Antibiotic prophylaxis in invasive urodynamics, a Delphi consensus of the Italian Society of Urodynamics (SIUD).

INTRODUCTION: Although antibiotic prophylaxis (AB) demonstrated a statistically significant reduction in bacteriuria after invasive urodynamics (UDS), no significant decrease in the incidence of urinary tract infections (UTI) has been confirmed. No absolute recommendations on the use of AB in case of relevant potential risk of UTI have been reported, though some categories of patients at increased infective probability after UDS have been recognized. The aim of this study is to report the experts' consensus on the best practice for the use of AB before UDS in the main categories of patients at potential risk of developing UTI. MATERIALS AND METHODS: A systematic literature review was performed on AB before UDS in males and females. A panel of experts from the Italian Society of Urodynamics, Continence, Neuro-Urology, and Pelvic Floor (SIUD) assessed the review data and decided by a modified Delphi method on 16 statements proposed and discussed by the panel. The cut-off percentage for the consensus was a ≥70% of positive responses to the survey. The study was a Delphi consensus with experts' opinions, not a clinical trial involving directly patients. RESULTS: The panel group was composed of 57 experts in functional urology and UDS, mainly urologists, likewise gynaecologists, physiatrists, infectivologists, pediatric urologists, and nurses. A positive consensus was achieved on 9/16 (56.25%) of the statements, especially on the need for performing AB before UD in patients with neurogenic bladder and immunosuppression. Urine analysis and urine culture before UDS are mandatory, and in the event of their positivity, UDS should be postponed. A consensus was reached on avoiding AB in menopausal status, diabetes, age, gender, bladder outlet obstruction, high postvoid residual, chronic catheterization, previous urological surgery, lack of urological abnormalities, pelvic organ prolapse, and negative urine analysis. CONCLUSIONS: Antibiotic prophylaxis is not recommended for patients without notable risk factors and with a negative urine test due to the potential morbidities that may result from antibiotic administration. However, AB can be used for risk categories such as neurogenic bladder and immunosuppression. The evaluation of urine analysis and urine culture and postponing UDS in cases of positive tests were considered good practices, as well as performing AB in the neurogenic bladder and immunosuppression.

Infection Rate after Transperineal Prostate Biopsy with and without Prophylactic Antibiotics: Results from a Systematic Review and Meta-Analysis of Comparative Studies.

PURPOSE: We performed a systematic review comparing the incidence of infectious complications following transperineal ultrasound-guided prostate biopsy (TPB) in cases utilizing antibiotic prophylaxis (AP) vs cases not utilizing antibiotic prophylaxis (NAP). MATERIALS AND METHODS: The incidences of complications were pooled using the Cochran-Mantel-Haenszel method with the random effect model and expressed as risk ratio (RR). RR higher than 1 indicates an increased risk of complication in patients undergoing TPB without antibiotics. Statistical significance was set at p <0.05 and 95% CI. RESULTS: A total of 1,748 papers were retrieved. After the screening process, 8 studies were included in the quantitative analysis (4 retrospective, and 4 prospective and nonrandomized), reporting on 3,662 patients. A total of 2,368 patients underwent TPB utilizing AP and 1,294 underwent TPB utilizing NAP. The pooled rates of post-biopsy fever from 6 available studies reporting this parameter were 0.69% in the AP group and 0.47% in the NAP group (RR: 1.02, 95% CI: 0.02-44.55, p=0.99). The pooled rates of post-biopsy genitourinary infections from 8 available studies reporting this parameter were 0.11% in the AP group and 0.31% in the NAP group (RR: 2.09, 95% CI: 0.54-8.10, p=0.29). The pooled rates of post-biopsy sepsis over 8 studies reporting this parameter were 0.13% in the AP group and 0.09% in the NAP group (RR: 1.09, 95% CI: 0.21-5.61, p=0.92). The pooled rates of post-biopsy readmission for infections over 8 studies reporting this parameter were 0.13% in the AP group and 0.23% in the NAP group (RR: 1.29, 95% CI: 0.31-5.29, p=0.73). Death due to post-biopsy sepsis did not occur in any study. CONCLUSIONS: This systematic review found no significant difference in infection rate, fever, sepsis or readmission rate after TPB between those cases utilizing AP and those cases without AP.

