Electrical stimulation is an underestimated asset in the treatment of urinary dysfunctions—unfortunately still unfamiliar to many urologists and with comparatively few people involved in this research area, being overshadowed by successful activities in other fields of urology. That been said, a plethora of interesting and important contributions have been published on a variety of technologies [1], but electrical stimulation in comparison with treatments like drugs and surgery is sparse in urology. The use of electro-medicine has been more prominent in other medical fields (for example, cardiology) and many highly rewarding experiences have been gained. A different recent example is research under way at the Karolinska Institute in Stockholm, in detail describing mechanisms for remission of gut inflammation resulting from n. vagus electrical stimulation, illustrating communications between nerves and the immune system [2]. In this context it may be relevant to mention some observations from our unit on effects on the lower urinary tract (LUT) of electrical stimulation made almost 40 years ago: In women with various forms of urinary incontinence treated by means of individually adjusted vaginal electrodes there was an effect on symptoms to various degrees in 90% of subjects and, even more remarkably, 45% of subjects were free of symptoms even when stimulation was interrupted, a phenomenon called reeducation [3]. In a case report on a quite different mode of electrical stimulation, implantation of electrodes into the conus medullaris because of the unusual state of persistent spinal shock, followed by subsequent chronic stimulation, another remarkable effect was observed; after several years of daily use of the stimulator the bladder state reverted into a reflex bladder, with no further need to use the electrical stimulator [4]. In quite a different population a limited part of patients treated with suprapubic transcutaneous electrical nerve stimulation owing to chronic interstitial cystitis became free of symptoms combined with loss of the distinctive clinical marks of the disease. Cases in question had suffered the typical features of bladder wall chronic inflammation, with decades of disease duration [5]. The described effects were unexpected and are still unexplored in detail. However, they indicate a unique potential of electrical stimulation to restore functions of LUT central neural pathways, among other things involving long term potentiation of synapses, and also inhibition of inflammatory responses following electrical stimulation. There is an underused potential for these techniques in urology. Unfortunately, just a few urology applications of electrostimulation have matured into general use progress requiring continuous technical and commercial efforts and support. The technique of sacral root neuromodulation pioneered by Tanagho and Schmidt [6] is one exception, has multiple users, and is constantly improving; now working quite well in centers with well-organized routines [7]. Considering the unique potentials of patient benefit these techniques should be more widespread. Limitations are the learning curve, sometimes vague indications and that volumes of patients per center have to be sufficient to maintain good technical skills as well as working routines. The present research group has to be congratulated [8]. Although they were in the beginning phase of the learning curve, and in spite of focusing on real problem cases with quite heterogenic causes, previously subjected to multiple treatment attempts, their results were favorable and, apart from two device infections, complications were mild. Their achievements have to be applauded, and the gain for their unfortunate group of patients is obvious. This treatment principle should be taken more seriously. Although not suited for every department, there should be a reasonable geographical spread of centers using these techniques, to make the methods accessible to a broader patient population. In the absence of more precise alternatives selection to neuromodulation is based on refractory symptoms and response to the percutaneous test. Multidisciplinary efforts are needed in the future, though: causally determined target diagnoses should be the preferred principle. Hopefully, by groups like the present author team networking and cooperating with other groups with investigating capacities specific diagnoses will be identified where electrical stimulation treatment can be selected as a first line treatment rather than as a last resort preceded by multiple trying and sometimes expensive treatment efforts.

Neurourology and UrodynamicsVolume 40, Issue 5 p. 1261-1261 LETTER TO THE EDITOR Comment on “Comparison of deep phenotyping features of UCPPS with and without Hunner lesion: A MAPP-II Research Network Study” by Lai et al., DOI:10.1002/nau.24623 Magnus Fall MD, PhD, Corresponding Author Magnus Fall MD, PhD magnus.fall@urology.gu.se orcid.org/0000-0002-7442-002X Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden Correspondence Magnus Fall MD, PhD, Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, SE-41345 Göteborg, Sweden. Email: magnus.fall@urology.gu.seSearch for more papers by this author Magnus Fall MD, PhD, Corresponding Author Magnus Fall MD, PhD magnus.fall@urology.gu.se orcid.org/0000-0002-7442-002X Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden Correspondence Magnus Fall MD, PhD, Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, SE-41345 Göteborg, Sweden. Email: magnus.fall@urology.gu.seSearch for more papers by this author First published: 16 May 2021 https://doi.org/10.1002/nau.24697Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume40, Issue5June 2021Pages 1261-1261 RelatedInformation

