Overactive bladder symptoms in patients undergoing rigid and flexible cystoscopy.

PURPOSE: To evaluate overactive bladder (OAB) symptoms in patients undergoing diagnostic cystoscopy. Overall changes in the entire study population were assessed, as well as broken down by various subgroups. METHODS: A prospective multi-center study among consecutive 450 adults undergoing diagnostic cystoscopy was conducted. OAB-symptoms were evaluated with the validated eight-item OAB Screening Awareness Tool (OAB-V8) immediately before and on days 1, 4, and 7 after cystoscopy. Patients were distinguished between being OAB-negative and OAB-positive (< 8 and ≥ 8 sum-score, respectively). Average sum-scores and subdomains were evaluated. RESULTS: Before cystoscopy, 44.7% of patients were screened OAB-positive and 55.3% OAB-negative. Out of those being screened negative, development of de-novo OAB was noticed in 16.8%, declining to 8.1% on day 7 (p < 0.001). In patients being OAB-positive before cystoscopy, a decline of OAB-positivity was noted during follow-up (p < 0.001). No statistically significant differences were noted when broken down by gender (p = 0.92), age (p = 0.82) and type cystoscope (rigid vs. flexible, p = 0.38). Average sum-scores declined from 8.68 before cystoscopy to 6.9 during follow-up. Flexible cystoscopy was superior over rigid in four subdomains: uncomfortable urge to urinate (p = 0.04), sudden urge to urinate with little or no warning (p = 0.02), uncontrollable urge to urinate (p = 0.03), and urine loss associated with a strong desire to void (p = 0.009). CONCLUSION: OAB-symptoms are common in patients undergoing cystoscopy. Cystoscopy itself can cause de-novo OAB-symptoms. Controversially, a decline of OAB-symptoms was noted after cystoscopy when patients were screened OAB-positive before cystoscopy. Flexible scopes were superior in some subdomains.

Syntactic ambiguity resolution in dyslexia: An examination of cognitive factors underlying eye movement differences and comprehension failures.

This study examined eye movements and comprehension of temporary syntactic ambiguities in individuals with dyslexia, as few studies have focused on sentence-level comprehension in dyslexia. We tested 50 participants with dyslexia and 50 typically developing controls, in order to investigate (a) whether dyslexics have difficulty revising temporary syntactic misinterpretations and (b) underlying cognitive factors (i.e., working memory and processing speed) associated with eye movement differences and comprehension failures. In the sentence comprehension task, participants read subordinate-main structures that were either ambiguous or unambiguous, and we also manipulated the type of verb contained in the subordinate clause (i.e., reflexive or optionally transitive). Results showed a main effect of group on comprehension, in which individuals with dyslexia showed poorer comprehension than typically developing readers. In addition, participants with dyslexia showed longer total reading times on the disambiguating region of syntactically ambiguous sentences. With respect to cognitive factors, working memory was more associated with group differences than was processing speed. Conclusions focus on sentence-level syntactic processing issues in dyslexia (a previously under-researched area) and the relationship between online and offline measures of syntactic ambiguity resolution.

Anxiety and depression analyses of patients undergoing diagnostic cystoscopy.

PURPOSE: To prospectively assess anxiety and depression in patients undergoing diagnostic cystoscopy. METHODS: Patients presenting for outpatient diagnostic cystoscopy were recruited from four European urological departments. Anxiety and depression were assessed with the 'Hospital Anxiety and Depression Scale' (HADS) before cystoscopy and after 1 week. Statistical analyses, including the Chi-square test, univariate, and multivariate logistic regression analyses, were carried out with SPSS v. 21 (IBM Corp., Armonk, NY). RESULTS: Prior to cystoscopy, 30.2 % of patients were anxious and 24.8 % depressive (n = 442). In the post-examination period, anxiety declined to 24.5 %, while depression was unchanged (24.4 %). Pre-cystoscopy anxiety was significantly more common in women (41.8 vs. 24.5 %, p < 0.0001), patients aged <65 years (34.9 vs. 25.9 %, p = 0.04), and in those being examined with rigid cystoscopes (35.7 vs. 23.9 %, p = 0.007). In multivariate regression analyses, female gender (OR 2.6, p < 0.0001), <65 years of age (OR 1.7, p = 0.03), and coexistence of depression (OR 7.8, p < 0.0001) were independently associated with elevated pre-cystoscopy anxiety. Anxious (OR 2.1, p = 0.03) and depressive (OR 2.1, p = 0.01) patients had higher odds of experiencing moderate or severe pain during cystoscopy. Bladder cancer diagnosis did not significantly change patient's anxiety (p = 0.23) or depression (p = 0.7) during the 1 week of follow-up. CONCLUSIONS: Women, patients aged <65 years, depressive patients and those being examined with rigid devices had higher rates of anxiety prior to cystoscopy. Anxious and depressive patients experienced more pain during cystoscopy. Bladder cancer diagnosis seems to have a minor effect on anxiety and depression during the first week after diagnosis.

