Onset Of Urinary Incontinence Research Articles

Correlation between ischemic stroke topography and female urinary incontinence

AimTo investigate the association between ischemic stroke topography and the onset of urinary incontinence (UI); to evaluate predictors of post-stroke UI in women. MethodWe prospectively followed up a cohort of women with ischemic stroke confirmed by clinical and computed tomography (CT) or magnetic resonance imaging (MRI) scans findings. Participants were subjected to interview, clinical evaluation, and urodynamic study if needed at 6 months post-stroke and divided in continent and incontinent groups. Non-parametric tests compared the baseline characteristics among the groups and determined association between post-stroke UI and the brain sites of injury. Logistic regression analysis determined predictors of post-stroke UI. Significance level at 5 % was set. Results162 S-women were included: 128 (79 %) continent and 34 (21 %) incontinent. Frontal lobe lesions were higher in the incontinent group (82.9 % versus 51.2 %, p = 0.001); lesions in the parietal lobe and the left cerebral hemisphere were higher in the continent group (40.9 % versus 20 %, p = 0.023; and 61.4 % versus 40 %, p = 0.024, respectively). Frontal lobe injury [RR 3.68 (CI 1.2–11.2)], body mass index (BMI) [RR1.16 (CI 1.062–1.266)] and number of vaginal deliveries [RR 1.358 (CI 1.163–1.585)] are risk factors for post-stroke UI. Left parietal lobe injury is less likely to occur in continent women after 6 months [RR 0.168 (CI 0.029–0.981; p = 0.048)]. ConclusionThere is a correlation between the topography of the ischemic stroke and the onset of UI. Frontal lobe lesion, BMI and number of vaginal deliveries are predictors of post-stroke UI.

Predictors and profiles of non-invasive management of urinary incontinence in residents living in nursing homes: A decision tree analysis

PurposeThe purpose of this study is to explore the characteristics and capabilities of nursing home residents with urinary incontinence in relation to urinary incontinence interventions. Materials and methodsA secondary data-analysis on the data from 1417 residents (65 years and above), suffering from urinary incontinence and living in nursing homes and collected by a cross-sectional multi-center point prevalence measurement, the Dutch annual independent (Inter)national Prevalence Measurement of Quality of Care of Maastricht University, was performed. In order to explore the relationship between an urinary incontinence intervention and the predictors diagnosis dementia, body posture, mobility, (un)dressing, hygiene and communication; onset urinary incontinence; frequency, time of loss and quantity urinary incontinence and fecal incontinence, a Chi-squared Automatic Interaction Detector (CHAID) analysis was performed. ResultsThe level of care dependency for hygiene is the key variable in predicting the use of an urinary incontinence intervention. The ability to adopt an appropriate body posture, being urinary incontinence prior to admission into a nursing home and being diagnosed with dementia are identified as significant predictors. Residents care independent for hygiene and for adopting an appropriate body posture and urinary incontinence before admission into a nursing home are more likely to use absorbing material. In residents being care dependent for hygiene and for adopting an appropriate body posture and diagnosed with dementia, a combination of absorbing material with toileting or other interventions are mostly applied. ConclusionsResults reveal that residents’ characteristics and capabilities determine the implementation of an urinary incontinence intervention.

Mental health problems, stressful life events and new-onset urinary incontinence in primary school-age children: a prospective cohort study

