Chronic Urinary Retention Research Articles

V06-08 SALVAGE ENBLOC LASER ENUCLEATION OF PROSTATE AFTER PROSTATIC ARTERY EMBOLIZATION

You have accessJournal of UrologyBPH & Infection & Imaging (V06)1 Sep 2021V06-08 SALVAGE ENBLOC LASER ENUCLEATION OF PROSTATE AFTER PROSTATIC ARTERY EMBOLIZATION Nicholas Smith, Jonathan Katz, and Hemendra Shah Nicholas SmithNicholas Smith More articles by this author , Jonathan KatzJonathan Katz More articles by this author , and Hemendra ShahHemendra Shah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002021.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Though not currently recommended as a treatment for benign prostatic hyperplasia by the American Urological Association (AUA), prostatic artery embolization (PAE) is often selected, in and out of clinical trials, as an option in men who have large prostate volumes >40 mL, surgical comorbidities, and anticoagulation dependence. Current literature suggests that 20-36% patients will fail to respond to PAE and will require surgical management for their enlarged prostate. Examination of prostate tissue after PAE show necrosis and granulomatous reaction, raising concern for any subsequent surgical intervention. Holmium laser enucleation of prostate (HoLEP) is a surgical option for BPH patients that the AUA recommends for prostates of all sizes. Patients that have failed PAE may turn to HoLEP since it is the next least invasive surgical option for massively enlarged prostates. For this reason, we present a video demonstrating our experience performing a salvage HoLEP after PAE. METHODS: An 85 year old wheelchair-bound male with a history of dementia, open cystolithalopaxy two years prior complicated by a vesico-cutaneous fistula, and chronic urinary retention and recurrent urosepsis. He underwent PAE nine months prior to presentation, however failed subsequent voiding trials, experienced recurrent urosepsis, persistent fistula drainage, and required chronic urethral catheterization that resulted in hypospadias. The patient and family desired for the patient to be catheter-free and elected HoLEP. His prostate volume was 135 cc with intra-prostatic cavities secondary to PAE. We utilized the Moses Pulse 120-Watt laser with a 550-micron laser fiber at 2 Joules and 30 Hz. The enucleated prostate was morcellated with VersaCut Morcellator. RESULTS: Despite embolization and diffuse necrosis throughout the specimen, the surgical capsule was preserved throughout. The procedure was notable for minimal bleeding due to the vascularity of the prostate after embolization. Procedure time was 90 minutes and estimated blood loss was 20 mL. Pathology demonstrated BPH, inflammation, necrosis, and embolization spherules. The patient was discharged home on first postoperative day after a successful voiding trial with a PVR of 0 mL. At two-week follow up, the patient’s family states that he voids volitionally, with minimal incontinence. CONCLUSIONS: This video demonstrates that HoLEP after PAE can be safely performed and may be an excellent salvage surgical option for such patients. Despite tissue changes induced by embolization, the surgical capsule is preserved in our experience. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e451-e451 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Smith More articles by this author Jonathan Katz More articles by this author Hemendra Shah More articles by this author Expand All Advertisement Loading ...

Unsuccessful Progression of Sacral Neuromodulation From the Evaluation to the Implantation Stage: A Single-Center Experience.

IntroductionOver the years, sacral neuromodulation (SNM) has become an established and effective treatment for chronic urinary system retention and incontinence. The process of SNM is performed in two stages, the first is an evaluation phase and the second an implant phase. This study aimed to assess the rate of failure of progression from the evaluation to the implantation stage and the factors predicting the outcome of this commonplace procedure.Materials and methodsThis retrospective cross-sectional study took place at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. All the patients who underwent SNM implantation from January 1, 2016 to January 1, 2021 were included. Patients younger than 14 years and patients who had the SNM implantation in a different hospital and were only followed-up at KAMC were excluded. Patient-related information were extracted from the BESTCare system. Frequency and percentage were used for the categorical variables, and the mean, median, and standard deviation to display the continuous variables. Chi-square test and Mann-Whitney U test were used to test for the association of the categorical variables.ResultsAmong 28 patients, 46.4% (n=13) failed to progress from the evaluation phase to the implantation phase. Gender, age, having a co-morbidity, and SNM indication were not significant factors for predicting the outcome of the SNM evaluation phase.ConclusionThe observed failure rate was marginally higher than the ones detected in other studies. Although no significant association was detected between evaluation stage failure and the assigned predictors, the results need to be interpreted with caution due to the small population size. Larger multicenter studies need to be done in order to investigate the link between patient characteristics and the efficacy of SNM. Establishing a concrete evidence would further refine the targeted patient population and indications for SNM.

