Does Sexual Intercourse Position Have a Role in Occurrence of Coital Urinary Incontinence?

INTRODUCTION AND HYPOTHESIS: This study was aimed at investigating the hypothesis that sexual intercourse positions may have an impact on the occurrence of coital urinary incontinence (CUI) in women. METHODS: This case-control observational study enrolled 360 married, heterosexual, sexually active female participants with CUI. Each patient was evaluated using medical and sexual histories, questionnaires, physical examinations, and laboratory tests, including urodynamics. Participants were asked whether or not their intercourse positions had an impact on the occurrence of their CUI. Patients with intercourse position-dependent CUI were included in group 1, and those independent of it were allocated to group 2. The clinic and laboratory findings of the patient groups were compared. RESULTS: The patients' mean age was 47.24 ± 0.57 years. Of these women, 28.9% (n = 104) were in group 1, and 71.1% (n = 256) were in group 2. Group 1 had a lower mean age, body mass index, Charlson comorbidity index, number of urinary incontinence episodes, severity of CUI and incontinence, and pad weight than group 2 (p < 0.05). The rates of detrusor overactivity and penetration type of CUI were higher in group 1 than in group 2 (p < 0.0009, p = 0.009 respectively). According to logistic regression analysis, the likelihood of sexual position-related CUI was 3.5 times higher in women with detrusor overactivity. CONCLUSIONS: In certain patients, intercourse position is associated with the occurrence of CUI. This condition seems to be related to detrusor overactivity and is inversely associated with incontinence severity. However, further studies are necessary to explain this phenomenon.

Does Transient Cessation of Antiplatelet Medication Prior to Shock Wave Lithotripsy Have Any Safety Concern: Evaluation of the Short Term Safety Results.

OBJECTIVE: The study aimed to evaluate the true safety of transient cessation of the antiplatelet medication before extracorporeal shock wave lithotripsy (SWL) on bleeding-related complications. PATIENTS AND METHODS: Forty cases undergoing SWL for renal pelvic stones were included and depending on the use of antiplatelet medication they were divided into 2 groups namely: group 1, cases under antiplatelet medication in whom the medication was stopped before ESWL; and group 2, cases without any antiplatelet medication. Comparative evaluation of patient, stone and treatment-related parameters were done in both groups. RESULTS: Although microscopic hematuria was present in all cases, the incidence of macroscopic hematuria was higher in cases undergoing antiplatelet medication when compared with the other cases. Regarding the microscopic hematuria again, the mean number erythrocytes per field of analysis was significantly higher in group 1 cases. The mean value of the hematoma size was similar in both groups. CONCLUSION: Our findings indicate that SWL can be applied safely in patients under antiplatelet therapy following the cessation of medication for a certain period of time. However, among the cases treated with this concept in our study, we clearly observed that the incidence of procedure-related hematoma formation and macroscopic hematuria were more common in such cases than in the normal ones.

Antegrade endourethroplasty with free skin graft for recurrent vesicourethral anastomotic strictures after radical prostatectomy.

PURPOSE: To investigate the efficacy of the antegrade endourethroplasty technique for the management of frequently recurrent vesicourethral anastomotic strictures that develop after retropubic radical prostatectomy. PATIENTS AND METHODS: Between January 2006 and February 2008, endoscopic antegrade urethroplasty was performed in 11 patients with recurrent vesicourethral anastomotic strictures that developed after retropubic radical prostatectomy (RRP). The mean age of the patients was 64.6 years. In the first step of this two-step procedure, the graft bed was prepared by transurethral resection of the vesicourethral anastomotic stricture region. In the next step, after 3 days, an Amplatz sheath was placed in the urinary bladder suprapubically. Then, an endobronchial catheter was inserted from the external urethral meatus and extended out of the body from the suprapubic region through the Amplatz sheath. A graft taken from anteromedial section of the arm was tubularized on the catheter balloon. The graft was placed into the bladder neck antegradely under endoscopic vision. Subsequently, the graft carrier catheter was fixed by previously placed two polypropylene sutures inserted into the proximal and distal part of the stricture zone percutaneously from the perineum. The transurethral catheter was taken out delicately on postoperative day 21. RESULTS: Urethral patency succeeded in 6 of the 11 (54.5%) patients, and maximum flow rate was more than 13 mL/s in follow-up. Graft necrosis occurred in two patients, and the stricture recurred in three patients in two months postoperatively. CONCLUSION: Antegrade endourethroplasty may be a suitable alternative to open surgical reconstruction in selected patients with recurrent bladder neck stricture following RRP. Further studies, including more patients with modifications, are needed to improve the success rate.

Minimal invasive treatment of vesicouterine fistula: a case report.

We report a case of vesicouterine fistula presenting after cesarean operation. The fistula was treated successfully by cystoscopic fulguration of the tract and hormonal amenorrhea. Although various surgical approaches to this problem have been described, to date there is no reports of treatment of this problem via cystoscopic fulguration and hormonal amenorrhea. The problem has been solved by hormonal amenorrhea and cystoscopic fulguration. We advocate this simple technique as a primary approach to proper case of vesicouterine fistulas.

Endoscopic subureteral injection treatment with calcium hydroxylapatite in primary vesicoureteral reflux.

