Management of Overactive Bladder in the Young Man
AbstractPurpose of ReviewIn this review, the current literature regarding idiopathic overactive bladder (OAB) in the young male will be discussed. We will also share the unique experience of providers at a single military institution in treating this specific patient population and their recommendations based on the unique etiologies, comorbidities, and treatment response and adherence.Recent FindingsDespite several studies addressing idiopathic OAB and providing the basis for existing guidelines, none offer guidance on how this syndrome affects a younger male population in whom OAB is less likely to be due to an obstructi...
Source: Current Bladder Dysfunction Reports - August 10, 2019 Category: Urology & Nephrology Source Type: research

Rectourethral Fistula: Operative Technique and Outcomes
AbstractPurpose of ReviewRectourethral fistula (RUF) is an infrequent yet distressing pathology that can lead to significant complications for patients. Its management has been debated over the years and physicians have yet to reach a consensus on RUF treatment. In this review, we outline the status of the current literature on RUF from the initial diagnosis to the outcomes, complications, and surgical techniques available for RUF repair.Recent FindingsHigher rates of success are achieved on the first surgical attempt. Therefore, when deciding which surgical procedure to use, it is of vital importance to consider both pati...
Source: Current Bladder Dysfunction Reports - July 17, 2019 Category: Urology & Nephrology Source Type: research

Management of Overactive Bladder After Treatment of Bladder Outlet Obstruction
AbstractPurpose of ReviewTo discuss the epidemiology and pathophysiology of overactive bladder (OAB) after bladder outlet surgery (BOS), review the prognostic factors associated with persistent OAB, and present evaluation and management strategies.Recent FindingsA randomized trial of preoperative urodynamics in male lower urinary tract symptoms is underway; however, high-level evidence for management of persistent OAB after BOS is lacking.SummaryIdentification of prognostic factors for persistent OAB symptoms is important for counseling patients before BOS; however, the data guiding such counseling are limited. In general,...
Source: Current Bladder Dysfunction Reports - July 17, 2019 Category: Urology & Nephrology Source Type: research

Urinary Retention Following Non-urologic Surgery
AbstractPurpose of ReviewTo evaluate the literature assessing postoperative urinary retention (POUR) after non-urologic surgeries, including risk factors, as well as short- and long-term consequences.Recent FindingsPOUR is multifactorial; however, several risk factors, such as male sex, advanced age, and preexisting lower urinary tract symptoms are well established. Procedures that do not involve damage to the urinary or nervous system are rarely associated with long-term consequences, as opposed to colorectal surgery in which long-term voiding dysfunction may be experienced. Improved surgical technique may improve results...
Source: Current Bladder Dysfunction Reports - July 16, 2019 Category: Urology & Nephrology Source Type: research

Historical and Current Concepts Regarding Urodynamics in Multiple Sclerosis Patients
AbstractPurpose of ReviewIn this review, current literature on management of neurogenic bladder in patients with multiple sclerosis (MS) is summarized. Topics include a review of MS, a brief overview of general treatment options, the effects of MS may manifest on lower urinary tract symptoms (LUTS), and clinical assessment of these patients. The utility of urodynamic evaluation in this patient population and the use of antibiotic prophylaxis in patients with MS on immunomodulatory medications are reviewed.Recent FindingsUnlike neurogenic bladder in spinal cord patients, lower urinary tract dysfunction in MS patients rarely...
Source: Current Bladder Dysfunction Reports - July 13, 2019 Category: Urology & Nephrology Source Type: research

The Argument For and Against the Use of Multichannel Urodynamics in the Assessment of Post-Prostatectomy Incontinence
AbstractPurpose of ReviewProstate cancer is a common male malignancy. Radical prostatectomy is a common treatment option in patients with localised disease. Post-prostatectomy incontinence (PPI) is not uncommon, with a significant impact on the quality of life. However, it is often under-reported and undertreated. There are no standard international guidelines specifically for investigation and diagnosis of PPI. The routine use of urodynamic studies (UDS), with an attempt to assess urinary incontinence aetiology and to predict success prior to invasive surgical treatment, has been widely adopted but remains controversial.R...
Source: Current Bladder Dysfunction Reports - July 5, 2019 Category: Urology & Nephrology Source Type: research

