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Aims: Antimuscarinic drugs are the first‐line choice in the treatment of patients with neurogenic Detrusor Overactivity (nDO). Fesoterodine fumarate is the newest antimuscarinic drug. Limited data are published about the use of fesoterodine fumarate in patients suffering from neurogenic lower urinary tract dysfunction. Our study aims to determine the efficacy of fesoterodine fumarate on patients with nDO due to spinal cord lesion or multiple sclerosis (MS). Methods: This is an open‐label prospective interventional study. Eligible patients were 18–80 years old with SCL or MS and nDO confirmed by a urodynamic study (UDS). At baseline, patients underwent a UDS to confirm nDO. Quality of life (QoL) was assessed by the Short‐Form (SF) Qualiveen questionnaire. Patients received fesoterodine 8 mg/day for 3 months and were re‐evaluated with UDS and SF‐Qualiveen. The primary endpoint was the confirmation of the maximum detrusor pressure (Pdetmax) reduction after treatment. Secondary endpoints were: evaluation of maximum bladder capacity and compliance and QoL effect. Statistical analysis included Wilcoxon‐test using SPSSv26. Results: One hundred and twenty‐four patients completed the study. Ninety‐five of them (76.6%) had SCL, while 29 (23.4%) had MS. Pdetmax, maximum bladder capacity, and compliance had significant reduction after treatment (p <.001) in the whole group and each subgroup. SF‐Qualiveen revealed a significant increase in QoL in each group (p <.001). Conclusions: Fesoterodine fumarate (8 mg) is an efficacious drag in patients with SCL and MS, as it significantly decreases the detrusor pressure, increases the bladder capacity and compliance, and improves the QoL. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic sacrocolpopexy (LSC) has established itself as a safe method for the management of pelvic organ prolapse (POP). Laparoscopic suturing is a time-consuming intraoperative task during LSC. Self-retaining barbed sutures (SBSs) are known to reduce the operative time in laparoscopic cases. The current study aimed to evaluate the efficacy and safety of SBS during the performance of LSC. Materials and Methods: Twenty female patients with symptomatic POP were treated with LSC by an expert surgeon. The preoperative evaluation included the International Continence Society POP-quantification (POP-Q) and the prolapse-specific quality-of-life questionnaire Mesh fixation was performed with SBS anteriorly on the anterior vaginal wall and posteriorly on the levator ani muscle. A 5-mm titanium tacking device was used for promontofixation. The peritoneum was also closed with an SBS. Results: Mean patient's age was 63 years (range: 50-79 years). According to POP-Q, system 3 patients (15%) had Stage I, 12 patients (60%) had Stage II, 3 patients (15%) had Stage III, and 2 patients (10%) had Stage IV prolapse. Concomitant hysterectomy was performed in 14 patients, respectively. Mean operative time was 99.75 (range: 65-140) min, mean blood loss was 57.75 (range: 30-120) ml. One patient had a bladder perforation intraoperatively, and three patients developed transient fever postoperatively. One patient had a recurrent cystocele and three patients recurrent rectocele. Conclusions: The current study renders the use of SBS during LSC to be safe and efficient. Further comparative studies would elucidate the impact of the use of SBS in LSC. [ABSTRACT FROM AUTHOR]

Overactive bladder (OAB) syndrome is a prevalent condition known to have a substantial impact on a patient's quality of life (QoL). Treatment options are numerous and include pharmacotherapy and other non-invasive measures, as well as more or less invasive interventions. Antimuscarinics are the cornerstone of medical management. Given that millions of patients suffer OAB symptoms worldwide and there is abundance of treatment options available, selecting the treatment strategy that offers the best balance of QoL improvement to resources spent in achieving it becomes crucial in the current situation of healthcare budget restrictions worldwide. This review summarizes available evidence on economic analyses of OAB treatments aimed at identifying the most cost-effective in terms of improving QoL. [ABSTRACT FROM AUTHOR]

