OBJECTIVE:To determine if using one 250 mL bottle of intravesical contrast followed by sterile saline alters interpretation of fluoroscopic images during fluoro-urodynamics.MATERIALS AND METHODS:Subjects were randomized to receive 250 mL of intravesical contrast followed by sterile saline until maximal cystometric capacity vs non-dilute intravesical contrast alone during fluoro-urodynamics. Interpreters, blinded to study group, graded images on an ordinal rank scale rating confidence in image interpretation. Primary endpoint was differences in image interpretation between the two groups using visual grading characteristics curves and contrast-to-noise ratios (CNR). Secondary endpoints were obtaining anthropometric data such as body mass index and waist circumference to determine predictors of CNR in a multivariate multiple regression analysis.RESULTS:26 subjects were randomized to receive dilute intravesical contrast and 22 non-dilute contrast; two subjects were unable to complete the study. There was no difference in baseline characteristics between the two groups. Visual grading characteristics demonstrated no difference in readability of the fluoroscopic images between groups and CNR was not statistically different between the two groups. No correlation was identified between CNR and waist circumference or body mass index.CONCLUSION:Interpretation of fluoro-urodynamic images and image quality was not altered with using of 250 mL of contrast followed by saline. Expert reviewers did not perceive a difference in their confidence to distinguish between the two groups. Fluoro-urodynamics can be reliably performed using only 250 mL of contrast without compromising the ability to read the fluoroscopic images.

INTRODUCTION Overactive bladder symptoms (OAB) affect 9-43% of women and are associated with underlying disorders, including pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The aim of this study is to identify urogynecological conditions associated with OAB symptoms. METHODS This prospective, institutional review board-approved study included women referred to a tertiary centre with lower urinary tract symptoms (LUTS). All women completed the self-administered OAB questionnaire (OABSS). Those with an OABSS ≥8, the cutoff, were considered to have OAB symptoms. Patients underwent a history and physical examination (including Baden-Walker prolapse grading and stress test), 24-hour voiding diary, pad test (for urinary incontinence), urinalysis, and uroflow with post-void residual volume. Patients were classified clinically into the following: idiopathic OAB, SUI, POP, bladder outlet obstruction (BOO) neurogenic bladder (NGB), recurrent urinary tract infection (UTI), and miscellaneous. RESULTS In total, 148 women met the inclusion criteria with a mean age of 67 years. Only 27% had no comorbid conditions and were considered idiopathic OAB. Associated urogynecological conditions included SUI in 37%, POP in 26%, miscellaneous conditions in 18%, recurrent UTI in 11%, NGB in 9%, and BOO in 8%. Some patients met criteria for more than one category, thus the total is greater than 100%. CONCLUSIONS In a tertiary care setting, a significant proportion of women with OAB symptoms have underlying conditions that may cause or contribute to their symptoms. Appropriate evaluation is desirable to enhance our understanding of the relationship of these conditions to the diagnosis, treatment, outcomes, and pathophysiology of OAB.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy III1 Apr 2017PD54-01 BRAIN ACTIVITY CHANGES ON FUNCTIONAL MAGNETIC RESONANCE IMAGING DURING SACRAL NERVE STIMULATION FOR OVERACTIVE BLADDER Bradley Gill, Javier Pizarro-Berdichevsky, Pallab Bhattacharyya, Brian Marks, Adrienne Quirouet, Sandip Vasavada, Stephen E Jones, and Howard B Goldman Bradley GillBradley Gill More articles by this author , Javier Pizarro-BerdichevskyJavier Pizarro-Berdichevsky More articles by this author , Pallab BhattacharyyaPallab Bhattacharyya More articles by this author , Brian MarksBrian Marks More articles by this author , Adrienne QuirouetAdrienne Quirouet More articles by this author , Sandip VasavadaSandip Vasavada More articles by this author , Stephen E JonesStephen E Jones More articles by this author , and Howard B GoldmanHoward B Goldman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2411AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sacral nerve stimulation(SNS) is used for refractory overactive bladder(OAB). Its mechanism of action is unknown, but likely involves spinal reflexes and afferent signaling to the brain. This study used functional magnetic resonance imaging(fMRI) to measure real-time SNS effects on brain activity in OAB. METHODS Following IRB approval, women with non-neurogenic refractory OAB who responded to SNS via InterStim II device, had a stable program for 3 or more months, and received no adjuvant OAB treatment were recruited. Enrolled patients completed pre-fMRI validated symptom and quality of life instruments[UDI-6, IIQ-7, PGI-S, Perceived Urgency Intensity(PUI)]. Stimulus settings were recorded, devices switched off for a 5-day washout, and instruments repeated. Three fMRI scans