Conservative Bladder Management and Medical Treatment in Chronic Spinal Cord Injury Patients.

To review the available data on non-surgical management for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI) and provide the most updated knowledge for readers. We categorized the bladder management approaches into storage and voiding dysfunction separately; both are minimally invasive, safe, and efficacious procedures. The main goals for NLUTD management are to achieve urinary continence; improve quality of life; prevent urinary tract infections and, last but not least, preserve upper urinary tract function. Annual renal sonography workups and regular video urodynamics examinations are crucial for early detection and further urological management. Despite the extensive data on NLUTD, there are still relatively few novel publications and there is a lack of high-quality evidence. There is a paucity of new minimally invasive and prolonged efficacy treatments for NLUTD, and a partnership between urologists, nephrologists and physiatrists is required to promote and ensure the health of SCI patients in the future.

Role of Urological Botulinum Toxin-A Injection for Overactive Bladder and Voiding Dysfunction in Patients with Parkinson's Disease or Post-Stroke.

Botulinum toxin A (BoNT-A) paralyzes muscle by blocking acetylcholine release at the synaptic junction. BoNT-A has shown its therapeutic effects in neurological disorders such as Parkinson's disease (PD) and post-stroke spasticity. A high proportion of patients with PD and post-stroke develop neurogenic detrusor overactivity (nDO) and then develop urinary incontinence and overactive bladder (OAB) symptoms. This study aimed to disclose the safety and efficacy of BoNT-A injection in treating bladder and voiding dysfunction in PD and post-stroke patients by reviewing the current evidence. At present, intradetrusor injection of BoNT-A is a Food and Drug Administration (FDA)-approved third-line therapy for nDO and idiopathic OAB. Although intradetrusor injection of onaBoNT-A 200 U is already approved for nDO treatment, most researchers would like to manage PD and post-stroke patients by using onaBoNT-A 100 U intradetrusor injection to achieve long-term efficacy and reduce adverse effects. However, in contrast to its inclusion in the International Continence Society guidelines for PD treatment, the clinical use of BoNT-A for post-stroke patients is limited to experimental use due to the development of urinary retention in about one-fifth of patients. For treating urethral pseudodyssynergia, half of patients may respond to onaBoNT-A 100 U urethral injection. However, refinement is needed to reduce unwanted urinary incontinence.

Metabolic Syndrome and Overactive Bladder Syndrome May Share Common Pathophysiologies.

Metabolic syndrome (MetS) is defined by a group of cardiovascular risk factors, including impaired glucose tolerance, central obesity, hypertension, and dyslipidemia. Overactive bladder (OAB) syndrome consists of symptoms such as urinary urgency, frequency, and nocturia with or without urge incontinence. The high prevalences of metabolic syndrome (MetS) and overactive bladder (OAB) worldwide affect quality of life and cause profound negative impacts on the social economy. Accumulated evidence suggests that MetS might contribute to the underlying mechanisms for developing OAB, and MetS-associated OAB could be a subtype of OAB. However, how could these two syndromes interact with each other? Based on results of animal studies and observations in epidemiological studies, we summarized the common pathophysiologies existing between MetS and OAB, including autonomic and peripheral neuropathies, chronic ischemia, proinflammatory status, dysregulation of nutrient-sensing pathways (e.g., insulin resistance at the bladder mucosa and excessive succinate intake), and the probable role of dysbiosis. Since the MetS-associated OAB is a subtype of OAB with distinctive pathophysiologies, the regular and non-specific medications, such as antimuscarinics, beta-3 agonist, and botulinum toxin injection, might lead to unsatisfying results. Understanding the pathophysiologies of MetS-associated OAB might benefit future studies exploring novel biomarkers for diagnosis and therapeutic targets on both MetS and OAB.

Low-pressure hydrodistension induces bladder glomerulations in female patients with interstitial cystitis/bladder pain syndrome.

AIMS: The role of hydrodistension in the diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS) is controversial. This study evaluated the effect of low-pressure hydrodistension on glomerulation formation in female patients diagnosed with the disease. METHODS: Sixty female patients with the clinical diagnosis of IC/BPS and 30 female controls without the disease underwent cystoscopy and hydrodistension. Cold-cup biopsy was taken from bladder posterior wall at sites with normal cystoscopic appearance before hydrodistension in the IC/BPS group. The tissue samples were processed for histology study. Low-pressure (40 cmH2 O) hydrodistension for 2 min was performed and the appearance of glomerulations was compared between the two groups. High-pressure (80 cmH2 O) hydrodistension for 8 min was then performed as a therapeutic measure for the IC/BPS patients. Further changes to the degree of glomerulations were recorded. RESULTS: Histology showed pathological changes in the normal-appearing IC/BPS bladder mucosa including urothelium denudation, inflammatory cell infiltration, stromal edema, fibrosis, and vascular congestion. Low-pressure hydrodistension induced significant glomerulation formation in the patient group (percentage of patients with Grades 0-4: 0%, 8.3%, 40%, 35%, 10%, respectively) while none in the controls. High-pressure hydrodistension further increased the glomerulation grading in the IC/BPS patients. CONCLUSIONS: Structural changes are present in prehydrodistension IC/BPS bladder wall, which may not be macroscopically detectable. Hydrodistension at low pressure is adequate to disrupt the integrity of such diseased mucosa and offers a more discriminative test in the diagnosis of IC/BPS.

