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Neu S, Matta R, Locke JA, Troke N, Tadrous M, Saskin R, Rebullar K, Nam R, Herschorn S. Reply to "The Role of Metformin in Overactive Bladder: More Studies Are Warranted". Urology 2024; 186:146. [PMID: 38369198 DOI: 10.1016/j.urology.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 02/20/2024]
Affiliation(s)
- Sarah Neu
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Rano Matta
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer A Locke
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Mina Tadrous
- ICES, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Karla Rebullar
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robert Nam
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sender Herschorn
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Neu S, Matta R, Locke JA, Troke N, Tadrous M, Saskin R, Rebullar K, Nam R, Herschorn S. The Use of Metformin in Overactive Bladder: A Retrospective Nested Case-control, Population-based Analysis. Urology 2024; 183:70-77. [PMID: 37805050 DOI: 10.1016/j.urology.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To determine if metformin use is associated with a lower rate of overactive bladder (OAB) medication use. Metformin facilitates the proliferation and migration of stem cells, which have been shown to improve bladder overactivity in animal models. METHODS We conducted a retrospective nested case-control cohort study using population-based health-care administrative databases. Our cohort included patients with diabetes mellitus type 2 (DM2) ≥69years. Cases received a prescription for an OAB medication, matched with up to 4 controls based on age, sex, and DM2 diagnosis date. Exposure was a new prescription for metformin prior to receiving an OAB medication. Adjusted odds ratios were estimated using conditional logistic regression. Sensitivity analysis was done to assess the relationship between cumulative days' supply of metformin and use of OAB medications. RESULTS Within our cohort of 2,233,084 patients with DM2, there were 16,549 case subjects who received a prescription for an OAB medication, and 64,171 matched controls. We found a positive association between OAB medication use and metformin use (adjusted odds ratios=1.07, 95% CI=1.03-1.12). Summed days' supply of metformin was also associated with OAB medication use, except when summed metformin days was >2220. CONCLUSION Older patients with DM2 exposed to metformin had a slightly higher rate of OAB medication use, until 2220+ days' metformin supply, whereafter no association was found. This suggests no protective role for metformin in the prevention of OAB in this patient population.
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Affiliation(s)
- Sarah Neu
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Rano Matta
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer A Locke
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Mina Tadrous
- ICES, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Karla Rebullar
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robert Nam
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sender Herschorn
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Neu S, Locke JA, Rebullar K, Carr L, Herschorn S. Recurrent triamcinolone injections for the treatment of Hunner’s lesions in bladder pain syndrome. Journal of Clinical Urology 2022. [DOI: 10.1177/20514158221122521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine if periodic triamcinolone injections into Hunner’s lesion in patients with bladder pain syndrome (BPS) reduces the need for opioids and other pain treatments. Methods: This is a retrospective analysis of 28 patients receiving endoscopic injections of 0.5–1.0 cc of triamcinolone acetate into Hunner’s lesions between 2010 and 2018. Wilcoxon signed-rank test was used to compare pain regimens before and after injections. Results: Median age at first triamcinolone injection was 63 (IQR 54–73). Median number of injections/patient was 3 (IQR 2–5.5), at a mean of 8-month intervals (2–80). The median number of pain treatments prior to triamcinolone was 4 (0–13), and 25% of patients were using opioids. With one or more injections, 92.9% had improvement in pain symptoms. There was a significant decrease in number of pain treatments following triamcinolone injections (4.1 vs 0.8, p = 0.006). Fifty-seven percent managed with triamcinolone injections alone, with no other pain treatments. Of the seven patients using opioids, four discontinued opioids altogether. Conclusions: Repeat triamcinolone injections into Hunner’s lesions are associated with a significant reduction in the number of pain treatments used for BPS, with an associated decrease in opioid use. Level of evidence: 4
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Affiliation(s)
- Sarah Neu
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Jennifer A Locke
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Karla Rebullar
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Lesley Carr
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
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Rebullar K, O'Kelly F, Koyle MA, Kirsch A, Al-Kutbi R, Zu'bi F. A systematic review of outcomes of Deflux® treatment for vesicoureteral reflux following pediatric renal transplantation. J Pediatr Urol 2021; 17:589.e1-589.e6. [PMID: 34364813 DOI: 10.1016/j.jpurol.2021.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 06/26/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Vesicoureteral reflux (VUR) after renal transplant in the pediatric population may be associated with an increased incidence of urinary tract infection (UTIs) leading to increased morbidity, including graft dysfunction and graft loss. The non-orthotopic location of the transplanted ureter, and lack of submucosal tunnel may pose challenges in correcting the VUR using endoscopic injection techniques. Herein we report the results of a systematic review evaluating the outcomes of endoscopic treatment of VUR using Deflux® in this population. METHODS Pubmed and Embase databases were searched from October 2001 to April 2019. Full-text English articles involving patients less than 18 years old at the time of transplant, with a diagnosis of VUR post-transplantation, who underwent Deflux® treatment were included. Figure 1 outlines our PRISMA-compliant search strategy. RESULTS We found 6 eligible studies describing Deflux® treatment outcomes in 67 pediatric patients with post-transplant VUR where voiding cystourethrogram (VCUG) confirmed the diagnosis and resolution of VUR. The mean success rate was 36.8%. Ureteral obstruction occurred in 7/67 cases (10.4%). In all these 7 cases of obstruction, ureteric stenting was the initial management, but was only successful in 1 patient. Open ureteroneocystostomy (UNC) was performed in 4/7 cases, while 2/7 were managed expectantly (unknown outcomes). Persistent VUR with UTI despite Deflux® were reported in 20 out of 67 cases. Of these, 7 were managed with prophylactic antibiotics, and 13 with UNC. Success rates were consistently low for UNC after failed Deflux® in comparison to redo UNC in transplant ureters without prior injection. CONCLUSION Low success rates are seen following injection techniques for VUR after pediatric renal transplant. Although an appealing option, Deflux® may prove counterintuitive due to the high rate of obstruction and suboptimal results if open reimplantation is required. A multi-institutional prospective study with a larger population size may further elucidate these results.
