Urodynamic Changes Research Articles

Evaluation of Peri-Operative Outcomes after Prostatic Urethral Lift with Emphasis on Urodynamic Changes, Symptom Improvement and Sexual Function.

Background and Aims: The aim of our study is to evaluate the possible urodynamic effect of prostatic urethral lift (PUL) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Methods: A consecutive series of patients undergoing PUL placement were consecutively enrolled in two centers. Inclusion criteria: ≥50 years of age, benign prostatic obstruction (BPO), international prostate symptom score (IPSS) ≥ 13, prostate volume ≤ 60 mL, and no middle prostate lobe. All patients were evaluated using a detailed clinical history, a validated questionnaire, flexible cystoscopy, and pressure flow studies (PFS) at baseline. PFS were performed at 6 months to evaluate the urodynamic effect of PUL. Results: Overall, 20 patients with a median age of 63 were enrolled. At six months, statistically significant improvements in terms of median Qmax (11.5 vs. 8.5; p < 0.05) and median IPSS (16 vs. 10.5; p < 0.05) were recorded, and sexual function was maintained. All urodynamic parameters improved at 6 months, and significance was reached for all values except for PdetQmax. Finally, Schäfer's class improved from a median of III to a median of II. More specifically, 16/20 presented an improvement in the Schäfer class, and 12/20 patients presented a BOOI < 20 at 6 months. Conclusions: PUL represents an effective treatment in patients with LUTS due to BPH and improves bladder outlet obstruction without any effect on sexual function.

An analysis of urodynamic parameters in diabetic and nondiabetic women.

Diabetes is highly prevalent worldwide, with an estimated 536 million living with diabetes in 2021, and that number projected to increase to 783 million by 2045. Diabetic bladder dysfunction is thought to affect up to 60%-90% of individuals with diabetes and can significantly impact quality of life. Despite the prevalence of diabetic bladder dysfunction, the exact pathophysiological mechanism, and resulting clinical presentation, remains debated. Our objective was to compare urodynamic parameters between diabetic and nondiabetic women, assessing the impact of various markers of diabetes severity on bladder function. A retrospective chart review was conducted on female patients aged 18 and above who underwent urodynamic studies at a single tertiary care university hospital system from 2014 to 2020. Patients were categorized based on diabetes status, and diabetes severity including duration of disease, hemoglobin A1c levels, insulin dependence, and markers of end-organ dysfunction. Urodynamic variables, including compliance, bladder voided efficiency, bladder contractility index, postvoid residual, maximum flow rate, capacity, voided volume, and detrusor overactivity, were assessed by two independent reviewers. Statistical analyses were performed to assess the impact of diabetes and diabetic severity on urodynamic parameters. A total of 652 female patients were included in the study, of which, 152 (23.3%) had diabetes, with an average duration of diagnosis of 82.3 months. Diabetic women were older and had higher body mass index compared to nondiabetic women. Diabetic retinopathy and neuropathy were present in 18% and 54.6% of diabetic patients, respectively. Significant differences in urodynamic parameters were observed between diabetic and nondiabetic women, with diabetic women showing higher rates of detrusor overactivity (p = 0.01), particularly associated with increasing BMI (p = 0.03). However, classic markers of diabetes severity including duration, as well as markers of end-organ damage, showed mixed associations with urodynamic changes. Despite the prevalence of diabetic bladder dysfunction and its impact on patient quality of life, the exact mechanisms and clinical presentation remain elusive. Our study highlights the significant differences in urodynamic parameters between diabetic and nondiabetic women, emphasizing the need for further research into the relationship between diabetes and diabetic bladder dysfunction.

Long-term urodynamic findings following colo-, gastro- and ileocystoplasty.

