Functional Connectivity as a Potential Mechanism for Language Plasticity.

BACKGROUND AND OBJECTIVES: Task fMRI is a clinical tool for language lateralization, but has limitations, and cannot provide information about network-level plasticity. Additional methods are needed to improve the precision of presurgical language mapping. We investigate language resting-state functional connectivity (RS fMRI; FC) in typically developing children (TD) and children with epilepsy. Our objectives were to (1) understand how FC components differ between TD children and those with epilepsy; (2) elucidate how the location of disease (frontal/temporal epilepsy foci) affects FC; and (3) investigate the relationship between age and FC. METHODS: Our sample included 55 TD children (mean age 12 years, range 7-18) and 31 patients with focal epilepsy (mean age 13 years, range 7-18). All participants underwent RS fMRI. Using a bilateral canonical language map as target, vertex-wise intrahemispheric FC map and interhemispheric FC map for each participant were computed and thresholded at top 10% to compute an FC laterality index (FCLI; [(L - R)/(L + R)]) of the frontal and temporal regions for both integration (intrahemispheric FC; FCLIi) and segregation (interhemispheric FC; FCLIs) maps. RESULTS: We found FC differences in the developing language network based on disease, seizure foci location, and age. Frontal and temporal FCLIi was different between groups (t[84] = 2.82, p < 0.01; t[84] = 4.68, p < 0.01, respectively). Frontal epilepsy foci had the largest differences from TD (Cohen d frontal FCLIi = 0.84, FCLIs = 0.51; temporal FCLIi = 1.29). Development and disease have opposing influences on the laterality of FC based on groups. In the frontal foci group, FCLIi decreased with age (r = -0.42), whereas in the temporal foci group, FCLIi increased with age (r = 0.40). Within the epilepsy group, increases in right frontal integration FCLI relates to increased right frontal task activation in our mostly left language dominant group (r = 0.52, p < 0.01). Language network connectivity is associated with higher verbal intelligence in children with epilepsy (r = 0.45, p < 0.05). DISCUSSION: These findings lend preliminary evidence that FC reflects network plasticity in the form of adaptation and compensation, or the ability to recruit support and reallocate resources within and outside of the traditional network to compensate for disease. FC expands on task-based fMRI and provides complementary and potentially useful information about the language network that is not captured using task-based fMRI alone.

Functional connectivity hemispheric contrast (FC-HC): A new metric for language mapping.

Development of a task-free method for presurgical mapping of language function is important for use in young or cognitively impaired patients. Resting state connectivity fMRI (RS-fMRI) is a task-free method that may be used to identify cognitive networks. We developed a voxelwise RS-fMRI metric, Functional Connectivity Hemispheric Contrast (FC-HC), to map the language network and determine language laterality through comparison of within-hemispheric language network connections (Integration) to cross-hemispheric connections (Segregation). For the first time, we demonstrated robustness and efficacy of a RS-fMRI metric to map language networks across five groups (total N = 243) that differed in MRI scanning parameters, fMRI scanning protocols, age, and development (typical vs pediatric epilepsy). The resting state FC-HC maps for the healthy pediatric and adult groups showed higher values in the left hemisphere, and had high agreement with standard task language fMRI; in contrast, the epilepsy patient group map was bilateral. FC-HC has strong but not perfect agreement with task fMRI and thus, may reflect related and complementary information about language plasticity and compensation.

Design and implementation of electronic health record common data elements for pediatric epilepsy: Foundations for a learning health care system.

