Low Back Pain Perceptions and Coping Strategies in Pre-Professional Dancers: A Qualitative Study

AIMS

Low back pain (LBP) is a common health problem in pre-professional dancers which could hamper the dancers' professional career. However, pre-professional dancers are not often studied, although they may have their own pain perceptions and coping strategies towards LBP. Considering the biopsychosocial nature of LBP, it is important to increase the understanding of these perceptions and coping strategies. The aim of this qualitative research study was to explore the dancers' perceptions about LBP and their coping strategies when they suffered from LBP.

METHODS

Eighteen pre-professional dancers with and without LBP from different dance schools in Belgium were included in this study. Participants were invited for an in-depth online video interview. These in-depth interviews were based on a topic list. Afterwards, the interview transcripts were analyzed thematically.

RESULTS

Two primary themes emerged from the data: 1) perceptions of LBP and 2) coping strategies which dancers applied when they suffered from LBP. The perceptions about LBP were related to two different themes: "it's all about the body" and "it's all about the psychosocial and contextual factors." In addition, the coping strategies were divided into "active coping strategies" and "passive coping strategies," whereas the most popular coping strategies were stretching exercises and passive coping strategies such as massages or heating cream.

CONCLUSION

Although LBP has clearly been shown to be a biopsychosocial phenomenon, this qualitative study showed that dancers mainly considered biomedical factors as contributing factors to LBP. Additionally, instead of relying on coping strategies aimed at directly improving pain or trying to treat LBP on the basis of a single-cause diagnosis, it is important to consider the biopsychosocial origin of LBP in the management plans.

The low dopamine hypothesis: A plausible mechanism underpinning residual urine, overactive bladder and nocturia (RON) syndrome in older patients

INTRODUCTION

Aging is associated with a combination of several lower urinary tract (LUT) signs and symptoms, including residual urine, overactive bladder and nocturia. One of the mechanisms of this LUT dysfunction that has not been discussed in dept so far is the role of dopamine (DA).

METHODS

In this narrative review, we explore the dopaminergic hypothesis in the development of this combination of LUT signs and symptoms in older adults.

RESULTS

DA is one of the neurotransmitters whose regulation and production is disrupted in aging. In synucleinopathies, altered DAergic activity is associated with the occurrence of LUTS and sleep disorders. Projections of DAergic neurons are involved in the regulation of sleep, diuresis, and bladder activity. The low dopamine hypothesis could explain the genesis of a set of LUT signs and symptoms commonly seen in this population, including elevated residual urine, Overactive bladder syndrome and Nocturia (discussed as the RON syndrome). This presentation is however also common in older patients without synucleinopathies or neurological disorders and therefore we hypothesise that altered DAergic activity because of pathological aging, and selective destruction of DAergic neurons, could underpin the presentation of this triad of LUT dysfunction in the older population.

CONCLUSION

The concept of RON syndrome helps to better understand this common phenotypic presentation in clinical practice, and therefore serves as a useful platform to diagnose and treat LUTS in older adults. Besides recognizing the synucleinopathy "red flag" symptoms, this set of multi-causal LUT signs and symptoms highlights the inevitable need for combination therapy, a challenge in older people with their comorbidities and concomitant medications.

1012 Urologic Features Related to the First Uninterrupted Sleep Period (FUSP) in Nocturia

Introduction

In nocturia, longer FUSP (time to first void) correlates with better quality sleep (Bliwise et al, JCSM 2015;11:53-5) and, with treatment, longer FUSP is associated with decreased nightly voids (Epstein et al, Neurourol Urodyn 2018;37:186-91). We examined urologic correlates of FUSP in an outpatient nocturia population without comorbidities (CHF, OSA, ESRD, diuretics).

Methods

Participants (n=119; men) kept a home flow/volume diary, tracking clock time and quantity of each urination across a 24-hr period. FUSP was defined as time between going to bed and time of first void. We analyzed the urine volume at first nocturnal void (FNVV) (i.e., at end of FUSP). We also analyzed all nighttime volumes and divided by reported hours of sleep to impute nocturnal urine production (NUP) (in ml/hr, classified as high [>90 ml/hr] [n=49] vs low [<90 ml/hr] [n=60])—a measure correlated with number of nocturia episodes (van Doorn et al, J Urol 2014;191:1034-9). Nocturnal maximal voided volume (NMVV) at any single nocturnal void defined maximal functional nocturnal bladder capacity. Data were analyzed non-parametrically.

Results

For 53 of 119 patients, FNVV was identical to NMVV. This was more likely in patients with NUP >90 ml/hr vs <90 ml/hr (59% vs 40%, p=.046). High (vs low) NUP rates were also associated with higher FNVV (300 [225-420] vs 135 [100-200] ml, p<.001), as well as higher number of voids (3 vs. 2, p=.03).

Conclusion

For nearly half of these nocturia patients, the volume at first void occurred at their maximal nocturnal volume. In nocturia, higher FNVV also reflects greater overall nocturnal volume of urine produced, and excess urine volume (as opposed to insufficient bladder capacity) likely plays a central role in the pathogenesis of nocturia in these patients. The extent to which these higher initial volumes represent free-water vs solute-driven clearance is currently under investigation.

Support

N/A

0823 Age-Related Changes in Nocturnal Urine Composition

Introduction

In humans sleeping nocturnally, nocturnal polyuria (NP) refers to high rate of overnight urine production. NP is a heterogeneous condition that may reflect both free water and/or sodium diuresis, but the influence of age on differential fluid handling remains poorly understood. This study examined diuresis rate, sodium clearance, and free water clearance (FWC) by age, time of day (nighttime vs. daytime) and NP status (positive/negative) in subjects under entrained conditions sleeping nocturnally.

Methods

Convenience samples (age range 18-91; 82 men, 148 women) recruited from a urology ambulatory care unit (n=135) or continence clinic (n=95) collected 8 urine samples at 3-hour intervals over a single 24-hr period. Three separate mixed linear models were constructed for diuresis rate, sodium clearance, and FWC using four predictors: NP status (present [>90mL/h] vs. absent), time of day (night = 0100, 0400, 0700), age (as a continuous measure), and study source.

Results

Subjects with NP experienced both higher nighttime vs. daytime diuresis rate (1.89 vs. 1.44 mL/min, p<0.001), sodium clearance (0.91 vs. 0.74 mL/min, p<0.001), and FWC (-0.38 vs. -0.71 mL/min, p<0.001), whereas subjects without NP demonstrated lower nighttime vs. daytime diuresis rate (0.94 vs. 1.06, p=0.004) and no difference in sodium clearance (0.59 vs. 0.64, p=0.120) or FWC (-0.80 vs. -0.86, p=0.268). Regardless of NP status, FWC increased with age (p=0.039), and older age (>70) was accompanied by an increase in the ratio of nighttime/daytime diuresis rate and both nighttime and daytime sodium clearance.