Is intravesical prostatic protrusion associated with more complications in benign prostatic hyperplasia patients?

Intravesical prostatic protrusion (IPP) is a noninvasive parameter that can predict disease progression and development of complications in benign prostatic hyperplasia (BPH). This study was to determine the relationship between IPP and the presence of complications in BPH patients. This was a cross-sectional study of BPH patients at Enugu State University of Science and Technology Teaching Hospital, Enugu. Patients were assessed for acute urinary retention (AUR), chronic urinary retention (CUR), epididymoorchitis, hematuria, hernia, urinary tract infection (UTI), serum creatinine, and prostate-specific antigen (PSA). They also had abdominal ultrasonography assessments for IPP, total prostate volume, bladder wall thickness (BWT), postvoid residual (PVR), hydronephrosis, bladder diverticulum, and urolithiasis using Sonoscape S11 with an abdominal-probe frequency of 3.5 MHz. IPP was measured in millimeter and divided into <10 mm and ≥10 mm. Data were analyzed using SPSS version 21 and were subjected to 1-way analysis of variance, chi-square test, and Pearson correlation. The odds ratios of development of complications at an IPP cutoff of 10 mm were calculated. P < .05 was considered significant. A total of 118 patients with a mean age of 64.18 ± 10.96 years and a mean IPP of 14.29 ± 10.20 mm were included. Forty-eight patients had IPP < 10 mm and seventy patients ≥10 mm. Patients with IPP ≥10 mm had significantly higher mean BWT, International Prostate Symptom Score (IPSS), PSA, and PVR (P ≤ .05) and significantly more AUR, CUR, hematuria, hydronephrosis, and UTI (P ≤ .01). Patients with IPP ≥ 10 mm have a significantly higher incidence of some complications.

V13 - Acute or chronic urine retention in males: A new temporary prostatic stent as an alternative to Foley catheter. A prospective non randomized study: 84 cases in 3 centers

V13 - Acute or chronic urine retention in males: A new temporary prostatic stent as an alternative to Foley catheter. A prospective non randomized study: 84 cases in 3 centers

Efficacy of sacral neuromodulation and percutaneous tibial nerve stimulation in the treatment of chronic nonobstructive urinary retention: A systematic review.

The aim of this systematic review is to provide an updated report on the efficacy and complications of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic nonobstructive urinary retention (CNOUR), with a focus on the contemporary technique of SNM utilizing the percutaneous placement of tined leads. This systematic review was conducted with the use of PRISMA guidelines and registered with PROSPERO (CRD42020208052). A systematic literature search was conducted in Embase, PubMed, and Cochrane databases. Inclusion criteria include English language and human participants. Exclusion criteria include SNM studies involving less than 10 CNOUR patients, studies containing data obtained using open, surgical implantation of nontined leads, and studies that only reported the test phase success rate with no long-term efficacy data. The risk of bias assessment was conducted using the National Institutes of Health study quality assessment tool. A total of 16 papers studies were included (11 SNM and 5 PTNS) in this review. The success rate for SNM ranges between 42.5% and 100% (median = 79.2%) for the test stimulation phase and 65.5%-100% (median = 89.1%) in the long term. Most SNM studies reported revision and explantation rates of lesser than 20%. The success rate was much lower for PTNS, in the 50%-60% range and complications were minimal. SNM using the contemporary percutaneous tined lead implantation technique appears to be an effective treatment for CNOUR and is durable in the long term. Compared to SNM, PTNS appears less efficacious with less evidence supporting its use in CNOUR. Further prospective studies are required to define the role of PTNS in the treatment of CNOUR.