OBJECTIVE: Common data elements (CDEs) are standardized questions and answer choices that allow aggregation, analysis, and comparison of observations from multiple sources. Clinical CDEs are foundational for learning health care systems, a data-driven approach to health care focused on continuous improvement of outcomes. We aimed to create clinical CDEs for pediatric epilepsy. METHODS: A multiple stakeholder group (clinicians, researchers, parents, caregivers, advocates, and electronic health record [EHR] vendors) developed clinical CDEs for routine care of children with epilepsy. Initial drafts drew from clinical epilepsy note templates, CDEs created for clinical research, items in existing registries, consensus documents and guidelines, quality metrics, and outcomes needed for demonstration projects. The CDEs were refined through discussion and field testing. We describe the development process, rationale for CDE selection, findings from piloting, and the CDEs themselves. We also describe early implementation, including experience with EHR systems and compatibility with the International League Against Epilepsy classification of seizure types. RESULTS: Common data elements were drafted in August 2017 and finalized in January 2020. Prioritized outcomes included seizure control, seizure freedom, American Academy of Neurology quality measures, presence of common comorbidities, and quality of life. The CDEs were piloted at 224 visits at 10 centers. The final CDEs included 36 questions in nine sections (number of questions): diagnosis (1), seizure frequency (9), quality of life (2), epilepsy history (6), etiology (8), comorbidities (2), treatment (2), process measures (5), and longitudinal history notes (1). Seizures are categorized as generalized tonic-clonic (regardless of onset), motor, nonmotor, and epileptic spasms. Focality is collected as epilepsy type rather than seizure type. Seizure frequency is measured in nine levels (all used during piloting). The CDEs were implemented in three vendor systems. Early clinical adoption included 1294 encounters at one center. SIGNIFICANCE: We created, piloted, refined, finalized, and implemented a novel set of clinical CDEs for pediatric epilepsy.

Using EHRs to advance epilepsy care.

The improved use of Electronic Health Record (EHR) Systems provides an opportunity to improve the overall efficiency and quality of care of patients with epilepsy. Tools and strategies that may be incorporated into the use of EHRs include utilizing patient generated data, clinical decision support systems and natural language processing systems. Standardization of data from EHR systems may lead to improvement in clinical research through the creation of data collections and multi-center collaborations. Challenges to collaborative use of EHR Systems across centers include costs and the diversity of EHR systems.

Soy isoflavones may protect against orchidectomy-induced bone loss in aged male rats.

Evidence from several studies suggests that soy protein and/or its isoflavones may have beneficial effects on bone in postmenopausal women and animal models who have osteoporosis. The present study examined the dose-dependent effects of soy isoflavones in the context of soy protein or casein on the male skeleton. Thirteen-month-old male Fisher 344 rats were orchidectomized (ORX; 5 groups) or sham-operated (Sham; 1 group) and immediately placed on dietary treatments for 180 days. Diets were semi-purified and the protein source was either casein (Sham and ORX; controls), casein with two added doses of isoflavones (Iso1; 600 mg/kg diet and Iso2; 1200 mg/kg diet), soy protein with normal isoflavones content (Soy; 600 mg/kg diet), or soy protein with added isoflavones (Soy+; 1200 mg/kg diet). A 7% loss of whole body bone mineral density (BMD) was observed due to orchidectomy; however, the ORX induced BMD loss was significantly reduced to 4.3 and 4.7 % with the Soy and Soy+, respectively. Both doses of isoflavones in conjunction with casein also reduced the loss of whole body BMD, albeit not significantly different from ORX control animals. Trabecular bone histomorphometric analysis of the proximal tibia further supported the bone-sparing role of soy isoflavones as indicated by higher percent bone volume and trabecular number, and lower trabecular separation. We conclude that isoflavones exert modest beneficial effects on the male skeleton whether provided with casein or a soy protein.

Soy protein may alleviate osteoarthritis symptoms.

Alternative and complementary therapeutic approaches, such as the use of a wide array of herbal, nutritional, and physical manipulations, are becoming popular for relieving symptoms of osteoarthritis (OA). The present study evaluated the efficacy of soy protein (SP) supplementation in relieving the pain and discomfort associated with OA. One hundred and thirty-five free-living individuals (64 men and 71 women) with diagnosed OA or with self-reported chronic knee joint pain not attributed to injury or rheumatoid arthritis were recruited for this double-blind, placebo-controlled, parallel design study. Study participants were assigned randomly to consume 40 g of either supplemental SP or milk-based protein (MP) daily for 3 months. Pain, knee range of motion, and overall physical activity were evaluated prior to the start of treatment and monthly thereafter. Serum levels of glycoprotein 39 (YKL-40), a marker of cartilage degradation, and insulin-like growth factor-I (IGF-I), a growth factor associated with cartilage synthesis, were assessed at baseline and at the end of the study. Overall, SP improved OA-associated symptoms such as range of motion and several factors associated with pain and quality of life in comparison to MP. However, these beneficial effects were mainly due to the effect of SP in men rather than women. Biochemical markers of cartilage metabolism further support the efficacy of SP in men as indicated by a significant increase in serum level of IGF-I and a significant decrease in serum level of YKL-40 compared to MP. This study is the first to provide evidence of possible beneficial effects of SP in the management of OA. Examining and verifying the long-term effects of SP on improving symptoms of OA, particularly in men, is warranted.

