Satisfaction with Detrusor OnabotulinumtoxinA Injections and Conversion to Other Bladder Management in Patients with Chronic Spinal Cord Injury

This study investigated the satisfaction with continued detrusor Botox injections for urinary incontinence and conversion to other surgical procedures and bladder management procedures for neurogenic detrusor overactivity (NDO) in patients with chronic spinal cord injury (SCI). A total of 223 patients with chronic SCI underwent detrusor Botox 200U for urodynamically confirmed NDO and urinary incontinence. After initial detrusor Botox injections, patients opted to either continue detrusor Botox injections every six to nine months and on clean intermittent catheterization (CIC), switch to other bladder management procedures, or receive surgical procedures to improve their urinary incontinence, correct emergent complications, or have better voiding conditions without CIC. Urinary incontinence improvement rates and satisfaction with bladder management were assessed and compared between different subgroups, urodynamic parameters, and bladder management procedures. Finally, a total of 154 male and 69 female patients were included, among whom 56 (25.1%), 81 (36.3%), 51 (22.9%), and 35 (15.7%) showed a marked, moderate, mild, and no reduction in urinary incontinence, respectively. However, only 48.4% of the patients continued detrusor Botox injections over the mean follow-up period of seven years. Patients with cervical or thoracic SCI had fair incontinence improvement rates. The presence of high detrusor pressure and higher-grade bladder outlet resistance also predicted a decrease in incontinence. Although more than 50% of the patients switched to other bladder management procedures or received surgical treatment, 69.1% expressed satisfaction with their current status. This large cohort of patients with chronic SCI who received initial detrusor Botox injections revealed that only 48.4% continued with Botox injections. Those who received surgical procedures due to urological complications or demanded change in bladder management could achieve high satisfaction rates.

Boari flap urinary tract reconstruction for rectosigmoid cancer with ureteral invasion: Report of a case

Introduction: The Boari flap technique is a unique urinary tract reconstruction procedure performed after resection of the urinary tract. However, few previous reports have described the application of this technique to gastrointestinal cancer. Moreover, we have not found any papers describing the long-term prognosis. We report a case of right ureteral tract resection followed by Boari flap reconstruction for rectosigmoid carcinoma, with survival for 108 months without any urological complications. Case presentation: A woman in her 50s was diagnosed with rectosigmoid caner by local physician and referred to our institution. Computed tomography revealed right hydronephrosis due to rectosigmoid cancer invasion at the lower two-thirds of the right ureter. During laparotomy, massive lymphatic infiltration from the primary lesion to right ureter was observed. After primary tumor resection with lower ureter excision, the Boari flap procedure was performed to reconstruct the ureteral deficit. Postoperative course was uneventful, and she was discharged on postoperative day 20. The patient has been followed every 4 months for 9 years with no recurrence or unpleasant symptoms. Discussion: This technique is usually performed to manage specific conditions such as ureteral stenosis caused by ureteral calculi, retroperitoneal fibrosis, and gynecological disorders. This procedure should be reconsidered as a possible option for gastrointestinal malignant cases instead of nephrostomy or cutaneous ureterostomy, given the low rate of complications and high patient satisfaction. Conclusion: The Boari flap technique is particularly useful for bridging between the ureter and bladder in cases of colorectal malignancy with combined resection of the lower urinary tract.

Diabetic Peripheral Neuropathy and Urological Complications in Type 1 Diabetes: Findings From the Epidemiology of Diabetes Interventions and Complications Study

Objective: <br>To evaluate associations between diabetic peripheral neuropathy (DPN) and urological complications in men and women with type 1 diabetes. <br>ResearchDesignandMethods: <br>Measurements of DPN at EDIC years 1, 13/14 and 17 and urological complications at EDIC year 17 were examined in 635 men (mean age 51.6 yrs, diabetes duration 29.5 yrs) and 371 women (mean age 50.6 yrs and diabetes duration 29.8 yrs) enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. DPN was defined by symptoms, signs and abnormal electrophysiology, or by abnormal Michigan Neuropathy Screening Instrument (MNSI) examination or questionnaire scores. <br>Results: <br>Erectile dysfunction (ED) in combination with lower urinary tract symptoms (LUTS) was reported in 15% of men, and female sexual dysfunction (FSD), LUTS and urinary incontinence (UI) in 16% of women. When controlling for age, drinking status, BMI, depression, DCCT/EDIC time-weighted mean HbA1c, microalbuminuria, hypertension, triglycerides and statin medication use, men with confirmed DPN at EDIC year 13/14 had a higher odds of ED/LUTS at year 17 compared to men without DPN (OR=3.52 95% CI 1.69,7.31). Men with DPN based on abnormal MNSI examination or questionnaire scores had significantly higher odds of ED and LUTS at year 17 than men without DPN at all time points. There were no significant differences in DPN between women reporting both FSD and LUTS/UI compared to those without FSD or LUTS/UI at EDIC year 17. <br>Conclusions: <br>In long-standing T1D, DPN is associated with the later development of urological complications in men. <b></b>

