Ansar U. Khan

Randomized Trial of Percutaneous Tibial Nerve Stimulation Versus Sham Efficacy in the Treatment of Overactive Bladder Syndrome: Results From the SUmiT Trial

PURPOSE The Study of Urgent PC vs Sham Effectiveness in Treatment of Overactive Bladder Symptoms (SUmiT) was a multicenter, double-blind, randomized, controlled trial comparing the efficacy of percutaneous tibial nerve stimulation to sham through 12 weeks of therapy. The improvement in global response assessment, voiding diary parameters, and overactive bladder and quality of life questionnaires was evaluated. MATERIALS AND METHODS A total of 220 adults with overactive bladder symptoms were randomized 1:1 to 12 weeks of treatment with weekly percutaneous tibial nerve stimulation or sham therapy. Overactive bladder and quality of life questionnaires as well as 3-day voiding diaries were completed at baseline and at 13 weeks. Subject global response assessments were completed at week 13. RESULTS The 13-week subject global response assessment for overall bladder symptoms demonstrated that percutaneous tibial nerve stimulation subjects achieved statistically significant improvement in bladder symptoms with 54.5% reporting moderately or markedly improved responses compared to 20.9% of sham subjects from baseline (p <0.001). All individual global response assessment subset symptom components demonstrated statistically significant improvement from baseline to 13 weeks for percutaneous tibial nerve stimulation compared to sham. Voiding diary parameters after 12 weeks of therapy showed percutaneous tibial nerve stimulation subjects had statistically significant improvements in frequency, nighttime voids, voids with moderate to severe urgency and urinary urge incontinence episodes compared to sham. No serious device related adverse events or malfunctions were reported. CONCLUSIONS This pivotal multicenter, double-blind, randomized, sham controlled trial provides level I evidence that percutaneous tibial nerve stimulation therapy is safe and effective in treating overactive bladder symptoms. The compelling efficacy of percutaneous tibial nerve stimulation demonstrated in this trial is consistent with other recently published reports and supports the use of peripheral neuromodulation therapy for overactive bladder.

Significance of Urinary Cytology in the Early Detection of Transitional Cell Cancer of the Upper Urinary Tract

Cytologic study of urine from 100 patients with transitional cell cancer of the upper urinary tract revealed that findings on the voided and catheterized specimens correlated well with grade and stage of the tumor. However, there was a significantly greater positive yield with urine specimens obtained by ureteral catheterization than by voiding. Consequently, because concomitant bladder tumors, diagnosed or not, can give questionable positive results ureteral catheterization specimens should be used for cytologic study.

Sustained therapeutic effects of percutaneous tibial nerve stimulation: 24-month results of the STEP study†‡§

To evaluate the safety, sustained effectiveness, and treatment interval for percutaneous tibial nerve stimulation (PTNS) for overactive bladder (OAB) therapy through 24 months.

Acute scrotal swelling in Henoch-Schonlein syndrome

A review of the literature regarding scrotal swelling in Henoch-Schönlein purpura is compared with our own experience at the Mayo Clinic over the previous ten years. Of 59 boys seen with Henoch-Schönlein purpura, 9 were noted to have scrotal swelling, and in 4 the presentation was of sufficient severity to suggest torsion. Two of these 4 were managed conservatively, and spontaneous recovery resulted. Surgical exploration of the scrotum in the other 2 revealed evidence of vasculitis in both and the possibility of torsion of appendix epididymis in 1. In patients with Henoch-Schölein purpura and scrotal pain and swelling, a conservative approach with cautious observation appears justified.

Clinical management of carcinoma of prostate, associated with bilateral ureteral obstruction.

A review of 34 cases of bilateral ureteral obstruction secondary to carcinoma of the prostate indicates that aggressive treatment in selected cases can increase survival without an associated increase in morbidity. In our series various modalities of treatment were used in 25 patients and the remaining 9 patients received no treatment. Bilateral ureteral obstruction in cases of carcinoma of the prostate should not uniformly imply a terminal event or hopeless prognosis.

Spontaneous urinary extravasation.

The diagnosis and management of 12 patients with spontaneous non-traumatic urinary extravasation are described. It is important to distinguish extravasation of the fornical backflow type from that owing to frank rupture of the diseased renal pelvis. Most cases of the former variety are caused by calculous ureteral obstruction and can be managed conservatively. Surgical intervention is indicated for the latter variety (frank rupture) and is based on the requirements imposed by the patients clinical condition, the persistence of obstruction or extravasation, or the presence of complications of extravasation such as urinoma or abscess.

IMMUNOLOGICAL DONOR PRETREATMENT IN COMBINATION WITH PULSATILE PRESERVATION IN CADAVERIC RENAL TRANSPLANTATION

The extended experience on the efficacy of pretreating the cadaveric renal allograft donor by means of large doses of cyclophosphamide and methylprednisolone (group A, 36 kidneys) was compared with the experience regarding untreated renal allografts (group B, 32 kidneys). Kidneys in both groups were perfused by pulsatile means using cryoprecipitated plasma. There was a significant difference in allograft survival (72% in group A versus 36% in group B at 3 years by actuarial means). Also, large doses of cyclophosphamide and methylprednisolone as pretreatment did not cause any detrimental effect to the allograft kidney when used in combination with cryoprecipitated plasma and pulsatile perfusion.

Primary Carcinoma in Situ of the Ureter and Renal Pelvis

Primary carcinoma in situ of the ureter or renal pelvis is rare. We describe 3 patients, each of whom had a different mode of presentation. When malignant cells in the urine from the upper urinary tract are associated with urographic evidence of an appropriate lesion, aggressive surgical therapy is indicated. In the absence of such a urographic abnormality patients with positive cytologic examinations should be followed closely because the exfoliated cells usually are from poorly differentiated neoplasms.

Reevaluation of vest technique of vesicourethral reconstruction in radical retropubic prostatectomy

Vesicourethral reconstruction after radical retropubic prostatectomy was done by the Vest technique in 36 patients and by direct vesicourethral anastomosis in 100 patients. Complications resulting from the two methods of vesicourethral reconstruction were similar. Incontinence after radical retropublic prostatectomy appears not to be related to the method of vesicourethral reconstruction but occurs because of damage during surgery or postoperative scarring of the distal sphincteric mechanism.