A retrospective study was conducted into technetium-99m sestamibi imaging of primary hyperparathyroidism to determine the accuracy of identification and localization of parathyroid pathology. Of 56 patients studied, 48 had full preoperative scan data, operative data and pathological results analysed. Overall scan accuracy was 96 per cent. For single gland pathology (adenoma) imaging had a sensitivity of 97 per cent, a specificity of 100 per cent and a positive predictive value of 100 per cent. For single gland disease the side was correctly identified in 100 per cent of cases and the site in 94 per cent, but the respective values were only 82 and 79 per cent for multiple gland pathology. Technetium-99m sestamibi imaging is highly sensitive and accurate for primary hyperparathyroidism, with sufficient positive predictive value and accuracy in single gland disease to allow scan-directed unilateral neck exploration.

ObjectiveTo assess the efficacy of OnabotulinumtoxinA (BTXA) injections in men with drug-refractory non-neurogenic overactive bladder (NNOAB). Patients and MethodsA total of 43 men received BTXA injections for NNOAB from 2004 to 2012. Patient Global Impression of Improvement (PGI-I) score was obtained. For men with wet NNOAB, change in number of pads per day was also assessed. ResultsForty-three men with a mean age of 69 (range 37-85) received at least one injection. Of the 43 men, 20 (47%) had prior prostate surgery: 11 had radical prostatectomy (RP) and nine had transurethral resection of prostate (TURP). Overall, average PGI-I score was 2.7. Comparing PGI-I score in men who had prior prostate surgery with men who have not: 2.6 AE 0.5 vs 2.8 AE 0.5 respectively (average AE 95% CI), P = 0.6. Comparing PGI-I score in men who had previous TURP with men who had previous RP: PGI-I score: 3.3 AE 0.8 vs 2.0 AE 0.5 respectively, P < 0.05. Men who had RP experienced a reduction in pad use (from 3.5 AE 1.7 to 1.6 AE 0.9 pads/day, P < 0.05) while this was not the case amongst men who had TURP (from 1.7 AE 1.5 to 1.4 AE 1.5 pads/day, P = 0.4). ConclusionOverall, BTXA injection in men with drug-refractory NNOAB does provide a symptomatic benefit. Amongst men who have had prior prostate surgery, men who have had RP experience a greater benefit than men who have had TURP, both in regards to PGI-I score and pad use.

The AdVance sling provides mid-term improvement in men with PPI. However, men with radiotherapy or DO have significantly poorer outcomes with mid-term results indicating a return to baseline degree of incontinence. Caution should be taken when considering the AdVance sling in these men. Pre-op urodynamics in men with radiotherapy and/or overactive bladder may be important when considering men for AdVance sling. Neurourol. Urodynam. 36:1147-1150, 2017. © 2016 Wiley Periodicals, Inc.

A married mother in her 50s acutely developed vomiting, diarrhoea and severe epigastric pain 2 weeks following discharge from an acute psychiatric inpatient unit. She presented to the emergency department complaining of a 2-day history of the above symptoms. Blood tests revealed neutrophilia, grossly raised inflammatory markers and amylase levels triple the normal range. Based on radiological investigations, she was treated for necrotising pancreatitis that quickly escalated to multi-system organ failure and a lengthy intensive care unit admission. Common causes of pancreatitis, including cholelithiasis, alcohol and other drugs, were ruled out. Despite this, she suffered recurrent episodes of pancreatitis with significant morbidity. Olanzapine, started during her psychiatric admission, was determined to be the offending agent. Two years following the discontinuation of olanzapine, the patient has had no further episodes of acute pancreatitis.

Purpose:To investigate the efficacy and safety of repeated botulinum toxin type-A (BTX-A) injections for patients with drug-refractory nonneurogenic overactive bladder (NNOAB) and explore factors predictive of outcome.Methods:Data were collected from all patients receiving repeated BTX-A injections for drug-refractory NNOAB between 2004 and 2012. Trigone-sparing injections were administered under sedation with antibiotic prophylaxis. Patient characteristics including age, sex, preoperative urodynamics, injection number, BTX-A dose, complications, and patient global impression of improvement (PGI-I) scores were collected. Correlations between patient factors and outcomes were assessed by using Pearson’s chi-square tests.Results:Fifty-two patients with a mean age of 67.4 years (range, 26–93 years) received 140 BTX-A injections in total; 33 (64%), 15 (29%), and 4 patients (7%) received 2, 3 to 4, and 5 to 8 injections, respectively. Mean follow-up time was 49 months (range, 9–101 months). Nine patients developed urinary tract infection; additionally, 3 patients experienced transient urinary retention. Median PGI-I score was 2 out of 7 (interquartile range [IQR], 2). For 46 patients, the PGI-I score remained stable with the administration of each injection. Pearson chi-square tests revealed that male patients or reduced bladder compliance was associated with a higher (worse) PGI-I score. Median PGI-I scores for men and women were 3 (IQR, 1) and 2 (IQR, 1), respectively; additionally, median PGI-I scores for those with normal bladder compliance and those with reduced bladder compliance were 2 (IQR, 2) and 4.5 (IQR, 1), respectively. Median PGI-I scores and complication rates were the same in the older patient (≥70 years) and younger (<70 years) patient cohorts.Conclusions:Efficacy is maintained with repeated BTX-A injections. Patients including the elderly show a good degree of tolerability with a low complication rate. Male patients or reduced bladder compliance is associated with poorer outcomes.