Conclusion

Irrespective of NP, older adults experience proportionally greater nocturnal sodium clearance, as well as a complex surge in both daytime and nighttime FWC. The data imply that both nocturnal sodium clearance and FWC may reflect the relevant substrate underlying excess nocturnal urine production in elderly persons.

Support

N/A

0822 Frail Older Men With Nocturia are Disproportionately Affected by Excess Nocturnal Urine Production

Introduction

Nocturia is a risk factor for falls and hip fractures in older adults. We determined whether the Frailty Index (FI), incorporating comorbidities, functional performance, and physical signs, was associated with nocturia frequency and/or overnight urine production.

Methods

We examined nightly (24-hour) voiding diaries (men ≥65 years) in an outpatient urologic clinic demonstrating ≥2 nocturnal voids (n=158). FI calculations followed Rockwood (CMAJ 2005;173:489-95). A total of 39 conditions were assessed. Three FI groups were established: Low (≤0.077) (n=59), Intermediate (>0.077 and <0.179) (n=58), and High (≥0.179) (n=41). We compared number of nocturnal voids (NV), nocturnal urine volume (NUV) (in mL), and 24-hr total urine volume (24-hr TUV) (in mL) across groups.

Results

NV did not differ by group (p=0.333) (median for all groups=3). However, NUV (916 [671-1419] vs. 690 [505-942] vs. 630 [500-1050] mL) differentiated the High, Medium and Low FI groups (p<0.001 via Kruskal-Wallis with Bonferroni pairwise adjustments), respectively. Similarly, 24-hr TUV differentiated the 3 groups (2200 [1800-2550] vs. 1620 [1259-2119] vs. 1650 [1390-2517] mL, p=0.005). Differences in NUV remained significant (p=0.006) after eliminating Diabetes Mellitus cases (n=44). However, differences did not persist for 24-hr TUV (p=0.180).

Conclusion

Higher NUV, but not 24-hr TUV, was a robust correlate of frailty in these older men. Accounting for diabetes did not diminish the effect. Although undiagnosed sleep apnea remains a possible cause, recent chronobiologic data (Monaghan et al, Age Aging, 2020, in press) suggest that nocturia in the aged is characterized by excess free water clearance early in the sleep period. This argues against solute-driven urine production (as might be expected in sleep apnea) in accounting for the effect. Nocturia may represent a conspicuous and important change in circadian rhythm of urine production occurring in old age.

Support

N/A

Nocturnal enuresis and nocturia, differences and similarities - lessons to learn?

This review highlights the current views on and differences and similarities between nocturnal enuresis (NE) in children and nocturia in adults, which might be a guidance to elucidate the missing links in our knowledge. In both conditions, a genetic factor is suspected. Reduced bladder capacity and nocturnal polyuria are the main underlying lower urinary tract-related conditions. There is a link with sleep disorders, although it is not clear whether this is a cause or consequence. Physical and mental health are comprised in both conditions, however, in different ways. In NE, constipation and attention deficit disorder are the most important comorbidities and the effect on mental health and quality of life is mainly through the negative impact on self-esteem. In nocturia, cardiovascular disease and fall injuries are important comorbidities, mainly affecting the older nocturia population; personal distress and depression are consequences of the related poor sleep quality. For both conditions, treatment is often inadequate and a more individualized approach seems to be necessary. The main difference between NE and nocturia seems to be the difference in arousal to bladder stimuli, suggesting that sleep characteristics might be a key factor in these conditions.

Pathophysiology, diagnosis and treatment of varicoceles: a review

In this article we reviewed the pathophysiology, diagnosis and treatment of varicoceles. The etiology and pathogenesis of varicoceles cannot be explained by one theory. Valve dysfunction, ontogenetic collateral formation and the nutcracker phenomenon seem to act synergistically. Hyperthermia, elevated hydrostatic pressure and antisperm agents are suggested as possible causes for the pathophysiology how varicoceles induce infertility. However the combination of patient's lifestyle, genetic factors and the consequences of reflux into the pampiniform plexus are believed to contribute to the infertility. Although venography stays the gold standard, the combination of physical examination, color Doppler ultrasound and thermography has the highest sensitivity and specificity to diagnose a varicocele. Regarding infertility, we are still searching for strict criteria or grading, to decide which patients with a varicocele may or may not have benefit from treatment. Treatment of varicoceles can be performed by different open surgical or percutaneous techniques. Treatment of varicoceles for infertility or to prevent infertility remains controversial, because the majority of men with varicoceles are still fertile. At the moment, inguinal or subinguinal microscopic surgery gave the highest pregnancy rates, the lowest recurrence and lowest complication rates. But retrograde superselective glue embolization or sclerosing of the ISV are the best percutaneous alternative and can be performed on an outpatient basis under local anesthesia and with faster return to normal activities than surgery.

Arterial hypertension related to the injection of onabotulinumtoxinA in the detrusor

OBJECTIVE AND IMPORTANCE

We want to report on a first case reported of a 50-year-old female with repetitive and clinical significant hypertension after each injection of onabotulinumtoxinA. This is a retrospective chart review and prospective evaluation of the natriuresis and blood pressure at baseline and after injection therapy. The aim was to explore the mechanism of action of this apparent onabotulinumtoxinA related hypertension.

CASE PRESENTATION

Retrospectively hypertension appeared after 7 days and vanished after 4-5 months following injection of 300 units of onabotulinumtoxinA in the detrusor, bladder symptoms disappeared after 2 weeks and reoccurred after 5 months. Urological, nephrological, cardiological and endocrinological evaluations were normal.

INTERVENTION

In the prospective evaluation a 3-day bladder diary at baseline revealed a bladder capacity of 131 ± 57 ml and at 1 month when full effect was experienced 173 ± 50 ml. At 1 month there were no leakages with six episodes of intermittent catheterization per day. The 24-hour blood pressure registration demonstrated the onset of hypertension at day 7 together with a reversal of the urinary sodium/creatinine ratios on the renal function profile.

CONCLUSION

The increasing natriuresis coinciding with the hypertension is a normal compensatory mechanism suggesting that the hypertension has a central cause rather than it is caused by haematogenous spreading.

Neuroanatomy and neurophysiology related to sexual dysfunction in male neurogenic patients with lesions to the spinal cord or peripheral nerves

STUDY DESIGN

Review article.

OBJECTIVES

The neuroanatomy and physiology of psychogenic erection, cholinergic versus adrenergic innervation of emission and the predictability of outcome of vibration and electroejaculation require a review and synthesis.

SETTING

University Hospital Belgium.

METHODS

We reviewed the literature with PubMed 1973-2008.

