Post-COVID-19 Demyelinating Disease and Its Effect on the Lower Urinary Tract: A Rare Case of a 14-Year-Old Man.

The COVID-19 pandemic caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) has led to a wide range of manifestations, including urological issues. Patients with COVID-19 frequently experience complications, such as acute kidney injury (AKI) and thromboembolism. Neurological problems, including demyelination in the central and peripheral nervous systems, have also been reported in COVID-19 cases. This neurological damage can be attributed to the virus's neurotropic and neuro-invasive properties. This case study presents a 14-year-old patient who developed severe lower urinary tract symptoms following a COVID-19 infection, leading to a demyelinating disease affecting the lower urinary tract. The patient was managed successfully with specialized neuro-urological care, highlighting the importance of multidisciplinary collaboration in managing post-COVID-19 complications. Clinicians need to be vigilant about potential neurological manifestations in COVID-19 patients, including those affecting the urinary system, and patients should seek specialized medical attention for persistent symptoms.

Risk factors for urinary tract infections associated with lower quality of life among intermittent catheter users.

BACKGROUND: Evidence shows that intermittent catheterisation (IC) for bladder emptying is linked to urinary tract infections (UTIs) and poor quality of life (QoL). AIM: To investigate the association between UTI risk factors and QoL and patient-reported UTIs respectively. METHODS: A survey was distributed to IC users from 13 countries. FINDINGS: Among 3464 respondents, a significantly poorer QoL was observed when experiencing blood in the urine, residual urine, bowel dysfunction, recurrent UTIs, being female, and applying withdrawal techniques. A lower UTI risk was found when blood was not apparent in urine (RR: 0.63; 95% CI: 0.55-0.71), the bladder was perceived empty (RR: 0.83; 95% CI: 0.72-0.96), not having bowel dysfunction (RR: 0.86; 95% CI: 0.76-0.98), and being male (RR: 0.70; 95% CI: 0.62-0.79). CONCLUSION: This study underlines the importance of risk factors and their link to QoL and UTIs, highlighting the need for addressing symptoms before UTIs become problematic.

Intrathecal Baclofen for Spasticity: Is There an Effect on Bladder Function? Report of Three Cases and Review of the Literature.

INTRODUCTION: traumatic brain injury (TBI) is very often associated with spasticity. Medical interventions may include medications such as baclofen, a Gamma-Aminobutyric Acid (GABA) -receptor agonist of poor lipid solubility. Intrathecal baclofen (ITB) administration is a contemporary treatment option which minimizes adverse effects in contrast with the oral form of the drug. Regarding low urinary tract dysfunction, TBI, as a suprapontine lesion, results in neurogenic detrusor overactivity. Frequency, urgency and urge incontinence are the predominant signs and symptoms of this condition. Our study aims to report the potential changes in bladder function in patients with spasticity, due to TBI, after the implantation of the baclofen pump and the control of spasticity. MATERIAL AND METHODS: We report three cases of TBI whose spasticity responded well to ITB. We evaluated our medical reports regarding bladder function retrospectively, before and after baclofen pump implantation. We compared the data of bladder diaries and urodynamic parameters. RESULTS: Bladder function was improved in all patients. Regarding bladder diaries; the number of incontinence and micturition episodes was decreased and the volume per void was slightly increased. Regarding urodynamic parameters; bladder capacity and reflex volume increased, Pdetmax decreased, PVR was the same and DLPP was slightly decreased. CONCLUSIONS: Although the baclofen pump is implanted to treat spasticity, detrusor activity may be also affected. Therefore, patients' urologic profiles should also be reevaluated after ITB. Further prospective studies are required to investigate the effect of ITB on bladder function in the clinical field and also at the basic science level.

Efficacy of fesoterodine fumarate (8 mg) in neurogenic detrusor overactivity due to spinal cord lesion or multiple sclerosis: A prospective study.