Update on the use of diode laser in the management of benign prostate obstruction in 2014.

AIM: To determine the status quo in respect of various diode lasers and present the techniques in use, their results and complications. We assess how these compare with transurethral resection of the prostate and other types of laser in randomized controlled trials (RCTs). When adequate RCTs were not available, case studies and reports were evaluated. MATERIALS AND METHODS: Laser for the treatment of benign prostatic hyperplasia (BPH) has aroused the interest and curiosity of urologists as well as patients. The patient associates the term laser with a successful and modern procedure. The journey that started with coagulative necrosis of prostatic adenoma based on neodymium: yttrium-aluminum-garnet (Nd:YAG) laser has culminated in endoscopic "enucleation" with holmium laser. Diode laser is being used in urology for about 10 years now. Various techniques have been employed to relieve bladder outlet obstruction due to BPH. RESULTS: The diode laser scenario is marked by a diversity of surgical techniques and wavelengths. We summarize the current published literature in respect of functional results and complications. CONCLUSION: More randomized controlled studies are needed to determine the position and the ideal technique of diode laser treatment for BPH.

Does a retrograde pyelography prior to ureteroscopy influence stone-free rates and complication rates in ureteral calculi?

OBJECTIVES: To evaluate the impact of retrograde pyelography (RPG) in patients treated with ureteroscopy (URS) for ureteral calculi. METHODS: Retrospective analysis of patients treated with and without RPG prior to URS at a single institution from 2010 to 2013. Assessment of stone-free rates and intraoperative complications. RESULTS: Out of 469 URS, 211 (45%) were done with and 258 (55%) without RPG. Complete stone removal was achieved in 86.8% without RPG compared to 73% with RPG (p=0.0001). Partial stone removal rates were similar in both groups (p=0.77). Stone removal was not achieved in 9.3 vs. 22.7% (p=0.0001), with concordant findings in the distal (7.4 vs. 16.9%, p=0.007) and the proximal ureter (14.5 vs. 38.6%, p=0.002). Patients with RPG had a threefold higher chance of an unsuccessful URS (OR 3.05, 1.71-5.43, p<0.0001) and were less likely of having a complete stone removal (OR 0.37, 0.22-0.61, p<0.0001). Ureteral avulsions (0%) and ureteral perforation rates were similar (4.7 vs. 3.8%, p=0.65). CONCLUSIONS: Patients treated with an RPG prior to URS had significantly inferior stone-free rates. RPG was identified as an independent risk factor for inferior results. RPG neither facilitates nor diminishes complication rates during URS.

Disfluency across the lifespan: an individual differences investigation.

This study had two research objectives. The first was to examine age-related differences in the fluency of speech outputs, as prior research contains conflicting findings concerning whether older adults produce more disfluency than younger adults. The second was to examine cognitive individual differences, and their relationship with the production of disfluency. One hundred and fifty-four adults completed a story re-telling task, and a battery of cognitive measures. Results showed that younger adults produced more um's and fewer repetitions. For individual differences, results showed that inhibition and set shifting were related to the production of repetitions, and inhibition and working memory were related to uh production. Our results provide clarification about mixed findings with respect age and disfluency production. The individual differences provide clarification on theoretical arguments for disfluent speech in aging (e.g. Inhibition Deficit Hypothesis), and also sheds light on the role of executive functions in models of language production.

Intravesical Mycetoma misdiagnosed as enterovesical fistula.

Fungus formation in the urinary tract mainly occurs in immunosuppressed patients, and is a rare and dangerous complication of candiduria that is commonly misdiagnosed. We report a case of intravesical mycetoma associated with hydronephrosis, initially diagnosed as enterovesical fistula. Cystoscopy revealed spongy material within the urinary bladder, and histopathological examination showed Mycetoma of Candida species. The urine culture showed Candida tropicalis. Endoscopic removal and antifungal therapy with fluconazole was initiated, and no complications occurred during follow-up.