RESULTS

Erection, emission and ejaculation are separate phenomena and have different innervations. It is important to realize, which are the afferents and efferents and where the motor neuron of the end organ is located. When interpreting a specific lesion it is important to understand if postsynaptic fibres are intact or not. Afferents of erection, emission and ejaculation are the pudendal nerve and descending pathways from the brain. Erection is cholinergic and NO-mediated. Emission starts cholinergically (as a secretion) and ends sympathetically (as a contraction). Ejaculation is mainly adrenergic and somatic. For vibratory-evoked ejaculation, the reflex arch must be complete; for electroejaculation, the postsynaptic neurons (paravertebral ganglia) must be intact.

CONCLUSION

Afferents of erection, emission and ejaculation are the pudendal nerve and descending pathways from the brain. Erection is cholinergic and NO-mediated. Emission starts cholinergically (as a secretion) and ends sympathetically (as a contraction). Ejaculation is mainly adrenergic and somatic. In neurogenic disease, a good knowledge of neuroanatomy and physiology makes understanding of sexual dysfunction possible and predictable. The minimal requirement for the success of penile vibration is a preserved reflex arch and the minimal requirement for the success of electroejaculation is the existence of intact post-ganglionic fibres.

Urinary tract infections in spinal cord injury: prevention and treatment guidelines

OBJECTIVES AND METHODS

The literature on prevention and therapy of urinary tract infection (UTI) in patients with spinal cord injury (SCI) was reviewed using 3 levels of evidence.

RESULTS

Antibiotic therapy is only indicated in symptomatic bacteriuria or in symptomatic exacerbations of chronic UTI. During the acute phase of a SCI, UTI's are more prevalent and bacteria are different and more resistant to antibiotics compared with the chronic phase of SCI. In SCI in general, routine screening urine cultures are not valuable as a high species turn over is seen. Intermittent catheterisation, tapping or Crédé manoeuvre coincide significantly with lower frequency of UTI compared to permanent catheter drainage. No measures are proven efficient in the long term in prevention of bacteriuria or UTI. Methenamine salts are perhaps useful in the prevention of UTI but not in patients with a permanent catheter (level III). Antibiotic prophylaxis was found useful in reducing asymptomatic bacteriuria but not in the prevention of symptomatic infections (level I). However, during prophylaxis a doubling of antibiotic resistance was found. In patients with augmented bladder antibiotic prophylaxis is useless (level II). In chronic SCI the first choice antibiotics are nitrofurantoin or trimethoprim, the second choice are fluoroquinolones (level III) whereas in acute SCI a higher resistance profile to antibiotics is frequent and therefore fluoroquinolones or cefuroxime are suggested (level III). There is no consensus in the literature but we suggest 5 days of antibiotic treatment in UTI during chronic SCI without fever, 7 days in acute SCI without fever and a minimum of 14 days in patients with UTI and fever (level III).

Intermittent catheterisation with hydrophilic-coated catheters (SpeediCath) reduces the risk of clinical urinary tract infection in spinal cord injured patients: a prospective randomised parallel comparative trial

OBJECTIVES

To compare the performance of SpeediCath hydrophilic-coated catheters versus uncoated polyvinyl chloride (PVC) catheters, in traumatic spinal cord injured patients presenting with functional neurogenic bladder-sphincter disorders.

METHODS

A 1-year, prospective, open, parallel, comparative, randomised, multi centre study included 123 male patients, > or =16 y and injured within the last 6 months. Primary endpoints were occurrence of symptomatic urinary tract infection (UTI) and hematuria. Secondary endpoints were development of urethral strictures and convenience of use. The main hypothesis was that coated catheters cause fewer complications in terms of symptomatic UTIs and hematuria.

RESULTS

57 out of 123 patients completed the 12-month study. Fewer patients using the SpeediCath hydrophilic-coated catheter (64%) experienced 1 or more UTIs compared to the uncoated PVC catheter group (82%) (p = 0.02). Thus, twice as many patients in the SpeediCath group were free of UTI. There was no significant difference in the number of patients experiencing bleeding episodes (38/55 SpeediCath; 32/59 PVC) and no overall difference in the occurrence of hematuria, leukocyturia and bacteriuria.

CONCLUSIONS

The results indicate that there is a beneficial effect regarding UTI when using hydrophilic-coated catheters.

Catalytic combustion of volatile organic compounds

Despite the success of adsorption and thermal incineration of (C)VOC emissions, there is still a need for research on techniques which are both economically more favorable and actually destroy the pollutants rather than merely remove them for recycling elsewhere in the biosphere. The catalytic destruction of (C)VOC to CO2, H2O and HCl/Cl2 appears very promising in this context and is the subject of the present paper. The experiments mainly investigate the catalytic combustion of eight target compounds, all of which are commonly encountered in (C)VOC emissions and/or act as precursors for the formation of PCDD/F. Available literature on the different catalysts active in the oxidation of (C)VOC is reviewed and the transition metal oxide complex V2O5-WO3/TiO2 appears most suitable for the current application. Different reactor geometries (e.g. fixed pellet beds, honeycombs, etc.) are also described. In this research a novel catalyst type is introduced, consisting of a V2O5-WO3/TiO2 coated metal fiber fleece. The conversion of (C)VOC by thermo-catalytic reactions is governed by both reaction kinetics and reaction equilibrium. Full conversion of all investigated VOC to CO2, Cl2, HCl and H2O is thermodynamically feasible within the range of experimental conditions used in this work (260-340 degrees C, feed concentrations 30-60 ppm). A first-order rate equation is proposed for the (C)VOC oxidation reactions. The apparent rate constant is a combination of reaction kinetics and mass transfer effects. The oxidation efficiencies were measured with various (C)VOC in the temperature range of 260-340 degrees C. Literature data for oxidation reactions in fixed beds and honeycomb reactors are included in the assessment. Mass transfer resistances are calculated and are generally negligible for fleece reactors and fixed pellet beds, but can be of importance for honeycomb monoliths. The experimental investigations demonstrate: (i) that the conversion of the hydrocarbons is independent of the oxygen concentration, corresponding to a zero-order dependency of the reaction rate; (ii) that the conversion of the hydrocarbons is a first-order reaction in the (C)VOC; (iii) that the oxidation of the (C)VOC proceeds to a higher extent with increasing temperature, with multiple chlorine substitution enhancing the reactivity; (iv) that the reaction rate constant follows an Arrhenius dependency. The reaction rate constant kr (s(-1)) and the activation energy E (kJ/mol) are determined from the experimental results. The activation energy is related to the characteristics of the (C)VOC under scrutiny and correlated in terms of the molecular weight. The kr-values are system-dependent and hence limited in design application to the specific VOC-catalyst combination being studied. To achieve system-independency, kr-values are transformed into an alternative kinetic constant K (m3/(m2u)) expressed per unit of catalyst surface and thus independent of the amount of catalyst present in the reactor. Largely different experimental data can be fitted in terms of this approach. Results are thereafter used to define the Arrhenius pre-exponential factor A*, itself expressed in terms of the activation entropy. Destruction efficiencies for any given reactor set-up can be predicted from E- and A*-correlations. The excellent comparison of predicted and measured destruction efficiencies for a group of chlorinated aromatics stresses the validity of the design approach. Since laboratory-scale experiments using PCDD/F are impossible, pilot and full-scale tests of PCDD/F oxidation undertaken in Flemish MSWIs and obtained from literature are reported. From the data it is clear that: (i) destruction efficiencies are normally excellent; (ii) the efficiencies increase with increasing operating temperature; (iii) the higher degree of chlorination does not markedly affect the destruction efficiency. Finally, all experimental findings are used in design recommendations for the catalytic oxidation of (C)VOC and PCDD/F. Predicted values of the a)VOC and PCDD/F. Predicted values of the acceptable space velocity correspond with the cited industrial values, thus stressing the validity of the design strategy and equations developed in the present paper.

