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Showing papers in "Current Bladder Dysfunction Reports in 2015"


Journal ArticleDOI
TL;DR: Given the complex nature of this disorder, these children should be managed at speciality centers with orthopedic, urologic, and nursing experience with these patients.
Abstract: Bladder exstrophy is a complex congenital birth defect ranging from complete epispadias to complete bladder exstrophy. Though not included in the exstrophy-epispadias complex (EEC) disease spectrum, cloacal exstrophy is a more severe form which includes bowel segments in the defect and has many of the same defects as the EEC. Initial care of these complex patients focuses on the primary repair of the defect, a repair which is the most important of the many operations these children will have in their lifetime. A failure of primary closure is associated with worse outcomes across the board. The most essential goal in treatment of the exstrophy patient is renal protection. Once that can be assured, social continence then becomes the most important goal. Given the complex nature of this disorder, these children should be managed at speciality centers with orthopedic, urologic, and nursing experience with these patients.

57 citations


Journal ArticleDOI
TL;DR: The neurogenic causes of detrusor underactivity, including diabetic bladder dysfunction, spinal cord injury, multiple sclerosis, Parkinson's disease, cerebrovascular accident, traumatic brain injury, and Fowler’s syndrome are reviewed.
Abstract: Detrusor underactivity (DU) is a poorly understood dysfunction of the lower urinary tract which arises from multiple etiologies. Symptoms of DU are non-specific, and a pressure-flow urodynamic study is necessary to differentiate DU from other conditions such as overactive bladder (OAB) or bladder outlet obstruction (BOO). The prevalence of DU ranges from 10 to 48 %, and DU is most prevalent in elderly males. The pathophysiology underlying DU can be from both neurogenic and non-neurogenic causes. In this article, we review the neurogenic causes of detrusor underactivity, including diabetic bladder dysfunction, spinal cord injury, multiple sclerosis, Parkinson’s disease, cerebrovascular accident, traumatic brain injury, and Fowler’s syndrome. As knowledge about the underlying causes of DU advances, there have been several potential therapeutic approaches proposed to help those who suffer from this condition.

30 citations


Journal ArticleDOI
TL;DR: This review provides an update on bladder tissue engineering and outlines the challenges that remain to clinical implementation.
Abstract: Substantial clinical need persists for improved autologous tissues to augment or replace the urinary bladder and research has begun to address this using tissue engineering techniques. The implantation of both tissue scaffolds which allow for native bladder tissue ingrowth and autologous bladder grafts created from in vitro cellularization of such scaffolds have been tested clinically; however, successful outcomes in both scenarios have been challenged by insufficient vascularity resulting from large graft sizes, which subsequently limits tissue ingrowth and leads to central graft ischemia. Consequently, recent research has focused on developing better methods to produce scaffolds with increased tissue ingrowth and vascularity. This review provides an update on bladder tissue engineering and outlines the challenges that remain to clinical implementation.

12 citations


Journal ArticleDOI
TL;DR: An overview of long-term cost considerations for the neurogenic bladder patient is provided to help the practitioner better help the patient select a bladder care regimen that balances the desire to both minimize symptoms now and preserve urinary tract integrity for the future, yet still remain cost-effective.
Abstract: Costs of neurogenic bladder vary widely and depend on a number of factors including severity of disease, symptomatology, patient insurance, and devices required. Recognition of how each treatment strategy will impact the patient financially could help guide selection of treatment as well as improve compliance with the chosen regimen. We have attempted to provide an overview of long-term cost considerations for the neurogenic bladder patient. Armed with this information, the practitioner can better help the patient select a bladder care regimen that balances the desire to both minimize symptoms now and preserve urinary tract integrity for the future, yet still remain cost-effective.