INTRODUCTION: In this study, we aimed to evaluate efficiency of subureteral injection of calcium hydroxylapatite treatment for primary vesicoureteral reflux (VUR). MATERIALS AND METHODS: A total of 25 children (mean age 6.9 +/- 2.7 years) underwent subureteral injection of calcium hydroxylapatite for primary VUR. Reflux was present in 39 ureteral units that were unilateral in 11 cases and bilateral in 14 cases. According to "International Reflux Classification"; grade II in 12 (30.8%), grade III in 18 (46.2%) and grade IV in 9 (23.1%) ureteral units were found. RESULTS: The refluxes were resolved in 23 (59.0%) ureteral units after a single injection and 5 ureteral units (12.8%) after a second injection. Overall success rate of reflux treatment with calcium hydroxylapatite was 71.8% in all ureteral units. CONCLUSION: Endoscopic subureteral injection of calcium hydroxylapatite in children with primary low-grade VUR appears to be an effective, safe and minimally invasive technique.

Immunohistochemical analysis of low-affinity nerve growth factor receptor in the human urinary bladder.

INTRODUCTION: Interest in the regulation of nerve growth factor (NGF) production in the urinary tract derives from its probable involvement in obstructive, inflammatory and developmental disorders. Our aim was to investigate the presence of low-affinity nerve growth factor receptor (LNGFR) in the vesical urothelium of patients with bladder outlet obstruction. SUBJECTS AND METHODS: The study included 20 patients with urodynamically confirmed outflow obstruction and 10 control patients without outflow obstruction. Cold cup biopsies of the posterior wall of the urinary bladder were obtained from all patients. Intensity and distribution of LNGFR in the human urinary bladder were examined immunohistochemically. RESULTS: We detected LNGFR immunostaining in all specimens, and it was observed at the (luminal) epithelial surface and in nerve fibers. In the obstruction group, LNGFR immunoreactivity scores were higher than in the control group, but there was no statistically significant difference (p > 0.05). CONCLUSIONS: The presence of LNGFR was demonstrated in the urothelium of the human urinary bladder, and these findings show that cells in hypertrophied and normal bladder can synthesize NGF. This observation may have a potential role for therapeutic implications. However, further studies are needed for an explanation of the pathophysiology and the role in treatment.

Position-related changes in uroflowmetric parameters in healthy young men.

AIMS: Uroflowmetric measurements are a common procedure in urological examination of patients presenting with lower urinary tract symptoms and it can be influenced by various factors. In this study, we investigated position-related changes in uroflowmetric parameters and postvoiding residual urine (PVR) volume in healthy young men. MATERIALS AND METHODS: Thirty normal healthy male volunteers, whose mean age was 28.6 +/- 0.7 years old were studied and evaluated with uroflowmetry in the standing, sitting, and squatting down voiding positions. Three measurements were obtained for each voiding position and for each man (total 270 urinary flows). PVR were measured by transabdominal ultrasound. The maximum flow rate (Q(max)), average flow rate (Q(ave)), corrected maximum flow rate (cQ(max)), voiding volume (VV), voiding time (VT), and PVR values were compared between the three different voiding positions. RESULTS: The mean Q(max) values for the standing, sitting, and squatting down voiding positions of the patient group were 26.8 +/- 1.3, 31.3 +/- 1.2, 31.0 +/- 1.0 ml/sec, respectively and the mean Q(ave) values were 16.8 +/- 0.6, 18.5 +/- 0.6, 18.6 +/- 0.6 ml/sec, respectively. There were significant differences between voiding positions regarding the Q(max) (P < 0.0001) and Q(ave) (P = 0.0002) values in the patient groups. However, the difference between VT, VV, and PVR in the standing, sitting, and squatting down voiding position of the patient group was not statistically significant. CONCLUSIONS: Our results suggest that the urinary flow rates are affected by the voiding position. Therefore, it is important to perform uroflowmetric measurements in the same position.

The effect of intravesical sodium nitroprusside on idiopathic detrusor overactivity.

Although nitric oxide (NO) plays an important role in the urethra and outlet region of the bladder, the role of this inhibitory neurotransmitter in the human detrusor remains unclear. We conducted a prospective, randomised, open study on 31 patients with urodynamically proven idiopathic detrusor overactivity in order to examine the effects of intravesical administration of the NO donor sodium nitroprusside (SNP) on detrusor overactivity. Thirty-one consecutive patients (14 male, 17 female; mean age 53.0+/-2.7 years) with idiopathic detrusor overactivity diagnosed by pressure-flow analysis were included in this study. The patients were randomised into two groups. Cystometries were performed with normal saline in the control group ( n=10) and with 7.2 mM SNP solution (2.16 mg/ml) in the study group ( n=21). We urodynamically investigated sensation, maximal cystometric capacity, compliance, instability index, amplitude and frequency of involuntary contractions. No statistically significant differences was found between the first (pressure-flow) and second (saline or SNP cystometry) urodynamic values in the control and study groups (P>0.05). We have demonstrated that SNP does not have any effect on uninhibited bladder contractions. These results suggest that the intravesical administration of SNP is not an effective treatment for detrusor overactivity.