Changes In Urodynamic Parameters Research Articles

Efficacy in Using Urodynamic Parameters of Intravesical Electrical Stimulation for Detrusor Underactivity.

Intravesical electrical stimulation (IVES) remains a controversial therapy for detrusor underactivity (DUA). The purpose of this study is to determine the efficacy of IVES in patients with DUA using pre- and post-IVES urodynamic parameters. Intravesical electrical stimulation procedure is performed using a specific catheter equipped with an internal electrical electrode (cathode). The anode is subsequently affixed to the lower abdomen (suprapubic). Afterward, this specialized catheter is connected to a stimulator. Patients undergo a series of 12 IVES procedures in 1 month with the following predetermined parameters: 20 mA amplitude, 20 Hz frequency, 200 µs pulse width, and 60 minutes stimulation time. Patients underwent a follow-up urodynamic examination 1 month after the IVES series is completed. After IVES, several notable changes were observed, including an increase in Qmax from 7.28 ± 5.24 to 7.29 ± 4.09 (P=.030), a decrease in post-void residual (PVR) from 73.03 ± 43.91 to 62.07 ± 39.10 (P=.005), and an increase in PDet@tQmax from 17.10 ± 12.35 to 18.87 ± 12.47 (P=.009). The aetiologies of DUA were categorized into 3 groups: chronic obstruction (CO), idiopathic (Idio), and neurological disorder (ND). The CO group exhibited significant changes in urodynamic parameters, specifically Qmax (P=.001), PVR (P=.001), and PDet@Qmax (P=.035). Similarly, the idiopathic group also demonstrated improvements in Qmax (P=.008), PVR (P=.037), and PDet@ Qmax (P=.033). Intravesical electrical stimulation has been shown to have a positive effect on patients diagnosed with DUA, particularly those whose DUA is idiopathic or due to chronic obstruction.

Effect of tamsulosin on urethral tone in healthy male cats.

Alpha-adrenergic antagonists are commonly used to prevent recurrent urethral obstruction in cats with mixed reports of efficacy. No published data on tamsulosin use in cats are available. The objective of this study was to measure changes in urodynamic parameters and blood pressure in five healthy male cats before and after administration of tamsulosin orally for 4 and 10 days. Five young healthy adult male cats from a research colony were administered tamsulosin at 0.1 mg/cat PO q24h for 10 days. Urethral pressure profile and blood pressure measurements were performed before treatment and approximately 6 h after treatment on days 4 and 10. Maximum urethral closure pressure (MUCP) for the prostatic and penile urethra, functional urethral length (FPL), functional area (FA) and systolic blood pressures were recorded and compared between the time points. Significant changes in blood pressure on day 4 (121.1 mmHg ± 20.2 mmHg) and on day 10 (112.6 mmHg ± 14.9 mmHg) compared with day 0 (141.1 mmHg± 33.4 mmHg) were not detected (P = 0.18) in anesthetized cats. No significant difference in MUCP, FA or FPL measurements were detected among baseline, day 4 and day 10 of treatment. Hematuria and transient pollakiuria were induced in two cats with 3.5 Fr urethral catheters. Tamsulosin at 0.1 mg/cat PO q24h did not induce hypotension in healthy cats. Urodynamic testing performed 6 h after the tamsulosin pill was administered did not detect consistent decreases in urodynamic functions induced by tamsulosin. Repeated catheterization of tom cats with 3.5 Fr catheters may induce significant urethral trauma.

Peripheral Sacral Magnetic Stimulation in Patients with Idiopathic Overactive Bladder: a Single Blind Prospective Randomized Comparative Clinical Study

INTRODUCTION. Overactive bladder (OAB) is a symptom complex that includes urgency, frequent urination, imperative urinary incontinence and nocturia. The idiopathic form of OAB is associated with dysfunction of sensory signal transmission at the level of the peripheral and central nervous system, which leads to bladder hypersensitivity. The low level of patients’ compliance to OAB drug therapy and the high level of refusal to take drugs emphasize the urgency of finding new effective methods of influencing the lower urinary tract. Magnetic stimulation (MS) is a non-drug treatment for lower urinary tract dysfunction.
 AIM. To study the efficacy and safety of the sacral MS method in women with idiopathic detrusor overactivity (DO) and OAB symptoms.
 MATERIALS AND METHODS. A single blind prospective randomized comparative study included 55 female patients with urodynamically confirmed idiopathic DO. The patients were divided by simple randomization into the main group (n = 29), which received MS 3 times a week for 5 weeks with a frequency of 5 Hz per sacral root area (S2–S4), and the placebo group (n = 26), in which sham stimulation was performed.
 RESULTS AND DISCUSSION. The study revealed that sacral MS is reliably effective against the clinical symptoms of OAB in idiopathic DO. The dynamics of clinical symptoms is confirmed by changes in urodynamic parameters. The effect of sacral MS significantly exceeds placebo. MS is a safe procedure and is well tolerated by patients.
 CONCLUSION. The sacral MS method, the effectiveness of which has been proven in comparison with placebo, is recommended to be included in the treatment regimen of patients with idiopathic OAB. The mechanism of action of sacral MS is associated with the activation of sympathetic and inhibition of parasympathetic influences, as well as changes in supraspinal control and cerebral activity.