A Prospective Randomized Trial Comparing the 1-Stage with the 2-Stage Implantation of a Pulse Generator in Patients with Pelvic Floor Dysfunction Selected for Sacral Nerve Stimulation

OBJECTIVE

The aim of this study was to evaluate in a prospective, randomized setting if the 2-stage implant, compared to a 1-stage implant, leads to a superior subjective or objective outcome of sacral nerve stimulation after implantation of the pulse generator in patients with lower urinary tract symptoms.

PATIENTS AND METHODS

We implanted a sacral (S3) foramen lead and a pulse generator (model 3023, Medtronic Inc, Minneapolis, MN, USA) in 42 patients. They were randomized in a 1-stage or a 2-stage implant if a more than 50% improvement in voided volume or reduction of residual urine was seen during the test stimulation phase as compared to baseline.

RESULTS

At 24 months follow-up, subjective (visual analogue scale) and objective (voided volume or residual urine) assessment were significantly better in the 2-stage group. Ten patients (24%) failed therapy, 7 in the 1-stage implant and 3 in the 2-stage group. Two patients were lost to follow-up. Logistic regression analysis revealed that failure was positively related to the 1-stage implant and negatively to the age of the patients. 76% of the treated patients had sustained clinical benefit with 23 revisions performed. The mean cost is respectively for the PNE (2006 Euro), for the 2-stage implant (10826 Euro) and for the 1 stage implant (8505 Euro).

CONCLUSION

With this study, we demonstrated that the 2-stage implantation technique of the sacral neuromodulation therapy performed as a longer test stimulation phase has a higher success rate.

Randomized, double-blind placebo- and tolterodine-controlled trial of the once-daily antimuscarinic agent solifenacin in patients with symptomatic overactive bladder

OBJECTIVE

To assess in a phase 3a trial the efficacy of solifenacin succinate, a once-daily oral antimuscarinic agent in development at 5-mg and 10-mg dosage strengths, for the treatment of overactive bladder (OAB) (Yamanouchi Pharmaceutical Co. Ltd, Tokyo, Japan) compared with placebo in patients with symptoms of OAB, i.e. urgency, incontinence, and frequency, with additional objectives being to assess the safety and tolerability of solifenacin and to compare the efficacy and safety of solifenacin with tolterodine 2 mg twice daily.

PATIENTS AND METHODS

The study was an international, multicentre, randomized, double-blind, tolterodine- and placebo-controlled trial conducted at 98 centres. Adult patients with symptomatic OAB for > or = 3 months were eligible; after a single-blind 2-week placebo run-in period patients were randomized equally to a 12-week double-blind treatment with either tolterodine 2 mg twice daily, placebo, solifenacin 5 mg or 10 mg once daily. Efficacy variables included change from baseline in the mean number of urgency, incontinence and urge incontinence episodes, and change from baseline in voids/24 h and mean volume voided/void.

RESULTS

In all, 1281 patients were enrolled, 1081 randomized and 1077 treated; 1033 were evaluated for efficacy. Compared with placebo, the change from baseline (-1.41, -32.7%) in the mean number of urgency episodes per 24 h was statistically significantly lower with solifenacin 5 mg (-2.85, -51.9%) and 10 mg (-3.07, -54.7%; both P < 0.001), but not with tolterodine (-2.05, -37.9%; P = 0.0511). There was a statistically insignificant decrease in episodes of incontinence with tolterodine (-1.14; P = 0.1122) but a significant decrease in patients treated with solifenacin 5 (-1.42; P = 0.008) and 10 mg (-1.45; P = 0.0038). Compared with placebo (-1.20, -8.1%) the mean number of voids/24 h was significantly lower in patients receiving tolterodine (-1.88, -15%; P = 0.0145), solifenacin 5 (-2.19, -17%) and 10 mg (-2.61, -20%; both P < 0.001). The mean volume voided/void was also significantly higher with all three active treatments (P < 0.001). Solifenacin was well tolerated; compared with placebo (4.9%), dry mouth (the most common side-effect), mostly mild, was reported in 18.6% of patients receiving tolterodine, 14.0% receiving 5 mg and 21.3% receiving 10 mg solifenacin.

CONCLUSION

Solifenacin 5 and 10 mg once daily improved urgency and other symptoms of OAB, and was associated with an acceptable level of anticholinergic side-effects. Solifenacin demonstrated significantly favourable efficacy to side-effect ratio in treating symptomatic OAB.

Removal of PCDD/F from flue gases in fixed or moving bed adsorbers

Whereas the PCDD/F-abatement in MSWIs is mostly achieved through entrained-phase adsorption upon activated carbon, the other thermal processes are more bending towards fixed/moving bed adsorption or catalytic destruction. The treatment of entrained-phase adsorption has been previously dealt with. The present paper focuses upon fixed/moving bed adsorption as abatement alternative. The characteristics of granular carbonaceous adsorbents are reviewed and commented upon, and stress some advantages of the fixed/moving bed operation. The equilibrium adsorption characteristics are expressed in terms of the number of active sites of the adsorbent and its saturation capacity. The breakthrough calculations for a fixed/moving bed adsorber are based upon these adsorption characteristics and expressed in terms of the relevant operating parameters of the flue gases to be treated. Although detailed literature data on these adsorbers are scarce, application of the design equations predicts meaningful results, thus demonstrating the predictive capacity of the design method.

Chronic prostatitis and male accessory gland infection--is there an impact on male infertility (diagnosis and therapy)?

