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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

Radical prostatectomy (RP) is the standard surgical treatment for localized prostate cancer (PCa), with excellent oncologic outcomes; however, complications such as post-prostatectomy incontinence could significantly affect quality of life.To provide data on long-term urinary functional outcomes of bladder neck preservation (BNP) combined with distal urethral length preservation (DULP) in patients treated with videolaparoscopic prostatectomy.In this retrospective study, data were analysed from 619 consecutive patients who underwent laparoscopic radical prostatectomy (LRP) due to localized prostate cancer between November 2014 and December 2018 in a single tertiary care centre in Poland. Of these patients, 227 had BNP and DULP during the procedure. Urinary continence status was assessed in patients at 3, 6, 12, and 18 months after LRP. Cancer resection was assessed by surgical margin status.In the group with BNP and DULP, urinary continence recurred earlier than it did in the control group up to 3 months after surgery: 204 (89.8%) patients in this group were fully continent compared with 283 (72.2%) in the control group (p0.001). The difference was also significant after 6 months (95.1% vs. 80.6%, respectively; p0.001). Despite these early promising results, there was no difference in urinary continence recovery after 12 and 18 months. There was also no difference between the 2 groups regarding surgical margin status of the resected tissue.Our study showed that BNP combined with DULP is a safe procedure that helps to improve early urinary continence rates after surgery without altering the risk of positive surgical margin.

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.

Aim: The aim of the study was to investigate the correlation between symptoms of overactive bladder (OAB) and severity of depressive symptoms in patients treated for depression. Method: 102 patients (43 males, 59 females) aged 20–67 (M = 46.1±11,3) treated for depression were included in this cross-sectional analysis. OAB symptoms were examined with the International Prostate Symptom Score (IPSS) and International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIQOAB). OAB-related quality of life was assessed with the International Consultation on Incontinence Questionnaire Overactive Bladder Quality of Life Module (ICIQ-OABqol). Depressive symptoms were assessed with the 17-item Hamilton Depression Rating Scale (HDRS) and Quick Inventory of Depressive Symptomatology - Self Report (QIDS-SR). Results: Symptoms of OAB assessed with IPSS and ICIQ-OAB were more severe in women than in men. In the entire group highest scores in IPSS of assessed OAB symptoms were observed in nocturia (1,53±1,64) followed by urinary frequency (1,19±1,48) and lowest in urgency (0,80±1,28). Symptoms of OAB (based on the ICIQOABqol total score) were more bothersome in women (48,74±29,18), than in men (39,18±17,70). In the whole group and in women the QIDS-SR total score correlated with the ICIQ-OAB score ( p < 0,05). The total QIDS-SR score correlated with the ICIQ-OABqol score in entire group (p < 0,05), in women (p < 0,05) and in men (p < 0,05). Patients suffering from at least moderate depression assessed with QIDS-SR had significantly more pronounced symptoms of urinary frequency (p = 0,005) and urgency (p = 0,039). A number of other significant (p < 0.05) correlations were observed between the total ICIQ-OAB score and certain items’ scores in the GHQ-30 both in women. Conclusions: OAB symptoms are common among patients treated for depressive disorders. There is a correlation between severity of depressive symptoms and OAB. OAB is bothersome and affects the quality of life in patients treated for depression. Comorbidity of OAB and depression has clinical significance and that should enhance interdisciplinary treatment approaches. Due to limitations of this study, further researches are essential to reveal more details of the correlation between OAB and depression.

The quality of vesicourethral anastomosis (VUA) in laparoscopic radical prostatectomy (LRP) is associated with complications that could significantly affect quality of life.To compare different types of sutures (Chlosta's versus Van Velthoven versus V-Loc), used for VUA in LRP in terms of complication rates and continence recovery.Patients who underwent LRP between 2014 and 2018 in a tertiary center were enrolled in the study. Data were extracted from medical records. Urinary continence was assessed at 3, 6, 12 and 18 months after LRP. Propensity score weighted regression models were used to estimate the effect of sutures on outcomes.A sample of 504 patients was analyzed, of which 109 patients underwent Chlosta's suture VUA, 117 patients had Van Velthoven suture VUA, and 278 patients had V-Loc VUA. Median time of anastomosis was 13 (IQR - interquartile range: 10-16) min using Chlosta's suture, 28 (IQR: 24-30) using Van-Velthoven suture and 12 (IQR: 11-16) min using V-Loc suture (p0.001). There were no significant differences between groups concerning complications and urinary continence at 12 and 18 months after surgery. The time of urinary continence recovery was on average 19 days (95% CI: 5-33) and 31 days (95% CI: 16-45) shorter during 1 year of observation when the V-Loc suture was used compared to the Van-Velthoven and Chlosta's suture, respectively.The study showed comparable results considering urinary continence recovery at 12 and 18 months after LRP in all VUA groups. Van Velthoven VUA was more time-consuming and continence recovery was faster in the V-Loc group.

