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1.
Clin Nephrol ; 97(2): 86-92, 2022 Feb.
Article in English | MEDLINE | ID: mdl-34784999

ABSTRACT

PURPOSE: Dehydration is a risk factor for kidney stone formation. Studying populations that may experience dehydration without a known increased incidence of stone formation may help understand stone formation and prevention. High-caliber athletes represent such a population. We characterized the urinary environment of high-caliber athletes utilizing 24-hour urine collections with comparison to non-athlete controls. MATERIALS AND METHODS: After Institutional Review Board (IRB) and National Collegiate Athletic Association (NCAA) compliance officer approval, 74 college-student athletes and 20 non-athletes were enrolled. Demographics, medical history, and sport of participation were recorded. Participants were asked to provide 24-hour urine collections as well as diet and activity logs at the time of urine collection. Standard stone risk parameters were assessed and compared to litholink reference standards. RESULTS: 34 athletes and 10 non-athletes provided at least one 24-hour urine specimen for evaluation. Athletes had a high prevalence of urinary risks for stone formation including low volume (median 1.46 L), low citrate, high sodium, high calcium (females), and high uric acid (males). However, athletes also had a high prevalence of known stone-protective factors such as high urine magnesium. Athletes had a lower urine pH but high supersaturation of uric acid and calcium oxalate compared to non-athletes. CONCLUSION: Student athletes appear to have a high prevalence of urinary risk factors for stone formation such as dehydration, high calcium, high uric acid, high sodium, and low citrate. Overall stone risk in this population may be offset by increased levels of stone-protective factors such as magnesium. Further study of this population may help generate hypotheses for effective stone prevention strategies in the general population.


Subject(s)
Kidney Calculi , Athletes , Calcium Oxalate , Citrates , Female , Humans , Kidney Calculi/diagnosis , Kidney Calculi/epidemiology , Kidney Calculi/etiology , Male , Risk Factors , Students
2.
Urology ; 153: 320-326, 2021 07.
Article in English | MEDLINE | ID: mdl-33901530

ABSTRACT

OBJECTIVE: To determine whether ejaculatory dysfunction (EjD) and post-void dribbling (PVD) after urethroplasty are associated, providing evidence for a common etiology. METHODS: We reviewed a prospectively maintained database for first-time, anterior urethroplasties. One item from the Male Sexual Health Questionnaire (MSHQ) assessed EjD: "How would you rate the strength or force of your ejaculation". One item from the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) assessed PVD: "How often have you had slight wetting of your pants after you had finished urinating?". The frequency of symptoms was compared after penile vs. bulbar repairs, and anastomotic versus augmentation bulbar repairs. Associations were assessed with chi-square. RESULTS: A total of 728 men were included. Overall, postoperative EjD and PVD were common; 67% and 66%, respectively. There was a significant association between EjD and PVD for the whole cohort (p<0.0001); this association remained significant after penile repairs (p=0.01), bulbar repairs (p<0.0007), and bulbar anastomotic repairs (p=0.002), but not after bulbar augmentation repairs (p=0.052). EjD and PVD occurred at similar rates after penile and bulbar urethroplasty. The rate of EjD was similar after bulbar augmentation and bulbar anastomotic urethroplasties, but PVD was more common after bulbar augmentation (70% vs. 52%) (p = 0.0001). CONCLUSION: EjD and PVD after anterior urethroplasty are significantly associated with one another, supporting the theory of a common etiology. High rates after penile repairs argue against a bulbospongiosus muscle damage etiology, and high rates after anastomotic repairs argue against graft sacculation. More work is needed to better understand and prevent symptoms.


