A 10-Year Case Series of Surgically Managed Periurethral Masses at a Single Tertiary Care Institution.

Objective: This study aimed to present the evaluation, diagnoses, and surgical management of symptomatic periurethral masses of women at an academic institution.

Methods: This study is an institutional review board-approved retrospective case series of women who presented with a symptomatic periurethral mass and scheduled for surgery within the Department of Urology and Female Pelvic Medicine and Reconstructive Surgery over a 10-year period (October 2003-July 2014).

Results: Fifty-nine women (mean age, 46 years; range, 22-73 years) were evaluated during the study period.

Bilateral Ureteral-Iliac Artery Fistula in a Patient with Chronic Indwelling Ureteral Stents: A Case Report and Review.

Ureteral-arterial fistula (UAF) is an exceedingly rare but life-threatening condition warranting emergent intervention. Prompt recognition and management of UAF in suspect patients presenting with gross hematuria are required for a successful outcome. We report a rare subset of UAF involving the bilateral common iliac arteries.

Randomized, controlled pilot trial of solifenacin succinate for overactive bladder in Parkinson's disease.

Objective: To evaluate the efficacy of solifenacin succinate in Parkinson's disease (PD) patients suffering from overactive bladder (OAB).

Background: Urinary dysfunction is a commonly encountered non-motor feature in PD that significantly impacts patient quality of life.

Design/methods: This was a double-blind, randomized, placebo-controlled, 3-site study with an open label extension phase to determine the efficacy of solifenacin succinate in idiopathic PD patients with OAB.

Ureteral replacement and onlay repair with reconfigured intestinal segments.

Purpose: Ureteral loss represents a surgical challenge to provide low pressure drainage while avoiding urinary stasis and reflux. The ideal replacement should optimize drainage while minimizing absorption, allowing for ureteral repair of varied lengths and locations with maximal preservation of the urinary tract. We reviewed our experience with ureteral repair, focusing on the use of reconfigured intestine.

Third sacral foramina morphometry for sacral neuromodulation.

Objective: This study is aimed to define the geometry and location of the human S3 foramen, with respect to bony landmarks visible on ultrasound.

Methods: Computed tomographic (CT) image data from an institutional review board-approved database of de-identified pelvic CT images were analyzed. Points along the S3 foramina and bony sacrum were tagged, and their locations saved.

Salvage spiral sling techniques: alternatives to manage disabling recurrent urinary incontinence in females.

Purpose: Females with recurrent stress urinary incontinence after anti-incontinence surgery represent a therapeutic challenge. In our experience and that of others standard sling procedures have occasionally failed to correct these problems. We determined the effectiveness of various spiral sling techniques used in these cases to manage pipe stem urethras in which conventional slings had failed.

Device to provide intuitive assistance in laparoscope holding.

This work proposes a new navigation device which autonomously handles the laparoscope, with a view to reducing latency and adjusting optics in real time. The system designed is an intuitive mechatronic device with three degrees of freedom and a sole active articulation. The device uses the point of insertion as the invariant point for navigation and has a work space that closely resembles an inverted cone.

Disabling complications with slings for managing female stress urinary incontinence.

Objective: To report an increase in the referral of patients with disabling complications after the failure of conservative therapy, their presentation, final surgical management and clinical outcome, following the use of non-autologous slings (NAS), currently the primary surgical procedure for managing stress urinary incontinence (SUI) in women.

Patient And Methods: Thirty-eight patients (mean age 64 years) required surgical management for disabling complications after placing a NAS for SUI. Sling types were synthetic (25), xenografts (six) and allografts (four).

Sexual function after surgery for prostate or bladder cancer.

Background: Compromised sexual function is often a side effect for patients following radical surgical procedures for bladder or prostate cancer.

Methods: The authors review the classification and physiology of sexual function and dysfunction. Moreover, they explain the possible pathophysiology directly resulting from surgery, and they discuss several approaches available to address these problems.

The continent bladder: indications and techniques for the continent catheterizable segment.

Purpose Of Review: Continent catheterizable segments are a substantial part of the urologist's armamentarium for providing bladder drainage. It is used for a myriad of indications, and there are multiple techniques currently used for its formation. Despite refinements in these techniques significant complications still occur, and there is continued advancement and ongoing investigation.

Macrophage migration inhibitory factor is upregulated in an endotoxin-induced model of bladder inflammation in rats.

Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine found in epithelial cells as preformed stores, such that MIF release can activate innate immune responses. Our identification of MIF stores in the urothelium suggests that MIF may function in the bladder's initial response to infectious stimuli, such as lipopolysaccharide (LPS). To test this hypothesis, we observed changes in MIF, cyclooxygenase-2 (COX-2) and c-fos in the bladder, L6-S1 spinal cord, dorsal root ganglion (DRG), and major pelvic ganglion (MPG) and MIF changes in the prostate following intravesical LPS.

Devastating complications after brachytherapy in the treatment of prostate adenocarcinoma.

Objective: To report a retrospective chart review of patients who developed recto-urethral fistula (RUF) or several bladder neck contracture (BNC) recurrences after brachytherapy for treating localized prostate cancer.

Patients And Methods: In the past 3 years 18 patients with devastating complications after prostate brachytherapy were referred to our centre (RUF in 11, BNC in seven; mean age 63 years, range 60-81). All patients with RUF initially underwent diverting colostomy (six cystoprostatectomy with closure of the fistula, omental interposition and urinary diversion; one prostatectomy, bladder neck closure, fistula closure with omentum flap and continent vesicostomy).

