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Introduction and hypothesis: The Overactive Bladder Questionnaire (OAB-q) measures overactive bladder patients' severity of symptoms and their impact on health-related quality of life (HRQoL). The aim of this study was to validate the OAB-q in Greek patients with overactive bladder and report clinical implications of the disease. Methods: In total, 107 patients were recruited consecutively in our clinic. They completed the OAB-q and Short Form-36 Health Survey (SF-36) twice, 3 months apart. Simultaneously, they initiated lifestyle changes and drug therapy. The reliability of OAB-q was estimated by its internal consistency (Cronbach's α). Validity was estimated by criterion validity and concurrent validity by comparison with SF-36. Results: The sample's mean age was 62.1 years, and 74.8% were women. Cronbach's α exceeded the 0.7 threshold in all OAB-q subscales, implying good reliability of internal consistency for the OAB-q. In addition, moderate (Pearson's r > 0.3) or strong (r > 0.5) correlations were observed between OAB-q subscales and the relevant SF-36 subscales, implying concurrent validity. Clinically, urgency incontinence affected symptom bother (p = 0.001), concern/worry (p = 0.031) and social interaction (p = 0.027). Nocturia had the largest impact on HRQoL in patients with overactive bladder, as it affected all the OAB-q subscales (p < 0.001). Conclusions: The Greek version of the OAB-q has shown strong psychometric properties of reliability and validity in our study. Urgency incontinence and especially nocturia seem to affect the HRQoL of patients with overactive bladder. OAB-q is valid for Greek patients with overactive bladder and can be used for clinical and academic purposes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of the autologous fascia rectus sling in treating female stress urinary incontinence. Methods: A total of 264 patients treated during a 3-year period for SUI using the autologous fascia rectus sling were retrospectively reviewed. Efficacy was evaluated by the number of pads used daily. Patient satisfaction and correlations between the preoperative parameters and outcome were assessed. Results: The mean follow-up time was 27.8 months. Of the 264 patients, 224 (85%) were successfully treated and satisfied with the outcome of the operation. Of the 224 patients, 200 (75.8%) were totally dry and 24 (9.1%) had improved markedly. The complication rate was 29.2%, with postoperative urgency the most common problem (49 of 264, 18.5%). None of the preoperative parameters were associated with the final outcome. Conclusion: The free autologous rectus fascia sling is a highly effective technique for the treatment of female stress incontinence with mild morbidity. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

Abstract Introduction Coital urinary incontinence (CUI) is not much explored during clinical history, and this could lead to an underestimation of the problem. Aim To evaluate the prevalence and clinical risk factors of CUI in women with urinary incontinence (UI), and to measure the impact of CUI on women's sexuality and quality of life. Methods This was a multicenter international study, conducted in Italy, Greece, the United States, and Egypt. Inclusion criteria were: sexually active women with UI and in a stable relationship for at least 6 months. Exclusion criteria were: age <18 years and unstable relationship. The UI was classified as stress UI (SUI), urgency UI (UUI), and mixed UI (MUI). Women completed a questionnaire on demographics and medical history, in particular on UI and possible CUI and the timing of its occurrence, and the impact of CUI on quality and frequency of their sexual life. Main Outcome Measures To evaluate the CUI and its impact on sexual life we used the open questions on CUI as well as the International Consultation on Incontinence questionnaire and Patient Perception of Bladder Condition questionnaire. Results In this study 1,041 women (age 52.4 ± 10.7 years) were included. In all, 53.8% of women had CUI: 8% at penetration, 35% during intercourse, 9% at orgasm, and 48% during a combination of these. Women with CUI at penetration had a higher prevalence of SUI, women with CUI during intercourse had higher prevalence of MUI with predominant SUI, and women with CUI at orgasm had higher prevalence of UUI and MUI with predominant UUI component. Previous hysterectomy was a risk factor for CUI during any phase, while cesarean delivery was a protective factor. Previous failed anti-UI surgery was a risk factor for CUI during penetration and intercourse, and body mass index >25 kg/m2 was a risk factor for CUI at intercourse. According to International Consultation on Incontinence questionnaire scores, increased severity of UI positively correlated with CUI, and had a negative impact on the quality and frequency of sexual activity. Clinical Implications This study should encourage physicians to evaluate the CUI; in fact, it is an underestimated clinical problem, but with a negative impact on quality of life. Strengths & Limitations The strength of this study is the large number of women enrolled, while the limitation is its observational design. Conclusion CUI is a symptom that can affect sexual life and should be investigated during counseling in all patients who are referred to urogynecological centers. Illiano E, Mahfouz W, Giannitsas K, et al. Coital Incontinence in Women With Urinary Incontinence: An International Study. J Sex Med 2018;15:1456–1462. [ABSTRACT FROM AUTHOR]

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

Objective: To test the hypothesis that the ultrasound-estimated bladder weight (UEBW) will correlate with the urodynamic diagnoses in women with lower urinary tract symptoms, in particular, detrusor underactivity and bladder outflow obstruction. Ultrasonography has been increasingly used in the assessment of lower urinary tract conditions. Methods: Adult women referred to the urodynamics suite for investigation of lower urinary tract symptoms were enrolled. After urodynamic evaluation, the portable BladderScan BVM 6500 device was used to calculate the bladder wall thickness and UEBW according to a standardized protocol. The patients were categorized according to the urodynamic findings. Women with normal findings, despite the symptoms for which they were referred, were used as the control group. The UEBW and bladder wall thickness measurements were compared between the groups and controls, using the Mann-Whitney and Kolmogorov-Smirnov tests. P <.05 was considered statistically significant. Results: A total of 187 women were enrolled. The UEBW was significantly lower in the patients with detrusor underactivity than in the controls (39.3 ± 3.0 g vs 45.7 ± 3.1 g, P <.001). Significant differences were also noted between the controls and patients with bladder outflow obstruction, with or without detrusor overactivity (45.7 ± 3.1 g vs 52.1 ± 3.9 g and 52.3 ± 6.2 g, respectively; P <.001 for both). The difference, in terms of the UEBW, between controls and patients with detrusor overactivity was not statistically significant (45.7 ± 3.1 g vs 45.3 ± 3.0, P > .05). Conclusion: A significantly reduced UEBW in female patients with detrusor underactivity and a significantly increased UEBW in patients with bladder outflow obstruction were found. However, the finding of a significantly increased bladder weight in patients with detrusor overactivity was not confirmed in the present study. [ABSTRACT FROM AUTHOR]

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

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