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Purpose:. This study aims to investigate the efficacy and safety of Allium metallic ureteral stents in treating patients with refractory ureteral strictures. Materials and methods:. A total of 13 patients with refractory ureteral strictures were prospectively enrolled in the study. After ureteral balloon dilation, an Allium stent was inserted into the ureter through the stricture. Serum blood urea nitrogen and creatinine levels, kidney-ureter-bladder x-ray, and renal ultrasonography reports were evaluated preoperatively, 3 months after the procedure, and at the last outpatient visit. Treatment success was defined as improvement in both renal function and the grade of hydronephrosis. Improvement was defined as the enhancement of renal function without the resolution of hydronephrosis. Adverse events were recorded. Results:. The median (interquartile range [IQR]) age of the patients was 63 (46–76) years. The median (IQR) follow-up was 15 (13.5–21) months. Treatment success and improvement were noted in 9 (69.2%) and 3 (23.1%) patients, respectively. Compared with the preoperative levels, the median (IQR) serum creatinine levels were significantly improved at 3 months after the operation (1.6 [1.25–2.85] versus 1.2 [1.05–2.05]; P = 0.02) and at the last visit (1.6 [1.25–2.85] versus 1.2 [1.05–1.8]; P = 0.02). Stent migration and encrustation were noted in 3 (23.1%) and 1 (7.7%) patients, respectively. Conclusion:. Allium ureteral stents are safe and effective for patients with refractory ureteral strictures.

Abstract Background Diabetes is an important factor in the development of penile inflammation. We studied whether type 2 diabetes (DM), with/without hypertension and hyperlipidemia increased the risk of circumcision among men aged between 30 and 69 using a population-based dataset in Taiwan during a 5-year follow-up period. Methods The research data in this study were obtained from Taiwan’s National Health Insurance Research Database between 1997 and 2010. We identified 23,197 patients who had a new diagnosis of DM and randomly matched 115,985 subjects as controls. We observed whether circumcision was the treatment after a new DM diagnosis. The initial step involved analyzing the data using Poisson regression analysis. To address potential confounding factors, this study employed propensity score matching based on three variables. Additionally, a Cox regression with a Gamma frailty was utilized to compare outcomes between different groups. Results Poisson regression analysis showed that DM (RR = 1.75, 95CI = 0.10 ~ 1.22), but not hypertension (RR = 1.14, 95CI=-0.44 ~ 0.70), hyperlipidemia (RR = 0.94, 95CI=-0.66 ~ 0.53), or age (RR = 0.83, 95CI=-0.43 ~ 0.62), had an impact on circumcision treatment. Cox regression with a frailty model found that DM was a risk factor associated with circumcision (HR = 2.31, 95% CI = 1.74 ~ 3.06, p-value

Despite the efficacy of onabotulinumtoxinA, its safety profile remains a concern. This meta-analysis reviewed the major adverse events (AEs) associated with intravesical onabotulinumtoxinA treatment in patients with neurogenic detrusor overactivity (NDO) and idiopathic overactive bladder (iOAB). Randomized controlled trials (RCTs) conducted between January 2000 and December 2022 were searched for adult patients administered different onabotulinumtoxinA dosages or onabotulinumtoxinA vs. placebo. Quality assessment was performed using the Cochrane Collaboration tool, and statistical analysis was performed using Review Manager version 5.3. A total of 26 RCTs were included in the analysis, including 8 on NDO and 18 on iOAB. OnabotulinumtoxinA vs. placebo significantly increased the urinary tract infection (UTI) incidence in patients with NDO (relative risk, or RR, 1.54) and iOAB (RR, 2.53). No difference in the RR with different onabotulinumtoxinA dosages was noted. Urinary retention was frequent with onabotulinumtoxinA use in the NDO (RR, 6.56) and iOAB (RR, 7.32) groups. Similar observations were made regarding the risks of de novo clean intermittent catheterization (CIC). The risk of voiding difficulty increased with onabotulinumtoxinA use in patients with iOAB. Systemic AEs of onabotulinumtoxinA, including muscle weakness (RR, 2.79) and nausea (RR, 3.15), were noted in patients with NDO; most systemic AEs had a low incidence and were sporadic.

