Faculty Bibliography

CASE: Xanthogranulomatous inflammation of the prostate is a rare condition that can cause lower urinary tract symptoms and may be mistaken for adenocarcinoma. It is often seen on prostate biopsy, but can usually be treated conservatively with temporary catheterization, alpha blockade, and allowing time for improvement. We present a case of a 78-year-old man found to have a 318 g prostate secondary to xanthogranulomatous inflammation. OUTCOME: After a negative MRI-guided biopsy to rule out malignancy, the patient was treated successfully with open suprapubic prostatectomy with significant improvement in voiding symptoms. CONCLUSION: This case highlights the ability of this clinical and pathologic entity to cause significant prostatic enlargement, how it is diagnosed, and the possible role of surgical therapy in its treatment.

Multiple sclerosis (MS) can be a debilitating neurological condition that attributes significant morbidity to bladder dysfunction. Although many effective treatment options exist, symptomatic patients are often underdiagnosed and undertreated. The purpose of this article is to give an overview of the current literature including new screening tools to identify symptomatic patients and updates on treatment options including medications, botulinum toxin, and neuromodulation.

Mixed urinary incontinence is estimated to affect 30% of all women who have urinary incontinence, and it has been shown to be more bothersome to women than pure stress incontinence. Given the degree of bother, many women will undergo surgical correction for incontinence. Patients have high expectations about the success of these interventions. Understanding mixed incontinence and the effects of our interventions can help guide therapeutic choices and manage patients' expectations.

Pelvic organ prolapse is a common condition for which age is a significant risk factor, making pelvic organ prolapse particularly prevalent in the elderly population. While not a life-threatening condition, pelvic organ prolapse can affect quality of life and impact daily activity with bothersome vaginal, urinary, bowel, and sexual symptoms. This review article addresses the management of symptomatic pelvic organ prolapse in the elderly population including evaluation, conservative and surgical approaches. Conservative management encompasses pelvic floor muscle training therapy and use of vaginal pessaries in addition to lifestyle modifications. Patients who have failed conservative management or desire definitive repair may be amenable to surgical intervention, comprising traditional and minimally invasive abdominal sacrocolpopexy, transvaginal repairs and obliterative procedures. Important pre-operative, intra-operative, and post-operative considerations unique to the elderly population are addressed as well

Benign multicystic mesothelioma (BMM) is a benign intra-abdominal lesion that generally occurs in women in their reproductive years. A urachal cyst occurs when the epithelial-lined urachal canal fails to completely obliterate. We report a case of a 38-year-old female presenting with abdominal pain found to have a lesion highly suspicious for a urachal cyst. On pathologic evaluation the lesion was identified as a BMM. This is the first report of BMM presenting as a lesion suspected to be a urachal cyst.

OBJECTIVE: To explain what role urinary urgency has on urinary frequency in patients with overactive bladder (OAB). MATERIALS AND METHODS: We prospectively enrolled 102 patients with OAB over a 6-week period. Patients were assessed with the OAB-q and a pilot questionnaire to identify which urinary symptoms were most bothersome and what underlying cause subjects attributed urinary frequency to. Associations between epidemiologic characteristics, OAB-q scores, and subject responses to the pilot questionnaire, were examined for statistical significance with the Pearson chi square test. RESULTS: The study population comprised 85% women and 15% men, with mean age 67.4 years and mean OAB-q score 54. Subjects reported their most bothersome symptom was: frequency 24.5%, urgency or urgency incontinence 48.0%, nocturia 27.5%. Of the patients most bothered by frequency, 64% identified the International Continence Society definition of urgency or "fear of leakage" as the underlying reason for their frequency. Overall, 82.4% and 48.0% of patients reported urgency or urgency incontinence as a symptom and most bothersome symptom respectively. However, when patients were specifically asked what drives their urinary frequency, these percentages increased to 89.2% and 63.7%. CONCLUSION: This pilot study confirms that urgency is a large factor underlying the drive to void frequently in OAB, even when patients do not admit to urgency as the most bothersome symptom.

PURPOSE: Many investigators have used number of pads to determine severity of post prostatectomy incontinence (PPI), yet the accuracy of this tool remains unproven. The aim of this study was to determine if patient's perception of pad use and urine loss reflects actual urine loss. We also sought to identify a quality of life (QoL) measure that distinguishes patients by severity of incontinence. MATERIALS AND METHODS: We prospectively enrolled 235 men from 18 sites >6 months after radical prostatectomy, with incontinence requiring protection. Patients completed a questionnaire about perception of number, size and wetness of pads and a QoL question, several standardized incontinence questionnaires, and a 24-hour pad test that assessed number, size, and weight of pads. SPSS was used for statistical analysis. RESULTS: Perception of number of pads used was in close agreement with number of pads collected during a 24-hour pad test. Perceived and actual pad size had excellent concordance (76%, p<0.001). Patients with "wet" and "soaked" pads had statistically, and clinically, significantly different pad weights uniquely different from each other, and from the "almost dry" and "slightly wet". The response to the QoL question separated men in to 4 statistically significantly different groups based on mean 24-hour pad weight. CONCLUSIONS: Patients accurately describe the number, size and the degree of wetness of pads collected during a 24-hour pad test. These correlate well with actual urine loss. The single question of "To what extent does urine loss affect your quality of life?" separated men into distinct categories.