Comparison of clinical effects between microscopic surgery and conventional surgery in children with penile hypospadias and difference analysis of postoperative urodynamics.

To compare and analyze the clinical effects of microscopic surgery and conventional surgery in children with penile hypospadias and the differences in postoperative urodynamic indexes. It was a clinical comparative study. A total of 80 children with penile hypospadias admitted to Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital from July 2018 to September 2022 were selected and randomly divided into two group. The experimental group were treated with microscopic urethroplasty, while the control group were treated with traditional urethroplasty. The operative effect, operation time, total intraoperative blood loss, postoperative hospital stay and incidence of surgical complications were compared and analyzed between the two groups. All the children were followed up for two years, and the changes in urodynamic parameters including maximum urine flow rate (Qmax), average urine flow rate (Qavc), urine flow time (FT), peak time (TQmax) and residual urine (PVR) were compared before, two weeks after, six months after and two years after surgery. The efficacy of the experimental group was significantly higher than that of the control group (p=0.013). The intraoperative blood loss and postoperative hospital stay in the experimental group were significantly better than those in the control group (p=0.000). The incidences of urinary leakage and urethral stricture in the experimental group were lower than those in the control group (p<0.05). The Qmax level in the experimental group was higher than that in the control group at six months and two years after surgery, while the FT level was lower than that of the control group (p<0.05). Microscopic surgery is a method with significant clinical value in the treatment of penile hypospadias.

EDITORIAL COMMENT

This is a timely and important article! We have been ignoring qualitative research for too long. While this project concentrates on semistructured qualitative interviews, other study designs such as mixed method studies may bring added value to the practical implementation of science to the care of our patients along with randomized controlled trials. 1 O'Cathain A. Thomas K.J. Drabble S.J. Rudolph A. Hewison J. What can qualitative research do for randomised controlled trials? A systematic mapping review. BMJ Open. 2013; 3 Crossref Scopus (255) Google Scholar This group is ahead of their time in adding to the quantitative outcomes spoken about for the last 50 years in the treatment of incontinence (improvement in the # of pads used per day, improvement in pad weight, change in urodynamic parameters). It’s clear from this paper that these don’t necessarily mean as much to our patients we may think. We are reminded that the patient’s primary concerns may be completely different than ours and based on things we have no knowledge about such as social situations, work requirements, fear and angst of further surgical procedures and loss of disease-free time.

Predictive Factors for a Successful Treatment Outcome in Patients with Different Voiding Dysfunction Subtypes Who Received Urethral Sphincter Botulinum Injection

Voiding dysfunction is a common but bothersome problem in both men and women. Urethral sphincter botulinum toxin A (BoNT-A) injections could serve as an option in refractory cases. This study analyzed the efficacy and outcome predictors of the injections in patients with functional, non-neurogenic voiding dysfunction. Patients who received urethral sphincter BoNT-A injection for refractory voiding dysfunction due to detrusor underactivity (DU) or urethral sphincter dysfunction were retrospectively reviewed. A successful outcome was defined as a marked improvement as reported in the global response assessment. The study evaluated the therapeutic efficacy of urethral sphincter BoNT-A injections and measured the changes in urodynamic parameters after the procedure in the patients. A total of 181 patients including 138 women and 43 men were included. The overall success rate was 64%. A lower success rate was noted in patients with DU compared to those with urethral sphincter dysfunction in both genders. In the multivariable analysis, recurrent urinary tract infection (UTI) and bladder voiding efficiency (BVE) were positive predictors for a successful outcome, while DU was a negative predictor. Urethral sphincter BoNT-A injection is an effective treatment for refractory non-neurogenic voiding dysfunction. Baseline BVE and history of recurrent UTI positively predict a successful outcome. DU is a negative outcome predictor.

