Christopher D. Betts

Photodynamic therapy for superficial bladder cancer under local anaesthetic.

Objectives To evaluate the use of local anaesthesia (LA) in 5‐aminolaevulinic acid (ALA) photodynamic therapy (PDT) for superficial transitional cell carcinoma (TCC) of the bladder, and to provide further toxicity and tolerability data on this new method within the context of a phase 1 trial.

Light penetration in bladder tissue: implications for the intravesical photodynamic therapy of bladder tumours

Objectives To assess (i) the optical properties and depth of penetration of varying wavelengths of light in ex‐vivo human bladder tissue, using specimens of normal bladder wall, transitional cell carcinoma (TCC) and bladder tissue after exposure to ionizing radiation; and (ii) to estimate the depth of bladder wall containing cancer that could potentially be treated with intravesical photodynamic therapy (PDT), assuming satisfactory tissue levels of photosensitizer.

The increased rate of prostate specific antigen testing has not affected prostate cancer presentation in an inner city population in the UK

To assess whether the increased use of prostate‐specific antigen (PSA) testing over the last 15 years has changed the way prostate cancer presents in an inner city UK population, where PSA screening rates might be expected to be lower than in epidemiological studies based in North America, where there is a significant tendency to a localized stage and earlier age at diagnosis.

The cost-effectiveness of sacral nerve stimulation (SNS) for the treatment of idiopathic medically refractory overactive bladder (wet) in the UK

To estimate the long‐term cost‐effectiveness of specialised treatment options for medically refractory idiopathic overactive bladder (OAB) wet.

Photodynamic therapy for superficial bladder cancer

In photodynamic therapy, a photosensitizing drug is activated by visible light and in the presence of oxygen, results in local cell death. This evolving modality is now being used to treat and palliate a very wide variety of human solid tumors and carcinoma-in-situ lesions. With regard to bladder cancer, advances in drug development and modern light delivery techniques mean that photodynamic therapy shows promise in the treatment of superficial bladder cancer resistant to conventional treatments.

Comparison of the cellular molecular stress responses after treatments used in bladder cancer

Objective  To investigate the molecular stress responses related to the quality of recovery of normal tissue after various treatments for bladder cancer, i.e. hyperthermia, ionizing radiation, mitomycin‐C and 5‐aminolaevulinic acid photodynamic therapy (ALA‐PDT).

External urethral sphincter electromyography in asymptomatic women and the influence of the menstrual cycle.

To investigate by electromyography (EMG), the presence of complex repetitive discharges (CRDs) and decelerating bursts (DBs) in the striated external urethral sphincter during the menstrual cycle in female volunteers with no urinary symptoms and complete bladder emptying.

Neuromodulation by Sacral Nerve Stimulation

Tanagho and Schmidt working in the 1980s developed sacral neuromodulation (SNM). The FDA approved InterStim® for the treatment of urge incontinence in 1997, and NICE did the same in 2004. In many centers, SNM has become second-line treatment for idiopathic detrusor overactivity (IDO) and nonobstructive urinary retention in women (NOURW). There is limited evidence for its use in neurogenic bladder dysfunction and painful bladder disorders.

Sphincter Electromyography (EMG)

Electromyography (EMG) is the study of bioelectrical potentials from striated muscle. Urethral sphincter activity may be studied in relation to bladder function, and this is known as kinesiologic EMG. Conventional EMG is used to examine individual motor units and to identify abnormal spontaneous activity. Conventional sphincter EMG is the more important neurophysiological test relating to the urinary tract.

Voiding dysfunction after left medial frontal lobe infarction

A 37-year-old right handed man was admitted to hospital after developing sudden onset weakness of his right arm and leg. At admission, he complained of urinary frequency and incontinence, with no prior urinary symptoms. His motor function returned to normal within 36 h. A computerised tomography (CT) scan demonstrated an abnormality in the left medial frontal lobe, and a subsequent magnetic resonance imaging (MRI) scan revealed a left medial frontal infarct involving the anterior cingulate cortex and underlying corpus callosum (Fig. 1a and b). Transoesopageal echocardiogram revealed a patent foramen ovale (subsequently closed surgically). When reviewed by the Neurologists 4 months after presentation, his urinary symptoms had changed to profound hesitancy of micturition, intermittent flow and needing to strain to empty