To evaluate the urodynamic changes in patients who have undergone colocystoplasty (CCP), gastrocystoplasty (GCP) and ileocystoplasty (ICP) in a retrospective study. Changes in urinary continence, incidence of pathologic contractions before and after augmentation, alterations of urodynamic parameters were also examined. Eighty-four patients were included in the study who underwent bladder augmentation between 1987 and 2017. Group I: 35 patients with CCP. Group II: 18 patients with GCP. Group III: 31 patients with ICP. Cystometry was performed at 3, 6, and every 12months, then biannually after augmentation. Pre- and postoperative urodynamic changes were analysed statistically. In Group I, two patients and in Group III, one patient remained incontinent after CCP and ICP. Bladder capacity increased significantly, maximal intra-vesical pressure decreased and compliance improved in all groups (p < 0.001). Postoperative studies showed pathologic contractions in the augmented bladder in half of the patients with GCP, in 43% of patients after CCP and 26% of patients with ICP. From the urodynamic point of view, ileum is the most adequate option in the long term. Contractions after augmentation might be caused by the remaining peristalsis of the detubularised segment. Further investigations are needed to evaluate pathologic contractions that remained after detubularisation.

Abnormal urodynamic changes in post-upper urinary tract dysfunction in ureteral obstruction rat models.

Objects: This study investigated changes in upper urinary tract urodynamics (UUTU) after upper urinary tract dysfunction (UUTD). Methods: The UUTD model was induced through unilateral ureteral obstruction. To measure the renal pelvis volume, and resting pressure. Ureteral electromyography (EMG) and in situ ureteral constriction experiments were performed. Ureteral tissue was obtained for HE and masson staining, IF staining and IHC research to explore the distribution of Piezo1, and the expression of Piezo1 was studied using Western blotting. Results: The study showed that the renal pelvis volumes and the renal pelvis resting pressures gradually increased post surgery in the experimental group. The degree of ureteral tissue edema, cell necrosis and fibrosis gradually increased. The maximum contraction force and frequency of ureter in the experimental group post surgery were significantly higher than in the sham group. Western blotting showed that the expression intensity of Piezo1 gradually increased and was significantly higher than in the sham group. Further analysis of each sub-layer of the ureter revealed that Piezo1 was highly expressed in the urothelium layer, followed by the suburothelium layer, and had low expression in the smooth muscle cell layer. Conclusion: The study observed that morphological and electrophysiological changes in the upper urinary tract may be important mechanisms of abnormal UUTU. Increased expression of the Piezo1 may be a new molecular mechanism of abnormal urodynamics after UUTD.

Urodynamic Changes Following Laparoscopic Versus Vaginal Hysterectomy: A Hospital based Comparative Cross-Sectional Study

Urodynamic Changes Following Laparoscopic Versus Vaginal Hysterectomy: A Hospital based Comparative Cross-Sectional Study

Cerrahi Yaklaşımın İdrar Yolu Fonksiyonuna Etkisi: Laparoskopik ve Vajinal Histerektomi Sonrası Ürodinamik Değişikliklerin Karşılaştırılması

Aim: The rapidly increasing prevalence of gynecological diseases worldwide emphasizes the need for a combination of effective surgical procedures and other treatments. Therefore, this study was conducted to evaluate the urodynamic changes of laparoscopic and vaginal hysterectomy. Materials and Method: A total of 86 participants who underwent hysterectomy for benign reasons between 2017 and 2021 in a tertiary hospital were selected and divided into two groups. Group I included 43 participants treated with vaginal hysterectomy, while group II included 43 participants treated with laparoscopic hysterectomy. ICIQ-FLUTS questionnaire was used and statistical analysis was performed to determine flow rate, voiding time and other factors in both groups. Results: The results from this study showed that there was no change in the initial sensory context in both groups (p = 3.63). Bladder capacity also did not differ in both groups. However, postoperatively, excessive activity in the detrusor muscle was observed in 8 participants (18.6%) in group I, while it was observed in 2 participants (4.6%) in group II. Similarly, the flow rate and residual volume of urine were within the clinical range in both groups. Conclusion: This study has been effective in providing several implications for improving treatment procedures for patients with gynecological diseases.