Prune suppresses ovariectomy-induced hypercholesterolemia in rats.

Elevated cholesterol among women who have experienced natural or surgical menopause has been linked to ovarian hormone deficiency. The purpose of this study was to investigate the efficacy of prune, a good source of dietary fiber and phytochemicals, on lowering cholesterol in an ovariectomized (ovx) rat model. Forty-eight 90-day-old female Sprague-Dawley rats were randomly assigned to four groups: sham-operated (sham) + control diet, ovx + control diet, ovx + low-dose (LD; 5%) prune, and ovx + high-dose (HD; 25%) prune. After 45 days of treatment, rats were euthanized and tissues were collected for analyses. Ovariectomy elevated serum total cholesterol by 22% compared with sham, and HD prune diet prevented this increase without affecting high density lipoprotein cholesterol concentrations. Animals fed the HD prune diet had 13% lower liver total lipids compared with ovx animals. The findings of this study showed that prune exhibits hypocholesterolemic properties in ovarian hormone deficiency. Dose-response studies should be conducted to establish the effectiveness of prune in prevention of hypercholesterolemia in postmenopausal women who are not on estrogen replacement therapy and seek dietary alternatives. Mechanistic studies also are needed to establish its mode of action.

Removal of UroLume endoprosthesis: experience of the North American Study Group for detrusor-sphincter dyssynergia application.

PURPOSE: We present the experience of the North American UroLume Multicenter Study Group with removal of the UroLume endoprosthesis. MATERIALS AND METHODS: A total of 160 neurologically impaired patients were enrolled in the North American UroLume Multicenter Study Group for detrusor external sphincter dyssynergia application. Analysis was performed in 2 groups of patients in which the device was removed during insertion and after implantation, respectively. RESULTS: Device retrieval was required during insertion in 21 patients (13%) mainly due to misplacement or migration in 17. Extraction was done with minimal complications and in all but 2 cases subsequent UroLume implantation was successful. Of 158 men with the device in place 31 (19.6%) required removal. In 34 procedures 44 devices were removed, mainly due to migration. Time from implantation to removal ranged from 4 days to 66 months (mean 22 months). The UroLume was removed en bloc in 20 cases and in parts or wire by wire in 19. The majority of patients had no or minimal complications after extraction. Only 2 patients had serious temporary complications, including bleeding and urethral injury, with no lasting consequences. No malignancy developed as a result of UroLume insertion. CONCLUSIONS: While there is a potential for urethral injury and bleeding, UroLume endoprosthesis removal is largely a simple procedure with minimal complications and consequences.

The synthetic phytoestrogen, ipriflavone, and estrogen prevent bone loss by different mechanisms.

Ipriflavone (IP), a synthetic isoflavone has been reported to prevent bone loss in both postmenopausal women and ovariectomized (ovx) rats. The purpose of this study was to compare and contrast some of the bone protective mechanisms of IP to those of 17beta-estradiol (E(2)) in ovarian hormone deficiency. Forty-eight 95-day-old Sprague-Dawley rats were assigned to four groups: sham, ovx, ovx+IP, and ovx+E(2). The doses of IP and E(2) were 100 mg and 10 microg/kg body weight per day, respectively. Rats were fed a diet that contained 0.4% calcium, 0.3% phosphorus, and 0.195 nmol vitamin D(3)/g diet. After sacrifice, left femoral bone densities were measured and bone histomorphometry was performed on the proximal tibial metaphysis. Ipriflavone as well as E(2) treatment completely prevented the ovx-induced femoral bone density loss. However, in contrast to E(2), IP did not lower the ovx-induced rise in serum alkaline phosphatase (ALP) activity or insulin-like growth factor (IGF)-I and IGF binding protein (IGFBP)-3 concentrations. On histomorphometry analysis, the ovariectomy-induced increase (P < 0. 09) in bone formation rate (BFR) was significantly (P < 0.05) suppressed by E(2) treatment, whereas this higher BFR was maintained in IP-treated animals. These findings indicate that IP is effective in preventing the ovx-associated bone loss. The bone protective mechanisms of IP in ovarian hormone deficiency may be different from those of E(2) and may involve increased rates of bone formation.