Emotional/behaviour problems and exposure to stressful life events are thought to contribute to new onset of urinary incontinence (UI) amongst children who have attained bladder control. However, very few prospective studies have examined these associations. We assessed whether mental health problems and stressful life events were associated with subsequent new onset in UI using multivariable logistic regression in a prospective UK cohort (n = 6408). Mothers provided information on their child’s symptoms of common mental disorders (Development and Wellbeing Assessment, 7 years), stressful life events (7–8 years) and wetting (day and night, 9 years). There was strong evidence that separation anxiety symptoms were associated with new-onset UI in the fully adjusted model (OR (95% CI) = 2.08 (1.39, 3.13), p < 0.001). Social anxiety, attention-deficit hyperactivity disorder and oppositional defiant disorder symptoms were associated with new-onset UI, but these associations attenuated following adjustment for child developmental level and earlier emotional/behaviour problems. There was weak evidence for a sex interaction with stressful life events (p = 0.065), such that females experiencing more stressful life events were at higher risk of new-onset UI (fully adjusted model OR (95% CI) = 1.66 (1.05, 2.61), p = 0.029), but there was no association in males (fully adjusted model OR (95% CI) = 0.87 (0.52, 1.47), p = 0.608). These results suggest that separation anxiety and stressful life events in girls may lead to an increase in UI.

First Case Report of AMPA Receptor Encephalitis Presenting With Features of Parkinsonism

Objective NA. Background Autoimmune Encephalitis is an inflammatory condition of the brain due to antibodies against onconeuronal proteins. Paraneoplastic Parkinsonism is very rare. We report the first case of AMPA receptor encephalitis presenting with symptoms of parkinsonism, an atypical presentation of a rare entity. Design/Methods NA. Results A 71-year-old female with multiple comorbidities presented in a state of stupor with complaints of insidious onset slowly progressive recent memory impairment, progressive slowness in performing daily activities, inability to communicate, and acute onset urinary incontinence. CNS examination initially showed a GCS of E2V1M4 with Grade 2 rigidity in all extremities. MRI Brain showed subtle T2 FLAIR hyperintensities in the peri-ventricular and subcortical white matter. Serum and CSF studies showed AMPA 1 antibody positivity. The FDG PET showed an avid speculated soft tissue density lesion in the upper inner quadrant of the right breast with active right axillary lymph nodes (Histopathology- Infiltrating duct carcinoma Grade 2 NST T2N2aMx). The patient was managed using IVIg and steroids following which her sensorium improved to a GCS of E4M6V5. UPDRS at this point was 29. She subsequently underwent therapy for her tumor following which there was a significant decrease in parkinsonian symptoms and an improvement in memory without the use of any antiparkinsonian medications (UPDRS score-6). During the four years of follow-up, she has remained independent and can perform all her activities of daily living. Hence this autoimmune encephalitis case can be classified as a definite paraneoplastic neurological syndrome (PNS Care score-9). Conclusions We propose that Parkinsonism, in our case, is probably a paraneoplastic neurological syndrome associated with antibodies against the AMPA receptor, as the symptoms and signs recovered with cancer treatment.

Interdisciplinary combined sacrocolporectopexy: Results after one-year follow-up

Abstract Objective Multicompartmental pelvic floor descensus typically affects women after menopause, leading to a combination of faecal and urinary incontinence, dyspareunia, and evacuation disorders. The aim of this study was to access postoperative quality of life and complications as well as outcome after one-year follow-up after operation of multicompartmental pelvic floor prolapse (POP). Methods All Patients undergoing ventral mesh rectopexy by surgical department and anterior mesh sacrocolpopexy by gynecologists at the same time between 2015 and 2020 were enrolled. The study is a retrospective cohort study approved by the local Ethics committee. Follow-up was scheduled at 6 weeks, 6, and 12 months and consisted of clinical examination and questionnaires. Perioperative and long-time morbidity was assessed according to the Clavien-Dindo classification. Quality of life and patients’ satisfaction were evaluated at each consultation. Results Twenty-seven patients were included. All patients were seen at one-year follow-up. Demographic and clinical features are reported in Table 1. Preoperatively, 22 patients (81.5%) were diagnosed with stage II-III (POP-Q) prolapse and severe multicompartment descensus detected on Magnetic Resonance (MR). Laparoscopic surgery was performed in 92.5% of cases and intraoperative conversion was necessary in 2 cases. In 15 cases (55%) a Dynamesh® Visible, in 11 cases (41%) a Gynamesh®, and in one (4%) case a Surgipro™ Mesh was used. No severe complications (Clavien-Dindo &amp;gt;=3) occurred postoperatively. 90-day mortality was 0%. Intraoperatively, a total of 1 vaginal, and 2 bladder lesions were corrected and healed without consequences. At 1 year, patients reported a high level of satisfaction and massive improvement of QoL (8.5 Pt. VAS Scale). During follow-up, one patient had to be reoperated because of incisional hernia and one to cover vaginal mesh exposure. A tension free vaginal tape (TVT) had to be inserted in 4 patients (15%) due to new onset of urinary incontinence. Symptomatic recurrence of prolapse did not occur. Conclusion Interdisciplinary combined sacrocolporectopexy is an effective therapy of multicompartmental pelvic floor descensus. It is a safe procedure with low perioperative morbidity and high patients’ satisfaction. Therefore, it might be the procedure of choice to correct multicompartmental POP.

