Ketamine: A Cause of Urinary Tract Dysfunction.

Drug addiction as a result of improper use of prescribed and illicit use has been on the increase globally. The effects of such use have implications in the urologic disease space. To this end, Ketamine has been reported to affect urologic function, causing a number of voiding symptoms. It may also confound the differential diagnosis of urologic diseases, such as interstitial cystitis, among others.

Characterization of overactive bladder in women in a primary care setting.

BACKGROUND: Overactive bladder (OAB) represents a disorder with overall increasing prevalence in the American population. However, gender-specific characteristics of OAB and how it relates to the general practitioner are not well described. We sought to determine the distribution and characteristics of OAB in women in a primary care setting. METHODS: Self-administered questionnaires were distributed to patients visiting a family medicine outpatient center. The modified questionnaire included eight questions on evidence of lower urinary tract symptoms (LUTS, OAB-validated 8-question screener [OAB-V8]), two questions on stress urinary incontinence, and one question on incomplete emptying. The questionnaire included demographic characteristics and relevant medical and surgical history. Body mass index was calculated based on weight and height. Chi-square test and risk ratio analysis were used to analyze the relationship between OAB and other independent variables. RESULTS: Of 1025 questionnaires administered, 386 were completed. Patients ranged from 16 to 97 years, the majority were African American (78.2%), and 49.7% were premenopausal while 50.3% were postmenopausal. OAB was present in 46.4% of premenopausal women and 41.7% of postmenopausal women. OAB was significantly associated with overweight status (body mass index 25.0-29.9, P = 0.042) and obesity (body mass index ≥30, P < 0.001). Overall, obese women were twice as likely to have OAB (relative risk = 1.99, 1.31-3.04) than women with normal weight. OAB was not shown to correlate with race, cigarette use, history of hysterectomy, or parity. CONCLUSION: OAB was evident in 44% of all female patients surveyed, which is much higher than previously reported estimates. In addition, overweight women were more likely to have OAB. Increased awareness of OAB in the primary care setting should be considered for women's general health.

Prevalence of overactive bladder, its under-diagnosis, and risk factors in a male urologic veterans population.

PURPOSE: We assess the prevalence of overactive bladder (OAB) and its risk factors in a male urologic veterans population. MATERIALS AND METHODS: Validated self-administered questionnaire was prospectively given. RESULTS: Among 1086 patients, OAB was present in 75%, of which 48% had not been diagnosed/treated. The risk of OAB increased with age. OAB was not associated with BMI, smoking, race, diabetes, CHF, and COPD. CONCLUSIONS: The prevalence of OAB in this population is under-diagnosed and under-treated.

Peripheral blood mononuclear cell gene array profiles in patients with overactive bladder.

OBJECTIVES: To investigate the utility of using peripheral blood mononuclear cells (PBMC) as a marker for patients with overactive bladder (OAB). Patients with OAB may suffer from varying degrees of symptoms such as frequency, urgency, nocturia, and incontinence; however, there is no definitive test for OAB at this time. Questionnaires may provide useful tools for screening patients for OAB but often clinicians may need to rely on more invasive procedures to confirm the diagnosis. We have previously demonstrated that PBMC can provide a reporter function in solid organ retroperitoneal disease. METHODS: Twenty-one patients were assessed for OAB. PBMC was obtained from whole blood of the patients, and RNA was subjected to microarray gene chip analysis. RESULTS: Microarray analysis revealed that 16 genes were differentially regulated (8 upregulated and 8 downregulated) in all patients with OAB in comparison with healthy controls. A sex-based analysis demonstrated 74 genes that were differentially regulated in males (25 upregulated and 49 downregulated), and 30 in females (13 upregulated and 17 downregulated). Of these platelet-derived growth factors, microfibrillar-associated protein and tropomyosin were downregulated in all sets that were analyzed. CONCLUSIONS: Microarray analysis revealed many genes that were differentially regulated in PBMC from OAB patients, including regulatory elements and genes encoding structural proteins, which may be important in regulating structural integrity of the bladder and supporting tissues. These data suggest that PBMC can provide a reporter function for patients with OAB and may serve as a diagnostic marker and elucidate genes involved in this condition.

Risks and benefits of the intercostal approach for percutaneous nephrolithotripsy.

