The energy based devices for vaginal "rejuvenation," urinary incontinence, vaginal cosmetic procedures, and other vulvo-vaginal disorders: An international multidisciplinary expert panel opinion

Aims: Energy-based devices using radiofrequency and laser technologies have gained popularity as therapies for vaginal atrophy, urinary incontinence, and vaginal prolapse. They have been promoted by cosmetic and aesthetic industries for vaginal "laxity" and vaginal "rejuvenation," both of which are undefined conditions and terms. This article aims to review the current available literature and its quality on this emerging technology. Methods: An international panel of gynaecologists, urogynaecologists, and urologists undertook a review of the available published literature, identifying articles, guidance, and society statements on the use vaginal energy-based devices. Results: There is currently no formal guidance for the use of vaginal energy based therapies. No randomized controlled trials have been published. No comparative studies to existing treatment has been carried out. Studies suggest that vaginal laser can be used in the treatment of vaginal prolapse or "vaginal laxity" and stress urinary incontinence with no quality evidence supporting the use of the therapy for vaginal atrophy or lichen sclerosis. Conclusions: This international group propose that whilst there remains a paucity of good quality data describing the safety, benefits, and appropriate use of vaginal radiofrequency or laser treatments in gynaecology and urogynaecology, a consensus best practice document by an established scientific community needs to be developed.info:eu-repo/semantics/publishedVersio

Germ line BRCA1 and BRCA2 gene mutations in Turkish breast cancer patients

Cataloged from PDF version of article.Germ line BRCA1 and/or BRCA2 mutations were screened in 50 Turkish breast and/or ovarian cancer patients composed of hereditary, familial, early onset and male cancer groups. Genomic DNA samples were tested by heteroduplex analysis and DNA sequencing. Two truncating BRCA2 mutations, one novel (6880 insG) and one previously reported (3034 delAAAC), were found in two out of six (33%) hereditary breast and/or ovarian cancer patients. A novel truncating (1200 insA) and a missense (2080A→G) BRCA1 mutation was found in two of 27 (7%) individuals in the early onset group. A total of four (8%) disease-causing mutations in 50 breast cancer patients were identified in BRCA1 and BRCA2 genes. In addition, five BRCA1 sequence variants have been identified in 23 patients. These results indicate that BRCA1 and BRCA2 genes are involved in some, but not all, forms of hereditary predisposition to breast cancer in the Turkish population. Copyright (C) 2000

The neurogenic bladder: medical treatment

Neurogenic bladder sphincter dysfunction (NBSD) can cause severe and irreversible renal damage and bladder-wall destruction years before incontinence becomes an issue. Therefore, the first step in adequate management is to recognize early the bladder at risk for upper- and lower-tract deterioration and to start adequate medical treatment proactively. Clean intermittent catheterization combined with anticholinergics (oral or intravesical) is the standard therapy for NBSD. Early institution of such treatment can prevent both renal damage and secondary bladder-wall changes, thereby potentially improving long-term outcomes. In children with severe side effects or with insufficient suppression of detrusor overactivity despite maximal dosage of oral oxybutynin, intravesical instillation is an effective alternative. Intravesical instillation eliminates systemic side effects by reducing the first-pass metabolism and, compared with oral oxybutynin, intravesical oxybutynin is a more potent and long-acting detrusor suppressor. There is growing evidence that with early adequate treatment, kidneys are saved and normal bladder growth can be achieved in children so they will no longer need surgical bladder augmentation to achieve safe urinary continence in adolescence and adulthood

Exogenous testosterone and estrogen affect bladder tissue contractility and histomorphology differently in rat ovariectomy model

Introduction. Changes in sex hormone levels may play a role in the etiology of lower urinary tract dysfunction of aging women where the possible role of testosterone is overlooked. Aim. To determine the effect of testosterone with/without estrogen replacement on histological and functional deterioration in ovariectomized rat bladder tissue. Methods. A total of 54 female Sprague Dawley rats were divided into 6 groups. Except sham operated (control group), all others underwent bilateral ovariectomy. No further treatment was given to the ovariectomy-only group (OVX group). At the third week of ovariectomy treatments were started; vehicle agent (VA group), estradiol (E2 group), testosterone undecanoate (T group), and estradiol + testosterone undecanoate combination (E2 + T group) in physiological doses. Nine weeks after ovariectomy, bladder strips were harvested for isometric tension and histopathological studies. Main Outcome Measures. To assess the effect of testosterone/estradiol on ovariectomized rat bladder tissue function and histomorphology. Results. OVX and VA groups showed statistically significant histological changes such as urothelial damage, inflammatory cell infiltration, increase in collagen fibers and muscular atrophy compared with the control group. Both E2 and T reversed these changes but best histomorphological restoration was observed in E2 + T group. In isometric tension studies, ovariectomy tended to increase contractile responses which were normalized after E2 treatment. In contrary to E2, T significantly increased contractile responses that were normalized with combination treatment. During relaxation studies statistically significant higher relaxation responses were observed in ovariectomized rats. Although both exogenous testosterone and estradiol tended to reverse this effect, a statistically significant difference was found only after testosterone treatment. Conclusion. Either estradiol or testosterone replacement alone or in combination prevents significant alterations in bladder tissue histology following ovariectomy whereas both affect the bladder tissue contractility. Thus, combination treatment appears to be the best method to restore both contractility and histomorphology of bladder tissue after ovariectomy. Tanidir Y, Ercan F, and Tarcan T. Exogenous testosterone and estrogen affect bladder tissue contractility and histomorphology differently in rat ovariectomy model. J Sex Med 2011;8:1626-1637