AIMS: Antimuscarinic drugs are the first-line choice in the treatment of patients with neurogenic Detrusor Overactivity (nDO). Fesoterodine fumarate is the newest antimuscarinic drug. Limited data are published about the use of fesoterodine fumarate in patients suffering from neurogenic lower urinary tract dysfunction. Our study aims to determine the efficacy of fesoterodine fumarate on patients with nDO due to spinal cord lesion or multiple sclerosis (MS). METHODS: This is an open-label prospective interventional study. Eligible patients were 18-80 years old with SCL or MS and nDO confirmed by a urodynamic study (UDS). At baseline, patients underwent a UDS to confirm nDO. Quality of life (QoL) was assessed by the Short-Form (SF) Qualiveen questionnaire. Patients received fesoterodine 8 mg/day for 3 months and were re-evaluated with UDS and SF-Qualiveen. The primary endpoint was the confirmation of the maximum detrusor pressure (Pdetmax ) reduction after treatment. Secondary endpoints were: evaluation of maximum bladder capacity and compliance and QoL effect. Statistical analysis included Wilcoxon-test using SPSSv26. RESULTS: One hundred and twenty-four patients completed the study. Ninety-five of them (76.6%) had SCL, while 29 (23.4%) had MS. Pdetmax , maximum bladder capacity, and compliance had significant reduction after treatment (p < .001) in the whole group and each subgroup. SF-Qualiveen revealed a significant increase in QoL in each group (p < .001). CONCLUSIONS: Fesoterodine fumarate (8 mg) is an efficacious drag in patients with SCL and MS, as it significantly decreases the detrusor pressure, increases the bladder capacity and compliance, and improves the QoL.

Sexual dysfunction in women with spinal cord injury living in Greece.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To provide data on the rates of sexual dysfunction (SD) among the Greek spinal cord injury (SCI) women and to investigate any association with demographic and clinical variables. SETTING: Greek territory. METHODS: Our sample was enrolled from rehabilitation institutes throughout Greece and included 30 women with SCI living in the community for at least 1 year after the primary inpatient rehabilitation program. They were assessed for SD using the Female Sexual Function Index (FSFI). Pearson's test was performed to examine the correlation of SD with clinical-demographic parameters as defined by specific questionnaires: Satisfaction With Life Scale (SWLS), World Health Organization Quality of Life-BREF (WHOQOL-BREF), Spinal Cord Independence Measure (SCIM), Patient Health Questionnaire (PHQ-9), Craig Handicap Assessment and Reporting Technique (CHART). RESULTS: SD was revealed in 63.3% of the study participants. The mean FSFI score was 14.4. Pearson's analysis showed that age was negatively correlated with FSFI scores (p = 0.006), while pain had a negative impact only on desire scores (p = 0.04). FSFI scores were negatively correlated with PHQ-9 (p = 0.04), while there was a positive correlation with SWLS (p = 0.003), SCIM (p = 0.013), and specific domains of WHOQOL-BREF (psychological, relations, environment), and CHART (mobility, social integration). CONCLUSIONS: The rate of SD (63.3%) generally agrees with the findings of high rates in most of the literature, although it is rather lower, in comparison to other populations. Old age and depressive symptoms were the major identified determinants of SD.

Neurogenic Erectile Dysfunction. Where Do We Stand?

Erectile Dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance, causing tremendous effects on both patients and their partners. The pathophysiology of ED remains a labyrinth. The underlying mechanisms of ED may be vasculogenic, neurogenic, anatomical, hormonal, drug-induced and/or psychogenic. Neurogenic ED consists of a large cohort of ED, accounting for about 10% to 19% of all cases. Its diversity does not allow an in-depth clarification of all the underlying mechanisms nor a "one size fits all" therapeutical approach. In this review, we focus on neurogenic causes of ED, trying to elucidate the mechanisms that lie beneath it and how we manage these patients.

Translation and cultural adaptation of SF Qualiveen questionnaire in Greek.

BACKGROUND: Most of neurologically impaired persons, who are suffering from spinal cord injury (SCI) or multiple sclerosis (MS), may face important lifestyle restrictions. Urinary disorders can further decrease their quality of life (QoL). SF Qualiveen is a validated questionnaire for the evaluation of QoL in this population related to neurogenic lower urinary tract dysfunction (NLUTD). AIM: The cross-cultural adaptation, the reliability check, and the validation of the SF Qualiveen in Greek. DESIGN: The design of this study was the observational cohort study. SETTING: Between November 2019 and May 2020, we addressed to 136 consecutive neurologic patients with MS or SCI from the outpatient clinic of the Unit of Neuro-urology of the National Rehabilitation Center in Athens. POPULATION: The study was based on 124 patients (68 males and 56 females). There were 55 paraplegics, 16 tetraplegics and 53 MS patients. METHODS: After a back forward translation of the SF Qualiveen between English and Greek, the patients completed the Greek version of SF Qualiveen and King's Health Questionnaire at baseline and 3 months later. Reliability check and validation were performed by factor analysis with the Explanatory Factor Analysis (EFA) method. Demographic data were collected as well. RESULTS: The Greek version of the questionnaire showed good internal consistency with Cronbach's α >70 for the total score and most of the four sub-scales for the test and retest. Test-retest reliability showed that all domains of the SF-Qualiveen (test) were correlated with the SF-Qualiveen total score (test) and the same applies to the SF-Qualiveen (retest). Domains of SF-Qualiveen (test) were poorly correlated with the domains of SF-Qualiveen (retest). Construct and criterion validity were satisfactory and CFA found that the model had good fit [χ2 (14)=19.133, GFI=0.964, NFI=0.954, RMSEA=0.055, CFI=0.987]. CONCLUSIONS: This Greek version of the SF Qualiveen was tested following well-established guidelines on measurement properties and showed good validity and reliability. It is reproducible, reliable, and valid for the Greek population. CLINICAL REHABILITATION IMPACT: This Greek version of the SF Qualiveen can be used as a tool to evaluate the impact of NLUTD on QoL in Greek-speaking patients with MS and SCI in research and clinical practice.

