IC (INTERSTITIAL CYSTITIS) SYMPTOM INDEX
DESCRIPTION Also called the Oleary–Sant Symptom Index, this is a validated questionnaire for patients with IC/PBS (interstitial cystitis/painful bladder syndrome) to measure urinary and pain symptoms. It is based on 4 questions that are graded from 0–5, with 5 being the most severe. It is frequently used with the IC problem index.
REFERENCE
O’Leary MP, Sant GR, Fowler FJ Jr, et al. The interstitial cystitis symptom index and problem index. Urology. 1997;49(5A Suppl):58–63.
ICE WATER TEST
DESCRIPTION Historically performed after standard cystometrogram, this test may aid in differentiation of upper and lower motor neuron lesions. Ice water is rapidly instilled into the bladder and left for 1 min. If the water is ejected or the bladder pressure rapidly rises, the test is positive. Most patients with upper motor neuron/suprasacral lesions (eg, Parkinson, MS, CVA) have a positive test. Patients with lower motor neuron lesions almost never have a positive test.
REFERENCE
Petersen T, et al. The ice-water test in detrusor hyper-reflexia and bladder instability. Br J Urol. 1997;79(2):163–167.
ICIQ-MLUTS (INTERNATIONAL CONSULTATION ON INCONTINENCE QUESTIONNAIRE-MALE LOWER URINARY TRACT SYMPTOMS)
DESCRIPTION The ICIQ-MLUTS is a patient questionnaire used to evaluate men with LUTS and impact on quality of life. The original questionnaire compromised of 22 items and was shortened to 11 items in 2 distinct factors of voiding and incontinence. Unlike other questionnaires, such as the American Urological Association symptom score, the ICIQ-MLUTS contains separate subscores for the domains of incontinence and voiding with separate consideration of frequency, nocturia, and impact on quality of life. It has been shown to be a validated and reliable instrument for evaluating men with LUTS.
REFERENCE
Donovan JL, Peters TJ, Abrams P, et al. Scoring the short form ICS male SF questionnaire. International Continence Society. J Urol. 2000;164(6):1948–1955.
IIEF (INTERNATIONAL INDEX OF ERECTILE FUNCTION)
DESCRIPTION The IIEF is a validated self-administered patient questionnaire useful in the assessment of male sexual dysfunction. A score of 0–5 is given to each of 15 questions in 4 main male sexual function domains: Erectile function, orgasmic function, sexual desire, and intercourse satisfaction. The IIEF questionnaire is limited by a superficial assessment of psychosexual issues and also partner relationship factors which can both impact male sexual dysfunction. The abridged 5-item questionnaire was subsequently developed to specifically diagnose the presence and severity of erectile dysfunction.
REFERENCES
Rosen R, Riley A, Wagner G, et al. The International Index of Erectile Function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–830.
Rosen R, et al. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319–326.
IMMUNOHISTOCHEMICAL STAINING, UROLOGIC CONSIDERATIONS
DESCRIPTION The following are common markers and patterns of immunohistochemical (IHC) and other staining patterns commonly used in urologic pathology. Individual labs and pathologists may use individual panel testing with selective staining (Image 
).
REFERENCES
Bostwick D, et al. Immunohistochemistry of the prostate and bladder, testis, and renal tumors. In: Dabbs D, ed. Diagnostic Immunohistochemistry. Philadelphia, PA: Churchill Livingstone; 2002:407–434.
Liu, Qian J, Singh H, et al. Immunohistochemical analysis of chromophobe renal cell carcinoma, renal oncocytoma, and clear cell carcinoma: An optimal and practical panel for differential diagnosis. Arch Pathol Lab Med. 2007;131(8):1290–1297.
IMPERFORATE HYMEN
DESCRIPTION The hymen is composed of endoderm from the urogenital sinus epithelium and is located between the vaginal canal and vestibule. Normally, it opens during embryonic development. If it does not open, the hymen is called imperforate. Patients may present with hydrocolpos or mucocolpos that may obstruct the urinary tract. At puberty, females may present with primary amenorrhea and cyclic abdominal pain. Treatment is surgical if it causes symptoms.
