Sacral neur al neuromodulation tr omodulation treatment for urinar eatment for urinary voiding dysfunctions: results of treatment with the largest single-center series in a ter series in a tertiary referral center in T al center in Turkey

BACKGROUND

Sacral neuromodulation (SNM) is a minimally invasive treatment that modulates spinal reflexes to regulate bladder, urinary sphincter, and pelvic floor and has successfully been used in the treatment of refractory voiding dysfunctions. The aim of this study was to present our experience with SNM in a tertiary referral center with the largest number of patients and review the safety and efficacy of the procedure.

METHODS

A total of 42 patients with refractory lower urinary tract symptoms were included into the study. After an initial test period, patients who showed more than 50% improvement in their symptoms underwent the second stage of SNM. Twelve patients had overactive bladder (OAB), bladder pain syndrome/interstitial cystitis (BPS/IC) and 17 had urinary retention. The clinical success was examined during follow-up by voiding diary, urodynamics, and global response assessment.

RESULTS

Between February 2015 and December 2020, a total of 29 patients underwent stages I&II SNM procedures. The mean ages of patients in OAB/BPS group and retention group were 40 (37-57 years) and 35 (27-44 years), respectively. Mean follow-up time was at least 1 year. Overall, 58.5% success rate was observed in OAB, BPS/IC, and urinary retention groups. Global response assessment score in both groups increased significantly (p = 0.001). No statistically significant difference was found between success or failure rates when sex and age were variable parameters (p > 0.05).

DISCUSSION

SNM appears to be an effective and safe treatment option in restoring voiding dysfunctions in patients with refractory idiopathic and neurogenic voiding dysfunctions. Our initial series revealed favorable results; however, further studies with larger series and longer follow-up are needed.

Sacral neuromodulation treatment for urinary voiding dysfunctions: Results of treatment with the largest single-center series in a tertiary referral center in Turkey

Background/aim: Sacral neuromodulation (SNM) is a minimally invasive treatment that modulates spinal reflexes to regulate bladder, urinary sphincter, and pelvic floor and has successfully been used in the treatment of refractory voiding dysfunctions. The aim of this study was to present our experience with SNM in a tertiary referral center with the largest number of patients and review the safety and efficacy of the procedure. Materials and methods: A total of 42 patients with refractory lower urinary tract symptoms were included into the study. After an initial test period, patients who showed more than 50% improvement in their symptoms underwent the second stage of SNM. Twelve patients had overactive bladder (OAB), bladder pain syndrome/interstitial cystitis (BPS/IC) and 17 had urinary retention. The clinical success was examined during follow-up by voiding diary, urodynamics, and global response assessment. Results: Between February 2015 and December 2020, a total of 29 patients underwent stages I&II SNM procedures. The mean ages of patients in OAB/BPS group and retention group were 40 (37-57 years) and 35 (27-44 years), respectively. Mean follow-up time was at least 1 year. Overall, 58.5% success rate was observed in OAB, BPS/IC, and urinary retention groups. Global response assessment score in both groups increased significantly (p = 0.001). No statistically significant difference was found between success or failure rates when sex and age were variable parameters (p > 0.05). Conclusion: SNM appears to be an effective and safe treatment option in restoring voiding dysfunctions in patients with refractory idiopathic and neurogenic voiding dysfunctions. Our initial series revealed favorable results; however, further studies with larger series and longer follow-up are needed.

Utility of semiquantitative strain elastography for differentiation between benign and malignant solid renal masses

OBJECTIVES

The aim of this study was to determine the role of semiquantitative strain elastography for differentiation of benign and malignant solid renal masses.

METHODS

Seventy-one patients with solid renal masses were prospectively examined with ultrasound elastography after grayscale sonography. Strain elastography was used to compare the stiffness of the renal masses and renal parenchyma. The ratio of strain in a renal mass and nearby renal parenchyma was defined as the strain index value. Mean strain index values for benign masses (n = 29; 24 angiomyolipomas and 5 oncocytomas) and malignant masses (n = 42; 34 renal cell carcinomas, 4 transitional cell carcinomas, 3 metastases, and 1 lymphoma) and mean strain index values for angiomyolipomas and renal cell carcinomas were compared.

RESULTS

There were no significant differences in the mean age of the patients, mean diameter of the masses, and mean probe-mass distance between benign and malignant groups. The mean strain index value ± SD for malignant masses (4.05 ± 2.17) was significantly higher than the value for benign masses (1.43 ± 0.94; P < .05). The mean strain index value for renal cell carcinomas (4.30 ± 2.27) was significantly higher than the value for angiomyolipomas (1.28 ± 1.01; P < .0001).

CONCLUSIONS

Strain elastography may be a useful imaging technique for differentiation between benign and malignant solid renal masses.

Renal leiomyoma: ultrasonography and computed tomography features with histopathologic correlation

Renal leiomyomas are not uncommon mesenchymal neoplasms of the kidney, found in 5% of autopsy specimens and comprising 0.3% of all treated tumors. These tumors arise from the smooth muscle cells of the kidney and are mostly located in the renal capsule. Typical imaging features of renal leiomyomas include a peripheral location, well-defined margins, and hyperattenuation on nonenhanced computed tomography (CT) images. The differential diagnosis of renal leiomyomas includes benign and malignant solid neoplasms of the kidney. Familiarity with typical renal leiomyoma imaging findings may help in the management of these patients and prevent unnecessary surgery.