Abstract: Context: This review focuses on the contemporary role of antimuscarinics in the management of men with symptoms of bladder outlet obstruction (BOO) and concomitant overactive bladder (OAB). Safety issues of antimuscarinics in this subpopulation of men are also reviewed. Objective: We reviewed the current literature and performed an analysis of the efficacy, suitability, and the safety of antimuscarinics in this subpopulation of men. Evidence acquisition: We performed a systematic search of Medline/PubMed, Embase, Scopus, and the Cochrane Database of Systematic Reviews for relevant articles published between 1990 and September 2010, restricted to studies in humans published in English. In addition, published abstracts presented at the annual meetings of the European Association of Urology, the American Urological Association, and the International Continence Society in the last decade (2000–2010) were hand-searched and evaluated. Each article''s title and abstract were reviewed for their appropriateness and relevance to the use of antimuscarinics in patients with BOO and concomitant OAB. Relevant articles were fully reviewed and included in the final data acquisition. Evidence synthesis: Treatment options include combination treatment with α-blockers and antimuscarinics, sequential use of α-blockers and antimuscarinics, monotherapy with antimuscarinics, and a combination of antimuscarinics and 5α-reductase inhibitors. The sequential use of α-blockers and antimuscarinics seems to be the most appropriate approach, and the use of antimuscarinics and α-blockers appears generally to be safe and efficacious. Data are insufficient for a possible stratification of patients for a specific sequence of the drugs reviewed. Conclusions: This review infers that the existing data confirm the safety of antimuscarinics administered for the treatment of these patients. The efficacy of antimuscarinics has been proven in different trials regarding different storage symptom end points, but not all end points regarding OAB reached significance. All the reported trials are of short duration (4–12 wk) and include only men with low postvoid residual urine volumes at baseline (<200ml). Overall, the addition of an antimuscarinic to the treatment of a patient with BOO and concomitant OAB seems to offer an amelioration of the symptoms and a moderate improvement in quality of life. [Copyright &y& Elsevier]

Abstract: Context: Overactive bladder (OAB) is a prevalent condition that has a significant negative impact on almost all aspects of health-related quality of life (HRQoL). Urgency is the core symptom experienced by all patients who have OAB, either with or without urgency urinary incontinence (UUI). Objective: To describe the assessment and impact of UUI on patients’ HRQoL. Evidence acquisition: A nonsystematic review of the literature including PubMed and congress abstracts was performed in 2010. Evidence synthesis: Urodynamic measures are not necessarily predictive of the impact of OAB symptoms on the individual patient. Thus the use of validated, disease-specific instruments to assess patient-reported outcomes such as symptom bother, HRQoL, treatment satisfaction, and symptom frequency and severity has become standard in the diagnosis and treatment of OAB. Use of these measures in clinical research has shown that OAB with UUI has a greater impact on HRQoL than OAB without UUI, and reduction of UUI episodes is an important goal for patients with OAB with UUI. The impact of UUI on HRQoL is also greater than that of stress urinary incontinence or other types of urinary incontinence. Furthermore, UUI episodes contribute substantially to the personal and societal cost burden of OAB. Conclusions: Effective treatment of OAB symptoms, focussing on UUI, is essential to improve patient HRQoL and to minimise the costs associated with this condition. [Copyright &y& Elsevier]

