Current urology reports
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Current urology reports · Feb 2015
ReviewPercutaneous tibial nerve stimulation and sacral neuromodulation: an update.
Neuromodulation is an important treatment modality for a variety of pelvic floor disorders. Percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (SNM) are currently the two approved methods for delivering this therapy. ⋯ Sacral neuromodulation uses an implanted device that stimulates the S3 nerve root and can improve symptoms of overactive bladder, non-obstructive urinary retention, fecal incontinence, and pelvic pain. This paper will review the most recent literature regarding this topic and discuss their advantages and limitations and recent innovations in their use.
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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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With the signing of H. R. 4302 ( https://beta.congress.gov/bill/113th-congress/house-bill/4302 ), the implementation date for using ICD-0-CM codes for coding and billing medical encounters in the United States is now scheduled for October 1, 2015. ⋯ Vital to this conversion is accurate documentation in the medical records by providers, knowledge of insurance coverage (local and national) rules, and acceptance of those codes by electronic health record systems, clearinghouses, and payors. Early preparation, appropriate education, and proper testing will minimize the financial impact.
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Current urology reports · Nov 2014
Current controversies regarding oncologic risk associated with polypropylene midurethral slings.
Midurethral synthetic slings are the gold standard treatment for stress urinary incontinence. However, recent concerns have been raised regarding a possible association between synthetic midurethral slings and malignancy. The aim of this editorial was to examine the data behind these concerns. After a review of the data, no evidence was found to suggest that polypropylene midurethral slings are associated with a risk of malignancy.ᅟ
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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.