147 ‘CHAMPIONING CONTINENCE’—ESTABLISHMENT OF A MULTIDISCIPLINARY CONTINENCE PROMOTION WORKING GROUP IN AN ACUTE TEACHING HOSPITAL

Abstract Background In line with the National Frailty Programme1, patients over the age of 75 admitted to hospital should have a comprehensive geriatric assessment including the assessment of current continence status and any history of incontinence. Up to 39% of adults are reported to develop new onset urinary incontinence during admission to hospital2,3, however studies show that is it a problem not always identified by staff members,4. In response to these observations within an acute teaching hospital, a continence working party was formed involving members of nursing, physiotherapy and occupational therapy colleagues to explore the current practice and culture relating to continence management. Methods The group established key objectives which were broken into four strands; 1. Audit of documentation of baseline continence on admission (therapy and nursing). 2. Obtaining access to additional types of continence wear. 3. Staff education. 4. Pre and post education survey. Results 1. Audit of documentation demonstrated poor standards of documentation of baseline continence. This led to an amendment to questioning prompts on therapy initial assessment forms and a plan to further evaluate the nursing documentation. 2. A wider array of continence wear has been made available on the wards providing greater options for patients. 3. Staff education session was compiled by a specialist physiotherapist and is widely available for staff to access on the hospitals online training portal. 4. Pre-education surveys have been completed with a view to re-administering following education roll-out. Conclusion The aim of this multidisciplinary working group is to equip staff with the correct resources, knowledge, and confidence to ensure best practice promotion of continence on the targeted wards. This project is the first strand of a wider culture changed that is needed around continence promotion for older adults in the acute setting.

Adjusting Client-Level Risks Impacts on Home Care Organization Ranking.

Quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) offer the opportunity to assess home care quality and compare home care organizations’ (HCOs) performance. For fair comparisons, providers’ QI rates must be risk-adjusted to control for different case-mix. The study’s objectives were to develop a risk adjustment model for worsening or onset of urinary incontinence (UI), measured with the RAI-HC QI bladder incontinence, using the database HomeCareData and to assess the impact of risk adjustment on quality rankings of HCOs. Risk factors of UI were identified in the scientific literature, and multivariable logistic regression was used to develop the risk adjustment model. The observed and risk-adjusted QI rates were calculated on organization level, uncertainty addressed by nonparametric bootstrapping. The differences between observed and risk-adjusted QI rates were graphically assessed with a Bland-Altman plot and the impact of risk adjustment examined by HCOs tertile ranking changes. 12,652 clients from 76 Swiss HCOs aged 18 years and older receiving home care between 1 January 2017, and 31 December 2018, were included. Eight risk factors were significantly associated with worsening or onset of UI: older age, female sex, obesity, impairment in cognition, impairment in hygiene, impairment in bathing, unsteady gait, and hospitalization. The adjustment model showed fair discrimination power and had a considerable effect on tertile ranking: 14 (20%) of 70 HCOs shifted to another tertile after risk adjustment. The study showed the importance of risk adjustment for fair comparisons of the quality of UI care between HCOs in Switzerland.

