with well-established causes include radiation cystitis, cystitis caused by microorganisms that are not detected by routine culture methodologies, and systemic disorders that affect the bladder. In addition, many gynecologic disorders can mimic PBS/IC [1]. PBS/IC has no easily discernible etiology. There are no pathognomonic findings on pathologic examination, and even the detection of petechial hemorrhages on the mucosa during cystoscopy after hydrodistention under anesthesia is no longer considered the sine qua non of PBS/IC that it had been until a decade ago [2]. PBS/IC is truly a diagnosis by exclusion. It may have multiple causes and represent a final common reaction of the to different types of insult. There are numerous theories regarding its pathogenesis, but confirmatory evidence found in clinical practice has proven sparse. Among numerous proposals that have been further studied are leaky epithelium, mast cell activation, neurogenic inflammation, inhibition of uroepithelial cell proliferation: antiproliferative factor (APF), nitric oxide metabolism, urine abnormality and the role of genetics or some combination of these and other factors leading to a self-perpetuating process resulting in chronic pain and voiding dysfunction [3]. Among the various possible evidences, APF has recently been the subject of much attention. The finding that cells from the lining of normal controls grow significantly more rapidly in culture than cells from PBS/IC patients led Keay et al. [4] at the University of Maryland to the discovery of an APF produced by the urothelium of IC patients. Studies are ongoing to confirm the hypotheses related to APF and expand on its significance in diagnosis and development of a rational targeting treatment approach. Especially, the article by Kim and Freeman [5] in this issue of the journal will be recognized as a valuable update on signal transduction pathways and networks that are responsive to APF to learning more about potential therapeutic pathways.

Chronic Prostatitis Is A Risk Factor For Erectile Dysfunction

Objectives. Chronic prostatitis (CP) is associated with a variety of irritative and obstructive voiding symptoms. A significant number of patients also complain of sexual dysfunction. Ejaculatory dysfunction has been reported in more than half of patients with CP. Our goal was to determine whether CP is a risk factor for erectile dysfunction (ED).Methods. The Sexual Health Inventory for Men (SHIM) was administered in our clinic and online at the Interstitial Cystitis Network. 305 men completed the SHIM questionnaire, which included 47 controls (healthy volunteers), 150 men for evaluation of other urologic complaints (urology group), and 108 men being treated for CP. The total SHIM score and response to each SHIM question were analyzed using ANOVA.Results: In the control group, the mean SHIM score was 22.7 of a possible 25 points, and mean SHIM Q1 score was 4.0 of a possible 5 points. In the general urology group, the mean SHIM score was 21 and mean SHIM Q1 score was 3.3. In the CP group, the mean SHIM score was 17 and mean SHIM Q1 was 2.91. The results had statistical significance (p=0.05). Patients with CP have significantly lower total SHIM and SHIM Q1 scores when compared with controls and patients seen for urologic complaints. Patients with prostatitis are younger than those typically seen for general urologic complaints. Conclusion: CP is a risk factor for ED. Patients with CP should be questioned about ED as part of their routine urologic care and offered treatment options.

Mesh-related chronic infections in silicone-coated polyester suburethral slings

despite claims of equivalence to the tension-free vaginal tape, a variety of suburethral slings have been introduced, with various modifications. Complications in certain synthetic slings and meshes have led to a recent FDA public health notification. we report the case histories and management of five women with complications following implant of an InFast sling. four of the five patients presented with symptom of chronic vaginal discharge, one presenting with irritative voiding symptoms and bladder pain. Resolution of presenting symptoms requires total removal of this silicone-coated polyester mesh, which often requires a combined vaginal-abdominal approach. the silicone-coated mesh of the AMS InFAST sling, can become a focus for chronic infection forming a sinus tract into the vagina or other viscus, causing symptoms years after its placement.

Diagnosis and Treatment of Interstitial Cystitis/Painful Bladder Syndrome: A Review

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic bladder disorder characterized by pelvic pain and irritative voiding symptoms. The symptoms of IC/PBS can overlap with such conditions as endometriosis, recurrent urinary tract infection, chronic pelvic pain, overactive bladder, and vulvodynia. The etiology of IC/PBS is likely multifactorial and may involve a defective urothelium, neurogenic upregulation, and mast cell activation. A thorough patient history and physical examination are critical in the differential diagnosis of IC/PBS. Frequent follow-up and patient education are important components of treatment once a condition is diagnosed. A multimodal approach to therapy can provide optimal relief for patients with IC/PBS.

