Rodney U. Anderson, MD FACS

All Publications

• Chronic Prostatitis and/or Chronic Pelvic Pain as a Psychoneuromuscular Disorder -A Meta-analysis UROLOGY Anderson, R. U., Wise, D., Nathanson, B. H. 2018; 120: 23–29

  View details for DOI 10.1016/j.urology.2018.07.002

  View details for Web of Science ID 000448386300011

• Equal Improvement in Men and Women in the Treatment of Urologic Chronic Pelvic Pain Syndrome Using a Multi-modal Protocol with an Internal Myofascial Trigger Point Wand APPLIED PSYCHOPHYSIOLOGY AND BIOFEEDBACK Anderson, R. U., Wise, D., Sawyer, T., Nathanson, B. H., Smith, J. N. 2016; 41 (2): 215-224

  Abstract

  Both men and women require treatment for urologic chronic pelvic pain syndromes (UCPPS), which includes interstitial cystitis/painful bladder syndrome, pelvic floor dysfunction, and chronic prostatitis/chronic pelvic pain syndrome. However, it is unknown if men and women respond differently to a protocol that includes specific physical therapy self-treatment using an internal trigger point wand and training in paradoxical relaxation. We performed a retrospective analysis by gender in a single arm, open label, single center clinical trial designed to evaluate the safety and effectiveness of a protocol for the treatment of UCPPS from October, 2008 to May, 2011. 314 adult men (79.9 %) and 79 (20.1 %) women met inclusion criteria. The median duration of symptoms was 60 months. The protocol required an initial 6-day clinic for training followed by a 6-month self-treatment period. The treatment included self-administered pelvic floor trigger point release with an internal trigger point device for physical therapy along with paradoxical relaxation training. Notable gender differences in prior treatments were observed. Men had a lower median [Interquartile Range] NIH-CPSI score at baseline than women (27 [21, 31] vs. 29 [22, 33], p = 0.04). Using a 1-10 scale with 10 = Most Severe, the median reduction in trigger point sensitivity was 3 units for both men and women after 6 months therapy (p = 0.74). A modified Intention to Treat analysis and a multivariate regression analysis found similar results. We conclude that men and women have similar, significant reductions in trigger point sensitivity with this protocol.

  View details for DOI 10.1007/s10484-015-9325-6

  View details for PubMedID 26721470

• Chronic Pelvic Pain Syndrome: Reduction of Medication Use After Pelvic Floor Physical Therapy with an Internal Myofascial Trigger Point Wand APPLIED PSYCHOPHYSIOLOGY AND BIOFEEDBACK Anderson, R. U., Harvey, R. H., Wise, D., Smith, J. N., Nathanson, B. H., Sawyer, T. 2015; 40 (1): 45-52

  View details for DOI 10.1007/s10484-015-9273-1

  View details for Web of Science ID 000351744500006

• OnabotulinumtoxinA Office Treatment for Neurogenic Bladder Incontinence in Parkinson's Disease UROLOGY Anderson, R. U., Orenberg, E. K., Glowe, P. 2014; 83 (1): 22-27

  Abstract

  To evaluate safety and effectiveness of low-dose (100 U) onabotulinumtoxinA (onabotA) bladder injections as an office procedure with topical anesthesia only for patients with Parkinson's disease (PD) and incontinence.Qualified patients who failed oral antimuscarinic agents participated in an open-label study. They discontinued antimuscarinics, provided a King's Health Questionnaire (KHQ), voiding symptom score, and 3-day voiding diary. Free uroflowmetry with post-void ultrasounds and cystometrogram pressure/flow studies were performed. Patients underwent flexible cystoscopy and injections of onabotA 100 U (10 U/mL) dispersed into 10-20 submucosal/detrusor sites of the bladder, including the trigone. Voiding diaries, questionnaires, and free uroflowmetry with post-void ultrasound residual urine measurements were repeated after 1, 3, and 6 months.Twelve men and 8 women were treated: mean age, 70.4 years; duration of disease, 10.6 years; median bladder contraction volume, 115 mL; maximum bladder pressure, 62 cm; and post-void volume, 9 mL. Moderate to marked symptom relief at 3 months and a 50% incontinence decrease over 6 months relative to pretreatment was reported in 59% patients (P ≤.02); 5 patients failed to complete the 6-month endpoint. No urinary retention required catheterization.Office cystoscopy with low-dose onabotA injection treatment is a potential long-term management strategy for patients with PD and urinary incontinence who fail oral antimuscarinic agents. The treatment seems to be safely utilized for older men with BPH as well as women with potential hypoactive detrusor function.

  View details for DOI 10.1016/j.urology.2013.09.017

  View details for Web of Science ID 000328695800009

  View details for PubMedID 24231202

• Randomized Multicenter Feasibility Trial of Myofascial Physical Therapy for the Treatment of Urological Chronic Pelvic Pain Syndromes JOURNAL OF UROLOGY FitzGerald, M. P., Anderson, R. U., Potts, J., Payne, C. K., Peters, K. M., Clemens, J. Q., Kotarinos, R., Fraser, L., Cosby, A., Fortman, C., Neville, C., Badillo, S., Odabachian, L., Sanfield, A., O'Dougherty, B., Halle-Podell, R., Cen, L., Chuai, S., Landis, J. R., Mickelberg, K., Barrell, T., Kusek, J. W., Nyberg, L. M. 2013; 189 (1): S75-S85

  Abstract

  We determined the feasibility of conducting a randomized clinical trial designed to compare 2 methods of manual therapy (myofascial physical therapy and global therapeutic massage) in patients with urological chronic pelvic pain syndromes.We recruited 48 subjects with chronic prostatitis/chronic pelvic pain syndrome or interstitial cystitis/painful bladder syndrome at 6 clinical centers. Eligible patients were randomized to myofascial physical therapy or global therapeutic massage and were scheduled to receive up to 10 weekly treatments of 1 hour each. Criteria to assess feasibility included adherence of therapists to prescribed therapeutic protocol as determined by records of treatment, adverse events during study treatment and rate of response to therapy as assessed by the patient global response assessment. Primary outcome analysis compared response rates between treatment arms using Mantel-Haenszel methods.There were 23 (49%) men and 24 (51%) women randomized during a 6-month period. Of the patients 24 (51%) were randomized to global therapeutic massage, 23 (49%) to myofascial physical therapy and 44 (94%) completed the study. Therapist adherence to the treatment protocols was excellent. The global response assessment response rate of 57% in the myofascial physical therapy group was significantly higher than the rate of 21% in the global therapeutic massage treatment group (p = 0.03).We judged the feasibility of conducting a full-scale trial of physical therapy methods and the preliminary findings of a beneficial effect of myofascial physical therapy warrants further study.