below, at, and above stimulus sensory threshold were done. Images were 2-dimensional gradient echo-planar imaging blood oxygenation level dependent contrast(EPI-BOLD) acquired over 5 stimulator-off and 4 on cycles of 42 seconds each. Output images use single voxel p-value 0.05 with false positive error of 0.05 (cluster-analysis determined). RESULTS A total 13 patients were enrolled (3 did not undergo fMRI, 4 were excluded for poor OAB symptom control or low image quality), 6 completed fMRI. The sample had a median age 52[36-64] years. Urinary bother significantly worsened with ‘washout' while symptoms worsened with a trend toward significance. Voiding diary data supported this. An overall pattern of brain activation generally progressed with increasing stimulation, but activation of the right inferior frontal gyrus remained stable, while deactivation of the pons and periacqueductal gray matter was only noted with sub-sensory stimulation. Sensory stimulation activated the insula but deactivated the medial and superior parietal lobes. Suprasensory stimulation activated multiple structures and the expected S3 sensory region. All devices had normal impedances after fMRI and PUI(p0.36) nor PGI-S(p0.36) changed from baseline. CONCLUSIONS Varying SNS stimulus influences fMRI signal intensity. These results suggest sacral nerve stimulation may have a centrally-mediated mechanism of action. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1045 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Bradley Gill More articles by this author Javier Pizarro-Berdichevsky More articles by this author Pallab Bhattacharyya More articles by this author Brian Marks More articles by this author Adrienne Quirouet More articles by this author Sandip Vasavada More articles by this author Stephen E Jones More articles by this author Howard B Goldman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Videourodynamics combines fluoroscopic voiding cystourethrography with multichannel urodynamics to better evaluate lower urinary tract symptoms. This article reviews current literature and guidelines outlining the indications for obtaining this specialized study as well as technique. Appropriate and judicious use of fluoro-urodynamics lends to improved diagnostic acumen in a well-selected patient population; however, clinicians must be mindful of the added cost, safety concerns, and limitations of its use.

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamics Testing1 Apr 20132282 CONTRAST CONCENTRATION DOES NOT ALTER FLUORO-URODYNAMIC INTERPRETATION Brian Marks, Sandip Vasavada, and Howard B. Goldman Brian MarksBrian Marks Cleveland, OH More articles by this author , Sandip VasavadaSandip Vasavada Cleveland, OH More articles by this author , and Howard B. GoldmanHoward B. Goldman Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2211AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of urodynamic studies in routine evaluation of the urologic patient has increased in recent years and patients with more complex voiding dysfunction often require evaluation with fluoro-urodynamics (FUDS). Standardization of contrast concentration has not been established and understanding differences in outcomes is important for developing guidelines. METHODS In this IRB approved, double-blinded prospective study, patients were randomized to receive either full strength intravesical contrast for the entire study or contrast for the first 250 mL followed by sterile saline. Fellowship trained urologists graded images using an ordinal scale to rank their confidence in interpreting the visibility of the bladder silhouette, bladder neck, and urethra during filling and voiding. Inter-reader reliability was compared and responses were analyzed using Visual Grading Characteristics (VCG), a validated method of radiological image analysis. Contrast-to-noise ratios (CNR) were compared to biometric and urodynamic variables. RESULTS Fifty subjects were randomized, 27 subjects to dilute and 23 to non-dilute contrast with mean age 52. Mean maximum cystometric capacity (MCC) was 424 mL in the dilute group and 472 mL in the non-dilute group; 73% had volumes greater than 250 mL Agreement was found between raters. VCG analysis demonstrated no difference in image interpretability between dilute and non-dilute contrast groups for each criterion assessed. Interpreters were unable to consistently identify the study group and were correct in only 55% of cases. The mean CNR was 7.4 ± 6.0 and 4.6 ± 3.2 in the dilute contrast group during filling and voiding, respectively, compared to 7.9 ±4.7 and 5.4 ±4.0 in the non-dilute group; these differences were not significant (p > 0.05). CNR did not correlate to body mass index, waist circumference, or MCC. CONCLUSIONS Image quality did not deteriorate and interpretability of FUDS images was not altered with the use of dilute intravesical contrast. Interpreters could not distinguish between dilute and non-dilute contrast studies. Contrast concentration had limited impact on study interpretation and intravesical contrast is only necessary for the first 250 mL of filling during FUDS. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e936 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Marks Cleveland, OH More articles by this author Sandip Vasavada Cleveland, OH More articles by this author Howard B. Goldman Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

