Bladder Outlet Obstruction In Patients Research Articles

Small prostate associated with higher incidence of detrusor underactivity and tendency of combination with bladder stone in patients with bladder outlet obstruction.

Benign prostate hyperplasia is the leading cause of lower urinary tract symptoms due to bladder outlet obstruction (BOO) in elderly male patients. The impact of prostate volume (PV) on clinical and urodynamic characteristics was evaluated in those patients with BOO requiring prostate de-obstruction maneuvers in this study. We retrospectively reviewed the clinical data of 301 patients underwent transurethral resection of prostate due to combination with urinary retention (UR) alone and bladder stone (BS) alone. The present study investigated the differences of subjective symptoms, sonographic parameters, and urodynamic characters and assessed the proportion of UR to BS as well as the incidence of detrusor underactivity (DU) in those patients according to PV. There was not a difference of age, international prostate symptoms scores, post-voiding residual, and peak flow rate (Qmax) among 3 groups (all P > .05), whereas increasing of intravesical prostate protrusion (IPP), bladder wall thick (BWT), detrusor pressure at Qmax, bladder contractility index, bladder outlet obstruction index (BOOI), and quality of life scores with enlargement of PV was found (all P < .05). Correlations between PV and IPP (R = 0.251), Qmax (R = -0.188), post-voiding residual (R = 0.215), BWT (R = 0.170), and quality of life scores (R = 0.165) at large prostate and relationships between BWT and BOOI (R = 0.246) and bladder contractility index (R = 0.239) in moderate prostate as well as IPP and BOOI (R = 0.204) in large prostate were significantly found (all P < .05). Significant higher proportion of UR was found in patients with moderate (18%) and large prostate (47.6%) when compared to that of small prostate (3.7%), whereas higher proportion of BS was found in patients with small prostate (96.7%) compared to that of moderate (82%) and large (52.4%) prostate. Lower incidence of DU was discovered in large prostate (31.9%) compared with small (55.6%) and moderate (47.2%) prostate. BOO patients with small prostate were associated with less severity of BOO but higher incidence of DU and had a tendency of occurrence of BS, which gave a support for the theory that multifactor involved in the formation of BS rather than BOO only.

Clinical value of neutrophil to lymphocyte ratio and ultrasonic parameters in the diagnosis of bladder outlet obstruction in benign prostatic hyperplasia

AimThis study aimed to investigate the clinical significance of neutrophil-to-lymphocyte ratio and ultrasonic parameters in diagnosing bladder outlet obstruction in patients with benign prostatic hyperplasia. MaterialBetween September 2022 and January 2024, a total of 106 patients with benign prostatic hyperplasia were collected from Hongqi Hospital affiliated to Mudanjiang Medical University followed by urodynamic testing. The patients were categorized into three groups based on the International Prostate Symptom Score: mild (45 cases), moderate (36 cases), and severe (25 cases). Thirty-five healthy men were recruited at the hospital as a control group. All patients had blood tests and ultrasound scans. ResultsNeutrophil-to-lymphocyte ratio, detrusor wall thickness, detrusor muscle elastic modulus, internal gland elastic modulus, intravesical prostatic protrusion, and post-voiding residual volume were significantly correlated with the bladder outlet obstruction stage and showed good diagnostic efficiency (all P<0.05. There was no statistically significant difference observed in the external gland elastic modulus between the experimental group and the control group (P>0.05). ConclusionsThe neutrophil-to-lymphocyte ratio, detrusor wall thickness, elastic modulus of the detrusor and glandular gland may hold clinical significance for diagnosing bladder outlet obstruction resulting from benign prostatic hyperplasia. Level of evidence3.

Outcomes of bladder outlet obstruction following extensive vaginal pelvic reconstruction surgery on patient with advanced pelvic organ prolapse.