  View details for DOI 10.1016/j.juro.2012.11.018

  View details for Web of Science ID 000312100000019

  View details for PubMedID 23234638

• Safety and Effectiveness of an Internal Pelvic Myofascial Trigger Point Wand for Urologic Chronic Pelvic Pain Syndrome CLINICAL JOURNAL OF PAIN Anderson, R., Wise, D., Sawyer, T., Nathanson, B. H. 2011; 27 (9): 764-768

  Abstract

  Pelvic muscle tenderness occurs often in patients with urologic chronic pelvic pain syndrome; symptoms frequently can be reduced with pelvic myofascial physical therapy. This open-label pilot study evaluated the safety of a personal wand that enables patient's self-treatment of internal myofascial trigger points in the pelvic floor and its effect in reducing pelvic muscle tenderness.A specially designed curved wand served as an extended finger to locate and release painful internal myofascial trigger points; an integrated algometer monitors and guides appropriate applied point pressure. Patients used the wand several times weekly after education and careful supervision. Evaluations for adverse events and assessments of pain sensitivity were conducted at 1 and 6 months after commencing use.One hundred and thirteen of the enrolled 157 patients completed 6 months of wand use-106 men and 7 women; 44 patients withdrew before study completion but none for adverse events. Median age was 41 years and 93% were male. Baseline median sensitivity visual analog scale score (1 to 10, 10=most sensitive) was 7.5 and decreased significantly at 6 months to 4 (P<0.001, Wilcoxon matched-pairs signed-rank test). Most patients (95.5%) reported the wand as either very or moderately effective in alleviating pain. No serious adverse events occurred.A multimodal protocol using an internal pelvic therapeutic wand seems to be a safe, viable treatment option in select refractory patients with pelvic pain.

  View details for DOI 10.1097/AJP.0b013e31821dbd76

  View details for Web of Science ID 000295846200003

  View details for PubMedID 21613956

• 6-Day Intensive Treatment Protocol for Refractory Chronic Prostatitis/Chronic Pelvic Pain Syndrome Using Myofascial Release and Paradoxical Relaxation Training JOURNAL OF UROLOGY Anderson, R. U., Wise, D., Sawyer, T., Glowe, P., Orenberg, E. K. 2011; 185 (4): 1294-1299

  Abstract

  Chronic prostatitis/chronic pelvic pain syndrome continues to elude conventional therapy. Evidence supports the concept that phenotypes of pelvic muscular tenderness and psychosocial distress respond to myofascial trigger point release and specific relaxation training. This case series reports long-term outcomes of a 6-day intensive combination of such therapies in refractory cases.A total of 200 men with pain for a median of 4.8 years referred themselves to Stanford University Urology for participation in an established protocol. Daily 3 to 5-hour sessions including intrapelvic/extrapelvic physiotherapy, self-treatment training and paradoxical relaxation training provided a solid introduction to facilitate self-management. Subjects answered baseline and followup questionnaires at variable intervals after initiation of therapy including the National Institutes of Health Chronic Prostatitis Symptom Index, global response assessment and a psychological query.We followed 116 men for a median of 6 months. Baseline total symptom index was 26 out of a maximum 43 points. Scores decreased by 30% (p <0.001) at followup with 60% of subjects demonstrating a 6-point or greater decrease (range 6 to 30). Domains of pain, urinary dysfunction and quality of life showed significant improvement (p <0.001). Global response assessment revealed that 82% of subjects reported improvement (59% marked to moderate, 23% slight).Men with chronic pelvic pain refractory to traditional treatment benefit from intensive myofascial trigger point therapy and concomitant paradoxical relaxation training. Education in techniques for self-administered trigger point release and continued pelvic muscle relaxation help patients reduce pain and dysfunction. Refinement of clinical phenotyping and selection of patients with pelvic muscle tenderness should enhance the success rate with this treatment modality.

  View details for DOI 10.1016/j.juro.2010.11.076

  View details for Web of Science ID 000288430200043

  View details for PubMedID 21334027

• Painful Myofascial Trigger Points and Pain Sites in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome JOURNAL OF UROLOGY Anderson, R. U., Sawyer, T., Wise, D., Morey, A., Nathanson, B. H. 2009; 182 (6): 2753-2758

  Abstract

  A combination of manual physiotherapy and specific relaxation training effectively treats patients with chronic prostatitis/chronic pelvic pain syndrome. However, little information exists on myofascial trigger points and specific chronic pelvic pain symptoms. We documented relationships between trigger point sites and pain symptoms in men with chronic prostatitis/chronic pelvic pain syndrome.We randomly selected a cohort of 72 men who underwent treatment with physiotherapy and relaxation training from 2005 to 2008. Patients self-reported up to 7 pelvic pain sites before treatment and whether palpation of internal and external muscle trigger points reproduced the pain. Fisher's exact test was used to compare palpation responses, ie referral pain, stratified by reported pain site.Pain sensation at each anatomical site was reproduced by palpating at least 2 of 10 designated trigger points. Furthermore, 5 of 7 painful sites could be reproduced at least 50% of the time (p <0.05). The most prevalent pain sites were the penis in 90.3% of men, the perineum in 77.8% and the rectum in 70.8%. Puborectalis/pubococcygeus and rectus abdominis trigger points reproduced penile pain more than 75% of the time (p <0.01). External oblique muscle palpation elicited suprapubic, testicular and groin pain in at least 80% of the patients at the respective pain sites (p <0.01).This report shows relationships between myofascial trigger points and reported painful sites in men with chronic prostatitis/chronic pelvic pain syndrome. Identifying the site of clusters of trigger points inside and outside the pelvic floor may assist in understanding the role of muscles in this disorder and provide focused therapeutic approaches.

