Bulkamid (PAHG) in mixed urinary incontinence: What is the outcome?

Introduction and hypothesis

Mixed urinary incontinence (MUI), defined as mixed symptoms of stress urinary incontinence (SUI) and overactive bladder (OAB), is a difficult entity if conservative treatment has failed. Cure rates are low compared with SUI, particularly the OAB component, may deteriorate after sling insertion. Bulking agents pose an appealing alternative for the treatment of MUI. They have shown beneficial effect in small case studies, but larger series are lacking. The aim of this prospective study was an analysis of treatment efficacy and safety profile of the bulking agent, Bulkamid, in female patients with MUI.

Methods

One hundred fifty-four women with MUI symptoms (components of SUI/OAB within the limits of 60–40% either way) received bulking therapy with polyacrylamide hydrogel (Bulkamid). Patients were followed-up 3 months postoperatively. Primary outcome was the domain Incontinence impact on the King’s Health Questionnaire (KHQ). Secondary outcomes were the other KHQ domains, visual analog scale (VAS), and International Continence Society (ICS) standardized pad weight test as objective measurement of incontinence.

Results

Statistically significant improvements were found for all KHQ domains, pad weight test, and the visual analog scale (VAS) before and after bulking. Overall complication rate was 13%.

Conclusions

This study has shown improvement in MUI after bulking therapy according to both subjective and objective outcomes. We can advocate bulking therapy for treating MUI, as it is simple and safe and shows both objective and subjective improvement and relief. Long-term results (up to 1 year) are awaited.

     

Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy

Monga U, Garber SL, Thornby J, Vallbona C, Kerrigan AJ, Monga TN, Zimmermann KP. Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy.

Objective

To show fatigue prevention and quality of life (QOL) improvement from cardiovascular exercise during radiotherapy.

Design

Prospective enrollment (n=21), randomized to exercise (n=11) and control groups (n=10), with pre- and post-radiotherapy between- and within-group comparisons.

Setting

Academic medical center.

Participants

Localized prostate cancer patients undergoing radiotherapy.

Interventions

The interventional group received radiotherapy plus aerobic exercise 3 times a week for 8 weeks whereas the control group received radiotherapy without exercise.

Main Outcome Measures

Pre- and post-radiotherapy differences in cardiac fitness, fatigue, depression, functional status, physical, social, and functional well-being, leg strength, and flexibility were examined within and between 2 groups.

Results

No significant differences existed between 2 groups at pre-radiotherapy assessment. At post-radiotherapy assessment, the exercise group showed significant within group improvements in: cardiac fitness (P<.001), fatigue (P=.02), Functional Assessment of Cancer Therapy-Prostate (FACT-P) (P=.04), physical well-being (P=.002), social well-being (P=.02), flexibility (P=.006), and leg strength (P=.000). Within the control group, there was a significant increase in fatigue score (P=.004) and a decline in social well-being (P<.05) at post-radiotherapy assessment. Between-group differences at post-radiotherapy assessment were significant in cardiac fitness (P=.006), strength (P=.000), flexibility (P<.01), fatigue (P<.001), FACT-P (P=.006), physical well-being (P<.001), social well-being (P=.002), and functional well-being (P=.04).

Conclusions

An 8-week cardiovascular exercise program in patients with localized prostate cancer undergoing radiotherapy improved cardiovascular fitness, flexibility, muscle strength, and overall QOL and prevented fatigue.     

Multiple endocrine cell types in thyroid medullary carcinoma

Summary 10 cases of thyroid medullary carcinoma (TMC) have been studied ultrastructurally and histochemically. Well differentiated calcitonin-producing C cells were present in all tumours, being prevalent in 9 cases. 5-Hydroxytryptamine (5HT) storing cells were found in two cases, somatostatin immunoreactive cells in at least 5 cases and ACTH-immunoreactive cells in 4 cases. Ultrastructurally, at least 3 types of apparently non-C cells were observed. Type 1 cells with large, poorly osmiophilic granules resembling those of gastroenteropancreatic D cells, were present in 6 cases; they appeared to correlate well with somatostatin immunoreactive cells. Type 2 cells with large osmiophilic granules were found in 5 cases; they resembled ACTH-MSH cells of the human pituitary and may correspond to the ACTH-immunoreactive cells of light microscopy. Type 3 cells with small granules and an unknown function were found in 6 cases, always in scarce number. It is concluded that TMC, although mainly made up of C cells, usually contains large proportions of other endocrine cell types.Supported in part by grant N. 75.00630.04 from the Italian National Research Council (C.N.R.). P.F. is a fellow of the Fondazione Anna Villa Rusconi, Varese     