The aim of this article was to discuss by means of a review of the literature and own study material the multifactorial aetiology of male infertility, extrapolate this hypothesis to male accessory gland infection (MAGI) and relate it to chronic prostatitis and its treatment. Infertility is a multifactorial disease and diagnosis and therapy must be oriented as such. Although the relationship between prostatitis and infertility remains unclear, bacteria, viruses, leucocytes, reactive oxygen species, cytokines, obstruction and immunological abnormalities must be seen as cofactors in the development of infertility in patients with MAGI and prostatitis. Infection, trauma, allergy, neurogenic damage, chemical or mechanical factors can lead to a long-lasting inflammation of the prostate or pelvic organs even after eradication of the aetiological agent, and is potentially related to infertility through cytokines. In relation to treatment of infertility, antibiotics play a role in bacterial prostatitis whereas in abacterial prostatitis other treatments like antioxidants, sacral nerve stimulation and anti-inflammatory treatment are worth to be studied in the future.

Urinary infections in patients with spinal cord injury

STUDY DESIGN

A retrospective study concerning urinary tract infections in spinal cord injury (SCI) patients.

OBJECTIVES

To check whether the regular (1/week) urine cultures allow a more accurate treatment of urinary tract infections in SCI patients compared to empiric treatment.

SETTING

Ghent University Hospital, East-Flanders, Belgium.

METHODS

Group 1: 24 tetraplegic patients; group 2: 22 paraplegic patients; group 3: 28 other polytrauma patients as controls. These groups were chosen as catheterisation and other voiding methods differ according to the underlying pathology.

RESULTS

An average of four clinically significant episodes of bacteriuria were found for groups 1 and 2, while group 3 experienced very few urinary infections. The mean species turnover of the first two groups was 2. No statistically significant difference was found in antibiotic-resistance patterns of organisms isolated.

CONCLUSION

Despite different catheterisation techniques in para- and tetraplegic patients, we conclude that: (1) the number of episodes of clinical significant nosocomial urinary infections is not different; (2) the mean species turnover is the same; (3) because of the species turnover, the value of regular urine cultures for 'documented' treatment of clinical relevant urinary infections seems to be limited. So urine culture could be performed less frequently or only when therapy becomes mandatory; (4) No oral antibiotic with superior activity was found: treatment is best started empirically (after sampling for urine culture) and adjusted to the resulting antibiotic sensitivity screening.

Urinary retention after hysterectomy for benign disease: extended diagnostic evaluation and treatment with sacral nerve stimulation

OBJECTIVE

To detect prospectively neurogenic damage in patients with urinary retention responding to sacral nerve stimulation (SNS) after hysterectomy for benign disease.

PATIENTS AND METHODS

From August 1995 to February 2002, 13 of 15 patients (mean age 43 years, sd 7) with urine retention for a mean (sd, range) of 25 (22, 6-240) months after hysterectomy for benign disease, were prospectively evaluated and treated with SNS. They were assessed using urodynamics at baseline and during the test stimulation. Sensory evoked potentials (SEPs), electrical sensory threshold (EST) measurements of the pudendal nerve, bladder neck and the bladder (2 Hz, 0-300 V), and needle electromyography of the external urethral sphincter (EUS) were undertaken in all patients.

RESULTS

De-afferentiation (EST >/= 200 V) was limited to the bladder in four of the 13 patients and extended to the bladder neck in one other, and was matched by no response at the SEP. Relative ESTs of the bladder neck correlated inversely with residual urine (r = - 0.76, P = 0.01, x = 546, fx = 1.22) and bladder capacity (r = - 0.77, P = 0.01, x = 611, fx = 1.26) at diagnosis. Complex repetitive discharges and decelerating bursts of the EUS were seen in these five patients. Unilateral SNS was applied in 10 patients (bilateral in three). A revision was needed in six patients. Uroflowmetry at the last follow-up showed a mean (sd) maximum urinary flow rate of 22 (18) mL/s (not significantly different from during trial stimulation) with residual urine of 50-100 mL in two and 200-400 mL in three patients. Intermittent catheterization was needed in four patients.

CONCLUSION

Urinary retention after hysterectomy for benign disease is associated with de-afferentiation of the bladder wall in some patients and is correlated inversely with the relative EST of the bladder neck. A Fowler syndrome was detected in five patients. For residual urine, about half the patients have a good and a third a partial long-term effect; we now offer SNS as a further treatment option.

Entrained phase adsorption of PCDD/F from incinerator flue gases

The emission abatement of polychlorinated dioxins and furans (PCDD/F) issued from municipal solid waste incineration (MSWI) is growing in importance because of more stringent emission standards and general health concern. These substances cannot be separated by conventional gas cleanup processes. They are successfully removed through adsorption onto carbonaceous materials, and the entrained-phase injection of pulverized adsorbents in the flue gas, followed by high-efficiency separation, is widely applied. Operating conditions and results obtained in Flemish MSWIs are given. The results illustrate the excellent overall removal efficiency: the regulation limit of 0.1 ng TEO/Nm3 dry gas at 11% O2 can be achieved. Furans are adsorbed to a slightly higher extent than the dioxins. The PCDD/F removal by carbonaceous adsorbents is thereafter modeled from first principles for the contribution of both entrained-phase (eta1) and cake filtration (eta2) to the overall efficiency (etaT), with dominant parameters being the operating temperature, the dosage and activity of adsorbent, and the fraction of adsorbent in the filter cake. Application of the model equations and comparison of measured and predicted overall efficiencies for the Flemish MSWIs demonstrate the validity of the model, which enables the MSWI operators both to predict the adsorption efficiencies for combinations of major operating parameters and to assess the sensitivity of the process to varying operating conditions. Finally, some practical difficulties encountered with the entrained-phase adsorption are discussed.

Removal of PCDD/F from incinerator flue gases by entrained-phase adsorption

The emission abatement of polychlorinated dioxins and furans (PCDD/F) Issued from municipal solid waste incineration is growing in importance because of more stringent emission standards and general concern about their toxic characteristics. These substances cannot be separated by conventional gas cleanup processes but are successfully removed through adsorption onto carbonaceous materials. The simplest technique is the entrained-phase injection of pulverized adsorbents in the flue gas, followed by fabric filter separation. The various related techniques are briefly reviewed here. Operating conditions and results obtained from Flemish MSWIs are given. The results illustrate the excellent overall removal efficiency. Furans are adsorbed to a slightly higher extent than dioxins. PCDD/F removal by carbonaceous adsorbents is thereafter modeled from first principles for the contribution of both entrained-phase (eta1) and cake filtration (eta2) to the overall efficiency (etaT). Application of the model equations and comparison of measured and predicted overall efficiencies for the Flemish municipal solid waste incinerators (MSWIs) demonstrate that the approach is meaningful and that the dominant parameters are the operating temperature, the dosage and activity of adsorbent, and the fraction of adsorbent in the filter cake. The model equations enable the MSWI operators to predict the adsorption efficiencies for any combination of operating parameters and to assess the sensitivity of the process to varying operating conditions.

