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OAB and IC/BPS: Two Conditions or a Continuum of One?
AbstractPurpose of ReviewOveractive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS) are defined as syndromes consisting of “urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence” and “an unpleasant sensation perceived to be related to the urinary bladder, associated with lower urinary tract symptoms,” respectively. Distinguishing between the two diagnoses ca n be challenging and although OAB and IC/BPS are traditionally considered separate conditions, more evidence is emerging to suggest a continuum between the symptoms. This review consi...
Source: Current Bladder Dysfunction Reports - January 12, 2020 Category: Urology & Nephrology Source Type: research

Colpocleisis for Advanced Pelvic Organ Prolapse
AbstractPurpose of ReviewThe purpose of this review is to consolidate and present the most recent literature on colpocleisis in the treatment of pelvic organ prolapse.Recent FindingsSince its origin in the 1800s, the techniques for colpocleisis have remain largely unchanged. We will review the peri-operative considerations for a patient undergoing an obliterative procedure, specifically focusing on the potential concern for uterine pathology. There are no universally accepted guidelines for endometrial evaluation in the asymptomatic post-menopausal patient, yet the majority of providers prefer to perform some type of pre-o...
Source: Current Bladder Dysfunction Reports - January 7, 2020 Category: Urology & Nephrology Source Type: research

Update on the Pathophysiology of Interstitial Cystitis /Bladder Pain Syndrome
AbstractPurpose of ReviewInterstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic, potentially debilitating condition characterized by lower urinary tract symptoms and pain perceived to be related to the bladder. The etiology of IC/BPS has been rigorously studied for more than a century, but remains unknown. IC/BPS comprises a wide variety of clinical phenotypes with different potential etiologies. Recently, the importance of IC/BPS subtyping has become recognized. In this review, we revisit current hypotheses on IC/BPS pathophysiology and discuss the most likely causes of IC/BPS according to current research.Rece...
Source: Current Bladder Dysfunction Reports - January 5, 2020 Category: Urology & Nephrology Source Type: research

Voiding Dysfunction After Neobladder Urinary Diversion
AbstractPurpose of ReviewRadical cystectomy and urinary diversion remains the gold standard treatment for patients with high risk or muscle invasive bladder cancer. Despite the fact that a majority of patients are eligible for orthotopic neobladder, over 85% of patients receive incontinent urinary diversions, primarily over concerns for complications or postoperative voiding dysfunction. In this review, we explore the incidence, etiology, and treatment of voiding dysfunction after orthotopic neobladder creation in male and female patients.Recent FindingsVoiding dysfunction after orthotopic neobladder consists of urinary in...
Source: Current Bladder Dysfunction Reports - January 5, 2020 Category: Urology & Nephrology Source Type: research

Treatment of Refractory Urinary Urgency, Frequency, and Incontinence in Pregnancy
AbstractPurpose of ReviewThe prevalence of urinary symptoms such as urgency, frequency, and urge incontinence is high in pregnancy and often becomes more bothersome further in pregnancy. First-line treatment often includes behavioral modifications such as avoidance of caffeine and timed voiding. Treating incontinence refractory to these first-line measures poses a challenge to the clinician given the concern for fetal harm, miscarriage, and preterm labor from current treatment modalities. The purpose of this review article is to summarize the most up-to-date literature of second- and third-line treatment options for urge i...
Source: Current Bladder Dysfunction Reports - December 17, 2019 Category: Urology & Nephrology Source Type: research

Recent Developments in Imaging in BPS/IC
AbstractPurpose of reviewIn this review, the current literature of imaging of bladder pain syndrome and interstitial cystitis (BPS/IC) will be addressed. Topics include BPS/IC, cystoscopy, computed tomography, and magnetic resonance image (MRI).Recent findingsThere are no randomized clinical trials on imaging of BPS/IC. Recently, contrast-enhanced MRI could detect the brain alterations and the changes in bladder permeability, and detection of the latter is enhanced by intravesical injection of contrast agents.SummaryMRI could advance the understanding of pathological changes in the brain and the bladder of BPS/IC patients....
Source: Current Bladder Dysfunction Reports - December 13, 2019 Category: Urology & Nephrology Source Type: research

Consequences of Pelvic Radiotherapy on Urinary Function in Women
The objective of this review is to critically evaluate recent literature on the urinary complications following pelvic radiation for malignancy in women.Recent FindingsLower urinary tract symptoms (LUTS) manifest in a significant population of women post-radiation with confirmed objective findings on urodynamic evaluation. Other serious consequences such as fistula, hemorrhagic cystitis, and strictures are less common but can be significant.SummaryThe sequelae of radiation on the female lower urinary tract can range from mild symptoms to those requiring major surgical intervention. Therefore, post-radiotherapy patients mus...
Source: Current Bladder Dysfunction Reports - December 4, 2019 Category: Urology & Nephrology Source Type: research