We reported 25 recipients (14 females and 11 males) aged from 18 to 65 years who unexpectedly received a primary dose of undiluted BNT162b2 vaccine (180 μg). The most common adverse reactions included injection site pain (n = 22), followed by fever (9), fatigue (8), chest tightness (6), and dizziness (6). The most common laboratory abnormalities were anemia (n = 4) and elevated liver transaminase level (4), followed by abnormal leukocyte counts (3) and elevated D-dimer level (3). The adverse reactions and laboratory abnormalities of these recipients were mild and spontaneously recovered within a few weeks. Significant elevations of anti-SARS-CoV-2 spike IgG titers after a booster dose of the BNT162b2 were found. Similar to reports of BNT162b2 clinical trials, the adverse reactions and laboratory abnormalities of these recipients were mild, and they spontaneously recovered within a few weeks. These results provide clinical and immunological effects of undiluted BNT162b2 vaccine inoculation.

This article reports the current evidence and expert opinions on patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among chronic spinal cord injured (SCI) patients in Taiwan. The main problems with SCI-NLUTD are failure to store, empty, or both. The management of SCI-NLUTD should be prioritized as follows: (a) preservation of renal function, (b) freedom from urinary tract infection, (c) efficient bladder emptying, (d) freedom from indwelling catheters, (e) patient agreement with management, and (f) avoidance of medication after proper management. The management of NLUTD in SCI patients must be based on urodynamic findings rather than neurologic evaluation inferences. It is important to identify high-risk patients to prevent renal functional deterioration in those with chronic SCI-NLUTD. Urodynamic studies should be performed on patients with SCI on a regular basis, and any urological complications should be adequately treated. When surgery is required, less invasive and reversible procedures should be considered first, and any unnecessary surgery in the lower urinary tract should be avoided. The most important aspect of treatment is to improve the quality of life in SCI patients with NLUTD. Annual active surveillance of bladder and renal function is required to avoid renal function deterioration and urological complications, particularly in high-risk SCI patients.

Purpose: This cohort study evaluates therapeutic efficacy and adverse events (AEs) of various overactive bladder (OAB) medications for patients with central nervous system (CNS) disorders. Methods: Patients with OAB and CNS disorders were prospectively enrolled. They were randomly allocated to 3 different treatment subgroups: (1) mirabegron 50 mg once daily (2) solifenacin 5 mg per day, and (3) combined solifenacin 5 mg and mirabegron 50 mg once daily. Efficacy and safety questionnaires and objective parameters were compared among the subgroups, and subgroups between baseline and 3 and 6 months after treatment. AEs, including cognitive dysfunction, were assessed using the Mini-Mental State Examination (MMSE). Results: 102 patients (mean age, 71.8 ± 8.7 years) were enrolled, including 35, 36, and 31 patients received mirabegron monotherapy, solifenacin monotherapy, and combination therapy, respectively. OAB symptoms scores all significantly improved 3 months after treatment in different subgroup. However, PVR increased and VE decreased significantly after treatment in patients receiving solifenacin monotherapy and combination therapy. Dry mouth and constipation were the most common AEs, especially in the solifenacin and combination subgroups. Mild incidence of AEs was noted in patients receiving mirabegron monotherapy. No significant change in MMSE was noted among the subgroups after treatment. Conclusion: OAB medication had good therapeutic efficacy in patients who had OAB with CNS disorders, especially in cerebrovascular accident and parkinsonism. No OAB medication or their combination affected cognitive function, whereas minimal AEs were noted with mirabegron. Mirabegron could be recommended as the first choice for managing OAB in these patients.