Normal Pressure Hydrocephalus: A Reversible Late Side-Effect Of Whole Brain Radiation

Describe the value to patients of ventriculoperitoneal (VP) shunting for normal pressure hydrocephalus (NPH) after receipt of whole brain radiation therapy (WBRT) for brain metastases. Patients who underwent WBRT at an NCI Comprehensive Cancer Center were retrospectively cross-matched to a list of patients who were subsequently diagnosed with, and underwent therapeutic VP shunt for NPH between January 1, 2016 and January 31, 2020. All patients were referred by a CNS specialist in radiation oncology to a neurosurgeon for clinical suspicion of NPH including new or progressive symptoms of magnetic gait (G), cognitive changes (C), and/or new onset of urinary incontinence (U). NPH was confirmed via large volume lumbar drain in all patients prior to shunting. Five patients were identified and constitute the subjects of this report. All patients were scored as either having (Y) or not (N) symptoms of G, C and U at diagnosis of NPH, and at post-shunting follow-ups. Time to any symptom failure or last follow-up was calculated. Median time from WBRT to presentation of symptoms suggesting NPH was 40 months (Range, 7-148m). The majority of patients were found to have improvement in all presenting symptoms. Patient 4 did not achieve improvement in cognitive impairment with VP shunt and patient 5 did not experience improvement in gait function after placement of VP shunt. Two patients were found to have durability of symptom improvement at the time of analysis. Three patients experienced relapse of symptoms after VP shunt placement with median time to failure being 2 months (Range, 1-8m). NPH is a potentially reversible side effect of WBRT. VP shunting may achieve complete or partial relief of symptoms in these patients and should be considered by clinicians in the follow-up of long-term survivors with cognitive, gait and urinary changes after WBRT.Abstract 3563; TableResponse to Shunting InterventionPatientWBRT to NPH Dx (Mos)Presenting NPH SxGaitCognitionUrinarySx at relapseTime to sx relapse (Mos)Follow-up without relapse (Mos)163G,C,UYYYNANA11237G,C,UYYYG,C8NA340G,C,UYYYNA447G,CYNNAG1NA5148C,UNANYCNA11NA = not applicable; Dx = Diagnosis Sx = Symptoms; Mos = months Open table in a new tab