To evaluate the impact of extensive vaginal pelvic reconstruction surgery (PRS) on advanced pelvic organ prolapse (POP) patients with bladder outlet obstruction (BOO). We conducted a single-center, retrospective analysis of women who received extensive vaginal pelvic reconstruction surgery for advanced POP (POP-Q ≥3) with BOO from January 2006 to January 2016. Data regarding preoperative evaluation, surgical procedure, and postoperative management were abstracted from medical records. Patients were considered to have BOO when detrusor pressure at maximum flow (Dmax) was ≥20 cm H2O and peak flow rate (Qmax) was ≤15 mL/s. Patients with postoperative value of Dmax lower than 20 cm H2O or Qmax higher than 15 mL/s were regarded as objectively cured. A total of 1894 patients with POP stages III or IV were assessed. The incidence of BOO was 22.8% (431/1894) within this patient population of advanced POP. One year after the vaginal PRS, the objective cure rate of BOO was 98.1%. Urodynamic parameters showed a significant increase in Qmax (P < 0.001), while Dmax (P < 0.001) and postvoid residual urine (PVR) (P < 0.001) were significantly decreased. Previous POP surgery, native tissue repair (NTR), PVR ≥200 mL, and maximal cystometric capacity (MCC) ≥500 mL increase the likelihood of persistent BOO in patients. Vaginal PRS demonstrated effectiveness in treating BOO in patients with advanced POP. Irrespective of the types of transvaginal mesh (TVM), using TVM achieved better outcome than did NTR. Previous POP surgery, preoperative PVR ≥200 mL, and MCC ≥500 mL were the risk factors predicting the failure of PRS in improving BOO.

Propensity score-matched evaluation of palliative transurethral resection and holmium laser enucleation of the prostate for bladder outlet obstruction in patients with prostate cancer.

While transurethral resection of the prostate (TURP) is the standard-of-care, Holmium laser enucleation of the prostate (HoLEP) is widely accepted as a size-independent method for surgical treatment of patients with lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction (BOO). However, in an ageing society an increasing number of patients presents with BOO due to locally advanced prostate cancer. There is currently no guidelines recommendation as to the enucleation or resection technique. Therefore, we compared intraoperative performance, postoperative outcomes, and safety for palliative (p)TURP and (p)HoLEP. We conducted a retrospective, propensity score-matched analysis of 1373 and 2705 men who underwent TURP or HoLEP for LUTS/BOO between 2014 and 2021, respectively. Patients were matched for age, prostate size and preoperative international prostate symptom score (IPSS). Patients were stratified by technique and groups were compared for perioperative parameters, safety, and functional outcomes. While postoperative symptoms and urodynamic parameters improved irrespective of technique, we report significantly increased resection and enucleation times for palliative indication. For corresponding efficiency parameters, we observed a two-fold higher surgical performance (g/min) for both techniques in patients without prostate cancer. While adverse events were comparable between groups, we found a two-fold higher hemoglobin drop in palliative patients. Currently, there is no standard-of-care for patients with BOO and locally advanced prostate cancer. Our data show that both TURP and HoLEP offer adequate symptom improvement and comparable safety profiles. While HoLEP is feasible even in larger prostates, both procedures become more difficult in patients with prostate cancer. Taken together, this study covers an important gap in current literature, helping urological surgeons to make evidence-based decisions for the benefit of their patients.

Bladder outlet obstruction in women: Advanced evaluation.

Herein, we provide a review of the indications, practical considerations, and interpretation of urodynamics (UDS) with or without fluoroscopy, as well as cystourethroscopy, for women with suspected bladder outlet obstruction (BOO). A narrative review was performed focusing on the current primary literature and society guidelines around advanced diagnostic modalities for female BOO patients. UDS studies help diagnose BOO by identifying high-pressure low-flow voiding patterns and/or the characteristic radiographic appearance of the bladder neck and urethra during micturition. Cystourethroscopy aids in evaluating structural aberrations of the bladder outlet, and in surgical planning. UDS studies and cystourethroscopy are useful adjuncts in carefully-selected female patients with suspected BOO.

The Efficacy and Safety of Intrasphincteric Botulinum Toxin-A Injections in Patients with Non-Spinal Cord Injury-Related Detrusor Sphincter Dyssynergia: A Retrospective Study.