11 citations


Journal ArticleDOI
TL;DR: Sexual function appears to be preserved after PUL with no reported new-onset erectile dysfunction or anejaculation events and urinary flow rate improvements have been shown to be durable through 2 years.
Abstract: Prostatic urethral lift (PUL) has been shown to be a safe, effective treatment option for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Discomfort with PUL is similar to that with rigid cystoscopy and can be tolerated with local anesthesia in an office setting. Of those who are given voiding trials, 70–80 % of subjects do not require a catheter. Subjects often quickly return to pre-operative activity level with minimal absence from work. Symptom relief can start within 2 weeks and be sustained through 2 years. Urinary flow rate improvements have been shown to be durable through 2 years. The most common adverse effects are dysuria, hematuria, pain, and urgency which are typically mild to moderate and transient. Sexual function appears to be preserved after PUL with no reported new-onset erectile dysfunction or anejaculation events. The retreatment rate is reported to be 7.5 % at 2 years.

11 citations


Journal ArticleDOI
TL;DR: This review focuses on the risk factors that predict failure of the common medical therapies for male LUTS and describes recently discovered molecular targets that show promise for treatment of LUTs recalcitrant to conventional therapies.
Abstract: Medical therapy has assumed a critical role in the treatment of male lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction. Targeting both bladder and prostate, these medications provide an effective means to manage LUTS for millions of men. However, significant proportion of men do not respond adequately to medical therapy and go on to surgical treatment of bladder outlet obstruction. In order to provide patients with appropriate therapy, prevent unnecessary exposure to drug side effects, and reduce medical costs, it is important to identify those men in whom medication will not be effective. In this review, we focus on the risk factors that predict failure of the common medical therapies for male LUTS. In addition, we describe recently discovered molecular targets that show promise for treatment of LUTS recalcitrant to conventional therapies.

8 citations


Journal ArticleDOI
TL;DR: Congenital urachal anomalies are present in less than 2 % of the general pediatric population and while traditionally thought of as pre-malignant, their clinical significance particularly in the asymptomatic patient has been questioned.
Abstract: Congenital urachal anomalies are present in less than 2 % of the general pediatric population. While traditionally thought of as pre-malignant, their clinical significance particularly in the asymptomatic patient has been questioned. The presence of a urachal anomaly in childhood does not appear to confer an increased risk of urachal cancer in adulthood. These remnants are classified based upon their anatomic location and communication with either the umbilicus or bladder and may present with a variety of symptoms. When clinical signs and symptoms suggest the presence of an urachal anomaly, ultrasonography is the most appropriate initial diagnostic imaging test. Observation with or without follow-up imaging is an acceptable initial step in management as these often regress without surgical intervention particularly in asymptomatic patients. When infectious symptoms are present, a course of antibiotics may be recommended prior to surgery to reduce the chance of postoperative wound infection.

8 citations


Journal ArticleDOI
TL;DR: Patients and physician concern regarding mesh slings for the treatment of stress urinary incontinence are likely to be a decrease in use of the gold standard of care for stress urinaryincontinence—the mid-urethral synthetic sling.
Abstract: Over 90,000 legal claims for complications related to transvaginal mesh have been filed to date. Safety issues specifically related to the use of transvaginal mesh for pelvic organ prolapse have not been appropriately differentiated from the use of mesh for stress urinary incontinence by either attorneys or the media. This litigious environment and nebulous communication on the safety issues have led to patient and physician concern regarding mesh slings for the treatment of stress urinary incontinence. The ultimate result is likely to be a decrease in use of the gold standard of care for stress urinary incontinence—the mid-urethral synthetic sling.

7 citations


Journal ArticleDOI
TL;DR: Validated questionnaires assessing incontinence and related symptoms along with their impact on quality of life are important for quantifying baseline burden of disease and response to treatment.
Abstract: Validated questionnaires assessing incontinence and related symptoms along with their impact on quality of life are important for quantifying baseline burden of disease and response to treatment. Many tools have been developed for use in either a general incontinence population or for specific etiologies of incontinence and gender-based concerns. Knowledge of current instruments and the populations they were designed for is key for trial design and optimal clinical utility.