Subject(s)
Ejaculation , Postoperative Complications/etiology , Sexual Dysfunction, Physiological/etiology , Urethra/surgery , Urinary Incontinence, Urge/etiology , Adult , Anastomosis, Surgical , Humans , Male , Middle Aged , Prospective Studies , Sexual Dysfunction, Physiological/complications , Urinary Incontinence, Urge/complications , Urination , Urologic Surgical Procedures, Male/methods
3.
Urology ; 146: 260-264, 2020 12.
Article in English | MEDLINE | ID: mdl-32791293

ABSTRACT

OBJECTIVE: To report our experience with a noneverted stoma technique used in ileal conduit urinary diversion. We successfully utilize this technique in patients when traditional everted stoma maturation is difficult due to a thick abdominal wall, bulky mesentery, and poor bowel compliance. METHODS: We retrospectively reviewed all patients who underwent surgical creation of ileal conduit using a noneverted stoma technique between 2009 and 2018. We recorded demographic and perioperative information, including 30-day postoperative complications, and stoma appearance at last follow-up visit. Using R software, chi-square testing of the distribution of stoma outcomes for obese and nonobese patients was performed. RESULTS: There were a total of 42 patients who underwent noneverted stoma maturation technique by a single surgeon. Our cohort meets obese criteria with a mean body mass index (BMI) of 30.2. Mean length of follow-up was 16.6 months (1-62). On follow-up, 35 (83.3%) of stomas were pink and everted appearing, 4 (9.5%) were flush, small, or noneverted, 1 (2.3%) had an eschar or area of granulation tissue around the stoma, and 2 (4.7%) did not have a stoma description documented. There were 9 (21%) stoma-related complications in our cohort. There was no statistical difference in stoma outcomes between obese (BMI > 30) and nonobese (BMI < 30) patients (P= .65). CONCLUSION: Ileal conduit creation with a noneverted stoma provides good stoma protuberance in patients with a thick abdominal wall, bulky mesentery, and poor bowel compliance. This technique is safe and should be considered in patients in whom stoma maturation is difficult.


Subject(s)
Surgical Stomas , Urinary Diversion/methods , Abdominal Wall/pathology , Aged , Aged, 80 and over , Female , Follow-Up Studies , Hernia, Abdominal/etiology , Hernia, Abdominal/surgery , Humans , Male , Middle Aged , Obesity/complications , Postoperative Complications/etiology , Reoperation , Retrospective Studies , Surgical Stomas/adverse effects
4.
Spinal Cord ; 58(12): 1274-1281, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32409777

ABSTRACT

STUDY DESIGN: Cross-sectional survey of the Neurogenic Bladder Research Group (NBRG) registry; a multicenter prospective observation study. OBJECTIVES: To assess how patient-reported urinary tract infections (PRUTIs) in spinal cord injury (SCI) affect quality of life (QOL). SETTING: Multiple United States hospitals. METHODS: 1479 participants with SCI were asked about neurogenic bladder-related QOL. Eligibility: age ≥ 18 years with acquired SCI. PRUTI frequency over the last year was classified as 0, 1-3, 4-6, or >6. Four UTI QOL domains were assessed: (1) UTIs limited daily activities, (2) UTIs caused increased muscle spasms, (3) UTIs would not go away, and (4) UTIs made me avoid going out. Multivariable regression identified variables associated with poor QOL. RESULTS: PRUTI frequency was 0 in 388 patients (26%), 1-3 in 677 (46%), 4-6 in 223 (15%), and more than 6 in 190 (13%). Increasing PRUTI rate was independently associated with worse QOL for all four questions. Compared with those with 0 PRUTIs, participants reporting >6 were more likely to limit daily activities (OR 9.0 [95% CI 8.1-21.2] p < 0.0001), experience increased muscle spasms (OR 12.4 [95% CI 7.5-20.6] p < 0.0001), perceive a UTI would not go away (OR 30.1 [95% CI 15.0-60.4] p < 0.0001), and avoid going out because of UTIs (OR 7.2 [95% CI 4.2-12.4] p < 0.0001). CONCLUSIONS: An increasing rate of PRUTIs is independently associated with worse QOL. Thorough evaluation and treatment may improve QOL in this population.


Subject(s)
Spinal Cord Injuries , Urinary Bladder, Neurogenic , Urinary Tract Infections , Adolescent , Cross-Sectional Studies , Humans , Patient Reported Outcome Measures , Prospective Studies , Quality of Life , Spinal Cord Injuries/complications , Spinal Cord Injuries/epidemiology , Urinary Bladder, Neurogenic/epidemiology , Urinary Bladder, Neurogenic/etiology , Urinary Tract Infections/epidemiology , Urinary Tract Infections/etiology
5.
J Urol ; 204(4): 805-810, 2020 10.
Article in English | MEDLINE | ID: mdl-32267191

