Female Urology

San Diego-Treatment with the dual neurotransmitter reuptake inhibitor duloxetine (Yentreve) results in durable improvement in symptoms of stress urinary incontinence, according to a study of open-label transition from placebo to active therapy.

San Diego--Two large studies have arrived at very different conclusions about the value of routine urine cytology and cystoscopy for evaluating women presenting with irritative voiding symptoms.

An investigational testosterone transdermal patch (Intrinsa) increases sexual activity and desire and decreases personal distress in women with hypoactive sexual desire disorder, according to study results presented at the North American Menopause Society annual meeting.

San Diego-A newer bulking agent consisting of synthetic calcium hydroxylapatite compares favorably with traditional glutaraldehyde cross-linked bovine collagen as a treatment for type III stress urinary incontinence or intrinsic sphincteric deficiency, according to an interim analysis of data from an ongoing randomized trial of the two substances.

San Diego--In a comparison of sling materials for sacral colpopexy, polypropylene mesh met the challenge of solvent-dehydrated cadaveric fascia lata and demonstrated a statistically significant outcome advantage at 1 year, University of Louisville (KY) researchers reported.

Revisions have been made to the precautions and adverse reactions sections of the label for the bisphosphonate zoledronic acid (Zometa).

San Francisco--Urinary incontinence remains a common medical condition in older women, even in those who rate their health as "good" or "excellent." Nearly 12% of elderly women experience stress, urge, or other form of incontinence, according to findings from an analysis of the Health, Aging, and Body Composition study published in Obstetrics & Gynecology (2004; 104:301-7). The condition is more prevalent in Caucasian women than in African-Americans, the study found.

San Francisco--Urinary incontinence remains a common medical condition in older women, even in those who rate their health as "good" or "excellent." Nearly 12% of elderly women experience stress, urge, or other form of incontinence, according to findings from an analysis of the Health, Aging, and Body Composition study published in Obstetrics & Gynecology (2004; 104:301-7). The condition is more prevalent in Caucasian women than in African-Americans, the study found.

A 6-month course of androgen suppression therapy following radiation treatment for clinically localized prostate cancer confers survival benefits similar to those seen with longer courses of androgen blockade (>3 years), according to a recent study from Brigham and Women's Hospital and the Dana Farber Cancer Institute, Boston. The study also suggests that only partial blockade with a luteinizing hormone-releasing hormone (LHRH) agonist may be sufficient.

Tel Aviv, Israel--Twin pregnancy per se, with no trial of labor, increases the risk of postpartum stress urinary incontinence, according to a prospective study by obstetrician-gynecologists from Tel Aviv University, Israel.

Toronto--Patients who show evidence of rare non-motile sperm after undergoing vasectomy will eventually become azoospermic-marking vasectomy success. However, patient compliance post-vasectomy remains low, despite aggressive pre- and postoperative counseling, University of Toronto researchers report.

The majority of testicular tumors identified during the course of an infertility examination would not otherwise have been found at that stage, according to urologists from Tel Aviv University in Israel.

San Francisco--As a salvage for locally recurrent prostate cancer after failed radiation, targeted cryoablation of the prostate (TCAP) provides a "significantly better overall quality of life" than salvage radical prostatectomy, said Aaron E. Katz, MD, at the AUA annual meeting.

San Francisco--Once infection has been ruled out as a cause of a man's pelvic pain, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the diagnosis. Although a symptom and problem index is available to help clinicians and researchers follow the patient's progress, there is no objective test that helps clinch a diagnosis, define the extent of disease, or measure its progression or regression.

New Orleans--Data from a randomized clinical trial show that long-term treatment with the bisphosphonate agent zoledronic acid (Zometa) halved the rate of skeletal events in patients with advanced prostate cancer and bone metastases.

Dextranomer/hyaluronic acid has the potential to lower the cost and also the morbidity of repeated voiding cystourethrograms in children.

Among the important research on male infertility presented at the 2004 AUA annual meeting, a new vasoepididymostomy technique and findings about the impact of long-term varicoceles on pregnancy rates took center stage, said Craig S. Niederberger, MD, chief of andrology at the University of Illinois, Chicago. This research, as well as data questioning the value of two widely used prognostic measures, provided the most significant take-home points for practicing urologists, he said

Studies reported at the AUA annual meeting have provided some answers to important questions concerning the management of localized prostate cancer, according to Richard D. Williams, MD, professor and Rubin H. Flocks chair, department of urology, University of Iowa, Iowa City. Among the issues addressed were the usefulness of adjuvant radiation therapy, the value of extended lymph node dissection, outcomes achieved with minimally invasive treatment options, and who is best suited to perform robotic-assisted laparoscopic prostatectomy.

The use of stem cells to treat otherwise incurable or serious human disease remains a political "hot potato." One must remember, however, that the sources of embryonic and adult stem cells are distinctly different. The use of adult stem cells avoids all of the ethical and political criticism associated with the former's fetal etiology. While not totipotential, adult stem cells still have the advantage of prolonged proliferation, self-renewal, generation of more differentiated cells, maintenance of developmental potential, and proliferation in response to injury.

San Francisco--The microsurgical approach is an effective method for varicocele repair in adolescents and offers the advantages of lower rates of persistence, recurrence, and hydrocele formation than alternative methods, according to the findings of two independent studies presented at the AUA annual meeting.

San Francisco--Scientific and technical obstacles notwithstanding, stem cell transplantation has considerable potential for treatment of male infertility.

The goal of endoscopic intervention for vesicoureteral reflux should be the same as it is for open surgery-a 95% to 98% cure rate after one treatment with the option of excluding a postoperative voiding cystogram.

San Francisco--The tricyclic antidepressant amitriptyline (Elavil) is a safe and effective treatment for interstitial cystitis with significant benefits for reducing overall symptoms along with pain and urgency, according to the results of a German study.

Prostate cancer survivors are the second largest group of cancer survivors in the United States, following breast cancer survivors as the largest group, according to a report by the Centers for Disease Control and Prevention and the National Cancer Institute.

San Francisco--A commonly prescribed antibiotic and alpha-blocker appear to be ineffective in the treatment of men with moderate to severe chronic prostatitis/chronic pelvic pain syndrome of long duration. Results of a multicenter study found that both ciprofloxacin and tamsulosin-used primarily in the treatment of urinary tract infections and BPH, respectively-offered no significant benefit in the treatment of chronic prostatitis in patients who were heavily pretreated and had long-standing symptoms.

Sequential monotherapy yields poor results in CPPS

San Francisco--It doesn't matter whether fresh or frozen spermis used for in vitro fertilization, as both have equivalent outcomes interms of fertilization rates, embryo quality, and the chance of having atleast one live birth event, according to a Mayo Clinic study.

Las Vegas--Radical cystectomy has a different risk profile in women than men, a difference that should be addressed during preoperative patient counseling, say investigators at Stanford (CA) Medical Center.

The last few years have witnessed an enormous interest in androgen replacement therapy for late-onset hypogonadism-also known as "androgen deficiency in the aging male." As urologists, we frequently deal with sexual dysfunction and are seen as experienced on issues of prostate health.

Varicocele is a common clinical finding, present in approximately 15%of adult men. When the patient with a varicocele visits a urologist, itis often due to testicular discomfort or fertility-related concerns. Atthe 2003 meeting of the American Society for Reproductive Medicine, bothof these issues were addressed and are discussed in this issue of UrologyTimes.