A Parental-Report Questionnaire for Language Abilities and Pragmatics in Children and Adolescents with Autism Spectrum Disorders.

The aim of this study was to test and validate a parental-report questionnaire, which assesses language abilities and pragmatics, in children with Autism Spectrum Disorders (ASD). We report two experiments: The first served as the initial test and the second sought to provide the first assessment of convergent validity. In total, we recruited 230 parents, where approximately two-thirds had a child with ASD. Results of factor analyses showed a consistent factor structure within each subscale, and the internal consistency was excellent for both sub-scales (Cronbach's alpha >0.90). Convergent validity was assessed by correlating the results of the questionnaire with two sub-scales of the Autism Quotient questionnaire. The correlations were all greater than 0.60. The final version of the questionnaire (following exclusion of problematic items) contains 30 items (12 for language abilities and 18 for pragmatics). We conclude that the questionnaire is a concise and practical instrument for use in a variety of contexts for assessing language functioning and communication in children with ASD.

Are language production problems apparent in adults who no longer meet diagnostic criteria for attention-deficit/hyperactivity disorder?

In this study, we examined sentence production in a sample of adults (N = 21) who had had attention-deficit/hyperactivity disorder (ADHD) as children, but as adults no longer met DSM-IV diagnostic criteria (APA, 2000). This "remitted" group was assessed on a sentence production task. On each trial, participants saw two objects and a verb. Their task was to construct a sentence using the objects as arguments of the verb. Results showed more ungrammatical and disfluent utterances with one particular type of verb (i.e., participle). In a second set of analyses, we compared the remitted group to both control participants and a "persistent" group, who had ADHD as children and as adults. Results showed that remitters were more likely to produce ungrammatical utterances and to make repair disfluencies compared to controls, and they patterned more similarly to ADHD participants. Conclusions focus on language output in remitted ADHD, and the role of executive functions in language production.

Processing emotion information from both the face and body: an eye-movement study.

This study examined the perception of emotional expressions, focusing on the face and the body. Photographs of four actors expressing happiness, sadness, anger, and fear were presented in congruent (e.g., happy face with happy body) and incongruent (e.g., happy face with fearful body) combinations. Participants selected an emotional label using a four-option categorisation task. Reaction times and accuracy for the categorisation judgement, and eye movements were the dependent variables. Two regions of interest were examined: face and body. Results showed better accuracy and faster reaction times for congruent images compared to incongruent images. Eye movements showed an interaction in which there were more fixations and longer dwell times to the face and fewer fixations and shorter dwell times to the body with incongruent images. Thus, conflicting information produced a marked effect on information processing in which participants focused to a greater extent on the face compared to the body.

Use of Parsing Heuristics in the Comprehension of Passive Sentences: Evidence from Dyslexia and Individual Differences.

This study examined the comprehension of passive sentences in order to investigate whether individuals with dyslexia rely on parsing heuristics in language comprehension to a greater extent than non-dyslexic readers. One hundred adults (50 dyslexics and 50 controls) read active and passive sentences, and we also manipulated semantic plausibility. Eye movements were monitored, while participants read each sentence, and afterwards, participants answered a comprehension question. We also assessed verbal intelligence and working memory in all participants. Results showed dyslexia status interacted with sentence structure and plausibility, such that participants with dyslexia showed significantly more comprehension errors with passive and implausible sentence. With respect to verbal intelligence and working memory, we found that individuals with lower verbal intelligence were overall more likely to make comprehension errors, and individuals with lower working memory showed particular difficulties with passive and implausible sentences. For reading times, we found that individuals with dyslexia were overall slower readers. These findings suggest that (1) individuals with dyslexia do rely on heuristics to a greater extent than do non-dyslexic individuals, and (2) individual differences variables (e.g., verbal intelligence and working memory) are also related to the use of parsing heuristics. For the latter, lower ability individuals tended to be more consistent with heuristic processing (i.e., good-enough representations).

Over-specified referring expressions impair comprehension: an ERP study.

