In clinical practice, many patients cannot empty their bladders within an acceptable duration. Common complaints include weak urinary stream and incomplete emptying, which may affect quality of life. Bladder emptying requires sufficient detrusor contractile power, velocity, and durability. The urodynamic term for inadequate detrusor contraction is detrusor underactivity (DU). Although this definition was provided by the ICS, it may not be clinically practical. Analogous to the relationship between overactive bladder (OAB) and detrusor overactivity (DO), the symptom complex caused by DU is termed underactive bladder (UAB). Many conditions lead to UAB, such as advanced age, neurogenic bladder and BOO, but the definite pathophysiology directly leading to UAB is still being widely studied without a widely-accepted consensus. The preferred mainstream treatment for increased residual urine volume caused by UAB is intermittent catheterization, while pharmacotherapy is still disappointing after decades of development. There are no studies on surgical treatment for UAB with an acceptable level of evidence. We reviewed the recent literature on UAB and DU to provide a comprehensive discussion of the related presentation, etiology, diagnosis and management.

According to traditional Chinese medicine (TCM) theory, a specific physiological and pathological relationship exists between the lungs and the large intestine. The aim of this study is to delineate the association of chronic obstructive pulmonary disease (COPD) and hemorrhoids in order to verify the “interior–exterior” relationship between the lungs and the large intestine. A retrospective cohort study is conceived from the National Health Insurance Research Database, Taiwan. The 2 samples (COPD cohort and non-COPD cohort) were selected from the 2000 to 2003 beneficiaries of the NHI, representing patients age 20 and older in Taiwan, with the follow-up ending on December 31, 2011. The COPD cohort (n = 51,506) includes every patient newly diagnosed as having Chronic Obstructive Pulmonary Disease (COPD, ICD-9-CM: 490–492, 494, 496), who have made at least 2 confirmed visits to the hospital/clinic. The non-COPD cohort (n = 103,012) includes patients without COPD and is selected via a 1:2 (COPD: non-COPD) matching by age group (per 5 years), gender, and index date (diagnosis date of COPD for the COPD cohort). Compared with non-COPD cohorts, patients with COPD have a higher likelihood of having hemorrhoids and the age-, gender- and comorbidies-adjusted hazard ratio (HR) for hemorrhoids is 1.56 (95% confidence intervals [CI]:1.50–1.62). The adjusted HR of hemorrhoids for females is 0.79 (95% CI: 0.77–0.83), which is significantly less than that for males. The elderly groups, 40 to 59 years and aged 60 or above, have higher adjusted HRs than younger age groups (20–39 years), 1.19 (95% CI: 1.14–1.26), and 1.18 (95% CI: 1.12–1.24), respectively. Patients with COPD may have a higher likelihood to have hemorrhoids in this retrospective cohort study. This study verifies the fundamental theorem of TCM that there is a definite pathogenic association between the lungs and large intestine.

Additional intervention and medical treatment of complications may follow the primary treatment of a ureteral stone. We investigated the cost of the treatment of ureteral stone(s) within 45 days after initial intervention by means of retrospective analysis of the National Health Insurance Research Database of Taiwan. All patients of ages ≥20 years diagnosed with ureteral stone(s)( International Classification of Diseases, Ninth Revision, Clinical Modification/ICD-9-CM: 592.1) from January 2001 to December 2011 were enrolled. We included a comorbidity code only if the diagnosis appeared in at least 2 separate claims in a patient’s record. Treatment modalities (code) included extracorporeal shock-wave lithotripsy (SWL; 98.51), ureteroscopic lithotripsy (URSL; 56.31), percutaneous nephrolithotripsy (PNL; 55.04), (open) ureterolithotomy (56.20), and laparoscopy (ie, laparoscopic ureterolithotomy; 54.21). There were 28 513 patients with ureteral stones (13 848 men and 14 665 women) in the randomized sample of 1 million patients. The mean cost was 526.4 ± 724.1 United States Dollar (USD). The costs of treatment were significantly increased in patients with comorbidities. The costs of treatment among each primary treatment modalities were 1212.2 ± 627.3, 1146.7 ± 816.8, 2507.4 ± 1333.5, 1533.3 ± 1137.1, 2566.4 ± 2594.3, and 209.8 ± 473.2 USD in the SWL, URSL, PNL, (open) ureterolithotomy, laparoscopy (laparoscopic ureterolithotomy), and conservative treatment group, respectively. In conclusion, URSL was more cost-effective than SWL and PNL as a primary treatment modality for ureteral stone(s) when the possible additional costs within 45 days after the initial operation were included in the calculation.

Keywords: diverticulum stone urethra calculi urethra diverticulum urethra stone a b s t r a c t Urethral diverticulum with multiple calculi is a rare condition that is often difficult to diagnose. We present a 46-year-old female with initial symptoms of stress urinary incontinence and subconscious urine leakage. Magnetic resonance imaging revealed a large diverticulum with multiple stones in it. Transvaginal repair of the urethral diverticulum was performed. Some authors and textbooks suggest concomitant anti-incontinence surgery in patients with a similar condition, but we did not do so under the considerations of patient autonomy and risk of infection. The incontinence subsided spontaneously after diverticulectomy alone, against our expectations.