Management of Incontinence After Orthotopic Bladder Substitution Post-Radical Cystectomy
AbstractPurpose of ReviewIncontinence after orthotopic bladder substitution (OBS) post-radical cystectomy can be devastating for the patient and its treatment a challenge for the physician. The aim of this narrative review was to summarize the available evidence on treatment options for incontinence after OBS and to facilitate deciding on treatment strategies.Recent FindingsDespite good continence rates after OBS, incontinence remains an issue and treatment poses a challenge for which limited evidence exists.SummaryTreatment of incontinence therapy after orthotopic bladder substitution (OBS) post-radical cystectomy current...
Source: Current Bladder Dysfunction Reports - July 3, 2019 Category: Urology & Nephrology Source Type: research

Physical Activity and Stress Incontinence in Women
AbstractPurpose of ReviewThis review aims to discuss the current literature addressing associations between physical activity and stress urinary incontinence in women.Recent FindingsMultiple cross-sectional studies utilize survey questionnaires to determine prevalence of stress urinary incontinence, impact of various types and intensities of physical activity on stress urinary incontinence, and explain differences in urinary symptoms among active women.SummaryAlthough there is evidence for increased rates of stress incontinence among women who are physically active, pathophysiology is not fully understood and there is a ne...
Source: Current Bladder Dysfunction Reports - July 1, 2019 Category: Urology & Nephrology Source Type: research

The Role of Estrogen Status in the Causation of Female Lower Urinary Tract and Pelvic Floor Dysfunction
AbstractPurpose of ReviewIn this review, we aim to examine current literature focused on the effects of estrogen in causing conditions such as urinary incontinence, overactive bladder, recurrent urinary tract infections, pelvic organ prolapse, and anorectal dysfunction.Recent FindingsSmall studies have confirmed the role of local estrogen therapy in the treatment of overactive bladder and recurrent urinary tract infection.SummaryAlthough well recognized that the female lower urinary tract and pelvic floor are estrogen responsive, there is paucity in the role of estrogen status in causing such conditions. (Source: Current B...
Source: Current Bladder Dysfunction Reports - June 29, 2019 Category: Urology & Nephrology Source Type: research

Outcomes of Bladder Preservation Following Treatment for Rhabdomyosarcoma
AbstractPurpose of ReviewGenitourinary rhabdomyosarcoma (RMS) is a relatively uncommon pediatric urologic oncologic condition with significant implications for both short- and long-term bladder functions. It is important for both pediatric and adult urologists to be aware of the pathophysiology, treatment, and long-term prognosis of this tumor and its potential impact on bladder function in both pediatric and adult survivors.Recent FindingsAbnormalities in bladder function may arise secondary to surgical or medical management. Typical presenting complaints include lower urinary tract symptoms, which may be more common in p...
Source: Current Bladder Dysfunction Reports - June 28, 2019 Category: Urology & Nephrology Source Type: research

Intraoperative Tips and Tricks for Successful Sacral Neuromodulation
AbstractPurpose of ReviewSacral neuromodulation (SNM) is an effective, minimally invasive treatment for refractory overactive bladder, non-obstructive urinary retention, and fecal incontinence. Although the treatment is 80% successful, optimal outcomes over time are achieved only by applying precise surgical technique. In this review, we will present the surgical technique for optimal SNM documented in the literature, as well as provide tips for ideal placement based on the authors ’ experience.Recent FindingsThe technique of SNM placement has greatly evolved over the last 10  years with the routine use of fluor...
Source: Current Bladder Dysfunction Reports - June 28, 2019 Category: Urology & Nephrology Source Type: research

Patient Education for Overactive Bladder in the Digital Era
AbstractPurpose of ReviewTo encourage clinicians to offer appropriate electronic resources to patients with overactive bladder (OAB) and to aid them in deciphering the quality of available online information.Recent FindingsPatients are turning to the Internet, including social media sites and podcasts, for further education on their medical conditions. Mobile medical applications also have a role in patient education, symptom management, and treatment. Internet-based interventions using behavioral changes may be a suitable option for patients. However, many resources on the Internet are not validated so physicians are stro...
Source: Current Bladder Dysfunction Reports - June 26, 2019 Category: Urology & Nephrology Source Type: research

