Outcomes for Intravesical Abobotulinumtoxin A (Dysport) Treatment in the Active Management of Overactive Bladder Symptoms-A Prospective Study.

OBJECTIVE: To present the results our active management protocol for bothersome overactive bladder (OAB) symptoms using abobotulinumtoxinA (Dysport) over a 9-year period. MATERIAL AND METHODS: Data from consecutive patients with OAB symptoms due to urodynamically-proven idiopathic detrusor overactivity who had failed maximum-dose pharmacotherapy and bladder drill were reviewed. All patients completed the Overactive Bladder Symptom Score (OABSS) and Likhart quality of life indices before treatment and again at review 6 weeks post-treatment. Two hundred and fifty units of abobotulinumtoxinA were injected under general anaesthesia. Repeat treatment was offered only after failed resumption of pharmacotherapy with bladder drill. RESULTS: The results of 299 treatments in 170 patients were reviewed. OABSS and quality of life indices improved by a mean of 35% (P ˂.001) and 41% (P ˂.001), respectively, with the OABSS improving by 2 or more points in 65% of cases. While urgency incontinence was completely abolished in 26%, the severity of incontinence was reduced in 44%. Pharmacotherapy was resumed after a mean of 10.2 months, and the mean interval between repeat abobotulinumtoxinA injection treatments was 21.3 months. De-novo self-catheterization was required in 18.2% of cases due to high postvoid residuals. CONCLUSION: The use of abobotulinumtoxinA is safe and highly effective treatment option for patients with refractory OAB symptoms. Our data show similar outcomes to onabotulinumtoxinA in terms of symptom score improvement and self-catheterization rates.

Comparing the left and right Whitnall's tubercles and their relation to the frontozygomatic suture: Application to symmetry following lateral orbital surgery.

We compare, on left and right side of human skulls, the length of Whitnall's tubercle as a relevant landmark and anchor point for the lateral retinaculum. Twenty human skulls were used in this study. A caliper was used to measure the length of Whitnall's tubercle, the distance from Whitnall's tubercle to the frontozygomatic suture and the height of the orbit. An overall mean for these three parameters was calculated using the data obtained. There were no significant differences between left and the right sides. The combined mean length of Whitnall's tubercle was 4.9 mm ± 23%. The combined mean distance from the frontozygomatic suture was 7.8 mm ± 25%. The orbital height was found to be the measurement with the highest congruence between the two sides having a combined mean of 32.3 mm ± 7%. Although 6 out of 20 skulls were found to have no tubercle, five out of twenty skulls had a tubercle only on one side. Even though human skulls develop from bilateral symmetric osteogenesis, surgeons should always be aware of possible asymmetry and possible absence of Whitnall's tubercle between sides or among individuals. The frontozygomatic suture was found to be a useful landmark in identifying the position of Whitnall's tubercle in the majority of specimens. Such information will be useful in realigning the lateral retinaculum following surgery.

Concomitant testicular seminoma and ectopic adrenal tissue of the cord in a 45-year-old male.

Aberrant adrenal tissue near the adrenal gland is common, but the finding of ectopic adrenal tissue in structures around the spermatic cord and testis is rare. We describe a case of concomitant seminoma and ectopic adrenal tissue of the spermatic cord occurring in an adult patient who had undergone orchidopexy as a child.

Avoid cruising on the uroflowmeter: evaluation of cruising artifact on spinning disc flowmeters in an experimental setup.

AIMS: The aim of our study was to access the variability of maximum flow rate (Q(max)), average flow rate (Q(av)) and flow pattern while varying the point of impact of flow on the flowmeter. METHODS: Water was delivered through a motorised tube holder in a standardised experimental set up. Flow was directed in 4 different directions on the funnel; 1) Periphery, 2) Base, 3) Centre and, 4) in a cruising motion from the periphery of the funnel to the centre and back again. The variation in the Q(max), Q(av) and the flow pattern were studied at 4 different flow rates. The variables recorded when the flow was directed at the centre of the funnel was taken as baseline. RESULTS: There was a significant difference in the Q(max) and Q(av)when the point of impact was at the periphery or in a cruising motion compared to the centre. The difference was more marked with cruising motion with a characteristic flow pattern. The maximum percentage difference in Q(av) was 4.1%, whereas the difference in Q(max) was higher at 16.6% on comparing crusing motion with the values from the centre. CONCLUSION: We have demonstrated a significant variation in Q(max), Q(av) and flow pattern with change in the point of impact on the flowmeter. Though the changes in Q(av) were statistically significant, the alteration in the recorded Q(max) values was more striking. Our study emphasizes the importance of combining Q(av) and flow pattern along with Q(max) in interpretation of results of uroflowmetry.

Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal.

OBJECTIVES: Because the term "interstitial cystitis" (IC) has different meanings in different centers and different parts of the world, the European Society for the Study of Interstitial Cystitis (ESSIC) has worked to create a consensus on definitions, diagnosis, and classification in an attempt to overcome the lack of international agreement on various aspects of IC. METHODS: ESSIC has discussed definitions, diagnostic criteria, and disease classification in four meetings and extended e-mail correspondence. RESULTS: It was agreed to name the disease bladder pain syndrome (BPS). BPS would be diagnosed on the basis of chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder accompanied by at least one other urinary symptom such as persistent urge to void or urinary frequency. Confusable diseases as the cause of the symptoms must be excluded. Classification of BPS types might be performed according to findings at cystoscopy with hydrodistention and morphologic findings in bladder biopsies. The presence of other organ symptoms as well as cognitive, behavioral, emotional, and sexual symptoms, should be addressed. CONCLUSIONS: The name IC has become misleading and is replaced by BPS. This name is in line with recent nomenclature recommendations by the European Association of Urology and is based on the axial structure of the International Association for the Study of Pain classification. To facilitate the change of the name, ESSIC agreed to include IC in the overall term (BPS/IC) during this transition period.

