With a minimum 6-year follow-up we determined that sacral neuromodulation provides adequate improvement for the symptoms of recalcitrant interstitial cystitis.

No abstract

No abstract

BackgroundA splenic rupture associated with extracorporeal shockwave lithotripsy (ESWL) is exceedingly rare. We report a case of stage 3 splenic laceration, hemoperitoneum and subsequent splenic rupture following an ESWL for a left mid polar renal calculus.Case presentationDuring the ESWL, although the patient’s pain was controlled the gentleman was very nervous and had to be repositioned eight individual times.Approximately 6 hours after the ESWL, the patient phoned the urologist complaining of severe left flank pain unlike any previous episode of renal colic. A computerized tomography (CT) scan demonstrated a stage 3 splenic injury with hemoperitoneum. The patient decompensated and an emergent splenectomy was then performed and the patient experienced an uneventful recovery.ConclusionsSplenic injury likely results from unintentional movement during the sound wave administration for the stone fragmentation procedure. Utilizing noise cancelling headphones during ESWL may preclude the potential pitfalls of patient nervousness.

BackgroundA Drum Dock Manager in an auto manufacturing company suffers a pelvic fracture, severing the bulbar urethra and completely fracturing the right side of his pelvis.He is unable to void without catheterization but has a complete sensation to void. Can neuromodulation help him achieve spontaneous voiding?Case presentationWe reviewed the electronic medical record of Mr. M.E. from Detroit Medical Center following his 2012 forklift accident and subsequent orthopedic surgeries. He successfully underwent bilateral sacral neuromodulation, with a resulting max flow of 16.8 mls/sec and post-void residual urine of 50–100 mls. Unfortunately, he later presented with bilateral pocket and sacral lead infection, and both systems had to be removed. Six weeks later, M.E. had bilateral pudendal neurostimulation placement to avoid the previously infected areas. Max flow improved to 14.5 mls/sec and 0–50 mls residual urine. However, urodynamics proved that his Pdet at max flow was in excess of 120 cm of H20 pressure while he had been on finesteride and tamsulosin for the preceding five years for the management of his documented benign prostate hyperplasia symptoms. He underwent Green light laser transurethral resection of the prostate and had max flow improvement to 22.5 mls/second with zero residual urine with multiple straight catheterization confirmations.ConclusionSacral neuromodulation may successfully correct traumatic urinary retention in male patients. Additionally, pudendal neuromodulation can be successfully utilized as a salvage method for an infected sacral neuromodulation impulse generator (IPG) and tined lead with a return to proper voiding.