Concurrent Repair of Stress Incontinence and Pelvic Organ Prolapse: Impact on Surgical Outcomes and Additional Considerations
AbstractPurpose of ReviewPelvic organ prolapse and stress urinary incontinence are highly prevalent conditions and may occur simultaneously. As such, surgical repairs for both conditions may be performed concurrently. The aim of this review is to discuss the literature reporting on efficacy and safety outcomes of concurrent surgery, as well as additional considerations for performing combined repairs.Recent FindingsThere is limited data focused on the potential impact of concurrent surgery on incontinence or prolapse outcomes. Generally, the majority of data suggest that performing concomitant repairs has little impact on ...
Source: Current Bladder Dysfunction Reports - June 21, 2019 Category: Urology & Nephrology Source Type: research

Sling Procedures for Post Prostatectomy Incontinence: What Devices Are Out There? and What Are Their Results?
AbstractPurpose of ReviewWith increasing rates of radical prostatectomy, post prostatectomy incontinence represents a growing challenge for urologists. The artificial urinary sphincter is a highly effective treatment but is invasive, expensive and associated with mechanical failure. Over the past two decades, a plethora of minimally invasive sling devices to treat post prostatectomy incontinence have become available. This review aims to describe the various male slings available and the evidence supporting their use.Recent FindingsVarious sling devices are available, each with limited generally low quality evidence report...
Source: Current Bladder Dysfunction Reports - May 16, 2019 Category: Urology & Nephrology Source Type: research

Chronic Prostatitis/Chronic Pelvic Pain Syndrome: a Literature Review of NIH III Prostatitis
AbstractPurpose of ReviewThis review seeks to review up to date literature surrounding the chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) to provide an overview of the subject. The review includes current understandings of the syndrome, the use of UPOINT, novel treatment strategies and future targets for management.Recent FindingsUsing the US National Institute of Health Chronic Prostatitis Symptom Index helps clinicians to monitor prostatitis symptoms, whilst using UPOINT as guidance of therapies based on patient phenotype(s) has advanced our ability to treat patients suffering with CP/CPPS. Furthermore, novel...
Source: Current Bladder Dysfunction Reports - May 10, 2019 Category: Urology & Nephrology Source Type: research

The Current Role of Botox in a Pediatric Neurogenic Bladder Condition
AbstractPurpose of ReviewThe neurogenic bladder is a medical term that describes a variety of bladder and sphincter dysfunctions. There are two major dangerous functional problems in a child with neurogenic bladder: high intravesical pressure in the storage phase and high pressure during urination. Two basic goals for urologic treatment in those children are protection of urinary tract from complications and improvement of continence in older children. This review focuses on the current role of botulinum toxin treatment in children with neurogenic bladder.Recent FindingsAt the beginning, treatment in this group of children...
Source: Current Bladder Dysfunction Reports - May 9, 2019 Category: Urology & Nephrology Source Type: research

New Diagnostics for Male Lower Urinary Tract Symptoms
AbstractPurpose of ReviewLower urinary tract symptoms (LUTS) are a common constellation of symptoms that affect the aging male population with an astonishing prevalence. New technology and new uses of established technology are being used to help further evaluate LUTS in the male population and help guide treatment options. This review focuses on the developments and future directions in diagnostic modalities for evaluation of male LUTS, focusing on evaluation of both the filling and voiding phases of micturition.Recent FindingsNew techniques in evaluating the voiding phase include penile cuff test, external pressure-sensi...
Source: Current Bladder Dysfunction Reports - May 3, 2019 Category: Urology & Nephrology Source Type: research

Molecular Characteristics of Underactive Bladder
This article reviews recent researches on the pathophysiology and molecular characteristics of UAB. Neurogenic, myogenic, urotheliogenic, bladder outlet, and psychogenic factors might all contribute to UAB. Comprehensive clinical investigations and basic researches may provide a better understanding and effective treatment for this common but difficult bladder disorder. (Source: Current Bladder Dysfunction Reports)
Source: Current Bladder Dysfunction Reports - May 2, 2019 Category: Urology & Nephrology Source Type: research