Chronic prostatitis effectively managed by transurethral prostatectomy (TURP) in a spinal cord injury male.

Introduction: Spinal cord injury (SCI), specifically suprasacral SCI, results in high intravesical pressures, elevated post-void residual and urinary incontinence which are all risk factors for urinary tract infections (UTIs). The management of UTIs usually is conservative medical antibiotic treatment. However, recurrent UTIs in the SCI patient population warrant further investigation. The method of urinary drainage (intermittent or indwelling urinary catheters, urinary diversion) and untreated complications of NLUTD (vesicoureteral reflux, stone formation, chronic incomplete emptying of the bladder) are risk factors for recurrent UTIs (rUTIs). Removal of these UTI risk factors and improving urinary drainage are goals of urologic management; however, when conservative interventions do not succeed, surgery may be a viable solution in select cases of rUTIs. Case presentation: We present a case of complicated persisting rUTIs and associated urethral discharge in a middle-aged SCI male who manages his bladder with intermittent catheterization (IC). We detail the evaluation and management approach that leads to an eventual transurethral prostatectomy (TURP) as a final solution for his rUTIs. Fortunately, the surgical intervention was successful, and the patient is free of UTIs after 4 years of follow-up. Discussion: In SCI male patients with rUTIs and suspected chronic prostatitis, TURP may be a valuable treatment option once all predisposing factors have been remediated.

Female Sexual Dysfunction Among Greek Women With Multiple Sclerosis: Correlations With Organic and Psychological Factors.

INTRODUCTION: Multiple Sclerosis (MS) is a degenerative neurological disease that usually occurs between the ages of 20 and 50 years. Sexuality issues are important factors that affect the quality of life of patients. AIM: To determine and evaluate the prevalence of female sexual dysfunction (FSD) in Greek women with MS and correlate it with organic and psychological factors. METHODS: 248 consecutive women with MS, aged over 18 who admitted to our outpatient clinics from February 2016 to March 2017 were included in the study. Demographics (age, marital status, menopause status, number of children) and disease-related data such as the duration of the disease, Expanded Disability Status Scale (EDSS) and medication for MS obtained. MAIN OUTCOME MEASURE: All participants completed the Greek validated versions of the Depression, Anxiety, Stress Scale (DASS-21) and the Female Sexual Function Inventory (FSFI) questionnaires. Statistics used to estimate the prevalence of FSD and its correlation with organic (age, EDSS, duration of the disease, menopause status) and psychological factors (depression, anxiety, stress). RESULTS: FSD was diagnosed in 64.5% of our sample. Age was associated with most subscales of the FSFI. There was no significant correlation in FSFI subscales with the disease duration. Correlation of EDSS and FSFI scores was found to be statistically significant with a negative correlation in all subscales apart from the Satisfaction subscale. Regarding the association between DASS domains and FSFI subscales, there were no significant correlations. CONCLUSION: FSD is common among Greek women; it is influenced by age, severity of disease, and it is independent of the existence of depression, anxiety, and stress. Konstantinidis C, Tzitzika M, Bantis A, et al. Female sexual dysfunction among Greek women with multiple sclerosis: Correlations with organic and psychological factors. Sex Med 2019;7:19-25.

Differential Expression of IGF-I Transcripts in Bladder Cancer.