Urodynamic changes before and after endoscopic valve ablation in boys diagnosed with the posterior urethral valve without chronic renal failure

IntroductionCurrent research on the posterior urethral valve (PUV) mainly focuses on the follow-up of bladder function after valve ablation. However, few studies exist on the changes in bladder function before and after valve ablation.ObjectivesTo investigate the urodynamic changes before and after PUV ablation and determine the effect of operation on bladder function, in patients.Materials and methodsThe clinical records of 38 boys diagnosed with PUV and undergone urodynamic exams before and after valve ablation were retrospectively reviewed. In addition, differences in patients’ radiographic studies and urodynamic characteristics between pre- and post-operation were evaluated. Moreover, the urodynamic data was compared using the paired t-test and all the data was expressed as means ± SEM. Additionally, p values less than 0.05 were considered to be statistically significant.ResultsAll the patients were diagnosed with PUV and the follow-up period after operation ranged between 9 and 114 months. The urodynamic exams were performed about 6 months after operation. The results revealed that bladder compliance improved from 8.49 ± 4.73 to 13.31 ± 6.78 ml/cmH2O while the maximum detrusor pressure decreased from 95.18 ± 37.59 to 50.71 ± 21.71 cmH2O, after valve ablation. Additionally, there were significant differences in the pre- and post-operation values of bladder compliance and maximum detrusor pressure (p < 0.05). However, there were no significant differences in the pre- and post-operation values with regard to the residual urine volume, maximum bladder volume and maximum urinary flow rate (p > 0.05).ConclusionsThe adequacy of the COPUM incision is necessary. But the study showed that endoscopic valve ablation couldn’t by itself completely improve the bladder function of patients diagnosed with PUV. However, it was able to improve bladder compliance and decrease maximum detrusor pressure to a certain extent. However, bladder compliance still couldn’t reach the normal level.

Prolonged inhibition of bladder function is evoked by low-amplitude electrical stimulation of the saphenous nerve in urethane-anesthetized rats.

To better understand the effects of saphenous nerve (SN) stimulation on bladder function, we investigated the duration of electrical stimulation as a key variable in eliciting urodynamic changes. SN stimulation is a novel approach to electrically modulating bladder function. In previous animal studies, bladder-inhibitory responses were evoked by low-amplitude (25 μA) stimulus pulses applied in short-duration (10min) trials and at frequencies between 10 and 20 Hz. Experiments were performed in urethane-anesthetized rats that were separated into three groups: intravesical saline infusion + SN stimulation (group A), intravesical 0.1% acetic acid infusion + SN stimulation (group B), and intravesical saline infusion + no SN stimulation (group C). Changes in bladder function- basal bladder pressure (P base ), contraction amplitude (ΔP), and inter-contraction interval (T ICI )-were measured in response to stimulation trials applied for different durations (10, 20, and 40 min). Trials were also repeated at frequencies of 10 and 20 Hz. In group A, longer-duration (40 min) stimulation trials applied at 10Hz evoked overflow incontinence (OI) episodes that were characterized by significant changes in P base (122.7 ± 9.1%, p=0.026), ΔP (-60.8 ± 12.8%, p=0.044), and T ICI (-43.2 ± 13.0%, p=0.031). Stimulation-evoked OI was observed in 5 of 8 animals and lasted for 56.5 ± 10.7min. In contrast, no significant changes in bladder function were observed in either group B or group C. Our findings show that longer-duration trials consisting of electrical pulses applied at 10Hz are important stimulation parameters that elicit inhibitory bladder responses in anesthetized rodents.

Urodynamic changes following laparoscopic versus vaginal hysterectomy.