A high easy-to-treat complication rate is the price for a continent stoma

OBJECTIVE

To evaluate the conduit-related complications and their treatment in Mitrofanoff continent urinary diversion and antegrade colonic enema (ACE) procedures.

PATIENTS AND METHODS

The files of 53 patients (18 men and 35 women) in whom 58 continent stomas were created were retrospectively reviewed. Gender, age, age at the time of surgery, underlying disease, concomitant surgery, abdominal position of the stoma, follow-up, complications and treatment were assessed. The mean (sd) age at the time of surgery was 19 (13) years; 30 patients were aged <15 years and the mean follow-up was 2.8 (1.9) years. Fifty-three continent vesicostomy-type Mitrofanoff stomas were constructed and five ACE procedures performed. Forty-five stomas were in the umbilicus and 13 on the abdominal wall. For 45 conduits the appendix was used; in the other 13 a transverse tubularized ileal segment according to Monti was created.

RESULTS

There were stoma-related complications in 19 patients (36%), with 27 in all and stomal stenosis accounting for more than half. Five patients had urinary leakage. The median time to the first complication was 9 months. Multiple regression analysis showed that gender and stoma location were the only significant determinants of the complication/follow-up ratio. Women had more complications than men and umbilical stomas fared worse than those on the abdominal wall. Age, underlying disease and type of stoma were not significantly related to the complication/follow-up ratio. The complication was treated by one procedure in 13 patients; four needed two and two needed three surgical revisions. Most complications were relatively easy to treat, i.e. dilatation in five, endoscopic incision in one, re-anastomosis in four, Y-V plasty in seven, a new channel in two, reimplantation in three, a bladder cuff in two for stomal leakage, and abdominoplasty in two. Only one stoma had to be abandoned.

CONCLUSION

The complication rate for continent small-diameter stoma is high. However, most complications are relatively easy to treat. Despite these complications, patient satisfaction remains high.

The formation and emission of dioxins in large scale thermal processes

The paper assesses extensive data of PCDD/F measurements on flue gas emissions from thermal processes, including, e.g. municipal solid waste incinerators (MSWIs), combustors of wood and industrial waste, coal fired powerplants and boilers, ferro and non-ferro processes. Numerous investigators have conducted laboratory experiments to assess the formation mechanisms of PCDD/F. The results, obtained from fixed-bed experiments, have been critically evaluated and indicate that de novo synthesis is the dominant mechanism in actual thermal processes where conditions that favour the precursor formation are not experienced. The analysis of PCDD/F profiles from the large scale thermal processes in general, and MSWIs in particular, supports the dominant role of the de novo synthesis, irrespective of the type of thermal process considered. The PCDF/PCDD ratio exceeds 1 and the degree of chlorination points towards the dominant presence of HpCDD and OCDD within the dioxin group, and of PeCDF, HxCDF and HpCDF within the furan group. Since real-time measurement of PCDD/F is impossible, the correlation of PCDD/F emissions with operating parameters and/or emission levels of other more easily measured pollutants could be a tool in predicting the PCDD/F formation levels. Data of Flemish MSWIs were used to statistically assess such correlations. From an evaluation of the data at a given operating temperature, misleading conclusions can be drawn. Only the effect of temperature is evident. After converting all data at a reference temperature of, e.g. 230 degrees C, PCDD/F concentrations achieve nearly constant values, irrespective of the values of other parameters, thus stressing that the major controlling parameter for the PCDD/F emission is the temperature of the ESP. The PCDD/F concentrations increase with temperature in the range up to 280 degrees C. The ESP temperature should be kept preferably between 180 degrees C and 200 degrees C, where de novo synthesis is reduced and where PCDD/Fs are increasingly adsorbed on the fly ash, in line with the standard temperature dependence of adsorption isotherms.

Transcutaneous neuromodulation for the urge syndrome in children: a pilot study

PURPOSE

Neuromodulation has been used to treat voiding dysfunction in adults. Due to its invasiveness it has rarely been used in children until now with the availability of transcutaneous neurostimulation. We evaluated clinical effects of transcutaneous neuromodulation on detrusor overactivity in children with the urge syndrome.

MATERIALS AND METHODS

Between May 1, 1998 and February 28, 1999, 15 girls (mean age 10.2 years) and 26 boys (mean age 10.7 years) with proved detrusor hyperactivity on videourodynamic study underwent neuromodulation. All children had been given anticholinergic therapy previously. Neurostimulation only was used in children in whom anticholinergics had no effect and those who had significant side effects. Anticholinergics were continued in children in whom they had a partial effect. Stimulation of 2 Hz. was applied for 2 hours every day. Surface electrodes were placed at the level of sacral root S3. After 1 month of trial stimulation those children who responded continued the treatment for 6 months, and were evaluated every 2 months.

RESULTS

Of the 41 children 15 boys and 13 girls responded after 1 month of trial therapy with an increase in bladder capacity, decrease in urgency, decrease in incontinence and/or better sensitivity. Of the 13 children who did not respond 9 lacked motivation and 4 had no clinical effect despite motivation. After 6 months of therapy a significant increase in bladder capacity, decrease in voiding frequency and decrease in incontinence periods were noted. Adverse effects were not observed. One year after therapy relapse was noted in 7 patients, leaving 21 of 41 children definitively cured.

CONCLUSIONS

Although preliminary, our results indicate that transcutaneous neuromodulation can improve symptoms of detrusor overactivity, as response to stimulation was noted in 76% of our patients and 56% were cured after 1 year. This therapeutic option is attractive for children because of its noninvasiveness and absence of adverse effects.

The pain cycle: implications for the diagnosis and treatment of pelvic pain syndromes

The aim of the study was to report our results of sacral nerve stimulation in patients with pelvic pain after failed conservative treatment. From 1992 to August 1998 we treated 111 patients (40 males, 71 females, ages 46 +/- 16 years) with chronic pelvic pain. All patients with causal treatment were excluded from this study. Pelvic floor training, transcutaneous electrical nerve stimulation (TENS) and intrarectal or intravaginal electrostimulation were applied and sacral nerve stimulation was used for therapy-resistant pain. The outcome of conservative treatment and sacral nerve stimulation (VAS <3/10; >50% pain relief) was related to symptoms of voiding dysfunction and dyschezia, and urodynamic proof of dysfunctional voiding, not to the pain localization or treatment modality. Outcome was inversely related to neuropathic pain. When conservative treatment failed, a test stimulation of the S3 root was effective in 16/26 patients, and 11 patients were implanted successfully with a follow-up of 36 +/- 8 months. So far no late failures have been seen. A longer test stimulation is needed in patients with pelvic pain because of a higher incidence of initial false positive tests. Our conclusion is that sacral nerve stimulation is effective in the treatment of therapy-resistant pelvic pain syndromes linked to pelvic floor dysfunction.

