Overactive bladder: A review and update.

Overactive bladder syndrome is a chronic, disabling condition with physical, psychological and social consequences that significantly affects the quality of life of millions of patients worldwide. The economic impact of this disorder is crucial. Overactive bladder syndrome is a little-known condition, with different manifestations from patient to patient, which causes a great deal of frustration to the medical staff involved. The patient requires a clear explanation and the full support of the attending physician. It is extremely important to establish a correct diagnosis and an effective individualized treatment. The collaboration and understanding of these patients are extremely important aspects. Improving the quality of life in these patients is the main purpose in managing this condition. There are several treatment modalities that may be used progressively, with favorable albeit inconsistent results. This condition remains extremely challenging for specialists and, unfortunately, always one of maximum interest.

Genital self-mutilation: A challenging pathology (Review).

Genital self-mutilation is a pathology that leads to numerous and important discussions, rarely presented in the medical literature. There have been many attempts to explain the reasons behind these medical phenomena, but single cases have been generally reported, making it extremely difficult to draw valid conclusions. It is acknowledged that there are psychotic and non-psychotic causes, from psychiatric problems and sexual identity disorders to cultural or religious reasons, alcohol or recreational drug consumption, unconventional types of sexual satisfaction or self-satisfaction. Recent theories consider self-mutilation as a phenomenon of reducing distress or tension, as an expression of feelings of anger or sorrow. It is believed that 55-85% of those who have resorted to self-mutilation have at least once in their life tried to commit suicide. There is evidence that early discovery and intervention as well as proper treatment in regards to psychosis can significantly reduce the number of self-mutilation episodes, with a protective role of these individuals. Cases of genital self-mutilation may be considered real medical emergencies, sometimes extremely challenging and accompanied by severe complications. Injury of the genital area is usually accompanied by numerous early or long-term complications due to the marked vascular area and to the microbial flora present in this part of the body. The degree of mutilation is an unforeseen aspect that the medical staff may have to encounter during the intervention, sometimes testing their imagination and surgical skills when dealing with such a case. Understanding the causes of these self-aggressive behaviors, which may be life-threatening, is critical and multidisciplinary mobilization is needed after treatment of the acute phases. The outcome of these patients depends on integrated collaborative work. These cases represent a serious reason for frustration for the physicians involved in solving them, and knowledge of these issues is valuable to urologists, psychiatrists and other health professionals.

Efficacy of instillation treatment with hyaluronic acid in relieving symptoms in patients with BPS/IC and uncomplicated recurrent urinary tract infections - Long-term results of a multicenter study.

The purpose of this study is to evaluate the efficacy of intra-vesical instillations with hyaluronic acid (HA) in relieving lower urinary tract irritation symptoms in patients with urinary tract infections (UTIs) and bladder pain syndrome/interstitial cystitis (BPS/IC). This research, conducted in Romania, includes 30 patients with UTIs (Group I) and 24 with BPS/IC (Group II) as defined by European Association of Urology (EAU) Diagnostic Criteria. Data were collected prospectively, using pre- and post-treatment questionnaires for pelvic pain with a symptom scale for urination and frequency as well as visual analog scale (VAS) pain quizzes. At follow-up visits, at an average of 20 months, a significant improvement in urinary bladder pain, day-time urinary frequency and quality of life was observed in Group I patients. Group II patients experienced significant improvement in urinary bladder pain, urgency, nocturia and quality of life at the 15-month follow-up visit. Eighteen patients (75%) showed a complete response to intravesical HA instillations and required no further treatment. Our study demonstrates that intravesical HA instillations may be considered as an important treatment component, with long term positive effects in therapeutic strategy for optimal results in uncomplicated recurrent UTIs and BPS/IC, with good compliance and minimal side effects.

Voluminous Urethral Stone - A Very Rare Complication After Male Suburethral Sling Surgery As A Result of Sling Erosion Into Proximal Urethra.

Male sling for urinary incontinence is usually accompanied by very good results, with a small number of complications,but, when appear, they may be redundant. Voluminous urethral stone developed on suburethral sling as a result of sling erosion into the proximal urethra is an extremely rare complication (following the analysis of cases published on the internet, the authors of this article no longer identified another similar case). We present the case of a patient who presented in our clinic for severe and permanent urinary incontinence, perineal discomfortand pain that was influenced by position. His past medical history showed polytrauma with lumbar fracture and medullary involvement (34 years ago) and transobturator suburethral sling surgery for urinary incontinence about 6 years ago in another urology unit, without relieving symptoms. Imaging investigations have showed a voluminous urethral stone developed on polypropylene sling and another small stones in that area. Stones surgical extraction was performed by perineal approach (together with the mesh), proximal urethra was closed after excision to apparently healthy urethral tissue (to prevent possibility of later severe incontinence) and a permanent suprapubic cystostomy catheter was inserted. Patient is dry at follow-up visits (at 1 and 3 months) and he reported significant improvement in quality of life. The case is spectacular due to the rarity of the complication presented, patient developingurethral erosion without clinical manifestations to suggest this matter (infection or fistula), the symptoms being absent for a long time.

Morbidity and impact on quality of life in patients with indwelling ureteral stents: A 10-year clinical experience.

OBJECTIVE: Prospective analysis of the prevalence of symptoms, tolerability and complications associated with ureteral stents and their impact on quality of life based on the Flanagan Quality of Life Scale and a not-validated questionnaire from our clinic. METHODS: A total of 2200 adult patient participated to this study in a period of 10 years (2003-2012). Those patients were asked to complete the QOLS and a not-validated questionnaire from our clinic, before ureteral indwelling, 7 day after ureteral indwelling and 14 days after removal of the stent. RESULTS: Total 1520 patient aged between 18 and 84 years completed the study. The analysis of data showed that the unpleasant symptoms caused by stent were encountered more frequently at 7 days after stent insertion, in terms of urinary frequency, dysuria, urgency and macroscopic haematuria, this difference being statistically significant (p<0.05). After analysis the responses to QOLS questionnaire, at 7 days after stent placement, mean scores show a clear reduction in the QoL of those patients, in all cases the standard deviation being at a great value, indicating a high variability of responses, but at 14 days after its suppression of stent the average scores are somewhat closer to the baseline. CONCLUSIONS: Our study brings many elements that shows a statistically significant increase in the incidence of numerous side effects and impaired quality of life. It contributes to existing data from the literature as regards the knowledge of the pathology determined by the presence of foreign body in the urinary tract and in providing patient counseling.