Objectives:: We investigated the efficacy and safety of a transdermal oxybutynin patch in treating patients with overactive bladder (OAB). Methods:: Ninety-three adult patients with OAB who were under stable treatment with antimuscarinic agents, mirabegron, or both for at least 1 month were prospectively recruited from seven hospitals in Taiwan. Patients who agreed to participate in the study stopped oral OAB medication for 2 weeks and started once-daily transdermal oxybutynin 75 mg. We evaluated the Overactive Bladder Symptom Score (OABSS), Patient Perception of Intensity of Urgency Scale (PPIUS), Patient Perception of Bladder Condition (PPBC), voiding diary, uroflowmetry, post-voiding residual urine, Global Response Assessment (GRA), and adverse events at baseline, 2 weeks, and 4 weeks. Results:: Mean patient age was 66.7 ± 14.8 years. Compared with the measurements at baseline, the GRA, OABSS, PPIUS, PPBC, urinary urgency incontinence, urgency, and frequency significantly improved after 2 and 4 weeks of treatment. At 4 weeks, 20 patients (25%) reported markedly improvement (GRA = +3), 11 (13.8%) reported moderate improvement (GRA = +2), and 28 (35%) reported mild improvement (GRA = +1). Patients with GRA ≥ 1 had a significantly less proportion of oral combination therapy compared with those with GRA < 1 (5/59, 8.5% vs 8/21, 38.1%, p < 0.01). Common adverse events included skin itching in 34 (36.6%) patients, dry mouth in 20 (21.5%), and erythema in 7 (7.5%). Conclusion:: The transdermal oxybutynin patch was effective and safe in the treatment of patients with OAB after switching from oral OAB medications.

The use of the flexible ureteroscope for treating renal and ureteral calculi has rapidly increased in the last decade. Although the use of the flexible ureteroscope by experienced surgeons has excellent outcomes and safety profiles, several studies have reported many surgical complications with its use. We conducted a narrative review of the published literature sourced from PubMed. We used a combination of three keywords: “ureteroscope,” “morbidity,” and “urolithiasis,” with or without the additional keywords of “infection,” “mortality,” “hematoma,” and “ureteral injury.” Infection, bleeding, and ureteral injury are the main complications. We analyzed the possible causes of morbidity and death after the use of a flexible ureteroscope. Finally, we propose recommendations to prevent these complications.

Purpose: To evaluate long-term antimuscarinic drug persistence and its associated characteristics in patients with overactive bladder (OAB) treated with antimuscarinic agents. We also assessed the efficacy and safety of switching from solifenacin to mirabegron in patients refractory to antimuscarinic therapy. Methods: In this prospective, open-label, 48-month study, 416 patients (mean age, 70.6 ± 12.4 years) were enrolled. All patients completed the overactive bladder symptom score and urgency severity score questionnaires, along with initial and follow-up uroflowmetry. All patients received antimuscarinic solifenacin 5 mg daily. Mirabegron (25 mg daily) was suggested in patients that were refractory to antimuscarinic therapy or had intolerable side effects. Results: The mean solifenacin persistence was 6.6 ± 8.1 months (range, 0.5–48 months). Only 81 (19.5%) patients had drug persistence of ≥12 months. Male sex, age, cerebral vascular accident, maximum flow rate, and post-void residual were associated with solifenacin persistence in the univariate analysis. Age (odds ratio [OR], 0.14; 95% CI, 0.08–0.21) was the only independent predictor in the multivariate logistic regression. Of the 416 patients, 171 (60.8%) changed from solifenacin to mirabegron for due to the persistence of OAB symptoms. The switch resulted in a significantly longer period of actual OAB pharmacotherapy (9.3 ± 9.2 vs 13.3 ± 9.3 months, p