The International Female Coital Incontinence Questionnaire (IFCI-Q): Development, Validation and Reliability Study.

INTRODUCTION: Coital urinary incontinence is an underestimated urinary symptom characterized by urine leakage during intercourse with a serious impact on female sexual function, which often may lead to the abandon of sexual activity. To date, there are no specific validated questionnaires for coital incontinence (CI). AIM: Aim of the study was to develop and validate a questionnaire "International Female Coital Incontinence- Questionnaire" (IFCI-Q) to evaluate the presence, severity and type of CI and its impact on quality of sexual intercourse. METHODS: The IFCI-Q validation process included the following stages: (i) Questionnaire development and expert focus group (urologists and gynecologists experts in the field of functional urology); (ii) Administration of IFCI-Q to sexually active women complained for CI, by cognitive interview; (iii) Expert focus group to assess for content validity; (iv) Psychometric assessment of internal consistency by Cronbach's alpha calculation; (v) Test-retest reliability. MAIN OUTCOME MEASURE: Aim of the questionnaire was to evaluate the presence, severity and type of CI, its impact on quality of sexual intercourse and psychological status and to identify concomitant urinary symptoms. Psychometric properties outcomes: internal consistency and reliability are considered acceptable for Cronbach's α coefficient >0.7 and Cohen's k-test >0.6, respectively. Test-retest reliability was detected by administering the questionnaire twice to the all included women with a time interval of 2 weeks. The content validity was evaluated by a panel of clinical experts. RESULTS: Thirty women (mean ± SD age: 43.4 ± 17.1 years) complained of CI completed the IFCI-Q. A total of 43.4% of patients had OAB symptoms, 23.3% had mixed urinary incontinence (UI) and 6.6% complained of stress UI. Patients with CI during penetration had a higher prevalence of predominant SUI (7/10), and all women suffering from CI during orgasm had OAB symptoms (11/11). A total of 80% women feel depressed and 56.6% patients reported that CI restricts their sexual activity. Internal consistency and replicability of data were in the adequate range (Cronbach α = 0.737). The test-retest procedure revealed that the k-values of each item are very good. CONCLUSION: IFCI-Q is a reliable questionnaire on CI and demonstrated a high level of internal consistency and reliability. Gubbiotti M, Giannantoni A, Rubilotta E, et al. The International Female Coital Incontinence Questionnaire (IFCI-Q): Development, Validation and Reliability Study. J Sex Med 2022;19:158-163.

Does a tailored magnetic resonance imaging technique affect the surgical planning and outcomes for different cystic urethral and periurethral swellings in females? Seven years tertiary center experience.

PURPOSE: To evaluate the use of magnetic resonance imaging (MRI) in preoperative delineation and surgical planning for the management of female urethral and periurethral cystic vaginal swellings, with emphasis on postoperative surgical outcomes. MATERIALS AND METHODS: This is a retrospective analysis of females complaining of periurethral and urethral cystic swellings referred to our tertiary center, who underwent MRI for preoperative planning in the period from January 2014 till January 2021, with a total number of 57 patients. Data retrieved from the medical records included: patients' demographics, presenting symptoms and signs, preoperative radiological investigations, duration of symptoms, previous surgical intervention, detailed intraoperative data, postoperative complications, and postoperative follow-up. RESULTS: Urethral diverticulum was the commonest cystic lesion representing (64.9%) followed by Skene gland cysts in 14%, Mullerian cysts in 7%, Gartner cysts in 3.5%, and dermoid inclusion cysts in 10.5%. MRI precisely diagnosed the various pathological entities and anatomical complex lesions prior to surgery. This was confirmed after surgery and pathology analysis. All patients were followed up with a mean duration of 35 months, without any evidence of recurrence. CONCLUSION: MRI as a standalone imaging technique is mandatory for diagnosis of all urethral and periurethral cystic lesions, as it offers the most accurate diagnostic modality for delineation of these lesions and hence aids in the preoperative surgical planning, aiming to avoid recurrence and improving surgical outcomes.

Urethral stricture following endoscopic prostate surgery: a systematic review and meta-analysis of prospective, randomized trials.

