Background: Percutaneous tibial nerve stimulation (PTNS) is used as a treatment to reduce the complaints of overactive bladder (OAB). Although it is rewarding therapy patients need maintenance treatment to preserve the beneficial effect. Aim: This real-life retrospective study was performed to assess the feasibility of PTNS adherence. Materials & Methods: All patients who underwent PTNS were retrospectively included. We analyzed the following: indication, kind of treatments (pharmacologic and third-line therapy) before and after PTNS treatment, time and reason for quitting therapy. Statistical analysis was done by performing competitive-risk analysis and Kaplan-Meier curves. Patients were categorized into four groups. Group 1: all patients; group 2: all patients on maintenance PTNS therapy (continuing after 12 weeks); group 3: patients on maintenance PTNS therapy excluding the following: (a) patients with initial good response who seized treatment due to death, (b) patient who successfully switched to transcutaneous stimulation, (c) patients who were cured of their OAB symptoms, or (d) patients who relocated; and group 4: group 3 but excluding those who stopped treatment because of nonmedical reasons (physical strain, inconveniencies associated with visiting the hospital).Results: Four-hundred two patients (70% female) with a median age of 70 years underwent PTNS. Underlying treatment indications were: OAB-wet (54%) and OAB-dry (29%). The median follow-up (FU) of group 1 was 4 months. Fiftyseven percent (N = 228) of the patients received maintenance PTNS therapy. Median FU in group 4 was 46 months (range, 3-111 months). Over 40% of the maintenance patients stopped PTNS because of logistic reasons and physical strain during an FU time of 6 years. Conclusion: The real-world data described here with is in line with earlier published work in terms of the success rate of OAB treatment. However, over 40% quit their therapy due to nonmedical reasons.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Samenvatting De trias nieragenesie, ipsilaterale retentiecyste van de vesicula seminalis en obstructie van de ductus ejaculatorius is een zeldzaam syndroom, dat in 1914 voor het eerst werd beschreven door dr. Zinner. Het syndroom ontstaat doordat tijdens de embryogenese een aberrante ductus mesonephricus (buis van Wolff) ontstaat en geen ureterknop wordt gevormd. Dit leidt tot ipsilaterale nieragenesie en obstructie van de ductus ejaculatorius, welke uiteindelijk leidt tot dilatatie van de vesicula seminales. De diagnose wordt meestal bij toeval gesteld, hoewel patiënten zich ook kunnen presenteren met klachten, zoals dysurie, frequency, urgency, hematurie/ hematospermie, scrotalgie en pijn bij ejaculatie. De diagnose wordt gesteld op basis van diverse beeldvormende technieken, waarbij de MRI-scan vaak het sluitende bewijs geeft. Dit case report het diagnose-en behandeltraject bij drie patiënten. Daarnaast wordt een overzicht van de embryologie en huidige stand van zaken binnen de beeldvorming en behandeling van het Zinner-syndroom gegeven. Trefwoorden Zinner-syndroom • nieragenesie • cyste vesicula seminalis Case report. Zinner syndrome: rare cause of agenesis of the kidney Abstract The trias of renal agenesis, unilateral cyst of the vesicula and obstruction of the ductus ejaculatorius is a rare syndrome which was first described drs. M. J. te Dorsthorst () • dr. M. R. van Balken afdeling Urologie,

The aim of this study was to demonstrate features predictive of treatment response for patient-tailored overactive bladder (OAB) intervention with an implantable tibial neurostimulator using patient and technical prediction factors.Materials and Methods: This study was designed as a follow-up study based on parameter settings and patients' preferences during the pilot and extended study of the implantable tibial nerve stimulator (RENOVA™ iStim system).For this study, we compared all treatment parameters (stimulation amplitude, frequency, and pulse width) and usage data (duration of treatment) during the different follow-up visits. Results: We obtained usage data from a total of 32 patients who were implanted with the system between February and September 2015. Age, sex, body mass index (BMI) and previous experience with percutaneous tibial nerve stimulation (PTNS) treatment were considered as possible prediction factors for treatment success. However, only BMI was considered a statistically significant prediction factor (p = 0.042). A statistically significant increase in mean treatment level was seen in the responder group during the 3 month follow-up visit (mean: 6.7 mA, SD 0.416) as compared with the initial system activation visit (mean: 5.8 mA, SD 0.400) (p = 0.049). No other visits demonstrated statistically significant changes in both groups (responders and nonresponders) during the defined timepoints. Conclusion:This data underscores the need to use patient-tailored OAB treatment. BMI was found to be a negative predictive factor for treatment success. However, it was not possible to develop a specific responder model. A model predicting response to treatment could be useful for implementing shared decision making.