Urethral sphincter botulinum-A toxin injection could be considered a reliable treatment modality in children with nonneurogenic neurogenic bladder after the failure of conservative therapy.

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ObjectiveTo compare the safety and efficacy of bipolar vs monopolar transurethral resection of bladder tumour (TURBT) in patients maintained on low-dose aspirin with tumours >3 cm.Patients and methodsA prospective randomised single-centre study was performed including 200 patients with bladder tumours of >3 cm, as measured by ultrasonography. All patients were using low-dose aspirin (81 mg/day), which was not stopped in the perioperative period. Patients were randomised into two groups: Group A, monopolar TURBT (M-TURBT); Group B, bipolar TURBT (B-TURBT). The primary endpoint of the study was the decrease in postoperative haemoglobin (Hb) concentration measured using an automated cell counter. The secondary endpoints of the study were intraoperative blood transfusion or the occurrence of urethral trauma during cystoscopy and the need for re-coagulation.ResultsThe postoperative reduction in Hb concentration, was significantly lower in the B-TURBT group [mean (SD) 0.55 (0.26) g/dL] compared with the M-TURBT group [mean (SD) 1.24 (0.61) g/dL] (P < 0.001). There was also a significant difference (in favour of B-TURBT) between the groups in the mean postoperative reduction in haematocrit and the mean postoperative hospital stay. There was no significant difference between the groups for the occurrence of obturator jerk, bladder perforation, and the need for blood transfusion.ConclusionB-TURBT in patients maintained on low-dose aspirin is better than M-TURBT for minimising postoperative drop in Hb concentration.

Introduction: Currently bariatric surgery is the most effective treatment for significant and sustained weight loss. Erectile and endothelial dysfunctions may share some metabolic and vascular pathways in common that may be influenced by weight loss. Aim: The aim of the study was to assess the impact of surgically induced weight loss on the erectile function on obese patients undergoing laparoscopic sleeve gastrectomy (LSG). We also aimed to examine the proposed underlying mechanism associated with improvement in erectile function after weight loss by LSG. Methods: Eighty-two consecutive obese men who underwent a LGS were followed up for 12 months. All operations were performed by the same surgeon at a single institution. Main Outcome measure: Patients were examined both before and after 12 months of LSG for biochemical tests; total serum cholesterol, triglyceride, C-reactive protein, interleukin-6, and endothelial nitric oxide synthase, and for erectile function tests. International Index of Erectile Function (IIEF) scores were recorded. Results: Eighty-two men (mean age 39 ± 14.6 years, range 24e62; mean BMI 41.2 ± 4.8 kg/m 2 ) completed all preoperative and postoperative questionnaires and biochemical tests. At 12 months, the mean weight loss was 34.8 kg and the mean BMI decrease was 8.6 kg/m 2 . Preoperative and postoperative IIEF scores of the 65 sexually active patients showed significant improvement in erectile function (21.2 ± 5.7 vs 26.5 ± 4.5; P ¼ .02). Seventeen (20.7%) men were not sexually active preoperatively; only 5 became sexually active postoperatively. Men had a significant decrease in serum cholesterol and triglyceride levels. Nitric oxide synthase activity showed a significant increase (P < .02). In addition, our patients showed a statistically significant decrease in interleukin-6 levels and C-reactive protein compared with preoperative period (P < .03 and P < .01, respectively). Conclusion: A significant improvement of erectile function was documented among obese young men undergoing LGS. This improvement was documented both clinically by improvement in IIEF score postoperatively and biochemically.