Minimally painful retrieval of ureteral stents using by ureterescope

Aim: The standard method for retrieving the ureteral stents is the cystoscopic technique. We describe a minimally painful method for retrieving ureteral stents by using an ureteroscope. Methods: A total of 60 patients with ureteral stents were enrolled in this study. The patients were randomized into a cystoscopic (30 cases) and an ureteroscopic (30 cases) group. All stents were retrieved by a cystoscope in the first group and by an ureteroscope in the second group, under topical anesthesia. Patients in each group were assessed for stented time, stent side and reason of stent placement, operative time, peroperative pain, postoperative pain, irritative voiding symptoms and hematuria. Results: Stents were successfully retrieved in 60 patients. There were no statistical differences in the two groups regarding patient’s gender and age or stent side, operative time and stented time (p>0.05). Mean operative pain score was significantly higher in the cystoscopic group than in the ureteroscopic group (p<0.01). The irritative voiding symptom scores and hematuria were more prevalent in the first group than the second (p< 0.05). Conclusion: In present study ureteroscopic stent retrieval was found to be minimally a painful, safe and reliable method. The ureteroscopic retrieval procedure is highly tolerable by patients than the cystoscopic retrieval. We suggest that it may be the standard technique for stent retrieval.

847 THE CLEVELAND CLINIC EXPERIENCE WITH ADULT HYPOSPADIAS PATIENTS UNDERGOING REPAIR: THEIR PRESENTATION AND A NEW CLASSIFICATION SYSTEM

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease III1 Apr 2010847 THE CLEVELAND CLINIC EXPERIENCE WITH ADULT HYPOSPADIAS PATIENTS UNDERGOING REPAIR: THEIR PRESENTATION AND A NEW CLASSIFICATION SYSTEM Christina Ching, Hadley Wood, Jonathan Ross, Tianming Gao, and Kenneth Angermeier Christina ChingChristina Ching More articles by this author , Hadley WoodHadley Wood More articles by this author , Jonathan RossJonathan Ross More articles by this author , Tianming GaoTianming Gao More articles by this author , and Kenneth AngermeierKenneth Angermeier More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2349AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While hypospadias is one of the most common genitourinary congenital anomalies, little is known about long-term outcomes both after childhood hypospadias repair and for uncorrected hypospadias. We reviewed our experience with adult hypospadiacs to better clarify their presentation, history, and intraoperative findings. In so doing, we identified a means of categorizing this group to better describe the natural history of this anomaly in adulthood. METHODS A retrospective chart review was performed on adults with hypospadias who underwent urethroplasty at Cleveland Clinic between 1993 and 2009. The charts were reviewed for site of hypospadias, presenting complaint, overall symptoms, history of repair, and type of surgery performed. RESULTS 55 adult patients between 18 and 72 years of age were identified (mean age 37.8). The majority (90.9%) of patients had an anterior urethral hypospadias (glanular/subcoronal 10.9%, penile/shaft 45.5%, bulbar 34.5%) (Figure 1a). Obstructive or irritative voiding symptoms were the most common presenting complaint (50.9%) and overall symptom (81.8%). Based on their history of repair, we found that patients fit into 3 categories: Category I: true hypospadias cripples; Category II: delayed complications after an initially successful childhood repair; and Category III: no previous repair. The majority of patients were Category I (58.2%); however, 7 patients (12.7%) were Category III (Figure 1b). Balanitis xerotica obliterans (BXO) was more common in this subgroup (p=0.037). The length of strictures among Category III patients with BXO were 3.5, 7, and 8 cm. CONCLUSIONS Adults with hypospadias represent a heterogeneous group. More than half of adults with hypospadias have had multiple surgeries (Category I). Interestingly, the majority of adult hypospadiacs presenting with complications have anterior hypospadias and not more proximal disease. Unrepaired hypospadiacs may be at risk for severe stricture disease in adulthood due to BXO. Cleveland, OH© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e330-e331 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christina Ching More articles by this author Hadley Wood More articles by this author Jonathan Ross More articles by this author Tianming Gao More articles by this author Kenneth Angermeier More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