REFERENCE
Katz V, Lentz G. Congenital abnormalities of the female reproductive system. In: Katz VL, ed. Comprehensive Gynecology. St. Louis, MO: Mosby; 2007.
IN VITRO FERTILIZATION (IVF) AND EMBRYO TRANSFER
DESCRIPTION Currently IVF is used for women with nonfunctioning oviducts, severe endometriosis, and in couples with male factor infertility or unexplained infertility. In most clinics, the female patient undergoes ovarian hyperstimulation with hormonal agents to increase the number of oocytes for follicle aspiration. The oocyte retrieval is performed by aspiration through the vagina with US guidance of needle placement. After aspiration of the oocyte, the eggs are incubated and placed in culture media. Sperm from the male is then integrated into the culture media after being separated from the semen. After about 48–96 hr, 1–4 splitting embryos are placed in the uterus via transcervical injection. (See also Section II: “Assisted Reproductive Techniques [ARTs].”)
REFERENCE
Lobo R. Infertility: Etiology, diagnostic evaluation management, prognosis. In: Katz VL, ed. Comprehensive Gynecology. 5th ed. St. Louis, MO: Mosby, 2007.
INCONTINENCE CLAMPS
DESCRIPTION The underlying pathophysiology of male incontinence is related to either detrusor over activity or external sphincter weakness, or a combination of the 2. Incontinence clamps are external devices that are used to treat male incontinence by increasing outflow resistance. They are applied externally to the penis to exert nonsurgical compression of the urethra, thereby preventing leakage of urine. The safety, efficacy, comfort, and patient satisfaction with 3 types of commercially available penile incontinence clamps (C3, U-Tex Male Adjustable Tension Band, and Cunningham clamp) has been studied in a small 12 patient trial. Results indicated that the Cunningham clamp was the most efficacious and most accepted by users. There was a concern over reduced distal blood flow velocity. None of the devices completely eliminated urine leakage when applied at a comfortable pressure. Complications of penile clamps can include edema, pain, urethral erosion, and obstruction. Penile clamps should not be used for >4 hr at a time. (See also Section I: “Incontinence, Urinary, Adult Male” and Section II: “Cunningham Clamp.”)
REFERENCES
Campbell SE, Glazener CM, Hunter KF, et al. Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev. 2012;1:CD001843.
Moore KN, Schieman S, Ackerman T, et al. Assessing comfort, safety, and patient satisfaction with three commonly used penile compression devices. Urology. 2004;63:150–154.
INCONTINENCE IMPACT QUESTIONNAIRE (IIQ-7)
DESCRIPTION Short version of the IIQ (Incontinence Impact Questionnaire). A 7-question validated questionnaire to assess the impact of female urinary incontinence on activities of daily living. Commonly used in a perioperative setting for patients undergoing anti-incontinence procedures and for research purposes.
REFERENCE
Ubersax JS, Wyman JF, Shumaker SA, et al. Short forms to assess life quality and symptom distress for urinary incontinence in women: The Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Neurourol Urodyn. 1995;14(2):131–139.
INCONTINENCE (URINARY) WITH ORGASM (CLIMACTURIA)
DESCRIPTION Coital urinary incontinence can be divided into 2 forms: Incontinence at penetration and incontinence during orgasm. Incontinence during orgasm has been associated with detrusor overactivity (DO), whereas female incontinence during penetration has been associated with stress incontinence. The term climacturia is used mostly when referring to males who have incontinence associated with orgasm; this condition is seen mostly after radical prostatectomy. (See also Section II: “Coital Incontinence [Coital Leakage/Intercourse Incontinence].”)
REFERENCE
Serati M, Salvatore S, Uccella S, et al. Female urinary incontinence during intercourse: A review on an understudied problem for women’s sexuality. J Sex Med. 2009;6(1):40–48.