BACKGROUND/AIM: A growing body of evidence shows that the differential expression of E domain-related insulin-like growth factor-I (IGF-I) transcripts (IFG-IEa, IGF-IEb and IGF-IEc) in normal and cancerous tissues, implicating specific biological roles for the putative Ea, Eb, and Ec peptides, beyond IGF-I. Herein, we investigated the expression profile of IGF-IEa, IGF-IEb and IGF-IEc transcripts in bladder cancer and compared them with samples from the normal adjacent bladder tissue. MATERIALS AND METHODS: Biopsies from 46 patients (39 men and 7 women), aged 73.3±10.9 years, were analyzed for the expression of IGF-I transcripts using semi-quantitative real time-PCR (qRT-PCR). RESULTS: The presence of all three IGF-I transcripts was detected in both normal urothelium and bladder carcinomas. The relative expression of the IGF-IEa and IFG-IEb was marginally increased in bladder cancer tissues compared to normal tissue (p>0.05). In contrast, the expression of the IGF-IEc was significantly decreased in bladder cancer as compared to normal adjacent urothelium (p<0.05). This specific suppression of IGF-IEc expression was evident and positively correlated with the histological and/or clinical characteristics of an advanced disease, referring to clinical stage, tumor grade and disease recurrence (p<0.05); however, in situ carcinomas exhibited an increased expression of all IGF-I transcripts. CONCLUSION: Our data confirm the differential expression of IGF-I transcripts in bladder cancer, revealing a distinct suppression of IGF-IEc. These findings suggest that IGF-IEc expression and putative Ec product may possess discrete biological role in disease progression beyond IGF-I.

Urinary Retention as the Only Symptom of Retained Surgical Sponge (Gossypiboma), 29 Years After Cesarean Procedure.

A 68 year old lady presented to urology department suffering from acute urinary retention. The U/S revealed hydronephrosis in left kidney and a mass at the left side of the small pelvis which pushed forward the uterus and the bladder. The CT scan confirmed a mixed (solid and cystic) mass, with diameter of 12 cm with interpretation of the left ovary. The patient underwent laparotomy and the mass was excised after a difficult dissection due to severe adhesion with the bowel. The well-capsulated mass was a retained surgical sponge. The patient had undergone cesarean procedure 29 years ago.

Optimal bladder diary duration for patients with suprapontine neurogenic lower urinary tract dysfunction.

PURPOSE: To identify the minimum bladder diary's length required to furnish reliable documentation of LUTS in a specific cohort of patients suffering from neurogenic urinary dysfunction secondary to suprapontine pathology. MATERIALS AND METHODS: From January 2008 to January 2014, patients suffering from suprapontine pathology and LUTS were requested to prospectively complete a bladder diary form for 7 consecutive days. Micturitions per day, excreta per micturition, urgency and incontinence episodes and voided volume per day were evaluated from the completed diaries. We compared the averaged records of consecutive days (2-6 days) to the total 7 days records for each patient's diary, seeking the minimum diary's length that could provide records comparable to the 7 days average, the reference point in terms of reliability. RESULTS: From 285 subjects, 94 male and 69 female patients enrolled in the study. The records of day 1 were significantly different from the average of the 7 days records in every parameter, showing relatively small correlation and providing insuficiente documentation. Correlations gradually increased along the increase in diary's duration. According to our results a 3-day duration bladder diary is efficient and can provide results comparable to a 7 day length for four of our evaluated parameters. Regarding incontinence episodes, 3 days seems inadequate to furnish comparable results, showing a borderline difference. CONCLUSIONS: A 3-day diary can be used, as its reliability is efficient regarding number of micturition per day, excreta per micturition, episodes of urgency and voided volume per day.

Optimal bladder diary duration for patients with suprapontine neurogenic lower urinary tract dysfunction

ABSTRACT Purpose: To identify the minimum bladder diary's length required to furnish reliable documentation of LUTS in a specific cohort of patients suffering from neurogenic urinary dysfunction secondary to suprapontine pathology. Materials and Methods: From January 2008 to January 2014, patients suffering from suprapontine pathology and LUTS were requested to prospectively complete a bladder diary form for 7 consecutive days. Micturitions per day, excreta per micturition, urgency and incontinence episodes and voided volume per day were evaluated from the completed diaries. We compared the averaged records of consecutive days (2-6 days) to the total 7 days records for each patient's diary, seeking the minimum diary's length that could provide records comparable to the 7 days average, the reference point in terms of reliability. Results: From 285 subjects, 94 male and 69 female patients enrolled in the study. The records of day 1 were significantly different from the average of the 7 days records in every parameter, showing relatively small correlation and providing insufficient documentation. Correlations gradually increased along the increase in diary's duration. According to our results a 3-day duration bladder diary is efficient and can provide results comparable to a 7 day length for four of our evaluated parameters. Regarding incontinence episodes, 3 days seems inadequate to furnish comparable results, showing a borderline difference. Conclusions: A 3-day diary can be used, as its reliability is efficient regarding number of micturition per day, excreta per micturition, episodes of urgency and voided volume per day.

