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Justyna Miszczyk,1 Mikołaj Przydacz,2 Michał Zembrzuski,2 Piotr L Chłosta2 1Department of Experimental Physics of Complex Systems, The H. Niewodniczański Institute of Nuclear Physics PAN, Krakow, Poland; 2Department of Urology, Jagiellonian University Medical College, Krakow, PolandCorrespondence: Justyna MiszczykDepartment of Experimental Physics of Complex Systems, The H. Niewodniczański Institute of Nuclear Physics PAN, Radzikowskiego 152 Street, Krakow, 31-342, PolandTel +48 126628409Fax +48 126628458Email Justyna.Miszczyk@ifj.edu.plPurpose: Radiotherapy is one of the most common treatments for prostate cancer. Finding a useful predictor of the therapeutic outcome is crucial as it increases the efficacy of treatment planning. This study investigated the individual susceptibility to radiation based on chromosome 1 aberration frequency measured by the FISH (fluorescence in situ hybridization) method.Patients and Methods: Whole blood samples were collected from 27 prostate cancer (PCa) patients and 32 subjects with benign prostatic hyperplasia (BPH), who were considered as a control group. Samples were irradiated with 2 Gy of x-rays, cultured, harvested, and used in the FISH procedure.Results: After irradiation, significantly higher levels of all studied chromosome 1 aberrations (except for deletions) in the group of PCa patients were revealed. Furthermore, in the lymphocytes of cancer patients, nearly five-fold higher frequencies of acentric fragments were observed compared to the BPH group. The highest individual radiosensitivities for all estimated biomarkers were seen in PCa patient cells who reported cancer incidence in the immediate family (CIF+).Conclusion: The differences in chromosome 1 aberrations between PCa and BPH demonstrate that lymphocytes taken from patients with prostate cancer have higher radiosensitivity which might be related to hereditary or familiar inclinations. Therefore, this technique may find future application in searching biomarkers of the cellular radiotherapy response in prostate cancer patients.Keywords: benign prostatic hyperplasia, chromosome 1, prostate cancer, radiotherapy planning, biomarkers, FISH method

Purpose: An established link exists between overactive bladder (OAB) syndrome and impaired sleep. However, earlier research on this subject only focused on the general population, and certain patient subgroups have not been examined adequately. Depressed patients constitute a unique population because of a possible bidirectional relationship between OAB and depression. Thus, we investigated the association between OAB symptoms and sleep quality in patients with depression.Methods: In this prospective, cross-sectional study, we analyzed data on depression, sleep quality, and OAB symptoms from depressed patients treated at our department of adult psychiatry. Data were collected with the Hamilton Rating Scale for Depression, the Holland Sleep Disorders Questionnaire, the Athens Insomnia Scale, and the OAB Module of the International Consultation on Incontinence Questionnaire.Results: In total, 102 patients treated for depression were enrolled. Thirteen patients (12.7%) met the diagnostic threshold of OAB with the International Consultation on Incontinence Questionnaire OAB Module. Patients with depression and concomitant OAB had significantly higher scores on the Holland Sleep Disorders Questionnaire than patients classified as nonOAB (P

Prospective cohort validation study. In spinal cord injury (SCI), neurogenic lower urinary tract dysfunction is associated with a reduced quality of life. No specific questionnaire has been translated, culturally adapted, and validated into Polish language to assess urinary disorder-specific quality of life in people after SCI. In this study, we translated, adapted, and validated the Polish versions of the Qualiveen and SF-Qualiveen in individuals with SCI. University Hospital in Krakow, Poland. Translation and cross-cultural adaptation of the Qualiveen and SF-Qualiveen were done using international recommendations and well-established methods. Adult patients with SCI from the Department of Urology at the University Hospital in Krakow, Poland completed the Polish versions of the Qualiveen, SF-Qualiveen, and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) at baseline and 2 weeks later. The ICIQ-SF served as the reference instrument. Validity and reliability were determined. Polish-speaking patients with SCI (n = 178) were included. Content validity/cross-cultural adaptation of the translated questionnaires was investigated during face-to-face interviews. Construct/criterion validity was assessed, and positive correlations were found between the Qualiveen and ICIQ-SF as well as the SF-Qualiveen and ICIQ-SF. A reliability study revealed good internal consistency (Cronbach’s alpha > 0.8) and reproducibility (intraclass correlation coefficients > 0.8) for both adapted questionnaires. We did not identify floor or ceiling effect. The Polish versions of the Qualiveen and SF-Qualiveen showed good measurement properties. Polish healthcare providers can now reliably and directly assess the urinary disorder-specific quality of life in individuals after SCI.

Introduction The year 2015 brought a major shift in the national health care system in Poland - the diagnosis and treatment of patients with malignant diseases became a priority. Close multidisciplinary collaboration was facilitated to optimize patients' care. The aim of this study was to investigate temporal changes in neoadjuvant chemotherapy (NAC) utilization in patients who underwent radical cystectomy (RC) due to muscle invasive bladder cancer (MIBC) in a single academic center in Poland. Material and methods Patients who underwent planned curative RC with bilateral pelvic lymph node dissection between January 2013 and December 2018 in a tertiary care center were included in the study. To assess the response to chemotherapy, tumor regression grades (TRGs) were included into the standard pathological examination of RC specimens. Results Out of 183 patients enrolled into the study, 105 (57.4%) underwent NAC before RC. Only 1 (4%) out of 25 patients underwent NAC prior to RC in 2013. The percentage of patients who received NAC in subsequent years were: 4% (1/25) in 2013, 36% (9/25) in 2014, 55.3% (21/38) in 2015, 62.9% (21/35) in 2016, 83.9% (26/31) in 2017 and 89.7% (26/29) in 2018 (p-value for trend

AIM To assess the impact of asymptomatic bacteriuria (ASB) on the safety and efficacy of intradetrusor onabotulinumtoxinA injections in patients with overactive bladder and neurogenic detrusor overactivity. METHODS We reviewed the medical records of patients who had received onabotulinumtoxinA between 2009 and 2014. Safety analysis was based on the appearance of urinary tract infections (UTIs), hematuria, and need for hospitalization because of related adverse event(s) in the month after injection. Patients who underwent urodynamic study before and 3 months after the first onabotulinumtoxinA treatment were included in efficacy analysis. Changes in maximal cystometric capacity (MCC), bladder compliance (BC), maximal detrusor pressure at maximal involuntary detrusor contraction (Pdetmax), and detrusor leak point pressure (DLPP) were assessed. RESULTS Totally, 183 patients underwent 457 injection sessions. ASB was found in 38.8% (185) of urine cultures taken before injections. After treatment, 49 patients (with or without ASB) developed UTI. Urosepsis did not occur. The odds ratio of UTI in patients with ASB was 16.48. The efficacy cohort, consisting of 83 patients, showed that ASB had no significant effect on any of the efficacy parameters (MCC-risk ratio [RR]: 0.93, 95% confidence interval [CI]: 0.72-1.21; BC-RR: 0.88, 95% CI: 0.62-1.24; Pdetmax-RR: 0.9, 95% CI: 0.69-1.21; DLPP-RR: 1.69, 95% CI: 0.72-3.97). CONCLUSIONS ASB is common among patients who are candidates for intradetrusor onabotulinumtoxinA treatment. ASB increases the risk of UTI, but does not heighten the risk of urosepsis, hospitalization, or therapy failure. This study should lead to the reconsideration of current recommendations.

