Jonathan S. Starkman

Comparison of bipolar transurethral resection of the prostate with standard transurethral prostatectomy: shorter stay, earlier catheter removal and fewer complications.

Authors from Detroit assess the use of the bipolar TURP against the monopolar technique; there were relatively few patients, reflecting the decreasing requirement for TURP in the USA. In addition, the amount of resected tissue was not particularly large, almost certainly a reflection of the decreasing size of resected prostatic tissue in that country. They found the bipolar TURP to have many advantages over standard monopolar TURP, and these are described.

The Evolution of Obstruction Induced Overactive Bladder Symptoms Following Urethrolysis for Female Bladder Outlet Obstruction

PURPOSE Bladder outlet obstruction following stress incontinence surgery may present as a spectrum of lower urinary tract symptoms. We evaluated the prevalence and impact of persistent overactive bladder symptoms following urethrolysis for iatrogenic bladder outlet obstruction. MATERIALS AND METHODS In a retrospective review we identified 40 patients who underwent urethrolysis. All patients underwent a standardized urological evaluation. Patients identified with genitourinary erosion, neurogenic bladder dysfunction and preexisting overactive bladder were excluded. Urethrolysis outcomes were determined by subjective bladder symptoms and objective parameters. Validated questionnaires were completed to assess symptom bother, patient satisfaction and quality of life. Statistical analyses were performed using Stata, version 9.0. RESULTS A total of 40 patients were included in the study with a mean +/- SD followup of 13 +/- 11 months (range 3 to 38). Of the patients 34 patients presented with obstructive symptoms, while 36 had overactive bladder symptoms. Obstructive symptoms resolved in 28 of the 34 patients (82%), while overactive bladder symptoms resolved completely in only 12 (35%) and they were significantly improved in 4 (12%). Overall 20 patients (56%) were on antimuscarinics for refractory overactive bladder and 8 ultimately required sacral neuromodulation. Pre-urethrolysis detrusor overactivity was more likely in patients with persistent overactive bladder symptoms than in those in whom overactive bladder symptoms resolved (70% vs 38%). Patients with persistent overactive bladder had significantly greater symptom severity/bother, and decreased perception of improvement and quality of life following urethrolysis. CONCLUSIONS Following urethrolysis overactive bladder symptoms may remain refractory in 50% or greater of patients, which has a negative impact on quality of life and the impression of improvement after surgery. Detrusor overactivity demonstrated preoperatively may be useful for predicting who may have persistent overactive bladder symptoms despite an effective urethrolysis procedure.

Spatial and temporal analysis of the Drosophila FMRFamide neuropeptide gene product SDNFMRFamide: Evidence for a restricted expression pattern

The expression of SDNFMRFamide, one of five different FMRFamide-containing peptides encoded by the Drosophila melanogaster FMRFamide gene, has been determined. To study expression, we generated antisera to the N-terminus of SDNFMRFamide to avoid crossreactivity with FMRFamide-containing peptides. The antisera were purified and the specificity characterized. SDNFMRFamide immunoreactive material is present in the central nervous system throughout development. Immunoreactivity is first observed in embryonic neural tissue in a cluster of cells in the subesophageal ganglion and immunoreactive fibers projecting from these cells to the brain and ventral ganglion. This pattern of expression is also observed in neural tissue dissected from larva, pupa, and adult. Double-labelling experiments indicate that cells recognized by SDNFM-antisera are also stained with FMRFamide antisera. Based on position, SDNFMRFamide immunoreactive material is expressed in a limited number of cells that contain the FMRFamide polypeptide precursor. This finding suggests that the Drosophila FMRFamide precursor undergoes differential post-translational processing.

Removal of Transobturator Midurethral Sling for Refractory Thigh Pain

Polypropylene midurethral slings have become the most common surgical procedure for the treatment of stress urinary incontinence. The efficacy has been well established through prospective and systematic evaluation. Transobturator midurethral slings have demonstrated comparable efficacy relative to the retropubic approach with the potential to minimize the morbidity associated with retropubic needle passage. We present a case of recalcitrant medial thigh pain after transobturator midurethral sling placement that ultimately required medial thigh/transobturator exploration and sling excision.