Do women with urinary incontinence really know where all the toilets are?: The toilet paper

AIMS OF STUDY: Aim of this study was to determine if women with overactive bladder really do have a more detailed knowledge about toilets and their conditions in their vicinity in comparison to women with urinary stress incontinence and those without any urinary symptoms. PATIENTS AND METHODS: A questionnaire survey of 270 women from three symptom groups, those with stress incontinence, overactive bladder and controls without any bladder symptoms from an inner city area and two local towns. The knowledge of the three groups was compared and measured by a score assessed by the authors who had visited the toilets themselves. RESULTS: Women with overactive bladder are more likely to exhibit precautionary voiding prior to leaving home and have significantly more detailed knowledge about toilets in their neighbourhood. DISCUSSION: The overactive bladder seems to have a greater influence on behaviour and on quality of life than stress incontinence which could mean that they are more tortured by their symptoms.     

Pre- and Post-Radiotherapy Sexual Functioning in Prostate Cancer Patients

The purpose of this study is to describe sexual function in patients with localized prostate cancer (LPC) before and after radiation therapy. Patients who were going to receive radiation therapy for LPC participated in a prospective quality of life study. Responses to questions regarding sexual function were extracted from Functional Assessment of Cancer Therapy for Prostate, Beck Depression Inventory, and Piper Fatigue Scale. Complete responses across all the study periods were present in 40 of the 62 patients who participated in the study. Twenty-eight patients were married. Patients' mean age was 67.6 years (range 55 to 79). Thirty-five percent of the patients were sexually active at Pre-radiotherapy, (PRT); 37.5% at completion of radiotherapy, (CRT); and 40% at long-term follow-up (FRT1). Twenty-two percent reported normal erection at PRT and CRT evaluation. At FRT1 30% of patients reported to have normal erection. There was no significant change in the satisfaction with sexual activity across the study periods. Relatively more patients reported a decline in sexual interest at CRT and FRT1 as compared with PRT assessment. At FRT1, 40% of the patients as compared with 32.5% PRT reported fatigue interfering in their sexual activity. Sexual problems were common even before starting radiotherapy. It may be concluded that radiotherapy frequently did not cause sexual problems. Pre-treatment sexual history should be considered in management of sexual problems in these patients.     

Hepatocyte growth factor induces Wnt-independent nuclear translocation of beta-catenin after Met-beta-catenin dissociation in hepatocytes

Hepatocyte growth factor (HGF) and Wnt signaling pathways have been shown to be important in embryogenesis and carcinogenesis. The aim of this study was to elucidate the mechanism of functional similarities observed in the two pathways. We used normal rat liver, primary hepatocyte cultures and a dominant-negative Met expression system to study the effect of HGF on Wnt pathway components. We demonstrate novel association of beta-catenin and Met, a tyrosine kinase receptor of HGF, at the inner surface of the hepatocyte membrane. HGF induces dose-dependent nuclear translocation of beta-catenin in primary hepatocyte cultures that is Wnt independent. The source of beta-catenin for translocation in hepatocytes is the Met-beta-catenin complex, which appears to be independent of the E-cadherin-beta-catenin complex. To test the functionality of this association, we used a dominant-negative Met expression system that expresses only the extracellular and transmembrane regions of the beta-subunit of Met. A loss of Met-beta-catenin association resulted in abrogation of nuclear translocation of beta-catenin upon HGF stimulation. This event is tyrosine phosphorylation dependent, and the association of Met and beta-catenin is crucial for this event. We conclude that the HGF causes similar redistribution of beta-catenin as Wnt-1 in the hepatocytes and that this effect is attributable to subcellular association of Met and beta-catenin. The intracellular kinase domain of Met is essential for tyrosine phosphorylation and nuclear translocation of beta-catenin. Part of the multifunctionality of HGF might be attributable to nuclear beta-catenin and the resulting target gene expression.