[Prediction of overactive bladder treatment outcome by using long-term urodynamics]

In Germany, overactive bladder (OAB) syndrome affects around 6.5 million people over the age of 40. The primary treatment consists of anticholinergics or beta-3-receptor agonists. After an anticholinergic treatment period of around 4 months, compliance is around 40%, which is probably due a larger proportion of nonresponders. One condition of an efficient medication treatment is the presence of detrusor overactivity (DO). However, the detection rate of DO during standard urodynamics is very low. The primary goal in the future is to target OAB treatment by detection of DO. Using the Wille Capsule (WiCa) in an in vitro model, DO could be detected over a time period of 72 h, which would ensure a higher compliance to the OAB treatment in a positive way.

[Is the validated ICIQ-SF suitable for evaluation of OAB patients? A data analysis of intravesicular botulinum toxin therapy]

BACKGROUND

The following data analysis studied the aspects of patient satisfaction following onabotulinum toxin A (BTX-A) treatment including modification of certain parameters, such as frequency of micturition and the use of pads and in particular, the applicability of the international consultation on incontinence questionnaire short form (ICIQ-SF) and the urgency perception scale (UPS) in patients with an overactive bladder (OAB).

PATIENTS AND METHOD

In this study 40 female patients were questioned in the form of validated questionnaires (extended ICIQ-SF and UPS) before and after being injected with 300 IU of BTX-A in each detrusor muscle. The average age of the patients was 66 years. All patients experienced anticholinergic refractory, non-neurogenic OAB.

RESULTS

The recommendation rate and related patient satisfaction was 82.5 %. A significant decrease in the frequency of micturition by 50.9 % (p < 0.01) was reported as well as a significant reduction in the use of pads by 66.7 % (p < 0.01). The average number of ICIQ-SF points could be significantly (p < 0.01) reduced via BTX-A from 15.9 to 7.3. Moreover, BTX-A demonstrated a significant improvement in the urgency to urinate, which was illustrated through the UPS.

CONCLUSION

Treatment with BTX-A achieves significant improvements in female patients with anticholinergic refractory OAB with regard to the individual symptoms of OAB (e.g. pollakisuria, nocturia, undesired urination and urgency). The use of the ICIQ-SF as the only questionnaire in OAB diagnostics proved to be unsuitable as it does not include female patients with dry OAB to an adequate degree. A combination of various validated questionnaires, such as ICIQ-SF and UPS, proved to be useful.

Generalized subcutaneous emphysema caused by injection of air into the penis for autoerotic purposes

The injection of air or water into the scrotum has been described only a few times so far in the literature. Injection of air into the penis and its consequences has not been described at all. Here, we present the case of a young man who, acting on his previously suppressed sexual fantasies, injected air into his penis and caused generalized subcutaneous emphysema.