Primary and Secondary Tethered Cord and Association with Pediatric Lower Urinary Tract Dysfunction
AbstractPurpose of ReviewTethered cord syndrome (TCS) due to adhesion defect of the spinal cord is one of the major causes of lower urinary tract dysfunction (LUTD) in children. The aim of this article is to evaluate the association, diagnosis, and treatment of TCS with LUT disorders in children.Recent FindingsTCS is divided into two groups as primary and secondary depending on whether it is congenital or acquired. TCS can manifest with gait disturbance, pain, orthopedic deformities, and LUT symptoms. LUT symptoms may be the only symptom in some cases. TCS may cause neurogenic LUTD characterized by detrusor sphincter dyssy...
Source: Current Bladder Dysfunction Reports - May 1, 2019 Category: Urology & Nephrology Source Type: research

Mathematical Modeling and Uroflow-Based Nomograms in Voiding Dysfunction Evaluation: Ready for Prime Time?
AbstractPurpose of ReviewIn this review, we will describe the interest and role of mathematical modeling and uroflow-based nomograms in voiding dysfunction evaluation.Recent FindingsDue to the time-consuming character of implementation and use, mathematical models are now used to build “numerized nomograms.” These have the advantage over nomograms to allow the study of systems with more than two parameters. While at early stages, assessment of bladder outlet obstruction using nomograms has been initiated in men, and recently, an interesting nomogram has been developed in women .SummaryMathematical modeling and ...
Source: Current Bladder Dysfunction Reports - April 29, 2019 Category: Urology & Nephrology Source Type: research

The WATER Study: a Review
This study compared the efficacy and safety of Aquablation to transurethral resection of the prostate (TURP) for the treatment of male lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).Recent FindingsThe WATER study compared Aquablation using the AquaBeam system to the current gold standard, TURP. It demonstrated that Aquablation was non-inferior to TURP when comparing the primary efficacy study endpoint of reduction in International Prostate Symptom Score at 6-month follow-up. Additionally, it proved superior for the primary safety endpoints at 3 and 6  months.SummaryAquablation has been s...
Source: Current Bladder Dysfunction Reports - April 25, 2019 Category: Urology & Nephrology Source Type: research

Urinary Biomarkers and Benign Prostatic Hyperplasia
AbstractPurpose of ReviewBenign prostatic hyperplasia (BPH) is a common age-related benign proliferation of the epithelial and stromal components of the prostate. Symptomatic BPH is associated with the progressive development of lower urinary tract symptoms (LUTS), which left untreated can deteriorate over time and lead to acute urinary retention, urinary incontinence, recurrent urinary tract infections, and/or obstructive uropathy.Recent FindingsSurgical or medical treatment that correct bladder outlet obstruction from BPH in patients generally resolves voiding symptoms and reduces the urine levels of neurotrophins. Histo...
Source: Current Bladder Dysfunction Reports - April 23, 2019 Category: Urology & Nephrology Source Type: research

The Inflammatory Contracted Bladder
AbstractPurpose of ReviewThis review will present the inflammatory contracted bladder as a clinical entity and will address its pathophysiology, diagnosis and treatment.Recent FindingsThe inflammatory contracted bladder is relevant since it is not a recognised urological condition and it can be found in several affections to the urinary tract. Its medical management depends on its aetiology and severity.SummaryThe inflammatory contracted bladder (ICB) is an ambiguous term that is used to describe the morphology of the inflamed bladder with a reduced volumetric capacity and compliance. This condition is found in some urolog...
Source: Current Bladder Dysfunction Reports - April 22, 2019 Category: Urology & Nephrology Source Type: research

The Effect of Major Pelvic Extirpative Surgery on Lower Urinary Tract Function
AbstractPurpose of ReviewThis review will explore how lower urinary tract dysfunction may result from pelvic oncological extirpative surgery across multiple disciplines and how to avoid it.Recent FindingsMinimally invasive colorectal surgery offers superior dexterity, precise movements and improved vision to identify and carefully dissect off neurovascular bundles. This reduces the incidence of postoperative retention and improved subjective and objective urodynamic parameters. Pneumoperitoneum and inappropriate retraction techniques may however still lead to urinary tract dysfunction. Data regarding presacral surgery and ...
Source: Current Bladder Dysfunction Reports - April 16, 2019 Category: Urology & Nephrology Source Type: research