MP70-12 SALVAGE FOCAL CRYOTHERAPY OFFERS SIMILAR SHORT-TERM ONCOLOGICAL CONTROL AND IMPROVED URINARY FUNCTION COMPARED TO SALVAGE WHOLE GLAND CRYOTHERAPY FOR RADIATION RESISTANT/RECURRENT PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II (MP70)1 Apr 2020MP70-12 SALVAGE FOCAL CRYOTHERAPY OFFERS SIMILAR SHORT-TERM ONCOLOGICAL CONTROL AND IMPROVED URINARY FUNCTION COMPARED TO SALVAGE WHOLE GLAND CRYOTHERAPY FOR RADIATION RESISTANT/RECURRENT PROSTATE CANCER Wei Phin Tan*, Ahmed Elshafei, Alireza Aminsharifi, and Thomas Polascik Wei Phin Tan*Wei Phin Tan* More articles by this author , Ahmed ElshafeiAhmed Elshafei More articles by this author , Alireza AminsharifiAlireza Aminsharifi More articles by this author , and Thomas PolascikThomas Polascik More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000950.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The treatment of radiation-persistent prostate cancer remains a challenge and should be tailored to the individual patient. We aim to compare short-term oncological and functional outcomes of salvage focal cryotherapy (SFC) to salvage total cryotherapy (STC) for radiation persistent/recurrent prostate cancer. METHODS: We queried the COLD registry for men who underwent SFC and STC of the prostate for radiation persistent/recurrent disease. Propensity score weighting was used to match age at time of treatment, pre-salvage therapy PSA, Gleason sum, and pre-salvage cryotherapy androgen deprivation therapy status. Primary outcome was progression-free survival (PFS). RESULTS: A total of 385 men with biopsy-proven persistent/recurrent prostate cancer after primary radiotherapy were included in the study. Median follow-up, age, PSA and Gleason sum pre-salvage cryotherapy was 24.4 months (1st/3rd quartile: 9.8/60.3), 70 years (1st/3rd quartile: 66/74), 4 ng/dl (1st/3rd quartile: 2.7/5.6) and 7 (1st/3rd quartile: 6/8), respectively. After propensity score weighting, patients who were treated with STC did not have a significant difference test in PFS compared to patients treated with SFC on weighted log-rank test (79.8% vs. 76.98%, p= 0.11). SFC was associated with a lower probability of post-treatment transient urinary retention (5.6% vs 22.4%. p<0.001). There were no significant differences in rectal fistula (1.4% vs 3.8, p=0.30), new onset urinary incontinence within 12 months (9.3% vs 15.1%, p=0.19) or new-onset erectile dysfunction within 12 months (52.6% vs 59.6, p=0.47) in the SFC vs STC group, respectively. CONCLUSIONS: STC has similar 2-year oncological outcome compared to SFC in the radiation- persistent/recurrent disease population, but patients who underwent SFC have a lower urinary retention rate compared to STC. Source of Funding: WPT is supported by the Ruth L. Kirschstein NRSA Institutional Research Training Grant (T32-CA093245). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1059-e1060 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wei Phin Tan* More articles by this author Ahmed Elshafei More articles by this author Alireza Aminsharifi More articles by this author Thomas Polascik More articles by this author Expand All Advertisement PDF downloadLoading ...

The Onset of Urinary Incontinence in Different Subgroups and its Relation to Menopausal Status: A Hospital-based Study.

Numerous risk factors have been reported to influence the development of urinary incontinence (UI). In this study, we took a closer look on the different forms of UI and tried to identify differences in regard to potential risk factors. Of special interest was the onset of UI symptoms and its relation to menopausal status. This was a hospital-based analysis of patients who presented with urinary incontinence in the outpatient ward of a tertiary hospital. The diagnosis of urinary incontinence was based on the subjective complaints of patients. Data concerning menopausal status, hormone replacement therapy, prior hysterectomy were assessed. The mean age was 53.8 years in the SUI group, 62.7 years in the MUI group and 66.1 years in the UUI group, respectively (p<0.001). The proportion of patients with UUI was higher in the postmenopausal group, whereas the proportion of SUI was higher in the premenopausal group (p<0.001). The mean age in which complaints occurred was significantly lower in the SUI group (45.4 years) compared to the MUI (51.0 years) and UUI groups (54.7 years) (p<0.001). There was no correlation between menopausal status and onset of urinary incontinence (p=0.143). Additional anamnestic information help further characterize the different types of urinary incontinence that can lead to an optimization of treatment options. Younger age and premenopausal status were accompanied by milder forms of UI while menopausal status itself had no influence on the onset of UI symptoms indicating that age-related changes may lead to different types of incontinence.

Microsurgical Resection of Spinal Cord Hemangioblastoma: 2-Dimensional Operative Video.