INDEVUS URGENCY SEVERITY SCALE (IUSS)
DESCRIPTION A validated patient-reported questionnaire for the report of urgency severity associated with overactive bladder. This scale has been validated to capture the urgency severity per toilet void. This scale, when combined with a 24-hr diary of frequency and urge incontinence episodes, creates the Overactive Bladder Symptom Composite Score (OAB-SCS).
REFERENCE
Zinner N, Harnett M, Sabounjian L, et al. The overactive bladder-symptom composite score: A composite symptom score of toilet voids, urgency severity and urge urinary incontinence in patients with overactive bladder. J Urol. 2005;173(5):1693–1643.
INDIANA POUCH
DESCRIPTION A urinary reservoir is created from the right colon, and the ileal cecal apparatus is used as a continent catheterizable limb. Originally described by Gilchrist et al. in 1950, the pouch was modified by Rowland and co-workers at the University of Indiana. Modifications included detubularizing the colon with subsequent closure in a Heineke–Mikulicz configuration, strengthening of the ileocecal valve with imbricating sutures (which are performed on the ileal limb), and then performing a tunneled ureterocolonic anastomosis (Image ).
REFERENCE
Bihrle R. The Indiana pouch continent urinary reservoir. Urol Clin North Am. 1997;24(4):773–779.
INFERTILE MALE SYNDROME
DESCRIPTION Syndrome caused by mutations in the androgen receptor gene, leading to partial androgen insensitivity and infertility. This is the mildest form of partial androgen insensitivity syndrome (PAIS) and has been termed the infertile male syndrome. Described as phenotypically normal males with azoospermia or oligospermia, and high/normal serum gonadotropins and testosterone. Testicular histology varies from complete absence of germinal elements to maturation arrest of spermatogenesis.
REFERENCE
Aiman J, Griffin JE, Gazak JM, et al. Androgen insensitivity as a cause of infertility in otherwise normal men. N Engl J Med. 1979;300:223–227.
INFLAMMATORY BOWEL DISEASE, UROLOGIC CONSIDERATIONS
DESCRIPTION Crohn disease and ulcerative colitis are inflammatory diseases of the GI tract. The inflammatory response in ulcerative colitis is mostly confined to the mucosa and submucosa, as opposed to Crohn disease, which can be transmural. These diseases can give rise to a number of urologic manifestations including fistula to the urinary tract, malabsorption syndromes leading to nephrolithiasis, and pyoderma gangrenosum of the genitalia (Image ).
REFERENCE
Stenson P. Inflammatory bowel disease In: Goldman L, ed. Cecil Medicine. 23rd ed. Philadelphia, PA: Saunders; 2007.
INFLAMMATORY PSEUDOTUMOR (PSEUDOSARCOMATOUS FIBROMYXOID TUMOR)
DESCRIPTION A benign mesenchymal tumor of the bladder also referred to by many other names: Postoperative pseudosarcomatous response or lesion, spindle cell nodule, pseudosarcomatous or atypical fibromyxoid tumor, atypical myofibroblastic tumor, plasma cell granuloma, nodular fasciitis, and pseudosarcomatous myofibroblastic proliferation. The differential diagnosis of benign inflammatory pseudotumors primarily includes the spindle variant of carcinoma and sarcomas. Immunohistochemical stains are used to distinguish spindle variants of carcinoma from benign inflammatory pseudotumors. These can be seen endoscopically as pedunculated nonpapillary intraluminal lesions or as difficult to identify submucosal lesions. These are more common in females. Management is by compete transurethral resection as inflammatory pseudotumors are benign lesions that grow slowly and do not metastasize or undergo malignant transformation.
REFERENCES
Lakshmanan Y, Wills ML, Gearhart JP, et al. Inflammatory (pseudosarcomatous) myofibroblastic tumor of the bladder. Urology. 1997;50:285–288.
Zubac DP, Malmfred S, Nerstrøm B. Inflammatory pseudotumor of the bladder: A case report. Scand J Urol Nephrol. 2000;34:72–74.
