Quiz Ref ID Benign prostatic hyperplasia (BPH) is a major contributor to lower urinary tract symptoms (LUTS) in older men. Symptoms are found in approximately one-quarter of men over 70 years.¹ Guidelines from American, Canadian, and European urology societies recommend a 5α-reductase inhibitor (5ARI) as medical therapy for BPH related LUTS.^2-4 As a medication class, 5ARIs target the 5α-reductase enzyme family, which is responsible for transforming steroid precursors into active hormones.⁵ This includes the conversion of testosterone to dihydrotestosterone, which accounts for the use of 5ARIs for androgenic alopecia and BPH.⁵ Quiz Ref ID Among BPH patients, 5ARIs reduce prostate volume, LUTS, and future BPH-related complications and surgery.^6,7 There are 2 equally efficacious 5ARI medications available for the treatment of BPH⁸: finasteride (which inhibits type 2 5α-reductase) and dutasteride (which inhibits both type 1 and type 2 5α-reductase).

The neurogenic bladder symptom score is a tool to measure urinary symptoms and consequences in patients with acquired or congenital neurogenic bladder. We describe score validity and reliability. Exploratory factor analysis was used to assess item variability and subscale structure. Reliability was assessed by the Cronbach α and correlation with retest data. Validity was assessed with a priori hypotheses specifying relationships with the AUASS (American Urological Association symptom score), ICIQ-UI (International Consultation on Incontinence-Urinary Incontinence) and urinary specific quality of life SF-Qualiveen questionnaires, and a self-assessed global bladder problem score. Known groups analysis was used to further assess construct validity. A cohort of 230 patients with spinal cord injury (35%), multiple sclerosis (59%) and congenital neurogenic bladder (6%) were included in study. Factor analysis suggested 3 neurogenic bladder symptom score domains, including incontinence, storage and voiding symptoms, and consequences. Overall internal consistency was high (Cronbach α=0.89). Test-rest reliability was also excellent with an ICC2,1 of 0.91. Validity was demonstrated by the confirmation of hypothesized correlations with the AUASS, ICIQ-UI and SF-Qualiveen, and significant differences in neurogenic bladder symptom score scores among known groups. Patients with a history of seeing a urologist had a significantly higher mean score, as did those with a higher global bladder problem score (22.1 vs 17.1 and 22.1 vs 12.6, respectively, each p<0.001). The neurogenic bladder symptom score, developed specifically to assess symptoms and consequences associated with neurogenic bladder dysfunction, has appropriate psychometric properties. Depending on the measurement need individual domains may be selected or it can be used as a comprehensive score.

Female stress urinary incontinence (SUI) is a common condition¹ that is often treated with surgery when conservative management options are unsuccessful. An estimated 1 in 7 women will undergo surgery for SUI during their lifetime.²

Prospective scoping review. To conduct a scoping review of all the literature related to bladder cancer in individuals with spinal cord injuries (SCI). Literature search of the databases Pubmed, CINAHL, ProQuest, PsychINFO and Scopus up to and including August 2012. Articles related to bladder cancer among SCI patients were identified, and data pertaining to epidemiology, risk factors, screening, prevention and management was reviewed and summarized. An association between bladder cancer and SCI was first reported in the 1960s, with some case reports suggesting an alarmingly high rate among SCI patients. More recent epidemiological studies have reported this risk to be substantially lower. However, bladder cancer in SCI patients tends to present at an earlier age and at a more advanced pathological stage than bladder cancer in the general population. Presenting symptoms may be atypical, and early recognition is important to improve prognosis with surgical resection. Several risk factors have been identified, including indwelling catheters, urinary tract infections and bladder calculi. Screening of SCI patients for bladder cancer is routinely recommended in many SCI management guidelines and by expert consensus; however, evidence for screening tools and protocols is lacking. Bladder cancer is a rare, and potentially lethal occurrence in SCI patients. Physicians need to have a high index of suspicion for bladder cancer, particularly among SCI patients managed with long-term indwelling catheters.

Gadolinium-based contrast agents are used for enhancement during magnetic resonance imaging (MRI). Safety concerns have emerged over retained gadolinium in the globus pallidi.^1,2 Neurotoxic effects have been seen in animals and when gadolinium is given intrathecally in humans.¹ In July 2015, the US Food and Drug Administration stated that it was unknown whether gadolinium deposits were harmful. The substantia nigra (affected in Parkinson disease) directs voluntary movement via signals to the globus pallidi. Consequences of damage to the globus pallidi may include parkinsonian symptoms.³ We conducted a population-based study to assess the association between gadolinium exposure and parkinsonism.