Urological Survey Voiding Function and Dysfunction , Bladder Physiology and Pharmacology , and Female Urology Re : Traumatic Spinal Cord Injury in the United States , 1993-2012

available at http://www.ncbi. nlm.nih. gov/pubmed/26057284 Editorial Comment: This problem is often directly associated with lower urinary tract dysfunction. There are some useful factoids in this article. In 1993 the estimated incidence of acute spinal cord injury was 53 cases per million persons, and in 2012 it was 54 cases per million. Incidence rates declined from 144 to 87 cases per million among the younger male population (ages 16 to 24 years) and from 96 to 71 cases per million in those 25 to 44 years old but there was a high rate of increase in men aged 65 to 74 years, from 84 to 131 cases per million. Percentage of spinal cord injuries associated with falls increased significantly, from 28% in 1997 to 2000 to 66% in 2010 to 2012 in individuals 65 years or older. Overall the in hospital mortality rate increased from 6.6% in 1993 to 1996 to 7.5% in 2010 to 2012 but decreased among persons 85 years or older from 1993 to 1996 (24.2%) to 2010 to 2012 (20.1%). Alan J. Wein, MD, PhD (hon) Re: Urinary Retention Rates after Intravesical OnabotulinumtoxinA Injection for Idiopathic Overactive Bladder in Clinical Practice and Predictors of this Outcome D. J. Osborn, M. R. Kaufman, S. Mock, M. J. Guan, R. R. Dmochowski and W. S. Reynolds Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee Neurourol Urodyn 2015; 34: 675e678. doi: 10.1002/nau.22642 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/24975819available at http://www.ncbi. nlm.nih. gov/pubmed/24975819 Editorial Comment: This is an interesting data set because it shows a difference in a real-life population as opposed to a previously reported study population. The cohort consisted of 160 patients, with the following from a larger group being excluded: history of a neurological condition, history of post-void residual greater than 200 ml, history of urinary retention and injection of more than 200 units of drug. Average age was 64 years, and 76% of the patients were women. Of the patients 56 (35%) experienced urinary retention and required initiation of intermittent catheterization for a mean duration of 16 weeks. Patients who received 100 units and had a 0022-5347/16/1953-0685/0 THE JOURNAL OF UROLOGY 2016 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH, INC. http://dx.doi. org/10.1016/j.juro. 2015.12. 040 Vol. 195, 685-693, March 2016 Printed in U.S.A. www.jurology. com j 685 686 VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY preoperative post-void residual of less than 100 cc demonstrated a 21% rate of retention. Postoperatively 16% of the patients experienced a urinary tract infection. Urgency incontinence was improved in 74% of the patients and 64% reported subjective improvement. Of those with retention 57% reported subjective success and 50 of these patients received further injections. Five patients had an indwelling catheter placed by the primary care physician or at an emergency room because of a diagnosis of urinary retention. The other 51 patients were instructed to initiate intermittent catheterization or had an indwelling catheter placed by the treating physician. The decision to catheterize was made in any patient with an increased post-void residual and symptoms consistent with urinary retention, or if the provider felt that the patient was experiencing asymptomatic retention based only on a high post-void residual volume. Average post-void residual in patients with asymptomatic retention was 443 ml (range 300 to 637). Another analysis done in the 87 patients who underwent a second injection showed that post-void residual before the second treatment, number of units injected and history of retention after the first injection were associated with an increased rate of retention after the second injection. This is a valuable study for 2 reasons: 1) it seems to reflect real-world usage of botulinum toxin A, and 2) it should modify the conversation with patients regarding the possibility of urinary retention, especially in individuals with a post-void residual of greater than 100 ml. Alan J. Wein, MD, PhD (hon)