  View details for DOI 10.1016/j.juro.2009.08.033

  View details for Web of Science ID 000271668600075

  View details for PubMedID 19837420

• Stress Induced Hypothalamus-Pituitary-Adrenal Axis Responses and Disturbances in Psychological Profiles in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome JOURNAL OF UROLOGY Anderson, R. U., Orenberg, E. K., Morey, A., Chavez, N., Chan, C. A. 2009; 182 (5): 2319-2324

  Abstract

  Chronic pelvic pain in men has a strong relationship with biopsychosocial stress and central nervous system sensitization may incite or perpetuate the pain syndrome. We evaluated patients and asymptomatic controls for psychological factors and neuroendocrine reactivity under provoked acute stress conditions.Men with pain (60) and asymptomatic controls (30) completed psychological questionnaires including the Perceived Stress, Beck Anxiety, Type A behavior and Brief Symptom Inventory for distress from symptoms. Hypothalamic-pituitary-adrenal axis function was measured during the Trier Social Stress Test with serum adrenocorticotropin hormone and cortisol reactivity at precise times, before and during acute stress, which consisted of a speech and mental arithmetic task in front of an audience. The Positive and Negative Affective Scale measured the state of emotions.Patients with chronic pelvic pain had significantly more anxiety, perceived stress and a higher profile of global distress in all Brief Symptom Inventory domains (p <0.001), scoring in the 94th vs the 49th percentile for controls (normal population). Patients showed a significantly blunted plasma adrenocorticotropin hormone response curve with a mean total response approximately 30% less vs controls (p = 0.038) but no differences in any cortisol responses. Patients with pelvic pain had less emotional negativity after the test than controls, suggesting differences in cognitive appraisal.Men with pelvic pain have significant disturbances in psychological profiles compared to healthy controls and evidence of altered hypothalamic-pituitary adrenal axis function in response to acute stress. These central nervous system observations may be a consequence of neuropsychological adjustments to chronic pain and modulated by personality.

  View details for DOI 10.1016/j.juro.2009.07.042

  View details for Web of Science ID 000270756900076

  View details for PubMedID 19762053

• Randomized Multicenter Feasibility Trial of Myofascial Physical Therapy for the Treatment of Urological Chronic Pelvic Pain Syndromes JOURNAL OF UROLOGY FitzGerald, M. P., Anderson, R. U., Potts, J., Payne, C. K., Peters, K. M., Clemens, J. Q., Kotarinos, R., Fraser, L., Cosby, A., Fortman, C., Neville, C., Badillo, S., Odabachian, L., Sanfield, A., O'Dougherty, B., Halle-Podell, R., Cen, L., Chuai, S., Landis, J. R., Mickelberg, K., Barrell, T., Kusek, J. W., Nyberg, L. M. 2009; 182 (2): 570-580

  Abstract

  We determined the feasibility of conducting a randomized clinical trial designed to compare 2 methods of manual therapy (myofascial physical therapy and global therapeutic massage) in patients with urological chronic pelvic pain syndromes.We recruited 48 subjects with chronic prostatitis/chronic pelvic pain syndrome or interstitial cystitis/painful bladder syndrome at 6 clinical centers. Eligible patients were randomized to myofascial physical therapy or global therapeutic massage and were scheduled to receive up to 10 weekly treatments of 1 hour each. Criteria to assess feasibility included adherence of therapists to prescribed therapeutic protocol as determined by records of treatment, adverse events during study treatment and rate of response to therapy as assessed by the patient global response assessment. Primary outcome analysis compared response rates between treatment arms using Mantel-Haenszel methods.There were 23 (49%) men and 24 (51%) women randomized during a 6-month period. Of the patients 24 (51%) were randomized to global therapeutic massage, 23 (49%) to myofascial physical therapy and 44 (94%) completed the study. Therapist adherence to the treatment protocols was excellent. The global response assessment response rate of 57% in the myofascial physical therapy group was significantly higher than the rate of 21% in the global therapeutic massage treatment group (p = 0.03).We judged the feasibility of conducting a full-scale trial of physical therapy methods and the preliminary findings of a beneficial effect of myofascial physical therapy warrants further study.

  View details for DOI 10.1016/j.juro.2009.04.022

  View details for Web of Science ID 000267850300056

  View details for PubMedID 19535099

  View details for PubMedCentralID PMC2872169

• HPA AXIS ENDOCRINE RESPONSES TO STRESS CHALLENGE AND PSYCHOMETRIC PROFILES OF MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS) 6th Annual Winter Meeting of the Society-for-Urodynamics-and-Female-Urology Anderson, R., Orenberg, E., Morey, A., Chavez, N., Chan, C. WILEY-LISS. 2009: 137–37

  View details for Web of Science ID 000263757400077

• Psychometric profiles and hypothalamic-pituitary-adrenal axis function in men with chronic prostatitis/chronic pelvic pain syndrome JOURNAL OF UROLOGY Anderson, R. U., Orenberg, E. K., Chan, C. A., Morey, A., Flores, V. 2008; 179 (3): 956-960

