Greg Bailly

2012 Update: Guidelines for Adult Urinary Incontinence Collaborative Consensus Document for the Canadian Urological Association

Adult urinary incontinence (UI) is a highly prevalentcondition, and one which can have a major impacton patients’ quality of life. It is also a major focus ofa urologist’s workload. As a result, the Canadian UrologicalAssociation (CUA), with the aid of its Guidelines Committee,commissioned the development of a practice guideline documentin 2005 first authored by Dr. Jacques Corcos. As perthe CUA Guidelines Committee’s mandate, all guidelinesare subject to revision after 5 years.

Effects of dietary fat on the urinary risk factors of calcium stone disease

OBJECTIVES To assess the association between dietary fat and various urinary risk factors of calcium stone disease in a group of calcium stoneformers attending an outpatient stone clinic. METHODS Mean daily fat intake from self-recorded 4-day dietary food records and mean 24-hour urinary risk factors from two separate collections were evaluated in 476 patients selected randomly from an adult population attending an outpatient stone clinic for the first time. RESULTS Mean daily total fat intake for men and women was significantly different at 105.6 and 78.1 g, respectively. Examination of the relationship between total fat intake and 24-hour urinary volume, pH, and excretions of magnesium, citrate, oxalate, calcium, and uric acid revealed no significant regressions in men and only a weak association between fat intake and urinary uric acid in women. CONCLUSIONS Dietary fat does not have a significant effect on the urinary risk factors of calcium stone disease.

Case studies in post-prostatectomy complications

As part of the program at the 3(rd) Annual Canadian Urology Forum (2013), participants engaged in interactive discussions of difficult cases throughout the event. The following is a summary of discussions pertaining to two challenging cases illustrating the management of complications, subsequent to radical prostatectomy.

Retubularization of the ileocystoplasty patch for conversion into an ileal conduit

INTRODUCTION We present the outcomes and long-term follow-up of patients who underwent conversion to an ileal conduit urinary diversion using the retubularized patch from the initial augmentation ileocystoplasty. METHODS We reviewed the charts of all patients who underwent this surgery at our centre. The indications for surgery, workup, clinical outcomes and complication rates were assessed. Patient-reported symptom response based on global response assessment (GRA) was determined and used as a subjective measure of overall treatment effectiveness. RESULTS Thirteen patients with either bladder pain syndrome/interstitial cystitis (BPS/IC) (n = 11) or neurogenic bladder (n = 2) were followed for a mean of 80 months. The most common indication for surgical conversion was persistent lower urinary tract symptoms (LUTS) or bladder pain. Late complications were frequent, typically low-grade, and usually manageable with conservative therapy; the most common were urinary tract infections (n = 6) and parastomal hernias (n = 5). Two patients developed ureteric strictures. Nine of 13 patients required additional surgery to manage complications or persistent symptoms. Only 5 of 11 GRA respondents reported a successful therapeutic outcome and BPS/IC patients who underwent concurrent cystourethrectomy tended to be most satisfied (2/3). Nevertheless, several patients still achieved symptom control when no other treatment options were available to them. CONCLUSION Conversion to an ileal conduit using the retubularized ileocystoplasty patch offers several technical and therapeutic advantages over creating a urinary diversion from a new bowel segment. It should therefore be considered a viable treatment option in patients who have exhausted more conservative management of their LUTS.

Painful bladder: Case studies

As part of the program at the 3(rd) Annual Canadian Urology Forum (2013), participants engaged in interactive discussions of difficult cases throughout the event. The following is a summary of discussions pertaining to two cases illustrating the difficulties in diagnosis and management of bladder pain symptoms.

Lower urinary tract symptoms in men: A case-based discussion

At the conclusion of the sessions on lower urinary tract symptoms (LUTS) in men, participants at the 2012 Canadian Urology Forum (academic and clinical urologists from across Canada) engaged in a discussion of optimal LUTS evaluation and management. The discussion was led by Dr. J. Curtis Nickel and was based on a patient case. This review provides a summary of the case and the discussion it generated.