Association of endometriosis with interstitial cystitis in chronic pelvic pain syndrome: Short narrative on prevalence, diagnostic limitations, and clinical implications.

INTRODUCTION: Chronic pelvic pain (CPP) is a diagnostic and therapeutic challenge affecting women of all ages globally. The syndrome is not well understood, but the association of interstitial cystitis (IC) with endometriosis in causing CPP should not be overlooked in managing this cohort. Herein, we present a mini review of this association to evaluate the literature in determining the prevalence of endometriosis and IC concomitantly in patients with CPP, diagnostic limitations, and clinical implications. METHODS: A Medline search of the key words "evil twins' syndrome," "interstitial cystitis," "bladder pain syndrome," and "endometriosis" was conducted for full-text articles published in English over the past 20 years. The search yielded 40 articles, of which 21 were selected. Cross-referencing bibliographies of each publication yielded an additional 25 references. RESULTS: Both endometriosis and IC share a similar array of symptoms that are often exacerbated during the perimenstrual period. Multiple authors have reported the frequent coexistence of these two conditions. Over 80% of patients with CPP were found to have both conditions. The prevalence of endometriosis and IC coexistence was greater than that of each condition separately. CONCLUSIONS: It is crucial to look beyond the traditionally diagnosed endometriosis as the cause of CPP. This is true especially in patients whose previous treatment was ineffective. Simultaneous assessment for both conditions is essential to avoid the frequently delayed diagnosis and prevent unsuccessful medical and surgical therapies.

Infected penile prosthesis: literature review highlighting the status quo of prevention and management.

INTRODUCTION: Erectile dysfunction affects over 50% of men 70 years and above, and penile prosthesis (PP) is its third-line treatment. Complications of PPs include infection, however, no formal guidelines exist for its management. METHODS: We performed a literature search and reviewed 53 recent published literatures of experiences with management of PP infections, prevention, and treatment. RESULTS: Acute infection can present early with pain and discharge and detection of early signs is of utmost importance. MRI studies are more sensitive than CT studies to diagnose and plan surgical intervention. Introduction of antibiotic impregnated devices attributed to the reduction of infection rates with superiority proven for certain types; the no-touch technique had further reduced this rate. The Mulcahy salvage remains the most widely used surgical approach for treatment despite modifications and novel techniques described; conservative management of PP infections is recently reported with promising results. CONCLUSIONS: Despite absence of strict guidelines for the management of infected PPs, we reviewed and discussed numerous panel opinions and suggestions throughout literature. More research into the pathology, prevention, conservative management and advances in surgical treatment of this condition are called for to produce guidelines that unite the efforts to tackle these infections.

Does Psychological Disturbance Predict Explantation in Successful Pelvic Neuromodulation Treatment for Bladder Dysfunction? A Short Series.

INTRODUCTION: Sacral neuromodulation (SNM) is a safe and effective therapy for patients with lower urinary tract dysfunction (LUTD). It is used in patients who have exhausted conservative and first line therapeutic options. The selection of eligible candidates could predict a successful therapeutic outcome. Although many factors have been identified, psychological/psychiatric disturbances are neither well understood nor are routinely evaluated prior to implantation. CASE REPORTS: We report three cases where identified psychological/psychiatric disturbances post-implantation could have influenced explantation in an otherwise successful implantation of SNM device assessed both subjectively and objectively. The device had to be explanted in two of the three. One more patient has requested but has not-yet undergone explantation and is receiving treatment for severe depression. One of the explanted cases has successfully undergone re-implantation after successful treatment of her diagnosed psychological condition, while the other's request for re-implantation has not yet been fulfilled. CONCLUSIONS: Psychological/psychiatric disturbance have possibly affected the treatment outcome and explantation of SNM in our patients despite a high success in resolution of the urinary symptoms. Addressing such disturbances when determining patient eligibility for SNM therapy could reduce the explantation rate after a successful therapeutic response, and is an interesting point of interest for future research into predictors of successful SNM implantation and therapy.

Safety of Sacral Nerve Stimulation in Pregnancy: A Literature Review.

OBJECTIVES: Sacral nerve stimulation (SNS) is an FDA approved intervention for a spectrum of conditions. Women of childbearing age and those who are pregnant constitute a fair number of sufferers of overactive bladder symptoms and nonobstructive urinary retention; however, hypothesized effects of SNS on the fetus, mother, and the device limit its use in such a group of patients. We present a literature review to support possible safety of SNS in pregnancy. MATERIALS AND METHODS: We reviewed a number of animal studies on effects of neuromodulation on myometrial activity and fetal abnormalities, and several case reports and series describing continued SNS as well as other related modes of neuromodulation during gestation and reported effects on the mother, fetus, and device. RESULTS: Studies on female mammals showed neurostimulation of myometrial tissue aided in embryo transfer and increased latency, evidence against inducing preterm labor, and follow-up of pregnant rats showed no effects on mothers or offspring. Reviewed cases adopted interrupted and uninterrupted courses of SNS until delivery. There were almost no pregnancy complications; infants were healthy at birth, delivered electively by Caesarean section close to term. One follow-up of 2 infants reported some health issues, though SNS was not concluded as a cause. Device replacement after delivery was occasionally performed for different reasons. CONCLUSION: No negative effects of SNS on fetus, mother or device were significantly reported in literature. Further studies expanding on data in the literature could place SNS therapy during pregnancy on the way for declaration as a safe practice.