INFUNDIBULAR STENOSIS
DESCRIPTION Infundibular stenosis can be characterized by a narrow infundibulum leading to a nondilated calyx which may or may not contain stones. Etiologies include extrinsic compression by either malignancy or retroperitoneal fibrosis or from intrinsic narrowing from TB, nephrolithiasis, or infection chronic scarring from renal surgery (eg, PCNL) and local neoplasm. The condition can be rarely caused by a crossing segmental artery. Patients can present with flank pain, hematuria, or deterioration of global kidney function. Indications for surgery include obstruction or to allow access to treat stones in an obstructed calyx. The use of a holmium:YAG laser or balloon is generally employed to incise or dilate the stenosis.
REFERENCE
Walsh RM, Kelly CR, Gupta M. Pecutaneous renal surgery: Use of flexible nephroscopy and treatment of infundibular stenosis. J Endourol. 2009;23(10):1679–1685.
INFUNDIBULOPELVIC DYSGENESIS
DESCRIPTION This is an obstructive process secondary to narrowing of the infundibulopelvic system that produces various congenital anomalies such as hydrocalycosis, calyceal diverticula, ureteropelvic junction stenosis, and multicystic kidney.
REFERENCE
Uhlenhuth E, Amin M, Harty JI, et al. Infundibulopelvic dysgenesis: A spectrum of obstructive renal disease. Urology. 2007;35:334–337.
INGUINAL HERNIA, ADULT, UROLOGIC CONSIDERATIONS
DESCRIPTION A direct hernia is the most common inguinal hernia in adult males. It occurs when there is a protrusion of intra-abdominal contents in an area called the Hesselbach triangle (formed by the rectus abdominis muscle, inferior epigastric artery, and inguinal ligament). Untreated bladder outlet obstruction can lead to recurrent hernia. In addition, urinary retention can occur after hernia repair. In cases of a large inguinal hernia, a portion of a distended bladder can herniate into the groin. Indirect inguinal hernias are more common in infants and children and are caused by a patent processus vaginalis.
REFERENCE
Jeyarajah R, Harford WV Jr, et al. Abdominal hernias and gastric volvulus In: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, PA: Saunders; 2006.
INGUINAL HERNIA, PEDIATRIC, UROLOGIC CONSIDERATIONS
DESCRIPTION Typically, an indirect hernia is the most common type of inguinal hernia in the pediatric population. During embryologic development, the spermatic cord and testis descend through the anterior abdominal wall to the inguinal canal through the projection of the process vaginalis. If the process vaginalis persists, an indirect inguinal hernia may form and is always associated with a hydrocele.
REFERENCE
Jeyarajah R, Harford WV Jr. Abdominal hernias and gastric volvulus In: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, PA: Saunders; 2006.
INJECTION THERAPY FOR VESICOURETERAL REFLUX
DESCRIPTION Endoscopic treatment of vesicoureteral reflux disease was 1st described in 1981 by Matouschek using polytetrafluoroethylene (PTFE) paste at the ureteral orifice. The primary principle behind injection therapy is to endoscopically inject a bulking agent beneath the ureteral orifice, which then helps to coapt the distal ureter. The technique involves placement of the needle approximately 2 mm distal to the 6 o’clock position of the ureteral orifice. The objective is to create a “volcano” like mound appearance of the ureteral orifice. Agents used for endoscopic correction of ureteral reflux should be nontoxic, cause minimal local inflammation, not migrate to other organs, and should be easy to inject. Broadly they can be categorized into 2 main categories: Nonautologous and autologous. PTFE (Teflon), bovine collagen, dextranmoer hyaluronic copolymer (Deflux), and coaptite are all examples of nonautologous materials. Chondrocytes, fat, collage, and muscles are some of the autologous materials that have been used (Image ).
REFERENCE
Molitierno JA, Scherz HC, Kirsch AJ. Endoscopic treatment of vesicoureteral reflux using dextranomer hyaluronic acid copolymer. J Pediatric Urol. 2008;4(3):221–228.