Denosumab Induced Severe Hypocalcemia in a Patient With Metastatic Prostate Cancer

Background: Denosumab can lead to severe hypocalcemia in patients with underlying risk factors such as vitamin D deficiency, low PTH, hypomagnesemia, and CKD. Denosumab is a monoclonal antibody against RANKL, reducing the activity of osteoclasts and thus reducing the release of calcium in the bloodstream causing hypocalcemia. Hypocalcemia can range from mild to severe symptoms requiring prolonged hospitalization. Medications such as zoledronic acid and Denosumab are known to reduce the occurrence of Skeletal related events (pathological fracture, spinal cord compression, and radiation to bone). For metastatic prostate cancer, about 90% can develop bone metastasis with significant morbidity and mortality [1]. Our patient presented with severe hypocalcemia after denosumab use without any above risk factors. Clinical Case: A 66-year-old male with a medical history of Prostate cancer with Metastasis to chest and bone presented to ER with syncope. Patient-reported poor oral intake, nausea, and vomiting for the last few days. In the ER, the patient was found afebrile, bp 116/76, HR 92, saturating 100% on room air. On examination, the patient was found lethargic, malnourished, foley in place due to chronic urinary retention. The abdomen was soft and non-tender. Laboratory findings were significant for Hb 9.1, Na 133, K3.6, bicarb 21, total calcium (Ca) 4.2, ionized Ca 0.63 and corrected Ca 5.4, magnesium 1.6, phosphorus 2.1, albumin 3.3, ALT 218, AST 229, ALP 1607. Lipase 82, Total bilirubin 1.5, direct bilirubin 0.8. Spot Urinary Ca 0.7, Vitamin D 25 OH 36.9, serum PTH 225 pg/mL. Serum cortisol AM 20.9, BUN 16, and serum Creatinine 1.0. The patient was started on 11g calcium gluconate in 1L dextrose @ 50c/hr and calcitriol 0.25mcg twice daily. Serum Ca level was monitored every 6 hours and reached 6.7. Later was started on Ca carbonate 1250 TID with meals. Finally, after electrolyte correction, the patient clinically improved and was discharged with the plan to follow Calcium at the outpatient clinic. On review of previous labs at the oncology clinic, the patient received Denosumab at his oncologist’s clinic 10 days before this hospital admission, last Ca level from 6 months ago 8.6, the patient was not any vitamin D or Ca supplement. Conclusion: Many case reports have been published on severe hypocalcemia after denosumab usage. Several patients had underlying risk factors such as vitamin D deficiency, osteoblastic lesion, and AKI leading to an additional cause of hypocalcemia. We emphasize careful monitoring of serum Ca levels particularly in the first few weeks of treatment even without significant risk factors for hypocalcemia.

Urinary retention concomitant with methamphetamine use: a case report

BackgroundUrinary retention is a condition in which impaired emptying of the bladder results in postvoid residual urine. It can be acute or chronic urinary retention. There have been only scattered case studies that have described urinary retention resulting from methamphetamine use. This case report is aimed at raising awareness about methamphetamine abuse as an important factor in the aetiological considerations when evaluating cases of urinary retention among healthy younger age groups.Case presentationWe report a patient who had acute urinary retention after brief amphetamine use. A 26-year-old Nigerian man presented at the emergency room on account of an inability to pass urine and lower abdominal pain. Before this incident, the patient reported a recent ingestion of amphetamine to achieve weight reduction and a fit body. A week after use, he started to experience difficulty passing out urine hence necessitating a visit to the emergency department. After a brief assessment, physical examination revealed a man in painful distress with mild suprapubic fullness. He had a successful passage of a urethral catheter for continuous bladder drainage with dramatic improvement in his symptoms. He was subsequently discontinued on methamphetamine use and referred to a urologist for further evaluation.ConclusionMost cases of urinary retention are diagnosed clinically and are rarely missed. But because urinary retention is associated with a wide range of aetiological factors, clinicians need to be aware of the effects of certain drugs in the aetiology of urinary retention. In the management of a case of urinary retention in the younger age group, clinicians should enquire about a history of drug use, the drug of particular interest being methamphetamine, and also employ the use of urodynamic studies in the evaluation of such cases.