Long-term followup of the North American multicenter UroLume trial for the treatment of external detrusor-sphincter dyssynergia.

PURPOSE: We determine the long-term efficacy and safety of the UroLume stent as minimally invasive treatment for external detrusor-sphincter dyssynergia in spinal cord injured men. MATERIALS AND METHODS: A total of 160 spinal cord injured men with a mean age plus or minus standard deviation of 36.3 +/- 12.1 years (range 16 to 74) were prospectively treated with an endoprosthesis at 15 centers as part of the North American UroLume trial for external detrusor-sphincter dyssynergia. Urodynamic parameters, including voiding pressure, residual urine volume and bladder capacity, were compared before treatment and at 1, 2, 3, 4 and 5 years after treatment. RESULTS: Mean voiding pressure was 75.1 +/- 28.2 cm. water before treatment in the 160 patients, and 37.4 +/- 23.9 at year 1 in 97, 39.5 +/- 22.2 at year 2 in 84, 42.6 +/- 27.3 at year 3 in 61, 46.3 +/- 33.2 at year 4 in 57 and 44.2 +/- 28.9 cm. at year 5 in 41 after stent insertion (p <0.001). Residual urine volume decreased after stent placement and was maintained throughout the 5-year followup (p <0.001). Mean cystometric capacity remained constant from 269 +/- 155 before insertion to 337 +/- 182 ml. 5 years later (p = 0.17). Hydronephrosis and autonomic dysreflexia improved or stabilized in most patients with functioning stents. Stent explant was necessary in 24 patients (15%), of whom 4 (16.7%) had another stent implanted. CONCLUSIONS: The UroLume stent demonstrates long-term safety and efficacy for the treatment of external detrusor-sphincter dyssynergia. The outcome was similar in men with and without previous sphincterotomy.

Role of soy protein with normal or reduced isoflavone content in reversing bone loss induced by ovarian hormone deficiency in rats.

Soy protein, a rich source of isoflavones, fed immediately after an ovariectomy prevents bone loss in rats. Reports of the effectiveness of natural and synthetic isoflavones in preventing or treating osteoporosis led us to examine the effect of soy protein in reversing established bone loss. Seventy-two 95-d-old female Sprague-Dawley rats were assigned to 6 groups. The rats were either sham operated (SHAM; 2 groups) or ovariectomized (OVX; 4 groups) and then fed a casein-based, semipurified diet. Thirty-five days after surgery, 1 SHAM and 1 OVX group were killed to examine the occurrence of bone loss. Thereafter, the other SHAM and 1 OVX groups continued to receive the casein-based diet. Whereas the remaining 2 OVX groups received diets in which casein was replaced by soy protein with normal (OVX+SOY) or reduced (OVX+SOY-) isoflavone content for 65 days. The OVX control group had significantly lower femoral and fourth lumbar vertebral bone densities than the SHAM group. Femoral density of rats fed SOY or SOY- diets were not significantly different from SHAM or OVX controls. This suggests a slight reversal of cortical bone loss that may be partially due to higher femoral insulin-like growth factor I mRNA transcripts resulting from both the SOY and SOY- diets. The ovariectomy-induced increases in indexes of bone turnover were not ameliorated by either of the soy diets, suggesting that any positive effect of soy was achieved through enhanced bone formation rather than slowed bone resorption. Long-term consumption of soy or its isoflavones may be needed to produce small but continued increments in bone mass.

Bone-sparing effect of soy protein in ovarian hormone-deficient rats is related to its isoflavone content.