Hydrochloric acid induced changes in macrophage migration inhibitory factor in the bladder, peripheral and central nervous system of the rat.

Purpose: We established the presence of the proinflammatory cytokine macrophage migration inhibitory factor (MIF) in the bladder and in nervous system structures innervating the bladder, and evaluated changes in MIF and cyclooxygenase-2 (COX-2) protein levels and expression following chemical cystitis.

Materials And Methods: Male Sprague-Dawley rats were anesthetized and a catheter was introduced into the bladder dome. Cystitis was induced by infusing 0.

Urinary incontinence after continent urinary diversion using cecal wrap or plicated ileum: a patient questionnaire review.

Objectives: To evaluate the clinical and urodynamic results of a tapered-cecal wrap (TCW) versus a tapered-plicated ileal (TPI) anti-incontinence mechanism.

Methods: Of 54 consecutive patients who had undergone continent urinary diversions, 33 (17 with TCW and 16 with TPI) were evaluated. The primary disease that prompted diversion included bladder cancer (84%), neurogenic bladder (12%), and interstitial cystitis (3%).

Continent colonic urinary reservoir (Florida pouch): long-term surgical complications (greater than 11 years).

Purpose: We analyzed the long-term results (greater than 10 years) of a continent cutaneous colonic urinary reservoir (Florida pouch), focusing primarily on the incidence of significant complications.

Materials And Methods: Between January 1986 and October 1991, 179 patients underwent continent cutaneous colonic urinary reservoir construction. Of these patients 105 died of primary disease or were lost to followup, leaving 38 males and 36 females with a mean followup of 133 months with adequate data for analysis who are the subject of this report.

Central effects of clozapine in regulating micturition in anesthetized rats.

Background: We previously showed that systemic administration of the atypical neuroleptic clozapine in the rat altered a number of urodynamic variables and inhibited the external urethral sphincter. Since clozapine acts at several receptor types both at the periphery and the central nervous system, the site of action remained uncertain. Therefore, the purpose of this study was to determine the effects of central administration of clozapine on the bladder and the external urethral sphincter during cystometry and to examine differences in spinal versus supraspinal administration.

Evaluation and management of mechanical dysfunction in continent colonic urinary reservoirs.

Purpose: We analyze a group of patients who presented with mechanical dysfunction of the reservoir and/or efferent limb of a continent colonic urinary diversion, and establish an evaluation and management algorithm.

Materials And Methods: A total of 16 patients with a mean age of 58 years and 1 or more symptoms related to continent colonic urinary diversion were evaluated. Presenting symptomatology included difficult catheterization in 8 cases (50%), disabling incontinence in 8 (50%) and recurrent urinary tract infections in 6 (37.

Evaluation of flap valve as an alternative continence mechanism in the Florida pouch.

Objectives: To evaluate urodynamic findings in a successful flap valve (FV) continence mechanism in association with a continent colonic urinary reservoir (Florida pouch) and to compare the urodynamic findings of the FV mechanism with the doubly plicated (PI) standard anti-incontinence segment in the same reservoir.

Methods: Thirteen patients who successfully received the Florida pouch between 1988 and 1996 agreed to undergo urodynamic evaluation as part of a pilot study. Eight patients had a PI continence mechanism and a mean time from surgery of 51 months; 5 had a FV continence mechanism and a mean time from surgery of 14 months.

Anterior enterocele following cystectomy for intractable interstitial cystitis.

Purpose: We clinically define the development of an anterior vaginal wall hernia following cystectomy for the management of intractable interstitial cystitis and establish surgical technique for its correction.

Materials And Methods: Of 27 women who underwent simple cystectomy and urethrectomy for intractable interstitial cystitis an anterior vaginal wall hernia developed in 3 (71, 56 and 61 years old) at 8, 14 and 16 months, respectively, postoperatively. Clinical appearance was similar to a midline cystocele but it contained bowel contents in the form of an anterior enterocele.

Penile prosthesis insertion with corporeal reconstruction with synthetic vascular graft material.

Difficulty with penile prosthesis insertion may be encountered in patients with severe cavernous scarring or tunica albuginea deficiencies. Eleven patients who underwent penile prosthesis implantation required simultaneous corporeal reconstruction due to prior prosthesis infection and/or erosion in 6, priapism in 2 and Peyronie's disease in 1. One patient underwent prior neophallus construction with a tubularized abdominal wall flap for gender reassignment and 1 had congenitally deficient corporeal bodies.

Surgical repair of stress urinary incontinence.

Genuine SUI is defined as that associated with hypermobility of the urethra and bladder neck. Accurate history-taking and physical examination allows for proper diagnoses and subsequent therapy in the majority of cases. Patients in whom bladder instability or intrinsic sphincteric deficiency are suspected may benefit from urodynamic testing.

Incontinence: defining the problem.

As this issue of Rhode Island Medicine demonstrates, incontinence is felt within all segments of society. No practitioners are insulated from patients suffering from this condition. Often, the suffering is silent for many reasons.

Diuretic Doppler sonography following successful repair of renal obstruction in children.

The measurement of resistive index (RI = [peak systolic velocity--end diastolic velocity]/peak systolic velocity) by Doppler sonography has demonstrated variable reliability as an indicator of pediatric urinary obstruction. By modifying Doppler studies with the addition of furosemide (diuretic Doppler sonography), we previously found significant differences between 10 nonobstructed and 10 obstructed kidneys in children (median age 7 months). The obstructed kidneys have since undergone surgical repair, and postoperative reevaluation has been performed by diuretic Doppler sonography and diuretic renography.