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Introduction: Encrustation of urinary biomaterials is common; however, the incidence of surface deposition on the Vesair® intravesical pressure-attenuation balloon has not been previously reported. The purpose of this analysis is to determine the incidence and potential risk factors for encrustation of the Vesair intravesical balloon.Methods: The SOLECT trial is a prospective randomized controlled trial conducted at several European centers to evaluate the safety and efficacy of the Vesair balloon for the treatment of female stress urinary incontinence (SUI). Women included in the study demonstrated SUI symptoms for more than 12 months without complicating factors, such as history of recurrent urinary tract infections or nephrolithiasis. All balloons removed from women enrolled in the SOLECT trial were analyzed for surface characteristics and encrustation. Surface deposition severity was quantified and composition analyzed with infrared spectroscopy and scanning electron microscopy. Incidence of surface deposition was tabulated and risk factors analyzed.Results: One hundred and five balloons removed from 75 women were included in this analysis. Measurable stone deposition of less than 1.5 mm was found on four balloons (3.8%), surface granules were noted on 42 (40.0%), surface film on 11 (10.5%), and both granules and film on two (1.9%). Analysis identified calcium oxalate both in measurable encrustation deposits as well as those with surface granulation. Pooled analysis found that dwell time was a risk factor for calcium deposition.Conclusion: The rate of encrustation on the Vesair intravesical balloon is low and does not appear to increase the rate of adverse outcomes or reduce clinical efficacy.Funding: Solace Therapeutics, Inc. [ABSTRACT FROM AUTHOR]

Abstract: The Future of Urology has been written in times of economic downturn, with the inevitable effects on health sector spending. Nevertheless, this document aims to define a path whereby the EAU can play a pivotal role in ensuring the highest standard of care throughout Europe, and by setting standards, throughout the rest of the world. The future of urology will be dependent on improved education and training leading to high quality urological care, and to developing a service that is patient focused. The patient focus is becoming increasingly important in urology. This means providing full information about disease processes and urological procedures to patients and allowing them to judge the quality of the urological service that they may choose. Education must start in medical school and as 5% of community medical practice is urology then every medical student must receive urological training. This also applies to nurses and the other professions allied to medicine (PAMS). The EAU should provide a urological curriculum for training of medical students, nurses and PAMS, as well as the more conventional curriculum for postgraduate training and continued medical education for urological specialists. An integrated EAU Knowledge and Learning Centre would provide an invaluable resource to patients and to those who deliver urologic care alike. With high quality training must come a vigorous assessment of knowledge and competence. In the future, the competence of all those delivering urological care will need to be assessed. For urologists in training and specialist urologists this will include not only an assessment of knowledge but an assessment of surgical competence. Improving quality will be supported by the continued subspecialisation of urology, ensuring that all urologists have a surgical portfolio which ensures their competency in the procedures they deliver. This will inevitably result in a concentration of urological services and indeed to the development of larger urological centres. The concept of Centres of Excellence could be developed to include all aspects and subspecialties of urological care. The SPO envisages that all urology will be carried out in Centres of Excellence which will vary in terms of their size and the range of urology offered, but nevertheless all urological care will be of the highest quality. Finally, the future of urology will depend on the medico-political interface and the EAU has a great deal to offer in this respect. The patterns of urological care differ throughout Europe but this should be seen as a challenge for the EAU to define quality, irrespective of the different methods of healthcare provision. The EAU has made extraordinary advances in the last two decades and the SPO hope this document will support the EAU''s efforts to maintain its aim of improving urological care for the benefit of patients. [Copyright &y& Elsevier]