805 EFFECTS OF PROSTATITIS ON SERUM PSA AND URINARY PCA3 GENE SCORE

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 2010805 EFFECTS OF PROSTATITIS ON SERUM PSA AND URINARY PCA3 GENE SCORE Leonard Marks, Art Weber, Harry Rittenhouse, Maria Luz Macairan, Sean Yee, and David Bostwick Leonard MarksLeonard Marks Los Angeles, CA More articles by this author , Art WeberArt Weber San Diego, CA More articles by this author , Harry RittenhouseHarry Rittenhouse San Diego, CA More articles by this author , Maria Luz MacairanMaria Luz Macairan Los Angeles, CA More articles by this author , Sean YeeSean Yee Los Angeles, CA More articles by this author , and David BostwickDavid Bostwick Richmond, VA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1481AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary PCA3 gene, a marker relatively specific for prostate cancer (CaP), has not yet been studied in prostatitis. Serum PSA levels, both total and %Free, can be altered for months by prostatitis, even after symptoms have resolved, falsely suggesting CaP. Hypothesis of this pilot study: prostatitis, causing PSA abnormalities, has little effect on PCA3 gene scores. METHODS Subjects were consecutive outpatients, ages 45-65 y.o., having onset of irritative voiding symptoms and pelvic discomfort with a clinical diagnosis of prostatitis in 2006-7, and increased PSA levels at presentation. All 10 men meeting criteria were recalled for PCA3 score (mRNA PCA3/PSA), during the first 2 weeks of illness; they then had serial PSA testing during a year or more of follow-up. Diagnosis of prostatitis and exclusion of CaP was supported by resolution of symptoms and sustained return of PSA to normal following antibiotic therapy (levofloxacin) in all men, and by biopsy in 5. None had a prostate nodule or bacteriuria. For PCA3 score urine was collected after rectal exam, and specimens were analyzed at Bostwick Labs with a method previously described (Clin.Chem. 52:1089, 2006). RESULTS Initial PSA at diagnosis was 5-62 ng/ml (median=11), gradually decreasing to 0.6-3.1 ng/ml (median=2.0) a year after antibiotic treatment. %Free PSA was 4-20 (median=12) initially, increasing to 8-38 (median=21) at one year. Early-on, when PSA levels were still altered, PCA3 scores were always normal, ranging between 4-31 (median=11.8, cutoff=35). PSA abnormalities persisted for months after treatment. CONCLUSIONS PCA3 gene scores appear unaffected by prostatitis, remaining low in all 10 men when PSA was abnormal from that condition. Abnormal PSA levels, both total and %Free, often persisted for months after treatment, even when the condition was subacute and without bacteriuria. These preliminary data suggest that the apparent cancer-specificity of the PCA3 gene score maintains during prostatitis when PSA is abnormal and could help defer biopsy in such cases. Mechanisms leading to production of PSA and PCA3 are different. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e314-e315 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leonard Marks Los Angeles, CA More articles by this author Art Weber San Diego, CA More articles by this author Harry Rittenhouse San Diego, CA More articles by this author Maria Luz Macairan Los Angeles, CA More articles by this author Sean Yee Los Angeles, CA More articles by this author David Bostwick Richmond, VA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Photoselective Prostatic Vaporization for Bladder Outlet Obstruction: 12-Month Evaluation of Storage and Voiding Symptoms

We evaluated voiding and storage symptom evolution in patients treated with prostate photoselective vaporization by a KTP laser. Enrolled in the study were 150 consecutive patients with lower urinary tract symptoms due to benign prostatic hyperplasia and a diagnosis of bladder outlet obstruction. Patients underwent prostate photoselective vaporization with the 80 W KTP laser. Baseline parameters included prostate volume, International Prostate Symptom Score with voiding and storage symptom subscores, uroflowmetry, pressure flow study and serum prostate specific antigen. Patients were followed 1, 3, 6 and 12 months after surgery. Mean +/- SD patient age was 69.6 +/- 10 years. Mean prostate volume was 52 +/- 18 ml. Mean International Prostate Symptom Score was 22.3 +/- 4, mean maximum urine flow was 9 +/- 2.9 ml per second and mean Schäfer obstruction class was 3.6 +/- 1. An average of 190 +/- 44 kJ were delivered in a mean of 68 +/- 24 minutes with an average of 3.6 kJ/ml prostate. The mean number of fibers was 1.2 +/- 0.4. Mean catheterization time was 20 +/- 8 hours. Retrograde ejaculation was reported in 67% of patients. Prostate specific antigen was significantly decreased at 12 months (2.6 +/- 2.3 vs 0.9 +/- 0.7 ng/ml, p = 0.001). Storage symptoms decreased by 54.5%, 63.6%, 72.7% and 81.8% at 1, 3, 6 and 12 months, respectively (p <0.001). Voiding symptoms decreased 63.6%, 72.7%, 81.8% and 90.9% at 1, 3, 6 and 12 months, respectively (p <0.001). As shown by a prostate specific antigen significant decrease, proper prostate debulking may be achieved by prostate photoselective vaporization. Significant continuous improvement in storage and voiding symptoms was observed at up to 12-month followup.