To compare urodynamic changes before and after hysterectomy (laparoscopic vs. vaginal approach) for benign gynecological diseases. A total of 90 women with a mean age of 56.36-years were enrolled in this study between August 2019 and April 2021. They were divided into two equal groups (45 patients each). Group, I had a vaginal hysterectomy, and Group II had a laparoscopic hysterectomy. All patients were assessed clinically using ICIQ-FLUTS questionnaire and a uro-dynamic study before and six months after surgery. Both vaginal and laparoscopic hysterectomy did not significantly change the maximum flow rate, voiding time, and average flow rate. The increase in residual urine volume in group I was not significant (p = 0.129), as was in Group II (p = 0.217). All the modifications, however, were within permis-sible limits. According to the cystometry result, volume at initial sensation rose in both groups after surgery, with no statistically significant difference (p = 0.364). After both forms of hysterecto-my, maximum bladder capacity did not vary considerably. Preoperatively, all study participants exhibited no overactivity of the detrusor muscle; nevertheless, following surgery, overac-tivity was noted in 9 patients after vaginal hysterectomy com-pared to three patients after laparoscopic hysterectomy, and all the alterations were within a clinically acceptable range. In addition, the ICIQ-FLUTS score was not significantly different between the study groups. According to the urodynamic study, hysterectomy for benign uterine conditions, whether vaginal or laparoscopic did not adversely affect urinary bladder function.

Clinical outcome and urodynamic changes of tailored transvaginal mesh surgery for pelvic organ prolapse: A mid-term 40 Months follow-up

To evaluate the changes in clinical outcome and urodynamic parameters after tailored anterior transvaginal mesh (ATVM) surgeries in a mid-term follow-up. Between November 2011 and December 2015, women with ≥stage II pelvic organ prolapse (POP) who underwent ATVM surgeries were retrospectively reviewed. The data-reviewing timeframe was until December 2021. Clinical and urodynamic diagnoses regarding urinary symptoms were evaluated before and after the operation. A total of 160 women were included. Stress urinary incontinence decreased significantly after the operation (99% (159/160) vs. 43% (68/160), p<0.01), as well as the pad weight (20.5±2.7 vs. 9.4±2.0, p<0.001) and diagnosis of urodynamic stress incontinence (83% (132/160) vs. 51% (82/160), p<0.01). Overactive bladder syndrome increased significantly after the operation (18% (29/160) vs. 28% (45/160), p=0.03), even though the objective parameters, such as first and strong desire to void, bladder oversensitivity, and detrusor overactivity, were all improved after the operation. The pad weight was mostly improved significantly within the first postoperative 2 years. Eighteen (11%) women had global recurrent POP, and only one (0.6%) woman had true recurrence of cystocele. Twenty-four (15%) women had mesh extrusion, and two-thirds of them could be managed in an office setting. In women with advanced cystocele, the ATVM surgery provides a favorable anatomic reduction outcome with an acceptable mesh extrusion rate. The ATVM provides an anti-incontinence effect, both in subjective symptoms and objective parameters, but this effect might decline after postoperative 2 years.

Urodynamics in Early Diagnosis of Diabetic Bladder Dysfunction in Women: A Systematic Review and Meta-Analysis

BackgroundUrodynamics can detect subtle voiding changes before cystopathy symptoms manifest. The aim of the present study was to assess urodynamic changes in diabetic women.Material/MethodsA systematic search was performed on 04 November 2021 to identify studies reporting urodynamic parameters in diabetic women. Data were analyzed in a single-arm meta-analysis due to lack of sufficient studies with direct comparisons to healthy women. For data synthesis, a random-effects model with restricted maximum-likelihood estimation was applied. The calculated effect sizes were visualized in forest plots. Statistical heterogeneity was assessed using the I2 measure and the χ2 test. The risk of bias was assessed using the QUIPS tool. PROSPERO ID: CRD42021256275.ResultsOut of 1750 records, 10 studies were used in the analysis (n=2342 diabetic women). Pooled event rates showed that mean voided volume was 288.21 mL [95% confidence interval (CI): 217.35–359.06, I2=98%], mean postvoid residual volume was 93.67 mL [95% CI: 31.35–155.99, I2=100%], mean Qmax was 18.80 mL/sec [95% CI: 15.27–22.33, I2=99%], mean PdetQmax is 30.13 cmH2O [95% CI: 25.53–34.73, I2=90%], mean first sensation of bladder filling was 178.66 mL [95% CI: 150.59–206.72, I2=97%], and mean cystometric capacity was 480.41 mL [95% CI: 409.32–551.50, I2=98%] in diabetic women.ConclusionsPooled results indicate that diabetic women tend to have a smaller voided volume, slower Qmax and PdetQmax, larger postvoid residual, and higher first sensation of bladder filling and cystometric capacity compared to the general female population.