Protective effects of hydrogen sulfide pretreatment on cyclophosphamide-induced bladder dysfunction in rats via suppression of bladder afferent nerves

Cyclophosphamide (CYP), a broad-spectrum anticancer drug, causes serious side effects, such as haemorrhagic cystitis (HC). Hydrogen sulfide (H2S), an endogenous gasotransmitter, has physiological properties, including anti-inflammation, anti-oxidation, and neuromodulation. In this study, we investigated the effects of NaHS (H2S donor) pretreatment on bladder dysfunction in CYP-treated rats. Male Wistar rats were intraperitoneally pretreated with NaHS (3 or 10 μmol/kg) or vehicle once daily for 7 days before cystometry, and CYP (150 mg/kg) or saline was intraperitoneally administered 2 days before cystometry. After cystometry, the bladder tissues were collected for haematoxylin and eosin staining. In some rats, capsaicin (CAP), which can desensitise CAP-sensitive afferent nerves, was subcutaneously injected at 125 mg/kg 4 days before cystometry. CYP reduced intercontraction intervals (ICI) and bladder compliance (Comp) and increased the number of non-voiding contractions (NVCs) compared with the saline-treated control group. NaHS pretreatment dose-dependently improved the CYP-induced these changes. In bladder tissues, CYP increased histological scores of neutrophil infiltration, haemorrhage, and oedema, while NaHS had no effect on these CYP-induced changes. CAP showed a tendency to suppress CYP-induced changes in ICI. NaHS-induced improvement in CYP-induced changes in urodynamic parameters were not detected in CAP-treated rats. These findings suggest that NaHS pretreatment prevented bladder dysfunction in CYP-treated rats by suppressing CAP-sensitive bladder afferent nerves, but not by suppressing bladder inflammation. Therefore, H2S represents a new candidate as a protective drug for bladder dysfunction induced by HC, a side effect of CYP chemotherapy.

PD38-06 TURPUDU TRIAL- A PROSPECTIVE STUDY EVALUATING THE EFFECT OF TRANSURETHRAL RESECTION OF PROSTATE ON URODYNAMIC PARAMETERS IN PATIENTS OF BENIGN ENLARGEMENT OF PROSTATE WITH UPPER URINARY TRACTS DILATATION

You have accessJournal of UrologyCME1 May 2022PD38-06 TURPUDU TRIAL- A PROSPECTIVE STUDY EVALUATING THE EFFECT OF TRANSURETHRAL RESECTION OF PROSTATE ON URODYNAMIC PARAMETERS IN PATIENTS OF BENIGN ENLARGEMENT OF PROSTATE WITH UPPER URINARY TRACTS DILATATION Shantanu Tyagi, Kalpesh Parmar, and Shrawan Singh Shantanu TyagiShantanu Tyagi More articles by this author , Kalpesh ParmarKalpesh Parmar More articles by this author , and Shrawan SinghShrawan Singh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002596.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pressure-flow changes after transurethral resection of prostate (TURP) for benign prostatic enlargement (BPE) with lower urinary tract symptoms have been well described in the literature. But, till date no study has evaluated the post-TURP urodynamic changes in patients with BPE with upper urinary tract dilatation (UTD). With this background, we evaluated the urodynamic outcomes of TURP in patients of BPE with UTD and correlate with International Prostate Symptoms Score (IPSS). METHODS: In this prospective study (TURPUDU stands for - TURP for Upper tract Dilatation and Urodynamic changes), patients of BPE with UTD from July 2017 to Jan 2021 were enrolled. Study protocol was registered and cleared with Institutional review board (NK/3880/MS/148). Detailed IPSS score, ultrasonography abdomen, serum creatinine, and serum PSA were recorded. All the patients were catheterised and observed for post-obstructive diuresis. At 4 weeks, repeat ultrasound and serum creatinine were recorded. Urodynamic study (UDS) was performed after ensuring sterile urine culture. Patients underwent TURP as per standard technique. A repeat UDS was performed after 3 months and analyses were done. RESULTS: Ninety-five patients were enrolled of which data of 90 patients were analysed. In the filling phase of the UDS study, there was a significant decrease in detrusor pressure at the end filling phase from 29 cm H2O to 8 cm H2O post-TURP. Maximum cystometric capacity (MCC) [409 ml to 485 ml (p-value <0.001)] and bladder compliance [10 ml/cm of H2O to 33 ml/cm of H2O (p-value <0.001)] significantly improved at 3 months following surgery. In the voiding phase, peak flow rate showed a significant increase [5 ml/sec to 16 ml/sec (p-value <0.001)], post-void residual urine volume significantly decreased [460 ml to 30 ml (p value <0.001)] and peak detrusor pressure marginally decreased following TURP. Detrusor contractility index also improved significantly at 3 months post TURP [53 to 108; (p-value <0.05)]. Among 78 patients with a weak bladder (BCI <100) before surgery, BCI improved in 55% of patients following TURP (n=43). The IPSS score decreased from 21±6 to 4±2 following TURP. CONCLUSIONS: This is the first study evaluating the effect of TURP on urodynamic parameters in patients of BPE with upper tract changes. Changes in the bladder dynamics and resolution of hydroureteronephrosis following TURP reflected in the changes in urodynamic parameters and International prostate symptom score. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e647 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shantanu Tyagi More articles by this author Kalpesh Parmar More articles by this author Shrawan Singh More articles by this author Expand All Advertisement PDF DownloadLoading ...