INTRODUCTION AND OBJECTIVES: This systematic review aims to evaluate the incidence and influencing factors of urethral stricture (US) in relation to different BPH endoscopic techniques. MATERIALS AND METHODS: We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The incidence of US was estimated through comparative studies between different endoscopic techniques. Patients were assigned into groups according to the type of surgery (enucleation, ablation and resection group). Incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values. RESULTS: A total of 80 studies were included for meta-analysis. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39-0.84, p = 0.004). US incidence was lower for Ablation procedures than TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61-1.3, p = 0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49-0.91, p = 0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12 months after surgery (RR 0.51 95% CI 0.33-0.81, p = 0.004). CONCLUSION: The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization.

Current trends in erectile rehabilitation after radical prostatectomy: Results from a worldwide survey.

We aimed to analyse the current trend of erectile rehabilitation (ER) following radical prostatectomy (RP) using a dedicated survey. An online survey was developed between July and September 2020, aiming to evaluate the ER protocols after RP in daily practice among urologists, andrologists, sexual medicine specialists and residents. We investigated demographics data, type of RP performed, and type, schedule, timing and duration of ER protocols. In total, 518 responders from 52 countries completed the survey. Surgical techniques reported were: 38.9% open, 22.9% laparoscopic and 38.2% robot-assisted RP. 33% of the responders begin ER at the catheter removal, 22% 1 month after surgery and 15% before surgery. Phosphodiesterase inhibitors were the most used medication as first-line treatment (99.4%). Tadalafil 20 mg was the most prescribed, and used daily in 48.2% of the cases, and 2-3 times/week in 46%. Intra-cavernosal injection of prostaglandin E1 was the second most common prescribed monotherapy (67.9%) followed by the association of phosphodiesterase inhibitors and vacuum-erection device (29.6%). The duration of ER was <6 months in 16.2%, between 6 and 11 months in 39%, between 12 and 18 months in 31.9%, between 19-24 months in 9.2% and >24 months in 3.7%. This study showed that the approach to ER after RP was inhomogeneous. International guidelines are urgently needed to standardise ER protocols.

Nephrostomy tube versus double J ureteral stent in patients with malignant ureteric obstruction. A systematic review and meta-analysis of comparative studies.

PURPOSE: We aimed to perform a systematic review to assess perioperative outcomes, complications, and survival in studies comparing ureteral stent and percutaneous nephrostomy in malignant ureteral obstruction. MATERIALS AND METHODS: This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Meta-analyses were performed on procedural data; outcomes; complications (device-related, accidental dislodgement, febrile episodes, unplanned device replacement), dislodgment, and overall survival. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel method with the random effect model and reported as Odds Ratio (OR), and 95% CI. Statistical significance was set two-tail p-value < 0.05 Results: Ten studies were included. Procedure time (MD -10.26 minutes 95%CI -12.40-8.02, p< 0.00001), hospital stay (MD -1.30 days 95%CI -1.69 - -0.92, p< 0.0001), number of accidental tube dislodgments (OR 0.25 95% CI 0.13 - 0.48, p< 0.0001) were significantly lower in the stent group. No difference was found in mean fluoroscopy time, decrease in creatinine level post procedure, overall number of complications, interval time between the change of tubes, number of febrile episodes after diversion, unplanned device substitution, and overall survival. CONCLUSION: Our meta-analysis favors stents as the preferred choice as these are easier to maintain and ureteral stent placement should be recommended whenever feasible. If the malignant obstruction precludes a stent placement, then PCN is a safe alternative.

Increased risk of transurethral and suprapubic catheter self-extraction in COVID-19 patients: real-life experience.