Urethral Pain Syndrome: A Systematic Review
AbstractPurpose of ReviewUrethral pain syndrome (UPS) is defined as pain localized to the urethra with an unpleasant sensation, dysuria often accompanied by urinary frequency and urgency present greater than 6  months in the absence of an identifiable cause. A paucity of information exists on the subject as it is often combined with conditions such as interstitial cystitis or prostatitis. The aim is to provide and explain different definitions and diagnostic work-up and discuss treatment options for prov iders.Recent FindingsFew recent studies exist addressing urethral pain syndrome. Most literature is decades old. Th...
Source: Current Bladder Dysfunction Reports - April 16, 2019 Category: Urology & Nephrology Source Type: research

Effects and Complications of Intravesical Instillation of Bacillus Calmette-Guerin Therapy
AbstractPurpose of ReviewThis review will address the current literature available regarding complications after intravesical Bacillus Calmette-Guerin (BCG) therapy for bladder cancer. Topics include intravesical BCG therapy –related complications, role of BCG therapy in immunosuppression, and future directions in the context of BCG-related complications.Recent FindingsThere are several new reviews and case reports discussing unique complications following intravesical BCG therapy that should raise awareness of possible short-term and long-term effects after using this common treatment modality in bladder cancer pati...
Source: Current Bladder Dysfunction Reports - April 8, 2019 Category: Urology & Nephrology Source Type: research

Functional Brain Imaging in Voiding Dysfunction
AbstractPurpose of ReviewVoiding dysfunction (VD) is morbid, costly, and leads to urinary tract infections, stones, sepsis, and permanent renal failure. Evaluation and diagnosis of VD in non-obstructed patients can be challenging. Potential diagnostic and therapeutic options beyond the bladder, such as brain centers involved in voiding have been proposed as promising targets. This review focuses on current and future applications of functional neuroimaging in human in voiding and in patients with VD.Recent FindingsThe current understanding of brain centers and their roles in initiating, maintaining, and/or modulating voidi...
Source: Current Bladder Dysfunction Reports - February 8, 2019 Category: Urology & Nephrology Source Type: research

Urethral Bulking and Salvage Techniques for Post-Prostatectomy Incontinence
AbstractPurpose of ReviewDespite limited evidence and efficacy, urethral bulking remains a common treatment for post-prostatectomy stress urinary incontinence (PP-SUI). Herein we provide an overview of the existing evidence for synthetic bulking agents and emerging evidence for stem cell-based sphincter rejuvenation in this setting. We also touch upon salvage techniques for management of PP-SUI after failed anti-incontinence interventions.Recent FindingsAutologous stem cell (ASC) therapies are currently undergoing phase III trials for use in female SUI and are poised to enter the market within the next decade. Early data s...
Source: Current Bladder Dysfunction Reports - January 21, 2019 Category: Urology & Nephrology Source Type: research

BPH-Related Voiding Dysfunction —i-Tind
We present the most current literature on this therapy. There are ongoing trials evaluating the use of the newer second-generation i-Tind, although there are currently no functional differences from the first-generation device. The pilot study of the first-generation device was shown to improve both IPSS score andQmax over the course of 12  months with a trend to benefit in the 24 to 36-month period. The i-Tind represents another attempt to introduce an office-based procedure for the treatment of BPH. The preliminary results seem to indicate that this device shows efficacy in improving urinary symptoms.SummaryThere is...
Source: Current Bladder Dysfunction Reports - January 19, 2019 Category: Urology & Nephrology Source Type: research

Cost-effectiveness of Medical Versus Surgical Therapy for BPH
AbstractPurpose of ReviewBenign prostatic enlargement and obstruction may result in lower urinary tract symptom (LUTS) and have a negative impact on a patient ’s quality of life. The purpose of this review is to analyze different management options, specifically evaluating the cost-effectiveness of medical versus surgical therapy for BPH.Recent FindingsWe performed a detailed review comparing various studies regarding the cost-effectiveness of different management options that were conducted in the last 5  years. When comparing monotherapy with combination therapy in medical treatments, the latter was found to b...
Source: Current Bladder Dysfunction Reports - January 19, 2019 Category: Urology & Nephrology Source Type: research