Loop surgery in women with urinary incontinence and urodynamics of the lower urinary tract

Objective: The aim of the study is to objectify and evaluate urodynamic changes in women having urinary incontinence before and after performing synthetic sling operations.Methods: During the period from 2002 to 2020 104 women were observed (average age 54 years) who underwent trocar synthetic sling surgery. The group under observation included patients with a combined form of incontinence. The main method of urodynamic diagnosis was non-invasive 2-day uroflowmonitoring.Results: When comparing the data before and after TSS operation the following changes were found: an increase in the minimum capacity and a decrease in the maximum released volume, but together with this, the change in the average effective volume was unreliable. At the same time the structure of urination has radically changed. The indicators of the average value of the maximum flow have decreased and the entire speed profile has changed in general.Conclusions: Uroflowmetric monitoring makes it possible to identify objectively, adequately and non-invasively the urodynamic disorders in patients with urinary incontinence, which occur both in the preoperative and postoperative periods. According to the neurophysiological model these changes can be explained by the influence of the implant on micturition reflexes.

Urodynamics findings pre- and post-untethering surgery in children with filum lipoma: A single-institution experience.

We aimed to investigate the changes in urodynamics and voiding cystourethrogram parameters on pre- and post-untethering surgery in patients aged under 2 years with filum lipoma. Sixty-two patients were enrolled in this study. The changes in urodynamics and voiding cystourethrogram parameters were compared before untethering surgery and 6 months after untethering surgery. These parameters were bladder volume, bladder deformity, vesicoureteral reflux during voiding cystourethrogram, detrusor overactivity, bladder compliance, and post-void residual volume in urodynamics. Bladder volume during voiding cystourethrogram and bladder compliance increased significantly from 89.8 ± 49.5 mL to 114.5 ± 50.5 mL (P = 0.0069) and 10.2 ± 6.2 mL/mmH2 O to 17.0 ± 13.3 mL/mmH2 O (P = 0.0008), respectively, at 6-month follow-up. Six patients required combination management with clean intermittent catheterization at 25.1 ± 8.2 months (14.3 ± 6.5-months follow-up) because of elevated post-void residual volumes. According to voiding cystourethrogram results, bladder function and urodynamics in patients with filum lipoma significantly improved after untethering surgery. Non-invasive assessment based on measurements of post-void residual should be considered as a postoperative follow-up method.

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 ...

PD44-10 URODYNAMIC PROFILE OF VOIDING IN PELVIC ORGAN PROLAPSE PATIENTS AFTER SURGERY: A SYSTEMATIC REVIEW WITH META-ANALYSIS