Is bladder outlet obstruction responsible for a successful surgical outcome in women with complicated stress urinary incontinence? Urodynamic results before and after a Remeex® readjustable sling.

To describe the changes in urodynamic parameters after Remeex® placement in women with recurrent stress urinary incontinence (rSUI) or intrinsic sphincteric deficiency (ISD) and to analyze a potential relationship between postoperative bladder outlet obstruction and a successful surgical outcome. Retrospective analysis of those women who had undergone Remeex® placement due to rSUI or ISD in our department between 2000 and 2017. All patients underwent urodynamic evaluation before and after the surgery. If tension readjustment was required, postoperative urodynamics was performed after the last regulation, once the final continence status had been achieved. The female Bladder Outlet Obstruction Index (BOOIf) was calculated for all patients postoperatively. Obstruction was considered present if BOOIf was >18. Pre- and postoperative urodynamic variables were compared. Postoperative urodynamic changes were also compared between cured and noncured patients. A total of 205 women were included. After a follow-up of 89 ± 36 months, 165 women (80.5%) were continent. A significant impairment in the majority of the urodynamic parameters was observed. Mean postoperative BOOIf was -11.8 ± 21.5 in cured patients and -15.3 ± 23.1 in noncured patients (p = 0.365);15 (9.1%) patients in the cured group had a postoperative BOOIf >18, whereas all (100%) patients in the noncured group had a postoperative BOOIf <18. Most urodynamic parameters may worsen after the Remeex® system placement. Postoperative urodynamic parameters may not differ substantially between cured and noncured patients, although a certain grade of bladder outlet obstruction could be related to postoperative continence status in some patients.

Effect of Transurethral Resection of the Prostate on Urodynamic Parameters in Patients with Benign Prostatic Enlargement with Upper Urinary Tract Dilatation

Objective: To evaluate the urodynamic outcomes of transurethral resection of the prostate (TURP) in patients of benign prostatic enlargement (BPE) with upper urinary tract dilatation and correlate with International Prostate Symptoms Score (I-PSS). Methods: In this prospective study, patients of BPE with upper urinary tract dilatation from July 2017 to June 2019 were enrolled. At presentation, detailed I-PSS, ultrasonography abdomen, serum creatinine, and serum PSA were recorded. All the patients were catheterized and observed for postobstructive diuresis. At 4 weeks, repeat ultrasound and serum creatinine were recorded. Urodynamic study (UDS) was performed after ensuring sterile urine culture. Patients underwent TURP as per the standard technique. A repeat UDS was performed after 3 months, and analysis was done. Results: Forty-four patients were enrolled of which data of 37 patients were analyzed. In the filling phase of the UDS, there was a significant decrease in detrusor pressure at the end filling phase from 27 to 9.0 cm H2O after TURP. Maximum cystometric capacity and bladder compliance significantly improved at 3 months following surgery. In the voiding phase, peak flow rate showed a significant increase, postvoid residual urine volume significantly decreased, and peak detrusor pressure marginally decreased following TURP. The I-PSS decreased from 20 ± 8 to 5 ± 6 following TURP. Conclusion: High detrusor pressure and reduced compliance is a risk factor for upper urinary tract dilatation. Changes in the bladder dynamics and resolution of hydronephrosis following TURP reflected in the changes in urodynamic parameters and I-PSS.

Therapeutic Effects of Urethral Sphincter Botulinum Toxin A Injection on Dysfunctional Voiding with Different Videourodynamic Characteristics in Non-Neurogenic Women.