High percentage of neurologic deficits in the electrophysiology study of the lower urinary tract in patients with detrusor underactivity and chronic urinary retention.

Both detrusor underactivity (DU) and bladder outlet obstruction are the common causes of chronic urinary retention. Some novel treatment approaches focus on modulating micturition reflex and external urethral sphincter (EUS) function. This study used electrophysiologic (EP) studies to investigate the micturition reflex and EUS conditions of chronic urinary retention patients. Sixty patients with urodynamic DU and chronic urinary retention were studied using (1) bulbocavernous reflex (BCR) by electric stimulation, (2) electromyography (EMG) of the EUS, and (3) nerve conduction velocity (NCV) studies of the pudendal nerve. The EP findings were analyzed in DU patients with different etiologies. The BCR was positive in 41.7% of patients. In EMG studies, denervation, reinnervation, and reduced recruitment of the EUS were observed in 21.7%, 71.7%, and 88.3% patients, respectively. Decreased amplitude of pudendal nerve conduction in NCV studies was noted in 73.3% of patients. Patients with sacral neuropathy had a lower BCR positive rate (p = 0.001), a nonsignificant but higher denervation rate (p = 0.059) in EMG studies, and a higher rate of decreased amplitude in NCV (p = 0.011) than those without sacral neuropathy. Excluding patients with sacral neuropathy or diabetes mellitus, a high percentage of neurologic deficits was still detected in EP studies. Chronic urinary retention patients with urodynamic DU not only have bladder dysfunction, but also potential neuropathy in the sacral reflexes, pudendal nerve, or urethral sphincter innervation. The neurologic deficits explored in EP studies may affect the decision-making around the therapy to restore the voiding function in DU.

Clinical characteristics and outcome of high-pressure chronic urinary retention: A systematic review

Background: Although not infrequent, publications on high-pressure chronic urinary retention (HPCR) are limited. Lack of awareness of this condition can lead to delayed diagnosis and suboptimal treatment. This systematic review aimed to describe the clinical characteristics and outcome of HPCR. Methods: Keywords were searched in PubMed, Scopus, EMBASE, LILACS, Cochrane-CENTRAL, APAMED Central and Google Scholar. Relevant articles were added from the list of references of eligible articles. Studies describing any two of the characteristic features related to HPCR were included. Qualitative analysis was performed using the available data. Results: Eight prospective studies with 271 patients ( Mage=66.4 years, range 14–89 years; 263 males) were identified. The commonest presentation was tense painless palpable bladder (99.6%). Late-onset nocturnal enuresis was reported in 68.4%, and resistant hypertension was reported in 41.6%. Elevated levels of serum creatinine were identified in 43–81%. Benign prostatic hyperplasia (64.1%) was the commonest aetiology followed by prostatic malignancy (22.6%). A satisfactory response was seen following the definitive treatment of the underlying aetiology. Initial bladder decompression reversed adverse cardiovascular changes and improved renal function but resulted in post-obstructive diuresis. Heterogeneity of the reported data in available studies was a major limitation. Conclusions: Late-onset nocturnal enuresis, a tense painless and non-tender palpable bladder and treatment-resistant hypertension are important clinical findings which would raise the suspicion of HPCR in the clinical setting. Urinary tract ultrasonography showing upper-tract dilatation and raised serum creatinine support the diagnosis. Definitive treatment targeting the underlying aetiology following careful decompression of the bladder showed satisfactory outcomes. Level of evidence: Level 2a(-).

Function of the orthotopic urinary reservoir formed from the ileocecal angle in the long term after radical cystectomy in women