INSECT BITE, PENIS AND SCROTUM
DESCRIPTION Insect bites and stings are typically acute processes with rapid onset of various symptomatologies, including pain, pruritus, signs of ecchymosis, and edema preceding exfoliating dermatitis. While this is a benign process requiring only analgesics and antihistamines for its treatment, it is imperative to rule out pathologic events such as testicular torsion or cancer.
REFERENCE
Moran ME, Ehreth JT, Drach GW. Venomous bites to the external genitalia: An unusual cause of acute scrotum. J Urol. 1992;147(4):1085–1086.
INTERMITTENT HORMONAL THERAPY (IHT)/INTERMITTENT ANDROGEN DEPRIVATION (IAD)
DESCRIPTION The role of testosterone and prostate cancer has been well established. The role of androgen deprivation therapy (ADT) is to achieve serum testosterone levels similar to that induced by surgical castration. The impact of ADT in patient overall survival is not well known and the ideal serum testosterone level is debated. Intermittent ADT is an alternative to continuous ADT. ADT is continued until PSA reaches a nadir level. ADT is then stopped and restarted when PSA rises to pretreatment levels. In general, intermittent ADT is better tolerated and improves overall quality of life when compared to standard ADT. A recent review stated: “There is fair evidence to recommend use of IAD instead of continuous androgen deprivation (CAD) for the treatment of men with relapsing, locally advanced, or metastatic prostate cancer who achieve a good initial response to androgen deprivation. This recommendation is based on evidence against superiority of either strategy for time-to-event outcomes and substantial decrease with IAD in exposure to androgen deprivation, resulting in less cost, inconvenience, and potential toxicity.”
REFERENCES
Niraula S, Le LW, Tannock IF. Treatment of prostate cancer with intermittent versus continuous androgen deprivation: a systematic review of randomized trials. J Clin Oncol. 2013;31(16):2029–2036.
Dason S, Allard CB, Wang JG, et al. Intermittent androgen deprivation therapy for prostate cancer: Translating randomized controlled trials into clinical practice. Can J Urol. 2014;21(Suppl 1):28–36.
INTERNATIONAL CHILDREN’S CONTINENCE SOCIETY (ICCS), TERMINOLOGY
DESCRIPTION The ICCS has developed standardized definitions for bladder dysfunction symptoms. These generally apply to children who are 5 or more years of age (unless noted otherwise). (See also Section I: “Incontinence, Urinary, Pediatric.”)
• Daytime frequency: Voiding 8 or more times during waking hours. Decreased daytime frequency is defined as 3 or fewer voids. (Note: Pollakiuria is also used to define abnormally frequent small voids in a previously toilet-trained child without evidence of polyuria or UTI).
• Hesitancy: Difficulty in the initiation of voiding or if a child must wait a considerable amount of time before voiding begins. Hesitancy can be applied to children who have achieved bladder control regardless of age.
• Holding maneuvers: Observed behavior used to either postpone voiding or suppress urgency. These maneuvers include: Standing on tiptoe, forcefully crossing the legs, or squatting with a hand or heel pressed into the perineum (also referred to as “Vincent’s curtsy”). These may be observed in children who have achieved bladder control regardless of age.
• Incontinence: Uncontrolled leakage of urine. Incontinence can be continuous or intermittent.
• Intermittent stream (Intermittency): A voiding stream of urine that occurs in several discrete bursts rather than in the normal continuous stream. Considered a normal physiologic pattern in children 3 yr of age or younger.
• Nocturia: Awakening to void at night.
• Postmicturition dribbling: Involuntary urine leakage immediately after completion of voiding in children who have achieved bladder control regardless of age.
• Straining: The application of abdominal pressure (a.k.a. Valsalva maneuver) to initiate and maintain voiding. Considered a pertinent finding in all age groups.
• Urgency: The sudden and unexpected experience of the immediate need to void.
• Weak stream: The observed ejection of urine with a weak force. Considered a pertinent finding in all age groups.
