Claire Dunphy

Relationship Between Depression and Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

This article provides an overview of current data on the relationship between depression and lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), with a focus on pathophysiology and patient management implications. Review of the literature indicated a clear relationship between LUTS secondary to BPH and depression. It is unknown whether this relationship is bidirectional or unidirectional. Depression is associated with the impact of LUTS on quality of life in men with BPH. Research suggests that depression alters the experience of LUTS in this population. Medical and surgical treatments for BPH may impact quality of life and, therefore, depression. Results conflict on the exact nature of the relationship examined, and on the extent to which the relationship may be attributed to physiological factors such as inflammation. Practicing clinicians should consider using a brief self-administered scale to assess for depression in patients with BPH. There is a clear need for additional research to decisively determine the nature of the relationship between LUTS secondary to BPH and depression, as well as the extent to which change in either condition may be affected by the other.

Effect of phosphodiesterase inhibitors in the bladder

Many aging men will experience lower urinary tract symptoms (LUTS). Phosphodiesterase type 5 (PDE5) inhibitors have shown promise in treating LUTS in these patients. PDE5 inhibitors mediate their effects through several pathways including cAMP, NO/cGMP, K-channel modulated pathways, and the l-cysteine/H2S pathway. PDE5 inhibitors exert their effect in muscle cells, nerve fibers, and interstitial cells (ICs). The use of PDE5 inhibitors led to improvement in LUTS. This included urodynamic parameters. PDE5 inhibitors may play a significant role in LUTS due to their effect on the bladder rather than the prostate.

Pathologic outcomes following urethral diverticulectomy in women

Purpose. Although most urethral diverticula in women are benign, there is a subset of patients who develop malignant changes. Limited studies report the pathologic findings associated with this relatively rare entity. We describe the clinicopathologic findings of women who underwent urethral diverticulectomy. Methods. A consecutive series of 29 women who underwent surgical resection of a urethral diverticulum were identified between 1992 and 2013. Clinical and radiographic data was collected by retrospective review of patient medical records. All pathological slides were rereviewed by a single urologic pathologist. Results. Of the 14 women with clinical data, 9 (64%) presented with urgency, 7 (50%) with urinary frequency, 3 (21%) with urinary incontinence, and 3 (21%) with dysuria. Mean diverticular size was 2.3 (±1.4) cm. Although one patient (3%) had invasive adenocarcinoma on final pathology, the remaining 28 cases (97%) demonstrated benign features. The most common findings were inflammation (55%) and nephrogenic adenoma (21%). Conclusions. Although most urethral diverticula in women are benign, there is a subset of patients who develop malignancy in association with the diverticulum. In this series, 97% of cases had a benign histology. These findings are important when counseling patients regarding treatment options.

Multi Institutional Experience with the GreenLight Simulator

Introduction: The objective of this study was to evaluate the GreenLight Laser SimTM for resident education in a multi institutional study using a structured curriculum. Materials and Methods: Residents from two tertiary care hospitals participated in this study. The curriculum included four SIM modules and four SIM cases on the GreenLight Laser SimTM. Participants of various training levels were evaluated by grams of tissue vaporized in allotted time, average sweep speed, blood loss, and average laser-tissue distance throughout the study. Results: 20 residents, PGY1-PGY6, completed 331 trials on the simulator. Increased number of trials on the simulator was associated with a statistically significant increase in vaporization efficiency and reduced laser distance. No significant difference was noted between training level or simulator trial number when examining blood loss. Conclusions: This study demonstrates that use of the GreenLight Laser SimTM is associated with improved vaporization efficiency. The simulator is a useful tool in resident education and instruction of important safety principles and procedural techniques and can help improve vaporization efficiency.

Diagnosis, Evaluation, and Treatment of Mixed Urinary Incontinence in Women.

Mixed urinary incontinence (MUI) is a common clinical problem in the community and hospital setting. The broad definition of the term makes it difficult to diagnose, as well as determine effective treatment strategies. There are no current guidelines recommended for physicians. The estimated prevalence of this condition is approximately 30% in all women with incontinence. It has also been suggested that patients with MUI report more bothersome symptoms than either stress or urge incontinence; approximately 32% of 40- to 64-year-olds with MUI report symptoms of depression. The authors examine the diagnosis, evaluation, and treatment of patients with MUI.

A Personal Reflection of Greenlight 532 nm Laser for BPH Treatment

Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia are a bothersome symptom set that affect approximately one in every four males above the age of 50. First line treatment is typically medication, but when medications fail surgical therapy is the next option. Technological advances have made surgical therapy safer and more effective. One area that our group has particular interest and focus in is the application of the 532 nm laser in surgical therapy. The high power 532 nm laser is used to remove obstructive prostatic tissue and the laser energy is selectively absorbed by hemoglobin in the prostate tissue, resulting in effective tissue vaporization and removal. We review our experience with Greenlight laser system and its evolution from the original 60-watt laser to the most recent 180-watt Greenlight system with MoXy fiber.