Reem Aldamanhori

Underactive bladder, detrusor underactivity, definition, symptoms, epidemiology, etiopathogenesis, and risk factors

Purpose of review Lower urinary tract symptoms are bothersome and significantly impair patients quality of life. Incomplete bladder emptying affects both men and women, and has shown to increase in incidence with aging. Incomplete bladder emptying is consequent upon an inability of the detrusor muscle to adequately contract to completely empty the bladder, with or without an increased bladder outlet resistance; this can be defined urodynamically as detrusor underactivity (DUA). The symptom complex consequent upon DUA is referred to as underactive bladder (UAB). Although the occurrence of DUA increases with age, and is commonly encountered in clinical practice, it is a largely unrecognized and consequently under researched condition. Recent findings In this article, we will highlight the importance of DUA. We will review UAB as currently defined, the symptoms of DUA, its epidemiology, and etiopathogenesis, risk factors for developing DUA, and methods of diagnosis with an up-to-date review of the contemporary literature. Summary DUA and its associated symptoms and signs are still poorly recognized entities. Difficulty and confusion arise in properly diagnosing DUA, as at present it can only be accurately defined on the basis of pressure flow urodynamics. Current attention is focused on validating a satisfactory definition for the syndrome complex of UAB.

Psoas Abscess Secondary to Urinary Tract Fungal Infection

Psoas abscess is a rare condition where infection spreads from a nearby or distant septic focus to the psoas sheath. The causative bacterial organisms at distal sites reach the psoas via lymphatic or hematogenous spread, whereas infection from nearby sites that include the urinary system reaches the psoas directly. There are few reports that account for bacterial infection after endourological procedures as the cause of direct spread of infection to the psoas muscle.2 We report a case of psoas abscess caused by fungal infection that spread from an injured left ureter to the psoas sheath.

Underactive bladder: Pathophysiology and clinical significance

Underactive bladder (UAB) is a voiding disorder which generates disabling lower urinary tract symptoms (LUTS) due to the inability to produce an effective voiding contraction sufficient to empty the bladder. The underlying abnormality, that is usually appreciated when performing urodynamic studies, has been defined by the International Continence Society (ICS) as detrusor underactivity (DUA). DUA is a common yet under-researched bladder dysfunction. The prevalence of DUA in different patient groups suggests that multiple aetiologies are implicated. Currently there is no effective therapeutic approach to treat this condition. An improved understanding of the underlying mechanisms is needed to facilitate the development of new advances in treatment. The purpose of this review is to discuss the epidemiology, pathophysiology, common causes and risk factors potentially leading to DUA; to aid in the appropriate diagnosis of DUA to potentially improve treatment outcomes.

Contemporary outcomes of hypospadias retrieval surgery in adults

To describe the surgical approach and outcomes in the treatment of adult patients with complications of childhood hypospadias surgery, as such patients present a significant reconstructive challenge due to the combination of anatomical and cosmetic deformity, which often results in major functional and psychosexual sequelae.

The Treatment Of Complex Female Urethral Pathology

Lower urinary tract symptoms (LUTS) in women produce significant bother. Common conditions causing LUTS in women include urinary tract infections, overactive bladder, and stress incontinence. Urethral diverticulae and female urethral strictures are rare pathologies. They can cause symptoms, which can mimic commoner conditions, leading to delay in diagnosis and unnecessary delay in treatment. In this article, we discuss in detail the definition, symptoms, epidemiology, pathogenesis, diagnosis, and treatment option for these two conditions. Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management.

Tissue Engineering and Cell Therapy for Underactive Bladder: Current and Future Approaches

The absence of any effective drug therapy for underactive bladder makes the use of regenerative medicine approaches an attractive option. Tissue engineering of whole bladders has been investigated for over a decade and resulted in a small clinical study with some success, however such bladders can only fulfill a storage function due to the difficulty of recreating the complex neural innervation to enable volitional emptying. Stem cell injection therapy would be appear to be a more workable and practical approach in the patients with underactive bladder, however only pre-clinical studies are available. It is likely that any future stem cell injection approach should be tailored to the particular likely underlying pathophysiology, such as targeting the bladder wall in patients with myogenic failure.

Management of the patient with failed hypospadias surgery presenting in adulthood

The management of patients who have had complications of primary surgery for the resolution of a hypospadiac deformity remains a therapeutic challenge. Adults with complications following childhood hypospadias repairs are undoubtedly a difficult population to treat, as there is usually a cosmetic deformity, lower urinary tract symptoms, and resulting psychosexual consequences. A surgeon’s experience has been and still remains an important factor in determining subsequent surgical outcomes, particularly with more severe or complex cases. The purpose of this review is to evaluate the complications of hypospadias repair that present in adults and review published experience in treating them.

Antimuscarinics, β-3 Agonists, and Phosphodiesterase Inhibitors in the Treatment of Male Lower Urinary Tract Symptoms: An Evolving Paradigm

It is increasingly recognized that the bladder is the originator of storage lower urinary tract symptoms, including overactive bladder in men. As these symptoms are most bothersome for patients, there has been an increasing interest in the evaluation of drug treatment to better target the bladder. Consequently, several new drug classes have been introduced to the therapeutic armamentarium. Antimuscarinics, which were previously avoided due to the concern regarding urinary retention, are now used in routine practice; however, their use is still hampered by discontinuation due to side effects.

Scrotal abscess, an unusual manifestation of Crohn's disease

Crohn′s disease (CD) is a chronic inflammatory disorder of the alimentary tract, usually involving the ileum and proximal colon, which is sometimes associated with extra intestinal manifestations. Urologic complications of CD are rarely reported in literature. CD-related complications involving the urinary tract include infections and urolithiasis as the most common manifestations. Rare more serious occurrences associated with penetrating type disease include ureteral obstruction and enterovesical fistulization. Here, a rare case of CD complicated with a recto-scrotal fistula and the scrotal abscess is presented.

Iatrogenic submucosal tunnel in the ureter: a rare complication during advancement of the guide wire.

BACKGROUND Inserting a guide wire is a common practice during endo-urological procedures. A rare complication in patients with ureteral stones where an iatrogenic submucosal tunnel (IST) is created during endoscopic guide wire placement. OBJECTIVE Summarize data on IST. DESIGN Retrospective descriptive study of patients treated from from October 2009 until January 2015. SETTING King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. PATIENTS AND METHODS Patients with ureteral stones were divided to 2 groups. In group I (335 patients), the ureteral stones were removed by ureteroscopy in one stage. Group II (97 patients) had a 2-staged procedure starting with a double J-stent placement for kidney drainage followed within 3 weeks with ureteroscopic stone removal. MAIN OUTCOME MEASURE (S) Endoscopic visualization of ureteric submucosal tunneling by guide wire. RESULTS IST occurred in 9/432 patients with ureteral stones (2.1%). The diagnosis in group I was made during ureteroscopy by direct visualization of a vanishing guide wire at the level of the stone (6 patients). In group II, IST was suspected when renal pain was not relieved after placement of the double J-stent or if imaging by ultrasound or intravenous urography showed persistent back pressure to the obstructed kidney (3 patients). The condition was subsequently confirmed by ureteroscopy. CONCLUSION Forceful advancement of the guide wire in an inflamed and edematous ureteral segment impacted by a stone is probably the triggering factor for development of IST. Definitive diagnosis is possible only by direct visualization during ureteroscopy. Awareness of this potential complication is important to guard against its occurrence. LIMITATIONS Relatively small numbers of subjects and the retrospective nature of the study.