INTRODUCTION: This study evaluated the prevalence of transurethral catheter self-removal in critically-ill COVID-19 non-sedated adult patients compared with non-COVID-19 controls. METHODS: COVID-19 patients who self-extracted transurethral or suprapubic catheters needing a urological intervention were prospectively included (group A). Demographic data, medical and nursing records, comorbidities and nervous system symptoms were evaluated. Agitation, anxiety and delirium were assessed by the Richmond Agitation and Sedation Scale (RASS). The control group B were non-COVID-19 patients who self-extracted transurethral/suprapubic catheter in a urology unit (subgroup B1) and geriatric unit (subgroup B2), requiring a urological intervention in the same period. RESULTS: 37 men and 11 women were enrolled in group A. Mean RASS score was 3.1 ± 1.8. There were 5 patients in subgroup B1 and 11 in subgroup B2. Chronic comorbidities were more frequent in group B than the COVID-19 group (P<0.01). COVID-19 patients had a significant difference in RASS score (P<0.006) and catheter self-extraction events (P<0.001). Complications caused by traumatic catheter extractions (severe urethrorrhagia, longer hospital stay) were greater in COVID-19 patients. CONCLUSION: This is the first study focusing on the prevalence and complications of catheter self-removal in COVID-19 patients. An increased prevalence of urological complications due to agitation and delirium related to COVID-19 has been demonstrated-the neurological sequelae of COVID-19 must be considered during hospitalisation.

Bladder neck stenosis after transurethral prostate surgery: a systematic review and meta-analysis.

PURPOSE: Bladder neck stenosis (BNS) is a long-term complication of surgical procedures for benign prostatic hyperplasia (BPH). We performed a systematic literature review and a meta-analysis of the incidence of BNS after transurethral procedures for BPH. METHODS: We performed a systemic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. We accepted only randomized trials comparing transurethral resection of the prostate (TURP) vs. other transurethral surgery for BPH that were grouped in Ablation vs. Enucleation modalities. The incidences of BNS were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and expressed as Risk Ratios, 95% Confidence Intervals, and p values. Study heterogeneity was assessed utilizing the I2 value. RESULTS: 72 studies were identified for meta-analysis, 46 comparing TURP vs. Ablation and 26 TURP vs. Enucleation. The pooled incidence of BNS was 1.3% after TURP, 0.66% after enucleation and 1.2% after Ablation. The incidence of BNS was higher after TURP than after Enucleation but the difference was not statistically significant (RR 1.75 95% CI 0.81-3.79, p = 0.16). There was no significant heterogeneity among the studies (I2 0%, Chi2 4.11, p = 0.90). The incidence of BNS was higher after TURP than after Ablation, but the difference was not statistically significant (RR 1.31, 95% CI 0.82-2.11, p = 0.26) with no significant heterogeneity (I2 0%, Chi2 21.1, p = 0.51). CONCLUSION: Our study showed no difference in the rate of BNS incidence among randomized trials comparing TURP vs. Ablation vs. Enucleation and can be used as a reference to counsel patients undergoing BPH surgery.

Resilience in the face of pelvic pain: A pilot study in males and females affected by urologic chronic pelvic pain.

AIMS: Resilience represents a fundamental element in the experience of pain, as it allows adaptation to suffering and increases psychological social well-being and quality of life (QoL). We investigated resilience in patients affected by urologic chronic pelvic pain (UCPP) and the relationships with pain severity and distribution, catastrophizing and psychological distress. METHODS: Forty-eight consecutive UCPP patients were classified on a pain body map as being affected by pelvic pain only or widespread pain (WP), and underwent the evaluation of resilience with the 14-item Resilience Scale (RS-14), with higher scores indicating high resilience levels; scores < 56 denote very poor resilience. Pelvic and nonpelvic pain intensity and the bother of urinary symptoms on QoL were measured by means of Pain Numerical Rating Scale (PNRS) and Visual Analog Scale (VAS). Pain Catastrophizing Scale (PCS) and Depression Anxiety Stress Scales (DASS-21) investigated catastrophizing and psychological conditions. RESULTS: Overall, RS-14 mean ± SD total score was 50.2 ± 12.5 in patients with pelvic pain only and 40.2 ± 10.2 in those with WP. Significant relationships were observed between low resilience levels and high scores of pelvic and nonpelvic PNRS, VAS, pain catastrophizing scale and depression and anxiety, stress scale (for all: p < 0.001). Significantly lower RS-14 scores were detected in females and in patients with WP. CONCLUSIONS: A very poor resilience has been identified in UCPP patients, particularly in those with greater catastrophizing and mood alterations. WP and female gender were mostly affected. In UCPP patients, low resilience appears as a crucial factor in pain experience.

Continuing care for patients affected by urologic chronic pelvic pain in the era of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic.