We conducted a phase IV, pre/post multi-center study to evaluate the efficacy and safety of intradetrusor onabotulinumtoxinA injection in patients with neurogenic detrusor overactivity (NDO, n = 119) or overactive bladder (OAB, n = 215). Patients received either 200U (i.e., NDO) and 100U (i.e., OAB) of onabotulinumtoxinA injection into the bladder, respectively. The primary endpoint for all patients was the change in the PPBC questionnaire score at week 4 and week 12 post-treatment compared with baseline. The secondary endpoints were the changes in subjective measures (i.e., questionnaires: NBSS for patients with NDO and OABSS for those with OAB) at week 4 and week 12 post-treatment compared with baseline. Adverse events included symptomatic UTI, de novo AUR, gross hematuria and PVR > 350mL were recorded. The results showed that compared with baseline, PPBC (3.4 versus 2.4 and 2.1, p < 0.001) and NBSS (35.4 versus 20.4 and 18.1, p < 0.001) were significantly improved at 4 weeks and 12 weeks in NDO patients. In addition, compared with baseline, PPBC (3.5 versus 2.3 and 2.0, p < 0.001) and OABSS (9.1 versus 6.2 and 5.7, p < 0.001) were significantly improved at 4 weeks and 12 weeks in OAB patients. Eight (6.7%) had symptomatic UTI and 5 (4.2%) had de novo AUR in NDO patients. Twenty (9.3%) had symptomatic UTI but no de novo AUR in OAB patients. In conclusion, we found that intradetrusor onabotulinumtoxinA injections were safe and improved subjective measures related to NDO or OAB in our cohort.

Objectives: We studied patients who underwent extracorporeal shock wave lithotripsy (SWL) to investigate the factors influencing the outcome, and built a logistic regression model to estimate the stone-free rate (SFR) after SWL. Material and methods: From January 2013 to December 2013, we retrospectively reviewed the clinical status of 641 patients with a solitary urinary calculus who underwent SWL in our hospital. Univariate logistic regression was used to identify the factors leading to a high SFR, and significant factors were further analyzed by multivariate logistic regression. After the optimal model had been developed, we placed it on the website so others could calculate the SFR at their institutions. Results: The overall SFR for all patients, patients with ureteral stones, and patients with renal stones were 54.8%, 67.8%, and 46.7%, respectively. Multivariate logistic regression showed that body mass index (BMI), stone length, stone width, and stone location were the independent factors that affected the overall successful rate. Stone length was the only significant factor to predict SFR for ureteral stones. BMI, stone length, and stone width were significant SFR predictors for renal stones. A logistic regression model was designed to estimate SFR, which has a sensitivity of 77.8% and specificity of 75.5%. Conclusion: BMI, stone length, stone width, and kidney and ureteral stones were all prognostic factors influencing the outcome of SWL. We built a logistic regression formula to predict the SFR, which helps urologists to select patients for SWL.

Objective: To investigate the risk factors of perirenal hematoma (PRH) after flexible ureteroscopic lithotripsy (FURSL). Materials and methods: We retrospectively reviewed the medical records of 45 patients who underwent FURSL with a holmium:yttrium–aluminum–garnet laser. We divided all patients in two groups: the PRH group and the non-PRH group. The patient demographic and baseline characteristics, surgical outcomes, and complications were compared and risk factors were identified and analyzed. Results: Of the 45 consecutive patients treated with FURSL, four (8.9%) developed PRH. Compared with patients without PRH, patients with PRH had a lower body mass index (BMI; 20.2 ± 3.2 kg/m2 vs 26.9 ± 5.5 kg/m2, p = 0.015), thinner kidney cortex thickness (0.88 ± 0.41 cm vs 1.39 ± 0.41 cm, p = 0.024), and a history of chronic kidney disease (CKD; 75% vs 14.6%, odds ratio = 17.5, confidence interval = 1.55–197.46, p = 0.021). However, patient age, diabetes mellitus, hypertension, liver disease, coronary artery disease, history of urolithiasis, presence of multiple stones, and stone size and location were comparable in both groups. Three patients with PRH were successfully managed with conservative treatment. One patient with PRH underwent an emergency nephrectomy within 1 day but died 2 weeks later despite vigorous resuscitation. Conclusion: Among our patients, those with lower BMI, CKD, and a thinner renal cortex had a higher risk of developing PRH after FURSL. Endourologists should have a heightened awareness for potential PRH when treating patients who present with low BMI, CKD, and a thin renal cortex.