BJU InternationalVolume 126, Issue 5 p. 549-550 Comment Towards a new paradigm in bladder pain syndrome and interstitial cystitis Philip Hanno, Corresponding Author pmhanno@stanford.edu orcid.org/0000-0002-6597-9155 Department of Urology, Stanford University School of Medicine, Stanford, CA, USA Correspondence: Philip Hanno, Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Suite S-287, Grant Building, 2nd Floor, Stanford, CA 94305-5118, USA. e-mail: pmhanno@stanford.eduSearch for more papers by this authorMagnus Fall, Department of Urology, Institute of Clinical Sciences, Sahigrenska Academy at the University of Gothenburg, Göteborg, SwedenSearch for more papers by this authorJane Meijlink, International Painful Bladder Foundation, Naarden, the NetherlandsSearch for more papers by this authorJørgen Nordling, Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, DenmarkSearch for more papers by this author Philip Hanno, Corresponding Author pmhanno@stanford.edu orcid.org/0000-0002-6597-9155 Department of Urology, Stanford University School of Medicine, Stanford, CA, USA Correspondence: Philip Hanno, Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Suite S-287, Grant Building, 2nd Floor, Stanford, CA 94305-5118, USA. e-mail: pmhanno@stanford.eduSearch for more papers by this authorMagnus Fall, Department of Urology, Institute of Clinical Sciences, Sahigrenska Academy at the University of Gothenburg, Göteborg, SwedenSearch for more papers by this authorJane Meijlink, International Painful Bladder Foundation, Naarden, the NetherlandsSearch for more papers by this authorJørgen Nordling, Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, DenmarkSearch for more papers by this author First published: 01 September 2020 https://doi.org/10.1111/bju.15223Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume126, Issue5November 2020Pages 549-550 RelatedInformation

Objectives: There is confusion about the terms of bladder pain syndrome (BPS) and Interstitial Cystitis (IC). The European Society for the Study of IC (ESSIC) classified these according to objective findings [9]. One phenotype, Hunner lesion disease (HLD or ESSIC 3C) differs markedly from other presentations. Therefore, the question was raised as to whether this is a separate condition or BPS subtype. Methods: An evaluation was made to explore if HLD differs from other BPS presentations regarding symptomatology, physical examination findings, laboratory tests, endoscopy, histopathology, natural history, epidemiology, prognosis and treatment outcomes. Results: Cystoscopy is the method of choice to identify Hunner lesions, histopathology the method to confirm it. You cannot distinguish between main forms of BPS by means of symptoms, physical examination or laboratory tests. Epidemiologic data are incomplete. HLD seems relatively uncommon, although more frequent in older patients than non-HLD. No indication has been presented of BPS and HLD as a continuum of conditions, one developing into the other. Conclusions: A paradigm shift in the understanding of BPS/IC is urgent. A highly topical issue is to separate HLD and BPS: treatment results and prognoses differ substantially. Since historically, IC was tantamount to Hunner lesions and interstitial inflammation in the bladder wall, still, a valid definition, the term IC should preferably be reserved for HLD patients. BPS is a symptom syndrome without specific objective findings and should be used for other patients fulfilling the ESSIC definitions.

Neurourology and UrodynamicsVolume 40, Issue 1 p. 560-560 LETTER TO THE EDITOR Comment on “Presenting an Atlas of Hunner lesions in interstitial cystitis which can be identified with office cystoscopy” by Ronstrom and Lai, Neurourology and Urodynamics 2020;1-7. https://doi.org/10.1002/nau.24500 Magnus Fall MD, PhD, Corresponding Author Magnus Fall MD, PhD magnus.fall@urology.gu.se orcid.org/0000-0002-7442-002X Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden Correspondence: Magnus Fall, MD, PhD, Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, SE-41345 Göteborg, Sweden. Email: magnus.fall@urology.gu.seSearch for more papers by this author Magnus Fall MD, PhD, Corresponding Author Magnus Fall MD, PhD magnus.fall@urology.gu.se orcid.org/0000-0002-7442-002X Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden Correspondence: Magnus Fall, MD, PhD, Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, SE-41345 Göteborg, Sweden. Email: magnus.fall@urology.gu.seSearch for more papers by this author First published: 04 November 2020 https://doi.org/10.1002/nau.24569Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume40, Issue1January 2021Pages 560-560 RelatedInformation