A double-blind, randomized controlled trial of cystometry using saline versus 0.3 M potassium chloride infusion in women with overactive bladder syndrome.

AIM: To evaluate the effect of 0.3 M potassium chloride on cystometric parameters by comparing it with normal saline as a filling solution in women with overactive bladder (OAB). PATIENTS AND METHODS: Twenty-three women with significant OAB symptoms underwent consecutive cystometrograms (CMGs) using 0.9% normal saline (NS) and 0.3 M potassium chloride (KCl), the order of which was randomized for each patient. Individual CMGs were performed by separate investigators and both patients and investigators were blinded to the order in which each solution was given and to the results of the other CMG. RESULTS: Regardless of the nature of the filling solution, the order in which the CMGs were performed had little influence on either first desire to void (FDV, mean 83.5 ml vs. 117.8 ml for first and second CMGs respectively, P = 0.10) or on maximum cystometric capacity (Cmax, mean 265.0 ml vs. 264.4 ml, P = 0.98). KCl produced a significant (24%) reduction in mean Cmax compared to NS (mean 228.6 ml vs. 300.8 ml, P = 0.001), irrespective of the order of infusion. CONCLUSION: This comparative study using 0.3 M KCl versus NS as filling solutions suggests that intravesical potassium may not simply act on urothelial sensory nerve endings; it may also stimulate detrusor muscle contraction. These findings may influence the interpretation of the potassium sensitivity test in patients with OAB symptoms, particularly in those suspected of having interstitial cystitis.

Interstitial cystitis versus detrusor overactivity: a comparative, randomized, controlled study of cystometry using saline and 0.3 M potassium chloride.

PURPOSE: We compared cystometric findings in interstitial cystitis and detrusor overactivity using 0.3 M KCl and 0.9% normal saline. MATERIALS AND METHODS: Female patients with established diagnoses of IC (7 patients according to NIDDK criteria) and urodynamically proven DO (10 patients) underwent consecutive cystometrograms using 0.9% normal saline and 0.3 M KCl, the order of which was randomized for each patient. Individual CMGs were performed by separate investigators, and patients and investigators were blinded to the order in which the solutions were used and to the results of the other CMG. The results were analyzed on a comparative basis using a 2-tailed t test for comparison of the means and a Kolmogorov-Smirnov z test was used for group comparison. A ROC curve was used to plot sensitivity to the false-positive rate. RESULTS: Irrespective of the diagnosis or the type of infusion used, the volume at FDV was slightly lower with the first CMG compared to the second (mean 76.1 vs 94.2 ml) but did not reach statistical significance (p = 0.20). However, Cmax was similar for first and second CMGs (mean 214 vs 213.2 ml, p = 0.98). Although lower with KCl, there was no significant difference in FDVs obtained with either solution (mean 78.2 vs 92.2 ml for KCl and NS, respectively, p = 0.33). However, KCl produced a significant reduction in Cmax across the whole group (mean 244.5 vs 182.7 ml, p = 0.008). This was most marked in the DO group in which there was a 23% reduction in Cmax with KCl compared to NS, while the IC group showed only a 15% reduction in mean Cmax. The ROC curve, comparing Cmax values for NS with KCl cutoff values of 15% and 30%, resulted in poor positive predictive values (51% and 66%, respectively) for comparative cystometry in distinguishing IC from DO. CONCLUSIONS: The 0.3 M KCl reduces Cmax in IC and DO, the effect being more pronounced in DO. Urothelial hyperpermeability is not specific to IC. Comparative cystometry using NS and 0.3 M KCl does not help to differentiate IC from DO.

Reinvestigation of patients with a diagnosis of interstitial cystitis: common things are sometimes common.

PURPOSE: We tested the accuracy of the diagnosis and the value of each step of the diagnostic process in a group of patients undergoing reinvestigation of interstitial cystitis (IC). MATERIALS AND METHODS: A total of 61 patients with a provisional diagnosis of IC underwent systematic reinvestigation by a pathway involving a thorough history and physical examination, a rigorous search for urinary infection, frequency volume records, urodynamics and cystoscopy under general anesthesia. Abnormalities detected in the course of this pathway were treated before proceeding with further investigation. RESULTS: The diagnosis of IC was confirmed or considered possible in only 34 cases (55%). Common alternative diagnoses included recurrent urinary tract infections, detrusor overactivity and vaginal candidiasis. Of 5 male patients only 1 was confirmed to have IC. The original diagnosis was overturned by history and physical examination (including urine cultures) in 11 cases, by urodynamic investigation in 11 and by cystoscopy in 5. CONCLUSIONS: While IC remains a diagnosis of exclusion, active exclusion of all possible causes of similar symptoms using a thorough investigative algorithm is imperative. Urodynamic investigation, together with a thorough history and physical examination, remains an important component of the diagnostic pathway.