Objective: To review multi-institutional, multidisciplinary experience in the management of Fournier's gangrene (FG) in an attempt to identify etiologic parameters as well as to propose methods of efficient management. Patients and Methods: Retrospective chart review of 45 patients diagnosed with FG and treated in three departments (general surgery and urology departments) was performed. Results: Average patient age was 50 ± 15.8 (range 33-81) years. Five female and 40 male patients. Seven patients deceased due to the disease. In 26 and 6 cases, perianal or ischiorectal abscess was present, respectively. These abscesses were extending up to the level of rectovesical/Douglas pouch in 12 cases. Abscesses in the scrotum and perineum were revealed in 10 and 6 cases, respectively. A fistula to the rectum and 8 sinuses to the skin were observed. Colostomy was performed in 25 cases, diverting cystostomy in 17, and orchidectomy in 12 cases. In 18 patients (40%) repeat debridement was deemed necessary. Three patients required more than 3 debridement procedures. Average hospitalization time was 15.7 ± 11.6 (range 4-40) days. Conclusion: FG is a life-threatening form of necrotizing soft tissue infection. The disease is unpredictable and the currently proposed methods for prognosis are promising but still questionable. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Overactive bladder is a common and bothersome condition. Antimuscarinic agents, as a class, are the cornerstone of medical treatment of overactive bladder. They offer significant improvements in symptoms and patients' quality of life. Antimuscarinics are generally well tolerated with mild and predictable side effects. Available antimuscarinics have small, yet statistically significant, differences in their efficacy and tolerability profiles. In clinical practice, finding the agent that offers the optimumbalance of efficacy and side effects for an individual patient remains the major challenge. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the efficacy of the InVance™ male sling in treating stress urinary incontinence. Patients and Methods: We retrospectively reviewed operative logs from a single surgeon of 43 patients treated over a 3-year period (Feb. 2004 to Nov. 2006) for stress incontinence by implantation of a male bulbourethral bone-anchoring sling (InVance™). The mean follow-up time was 24.2 months (range 4-38). Radical prostatectomy was the most common cause of incontinence in this group (33/ 43 cases; 76.7%). Efficacy was evaluated objectively in terms of the number of pads used per day, while subjective patient satisfaction was also recorded. We also investigated a possible correlation between preoperative parameters and outcome. Results: Twenty-two patients (51.2%) were cured (totally dry: 30.2%; the remainder: 1 pad per day), while 8 (18.6%) patients improved but still required two pads per day. Overall, 30 of 43 patients (69.6%) were satisfied with the outcome of the operation. Postoperative infection was the most common complication (11.6%). The severity of preoperative incontinence correlated with the outcome of the operation, with mild incontinence giving better results. Conclusions: The bone-anchored male sling is an effective and minimally invasive treatment for mild-to-moderate male urinary incontinence. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aim To review if the existing data support the new concept that antimuscarinic agents can be used for the treatment of bladder outlet obstruction (BOO) with coexisting overactive bladder (OAB). Method A literature search of Medline publications (up to 2008) on use of antimuscarinic agents for treatment BOO was performed and all data were presented. All relevant data from published studies in congress abstracts were as well included. Results The existing data show that this treatment effectively improves patient quality of life. Concerns about the possibility of urinary retention were shown to be unfounded. It seems that antimuscarinic agents do not affect voiding pressures and the use of antimuscarinic agents for BOO seems safe. Conclusions The combination of an α-blocker and antimuscarinic agent for the treatment of BOO with concomitant OAB seems promising. Neurourol. Urodynam. 29:S46-S50, 2010. © 2010 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Summary: Purpose: To assess the improvement of concurrent erectile dysfunction (ED) in men with overlap syndrome (obstructive sleep apnea and chronic obstructive pulmonary disease), treated with continuous positive airway pressure (CPAP) and bronchodilators. Material and methods: We evaluated 48 men of a mean age of 52.8±10 years suffering from both obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), and concurrent ED. They were treated with conventional for pulmonary obstruction therapy (CPAP and bronchodilators) for 6 months and then their erectile function (EF) status was reassessed. ED was considered as improved, if ED intensity score increased for at least five points compared to that of baseline. The determinants for improvement of ED were also evaluated, as well as patient''s personal degree of satisfaction with the treatment they received as far as the disorder was concerned. Results: EF was improved in 12 patients (25%), but only two thirds of them were satisfied with the grade of improvement after treatment. ED improvement was related positively with age and apnea/hypopnea index and negatively with ED duration. ED intensity score, O2 saturation at night and BMI were not significantly related to the outcome of EF improvement. Conclusions: Conventional treatment for OSA and COPD, has a positive effect on concurrent ED on the minority of patients. This effect is possibly due to the improvement of respiration during sleep with CPAP and of oxygenation with bronchodilators continuously. Of the improved men, one third was not satisfied with the impact of this treatment modality on their EF. It is likely that specific for ED treatment is needed in these individuals. [Copyright &y& Elsevier]

Objective. To investigate the association of retrocaval ureter with other congenital abnormalities. Methods and patients. Two new cases of retrocaval ureter are discussed and a detailed electronic search of the literature was mainly focused on the concomitant abnormalities. The first of our patients had also a glandular hypospadias and a supernumerary lumbar vertebra, while the second one had syndactylia (fixed toes) in both feet. Results. The review of the literature revealed that 21% of the cases of retrocaval ureter present with concomitant abnormalities mainly from the cardiovascular system and the genitourinary tract. Conclusion. Diagnosis of retrocaval ureter should increase the awareness of the responsible physician on the possibility of concomitant malformations where treatment could prevent future symptoms. [ABSTRACT FROM AUTHOR]