  Abstract

  Abnormal regulation of the hypothalamic-pituitary-adrenal axis and diurnal cortisol rhythms are associated with several pain and chronic inflammatory conditions. Chronic stress may have a role in the disorder of chronic prostatitis/chronic pelvic pain syndrome related to initiation or exacerbation of the syndrome. We tested the hypothesis that men with chronic pelvic pain syndrome have associated disturbances in psychosocial profiles and hypothalamic-pituitary-adrenal axis function.A total of 45 men with chronic pelvic pain syndrome and 20 age matched, asymptomatic controls completed psychometric self-report questionnaires including the Type A personality test, Perceived Stress Scale, Beck Anxiety Inventory and Brief Symptom Inventory for distress from physical symptoms. Saliva samples were collected on 2 consecutive days at 9 specific times with strict reference to time of morning awakening for evaluation of free cortisol, reflecting secretory activity of the hypothalamic-pituitary-adrenal axis. We quantified cortisol variations as the 2-day average slope of the awakening cortisol response and the subsequent diurnal levels.Men with chronic pelvic pain syndrome had more perceived stress and anxiety than controls (p <0.001). Brief Symptom Index scores were significantly increased in all scales (somatization, obsessive/compulsive behavior, depression, anxiety, hostility, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychoticism) for chronic pelvic pain syndrome, and Global Severity Index rank for chronic pelvic pain syndrome was 93rd vs 48th percentile for controls (p <0.0001). Men with chronic pelvic pain syndrome had significantly increased awakening cortisol responses, mean slope of 0.85 vs 0.59 for controls (p <0.05).Men with chronic pelvic pain syndrome scored exceedingly high on all psychosocial variables and showed evidence of dysfunctional hypothalamic-pituitary-adrenal axis function reflected in augmented awakening cortisol responses. Observations suggest variables in biopsychosocial interaction that suggest opportunities for neurophysiological study of relationships of stress and chronic pelvic pain syndrome.

  View details for DOI 10.1016/j.juro.2007.10.084

  View details for Web of Science ID 000253176000050

  View details for PubMedID 18207189

  View details for PubMedCentralID PMC2694575

• Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: Improvement after trigger point release and paradoxical relaxation training JOURNAL OF UROLOGY Anderson, R. U., Wise, D., Sawyer, T., Chan, C. A. 2006; 176 (4): 1534-1538

  Abstract

  The impact of chronic pelvic pain syndrome on sexual function in men is underestimated. We quantified sexual dysfunction (ejaculatory pain, decreased libido, erectile dysfunction and ejaculatory difficulties) in men with chronic pelvic pain syndrome and assessed the effects of pelvic muscle trigger point release concomitant with paradoxical relaxation training.We treated 146 men with a mean age of 42 years who had had refractory chronic pelvic pain syndrome for at least 1 month with trigger point release/paradoxical relaxation training to release trigger points in the pelvic floor musculature. The Pelvic Pain Symptom Survey and National Institutes of Health-Chronic Prostatitis Symptom Index were used to document the severity/frequency of pain, urinary and sexual symptoms. A global response assessment was done to record patient perceptions of overall therapeutic effects at an average 5-month followup.At baseline 133 men (92%) had sexual dysfunction, including ejaculatory pain in 56%, decreased libido in 66%, and erectile and ejaculatory dysfunction in 31%. After trigger point release/paradoxical relaxation training specific Pelvic Pain Symptom Survey sexual symptoms improved an average of 77% to 87% in responders, that is greater than 50% improvement. Overall a global response assessment of markedly or moderately improved, indicating clinical success, was reported by 70% of patients who had a significant decrease of 9 (35%) and 7 points (26%) on the National Institutes of Health-Chronic Prostatitis Symptom Index (p < 0.001). Pelvic Pain Symptom Survey sexual scores improved 43% with a markedly improved global response assessment (p < 0.001) but only 10% with moderate improvement (p = 0.96).Sexual dysfunction is common in men with refractory chronic pelvic pain syndrome but it is unexpected in the mid fifth decade of life. Application of the trigger point release/paradoxical relaxation training protocol was associated with significant improvement in pelvic pain, urinary symptoms, libido, ejaculatory pain, and erectile and ejaculatory dysfunction.

  View details for DOI 10.1016/j.juro.2006.06.010

  View details for Web of Science ID 000240471300066

  View details for PubMedID 16952676

• Traditional therapy for chronic pelvic pain does not work: what do we do now? NATURE CLINICAL PRACTICE UROLOGY Anderson, R. U. 2006; 3 (3): 145-156

  Abstract

  The dilemma of managing patients with chronic pelvic pain syndromes continues to frustrate physicians confronted with these complaints. Multiple diagnoses traditionally label this condition in men and women and, typically, implicate a pelvic-organ system when, in fact, very little objective evidence for a pathophysiologic process exists. Traditional therapies, consisting of antibiotics, anti-inflammatories, and muscle relaxants, simply do not work, and their lack of efficacy compared with placebo has been documented by randomized clinical trials in the US that were sponsored by the NIH. What do we do now? This review article attempts to describe the clinical efforts of several investigators and to put their patients' outcomes in perspective, and thereby suggest alternative therapies to help these patients.

  View details for DOI 10.1038/ncpuro0438

  View details for Web of Science ID 000235845100010

  View details for PubMedID 16528287

• Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men JOURNAL OF UROLOGY Anderson, R. U., Wise, D., Sawyer, T., Chan, C. 2005; 174 (1): 155-160

  Abstract

  A perspective on the neurobehavioral component of the etiology of chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) is emerging. We evaluated a new approach to the treatment of CP/CPPS with the Stanford developed protocol using myofascial trigger point assessment and release therapy (MFRT) in conjunction with paradoxical relaxation therapy (PRT).A total of 138 men with CP/CPPS refractory to traditional therapy were treated for at least 1 month with the MFRT/PRT protocol by a team comprising a urologist, physiotherapist and psychologist. Symptoms were assessed with a pelvic pain symptom survey (PPSS) and National Institutes of Health-CP Symptom Index. Patient reported perceptions of overall effects of therapy were documented on a global response assessment questionnaire.Global response assessments of moderately improved or markedly improved, considered clinical successes, were reported by 72% of patients. More than half of patients treated with the MFRT/PRT protocol had a 25% or greater decrease in pain and urinary symptom scores, as assessed by the PPSS. In those at the 50% or greater improvement level median scores decreased 69% and 80% for pain and urinary symptoms, respectively. The 2 scores decreased significantly by a median of 8 points when the 25% or greater improvement was first observed, that is after a median of 5 therapy sessions. PPSS and National Institutes of Health-CP Symptom Index showed similar levels of improvement after MFRT/PRT protocol therapy.This case study analysis indicates that MFRT combined with PRT represents an effective therapeutic approach for the management of CP/CPPS, providing pain and urinary symptom relief superior to that of traditional therapy.