Botulinum toxin-A (BoNT-A) injections into the external urethral sphincter are an established therapeutic procedure for reducing bladder outlet obstruction in patients with detrusor sphincter dyssynergia (DSD) due to spinal cord injury (SCI). Given the paucity of data on patients with DSD but without SCI, we aimed to assess the efficacy of intrasphincteric BoNT-A injections in this cohort. For this retrospective study, we screened all patients who underwent their first intrasphincteric BoNT-A injection at our institution between 2015 and 2021. The inclusion criteria were patients aged 18 years or older with neurogenic detrusor overactivity (NDO) and DSD with a maximum detrusor pressure (Pdetmax) of >40 cmH2O, confirmed via video-urodynamic studies (VUDS). The primary outcome was a reduction in Pdetmax and detrusor overactivity leak point pressure (DOLPP) during NDO-associated urinary incontinence posttreatment. The secondary outcome was a reduction in patients relying on indwelling urinary catheters posttreatment. We included 13 eligible patients (all male, median age 31 years, with different underlying neurological disorders, except SCI). All underwent intrasphincteric BoNT-A injections with either 100 (n = 7) or 150 (n = 6) units, respectively. Pdetmax during voiding was significantly reduced posttreatment (median 105 vs. 54 cmH2O, p = 0.006), whereas DOLPP remained unchanged (i.e., median 50 cmH2O). While seven patients relied on indwelling urinary catheters pre-treatment, all were catheter-free posttreatment. Intrasphincteric BoNT-A injections in patients with non-SCI related DSD appear feasible for reducing bladder outlet obstruction to a certain degree in this cohort and subsequently for reducing the rate of indwelling catheters.

Sonographic Correlations between Intravesical Prostatic Protrusion and Bladder Outlet Obstruction in Patients with Symptomatic Benign Prostatic Hyperplasia in Ibadan, Nigeria

Background: Evaluating bladder outlet obstruction (BOO) in patients with prostatic enlargement may reflect the severity of the disease and aid in predicting the treatment outcome. Objectives: To determine the sonological correlation between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic enlargement. Methods: This prospective study was conducted over one year at the Department of Radiology, University College Hospital, Ibadan. A transabdominal ultrasound scan of the urinary bladder and prostate gland was carried out on patients with prostatic enlargement and BOO. The intravesical prostatic protrusion, pre-and post-void urine volumes, prostate volume and bladder wall thickness were measured. Results: A total of 132 men aged 43 to 90 years (mean age: 63.8±8.64 years) were studied. The median size of the intravesical prostatic protrusion (IPP) was 7.25 mm (IQR: 0.00 mm; 14.9 mm). The mean prostate volume was 63.3ml±36.0ml. Most subjects (55; 41.7%) had a prostate volume above 60ml, and most patients (101, 77.2%) had bladder wall thickness less than 5mm. The mean bladder wall thickness was 4.26mm±1.54mm. There was a statistically significant correlation between IPP and pre-void urine volume and prostate volume (p = 0.002 and &lt;0.001, respectively). Patients over 70 years had increasing IPP and post-void urine, which lacked statistical significance (p = 0.15). Conclusion: The severity of bladder outlet obstruction was reflected in the pre-void urine volume, which correlated with the size of IPP.

Simultaneous thulium laser resection of the prostate and transperineal prostate biopsy in clinically diagnosed metastatic prostate cancer with bladder outlet obstruction.

Metastatic prostate cancer (mPCa) patients complicated with bladder outlet obstruction (BOO) are often referred to a urologist. Androgen deprivation therapy (ADT) combined with indwelling catheter usually be the initial management.To retrospectively analysis the safety and efficacy of simultaneous thulium laser resection of the prostate (TmLRP) and transperineal prostate biopsy in metastatic prostate cancer with bladder outlet obstruction.From January 2016 to December 2021, 67 clinically diagnosed mPCa with BOO patients were included in this study. All patients were preoperatively assessed with international prostate symptom score (IPSS), QoL, serum prostate-specific antigen (PSA), prostate volume evaluation by transrectal ultrasound, postvoid residual urine volume (PVR), and maximum flow rate (Qmax). Preoperative and perioperative parameters at 1-, 3-, and 6-month follow-up were also evaluated. All complications were recorded.Simultaneous TmLRP and transperineal prostate biopsy had obvious advantages for clinically diagnosed mPCa patients with BOO, including short overall operation time (52 ± 23.3min), little hemoglobin decrease (0.6 ± 0.7g/l), and short hospital stay (average 3.8days). In addition, simultaneous TmLRP and transperineal prostate biopsy also brought them significant improvement on IPSS, QoL score, Qmax, and PVR volume (P < 0.001) at 1-, 3-, and 6-month follow-up after operation compared to preoperative parameters. Complications were in a low incidence.Simultaneous TmLRP and transperineal prostate biopsy is a bloodless operation with immediate effect and little perioperative complication. Importantly, it is a promising technology in the diagnosis and treatment of clinically diagnosed mPCa patients with BOO.