Diabetic Peripheral Neuropathy and Urological Complications in Type 1 Diabetes: Findings From the Epidemiology of Diabetes Interventions and Complications Study

Objective: <br>To evaluate associations between diabetic peripheral neuropathy (DPN) and urological complications in men and women with type 1 diabetes. <br>ResearchDesignandMethods: <br>Measurements of DPN at EDIC years 1, 13/14 and 17 and urological complications at EDIC year 17 were examined in 635 men (mean age 51.6 yrs, diabetes duration 29.5 yrs) and 371 women (mean age 50.6 yrs and diabetes duration 29.8 yrs) enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. DPN was defined by symptoms, signs and abnormal electrophysiology, or by abnormal Michigan Neuropathy Screening Instrument (MNSI) examination or questionnaire scores. <br>Results: <br>Erectile dysfunction (ED) in combination with lower urinary tract symptoms (LUTS) was reported in 15% of men, and female sexual dysfunction (FSD), LUTS and urinary incontinence (UI) in 16% of women. When controlling for age, drinking status, BMI, depression, DCCT/EDIC time-weighted mean HbA1c, microalbuminuria, hypertension, triglycerides and statin medication use, men with confirmed DPN at EDIC year 13/14 had a higher odds of ED/LUTS at year 17 compared to men without DPN (OR=3.52 95% CI 1.69,7.31). Men with DPN based on abnormal MNSI examination or questionnaire scores had significantly higher odds of ED and LUTS at year 17 than men without DPN at all time points. There were no significant differences in DPN between women reporting both FSD and LUTS/UI compared to those without FSD or LUTS/UI at EDIC year 17. <br>Conclusions: <br>In long-standing T1D, DPN is associated with the later development of urological complications in men. <b></b>

Urological complications in obstetrics

Urinary tract injury is a rare but severe complication during abdominal delivery. Over the past quarter of the last century, the frequency of abdominal delivery in Russia has more than tripled due to the increase in the number of pregnant women at high risk for the development of maternal and perinatal complications. Intraoperative diagnosis of urinary tract injuries allows timely treatment with better postoperative outcomes. Given the high percentage of caesarean sections in many countries, the risk of the above complications remains high. Risk factors for urinary tract injury during cesarean section are an increase in womens average age and body mass index, high parity, the presence of adhesions, prior cesarean section, emergency cesarean section, and cesarean section in the second stage of labor. This article discusses several clinical cases on the development of urological complications in obstetrics and gynecology. Due to modern progress in the field of operative obstetrics, vesicouterine fistulas caused by obstetric causes may not occur as often as in the last century. Nevertheless, even despite this, one should not forget about elementary preventive measures in operative delivery, especially in such obstetric situations as placental ingrowth, bleeding, hematoma, and parametria.

Autonomic dysreflexia in the practice of a urologist

Autonomic dysreflexia (AD) is a potentially life-threatening condition that develops in patients with spinal cord injury (SCI) at or above the T6 segment. First of all this condition is characterized by uncontrolled arterial hypertension, which can lead to catastrophic complications and even death. The trigger for the development of AD is often urological complications, as well as diagnostic and therapeutic manipulations on the lower urinary tract. It is important for urologists to be aware of the AD syndrome, clinical features of AD, acute and chronic management, as well as prevention episodes of AD in patients with neurogenic lower urinary dysfunction. AD is defined as an increase of systolic blood pressure of 20 mmHg from baseline in response to various afferent stimuli originating below the level of spinal cord injury. AD is based on exaltation of spinal reflex activity with irradiation of impulses in the spinal cord under conditions of dennervation preganglionic sympathetic neurons located above the T6 segment and hyperactivity of peripheral -adrenergic receptors. The main pathophysiological mechanism of AD is hypernoradrenalinemia, leading to vasoconstriction the vessels of the skin, abdominal cavity, muscles below the level of neurological injury.

Urological complications after kidney transplant

Urological complications after kidney transplantation are common and can have a significant impact on the function of the transplant, survival and morbidity of the patient. This review looks at the incidence of urological complications, risk factors, diagnosis, and management options for the most common urological complications.