ABSTRACT

PURPOSE: Clinical trials serve as a critical source of information to guide evidence-based practices in urology. Conversely, trials that are abandoned consume significant resources and results are underreported in the literature. MATERIALS AND METHODS: ClinicalTrials.gov was queried for urology trials from 2006 to 2016. Trials were screened by 2 screeners for applicability to urology and disputes were resolved by a third independent reviewer. Overall 1,340 trials met final inclusion criteria (722 successful trials, 618 failed trials). Univariable analysis used Fisher's exact, chi-squared and Wilcoxon rank sum tests. Trial characteristics, including AUA (American Urological Association) section, phase, subspecialty, intervention type, source of funding and randomization were examined for association with failure using multivariable logistic regression. RESULTS: Trial failure is associated with oncology subspecialty (adjusted odds ratio 2.25, 95% CI 1.60-3.18), infertility/andrology subspecialty (AOR 4.99, CI 1.60-17.61), device trials (AOR 1.64, CI 1.00-2.70) and combination funding by industry/government/grants (AOR 3.13, CI 2.21-4.48). Clinical trials in AUA sections were less likely to fail than international and multisectional trials. Among trials that failed, poor accrual was the primary reason for trial failure, comprising 41% of all failures. Other reasons for failure include inadequate budget (9%), sponsor cancellation (7%), poor interim results (7%) and toxicity (3%). CONCLUSIONS: Despite their significance, many urological trials fail prematurely due to poor accrual. Complex features inherent to oncology, andrology/infertility, devices and multisectional trials pose significant barriers to success.


Subject(s)
Randomized Controlled Trials as Topic , Forecasting , Humans , Randomized Controlled Trials as Topic/standards
6.
Am J Physiol Regul Integr Comp Physiol ; 318(2): R428-R434, 2020 02 01.
Article in English | MEDLINE | ID: mdl-31913685

ABSTRACT

Nonobstructive urinary retention (NOUR) is a medical condition without an effective drug treatment, but few basic science studies have focused on this condition. In α-chloralose-anesthetized cats, the bladder was cannulated via the dome and infused with saline to induce voiding that could occur without urethral outlet obstruction. A nerve cuff electrode was implanted for tibial nerve stimulation (TNS). The threshold (T) intensity for TNS to induce toe twitch was determined initially. Repeated (6 times) application of 30-min TNS (5 Hz, 0.2 ms, 4-6T) significantly (P < 0.05) increased bladder capacity to 180% of control and reduced the duration of the micturition contraction to 30% of control with a small decrease in contraction amplitude (80% of control), which resulted in urinary retention with a low-voiding efficiency of 30% and a large amount of residual volume equivalent to 130% of control bladder capacity. This NOUR condition persisted for >2 h after the end of repeated TNS. However, lower frequency TNS (1 Hz, 0.2 ms, 4T) applied during voiding partially reversed the NOUR by significantly (P < 0.05) increasing voiding efficiency to 60% and reducing residual volume to 70% of control bladder capacity without changing bladder capacity. These results revealed that tibial nerve afferent input can activate either an excitatory or an inhibitory central nervous system mechanism depending on afferent firing frequencies (1 vs. 5 Hz). This study established the first NOUR animal model that will be useful for basic science research aimed at developing new treatments for NOUR.


Subject(s)
Electric Stimulation , Tibial Nerve/physiopathology , Urinary Bladder/innervation , Urinary Retention/etiology , Urination , Urodynamics , Animals , Cats , Disease Models, Animal , Electric Stimulation Therapy , Female , Male , Time Factors , Urinary Retention/physiopathology , Urinary Retention/therapy
7.
Eur Urol Focus ; 6(2): 215-217, 2020 03 15.
Article in English | MEDLINE | ID: mdl-31231009

ABSTRACT

Radical prostatectomy has largely become a procedure requiring a single day in the hospital with improving convalescence. Pre-operative counseling on perioperatively expectations including a discussion of pain management using non-opioid alternatives is critical to further improve postoperative recovery and limit narcotic use. Preoperative regional pain blocks and intraoperative multi-modal analgesia, and scheduled non-opioid pain medication alternatives can greatly limit opioid exposure perioperatively. Liberal use of acetaminophen and non-steroidal anti-inflammatories upon discharge may eliminate the need for narcotic prescriptions at the time of discharge.