6 citations


Journal ArticleDOI
TL;DR: With the use of improved teaching methods, devices to assist with passing the catheter, and ongoing education and follow-up, it is believed that CIC can be a viable option for bladder management in elderly patients with urinary retention.
Abstract: Clean intermittent catheterization (CIC) has become the gold standard for bladder management in a host of neurologic and non-neurologic disease states causing urinary retention. While CIC has been extensively studied, there has been limited research in applying CIC to the elderly population. In this review paper, we evaluate the lessons learned about the feasibility, complications, and obstacles to compliance associated with CIC and apply them to an elderly population. With the use of improved teaching methods, devices to assist with passing the catheter, and ongoing education and follow-up, we believe that CIC can be a viable option for bladder management in elderly patients with urinary retention.

6 citations


Journal ArticleDOI
TL;DR: Urinary dysfunction may result from damage to the nerve supply during pelvic dissection or by the anatomical changes created by altering the physical structure of the pelvis after appropriate oncologic resection of rectal cancer adhering to globally accepted tenets of total mesorectal excision.
Abstract: Urinary dysfunction may result from damage to the nerve supply during pelvic dissection or by the anatomical changes created by altering the physical structure of the pelvis. This problem may occur after appropriate oncologic resection of rectal cancer adhering to the globally accepted tenets of total mesorectal excision with either anterior resection or abdominoperineal resection. The most frequent type of urinary dysfunction is urinary retention, a transient problem which occurs in up to 25 % of men and 15 % of women. Fortunately, more severe chronic dysfunctions including voiding difficulty and incontinence are less common. Laparoscopy may confer a protective benefit although definitive evidence of a lower rate of dysfunction as compared to laparotomy remains elusive.

Journal ArticleDOI
TL;DR: Toxicity of radiotherapy for prostate cancer affects the bladder, prostate, urethra, and rectum which results in a range of complications including radiation cystitis, urinary incontinence, fistulas and outlet obstruction from bladder neck contractures, and the prostate.
Abstract: Use of radiotherapy including external beam radiation therapy (EBRT), brachytherapy (BT), and combination therapy (EBRT + BT) for the treatment of prostate cancer (PCa) is rising. Persistent lower urinary tract symptoms (LUTS) requiring surgical intervention after radiation for the treatment of prostate cancer are rare, and as a result, there is a paucity of data in the urologic literature. Owing to the location of the prostate, toxicity of radiotherapy for prostate cancer affects the bladder, prostate, urethra, and rectum which results in a range of complications including radiation cystitis, urinary incontinence, fistulas and outlet obstruction from bladder neck contractures, and the prostate or bulbomembranous urethral strictures. We review the cause and incidence of LUTS, workup and treatment options.

Journal ArticleDOI
TL;DR: Children with refractory neurogenic bladder (NGB) who have failed maximal medical management are presented with options for bladder reconstruction and careful patient selection and preoperative counseling are paramount for those undergoing bladder reconstruction which includes intestinal bladder augmentation.
Abstract: Children with refractory neurogenic bladder (NGB) who have failed maximal medical management are presented with options for bladder reconstruction. It is critical to understand the long-term sequela of bladder augmentation and bladder neck reconstruction to properly counsel families regarding these procedures. Benefits may include preservation of renal function, continence, reduced risk of renal-related mortality, and potential improvements in quality of life (QOL). However, these advantages must be balanced with the risks of bladder calculi, perforation, need for additional surgery, acid/base disturbances, vitamin B12 deficiency, and malignancy. Therefore, careful patient selection and preoperative counseling are paramount for those undergoing bladder reconstruction which includes intestinal bladder augmentation, as these patients require lifelong vigilant follow-up.

