Ureteric colic is a common presentation to acute emergency services. The gold standard test for the diagnosis of acute ureteric colic is a non-contrast computer tomography of the kidneys ureters and bladder (CT KUB). Non-steroidal anti-inflammatory drugs (NSAIDs) should be used as first-line analgesia, with studies showing that there is no role for steroid or phosphodiesterase-5 inhibitors. There is emerging evidence that a high body mass index (BMI) is a risk factor. The drugs used to facilitate stone passage are known as medical expulsive therapy (MET). The most evaluated being alpha-blockers. The Spontaneous Urinary Stone Passage Enabled by Drugs (SUSPEND) trial was designed to evaluate the use of MET (tamsulosin and nifedipine). This trial showed that there was no difference with MET and placebo for the spontaneous passage of ureteric stones. There is an emerging role for the use of primary ureteroscopy in the management of non-infective ureteric stones.
Nephron-sparing surgery (NSS) is the established treatment of choice for most T1 renal masses [1]. By contrast, a large and/or endophytic mass usually requires radical nephrectomy (RN) to reduce the risk of disappointing oncological outcomes. Yet, when a complex mass arises in a solitary kidney (SK) and partial nephrectomy (PN) is imperative, the oncological and the technical risks must be balanced against the benefits of avoiding dialysis. Complexity of renal tumours is best quantified by validated nephrometry scores, e.g. the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score [2]. A PADUA score of ≥10 is considered complex, typically indicating an endophytic, large (>7 cm), central tumour. For a complex mass in a SK open excision under cold ischaemic conditions is performed, as it can preserve renal function if prolonged ischaemia is anticipated (>30 min) [3].
The first reported application of Botulinum toxin-A (BTX-A) into the urethral sphincter predates the first documented use in the bladder. The aim of this review is to describe the clinical indications of BTX-A injection into the urethral sphincter and its clinical efficacy. This review of the literature includes the larger more significant published studies that have reported on this use of BTX-A. Case reports and articles not published in English were excluded. There have been many published clinical studies describing the use of BTX-A in the urethral sphincter, four of which are randomized placebo controlled trials. These studies tend to include patients either in urinary retention or with obstructed voiding, both in the neuropathic and non-neuropathic populations. Studies tend to demonstrate improvements in urodynamic parameters and quality of life after injection. There have been many small clinical studies in this area, however larger placebo-controlled trials are needed to evaluate this treatment at higher levels of evidence.
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