Subject(s)
Anesthetics, Local , Robotics , Double-Blind Method , Humans , Male , Pain, Postoperative , Prostatectomy
9.
Urology ; 133: 229-233, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31369750

ABSTRACT

OBJECTIVE: To determine the prevalence of penile cancer in patients with adult acquired buried penis (AABP). Penile cancer is a rare but aggressive cancer. Several case reports have recently been published that indicate that AABP may increase the risk of penile cancer. MATERIALS AND METHODS: A retrospective review was conducted of adults diagnosed with AABP and penile cancer between January, 2008 and December, 2018 seen at a tertiary referral center. Demographics including age, BMI, comorbidities, etiology of AABP, smoking history, circumcision status, and premalignant lesions (condyloma, lichen sclerosus [LS] carcinoma in situ [CIS]) were recorded. For patients with penile cancer, AJCC staging, grade, TNM staging and treatments were recorded. Basic descriptive statistics were performed for the overall cohort. We used Chi-square tests and Fisher exact tests to compare differences between patients with benign pathology and patients with malignant or pre-malignant pathology. RESULTS: We identified 150 patients with the diagnosis of AABP. The prevalence of penile squamous cell carcinoma was 7%. There was a 35% rate of premalignant lesions. This study is limited by its retrospective and single-institution nature. CONCLUSION: AABP is a condition that incorporates multiple risk factors for penile cancer. The prevalence of penile cancer appears to be higher in patients with AABP; however, more data are needed to confirm these initial findings. Patients with AABP should be counseled on these risks and should be considered for buried penis repair if a physical examination cannot be performed.


Subject(s)
Penile Diseases/complications , Penile Neoplasms/complications , Penile Neoplasms/epidemiology , Adult , Humans , Male , Middle Aged , Obesity/complications , Penile Diseases/etiology , Prevalence , Retrospective Studies
10.
World J Urol ; 37(7): 1409-1413, 2019 Jul.
Article in English | MEDLINE | ID: mdl-30298286

ABSTRACT

PURPOSE: To describe the prevalence and surgical management of coexistent adult acquired buried penis (AABP) and urethral stricture disease. AABP patients often have urinary dribbling with resultant chronic local moisture, infection, and inflammation that combine to cause urethral stricture disease. To date, no screening or surgical management algorithms have been described. METHODS: A multi-institutional retrospective study was conducted of the surgical management strategies for patients with concurrent AABP and urethral stricture disease from 2010 to 2017. AABP patient demographics, physical exam findings, and comorbidities were compared between those with and without stricture disease to suggest those that would selectively benefit from screening for stricture disease. RESULTS: Of the 42 patients surgically managed for AABP, 13 had urethral stricture disease (31.0%). Stricture location was universal in the anterior urethra. Sixty-one percent (n = 8) of strictures were 6 cm or longer and managed prior to AABP repair with Kulkarni urethroplasty. Patients with urethral stricture disease were significantly more likely to have clinically diagnosed lichen sclerosus (p = 0.00019). There was no significant difference in BMI, age, or comorbidities between patients with and without urethral stricture disease. CONCLUSIONS: Extensive anterior urethral stricture is common in patients with AABP. Clinical characteristics cannot predict stricture presence except possibly the presence of lichen sclerosus. Definitive stricture surgical options include extensive Johanson Urethroplasty or Kulkarni Urethroplasty. Kulkarni Urethroplasty prior to AABP repair has the benefits of a single-stage repair, good cosmetic outcome with meatal voiding, and dorsal graft placement to allow safe degloving of the penis in the subsequent AABP repair.


