Evaluation of Percutaneous Tibial Nerve Stimulation for Treatment of Refractory Painful Bladder Syndrome.

OBJECTIVE: To evaluate the efficacy of intermittent percutaneous tibial nerve stimulation (PTNS) as a treatment modality for patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS). PATIENTS AND METHODS: Twenty female patients with IC/BPS (mean symptom duration of 4.5 ± 2.4 years) each had a 30-minute session of PTNS per week for 12 successive weeks and the symptoms were assessed before, during, and after the treatment sessions by voiding diary, visual analog scale (VAS) for pain, interstitial cystitis symptom and problem indices (ICSI and ICPI), and global response assessment (GRA) scale. The scores of the previous questionnaires were evaluated at weeks 0, 6, and 12. RESULTS: At week 0, the VAS, day time frequency, nocturia, and average voiding volume were 5.6 ± 1.1, 14.5 ± 4.0, 3.0 ± 0.9, and 131.8 ± 35.3 mL, respectively, meanwhile at week 12 these scores were 5.2 ± 1.5, 12.15 ± 3.7, 2.6 ± 0.7, and 141.0 ± 36.2, respectively. There was no statistically significant difference between the scores of the ICPI between weeks 0, 6, and 12 (P = .937). As regards the GRA score after the 12th session, 17 patients (85%) reported having no effect, 1 patient (5%) reported as having worse symptoms, and 2 patients (10%) reported having a mild good response. CONCLUSION: Intermittent PTNS is not a satisfactory treatment for refractory IC/BPS. However, it is recommended to perform more studies with other treatment protocol (maybe closer sessions) to confirm these results.

Idiopathic Parkinson's disease patients at the urologic clinic.

AIMS: To quantitatively evaluate the urinary symptoms at different stages of idiopathic Parkinson's disease (IPD) severity and its relation to urodynamic parameters. METHODS: This study was conducted on 49 patients with probable IPD to quantitatively evaluate their urinary symptoms using International Prostate Symptom Score and urodynamic tests. Four, 10, 29, 5, and 1 cases were classified as stages 1-5, respectively, according to Hoehn and Yahr staging of IPD severity. RESULTS: The most prevailing urinary symptom in IPD was nocturia (77.5%) followed by urgency (36.7%) and frequency (32.6%). Urodynamic tests revealed neurogenic detrusor overactivity in 33 patients (67.3%), detrusor underactivity in 6 patients (12.2%), and 10 (20.4%) patients with normal detrusor function. Irritative symptom index score correlated significantly with disease severity as well as the volume at initial desire to void and maximum bladder capacity meanwhile obstructive symptom index score had no significant correlation with any of the urodynamic parameters or disease severity. Total IPSS symptoms score significantly correlated with quality of life score. The mean of urodynamic parameters did not differ in IPD patients who did or did not receive anticholinergic or dopaminergic drugs. CONCLUSION: The irritative urinary symptoms manifested urodynamically as neurogenic detrusor overactivity are more common in IPD patients than obstructive symptoms. These irritative symptoms deteriorate progressively with the disease severity and significantly affect the quality of life of these patients. The International Prostate Symptom Score is a valuable tool in evaluating the urinary dysfunction in such patients.

Laparoscopic radical prostatectomy: Washington University initial experience and prospective evaluation of quality of life.

BACKGROUND AND PURPOSE: The laparoscopic approach to radical prostatectomy offers an alternative to the open surgical procedure with less morbidity. We prospectively collected data including a validated quality-of-life questionnaires on our first 38 laparoscopic radical prostatectomies (LRPs). The first 10 patients (group 1), second 10 patients (group II), and the most recent 18 patients (group III) were examined separately to study the learning curve for this procedure. In addition, we determined the pattern of recovery of urinary continence, potency, and quality of life. PATIENTS AND METHODS: Between July 1999 and July 2002, 38 consecutive transperitoneal laparoscopic radical prostatectomies were performed for clinically localized prostate carcinoma. Patients completed quality-of-life questionnaires (Rand 36 Health Survey) before surgery as well as at 1, 3, 6, and 12 months and every 6 months thereafter. The patients were also interviewed by an individual not directly involved in patient care. RESULTS: One patient (the second in our experience) was converted to the open approach because of failure to progress. The average operating time for the whole series was 423 +/- 137.6 minutes (range 215-825 minutes), the last 10 procedures taking 305 +/- 63 minutes (range 215-420 minutes). Complications consisted of one case each of intraoperative bladder injury, transient superficial peroneal nerve palsy, pulmonary embolism, and bladder neck obstruction. The bladder injury was closed laparoscopically without further complication. Bladder neck obstruction was secondary to a bladder wall fold that was treated with transurethral resection 14 months after surgery with good results. Four patients in group 1 had minor anastomotic leaks, while only one patient after that had a leak (group III). Four patients required transfusion, two intraoperatively and two postoperatively. In group III, the urethral catheter remained in place for an average of 8 days (range 6-10 days). With a mean follow-up of 22.8 months (range 9-43 months), 84.8% of the patients had perfect urinary control. Postoperatively, 9 patients (27%) were fully continent on removal of the Foley catheter. At 1, 3, 6, and 9 months postoperatively, diurnal urinary control was reported by 30.3%, 48%, 72.7%, and 84.8% of the patients, respectively. One patient needed an artificial urinary sphincter. Among the incontinent patients, 24.2% had urinary urgency, and one third of these patients reported urge incontinence. CONCLUSIONS: Laparoscopic prostatectomy is a reproducible technique with a steep learning curve. Operating times and the incidence of anastomotic leaks and urinary incontinence decrease significantly after the initial 10 patients.

Smooth-muscle regeneration after electrosurgical endopyelotomy in a porcine model as confirmed by electron microscopy.

BACKGROUND AND PURPOSE: Endopyelotomy is the preferred treatment for ureteropelvic junction (UPJ) obstruction because of its short operating time, limited morbidity, fast recovery, and reasonable efficacy. We used tissue and immunohistochemistry staining and electron microscopy to look at the muscle regeneration following an endopyelotomy incision in a porcine model. MATERIALS AND METHODS: Bilateral electrosurgical endopyelotomy was performed in six domestic pigs with placement of 7F 20-cm Percuflex double-J stents for up to 4 weeks, and urinary tracts were harvested at 3 or 5 months. Specimen evaluation included tissue staining with hematoxylin-eosin, Masson's trichrome, and Verhoeff's iodine and Van Gieson solution; histochemical staining for smooth-muscle actin, desmin and myosin staining, and electron microscopy. Each specimen was assigned a "healing" score of 0 (normal) 1 (slight changes), 2 (mild changes), or 3 (severe changes). The fibrosis score was based on six factors: muscle layer fibrosis, lamina propria fibrosis, amount of granulation tissue present, new deposits of collagen, fibrosis in the periureteral fat, and presence of myofibroblasts. The muscles were characterized with immunohistochemistry and electron microscopy. RESULTS: At both 3 and 5 months, the urothelium was healed, and the lamina propria was healed with focal loss. By 3 months, smooth-muscle bundles bridged the defect, and by 5 months, the whole defect was covered. Smooth muscle cells were evident by electron microscopy by 3 months, and actin and myosin could be detected by immunohistochemistry. Desmin-positive cells accounted for 50% of the population at 3 months and 40% at 5 months. The regenerated smooth-muscle bundles were oriented in different directions and intermingled with fibrous tissue. They could be distinguished easily from normal ureter under the microscope. CONCLUSION: Verifiable, functional smooth-muscle bundles bridge the endopyelotomy defect by 3 months, as confirmed by immunohistochemistry staining and electron microscopy.