Epidemiología de la incontinencia urinaria en el cáncer de próstata: Incidencia, calidad de vida y aspectos farmacoeconómicos

To present recent data on the epidemiology of urinary incontinence in prostate cancer (PCa). To review the incidence of urinary incontinence, its impact on quality of life and related pharmacoeconomic features. We performed a bibliographic review about the complications of the various therapeutic options for PCa including radical prostatectomy (RP) (open, laparoscopic and robotic), external beam radiotherapy, brachytherapy, cryotherapy, and high intensity focused ultrasound (HIFU). The lack of uniformity for urinary incontinence definition, for its evaluation, and for the way to report it makes the interpretation of functional results and impact on quality of life after any treatment option difficult and uneven. Generally, we documented that urinary incontinence after treatment appears more often in patients undergoing radical surgery. Nevertheless, we stated that neurovascular bundle preservation, performance of the procedure in high volume centers, by high volume surgeons, and development of robotic surgery may positively influence the global outcomes of this technique. Moderate incontinence is less frequent after external beam radiotherapy, but the association of rectal pain and diarrhea, in up to 40%of the patients, worsens voiding symptoms. Irritative and obstructive voiding symptoms after perineal brachytherapy are especially associated with long term erectile dysfunction as well as rectal morbidity. In the case of cryotherapy and HIFU the available studies are case series and there are not randomized studies comparing them with the primary treatment of localized PCa. Each treatment modality for PCa is associated with a different pattern of changes in the urinary, sexual, intestinal and hormonal related quality of life domains. Two key factors when evaluating incontinence are information about continence before the procedure and the use of validated, self-administered evaluation means. Although technical improvements in all procedures should contribute to diminish the impact of complications, we should not forget the trend to the association of therapies- multimodal therapy- has a higher complication profile. Therefore, they should be reserved for patients in whom a benefit has been proved.

Stone Formation in Prostatic Urethra After Potassium-Titanyl-Phosphate Laser Ablation of the Prostate for Benign Prostatic Hyperplasia

We report three cases of stone formation at the prostatic urethra after 80 W potassium-titanyl-phosphate laser ablation of the prostate for benign prostatic hyperplasia. These complications occurred several months after the procedure. The diagnosis was made by ultrasonography, plain radiography of the kidneys, ureters, and bladder, and cystoscopy in patients who were being evaluated after presenting with irritative voiding symptoms. The patients were treated by cystolithotripsy and resection of the calcified prostatic tissue.

The relationship between sexual abuse and interstitial cystitis/painful bladder syndrome

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic syndrome characterized by irritative voiding symptoms and pelvic pain or discomfort. IC/PBS represents localized bladder pathophysiologic changes and central nervous system upregulation. Patients exhibit bladder hyperalgesia and allodynia. Childhood sexual abuse occurs in up to 27% of females in the United States. Adults with a prior history of abuse or traumatization demonstrate hypothalamic-pituitary-adrenal (HPA) axis abnormalities, similar to IC/PBS patients. Childhood sexual abuse and physical traumatization are associated with subsequent lifelong risks of chronic pain syndromes. IC/PBS patients have increased rates of sexual abuse or physical traumatization histories compared with controls. IC/PBS patients with abuse histories tend to have greater pain intensity and lesser irritative voiding symptoms compared with nonabused IC/PBS patients. This article reviews the relationship between sexual abuse, HPA axis abnormalities, IC/PBS pathophysiology, and the role of sexual abuse on subsequent IC/PBS.