  View details for DOI 10.1097/01.jun.0000161609.31185.d5

  View details for Web of Science ID 000229946400042

  View details for PubMedID 15947608

• Once daily controlled versus immediate release oxybutynin chloride for urge urinary incontinence JOURNAL OF UROLOGY Anderson, R. U., Mobley, D., Blank, B., Saltzstein, D., Susset, J., Brown, J. S. 1999; 161 (6): 1809-1812

  Abstract

  We compared the efficacy and safety of once daily controlled and immediate release oxybutynin for incontinence.This multicenter, randomized, double-blind, active control, parallel study was designed to evaluate urge urinary incontinence episodes using a 7-day diary.A total of 97 women and 8 men 34 to 76 years old with urge incontinence or mixed incontinence with a clinically significant urge component were enrolled in the study. The number of weekly urge incontinence episodes decreased from 27.4 to 4.8 after controlled and from 23.4 to 3.1 after immediate release oxybutynin (p = 0.56), and total incontinence episodes decreased from 29.3 to 6 and from 26.3 to 3.8, respectively (p = 0.6). Weekly urge incontinence episodes from baseline to end of study also decreased to 84% after controlled and 88% after immediate release oxybutynin (p = 0.7). Continence was achieved in 41% of the controlled and 40% of the immediate release group (p = 0.9). Dry mouth of any severity was reported by 68 and 87% of the controlled and immediate release groups, respectively (p = 0.04), and moderate or severe dry mouth occurred in 25 and 46%, respectively (p = 0.03).Participants taking a single daily does of controlled release oxybutynin had similar reductions in urge incontinence and total incontinence episodes compared to those taking oxybutynin 1 to 4 times daily. A lower incidence of dry mouth was reported for controlled release oxybutynin.

  View details for Web of Science ID 000080202500019

  View details for PubMedID 10332441

• URODYNAMIC PATTERNS AFTER ACUTE SPINAL-CORD INJURY - ASSOCIATION WITH BLADDER TRABECULATION IN MALE-PATIENTS JOURNAL OF UROLOGY Anderson, R. U., McGuire, E. J. 1983; 129 (4): 777-779

  Abstract

  A study was done on 80 male acute spinal cord injury patients with reflex bladder voiding to demonstrate an association between the development of radiological bladder trabeculation and serial urodynamic pressure/flow measurements. All patients were evaluated with cystograms and urodynamic studies during 1 to 3, 4 to 9 and 10 to 24 months after injury. Urodynamic measurements from those patients with bladder trabeculation were compared to those who retained normal-appearing bladders on x-ray. A high percentage of patients (70 per cent) suffered trabeculation by 24 months after injury. Post-void residual urine volumes were not clinically helpful in identifying those patients with bladder deterioration. However, analysis of the urodynamic pressure/flow measurements revealed significant differences between patients who had trabeculation and those who maintained normal bladders on x-ray during the 3 sequential intervals after injury.

  View details for Web of Science ID A1983QN33400023

  View details for PubMedID 6842700

• Chronic Prostatitis/Chronic Pelvic Pain as a Psycho-Neuromuscular Disorder-A Meta-analysis. Urology Anderson, R. U., Wise, D., Nathanson, B. H. 2018

  Abstract

  OBJECTIVE: To evaluate effectiveness of physical therapy, biofeedback, and/or cognitive behavioral therapy for Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). This symptom complex has resisted resolution from conventional urologic treatment of the prostate, which includes antibiotics, alpha-blockers, and analgesics. Beginning in 1995, a new paradigm was introduced viewing CP/CPPS as a psycho-neuromuscular disorder driven by protective pelvic floor guarding and psychosocial stress.METHODS: A literature search (PubMed, Google Scholar, and the Cochran Library) was conducted from inception through December 2017 using key words related to CP/CPPS (e.g., prostatitis, pelvic pain) with physical therapy (e.g., myofascial trigger point release) and/or biofeedback or cognitive behavioral treatment. Studies were required to include pre and post- treatment with the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores.RESULTS: Eight studies inclusive of 280 patients met primary inclusion criteria. Study sample sizes ranged from 8 to 116 men (mean = 35); treatment duration ranged from 8 to 26 weeks (mean = 14). Pre-treatment mean CPSI scores ranged from 21.7 to 33.5. The non- standardized weighted mean reduction of CPSI score from baseline was 8.8 points; 95% CI (7.5, 11.1); p<0.001. The I2 statistic = 18.5% indicating little heterogeneity between studies. A sensitivity analysis including an additional multimodal intervention study of with 100 patients produced similar findings.CONCLUSION: Conventional medical treatment often fails to resolve CP/CPPS. A 6-point reduction in CPSI score is considered a clinically meaningful improvement of symptoms. This meta-analysis shows that treating CP/CPPS as a psycho-neuromuscular disorder can significantly exceed this clinical threshold.

  View details for PubMedID 30056195

• Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. journal of urology FitzGerald, M. P., Anderson, R. U., Potts, J., Payne, C. K., Peters, K. M., Clemens, J. Q., Kotarinos, R., Fraser, L., Cosby, A., Fortman, C., Neville, C., Badillo, S., Odabachian, L., Sanfield, A., O'Dougherty, B., Halle-Podell, R., Cen, L., Chuai, S., Landis, J. R., Mickelberg, K., Barrell, T., Kusek, J. W., Nyberg, L. M. 2013; 189 (1): S75-85