REFERENCE
Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol. 2006;176(1):314–324.
INTERNATIONAL GERM CELL CANCER COLLABORATIVE GROUP (IGCCCG)
DESCRIPTION Effective chemotherapy regimens for germ cell tumors (GCT) resulted in the development of prognostic groups for patients with metastatic disease. With good-risk disease, the goal is to minimize the toxicity of current regimens, while preserving the high cure rates. In patients with high-risk disease, investigational studies have been designed to improve long-term response rates. In the IGCCCG staging system, patients are divided into good-, intermediate-, and poor-risk groups, based upon primary site of the GCT, sites of metastasis, and serum tumor markers. Within each risk group, criteria differ for seminomas and nonseminomatous GCT. Survival in >5,200 patients is correlated with risk status: Good-risk disease, 91% 5-yr survival; intermediate-risk disease, 79% 5-yr survival; poor-risk disease, 48% 5-yr survival. (See also Section I: “Testis, Cancer, General”; Section I: “Testis, Nonseminomatous Germ Cell Tumors, General”; Section I: “Testis, Seminoma.”)
__________________________________________________________________________________
SEMINOMA: GOOD RISK
All of the following:
• Any primary site
• No nonpulmonary visceral metastases
• Normal serum AFP
SEMINOMA: INTERMEDIATE RISK
All of the following:
• Any primary site
• Nonpulmonary visceral or brain metastases present
• Normal serum AFP
NONSEMINOMATOUS GERM CELL TUMORS: GOOD RISK
All of the following;
• Testicular or retroperitoneal primary tumors
• No nonpulmonary visceral metastases
• Serum AFP <1,000 ng/mL and β-hCG <5,000 mlU/mL and LDH <1.5 × upper limit of normal
NONSEMINOMATOUS GERM CELL TUMORS: INTERMEDIATE RISK
All of the following:
• Testicular or retroperitoneal primary tumors
• No nonpulmonary visceral metastases
• Intermediate level of any of the following: AFP 1,000–10,000 ng/mL or β-hCG 5,000–50,000 mlU/mL or LDH 1.5–10 × upper limit of normal
NONSEMINOMATOUS GERM CELL TUMORS: POOR RISK
Any of the following:
• Mediastinal primary germ cell tumor
• Nonpulmonary visceral metastases,
• Serum AFP >10,000 ng/mL
• Serum β-hCG >50,000 mlU/mL
• LDH >10 × upper limit of normal
__________________________________________________________________________________
REFERENCES
Bhala N, Coleman JM, Radstone CR, et al. The management and survival of patients with advanced germ-cell tumours: Improving outcome in intermediate and poor prognosis patients. Clin Oncol (R Coll Radiol). 2004;16(1):40–47.
International Germ Cell Consensus Classification: A prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol.1997;15(2):594–603.
INTERNATIONAL PROSTATE SYMPTOM SCORE (I-PSS)
DESCRIPTION A patient self-scoring instrument used for assessment of symptom severity in men with LUTS. The symptoms are scored from mild (0–7), moderate (8–19), to severe (20–35); the score can also be used to measure treatment response. The I-PSS uses the same 7 questions as the AUA Symptom Index for BPH with the addition of the disease-specific QoL question (known as the bother score), scored on a scale from 0–6 points (delighted to terrible). (See Section VII: “AUA Symptom Index for BPH” and “the I-PSS Appendix VII.”)
REFERENCES
Hakenberg OW, Pinnock CB, Marshall VR. Does evaluation with the International Prostate Symptom Score predict the outcome of transurethral resection of the prostate? J Urol. 1997;158(1):94–99.
Kapoor A. Benign prostatic hyperplasia (BPH) management in the primary care setting. Can J Urol. 2012;19(Suppl 1):10–17.
