Intradetrusor injection of botulinum toxin A (BTX-A) is an effective option in the management of patients with neurogenic detrusor overactivity (NDO) who do not respond to or tolerate oral pharmacologic agents. There is level I evidence that intradetrusor injection of onabotulinumtoxinA for the treatment of refractory NDO in patients with multiple sclerosis and spinal cord injury is associated with a significantly greater achievement of patients' goals and improved performance in urodynamic studies than results with placebo. Only pilot studies or small case series support the use of BTX-A for NDO in patients with Parkinson's disease (PD) and cerebrovascular accident (CVA). BTX-A seems to be effective in children with myelomeningocele (MMC) but this statement is not supported by high level of evidence.
Adults with CGUA desire more sexuality and fertility education, yet they are uncomfortable completing current questionnaires. Our sexuality and fertility questionnaires are too challenging for this patient population to complete despite assistance. Thus, modifications are urgently needed. Additionally, medical providers should discuss sexual and reproductive health with these patients earlier and in more detail.
Prostate cancer, according to the World Health Organization, is the second most common cause of cancer worldwide. With an estimated 1.1 million people affected by prostate cancer in 2012, composing 15% of all new cancer cases worldwide, this condition poses a significant burden of mortality and morbidity on society. Even though the burden of prostate cancer is present worldwide, there are disparities in mortality rates worldwide. While in Sub-Saharan Africa and Caribbean, the age-adjusted mortality rates are as high as 24 per 100,000, in Asia the age-adjusted mortality rates are as low 2.9 per 100,000. Specific countries in Sub-Saharan Africa like Uganda have a prostate cancer mortality rate as high as 38.8 per 100,000, which is close to the incidence rate of 48.2 per 100,000. Even though in the United Kingdom the incidence rate is much higher at 111.1 per 100,000, the mortality rate is comparable to that of Sub-Saharan Africa at 22.8 per 100,000. As demonstrated in this global review of prostate cancer, the age-adjusted incidence rate and mortality rate are closer together in Sub-Saharan Africa than in high income countries. Also, there are disparities in age-adjusted mortality rates of prostate cancer. There is plausibly a large gap in data on incidence and mortality rates of prostate cancer, leading to potential underreporting of incidence rates. There are also different awareness related gaps in developing and developed countries. Improved surveillance systems need to be established in order to improve early detection screening programs and prioritized interventions for evidence-based policy for prostate cancer in all countries.
Purpose Published data regarding intradetrusor injection of onabotulinumtoxinA in adults with congenital spinal dysraphism are scarce. In this study, we retrospectively investigated the outcomes of intradetrusor injection of onabotulinumtoxinA in this setting. Materials and Methods Billing codes were used to identify 149 patients who underwent onabotulinumtoxinA injection between 2012–2016 at our tertiary transitional urology clinic. Charts were then reviewed to identify patients with congenital spinal dysraphism. Results A total of 18 patients with the mean age of 20.76 (±3.03) years at the time of 1st onabotulinumtoxinA injection were identified. All patients had urinary incontinence. Urinary incontinence improved by injection of 200 or 300 U of onabotulinumtoxinA in 81.2% of patients and 63.6% of them became dry (p= 0.023). Mean glomerular filtration rate before and 13.3 (±9) months after treatment was 100.2 (±17.2) and 120.1 (±16.6) mL/min/1.73 m2 respectively (p= 0.41). Baseline hydronephrosis improved in 3 of 4 patients. Repeat urodynamic study after injection was done in 11 patients who did not clinically improve or who had loss of bladder compliance at baseline (29.3 Vs. 67.2 ml/cmH2O). Mean maximum cystometric capacity before and after injection was 310.1 and 380.2 mL (p= 0.045). Mean bladder compliance before and after treatment was 29.2 and 28.7 ml/cmH2O respectively (p= 0.48) in this high risk group. Conclusions Intradetrusor onabotulinumtoxinA injection may improve refractory urinary incontinence in selected adults with spinal dysraphism. However, despite improvement in maximum cystometric capacity, bladder compliance does not improve following therapy in patients who had loss of compliance at baseline.
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