Presenting manifestations of eosinophilic cystitis in two Filipino children

Eosinophilic cystitis is a very rare clinical disease entity in the pediatric population. We report two cases of Filipino children with eosinophilic cystitis who presented with irritative voiding symptoms, gross hematuria, peripheral eosinophilia, and hydroureteronephrosis and urinary bladder wall thickening visualized on ultrasonography and CT urography. Cystoscopy and transurethral biopsy confirmed the diagnosis. Both patients were started with corticosteroid with or without an antihistamine. Resolution from the signs and symptoms were observed in both patients as documented by disappearance of peripheral eosinophilia, normal urinalysis results, and resolution of the hydroureteronephrosis and urinary bladder wall thickening on ultrasonography on follow-up.

Urodynamic testing and interstitial cystitis/painful bladder syndrome

The objective of this study is to evaluate the relationship between symptom severity in interstitial cystitis/painful bladder syndrome, urodynamic testing (UDT), and cystoscopy. Charts of subjects who underwent cystoscopy and bladder overdistention (BOD) from January 2006 to July 2007 were reviewed for data points, questionnaires, UDT, and BOD findings. The independent T test and Mann-Whitney U test were performed between questionnaires, urodynamic data, and cystoscopic findings. Significantly lower volumes on all UDT parameters and higher scores on the interstitial cystitis problem index and pain Likert scale were found in subjects who felt pain with filling on UDT. Significantly lower median volumes for certain urodynamic parameters were found in subjects with high pain Likert scores and O'leary-Sant indices and those with grade 3 glomerulations and anesthetic bladder capacities of less than 600 mL on BOD. UDT may be a useful adjunctive test in the evaluation of patients with irritative voiding symptoms.

Effects of Potassium Citrate on Irritative Voiding Symptoms of Bladder

Participants will learn that potassium citrate may be a contributor to irritative voiding symptoms.

Invited Commentary: Lower Urinary Tract Symptoms and Inflammation--Weighing the Evidence

Lower urinary tract symptoms (LUTS) are a common condition, particularly among older men. The etiology of these symptoms is often obscure and not always clearly related to prostatic enlargement or benign prostatic hyperplasia. St. Sauver et al. (Am J Epidemiol. 2009;169(11):1281-1290) hypothesized that systemic inflammation may be associated with LUTS and benign prostatic hyperplasia. Using a well-defined cohort, they found that, in general, inflammation was not related to LUTS or to benign prostatic hyperplasia progression. However, men with the highest amount of systemic inflammation, as measured by C-reactive protein levels, were at increased risk of a rapid change in irritative voiding symptoms and decreased urinary flow but not obstructive voiding symptoms or prostate size. To what degree systemic inflammation relates to inflammation within the urinary system and specifically the bladder and/or prostate is unclear. Furthermore, to what degree inflammation within the urinary system contributes to LUTS is unclear. Given that clinical trials of antiinflammatory drugs for LUTS have been largely unsuccessful, the role of inflammation as a contributor to LUTS remains an interesting hypothesis that requires further study.

Sesquiterpene Lactone Parthenolide Ameliorates Bladder Inflammation and Bladder Overactivity in Cyclophosphamide Induced Rat Cystitis Model by Inhibiting Nuclear Factor-κB Phosphorylation

Cyclophosphamide (Sigma) is associated with urological complications, including irritative voiding symptoms and hemorrhagic cystitis. Evidence suggests that tumor necrosis factor-alpha (R&D Systems), interleukin-1beta and cyclooxygenase-2 are directly involved in the pathogenesis of cyclophosphamide induced cystitis and these molecules depend on transcription factor NF-kappaB for maximal secretion. Additionally, sesquiterpene lactone parthenolide has been shown to be a potent nuclear factor-kappaB inhibitor. We hypothesized that enhanced nuclear factor-kappaB activity contributes to cyclophosphamide induced cystitis and, therefore, it may be an attractive target for preventing cyclophosphamide cystitis. We determined whether parthenolide could be used as a preventive agent for hemorrhagic cystitis and bladder overactivity. Moreover, we determined the molecular mechanisms of parthenolide on the inhibitory action of nuclear factor-kappaB in inflammatory human benign urothelial cells. Rats were pretreated with parthenolide or vehicle solution and administered cyclophosphamide. Histological analysis and cystometry were performed 24 hours after cyclophosphamide administration. Human urothelial cells were pretreated with parthenolide and stimulated with tumor necrosis factor-alpha. Western blotting and immunofluorescence were performed to determine activation of the cyclooxygenase-2 and nuclear factor-kappaB pathway. Parthenolide pretreatment inhibited bladder inflammation as well as bladder overactivity and it was also associated with nuclear factor-kappaB activation in the bladder. Parthenolide dose dependently suppressed tumor necrosis factor-alpha induced cyclooxygenase-2 expression and prevented nuclear factor-kappaB phosphorylation as well as nuclear factor-kappaB nuclear translocation and IkappaBalpha phosphorylation/degradation. Nuclear factor-kappaB may have a crucial role in the pathogenesis of cyclophosphamide induced cystitis models. Parthenolide ameliorates bladder inflammation and bladder overactivity, and it might be a promising agent for preventing cyclophosphamide induced complications.

