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Repeated detrusor botulinum neurotoxin type A injections for refractory neurogenic detrusor overactivity in patients with multiple sclerosis have a consistent effect on bladder control, resulting in sustained improvement in quality of life.

Intradetrusor botulinum neurotoxin type A injections for refractory idiopathic detrusor overactivity significantly improved quality of life. This effect was sustained after repeat injection. More than 2 of 5 patients with refractory idiopathic detrusor overactivity required clean intermittent self-catheterization after botulinum neurotoxin type A injections and all prospective patients should be informed about this.

The current developed curriculum demonstrates that integrating both technical and non-technical skills teaching is both educationally valuable and feasible. Additionally, the curriculum offers a validated simulation-based training modality within ureteroscopy and a framework for the development of other simulation-based programmes.

Objective: To conduct a systematic review and meta-analysis comparing outcomes between Open Radical Cystectomy (ORC), Laparoscopic Radical Cystectomy (LRC) and Robot-assisted Radical Cystectomy (RARC). RARC is to be compared to LRC and ORC and LRC compared to ORC. Material and methods: A systematic review of the literature was conducted, collating studies comparing RARC, LRC and ORC. Surgical and oncological outcome data were extracted and a meta-analysis was performed. Results: Twenty-four studies were selected with total of 2,104 cases analyzed. RARC had a longer operative time (OPT) compared to LRC with no statistical difference between length of stay (LOS) and estimated blood loss (EBL). RARC had a significantly shorter LOS, reduced EBL, lower complication rate and longer OPT compared to ORC. There were no significant differences regarding lymph node yield (LNY) and positive surgical margins (PSM.) LRC had a reduced EBL, shorter LOS and increased OPT compared to ORC. There was no significant difference regarding LNY. Conclusion: RARC is comparable to LRC with better surgical results than ORC. LRC has better surgical outcomes than ORC. With the unique technological features of the robotic surgical system and increasing trend of intra-corporeal reconstruction it is likely that RARC will become the surgical option of choice. SummaryNo conflict of interest declared. my (RARC) has since emerged as a viable alternative. RARC has been reported to be associated with fewer complications compared to LRC (2) and the appeal of the robotic surgical system has led to the adoption of the procedure worldwide. However the production of high-quality evidence that measures the relative merits of ORC, LRC and RARC is lacking with surgeons having to rely on systematic review. This article aims to compare surgical and oncological outcomes of ORC, LRC and RARC. METHODS Eligibility criteriaData were collected on all patients over the age of 60 with muscle-invasive bladder cancer undergoing RARC, LRC or ORC. Surgical outcomes were; operative time (OPT), estimated blood loss (EBL), length of stay (LOS) and complication rate 90 days post-operatively. Oncological outcomes were; lymph node yield (LNY) and positive surgical margins (PSM). Comparisons were made between RARC, LRC and ORC and the outcomes of interest measured included both surgical and oncological outcomes. The studies forming the current meta-analysis include comparative studies, either retrospective or prospective, as well as randomized control trials. For a study to be included in our analysis it had to fulfill the following criteria. The study had to: -Compare outcome measures of two or all three surgical techniques (ORC, LRC and RARC). -Use quantitative data for at least one outcome measure.-Be a high quality study.If it was one of two studies that were produced by the same institution, it was ensured the data were mutually exclusive. Studies were excluded if they: -Lacked reporting of the desired outcome measures listed above or presented the data in such a way that...

The cause of urinary retention may remain unknown in spite of extensive investigations. Young women regularly using prescription opiates for various undiagnosed pain syndromes present a challenging clinical problem and this study suggests that iatrogenic causes should be considered if voiding difficulties emerge. An association between opiate use and constipation is well-known and, although urinary retention is a listed adverse event, it appears to be often overlooked in clinical practice. It is hypothesized that Fowler's syndrome is due to an up-regulation of spinal cord enkephalins and that exogenous opiates may compound any functional abnormalities predisposing young women to urinary retention.

ObjectivesTo assess the efficacy (defined as improvements in maximum urinary flow rate [Q max ] of ≥50%, post-void residual urine volume [PVR] and scores on the International Prostate Symptom Score [IPSS] questionnaire) and safety of urethral sphincter injections of onabotulinumtoxinA in women with a primary disorder of urethral sphincter relaxation, characterised by an elevated urethral pressure profile (UPP) and specific findings at urethral sphincter electromyography (EMG), i.e. Fowler's syndrome. Patients and MethodsIn this open-label pilot Institutional Review Board-approved study, 10 women with a primary disorder of urethral sphincter relaxation (elevated UPP, sphincter volume, and abnormal EMG) presenting with obstructed voiding (five) or in complete urinary retention (five) were recruited from a single tertiary referral centre. Baseline symptoms were assessed using the IPSS, and Q max and PVR were measured. After 2% lidocaine injection, 100 U of onabotulinumtoxinA was injected into the striated urethral sphincter, divided on either side, under EMG guidance. Patients were reviewed at 1, 4 and 10 weeks after injection, and assessed using the IPSS, Q max and PVR measurements. The UPP was repeated at week 4. ResultsThe mean (range) patient age was 40 (25-65) years, and the mean symptom scores on the IPSS improved from 25.6 to 14.1, and the mean 'bother' score reduced from 6.1 to 3.5 at week 10. As compared with a baseline mean Q max of 8.12 mL/s in the women who could void, the Q max improved to 15.8 mL/s at week 10. Four of the five women in complete retention could void spontaneously, with a mean Q max of 14.3 mL/s at week 10. The mean PVR decreased from 260 to 89 mL and the mean static UPP improved from 113 cmH 2 O at baseline to 90 cmH 2 O. No serious side-effects were reported. Three women with a history of recurrent urinary tract infections developed a urinary tract infection. There were no reports of stress urinary incontinence. Seven of the 10 women opted to return for repeat injections. ConclusionsThis pilot study shows an improvement in patient-reported lower urinary tract symptoms, and the objective parameters of Q max , PVR and UPP, at 10 weeks after urethral sphincter injections of onabotulinumtoxinA. No serious side-effects were reported. This treatment could represent a safe outpatient treatment for young women in retention due to a primary disorder of urethral sphincter relaxation. However, a larger study is required to confirm the findings of this pilot study.