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.

Biomarkers for the Noninvasive Diagnosis of Endometriosis: State of the Art and Future Perspectives.

BACKGROUND: Early and accurate diagnosis of endometriosis is crucial for the management of this benign, yet debilitating pathology. Despite the advances of modern medicine, there is no common ground regarding the pathophysiology of this disease as it continues to affect the quality of life of millions of women of reproductive age. The lack of specific symptoms often determines a belated diagnosis. The gold standard remains invasive, surgery followed by a histopathological exam. A biomarker or a panel of biomarkers is easy to measure, usually noninvasive, and could benefit the clinician in both diagnosing and monitoring the treatment response. Several studies have advanced the idea of biomarkers for endometriosis, thereby circumventing unnecessary invasive techniques. Our paper aims at harmonizing the results of these studies in the search of promising perspectives on early diagnosis. METHODS: We selected the papers from Google Academic, PubMed, and CrossRef and reviewed recent articles from the literature, aiming to evaluate the effectiveness of various putative serum and urinary biomarkers for endometriosis. RESULTS: The majority of studies focused on a panel of biomarkers, rather than a single biomarker and were unable to identify a single biomolecule or a panel of biomarkers with sufficient specificity and sensitivity in endometriosis. CONCLUSION: Noninvasive biomarkers, proteomics, genomics, and miRNA microarray may aid the diagnosis, but further research on larger datasets along with a better understanding of the pathophysiologic mechanisms are needed.

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.

The Relation of Dependency and the Predictive Potential of Several Factors Possibly Involved in Determining Pulmonary Hypertension in Graves' Disease.

OBJECTIVES: To establish a possible relation of dependency between pulmonary hypertension (PHT) and several factors, with the evaluation of their predictive potential, in Graves' disease. METHODS: For identifying the factors implied in producing PHT and for evaluating its reversibility, we made echocardiography exams, sessions of monitoring the blood pressure during 24 hours and biological test in a group of 42 patients with Graves' disease (group H), comparing them with themselves in a euthyroid status (group E, n=25) and with a control group (group C, n=25). In order to analyse the relation of dependency between pulmonary hypertension (PHT) and the factors identified in the H group, we used both the simple linear regression method (polynomial of degree 1) and the non-linear regression method (polynomial of degree 2, 3) for establishing one model of functional dependency. We used the values of the coefficients of correlation r (degree of dependency) and of determination R2 (the type of dependency). The statistical test (F-test, AIC criterion, test t) was applied by choosing the most appropriate model of determination, with a higher predictive potential. RESULTS: We identified PHT at 47.6% of the patients with Graves' disease. Once the euthyroidism status is obtained, PHT is normalized. While inducing PHT, we identified a strong relationship of dependency on several possible new factors such as: pre-treatment period, age, level of the thyroid stimulating hormone receptor antibody and values of systolic blood pressure, besides the already known ones (high level of thyroids hormones, cardiac output, pulmonary vascular resistance). CONCLUSIONS: The non-linear model best explains the relation of determination between pulmonary pressure and those factors having a better predictive potential (from 51% to 90%), compared with the linear model, the only exception being the age factor and the systolic blood pressure, where both models seems to be appropriate.

Therapeutic Approaches of Botulinum Toxin in Gynecology.

Botulinum toxins (BoNTs) are produced by several anaerobic species of the genus Clostridium and, although they were originally considered lethal toxins, today they find their usefulness in the treatment of a wide range of pathologies in various medical specialties. Botulinum neurotoxin has been identified in seven different isoforms (BoNT-A, BoNT-B, BoNT-C, BoNT-D, BoNT-E, BoNT-F, and BoNT-G). Neurotoxigenic Clostridia can produce more than 40 different BoNT subtypes and, recently, a new BoNT serotype (BoNT-X) has been reported in some studies. BoNT-X has not been shown to actually be an active neurotoxin despite its catalytically active LC, so it should be described as a putative eighth serotype. The mechanism of action of the serotypes is similar: they inhibit the release of acetylcholine from the nerve endings but their therapeutically potency varies. Botulinum toxin type A (BoNT-A) is the most studied serotype for therapeutic purposes. Regarding the gynecological pathology, a series of studies based on the efficiency of its use in the treatment of refractory myofascial pelvic pain, vaginism, dyspareunia, vulvodynia and overactive bladder or urinary incontinence have been reported. The current study is a review of the literature regarding the efficiency of BoNT-A in the gynecological pathology and on the long and short-term effects of its administration.

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.

Comparison of Linear and Non-linear Regression Analysis to Determine Pulmonary Pressure in Hyperthyroidism.

OBJECTIVES: This study aimed at assessing the incidence of pulmonary hypertension (PH) at newly diagnosed hyperthyroid patients and at finding a simple model showing the complex functional relation between pulmonary hypertension in hyperthyroidism and the factors causing it. METHODS: The 53 hyperthyroid patients (H-group) were evaluated mainly by using an echocardiographical method and compared with 35 euthyroid (E-group) and 25 healthy people (C-group). In order to identify the factors causing pulmonary hypertension the statistical method of comparing the values of arithmetical means is used. The functional relation between the two random variables (PAPs and each of the factors determining it within our research study) can be expressed by linear or non-linear function. By applying the linear regression method described by a first-degree equation the line of regression (linear model) has been determined; by applying the non-linear regression method described by a second degree equation, a parabola-type curve of regression (non-linear or polynomial model) has been determined. We made the comparison and the validation of these two models by calculating the determination coefficient (criterion 1), the comparison of residuals (criterion 2), application of AIC criterion (criterion 3) and use of F-test (criterion 4). RESULTS: From the H-group, 47% have pulmonary hypertension completely reversible when obtaining euthyroidism. The factors causing pulmonary hypertension were identified: previously known- level of free thyroxin, pulmonary vascular resistance, cardiac output; new factors identified in this study- pretreatment period, age, systolic blood pressure. According to the four criteria and to the clinical judgment, we consider that the polynomial model (graphically parabola- type) is better than the linear one. CONCLUSIONS: The better model showing the functional relation between the pulmonary hypertension in hyperthyroidism and the factors identified in this study is given by a polynomial equation of second degree where the parabola is its graphical representation.

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.

Botulinum-A Toxin's efficacy in the treatment of idiopathic overactive bladder.

The systematic literature review was carried out to point out the efficacy of botulinum type A toxin (BTX-A) intra-detrusor injections in adults with idiopathic overactive bladder (OAB) and urgency urinary incontinence (UUI). A PubMed search for clinical studies with BTX-A intra-detrusor injections in adults with OAB was performed.The studies showed improvements in quality of life by relieving symptoms (decreased urinary frequency, urgency episodes, incontinence and nocturia). Randomised controlled trials conducted in the preceding two years showed complete continence in patients treated with BTX-A in 22.9% to 55% cases. Following treatment, most studies showed an increase in post-void residual volume, a fact that may lead to urinary tract infections (UTIs) and urinary retention requiring catheterisation. BTX-A is an effective treatment for OAB and results in a significant improvement in the quality of life of patients.