INTERSTITIAL NEPHRITIS
DESCRIPTION Acute interstitial nephritis is most commonly caused by drugs, but autoimmune diseases (eg, lupus) and a variety of infections (eg, streptococcal or legionella) can also be the cause. Many drug-related causes have been described, but the most common are penicillins, cephalosporins, NSAIDs, ciprofloxacin, rifampin, sulfonamides, allopurinol, cimetidine, and indinavir. Nonspecific symptoms and signs, along with acute renal dysfunction include nausea, vomiting, and malaise. Urine analysis reveals WBCs, RBCs, WBC casts. Proteinuria is usually absent or mild (<1 g/d). With drug-related interstitial nephritis, allergic-type reactions may be present, such as rash, fever, and eosinophilia. Diagnosis can only be confirmed on renal biopsy. Chronic interstitial nephritis is typically caused by long-term exposure to medications such as analgesics, anticonvulsants, and Chinese herbal medications; heavy met al exposure; chronic obstruction; and other causes. Presentation is insidious with hypertension, inability to concentrate urine, acidosis, and anemia being the more common symptoms. Treatment involves stopping the offending medication or treating the underlying infection or condition (eg, lupus or sarcoidosis). Steroids are controversial in treating acute interstitial nephritis but they may benefit chronic interstitial nephritis; most cases resolve spontaneously, although persistent renal dysfunction may remain.
REFERENCE
Patel N, Menolasino, M. Interstitial nephritis. In: Domino FJ, ed. The 5-Minute Clinical Consult. 22nd ed. Philadelphia, PA: Lippincott; 2014.
INTRACYTOPLASMIC SPERM INJECTION (ICSI)
DESCRIPTION An assisted repoduction technique (ARRT) in which a single spermatozoon is injected into the cytoplasm of an ovum. This technique is typically utilized in males with severe oligospermia or azoospermia, as the cost is high. (See also Section II: “Assisted Reproductive Techniques [ARTs].”)
REFERENCE
Lobo R. Infertility: Etiology, diagnostic evaluation, management, prognosis. In: Katz VL, ed. Comprehensive Gynecology. 5th ed. St. Louis, MO: Mosby, 2007.
INTRAOPERATIVE FLOPPY IRIS SYNDROME (IFIS)
DESCRIPTION The triad of intraoperative observations of flaccid iris stroma that undulates and billows in response to ordinary intraocular fluid currents, a propensity for the floppy iris to prolapse toward the phacoemulsification tip and incision, and progressive intraoperative pupil constriction. This syndrome has been associated with α-blocker therapy in men with BPH, especially tamsulosin and is due to relaxation of the dilator muscle. Discontinuation of tamsulosin appears to be unpredictable and may not reliably reduce the severity. To mitigate the intraoperative problems, pharmacologic and mechanical strategies are used.
REFERENCE
Friedman AH. Tamsulosin and the intraoperative floppy iris syndrome. JAMA. 2009;301(19):2044–2045.
INTRAUTERINE INSEMINATION (IUI)
DESCRIPTION An ART in which the placement of spermatozoa that have been separated from the seminal fluid are placed into the endometrial cavity through a small catheter. Typically used to treat male factor infertility caused by oligospermia and abnormalities of semen volume or viscosity. Also used with cervical stenosis or “hostile cervical mucous” in females (See also Section II: “Assisted Reproductive Techniques [ARTs].”)
REFERENCE
Lobo R. Infertility: Etiology, diagnostic evaluation, management, prognosis. In: Katz VL, ed. Comprehensive Gynecology. 5th ed. St. Louis, MO: Mosby; 2007.
INTRINSIC SPHINCTER DEFICIENCY (ISD)
DESCRIPTION ISD is one of many components that contribute to stress urinary incontinence (SUI) and is defined as the loss of coaptation and compression of the urethra along its length. Its etiology is usually multifactorial. ISD in women may occur simultaneously with urethral hypermobility, but should be differentiated, as the latter is an anatomic cause of SUI and not synonymous with ISD. After radical prostatectomy, SUI caused by ISD in most cases. The clinical parameters for ISD are loosely defined as a Valsalva leak-point pressure <60 cm H2O or a maximal urethral closure pressure <20 cm H2O, consensus is lacking.
