RESUMEN
The overactive bladder [OAB] is extremely common. The treatment of refractory overactive bladder conditions has changed radically over the last decade. The efficacy of OAB treatment protocols in improving patient symptoms are not satisfactory, so new agents such as botulinum-A toxin must be investigated. To evaluate the safety and efficacy of intradetrusor botulinum -A toxin injection in patients with idiopathic detrusor overactivity resistant to anticholinergic drugs. From March 2010 to September 2011, 38 women with refractory idiopathic detrusor overactivity [IDO], from the urologic consultation department in Baghdad Medical City and Al-Ramadi teaching hospital, were included in this prospective study. Their age ranged from 45 to 70 years. Inclusion criteria were women with idiopathic detrusor overactivity not responding to different anticholenergic treatments. Patients with urinary tract infection, mixed incontinence, bladder stone, hematuria, neurogenic detrosur overactivity, high postvoiding residual urine volume [more than 50 ml] and history of bladder tumour were excluded from this study. Full clinical and urodynamic evaluations were done before intradetrusor injection of 300 units of botulinum-A toxin and at 2 weeks and 24 weeks after injection. Thirty six patients achieved urinary continence [94.7%]. The age ranged from 45 to 70 years [mean 56.67 +/- 7.34]. There was significant clinical improvement after botulinum toxin injection at both 2 weeks and 24 weeks of follow up as reflected by statistically significant decrease in the daytime frequency, nocturia and the incontinence episodes [p value <0.05]. There was significant urodynamic improvement after botulinum toxin injection at both 2 weeks and 24 weeks of follow up as reflected by statistically significant increase in the maximum cystometric bladder capacity and the bladder compliance and by statistically significant decrease in the detrusor pressure at maximum flow rate[p value <0.05]. Postvoiding residual urinary volume shows statistically significant increase at both 2 weeks and 24 weeks of follow up [p value <0.05] . The use of intradetrusor injection of botulinum toxin-A [BTX A] in refractory idiopathic detrusor overactivity was well tolerated and demonstrated clinically meaningful and statistically significant improvement in the clinical and urodynamic parameters of the patients. The effect was durable for the period of study which is 6 months
RESUMEN
Testicular microlithiasis [TM] is an uncommon condition, usually brought to attention when some other condition is being investigated. There have been reports suggesting a link between testicular microlithiasis and testicular dysfunction and tumors. To study the association between testicular microlithiasis and male infertility. From January 2010 to January 2011, 140 patients with different scrotal lesions presented to urologic consultation department at Al-Ramadi teaching hospital were included in this prospective study, all patients were examined by gray scale and doppler ultrasonograghy, their age ranges from 15 to 55 years. All cases of microlithiasis were recorded and complete information obtained from each patient. Seminal fluid analysis [SFA] was done for each patient with microlithiasis. The age of patients ranges from 15 to 55 years [mean 34.6]. Of 140 patients, 6 patients had microlithiasis [4.28%]. Of 6 patients with microlithiasis, 5 patients were married and infertile and one of them had varicocele and one patient had testicular atrophy. One patient was unmarried but has varicocele and abnormal seminal fluid analysis. There is strong association between testicular microlithiasis and infertility. Hypospermatogenesis in patients with TM may relate to both the degree of testicular dysgenesis and the presence or absence of concomitant scrotal pathology [eg, scrotal varicocele and testicular atrophy]