Choice Of treatment method for symptomatic Bladder outlet obstruction in patients with benign prostatic hyperplasia after kidney transplantation

St. Petersburg, Russian Federation The paper presents a comparative assessment of different methods of treating symptomatic bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH) who underwent kidney transplantation (KT).

LBA01-20 DETRUSOR ULTRASTRUCTURAL STUDY PREDICTS LONG TERM VOIDING OUTCOMES IN MALE PATIENTS WITH DETRUSOR UNDERACTIVITY WHO UNDERWENT TRANSURETHRAL RESECTION OF PROSTATE (TURP)

You have accessJournal of UrologyCME1 Apr 2023LBA01-20 DETRUSOR ULTRASTRUCTURAL STUDY PREDICTS LONG TERM VOIDING OUTCOMES IN MALE PATIENTS WITH DETRUSOR UNDERACTIVITY WHO UNDERWENT TRANSURETHRAL RESECTION OF PROSTATE (TURP) Amanda Chung, Vincent Tse, and Lewis Chan Amanda ChungAmanda Chung More articles by this author , Vincent TseVincent Tse More articles by this author , and Lewis ChanLewis Chan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with detrusor underactivity (DU) have a variable voiding outcome after TURP which may not be predicted by urodynamics. Our previous detrusor ultrastructural studies demonstrated that features of ‘myohypertrophy pattern’ were associated with bladder outlet obstruction(BOO) and poor short term voiding outcomes. We report the largest ultrastructural study on DU and correlate detrusor ultrastructure features with long term voiding outcomes in men with urodynamic proven DU who have had TURP. METHODS: Patients with urodynamic diagnosis of DU or BOO who underwent TURP were studied. Detrusor biopsies were obtained at cystoscopy and processed for electron microscopy. Detrusor ultrastructural features including myohypertrophy pattern (cell size, irregularity), degeneration and elastosis were assessed using a simplified protocol with observers blinded to clinical data. Postoperative voiding outcomes (mean 16yrs) were correlated with ultrastructural features and urodynamic parameters. RESULTS: 27 patients (mean age 78 yrs) were recruited (23 DU and 4 BOO). In DU patients, the mean postvoid residual urine (PVR) was 630ml (IQR 240-985). Postoperatively all BOO patients voided, 9 DU patients (39%) were catheter-free at 3 months, 14 patients (61%) required catheterisation. At long term follow-up, only 29% DU (6/21) patients were catheter-free. Functional parameters including PVR, Voiding efficiency and Bladder contractility index did not correlate with voiding outcomes. Ultrastructural studies of DU patients showed voiding outcome after TURP was significantly associated with myocyte irregularity/derangement (p=0.034) and collagenosis (p=0.041). Overall, moderate to severe changes of ‘myohypertrophy’ pattern (myocyte size variation, increased cell separation, increased intercellular collagen, degeneration) predicted poor long term voiding outcomes (p=0.029, OR of catheter-dependence 5.5). CONCLUSIONS: Detrusor ultrastructural features of myocyte irregularity, degeneration, collagenosis (moderate to severe ‘myohypertrophy pattern’) are associated with impaired detrusor contractility and predicted poor long term voiding outcomes and catheter dependence after TURP. Detrusor biopsy with ultrastructural analysis can be a useful diagnostic and prognostic tool in men with DU considering surgery. Source of Funding: Royal Australasian College of Surgeons Foundation Scholarship © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1185 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Chung More articles by this author Vincent Tse More articles by this author Lewis Chan More articles by this author Expand All Advertisement PDF downloadLoading ...

Correlation between prostate volume measured by ultrasound and symptoms severity score in patients with benign prostatic hypertrophy in Southeastern Nigeria.