Recent Non-neurogenic Overactive Bladder Trials
AbstractPurpose of ReviewWe sought to address the most important trials regarding overactive bladder (OAB) syndrome published in the past 5  years regarding pharmacological treatment and minimally invasive procedures (botulinum toxin A, percutaneous tibial nerve stimulation, and sacral neuromodulation).Recent FindingsMost of the randomized controlled trials related to OAB are studying anticholinergics and/or beta-adrenergics versus each other or to a placebo-comparator group. Studies have shown stability of using mirabegron and that combination therapy (anticholinergics plus beta-adrenoceptors) seems a good choice for...
Source: Current Bladder Dysfunction Reports - January 19, 2019 Category: Urology & Nephrology Source Type: research

A Review of Multiple Sclerosis for Urologists and Urogynecologists with an Emphasis on Management
AbstractPurpose of ReviewMultiple sclerosis is a common immune-mediated condition of the central nervous system. It remains one of the most disabling conditions affecting young people, and there is significant cost associated with managing this condition. Revisions of the diagnostic criteria have contributed to better identification and diagnosis of the condition, but consensus approaches to managing the condition are not fully established. Approaches to managing acute demyelination, chronic demyelination, and symptomatic treatments are reviewed.Recent FindingsThe most common treatment for acute demyelination continues to ...
Source: Current Bladder Dysfunction Reports - December 20, 2018 Category: Urology & Nephrology Source Type: research

Is There Still a Role for Transvaginal Mesh in Treatment of Pelvic Organ Prolapse?
AbstractPurpose of ReviewThe purpose of this review is to facilitate an understanding of where TVM may still serve a role in POP repair surgery. It provides a broad overview of evidence examining the differences in outcomes between TVM and other surgical interventions for POP.Recent FindingsAlthough in 2003 TVM was introduced into the treatment paradigm for POP with limited data regarding safety and efficacy, the body of literature that has accrued in years gone by finds a narrow list of utility. Certain sub-categories of POP patients at increased risk for recurrence could potentially benefit from TVM placement for POP, in...
Source: Current Bladder Dysfunction Reports - November 19, 2018 Category: Urology & Nephrology Source Type: research

Salvage Combination Therapies for Refractory Overactive Bladder
AbstractPurpose of ReviewWith a high prevalence of overactive bladder (OAB) worldwide and rising health care costs for patients who fail first-, second-, and third-line treatments, there is a growing need to explore novel strategies to address the most refractory cases of OAB. The concept of utilizing combination treatment regimens to maximize efficacy while minimizing morbidity and side effects, in a cost-effective manner, is discussed in this review article.Recent FindingsA literature review over the last 10  years was performed, focusing on therapies used in combination for OAB including behavioral therapy, pharmac...
Source: Current Bladder Dysfunction Reports - November 12, 2018 Category: Urology & Nephrology Source Type: research

Current Update on Management of Male Stress Urinary Incontinence
AbstractPurpose of ReviewMale stress urinary incontinence has significant economic and psychosocial effects on a patient. The following manuscript examines the surgical treatment as well as the recent technological advances in implantable devices for male stress urinary incontinence.Recent FindingsThe number of urethral slings available to the male patient with stress incontinence has increased dramatically over the last several years has increased. Since its introduction, the male transobturator sling has been shown to have particular unique advantages. Data is rapidly becoming available regarding the use of adjustable sl...
Source: Current Bladder Dysfunction Reports - November 5, 2018 Category: Urology & Nephrology Source Type: research

Challenges of Training General Surgery Residents to Do Urology in the Developing World
AbstractPurpose of ReviewThe purpose this manuscript is to describe the work of one program in Kenya, East Africa, to train general surgery residents in urology to make available the much needed service to the underserved rural population.Recent FindingsPeople in developing countries continue to face the challenge of accessing surgical care with a ratio of 1 surgeon to 20,000 people. This is due, in part, to the inadequate number of trained surgeons. The availability of specialized surgical care such as urology is even more unlikely due to fewer numbers of specialists in urology. Such disciplines take many years of trainin...
Source: Current Bladder Dysfunction Reports - November 5, 2018 Category: Urology & Nephrology Source Type: research