Our previous studies showed that a soy-protein diet prevents ovariectomy-induced bone loss. The purpose of this study was to determine whether isoflavones in soy protein are responsible for this bone-protective effect. Forty-eight 95-d-old Sprague-Dawley rats were divided into 4 groups: sham-operated fed a casein-based diet (SHAM), ovariectomized fed a casein-based diet (OVX+CASEIN), ovariectomized fed soy protein with normal isoflavone content (OVX+SOY), and ovariectomized fed soy protein with reduced isoflavone content (OVX+SOY-). The OVX+SOY group had significantly greater femoral bone density (in g/cm3 bone vol) than the OVX+CASEIN group, whereas OVX+SOY- was similar to OVX+CASEIN (mean +/- SD; SHAM, 1.522 +/- 0.041; OVX+CASEIN, 1.449 +/- 0.044; OVX+SOY, 1.497 +/- 0.030; OVX+SOY-, 1.452 +/- 0.030). Ovariectomy resulted in greater bone turnover as indicated by higher serum alkaline phosphatase activity, serum insulin-like growth factor I and insulin-like growth factor binding protein 3 concentrations, and urinary hydroxyproline. These increases were not affected by soy with either normal or reduced isoflavone content. Similarly, histomorphometry revealed a greater bone formation rate with ovariectomy, and this was not altered by the soy diets. The findings of this study suggest that isoflavones in soy protein are responsible for its bone-sparing effects. Further studies to evaluate the mechanism of action of isoflavones on bone are warranted.

Bragg grating fabrication in germanosilicate fibers by use of near-UV light: a new pathway for refractive-index changes.

Using 334-nm light, we demonstrate side writing of Bragg gratings with an index change of ~10(-4) in germanium-doped fibers. No hydrogen loading of the fibers was required. These gratings have the same temperature stability as gratings fabricated with 240-nm light. Our results suggest that photoionization is not needed for formation of gratings in Ge-doped glass. We observe an enhancement of the 334-nm photosensitivity in boron-codoped fibers and suggest that B facilitates a structural transformation of the glass.

Ultrashort pulse propagation in multiple-grating fiber structures.

We propose a multiple-grating fiber structure that decomposes an ultrashort broadband optical pulse simultaneously in both wavelength and time. As an initial demonstration, we used a transform-limited 1-ps Gaussian pulse centered at 1.55 mu;m as the ultrashort broadband input into a three-grating fiber structure and generated three output pulses separated in wavelength and time with good correlation between experimental results and simulations. This device structure can be used to generate a multiwavelength train of pulses for use in wavelength-division-multiplexed systems or to implement frequency-domain encoding of coherent pulses for optical code-division multiple access.

Native and partially hydrolyzed psyllium have comparable effects on cholesterol metabolism in rats.

This study was conducted to determine whether the storage conditions and the levels of psyllium in the diet modulate its hypocholesterolemic effects. Seventy-five male Sprague-Dawley rats, age 90 d, were randomly divided into five treatment groups and were fed cholesterol-containing diets for 21 d. Diets included 10% cellulose (control); 5 or 10% psyllium stored 8 mo at 5 degrees C (PS5); or 5 or 10% psyllium stored 8 mo at 40 degrees C (PS40). The higher storage temperature caused a gradual decrease in molecular weight of the psyllium, as measured by changes in solution viscosity. Hepatic rates of sterol synthesis were significantly (P < 0.001) higher in all of the psyllium-fed rats compared with control rats [21 +/- 2, 312 +/- 35, 464 +/- 40, 328 +/- 49 and 439 +/- 57 nmol [3H]digitonin-precipitable sterol (DPS)/(g liver x h), respectively, for control, 5% PS5, 10% PS5, 5% PS40 and 10% PS40]. A similar trend was observed in intestinal rates of sterol synthesis, and the difference was significant (P < 0.05) for all treatment groups except the 5% PS5-fed group compared with the control group. Liver total cholesterol and total lipid concentrations were significantly lower in all psyllium-fed rats compared with controls. There were no significant differences in serum total cholesterol concentrations among the psyllium-fed groups, although serum cholesterol levels in both the PS5-fed groups were significantly (P < 0.05) lower than that in the control group (2.66 +/- 0.18, 2.62 +/- 0.15 and 3.26 +/- 0.12 mmol/L, respectively, for 5% PS5, 10% PS5 and control). Serum triglyceride and HDL cholesterol concentrations did not vary significantly among groups. The findings of this study indicate that the cholesterol-lowering activity of psyllium is unaltered by storage conditions shown to cause a moderate degree of hydrolysis.

Epidemiology of current treatment for sexual dysfunction in spinal cord injured men in the USA model spinal cord injury centers.

