Ancillary benefits of bladder chemodenervation for SCI neurogenic bladder.

STUDY DESIGN: Case series. OBJECTIVE: Bladder chemodenervation is effective in treating neurogenic detrusor overactivity (NDO) in patients with neurogenic bladder due to spinal cord injury. Anecdotal reports also describe the improvement of non-bladder symptoms, specifically those related to autonomic dysreflexia (AD) and muscle spasticity. We conducted a study to further investigate this phenomenon. SETTING: USA, Urban Tertiary Care Center. METHODS: Twenty-one persons with SCI completed the study between March and December 2015. Mean age was 45 years (range 21-69). All were scheduled to undergo bladder chemodenervation with onabotulinumtoxinA 200 units to treat bothersome NDO refractory to oral medications. Each completed a questionnaire detailing symptoms unrelated to NDO immediately prior to the procedure, and again between 6 and 12 weeks after. RESULTS: All patients reported improvement in NDO symptoms following chemodenervation. Ten patients with prior symptoms of AD reported improvement in AD symptoms after injection. Seventeen patients reported skeletal muscle spasticity in the 3-month period before chemodenervation. In the follow up period, only 14 patients reported having muscle spasticity. In aggregate, 12 of 21 patients reported improvement of non-bladder symptomatology following chemodenervation. CONCLUSIONS: Chemodenervation of the bladder in patients with SCI can provide ancillary benefits in addition to mitigation of lower urinary symptoms. The mechanism may be related to dampening the bladder's ability to initiate noxious reflex responses.

Evaluation of Vasectomy Trends in the United States.

OBJECTIVE: To use the Truven Health MarketScan database to better approximate the annual rate of vasectomies performed in the US population, to determine changes over time, regional differences, providers performing this, and to know if there is any monthly variation in vasectomy rates. MATERIALS AND METHODS: Claims data were evaluated from 2007 to 2015 to determine the annual prevalence of vasectomy by patient age and region in the United States. The cohort included men aged 18-64 years with at least 1 claim in any given year in Truven Health MarketScan. Provider type and place of service were evaluated in 2014 and 2015. Monthly evaluation of vasectomy prevalence compared with total claims was performed. RESULTS: The prevalence of vasectomies decreased from 2007 to 2015, across all age groups and in all locations of the country (P <.001). Using these data and the most recent US census data, an estimated 527,476 vasectomies were performed in the United States in 2015. The North Central and West regions (0.64% and 0.60%, respectively) had the highest annual prevalence of vasectomies. The month of March and the end of the year had the highest proportion of vasectomies performed. In both 2014 and 2015, a urologist in the office setting performed 82% of vasectomies. CONCLUSION: An estimated 527,476 vasectomies were performed in the United States in 2015. From 2007 to 2015 there was a decrease in the proportion of vasectomies performed in all age groups and in all locations of the country. The end of the year and the month of March are when the most vasectomies are performed.

Preoperative Belladonna and Opium Suppository for Ureteral Stent Pain: A Randomized, Double-blinded, Placebo-controlled Study.

OBJECTIVE: To investigate whether the use of a belladonna and opium (B&O) rectal suppository administered immediately before ureteroscopy (URS) and stent placement could reduce stent-related discomfort. METHODS: A randomized, double-blinded, placebo-controlled study was performed from August 2013 to December 2014. Seventy-one subjects were enrolled and randomized to receive a B&O (15 mg/30 mg) or a placebo suppository after induction of general anesthesia immediately before URS and stent placement. Baseline urinary symptoms were assessed using the American Urological Association Symptom Score (AUASS). The Ureteral Stent Symptom Questionnaire and AUASS were completed on postoperative days (POD) 1, 3, and after stent removal. Analgesic use intraoperatively, in the recovery unit, and at home was recorded. RESULTS: Of the 71 subjects, 65 had treatment for ureteral (41%) and renal (61%) calculi, 4 for renal urothelial carcinoma, and 2 were excluded for no stent placed. By POD3, the B&O group reported a higher mean global quality of life (QOL) score (P = .04), a better mean quality of work score (P = .05), and less pain with urination (P = .03). The B&O group reported an improved AUASS QOL when comparing POD1 with post-stent removal (P = .04). There was no difference in analgesic use among groups (P = .67). There were no episodes of urinary retention. Age was associated with unplanned emergency visits (P <.00) and "high-pain" measure (P = .02) CONCLUSION: B&O suppository administered preoperatively improved QOL measures and reduced urinary-related pain after URS with stent. Younger age was associated with severe stent pain and unplanned hospital visits.