Jai Seth

Ensuring patient adherence to clean intermittent self-catheterization.

Patient performance of clean intermittent self-catheterization is a crucial component of the management of incomplete bladder emptying, which can arise from a variety of conditions. This allows patients to have more control over their bladder emptying, and avoids the inconveniences that come with an indwelling urethral catheter. There are, however, barriers that patients face when performing this task which may ultimately limit adherence. In this article, these barriers are discussed in more detail with potential solutions to counter them.

Nerve growth factor (NGF): a potential urinary biomarker for overactive bladder syndrome (OAB)?

The search for a biomarker in overactive bladder syndrome (OAB) is an emerging field of interest, as bladder dysfunction is a common complaint that causes significant morbidity. A biomarker may give us insight as a diagnostic tool, and also inform us about how severe the condition is, how it may progress and how it may best be treated. The protein of interest here is nerve growth factor (NGF) and it has been shown to be a dynamic molecule in the bladder of patients with OAB. Urinary levels have been seen to rise in patients with OAB and fall in those who respond to treatment. However, there have also been many studies that examine this trend in numerous other conditions, e.g. interstitial cystitis, bladder outflow obstruction, renal stone disease and patients with neurological impairment after stroke. As a result the specificity of this as a potential urinary biomarker for OAB is questioned.

Neurogenic Detrusor Overactivity in Patients With Spinal Cord Injury: Evaluation and Management

Lower urinary tract dysfunction can have a significant impact on patients with spinal cord injury. Over the years, many treatment options have become available. This article reviews the assessment and management of neurogenic detrusor overactivity, with a particular focus on articles from the recent literature. Recent guidelines on the subject will be discussed. Management options include antimuscarinics and bladder emptying measures, botulinum toxin A, and neuromodulation in refractory cases and surgery for intractable cases. Recent and relevant publications in these areas will be summarized and discussed.

Axial torsion as a rare and unusual complication of a Meckel's diverticulum: a case report and review of the literature

IntroductionIn 1809, Johann Friedrich Meckel described the embryology of a small bowel diverticulum, which now bears his name. Meckels diverticulum is the most common congenital abnormality of the gastrointestinal tract, with a prevalence ranging from 1% to 4% of the population. The majority are clinically silent and are incidentally identified at surgery or at autopsy. The lifetime risk of complications is estimated at 4%, with most of these complications occurring in adults. It is these cases that can cause problems for the clinician, as the diagnosis can be elusive and the consequences extremely serious.Case presentationWe present the case of a 68-year-old Caucasian man with axial torsion of a Meckels diverticulum around its base, a rare complication. He presented with acute, severe abdominal pain, and a clinical diagnosis of perforated acute appendicitis was made. Laparotomy revealed a torted Meckels diverticulum with distal necrosis and perforation, which was resected. His recovery was uncomplicated, and he was discharged to home six days post-operatively.ConclusionTorsion is an extremely rare complication of Meckels diverticulum. Its presentation can be elusive, and it can mimic a number of different, more common intra-abdominal pathologies. Imaging appears to be an unreliable diagnostic tool, and the diagnosis is usually made intra-operatively. Factors pre-disposing these patients to axial torsion of Meckels diverticulum include the presence of mesodiverticular bands, a narrow base, excessive length, and associated neoplastic growth or inflammation of the diverticulum. The importance of searching for a diseased Meckels diverticulum at laparotomy in appropriate circumstances is highlighted. Once identified, prompt surgical excision generally leads to an uncomplicated recovery.

Nocturia in Patients With Parkinson's Disease

Waking up from sleep more than once to pass urine, known as nocturia, is an important nonmotor symptom in Parkinsons disease (PD). Very little is known about the cause for nocturia. The aim of this work was to evaluate lower urinary tract (LUT) symptoms in patients with PD reporting nocturia using standardized validated questionnaires and bladder diaries and to assess the impact of nocturia on quality of life and sleep.

Validation of the bladder control self‐assessment questionnaire (B‐SAQ) in men

To validate the Bladder Control Self‐Assessment Questionnaire (B‐SAQ), a short screener to assess lower urinary tract symptoms (LUTS) and overactive bladder (OAB) in men.

Stress urinary incontinence as the presenting complaint of benign joint hypermobility syndrome

Stress incontinence may be associated with benign joint hypermobility syndrome (BJHS), highlighting the importance of inquiring about such symptoms in nulliparous women.

Urolithiasis following urinary diversion

Urolithiasis is a well-known occurrence after cystectomy and urinary diversion. With high incidence and recurrence rates of urolithiasis, complex anatomy and associated morbidities, these patients remain a management challenge for urologists. The purpose of this review is to examine the literature and consider the risk factors for stone formation in this group of patients and reflect on the reported outcomes with the range of available treatment options.

Urinary retention for the neurologist.

Urinary retention is a common problem, most often due to an anatomical lesion in the urinary tract causing obstruction, such as a urethral stricture or prostate enlargement. However, a subset of patients have no structural urological lesion, and so require neurological evaluation. We present a patient with acute urinary retention who was found to have chronic meningitis, and review the neurological causes for urinary retention.

Current State of the Art in Non-Invasive Urodynamics

Lower urinary tract symptoms (LUTS) are highly prevalent and bothersome. The pressure flow or voiding part of urodynamics gives information regarding detrusor contractility and whether bladder outlet obstruction (BOO) is present. However, urodynamics are invasive and can be associated with infection and take time to perform. Moreover it is not clear whether urodynamics are beneficial in assessing LUTS routinely or whether they are able to predict outcomes following surgery for obstruction. As a result several non-invasive techniques and investigations have been developed to try to aid in the work up and management of patients with LUTS / BPE. A PubMed search was performed to review the literature on non-invasive urodynamic tests for voiding dysfunction. Techniques include transition zone index, intravesical prostatic protrusion, prostate circle area ratio, prostatic urethral angle, resistive index, bladder wall and detrusor wall thickness, ultrasound estimated bladder weight, near infrared spectroscopy, condom catheter and penile cuff compression techniques and are summarized in this review.