Background: The aim of this study was to perform a cross-sectional study of Polish neurogenic patients to measure, at the population level, the prevalence, bother and behavior associated with treatment for lower urinary tract symptoms (LUTS) and overactive bladder (OAB). Methods: This epidemiological study was based on data from LUTS POLAND, a computer-assisted and population-representative telephone survey. Participants were classified by age, sex and place of residence. Results: LUTS POLAND includes 6005 completed interviews, of which 1166 (19.4%) were for individuals who had ever received any treatment by neurologists and/or neurosurgeons. Among these neurogenic participants, LUTS prevalence was 72.3%, statistically higher than for non-neurogenic respondents. At the population level, neurogenic patients had about a 20% higher risk for LUTS presence than non-neurogenic participants (relative risk: 1.17–1.21). LUTS prevalence did not differ between men and women. Frequency was the most common of the LUTS. Forty percent of neurogenic respondents described having more than one LUTS subtype (i.e., storage, voiding, and/or post-micturition symptom subtype), and more than 50% of respondents reported OAB symptoms. Both storage and voiding symptoms were bothersome, and many neurogenic individuals (42.3–51.0%) expressed anxiety about bladder function affecting quality of life. Only one-third (34.9–36.6%) of neurogenic participants had sought treatment for their LUTS, and the majority of such individuals received and maintained treatment. Conclusions: LUTS and OAB symptoms were highly prevalent and bothersome among Polish neurogenic patients at the population level. Because the scale of seeking treatment for LUTS was low, Polish neurogenic patients may not be adequately informed about multiple effects of LUTS and OAB.

Objectives: Population-level data are lacking for urinary incontinence (UI) in Central and Eastern European countries. Therefore, the objective of this study was to estimate the prevalence, bother, and behavior regarding treatment for UI in a population-representative group of Polish adults aged ≥ 40 years. Methods: Data for this epidemiological study were derived from the larger LUTS POLAND project, in which a group of adults that typified the Polish population were surveyed, by telephone, about lower urinary tract symptoms. Respondents were classified by age, sex, and place of residence. UI was assessed with a standard protocol and established International Continence Society definitions. Results: The LUTS POLAND survey included 6005 completed interviews. The prevalence of UI was 14.6–25.4%, women reported a greater occurrence compared with men (p &lt, 0.001). For both sexes, UI prevalence increased with age. Stress UI was the most common type of UI in women, and urgency UI was the most prevalent in men. We did not find a difference in prevalence between urban and rural areas. Individuals were greatly bothered by UI. For women, mixed UI was the most bothersome, whereas for men, leak for no reason was most annoying. More than half of respondents (51.4–62.3%) who reported UI expressed anxiety about the effect of UI on their quality of life. Nevertheless, only around one third (29.2–38.1%) of respondents with UI sought treatment, most of whom received treatment. Persons from urban and rural areas did not differ in the degrees of treatment seeking and treatment receiving. Conclusion: Urinary incontinence was prevalent and greatly bothersome among Polish adults aged ≥ 40 years. Consequently, UI had detrimental effects on quality of life. Nonetheless, most affected persons did not seek treatment. Therefore, we need to increase population awareness in Poland about UI and available treatment methods, and we need to ensure adequate allocation of government and healthcare system resources.

Background and Objectives: The purpose of this study was to measure at the population level the prevalence, bother, effect on quality of life, and behavior associated with treatment for nocturia in a large representative cohort of Polish adults aged ≥40 years. Materials and Methods: Data were derived from LUTS POLAND, a computer-assisted telephone survey of urological health that mirrored the entire Polish population in urban and rural areas. Results: Six thousand persons completed the survey. The respondents were representative for age, sex, and place of residence. Nocturia was highly prevalent because 73.7% of all participants reported ≥1 nocturia episode, and 36.1% reported ≥2 nocturia episodes. We did not identify differences between urban and rural areas. Women were more often affected than men, and the prevalence of nocturia increased with age. More than one-third (29.7–45.3%) of respondents who reported nocturia were bothered by the symptom and, thereby, concerned about their urinary-specific quality of life. Notably, we found a statistically significant correlation between the frequency of nocturia and intensification of its bother (p &lt, 0.001 for men and women). However, only about one-fourth (22.2–29.2%) of respondents with nocturia sought treatment, most of whom received treatment. Conclusions: Nocturia was highly prevalent and often bothersome with negative effects on quality of life of Polish adults aged ≥40 years. However, the percentage of treatment seeking was low. Combined with the fact that nocturia has multiple causes and consequences, including high morbidity and mortality, our findings revealed that nocturia was a significant public health issue. We need to develop strategies to specifically increase awareness about nocturia and provide greater healthcare and financial resources for persons with nocturia in Poland.

Background Polish physicians and researchers lack an extensive and precise instrument in their native language for evaluating sexual dysfunction in individuals with neurogenic disorders. The aim of this study was to create a culturally adapted, validated, Polish language version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15) for persons with multiple sclerosis (MS) and spinal cord injury (SCI). Methods International recommendations and standardized methods for instrument validation were followed. Sexually active patients with MS and SCI completed the MSISQ-15, International Index of Erection Function (IIEF-15, men), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-31, women). IIEF-15 and PISQ-31 were used as reference questionnaires. Responses were collected at baseline (test) and after 2 weeks (re-test). Results We recruited 299 Polish-speaking patients with MS or SCI. Interviews disclosed that the translated questionnaire had optimal content validity/cross-cultural adaptation. MSISQ-15 scores correlated significantly with the severity of sexual dysfunction as evaluated by IIEF-15 (r = − 0.487) and PISQ-31 (r = − 0.709). These correlations substantiated the high quality construct/criterion validity. An analysis of reliability presented good internal consistency (Cronbach’s alpha of 0.93 for the total score of MS patients and 0.86 for the total score of SCI patients) and reproducibility (intraclass correlation coefficients of 0.91 for the total score of MS patients and 0.92 for the total score of SCI patients). There were no ceiling or floor effects. Conclusions The Polish version of MSISQ-15 exhibited excellent measurement properties. It is a suitable and reliable instrument to assess sexual dysfunction in MS and SCI individuals. The Polish MSISQ-15 will enhance routine clinical practice and assist research for neurogenic patients in Poland.

