Evolution of transdermal oxybutynin in the treatment of overactive bladder.

Overactive bladder (OAB) syndrome affects millions of people worldwide. In addition to adversely affecting quality of life, the direct and indirect costs in managing patients with OAB incur a substantial financial burden on health services. Among the approved anticholinergics for treating OAB, oxybutynin is the most extensively studied drug in clinical trials. The principle metabolite of oxybutynin has a higher affinity for muscarinic receptors in salivary glands which lead to significantly high dry mouth rates. This prompted the development of alternative formulations of oxybutynin aiming to achieve better tolerability whilst sustaining efficacy. This editorial examines the efficacy and tolerability of transdermal oxybutynin (OXY-TD) in treating OAB. Articles were retrieved from PubMed between 2000 to the present day relating to OXY-TD. Data is presented from phase I-IV trials. The results from placebo-controlled trials indicate that OXY-TD is efficacious in treating patients with OAB associated with urge urinary or mixed incontinence. Systemic side effects most notably dry mouth, appear to be less with this formulation compared with oral anticholinergics. However, further study is required in different OAB populations. The main limitation appears to be related to application site adverse events such as pruritus and erythema. OXY-TD is likely to find its place as first-line pharmacotherapy in the clinicians' armamentarium in treating OAB.

Day-case holmium laser enucleation of the prostate for gland volumes of < 60 mL: early experience.

OBJECTIVE: To examine the safety and effectiveness of holmium laser enucleation of the prostate (HoLEP), as a day-case procedure for selected patients. PATIENTS AND METHODS: Thirty-eight men underwent HoLEP as a day-case procedure; they were discharged with an indwelling catheter for 48 h with 'Hospital In The Home' nursing management. They were evaluated for symptomatic and flow rate improvements after 3 months. Morbidity, length of stay, the duration of catheterization and readmission rates were evaluated. RESULTS: The objective symptom score and flow-rate improvements were equivalent to those previously published for transurethral resection of the prostate (TURP). There were five minor complications, three of which required readmission to hospital and one repeat surgery. The mean stay after surgery was 302 min. CONCLUSIONS: Day-case HoLEP is a safe and effective treatment for symptomatic benign prostatic hyperplasia. The outcomes are equivalent to those from TURP. Whilst there were three re-admissions to hospital, two only required an overnight stay and no patient required a blood transfusion.

To stent or not to stent? That is still the question.

BACKGROUND AND PURPOSE: Most patients are stented after ureteroscopy for stone extraction. This practice necessitates a second procedure to remove the stent, with its inherent morbidity. The aim of our study was to determine whether routine stenting of the ureter is really necessary after ureteroscopy. PATIENTS AND METHODS: This prospective study evaluated 26 men and 18 women admitted for elective distal ureteral stone fragmentation. The stones ranged in size from 6 mm to 1 cm. Of the series, 16 patients (10 men) had been stented prior to ureteroscopy. A 9F semirigid ureteroscope was used in 31 cases, and a 7.5F semirigid ureteroscope was used in the other 11 cases; there was no need for ureteral orifice dilatation with either ureteroscope. Ballistic intracorporeal lithotripsy was performed in all cases with the Swiss Lithoclast; all stone fragments were retrieved with a 3F helical basket. The patients were followed up as inpatients for 24 hours and reviewed in the clinic 1 week later with a request to report if they felt significant discomfort or loin pain or became feverish. RESULTS: Only one patient (male) had to be readmitted with loin pain. Two others (both women) complained when they attended for follow-up of having had dull lower abdominal pain and some frequency. CONCLUSIONS: The low incidence of complications in this preliminary study suggests that routine stenting is not necessary after ureteroscopy. The chief exception to this statement is patients who had a difficult and prolonged stone fragmentation.