Background: Urethral catheterization can often be technically demanding due to the presence of obstructing segments within the urethra. Conventional methods attempting to restore urethral patency often are unsuccessful and traumatize the urethral lumen. Method: We present an innovative technique by using a hydrophilic guidewire and a hydrophilic ureteral access sheath for the ‘first-line’ catheterization and management of ‘difficult’ urethral strictures. We used this technique in 10 extremely difficult cases of strictures present in all the urethral segments. Result: The dilation was successful and atraumatic in all the cases due to the hydrophilic nature of the access sheath. In all patients, larger sizes of urethral catheters were gradually inserted within the next couple of days. Conclusion: We propose ‘access sheath’-assisted urethral dilatation as a safe and simple alternative for the ‘first-line’ catheterization and, possibly, management of ‘difficult’ urethral strictures. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The rare‘burned out’ phenomenon in germ cell tumors is known as the presence of an extragonadal germ cell tumor without traces of neoplasm in the testis. This condition is different and less common from the primary extragonadal germ cell malignancies. These malignancies are treated surgically with or without adjuvant chemotherapy or radiotherapy and their prognosis is better than that of other types of primary extragonadal tumors. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the present study was to evaluate the use of externally coated stents in patients with malignant ureteral obstruction.Materials and Methods: We have prospectively evaluated 16 patients, 10 men and 6 women, with malignant ureteral obstruction treated successfully by placement of Passager metal stents (Boston Scientific, Natick, MA, USA) bypassing the stricture. Mean patient age was 65.6 years (range 62–78 years). Ureteral patency was confirmed 24 and 48 hours by injection of contrast material through the nephrostomy tube, and after patency confirmation the nephrostomy catheter was removed.Results: All stents were positioned successfully, and the postoperative course was uneventful. In 13 cases (81.2%) the prostheses finally migrated into the bladder hindering overall ureteral patency (mean time of migration: 1.5 months). Patency was achieved in the remaining ureters (n=3), during the follow-up period (mean: 8 months, range 6–16 months), without any need for further intervention.Conclusion: The inappropriate anchorage and the increased ureteral peristalsis are the main causes of migration towards the bladder, thus, minimizing the usefulness of this stent for the treatment of ureteral strictures. [ABSTRACT FROM AUTHOR]

Background: Most of neurologically impaired persons, who are suffering from spinal cord injury (SCI) or multiple sclerosis (MS), may face important lifestyle restrictions. Urinary disorders can further decrease their quality of life (QoL). SF Qualiveen is a validated questionnaire for the evaluation of QoL in this population related to neurogenic lower urinary tract dysfunction (NLUTD)., Aim: The cross-cultural adaptation, the reliability check, and the validation of the SF Qualiveen in Greek., Design: The design of this study was the observational cohort study., Setting: Between November 2019 and May 2020, we addressed to 136 consecutive neurologic patients with MS or SCI from the outpatient clinic of the Unit of Neuro-urology of the National Rehabilitation Center in Athens., Population: The study was based on 124 patients (68 males and 56 females). There were 55 paraplegics, 16 tetraplegics and 53 MS patients., Methods: After a back forward translation of the SF Qualiveen between English and Greek, the patients completed the Greek version of SF Qualiveen and King's Health Questionnaire at baseline and 3 months later. Reliability check and validation were performed by factor analysis with the Explanatory Factor Analysis (EFA) method. Demographic data were collected as well., Results: The Greek version of the questionnaire showed good internal consistency with Cronbach's α >70 for the total score and most of the four sub-scales for the test and retest. Test-retest reliability showed that all domains of the SF-Qualiveen (test) were correlated with the SF-Qualiveen total score (test) and the same applies to the SF-Qualiveen (retest). Domains of SF-Qualiveen (test) were poorly correlated with the domains of SF-Qualiveen (retest). Construct and criterion validity were satisfactory and CFA found that the model had good fit [χ2 (14)=19.133, GFI=0.964, NFI=0.954, RMSEA=0.055, CFI=0.987]., Conclusions: This Greek version of the SF Qualiveen was tested following well-established guidelines on measurement properties and showed good validity and reliability. It is reproducible, reliable, and valid for the Greek population., Clinical Rehabilitation Impact: This Greek version of the SF Qualiveen can be used as a tool to evaluate the impact of NLUTD on QoL in Greek-speaking patients with MS and SCI in research and clinical practice.

Purpose of Review: To summarize data concerning the medical treatment of men with overactive bladder symptoms published in peer-reviewed journals between January 2012 and March 2013., Recent Findings: Results of large, randomized trials of solifenacin in combination with tamsulosin in men with lower urinary tract symptoms, including voiding and storage ones, have dominated the medical literature on the subject for the past 12-16 months. Solifenacin in upfront combination with alpha-blockers or as add-on therapy in men with residual storage symptoms despite alpha-blockade offers additional benefits in symptom control. In accordance with data from previous studies on other antimuscarinics, improvements are significant only for some of the efficacy outcomes. Solifenacin in combination with alpha-blockers is associated with an increase in postvoid residual urine volume but not a significantly increased risk of retention. Recent data also indicate that the combination of antimuscarinics with alpha-blockers is cost-effective with long-term efficacy and safety., Summary: Recent evidence further supports the efficacy and safety of antimuscarinics in combination with alpha-blockers in treating storage symptoms in men with lower urinary tract symptoms. More studies are needed to evaluate criteria for selecting men likely to benefit more from antimuscarinics and investigate other overactive bladder treatments in male populations.