Correlation of PCDD/F emissions with operating parameters of municipal solid waste incinerators

Municipal solid waste incinerator (MSWI) operators frequently have expressed the need for an indirect indication of the expected production of PCDD/F and associated abatement procedures through a possible correlation with other real-time data, through using marker pollutants (e.g., penta/hexachlorinated aromatics), or through other indications. Since real-time measurement of PCDD/F is impossible, a correlation of PCDD/F emissions with other operating parameters could help in achieving these goals. Literature data of large-scale MSWIs concerning these correlations are scarce and seldom conclusive. Extensive data of Flemish MSWIs are used to statistically assess possible correlations of PCDD/F and other operating parameters. The effect of temperature in the electrostatic precipitator (ESP) is of major importance. When converting values measured between 180 and 270 degrees C to a reference temperature of, for example, 230 degrees C, PCDD/F concentrations achieve nearly constant values, stressing that the major correlating parameter is the temperature of the ESP. High temperatures that enhance de novo synthesis should be avoided.

Urodynamic assessment of voiding dysfunction and dysfunctional voiding in girls and women

Voiding dysfunction is defined as impaired bladder emptying, and presents with a mixture of lower urinary tract symptoms. Dysfunctional voiding is a condition in which there is a lack of coordination between the sphincter and detrusor during emptying in a patient without overt uropathy or neuropathy. Assessment of voiding dysfunction is important in women and girls in the prevention and treatment of urinary incontinence, retention, urinary tract infection and subsequent kidney damage. Accurate diagnosis is essential in order to select the correct treatment. Screening can be done by history-taking: symptom scores can help to guide the screening. More objective measures are uroflowmetry, ultrasonography and video-urodynamics. The latter is the gold standard for the diagnosis of voiding dysfunction and consists of simultaneous registration of pressure in the bladder and rectum and external sphincter behavior, either by electromyographic recording of pelvic floor activity or by pressure recording at the external sphincter, during the whole bladder cycle of filling and emptying. On fluoroscopy the bladder can be visualized throughout the filling and emptying phase. In dysfunctional voiding, hypertonicity and instability of the external urethral sphincter during filling cystometry and impaired external sphincter relaxation during emptying are pathognomonic findings. Pressure-flow analysis reveals no obstruction and the detrusor contractility is low.

Patient satisfaction and complications following sacral nerve stimulation for urinary retention, urge incontinence and perineal pain: a multicenter evaluation

The aim of the study was to determine the success rate, the complications, the failures and the solutions found in troublesome cases. A retrospective study was performed in three university centers in Belgium. Between March 1994 and April 1998, a quadripolar electrode and a pulse generator were implanted in 53 patients (8 men, 45 women, 43 +/- 12 years, mean follow-up 24 +/- 8 months, range 13-39 months). During the first few months, 45 (85%) of the 53 patients had an objective response. Eight late failures occurred, with a mean failure delay of 9 +/- 5 months. We performed 15 revisions in 12 patients. Major complications were pain and current-related troubles. The outcome was significantly better (P = 0.001) in post-stress incontinence surgery patients. Device-related pain was found more frequently in patients with dysuria and/or retention or perineal pain, and the test stimulation was less reliable (P = 0.025) in patients with a psychiatric history. Sacral nerve stimulation is efficient in treating patients with refractory lower urinary tract symptoms and/or perineal pain.

The Belgian PCB and dioxin incident of January-June 1999: exposure data and potential impact on health

In January 1999, 500 tons of feed contaminated with approximately 50 kg of polychlorinated biphenyls (PCBs) and 1 g of dioxins were distributed to animal farms in Belgium, and to a lesser extent in the Netherlands, France, and Germany. This study was based on 20,491 samples collected in the database of the Belgian federal ministries from animal feed, cattle, pork, poultry, eggs, milk, and various fat-containing food items analyzed for their PCB and/or dioxin content. Dioxin measurements showed a clear predominance of polychlorinated dibenzofuran over polychlorinated dibenzodioxin congeners, a dioxin/PCB ratio of approximately 1:50,000 and a PCB fingerprint resembling that of an Aroclor mixture, thus confirming contamination by transformer oil rather than by other environmental sources. In this case the PCBs contribute significantly more to toxic equivalents (TEQ) than dioxins. The respective means +/- SDs and the maximum concentrations of dioxin (expressed in TEQ) and PCB observed per gram of fat in contaminated food were 170.3 +/- 487.7 pg, 2613.4 pg, 240.7 +/- 2036.9 ng, and 51059.0 ng in chicken; 1.9 +/- 0.8 pg, 4.3 pg, 34.2 +/- 30.5 ng, and 314.0 ng in milk; and 32.0 +/- 104.4 pg, 713.3 pg, 392.7 +/- 2883.5 ng, and 46000.0 ng in eggs. Assuming that as a consequence of this incident between 10 and 15 kg PCBs and from 200 to 300 mg dioxins were ingested by 10 million Belgians, the mean intake per kilogram of body weight is calculated to maximally 25,000 ng PCBs and 500 pg international TEQ dioxins. Estimates of the total number of cancers resulting from this incident range between 40 and 8,000. Neurotoxic and behavioral effects in neonates are also to be expected but cannot be quantified. Because food items differed widely (more than 50-fold) in the ratio of PCBs to dioxins, other significant sources of contamination and a high background contamination are likely to contribute substantially to the exposure of the Belgian population.

Impact of urinary tract infection and detrusor pressure on renal tubular function in patients with vesicoureteral reflux

OBJECTIVE

The aim of this study was to evaluate prospectively the impact of bacteriuria with or without pyuria and/or detrusor pressure on renal tubular function in patients with secondary vesicoureteral reflux.

METHODS

From October 1994 to December1998, we evaluated 54 patients with secondary vesicoureteral reflux (26 men and 28 women; age 30+/-24 years), of whom 28 had a neurogenic and 26 a nonneurogenic voiding dysfunction. In a reference population (n = 48; 28 men, 20 women; age 38+/-14 years), 43 had a neurogenic and 5 a nonneurogenic voiding dysfunction. Urinary alpha-1-microglobulin was measured immunonephelometrically. Statistical analysis was performed by multiple regression analysis.

RESULTS

Patients with vesicoureteral reflux had a significantly higher urinary alpha-1-microglobulin/creatinine ratio. Urinary alpha-1-microglobulin excretion was related to the grade of vesicoureteral reflux, detrusor pressure and compliance, but not to bacteriuria or pyuria, and was diagnostic for vesicoureteral reflux with a sensitivity of 90%, a specificity of 70% and a negative predictive value of 97%.

CONCLUSION

Urinary alpha-1-microglobulin excretion is diagnostically useful in patients with secondary vesicoureteral reflux. The use of urinary alpha-1-microglobulin excretion in the follow-up of patients with vesicoureteral reflux has yet to be established.