Journal ArticleDOI
TL;DR: Identification and appropriate therapeutic management of the myofascial trigger points is paramount to successful treatment of the pain and symptoms associated with chronic pelvic pain.
Abstract: Chronic pelvic pain, in its many forms, commonly has a myofascial component that must be considered in the evaluation and treatment of women and men seeking medical care. Myofascial pain syndrome is a regional pain syndrome characterized by myofascial trigger points. At this time, the exact mechanism surrounding the formation of a trigger point is not known. Myofascial pelvic pain can develop as a result of a trigger point within the pelvic floor musculature or from extra-pelvic muscles that can refer into the pelvic region. Identification and appropriate therapeutic management of the myofascial trigger points is paramount to successful treatment of the pain and symptoms associated with chronic pelvic pain.

Journal ArticleDOI
TL;DR: The urodynamic evaluation (urodynamic study (UDS) has an important role in diagnosing the patient’s underlying bladder pathology, but surveillance with UDS has not yet been linked to improved outcomes.
Abstract: This is a review of the most recent literature on the long-term complications of the neurogenic bladder (NGB). It is widely accepted that this condition, when left untreated, has a natural history that has a potential for causing deterioration of renal function over time. Consensus has not been reached regarding what patient profiles are at highest risk for these complications, as well as what surveillance strategies should be adopted. Chronic kidney disease (CKD) may be more prevalent in the NGB population than previously reported in the literature, as creatinine may not accurately reflect true renal function in these patients. Risk factors for upper urinary tract (UUT) deterioration include loss of bladder compliance, repeated bouts of pyelonephritis, and presence indwelling catheterization. Reduced access to urologic care and lack of adequate surveillance are also correlated with increased risk of upper tract complications. The urodynamic evaluation (urodynamic study (UDS)) has an important role in diagnosing the patient’s underlying bladder pathology, but surveillance with UDS has not yet been linked to improved outcomes. Particularly vulnerable are those patients with decreased functional status or those requiring input from a multidisciplinary team. Some patients develop refractory NGB and UUT risk or overt deterioration. Treatment options that can offer benefit include onabotulinum A injections, augmentation cystoplasty with or without sling placement, or urinary diversion.

Journal ArticleDOI
TL;DR: The relationship between OAB and diet-related medical conditions such as obesity and insulin resistance is described and the specific nutritional factors found to be associated with OAB are reviewed.
Abstract: Overactive bladder (OAB) is a clinical diagnosis defined by the presence of urinary urgency with or without urgency urinary incontinence (UUI) and is often associated with frequency and nocturia. First-line treatment for OAB is behavioral and dietary modifications because they have minimal side effects and high potential benefits. There is evidence that diet can have a significant effect on the symptoms of OAB. This has led to increasing interest in characterizing the effect of specific dietary changes on OAB prevalence and severity. The aim of this paper is to review the specific nutritional factors that have been found to be associated with OAB and describe the relationship between OAB and diet-related medical conditions such as obesity and insulin resistance.

Journal ArticleDOI
TL;DR: With treatment for EPN now moving away from nephrectomy towards less invasive interventions, mortality rates are improving but remaining high, and gold standard diagnosis and classification of EPN is made with contrast CT.
Abstract: Emphysematous pyelonephritis (EPN) is a rare condition which is potentially life threatening. It is characterised by gas formation within the collecting system, renal parenchyma and/or perirenal tissues. Diabetes is the single most common risk factor for the development of EPN. Other risk factors include urinary tract obstruction and immunocompromise. Escherichia Coli is the most common pathogen. EPN is characterised by fever, loin pain and systemic upset. Gold standard diagnosis and classification of EPN is made with contrast CT. Classification can be used as a prognostic indicator for mortality and to guide management. EPN may be managed conservatively or surgically. Patients managed conservatively are resuscitated and administered with intravenous antibiotics. Intravenous fluid, glucose control for diabetics and acid base balance are vital components for primary management. For those in whom conservative management is unsuccessful, a parenchymal drain may be considered to drain gas or a collection of pus. Patients with hydronephrosis will benefit from a nephrostomy or JJ stent insertion. Patients who have failed minimally invasive surgical intervention or who have a number of risk factors predisposing them to EPN should undergo either immediate or delayed nephrectomy. With treatment for EPN now moving away from nephrectomy towards less invasive interventions, mortality rates for EPN are improving but remaining high.

