This Month in Adult Urology

You have accessJournal of UrologyThis Month in Adult Urology1 Aug 2019This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000348AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail In contrast to encouraging results of a phase II study of a novel drug that targeted the SHIP1 pathway in women with interstitial cystitis/bladder pain syndrome, a followup multicenter, randomized, prospective trial of 298 patients by Nickel et al (page 301) showed no clinical benefit in terms of maximum daily bladder pain compared to placebo and no difference in secondary end points.1 An exploratory trial in men likewise failed to demonstrate clinical benefit. There is a strong publication bias against negative trials. They may not change clinical practice and do not garner as many citations as a positive trial. Nonetheless, there can be substantial merit in publishing a negative study. First of all, a negative study emphasizes the value of well-performed prospective trials to confirm or refute what may appear to be promising results in nonrandomized or even retrospective studies. Lessons learned, in this case about the inflammatory phenotype of interstitial cystitis/bladder pain syndrome, can be carried forward in treatment planning and in the development of new therapeutic options. Everyone wants to be part of a study that identifies an effective new treatment but learning what does not work can have equal value. Bone Fractures after Urinary Intestinal Diversion Although more often a clinical problem with orthotopic neobladders or continent diversion, acidosis is also observed in patients with ileal conduit diversion. Bone loss is a consequence of acidosis. Richard et al (page 319) from Canada analyzed the rate of bone fracture in a cohort of more than 5,000 patients who underwent intestinal urinary diversion compared to a matched control group.2 The rate of bone fracture in the diversion group was almost twofold greater and the time of fracture was significantly shorter. These data support treatment of acidosis in these patients but also monitoring of bone health. Bladder Cancer Diagnosis and Smoking Cessation The association of smoking with the occurrence of bladder cancer has been convincingly demonstrated. Physicians may inform patients with bladder cancer of this finding but often without enough emphasis that smoking cessation is the most valuable modifiable factor for tumor recurrence. Using the SEER (Surveillance, Epidemiology, and End Results) database, Winters et al (page 241) from Seattle, Washington report no difference in the rate of smoking cessation by smokers diagnosed with bladder cancer compared to matched controls without cancer.3 Obviously, the patient is the one who most determine how successful smoking cessation may be but the urologist can be a major influence in helping prompt a patient toward appropriate measures to overcome barriers that prevent success. Bladder Filling Rate and Voiding Behavior The impact of bladder filling rate on symptoms of overactive bladder (OAB) in women was tested in this prospective study by Redmond et al (page 326) from Ireland.4 The rate of bladder filling was an independent predictor of urgent voiding symptoms in patients with OAB but not in a matched control group. Patients with OAB had bladder symptoms at lower voided volume than the control group. This study seems to validate the advice sometimes given to women with OAB that spreading fluid intake throughout the day may reduce symptoms of frequency and urgency. Outpatient Visits for Urinary Incontinence in Older Women In this multicenter study Erekson et al (page 333) evaluated the records of 18,576 women from the Nurses’ Health Study who reported symptoms of incontinence and linked this information to Medicare utilization data.5 Only 16% of those reporting incontinence had an identifiable outpatient visit to address incontinence symptoms in the 2 years prior to the survey. It makes sense that incontinence severity was associated with a higher likelihood of a clinic visit as was urgency compared to stress incontinence. This information indicates that many patients with incontinence symptoms do not seek medical care for unknown reasons. However, since this was a study of nurses, it seems reasonable that most had access to care. African American Gene Panel Predictive of Poor Prostate Cancer Outcome That African American men (AAM) have more advanced prostate cancer at presentation and may have more aggressive tumors has been shown in many studies. The reasons for these findings are more elusive and a key question is how often genetics contribute. In this multicenter study Echevarria et al (page 247) evaluated 1,427 AAM and identified 3,047 genes that were differentially expressed based on the ETS transcription factor family fusion event status.6 Of the genes 362 were race specific, and 81 were race specific and overexpressed in AAM with biochemical recurrence. A final gene panel was associated with an increased risk of 5-year biochemical recurrence, and improved the accuracy