Objective: to study the long-term functional results of creating an orthotopic urinary reservoir from the ileocecal angle in comparison with the Studer technique of creating a urinary reservoir after radical cystectomy in women. Materials and methods. From 2004 to 2018 radical cystectomy for bladder cancer was performed in 120 women. In 71 (59.2 %) patients, an orthotopic urinary reservoir was formed: 48 (67.6 %) from the ileum, 23 (32.4 %) from segments of the colon. This study included 11 patients who had a reservoir formed from the ileocecal angle, including by their own modification, and 13 patients who had a reservoir forme by Studer. The average age of the patients was 62.6 ± 2.6 (29—82) years. The average follow-up time was 77.1 ± 10.5 (19—184) months. The presence and degree of urinary incontinence was assessed using a questionnaire and a Pad test. 12 months or more after the operation, a complex urodynamic study was performed. Results. The overall 5-year survival rate was 92.3 %: in the Studergroup it was 90.9 %, in the ileocecal angle group it was 100 % (p = 0.317). In the general population of patients, 37.5 % were completely continent. Women after plastic surgery by Studer retained urine better than after plastic surgery by ileocecal angle (46.2 % vs 27.3 %), the difference was only for mild urinary incontinence, which was more common in the ileocecal angle group. The frequency of severe urinary incontinence in both groups was the same. Nocturnal urinary incontinence was more common in patients in the Studer group (46.2 %). In the group of patients with ileocecal angle plastic surgery, there was no chronic urinary retention requiring intermittent catheterization, and in the group of Studer plastic surgery — in 1 (7.7 %) case. Analysis of urodynamic parameters revealed the presence of a greater physiological capacity of the urinary reservoir in the group of patients after plastic surgery according to Studer (p = 0.043). In the group of patients with ileocecal angle plastic surgery, higher values of the maximum pressure of the reservoir wall, “leakage pressure” and maximum expulsion pressure are observed, possibly associated with a more pronounced muscle layer of the intestinal segment used. Conclusion . The functional results of the orthotopic reservoir formedfrom the ileocecal angle are comparable to the results of urine derivation using the classical Studer method. Complex urodynamic study showed a direct influence of various characteristics of the reservoir on the nature and degree of urination disorders in patients.

The Effect of Sacral Neuromodulation in Ambulatory Spina Bifida Patients with Neurogenic Bladder and Bowel Dysfunction

OBJECTIVETo assess the effect of sacral neuromodulation (SNM) in ambulatory spina bifida patients with neurogenic bladder and bowel dysfunction. MATERIALS AND METHODSWe retrospectively reviewed the records of 29 ambulatory spina bifida patients with neurogenic bladder and bowel dysfunction who underwent SNM testing from July 2012 to January 2020. Clinical data and video-urodynamic parameters were collected and compared using the t-test and the chi-square test. The potential risk factors were considered by logistic regression analysis. P < .05 was considered significant. RESULTSIn the test phase, 21 patients (72.4%) achieved successful improvement of at least 1 symptom. The success rate for chronic urinary retention (26.09%) was significantly lower (P <.05) than that for urgency–frequency syndrome (58.82%) and urinary incontinence (56.25%). The mean neurogenic bowel dysfunction score decreased from 13.3±6.29 to 6.9±5.09 (P <.0001). The urodynamic evaluation showed a significant improvement in the mean maximum cystometric capacity, compliance, and maximum detrusor pressure (P <.05). Implantation was performed in 16 cases (55.17%). The analysis of the risk factors showed that chronic urinary retention was a statistically significant variable (P <.05). No complications were reported in the test phase. The average follow-up time was 41.19±33.06 months. Two patients changed to intermittent catheterization, and 2 patients changed to augmentation cystoplasty. CONCLUSIONSNM is effective for neurogenic bladder and bowel dysfunction in patients with ambulatory spina bifida, especially in those without chronic urinary retention. And SNM can also significantly improve the urodynamic parameters of these patients during the storage period.

Innovative option for removal of encrusted, incarcerated longstanding indwelling Foleys catheter

Encrustation of indwelling Foley’s catheter is one of the common complication associated with long term indwelling catheter, encrusted catheter are often incarcerated and difficult to remove. Many methods have been evolved to remove stuck urethral catheter but each has its own complications. Here we have described a case of 90 year old male patient with chronic indwelling (7 months) Foley urethral catheter, who presented with chronic urinary retention. After initial bladder drainage with 8 Fr feeding tube by the side of catheter. Massive encrustation was fragmented by performing laser cyst lithotripsy with 6/7.5 Fr semi rigid ureter scope and 30 Watt Holmium laser. Catheter was removed intact and stone fragments evacuated. Post-operative recovery was uneventful. Surgical removal with minimally invasive technique should be treatment of choice for encrusted and stucked urethral catheter. Traditional technique of performing suprapubic cystostomy for removal of Foleys catheter are associated with various complications and should be reserved for hospital with limited facilities.