Bladder neck closure for treating pediatric incontinence

AIMS OF STUDY

In order to evaluate the effects of bladder neck closure (BNC) for treatment of pediatric incontinence, on the quality of life of those children, we reviewed the files of 17 children who underwent this procedure during the last 5 years. Information on previous surgery before BNC, continence and complications after BNC and patient satisfaction are gathered.

MATERIAL AND METHODS

During the study period, 17 children (9 male, 8 female) underwent BNC with continent diversion. Ten children (5 male, 5 female) suffered neurogenic incontinence in meningomyelocele, 5 children (4 male, 1 female) had bladder exstrophy, 1 girl suffered iatrogenic incontinence after treatment of an ectopic ureterocele and 1 girl suffered structural incontinence after pelvic fracture. Previous surgery for incontinence was done in 12 children with 36 procedures. Primary BNC was done in 5 children. For continent diversion the appendix was used in 13, the ureter in 2, a Monti procedure in 1, and an ileal valve in 1. In 9 children, ileal bladder augmentation was performed at the time of BNC. Four children were augmented before. Mean age at time of operation was 13.5 years. Mean follow-up is 35 months.

RESULTS

After BNC, all patients were completely dry. One girl suffered some stomal incontinence during the night. This disappeared after recent bladder augmentation. Patient satisfaction is extremely high after surgery. All patients feel happy with their stoma and do not regret the choice they made. As for complications, urinary tract infections were seen in 9 patients. Stomal complications were seen in 8 patients. Three patients had some difficulty with catheterization, which could be solved with dilatation. Appendiceal polyps, which could be removed under local anesthesia, were seen in 3 and stomal stenosis which needed re-intervention in 2. In 1 patient, three revisions of the stoma were done, in the other patient, two surgical corrections. Out of 8 patients showing stomal complications, only 2 needed revision under anesthesia. All complications are seen in the first 6 months after the continent diversion.

CONCLUSIONS

We present a series of patients who underwent BNC for treatment of incontinence. BNC is the ultimate bladder neck reconstruction. However, regarding the high success rate, the low complication rate and the high patient satisfaction, we must consider BNC as an important procedure for the reconstructive surgeon. If reconstruction fails, closure must be considered. Compared to most other procedures for bladder neck reconstruction, BNC gives the highest continence rate. Good patient compliance and strict medical follow-up of the upper tract is mandatory in these patients.

A review on urinary proteins in outflow disease of the upper urinary tract

INTRODUCTION

[corrected] No review articles on outflow disease of the upper urinary tract discuss urinary protein excretion.

DISCUSSION

Following acute partial and/or complete ureteral obstruction (UO) or chronic partial UO, alpha-1-microglobulin excretion is significantly higher than in the reference population or patients with proven renal dilatation without obstruction, but is not found to be diagnostic for these conditions as such. Chronic partial UO is followed first by a destructive and then by a steady-state phase in renal damage. The observed increase in tubular proteinuria during the destructive phase correlates with the decrease in absolute dimercaptosuccinic acid (DMSA) uptake. If the destructive phase is not followed by a stable phase, a mixed tubular and glomerular proteinuria is seen. Urinary alpha-1-microglobulin excretion is found to be diagnostically useful in vesico-ureteral reflux (VUR) patients, increases with higher intravesical-intrapyelic pressure, correlates with the decrease in absolute DMSA uptake or with urinary epidermal growth factor excretion (both markers of the number of functioning nephrons) and predicts the outcome after treatment.

CONCLUSION

alpha-1-Microglobulin is useful in the detection of renal tubular damage in patients with outflow disease of the upper tract, is diagnostic for VUR but is not so for ureteral obstruction.

Fertilization, pregnancy and embryo implantation rates after ICSI in cases of obstructive and non-obstructive azoospermia

The aetiology of azoospermia can be grossly divided into obstructive and non-obstructive causes. Although in both cases testicular spermatozoa can be used to treat male fertility, it is not well established whether success rates following intracytoplasmic sperm injection (ICSI) are comparable. Therefore, a retrospective analysis of fertilization, pregnancy and embryo implantation rates was performed following ICSI with testicular spermatozoa in obstructive or non-obstructive azoospermia. In total, 193 ICSI cycles were carried out with freshly retrieved testicular spermatozoa; in 139 cases of obstructive and 54 cases of non-obstructive azoospermia. The fertilization rate after ICSI with testicular spermatozoa in non-obstructive azoospermia was significantly lower than in obstructive azoospermia (67.8% versus 74.5%; P = 0.0167). Within the non-obstructive group, the fertilization rate in the group of maturation arrest (47.0%) was significantly lower than in case of Sertoli cell-only (SCO) syndrome (71.2%) or germ cell hypoplasia (79. 5%). Embryo quality on day 2 after ICSI was similar for all groups. Pregnancy rates per transfer between obstructive (36.8%) and non-obstructive groups (36.7%) were similar. In cases of maturation arrest the pregnancy rate per transfer was lowest (20.0%) although not significantly different from SCO syndrome or hypoplasia groups. Embryo implantation rates were not different between the obstructive (19.6%) and non-obstructive groups (25.8%), and were lowest in cases of germ cell hypoplasia (15.8%). This retrospective analysis shows that although fertilization rate after ICSI with testicular spermatozoa in non-obstructive azoospermia is significantly lower than in obstructive azoospermia, pregnancy and embryo implantation rates are similar.

Bilateral S3 nerve stimulation, a minimally invasive alternative treatment for postoperative stress incontinence after implantation of an anterior root stimulator with posterior rhizotomy: a preliminary observation

STUDY DESIGN

A preliminary report.

OBJECTIVES

Urinary stress incontinence following implantation of an anterior root stimulator and a posterior rhizotomy is a rare complication which is difficult to treat. It is seen in patients with an open bladder neck (T9-L2 lesion). An artificial urinary sphincter is a possible treatment for this condition but has a higher failure rate in patients with neurogenic bladder disease and could complicate micturition.

SETTING

Ghent, Belgium.

METHODS

A male paraplegic patient (T9, complete lesion) aged 36 was suffering from severe urinary incontinence due to detrusor hyperreflexia. Preoperatively the bladder neck was closed on cystography. Following implantation (6/95) of an intradural anterior root stimulator with posterior rhizotomy, severe urinary stress incontinence presented. Bilateral S3 foramen leads were implanted and connected to a pulse generator.

RESULTS

The patient has been continent with continuous stimulation of both S3 roots for 4 years, and no fatigue of the levator muscles has been seen. Preoperative urodynamics are compared to results 3 years postoperatively.

CONCLUSION

Bilateral S3 stimulation is a feasible and minimally invasive treatment of urinary stress incontinence following implantation of an anterior root stimulator.