This study is a prospective multicenter cooperative survey of the evaluation and treatment of erectile dysfunction in men with spinal cord injury (SCI). Uniform database questionnaires were completed prospectively by patients seeking therapy for erectile dysfunction. Eighty-five SCI men aged 17-68 years (mean age = 26 +/- 17) were enrolled. Mean duration of traumatic SCI was 3 +/- 3.2 years (Range = 0.3-18 years). The level of injury was cervical in 20 patients, thoracic in 31, lumbar in 29 and sacral in five. Patients were fully evaluated and then counseled as to their therapeutic options. Twenty-eight chose to use a vacuum erection device (VED), 26 preferred pharmacological penile injection and five used both intracorporeal therapy and VED. The remainder were managed with marriage and sexual counseling in 10 patients, three underwent penile prosthesis placement and two used topical pharmacotherapy. Four patients used other forms of treatment and in nine no therapy was recommended. Of the patients that used pharmacologic injection only, 74 percent used papaverine as a single agent, 20 percent used papaverine with phentolamine, five percent used prostaglandin E (PGE1) alone and one percent used a mixture. Patients using injection therapy report sexual intercourse a mean of 3 +/- 3.4 times per month as compared with 5 +/- 3.2 times per month in those using VED. Five intracorporeal injection patients developed priapism while two patients using the VED developed subcutaneous bleeding and one developed penile ischemia. We conclude that although a spectrum of erectile dysfunction treatment is present among SCI centers, VED and pharmacological penile injection are by far the two most popular methods of treatment and papaverine is the most common drug. The incidence of complications is small in the model centers.

Psychogenic impotence in spinal cord injury patients.

OBJECTIVE: To compare subjective assessments of erectile function with results obtained from nocturnal penile tumescence and rigidity (NPTR) monitoring in patients with spinal cord injury (SCI). DESIGN: A prospective study. SETTING: Erectile function questionnaires were completed by each patient. NPTR monitoring was performed at the patient's home with the Rigiscan system. PATIENTS: Thirty SCI patients (8 cervical, 16 thoracic, 5 lumbar, 1 sacral) were between 22 and 75 (mean 48) years old. Twenty patients (67%) had complete SCI and 10 patients (33%) had incomplete SCI with mean duration since injury of 14 years. MAIN OUTCOME MEASURES: The results from two consecutive nights of NPTR monitoring were compared with each patient's own response to our erectile function questionnaire. RESULTS: Twenty-three patients (77%) reported normal erectile function: 16 had normal NPTR studies and the remaining 7 had abnormal NPTR studies. Seven patients (23%) reported poor-to-absent erectile function: 3 had normal NPTR studies and 4 had abnormal NPTR studies. All 10 patients (100%) with incomplete SCI had NPTR studies that corroborated their own assessment of erectile function, compared to 11 of 20 patients (55%) with complete SCI. NPTR studies in the remaining 9 patients (45%) with complete SCI were inconsistent with their own assessment of erectile function. CONCLUSION: A direct correlation (p<.05) existed between incomplete SCI patients' NPTR studies and their own assessment of erectile function. Complete SCI patients demonstrated significant discrepancy between their own assessments of erectile function and results from NPTR studies. Incomplete SCI patients tended to maintain normal erectile function, as opposed to complete SCI patients. Ten percent of SCI patients who reported erectile dysfunction may actually be suffering from psychogenic impotence.

Transurethral fulguration of the prostate with the roller ball.