OBJECTIVE: The objective of our retrospective study was to provide evidence on the efficacy of the intercostal versus subcostal access route for percutaneous nephrolithotripsy. MATERIALS AND METHODS: 642 patients underwent nephrolithotomy or nephrolithotripsy from 1996 to 2005. A total of 127 had an intercostal access tract (11th or 12th); 515 had a subcostal access tract. RESULTS: Major complications included one pneumothorax (1.0%), one arterio-calyceal fistula (1.0%) and three arteriovenous fistulae (2.7%) for intercostal upper pole access; two pneumothoraces (1.7%), one arteriovenous fistula (1.0%), one pseudoaneurysm (1.0%), one ruptured uretero-pelvic junction (1.0%), 4 perforated ureters (3.4%) for subcostal upper pole access; one hemothorax (1.6%), one colo-calyceal fistula (1.6%), one AV fistula (1.6%), and two perforated ureters (3.2%) with subcostal interpolar access. Diffuse bleeding from the tract with a subcostal interpolar approach occurred 3.2% of the time compared with 2.4% with a lower pole approach. Staghorn calculi demonstrated similar rates of complications. CONCLUSION: Considering the advantages that the intercostal access route offers the surgeon, it is reasonable to recommend its use after proper pre-procedural assessment of the anatomy, and particularly the respiratory lung motion.

Risks and benefits of the intercostal approach for percutaneous nephrolithotripsy

OBJECTIVE:The objective of our retrospective study was to provide evidence on the efficacy of the intercostal versus subcostal access route for percutaneous nephrolithotripsy. MATERIAL AND METHODS: 642 patients underwent nephrolithotomy or nephrolithotripsy from 1996 to 2005. A total of 127 had an intercostal access tract (11th or 12th); 515 had a subcostal access tract. RESULTS: Major complications included one pneumothorax (1.0 percent), one arterio-calyceal fistula (1.0 percent) and three arteriovenous fistulae (2.7 percent) for intercostal upper pole access; two pneumothoraces (1.7 percent), one arteriovenous fistula (1.0 percent), one pseudoaneurysm (1.0 percent), one ruptured uretero-pelvic junction (1.0 percent), 4 perforated ureters (3.4 percent) for subcostal upper pole access; one hemothorax (1.6 percent), one colo-calyceal fistula (1.6 percent), one AV fistula (1.6 percent), and two perforated ureters (3.2 percent) with subcostal interpolar access. Diffuse bleeding from the tract with a subcostal interpolar approach occurred 3.2 percent of the time compared with 2.4 percent with a lower pole approach. Staghorn calculi demonstrated similar rates of complications. CONCLUSION: Considering the advantages that the intercostal access route offers the surgeon, it is reasonable to recommend its use after proper pre-procedural assessment of the anatomy, and particularly the respiratory lung motion.

Prevalence, evaluation and management of overactive bladder in primary care.

BACKGROUND: Patients with overactive bladder (OAB) are under-diagnosed in the primary care setting. Primary care physicians (PCP) approach to the patient and appropriate patient disclosure may contribute to under-diagnosis. METHODS: An outpatient primary care setting was used to determine the prevalence and characteristics of OAB. Patients who visited the family medicine outpatient clinic were invited to answer a self-administered questionnaire. It included questions on evidence of lower urinary tract symptoms (modified Overactive Bladder-Validated 8-question Screener [OAB-V8]), relevant medical and surgical history, and demographic data. Relationship between OAB and other independent variables were analyzed using chi-square and risk ratio (RR) analysis. RESULTS: Of 325 questionnaires distributed, 311 were returned completed. Patients ranged from 18 to 97 years, the majority women (74.0%) and African American (74.3%). OAB was present in 60.5% of men and 48.3% of women (p = 0.058). OAB was significantly associated with obesity (BMI > or = 30) in women (p = 0.018, RR = 1.72), specifically obese premenopausal women (age < 55 years) (p = 0.011, RR = 1.98). CONCLUSION: OAB prevalence is more than double and higher in men than previously reported. The relative risk for OAB is significantly greater in obese premenopausal women.

Unilateral ectopic right kidney, an incidental finding during pelvic sonogram.

An ectopic renal kidney was found incidentally during pelvic sonogram of a woman with incomplete abortion. The importance of pelvic ectopic kidney in obstetrics and gynecology and the significance of looking for a contralateral kidney before any pelvic surgery is embarked upon are discussed. A short review of significant differential diagnosis was also made.