Benign prostatic hypertrophy (BPH) is a common urological condition in men older than 50 years. It is important in the aetiologies of life-threatening obstructive uropathies. Ultrasound measurement of prostate volume is non-invasive, easily available, and a cost-effective method, useful in assessing bladder outlet obstruction (BOO). The International Prostate Symptoms Score (IPSS) on the other hand objectively assesses symptoms severity in BOO patients. This study was aimed at determining the correlation between ultrasound-measured prostate volume and IPSS in men with BPH. Following ethical approval from the Nnamdi Azikiwe University Teaching Hospital Ethical Committee, 100 patients who met the inclusion criteria and were diagnosed with clinical BPH were enrolled into the study. They had no other identifiable cause of BOO except BPH after clinical evaluation. The IPSS, Quality of life score (QOL), and prostate volumes were measured. Correlation between prostate volume, IPSS, and QOL were done using SPSS version 20. P value <0.05 was considered significant. The mean age of patients was 69.3 ± 10.6 years with a range of 48-100 years. The mean prostate volume, IPSS, and QOL were 96.0 ± 70.5 cm3, 15.63 ± 8.6, and 4.8 ± 1.3, respectively. The highest recorded IPSS was 35 and the lowest was 4, whereas the smallest and largest recorded prostate volumes were 19 cm3 and 350 cm3, respectively. Nocturia was the major IPSS subscore. There was a weak positive correlation between prostate volume and IPSS in men with BPH (r = +0.109; P = 0.28) and between prostate volume and QOL (r = +0.072; P = 0.45). There was also a weak positive correlation between patients with only severe symptoms and corresponding prostate volumes (r = +0.122; P = 0.125). The correlation between patients with severe symptoms and their corresponding QOL was strong (r = +0.537; P = 0.135, respectively). These findings were, however, not statistically significant. There is a weak positive correlation between prostate volume measured by ultrasound and symptoms severity scores in patients with BPH, although not statistically significant. This may be as a result of the small sample size. A larger sample size may be able to achieve statistical significance.

The significance of the extent of tissue embedding for the detection of incidental prostate carcinoma on transurethral prostate resection material: the more, the better?

The aim of this study is to investigate the incidental prostate cancer (iPCa) detection rates of different embedding methods in a large, contemporary cohort of patients with bladder outlet obstruction (BOO) treated with transurethral surgery. We relied on an institutional tertiary-care database to identify BOO patients who underwent either transurethral loop resection or laser (Holmium:yttrium–aluminium garnet) enucleation of the prostate (HoLEP) between 01/2012 and 12/2019. Embedding methods differed with regard to the extent of the additional prostate tissue submitted following the first ten cassettes of primary embedding (cohort A: one [additional] cassette/10 g residual tissue vs. cohort B: complete embedding of the residual tissue). Detection rates of iPCa among the different embedding methods were compared. Subsequently, subgroup analyses by embedding protocol were repeated in HoLEP-treated patients only. In the overall cohort, the iPCa detection rate was 11% (46/420). In cohort A (n = 299), tissue embedding resulted in a median of 8 cassettes/patient (range 1–38) vs. a median of 15 (range 2–74) in cohort B (n = 121) (p < .001). The iPCa detection rate was 8% (23/299) and 19% (23/121) in cohort A vs. cohort B, respectively (p < .001). Virtual reduction of the number of tissue cassettes to ten cassettes resulted in a iPCa detection rate of 96% in both cohorts, missing one stage T1a/ISUP grade 1 carcinoma. Increasing the number of cassettes by two and eight cassettes, respectively, resulted in a detection rate of 100% in both cohorts without revealing high-grade carcinomas. Subgroup analyses in HoLEP patients confirmed these findings, demonstrated by a 100 vs. 96% iPCa detection rate following examination of the first ten cassettes, missing one case of T1a/ISUP 1. Examination of 8 additional cassettes resulted in a 100% detection rate. The extent of embedding of material obtained from transurethral prostate resection correlates with the iPCa detection rate. However, the submission of 10 cassettes appears to be a reasonable threshold to reduce resource utilization while maintaining secure cancer detection.

Frequency of Urinary Tract Abnormalities on Ultrasound with Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia is a common problem effecting the men with increasing age which can cause many complications. Objective: To find out the frequency of Urinary Tract Abnormalities on Ultrasound associated with BPH. Methods: Descriptive study with sample size of 230 patients, conducted at Gilani Ultrasound Centre Lahore and Sanabil Health Services From July to November 2021.All patients coming with BPH were included in this study and their KUB scan done to diagnosed any urinary tract abnormalities. A convex transducer with a frequency of 3.5 to 5MHz was used for transabdominal scanning. Results: There were total of 230 patients who were presented with Benign prostate hyperplasia on Ultrasound scan, the minimum age ranged was 26 and maximum age was 90. In this study, Normal patients was 77 with 33.3%, Bilateral Hydronephrosis was in 3 patients 1.3%, Bilateral hydronephrosis with right sided Hydro ureter was in 1 patient 0.4%, Bilateral renal stones was in 3 patients 1.3%,Cystitis was in 50 patients 21.6%, Left renal cyst was in 9 patients 3.9%. Conclusion: Our study concluded that the patients coming with BPH presented with different urinary tract abnormalities on Ultrasound. Vesicoureteral reflux may concur the extravasation of urine may rarely occur due to bladder outlet obstruction in patients with BPH. BPH is a risk factor to develop UTI, cystitis, hydronephrosis and hydroureter

