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Objective: To compare the short-time complications associated with time-opening suprapubic catheter (SPT) versus intermittent catheter (IC) in male patients with spinal cord injury (above level C5). Methods: A prospective review of records was carried out to identify SCI patients managed with SPT or IC between 2011 and 2016. The complications included renal function (Serum creatinine), urinary tract infection (UTI), bladder stones, urethral complications, scrotal, and gross hematuria. Patients were followed at week 4, 3 and 6 months; the urodynamic assessment was repeated at 6 months. Results: A total of 30 patients (11 SPT, 19 IC) were recruited in this trial. There is no significant difference between the two catheter groups for the entire out-come. Scrotal abscesses and urethral stricture were only seen in patients with IC. Conclusions: SPT has similar urological complication with IC for SCI patients (above level C5) except the incidence of scrotal abscesses and urethral stricture.

OBJECTIVE To evaluate the safety and effect of botulinum toxin A injection in the detrusor and external urethral sphincter in male patients with detrusor overactivity (DO) and detrusor external sphincter dyssynergia (DESD) secondary to spinal cord injury. METHODS A multicentre trial was conducted from June 2012 to August 2015. A total of 65 spinal cord injury patients with DO and DESD participated in the study. Of these, 59 received 200 U botulinum toxin Aintradetrusor and 100 U external urethral sphincter injections. The effective outcomes included maximum detrusor pressure at first DO and DESD, VDO-DESD, maximum urethral closure pressure, duration of first DO and DESD, Incontinence-Specific Quality-of-Life Instrument, voiding volume, urinary incontinence episodes and complete dryness. Adverse events were recorded. RESULTS All patients experienced a significant mean reduction in PdetmaxDO -DESD (46.60%), maximum urethral closure pressure (29.61%), duration of first DO and DESD (42.93%) and a significant mean increase in VDO-DESD (38.11%) 12-weeks post-injection. Significant (p

Objective: To assess the safety and efficacy of bladder irrigation for reducing the morbidity of bladder stones in patients with neurological lower urinary tract dysfunction (NLUTD). Methods: From June 2012 to July 2013, patients with NLUTD 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. Patients were followed up at 6 months respectively. Primary outcomes were Incontinence-Specific Quality-of-Life Instrument (I-QoL), the rate incidences of bladder stone. All adverse events were also noted. 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 < 5 mm, 84.21% for volume of bladder stone < 0.2 cm3). Bladder stones were removed by vigorous bladder irrigation guided by ultrasound (73.68%) or endoscopic lithotripsy (26.32%). The I-QOL was significantly better in the bladder irrigation group than in no bladder irrigation group at weeks 6, 12, 18, and 24 of follow-up. Conclusion: Bladder irrigation may be more effective and safer than no bladder irrigation for reducing the morbidity of bladder stone in spinal cord injury patients.

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.