QUALITY OF LIFE ANALYSIS OF PATIENTS WHO UNDERWENT HIGH DOSE RATE BRACHYTHERAPY WITH EXTERNAL BEAM RADIOTHERAPY (HDR+EBRT) COMPARING WITH THOSE WHO HAD RETROPUBIC RADICAL PROSTATECTOMY (RRP)

The mean age of BT and RP treated patients was 68 and 64 years. 71,7% (n=620) of RP treated patients had non-nerve-sparing surgery. 89,3% (n=303) and 90,6% (n=770) of the BT and RP treated patients had clinical tumor stage of cT1a-2b. Significant better results in concern of increased voiding frequency (BT 67,8% vs. RP 60,4%), nocturia (BT 43,7% vs. RP 28,9%) and urge symptoms (BT 47,4% vs. RP 36,4%) were recognized at the RP treated group. Significant better results in term of incontinence was achieved in the BT group (BT 11,6% vs. RP 15,6%), but interestingly the group with nerve sparing RP showed almost similar results to BT (BT 11,6% and nerve-sparing RP 11,2%). Absence of erections was reported by 43% of the BT, 85% of RP without nerve sparing, 45% of RP with unilateral nerve sparing and 38% of the RP with bilateral nerve sparing. CONCLUSIONS: In regards to functional outcome BT causes significant higher rates of irritative voiding symptoms. However continence and Preservation of erectile function seems superior in BT compared to RP patients without nerve sparing. Nevertheless differences became minor or insignificant in RP with bilateral nerve sparing.

Phosphodiesterase type 5 inhibitors: a viable treatment option for lower urinary tract symptoms?

Background: Epidemiological data link erectile dysfunction (ED) and lower urinary tract symptoms (LUTS), two highly prevalent conditions in men, assuming a common pathophysiology. Preliminary data showed that phosphodiesterase type 5 inhibitors (PDE5i) might be a promising class of drugs also for LUTS. Objective: The aim of this review is to provide an overview of current knowledge on the association between ED and LUTS with a particular focus on PDE5i as a viable treatment option for LUTS. Methods: A Medline search was completed using the Medical Subject Headings (MESH® keywords) ‘erectile dysfunction’ and the expression ‘lower urinary tract symptoms’ in all fields of the database. This search revealed 122 relevant references (all Medline database until 31 October 2008). Results/conclusions: LUTS are an independent risk factor for ED. Although the pathophysiological link between these conditions is not clear, several theories have been described with various levels of supporting data. Current data show that PDE5i reduce obstructive and irritative voiding symptoms but have no effect in uroflowmetry parameters of postvoid residual volume. The combination with α-adrenergic antagonists may be another treatment option for LUTS. However, further research is needed to establish efficacy and safety of PDE5i in the treatment of LUTS.

Ejaculatory duct dysfunction and chronic pelvic pain syndrome in men

Chronic pelvic pain syndrome (CPPS) describes unexplained pelvic pain in men associated with irritative voiding symptoms, post-orgasmic pain, and/or pain located in the groin, genitalia, or perineum in the absence of bacterial infection. Many different etiologies of CPPS have been proposed, including roles for immunologic, neurologic, endocrine, and psychologic factors. This article examines one such factor—ejaculatory duct obstruction (EDO). Because EDO is correctable with relatively minor surgery, it should be considered by any clinician caring for a patient who reports symptoms of CPPS.