Although female dysfunctional voiding (DV) is common in urological practice, it is difficult to treat. This study evaluated the therapeutic efficacy of urethral botulinum toxin A (BoNT-A) on non-neurogenic female DV. Based on the videourodynamic study (VUDS), the DV was classified into three subgroups according to the obstructive site. A successful treatment outcome was defined as an improvement of voiding efficiency by 10% and reported global response assessment by ≥1. The study compared therapeutic efficacy, baseline urodynamic parameters, and changes in urodynamic parameters between the treatment success and failure groups and among three DV subgroups. Predictive factors for successful treatment were also investigated. A total of 81 women with DV were categorized into three groups: 55 (67.9%) had mid-urethral DV, 19 (23.5%) had distal urethral DV, and 7 (8.6%) had combined BN dysfunction and mid-urethral DV after BN transurethral incision. The treatment outcome was successful for 55 (67.9%) patients and failed for 26 (32.1%). Successfully treated patients had a significant decrease of detrusor pressure, post-void residual volume, and bladder outlet obstruction index, as well as an increase in voiding efficiency at follow-up versus the treatment failure group. The logistic regression of urodynamic parameters and clinical variables revealed that a greater volume of first sensation of filling predicts a successful BoNT-A treatment outcome (p = 0.047). The urethral BoNT-A injection is effective in treating non-neurogenic women with DV, with a success rate of 67.9%. The videourodynamic characteristics of DV may differ among patients but does not affect the treatment outcome.

Randomized Crossover-Controlled Evaluation of Simultaneous Bilateral Transcutaneous Electrostimulation of the Posterior Tibial Nerve During Urodynamic Studies in Patients With Lower Urinary Tract Symptoms.

PurposeTranscutaneous tibial nerve stimulation (TTNS) has proven to be a valuable treatment option for various lower urinary tract conditions, such as overactive bladder syndrome and neurogenic detrusor overactivity. The aim of this study was to investigate acute changes in urodynamic parameters due to bilateral TTNS.MethodsFifty-one patients (18–87 years; 61% female) with various lower urinary tract symptoms were enrolled in this study. They were single-blinded and randomly assigned to receive simultaneous bilateral TTNS either during their first urodynamic examination, followed by a second round using a placebo stimulation technique, or vice versa.ResultsFor subjects without signs of anatomical pathologies, the filling volume at the first desire to void (FDV) increased significantly by 54 mL (interquartile range [IQR], 26–81 mL; P<0.01) under the influence of TTNS compared to placebo. The maximum cystometric capacity increased by 41 mL (IQR, 10–65 mL; P=0.02). The median micturition volume of patients with pathological postvoid residual volumes (>100 mL) increased by 76 mL compared to patients without urinary retention (IQR, 6–166 mL; P=0.03).ConclusionsCompared to placebo, simultaneous bilateral TTNS showed significant improvements in bladder functioning, such as delayed FDV, increased maximum cystometric capacity, and reduced urinary retention. Patients with signs of anatomical pathologies did not seem to benefit from TTNS. Further studies need to be conducted to compare the effectiveness of bilateral versus unilateral TTNS.

Therapeutic Efficacy of Urethral Sphincter Injections of Platelet-Rich Plasma for the Treatment of Stress Urinary Incontinence due to Intrinsic Sphincter Deficiency: A Proof-of-Concept Clinical Trial.

PurposeThe aim of this study was to investigate the efficacy of autologous platelet-rich plasma (PRP) in the treatment of stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) refractory to medical treatment.MethodsThirty-five patients with SUI due to urodynamically proven ISD were prospectively enrolled. Five milliliters of PRP (2.5–5 times the platelet concentration in peripheral blood) was injected into the external sphincter at 5 sites; all patients received 4 injections at monthly intervals. The primary end-point was the change in SUI severity as assessed by a visual analogue scale (VAS of SUI). The secondary-endpoints were the Global Response Assessment score and changes in urodynamic parameters from baseline to 3 months after treatment.ResultsThe mean age of patients was 68.7±12 years; the median duration of SUI was 4 years. Five patients had neurogenic SUI, while 30 had nonneurogenic SUI (21 with postprostatectomy incontinence, 6 with previous radical cystectomy, and 3 with other etiologies). Complete dryness was achieved in 7 patients (20.0%) while moderate improvement was observed in 14 (40.0%). The mean VAS of SUI score decreased significantly from 6.57±1.89 to 3.77±2.41 after treatment. The abdominal leak point pressure (ALPP) increased significantly from 98.3±55.8 to 157.3±79.3 cm H2O. There was no increase of ALPP in neurogenic SUI and less increase of ALPP in patients with failed treatment outcomes. No perioperative adverse events or severe complications occurred.ConclusionsUrethral PRP injection is safe and effective in increasing urethral resistance and improving SUI. PRP could be an alternative treatment modality for male and female patients with moderate SUI due to nonneurogenic causes.

