Author(s): Bray R.; Khullar V.; Cartwright R.; Cardozo L.; Hill S.; Guan Z.

Source: Neurourology and Urodynamics; 2017

Publication Date: 2017

Publication Type(s): Article In Press

Available in full text at Neurourology and Urodynamics -  from John Wiley and Sons

Abstract:AIMS: We evaluated the effect of Tolterodine extended release (TER) versus placebo on bladder wall thickness (BWT) using transvaginal ultrasound in women with overactive bladder (OAB). MATERIALS AND METHODS: We recruited 79 women with symptoms of OAB with a mean age of 47 years who had a BWT of at least 5mm and a post-micturition volume of less than 50mL at screening. Subjects received TER 4mg or placebo once daily for the first 12 weeks of the study. For the subsequent 12 weeks, all subjects received TER 4mg once daily. BWT was measured at screening, weeks 12 and 24. Subjects recorded number of micturitions, incontinence episodes and urgency episodes, and volume voided per micturition at regular intervals during the study. RESULTS: Treatment with TER for 12 weeks produced a statistically significant decrease from baseline in BWT (mean [SD]=0.9 [1.4] mm; P<0.05) that was not evident following treatment with placebo (0.2 [1.6] mm; P=0.54). However, the treatment difference did not reach statistical significance (LS Mean=-0.4; 95%CI: -1.2, 0.3; P=0.25). After 12 weeks of treatment, subjects who had taken TER showed an improvement in each bladder diary variable compared to placebo-treated subjects. CONCLUSIONS: TER may have a direct effect on BWT in women with OAB. Larger studies are warranted to further investigate the effect of behavioral interventions and antimuscarinics, such as TER, on BWT in women with OAB and increased BWT.Copyright © 2017 Wiley Periodicals, Inc.
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Database: EMBASE

Author(s): Luk, Angus Chin On; Cleaveland, Paul; Olson, Louise; Neilson, Donald; Srirangam, Shalom
Source: Journal of endourology; Jan 2017

Publication Date: Jan 2017

Publication Type(s): Journal Article

Abstract:Pelvic phleboliths are commonly encountered on plain and CT imaging and remain a source of frustration when attempting to differentiate them from ureteral calculi. Given their frequency, surprising little is known about their significance. We review the literature on pelvic phleboliths, specifically in relation to their history, demography, clinical significance, and methods to distinguish them from ureteral calculi.           A comprehensive literature search was performed for all articles concerning pelvic phleboliths. Pelvic phleboliths were first described in 19th century when the presence of calcified intravenous nodules was observed in human dissection. With the discovery of X-ray imaging in 1895, they have caused much diagnostic controversies since. Histologically they are composed of calcified laminated fibrous tissue, with a surface layer continuous with vein endothelium. Prevalence of pelvic phleboliths in adults is reported to be 38.9-48%. They are more common in adults aged over 40, and appear to equally affect both genders. They may be associated with diverticulitis, vascular abnormalities, and are more commonly seen in individuals from economically-developed countries. The soft-tissue 'rim' sign (50-77% sensitivity, 92-100% specificity), and a geometric shape (100% positive predictive value(PPV)) are radiological signs predictive of a ureteral calculi on unenhanced CT scanning. Radiological signs suggestive of phleboliths include the presence of central lucency (8-60% sensitivity, 100% specificity), rounded shape (91% PPV) and the comet-tail sign (21-65% sensitivity, 100% specificity). Phleboliths appear to have a significantly lower Hounsfield unit enhancement than ureteric calculi (160 to 350HU).           Pelvic phleboliths are a common radiological finding, especially in the older population, which continue to present diagnostic challenges in those with suspected ureteral calculi. With greater awareness, the uncertainty can be overcome by identifying defining characteristics when interpreting radiological investigations.
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Database: Medline

Source: Urology

Publication Type(s): Journal Article Review

Author(s): Jones, Patrick; Aboumarzouk, Omar M; Rai, Bhavan Prasad; Somani, Bhaskar K

Abstract:Stones in solitary kidney represent a management dilemma for the endourologist. The advantage of bilateral fully functioning kidneys is not present. Therefore, any insult to either the solitary kidney itself or drainage system can lead to significant morbidity. Key clinical objectives include maximum preservation of existing renal function, high stone clearance and minimising post procedure complications. To date there exists no Level 1 evidence on this subject. This systematic review serves to evaluate the safety and efficacy of percutaneous nephrolithomy (PCNL) for patients (adults only) with stones in a solitary kidney.        
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Citation: European Urology, Supplements, April 2015, vol./is. 14/2(e969-e969a), 1569-9056 (April 2015)
Author(s): Srirangam S., Zelhof B., Neilson D.
Language: English
Abstract: INTRODUCTION & OBJECTIVES: Patients with ileal conduits are at increased risk of long term complications, including urolithiasis, stricture formation and cancer recurrence in the upper tract. Despite advances in minimally invasive technology and expertise, retrograde ureteroscopic manipulation via the ileal conduit still poses a challenge for the endourologist. We describe our single centre experience in performing retrograde ureteroscopy in patients with ileal conduit urinary diversions. MATERIAL & METHODS: We retrospectively analysed all patients with previous urinary diversion who underwent a retrograde ureteroscopic procedure over a 5 year period. We evaluated the success rate in accessing the ureter, causes of failure, and identify technical aspects which have aided the procedure. RESULTS: Twenty five procedures were performed in 17 patients. Mean age was 59 (28-90) years. Median time from ileal conduit diversion to ureteroscopy was 19.5 (0.5-53) years. Stone disease was the primary indication for intervention in the majority (n=11, 44%). Other indications included ureteric/uretero-ileal anastomotic stricture (n=6, 24%), upper tract tumour (n=2, 8%), unexplained haematuria (n=3, 12%), calcified retained ureteric stents (n=2, 8%), and change of stents (n=1, 4%). Retrograde loopogram was performed in 17 cases to clarify the orientation/ anatomy of the ileal loop. Initial inspection was undertaken using a flexible cytoscope to examine the loop and cannulate the ureteral openings. Subsequent flexible ureteroscopic manipulation was aided by use of a highstiffness guide-wire and ureteral multiple access sheath. Access to the ureters was achieved in 76% (19/25) of cases. A long and tortuous ileal loop was the only cause of failure to access the ureter (n=6). Of these 6 patients, 2 cases underwent simultaneous PCNL to clear renal stones; 1 stent calcification was treated within the ileal loop; 2 patients with haematuria had normal retrograde studies and no tumour was found on subsequent follow up; 1 patient with stricture disease was followed up symptomatically. All stones were cleared using laser lithotripsy. Stone free rate was 72.7% (8/11). A retrograde approach was combined with a PCNL in 24% (6/25) of cases. Post operative renal drainage when required (n=18) was achieved using a double J stent (n=10), 6Ch ureteric catheter (n=3) or nephrostomy tube (n=5). Post operative complications including temporarily pyrexia (3 cases) and urosepsis (2 cases). Median length of stay was 2 days (ureteroscopy with simultaneous PCNL) and 1 day (ureteroscopy without PCNL) (range 1-10 days) with the majority only staying overnight (48%). CONCLUSIONS: Retrograde ureteroscopy via an ileal loop is technically challenging, but a high success rate is achievable in experienced centres, with access to standard endourology equipment. The main cause of failure is a long and tortuous ileal segment.

Publication Type: Journal: Conference Abstract

Source: EMBASE