Objective and subjective improvement in children with idiopathic detrusor overactivity after intravesical botulinum toxin injection: A preliminary report.

OBJECTIVE: The purpose of this study is to evaluate the effect of Intravesical Botulinum toxin injection on the symptoms and urodynamic parameters in pediatric patients with idiopathic overactive bladder (iOAB) refractory to medical treatment. MATERIALS AND METHODS: The study was designed as an open-label uncontrolled therapeutic clinical trial. The eligible patients who underwent Intravesical botulinum toxin injection were evaluated before treatment. The evaluation included a 7-day paper bladder diary to assess OAB symptoms (frequency, urgency urinary incontinence (UUI) and nocturnal enuresis (NE)), filling the Arabic International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI short form), and conducting urodynamic study. The Urodynamic parameters obtained were the maximum filling detrusor pressure, cystometric bladder capacity, and compliance. After 12 weeks of the intravesical injection, the patients were revaluated and the results were compared using paired samples t-test. RESULTS: The study enrolled 75 patients. And of those, statistical analysis was done on 46 patients who did follow the study protocols. The mean age was 8.9 years and male to female ratio was 1:4. There was a statistically significant improvement in overactive bladder symptoms and urodynamic parameters in the patient injected with botulinum toxin with minimal side effects. CONCLUSION: The evidence in this study would support the safety and efficacy of Intravesical botulinum toxin injection in children with refractory idiopathic OAB with significant improvement of symptoms, quality of life, as well as urodynamic parameters. TYPE OF STUDY: Open-label uncontrolled therapeutic clinical trial. LEVEL OF EVIDENCE: III.

Squamous cell carcinoma of the bladder presented with spontaneous intraperitoneal bladder rupture: A case report.

INTRODUCTION: Spontaneous intraperitoneal bladder rupture can present with symptoms of acute abdomen. The associated high mortality rate is attributed to the delay in diagnosis, and the possibility of the presence of a bladder carcinoma contributes to high mortality as well. CASE PRESENTATION: We present a case of spontaneous intraperitoneal bladder rupture associated with squamous cell carcinoma managed with partial cystectomy. DISCUSSION: The incidence of this condition is (1:126,000) but with high mortality rate. It occurs more commonly in male [1]. It can be associated with carcinoma, chronic cystitis, chronic catheterization, bladder outflow obstruction and others. Standard management includes timely diagnosis of this condition, followed by bladder repair in the form of primary closure, partial cystectomy or radical cystectomy. However in the presence of carcinoma the prognosis is poor. CONCLUSION: high index of clinical suspicion and the timely diagnosis can lead to a more favorable outcome.

Long term efficacy of extracorporeal shock wave therapy [ESWT] for treatment of refractory chronic abacterial prostatitis.

OBJECTIVE: To evaluate the effect and safety of extracorporeal shockwave therapy (ESWT) on chronic pelvic pain syndrome (CPPS)/chronic abacterial prostatitis after failure of most other modalities of treatment, the maintenance of the treatment effect for up to one year post treatment and whether the patients are in need for further sessions. MATERIALS AND METHODS: In a follow-up survey of 41 patients, the study inclusion criteria were CPPS patients who failed at least previously 3 modalities of treatment other than ESWT, who were treated by ESWT once a week for one month with a protocol of 2500 pulses at 1 bar over 13 min, Nonaddiction to drugs and narcotics. The exclusion criteria included being under treatment by another method another diagnosis such as prostate cancer, therapy plan alteration, and noninclination to continue this treatment. Then the patients were followed up at 2 weeks, 6 months and 12 months after finishing the course of ESWT. The study was designed as an open-label uncontrolled therapeutic clinical trial which was conducted in Jordan university hospital through the period 2015-2016. Data were compared using paired samples t-test. RESULTS: Of our total 55 patients 8 of them did not complete the study protocol, 6 of them had missed follow up over the whole follow up period and 41 patients were evaluated. The patient's age group ranged between 18 and 78 years with a mean age of 42 and a median age of 43. The mean of National Institutes of Health -Chronic Prostatitis Symptom Index (NIH-CPSI), the International Prostate Symptom Score (IPSS), American Urological Association Quality of Life Due to Urinary Symptoms (AUA QOL_US) and International Index of Erectile Function (IIEF) were evaluated pre and post ESWT at 2 weeks, 6 months and 12 months and it showed statistically significant improvement in all parameters with maintenance of the effect without any significant side-effect of the treatment over the 12 months. CONCLUSIONS: The evidence in this study would support the safety and efficacy of ESWT in refractory cases of CPPS at least for one year post treatment.