This video demonstrates microsurgical resection of spinal cord hemangioblastoma. Hemangioblastomas are rare, benign, highly vascularized tumors classified as grade I according to World Health Organization classification systems. About 3% of all intramedullary tumors are hemangioblastomas.1,2 Spinal cord hemangioblastomas are either sporadic3,4 or manifestations of von Hippel-Lindau (VHL) disease in 20% to 45% of patients.5,6 A 30-year-old male presented with sudden onset urinary incontinence. Magnetic resonance imaging showed contrast enhancing intramedullary tumor with adjacent cyst in T11, and syringomyelia extending to C1. Surgical resection followed rules that apply to resection of arteriovascular malformations: coagulation of arterial feeders precedes the coagulation of the draining vein, which is preserved until the end of surgery.2,4,5,7,8 First, posterior midline myelotomy was performed and the tumor cyst was drained in order to develop a dissection plane. Following this, we continuously separated dorsal nerve roots from the tumor nodule using microsurgical technique. The key step in tumor resection is devascularization of the tumor, achievable in 2 ways.2,7,9-13 The circumferential detachment of the normal pia from the tumor pia is crucial in developing a plane of dissection. The coagulation and division of arterial feeders while preserving the drainage vein further devascularizes the tumor. Once the tumor mural nodule was detached from the spinal cord, the drainage vein was coagulated last and the tumor was removed. The patient fully recovered from his incontinence and was neurologically intact. Screening for VHL disease was negative. Written consent was obtained directly from the patient.

127Frailty as a Predictor of New Onset Urinary Incontinence Among Hospitalised Adults

127Frailty as a Predictor of New Onset Urinary Incontinence Among Hospitalised Adults

Teratoma of the spinal cord in an adult: Report of a rare case and review of the literature

Teratomas of the spinal cord are incredibly rare, comprising less than 0.5% of all spinal cord tumors. These tumors are exceptionally rare in adults, with only a handful of cases reported in the literature. We present the case of a 49-year-old gentleman with new onset urinary incontinence who presented with a large intradural tumor of the thoracolumbar spine. The patient underwent a laminectomy with midline durotomy for subtotal tumor resection. Surgical pathology diagnosed the tumor as a mature teratoma, exhibiting the presence of all three germ layers. These tumors tend to present with an indolent onset of symptoms characteristic of the tumor location within the spinal cord and the affected surrounding nerve roots. Magnetic resonance imaging (MRI) is useful in determining the location and nature of these tumors, but final diagnosis ultimately rests on histopathological analysis. Surgical resection is the preferred treatment, with subtotal resection being favored if there is a high risk of intraoperative neurological damage due to adherent or infiltrative tumor. In general, the prognosis for these tumors is good, with most patients exhibiting stable or improved neurological status after resection.

A randomized controlled trial comparing anatomical and functional outcome between vaginal colposuspension and transvaginal mesh

Our aim was to compare anatomical and functional outcome between vaginal colposuspension and transvaginal mesh. This was a prospective randomized controlled trial in a teaching hospital. Sixty-eight women with stage ≥3 anterior vaginal wall prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system were assessed, randomized, and analyzed. Patients were randomized to anterior colporrhaphy with vaginal colposuspension (n = 35) or transvaginal mesh (n = 33). Primary outcome was objective cure rate of the anterior vaginal wall, defined as POP-Q ≤1 at 2years. Secondary outcomes were functional results, quality-of-life (QoL) scores, mesh-related morbidity, and onset of urinary incontinence. The anatomical result for point Ba was significantly better at 2years in the mesh group (-2.8cm) than in the colposuspension group (-2.4cm) (p = 0.02). Concerning POP-Q stages, the anatomical success rate at 2years was 84.4% for colposuspension and 100% for mesh (p = 0.05). There were 5 anatomic recurrences (15.6%) in the colposuspension group. The erosion rate was 6% (n = 2). No significant difference was noted regarding minor complications. Analysis of QoL questionnaires showed overall improvement in both groups, with no significant difference between them. The vaginal colposuspension technique of anterior vaginal wall prolapse repair gave good anatomical and functional results at 2years. Transobturator vaginal mesh gave better 2-year anatomical results than vaginal colposuspension, with overall improvement in QoL in both groups.