The aim of this study was to investigate the effect of lower urinary tract symptoms (LUTS) on behavior related to treatment of Polish adults aged &ge, 40 years. Methods: We conducted a computer-assisted telephone survey with a study sample stratified by age, sex, and place of residence (type, size, urban versus rural) reflecting the entire Polish population. Participants rated the frequency and symptom-specific bother of individual LUTS and their effects on seeking and receiving treatment, treatment satisfaction, and treatment continuation. We adjusted multiple logistic regression models to analyze the simultaneous effects of predictor variables on each dependent variable. Results: Overall, 6005 participants completed the interview. One third (29.6&ndash, 33.5%) of participants with LUTS were seeking treatment, and 24.0&ndash, 26.4% received treatment. There was no difference in treatment seeking and receiving between urban and rural areas. Whereas storage and voiding symptoms were significantly related to treatment seeking by both men and women, treatment receiving correlated only with voiding symptoms in men and only with storage symptoms in women. Most respondents who received treatment were satisfied, treatment dissatisfaction was related to the presence of storage symptoms in both men and women. Only 50% of all participants continued their treatment, discontinuation of treatment was statistically more prevalent for women than for men. Conclusion: This investigation, the first population-representative study performed in Eastern Europe, revealed a low frequency of seeking treatment for LUTS. In addition, symptoms that inclined participants to seek treatment might not have been adequately addressed by the treatment they received. We also found a relatively high rate of treatment discontinuation. Clearly, there is a need for both improved patient education about LUTS treatment and a need for increased clinician awareness of the coexistence of different symptoms in men and women plus proactive evaluation by physicians for all types of LUTS and associated bother.

Previously, there was no specific questionnaire in the Polish language for overall assessment of lower urinary tract symptoms (LUTS) in women. The aim of this study was to translate, culturally adapt, and validate Polish versions of the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS and ICIQ-FLUTS LF, short and long forms) for use in clinical practice and research in Poland. The original English ICIQ-FLUTS and ICIQ-FLUTS LF were adapted to Polish according to international standards and recommended procedures. Adult women with LUTS who were seen at the Department of Urology at the Jagiellonian University, Krakow, Poland, completed the ICIQ-FLUTS and ICIQ-FLUTS LF at baseline and 2 weeks later. Control participants completed the questionnaires once. Validity and reliability were determined. One hundred and eighty Polish-speaking women who had LUTS completed the questionnaires. Content validity was high. Significant differences between women with LUTS and controls for both ICIQ-FLUTS and ICIQ-FLUTS LF confirmed optimal construct validity. An intercorrelation analysis revealed that internal consistency was good for ICIQ-FLUTS and ICIQ-FLUTS LF (Cronbach’s alpha >0.7). Test–retest reliability (reproducibility) demonstrated strong stability (intraclass correlation coefficient > 0.7). Floor and ceiling effects were absent from women with LUTS, whereas a floor effect was detected in the control group. The Polish ICIQ-FLUTS and ICIQ-FLUTS LF are valid, reliable, and consistent measures of overall evaluation of LUTS in women. They are equivalent to the original English versions, and they retained the psychometric properties of the original questionnaires.

Purpose: The aim of this study was to measure, at the population level, the prevalence, bother, and treatment-related behavior for lower urinary tract symptoms (LUTS) and overactive bladder syndrome (OAB) in a large cohort of cardiology patients. Methods: This report is a further analysis of data from LUTS POLAND, a computer-assisted telephone survey that reflected the entire Polish population, stratified by age, sex, and place of residence. LUTS and OAB were assessed by a standardized protocol, the International Continence Society definitions, and validated questionnaires. In addition, all participants provided information regarding their behavior as it related to LUTS treatment. Results: Overall, 6005 participants completed interviews, and 1835 (30.6%) had received treatment by cardiologists. The prevalence of LUTS was 73.3% for cardiology participants compared with 57.0% for respondents who were not treated by cardiologists (p &lt, 0.001). There were no differences between men and women in LUTS prevalence for cardiology patients. Nocturia was the most prevalent LUTS. LUTS were often bothersome, and storage symptoms were more bothersome than voiding or postmicturition symptoms. The prevalence of OAB syndrome was 50.7% in cardiology patients, higher than in noncardiology participants (36.6%, p &lt, 0.001), and more women were affected than men. Only one-third of cardiology patients who reported LUTS were seeking treatment for LUTS, and most of them received treatment. There were no differences between persons living in urban and rural areas. Conclusions: LUTS and OAB were highly prevalent among cardiology patients. Although LUTS were often bothersome in this unique population, we found that the seeking of treatment for LUTS was minimal. These results highlight the need for cooperation between cardiologists and urologists.

The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) has been measured by population-based investigations in many parts of the world. However, data are lacking for Eastern Europe, and there has not been any large population-representative study in any country of this region. Therefore, the aim of this study was to evaluate the prevalence and associated bother of LUTS and OAB in a population-representative sample of persons aged ≥ 40 years in Poland. This investigation was conducted as a computer-assisted telephone interview. The survey sample was stratified by age, sex, and place of residence to reflect the entire Polish population. LUTS and OAB were assessed by a standardized protocol based on the International Continence Society definitions and validated questionnaires. Of 6005 participants, 57% were women, and the mean age (range) was 60.7 (40–93) years. The prevalence of LUTS was 69.8% (men 66.2%; women 72.6%). There was no difference in prevalence between urban and rural areas. LUTS were often bothersome among men and women, but women were more likely to be bothered compared with men. There were also statistically significant correlations between the frequency and the bother intensity of each of the LUTS. The prevalence of OAB was higher in women (39.5%) than in men (26.8%), and OAB increased with age. Lastly, LUTS had detrimental effects on the quality of life because one third of the participants had concerns about their urinary-specific quality of life. This investigation was the first nationwide, population-representative epidemiological study of LUTS and OAB in an Eastern-European country. LUTS were highly prevalent, often bothersome, and had negative effects on the quality of life of men and women aged ≥ 40 years. Our findings are comparable with other epidemiologic studies of LUTS and OAB conducted in different regions of the world.Trial registration: NCT04121936.