Tibial Nerve and Sacral Neuromodulation in the Multiple Sclerosis Patient with Voiding Dysfunction
AbstractPurpose of ReviewStorage and voiding dysfunction are highly prevalent in patients with multiple sclerosis (MS). Many MS patients fail behavioral modifications and oral medications. Neuromodulation in the form of posterior tibial nerve stimulation (PTNS) and sacral neuromodulation (SNM) is a potential treatment for this group of patients. We review contemporary and impactful literature regarding neuromodulation in the MS patient with lower urinary tract dysfunction.Recent FindingsLarge-scale randomized trials regarding the use of neuromodulation in the treatment neurogenic lower urinary tract dysfunction are limited...
Source: Current Bladder Dysfunction Reports - October 25, 2018 Category: Urology & Nephrology Source Type: research

Optimizing Postoperative Pain Management in Pelvic Floor Surgery
AbstractPurpose of ReviewSurgical treatment of pelvic floor dysfunction is very common, and women who undergo surgery experience varying degrees of postoperative pain. Opioid pain medications have been the mainstay of postoperative pain control, but with the growing opioid epidemic, alternative pain management strategies are needed. This review examines the current literature on opioid use in pelvic floor surgery, non-opioid pain control strategies, and surgical approach as it pertains to postoperative pain.Recent FindingsOver prescription of opioids is common in pelvic floor surgery and it poses a risk of developing long-...
Source: Current Bladder Dysfunction Reports - October 4, 2018 Category: Urology & Nephrology Source Type: research

Current Management Strategies for Autonomic Dysreflexia
AbstractPurpose of ReviewAutonomic dysreflexia (AD) is an acute, imbalanced autonomic response to noxious or visceral stimuli in patients with a spinal cord injury (SCI) above T6. In this review, we provide the clinician with an overview of the prevention, diagnosis, and management of AD.Recent FindingsPractice patterns of physicians that manage AD are shifting. Many practitioners are moving away from use of nifedipine and towards alternate pharmacologic therapies, namely nitrates and analgesics. Additionally, through better awareness of common triggers of AD, anesthetics have helped to prevent many cases of AD that may ha...
Source: Current Bladder Dysfunction Reports - September 28, 2018 Category: Urology & Nephrology Source Type: research

Tibial Nerve and Sacral Neuromodulation in the Elderly Patient
This article aims to review sacral and tibial neuromodulation outcomes in elderly patients. Safety and efficacy of these two neuromodulatory treatments for both urinary and fecal indications are addressed.Recent FindingsRecent data assessing sacral neuromodulation (SNM) for refractory overactive bladder and urge urinary incontinence (UUI) demonstrates that older patients have similar outcomes and complication rates when compared to the general population. For both urinary and fecal indications, SNM has been shown to significantly increase quality of life in older patients. Age has additionally not been a factor affecting t...
Source: Current Bladder Dysfunction Reports - September 26, 2018 Category: Urology & Nephrology Source Type: research

Shared Pathophysiology of Detrusor Overactivity and Detrusor Underactivity
AbstractPurpose of ReviewDetrusor overactivity (DO) and the associated symptom complex of overactive bladder (OAB) is well-studied with many treatment options. In contrast, detrusor underactivity (DU) and its associated symptom complex, underactive bladder (UAB), is poorly understood. Researchers have proposed explanations that link OAB and UAB with a common pathophysiology. The purpose of this review is to examine concepts and recent underlying research supporting a shared pathophysiology of DO and DU.Recent FindingsIn 2014, Dr. Michael Chancellor proposed “The Overactive Bladder Progression to Underactive Bladder H...
Source: Current Bladder Dysfunction Reports - September 26, 2018 Category: Urology & Nephrology Source Type: research