Diabetes mellitus (DM) is an independent risk factor for overactive bladder (OAB). The pathophysiology of DM-associated OAB is multifactorial and time-dependent. Diabetic bladder dysfunction is highly associated with diabetic complications, mainly including diabetic neuropathy and atherosclerosis. Chronic systemic inflammation and bladder urothelial inflammation may contribute to the onset of OAB. Intravesical botulinum toxin A (BoNT-A) injection has proved to be a successful treatment for idiopathic and neurogenic OAB. BoNT-A can inhibit the efferent pathways of the bladder as well as the chronic inflammation and hypersensitivity via the afferent pathways. We conducted a review of the published literature in Pubmed using a combination of two keywords, namely “botulinum toxin A” (BoNT-A) and “overactive bladder”, with or without the additional keywords “detrusor overactivity”, “diabetes mellitus”, “inflammation”, and “urodynamic study”. We also reviewed the experience of our research teams, who have published several studies of the association between DM and OAB. Since limited data support the effectiveness and safety of BoNT-A for treating patients with DM-associated OAB, a comprehensive evaluation of diabetic complications and urodynamic study is needed before treatment. In the future, it is imperative to explore the clinical characteristics and inflammatory biomarkers of diabetes as determining predictors of the treatment efficacy.

Large total prostate volumes (TPVs) or high serum prostate-specific antigen (PSA) levels indicate high-risk clinical progression of benign prostatic hyperplasia. This prospective study investigated the treatment outcome of combined 5α-reductase inhibitor and α-blocker in patients with and without large TPVs or high PSA levels. Methods: Men aged ≥ 45 years with International Prostate Symptom scores (IPSS) ≥ 8, TPV ≥ 20 mL, and maximum flow rate ≤ 15 mL/s received a combination therapy (dutasteride plus doxaben) for 2 years. Patients with baseline PSA ≥ 4 ng/mL underwent prostatic biopsy for excluding malignancy. The changes in the parameters from baseline to 24 months after combination therapy were compared in those with and without TPV ≥ 40 mL or PSA levels ≥ 1.5 ng/mL. Results: A total of 285 patients (mean age 72 ± 9 years) completed the study. Combination therapy resulted in significant continuous improvement in IPSS, quality of life index, maximum flow rate, and postvoid residual (all p

Objective: This study was conducted to investigate the efficacy and safety of ureteral dilation and placement of a long-term ureteral stent for patients with various types of ureteral obstructions. Methods: We retrospectively reviewed the records of 39 patients presenting with ureteral obstruction secondary to malignant strictures (n = 9) or nonmalignant strictures (n = 30). The mean age of these patients was 55.8 ± 16.1 years (range, 13–87 years). All patients underwent retrograde ureteral balloon dilation and placement of one to three ureteral stents. Stent patency rate and complications including febrile urinary tract infection, stent encrustation, and stent fragmentation were recorded. Results: A total of 117 ureteral stents were implanted during the 83 procedures. Three stents were placed in seven patients and two stents in 20 patients. The patency rate was 95.2% with a mean 75-day follow-up. There was no encrustation in 104 stents and Grade 1 in 13 stents. The patency rate was similar between the patients with malignant strictures and those with nonmalignant strictures (100% vs. 94.7%, p = 0.57). However, three episodes of febrile urinary tract infection were noted only in patients with malignant strictures. The improvement of hydronephrosis and complications were also comparable between those patients with ureteral stents indwelling for >90 days and those for

The purpose of this guideline is to direct urologists and patients regarding how to identify overactive bladder (OAB) in male patients with lower urinary tract symptoms (LUTS) and to make an accurate diagnosis and establish treatment goals to improve the patients' quality of life (QoL). LUTS are commonly divided into storage, voiding, and postmicturition symptoms, and are highly prevalent in elderly men. LUTS can result from a complex interplay of pathophysiologic features that can include bladder dysfunction and bladder outlet dysfunction such as benign prostatic obstruction (BPO) or poor relaxation of the urethral sphincter. Diagnosis of OAB in male LUTS leads to accurate diagnosis of pure OAB and bladder outlet-related OAB, and appropriate treatment in men with residual storage symptoms after treatment for LUTS.