A review of continuous vs intermittent androgen deprivation therapy: redefining the gold standard in the treatment of advanced prostate cancer. Myths, facts and new data on a ″perpetual dispute″.

OBJECTIVES: To review the literature and present new data of continuous androgen deprivation therapy (ADT) vs intermittent androgen deprivation (IAD) as therapies for prostate cancer in terms of survival and quality of life and clarify practical issues in the use of IAD. MATERIALS AND METHODS: We conducted a systematic search on Medline and Embase databases using ″prostatic neoplasm″ and ″intermittent androgen deprivation″ as search terms. We reviewed meta-analyses, randomised controlled trials, reviews, clinical trials and practise guidelines written in English from 2000 and onwards until 01/04/2013. Ten randomized controlled trials were identified. Seven of them published extensive data and results randomizing 4675 patients to IAD versus CAD. Data from the other three randomized trials were limited. RESULTS: Over the last years studies confirmed that IAD is an effective alternative approach to hormonal deprivation providing simultaneously several potential benefits in terms of quality of life and cost effectiveness. Thus, in patients with non metastatic, advanced prostate cancer IAD could be used as standard treatment, while in metastatic prostate cancer IAD role still remains ambiguous. CONCLUSIONS: Nowadays, revaluation of the gold standard of ADT in advanced prostate cancer appears essential. Recent data established that IAD should no longer be consi¬dered as investigational, since its effectiveness has been proven, especially in patients suffering from non-metastatic advanced prostate cancer.

A review of continuous vs intermittent androgen deprivation therapy: Redefining the gold standard in the treatment of advanced prostate cancer. Myths, facts and new data on a perpetual dispute / Editorial Comment

Objectives: To review the literature and present new data of continuous androgen deprivation therapy (ADT) vs intermittent androgen deprivation (IAD) as therapies for prostate cancer in terms of survival and quality of life and clarify practical issues in the use of IAD. Materials and Methods: We conducted a systematic search on Medline and Embase databases using “prostatic neoplasm” and “intermittent androgen deprivation” as search terms. We reviewed meta-analyses, randomised controlled trials, reviews, clinical trials and practise guidelines written in English from 2000 and onwards until 01/04/2013. Ten randomized controlled trials were identified. Seven of them published extensive data and results randomizing 4675 patients to IAD versus CAD. Data from the other three randomized trials were limited. Results: Over the last years studies confirmed that IAD is an effective alternative approach to hormonal deprivation providing simultaneously several potential benefits in terms of quality of life and cost effectiveness. Thus, in patients with non metastatic, advanced prostate cancer IAD could be used as standard treatment, while in metastatic prostate cancer IAD role still remains ambiguous. Conclusions: Nowadays, revaluation of the gold standard of ADT in advanced prostate cancer appears essential. Recent data established that IAD should no longer be considered as investigational, since its effectiveness has been proven, especially in patients suffering from non-metastatic advanced prostate cancer. .

Lower urinary tract symptoms associated with benign prostatic hyperplasia: combined treatment with fesoterodine fumarate extended-release and tamsulosin--a prospective study.

OBJECTIVE: To evaluate the efficacy and safety of fesoterodine extended-release (ER) plus tamsulosin in men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Men aged ≥50 years, with LUTS, prostate volume ≤60 ml and International Prostate Symptom Score (IPSS) ≥13 were enrolled in this study. 173 consecutive patients were treated initially with tamsulosin (0.4 mg) for 1 week. At the second visit, 47 patients out of the sample of 173 who were still experiencing inconvenient LUTS were randomized into two groups. The first group received a therapy with tamsulosin and fesoterodine combination (group 1, n = 24) while the second continued the therapy with the single administration of tamsulosin (group 2, n = 23) for an additional 4-week period. RESULTS: There was no statistically significant difference in age, prostate volume, Q, and postvoid residual urine between the two groups. A statistical significance appeared in the combination group regarding the storage and the total IPSS values among the second and third visits (10.5 ± 1.4 to 8.5 ± 1.3 and 16.1 ± 1.8 to 13.7 ± 1.5 respectively). CONCLUSION: Regarding bothersome LUTS and storage symptoms, fesoterodine ER and tamsulosin combination was significantly more effective than the single administration of tamsulosin.