Nicotinic Signaling Ameliorates Acute Bladder Inflammation Induced by Protamine Sulfate or Cyclophosphamide

PURPOSE Nicotinic afferent pathways may be involved in the regulation of bladder inflammation. Based on that hypothesis we investigated the role of nicotinic signaling in a comparative analysis of 2 models of experimental bladder inflammation using protamine sulfate and cyclophosphamide. MATERIALS AND METHODS Protamine sulfate and cyclophosphamide were used to induce acute bladder inflammation. Nicotinic agonists and antagonists were given concomitant to the bladder inflammatory agents. Changes in bladder inflammation were measured histologically by a pathologist and through the expression of inflammatory genes. RESULTS Histologically cyclophosphamide induced more inflammatory changes than protamine sulfate during acute bladder inflammation. Antagonizing nicotinic signaling with mecamylamine induced further inflammatory changes on histology when used with cyclophosphamide but not with protamine sulfate. However, antagonizing nicotinic signaling in combination with protamine sulfate induced greater increases in mRNA expression of the inflammatory cytokine interleukin-6 compared to cyclophosphamide and mecamylamine combination treatments. The activation of nicotinic signaling attenuated acute bladder inflammation by protamine sulfate and cyclophosphamide independently through the down-regulation of increased interleukin-6 expression. CONCLUSIONS Acutely cyclophosphamide treatment results in a greater frank bladder inflammation model in mice than protamine sulfate. However, cholinergic signaling can inhibit inflammation by either mechanism of induced bladder injury. Interleukin-6 gene expression is present and it can be regulated by afferent neuronal signaling even in the absence of observed histological changes in acute bladder inflammatory models.

Transdermal drug delivery treatment for overactive bladder

Overactive bladder is commonly treated with oral anticholinergic drugs such as oxybutynin chloride. Although oral anticholinergic agents have been effective in controlling urinary urgency and incontinence, adverse events, particularly dry mouth, often cause patients to discontinue oral therapy and to endure incontinence. Oxybutynin can be delivered transcutaneously, maintaining the efficacy of oral oxybutynin while significantly minimizing side effects (e.g., dry mouth) that may complicate therapy. By avoiding hepatic and gastrointestinal metabolism of oxybutynin, less N-desethyloxybutynin (N-DEO) is produced and this compound is deemed to be responsible for anticholinergic side effects such as dry mouth. This novel oxybutynin formulation offers patients with OAB and urge urinary incontinence a well-tolerated option for managing the symptoms of overactive bladder.

Vesicovaginal fistula following a transobturator midurethral sling procedure.

Synthetic mid-urethral slings are currently the most common surgical procedure performed for the treatment of female stress urinary incontinence. The transobturator mid-urethral sling technique was originally described in 2001 and has since become widely accepted due to its high rate of success and low complication rate. Although complications remain infrequent, when they do occur, there is potential for significant patient morbidity. We report a case of a vesicovaginal fistula following a transobturator mid-urethral sling procedure and describe successful reconstruction with transvaginal sling excision, fistula closure, and placement of an autologous pubovaginal sling.

Tissue ingrowth in penile implants and its effect on repeat penile surgery

Penile implant malfunction is usually treated by removal of the original malfunctioning implant followed by replacement with a new device. During replacement, the original implant can be explanted without any difficulty, as it is not adherent to the surrounding tissue. Herein, we describe two cases of tissue ingrowth into the implant that produced difficulty during explantation and suggest ways in which this condition can be managed.

DPKQDFMRFamide expression is similar in two distantly related Drosophila species

Drosophila melanogaster DPKQDFMRFamide was isolated and its expression reported. Distribution of DPKQDFMRFamide immunoreactivity is now described in Drosophila virilis. DPKQDFMRFamide antibody stained a cell in the subesophageal ganglion in embryo. DPKQDFMRFamide antibody stained cells in the superior protocerebrum, subesophageal ganglion, thoracic ganglia, and an abdominal ganglion in larva, pupa, and adult. DPKQDFMRFamide antibody stained an additional pair of cells in the optic lobe and a cell in the lateral protocerebrum in adult. Structure identity and similar distribution of DPKQDFMRFamide in D. virilis and D. melanogaster, two distantly related Drosophila species, suggests an important and conserved activity for the peptide.

Augmented repairs and use of interposition grafts in pelvic reconstructive surgery: Part II

Because the prevalence of pelvic organ prolapse increases with age and the number of women aged 65 years and older is expected to double in the next 25 years, demand is increasing for subspecialty services related to pelvic floor disorders. Synthetic and biologic interposition grafts have been proposed as a way of augmenting weakened host tissues during pelvic reconstructive surgical procedures because the rate of recurrent pelvic organ prolapse is unacceptably high. Although graft use is rapidly increasing among pelvic reconstructive surgeons, the role of prosthetics is controversial and currently in the process of evolution, with few evidence-based data to support their routine use. This review provides a context for the use of prosthetic grafts in pelvic reconstructive surgery, discusses the properties of both synthetic and biologic materials commonly used during transvaginal reconstructive procedures, and reviews the literature with respect to the role of graft interposition during anterior compartment prolapse repair.