Journal ArticleDOI
TL;DR: Synthetic midurethral slings have become the most popular and efficacious surgical intervention for women suffering from urinary stress incontinence and numerous studies have demonstrated that these procedures are minimally invasive with a very low morbidity.
Abstract: Synthetic midurethral slings have become the most popular and efficacious surgical intervention for women suffering from urinary stress incontinence. They include retropubic, transobturator, and single-incision slings. Numerous studies have demonstrated that these procedures are minimally invasive with a very low morbidity. The most common complications include bladder perforation, mesh erosion, and voiding dysfunction, which can usually be appropriately managed without any significant long-term sequelae. Pain and dyspareunia will occur in a small percentage of women for a variety of reasons that will be discussed. Life-threatening complications such as vascular or bowel injury have been reported as rare complications of retropubic synthetic midurethral slings.

Journal ArticleDOI
TL;DR: This detailed review focuses on history, presentation, diagnosis, and management of PBNO in both men and women.
Abstract: Primary bladder neck obstruction (PBNO) is a rare condition of the lower urinary tract seen in young and middle-aged patients. The true prevalence of this entity is unknown; however, it has been reported in 5–11 % of young women and 28–54 % of young men with lower urinary tract symptoms (LUTS). The diagnosis of PBNO requires a high index of suspicion and an experienced clinician due to the variety of presenting urinary symptoms, and often a much delayed presentation, which frequently is not reported by patients, and often misdiagnosed by clinicians. Videourodynamics (VUDS) will greatly assist in making the diagnosis. Observation, medical therapy, and surgical therapy are the treatment options with variable success rates. This detailed review focuses on history, presentation, diagnosis, and management of PBNO in both men and women.

Journal ArticleDOI
TL;DR: The mainstay of treatment remains early diagnosis with early establishment of drainage and subsequent management of bladder dysfunction with behavioral therapy, medication, clean intermittent catheterization, and occasionally with bladder augmentation.
Abstract: Posterior urethral valves (PUV) are the most common cause of lower urinary tract obstruction in male infants Due to improved technique and availability of prenatal imaging, diagnosis is typically suspected prenatally and confirmed postnatally Prenatal intervention is performed in select centers with vesicoamniotic shunting or with fetal cystoscopy and antegrade ablation of the PUV when detected Prenatal intervention has been associated with an improvement in neonatal survival; however, evidence that renal function is indeed improved remains scant The mainstay of treatment remains early diagnosis with early establishment of drainage and subsequent management of bladder dysfunction with behavioral therapy, medication, clean intermittent catheterization, and occasionally with bladder augmentation Other measures such as nephrectomy can be implemented to manage polyuria Ultimately, 30 % of patients born with PUV develop end-stage renal disease and require renal transplantation

Journal ArticleDOI
TL;DR: It is likely that the causes of PUR are multifactorial, and that physiologic changes of pregnancy and trauma from childbirth play a critical role.
Abstract: Postpartum urinary retention (PUR) can be classified as covert, those with postvoid residuals higher than 150 cm3, or overt, those unable to void 6 hours after vaginal delivery or after removal of a catheter after cesarean section There is limited data and research on the mechanism of PUR However, it has been suggested that there is a neurological component to the development of PUR This includes disruption of the afferent system through analgesic blockade, crush or stretch injuries to the pudendal nerve during delivery, and impairment of neurotransmitters required for proper signal transduction However, it is likely that the causes of PUR are multifactorial, and that physiologic changes of pregnancy and trauma from childbirth play a critical role

Journal ArticleDOI
TL;DR: An overview of the etiology, diagnosis, treatment, and prevention of urinary tract infections with focus on the geriatric patient is provided.
Abstract: Urinary tract infections are among the most common infections seen in both the ambulatory inpatient and nursing facility settings. Due to unique characteristics of the geriatric population, including physiology, comorbidities, and social history, incidences of these infections increase with age requiring special attention. Here, we provide an overview of the etiology, diagnosis, treatment, and prevention of urinary tract infections with focus on the geriatric patient.