  Abstract

  We determined the feasibility of conducting a randomized clinical trial designed to compare 2 methods of manual therapy (myofascial physical therapy and global therapeutic massage) in patients with urological chronic pelvic pain syndromes.We recruited 48 subjects with chronic prostatitis/chronic pelvic pain syndrome or interstitial cystitis/painful bladder syndrome at 6 clinical centers. Eligible patients were randomized to myofascial physical therapy or global therapeutic massage and were scheduled to receive up to 10 weekly treatments of 1 hour each. Criteria to assess feasibility included adherence of therapists to prescribed therapeutic protocol as determined by records of treatment, adverse events during study treatment and rate of response to therapy as assessed by the patient global response assessment. Primary outcome analysis compared response rates between treatment arms using Mantel-Haenszel methods.There were 23 (49%) men and 24 (51%) women randomized during a 6-month period. Of the patients 24 (51%) were randomized to global therapeutic massage, 23 (49%) to myofascial physical therapy and 44 (94%) completed the study. Therapist adherence to the treatment protocols was excellent. The global response assessment response rate of 57% in the myofascial physical therapy group was significantly higher than the rate of 21% in the global therapeutic massage treatment group (p = 0.03).We judged the feasibility of conducting a full-scale trial of physical therapy methods and the preliminary findings of a beneficial effect of myofascial physical therapy warrants further study.

  View details for DOI 10.1016/j.juro.2012.11.018

  View details for PubMedID 23234638

• Sacral Nerve Stimulator Revision Due to Somatic Growth JOURNAL OF UROLOGY Clark, C., Tin Ngo, T., Comiter, C. V., Anderson, R., Kennedy, W. 2011; 186 (4): 1576-1580

  Abstract

  Sacral nerve modulation is a Food and Drug Administration approved treatment for refractory urgency, frequency, urge incontinence and nonobstructive urinary retention in adults. The sparse literature on sacral nerve modulation in children focuses on its initial efficacy in patients with neurogenic bladder and dysfunctional elimination. We describe our initial experience with sacral nerve modulation and the phenomenon of growth spurts associated with lead malfunction that necessitates revision.After receiving institutional review board approval we retrospectively reviewed the charts of pediatric patients who underwent sacral nerve modulation surgery at our institution. Charts were examined for patient demographics, subjective success, the need for further surgery and success after revision.Four patients underwent sacral nerve modulation at an average age of 12.1 years. All patients reported initial success, defined as greater than 50% symptom improvement. Subsequently 3 patients required a total of 5 revisions due to lead malfunction with an average of 1.5 years between surgeries. In those requiring revision the average somatic growth between revisions was 8.1 cm. Return of efficacy was reported after each revision. All patients had functioning nerve stimulators in place and continued to have a positive subjective response.The sparse data on sacral nerve modulation in children shows efficacy and safety similar to those in adults. Somatic growth may be associated with lead malfunction and require surgical revision. We report a small series showing that revision can be done successfully and safely. Informed consent for sacral nerve modulation in pediatric patients should include a discussion of somatic growth as a possible cause of lead malfunction necessitating revision.

  View details for DOI 10.1016/j.juro.2011.03.098

  View details for Web of Science ID 000295043000003

  View details for PubMedID 21855923

• Chronic prostatitis/chronic pelvic pain: Is there a psychosocial component? CUAJ-CANADIAN UROLOGICAL ASSOCIATION JOURNAL Anderson, R. U. 2011; 5 (5): 333-334

  View details for DOI 10.5489/cuaj.11219

  View details for Web of Science ID 000296410900009

  View details for PubMedID 22031614

  View details for PubMedCentralID PMC3202006

• Drug therapies for CP/CPPS: help or hype? NATURE REVIEWS UROLOGY Anderson, R. U., Nathanson, B. H. 2011; 8 (5): 236-237

  View details for DOI 10.1038/nrurol.2011.51

  View details for Web of Science ID 000290517200002

  View details for PubMedID 21562480

• Randomized multicenter pilot trial shows benefit of manual physical therapies in treatment of urologic chronic pelvic pain 38th Annual Meeting of the International-Continence-Society Fitzgerald, M. P., Anderson, R. U., Payne, C. K., Peters, K. M., Clemens, J. Q., Potts, J., Cen, L., Chuai, S., Kusek, J. W., Nyberg, L. M. WILEY-LISS. 2008: 684–84

  View details for Web of Science ID 000259114800097

• Effectiveness and tolerability of extended-release oxybutynin vs extended-release tolterodine in women with or without prior anticholinergic treatment for overactive bladder INTERNATIONAL UROGYNECOLOGY JOURNAL Anderson, R. U., MacDiarmid, S., Kell, S., Barada, J. H., Serels, S., Goldberg, R. P. 2006; 17 (5): 502-511

  Abstract

  The efficacy and the tolerability of extended-release oxybutynin chloride, 10 mg daily, and extended-release tolterodine tartrate, 4 mg daily, in women with or without prior anticholinergic treatment for overactive bladder (OAB) were compared in a post-hoc analysis of data from the Overactive Bladder: Performance of Extended Release Agents (OPERA) trial. The patient population and study methods have been described previously (Diokno et al., for the OPERA Study Group, Mayo Clin Proc 78:687-695, 2003). Among the group with anticholinergic experience, extended-release oxybutynin was significantly more effective than extended-release tolterodine in reducing micturition frequency at last observation (p=0.052). Complete freedom from urge incontinence was reported by significantly more patients taking oxybutynin than tolterodine at last observation (23.6 vs 15.1%, p=0.038). In addition, among patients completing a full 12 weeks of oxybutynin treatment, significantly greater reductions were observed compared with those taking tolterodine on the primary efficacy variable, number of urge incontinence episodes (p=0.049), and the combined total of urge and non-urge episodes (p=0.012), although the differences between treatment groups were not significant at last observation. In the anticholinergic-naïve group, efficacy and tolerability outcomes were similar across treatments, except that oxybutynin was associated with a significantly lower frequency of micturition at last observation (p=0.035). No efficacy differences favoring tolterodine were observed, and tolerability of the treatments was comparable. Dry mouth (mostly mild to moderate in severity) was reported significantly more often among participants taking extended-release oxybutynin than extended-release tolterodine (32.2 vs 19.2%, p=0.004), but only among those with previous anticholinergic experience. Discontinuation rates were comparably low across groups. The results demonstrate the appropriateness of initiating treatment for OAB with extended-release oxybutynin, particularly in women presenting with incontinence.

