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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 Hypot...
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