Aims No specific questionnaire to date has been available in Polish for evaluating health-related quality of life for urinary dysfunctions associated with multiple sclerosis (MS). The aim of this study was to translate, culturally adapt, and validate Polish versions of the Qualiveen and SF-Qualiveen for use in patients with MS. Methods Cross-cultural adaptation of the original English Qualiveen and SF-Qualiveen into Polish was performed according to international recommended and standard procedures. Adult patients with MS of the Department of Urology at the Jagiellonian University, Krakow, Poland, completed the Qualiveen, SF-Qualiveen, and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) twice: at baseline and 2 weeks later. Results One hundred eighty-nine Polish-speaking patients with MS completed the questionnaires. An intercorrelation study revealed that internal consistency was good for the total Qualiveen and SF-Qualiveen (Cronbach's α >0.8). Test-retest reliability (reproducibility) demonstrated strong stability (intraclass correlation coefficient >0.8). Content validities were optimal. Significant relationships between the Qualiveen and the ICIQ-SF, as well as the SF-Qualiveen and the ICIQ-SF, confirmed good construct/criterion validity. Conclusion The Polish Qualiveen and SF-Qualiveen are reliable, valid, and consistent measures of urinary disorder-specific quality of life in patients with MS. After years of no appropriate Polish instrument being available for healthcare professionals to evaluate patients with MS, we provide these versions and recommend their use in research and clinical practice in Poland.

Introduction Desmopressin is an effective and safe therapy for nocturia caused by nocturnal polyuria. However, many physicians are unsure about the proper diagnosis of nocturnal polyuria and the identification of patients who may benefit from desmopressin treatment. Therefore, to support urologists in their routine clinical practice, the aim of this study was to provide a comprehensive paradigm for diagnosing nocturnal polyuria with recommendations for the use of desmopressin. Material and methods A multidisciplinary group of experts reviewed the available literature. Findings were compiled into a practice-based approach for workup and treatment. Results We designed the nocturia diagnostic pathway to confirm nocturnal polyuria, identify possible causes of nocturnal polyuria, and classify patients with indications and contraindications for desmopressin therapy. A bladder diary remains a basic diagnostic tool. Underlying conditions that may lead to nocturnal polyuria include mainly cardiac insufficiency, arterial hypertension, chronic kidney failure, obstructive sleep apnea, peripheral edema, and excessive fluid intake at night. Treatment for nocturia caused by nocturnal polyuria is based on conservative management and pharmacotherapy, but pharmacological treatment should not precede a prior attempt at conservative treatment. Before administration of desmopressin, patients should be assessed for serum sodium concentration and carefully educated about the symptoms of hyponatremia. Older individuals or persons with risk factors for the development of hyponatremia should be checked regularly for hyponatremia during desmopressin therapy. Conclusions People with nocturia due to nocturnal polyuria should be evaluated carefully before initiating desmopressin treatment. Patients treated with desmopressin should be followed for both clinical efficacy and treatment-related adverse effects.

Introduction There is no comprehensive and specific questionnaire translated, adapted and validated in the Polish language for evaluating symptoms, quality of life and complications associated with the neurogenic lower urinary tract dysfunction (NLUTD). The aim of this study was to translate, culturally adapt and validate a Polish version of the Neurogenic Bladder Symptom Score (NBSS) for patients who experience NLUTD. Material and methods Standardised guidelines and well-established methods were used for translation and cross-cultural adaptation of the NBSS. Adult patients with multiple sclerosis and spinal cord injury completed the NBSS, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the International Prostate Symptom Score (IPSS) and the SF-Qualiveen. Responses were recorded twice within a 14-day period. Results Two hundred seventy-four Polish-speaking patients with NLUTD were included in the study. Content validity was optimal. Significant relationships between NBSS (Incontinence) and ICIQ-SF, NBSS (Storage and Voiding) and IPSS, and NBSS (Quality of Life) and SF-Qualiveen confirmed good construct/criterion validity. An intercorrelation study revealed that internal consistency was good for the total NBSS and specific domains (Cronbach's alpha >0.7). Test-retest reliability (reproducibility) demonstrated strong stability (intra-class correlation coefficients >0.7 for the total NBSS). No ceiling or floor effects were present. Conclusions The Polish NBSS demonstrated good measurement properties for a large cohort of patients with NLUTD. It is a suitable tool to assess NLUTD symptoms, consequences and quality of life. The Polish NBSS will support routine clinical practice of all types of physicians in Poland who care for patients with NLUTD.

Introduction Urinary incontinence (UI) is a major public health issue because of the high number of individuals affected, its adverse effects on job-related functioning, and the decline in quality of life. The association between UI and symptoms of depression has been evaluated extensively for the general population. However, relationships between UI and depression have not been adequately assessed for specific patient groups. Thus, we investigated the association between UI and depression severity in patients treated for depression. Material and methods This study was a single-center, prospective, cross-sectional inquiry. We analyzed questionnaire data on UI and depression from depressed patients treated in our Department of Adult Psychiatry. Patients completed the International Consultation on Incontinence Questionnaire Short Form and General Health Questionnaire whereas psychiatrists administered the Hamilton Rating Scale for Depression. Results One hundred two patients were enrolled in the study. Most patients had mild depression. Patients who were incontinent mostly reported moderate UI and UI was statistically more prevalent in women than in men. Further, with the General Health Questionnaire, depression severity in women was significantly associated with the severity of UI. We did not observe correlation between depression severity analyzed with the Hamilton Rating Scale for Depression and UI. Conclusions In the cohort of patients treated for depression, UI affected more women than men. In wo- men, UI was associated with the severity of depression. Because UI and depression may coexist and share the symptom burden, particularly in women, clinicians should be aware of the interconnection between these two conditions.

Sept 15, 2020 Introduction Poland was initially less affected by the coronavirus disease 2019 (COVID-19) pandemic, however, severe restrictions, and health care restructuration have impacted all areas of medicine, including urology [ ]we aimed, via an online survey, to examine the impact of the COVID-19 pandemic on Polish urologists and urology residents [ ]despite initial success with flattening the COVID-19 incidence curve, escalating restrictions, further health care restructuration (including the opening of COVID-19-dedicated hospitals), and unexplored COVID-19 fear likely led to indirect adverse effects of the pandemic also impacting Polish physicians and their work [ ]COVID-19, a droplets-transmitted respiratory infection, despite not being in the initial scope of treatment of urologists, has impacted all areas of urology including emergencies, outpatient clinics, elective surgeries, as well as physicians' everyday lives [6, 7] Most of the responders felt that their main worksite provided PPE (definitely yes: 20 09%;rather yes: 49 78%), with 78 60% believing that the availability of PPE has improved since the outbreak in March, 2020 [ ]86 92% of doctors reported over 25% declines in outpatient consultations and 55 90% claimed that their income dropped over 25% There were also other borderline significant results, such as more urologists and residents working in the COVID-19 centers indicating >50% earnings decreases as compared to those not in COVID-19 dedicated centers (36 1% vs 21 2%) DISCUSSION Our study indicates that the COVID-19 pandemic has deeply and negatively influenced Polish urologists and urology residents, in terms of clinical practice, financial situation, mental health, and family life

