Journal of Clinical Urology

To report our experience of intravesical botulinum toxin for idiopathic overactive bladder syndrome (OAB) without detrusor overactivity (DOA) on urodynamic assessment.

Data regarding presentation, diagnosis, urodynamic findings, date and dose of treatment, and outcomes were recorded prospectively for 94 patients undergoing intravesical botulinum toxin injection for idiopathic overactive bladder syndrome at our institution. The cohort included 19 patients without DOA on urodynamics. A positive response to treatment was defined as patient-reported improvement without the need for further treatment. ICIQ-OAB and UI scores, and bladder diary parameters were also recorded. Rates of urinary retention requiring intermittent or indwelling catheterisation were noted.

The overall response rate to treatment was 82% (n = 94). Patients without DOA (n = 19) had a response rate of 89%, which compared favourably with a response rate of 81% in patients with DOA (n = 75). Overall, 29% of patients who were voiding normally prior to treatment required intermittent self-catheterisation after the procedure. The requirement for self-catheterisation did not appear to be influenced by urodynamic findings.

These preliminary, non-randomised data suggest that intravesical botulinum toxin injection may be efficacious in patients with OAB symptoms without DOA. Further evaluation by means of a randomised, controlled trial is suggested.

A review of our experience in laparoscopic simple nephrectomies from May 2003 to May 2011 in the Urology Departments in Oxford and Reading.

A total of 100 patients, median age 46years (IQR = 27, range 17–82) underwent a laparoscopic simple nephrectomy for benign disease in the 8-year period reviewed. Data on patient demographics, pre-operative diagnosis, operating time, operative approach, estimated blood loss, in hospital post-operative complications and length of stay were collected from electronic databases held in the departments and regularly updated.

100 laparoscopic simple nephrectomies were performed between May 2003 and May 2011. Median operating time was 180min (IQR = 60min, range 75–375min). Median estimated blood loss was 50ml (IQR = 50ml, range 10–1000ml). Median length of stay was 3 days (IQR = 3, range 2–14 days). No patients suffered from significant changes in renal function. Three patients were transfused between 2 and 3 units. 26 complications were recorded for 22 patients. Four were Clavien grade IIIb and 22 were grades I—II.

Although laparoscopic simple nephrectomy is feasible and confers the usual benefits of laparoscopy it is often a technically challenging procedure. We used the Clavien Classification to standardise complications of laparoscopic simple nephrectomies. The term “simple” nephrectomy is misleading and should be changed.