Base Study: concepts and preliminary baseline descriptive statistics. Urology 1997; 49: 64–75. 63 Wennevik G, Meijlink J, Hanno P, Nordling J. The Role of Glomerulations in Bladder Pain Syndrome: a Review. J. Urol. 2016; 195: 19–25. 64 Greenberg E, Barnes R, Stewart S, Furnish T. Transurethral resection of Hunner’s ulcers. J. Urol. 1974; 111: 764–6. 65 Payne RA, O’Connor RC, Kressin M, Guralnick ML. Endoscopic ablation of hunner’s lesions in interstitial cystitis patients. Can. Urol. Assoc. J. 2009; 3: 473–7. 66 Rossberger J, Fall M, Jonsson O, Peeker R. Long-term results of reconstructive surgery in patients with bladder pain syndrome/interstitial cystitis: subtyping is imperative. Urology 2007; 70: 638–42. 67 Peters K, Jaeger C, Killinger K, Rosenberg B, Boura J. Cystectomy for ulcerative interstitial cystitis: sequelae and patients’ perceptions of improvement. Urology 2013; 82: 829–33. 68 Swamy S, Barcella DeIorio M, Gill K et al. Recalcitrant chronic bladder pain and recurrent cystitis but negative urinalysis: What should we do? Int. Urogynecol. J. 2018; 29: 1035–43. 69 Quaghebeur J, Wyndaele JJ, DeWatcher S. Pain areas and mechanosensitivity in patients with chronic pelvic pain syndrome: a controlled clinical investigation. Scand. J. Urol. 2017; 51: 414–9. 70 Aldenborg F, Fall M, Enerb€ack L. Proliferation and transepithelial migration of mucosal mast cells in interstitial cystitis. Immunology 1986; 58: 411–6. 71 Larsen M, Mortensen S, Nordling J, Horn T. Quantifying mast cells in bladder pain syndrome by immunohistochemical anzalysis. BJU Int. 2008; 102: 204–7. 72 Theoharides T, Kempuraj D, Tagen M, Conti P, Kalogeromitros D. Differential release of mast cell mediators and the pathogenesis of inflammation. Immunol. Rev. 2007; 217: 65–78. 73 Peeker R, Aldenborg F, Fall M. Nephrogenic adenoma – a study with special reference to clinical presentation. Br. J. Urol. 1997; 80: 539–42.

OBJECTIVE:To investigate whether urinary levels of macrophage migration inhibitory factor (MIF) are elevated in interstitial cystitis/bladder pain syndrome (IC/BPS) patients with Hunner lesions and also whether urine MIF is elevated in other forms of inflammatory cystitis. METHODS:Urine samples were assayed for MIF by enzyme-linked immunosorbent assay. Urine samples from 3 female groups were examined: IC/BPS patients without (N = 55) and with Hunner lesions (N = 43), and non-IC/BPS patients (N = 100; control group; no history of IC/BPS; cancer or recent bacterial cystitis). Urine samples from 3 male groups were examined: patients with bacterial cystitis (N = 50), radiation cystitis (N = 18) and noncystitis patients (N = 119; control group; negative for bacterial cystitis). RESULTS:Urine MIF (mean MIF pg/mL ±  standard error of the mean) was increased in female IC/BPS patients with Hunner lesions (2159 ± 435.3) compared with IC/BPS patients without Hunner lesions (460 ± 114.5) or non-IC/BPS patients (414 ± 47.6). Receiver operating curve analyses showed that urine MIF levels discriminated between the 2 IC groups (area under the curve = 72%; confidence interval 61%-82%). Male patients with bacterial and radiation cystitis had elevated urine MIF levels (2839 ± 757.1 and 4404 ± 1548.1, respectively) compared with noncystitis patients (681 ± 75.2). CONCLUSION:Urine MIF is elevated in IC/BPS patients with Hunner lesions and also in patients with other bladder inflammatory and painful conditions. MIF may also serve as a noninvasive biomarker to select IC/BPS patients more accurately for endoscopic evaluation and possible anti-inflammatory treatment.

Vasculitis of the urinary bladder is rare and may represent a manifestation of systemic disease. Isolated vasculitis is even rarer, and at presentation may cause a diagnostic dilemma because of its...

OBJECTIVE:The aim of this study was to investigate whether protein expression of the extracellular matrix-degrading protease ADAMTS5 can be demonstrated in the urinary bladder of healthy rats, and, if so, to determine the localization of this enzyme.MATERIALS AND METHODS:The experiments were conducted with eight inbred male Sprague-Dawley rats. Immunohistochemistry was used to investigate the expression of ADAMTS5 in the urinary bladder. Negative controls were established by either excluding the primary antibody or applying the antibody after it had been preabsorbed with its immunogenic peptide. Confocal microscopy was used to visualize the distribution of ADAMTS5 in the urinary bladder tissue.RESULTS:Immunoreactivity for ADAMTS5 was demonstrated in the urothelium and in the detrusor. This expression was localized not only in the cytoplasm, but also in the nuclei. Confocal microscopy corroborated these findings.CONCLUSION:Expression of ADAMTS5 was demonstrated in the cytoplasm as well as in the nuclei of the urothelium and detrusor cells, suggesting that it may play a role at the transcriptional level.