Ureterosigmoidostomy has largely been disregarded in recent times but has now seen a resurgence of interest because of its potential applicability to newer, minimally invasive surgical techniques. The advantages of ureterosigmoidostomy over intestinal conduits are urinary continence (obviating the need for stoma and external appliances), ease, and rapidity of performance as well as acceptance by patients. Ureterosigmoidostomy has been characterized by good continence outcomes and it offers good quality of life. Possible complications are anastomosis stenosis, coloureteral reflux, electrolyte imbalance, hydronephrosis, pyelonephritis, chronic renal failure, colorectal cancer, and others. Ureterosigmoidostomy is therefore only advisable for patients ready to accept long-term follow-up.

To review currently available guidelines and recommendations regarding urological follow-up of patients after spinal cord injury (SCI) and present an evidence-based summary to support clinicians in their clinical practice. Maximum data were collected according to different methods, including searches with multiple and specific keywords, reference checks, gray literature searches (congress reports, working papers, statement documents), and browsing-related Web site access. Obtained data were analyzed with the modified version of the Oxford grading system for recommendations using levels of evidence (LE) and grades of recommendation (GR). Different surveillance strategies exist, but there is no consensus among authors and organizations. As a result, practice patterns vary around the world. The present review indicates that proper urological follow-up of SCI patients should consist of medical history (LE 1-4, GR B-C), clinical examination (LE 4, GR C), renal laboratory tests (LE 1-3, GR B), imaging surveillance of the upper urinary tract (LE 1-3, GR A-B), urodynamic study (LE 2-4, GR B-C), and cystoscopy/cytology (LE 1-4, GR D). Clinicians agree that SCI patients should be followed up regularly with an individually tailored approach. A 1-year follow-up schedule seems reasonable in SCI patients without additional risk factors of renal deterioration (LE 3-4, GR C). In those who manifest risk factors, report changes in bladder behavior, or present with already developed complications of neurogenic bladder dysfunction, follow-up plans should be modified with more frequent checkups (LE 4, GR C). Urodynamic study should be repeated and considered as a routine monitoring strategy. Individuals with neurogenic lower urinary tract dysfunction are at increased risk of multiple complications. Nevertheless, proper follow-up after SCI improves the prognosis for these patients and their quality of life.

Introduction To evaluate the impact of design features of the synthetic mid-urethral slings on tissue integrity and inflammatory responses. Material and methods In total 30 female Sprague-Dawley rats were implanted with type I monofilamentous, macroporous polypropylene meshes: Gynecare TVT-Obturator tape® (Ethicon Inc., Johnson & Johnson, Somerville, NJ, USA) and I-STOP® (CL Medical Inc., Lyon, France). All animal groups were sacrificed at set time intervals - 6 weeks, 3 months, 6 months, 9 months and 12 months - and the abdominal wall was harvested with mesh strips for histological evaluation. Results All mesh strips appeared to be well incorporated into the abdominal wall, and no signs of shrinkage was noticed. All specimens showed a thin/delicate, loose, fibrous interface between the synthetic graft plate and abdominal wall, along with mild inflammatory reactions from 6 weeks to 12 months. Conclusions Both mesh brands induced comparable, minimal foreign body reactions and integrated well into the host tissues despite differences in architectural features. TVT-O® and I-STOP® evoked similar low-grade inflammatory responses up to 12 months in this animal model. Structural differences and architectural features of polypropylene slings used in this study have had no impact on tissue integrity and inflammatory responses.

Cel pracyOcena powiązania występowania objawów z dolnego odcinka układu moczowego u pacjentów kwalifikowanych do psychoterapii,z nasileniem i profilem ich nerwicowych zaburzeń osobowości.MetodaRetrospektywna analiza kwestionariuszy zawartych w historiach chorób 2450 pacjentów kwalifikowanych do leczenia psychoterapią w latach 2004-2014 pod kątem powiązań między zgłaszanymi w kwestionariuszu objawowym symptomami częstego oraz bezwiednego oddawania moczu a globalnym nasileniem objawów nerwicowych,globalnym nasileniem nerwicowych zaburzeń osobowości oraz nieprawidłowymi wartościami 24 skal kwestionariusza KON-2006. Powiązania w postaci współczynników OR z 95% przedziałami ufności oszacowano za pomocą analiz regresji logistycznej.WynikiObjawy z dolnego odcinka układu moczowego wiążą się z istotnie większym nasileniem neurotyczności zarówno opisywanej przez globalne nasilenie objawów jak i współczynnik globalnego nasilenia nerwicowych zaburzeń osobowości oraz z nieprawidłowymi wartościami skal kwestionariusza KON-2006. Dla występowania dla obu objawów stwierdzono powiązania ze skalami: Negatywna samoocena i Zawiść, dla częstomoczu ze skalami Poczucie uzależnienia od otoczenia, Demobilizacja, Przekonanie o niezaradności życiowej i Poczucie braku wpływu, dla moczenia: Poczucie wyobcowania i Egzaltacja – dla obu płci, a jedynie u mężczyzn – Unikanie (niska Skłonność do) ryzyka,Przekonanie o niezaradności życiowej, Trudności w relacjach interpersonalnych. Skrajne nasilenie częstomoczu wiązało się z wieloma wymienionymi skalami silniej, oraz nieco inaczej z innymi np. u mężczyzn z Poczuciem przeciążenia i Wyobraźnią, fantazjowaniem.WnioskiNeurotyczne cechy osobowości opisywane przez nieprawidłowe wartości skal kwestionariusza KON-2006 wiążą się z obecnością (a także do pewnego stopnia z nasileniem) psychogennych objawów z dolnego odcinka dróg moczowych. Powiązania mogą być dwukierunkowe - w niektórych przypadkach przeżywanie i samoopis cech osobowości mogą być wtórne do cierpienia związanego z objawami częstomoczu i moczenia.