AIMS: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic poses a challenge to treatment of patients with urologic chronic pelvic pain (UCPP), who are at risk to be postponed in the priority of care. We investigated pain, catastrophizing, and psychological status in UCPP patients during SARS-CoV-2 by means of Skype telephone calls. METHODS: A total of 28 UCPP patients underwent Skype video consultations. Pain intensity was assessed with Pain Numerical Rating Scale (PNRS). Pain Catastrophizing Scale (PCS) and Depression Anxiety Stress Scales (DASS-21) were used to assess catastrophizing and psychological status. RESULTS: During SARS-CoV-2, UCPP patients showed higher intensity of pain than before (mean ± SD PNRS score: 7.25 ± 0.9 vs. 5.4 ± 0.7; p < .0001), with pain exacerbation in 75%; they showed higher PCS and DASS-21 scores as compared to before the pandemic (mean ± SD PCS total score: 32.4 ± 1.2 vs. 23.7 ± 3.5; mean ± SD DASS-21 total score: 42.03 ± 4.5 vs. 34.4 ± 2.2; p < .001 and p < .001, respectively). CONCLUSION: During SARS-CoV-2 pandemic UCPP patients presented with high intensity of pain, marked catastrophizing thoughts and severe alteration of the psychological status. These observations impose the need not to postpone assessment and treatment of these patients during the pandemic. Remote visits with video telephone calls are a simple way of continuing care in UCPP patients.

Urodynamics criteria of detrusor underactivity in women underwent middle urethral sling for stress urinary incontinence: What is the clinical role?

AIMS: To assess the role of detrusor underactivity (DUA), diagnosed by different urodynamic criteria, on outcomes of women underwent middle urethral sling (MUS) for stress urinary incontinence (SUI). METHODS: In this prospective study, DUA criteria of women with SUI, naïve for SUI surgery, candidates to MUS were: I Pdet@Qmax ≤10 cm H2O and Qmax ≤12 mL/s (Jeong et al.) ii Pdet@Qmax<30 cm H2O and Qmax<10 mL/s (Abarbanel and Marcus) iii Pdet@Qmax<20 cm H2O and Qmax<15 mL/s and BVE < 90% (BVE criteria) iv Pdet@Qmax<20 cm H2O + Qmax (PIP1 Griffiths) Control group (CG) comprised non-DUA patients. Preoperative and at 2-years follow-up evaluation included physical examination, uroflowmetry, post void residual urine (PVR), ICIQ-FLUTS. RESULTS: 102 patients fulfilled 2-years controls. DUA rate range was 16.7% (BVE) - 53.9% (PIP1-Griffith). The POUR rate varied: 20% (PIP1-Griffith) - 35.3% (BVE), 10% in CG. Tape incision rate for POUR was 3.4% in DUA, 4.5% in CG. No patients had urinary retention at 2-years follow-up. In DUA groups, Qmax did not change significantly after surgery and PVR was low. SUI recurrence rate was 2.8% in DUA, 4.5% in CG. Preoperatively, urgency and post-micturition dribble were the most (82.4%) and the less (26.7%) reported symptoms, respectively. At follow-up, frequency was the most prevalent (56.1%), reduced sensation/bladder pain the less usual (23.1%). ICIQ-FLUTS scores were higher in DUA groups. CONCLUSIONS: DUA did not have a negative impact on MUS outcomes in a mid-term follow-up. Early postoperative voiding complication rates changed according to the type of DUA urodynamic criteria.

Comparison between thulium laser vapoenucleation and plasmakinetic resection of the prostate in men aged 75 years and older in a real-life setting: a propensity score analysis.