Journal ArticleDOI
TL;DR: The available evidence confirms that all three treatment approaches are well tolerated and effective, although only botulinum toxin type A (BoNTA) and SNS can achieve nearly a cure of urgency urinary incontinence (UUI).
Abstract: Overactive bladder (OAB) is a syndrome of urinary urgency, usually accompanied by frequency, nocturia, and sometimes urinary urgency incontinence. There are many guidelines for the OAB treatment which are constructed on a stepwise fashion starting from the least invasive to the more invasive therapy. The emergence of third-line therapy (AUA/SUFU guidelines) has resulted in significant decrease of more invasive surgery and improved patients’ quality of life. The aim of a clinical pathway is to improve the quality of care, reduce risks, increase patient satisfaction, and increase the efficiency in the use of resources. The available options for the third-line OAB treatments include intravesical injection of botulinum toxin A, percutaneous tibial nerve stimulation (PTNS), and sacral nerve stimulation (SNS). The available evidence confirms that all three treatment approaches are well tolerated and effective, although only botulinum toxin type A (BoNTA) and SNS can achieve nearly a cure of urgency urinary incontinence (UUI). The choice among the different third-line treatment depends on patient preference, availability, and local expertise. The application of these pathways can improve incontinence care by letting physicians adequately communicate with patients and select individualized therapy at an early stage especially for elderly patients.

Journal ArticleDOI
TL;DR: The main purpose of this article is to review etiology and treatment options available for HC, focusing latest updates and tendencies.
Abstract: Hemorrhagic cystitis is an inflammatory condition caused by infectious and non-infectious (radiation, drugs) factors. Hematuria is the most important sign. Clinical course ranges from asymptomatic microscopic hematuria to massive bleeding. Fulminating hemorrhagic cystitis is a life-threatening condition. There is a wide variety of treatments like saline irrigation, intravesical instillation of a great class of drugs, systemic drugs, hyperbaric oxygen therapy, and even surgery (angioembolization, urinary diversion, and cystectomy). The main purpose of this article is to review etiology and treatment options available for HC, focusing latest updates and tendencies.

Journal ArticleDOI
TL;DR: Specific pregnancy/delivery impact on lower urinary tract symptoms, including its management, is highlighted.
Abstract: Management of lower urinary tract dysfunction in pregnancy can be challenging, with the need to take into account impact of treatment on gestation and impact of pregnancy and delivery on intervention. Whilst the approach to lower urinary tract symptoms is not significantly different, this article will highlight specific pregnancy/delivery impact on lower urinary tract symptoms, including its management.

Journal ArticleDOI
TL;DR: Recent progress in the understanding of the BPS/IC complex will be discussed, emphasizing the fact that the classic Hunner disease (BPS type 3C according to the European Society for the Study of Interstitial Cystitis (ESSIC) classification) is a well-defined condition that fulfills the requirements of the denomination interstitial cystitis.
Abstract: When first recognized, more than one hundred years ago, the term interstitial cystitis (IC) was reserved for subjects with a special type of deep inflammation of the bladder wall. Later, the scope of IC widened, including all kinds of bladder pain syndromes (BPS), giving rise to a lot of confusion and difficulties in research as well as in clinical practice. Herein, recent progress in the understanding of the BPS/IC complex will be discussed, emphasizing the fact that the classic Hunner disease (BPS type 3C according to the European Society for the Study of Interstitial Cystitis (ESSIC) classification) is a well-defined condition that fulfills the requirements of the denomination interstitial cystitis. The paper will also discuss recent research on diagnostics, markers, genetics, and various types of remedies for classic IC. For the benefit of our patients, in BPS/IC, it is time for a final separation of the concepts BPS and IC. Classic IC is a well-defined entity with multiple unique characteristics, those characteristics having a potential for development of a specific rational, pharmacological, and surgical treatment algorithm if further investigated. BPS, on the other hand, seems to include a heterogenic composition of conditions calling for broad attempts to be more closely explored.

