Efficacy of transvaginal biofeedback and electrical stimulation in women with urinary urgency and frequency and associated pelvic floor muscle spasm.

Women with urinary urgency and frequency may also have pelvic floor muscle spasm. Transvaginal biofeedback (TVBF) and electrical stimulation (EStim) is a treatment modality that has been used to treat vaginismus and chronic pelvic pain. In this study, TVBF/EStim was evaluated in women with pelvic floor muscle spasm associated with urinary symptoms. Fifty-two women underwent therapy with TVBF/EStim and reported a mean symptom improvement of 64.5%.

Complete eversion of the urinary bladder: presentation, review, and algorithm for management.

BACKGROUND: Complete eversion of the urinary bladder is a rare problem that presents a serious management challenge. Currently no standard treatment recommendations exist for management. We describe our experience with bladder eversion and present an algorithm for treatment. CASE: An elderly, multiparous woman presented with complete bladder eversion after partial colpocleisis. Her bladder was reduced by a combined suprapubic and perineal approach with cystopexy to the anterior abdominal wall. CONCLUSION: Multiparous postmenopausal women appear to be at highest risk for complete bladder eversion. External transurethral reduction is sometimes successful, but most cases require laparotomy.

Manganese superoxide dismutase enhances the invasive and migratory activity of tumor cells.

Clinically significant elevations in the expression of manganese superoxide dismutase (Sod2) are associated with an increased frequency of tumor invasion and metastasis in certain cancers. The aim of this study was to examine whether increases in Sod2 activity modulate the migratory potential of tumor cells, contributing to their enhanced metastatic behavior. Overexpression of Sod2 in HT-1080 fibrosarcoma cells significantly enhanced their migration 2-fold in a wound healing assay and their invasive potential 3-fold in a transwell invasion assay. Severity of invasion was directly correlated to Sod2 expression levels and this invasive phenotype was similarly observed in 253J bladder tumor cells, in which Sod expression resulted in a 3-fold increase in invasion compared with controls. Further, migration and invasion of the Sod2-expressing cells was inhibited following overexpression of catalase, indicating that the promigratory/invasive phenotype of Sod2-expressing cells is H(2)O(2) dependent. Sod2 overexpression was associated with a loss of vinculin-positive focal adhesions that were recovered in cells coexpressing catalase. Tail vein injections of Sod2-GFP-expressing HT-1080 cells in NCR nude mice led to the development of pulmonary metastatic nodules displaying high Sod2-GFP expression. Isolated tumors were shown to retain high Sod2 activity in culture and elevated levels of the matrix degrading protein matrix metalloproteinase-1, and a promigratory phenotype was observed in a population of cells growing out from the tumor nodule. These findings suggest that the association between increased Sod2 activity and poor prognosis in cancer can be attributed to alterations in their migratory and invasive capacity.

Management of neonatal hydronephrosis.

Management of neonatal hydronephrosis is a clinical challenge. The natural history of hydronephrosis has shown that most resolve spontaneously; however, there are a significant number that do not. Although hydronephrosis does not always mean obstruction, it becomes the clinician's role to determine when obstruction will eventually lead to renal damage. Work-up of hydronephrosis diagnosed prenatally starts with a postnatal ultrasound. Using the Society of Fetal Urology (SFU) grading of hydronephrosis based on ultrasonography, a management and treatment algorithm can be constructed. Other studies include a voiding cystourethrogram to evaluate for vesicoureteral reflux or in severe cases of bilateral hydronephrosis to evaluate for posterior urethral valves. Diuretic renography is useful in many cases to evaluate the degree of obstruction and determine differential renal function. The goal is to select the patients who would benefit from early surgical intervention. To achieve that goal, aggressive observation is often required.