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.

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.

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.

Alternative Splicing of IGF1 Gene as a Potential Factor in the Pathogenesis of Peyronie's Disease.

BACKGROUND/AIM: Peyronie's disease (PD) is a fibrotic entity for which the pathogenetic mechanism remains unclear and if resulting in severe deformity, its treatment is only surgical. In this study we investigated the possible role of insulin-like growth factor 1 (IGF1) expression in the pathogenesis of PD. MATERIALS AND METHODS: Tissue samples were obtained from plaques of 24 patients with PD. The expression of IGF1 isoforms was investigated using quantitative real-time polymerase chain reaction and immunofluorescence. RESULTS: All IGF1 isoform gene expression (Ea, Eb and Ec) were found significantly decreased in the affected tunica albuginea, compared to normal tunica albuginea, with Ec showing the greatest decrease. Staining of tissue sections with an antibody against IGF1Ec confirmed greater expression of IGF1Ec isoform in normal tunica albuginea. CONCLUSION: The expression of all IGF1 alternative spliced isoforms is decreased in patients with PD, suggestive of its possible participation in the pathophysiology of PD.

Penile Mondor's disease: a case report.

INTRODUCTION: Thrombosis or thromboflebitis of the superficial dorsal vein of the penis, known as penile Mondor's disease was first described by Braun-Falco in 1955. CASE PRESENTATION: A physically healthy 32-year-old man proceed in our unit suffered from a painful swelling, on the dorsal aspect of his penis, being more painful during erections. Ultrasonography examination revealed a non-compressible portion of superficial dorsal vein as well as the lack of venous flow signals in Doppler ultrasonography and the patient was treated conservatively. CONCLUSION: Penile Mondor's disease is a rare clinical entity that every urologist should be able to recognize. Although it is a benign condition and usually self-limited, patients proceed to specialist with considerable psychological stress.