Botulinum Neurotoxin Uses in Overactive Bladder

Botulinum neurotoxin has been approved for use in different urologic disorders, especially overactive bladder (OAB). OAB is highly prevalent, with a relevant impact on patients’ quality of life and the available health resources. The prevalence of OAB is 11.8% with no significant difference between male and female. Botulinum neurotoxin is now approved as a treatment of choice for refractory overactive bladder (ROAB) after the failure of behavioral and pharmacological therapy. It is associated with improvement of urgency and urge urinary incontinence in 60–70% of patients. Yet the effect is not long-standing and fades out in a mean of 6-months duration and repeated injection is warranted. Moreover, its associated side effects are not uncommon, especially urinary tract infection and urine retention. New modifications have been studied to make it less invasive, effective, and tolerable by the patients through injection-free mode. The subject to be explained in the book chapter is the role of botulinum neurotoxin in ROAB, including the mechanism of action, different types of botulinum toxin used, the accepted dose, associated side effects, and comparison of the outcome to other available treatment modalities. In addition, a close look at the new accepted approaches for intravesical administration of botulinum toxin in the bladder will be done

A rare case of emphysematous pyelonephritis associated with pneumatosis intestinalis and bowel ischemia

Emphysematous pyelonephritis (EPN) is a rare life-threatening gas producing kidney infection, commonly affects uncontrolled diabetic patients with underlying urinary tract obstruction. Presence of pneumoperitoneum and involvement of the bowels are uncommon presentation of EPN. In the present report, we present a 59-year-old African male who had extensive EPN with pneumoperitoneum, pneumatosis intestinalis and extension to the bowel causing ischemia. Successful surgical exploration was done, with resection anastomosis of the ischemic bowel segment and drainage of the kidney

Warm ischemia time length during on-clamp partial nephrectomy: dose it really matter?