Subject(s)
Obesity/epidemiology , Penile Diseases/epidemiology , Urethra/surgery , Urethral Stricture/epidemiology , Comorbidity , Humans , Lichen Sclerosus et Atrophicus/epidemiology , Lower Urinary Tract Symptoms/epidemiology , Male , Middle Aged , Penile Diseases/surgery , Prevalence , Plastic Surgery Procedures , Retrospective Studies , Urethral Stricture/surgery , Urologic Surgical Procedures, Male
11.
Urology ; 123: 101-107, 2019 01.
Article in English | MEDLINE | ID: mdl-30149041

ABSTRACT

OBJECTIVE: To examine the use of prescription opioids in patients undergoing major prostate and kidney operations. METHODS: This is a prospective observational study that includes opioid naïve patients who underwent a major prostate or kidney operation from January 2017-May 2017. A telephone survey was conducted 3-4 weeks postoperatively. The survey assessed the number of 5 mg oxycodone-equivalents prescribed, opioid use, and disposal. RESULTS: A total of 155 patients were included in our analysis. Most patients were male (86%), most were married (74%), the median was age 64 (interquartile range 59-70), and the majority were Caucasian (84%). Most patients reported social alcohol use (56%), but most denied current tobacco use (77%) or current and/or previous drug use (76%). Opioid prescribing exceeded use from 1.9- to 6.8-fold for all procedural categories. Overall, a total of 4065 oxycodone-equivalents were prescribed during this study and 60% of pills prescribed went unused. This resulted in 2622 excess pills in the community. CONCLUSION: Opioids are prescribed far in excess of need following major open and minimally invasive urologic procedures. Overall, 60% of prescribed opioids were unused. These data provide initial benchmarks for appropriate opioid prescribing after major prostate and kidney procedures. Future work to validate this initial guideline and improve patient counseling regarding appropriate perioperative opioid use and disposal is needed.


Subject(s)
Analgesics, Opioid/therapeutic use , Drug Prescriptions/statistics & numerical data , Inappropriate Prescribing/statistics & numerical data , Nephrectomy , Pain, Postoperative/drug therapy , Prostatectomy , Aged , Female , Humans , Male , Middle Aged , Prospective Studies
13.
Urology ; 124: 223-228, 2019 02.
Article in English | MEDLINE | ID: mdl-30359708

ABSTRACT

OBJECTIVE: To characterize geographic variability of generic benign prostatic hyperplasia (BPH) medications in order to improve drug price transparency and improve patient access to affordable medication sources. This is of interest because BPH is one of the most common chronic diseases in men and contributes to individual healthcare cost. Medical therapy is the main treatment modality for BPH, burdening patients with lifelong medication expenses which may impact adherence and subsequent outcomes. With an aging population, this is compounded by many older individuals requiring multiple daily medications. METHODS: All pharmacies within a 25-mile radius of our institution were identified and classified as chain, wholesale or independent. The out-of-pocket price for a 30-day supply of tamsulosin (0.4 mg), finasteride (5 mg), oxybutynin (5 mg TID), and oxybutynin 10 mg XL were obtained using a scripted telephone survey. Multivariable linear regression assessed the association between census-tract level demographic and socioeconomic factors and disparate generic out-of-pocket drug-pricing. RESULTS: The response rate was 93% with 255 pharmacies across 173 census tracts providing data. By pharmacy type, there was up to 5.5-fold variation in median out-of-pocket drug prices for the most common BPH medications. Demographic and socioeconomic factors were not significantly associated with generic BPH drug price variation. CONCLUSION: The out-of-pocket price of generic medications for BPH varies significantly between pharmacies in a geographically-confined area. This study highlights the need for quality improvement initiatives that empower patients to price-compare and improve drug price transparency.


Subject(s)
Commerce/statistics & numerical data , Drugs, Generic/economics , Drugs, Generic/therapeutic use , Prostatic Hyperplasia/drug therapy , Humans , Male , Pennsylvania
14.
Neuromodulation ; 21(7): 700-706, 2018 Oct.
Article in English | MEDLINE | ID: mdl-29949663