Introduction The aim of this single centre retrospective study was to analyse the results of second resection (repeat transurethral resection of bladder tumour - reTURBT) after a macroscopically complete resection of T1 urothelial bladder tumour and to identify prognostic factors for absence of residual disease (T0) in the second resection of T1 bladder cancer. Material and methods Patients with T1 bladder cancer diagnosed in a macroscopically complete initial resection who underwent second resection within 12 weeks were included into the retrospective analysis. Based on the presence or absence of residual disease, patients were grouped for further analysis. Univariate and multivariable logistic regressions were performed to identify potential prognostic factors. Results Among the 139 patients who met the inclusion criteria, 96 (69.1%) had no residual disease (T0) and 43 (30.9%) had residual disease in the second resection (including muscle invasive bladder cancer in 2.2%). Adjusted odds ratios (OR) of T0 status obtained from the final model were as follows: detrusor muscle presence in the first resection (OR 3.05; 95% CI 1.12-8.35, p = 0.03), immediate post-operative intravesical mitomycin C administration after the first TURBT (OR 2.52, 95% CI 1.12-5.68; p = 0.03) and primary bladder cancer setting (OR 2.45, 95% CI 1.10-5.47; p = 0.03). Conclusions Our results add evidence regarding the importance of detrusor muscle presence in the first TURBT. Identification of predictors of T0 status at second resection could help design prospective studies assessing the possibility to avoid re-resection in selected patients with T1 bladder cancer without compromising oncological outcomes.

Intra-detrusor injection therapy with onabotulinumtoxinA is generally accepted as a highly effective, minimally invasive and well-tolerated day procedure for patients with refractory overactive bladder (OAB) and neurogenic detrusor overactivity (NDO). The aim of this study was to summarize currently available methods of assessing treatment efficacy and risk factors that may influence the therapeutic effect of this approach. We found that there are discrepancies in the assessment methods. The evaluation of intra-detrusor injections with onabotulinumtoxinA in clinical trials are not always transposable into day-to-day practice. Moreover, the primary endpoints in clinical trials do not explore the entirety of meaningful patient-centered outcomes. Therefore, in daily clinical practice with patients with overactive bladder syndrome, the therapy should be assessed with objective measures (bladder diaries) and patient-oriented outcomes analyzing the quality of life (questionnaires). In neurogenic individuals, therapeutic efficacy should be additionally evaluated with urodynamic studies. Potential risk factors that may influence the treatment outcomes include urodynamically proven detrusor overactivity, elevated maximum detrusor pressure, greater maximum cystometric capacity, impaired bladder compliance, older age, male gender, a higher baseline bother score, previous anticholinergic treatment, and repeated injections with a subsequent decline in efficacy. The risk of intermittent catheterization following injections seems to depend on the etiology of detrusor overactivity, the injected dose, the injection technique, and the definition of significant post-void residual urine requiring catheterization.

Introduction Even though the survival benefit of neoadjuvant chemotherapy (NAC) in the treatment of muscle invasive bladder cancer (MIBC) is well established, NAC has not been widely used in Poland until recently. The aim of our study was to evaluate the utilization of NAC and its association with survival in MIBC. Material and methods Patients who underwent radical cystectomy (RC) for MIBC between December 2012 and December 2017 were included in the study. Data were collected in the perioperative period and long-term observation was continued up to August 2018. Kaplan-Meier curves were used to estimate the probability of survival. Results A sample of 155 patients with a median age of 65 (IQR: 60-69) years was analyzed. In this group, 79 patients (51%) were treated with NAC prior to RC. Patients in the NAC+RC group were younger, more often had a positive smoking history, and had lower preoperative levels of hemoglobin, white blood cells and C-reactive protein. A 90-day complication rate and mortality were similar in both groups and in the entire cohort were equal to 64.5% and 5.2%, respectively. The overall survival (OS) was on average 150 days longer in the RC+NAC group compared to the RC-only group when patients were followed-up for 3 years (95%CI:3 4 - 267; p = 0.011). Conclusions We demonstrated a high utilization of NAC at our institution. The use of NAC was associated with a better prognosis than RC alone and was not associated with an increased morbidity or mortality. Our results support the use NAC as a safe and effective treatment modality in MIBC.

Introduction The ZSI 375 is a new artificial urinary sphincter utilised in men suffering from stress urinary incontinence (SUI). We present the first European multicentre study on the effectiveness of ZSI 375. Material and methods This study was conducted in a retrospective, non-randomized format in centres across Europe. Between May 2009 and December 2014, ZSI 375 was fitted in 109 SUI patients following radical prostatectomy, transurethral resection of prostate (TURP), rectal surgery and high intensity focused ultrasound (HIFU). Patients with history of pelvic radiotherapy or previous surgical treatment for incontinence or stricture were excluded from the series. Follow-up was completed by December 2016. The key outcome measures included overall improvement and complication rates. Results A total of 109 patients in 10 European centres were recruited and had the ZSI 375 device implanted. The average patient age was 72 years old. The indication for the majority of patients was incontinence following radical prostatectomy (100/109 patients, 91.74%). On average, patients were incontinent for 48.6 months prior to treatment. All patients used ≥4 pads daily at baseline and thus were classified as suffering from 'severe incontinence'. The average follow-up until the final visit was 43 months. The pad usage decreased to 0.84 on average by the last visit. There were no reported cases of device infection. A total of 9 patients had urethral cuff erosion (8.25%),which was the most common complication in this series. A further 3 men (2.75%) experienced mechanical failure requiring subsequent device reimplantation. The implantation of the ZSI 375 device was considered successful in 92.66% of patients. Conclusions The ZSI 375 is an effective surgical treatment option in men with severe stress urinary incontinence.

Cel pracyOcena związku subiektywnie ocenianych okoliczności biograficznych i skarg z zakresu dolnego odcinka układu moczowego sprawozdawanych przez pacjentów z zaburzeniami nerwicowymi i osobowości.MetodaRetrospektywna analiza współwystępowania okoliczności biograficznych opisanych w ustrukturowanym wywiadzie kwestionariuszowym (ankiecie życiorysowej) z częstomoczem i bezwiednym oddawaniem moczu zgłoszonymi przez 3929 pacjentów dziennego oddziału leczenia zaburzeń nerwicowych w wypełnianych przed kwalifikacją do leczenia kwestionariuszach objawowych.WynikiZgłaszanie objawu częstego oddawania moczu wiąże się u pacjentów oddziału dziennego leczenia nerwic z trudnościami w okresie dzieciństwa i adolescencji (m.in. poczuciem gorszości rodziny oraz poczuciem gorszości w rodzeństwie, niższym wykształceniem rodziców), a także z zakłóceniami wychowania seksualnego (nie uświadomieniem przed 18rż, karaniem za masturbację), oraz konfliktami w związku (nienawiścią, niechęcią do partnera, nie komunikowaniem się wprost), jak również zaburzoną historią/motywacją do jego powstania (szczególnie zawarciem małżeństwa pod naciskiem/przymusem lub z powodu zobowiązań) (...)WnioskiW analizowanej grupie pacjentów z zaburzeniami nerwicowymi i osobowości wybrane dolegliwości z zakresu układu moczowego okazały się wiązać zarówno z niekorzystnymi okolicznościami życiowymi z okresu dzieciństwa i adolescencji (co mogłoby wskazywać na tendencje do regresji oraz przetrwały charakter przeżywania dysfunkcji rodziny pochodzenia m.in. doznawania sytuacji opuszczenia) jak i ze stanowiącym w większym lub mniejszym stopniu ich konsekwencje dysfunkcjami wieku dorosłego - związku/małżeństwa oraz funkcjonowania zawodowego i radzenia sobie w sferze finansowej. Te powiązania, wskazują na prawdopodobne znaczenie tych obszarów przeżywania u pacjentów – nie tylko oddziałów dziennych i nie tylko placówek psychiatrycznych zgłaszających ‘skargi pseudo-urologiczne’, lecz także przynajmniej części pacjentów urologicznych – zgłaszających się faktycznie z powodu zaburzeń nerwicowych, szczególnie występujących pod postacią somatyczną.