BACKGROUND: Urologists may hesitate to offer transurethral resection of the prostate (TURP) because of increased morbidity in elderly patients. AIMS: We aimed to compare data on postoperative outcomes of elderly men undergoing bipolar transurethral resection of the prostate (B-TURP) as compared to thulium laser vapoenucleation of the prostate (ThuVEP). METHODS: We retrospectively reviewed data of all patients aged ≥ 75 years who underwent benign prostatic hyperplasia surgery. Differences between interventions were estimated using propensity scores (PS) to adjust for different patients characteristics. RESULTS: Between 2017 and 2020, 275 men were included in the analysis. Propensity score retrieved 65 patients in each group. Median age was 78 (4) years in B-TURP group and 78 (6) in ThuVEP group. Median prostate volume was 63 (35) ml and 54 (24) ml in B-TURP group and ThuVEP group, respectively. Only American Society of Anesthesiologists score was significantly higher in ThuVEP group (p = 0.006). Median operation time, catheterization time, and hospital stay were similar in both groups (55 min, 2 and 3 days). Overall, 84.6% of men had no complications, with no significant differences between the groups (p = 0.234). Only one patient in B-TURP group experienced a Clavien grade IIIb complication. By 1 year, there were a statistically significant differences in International Prostate Symptom Score (p = 0.000) in favor of B-TURP group and in maximal urine flow rate (p = 0.000) in favor of ThuVEP group. DISCUSSION AND CONCLUSIONS: Both procedures showed excellent functional improvements one year after surgery with a low rate of major complications in men aged ≥ 75 years with small-to-medium sized prostates.

Outcomes of transurethral resection of the prostate in unobstructed patients with concomitant detrusor underactivity.

AIMS: The aim of the study was to evaluate the transurethral resection of the prostate (TURP) outcomes of unobstructed patients with detrusor underactivity (DUA), comparing the surgical results between obstructed and unobstructed males with concomitant DUA, at midterm follow-up. METHODS: This was an observational, prospective, comparative, nonrandomized study. Candidates to TURP underwent preoperative urodynamics (UD), with a diagnosis of DUA, were divided in two cohorts: Group A unobstructed men, group B males with bladder outlet obstruction (BOO). Males were evaluated yearly with uroflowmetry (UF), post-void residual (PVR), and bladder voiding efficiency (BVE), International Prostate Symptom Score (IPSS) questionnaire, visual analogic scale (VAS) for subjective assessment of the quality of life. The degree of the variation of maximum flow rate (Qmax), PVR, BVE, IPSS, VAS between baseline and follow-up (Δ) was evaluated. RESULTS: Patients in group A were 28 and in group B 23. Overall patient's mean ± SD age was 63.37 ± 12.41 years. Preoperative urodynamics characteristics: mean bladder contractility index (BCI) of 61.15 and 76.25 in group A and B, respectively; mean bladder outlet obstruction index (BOOI) of 17.25 and 50.15 in group A and group B, respectively. After surgery, overall patient group, group A, and group B showed a statistical improvement in IPSS score (P < .0001), Qmax (P < .0001), PVR (P < .0008), BVE (P < .03) and VAS (P < .0001). CONCLUSIONS: BOO had an important impact on the degree of improvement of Qmax and PVR/BVE, while had a poor influence on lower urinary tract symptoms amelioration. The most relevant outcomes were found when BOO was associated with DUA, which was not a contraindication to surgery.

What urologists need to know about ketamine-induced uropathy: A systematic review.

AIMS: Ketamine is a general anesthetic. Dissociative effects and low cost led ketamine becoming an illegal recreational drug in young adults. Ketamine-induced uropathy (KIU) is one of the complications observed in abusers. This study aimed to provide a systematic literature review on KIU clinical presentation, pathophysiology, and treatments. METHODS: We performed the literature search in PubMed, Web of Science, Scopus, and Embase using the terms ketamine and bladder. English papers on human and animal studies were accepted. RESULTS: A total of 75 papers were selected. Regular ketamine users complain about severe storage symptoms and pelvic pain. Hydronephrosis may develop in long-term abusers and is correlated to the contracted bladder, ureteral stenosis, or vesicoureteral reflux due to ureteral involvement and/or bladder fibrosis. Cystoscopy shows ulcerative cystitis. Ketamine in urine might exert direct toxicity to the urothelium, disrupting its barrier function and enhancing cell apoptosis. The presence of ketamine/ions in the bladder wall result in neurogenic/IgE-mediated inflammation, stimulation of the inducible nitric oxide synthase-cytokines-cyclooxygenase pathway with persistent inflammation and fibrosis. Abstinence is the first therapeutic step. Anti-inflammatory drugs, analgesics and anticholinergics, intravesical instillation of hyaluronic acid, hydrodistension and intravesical injection of botulin toxin-A were helpful in patients with early-stage KIU. In patients with end-stage disease, the control of intractable symptoms and the increase of bladder capacity were the main recommendations to perform augmentation enterocystoplasty. CONCLUSIONS: KIU is becoming a worldwide health concern, which should be taken into account in the differential diagnosis of ulcerative cystitis.