Abstract: Context: The increasing body of evidence and number of potential indications for the use of botulinum neurotoxins (BoNTs) in the lower urinary tract (LUT) underlines the pressing need for evidence-based guidelines. Objective: A European expert panel consensus conference was convened with the main aim of evaluating the evidence and clinical considerations for the use of BoNTs in the treatment of urologic and pelvic-floor disorders and to propose relevant recommendations. Evidence acquisition: The quality of evidence from fully published English-language literature in the PubMed and EMBASE databases was assessed using the European Association of Urology (EAU) levels of evidence (LoE). Recommendations were graded and approved by a unanimous consensus of the panel. Evidence synthesis: The use of botulinum neurotoxin type A (BoNTA) is recommended in the treatment of intractable symptoms of neurogenic detrusor overactivity (NDO) or idiopathic detrusor overactivity (IDO) in adults (grade A). Caution is recommended in IDO because the risk of voiding difficulty and duration of effect have not yet been accurately evaluated. Repeated treatment can be recommended in NDO (grade B). The depth and location for bladder injections should be within the detrusor muscle outside the trigone (grade C). Dosage in children should be determined by body weight, with caution regarding total dose if also being used for treatment of spasticity, and minimum age (grade B). Existing evidence is inconclusive for recommendations in neurogenic detrusor–sphincter dyssynergia, bladder pain syndrome, prostate diseases, and pelvic-floor disorders. The use of BoNTA in the LUT with the current dosages and techniques is considered to be safe overall (grade A). Conclusions: The consensus committee recommends larger placebo-controlled and comparative trials to evaluate the efficacy of single and repeat injections, the duration of effect, the optimal dosage and injection technique, the timing for repeat injection, and the short- and long-term safety of the treatment in LUT and pelvic-floor disorders. [Copyright &y& Elsevier]

Context: Most patients with neurogenic lower urinary tract dysfunction (NLUTD) require life-long care to maintain their quality of life (QoL) and to maximise life expectancy., Objective: To provide a summary of the 2008 version of the European Association of Urology (EAU) guidelines on NLUTD and to assess the effectiveness of currently available diagnostic tools, particularly ultrasound imaging and urodynamics., Evidence Acquisition: The recommendations provided in the 2008 EAU guidelines on NLUTD are based on a review of the literature, using online searches of Medline and other source documents published between 2004 and 2007. A level of evidence and/or a grade of recommendation have been assigned to the guidelines where possible., Evidence Synthesis: NLUTD encompasses a wide spectrum of pathologies, and patients often require life-long, intensive medical care to maximise their life-expectancy and to maintain their QoL. Treatment must be tailored to the needs of the individual patient and, in many cases, involves a multidisciplinary team of experts. Timely diagnosis and treatment are essential if irreversible deterioration of both the upper and lower urinary tracts are to be avoided. Therapeutic decisions are made on the basis of a comprehensive medical assessment, including urodynamics to identify the type of dysfunction. Advances in investigative technologies have facilitated the noninvasive and conservative management of patients who have NLUTD., Conclusions: The diagnosis and treatment of NLUTD, which is a highly specialised and complex field involving both urology and medicine, requires up-to-date expert advice to be readily available. The current guidelines are designed to fulfil this need.

Objectives: Because the term "interstitial cystitis" (IC) has different meanings in different centers and different parts of the world, the European Society for the Study of Interstitial Cystitis (ESSIC) has worked to create a consensus on definitions, diagnosis, and classification in an attempt to overcome the lack of international agreement on various aspects of IC., Methods: ESSIC has discussed definitions, diagnostic criteria, and disease classification in four meetings and extended e-mail correspondence., Results: It was agreed to name the disease bladder pain syndrome (BPS). BPS would be diagnosed on the basis of chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder accompanied by at least one other urinary symptom such as persistent urge to void or urinary frequency. Confusable diseases as the cause of the symptoms must be excluded. Classification of BPS types might be performed according to findings at cystoscopy with hydrodistention and morphologic findings in bladder biopsies. The presence of other organ symptoms as well as cognitive, behavioral, emotional, and sexual symptoms, should be addressed., Conclusions: The name IC has become misleading and is replaced by BPS. This name is in line with recent nomenclature recommendations by the European Association of Urology and is based on the axial structure of the International Association for the Study of Pain classification. To facilitate the change of the name, ESSIC agreed to include IC in the overall term (BPS/IC) during this transition period.