To analyze the underlying lower urinary tract dysfunctions by video-urodynamic studies in men who have persistent storage symptoms after initial drug therapy for lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).The medical records of 614 men ≥40 years of age with LUTS and an International Prostate Symptom Score of ≥8 were retrospectively analyzed. All patients had persistent storage symptoms after medical treatment for at least 6 months. A video-urodynamic study was done to investigate the underlying bladder or bladder outlet dysfunction. Predictors of bladder outlet obstruction (BOO) by baseline urine flow metrics and prostate parameters were investigated.The final results revealed bladder neck dysfunction (BND) in 137/614 (22.3%), benign prostatic obstruction (BPO) in 246/614 (40.1%), detrusor overactivity (DO) in 193/614 (31.4%), and DO with detrusor underactivity (DO+DU) in 38/614 (6.2%) patients. Among the patients, 221/281 (78.6%) with a total prostatic volume (TPV) ≥40 ml had BOO, including 43/281 (15.3%) with BND and 178/281 (63.3%) with BPO. If we combined TPV ≥40 ml and Qmax

This article reports the current evidence and expert opinions on diagnosis and management of neurogenic lower urinary tract dysfunction (NLUTD) in Taiwan. The main problems of NLUTD are failure to store, failure to empty, and combined failure to store and empty. The priority of management of NLUTD should follow the order of: (1) preservation of renal function; (2) freedom from urinary tract infection (UTI); (3) efficient bladder emptying; and (4) freedom from indwelling catheter, and patients' expectation of management should be respected. Management of the urinary tract in patients with spinal cord injury (SCI) or multiple sclerosis (MS) must be based on urodynamic findings, rather than inferences from the neurologic evaluation. Selecting high risk patients is important to prevent renal function impairment in patients with chronic NLUTD. Patients with NLUTD should be regularly followed up for their lower urinary tract dysfunction by urodynamic study and any urological complication should be adequately treated. Avoiding a chronic indwelling catheter can reduce the incidence of developing a low compliant bladder. Antimuscarinic agents with clean intermittent catheterization (CIC) may reduce urological complications and improve quality of life (QoL) in patients with NLUTD. Intravesical injection of botulinum toxin A provides an alternative treatment for refractory detrusor overactivity (DO) or low compliant bladder and can replace the need for bladder augmentation. When surgical intervention is necessary, we should consider the least invasive type of surgery and reversible procedure first and avoid any unnecessary surgery of the lower urinary tract. Keeping the bladder and urethra in a good condition without interference of the neuromuscular continuity provides patients with NLUTD a chance for future new technologies. It is most important to never give up on improving the QoL in patients with NLUTD.

Purpose To assess the occurrence and the associated risk factors for nocturia among middle-aged and elderly people from public health centers in southern Taiwan. Materials and Methods Data were part of our previous cross-sectional study which used a self-administered questionnaire for the assessment of lower urinary tract symptoms. A total of 1011 responders who were at least 40 years of age were enrolled from any of four local public health centers for any reason in Pingtung County, Taiwan. Nocturia, as a dependent variable, was defined as two or more episodes per night. Covariables included age, gender, and chronic illnesses (obesity, hypertension, diabetes, cardiovascular disease, and stroke). Multivariate logistic regression was applied to determine the risk factors associated with nocturia. A p-value of less than 0.05 was considered statistically significant. Results About 38.1% (385/1011) of the participants reported having nocturia ≥ 2 episodes/night, and the occurrence of nocturia increased with advanced age. More than half (51.2%, 197/385) participants with nocturia perceived at least “a bit of a problem” on the sleep quality. The multivariate logistical regression showed that the independent risk factors for nocturia were age (OR:1.06, CI:1.05-1.08), hypertension (OR:1.58, CI:1.16-2.16) and diabetes (OR:1.59, CI:1.03-2.45) and obesity (OR:1.47, CI:1.02-2.10), while a borderline effect on nocturia was produced by cardiovascular disease (OR:1.66, CI: 0.98-2.79) and stroke (OR:2.75, CI:0.88-8.64). Conclusions Several chronic illnesses coexisted with nocturia. Health care providers need to be aware of an increased risk of nocturia among people with certain chronic illnesses, and provide appropriate health care.

