Purpose-We determined the effectiveness of cystoscopic administration of botulinum-A toxin compared to placebo for the treatment of urinary incontinence in subjects with idiopathic overactive bladder.Materials and Methods-Subjects were recruited from the Division of Urogynecology at the University of Rochester. Inclusion criteria were overactive bladder refractory to anticholinergic medications, multiple daily incontinence episodes and a 24hour pad weight of 100 gm or greater. Subjects with low leak point pressures, increased post-void residual volume or neurological etiologies were excluded from study. Subjects were randomized to placebo or to 1 of 2 doses of botulinum-A toxin. The detrusor was injected at 8 to 10 sites above the trigone. Evaluations were performed at baseline, and at 3 and 6 weeks after injection, and included bladder diaries, pad weights, quality of life questionnaires and urodynamic studies.Results-A total of 22 subjects participated in stage 1 of this 2-stage study. We report on the outcomes of stage 1 of this study. Because stage 2 is still ongoing and investigators remain blind to the doses of botulinum-A toxin, the 2 botulinum-A toxin groups were combined for this report. There were no differences in mean baseline measurements between the 2 groups. Statistically significant improvements in daily incontinence episodes, pads changed per day and quality of life questionnaires were seen in the botulinum-A toxin group with no changes in the placebo group. No change in nocturia, daily voiding frequency, peak flow or detrusor pressure was seen in either group. Of 15 subjects 4 (26%) receiving botulinum-A toxin had a post-void residual volume of 200 cc or greater and 1 subject required intermittent catheterization. Four subjects experienced a urinary tract infection, 2 (13%) in the botulinum-A toxin group and 2 (28%) in the placebo group (not significant).Conclusions-Botulinum-A toxin can significantly reduce urge urinary incontinence due to overactive bladder at 6 weeks. However, there is a risk of urinary retention requiring selfcatheterization. The effects of botulinum-A toxin on striated muscle are well documented in the neurology and plastic surgery literature. [3][4][5][6][7][8] Several studies including a recent randomized, placebo controlled trial have shown that BTX is effective for neurogenic detrusor overactivity. 9-11 Recent uncontrolled case series have shown significant reductions in incontinence and improvement in urodynamic parameters in subjects with idiopathic OAB. [12][13][14][15][16] We describe the out comes of a randomized, double-blind, placebo controlled trial of BTX for the treatment of severe OAB. Keywords MATERIALS AND METHODSThis study was performed at the University of Rochester, Rochester, New York. The institutional review board approved this protocol and the trial was registered with the National Institutes of Health clinical trials website before study initiation. This study includes 2 stages, with stage 1 a 6-week randomized, placebo controlled trial and...

Although there are case reports regarding treatment of uterine arteriovenous malformations by embolization performed by interventional radiology, to our knowledge, the noninvasive long-term management of a uterine arteriovenous malformation has not been reported.

Prevention of meningococcal disease relies in part on the prompt treatment of household and other close contacts of cases. New York State requires that all meningococcal disease cases be reported within 24 hours of diagnosis to ensure that chemoprophylaxis is given to all exposed persons. The authors used a capture-recapture method to assess completeness of reporting of meningococcal disease in 1991 by comparing persons reported to the Department of Health surveillance system with patients listed in the New York State computerized hospital discharge data set who had a discharge diagnosis of meningococcal disease. Medical records of persons identified from the discharge data set were reviewed to verify the diagnosis of meningococcal disease, and timeliness of reporting was assessed by reviewing surveillance case reports. In 1991, 110 cases of meningococcal disease were reported to the Department of Health and 197 patients were identified from hospital discharge data, of which charts were reviewed for 179 (91%). Of the charts reviewed, 116 (65%) had confirmed or probable meningococcal disease, and 57 (32%) did not have the disease. Completeness of reporting to the notifiable disease surveillance system was estimated to be 93%, and 78% were reported within 2 days of diagnosis. Errors of physicians and medical records departments contributed to the misclassification of medical records. The authors conclude that notifiable disease surveillance for meningococcal disease is relatively complete, but there is a delay in reporting some cases. Frequent errors may make invalidated hospital discharge data unsuitable for communicable disease surveillance.

Botulinum-A toxin can significantly decrease urge urinary incontinence and improve quality of life for 3 months after injection. Additional studies are needed to determine ideal doses, dosing intervals, safety and cost-effectiveness of this therapy.