AimWe present the surgical management and outcomes of patients who underwent transvaginal neo‐bladder vaginal fistula (NBVF) repair at our institution.MethodsBetween 2002 and 2012, eight patients underwent transvaginal NBVF repair. The surgical management entailed placing a Foley catheter into the fistula tract. A circumferential incision was made around the fistula tract after which a plane between the serosa of the neobladder and the vaginal epithelium was created. Interrupted polyglycolic acid sutures were used to close the fistula. An additional layer of vaginal wall, Martius, or omental flap was interposed before vaginal wall closure. A urethral catheter was placed for a minimum of 14 days and removed after a negative cystogram and pelvic exam with retrograde neobladder filling without leakage.ResultsAll patients presented with a fistula following radical cystectomy with orthotopic ileal neobladder. Two patients had failed two prior transvaginal fistula repairs. A unilateral Martius flap was used in five patients and an omental flap was used in one patient. The surgery was successful in all patients. After a mean follow up of 33 months [4–117], five patients underwent or are waiting to undergo management of stress urinary incontinence with bulking agents. No patient had a recurrent fistula.ConclusionsManagement of NBVF is challenging but cure is possible using a transvaginal approach. Most patients will suffer from incontinence after the repair because of a short and incompetent urethra. Patients should be counseled about the high probability of requiring a secondary procedure to achieve continence. Neurourol. Urodynam. 35:90–94, 2016. © 2014 Wiley Periodicals, Inc.

The use of modern endoscopy for research purposes has greatly facilitated our understanding of gastrointestinal pathologies. In particular, experimental endoscopy has been highly useful for studies that require repeated assessments in a single laboratory animal, such as those evaluating mechanisms of chronic inflammatory bowel disease and the progression of colorectal cancer. However, the methods used across studies are highly variable. At least three endoscopic scoring systems have been published for murine colitis and published protocols for the assessment of colorectal tumors fail to address the presence of concomitant colonic inflammation. This study develops and validates a reproducible endoscopic scoring system that integrates evaluation of both inflammation and tumors simultaneously. This novel scoring system has three major components: 1) assessment of the extent and severity of colorectal inflammation (based on perianal findings, transparency of the wall, mucosal bleeding, and focal lesions), 2) quantitative recording of tumor lesions (grid map and bar graph), and 3) numerical sorting of clinical cases by their pathological and research relevance based on decimal units with assigned categories of observed lesions and endoscopic complications (decimal identifiers). The video and manuscript presented herein were prepared, following IACUC-approved protocols, to allow investigators to score their own experimental mice using a well-validated and highly reproducible endoscopic methodology, with the system option to differentiate distal from proximal endoscopic colitis (D-PECS).

Reports in the literature of high recurrence rates after native tissue repair for pelvic organ prolapse led to the development of alternative techniques, such as those using synthetic mesh. Transvaginal mesh (TVM) delivery systems were implemented in search of better outcomes. Despite reported recurrence as low as 7.1 % after posterior colporrhaphy, mesh kits were developed to correct posterior compartment prolapse. There is a paucity of data to substantiate better results with TVM for rectocele repair. Three randomized controlled trials comparing native tissue repair to synthetic mesh reported posterior compartment outcomes and two of these failed to show a significant difference between groups. Complications of TVM placement are not insignificant and mesh extrusion was reported in up to 16.9 %. Based on currently available data, native tissue repairs have similar outcomes to synthetic mesh without the risks inherent in mesh use and remain the standard of care for the typical patient.

Since the introduction of the synthetic midurethral sling, several transvaginal mesh delivery systems have been developed for treating stress incontinence and pelvic organ prolapse. Widespread use of these "kits" has introduced a new dilemma of mesh-specific complications that female pelvic surgeons must manage. Differing treatment techniques have been described and controversy exists as to which method is preferred for vaginal mesh extrusion, mesh perforations, pelvic pain, and dyspareunia. This article addresses the differing management strategies for mesh complications after reconstructive surgery and highlights the available literature on the success of each option.

