Oral sildenafil is an effective, well-tolerated treatment for men with erectile dysfunction.

The autologous fascial sling results in a higher rate of successful treatment of stress incontinence but also greater morbidity than the Burch colposuspension. (ClinicalTrials.gov number, NCT00064662 [ClinicalTrials.gov] .).

Urethral obstruction produces increased voiding frequency (0.7±0.06 to 1.1±0.08 h-') and hypertrophy of the urinary bladder (89±1.7 to 708±40 mg) with profound increments in the dimensions of afferent (4, 6) and efferent neurons (299±4.7 to 573±8.6 gm2) supplying this organ in the rat. We discovered that hypertrophied bladders of rat and human contain significantly more nerve growth factor (NGF) per milligram wet weight, protein, and DNA than normal bladders. The temporal correlation between NGF content, neuronal hypertrophy, and bladder weight was consistent with a role for this growth factor in the neurotrophic effects associated with obstruction. Autoimmunity to NGF abolished the hypertrophy of NGF-sensitive bladder neurons in the pelvic ganglion after obstruction. Relief of urethral obstruction reduced bladder size (349±78 mg), but neuronal hypertrophy (460.2±10.2 Mm2) and elevated NGF levels were only partially reversed. Bladder hypertrophy (133±43 mg) induced by osmotic diuresis slightly increased ganglion cell area (365.2±6.1 gm2) and only doubled NGF content of the bladder. These findings provide important new evidence that parenchymal cells in the hypertrophied bladder can synthesize NGF and possibly other molecular messengers that act to alter the size and function of neurons in adult animals and man. (J.

A total of 93 patients with intractable spasticity due to either spinal cord injury (59 cases), multiple sclerosis (31 cases), or other spinal pathology (three cases) were entered into a randomized double-blind placebo-controlled screening protocol of intrathecal baclofen test injections. Of the 88 patients who responded to an intrathecal bolus of 50, 75, or 100 micrograms of baclofen, 75 underwent implantation of a programmable pump system for chronic therapy. Patients were followed for 5 to 41 months after surgery (mean 19 months). No deaths or new permanent neurological deficits occurred as a result of surgery or chronic intrathecal baclofen administration. Rigidity was reduced from a mean preoperative Ashworth scale score of 3.9 to a mean postoperative score of 1.7. Muscle spasms were reduced from a mean preoperative score of 3.1 (on a four-point scale) to a mean postoperative score of 1.0. Although the dose of intrathecal baclofen required to control spasticity increased with time, drug tolerance was not a limiting factor in this study. Only one patient withdrew from the study because of a late surgical complication (pump pocket infection). Another patient received an intrathecal baclofen overdose because of a human error in programming the pump. The results of this study indicate that intrathecal baclofen infusion can be safe and effective for the long-term treatment of intractable spasticity in patients with spinal cord injury or multiple sclerosis.

No abstract

Most epidemiologic studies of urine leakage in the United States report on women and White populations. In this study, the authors determined the prevalence of urine leakage across genders and racial/ethnic groups in a population-based sample of 5,506 adults aged 30-79 years and identified factors related to leakage within genders and racial/ethnic groups. The prevalence of weekly urine leakage was 8% overall, 10.4% in women, and 5.3% in men. White women (11.7%) were more likely than Black (9.4%) and Hispanic (7.3%) women to report weekly leakage and to report stress-type (35.4% vs. 9.4% and 14.5%, respectively) and urge-type (13.4% vs. 3.3% and 10.8%, respectively) leakage. Rates and leakage types for men did not vary by race/ethnicity. For women, central obesity, asthma, and arthritis increased the odds of weekly leakage. For men, the odds of leakage increased for Blacks and Whites at ages 50 and 60 years, respectively, and for Hispanics of higher social class. For both genders, various comorbid conditions, including heart disease, asthma, and depression, increased the odds of leakage in varying racial/ethnic groups. The authors conclude that types of and risk factors for urine leakage vary by gender and racial/ethnic group.

These data suggest a strong association between depression and idiopathic urinary incontinence. This link may be due to altered serotonin function and may help explain the efficacy of serotonergic based antidepressants in the treatment of urge incontinence.

The case is compelling for the involvement of nerve growth factor (NGF) in the pathogenesis of lower urinary tract disease, especially in conditions with altered neural function. Remodeling of the micturition pathways occurs following experimental bladder-outlet obstruction, denervation, spinal cord injury, cystitis, and diabetes mellitus. Clinically, NGF levels are elevated in the bladders of men with benign prostatic hyperplasia, women with interstitial cystitis and in patients with idiopathic overactive bladder. Blockade of NGF, using either an endogenous antibody or an antibody against the NGF receptor, prevents neural plasticity and bladder overactivity in experimental models of these conditions. The ability of NGF to trigger bladder overactivity might rely on altering the properties of sodium or potassium channels (or their expression) in bladder afferent fibers. Therapies based on altered NGF levels, or changes in channel properties in afferent nerves, represent an intriguing avenue of investigation for the management of detrusor overactivity or diabetic cystopathy.