Endoscopic Internal Urethrotomy (EIU): Results of a Dynamic Study at the Urology-Andrology Department of the University Hospital Center (UHC) of Conakry

Introduction: Endoscopic internal urethrotomy (EIU) is a technique that consists of an incision of the stenosed urethra under visual control. Its indication is widespread since the first description in 1971 by Sachse. The objective was to analyze the results of EIU in the treatment of urethral stenosis (US) at the Andro-Urology Department of the UHC of Conakry. Methodology: It is a prospective descriptive study, lasting 18 months (January 2016-30 June 2017). It involved 102 patients. The variables were: age, etiology of US, type of catheter, duration of catheter wear and recurrences. After a 12-month follow-up, our results were considered good in the absence of recurrences. Results: The average age was 54.25 years with the extremes comprising between 16 and 96 years. The main reasons for medical checkup were chronic urine retention at 58.82%. Etiology infection was the most frequent with a ratio of 81.37%, while Escherichia coli was found at 51.29%. US was bulbar (71.57%), unique (67.64%) and less than 1 cm (60.78%). Surgical complication occurred with 9 patients (8.82%) with urethrorrhagia and the external genital organs infiltration in 4 cases. Results were good for 77 patients (75.49%). Stenosis post infection, long and multiple stenoses, urethral catheterization with latex catheter and urethral catheterization of more than 4 days were strongly associated with the recurrence occurrence. Conclusion: The EIU is a minimally invasive surgical technique that offers good results.

Estimated Prevalence of Chronic Urinary Retention in Women in the United States

Estimated Prevalence of Chronic Urinary Retention in Women in the United States

Fournier’s Gangrene: Experience with Two Severe Cases

Fournier’s Gangrene is a formidable rare disease characterized by high mortality rates despite optimal medical and surgical management. It is an acute surgical emergency and requires a high degree of suspicion. The mainstay of treatment is swift open drainage and early aggressive surgical debridement of all necrotic tissue, followed by targeted antibiotic therapy. The authors report on two patients who were admitted to the surgical ward. Both presented with initial perianal sepsis complicated by painful swollen scrotum with rapid progression of gangrene of the scrotal skin and subcutaneous tissue, extensive cellulitis of the perineum, and in one patient crepitation of the anterior abdominal wall. A diagnosis of Fournier’s Gangrene was made and they were both managed by prompt resuscitation, broad-spectrum antibiotics, extensive debridement of all necrotic tissue in theatre, daily wound dressing, and repeated neurectomy on the ward. One of the patients had a colostomy done and the other a cystostomy to divert feces and relieve chronic urinary retention respectively. These patients were successfully treated despite the severity of their conditions which was complicated by severe sepsis in the face of limited diagnostic capabilities and resources, using a multidisciplinary approach and basic clinical monitoring as a guide.

Применение альфузозина в терапии пациентов с острой задержкой мочеиспускания

AIM To study the efficiency of using alfuzosin 10 mg (Alfuprost MR, SUN Pharma) in routine clinical practice in order to predict its feasibility for treating acute urinary retention. MATERIALS AND METHODS A total of 47 patients, aged from 54 to 88 years old (mean 68.5+/-5.6) with acute urinary retention due to benign prostatic hyperplasia were treated at the urology department of City clinical hospital named after D.D. Pletnev from September to December 2019. 14 patients were excluded from the study since they had chronic urinary retention. In all cases, urethral catheter was put and left in place for 24-72 hours (mean 44+/-12). All 33 patients were prescribed alfuzosin 10 mg. After removal of the urethral catheter, spontaneous voiding was restored in 19 patients. Transurethral resection of the prostate was consequently performed in three patients. In one patient, the urethral catheter was changed to cystostomy tube due to the urethritis. Recurrent urinary retention occurred in 10 men, and 8 patients underwent cystostomy. In other two cases, spontaneous voiding was restored after repeated removal of the urethral catheter. RESULTS the efficiency of conservative therapy was 63.6% (21/33). According to our results, history of severe lower urinary tract symptoms, the prostate volume more than 50 cc and intravesical protrusion of more than 1 cm have a significant influence on the outcome of conservative therapy in patients with acute urinary retention. CONCLUSIONS Based on a prospective study, a high efficiency and safety of the Alfuprost MP 10 mg/day in patients with acute urinary retention was established.

