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WATER II Trial (Aquablation)
AbstractPurpose of ReviewThis review discusses the role of aquablation therapy for the treatment of benign prostatic hyperplasia in those with prostate volumes between 80 and 150  mL (WATER II trial).Recent FindingsAquablation therapy reduced International Prostate Symptoms Scores, improved urinary flow rate, and preserved ejaculatory function in the majority of sexually active patients. Other advantages include faster operative times and a shorter learning curve. Adverse events were low and predominantly centered around bleeding risk.SummaryAquablation therapy is effective and safe in the surgical management of large pro...
Source: Current Bladder Dysfunction Reports - June 4, 2020 Category: Urology & Nephrology Source Type: research

Impact of Frailty on the Treatment of Pelvic Floor Disorders
AbstractPurpose of ReviewFrailty is highly prevalent with increasing age and contributes to adverse health outcomes. Prior to medical and surgical intervention for the treatment of pelvic floor disorders (PFD), a comprehensive evaluation is necessary to evaluate frailty. Beyond a standard assessment, the care of frail patients requires consideration of additional factors including functional ability, cognitive impairment, and the role of caregivers. In this article, we review the current literature on PFD, specifically urinary and fecal incontinence and pelvic organ prolapse, in frail individuals and highlight the risks an...
Source: Current Bladder Dysfunction Reports - June 3, 2020 Category: Urology & Nephrology Source Type: research

Optimizing Neuromodulation Testing —Who, When, and How?
AbstractPurpose of ReviewWe review the current literature pertaining to recommendations for selecting appropriate patients and performing a test phase for sacral neuromodulation.Recent FindingsCurrent literature reveals that this therapy can be successfully offered to patients with mild and severe forms of refractory overactive bladder, wet or dry. It can also be offered to elderly patients and patients with concurrent fecal incontinence, even in the setting of a known history of obstetric anal sphincter injury. Patients with non-obstructive urinary retention should be carefully selected with other etiologies ruled out, an...
Source: Current Bladder Dysfunction Reports - June 2, 2020 Category: Urology & Nephrology Source Type: research

Immunomodulatory Therapies for Interstitial Cystitis/Bladder Pain Syndrome
AbstractPurpose of ReviewInterstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic, debilitating condition of unknown etiology characterized by persistent pain perceived to be related to the urinary bladder and lower urinary tract symptoms. Evidence shows that immunological inflammatory responses underlie the pathophysiology of IC/BPS with Hunner lesions but not that of IC/BPS without Hunner lesions. Here, we review the current understanding of the immunological inflammatory nature of IC/BPS with Hunner lesions and the clinical outcomes of immunomodulatory therapies.Recent FindingsOpen trials show that steroids imp...
Source: Current Bladder Dysfunction Reports - May 28, 2020 Category: Urology & Nephrology Source Type: research

Predicting Upper Urinary Tract Risk in the Neurogenic Bladder Patient
AbstractPurpose of ReviewIn this review, we explore if risk factors for developing renal deterioration can be identified in a timely fashion, thereby preventing or delaying the progression of renal injury in the neurogenic bladder patient.Recent FindingsHistorically detrusor leak point pressure (DLPP)>  40 cm H2O has been used to identify risk of upper urinary tract dysfunction (UUTD). Recent studies suggest that DLPP should not be the only decision-making parameter to predict the risk of UUTD and that patients with DLPP>  20 cm H2O should be followed closely for upper tract assessment. Furthermore, a variety o...
Source: Current Bladder Dysfunction Reports - May 20, 2020 Category: Urology & Nephrology Source Type: research

A Review of Enhanced Recovery Protocols in Pelvic Surgery
AbstractPurpose of ReviewTo evaluate recent literature relevant to the review and appraisal of enhanced recovery protocol after pelvic surgery.Recent FindingsSeveral protocols have recently been implemented and published that utilize aspects of guidelines published by the Enhanced Recovery After Surgery (ERAS) Society. These studies have added to the body of literature confirming the efficacy of enhanced recovery protocols.SummaryWhile evidence exists and is commonly cited for individual interventions, in recent years, there has been an increase in the study of novel protocols for enhanced recovery. These studies show that...
Source: Current Bladder Dysfunction Reports - May 16, 2020 Category: Urology & Nephrology Source Type: research

Is Urinary Retention Following Extravesical Ureteral Reimplantation Still a Concern?
AbstractPurpose of ReviewTransient urinary retention is a known complication of bilateral extravesical ureteral reimplantations. Recent studies have shown that the robotic-assisted bilateral extravesical reimplantation may have lower transient urinary retention rates than previously reported for the open approach. The purpose of this review is to compare urinary retention incidence in patients undergoing open versus robotic-assisted extravesical reimplantations.Recent FindingsIn some of the larger series, open bilateral extravesical ureteral reimplantation was noted to have a temporary urinary retention rate of 4 –15%. I...
Source: Current Bladder Dysfunction Reports - May 11, 2020 Category: Urology & Nephrology Source Type: research