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Affiliation(s)
- Karla Rebullar
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Fardod O'Kelly
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrew Kirsch
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Rusul Al-Kutbi
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Fadi Zu'bi
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Urology, Rambam Health Care Campus, Haifa, Israel; Department of Urology, The Nazareth Hospital EMMS, Nazareth, Israel.
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Rebullar K, Hemminki O, Skeldon S, Semotiuk K, Aronson M, Kuk C, Lajkosz K, Gallinger S, Cohen Z, Zlotta A. Risk of genitourinary malignancies in Lynch syndrome patients with DNA mismatch repair gene mutations in a large Canadian Familial Registry. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01104-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ramogida CF, Pan J, Ferreira CL, Patrick BO, Rebullar K, Yapp DTT, Lin KS, Adam MJ, Orvig C. Nitroimidazole-Containing H2dedpa and H2CHXdedpa Derivatives as Potential PET Imaging Agents of Hypoxia with (68)Ga. Inorg Chem 2015; 54:4953-65. [PMID: 25928800 DOI: 10.1021/acs.inorgchem.5b00554] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
(68)Ga is an attractive radiometal for use in positron emission tomography (PET) imaging. The success of (68)Ga-based agents is dependent on a chelator that exhibits rapid radiometal incorporation, and strong kinetic inertness to prevent transchelation of (68)Ga in vivo. The linear chelating agents H2dedpa (1,2-[[6-carboxypyridin-2-yl]methylamino]ethane) and H2CHXdedpa (CHX = cyclohexyl/cyclohexane) (N4O2) have recently been developed that bind Ga(3+) quickly and under mild conditions, ideal properties to be incorporated into a (68)Ga PET imaging agent. Herein, nitroimidazole (NI) derivatives of H2dedpa and H2CHXdedpa to investigate specific targeting of hypoxic tumor cells are investigated, given that NI can be reduced and retained exclusively in hypoxic cells. Nine N,N'-bis-alkylated derivatives of H2dedpa and H2CHXdedpa have been synthesized; they have been screened for their ability to bind gallium, and cyclic voltammetry of nonradioactive complexes was performed to probe the redox cycling mechanism of NI. The compounds were radiolabeled with (67)Ga and (68)Ga and show promising radiolabeling efficiencies (>99%) when labeled at 10(-5) M for 10 min at room temperature. Moreover, stability studies (via apo-transferrin challenge, 37 °C) show that the (67)Ga complexes exhibit exceptional stability (86-99% intact) after 2 h. In vitro uptake studies under hypoxic (0.5% O2) and normoxic (21% O2) conditions in three cancerous cell lines [HT-29 (colon), LCC6(HER-2) (breast), and CHO (Chinese hamster ovarian)] were performed. Of the four H2dedpa or H2CHXdedpa NI derivatives tested, all showed preferential uptake in hypoxic cells compared to normoxic cells with hypoxic/normoxic ratios as high as 7.9 ± 2.7 after 120 min. The results suggest that these novel bis-alkylated NI-containing H2dedpa and H2CHXdedpa ligands would be ideal candidates for further testing in vivo for PET imaging of hypoxia with (68)Ga.
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Affiliation(s)
- Caterina F Ramogida
- †Medicinal Inorganic Chemistry Group, Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, British Columbia V6T 1Z1, Canada.,‡TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - Jinhe Pan
- §BC Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Cara L Ferreira
- ∥Nordion, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - Brian O Patrick
- †Medicinal Inorganic Chemistry Group, Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, British Columbia V6T 1Z1, Canada
| | - Karla Rebullar
- †Medicinal Inorganic Chemistry Group, Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, British Columbia V6T 1Z1, Canada
| | - Donald T T Yapp
- §BC Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Kuo-Shyan Lin
- §BC Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Michael J Adam
- ‡TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - Chris Orvig
- †Medicinal Inorganic Chemistry Group, Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, British Columbia V6T 1Z1, Canada
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