OBJECTIVES: To assess the histologic changes in the prostate and the clinical outcome in men with symptomatic benign prostatic hyperplasia (BPH) following transurethral fulguration of the prostate (TUFP) with the roller ball. METHODS: The study was conducted in two phases. In the first phase of the study, histologic changes in the prostate following fulguration with the roller ball were studied in 10 men with BPH who were already scheduled for transurethral resection of the prostate (TURP). In the second phase of the study, 20 male patients with symptomatic BPH underwent TUFP with the roller ball. All patients had preoperative assessment with history and physical examination, urinalysis, uroflow, transrectal ultrasound of the prostate, serum prostate-specific antigen, serum hemoglobin and electrolytes, and cystoscopy. The procedure was performed under general or spinal anesthesia using standard equipment and 3-mm roller ball. The patients were seen in follow-up at 1, 3, 6, 9, and 12 months. RESULTS: The results of the first phase of the study indicate that the coagulating current results in thermal destruction of prostatic tissue in the form of coagulative necrosis with minimal if any vaporization. The cutting current results in tissue vaporization with minimal coagulative necrosis. Twenty men have enrolled in the second phase of the study. Their mean age is 63.2 +/- 7.5 years and their mean follow-up is 4.6 months (range, 1 to 12). Their mean American Urological Association (AUA) symptom score declined from 22.9 +/- 4.2 preoperatively to 6.4 +/- 4.9, 5.3 +/- 3.2, 4.3 +/- 1.9, 6 +/- 2.9, and 9 at 1, 3, 6, 9, and 12 months, respectively. The mean maximum flow rate (Qmax) increased from 8.9 +/- 3.4 mL/s preoperatively to 24.3 +/- 1.9 mL/s at 3 months, 22 +/- 4.4 mL/s at 6 months, 17.6 +/- 5 mL/s at 9 months, and 21 mL/s at 12 months postoperatively. The mean prostate volume was 31.9 +/- 10 mL and the mean operative time was 44.9 +/- 10 minutes. No significant changes were seen in serum hemoglobin and serum sodium. The mean hospital stay was 0.7 day (0 to 2). Nineteen patients had their catheters removed within 24 hours and 1 patient had his catheter removed 48 hours postoperatively. No patient experienced impotence, incontinence, urethral stricture, post-transurethral resection syndrome, or required blood transfusion. In 1 patient (5%) bladder neck stenosis developed at 9 months and 1 patient required TURP for residual apical adenoma at 3 months. CONCLUSIONS: The nature and the degree of tissue changes in the prostate following fulguration with the roller ball are well controlled and predictable. When the cutting current is used, prostatic tissue can be removed safely and effectively. The clinical outcome after TUFP with the roller ball demonstrates significant improvement in subjective (AUA symptom score) and objective (Qmax) parameters, with reduced morbidity and short hospital stay. These early results compare favorably with those seen after TURP and laser ablation of the prostate. Larger series with longer follow-up are necessary to establish the long-term efficacy of TUFP in the treatment of BPH.

Anterior vaginal suspension for vaginal vault prolapse.

Vaginal prolapse may occur following hysterectomy or may evolve with the uterus in place. Current treatment options for vaginal prolapse have a limited success rate or are associated with significant morbidity. In this retrospective review, we present our experience with a new procedure for repair of vaginal prolapse. This technique relies on anterior suspension of the vaginal vault to the anterior rectus sheath in a fashion similar to bladder neck suspension. Forty patients have undergone this procedure. All patients had vaginal prolapse, cystocele, and urinary incontinence. In addition, 34 patients had enterocele, six had uterine prolapse, 33 had rectocele, and two had urethral diverticula. All patients had anterior vaginal suspension (AVS), with cystocele repair and bladder neck suspension. Six patients had vaginal hysterectomy, 34 had enterocele repair, 33 had rectocele repair, and two had urethral diverticulectomy. The mean hospital stay was 2.5 days (range, 1-7 days), and their mean follow-up was 30 months (range, 12-54 months). Thirty-six (90%) patients have excellent support of the vagina with no evidence of recurrent cystocele, enterocele, or rectocele. Four (10%) patients have recurrent enterocele. Thirty-three (82.5%) patients are dry or have rare episodes of urinary incontinence (less than one episode/month), whereas four (10%) patients have recurrent stress incontinence and three (7.5%) have urge incontinence. Constipation and fecal incontinence were resolved in all patients. All patients who were sexually active preoperatively remained so postoperatively, and none reported dyspareunea. Vaginogram in 10 patients demonstrated that posterior angulation of the vaginal axis was retained in all patients. AVS is associated with an excellent success rate in terms of resolution of symptoms and correction of prolapse. Morbidity is minimal, and hospital stay is short. The technique is simple and relies on anatomy that is familiar to all urologists. In addition, the vaginal approach allows for simultaneous correction of all components of vaginal prolapse and any associated vaginal pathology.

Magnetic resonance imaging of the UroLume urethral stent.

We discuss the use of magnetic resonance imaging of the pelvis in a patient with the UroLume urethral stent. This case demonstrates that magnetic resonance imaging is a safe and effective modality for imaging tissue surrounding the stent.