of predictive clinical and pathological variables. The findings offer opportunity for the use of biomarkers that predict aggressive prostate cancer in AAM. Alpha Blocker and Risk of Dementia in Men with Benign Prostatic Hyperplasia Alpha1-adrenoreceptors are present in the brain, and an association between use of tamsulosin for symptoms of benign prostatic hyperplasia and dementia has been suggested, which has introduced a highly contested but important consideration. Using the Korean National Health Insurance Service database, Tae et al (page 362) from the Republic of Korea studied 59,263 men treated with various alpha blockers.7 Overall, there was no difference in the incidence of dementia between the drugs, and the risk was not increased for any compared to a no medication cohort. Septic Shock after Percutaneous Nephrolithotomy The systemic inflammatory response syndrome (SIRS) criteria have been used to predict the risk of postoperative infectious complications. More recently, the quick organ failure assessment quick score for sepsis (qSOFA) has been promoted as a more accurate predictor of sepsis and a need for placement in an intensive care unit. Yaghoubian et al (page 314) retrospectively evaluated 320 patients from various centers who underwent percutaneous nephrolithotomy.8 The specificity for postoperative sepsis was significantly higher for qSOFA vs SIRS (93.3% vs 68.4%, p <0.001) and the positive predictive value was 13% for qSOFA and 2.9% for SIRS. A positive qSOFA also significantly predicted an increase in the probability of an emergency department visit within 30 days, operative complications and transfusion. The authors conclude that qSOFA is a useful assessment that outperforms SIRS for percutaneous nephrolithotomy. Persistent Symptoms after Mid Urethral Sling Revision In this retrospective study Dray et al (page 339) from Ann Arbor, Michigan evaluated 430 women who underwent revision of a synthetic mid urethral sling.9 Mesh exposure or erosion, pain or dyspareunia, incontinence and bladder outlet obstruction were the most common presenting symptoms in 77% of patients. Symptoms resolved in 95% of those with erosion or mesh exposure and in 80% with obstruction. Pain resolved in 60% of patients postoperatively, and preoperative narcotic use was a predictor of persistent pain on multivariable analysis. Sleep Disturbance Worsens Lower Urinary Tract Symptoms Sleep disturbance and the presence of nocturia have a known association but the exact relationship between them is still a subject of debate. Fukunaga et al (page 354) from Japan analyzed 5,319 participants in the Nagahama study and found that 22% reported sleep disturbance at baseline and 23% had lower urinary tract symptoms.10 Sleep disturbance was more common in elderly and female participants as well as in those with lower mental health. There was a statistically significant (p <0.001) association with the presence of lower urinary tract symptoms and sleep disturbance. Deterioration of those symptoms during the study was further associated with sleep disturbance but only in women on multivariable analysis. References 1. : Targeting the SHIP1 pathway fails to show treatment benefit in interstitial cystitis/bladder pain syndrome: lessons learned from evaluating potentially effective therapies in this enigmatic syndrome. J Urol 2019; 202: 301. Link, Google Scholar 2. : Risk of bone fractures following urinary intestinal diversion: a population based study. J Urol 2019; 202: 319. Link, Google Scholar 3. : Does the diagnosis of bladder cancer lead to higher rates of smoking cessation? Findings from the Medicare Health Outcomes Survey. J Urol 2019; 202: 241. Link, Google Scholar 4. : The effect of bladder filling rate on the voiding behavior of patients with overactive bladder. J Urol 2019; 202: 326. Link, Google Scholar 5. : Outpatient evaluation and management visits for urinary incontinence in older women. J Urol 2019; 202: 333. Link, Google Scholar 6. : African American specific gene panel predictive of poor prostate cancer outcome. J Urol 2019; 202: 247. Link, Google Scholar 7. : α-Blocker and risk of dementia in patients with benign prostatic hyperplasia: a nationwide population based study using the National Health Insurance Service database. J Urol 2019; 202: 362. Link, Google Scholar 8. : Use of the quick sequential organ failure assessment score for prediction of intensive care unit admission due to septic shock after percutaneous nephrolithotomy: a multicenter study. J Urol 2019; 202: 314. Link, Google Scholar 9. : A retrospective analysis of surgical outcomes and risk factors for persistent postoperative symptoms following synthetic mid urethral sling revision. J Urol 2019; 202: 339. Link, Google Scholar 10. : Sleep disturbance worsens lower urinary tract symptoms: the Nagahama study. J Urol 2019: 202: 354. Link, Google Scholar © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 202Issue 2August 2019Page: 181-182 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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