Urodynamic of lower urinary tract in spinal tuberculosis after surgery

Spinal tuberculosis can lead to neurogenic disturbanc-esin 10–61.6%. Patients undergo surgery due to neuro-logical complications, but there is lack of publications for recovery of neurogenic lower urinary tract dysfunc-tion after surgery. Objective.To evaluate changes in urodynamic parameters after spinal surgery in patients with tuberculous spondylitis and neurogenic dysfunc-tion of the lower urinary tract. Materials and me thods.We observed 49 patients with spinal tuberculosis, who had symptoms of micturition’s impairment. Be-fore the operation, detrusor overactivity was detected in 13 (26.5%) patients, and in 9 more cases (18.4%) — a combination of detrusor overactivity with detrusor-sphincter dissinergia. Violation of the contractile func-tion of the bladder in the form of hypo- or acontractility of detrusor was diagnosed in 22 patients (44.9%). Iso-lated detrusor-sphincter dissinergia was diagnosed in 5 patients (10.2%). In the postoperative period, an improvement in urodynamic parameters was noted in 15 cases (30.6%). In 4 patients, no urodynamic disorders were detected during the control examination. In 7 cas-es (14.3%), the conversion of one type of dysfunction to another was observed, in all other cases, the nature of urodynamic disorders in the early postoperative period did not change. Conclusion.In the early postoperative period, urodynamic parameters after spinal surgery im-prove in 30.6% of patients. In 14.3% of cases, there are changes in the type of neurogenic dysfunction. Urody-namic disorders persist in a significant number (55.1%) of patients.

A retrospective review of the long term clinical outcomes of patients with neurogenic lower urinary tract dysfunction following transverse myelitis.

Transverse myelitis (TM) is an inflammation of the spinal cord which causes neurological deficit in motor, sensory, and autonomic pathways. Persistent neurogenic lower urinary tract dysfunction (NLUTD) is common even where motor and sensory impairment is recovered. Long term follow-up is required to ensure optimal bladder management and protection of the upper tracts. We describe the clinical outcomes for a cohort of patients with TM who have received neurourological follow-up in a specialist center. A retrospective review of TM patient records was performed. Current pharmaceutical and surgical management, upper tract status, and patient reported symptoms are reported. Changes in urodynamic parameters and bladder emptying technique between current and baseline were analyzed. Sixty patients with NLUTD following TM were identified. The mean age at onset of NLUTD was 29 years (0-77 years). The mean follow-up was 13 years. 55% of patients were taking antimuscarinic medication, 53% of patients had intradetrusor botulinum toxin injections and 5% had bladder augmentation surgery. Forty-one patients had a baseline and recent urodynamic study which could be compared. Fifty-three of fifty-eight patients with a recent renal ultrasound had normal renal appearance. Four had mild hydronephrosis and one more extensive hydronephrosis. TM can have a persistent effect on lower urinary tract function. There is potential for upper tract damage if bladder management is not optimized. We have demonstrated that in a specialist neurourology unit within a tertiary center, one can provide acceptable long term outcomes following international guidelines.

Noninvasive Pressure Flow Studies in the Evaluation of Men with Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Review of 50,000 Patients.

The UroCuff® Test is a noninvasive pressure flow study used to manage men with lower urinary tract symptoms. UroCuff Tests were performed on men with lower urinary tract symptoms to evaluate voiding characteristics and quantify changes in urodynamic parameters with age. This cross-sectional study included all UroCuff Tests performed at 103 urology practices in the U.S. Tests were de-identified prior to collection and analysis. Inclusion criteria required initial pressure flow study with subsequent tests excluded, voided volume 50 ml or greater, at least 1 cuff inflation and patient age greater than 20 years. Pressure, maximum flow rate, flow rate efficiency (maximum flow rate/Pcuff), voided volume and post-void residual were plotted by age and stratified by Newcastle Noninvasive Nomogram category. A total of 50,680 patients 20 to 100 years old (median age 66.0) met inclusion criteria. Median Pcuff was 144.3 cmH2O and 60.8% of patients were categorized in the obstructed or high pressure/high flow Newcastle Noninvasive Nomogram quadrants. Median maximum flow rate was 10.9 ml per second and 55.8% had maximum flow rate greater than 10 ml per second. Median voided volume and post-void residual were 219.0 and 75.0 ml, respectively. All measures deteriorated with age (p <0.0001). Pcuff reflects the compensated/decompensated bladder function lifecycle. Values initially increased and reached peak pressure at age 62, then decreased by approximately 0.96 cmH2O per year until age 90. This study demonstrates that symptomatic patients enter urological practices at different urodynamic stages of bladder function and outlet obstruction, that Pcuff, maximum flow rate, voided volume, flow rate efficiency and post-void residual deteriorate with age, and that UroCuff is a sensitive evaluation of bladder performance.