ABSTRACT

OBJECTIVE: This study is aimed at determining if tibial nerve stimulation (TNS) can modulate both bladder underactivity and overactivity. METHODS: In α-chloralose anesthetized cats, tripolar cuff electrodes were implanted on both tibial nerves and TNS threshold (T) for inducing toe twitching was determined for each nerve. Normal bladder activity was elicited by slow intravesical infusion of saline; while bladder overactivity was induced by infusion of 0.25% acetic acid to irritate the bladder. Bladder underactivity was induced during saline infusion by repeated application (2-6 times) of 30-min TNS (5 Hz, 4-8T, 0.2 msec) to the left tibial nerve, while TNS (1 Hz, 4T, 0.2 msec) was applied to the right tibial nerve to reverse the bladder underactivity. RESULTS: Prolonged 5-Hz TNS induced bladder underactivity by significantly increasing bladder capacity to 173.8% ± 10.4% of control and reducing the contraction amplitude to 40.1% ± 15.3% of control, while 1 Hz TNS normalized the contraction amplitude and significantly reduced the bladder capacity to 130%-140% of control. TNS at 1 Hz in normal bladders did not change contraction amplitude and only slightly changed the capacity, but in both normal and underactive bladders significantly increased contraction duration. The effects of 1 Hz TNS did not persist following stimulation. Under isovolumetric conditions when the bladder was underactive, TNS (0.5-3 Hz; 1-4T) induced large amplitude and sustained bladder contractions. In overactive bladders, TNS during cystometry inhibited bladder overactivity at 5 Hz but not at 1 Hz. CONCLUSIONS: This study indicates that TNS at different frequencies might be used to treat bladder underactivity and overactivity.


Subject(s)
Biophysical Phenomena/physiology , Electric Stimulation Therapy/methods , Tibial Nerve/physiology , Urinary Bladder Diseases/therapy , Acetic Acid/toxicity , Animals , Biophysics , Cats , Disease Models, Animal , Female , Male , Reflex/physiology , Urinary Bladder Diseases/chemically induced
15.
BJU Int ; 122(5): 754-759, 2018 11.
Article in English | MEDLINE | ID: mdl-29896932

ABSTRACT

Opioid abuse and addiction is causing widespread devastation in communities across the USA and resulting in significant strain on our healthcare system. There is increasing evidence that prescribers are at least partly responsible for the opioid crisis because of overprescribing, a practice that developed from changes in policy and reimbursement structures. Surgeons, specifically, have been subject to scrutiny as 'adequate treatment' of post-surgical pain is poorly defined and data suggest that many patients receive much larger opioid prescriptions than needed. The consequences of overprescribing include addiction and misuse, dispersion of opioids into the community, and possible potentiation of illicit drug/heroin use. Several solutions to this crisis are currently being enacted with variable success, including Prescription Drug Monitoring Programmes, policy-level interventions aimed to de-incentivize overprescribing, limiting opioid exposures through Enhanced Recovery After Surgery protocols, and the novel idea of creating surgery- and/or procedure-specific prescribing guidelines. This problem is likely to require not one, but several potential solutions to reverse its trajectory. It is critical, however, that we as physicians and prescribers find a way to stop the needless overprescribing while still treating postoperative pain appropriately.


Subject(s)
Analgesics, Opioid , Health Policy/legislation & jurisprudence , Inappropriate Prescribing , Opioid-Related Disorders , Pain, Postoperative/drug therapy , Analgesics, Opioid/adverse effects , Analgesics, Opioid/therapeutic use , Epidemics , Humans , Inappropriate Prescribing/legislation & jurisprudence , Inappropriate Prescribing/prevention & control , Organizational Culture , Practice Patterns, Physicians' , Surgeons , United States
16.
Urology ; 116: 180-184, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29625136

ABSTRACT

OBJECTIVE: To assess postoperative patient-reported quality of life outcomes after surgical management of adult-acquired buried penis (AABP). We hypothesize that surgical treatment of AABP results in improvements in urinary and sexual quality of life. METHODS: Patients that underwent surgical treatment of AABP were retrospectively identified. The Expanded Prostate Cancer Index (EPIC) questionnaire was completed at ≥3 months postoperatively, and completed retrospectively to define preoperative symptoms. EPIC is validated for local treatment of prostate cancer. Urinary and sexual domains were utilized. Questions are scored on a 5-point Likert scale, with higher scores indicating better quality of life. Preoperative scores were compared with postoperative scores. RESULTS: Sixteen patients completed pre- and postoperative questionnaires. Mean time from surgery to questionnaire was 12.6 months. There was a significant improvement in 10 of 12 urinary domain questions and 10 of 13 sexual domain questions. Fourteen of 16 patients (87.5%) reported significant improvement in overall sexual function (median score changed from 1.5 to 5, P <.0001). Similarly, 14 of 16 patients (87.5%) reported significant improvement in overall urinary function (median score changed from 1 to 4, P <.0001). CONCLUSION: AABP is a challenging condition to treat and often requires surgical intervention to improve hygiene and function. There are limited data on patient-reported quality of life outcomes. We found that surgical management of AABP results in significant improvements in both urinary and sexual quality of life outcomes.