Speakers often include extra information when producing referring expressions, which is inconsistent with the Maxim of Quantity (Grice, 1975). In this study, we investigated how comprehension is affected by unnecessary information. The literature is mixed: some studies have found that extra information facilitates comprehension and others reported impairments. We used an attentional-cueing paradigm to assess how quickly participants could orient attention to an object upon hearing a referring expression, such as the red square. If there are two squares differing in color, then the modifier is required. However, if there is only one (red) square, then the modifier is unnecessary. We also recorded event-related potentials (ERPs) in order to investigate online processing. Reaction times were significantly longer for referring expressions that contained extra information, and ERPs revealed a centroparietal negativity (N400) that emerged approximately 200-300 ms after modifier onset. We conclude that referring expressions with an unnecessary pre-nominal modifier impair comprehension performance.

Long-term results of intravesical hyaluronan therapy in bladder pain syndrome/interstitial cystitis.

INTRODUCTION AND HYPOTHESIS: While the short-term efficacy of intravesical hyaluronan for bladder pain syndrome/interstitial cystitis (BPS/IC) has been demonstrated, no data exist on the long-term outcome of this therapy. METHODS: Seventy BPS/IC patients treated with intravesical hyaluronan therapy from 2001 to 2003 were asked to rate their present status of bladder symptoms on a visual analog scale. RESULTS: Forty-eight of 70 patients responded after a mean follow-up of 4.9 years. The average initial VAS score of 8.15 had been reduced to 2.71 after therapy and further to 2.14 5 years later. Fifty percent of patients (24/48) reported complete bladder symptom remission at 5 years follow-up without any additional therapy; 41.7% (20/48) with symptom recurrence was improved with hyaluronan maintenance therapy. No improvement was reported by four patients. CONCLUSIONS: Besides a high rate of acute symptom remission, intravesical hyaluronan also shows long-term efficacy in a considerable number of BPS/IC patients.

Comprehension and Eye Movements in the Processing of Subject- and Object-Relative Clauses: Evidence from Dyslexia and Individual Differences.

In this study, we examined eye movements and comprehension in sentences containing a relative clause. To date, few studies have focused on syntactic processing in dyslexia and so one goal of the study is to contribute to this gap in the experimental literature. A second goal is to contribute to theoretical psycholinguistic debate concerning the cause and the location of the processing difficulty associated with object-relative clauses. We compared dyslexic readers (n = 50) to a group of non-dyslexic controls (n = 50). We also assessed two key individual differences variables (working memory and verbal intelligence), which have been theorised to impact reading times and comprehension of subject- and object-relative clauses. The results showed that dyslexics and controls had similar comprehension accuracy. However, reading times showed participants with dyslexia spent significantly longer reading the sentences compared to controls (i.e., a main effect of dyslexia). In general, sentence type did not interact with dyslexia status. With respect to individual differences and the theoretical debate, we found that processing difficulty between the subject and object relatives was no longer significant when individual differences in working memory were controlled. Thus, our findings support theories, which assume that working memory demands are responsible for the processing difficulty incurred by (1) individuals with dyslexia and (2) object-relative clauses as compared to subject relative clauses.

An experimental eye-tracking study of text adaptation for readers with dyslexia: effects of visual support and word frequency.

Easy-to-read guidelines recommend visual support and lexical simplification to facilitate text processing, but few empirical studies confirm a positive effect from these recommendations in individuals with dyslexia. This study examined the influence of the visual support and lexical simplification on sentence processing through eye movements at both the text- and word-level, and the differences between readers with and without dyslexia. Furthermore, we explored the influence of reading experience and vocabulary, as control variables. We tested 20 young adults with dyslexia and 20 chronological age-matched controls. Participants read 60 sentences in total. Half the sentences contained an image and the other half did not, and half contained a low-frequency word and half a high-frequency word. Results showed that visual support and lexical simplification facilitated sentence processing, potentially by jointly facilitating lexical semantic access. We also found that participants with lower print exposure and lower vocabulary benefited more from word-level lexical simplification. We conclude that both adaptations could benefit readers with low print exposure and smaller vocabularies, and therefore, to many dyslexic readers who show these characteristics.

Are Linguistic Prediction Deficits Characteristic of Adults with Dyslexia?