Bladder and bowel dysfunction, adaptive behaviour and psychiatric profiles in adults affected by autism spectrum disorders.

AIMS: Bladder and bowel dysfunction (BBD) have been recognized in children affected by autism spectrum disorder (ASD), but no consistent information exist in adults with the condition. We evaluated the prevalence of BBD and the impact of psychiatric and behavioural profiles in adults affected by ASD. METHODS: Twenty-two adults and 13 children/teens with ASD and a matched group of typically developing subjects (TD) were prospectively studied. Patients and TD subjects underwent the evaluation of urinary incontinence (UI: diurnal, continuous or intermittent), nocturnal enuresis (NE), and bowel disturbances with the 3-day voiding and bowel diary. In addition, assessment of intellectual disability (ID) and psychiatric and adaptive behaviours with the Neuropsychiatric Inventory Scale (NPI) and the Vineland Adaptive Behaviour Scale 2nd Edition (Vineland-II), was performed. RESULTS: In adults, any type of incontinence was observed in 81.8% of cases, and NE and intermittent UI in 59.0% and 36.3% of patients, respectively. Faecal incontinence and constipation were detected 36.3% and in 68.1% of cases, respectively. ID was severe in 2 cases and profound in 18; NPI and Vineland-II items most affected were "Irritability/Lability," "Motor Activity," and "Agitation," and IQ-Socialization and IQ-Communication. Significant relationships were identified between intermittent UI and greater ID (P < .02) and high "anxiety" (P < .05), and between NE and high "euphoria/elevated mood" (P < .05). These results were similar to those observed in children/teens. CONCLUSIONS: Adults with ASD, and greater ID and mood disorders, present with a high prevalence of BBD. A shared pathogenetic mechanism could underlie the co-occurrence of ASD, mood disorders, and BBD.

Urodynamic findings and functional outcomes after laparoscopic sacrocolpopexy for symptomatic pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to evaluate the functional outcomes and urodynamic findings after laparoscopic sacrocolpopexy (LSC) in patients with stages II-IV pelvic organ prolapse (POP). METHODS: In this single-center prospective study, we evaluated 63 women (mean age 62.5 ± 7.5 years) women with symptomatic and advanced POP (stage II-IV) who underwent LSC without concomitant anti-incontinence surgery. The preoperative evaluation incuded history, clinical examination, and urodynamic testing. Women were followed up at 1, 3, 6, and 12 months after surgery and then annually using history, examination, and uroflowmetry. At 6 months, we performed urodynamic testing. To evaluate urinary symptoms, we used the Urogenital Distress Inventory (UDI)-6 questionnaire before and 6 months after surgery. RESULTS: Median follow- up was 22 months (range 8-48). After surgery, maximum flow (Qmax) significantly improved compared with baseline (14.17 ± 2.3 vs 27 ± 8.4 ml/s; p = 0.02), and the percentage of patients with elevated postvoid residual (PVR) significantly decreased (33.3% vs 11.1%; p = 0.001). Detrusor overactivity and bladder outlet obstruction disappeared in 73.6% and 85.7% of patients, respectively, while detrusor underactivity persisted in 66.6% of women. Twenty women (31.7%) reported stress urinary incontinence (SUI) before surgery (14 clinically evident and 6 as occult form), which persisted in only 7/20 (11%) patients following LSC, with no de novo cases. The most common preoperative symptoms were voiding symptoms, present in 42/63 (66.6%) patients, which resolved in 36 (85.7%). The overactive bladder syndrome disappeared in 60% of women, with no de novo cases. Results were reflected by a significant decrease in UDI-6 score from a median of 16 (0-45) at baseline to 5.5 (0-17) at the final follow-up (p = 0.001). The domain on storage symptoms (median 3 vs 1) and voiding symptoms (median 3 vs 1) of UDI-6 showed an improvement after surgery (p = 0.001). CONCLUSIONS: The urodynamic finding showed that LSC in women with advanced POP provides good functional outcomes.

The impact of Mirabegron on sexual function in women with idiopathic overactive bladder.

