Purpose: Neurogenic detrusor overactivity (NDOA) is characterized by involuntary detrusor muscle contractions during bladder filling in patients with neurological disorders. Anticholinergic therapy is the primary treatment; however, the reasons for treatment resistance in NDOA are not well understood. This study aimed to identify predictors of treatment failure by comparing urodynamic and frequency-volume chart data between patients with NDOA who respond and patients who do not respond to anticholinergic therapy. Methods: We reviewed the records of 362 patients presenting with lower urinary tract symptoms and selected 85 who had NDOA and were on anticholinergic therapy. Ultimately, 67 patients were analyzed. We categorized these individuals into responders (group R) and nonresponders (group NR) based on clinical and urodynamic improvements. Three-day frequencyvolume charts and urodynamic study results were retrospectively reviewed. Results: Of the 85 initial patients, 12 refused medication, and 6 were lost to follow-up. Pre- to posttreatment changes differed significantly between groups in the number of urgency urinary incontinence (UUI) episodes per 24 hours (P=0.001), maximum cystometric capacity (mL, P=0.003), NDOA frequency (P=0.004), and bladder compliance (mL/cm H2O, P=0.003). Multivariate analysis revealed that NDOA frequency (P=0.014) and UUI episodes per 24 hours (P=0.002) were significant factors associated with treatment failure. Conclusions NDOA varies according to underlying neurological conditions. The frequencies of UUI episodes and NDOA in urodynamic studies can predict resistance to initial anticholinergic treatment.

PURPOSE: In this study, we evaluated the effect of preputial type on bacterial colonization and wound healing in boys undergoing circumcision. MATERIALS AND METHODS: This study consisted of 78 boys consecutively admitted to our clinic for circumcision between 2009 and 2011. Preputial status was classified into five types on the basis of preputial retractability. One sterile culture swab was swept circumferentially once around the surface of the glans starting just proximal to the urethral meatus. Three weeks following circumcision, control swabs from the same regions of the same patients were taken and inoculated. Thus, the same patients formed the control group. Patients were evaluated on days 1 and 7 after the operation to assess whether the preputial type affected healing. RESULTS: The mean age of the children was 46.3 months. In our study, the growth rate was 71.8% in pre-circumcision patients, whereas the rate was 10.25% in the post-circumcision group. Types 1, 2, 3, 4, and 5 had 100%, 93.8%, 71.4%, 44.4%, and 53.6% colonization, respectively. A significant difference was observed among these types in terms of colonization. The most common agent was Enterococcus species (33%). When postoperative patients were evaluated, all had local swelling and hyperemia on postoperative day 1, whereas there was a significant difference on day 7. CONCLUSIONS: There was a significant correlation between preputial type and bacterial colonization, and the preputial type affected post-circumcision wound healing. Practitioners should keep in mind that the healing period will be longer in patients with type 1, 2, and 3 preputium.
Child ; Circumcision, Male ; Colon ; Enterococcus ; Female ; Humans ; Hyperemia ; Male ; Wound Healing