PurposeTo assess the occurrence and the associated risk factors for nocturia among middle-aged and elderly people from public health centers in southern Taiwan.Materials and MethodsData were part of our previous cross-sectional study which used a self-administered questionnaire for the assessment of lower urinary tract symptoms. A total of 1011 responders who were at least 40 years of age were enrolled from any of four local public health centers for any reason in Pingtung County, Taiwan. Nocturia, as a dependent variable, was defined as two or more episodes per night. Covariables included age, gender, and chronic illnesses (obesity, hypertension, diabetes, cardiovascular disease, and stroke). Multivariate logistic regression was applied to determine the risk factors associated with nocturia. A p-value of less than 0.05 was considered statistically significant.ResultsAbout 38.1% (385/1011) of the participants reported having nocturia ≥ 2 episodes/night, and the occurrence of nocturia increased with advanced age. More than half (51.2%, 197/385) participants with nocturia perceived at least “a bit of a problem” on the sleep quality. The multivariate logistical regression showed that the independent risk factors for nocturia were age (OR:1.06, CI:1.05-1.08), hypertension (OR:1.58, CI:1.16-2.16) and diabetes (OR:1.59, CI:1.03-2.45) and obesity (OR:1.47, CI:1.02-2.10), while a borderline effect on nocturia was produced by cardiovascular disease (OR:1.66, CI: 0.98-2.79) and stroke (OR:2.75, CI:0.88-8.64).ConclusionsSeveral chronic illnesses coexisted with nocturia. Health care providers need to be aware of an increased risk of nocturia among people with certain chronic illnesses, and provide appropriate health care.

Emphysematous prostatic abscess is a rare but relatively serious infectious disease, and its association with rectoprostatic fistula is extremely unusual. The reported risk factors for this condition include diabetes mellitus, immunosuppression, and prostate surgery. We report a rare case of emphysematous prostatic abscess successfully treated by transurethral drainage. Nonetheless, a rectoprostatic fistula was found postoperatively. The fistula healed spontaneously without fasting or fecal diversion after suprapubic cystostomy and placement of a urethral catheter. This case highlights the importance of surgical drainage for the treatment of an emphysematous prostatic abscess and that conservative treatment can be a safe and effective approach for an associated rectoprostatic fistula.

We investigated the efficacy and safety of intravesical onabotulinumtoxinA injection in patients with detrusor hyperactivity and impaired contractility (DHIC). Twenty-one patients with urodynamically proven DHIC and 21 age-matched patients with overactive bladder (OAB) with urodynamic detrusor overactivity were treated with intravesical injections of 100 U of onabotulinumtoxinA. The overactive bladder symptom score, urgency severity score, patient perception of bladder condition, global response assessment, voiding diary, and procedure-related adverse events (AE) at baseline, two weeks, one, three, and six months after treatment were assessed. The results showed that the subjective symptom scores improved significantly in both groups, and the scores did not differ between the groups. The decrease in urgency episodes and urgency urinary incontinence were noted in OAB patients but not in DHIC patients. Although the incidence of AEs was comparable between the groups, the therapeutic efficacy lasted for a mean of 4.9 ± 4.8 months in DHIC patients and 7.2 ± 3.3 months in OAB patients (p = 0.03). We concluded that the efficacy of intravesical onabotulinumtoxinA injection for DHIC patients was limited and short-term. Nevertheless, AEs did not increase in DHIC. Intravesical onabotulinumtoxinA might not be a good indication in patients with DHIC and high post-voiding residual urine. Physicians should inform patients of the potential benefits and risks of onabotulinumtoxinA injection for treatment of DHIC.