BACKGROUND: Overactive bladder (OAB) can frequently exert a negative effect on female sexual function. Mirabegron, a ß3 receptor agonist, improves OAB symptoms, but there are very few information about its role on female sexual dysfunction (FSD). Aim of the study was to assess the impact of Mirabegron on FSD in women affected by OAB. METHODS: Fifty sexually active women suffering from idiopathic OAB were included in the study. Patients were assessed by means of a urogynecologic physical examination and were asked to complete the 3-day voiding diary, the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-SF), the Female Sexual Function Index (FSFI) questionnaire and VAS, before and 12 weeks after treatment with Mirabegron. In addition, at the same time points, patients underwent uroflowmetry with the measurement of post- void residual volume (PVR). RESULTS: At baseline all patients were affected by OAB symptoms, with 49/50 patients (98%) presenting with FSD. At 12- weeks follow- up, OAB symptoms improved significantly in all patients, with 59.5% of subjects achieving a complete urinary continence. FSFI Total Score significantly improved in 42/50 patients (84%) from 18.9 ± 4.3 to 21.8 ± 4.5 (p < 0.0001). Sixteen cases (32%) presented with no FSD. Also mean ± SD scores of ICIQ-SF and VAS significantly improved (from 17.1 ± 5 to 7.9 ± 4.8 and from 3.9 ± 1.2 to 6.9 ± 1.2 respectively, p < 0.000). CONCLUSIONS: Mirabegron not only is able to control urinary symptoms in women with OAB, but also induces a significant improvement in their sexual life.

Beyond the Disease: "...Am I My Brother's Keeper?"

Today, the concepts of health and illness require a global vision of man; the suffering of the person places the entire environment in great difficulty: health professionals, family, society. It is important not to simplify the response to a purely health-focused view of the disorder, because fragile people possess a deep need to feel welcomed, listened to, understood and accepted. Service provision that is respectful of the dignity of the person is an important challenge both for those who are responsible for providing services to individuals and their families as well as for the entire community. Therefore in providing care the human qualities of the health professional and not only his technical skills come into play: blending together science and humanitarian ethos. The provision of care therefore "forces" us to broaden our horizons and requires us to face the challenge of responsibility towards the Other, the human condition of being-for. However, ethical capacity cannot be born solely out of sharing standards or adhering to regulations and respecting prohibitions: it stems from high and unconditional moral values and meanings. The ME-YOU relationship represents the primary ethical factor of the human being: my responsibility towards the Other is unconditional. In the book of Genesis when the Lord asks Cain: "... where is Abel, your brother?" He responds with another question: "Am I my brother's keeper?" In this biblical passage Cain kills Abel: the rejection of brotherhood and the care of the other only leads to the death of the Other. "Where is your brother?" This question is crucial in today's day and age and must be taken seriously: it is the decisive question that forces us to decide how to place ourselves in relationship with the other and with the world: do we choose proximity or distance, connection or indifference?

Urinary and bowel disfunction in autism spectrum disorder: a prospective, observational study.

BACKGROUND: Vesico- sphincter and bowel dysfunction have been frequently detected in Autism spectrum disorder (ASD) patients, but to date no consistent information exist on adults affected by the disease. We evaluated the prevalence and types of bladder and bowel disfunction (BBD) in young and adult patients affected by ASD. SUBJECTS AND METHODS: Twenty- seven adults and 20 children/teens with ASD and a matched group of typically developing subjects were enrolled. Daily pads use and episodes of urinary incontinence (UI) were recorded in a 3- day voiding diary. Patients underwent also the measurement of post-void urinary residual volume and 3- day bowel diary. In addition, type and duration of the pharmacological agents assumed by the patients were accurately recorded. RESULTS: Any type of UI was observed in 85.1% of adults and in 90% of children/teens. In adults, nocturnal enuresis (NE, 62.9%) and diurnal intermittent UI (37%) were the most frequently observed bladder dysfunction while in children/ teens were NE (75%) and diurnal continuous UI (40%). In all patients was demonstrated a significant relationship between urinary symptoms and pharmacological agents, particularly NE and clotiapine (p<0.004) and periciazine (p<0.008). CONCLUSIONS: Young and adult patients with ASD present with a high prevalence of BBD and concomitant antipsychotic medications could to play a contribution in induction and/or maintaining of BBD.