  View details for DOI 10.1007/s00192-005-0057-7

  View details for Web of Science ID 000239355000016

  View details for PubMedID 16724169

• Pharmacotherapy for neurogenic detrusor overactivity AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION Chancellor, M. B., Anderson, R. U., Boone, T. B. 2006; 85 (6): 536-545

  Abstract

  Chancellor MB, Anderson RU, Boone TB: Pharmacotherapy for neurogenic detrusor overactivity. Am J Phys Med Rehabil 2006;85:536-545. Patients with neurogenic detrusor overactivity are a heterogeneous group with voiding dysfunction secondary to neurologic injury or disease. The neurogenic detrusor overactivity syndrome, which may include urinary frequency, urgency, and incontinence, frequently contributes to a loss of independence, or even institutionalization. Urodynamic assessment provides the best method of quantifying and classifying neurogenic detrusor overactivity dysfunction in patients with primary diagnoses as diverse as Parkinson's disease, cerebral palsy, multiple sclerosis, spinal cord injury, and spina bifida. For many patients, management of urinary symptoms includes pharmacotherapy with an anticholinergic agent. Several novel approaches to managing neurogenic detrusor overactivity, including intravesical instillation of anticholinergic agents, vanilloids, and neurotoxins, are being investigated. For most patients, however, flexible dosing with an anticholinergic agent, with clean intermittent catheterization when indicated, has been shown to reduce the risks of urologic complications, improve levels of continence, and enhance patient quality of life in both children and adults.

  View details for DOI 10.1097/01.phm.0000219229.92056.c2

  View details for Web of Science ID 000237856200008

  View details for PubMedID 16715024

• Efficacy and safety of extended release oxybutynin for the treatment of urge incontinence: An analysis of data from 3 flexible dosing studies JOURNAL OF UROLOGY MacDiarmid, S. A., Anderson, R. U., Armstrong, R. B., Dmochowski, R. R. 2005; 174 (4): 1301-1305

  Abstract

  We assessed the efficacy and safety of extended release (ER) oxybutynin at individualized doses for urge urinary incontinence.Data were combined from 3 flexible dosing studies of a total of 420 patients with urge urinary incontinence or mixed incontinence in whom ER oxybutynin dose adjustments were made to achieve the optimal balance between efficacy and tolerability, as judged by each participant. Individual doses were adjusted in 5 mg increments across a dose range of 5 to 30 mg daily. Efficacy was assessed during maintenance therapy using a 7-day diary.Data on 368 patients who completed dose adjustment were included in the analysis. In 47% of patients the preferred dose was greater than 10 mg daily. Individualized doses of ER oxybutynin produced a 79.3% decrease from baseline in the total of all incontinence episodes and an 83.2% decrease in urge episodes. Of patients 81% achieved a decrease of at least 70% in all incontinence episodes and 43% achieved total dryness. Moderate or severe dry mouth was reported by 23% of patients and it was cited as the cause for early withdrawal by 1.4% who completed dose adjustment. Therapy was well tolerated. In the pooled sample overall 6.7% of patients cited adverse events as the reason for discontinuing.Individualized dosing with ER oxybutynin was associated with highly effective and well tolerated control of urinary incontinence with more than 40% of patients achieving total dryness.

  View details for DOI 10.1097/01.ju.0000173076.93737.d5

  View details for Web of Science ID 000231831400035

  View details for PubMedID 16145407

• Management of chronic prostatitis-chronic pelvic pain syndrome UROLOGIC CLINICS OF NORTH AMERICA Anderson, R. U. 2002; 29 (1): 235-?

  Abstract

  Although the neurobiologic basis of CPPSs in men remains unclear, therapeutic interventions should continue to be improved. Invasive or destructive modalities should be avoided when possible. Electrical neuromodulation techniques seem to be a promising, among other multimodal approaches. Physicians must learn from patients in attempt to relieve symptoms.

  View details for Web of Science ID 000176538200025

  View details for PubMedID 12109351

• Management of lower urinary tract infections and cystitis UROLOGIC CLINICS OF NORTH AMERICA Anderson, R. U. 1999; 26 (4): 729-?

  Abstract

  It is possible to understand the pathophysiology, diagnostic laboratory methodology, and appropriate medical and surgical management of urinary tract infections in today's modern medical world. The foundation of success lies within an appropriate determination of the presence of mitigating complications, careful documentation of invading organisms, and judicious selection and administration of modern antimicrobial agents. Virtually all urinary tract infections begin in the lower system through bacterial exposure and adherence phenomena, creating simple uncomplicated infections in otherwise healthy hosts and serious complicated infections in others. Not all bacteriuria should be treated, and not all infections should be treated equally; knowing the difference is the secret.

  View details for Web of Science ID 000083292200006

  View details for PubMedID 10584614

• Detrusor-sphincter dyssynergia and vesico urethral reflux: management SPINAL CORD Perkash, I., Linsenmeyer, T. A., Bodner, D. R., Anderson, R. U. 1998; 36 (1): 2-5

  View details for Web of Science ID 000071539600002

  View details for PubMedID 9471129

• Mucinous adenocarcinoma of the renal pelvis in natives of India UROLOGIA INTERNATIONALIS Terris, M. K., Anderson, R. U. 1997; 58 (2): 121-123

  Abstract

  A case of mucinous adenocarcinoma of the renal pelvis and ureter presenting as chronic flank pain, calculus, and hydronephrosis in an immigrant from India is presented. A literature review reveals a high frequency of reporting this otherwise rare tumor in India and suggests an inflammatory, environmental, or dietary etiology.