Development of a Predictive Model for the Diagnosis of Lower Urinary Tract Obstruction in Men

We sought to develop and validate a bladder outlet obstruction predictive model for men with nonneurogenic lower urinary tract symptoms. We retrospectively included 1,148 patients who underwent a urodynamic study in the Urology Service of the Burgos University Hospital from January 2007 to December 2019. Obstruction was defined using the Abrams-Griffiths number. A multivariable logistic regression analysis was conducted to determine the predictors of bladder outlet obstruction. We transferred these data to a model to calculate the individual probability of obstruction. A first group with 563 patients randomly divided was selected for the design of the predictive risk model and a second group of 585 patients for the validation. A total of 331 patients (58.8%) in the development group and 381 (65.1%) in the validation group had a diagnosis of obstruction. A multivariable logistic regression model showed that age, history of previous surgical intervention, presence of voiding symptoms, preserved anal tone, maximum urinary flow rate and voiding efficiency were significant for predicting obstruction. The model had an area under the receiver operating characteristic curve of 0.78 (95% CI 0.75-0.82) and a model validation of 0.78 (0.72-0.83). Our proposed model based on clinical and noninvasive urodynamics parameters allows us to predict the risk of presenting bladder outlet obstruction in patients with lower urinary tract symptoms.

Bladder Sonomorphological Tests in Diagnosing Bladder Outlet Obstruction in Patients with Lower Urinary Tract Symptoms: A Systematic Review and Meta-Analysis

Aims: We aimed to investigate the accuracy of bladder sonomorphological parameters including detrusor wall thickness (DWT) and ultrasound-estimated bladder weight (UEBW) for diagnosing bladder outlet obstruction (BOO) in patients with lower urinary tract symptoms (LUTS). Methods: A comprehensive search was conducted through databases including PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, China Knowledge Network (CNKI), China Biomedical Literature Database, Wanfang Database, the Chongqing VIP Chinese Science, and Technology Periodical Database (VIP) to select studies assessing the diagnostic accuracy of DWT and UEBW to diagnose BOO in adults with LUTS. Databases were searched from inception to 2020 without restriction. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), and measures of accuracy were calculated using random-effects model. Results: The initial search included 84 publications, of which 78 publications were screened, and 16 studies with 1,847 patients finally contained diagnostic data. The results from 10 out of 16 studies assessing DWT showed a pooled sensitivity (SSY) of 0.68 (95% CI, 0.56–0.78) and specificity (SPY) of 0.91 (95% CI, 0.82–0.96) with I² values of 93%, while 6 studies evaluating UEBW were analyzed with a SSY of 0.88 (95% CI, 0.78–0.93) and SPY of 0.81 (95% CI, 0.67–0.90) with I² values of 83%. Conclusions: DWT shows high SPY, and UEBW performs high SSY of diagnosing BOO. Further well-designed studies are needed to evaluate the utilization of DWT and UEBW for the diagnosis of BOO.

MP09-18 COMPARING DIFFERENT TREATMENT OPTIONS FOR BLADDER OUTLET OBSTRUCTION IN PATIENTS FOLLOWING RADIOTHERAPY FOR PROSTATE CANCER