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.

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.

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

Introduction Urinary collecting system invasion (UCSI) has been found to have significant prognostic value for patients with renal cell carcinoma (RCC). However, for RCC patients with venous tumor thrombus (VTT), only contradictory data exist regarding the prognostic efficacy of UCSI. Therefore, the aim of this study is to assess the prognostic relevance of UCSI in survival of patients with RCC and VTT. Material and methods Medical records in a prospectively maintained institutional database were analyzed for RCC-VTT patients who had undergone nephrectomy with thrombectomy. Then, the effect of UCSI on overall survival was analyzed. Results The study examined data for 114 patients, including patients with VTT present in the renal vein (35 patients, 31%), infrahepatic inferior vena cava (28 patients, 24%), and suprahepatic inferior vena cava (51 patients, 45%). Nineteen percent of patients had UCSI. The median overall survival of patients with UCSI was 9 months, whereas median overall survival was 10 months for patients without collecting system invasion. Survival and regression analyses rejected UCSI as a prognostic marker for overall survival. Conclusions UCSI has no effect on survival in our cohort of RCC-VTT patients. Therefore, it should not be considered in risk stratification models or in treatment decision-making for this patient group.

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 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: 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.

Patients with neurogenic bladder dysfunction who have developed benign prostatic hyperplasia represent a unique population. Proper diagnosis and treatment of these individuals remain a challenge for urologists. Therapy should aim to preserve renal function and maintain a low-pressure bladder system as well as help to minimize distress and pain by continued bladder decompression. Initial management should include pharmacotherapy (α-blockers often in combination with 5-α reductase inhibitors). When medical therapy has failed or is contraindicated, surgery or indwelling catheterization should be considered in carefully selected patients.

Bladder cancer is a significant oncologic complication in patients suffering from neurogenic lower urinary tract dysfunction. Available data suggest that bladder cancer occurs more often in neurogenic individuals than in the general population. It is also associated with significant mortality. Several risk factors have been identified, but the proposed screening strategies still remain a matter of dispute because available screening tests do not fulfill multiple criteria of a proper screening test. The potential morbidity, financial burden, and lack of proven benefit discourage currently available screening strategies in this specific population. Neurogenic individuals continue to have active sexual lives and to consider sexuality as one of their priorities. Sexual dysfunction is highly prevalent and adversely affects the quality of life of neurogenic patients. Neurogenic sexual dysfunction remains difficult to diagnose and treat effectively. Neurogenic patients, regardless of sex, should be specifically queried about sexual function. In males, treatment includes oral and local pharmacotherapy, mechanical (vacuum constriction) devices, and prosthetics. Treatment of sexual dysfunction in neurologically impaired women is rather limited and poorly studied.

Aim: To investigate the safety, surgical efficiency and patients' ability to recover from urinary continence as a result of a single absorbable running suture versus single-knot running suture for vesicourethral anastomosis (VUA) during laparoscopic radical prostatectomy (LRP). Material and Methods: In a prospective randomised study, we evaluated 162 consecutive patients who underwent LRP with VUA using the single running suture technique or the single-knot running suture technique. Perioperative patients' characteristics, morbidity and urinary continence were analysed. Results: The baseline characteristics were similar between the 2 groups. The single running suture technique was related to decreased anastomotic and total operative times compared with the Van Velthoven technique (13.17 ± 5.74 min vs. 28.49 ± 6.45 min, p = 0.0001, and 174.41 ± 62.97 min and 184.94 ± 46.16 min, p = 0.04, respectively). Overall, urinary continence rates at 3, 6 and 12 months in groups 1 and 2 were 49.4 and 69.1%, 81.5 and 86.4%, and 91.4 and 93.8%, respectively (all with p > 0.05 except the follow-up assessment at 3 months following surgery, p = 0.011). Conclusions: Both methods ensure satisfactory rates of urinary leakage and bladder neck stricture, as well as continence after LRP. However, since the single running suture VUA technique is easier to perform, and the mean anastomosis time of the single running suture VUA technique is shorter than that of the Van Velthoven technique, it appears, therefore, preferable.

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.

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