CAUSES
• Complete loss of urethral tone (catheter trauma, surgical trauma)
• Pudendal nerve dysfunction and denervation of the mid-urethral complex (external sphincter)
• Estrogen deficiency (resulting in mucosal changes effecting coaptation)
• Diabetes (autonomic dysfunction of smooth and nonstriated skelet al muscle)
• Parity (pudendal neuropathy and pelvic floor destruction)
– Sphincteric injury during RP or other transurethral procedure
– Traumatic injury (ie, pelvic fracture)
TREATMENT
• Conservative management including Kegel exercises and biofeedback
• Females: Retropubic and needle suspension; periurethral bulking agents; synthetic (mesh) urethral sling; fascial urethral sling; artificial urinary sphincter
• Males: Male sling; artificial urinary sphincter (Image )
REFERENCE
Shah SM, Gaunay GS. Treatment options for intrinsic sphincter deficiency. Nat Rev Urol. 2012;9(11):638–651.
INVERTED PAPILLOMA, BLADDER
DESCRIPTION An uncommon tumor of the urinary tract characterized by proliferating urothelium arranged as inverting cords and nests with an intact overlying urothelium. Inverted papilloma is thought to be a benign lesion but because of reports of multiplicity, recurrence, and associated TCC have been seen in the literature. Its management has been controversial (Image ).
REFERENCE
Picozzi S, Casellato S, Bozzini G, et al. Inverted papilloma of the bladder: A review and an analysis of the recent literature of 365 patients. Urol Oncol. 2013;31(8):1584–1590.
INVERTED PAPILLOMA, URETER AND RENAL PELVIS
DESCRIPTION Considered by most researchers to be benign, this lesion can coexist with malignant tumors. These rare, benign lesions have a presentation similar to that of other upper tract tumors. Papillary fronds project opposite into the mucosa, appearing as smooth-surfaced, pedunculated, or sessile lesions of the urothelium. There is a strong male predominance (91%). The lesions are typically small (<3 cm), pedunculated, and polypoid. Muscularis invasion is not seen microscopically. Inverting cords and nests of urothelial cells continuous with the urothelium is a typical finding. The etiology is unknown, but probably generated by reaction to inflammation. Although benign, the lesions have a high association with urothelial carcinoma (TCC). Diagnosis is by ureteroscopy for direct visualization and biopsy. Treatment has been nephroureterectomy; however, local excision is possible, but careful follow-up for other sites of cancer along the urinary tract is essential.
REFERENCE
Luo JD, Wang P, Chen J, et al. Upper urinary tract inverted papillomas: Report of 10 cases. Oncol Lett. 2012;4(1):71–74.
IRS (INTERGROUP RHABDOMYOSARCOMA STUDY) CLINICAL CLASSIFICATION
DESCRIPTION A generally accepted classification and staging system used in the IRS. (See Section I: “Rhabdomyosarcoma, Pediatric [Sarcoma Botryoides].”):
• Group I: Localized disease, completely removed, regional nodes not involved
– A: Confined to muscle or organ of origin
– B: Contiguous involvement, with infiltration outside the muscle or organ of origin; this group includes both gross impression of complete removal and microscopic confirmation of complete removal
• Group II:
– A: Grossly removed tumor with microscopic residual disease; no evidence of gross residual tumor; no evidence of regional node involvement
– B: Regional disease, completely removed (regional nodes involved and/or extension of tumor into an adjacent organ; no microscopic residual disease)
– C: Regional disease with involved nodes, grossly removed, but with evidence of microscopic residual disease
• Group III: Incomplete removal or biopsy with gross residual disease
• Group IV: Distant metastatic disease present at onset
REFERENCE
Andrassy RJ, Hays DM, Raney RB, et al. Conservative surgical management of vaginal and vulvar pediatric rhabdomyosarcoma: A report from the Intergroup Rhabdomyosarcoma Study III. J Pediatr Surg. 1995;30:1034–1036.