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP09)1 Sep 2021MP09-18 COMPARING DIFFERENT TREATMENT OPTIONS FOR BLADDER OUTLET OBSTRUCTION IN PATIENTS FOLLOWING RADIOTHERAPY FOR PROSTATE CANCER Monika Tedeschi, Lauren Keenan, Gregg Eure, and Kurt McCammon Monika TedeschiMonika Tedeschi More articles by this author , Lauren KeenanLauren Keenan More articles by this author , Gregg EureGregg Eure More articles by this author , and Kurt McCammonKurt McCammon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001982.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is no consensus on the best treatment option for bladder outlet obstruction (BOO) in patients who have received radiation therapy for prostate cancer. In this review, we look at the efficacy of prostatic urethral lifts (PULs), laser photovaporization of the prostate (PVP), and transurethral resection of the prostate (TURP) in the treatment of BOO in patients who have undergone radiotherapy. METHODS: In this retrospective review, patients with a history of radiotherapy who required a BOO procedure between October 2011 and September 2020 were investigated. Different forms of radiation included external beam radiation (EBRT), brachytherapy (BT), EBRT + BT, and proton therapy. International Prostate Symptom Scores (IPSS) and Quality of Life (QOL) scores were assessed prior to the intervention and at 6-month and 12-month post-procedure intervals. Need for additional procedures as well as adverse side effects following initial BOO procedure were assessed. RESULTS: Eighty-five patients with a history of radiation underwent treatment for BOO between October 2011 and September 2020. Twenty-five, 28, and 32 patients underwent PULs, PVP, and TURP, respectively. The average time from radiotherapy to a BOO procedure was 6.9 years. Prior to undergoing PULs, the mean IPSS and QOL scores were 21.3 and 4.7, respectively. Six-month post-procedure IPSS and QOL scores were significantly improved from pre-procedure scores (14.4 (p=0.0009) and 3.2 (p=0.003), respectively). Twelve-month post-procedure IPSS and QOL scores were also significantly improved compared to pre-procedure scores (13.4 (p=0.002) and 3.1 (p=0.008), respectively). Thirty-two percent of patients who underwent PULs required additional procedures compared to 68% of patients who underwent PVP (p=0.009). The was no significant difference between TURP and PULs in the need for additional procedures. Regardless of surgical approach, incontinence was the most common adverse event (40%, 54%, and 28% of patients undergoing PULs, PVP, and TURP, respectively). PVP had the highest rate of urethral strictures (28%). PULs had the highest rate of prostatic calcifications (16%). Of the radiation treatments, EBRT + BT had the highest rate of incontinence at 81%. CONCLUSIONS: PULs significantly improved patients’ obstructive voiding symptoms and quality of life at 6 and 12 months following the procedure. Regardless of the surgical approach, patients with BOO and a history of radiation need to be counseled on adverse side effects and the high likelihood of multiple additional procedures. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e167-e167 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Monika Tedeschi More articles by this author Lauren Keenan More articles by this author Gregg Eure More articles by this author Kurt McCammon More articles by this author Expand All Advertisement Loading ...

STUDY OF PREVALENCE OF LOWER URINARY TRACT SYMPTOMS IN PATIENTS UNDERGOING INGUINAL HERNIA REPAIR AT SKMCH, MUZAFFARPUR, BIHAR

Background: Lower urinary tract symptoms (LUTS) are frequently associated with inguinal hernias. It is important to recognise and treat bladder outlet obstruction in patients before inguinal hernia repair to prevent recurrence of hernia. Methods: This prospective study was conducted at Department of Surgery, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. Hundred patients who presented with inguinal hernia repair were evaluated for LUTS using AUA scoring for urinary symptoms, uroowmetry (Qmax) and post voidal residual urine using ultrasonography along with urine routine microscopic examination and urine culture and sensitivity. Results: Eleven patients out of 100 who came for hernia repair had clinically signicant LUTS due to benign enlargement of prostate (BEP) and required treatment for BEP but none of these 11 patients had urinary symptoms as primary complaint. Ten patients were found to have urinary tract infection without any urinary symptom. Three patients had urethral stricture out of which 2 had Qmax of &lt;10 ml/second. Conclusions: Signicant number of patients (14 percent) with inguinal hernia had lower urinary tract symptoms. An effort should be made to identify LUTS in patients presenting with inguinal hernia before surgery and treat the cause of LUTS. Ten percent of patients had asymptomatic UTI with AUA score less than 8 but Qmax on uroowmetry was in between 10-15 ml/second.