US Imaging in Peyronie's Disease.

The aim of this study is to assess the role of ultrasound (US) in Peyronie's Disease (PD). PD is a psychologically and physically devastating disorder that manifests in middle-aged men. Fibrous inelastic plaques in the tunica albuginea, result in palpable penile scar in the flaccid condition and cause painful erections and penile deformity, including penile curvature, hinging, narrowing, and shortening of penis. Penile deformity is the most common (52%) first symptom of PD and is present in 94% of affected men. US is the primary imaging modality of choice due to its easy availability, low risk, and ability to image and quantify both calcified and soft tissue elements of PD. US provides identification of smaller and non-palpable lesions and shows the extent of fibrosis. Detection of calcifications within the plaque suggests stabilization of the disease and provides information useful to select patients for appropriate treatment.

Comparison between lidocaine and glyceryl trinitrate ointment for perianal-intrarectal local anesthesia before transrectal ultrasonography-guided prostate biopsy: a placebo-controlled trial.

OBJECTIVE: To evaluate the use of topical lidocaine gel and glyceryl trinitrate ointment (GTN) vs placebo, in reducing anal pain and discomfort as an adjunct to periprostatic anesthesia because of probe insertion, during the use of transrectal ultrasonography (TRUS) prostate-guided biopsy in young patients. PATIENTS AND METHODS: Two-hundred twenty-three men who underwent prostate biopsy were divided into 3 groups. Seventy-four patients (first group) and 76 patients (second group) received perianal local anesthesia with lidocaine gel 2%, and 1 g of 0.4% GTN ointment, respectively, whereas 73 patients (third group) received lubricant gel as perianal local anesthesia. All patients also underwent periprostatic nerve block (PPNB). Visual analogue scales (VAS 1 and VAS 2) were used to estimate the pain and discomfort during probe insertion and biopsy. RESULTS: Men in the first and second groups reported significantly less pain score (mean, 1.7 and 1.6, respectively) vs men from the third group (mean, 5.7) during probe insertion. Comparing the 3 different groups subsequently with the periprostatic anesthesia, no significant difference in VAS scores between the first and the third groups (mean, 1.9 and 2.1, respectively) was found; in addition, patients from the second group reported significantly less pain score (mean, 1.3) during biopsy. CONCLUSIONS: Lidocaine gel and GTN ointment is safe and effective in reducing anal pain associated with the insertion of an ultrasound probe. Furthermore, men with GTN ointment also reported less pain during biopsy. We suggest that analgesia before PPNB could significantly reduce anal pain and improve tolerance during TRUS prostate-guided biopsy.

The effect of unions on the distribution of wages of hospital-employed registered nurses in the United States.

AIMS AND OBJECTIVES: We estimate the impact of unionisation on the wage structure of hospital-employed registered nurses in the USA. We examine whether unions have an effect on wage differences associated with race, gender, immigration status, education and experience, as well as whether there is less unexplained wage variation among unionised nurses. BACKGROUND: In the past decade, there has been resurgence in union activity in the health care industry in the USA, particularly in hospitals. Numerous studies have found that unions are associated with higher wages. Unions may also affect the structure of wages paid to workers, by compressing the wage structure and reducing unexplained variation in wages. DESIGN: Cross-sectional analysis of pooled secondary data from the United States Current Population Survey, 2003-2006. METHOD: Multivariate regression analysis of factors that predict wages, with models derived from labour economics. RESULTS: There are no wage differences associated with gender, race or immigration status among unionised nurses, but there are wage penalties for black and immigrant nurses in the non-union sector. For the most part, the pay structures of the union and non-union sectors do not significantly differ. The wage penalty associated with diploma education for non-union nurses disappears among unionised nurses. Unionised nurses receive a lower return to experience, although the difference is not statistically significant. There is no evidence that unexplained variation in wages is lower among unionised nurses. CONCLUSIONS: While in theory unions may rationalise wage-setting and reduce wage dispersion, we found no evidence to support this hypothesis. RELEVANCE TO CLINICAL PRACTICE: The primary effect of hospital unions is to raise wages. Unionisation does not appear to have other important wage effects among hospital-employed nurses.