Subject(s)
Patient Reported Outcome Measures , Penile Diseases/surgery , Penis/surgery , Plastic Surgery Procedures , Quality of Life , Urologic Surgical Procedures, Male , Erectile Dysfunction/etiology , Humans , Male , Middle Aged , Penile Diseases/complications , Penile Diseases/physiopathology , Postoperative Period , Retrospective Studies , Sexual Behavior/statistics & numerical data , Urination
17.
Neurourol Urodyn ; 37(7): 2121-2127, 2018 09.
Article in English | MEDLINE | ID: mdl-29635834

ABSTRACT

AIMS: To establish an animal model of bladder underactivity induced by prolonged and intense stimulation of somatic afferent axons in the tibial nerve. METHODS: In seven cats under α-chloralose anesthesia, tibial nerve stimulation (TNS) of 30-min duration was repeatedly (3-8 times) applied at 4-6 times threshold (T) intensity for inducing a toe twitch to produce bladder underactivity determined by cystometry. Naloxone (1 mg/kg, i.v.) was administered to examine the role of opioid receptors in TNS-induced bladder underactivity. RESULTS: After prolonged (1.5-4 h) and intense (4-6T) TNS, a complete suppression of the micturition reflex occurred in six cats and an increase in bladder capacity to about 150% of control and a decrease in the micturition contraction amplitude to 50% of control occurred in one cat. The bladder underactivity was maintained for at least 1-1.5 h. Naloxone reversed the bladder underactivity, but an additional 30-min TNS removed the naloxone effect. CONCLUSIONS: The results indicate that prolonged and intense activation of somatic afferent axons in the tibial nerve can suppress the central reflex mechanisms controlling micturition. This animal model may be useful for examining the pathophysiology of neurogenic bladder underactivity and for development of new treatments for underactive bladder symptoms.


Subject(s)
Axons/physiology , Electric Stimulation , Neurons, Afferent/physiology , Tibial Nerve/physiology , Urinary Bladder, Underactive/physiopathology , Animals , Cats , Disease Models, Animal , Female , Male , Naloxone/pharmacology , Narcotic Antagonists/pharmacology , Receptors, Opioid/drug effects , Reflex/physiology , Urination/physiology
18.
Curr Urol Rep ; 19(3): 22, 2018 Feb 28.
Article in English | MEDLINE | ID: mdl-29492732

ABSTRACT

PURPOSE OF REVIEW: Adult acquired buried penis is a morbid condition characterized by complete entrapment of the phallus as a result of morbid obesity, post-surgical cicatrix formation, or primary genital lymphedema. Hygienic voiding is not possible and urinary dribbling is frequent with accompanying inflammation, skin breakdown, and infection from the chronic moisture. The end result is penile skin fibrosis resulting in permanent functional loss. Herein, we describe the etiology of adult acquired buried penis, advances in its surgical management, and quality of life outcomes with treatment. RECENT FINDINGS: Adult acquired buried penis is increasing in incidence as morbid obesity becomes more prevalent. Frequently comorbid conditions affect treatment including those affecting wound healing such a diabetes mellitus. Functional and cosmetic surgical outcomes are being published in greater volume in recent years leading to more refined treatment algorithms. Patient quality of life is greatly improved by definitive surgical management. Adult acquired buried penis is a morbid condition that is increasing in incidence as obesity becomes more commonplace. Surgical management often necessitates surgical lipectomy of the suprapubic fat pad, scrotoplasty, and penile split thickness skin graft. Substantial quality of life improvements have been consistently reported after surgical treatment.