Correlation of intravesical prostatic protrusion with severity of lower urinary symptoms among patients with benign prostatic hyperplasia

BackgroundBenign prostate hyperplasia (BPH) is characterized by an increase in the number of epithelial and stromal cells in the periurethral area of the prostate. Lower urinary tract symptoms (LUTS) often develop as a manifestation of bladder outlet obstruction (BOO) due to benign prostate enlargement. When the prostate enlarges, protrusion into the bladder often occurs as a result of morphological changes of the gland. Prostatic protrusion into the bladder can be measured with ultrasound as intravesical prostatic protrusion (IPP). There are studies that have shown IPP as a reliable predictor of bladder obstruction index (BOOI) as measured by pressure flow studies. IPP is thereby reliable in assessing the severity of BOO in patients with BPH. The severity of symptoms in patients with BPH can be assessed through several scoring systems. The most widely used symptoms scoring system is the International Prostate Symptoms Score (IPSS). The aim of this study is to determine the correlation of IPP with IPSS in men with BPH at our facility.MethodsThe study was a cross-sectional observational study that was conducted at the Division of Urology, Department of Surgery, in our facility. The study was conducted on patients greater than 50 years LUTS and an enlarged prostate on digital rectal examination and/or ultrasound. All consenting patients were assessed with the International Prostate Symptoms Score (IPSS) questionnaire, following which an abdominal ultrasound was done to measure the intravesical prostatic protrusion (IPP), prostate volume (PV) and post-void residual (PVR) urine. All the patients had uroflowmetry, and the peak flow rate was determined. The data obtained were entered into a proforma. The results were analyzed using Statistical Package for Social Sciences (SPSS) software package version 20.ResultsA total of 167 patients were seen during the study period. The mean age was 63.7 ± 8.9 years, with a range of 45–90 years. The mean IPSS was 18.24 ± 6.93, with a range of 5–35. There were severe symptoms in 49.1%, while 43.1% had moderate symptoms and 7.8% had mild symptoms. The overall mean IPP was 10.3 ± 8 mm. Sixty-two patients (37.1%) had grade I IPP, 21 patients (12.6%) had grade II IPP and 84 patients (50.3%) had grade III IPP. The mean prostate volume and peak flow rate were 64 g ± 34.7 and 11.6 ml/s ± 5.4, respectively. The median PVR was 45 ml with a range of 0–400 ml. There was a significant positive correlation between the IPP and IPSS (P = 0.001). IPP also had a significant positive correlation with prostate volume and post-void residual and a significant negative correlation with the peak flow rate (P < 0.01).ConclusionIntravesical prostatic protrusion is a reliable predictor of severity of LUTS as measured by IPSS, and it also shows good correlation with other surrogates of bladder outlet obstruction.

Role of Shear Wave Elastography in Assessing the Severity of Bladder Outlet Obstruction in Patients with Benign Prostatic Hyperplasia: A Cross-sectional Study

Role of Shear Wave Elastography in Assessing the Severity of Bladder Outlet Obstruction in Patients with Benign Prostatic Hyperplasia: A Cross-sectional Study

Efficacy, safety, and perioperative outcomes of holmium laser enucleation of the prostate\u2014a comparison of patients with lower urinary tract symptoms and urinary retention

Holmium laser enucleation of the prostate (HoLEP) is a valid treatment option to relieve bladder outlet obstruction in patients with large prostate volumes (PV). Its efficacy, tolerability, and safety are comparable to the ones of other laser treatments of the prostate and resection techniques. However, safety and efficacy of HoLEP have not been compared between patients with and without preoperative urinary retention. We included 350 patients (mean age 71.2 years) who had undergone HoLEP due to lower urinary tract symptoms (LUTS) or urinary retention caused by prostatic hyperplasia. We evaluated the differences in peri- and postoperative outcomes and complications between patients with and patients without preoperative urinary retention. The mean PV was 115 cm3. PV was > 100 cm3 in 61.9% and < 100 cm3 in 38.1% of the patients. Perioperative complications occurred in 23 patients (6.6%), 15 of which (4.3%) required operative revision. We found no significant differences in terms of complication rates between patients with PV > 100 cm3 and patients with PV < 100 cm3. Mean catheterization-duration was 3.3 days. Preoperatively, 140 patients (40%) had a suprapubic or transurethral indwelling catheter; they did not differ from patients without preoperative catheter regarding postoperative catheter removal success rate, early postoperative complications, and functional outcomes. Prostate cancer was diagnosed in 43 patients (12.3%). Median postoperative PSA-decline was 6.1 ug/l (89.8% drop). HoLEP is a safe and effective treatment for patients with LUTS or urinary retention and large PV. PV > 100 cm3 was not associated with higher complication rates or successful catheter-removal. Furthermore, functional outcomes were independent of preoperative catheterization.