Lindsey Cox

OnabotulinumtoxinA for the treatment of overactive bladder

OnabotulinumtoxinA injection is a safe and effective treatment for adults with refractory overactive bladder. There is sufficient level 1 evidence to support offering onabotulinumtoxinA injections as a second-line treatment to patients who have failed behavioral therapy and oral medications such as antimuscarinics and β3 agonists. An intradetrusor injection of 100 U of onabotulinumtoxinA is likely the optimal dose to balance risks and benefits, and this is the dose approved by the US Food and Drug Administration. Improvement in urgency urinary incontinence episodes, as well as symptom scores and quality of life, were seen in around 60%–65% of patients, and were significantly improved compared with those on placebo. Most studies have reported a duration of symptom relief ranging from 6 to 12 months, with repeat injections being safe and efficacious. Overall, the risk of urinary retention was around 6% across the study populations.

Gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization

INTRODUCTION This study aimed to determine if gentamicin bladder instillations reduce the rate of symptomatic urinary tract infection (UTI) in neurogenic bladder (NGB) patients on intermittent self-catheterization (ISC) who have recurrent UTIs. Secondary aims were to examine the effects of intravesical gentamicin on the organism resistance patterns. METHODS We retrospectively reviewed our prospective NGB database. Inclusion criteria were NGB patients performing ISC exclusively for bladder drainage with clinical data available for six months before and six months after initiating prophylactic intravesical gentamicin instillations. Symptomatic UTIs were defined as symptoms consistent with UTI plus the need for antibiotic treatment. RESULTS Twenty-two patients met inclusion criteria; etiology of NGB was 63.6% spinal cord injury, 13.6% multiple sclerosis. Median time since injury/diagnosis was 14 years and 6/22 (27.3%) had undergone urological reconstruction. Patients had fewer symptomatic UTIs (median 4 vs. 1 episodes; p<0.004) and underwent fewer courses of oral antibiotics after initiating gentamicin (median 3.5 vs. 1; p<0.01). Days of oral antibiotic therapy decreased from 15 before to five after gentamicin, but this did not reach significance. There were fewer telephone encounters for UTI concerns per patient (median 3 vs. 0; p=0.03). The proportion of multi-drug-resistant organisms in urine cultures decreased from 58.3% to 47.1% (p=0.04) and the rate of gentamicin resistance did not increase. Adverse events were mild and rare. CONCLUSIONS Gentamicin bladder instillations decrease symptomatic UTI episodes and reduce oral antibiotics in patients with NGB on ISC who were suffering from recurrent UTIs. Antibiotic resistance decreased while on gentamicin instillations.

Urodynamics in Male LUTS: When Are They Necessary and How Do We Use Them?

In this article, the value of urodynamic studies in the evaluation of treatment of male lower urinary tract symptoms is appraised based on current evidence. The information gained by urodynamics can be a valuable tool for counseling patients considering invasive outlet reduction procedures.

Prevention of Urinary Tract Infection for Patients with Neurogenic Bladder

Urinary tract infection is a common problem among patients with neurogenic bladder dysfunction that can be costly and challenging to manage. Current literature on the topic of preventing urinary tract infections in this heterogeneous patient population is challenged by the difficulty in defining urinary tract infections and by the lack of long-term data from controlled randomized studies. New research suggests that intradetrusor injection of onabotulinumtoxin A may be a useful adjunct in preventing urinary tract infections, and further studies are needed to determine if probiotics, bacterial interference, and/or vaccines will prove to be of use in the population.

MP63-10 DO URODYNAMICS PREDICT URINARY RETENTION AFTER SLING PLACEMENT IN THE COMPLEX PATIENT: VALUE OF REPRODUCING SYMPTOMS OF URODYNAMICS

experienced UUI resolution in the successes, and 10 (17.2%) in the failures (P .001). Among successes, a significant interaction (p<.001) was detected between the baseline and postoperative urodynamic parameters, including Qmax, corrected Qmax, postvoid residual (PVR), voiding volume, voiding efficiency(VE), and bladder outlet obstruction index (BOOI). Significantly increased PdetQmax was also observed after surgery (P .015). A significant interaction (P .034) is detected from the baseline to 6 months between successes and failures for BOOI. CONCLUSIONS: Suburethral sling has a durable long-term effect in our study. There is a trend suggesting that the decreased Qmax, corrected Qmax and VE are associated with surgical success, while increased Pdet. Qmax, BOOI, and PVR are also associated with success. Slight obstruction makes efficacious sling surgery. The increased outlet resistance is essential for achieving dryness.

Female urology in 2013: Evaluating progress on longstanding issues

In 2013, data began to emerge that shed light on several longstanding issues in female urology, from the safety of adrenergic receptor agonists and onabotulinumtoxinA for overactive bladder to the use of physical therapy and mesh suburethral slings for stress urinary incontinence.

Evaluating progress on longstanding issues: Female urology in 2013

In 2013, data began to emerge that shed light on several longstanding issues in female urology, from the safety of adrenergic receptor agonists and onabotulinumtoxinA for overactive bladder to the use of physical therapy and mesh suburethral slings for stress urinary incontinence.

Evaluating progress on longstanding issues.

In 2013, data began to emerge that shed light on several longstanding issues in female urology, from the safety of adrenergic receptor agonists and onabotulinumtoxinA for overactive bladder to the use of physical therapy and mesh suburethral slings for stress urinary incontinence.

Voided midstream urine culture is a good test for acute cystitis in premenopausal women

Commentary on: Hooton TM, Roberts PL, Cox ME, et al. Voided midstream urine culture and acute cystitis in premenopausal women. N Engl J Med 2013;369:1883–91.[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Uncomplicated acute cystitis is a common and uncomfortable condition in premenopausal women. Controversy exists over the value of culture data obtained from clean-catch midstream urine specimens for directing antimicrobial therapy, due to the risk of contamination by periurethral and vaginal organisms affecting the detection of true bladder bacteriuria. In the past, bacterial colony counts have been used to determine the threshold for clinically meaningful results. The authors attempt to clarify this issue by comparing culture results in premenopausal women displaying symptoms of acute cystitis from specimens obtained through midstream urine collection with specimens obtained by urethral catheterisation. The study compared the results of 202 paired, quantitative cultures of midstream and catheterised urine specimens from premenopausal women with symptoms of acute cystitis (dysuria and urinary frequency or … [1]: {openurl}?query=rft.jtitle%253DN%2BEngl%2BJ%2BMed%26rft.volume%253D369%26rft.spage%253D1883%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa1302186%26rft_id%253Dinfo%253Apmid%252F24224622%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa1302186&link_type=DOI [3]: /lookup/external-ref?access_num=24224622&link_type=MED&atom=%2Febmed%2F19%2F4%2F151.atom [4]: /lookup/external-ref?access_num=000330468300007&link_type=ISI