Central nervous system findings on functional magnetic resonance imaging in patients before and after treatment with anticholinergic medication.

PURPOSE: Anticholinergic medications are commonly used to treat urinary urgency and frequency. Muscarinic receptors are located in areas beyond the detrusor muscle. In this study we measured changes in central nervous system activity in patients with lower urinary tract symptoms treated with tolterodine or a placebo. MATERIALS AND METHODS: A total of 20 female patients with urinary frequency were randomized to 4 weeks of treatment with tolterodine or a placebo. Functional magnetic resonance imaging based on blood oxygenation level dependant imaging of the brain during bladder filling was performed before and after treatment. For each patient the bladder was filled by a urethral catheter and emptied 5 times. RESULTS: Multiple brain areas showed significant activation with bladder filling compared to the empty state and many areas also showed deactivation. Overall brain activation with bladder filling was decreased after treatment in both groups. After treatment 2 areas of the parietal cortex (precuneus and postcentral gyrus) showed significantly greater activity in patients treated with tolterodine vs placebo. Two areas of the cerebellum (anterior lobe and culmen) showed significantly greater activity in the placebo group, and these were also areas of significant deactivation in the tolterodine group. CONCLUSIONS: Brain activity changes as well as the areas of activation after treatment of lower urinary tract symptoms in patients with an anticholinergic medication or placebo are different in the 2 groups. Whether this finding represents action at the central nervous system or the bladder level is not known.

Histopathological characteristics of localized renal cell carcinoma correlate with tumor size: a SEER analysis.

PURPOSE: We determined whether a relationship exists between primary tumor size and histopathological features in cases of localized renal cancer. MATERIALS AND METHODS: SEER data were used to create a cohort of patients who were diagnosed with localized node negative renal masses from 1988 to 2004. Nuclear grade was divided into low and high grade groups. We used a multinomial logistic model to predict the probability of nuclear grade and histological subtype with increasing primary tumor size. RESULTS: SEER data showed that 19,932 patients with localized renal masses were evaluated. The overall nuclear grade distribution was 80% and 20% for low and high grade tumors, respectively. A multinomial logistic model revealed that the probability of a high grade tumor increased with size. For each 1 cm increase in size of a primary localized renal cell carcinoma the odds of high grade disease increased by 13% (OR 1.13, p <0.001). Multinomial models also predicted that the odds of papillary vs clear cell renal cell carcinoma decreased with tumor size. Conversely the odds of chromophobe vs clear cell renal cell carcinoma increased with increasing tumor size. CONCLUSIONS: Most localized node negative renal cell carcinomas are low grade. Although the probability of a high grade tumor increases with size, almost 85% of renal cell carcinomas smaller than 4 cm and 70% of localized renal cell carcinomas larger than 7 cm demonstrate low nuclear grade. The probability of detecting particular histological subtypes also varies with increasing tumor size. These data suggest that many localized renal tumors can grow large locally without acquiring metastatic potential.

HIV-AIDS: urologic considerations.

The prevalence of HIV continues to grow in the United States and worldwide. HIV-positive patients experience many genitourinary disease processes. With improvements in HIV therapy, patients have questions and concerns pertaining to their quality of life. This article reviews conditions such as HIV-related urinary tract infections, urolithiasis, voiding dysfunction, fertility, sexual dysfunction, HIV-related nephropathy, malignancies, and occupational exposure and prophylaxis. Knowledge of the various HIV manifestations of genitourinary conditions and their treatment options benefits clinicians and improves patient outcomes.