  View details for Web of Science ID A1997WN83100012

  View details for PubMedID 9096276

• Treatment of complicated and uncomplicated urinary tract infections. Antibiotic Treatment of Urinary Tract Infections Lippincott-Raven Anderson RU 1996
• MEDICAL THERAPY ALONE FOR THE TREATMENT OF GAS-FORMING INTRARENAL ABSCESS JOURNAL OF UROLOGY Nickas, M. E., Reese, J. H., Anderson, R. U. 1994; 151 (2): 398-400

  Abstract

  Gas forming renal infections are severe, potentially lethal conditions. Gas formation in an intrarenal abscess is extremely rare. Formerly, these patients were uniformly treated by a combined medical and surgical approach. We describe 2 patients with intrarenal gas abscess who were successfully treated with antibiotics alone. We review the literature concerning intrarenal gas abscess and propose a pathophysiological mechanism for its formation as well as a treatment schema.

  View details for Web of Science ID A1994MR27400024

  View details for PubMedID 8283534

• Voiding symptoms and bladder function following CVA: a prospective time course study NeuroRehab Linsenmeyer TA, Anderson RU 1994; 4: 259-265
• FUNCTIONAL AND URODYNAMIC CHARACTERISTICS OF AN ILEAL NEOBLADDER JOURNAL OF UROLOGY Iwakiri, J., Gill, H., Anderson, R., Freiha, F. 1993; 149 (5): 1072-1076

  Abstract

  We examined the urodynamic characteristics and symptoms of 28 patients who had undergone the Stanford pouch bladder substitution following cystoprostatectomy. Urodynamics were obtained a mean of 18 months (range 6 to 43) after construction of the neobladder. Mean cystometric capacity was 699 cc (range 366 to 1,370). All patients voided by the Valsalva maneuver and achieved good peak flow rates (mean 19 cc per second). Of the patients 23 emptied to near completion with a mean post-void residual of 34 cc, while 5 had post-void residuals of greater than 150 cc (mean 630 cc). The neobladders demonstrated good compliance for the storage of urine, with a mean basal pressure of less than 15 cm. water at volumes of less than 500 cc at which most bladders function, and of 22.4 cm. water (range 1 to 72) at 100% capacity. Phasic neobladder contractions were present during filling cystometrography. While the number increased at higher neobladder volumes, the mean length and mean pressure did not. The mean pressure of contractions was less than 40 cm. water at lower and higher volumes. Daytime continence was attained in 26 of 28 patients (93%), while 17 (61%) attained nighttime continence. Of these 17 patients 14 (82%) had to void at least once at night to stay dry. Daytime incontinent patients had decreased neobladder compliance at high volumes compared to daytime continent patients (p < 0.05) but there was no difference in the maximal urethral closure pressure or the pressure of phasic contractions between these 2 groups. No difference was found in any urodynamic parameter between nighttime continent and incontinent patients. Patients with poor emptying ability (defined as a post-void residual of more than 150 cc) had increased neobladder compliance relative to patients with good emptying ability, as well as a statistically significant increased capacity (1,067 cc versus 623 cc). There was no difference in any important urodynamic parameter between patients who had and had not received postoperative chemotherapy. We conclude that a neobladder constructed from detubularized ileum achieves adequate capacity at low pressures with a satisfactory continence rate. Most patients empty the bladder to completion by Valsalva's maneuver. Low compliance at high volumes appears to be a factor in daytime incontinence.

  View details for Web of Science ID A1993LA46400032

  View details for PubMedID 8483213

• Neurogenic bladder Monographs in Urol. Anderson RU 1992; 13: 6
• ENDOSCOPIC URETHROPLASTY - AN IMPROVED TECHNIQUE JOURNAL OF UROLOGY DeVries, C. R., Anderson, R. U. 1990; 143 (6): 1225-1226

  Abstract

  Endoscopic urethroplasty is an excellent alternative to open repair of the traumatically disrupted posterior urethra. It offers the advantage of limiting surgical trauma to an already scarred urethra and pelvic floor. Our technique also allows fluoroscopic guidance of the recanalization procedure to align the new urethral channel precisely with minimum disruption of the nerves and muscles of the periurethral tissue and pelvic floor. It obviates the need for a second surgeon viewing the urethra from above as has been required in previously described techniques. This procedure allows for maximal preservation of residual post-traumatic continence and erectile function because it minimizes blind passage of instruments.

  View details for Web of Science ID A1990DG20400032

  View details for PubMedID 2342187

• SPLENIC ABSCESS ARISING BY DIRECT EXTENSION FROM A PERINEPHRIC ABSCESS UROLOGIC RADIOLOGY Reese, J. H., Anderson, R. U., Friedland, G. 1990; 12 (2): 91-93

  Abstract

  A case of a perinephric abscess invading the spleen in a 25-year-old woman with bladder exstrophy is reported. Treatment utilized both percutaneous drainage and open surgery. Perinephric abscesses have not been previously reported to extend into the spleen.

  View details for Web of Science ID A1990EA90100006

  View details for PubMedID 2238290

• UROLOGIC COMPLICATIONS IN SPINAL CORD-INJURED PATIENTS UROLOGY Anderson, R. U. 1988; 32 (3): 31-32

  View details for Web of Science ID A1988Q366900009

  View details for PubMedID 3420732

• TREATMENT OF EXPERIMENTAL BLADDER-CANCER WITH HYPERTHERMIA AND PHASE-TRANSITION LIPOSOMES CONTAINING METHOTREXATE JOURNAL OF UROLOGY BASSETT, J. B., Tacker, J. R., Anderson, R. U., Bostwick, D. 1988; 139 (3): 634-636

  Abstract

  Serially transplanted murine bladder cancer was treated with localized capacitive radiofrequency hyperthermia and liposome-delivered methotrexate (MTX). Liposomes were manufactured to retain MTX at 37C but specifically release encapsulated MTX as they passed through preheated tumors. When compared to controls, neither free MTX nor liposome-delivered MTX caused significant tumoricidal activity. Heat alone did cause a slowing of tumor growth and an increase in animal survival. Because large unilamellar liposomes are known to be cleared by the liver, sixteen animals were autopsied to determine the extent of liver toxicity which may have been a result of the various treatments. No hepatotoxic effects were observed after injection of liposomes containing MTX or other experimental combinations of drug and/or liposomes.

  View details for Web of Science ID A1988M285400055

  View details for PubMedID 3343756