Individuals with dyslexia show deficits in phonological abilities, rapid automatized naming, short-term/working memory, processing speed, and some aspects of sensory and visual processing. There is currently one report in the literature that individuals with dyslexia also show impairments in linguistic prediction. The current study sought to investigate prediction in language processing in dyslexia. Forty-one adults with dyslexia and 43 typically-developing controls participated. In the experiment, participants made speeded-acceptability judgements in sentences with word final cloze manipulations. The final word was a high-cloze probability word, a low-cloze probability word, or a semantically anomalous word. Reaction time from the onset of the final word to participants' response was recorded. Results indicated that individuals with dyslexia showed longer reaction times, and crucially, they showed clear differences from controls in low predictability sentences, which is consistent with deficits in linguistic prediction. Conclusions focus on the mechanism supporting prediction in language comprehension and possible reasons why individuals with dyslexia show less prediction.

The role of inhibition in the production of disfluencies.

Disfluency is a common occurrence in speech and is generally thought to be related to difficulty in the production system. One unexplored issue is the extent to which inhibition is required to prevent incorrect speech plans from being articulated. Therefore, we examined disfluency production in participants with attention-deficit/hyperactivity disorder (ADHD), which is linked to deficits in inhibitory function and response suppression (Nigg, 2001). Participants completed a sentence production task in which they were presented with two pictures and a verb and their task was to produce a sentence. If inhibition plays a role in preventing incorrect speech plans, we would expect ADHD participants to produce more repetition and repair disfluencies than would non-ADHD controls. The results showed that one subtype of ADHD (i.e., the combined) produced more repair disfluencies as task demands increased. We conclude that the production system relies on inhibitory control in order to prevent errors in language production.

Processing coordination ambiguity.

We examined temporarily ambiguous coordination structures such as put the butter in the bowl and the pan on the towel. Minimal Attachment predicts that the ambiguous noun phrase the pan will be interpreted as a noun-phrase coordination structure because it is syntactically simpler than clausal coordination. Constraint-based theories assume that interpretations are the result of a constraint-satisfaction process, which predicts that frequency or context can bias the parser to initially pursue a more complex interpretation.The results showed an initial preference for noun-phrase coordination, despite the fact that sentential coordination is more frequent in imperative structures. These data suggest that the parser uses a syntactic simplicity heuristic for building initial structural analyses.

Developmental Dyslexia: Where Do We Go from Here?

This editorial follows an influential review paper published in Brain Sciences in 2018 (What is Developmental Dyslexia? by John Stein). In this editorial, I present a critical look at the arguments in Stein's review, with a particular view towards "looking ahead". In looking ahead, I will focus on why dyslexia has been largely neglected by psycholinguistics and, in particular, shortfalls in knowledge about sentence processing. I will highlight some things that I think psycholinguistic methodologies can contribute to the understanding of developmental dyslexia. The editorial will then turn to address the larger research context of dyslexia. In short, investigations of dyslexia tend to be conducted across a wide range of disciplines, and by individuals with varied backgrounds, divergent views, and different goals. One argument I advance is that dyslexia has reached a point where "interdisciplinary" collaboration is essential, and in the event that that is not successful, the field would at least benefit from "adversarial collaborations". Finally, I briefly address the issue of interventions (raised by Stein) for older children and adolescents by returning to the contributions that psycholinguistics can provide to dyslexia. The crux of my argument here is that there exists a missing link in interventions, and that missing link is sentence-level language comprehension.

Effects of speech rate on anticipatory eye movements in the visual world paradigm: Evidence from aging, native, and non-native language processing.

Research has shown that suprasegmental cues in conjunction with visual context can lead to anticipatory (or predictive) eye movements. However, the impact of speech rate on anticipatory eye movements has received little empirical attention. The purpose of the current study was twofold. From a methodological perspective, we tested the impact of speech rate on anticipatory eye movements by systemically varying speech rate (3.5, 4.5, 5.5, and 6.0 syllables per second) in the processing of filler-gap dependencies. From a theoretical perspective, we examined two groups thought to show fewer anticipatory eye movements, and thus likely to be more impacted by speech rate. Experiment 1 compared anticipatory eye movements across the lifespan with younger (18-24 years old) and older adults (40-75 years old). Experiment 2 compared L1 speakers of English and L2 speakers of English with an L1 of German. Results showed that all groups made anticipatory eye movements. However, L2 speakers only made anticipatory eye movements at 3.5 syllables per second, older adults at 3.5 and 4.5 syllables per second, and younger adults at speech rates up to 5.5 syllables per second. At the fastest speech rate, all groups showed a marked decrease in anticipatory eye movements. This work highlights (1) the importance of speech rate on anticipatory eye movements, and (2) group-level performance differences in filler-gap prediction.