52siBackground: The impact of warm ischemia time (WIT) on renal functional recovery remains controversial. We examined the length of WIT >30 min. on the long-term renal function following on-clamp partial nephrectomy (PN). Methods: Data from 23 centers for patients undergoing on-clamp PN between 2000 and 2018 were analyzed. We included patients with two kidneys, single tumor, cT1, minimum 1-year followup, and preoperative eGFR ≥60 ml/min/1.73m2. Patients were divided into two groups according to WIT length: group Ⅰ "WIT ≤30 min." and group Ⅱ "WIT >30 min.". A propensity-score matched analysis (1:1 match) was performed to eliminate potential confounding factors between groups. We compared eGFR values, eGFR (%) preservation, eGFR decline, events of chronic kidney disease (CKD) upgrading, and CKD-free progression rates between both groups. Cox regression analysis evaluated WIT impact on upgrading of CKD stages. Results: The primary cohort consisted of 3526 patients: group Ⅰ (n=2868) and group Ⅱ (n=658). After matching the final cohort consisted of 344 patients in each group. At last followup, there were no significant differences in median eGFR values at 1, 3, 5, and 10 years (P>0.05) between the matched groups. In addition, the median eGFR (%) preservation and absolute eGFR change were similar (89% in group Ⅰ vs. 87% in group Ⅱ, p=0.638) and (-10 in group Ⅰ vs. -11 in group Ⅱ, p=0.577), respectively. The 5 years new-onset CKD-free progression rates were comparable in the non-matched groups (79% in group Ⅰ vs. 81% in group Ⅱ, log-rank, p=0.763) and the matched groups (78.8% in group Ⅰ vs. 76.3% in group Ⅱ, log-rank, p=0.905). Univariable Cox regression analysis showed that WIT >30 min. was not a predictor of overall CKD upgrading (HR:0.953, 95%CI 0.829-1.094, p=0.764) nor upgrading into CKD stage ≥Ⅲ (HR:0.972, 95%CI 0.805-1.173, p=0.764). Retrospective design is a limitation of our study. Conclusions: Our analysis based on a large multicenter international cohort study suggests that WIT length during PN has no effect on the long-term renal function outcomes in patients having two kidneys and preoperative eGFR ≥60 ml/min/1.73m2.reservedopenAbdel Raheem, Ali; Alowidah, Ibrahim; Capitanio, Umberto; Montorsi, Francesco; Larcher, Alessandro; Derweesh, Ithaar; Ghali, Fady; Mottrie, Alexader; Mazzone, Elio; DE Naeyer, Geert; Campi, Riccardo; Sessa, Francesco; Carini, Marco; Minervini, Andrea; Raman, Jay D; Rjepaj, Chris J; Kriegmair, Maximilian C; Autorino, Riccardo; Veccia, Alessandro; Mir, Maria Carmen; Claps, Francesco; Choi, Young Deuk; Ham, Won S; Tadifa, John P; Santok, Glen D; Furlan, Maria; Simeone, Claudio; Bada, Maida; Celia, Antonio; Carrion, Diego M; Aguilera Bazan, Alfredo; Ruiz, Cristina B; Malki, Manar; Barber, Neil; Hussain, Muddassar; Micali, Salvatore; Puliatti, Stefano; Alwahabi, Abdelaziz; Alqahtani, Abdulrahman; Rumaih, Abdullah; Ghaith, Ahmed; Ghoneem, Ayman M; Hagras, Ayman; Eissa, Ahmed; Alenzi, Mohammed J; Pavan, Nicola; Traunero, Fabio; Antonelli, Alessandro; Porcaro, Antonio B; Illiano, Ester; Costantini, Elisabetta; Rha, Koon HAbdel Raheem, Ali; Alowidah, Ibrahim; Capitanio, Umberto; Montorsi, Francesco; Larcher, Alessandro; Derweesh, Ithaar; Ghali, Fady; Mottrie, Alexader; Mazzone, Elio; DE Naeyer, Geert; Campi, Riccardo; Sessa, Francesco; Carini, Marco; Minervini, Andrea; Raman, Jay D; Rjepaj, Chris J; Kriegmair, Maximilian C; Autorino, Riccardo; Veccia, Alessandro; Mir, Maria Carmen; Claps, Francesco; Choi, Young Deuk; Ham, Won S; Tadifa, John P; Santok, Glen D; Furlan, Maria; Simeone, Claudio; Bada, Maida; Celia, Antonio; Carrion, Diego M; Aguilera Bazan, Alfredo; Ruiz, Cristina B; Malki, Manar; Barber, Neil; Hussain, Muddassar; Micali, Salvatore; Puliatti, Stefano; Alwahabi, Abdelaziz; Alqahtani, Abdulrahman; Rumaih, Abdullah; Ghaith, Ahmed; Ghoneem, Ayman M; Hagras, Ayman; Eissa, Ahmed; Alenzi, Mohammed J; Pavan, Nicola; Traunero, Fabio; Antonelli, Alessandro; Porcaro, Antonio B; Illiano, Ester; Costantini, Elisabetta; Rha, Koon

External validation of yonsei nomogram predicting chronic kidney disease development after partial nephrectomy: An international, multicenter study

Objective: To externally validate Yonsei nomogram. Methods: From 2000 through 2018, 3526 consecutive patients underwent on-clamp PN for cT1 renal masses at 23 centers were included. All patients had two kidneys, preoperative eGFR ≥60 ml/min/1.73 m2, and a minimum follow-up of 12 months. New-onset CKD was defined as upgrading from CKD stage I or II into CKD stage ≥III. We obtained the CKD-free progression probabilities at 1, 3, 5, and 10 years for all patients by applying the nomogram found at https://eservices.ksmc.med.sa/ckd/. Thereafter, external validation of Yonsei nomogram for estimating new-onset CKD stage ≥III was assessed by calibration and discrimination analysis. Results and limitation: Median values of patients' age, tumor size, eGFR and follow-up period were 47 years (IQR: 47-62), 3.3 cm (IQR: 2.5-4.2), 90.5 ml/min/1.73 m2 (IQR: 82.8-98), and 47 months (IQR: 27-65), respectively. A total of 683 patients (19.4%) developed new-onset CKD. The 5-year CKD-free progression rate was 77.9%. Yonsei nomogram demonstrated an AUC of 0.69, 0.72, 0.77, and 0.78 for the prediction of CKD stage ≥III at 1, 3, 5, and 10 years, respectively. The calibration plots at 1, 3, 5, and 10 years showed that the model was well calibrated with calibration slope values of 0.77, 0.83, 0.76, and 0.75, respectively. Retrospective database collection is a limitation of our study. Conclusions: The largest external validation of Yonsei nomogram showed good calibration properties. The nomogram can provide an accurate estimate of the individual risk of CKD-free progression on long-term follow-up