Journal ArticleDOI
TL;DR: The diagnosis and treatment of chronic pelvic pain have shifted from organ-specific to multifactorial, multidisciplinary, multi-disciplinary, and individualized approach.
Abstract: The diagnosis and treatment of chronic pelvic pain have shifted from organ-specific to multifactorial, multidisciplinary, and individualized approach While many organizations have had diverse outlooks on classification and treatment plans, new research has identified varied clinical phenotypes and updated classification systems These phenotypes are based on pain, gender, symptomatology, and comorbid pain syndromes These new classification systems allow a multimodal therapeutic approach and evaluation of patients Multidisciplinary care, including urology, gynecology, gastroenterology, neurology, psychology, physiotherapy, and pain medicine, is also further recognized for adequate management of patients with chronic pelvic pain because of its variable etiology The purpose of this review is to emphasize these changes and discuss management strategies

Journal ArticleDOI
TL;DR: Naftopidil was approved in Japan as a drug for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) in 1999 and has three times higher affinity for the alpha-1D adrenergic receptor (α1D-AR).
Abstract: In this paper, we review reports related to naftopidil since 2011. Naftopidil was approved in Japan as a drug for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) in 1999. It has three times higher affinity for the alpha-1D adrenergic receptor (α1D-AR) than for the alpha-1A adrenergic receptor (α1A-AR). Although there are several α1 adrenoceptor antagonists, the differences among them with regard to their overall efficacy for LUTS/BPH are unclear. The efficacy of naftopidil for storage symptoms is frequently focused on as a central property of the α1D-AR antagonist.

Journal ArticleDOI
Nathan Hoag1, Johan Gani1
TL;DR: This review provides an update on SNM and focuses on developments in SNM relating to the less-studied applications of non-obstructive urinary retention and painful bladder syndrome.
Abstract: Sacral neuromodulation (SNM) is an established treatment option for several urologic conditions, and its use continues to grow. Indications and applications for SNM are expanding as our understanding of its mechanism of action improves, and our experience develops. Current urologic applications include overactive bladder (OAB), non-obstructive urinary retention, and pelvic pain disorders. SNM has become an established therapeutic modality for non-obstructive urinary retention, while SNM for pelvic pain disorders has found a place in accepted treatment guidelines. This review provides an update on SNM and focuses on developments in SNM relating to the less-studied applications of non-obstructive urinary retention and painful bladder syndrome.

Journal ArticleDOI
TL;DR: Urodynamic studies (UDS) in male LUTS (MLUTS) are useful for both diagnosis and prognosis and are indicated in the subset of patients with MLUTS being considered for invasive and potentially morbid therapy.
Abstract: Lower urinary tract symptoms (LUTS) in men are due to bladder dysfunction or bladder outlet disorders such as benign prostatic enlargement and bladder neck or urethral sphincter dysfunction. Men with lower urinary tract symptoms prefer shared problem-solving and decision making during treatment planning. Urodynamic studies (UDS) in male LUTS (MLUTS) are useful for both diagnosis and prognosis. UDS help both the clinician and the patient in shared decision making regarding treatment of these men. The AUA/SUFU guidelines and EAU guidelines are helpful in cost-effective selection of patients with MLUTS for urodynamic evaluation. UDS are indicated in the subset of patients with MLUTS being considered for invasive and potentially morbid therapy. Uroflowmetry and post-void residual (PVR) volume measurement by bladder ultrasound scan are good screening tests in MLUTS. Urodynamic evidence of bladder outlet obstruction has been correlated with better outcomes following invasive therapy.