No abstract

blood loss >500 mL in 16 (2.5%). Immediate complications after surgery were urinary retention (>24 h after) in 47 patients (19.7%), pelvic haematoma in four (1.9%) and suprapubic wound infection in one (0.4%). Of the 47 patients in retention, 32 were in retention for <48 h and treated with an indwelling catheter. The 15 remaining patients were treated with an indwelling catheter (one) or clean intermittent catheterization for a mean of 22 days. To correct the retention the TVT was released in seven patients and the tape sectioned in three. Late complications were de novo urgency, persistent suprapubic discomfort and intravaginal tape erosion in 36 (15%), 18 (7.5%) and one (0.4%) patient, respectively. Most of these complications resolved with observation and medical management, but intravaginal tape erosion required partial resection of the tape with closure and repair of the vaginal mucosa. CONCLUSIONSThe present TVT complication rates were slightly higher than reported previously. This multi-institutional review in both academic and community hospitals may better reflect the morbidity of TVT insertion in clinical practice. TVT is a highly effective, minimally invasive method for treating SUI. A stricter definition of each complication and a better understanding of the mechanism of these complications may further improve the surgical outcome and decrease patient morbidity. KEYWORDSurinary incontinence, stress, tension-free vaginal tape, complications, urinary retention, bladder injury OBJECTIVETo analyse the complications of tension-free vaginal tape (TVT) surgery, a minimally invasive alternative for treating patients with stress urinary incontinence (SUI), at six institutions, and to review the management of these complications and their effect on patient outcome. PATIENTS AND METHODSIn all, 241 patients who had a TVT procedure by six urologists at six hospitals (two university and four community) were reviewed retrospectively by the same urologist. Complications during and after surgery, and their management, were analysed.

Urethral duplication is a rare congenital anomaly with a variable clinical presentation. This pathological condition may easily be under diagnosed, especially in patients with other associated anomalies, such as hypospadias or bladder exstrophy. Surgical management should be planned individually according to the anatomical findings of the abnormality.

No abstract

MethodologyThe following guidelines were based on MEDLINE and PUBMED searches of English language literature, in addition to consensus conference proceedings. Levels of evidence and grades of recommendation were assigned for each investigation and treatment, as per the modified Oxford Centre for Evidence-Based Medicine grading system. Where the literature was inconsistent or scarce, a consensus expert opinion was generated to provide treatment guidelines.

diagnostic category from benign prostate tissue to HGPIN and PCA ( P ≤ 0.001). Furthermore, in 29 patients where all three tissues were available, PTEN genomic aberrations in PCA were significantly different from those in benign tissue ( P = 0.005) and HGPIN ( P = 0.02), reflecting the accumulation of genomic aberrations in the early stages of disease progression. Within this cohort, 71.4% of homozygous and 44.2% of hemizygous PTEN deletions occurred simultaneously with ERG rearrangements ( P ≈ 0). Stratified according to Gleason score (GS), hemizygous PTEN deletions across various GS groups were observed at a higher frequency than homozygous deletions. However, PTEN homozygous deletions showed positive trends with higher GS, increasing in poorly differentiated PCA (GS 8-10) in comparison to moderately and well differentiated tumours (GS 6 and 7). CONCLUSIONWe show significant association between ERG gene rearrangements and PTEN genomic aberrations in subset of PCA. Our analysis also provides further support for the observation that homozygous PTEN deletions can occur within the subset of HGPIN lesions, and shows accumulating genetic aberrations with disease progression, evidenced by higher detection in PCA than in HGPIN and more PTEN homozygous deletions in GS 8-10 than in 6-7. KEYWORDSERG rearrangements, PTEN , fluorescence insitu hybridization, high-grade prostatic intra-epithelial neoplasia, prostate cancer, Gleason score, disease progression What's known on the subject? and What does the study add? So far we know that ERG rearrangements and PTEN deletions interact to induce prostate cancer in transgenic mice. The study confirms that an association also exists between the two genetic aberrations in human prostate cancer, as there is increased incidence of PTEN deletions in cases with ERG rearrangements. OBJECTIVETo investigate the interaction between, and significance of, ERG gene rearrangements and PTEN genomic deletions in relation to the development and progression of prostate cancer (PCA). PATIENTS AND METHODSWe interrogated an initial cohort of 220 men with localized PCA using fluorescence in situ hybridization for ERG rearrangements and PTEN genomic deletions. RESULTSThe incidences of ERG rearrangements and PTEN deletions in PCA were significantly higher than in high-grade prostatic intraepithelial neoplasia (HGPIN) and benign prostate tissue ( P < 0.001). ERG rearrangements and PTEN deletions were detected in 41.9 and 42.6% of patients' tumours, respectively. ERG rearrangements were never detected in benign prostate tissue, while PTEN aberrations were present at a basal level of 4.6%. PTEN hemizygous deletions showed higher frequency than homozygous deletions within each

No abstract

In adults with antimuscarinic refractory neurogenic detrusor overactivity and multiple sclerosis onabotulinumtoxinA is well tolerated and provides clinically beneficial improvement for up to 9 months.