You have accessJournal of UrologyCME1 May 2022PD44-10 URODYNAMIC PROFILE OF VOIDING IN PELVIC ORGAN PROLAPSE PATIENTS AFTER SURGERY: A SYSTEMATIC REVIEW WITH META-ANALYSIS Hugo Santos, Danilo Lourenço, Alexandre Partezani, Saulo Teles, Lucas Takemura, Felipe Gushiken, Guilherme Andrade, Bianca Bianco, Luis Rios, Gustavo Lemos, and Arie Carneiro Hugo SantosHugo Santos More articles by this author , Danilo LourençoDanilo Lourenço More articles by this author , Alexandre PartezaniAlexandre Partezani More articles by this author , Saulo TelesSaulo Teles More articles by this author , Lucas TakemuraLucas Takemura More articles by this author , Felipe GushikenFelipe Gushiken More articles by this author , Guilherme AndradeGuilherme Andrade More articles by this author , Bianca BiancoBianca Bianco More articles by this author , Luis RiosLuis Rios More articles by this author , Gustavo LemosGustavo Lemos More articles by this author , and Arie CarneiroArie Carneiro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002605.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic organ prolapse (POP) originates due to defects on the female pelvic floor and is a prevalent disorder in women. Stress urinary incontinence (SUI), urge urinary incontinence (UUI), and obstructive symptoms may concur in these patients. Surgical treatment of POP aims to restore the anatomy and function of the genitals; however, it may prompt urinary symptoms not presented previously. We aimed to perform a systematic review and meta-analysis of urodynamic changes in patients undergoing surgical correction for POP. METHODS: This study was conducted according to the PRISMA protocol. Studies in English, published from 1976 to July 2020 in Pubmed and Cochrane were included. Studies included contained data from urodynamic evaluation from before and after vaginal surgery for POP, with or without anti-incontinence procedures. The main urodynamic data collected were: (1) Free uroflowmetry: Qmax, voided volume, and PVR; (2) Cystometry: Bladder capacity, presence of DO, SUI or UUI and VLPP; (3) Pressure x flow study: PdetQmax, Qmax and PVR. Bias risk assessment was performed in all studies. RESULTS: 22 studies published between 1989 and 2018 were included, involving 1,549 women. MUS placement was assessed independently in 3 studies. Patients had a significantly higher prevalence of DO before surgery (OR 1.56, 95% CI 1.06-2.29; p=0.02), surgeries without sling placement demonstrated a tendency of ameliorating DO. Patients that did not receive sling were more incontinent after surgery, with a lower prevalence of SUI before surgery (OR 0.23, 95% CI 0.09-0.61; p=0.003). Bladder emptying parameters improved after surgery, with higher PdetQmax before surgery (IV 3.23, 95% CI 0.45-1.18; p=0.02). For patients that did not receive MUS, a lower Qmax (IV -3.19, 95% CI -4.09 - -2.30; p=<0.001) and a higher PVR (IV 27.89, 95% CI 15.68-40.1; p<0,001) was observed before surgery. CONCLUSIONS: POP correction surgery yields better urodynamic emptying parameters, with a lower PdetQmax, higher Qmax and lower PVR. The procedure is associated with a reduction of detrusor overactivity. Sling placement enhances obstructive parameters. Patients significantly improve their symptoms with POP correction surgery. Source of Funding: Not applicable © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e711 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hugo Santos More articles by this author Danilo Lourenço More articles by this author Alexandre Partezani More articles by this author Saulo Teles More articles by this author Lucas Takemura More articles by this author Felipe Gushiken More articles by this author Guilherme Andrade More articles by this author Bianca Bianco More articles by this author Luis Rios More articles by this author Gustavo Lemos More articles by this author Arie Carneiro More articles by this author Expand All Advertisement PDF DownloadLoading ...

Urodynamic profile of voiding in patients with pelvic organ prolapse after surgery: a systematic review with meta-analysis.

Pelvic organ prolapse (POP) is a defect of the female pelvic floor. Stress urinary incontinence (SUI), urge urinary incontinence (UUI), and obstructive symptoms may occur in these patients. The objective of surgical treatment is to restore the anatomy and function of the pelvic floor; however, it may prompt urinary symptoms not present previously. We performed a systematic review and meta-analysis to determine urodynamic changes in patients undergoing surgical correction for POP. PubMed and Cochrane databases were searched for studies that contained data from urodynamic evaluation before and after vaginal surgery for POP. The main urodynamic data collected were free uroflowmetry (maximum flow [Qmax], voided volume, and post-void residual volume [PVR]), cystometry (bladder capacity, presence of detrusor overactivity [DO], SUI or UUI, and Valsalva leak point pressure), and pressure × flow study (detrusor pressure at maximum flow [PdetQmax], Qmax, and PVR). A total of 22 studies were included (1,549 women). Patients had a significantly higher prevalence of DO before surgery (OR = 1.56; 95% CI = 1.06-2.29), and surgeries without sling placement demonstrated a tendency to ameliorate DO. Patients who did not receive a sling were more incontinent after surgery. Bladder-emptying parameters improved after surgery, with higher PdetQmax before surgery (IV = 3.23; 95% CI = 0.45-1.18). Patients who did not receive MUS presented a lower Qmax (IV = -3.19; 95%CI = -4.09 to -2.30) and a higher PVR (IV = 27.89; 95%CI = 15.68-40.1) before surgery. Correction surgery for POP yields better urodynamic emptying parameters, with a reduction in the prevalence of DO. In contrast, sling placement enhances obstructive parameters.