Cel pracyOcena występowania wybranych objawów z dolnego odcinka dróg moczowych w populacji pacjentów z zaburzeniami nerwicowymi i osobowości.MetodaRetrospektywna analiza występowania, współwystępowania i nasilenia dwóch wybranych objawów z dolnego odcinka układu moczowego u 3929 pacjentów dziennego oddziału leczenia zaburzeń nerwicowych w oparciu o wypełniane przez badanych przed kwalifikacją do leczenia kwestionariusze objawowe.WynikiWprawdzie objawy dotyczące oddawania moczu nie są najpowszechniejszymi symptomami zaburzeń nerwicowych ani nie należą do ich objawów typowych, rozpowszechnienie poczucia częstego oddawania moczu jest jednak w grupie pacjentów oddziału dziennego znaczne – sięgające połowy badanych – i to w odniesieniu do tygodnia poprzedzającego wypełnienie kwestionariusza przed psychoterapią. Dużo mniej powszechny objaw o znacznych jednak konsekwencjach dla samooceny i funkcjonowania społecznego jakim jest bezwiedne oddawanie moczu został zgłoszony przez około 5% pacjentów we względnie zdrowej i stosunkowo młodej grupie badanej. Znaczna uciążliwość częstego oddawania moczu dotyczyła 9-14% pacjentów a bezwiednego oddawania moczu tylko 0,6-1% badanych.WnioskiUzyskane wyniki pozwalają uznać objawy ‘urologiczne’ za istotną część spektrum dolegliwości odczuwanych przez pacjentów z zaburzeniami nerwicowymi i osobowości, w znacznym stopniu niezależnie od ich rozpoznania szczegółowego oraz płci, oraz przy możliwym do przewidzenia związku ich występowania z wiekiem. Ich współwystępowanie z innymi symptomami zaburzeń nerwicowych zgłaszanych przez pacjentów wskazuje przede wszystkim (choć nie wyłącznie) na ich najsilniejsze powiązanie z zespołami objawów somatyzacyjnych, dysocjacyjnych/konwersyjnych, seksualnych oraz agorafobicznych.

Introduction: Overactive bladder (OAB) syndrome is a highly prevalent and costly condition worldwide, with negative impact on health-related quality of life. Although many guidelines exist and anticholinergics are considered to be the mainstay of pharmacological treatment, data are lacking regarding optimal treatment duration. Therefore, the aim of this study was to determine practice patterns of Canadian urologists and gynecologists regarding duration of OAB pharmacotherapy.Methods: A 14-question survey was designed and survey links (English and French) were sent by email to all practicing urologists and gynecologists registered with the Canadian Urological Association and the Society of Obstetricians and Gynecologists of Canada via the associations’ email lists. The SurveyMonkey website served as platform where responses were collected and stored.Results: A total of 301 physicians completed the questionnaire; 250 respondents (83%) prescribe anticholinergics or beta-3-adrenoceptor agonist (mirabegron) in their practice, and 202 (81%) start patient treatment with the lowest recommended medication dose. One hundred and twelve respondents (45% of those who prescribe OAB medications) classified OAB pharmacotherapy as a lifelong management strategy, whereas 130 (52% of those who prescribe OAB medications) think that OAB pharmacotherapy should be administered for a defined time period. Six-month and one-year time periods of drug treatments are the most commonly chosen answers given by physicians who treat their patients for a defined duration.Conclusions: There is general agreement among Canadian urologists and gynecologists that OAB treatment should be started with the lowest recommended medication dose. A slim majority of respondents think that OAB pharmacotherapy should be administered for a defined duration.

Cel pracyObjawy z dolnego odcinka dróg moczowych (lower urinary tract symptoms – LUTS) są powszechne i związane są z wysokimi kosztami leczenia. Liczne badania wykazały ich negatywny wpływ na jakość życia uwarunkowaną stanem zdrowia pacjentów, jak również na ich zdrowie fizyczne i psychiczne. Równoczesne występowanie LUTS oraz objawów psychiatrycznych jest częste i zostało opisane przez psychiatrów, urologów oraz ginekologów, jednak percepcja objawów z dolnego odcinka dróg moczowych przez lekarzy psychiatrów na nie została jak dotąd przeanalizowana.MetodaOpracowaną ankietę składającą się z 31 pytań dotyczących percepcji LUTS przez lekarzy psychiatrów, wysłano pocztą elektroniczną do lekarzy zarejestrowanych w Polskim Towarzystwie Psychiatrycznym. Internetowa platforma SurveyMonkey została użyta jako miejsce do zbierania i przechowywania odpowiedzi.WynikiDziewięćset pięćdziesiąt trzech lekarzy psychiatrów wypełniło kwestionariusz. Większość badanych stwierdziła, że jedynie ,,okazjonalnie” pyta swoich pacjentów o zaburzenia związane oddawanie moczu. Ankietowani oszacowali częstość zaburzeń oddawania moczu u swoich pacjentów jako ,,umiarkowanie częste” dolegliwości, występujące u ,,10-30%” chorych. Odnotowano jednak rozbieżności pomiędzy różnymi podgrupami ankietowanych. Ponadto, uzyskane odpowiedzi wskazują, że psychiatrzy mogą być nie w pełni świadomi wpływu swojego leczenia (psychoterapii/farmakoterapii) na poprawę LUTS. Większość ankietowanych nie zauważa również związku pomiędzy progresją choroby psychicznej a nasileniem LUTS.WnioskiPercepcja objawów z dolnego odcinka układu moczowego przez lekarzy psychiatrów wydaje się być ograniczona. Edukacja oraz informowanie lekarzy psychiatrów na temat wpływu LUTS może przyczynić się do poprawy jakości życia pacjentów, ich rokowania oraz długoterminowej opieki.