Management of Mesh-Related Pelvic Inflammation
AbstractPurpose of ReviewTo review mesh used for transvaginal surgeries, specifically slings and prolapse repairs, as well as offer a review of management after mesh-induced inflammation occurs.Recent FindingsThere have been changes to FDA notifications regarding vaginal mesh, with continued high-profile press. The inflammatory changes and possible complications vary with different mesh characteristics. Risk for complications due to transvaginal mesh placed for prolapse is higher than that when placed for the treatment of stress urinary incontinence.SummaryTransvaginal mesh aids in the effective treatment of female stress ...
Source: Current Bladder Dysfunction Reports - September 26, 2018 Category: Urology & Nephrology Source Type: research

Tibial Nerve and Sacral Neuromodulation in the Elderly Patient
This article aims to review sacral and tibial neuromodulation outcomes in elderly patients. Safety and efficacy of these two neuromodulatory treatments for both urinary and fecal indications are addressed.Recent FindingsRecent data assessing sacral neuromodulation (SNM) for refractory overactive bladder and urge urinary incontinence (UUI) demonstrates that older patients have similar outcomes and complication rates when compared to the general population. For both urinary and fecal indications, SNM has been shown to significantly increase quality of life in older patients. Age has additionally not been a factor affecting t...
Source: Current Bladder Dysfunction Reports - September 26, 2018 Category: Urology & Nephrology Source Type: research

Shared Pathophysiology of Detrusor Overactivity and Detrusor Underactivity
AbstractPurpose of ReviewDetrusor overactivity (DO) and the associated symptom complex of overactive bladder (OAB) is well-studied with many treatment options. In contrast, detrusor underactivity (DU) and its associated symptom complex, underactive bladder (UAB), is poorly understood. Researchers have proposed explanations that link OAB and UAB with a common pathophysiology. The purpose of this review is to examine concepts and recent underlying research supporting a shared pathophysiology of DO and DU.Recent FindingsIn 2014, Dr. Michael Chancellor proposed “The Overactive Bladder Progression to Underactive Bladder H...
Source: Current Bladder Dysfunction Reports - September 26, 2018 Category: Urology & Nephrology Source Type: research

Management of Mesh-Related Pelvic Inflammation
AbstractPurpose of ReviewTo review mesh used for transvaginal surgeries, specifically slings and prolapse repairs, as well as offer a review of management after mesh-induced inflammation occurs.Recent FindingsThere have been changes to FDA notifications regarding vaginal mesh, with continued high-profile press. The inflammatory changes and possible complications vary with different mesh characteristics. Risk for complications due to transvaginal mesh placed for prolapse is higher than that when placed for the treatment of stress urinary incontinence.SummaryTransvaginal mesh aids in the effective treatment of female stress ...
Source: Current Bladder Dysfunction Reports - September 26, 2018 Category: Urology & Nephrology Source Type: research

Detrusor Underactivity and Bladder Outlet Procedures in Men
AbstractPurpose of ReviewDetrusor underactivity (DU) is a common but poorly understood clinical problem. The diagnosis and treatment of DU are difficult and full of uncertainties. There are many overlaps between DU and bladder outlet obstruction (BOO) in clinical symptoms and managements. In this review, we discuss the relationship of clinical diagnosis and treatment between DU and BOO in men, especially the outcome of bladder outlet surgery in patients with DU.Recent FindingsDU could be resulted from many different etiologies, including psychogenic, neurogenic, myogenic, and the reduced detrusor contractility after increa...
Source: Current Bladder Dysfunction Reports - September 24, 2018 Category: Urology & Nephrology Source Type: research

Autologous Muscle-Derived Cells for Urinary Sphincter Regeneration: Where are we now?
Conclusions from the pooled analyses indicate that injection of AMDC-USR across a range of dosages appears safe. Efficacy data suggests a dose response with more patients responsive to the higher doses of AMDC-USR.SummaryPromising technologies for utilization of autologous cellular therapies for treatment of SUI, and conceivably multiple additional indications, are approaching fruition. Multiple phase III randomized, placebo-controlled studies for AMDC-USR are ongoing to bring this regenerative option forth for the millions of patients who may ultimately benefit. (Source: Current Bladder Dysfunction Reports)
Source: Current Bladder Dysfunction Reports - September 19, 2018 Category: Urology & Nephrology Source Type: research