Daniel Caruso

Predictors of Response to Intradetrusor Botulinum Toxin-A Injections in Patients with Idiopathic Overactive Bladder

Objectives. To evaluate whether there are any demographic or urodynamic differences in patients with idiopathic overactive bladder (I-OAB) that respond and do not respond to intradetrusor injections of botulinum toxin-A (BTX-A). Methods. This represents a secondary analysis of data collected from an investigator initiated randomized trial designed to evaluate clinical differences in outcomes for 100 versus 150 U BTX-A in patients with I-OAB. Preinjection demographic and urodynamic data were collected. Patients were evaluated 12 weeks after injection and were determined to be responders or nonresponders as defined by our criteria. Statistical comparisons were made between groups. Results. In patients with overactive bladder without incontinence (OAB-Dry), there were no variables that could be used to predict response to BTX-A. On univariate analysis, younger patients with overactive bladder with incontinence (OAB-Wet) were more likely to respond to BTX-A than older patients. However, this relationship was no longer statistically significant on multivariate analysis. Conclusions. We were unable to identify any preinjection demographic or urodynamic parameters that could aid in predicting which patients will achieve clinical response to BTX-A. Future studies are necessary to further evaluate this question.

THE NEED FOR INTERMITTENT CATHETERIZATION DURING REPEATED BOTOX® INJECTIONS FOR IDIOPATHIC OAB

Hypothesis / aims of study In this prospective, IRB approved, randomized, ongoing study we evaluated the efficacy of intra-detrusor injection of BOTOX ® botulinum A toxin (BTX) in patients (pts) with idiopathic overactive bladder (IOAB) resistant to antimuscarinic therapy. The aim of this study was to evaluate the post-void residual volume (PVR) throughout the study and to assess how many patients will need self intermittent catheterization (CIC).

Response by authors re: Differentiation of oncocytoma and renal cell carcinoma in small renal masses (<4 cm): the role of 4-phase computerized tomography

Throughout medicine, there is a recurrent paradigm of development of noninvasive/less invasive testing used to identify patients who may then be able to forgo relatively more invasive diagnostic testing and treatment. In the realm of cardiology, reconstructed advanced imaging has been extensively investigated as a substitute for cardiac catheterization [1]. In the realm of urology, we have long pursued use of PSA testing to identify men at risk for the prostate cancer and have used this to aid in the selection of patients to undergo prostate biopsy. More recently, further refinements in overall care to those patients diagnosed with prostate cancer, in response to potentially excessive diagnosis and treatment related morbidity, have been introduced with the development of active surveillance protocols to aid in the identification of patients with prostate cancer that may potentially be spared treatment-associated morbidity [2]. In the case of renal tumors, to date, only limited advancements have taken place in terms of preoperative characterization of renal masses. Due to lack of such advancements, notably in the case of small renal masses, we as urologists, in the majority of cases, essentially resort to excisional biopsy of these poorly characterized lesions, for lack of better preoperative characterization. Though partial nephrectomy has certainly undergone a number of refinements and technical advances, this procedure, even in centers of excellence, has well defined risk for morbidity [3]. The effects and nature of renal ischemia are also currently under investigation at a large number of institutions due to concerns over what long-term impact this may have for the patient [4, 5].