Salvage focal and salvage total cryoablation for locally recurrent prostate cancer after primary radiation therapy

To present the oncological and functional outcomes of salvage focal (SFC) and salvage total (STC) cryoablation for recurrent prostate cancer (PCa) after failed primary radiotherapy. From March 2003 to August 2010, 50 men with biopsy-proven unilateral (n = 25) or bilateral (n = 25) radio-recurrent PCa underwent SFC or STC, respectively. Patients were assessed after treatment by prostate-specific antigen (PSA) testing, transrectal ultrasonography, biopsy and questionnaires. Biochemical failure (BF) was defined using the Phoenix criteria (PSA nadir + 2 mg/mL). Data were prospectively collected and retrospectively analysed. The median pre-cryoablation PSA level and Gleason score were, respectively, 2.8 ng/mL and 7 for SFC, and 3.9 ng/mL and 7 for STC. The median follow-up was 31 and 53 months (P = 0.004) for SFC and STC, respectively. Oncological outcomes were as follows: no patient died; one patient who underwent STC developed bone metastases; eight patients who underwent SFC and three who underwent STC had BF and the 5-year BF-free survival rates were 54 and 86%, respectively. In those patients without BF, the mean PSA decreased by 86% for SFC and 90% for STC within the first year and remained stable. Functional outcomes were as follows: new onset urinary incontinence occurred in three (13%) patients in the STC group, whereas no patient in the SFC group developed incontinence (P = 0.10); Two of seven patients in the SFC group retained postoperative potency, but none of the four potent patients in the STC group recovered potency postoperatively (P = 0.48); one (4%) patient in the STC group developed a recto-urethral fistula, but none occurred in the SFC group (P = 0.48). SFC and STC are feasible and safe with acceptable mid-term oncological outcomes. For carefully selected patients, SFC is an option that could be associated with lower treatment-related morbidity compared with STC. Although longer follow-up and more patient numbers are needed, our initial oncological and functional outcomes of SFC and STC are encouraging.

Salvage focal versus salvage total cryoablation for radio-recurrent prostate cancer: Seven years experience.

e15212 Background: Salvage cryoablation (SC) of the whole prostate is a curative option for radio (RT)-recurrent prostate cancer (PCa). Focal SC has emerged as an option for minimizing morbidity. We present our 7-year experience of oncological and functional outcomes of Salvage Focal (SFC) and Salvage Total (STC) Cryoablation (CRYO) for RT-recurrent PCa. Methods: From Dec 2003 to Aug 2010, 50 men underwent SFC (n=25) or STC (n=25) for RT-recurrent PCa. SFC patients had biopsy-proven unilateral PCa and underwent a hemi-CRYO of the prostate. STC patients underwent CRYO of the whole prostate gland. All patients were evaluated to exclude metastases prior to treatment. Two freeze-thaw cycles were used to perform transperineal prostate CRYO under TRUS guidance. Follow up was assessed by PSA, TRUS, biopsy and questionnaires at 3, 6, 12, 24 and 36 mth. Results: Median (range) age, PSA and Gleason score for the SFC group were 71 y (59-81); 2.8 ng/ml (0-8.2) and 7 (6-8), while those for STC were 73 y (57-83), 3.9 ng/ml (0.1-12) and 7 (6-9), respectively. Oncological outcomes: Within one year after SC, the median percent PSA-decrease was 89% for SFC and 98% for STC. The median (range) follow up was 31 mth (4-90) for SFC and 53 mth (12-92) for STC. No patient died. One patient treated with STC developed bone metastases. Using the Phoenix criteria (PSA nadir + 2 ng/ml), 8 SFC and 3 STC patients had biochemical failure (BF), and the 5-year biochemical free survival (BFS) was 54% and 86% respectively (p=0.05). In those patients with no BF, the median PSA remained stable, ranging from 0.2 to 0.6 ng/ml for SFC and 0.1 to 0.1 ng/ml for STC during the follow up period. Follow up biopsy-proven cancer occurred in 2 patients in the SFC group (both on the untreated side), and in 1 patient in the STC group. Functional outcomes: New onset urinary incontinence occurred in none (0) of the SFC vs 3 (13%) of the STC patients. One (4%) patient in the STC group developed a recto-urethral fistula. Conclusions: Salvage Focal and Total CRYO after RT-failure are feasible and safe. Although STC had a favorable BFS compared with SFC, there was no significant difference in disease specific or overall survival between groups. SFC offered comparable cancer control to STC with lower morbidity.

