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Objective To compare the safety and efficacy of trigone-including versus trigone-excluding intradetrusor injection of botulinum toxin A (BTX-A) for decreasing detrusor leak point pressure (DLPP) in patients with urinary incontinence (UI) secondary to spinal cord injury (SCI) in China. Methods A prospective, multicenter, single-blind and randomized controlled trial (RCT) was conducted between December 2012 and June 2015. Patients with UI and low compliance bladder secondary to SCI were recruited. At a 1:1 ratio, patients randomly received 200 U BTX-A intradetrusor injections excluding the trigone (control group) or 160 U intradetrusor and 40 U intratrigonal injections (experimental group). Patients were evaluated at baseline, and 4, 12 weeks after injection. The efficacy and safety outcomes included DLPP, detrusor leak point volume (LPV), I-QoL, voiding volume, UI episodes, complete dryness. Vesicoureteral reflux (VUR) and other adverse events were recorded. Results Eighty-six patients were recruited and 80 (41 in experimental group and 39 in the control group) of them completed the trial. There were no significant differences in baseline evaluation items (gender, age, duration of SCI, level of neurological injury, AIS scores) between the two groups. At 12 weeks, the improvement was significantly better in the experimental group than in the control group for DLPP (−25.66 vs. −19.70 cmH2O, P=0.02), DLPV (116.09 vs. 87.34 mL, P=0.03), I-QoL (27.02 vs. 20.32, P=0.02), mean UI episodes (−7.19/d vs. −6.65/d, P=0.01), complete dryness (22 vs. 10, P=0.01),mean voiding volume (142.84 vs. 110.36 mL, P=0.01). In both of two groups, no patients developed VUR. Conclusions Trigone-including intradetrusor injection of BTX-A are more effective than those excluding the trigone to decrease DLPP for patients with UI and poor compliant bladders secondary to SCI. It does not induce VUR.

Objective To evaluate the effect and safety of trigonal injection of botulinum toxin A (BTX-A) for patients with neurological detrusor overactivity (NDO) with incontinence. Methods A prospective, multicenter, single-blind and randomized controlled trial (RCT) was conducted between June 2011 and June 2014. Spinal cord injury patients with urinary incontinence secondary to NDO were recruited. At a 1:1 ratio, patients randomly received 200 U BTX-A intradetrusor injections excluding the trigone (control group) or 160 U intradetrusor and 40 U intratrigonal injections (experimental group). Patients were evaluated at baseline, and 4, 12 weeks after injection. The efficacy and safety outcomes included I-QoL, voiding volume, urinary incontinence episodes, complete dryness, maximum detrusor pressure (Pdetmax), volume at first involuntary detrusor contraction (VFIDC). Vesicoureteral reflux (VUR) and other adverse events were recorded. Results Ninety-six patients were recruited and 91 of them completed the trial. Among the 91 patients, 47 were randomized to experimental group and 44 to the control group. There were no significant differences in baseline evaluation items (gender, age, duration of spinal cord injury, level of neurological injury, AIS scores) between the two groups. At 12 weeks, the improvement was significantly better in the experimental group than in the control group for I-QoL (26.01 vs. 18.75, P=0.01), mean urinary incontinence episodes (−5.22/d vs. −4.68/d, P=0.01), complete dryness (13 vs. 5, P=0.03), mean voiding volume (159.72 vs. 139.07 mL, P=0.02), Pdetmax (−33.34 vs. −28.02 cmH2O, P=0.04), and VFIDC (106.81 vs. 97.86 mL, P=0.02), duration of first detrusor contraction (−41.54 vs. −18.65 s, P=0.03) and the number of patients with detrusor contraction (−20 vs. −9, P=0.02). In both of two groups, no patients developed VUR. Conclusions BTX-A intradetrusor and intratrigonal injections are more effective than those excluding the trigone for patients with NDO with incontinence. Intratrigonal injections do not induce VUR.

Objective To assess the safety and efficacy of bladder irrigation for reducing the morbidity of bladder stones in spinal cord injury (SCI) patients. Methods From December 2011 to July 2013, SCI patients were prospectively randomized and assigned to either a bladder irrigation group or a no bladder irrigation group. Bladder irrigations were performed twice a week by urologists. The primary outcomes were incidences of bladder stones and Incontinence-Specific Quality-of-Life Instrument (I-QoL). Secondary outcomes were related adverse events. Results A total of 80 eligible patients participated and 78 (97.5%) patients (bladder irrigation, n=39; no bladder irrigation, n=39) completed 24 weeks of follow-up. Out of the 78 patients, 19 (24.3%) developed bladder stones. All occurred in no bladder irrigation group. In 8 of the 19 patients (42.1%), stones were only detected by cystoscopy .The bladder stones were mostly thin with an eggshell appearance (78.95% for diameter of stone

Objective To compare laparoscopic prostatectomy with open prostatectomy for benign prostatic hyperplasia with large volume. Methods The literature was identified systematically using Medline, Embase. Meta-analysis was performed by Review Manager 5.0. Results Three CCTs were included. There was no difference between LP and OP in terms of IPSS, Qmax. LP was associated with significantly less blood loss, a shorter irrigation, catheterization and hospital stay time except longer operating time. LP and OP were similar in terms of urethral stricture, incontinence, transfusion requirement and rate of reintervention. Conclusions LP served a significant improvement in IPSS, Qmax as well as OP. Although more operating time and less resected tissue, LP has several advantages over OP. It was as safe as OP in terms of adverse events.

Objective: To assess effective outcomes following repeated treatment with intradetrusor botulinum toxin type an in patients with neurogenic detrusor overactivity (NDO). Methods: Patients with NDO secondary to spinal cord injury (SCI) were enrolled. Botulinum toxin type A 200 U detrusor injections by a rigid cystoscope were repeated. Primary outcomes were urodynamic variables including maximum detrusor pressure during first involuntary detrusor contraction (P detmaxIDC) filling cystometry, detrusor compliance (DC). Secondary outcomes were improvement of the patient’s QoL measured by Incontinence-Specific Qualityof-Life Instrument (I-QoL), the validated short forms of Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Related adverse events were recorded. Results: From 2012 to 2014, 159 injections were performed in 52 patients (44 male, 8 female). The mean age was 36.67 years. The maximum number of repeated injections was five. BC increased from (4.03-7.45) to (6.96-10.86) ml/cm H2O, Pdetmax in bladder storage decreased from (42.80-79.52) to (26.40-43.33) cm H 2 O, respectively. The I-QoL, UDI-6 and IIQ-7 showed a consistent improvement after repeated injections. Conclusion: Repeated intradetrusor botulinum toxin type A injections remain improve Quality of Life in patients with NDO secondary to spinal cord injury.