Vaginal Mesh Survivorship
The objective is to propo se the concept of vaginal mesh survivorship, examine which aspects of the cancer survivorship framework are applicable to patients with vaginal mesh complications, and apply these accordingly.Recent findingsA literature review of vaginal mesh complications was performed to identify the current state of care received by patients and patient-reported outcomes. Subcategories from the cancer survivorship framework were compared with the current care of women with vaginal mesh complications. Areas of improvement and gaps in research were identified.SummaryNearly all domains of the cancer survivorship f...
Source: Current Bladder Dysfunction Reports - May 10, 2020 Category: Urology & Nephrology Source Type: research

Valve Bladder Syndrome Associated with Posterior Urethral Valves: Natural History, Work-up, and Management
AbstractPurpose of ReviewThis review focuses on the diagnosis, evaluation, and management of valve bladder syndrome (VBS) following initial treatment of posterior urethral valves (PUV). Based on current literature, we discuss the effect of PUV management in VBS and investigate the role of medications, catherization, surgery, and novel interventions.Recent FindingsThe current initial management of PUV involves valve ablation. Cutaneous urinary diversions are secondary options based on patient characteristics, PUV severity, and response to catheter drainage. VBS can independently occur as a consequence of PUV due to reduced ...
Source: Current Bladder Dysfunction Reports - May 1, 2020 Category: Urology & Nephrology Source Type: research

Opioid Use in Urologic Practice
AbstractPurpose of ReviewThe opioid epidemic has become a major public health crisis over the last two decades. The opioid-related deaths and economic costs have increased dramatically since opioid analgesics started to be prescribed regularly to help control cancer- and non-cancer-related pain in the late twentieth century. As a result of the worsening opioid crisis, various guidelines and government regulations have recently been implemented to cope with this opioid problem as it affects all fields of medicine, urology included. Many conditions in urology involve chronic pain medication, including neurogenic bladder. Thi...
Source: Current Bladder Dysfunction Reports - April 28, 2020 Category: Urology & Nephrology Source Type: research

Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors
AbstractPurpose of ReviewThe epidemiology of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) is continuously evolving with an increasing life span and the prevalence of metabolic diseases, including obesity, diabetes, cardiovascular disease, and hypertension. As a result, there is a substantial financial strain on health care.Recent FindingsRecent studies and clinical trials have strengthened the relationship of known risk factors of BPH and LUTS. These include metabolic syndrome, diabetes, obesity, hypertension, and elevated serum dihydrotestosterone. Excessive consumption of red meat, saturated...
Source: Current Bladder Dysfunction Reports - February 25, 2020 Category: Urology & Nephrology Source Type: research

Cognition, Emotion, and the Bladder: Psychosocial Factors in Bladder Pain Syndrome and Interstitial Cystitis (BPS/IC)
AbstractPurpose of ReviewTo review findings from empirical studies assessing the role of psychosocial factors in bladder pain syndrome and interstitial cystitis (BPS/IC).Recent FindingsThere is a high rate of psychosocial comorbidity in BPS/IC, including elevated levels of anxiety and depression. Recent studies assessing the role of illness perceptions in BPS/IC relate poorer illness perceptions to more unhelpful illness coping patterns. Conversely, positive illness perceptions including self-efficacy in illness management are associated with more adaptive coping behaviors such as exercising and acceptance. New research is...
Source: Current Bladder Dysfunction Reports - January 30, 2020 Category: Urology & Nephrology Source Type: research

Prevention of Stress Urinary Incontinence in Women
AbstractPurpose of ReviewLower urinary tract dysfunction (LUTD), including stress urinary incontinence (SUI), is increasingly recognized as a public health issue due to the prevalence, individual burden, and societal impact. Women are disproportionately affected by UI and are exposed to unique events that affect LUT function including higher rates of LUT infection, childbirth, pelvic floor anatomic changes, and hormonal milieu. The majority of LUTD research and clinical practice has focused on treatment of the most affected subset of women, but there are millions of women living with urinary incontinence that do not seek a...
Source: Current Bladder Dysfunction Reports - January 29, 2020 Category: Urology & Nephrology Source Type: research

Underactive Bladder and Bladder Outlet Procedures in Women
AbstractPurpose of ReviewThis review outlines current options for women suffering from both stress urinary incontinence (SUI) and underactive bladder (UAB). This is often a challenging patient population; however, many treatment options are available including behavioral, pharmacologic, and surgical. Therapies can be divided into those specifically targeting either the bladder or the bladder outlet.Recent FindingsFor patients with SUI and UAB, several clinical trials have helped to formulate current guidelines. Also, a number of novel techniques and therapeutic agents are currently under investigation. Current surgical tre...
Source: Current Bladder Dysfunction Reports - January 29, 2020 Category: Urology & Nephrology Source Type: research

Overactive Bladder in Women: an Update for Primary Care Physicians
AbstractPurpose of ReviewOveractive bladder (OAB) is a widely prevalent urinary condition affecting women of all ages, with increasing incidence in advancing age. A primary care provider is likely to encounter a significant proportion of women experiencing lower urinary tract symptoms (LUTS). This review serves primary care physicians as a thorough reference for a common condition causing LUTS in women.Recent FindingsMost emerging data addressing overactive bladder relates to the different treatment modalities available. The side effect profile of antimuscarinic drugs remains an ongoing concern among OAB patients, especial...
Source: Current Bladder Dysfunction Reports - January 12, 2020 Category: Urology & Nephrology Source Type: research