Ectopic Ureter in an Adolescent Female Presenting With Primary Nocturnal Enuresis and New Onset Urinary Incontinence

No AccessJournal of UrologyRadiology Page1 Feb 2011Ectopic Ureter in an Adolescent Female Presenting With Primary Nocturnal Enuresis and New Onset Urinary Incontinence Boyd R. Viers, Landon W. Trost, and Stephen A. Kramer Boyd R. ViersBoyd R. Viers More articles by this author , Landon W. TrostLandon W. Trost More articles by this author , and Stephen A. KramerStephen A. Kramer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.11.012AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Ectopic Ureter in an Adolescent Female Presenting With Primary Nocturnal Enuresis and New Onset Urinary Incontinence." The Journal of Urology, 185(2), p. 689 © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 2February 2011Page: 689 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Boyd R. Viers More articles by this author Landon W. Trost More articles by this author Stephen A. Kramer More articles by this author Expand All Advertisement PDF downloadLoading ...

Diagnostic Criteria of Urinary Tract Infection in Male Patients With Spinal Cord Injury

Background. The current diagnostic criteria of urinary tract infection (UTI) in male patients with spinal cord injury (SCI) are not clear. Methods. The authors studied 381 episodes of “symptomatic” UTI (209 participants) and 277 episodes of “asymptomatic” UTI (205 participants) in male SCI patients using intermittent catheterization. UTI was defined as a bacterial count ≥102 colony-forming units (cfu)/mL (American Paraplegia Society criterion). Univariate analysis and receiver operating characteristic (ROC) curve analysis were used to determine optimal cfu and white blood cell (WBC) thresholds. Results. The most prevalent clinical signs, alone or in combination, were cloudy and/or malodorous urine (51.4%), onset of urinary incontinence (51.2%), fatigue (41.7%), fever (30.7%), and increased spasticity (30.2%). Urine cfu and WBC levels in patients with only one sign, including fever, were not significantly higher than those in asymptomatic controls. WBC, but not cfu, levels increased significantly with the number of signs (P = .026). Univariate analysis and ROC curve analysis failed to identify cfu, WBC, or a combination of cfu and WBC count thresholds, allowing discrimination between the symptomatic and asymptomatic UTI groups. Conclusions. Clinical signs of UTI correlate poorly with the urine cfu and WBC levels in SCI patients, except for a positive relationship between WBC counts and the number of signs. Fever alone has no higher diagnostic value. There are no satisfactory cfu and WBC thresholds: thresholds more restrictive than the current American Paraplegia Society criteria provide higher specificity values but with equivalent loss of sensitivity.

An Unusual Case of Incontinence After Hymenectomy

Background: Urinary incontinence is common in children and carries significant psychosocial implications. Incontinence in children can be neurogenic, functional or anatomic in etiology. Here we present a case of a teenage patient with new onset urinary incontinence following hymenectomy.

Oestrogens and the lower urinary tract

atrophic changes within the urogenital tract, 3 and is associated with urinary symptoms such as frequency, urgency, nocturia, incontinence, recurrent infection. These may also coexist with symptoms of vaginal atrophy such as dyspareunia, itching, burning and dryness. Epidemiological studies have implicated oestrogen deficiency in the aetiology of lower urinary tract symptoms with 70% of women relating the onset of urinary incontinence to their final menstrual period. 3 Lower urinary tract symptoms have been shown to be common in postmenopausal women attending a menopause clinic with 20% complaining of severe urgency, and almost 50% complaining of stress incontinence. 4 Urge