MP48-13 PROSPECTIVE EVALUATION OF INTRADETRUSOR INJECTIONS OF ONABOTULINUMTOXINA IN ADULTS WITH SPINAL DYSRAPHISM

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (MP48)1 Apr 2020MP48-13 PROSPECTIVE EVALUATION OF INTRADETRUSOR INJECTIONS OF ONABOTULINUMTOXINA IN ADULTS WITH SPINAL DYSRAPHISM Alexander Mackay*, Rachel Sosland, Khue Tran, Julie Stewart, Timothy Boone, and Rose Khavari Alexander Mackay*Alexander Mackay* More articles by this author , Rachel SoslandRachel Sosland More articles by this author , Khue TranKhue Tran More articles by this author , Julie StewartJulie Stewart More articles by this author , Timothy BooneTimothy Boone More articles by this author , and Rose KhavariRose Khavari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000903.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: OnabotulinumtoxinA (BTX-A) injection is a well-established management strategy in the treatment of patients with neurogenic overactive bladder (NOAB). Few studies, however, have investigated the treatment effects of BTX-A in adult patients with congenital spinal dysraphism (CSD), despite the fact that sustained pathologic bladder conditions may render BTX-A less effective. Furthermore, there are no recommendations regarding urodynamics (UDS) evaluation to monitor patients with spinal dysraphism following injection of BTX-A. The objective of this study is to report both subjective changes in outcomes and objective changes in urodynamic parameters after intra-detrusor injections of BTX-A in adults with CSD. METHODS: This study is a prospective, nonrandomized clinical trial which is currently enrolling. Seventeen adults with CSD and NOAB have been enrolled beginning in March 2019. Target enrollment is 20 patients (anticipation of study completion is December 2019). Patients are evaluated at baseline with (video) UDS and validated questionnaires, and then again at 1-3 months following injection of BTX-A. RESULTS: Of the 17 participants enrolled to date, nine have completed baseline UDS, BTX-A injection, and post-injection UDS. Of the patients enrolled, 60% are female with a mean age of 26 (range 20-35), and 66% of patients are non-ambulatory. Preliminary results, for those who have completed the study, show a mean total score on I-QOL Feelings Score before and after treatment is significantly improved (53.79 vs. 61.24, p= 0.037). Results of the Neurogenic Bladder Symptom Score before and after treatment showed significant improvement in incontinence (17.33 vs 13.56, p = 0.037) and Quality of Life (QOL) 2.44 vs 1.44 (p= 0.009). Neither mean maximum cystometric capacity (292.3 vs. 283.2, p= 0.899) nor mean bladder compliance (43.2 vs. 81.6, p= 0.075) is significantly different following injection. CONCLUSIONS: A prospective evaluation of BTX-A in adults with CSD is needed to determine the optimal treatment in this understudied population. Initial findings show BTX-A injection may improve refractory urinary incontinence and quality of life in adults with CSD. While subjectively patients may feel improved, preliminary data does not reflect significant improvement in objective UDS parameters. Additional data are needed to determine if BTX-A injection is as effective in adult patients with CSD compared to other etiologies of NOAB. Source of Funding: Funding has been provided from an internal Houston Methodist Specialty Physician Group Performance Grant for 2019. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e699-e699 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Mackay* More articles by this author Rachel Sosland More articles by this author Khue Tran More articles by this author Julie Stewart More articles by this author Timothy Boone More articles by this author Rose Khavari More articles by this author Expand All Advertisement PDF downloadLoading ...

The effects of "unilateral midurethral sling cut down" in women with voiding dysfunctions after anti-incontinence surgery.

Midurethral synthetic sling (MUS) placement via either the retropubic or transobturator route is the standard surgical procedure for women with stress urinary incontinence. However, a small portion of patients experienced voiding dysfunction after the surgery, which was debilitating to their quality of life. Our study was aimed at demonstrating the effectiveness of the unilateral sling cut down for post-midurethral sling (MUS) voiding dysfunction and, secondarily, at evaluating the changes in urodynamic parameters. We retrospectively reviewed the charts of patients who received unilateral midurethral sling cut down for voiding dysfunction after an MUS procedure. The cut-down procedures were performed at the urethral meatus, in the 9 or 3 o'clock direction. Preoperative and postoperative subjective and objective parameters were compared to evaluate the outcome of the cut-down procedures. We selected 15 patients who underwent unilateral MUS cut down for voiding dysfunction after anti-incontinence procedures with various MUSs. The cut-down procedures were performed at a median interval of 7.1months after sling insertion. The subjective results of the Patient Global Impression of Improvement (PGI-I) after the cut-down procedure showed an overall satisfaction of 93.33%. After the cut-down procedure, the median flow rate increased from 14.8 to 22ml/s (P > 0.05), and the post-void residual urine volume decreased from 193.5 to 35.0ml (P < 0.05). All patients attained continence after the cut-down procedures. Unilateral MUS cut down is effective in the management of voiding dysfunction after anti-incontinence surgery, with a low risk of recurrence of urinary incontinence.

