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Re: Sacral Neuromodulation in Urological Practice
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VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
Unfortunately none of these findings convincingly answers the question, which came first, the chicken or the egg? The authors do indicate biologically plausible relationships between overactive bladder and anxiety via a serotonergic pathway or a dysregulation of the hypothalamic-pituitaryadrenal axis resulting in increased corticotropin releasing factor release. The authors report their study limitations as 1) it is a single institution study with a small sample size; 2) the finding in some patients seeking care at a tertiary center such as theirs may not be generalizable to the general OAB population, and 3) anxiety assessment was based on self-reported symptoms. The association seems solid but concrete data regarding a longitudinal progression from 1 set of symptoms to the other remain inconsistent. Alan J. Wein, MD, PhD (hon) 1. Lai HH, Morgan CD, Vetter J et al: Impact of childhood and recent traumatic events on the clinical presentation of overactive bladder. Neurourol Urodyn 2016; 35: 1017. 2. Lai H, Gardner V, Vetter J et al: Correlation between psychological stress levels and the severity of overactive bladder symptoms. BMC Urol 2015; 15: 14.
Suggested Reading Bradley CS, Nygaard IE, Torner JC et al: Overactive bladder and mental health symptoms in recently deployed female veterans. J Urol 2014; 191: 1327.
Re: Sacral Neuromodulation in Urological Practice D. Liberman, M. J. Ehlert and S. W. Siegel Metro Urology, Woodbury, Minnesota Urology 2017; 99: 14e22. doi: 10.1016/j.urology.2016.06.004
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27298200 Editorial Comment: This is a nicely done review article that gives a historical perspective of sacral neuromodulation and reviews the evidence on U. S. Food and Drug Administration approved indications (overactive bladder and nonobstructive urinary retention) as well as other off-label uses such as pelvic pain, constipation, lower urinary tract dysfunction, certain neurological diseases/ conditions and sexual dysfunction. It also reviews ideas about mechanism of action, including that “the true mechanism of action is not fully elucidated but clearly involves multiple neuropathways,” and the surgical technique of device implantation, along with “pearls” for lead placement and risks and side effects. Supplementary table 1 (“Easy Access”) outlines the pros and cons of the InterStimÒ neurostimulator, posterior tibial nerve stimulation and BotoxÒ. Alan J. Wein, MD, PhD (hon)
Re: Long-Term Efficacy of Holmium Laser Enucleation of the Prostate in Patients with Detrusor Underactivity or Acontractility D. J. Lomas and A. E. Krambeck Department of Urology, Mayo Clinic, Rochester, Minnesota Urology 2016; 97: 208e211. doi: 10.1016/j.urology.2016.07.010
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27450935 Editorial Comment: This article is included because it describes results in a group of patients diagnosed with detrusor underactivity or acontractility, and raises questions regarding the definition and documentation of these 2 entities. The authors report that 8 of 9 patients with detrusor underactivity and 5 of 8 diagnosed with acontractility were catheter-free following holmium laser enucleation of the prostate with median followup of 50.9 and 38.6 months, respectively. Diagnosis of detrusor underactivity was based on the definition of a bladder contractility index of less than 100, and in fact the average score in this group was 70. The inference is that this measurement, although urodynamically useful, is insufficient to predict voiding following outlet reduction in men in urinary Dochead: Urological Survey
LIT 5.5.0 DTD JURO14875_proof 18 July 2017 1:33 am EO:
400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456
343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399
VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
Unfortunately none of these findings convincingly answers the question, which came first, the chicken or the egg? The authors do indicate biologically plausible relationships between overactive bladder and anxiety via a serotonergic pathway or a dysregulation of the hypothalamic-pituitaryadrenal axis resulting in increased corticotropin releasing factor release. The authors report their study limitations as 1) it is a single institution study with a small sample size; 2) the finding in some patients seeking care at a tertiary center such as theirs may not be generalizable to the general OAB population, and 3) anxiety assessment was based on self-reported symptoms. The association seems solid but concrete data regarding a longitudinal progression from 1 set of symptoms to the other remain inconsistent. Alan J. Wein, MD, PhD (hon) 1. Lai HH, Morgan CD, Vetter J et al: Impact of childhood and recent traumatic events on the clinical presentation of overactive bladder. Neurourol Urodyn 2016; 35: 1017. 2. Lai H, Gardner V, Vetter J et al: Correlation between psychological stress levels and the severity of overactive bladder symptoms. BMC Urol 2015; 15: 14.
Suggested Reading Bradley CS, Nygaard IE, Torner JC et al: Overactive bladder and mental health symptoms in recently deployed female veterans. J Urol 2014; 191: 1327.
Re: Sacral Neuromodulation in Urological Practice D. Liberman, M. J. Ehlert and S. W. Siegel Metro Urology, Woodbury, Minnesota Urology 2017; 99: 14e22. doi: 10.1016/j.urology.2016.06.004
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27298200 Editorial Comment: This is a nicely done review article that gives a historical perspective of sacral neuromodulation and reviews the evidence on U. S. Food and Drug Administration approved indications (overactive bladder and nonobstructive urinary retention) as well as other off-label uses such as pelvic pain, constipation, lower urinary tract dysfunction, certain neurological diseases/ conditions and sexual dysfunction. It also reviews ideas about mechanism of action, including that “the true mechanism of action is not fully elucidated but clearly involves multiple neuropathways,” and the surgical technique of device implantation, along with “pearls” for lead placement and risks and side effects. Supplementary table 1 (“Easy Access”) outlines the pros and cons of the InterStimÒ neurostimulator, posterior tibial nerve stimulation and BotoxÒ. Alan J. Wein, MD, PhD (hon)
Re: Long-Term Efficacy of Holmium Laser Enucleation of the Prostate in Patients with Detrusor Underactivity or Acontractility D. J. Lomas and A. E. Krambeck Department of Urology, Mayo Clinic, Rochester, Minnesota Urology 2016; 97: 208e211. doi: 10.1016/j.urology.2016.07.010
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27450935 Editorial Comment: This article is included because it describes results in a group of patients diagnosed with detrusor underactivity or acontractility, and raises questions regarding the definition and documentation of these 2 entities. The authors report that 8 of 9 patients with detrusor underactivity and 5 of 8 diagnosed with acontractility were catheter-free following holmium laser enucleation of the prostate with median followup of 50.9 and 38.6 months, respectively. Diagnosis of detrusor underactivity was based on the definition of a bladder contractility index of less than 100, and in fact the average score in this group was 70. The inference is that this measurement, although urodynamically useful, is insufficient to predict voiding following outlet reduction in men in urinary Dochead: Urological Survey
LIT 5.5.0 DTD JURO14875_proof 18 July 2017 1:33 am EO:
400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456