Study on the pathophysiological mechanism responsible for lower urinary tract symptoms associated with prostate cancer using an animal model.

OBJECTIVES: To investigate the pathophysiological mechanism leading to lower urinary tract symptoms in prostate cancer (PCa) by using an animal model. METHODS: An orthotopic PCa model in mice was established by injection of human DU145 cells into the prostate gland lateral lobe of NOD.CB17-Prkdcscid /NcrCrlBltw (NOD-SCID) mice. Cancer growth was quantified by a luciferase-based in vivo imaging system (IVIS) serially every 7 days. Comparisons were made for urodynamic parameters, bladder histology, and biological markers until the sixth week. Bladder wall structural changes were assessed by the bladder wall thickness and degree of fibrosis. Biomarker expressions in bladder tissue including muscarinic acetylcholine receptor 2 (M2 ), transient receptor potential cation channel subfamily V member 4 (TRPV4), BCL2-associated X protein (Bax), and caspase3 were evaluated by immunohistochemical staining and immunofluorescence confocal laser scanning microscopy. RESULTS: DU145 cell growth in the prostate was successfully monitored by a luciferase-based IVIS. after orthotopic injection. Using our injection technique, no anatomical obstruction of the bladder outlet and urethra was noted up to 6 weeks after injection. The presence of PCa induced changes in urinary bladder histology, biomarkers, and urodynamic parameters. Cystometry showed features of detrusor overactivity with increased voiding frequency and high-amplitude voiding contractions from the fourth week onward. Histological analyses 4 weeks after DU145 injection demonstrated detrusor thickening and bladder wall fibrosis. Immunohistochemistry showed increased expressions of bladder M2 , TRPV4, Bax, and caspase3 in the PCa mice as early as in the first or second week. CONCLUSIONS: PCa can induce bladder microenvironment changes involving neural receptors and biological mediators leading to histological and functional alterations even in the absence of overt anatomical obstruction.

Correction to: Comparisons of percutaneous versus retroperitoneoscopic cryoablation for renal masses.

In the original publication, Prof. Lin-Nei Hsu's institution was incorrectly published as 'Tainan Municipal An-Nan Hospital' in affiliation 4. The correct affiliation should read as 'Department of Urology, An-Nan Hospital, China Medical University, Tainan, Taiwan'.

Comparisons of percutaneous versus retroperitoneoscopic cryoablation for renal masses.

PURPOSE: Preserving renal function and controlling oncological outcomes are pertinent while managing renal tumours. We compared outcomes of percutaneous cryoablation (PCA) and retroperitoneoscopic cryoablation (RCA) in patients with renal neoplasms. METHODS: We identified 108 patients with renal tumours at two medical centres, where 63 patients received PCA and 45 patients underwent RCA from August 2009 to July 2015, and they were followed up until February 2017. We compared preoperative and postoperative parameters, namely gender, systemic diseases, age, American Society of Anesthesiologists score, body mass index (BMI), haemoglobin, the estimated glomerular filtration rate, tumour size, operative time, tumour type, Clavien-Dindo classification of surgical complications, and tumour recurrence, by using an independent sample t test, Pearson's Chi-square test, Fisher's exact test, a Mann-Whitney test, and a generalised linear model. RESULTS: Based on baseline characteristics, we found that the patients in the PCA group were older and had higher BMI than those in the RCA group, whereas the patients in the RCA group had more comorbidities than those in the PCA group. Retroperitoneoscopic and percutaneous methods had similar operative times, blood transfusion rates, postoperative fever episodes, and complication rates for either minor or major complications. However, the percutaneous method was associated with a shorter length of stay. No patient experienced deterioration in renal function until 2 years after both procedures. Impaired renal function was found in both groups in the 3-year follow-up. In both groups, tumour recurrence was significant for tumours > 4 cm. CONCLUSIONS: Our results confirm that both cryoablation methods (PCA and RCA) are safe and effective for renal cell carcinoma. Favourable oncological control was achieved in both groups if the renal tumour size was ≤ 4 cm.

Double-barreled colon conduit and colostomy for simultaneous urinary and fecal diversions: long-term follow-up.

BACKGROUND: Best strategies for simultaneous urinary and stool diversion remain indeterminate. Here we present what is to our knowledge the longest outcome data on double-barreled colon conduit and colostomy (DBCCC) in a cohort of patients needing simultaneous urinary and fecal diversion. METHODS: We identified 9 patients who underwent DBCCC between March 2002 and March 2013. Nine patients who underwent separate urinary and fecal diversion (colostomy plus percutaneous nephrostomy or ureterocutaneostomy) served as the control group. We compared demographics, comorbidities, follow-up morbidities, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-item questionnaire in the two groups. RESULTS: The preservation of renal function was better in the DBCCC group. There were significant improvements in global state of health, fatigue, insomnia, appetite, bowel habit, and social function in the DBCCC group. In comparison with the separate urinary and fecal diversion group, the patients in the DBCCC group had statically significant improvement in global health status, functional scales, and symptom scales. CONCLUSIONS: Compared with the separate urinary and fecal diversion technique, DBCCC provides preservation of renal function, easy stoma bag care, better quality of life, and improved body image for patients who need simultaneous urinary and fecal diversion.