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-Neurogenic Voiding Dysfunction I1 Apr 20101529 NOVEL NON-PEPTIDE PHARMACOLOGIC THERAPY FOR NOCTURIA IN MEN Mariam Imnadze, Jeffrey Weiss, Christopher Yea, Brian Marks, Hilary McElwaine-Johnn, and Mahendra Nathadwarawala Mariam ImnadzeMariam Imnadze Brooklyn, NY More articles by this author , Jeffrey WeissJeffrey Weiss Brooklyn, NY More articles by this author , Christopher YeaChristopher Yea Southampton, United Kingdom More articles by this author , Brian MarksBrian Marks Brooklyn, NY More articles by this author , Hilary McElwaine-JohnnHilary McElwaine-Johnn Southampton, United Kingdom More articles by this author , and Mahendra NathadwarawalaMahendra Nathadwarawala Plymouth, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1280AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This study reports the effects of a novel non-peptide drug, 1- [2 - methyl - 4 -(2,3,4,5 tetrahydro-1 -benzazepin-1 -ylcarbonyl) benzyl- carbamoyl] -L-prolineN,N-dimethylamide (VA106483), a selective vasopressin V2-receptor agonist, on urinary volume and osmolality in elderly males with nocturia. METHODS Twenty-seven subjects, mean age 69.4 years were randomized in this IEC approved, double-blinded, placebo controlled study conducted at a single center and subdivided into 3 cohorts, each consisting of 9 subjects. In each cohort, 3 subjects received VA106483 (2mg, 4mg or 8mg) and 6 subjects received placebo on the first night. On nights 2 through 8, subjects crossed over to receive the alternative treatment - 6 received VA106483 and 3 received placebo for 7 consecutive nights of repeated dosing. All subjects underwent pre-treatment water loading 2 hours before dosing at 0h on nights 1, 2 and 8. At designated time intervals, determination was made of serum electrolytes, urine osmolality and urine volume RESULTS The population mean age was 69.4 years (SD 3.5) with a mean BMI of 26.1 kg/m2(SD 2.8) At all doses, mean urine osmolality increased after drug administration in a dose-dependent fashion as compared with placebo (see figure). At all doses, diuresis decreased after drug administration compared to placebo. Response to the drug did not dissipate during continued dosing, and the change in urine osmolality and diuresis on night 8 did not statistically differ from that on night 2 for all doses. CONCLUSIONS VA106483 increased urine osmolality and reduced diuresis in all elderly men with a history of nocturia in the study, with an increasing duration of anti-diuresis corresponding to increased doses from 2 to 8 mg. The effect and duration of anti-diuresis remained constant after repeated doses. Clinical application of the drug in doses up to 4 mg predictably produce antidiuretic response to reduce the number of nocturnal voids. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e590 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Metrics Author Information Mariam Imnadze Brooklyn, NY More articles by this author Jeffrey Weiss Brooklyn, NY More articles by this author Christopher Yea Southampton, United Kingdom More articles by this author Brian Marks Brooklyn, NY More articles by this author Hilary McElwaine-Johnn Southampton, United Kingdom More articles by this author Mahendra Nathadwarawala Plymouth, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PURPOSE:We determined the differential diagnosis of concomitant pathological conditions in men with overactive bladder symptoms.MATERIALS AND METHODS:We performed an observational, descriptive study to elucidate the differential diagnosis in men with overactive bladder symptoms using a previously validated overactive bladder symptom questionnaire. All patients provided an extensive history, completed the self-administered questionnaire and a 24-hour voiding diary, and underwent physical examination, 24-hour pad test, uroflowmetry, post-void residual urine measurement, cystoscopy and urodynamics. Selection criteria were developed to assign cases to a category, including idiopathic overactive bladder, benign prostatic enlargement, benign prostatic obstruction, neurogenic bladder, bladder cancer, prostate cancer treatment complications, urethral stricture, bladder stones and bladder diverticulum.RESULTS:Of 122 men who met selection criteria for overactive bladder detrusor overactivity was identified in 99 (79%) on urodynamics. The differential diagnosis was benign prostatic enlargement in 40 men (32%), benign prostatic obstruction in 27 (22%), complications of prostate cancer treatment in 25 (20%), neurogenic bladder in 13 (11%), urethral stricture in 7 (6%), idiopathic overactive bladder in 6 (5%), bladder stone in 2 (2%), bladder cancer in 1 (1%) and bladder diverticulum in 1 (1%).CONCLUSIONS:Overactive bladder is a complex diagnosis with many underlying, contributing urological pathologies. It should be considered a symptom complex and not a syndrome. Knowledge of the differential diagnosis in men with overactive bladder symptoms would hopefully provide clinicians with a diagnostic rubric to more specifically treat such patients with improved success.