Cel pracyZwiązek pomiędzy nykturią, depresją i zaburzeniami snu w populacji ogólnej został szeroko udokumentowany. Dotychczasowe badania nie przeanalizowały jednak wpływu nykturii na nasilenie choroby u pacjentów chorujących na depresję, a także związku pomiędzy nykturią a zaburzeniami snu wśród omawianych pacjentów. W tym celu zbadaliśmy wpływ nykturii na nasilenie depresji oraz jakość snu u pacjentów cierpiących na depresję.MetodaPrzeprowadziliśmy badanie przekrojowe wśród pacjentów depresyjnych leczonych w oddziale oraz poradni przyklinicznej Kliniki Psychiatrii Dorosłych Uniwersytetu Jagiellońskiego w Krakowie. Wszyscy pacjenci spełnili kryteria DSM-5 oraz ICD-10 dla depresji. Nykturia została oceniona za pomocą skali International Prostate Symptom Score (IPSS), nasilenie depresji za pomocą 17-punktowego kwestionariusza Hamilton Rating Scale for Depression (HRSD), a jakość snu za pomocą Holland Sleep Disorders Questionnaire (HSDQ). Analiza statystyczna została przeprowadzona za pomocą testu ANOVA (post-hoc Tukey test).WynikiDo badania zostało włączonych 98 pacjentów. Nykturia została stwierdzona u 68 z nich. Większość pacjentów (35) wykazała łagodne nasilenie depresji. Średni wynik z kwestionariusza HSDQ wyniósł 78.8 (zakres 32-146). Wykonana przez nas analiza statystyczna wykazała brak wpływu nykturii na nasilenie depresji (p=0.625) przy jednak istotnie statystycznej korelacji pomiędzy nykturią a jakością snu (p=0.037). Test post-hoc analizujący korelację pomiędzy stopniem nasilenia nykturii a zaburzeniami snu pokazał, że większa liczba nocnych mikcji (co najmniej 3 epizody) prowadzi do istotnie wyższych wyników punktowych w kwestionariuszu HSDQ.WnioskiNasze badanie wykazało brak wpływu nykturii na nasilenie depresji u pacjentów ze zdiagnozowaną depresją. Niemniej, wskazaliśmy istotnie statystycznie związek pomiędzy nykturią a jakością snu u omawianych chorych. Dalsze badania z większą liczbą pacjentów są niezbędne do potwierdzenia omawianych wyników.

Objective To summarize information on Neurogenic Bladder (NB) epidemiology, management and access to patient treatment in developing countries and emerging regions of the world in order to propose future interventions and help governmental as well as non-governmental organizations design their action plans. Methods Different search methods were used to gather the maximum available data. They included strategic searches; reference checks; grey literature searches (reports, working papers, government documents, civil society information); contacting professional societies, registries, and authors; requesting unpublished data from organizations; and browsing related websites and journals. Results The incidence and prevalence rates of NB in developing countries are difficult to establish because epidemiological reports are few and far between. The frequency of bladder dysfunction in neurologically impaired populations can be approximately estimated in some of these countries. Similar information paucity affects diagnostic and therapeutic approaches to NB patients living in less-developed regions of the world. The assessment and management of NB seems to vary markedly between countries, and care of patients from emerging regions of the world is often inadequate. Conclusion Strong concerted efforts are needed on the part of international scientific societies, non-governmental organizations and local governments to work together to change the prognosis for these patients and to improve their quality of life.

The overactive bladder (OAB) picture has dramatically changed in the last 20 years. A quarter century ago, this symptom complex did not even exist. Bladder hyperactivity and urgency incontinence were separate entities poorly understood and treated only with the first-generation anti-muscarinic medications, propantheline and oxybutynin. Only in early 2000 came the concept of this syndrome made of four intimately linked symptoms that we today call OAB. With this concept, new pharmacological agents were launched. These new agents may have not dramatically improved symptoms in comparison with older agents, but undeniably have a more tolerable side effect profile, leading to better compliance and adherence. Neuromodulation was introduced a few years later, giving hope to the worst OAB cases, but with a limited applicability due to its cost. A real revolution occurred around 2010 with the demonstration of onabotulinumtoxinA’s efficacy in controlling the symptoms of OAB. Several years passed before it proved its place in the treatment algorithm for OAB. It is definitely time for the Canadian Urological Association (CUA) to produce guidelines to help Canadian urologists better integrate a sequence of investigation, diagnosis, and treatment, which has become more complex over the years. To do so, the CUA gave a group of experts, Canadian physicians and nurses, the difficult task of putting together a comprehensive document to guide all interested professionals in the management of this interesting and common syndrome, which has so much impact on our patients’ quality of life. An executive summary of the CUA guideline on OAB is available as an Appendix at www.cuaj.ca.

Background In spinal cord injury, onset of detrusor overactivity (DO) is detrimental for quality of life (incontinence) and renal risk. Prevention has only been achieved with complex sophisticated electrical neuromodulation techniques. Purpose To assess the efficacy of early fesoterodine fumarate (FF) administration in preventing bladder overactivity in a spinal cord transected (SCT) rat model. Methods 33 Sprague-Dawley rats were allocated to 6 groups-Group 1: 3 normal controls; Group 2: 6 SCT controls; Group 3: 6 SCT rats + FF 0.18 mg/kg/d; Group 4: 6 SCT rats + FF 0.12 mg/kg/d; Group 5: 6 SCT rats + FF 0.18 mg/kg/d + 72-h wash-out period; Group 6: 6 SCT rats + FF 0.12 mg/kg/d + 72-h wash-out period. SCT was performed at T10. FF was continuously administered. Cystometry was undertaken 6 weeks after SCT in awake rats recording intermicturition pressure (IMP), baseline pressure, threshold pressure (Pthres) and maximum pressure (Pmax). Normal controls and SCT controls were initially compared using the Mann-Whitney U tests in order to confirm the SCT effect on cystometric parameters. The comparisons in cystometric and metabolic cage parameters between SCT controls and treated rats were done using post-hoc Dunn's tests for Kruskal-Wallis analysis. Statistical testing was conducted at the two-tailed α-level of 0.05. Results Pressure parameters were significantly higher in SCT control group compared to normal controls. Six weeks after SCT, IMP was significantly lower in low dose treated group than in SCT controls. Pmax was significantly lower in 3 treated groups compared to SCT controls. Pthres was significantly lower in full time treated groups than in SCT controls. Conclusion Early administration of FF modulates bladder overactivity in a SCT rat model. Whereas short-term prevention has been demonstrated, the long-term should be further analyzed. Clinical application of these results should confirm this finding through randomized research protocols.