Post-Prostatectomy Incontinence: an Update on Current Management
AbstractPurpose of ReviewTo review the most recent literature on the treatment of post-prostatectomy incontinence.Recent FindingsNew technology and implementation of surgical devices have resulted in a myriad of treatment options for men suffering post-prostatectomy incontinence. However, many of these have widely varied results.SummaryThe treatment of post-prostatectomy incontinence is consistent and continues to expand with more devices being introduced in the market. However, optimization of patient outcomes and determination of which devices work best will be required. To date, there are few randomized controlled trial...
Source: Current Bladder Dysfunction Reports - December 3, 2019 Category: Urology & Nephrology Source Type: research

Central Nervous System Changes in Pelvic Inflammation/Pain Patients
AbstractPurpose of ReviewCentralized pain syndromes (CPS), including chronic pelvic pain (CPP) syndrome, are significant public health problems with prevalence more than diabetes, cancer, or cardiovascular disease. A variety of pathologies are linked with CPP syndrome; however, pain often continues without the presence of pathology, or when an underlying pelvic disease is found, the extent and severity of pain are disproportionate. Although this is not a systematic review, we performed a detailed literature search to identify relevant papers and to provide the available evidence for central changes in association with CPP ...
Source: Current Bladder Dysfunction Reports - December 1, 2019 Category: Urology & Nephrology Source Type: research

Nocturia: Evaluation and Management
AbstractPurpose of ReviewNocturia, defined as waking to pass urine during the main sleep period, is among the most common and bothersome lower urinary tract symptoms. In this review, the current literature as it pertains to the etiology, evaluation, and management of nocturia is addressed.Recent FindingsOver the past decade, there has been increased interest in nocturia as a specific lower urinary tract symptom, with efforts made to improve understanding of underlying mechanisms and consequences. Several publications now classify nocturia according to underlying cause (such as nocturnal polyuria), in that what was a previo...
Source: Current Bladder Dysfunction Reports - November 27, 2019 Category: Urology & Nephrology Source Type: research

Detrusor Underactivity and Underactive Bladder in Women: What Is New?
AbstractPurpose of ReviewDetrusor underactivity (DU) and its symptom-based correlation, the underactive bladder (UAB), are common problems encountered in urological practice. Whilst DU has been defined for many years, only recently has UAB received a formal definition and there is now accumulating literature based on this condition. In this article, we reviewed the recent literature on the aetiology, pathogenesis, diagnosis and management of DU/UAB in women.Recent FindingsDetrusor underactivity is diagnosed on urodynamic studies but there still remains a lack of widely recognised and accepted diagnostic criteria. Commencin...
Source: Current Bladder Dysfunction Reports - November 26, 2019 Category: Urology & Nephrology Source Type: research

Advances in Pharmacotherapy for the Treatment of Overactive Bladder
AbstractPurpose of ReviewTo present the current literature on the pharmacologic management of overactive bladder, including combination therapies, agents still in clinical development, and special considerations related to individuals with cognitive decline, frailty and cardiovascular risk.Recent FindingsCombination therapy is shown to be more effective than monotherapy, without additional side effects. Preliminary studies on novel treatment methods, including new medications, as well as novel use of established medications, demonstrate improved efficacy with a favorable side effect profile. Investigation into new target p...
Source: Current Bladder Dysfunction Reports - November 24, 2019 Category: Urology & Nephrology Source Type: research

The Role of Local Hormone Replacement in Overactive Bladder
AbstractPurpose of ReviewOveractive bladder (OAB) is a common and distressing condition which is known to increase with age and to have a significant effect on quality of life (QoL). Whilst OAB is a symptomatic diagnosis, many patients will require basic investigations prior to initiating the appropriate management. This paper will explore the prevalence and pathophysiology of OAB as well as diagnosis and management of the condition.Recent FindingsThere is increasing evidence that local oestrogen therapy may be beneficial in the management of postmenopausal women with OAB, either when used alone or as combination therapy w...
Source: Current Bladder Dysfunction Reports - November 24, 2019 Category: Urology & Nephrology Source Type: research

The Bladder is Not Sterile: an Update on the Urinary Microbiome
AbstractPurpose of ReviewThe article discusses (1) techniques used to study bacterial urinary microbiota; (2) existence of non-bacterial urinary microbiota; (3) associations between changes in urinary microbiota and various benign lower urinary tract disorders.Recent FindingsUrine harbors a diverse microbial community that resides within it. A multitude of studies have identified differences in these communities associated with urologic conditions, suggesting that microbial communities may maintain normal bladder homeostasis. Technological advances in analytic approaches have improved our understanding of the urinary micro...
Source: Current Bladder Dysfunction Reports - November 14, 2019 Category: Urology & Nephrology Source Type: research

Dilemmas in Management of the Geriatric Bladder
AbstractPurpose of ReviewIn this article, we will review current dilemmas regarding evaluation and management of the geriatric bladder incorporating concepts of normal changes of aging as well as common lower urinary tract dysfunction.Recent FindingsIncreasing age leads to functional changes in essentially all organ systems including the genitourinary system. Understanding the natural changes with age of the bladder as well as the signs and symptoms of pathologic conditions is paramount to diagnosis and treatment of urologic conditions in the geriatric population.SummaryThere are several conundrums in the diagnosis and eva...
Source: Current Bladder Dysfunction Reports - November 12, 2019 Category: Urology & Nephrology Source Type: research