Current urology reports
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Current urology reports · Dec 2014
ReviewMixed incontinence: what takes precedence in its management?
Mixed urinary incontinence is a commonly encountered condition for urologists, urogynecologists, and primary care providers. In this review, we discuss the approach to the evaluation and management of patients with simultaneous stress and urgency urinary incontinence. The available evidence for treatment modalities in the setting of mixed urinary incontinence is presented, and we discuss our treatment algorithm for this common but challenging clinical scenario. An accurate assessment of stress and urge symptoms and their relative impact on quality of life help guide the management plan, appropriate counseling, and appropriate appraisal of patient expectations for treatment.
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Urinary tract infections (UTI) remain one of the most prevalent and frustrating morbidities for neurogenic bladder patients, and death attributed to urosepsis in the spinal cord injury (SCI) patient is higher when compared to the general population. Risk factors include urinary stasis, high bladder pressures, bladder stones, and catheter use. ⋯ Of these, bladder inoculation with E. coli HU2117, irrigation with iAluRil(®), detrusor injections, and weekly prophylaxis with alternating antibiotics appear to have a positive reduction in UTI but require further study. Ultimately, treatment for symptomatic UTI should account for the varied flora and possible antibiotic resistances including relying on urine cultures to guide antibiotic therapy.
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Current urology reports · Aug 2013
ReviewColorectal surgery and its impact on male sexual function.
The quality of functional outcome has become increasingly important in view of improvement in prognosis with colorectal cancer patients. Sexual dysfunction remains a common problem after colorectal cancer treatment, despite the good oncologic outcomes achieved by expert surgeons. Although radiotherapy and chemotherapy contribute, surgical nerve damage is the main cause of sexual dysfunction. ⋯ The concept of total mesorectal excision (TME) in rectal cancer treatment has led to a substantial improvement of autonomic nerve preservation. In addition, use of laparoscopy has allowed favorable results with regards to sexual function. The present paper describes the anatomy and pathophysiology of autonomic pelvic nerves, prevalence of sexual dysfunction, and the surgical technique of nerve preservation in order to maintain sexual function.
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Botulinum toxin-A (BTX-A) is well established in the management of various aspects of lower urinary tract dysfunction (LUTD). One formulation, OnabotulinumtoxinA has recently been licensed in many parts of the world for use in neurogenic detrusor overactivity (NDO), and in the US for idiopathic overactive bladder (OAB), in patient's refractory to antimuscarinics. This review article looks at recent clinical publications that examine the use of BTX-A for the treatment of LUTD with a focus on OAB, detrusor overactivity (DO), benign prostatic hyperplasia (BPH) and Painful bladder syndrome / interstitial cystitis (PBS / IC). ⋯ Repeated injections in DO appear efficacious. Results from BPH studies are mixed, and the largest randomised study in this setting has shown significant improvements in a number of parameters for a variety of OnabotulinumtoxinA doses, but none of the doses were statistically better than placebo. Few studies have been conducted in PBS / IC and larger scale randomised placebo controlled trials are required to validate its use in this setting.
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Current urology reports · Jun 2013
Review Comparative StudyProton beam radiation therapy for prostate cancer-is the hype (and the cost) justified?
Although in use for over 40 years, proton beam therapy for prostate cancer has only recently come under public scrutiny, due to its increased cost compared to other forms of treatment. While the last decade has seen a rapid accumulation of evidence to suggest that proton beam therapy is both safe and effective in this disease site, a rigorous comparison to other radiotherapy techniques has not yet been completed. In this review, we provide an in-depth look at the evidence both supporting and questioning proton beam therapy's future role in the treatment of prostate cancer, with emphasis on its history, physical properties, comparative clinical and cost effectiveness, advances in its delivery and future promise.