A0849 - 10-year follow-up observation of idiopathic detrusor underactivity in the elderly living in community: Treatment and urodynamic changes

A0849 - 10-year follow-up observation of idiopathic detrusor underactivity in the elderly living in community: Treatment and urodynamic changes

Risk stratification for renal deterioration in the neurogenic bladder patient: Should it be a prerequisite for patient selection in video-urodynamic studies?

Objective: The aim of this retrospective review is to determine whether risk stratification for renal deterioration in neuro-urology patients is supported by urodynamic findings in terms of bladder safety and whether urodynamic findings affect bladder management in this patient group. The primary endpoints are to determine any statistically significant differences between the high and low risk for renal deterioration groups in terms of urodynamic findings regarding bladder safety, and the frequency of changes in bladder management following video-urodynamics (VUDs). Methods: VUDs, which were performed between March 2015 and March 2021 in view of neurogenic lower urinary tract dysfunction, were included in the study. These were divided into those performed in patients with high risk and those in patients with low risk for renal deterioration categories according to criteria specified in the National Institute of Clinical Excellence (NICE) Urinary Incontinence in Neurological Disease guidelines. The two groups were then statistically compared in terms of urodynamic parameters for bladder safety and changes in management thereafter. Results: In total, 69 VUDs were included, 49.3% were classified as having been performed in high risk for renal deterioration patients, and 50.7% as low risk. 50% of those in the former group were found to have an unsafe bladder versus 31.4% in the latter group ( p = 0.12). Meanwhile, 65.2% of VUDs resulted in a change in bladder management, with no difference in change in management frequency between the two risk stratification groups ( p = 0.36). Conclusion: The lack of statistically significant difference in urodynamic bladder safety findings and change in frequency of bladder management for the low and high risk for renal deterioration categories in this cohort bring into question the need for risk stratification in the clinical decision to perform VUDs in the neurogenic bladder patient. Level of evidence: 2c

Electroacupuncture Inhibits Inflammatory Response in Rats With Interstitial Cystitis

OBJECTIVE: Electroacupuncture (EA) has been clinically utilized to manage interstitial cystitis (IC), but its related mechanism research is remained to be researched. This study aimed to explore the role of EA in inhibiting the inflammatory response of IC rats, and research the possible mechanism based on the changes of urodynamics, mast cell tryptase expression and the content of inflammatory substances.&lt;br/&gt; METHODS: EA (continuous wave, 30 Hz, 1 mA) was applied to stimulate the Ciliao point (BL32) and the Huiyang point (BL35) of rats. Changes of urodynamics, mast cell tryptase expression and the content of IL-6 and TNF-α were detected after 24 hours of the treatment.&lt;br/&gt; RESULTS: The results showed that after EA treatment, compared with the model group, the initial urination time of the rats was prolonged (3.23 ± 0.60 to 5.27 ± 0.27 min), the bladder capacity was increased (0.80 ± 0.15 to 1.31 ± 0.07 ml), and the degree of bladder mucosal damage was restored. The expression of mast cell tryptase, and the content of IL-6 and TNF-α in its bladder tissue and urine were reduced.&lt;br/&gt; CONCLUSION: These findings suggested that EA could suppress bladder overactivity and inhibit inflammatory response of IC rats, and its mechanism was proved to be related to the inhibition of mast cell degranulation and the down-regulation of inflammatory substances IL-6 and TNF-α in bladder tissue.

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.