Subject(s)
Lymphedema/complications , Obesity, Morbid/complications , Penile Induration/etiology , Penile Induration/surgery , Adult , Humans , Male , Penis/surgery , Quality of Life , Plastic Surgery Procedures/methods
19.
Am J Physiol Regul Integr Comp Physiol ; 314(1): R34-R42, 2018 01 01.
Article in English | MEDLINE | ID: mdl-28931549

ABSTRACT

This study tested the hypothesis that sacral neuromodulation, i.e., electrical stimulation of afferent axons in sacral spinal root, can block pudendal afferent inhibition of the micturition reflex. In α-chloralose-anesthetized cats, pudendal nerve stimulation (PNS) at 3-5 Hz was used to inhibit bladder reflex activity while the sacral S1 or S2 dorsal root was stimulated at 15-30 Hz to mimic sacral neuromodulation and to block the bladder inhibition induced by PNS. The intensity threshold (T) for PNS or S1/S2 dorsal root stimulation (DRS) to induce muscle twitch of anal sphincter or toe was determined. PNS at 1.5-2T intensity inhibited the micturition reflex by significantly ( P < 0.01) increasing bladder capacity to 150-170% of control capacity. S1 DRS alone at 1-1.5T intensity did not inhibit bladder activity but completely blocked PNS inhibition and restored bladder capacity to control level. At higher intensity (1.5-2T), S1 DRS alone inhibited the micturition reflex and significantly increased bladder capacity to 135.8 ± 6.6% of control capacity. However, the same higher intensity S1 DRS applied simultaneously with PNS, suppressed PNS inhibition and significantly ( P < 0.01) reduced bladder capacity to 126.8 ± 9.7% of control capacity. S2 DRS at both low (1T) and high (1.5-2T) intensity failed to significantly reduce PNS inhibition. PNS and S1 DRS did not change the amplitude and duration of micturition reflex contractions, but S2 DRS at 1.5-2T intensity doubled the duration of the contractions and increased bladder capacity. These results are important for understanding the mechanisms underlying sacral neuromodulation of nonobstructive urinary retention in Fowler's syndrome.


Subject(s)
Lumbosacral Plexus , Neural Inhibition , Pudendal Nerve/physiopathology , Reflex , Transcutaneous Electric Nerve Stimulation/methods , Urinary Bladder/innervation , Urinary Retention/therapy , Urination , Animals , Cats , Disease Models, Animal , Female , Male , Pelvic Floor/innervation , Syndrome , Urethra/innervation , Urinary Retention/etiology , Urinary Retention/physiopathology , Urodynamics
20.
Am J Physiol Renal Physiol ; 315(2): F247-F253, 2018 08 01.
Article in English | MEDLINE | ID: mdl-29070575

ABSTRACT

This study in α-chloralose-anesthetized cats aimed at investigating the bladder responses to saphenous nerve stimulation (SNS). A urethral catheter was used to infuse the bladder with saline and to record changes in bladder pressure. With the bladder fully distended, SNS at 1-Hz frequency and an intensity slightly below the threshold (T) for inducing an observable motor response of the hindlimb muscles induced large amplitude (40-150 cmH2O) bladder contractions. Application of SNS (1 Hz, 2-4T) during cystometrograms (CMGs), when the bladder was slowly (1-3 ml/min) infused with saline, significantly ( P < 0.05) increased the duration of the micturition contraction to >200% of the control without changing bladder capacity or contraction amplitude. Repeated application (1-8 times) of intense (4-8T intensity) 30-min tibial nerve stimulation (TNS) produced prolonged post-TNS inhibition that significantly ( P < 0.01) increased bladder capacity to 135.9 ± 7.6% and decreased the contraction amplitude to 44.1 ± 16.5% of the pre-TNS control level. During the period of post-TNS inhibition, SNS (1 Hz, 2-4T) applied during CMGs completely restored the bladder capacity and the contraction amplitude to the pre-TNS control level and almost doubled the duration of the micturition contraction. These results indicate that SNS at 1 Hz can facilitate the normal micturition reflex and normalize the reflex when it is suppressed during post-TNS inhibition. This study provides an opportunity to develop a novel neuromodulation therapy for underactive bladder using SNS.


Subject(s)
Reflex , Tibial Nerve/physiopathology , Transcutaneous Electric Nerve Stimulation/methods , Urinary Bladder, Underactive/therapy , Urinary Bladder/innervation , Urination , Animals , Cats , Disease Models, Animal , Electric Stimulation , Female , Male , Pressure , Recovery of Function , Urinary Bladder, Underactive/etiology , Urinary Bladder, Underactive/physiopathology , Urodynamics
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