Chronic pelvic pain and dysfunction : , Chronic pelvic pain and dysfunction : , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی

La grande difficulté de la lutte antituberculeuse à travers le monde demeure la disponibilité de moyens de diagnostic rapide, sensible et spécifique surtout pour les pays en voie de développement et à forte prévalence de tuberculose. Une nouvelle méthode de diagnostic rapide, le GeneXpert MTB/RIF, basée sur une PCR à temps réel offre une meilleure alternative par rapport à la microscopie qui a une faible sensibilité et à la culture qui est longue.

Objectives: The purpose of this study carried out at a department of pediatric surgery in Senegal, West Africa, was to evaluate the epidemiological, clinical and therapeutic aspects of cryptorchidism.Patients and Methods: This retrospective study included 123 cases of cryptorchidism seen at the Department of Paediatric Surgery of Aristide Le Dantec University Hospital, Dakar, Senegal between May 1st, 2000 and April 30th, 2008. The parameters studied were the prevalence of cryptorchidism compared to other pathologies of the inguinal canal, the patients' age, the reasons for consultation, the results of physical examination, the operative outcome, the duration of hospitalization and the results, in particular the cosmetic and morphological results, on follow-up.Results: Cryptorchidism was the third most frequent congenital defect after inguinal hernia (1537 cases) and hydrocele (327 cases). The age of our patients ranged from 17 days to 15 years with a mean age of 5.7 years. Scrotal emptiness seen in 105 (84.5%) patients was the main reason for consultation. Bilateral cryptorchidism was found in 9.5% of the cases, while it was on the right side in 62% and on the left in 28.5%. The testis was palpable in only 34.5% of the patients. On surgical exploration, the testicle was found to be located in the inguinal canal in 93.43% and in the abdomen in 2.5%. A hernia sac was found in 84.7% of the cases. The connection between the testis and the epididymis was poor in 43.1% of the cases. Dartos pouch fixation was possible in 97.5% of cases. The mean duration of hospitalization was 14.5 hours. The postoperative course was uneventful in 87.8% of the cases. Complications were encountered in 11 patients and included suppuration in 5, as well as hematoma of the spermatic cord, testicular atrophy and recurrence in 2 patients each.Conclusion: In our context, cryptorchidism is seen at a relatively late age. In such cases, immediate intervention is necessary as there may be possible dysphasic lesions warranting continued monitoring until puberty when a spermogram can be done. (C) 2015 Pan African Urological Surgeons' Association. Production and hosting by Elsevier B.V. All rights reserved.

When first recognized, more than one hundred years ago, the term interstitial cystitis (IC) was reserved for subjects with a special type of deep inflammation of the bladder wall. Later, the scope of IC widened, including all kinds of bladder pain syndromes (BPS), giving rise to a lot of confusion and difficulties in research as well as in clinical practice. Herein, recent progress in the understanding of the BPS/IC complex will be discussed, emphasizing the fact that the classic Hunner disease (BPS type 3C according to the European Society for the Study of Interstitial Cystitis (ESSIC) classification) is a well-defined condition that fulfills the requirements of the denomination interstitial cystitis. The paper will also discuss recent research on diagnostics, markers, genetics, and various types of remedies for classic IC. For the benefit of our patients, in BPS/IC, it is time for a final separation of the concepts BPS and IC. Classic IC is a well-defined entity with multiple unique characteristics, those characteristics having a potential for development of a specific rational, pharmacological, and surgical treatment algorithm if further investigated. BPS, on the other hand, seems to include a heterogenic composition of conditions calling for broad attempts to be more closely explored.

Interstitial cystitis (IC) is a chronic disease of as yet unknown etiology. It commonly affects females, presenting with symptoms of pain on bladder filling, and urinary frequency. Accumulated evidence indicates that IC is a heterogeneous syndrome. Compared to classic IC, the non-ulcer type appears different concerning symptomatic, endoscopic and histological findings, as well as the response to various forms of treatment. This review gives an introduction to the syndrome of IC, concerning epidemiology, clinical characteristics, diagnostic criteria and etiological considerations. A variety of treatment modalities have been suggested and are assessed and reviewed, such as hydrodistension of the bladder, intravesical instillation therapy, oral medication, transcutaneous electrical nerve stimulation, transurethral resection of diseased bladder tissue, and supratrigonal cystectomy followed by enterocystoplasty and urinary diversion. Our algorithm on non-surgical and surgical treatment for classic and non-ulcer IC is presented.