Lukas K. Daha

ELECTROMOTIVE ADMINISTRATION OF INTRAVESICAL BETHANECHOL AND THE CLINICAL IMPACT ON ACONTRACTILE DETRUSOR MANAGEMENT:: INTRODUCTION OF A NEW TEST

PURPOSE It is often difficult to determine the functional status of the detrusor muscle in patients with detrusor areflexia. We performed a clinical study to establish a test defining residual detrusor capacity in such patients. MATERIALS AND METHODS In phase 1, 5 controls with detrusor areflexia were tested with an intravesical instillation of 20 mg. bethanechol in 150 cc of sodium chloride 0.3% with and without 20 mA. of pulsed current applied via an electrode catheter through the saline. Cystometry simultaneously recorded intravesical pressure changes. In phase 2, 45 patients with detrusor areflexia were tested with electromotive administration of intravesical bethanechol. In phase 3, 25 mg. bethanechol given orally once daily were prescribed for 15 patients and voiding control was assessed after 6 weeks of therapy. RESULTS Neither bethanechol without current nor current through saline only led to increased intravesical pressure. However, we noted a mean pressure increase of 34 cm. water during the electromotive administration of bethanechol in 24 of 26 patients with areflexia and neurological disease compared to only 3 cm. water in 3 of 11 with a history of chronic bladder dilatation. Oral bethanechol restored spontaneous voiding in 9 of 11 patients who had had a positive response to the electromotive administration of bethanechol, whereas all 4 without a pressure increase during the electromotive administration of bethanechol did not void spontaneously. CONCLUSIONS Electromotive administration of intravesical bethanechol identifies patients with an atonic bladder and adequate residual detrusor muscle function who are candidates for restorative measures, such as oral bethanechol and intravesical electrostimulation. Those who do not respond to the electromotive administration of bethanechol do not benefit from oral bethanechol and are candidates for catheterization.

Effect of intravesical glycosaminoglycan substitution therapy on bladder pain syndrome/interstitial cystitis, bladder capacity and potassium sensitivity

Objective. To evaluate changes in bladder capacity and potassium sensitivity after glycosaminoglycan (GAG) substitution therapy. Material and methods. The study population comprised two groups of female patients with bladder pain syndrome/interstitial cystitis (BPS/IC): responders (those with symptom improvement) and non-responders (those without symptom improvement) after a 10-week period of intravesical, episodic, weekly, GAG substitution therapy. A total of 27 volunteers with increased pre-therapeutic potassium sensitivity were enrolled in the study and re-evaluated using the modified comparative potassium test (maximal bladder capacity with a saline solution versus a 0.2 M KCl solution) following intravesical GAG substitution therapy. Results. In the 13 responders, the average maximal bladder capacity increased by 17% with the saline solution and by 101.5% with the 0.2 M KCl solution. In the 14 non-responders, post-therapeutic average maximal bladder capacity was decreased by 35% with the saline solution and remained relatively unchanged after instillation with a 0.2 M KCl solution. Conclusion. These data demonstrate that in patients who respond symptomatically to intravesical GAG substitution therapy, cystometric bladder capacity is increased, whereas non-responders experience a decrease in bladder capacity.

LB15 Intravesical hyaluronic acid for the treatment of interstitial cystitis: An update

INTRODUCTION & OBJECTIVES: Current pathogenetic concepts of interstitial cystitis (IC) are based on an increased urothelial permeability due to dysfunction of the GAG (glycosaminoglycane)-layer and the urothelium. The efficacy of GAG-substitution therapy has been demonstrated with various drugs. Instillation of hyaluronic acid, a GAG-component, for IC therapy was introduced by Morales (J.Urol., 156: 45-48, 1996.) who found a 71% rate of symptom improvement. For the present study, we analyzed the outcome of intravesical hyaluronic acid therapy in IC patients treated at our institutions. MATERIAL & METHODS: We retrospectively evaluated 95 IC patients by a questionnaire mailed several months after the last instillation. Patients had been assigned for hyaluronic acid therapy in case of increased potassium sensitivity demonstrated by the modified potassium sensitivity test (Daha et al., J.Urol., 170: 807, 2003). Weekly instillations of 50 cc hyaluronic acid 40 mg were performed until patients were free of symptoms or significantly improved to their satisfaction. Patients rated their preand posttreatment as well as their present symptoms on a visual analog scale (VAS, 0-10) and were asked to comment on their personal benefit on quality of life.

Hormonal replacement therapy for the aging bladder

Aging is accompanied by the development of various, sometimes distressing, symptoms of different organ systems including the genitourinary tract. Alterations of the genitourinary tract are common during aging, with sex specific differences, that is, the development of irritative bladder symptoms both in men and women, stress incontinence more often reported by women, and bladder outlet obstruction in aging men.

Acupuncture Treatment of Psychogenic Erectile Dysfunction: A Four-Year Follow-Up Study

The aim of the study was to assess the longterm effects of acupuncture treatment in patients suffering from psychogenic erectile dysfunction (ED). Patients and Methods: Twenty patients with psychogenic ED who underwent acupuncture treatment between 1999 and 2001 were invited to an after-care interview with the items International Index of Erectile Function (IIEF) 15 Score, influence of acupuncture on quality of life, effect and duration of acupuncture treatment on erectile status and willingness to repeat the treatment. Results: Fifteen patients accepted our invitation. Comparison of the IIEF 15 Score shortly after treatment with the Score in 2005 showed no statistically relevant difference (P = 0.608). Sixty-seven percent (n = 10) of the after-care patients reported an improvement in their quality of life and 53% (n = 8) would repeat this acupuncture treatment. Conclusions: The results are a first indication that long-term effects could be reached through acupuncture treatment.

534Comparative assessment of maximal bladder capacity, 0.9% NaCl VS. 0.2 M KCl before and after therapy for interstitial cystitis

INTRODUCTION & OBJECTIVES: For diagnosis of increased potassium sensitivity in patients with interstitial cystitis (IC) comparative assessment of maximal bladder capacity (CAMBC) with a 0.9% NaCl solution vs. a 0.2 M KCl solution is a well tolerated alternative to the 0.4M potassium sensitivity test (PST) (Daha et al., J.Urol., 165, Supp: A 280, 2001). In the present study comparative assessment of maximal bladder capacity was performed before and after GAG substitution therapy to asses the post therapeutic changes in potassium sensitivity.

Incidence of urological diseases in geriatric patients in a large community hospital

To the Editor: The medical community is aware of the increasing health problems caused by the aging society, but we are still lacking specific incidence data for most age-related diseases, which may be used by scientific and governmental authorities for the initiation of future healthcare and research funding programs. In Austria, the percentage of people aged 80 and older is about 2%, 1 and 14.7% of the population is aged 65 and older. As a consequence, we face an increasing number of urological problems and diseases in the geriatric population. To assess the incidence of urological diseases in older people, we performed a retrospective analysis of patient data in 1996 and 1997. The municipal hospital Lainz in Vienna, Austria, has 23 departments with 965 beds, of which 32 regular and five intensive care beds belong to the urological department. Patients were grouped according to their age: 80 and older (Group 1), 70 to 79 (Group 2), and 60 to 69 (Group 3) (Table 1). The total number of in/outpatients was 1,029/3,933 in 1996 and 2,228/3,376 in 1997. About 10% of all inand