Possible predictor of early recovery on urinary continence after laparoscopic radical prostatectomy - Bladder neck level and urodynamic parameters.

To investigate the relationship between post-operative bladder neck levels and urodynamic parameters and their effect on urinary incontinence after laparoscopic radical prostatectomy (LRP). Forty-eight consecutive patients undergoing LRP were retrospectively reviewed. All patients were assessed using retrograde cystography after LRP and were grouped according to their bladder neck position: Level 0: at or above the superior margin of the symphysis pubis (SMSP); Level -1: at <2cm below SMSP; and Level -2: at >2cm below SMSP. Urodynamic studies were conducted at baseline as well as at 1 and 3 months post-operatively. Early recovery of urinary continence was defined as no urine leakage or only one pad/day used within 3 months after surgery. Demographic characteristics, changes in urodynamic parameters, and continence outcomes were analyzed. Overall rate of early recovery of urinary continence was 33.3%. Patients with higher bladder neck levels experienced a significantly earlier recovery of urinary continence in univariate analysis (77.8%, 29.2%, and 13.3% for bladder neck levels 0, -1, and -2, respectively, p=0.004). Patients with early recovery of urinary continence had significantly longer functional profile lengths (FPLs) 1 month post-surgery (21.0mm vs 14.8mm, p=0.019). Higher bladder neck levels were significantly associated with longer FPLs at 1 month (p=0.032). Bladder neck level is associated with FPLs at 1 month post-surgery, which is the possible predictor of early recovery of urinary continence after LRP. Patients with longer FPL at 1 month after LRP have a higher rate of early recovery of urine continence.

PD01-03 VIDEOURODYNAMIC CHANGES AND THE PREDICTORS OF EARLY RECOVERY ON URINARY CONTINENCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2016PD01-03 VIDEOURODYNAMIC CHANGES AND THE PREDICTORS OF EARLY RECOVERY ON URINARY CONTINENCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY Hsu-Che Huang, Yuan-Hong Jiang, and Hann-Chorng Kuo Hsu-Che HuangHsu-Che Huang More articles by this author , Yuan-Hong JiangYuan-Hong Jiang More articles by this author , and Hann-Chorng KuoHann-Chorng Kuo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2023AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although laparoscopic radical prostatectomy (LRP) is effective in treatment of localized prostate cancer, patients might suffer from stress urinary incontinence (SUI) after LRP. This study investigated the changes of videourodynamic parameters after LRP and impact on urinary incontinence METHODS A total of 48 male patients underwent LRP received videourodynamic study (VUDS) at baseline, 3 months and 6 months after operation. The changes of urodynamic parameters including detrusor pressure (Pdet), voided volume, cystometric bladder capacity (CBC), maximum flow rate (Qmax), postvoid residual (PVR), maximal urethral closure pressure (MUCP) and functional profile length (FPL) were measured at 3 and 6 months after opeation. The bladder neck (BN) level to the superior margin of the symphysis pubis (SMSP) after LRP was also measured 7 to 10 days after opeartion by retrigrade cystography. The BN level at or above SMSP was defined as 0, and BN level below SMSP more than 2 cm was defined as -2, otherwise, the BN level was -1. The SUI condition was evaluated by questionare during out-patient clinic follow up. RESULTS The overall SUI rate was 66.7%,47.9%, and 16.7% at 3,6,12 months after LRP, respectively. MUCP, FPL and Pdet significantly declined from 62.6cmH2O, 48.7mm and 41.8cmH2O, which was measured at baseline, to 46.4cmH2O,16.8mm and 25.4cmH2O at 6 months, respectively. Among patients with SUI at 3 months and 6 months after operation, the MUCP level at 3 months and bladder neck level were significantly lower than patients without SUI. For patients with prolonged SUI (12 months postoperatively), the MUCP at 3 months showed significant association. (Table.1 and Table. 2) CONCLUSIONS BN level and MUCP can strongly predict the early continence recovery after LRP. The BN level not below the symphysis pubis and higher MUCP level at 3 months after operation are associated with an early recovery of SUI after LRP © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e46 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Hsu-Che Huang More articles by this author Yuan-Hong Jiang More articles by this author Hann-Chorng Kuo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...