You have accessJournal of Urology1 Apr 2008PROSTATE BIOPSY IN MEN 75 AND OLDER: THE IMPACT OF PSA, DRE AND RACE ON HISTOLOGIC FINDINGS Ervin Teper, Andrew Seymour, Alexander Sokol, Brian Marks, Maureen Furnari, William Blank, Ivan Colon, Richard J Macchia, and Nicholas Karanikolas Ervin TeperErvin Teper More articles by this author , Andrew SeymourAndrew Seymour More articles by this author , Alexander SokolAlexander Sokol More articles by this author , Brian MarksBrian Marks More articles by this author , Maureen FurnariMaureen Furnari More articles by this author , William BlankWilliam Blank More articles by this author , Ivan ColonIvan Colon More articles by this author , Richard J MacchiaRichard J Macchia More articles by this author , and Nicholas KaranikolasNicholas Karanikolas More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)62078-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "PROSTATE BIOPSY IN MEN 75 AND OLDER: THE IMPACT OF PSA, DRE AND RACE ON HISTOLOGIC FINDINGS." The Journal of Urology, 179(4S), p. 713 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 713 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Ervin Teper More articles by this author Andrew Seymour More articles by this author Alexander Sokol More articles by this author Brian Marks More articles by this author Maureen Furnari More articles by this author William Blank More articles by this author Ivan Colon More articles by this author Richard J Macchia More articles by this author Nicholas Karanikolas More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of Urology1 Apr 2008DIFFERENTIAL DIAGNOSIS OF MEN WITH OVERACTIVE BLADDER SYMPTOMS Jerry G Blaivas, Jeffrey P Weiss, Chandra Somaroo, Ruhee K Sidhu, Brian Marks, and Courtney L Lee Jerry G BlaivasJerry G Blaivas More articles by this author , Jeffrey P WeissJeffrey P Weiss More articles by this author , Chandra SomarooChandra Somaroo More articles by this author , Ruhee K SidhuRuhee K Sidhu More articles by this author , Brian MarksBrian Marks More articles by this author , and Courtney L LeeCourtney L Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61552-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "DIFFERENTIAL DIAGNOSIS OF MEN WITH OVERACTIVE BLADDER SYMPTOMS." The Journal of Urology, 179(4S), pp. 527–528 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 527-528 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Jerry G Blaivas More articles by this author Jeffrey P Weiss More articles by this author Chandra Somaroo More articles by this author Ruhee K Sidhu More articles by this author Brian Marks More articles by this author Courtney L Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: We previously found that higher NADPH levels produced by glucose-6-phosphate dehydrogenase (G6PD) can enhance myocardial superoxide generation by NAD(P)H oxidase in a dog model of dilated cardiomyopathy. Therefore, we tested whether G6PD activity is elevated and enhances NADPH level and increases NAD(P)H oxidase-derived superoxide production in the myocardium from patients with heart failure from ischemic cardiomyopathy.Methods and Results: Surgical discards of left ventricle were collected from 8 congestive heart failure patients undergoing surgical ventricular restoration procedures, whereas control left ventricle tissue was obtained from 5 normal donor hearts deemed not suitable for transplantation. Biochemical assays were performed in tissue homogenates. We found that superoxide and hydrogen peroxide were elevated, respectively, by 9- and 3-fold in failing versus normal hearts (P <.05). The NAD(P)H oxidase inhibitors gp91(ds-tat), apocynin, and diphenyleneiodonium, significantly inhibited superoxide generation by approximately 75%, 89%, and 91%, respectively. Superoxide production by NAD(P)H oxidase increased 10- and 3-fold by adding NADPH (100 mu mol/L) and NADH (100 mu mol/L), respectively, in a DPI- and gp91(ds-tat) inhibitable manner. Interestingly, chelerythrine, a PKC inhibitor, and PP2, a Src kinase family inhibitor, reduced G6PD activity (0.29 +/- 0.04 nM - min - mg protein) by 50% and 51% and these inhibitors also decreased myocardial superoxide by 99% and 79%, respectively. Furthermore, 6-aminonicotinamide, a G6PD inhibitor, decreased myocardial superoxide production by 71%.Conclusions: These data suggest that high NAD(P)H oxidase, fueled by G6PD-derived NADPH, generates most of the superoxide in failing hearts of patients with ischemic cardiomyopathy. In addition, PKC-Src kinase signaling pathways seem to coordinate the activation of both G6PD and NAD(P)H oxidase in human cardiac muscle.