Гольмиевая лазерная энуклеация предстательной железы – новый «золотой стандарт» хирургического лечения ДГПЖ в г. Москве

Introduction. Benign hyperplasia of prostate (BPH) is still one of the most common urological diseases of elderly and senile age. Transurethral resection of prostate (TURP) is considered as a gold standard of BPH surgical treatment. However, TURP is recommended for prostates with volume up to 80 cm3 . In this connection new minimally invasive methods are being searched permanently to improve the results of surgical treatment of patients with prostate volume exceeding 80 cm3 . Materials and methods. The results of 150 cases of HoLEP performed by a single surgeon in the period from June 2018 till December 2019 are analyzed. Average age 67,8 (±7,7) years. Preoperative examination besides general clinical tests, IPSS, TRUS of prostate, uroflowmetry, US-measure of postvoiding residual volume (PVR), PSA testing. The median of prostate volume was 74 (29-272) сm3 , 94 (62%) patients were able to urinate with average Qmax of 7 (2-25) ml/sec, average IPSS score was 21.6 ± 4.4, chronic urinary retention (PVR &gt; 100 ml) was diagnosed in 44 (29%) patients. 56 (38%) patients had suprapubic catheter. Hemoglobin before surgery 142.6 ± 12.3 g/l. Surgery was performed with holmium laser Lumenis Pulse 100H. Postoperative control tests were performed before discharge of patients from the hospital. Results. The median of surgery time was 90 (30 – 180) min. The mean estimated blood loss was 133,4 ± 14,3 g/l. We drained bladders with urethral catheters for 3.0 (1-5) days in average. Average Qmax was 22,9 ± 8,6 ml/sec and PVR was 55,0 ± 8,0 ml. Average hospital stay was 5,0 (2-15) days. Intra- and postoperative complications were: perforation of bladder wall in 4,6% cases, perforation of prostate capsule in 7.3% patients, residual tissue in the bladder after morcellation in 2,6% cases, clot retention in 5,3% cases, 1,3% patients needed blood transfusion, acute urinary retention after urethral catheter removal was in 8.6% cases, acute bacterial prostatitis in 3.3% patients, acute urethritis in 2.6% cases, acute epididymo-orchitis in 4% cases, stress urinary incontinence in 14% patients. Discussion. At present, the search for new techniques to improve the quality of surgical treatment of BPH, including with a large pancreatic volume, is not stopped. The developed «laser technologies» are aimed at reducing the risk of complications and improving the quality of life of patients in the postoperative period. The results of numerous studies and our results carried out indicate the high clinical efficiency of the holmium laser, the possibility of its application for large and gigantic pancreatic sizes. It should be noted that the safety level of HoLEP is higher, the period of bladder catheterization is shorter, the patient's stay in the hospital and financial costs are less, and the quality of life after surgery is higher. The results obtained are comparable with the data of the international literature and indicate the high efficiency and relative safety of HoLEP. Conclusion. The obtained results indicate the high efficiency and relative safety of HoLEP in the surgical treatment of BPH, regardless of its volume. The results obtained allow us to assert that there is a new «gold standard» for surgical treatment of BPH and consider the possibility of introducing HoLEP into the standards of medical care for urological patients with BPH.

Urinary retention after AdVance™ Sling: A multi-institutional retrospective study.

To identify risk factors for urinary retention following AdVance™ Sling placement using preoperative urodynamic studies to evaluate bladder contractility. A multi-institutional retrospective review of patients who underwent an AdVance Sling for post-prostatectomy stress urinary incontinence from 2007 to 2019 was performed. Acute urinary retention (AUR) was defined as the complete inability to void or elevated post-void residual (PVR) leading to catheter placement or the initiation of intermittent catheterization at the first void trial postoperatively. Bladder contractility was evaluated based on preoperative urodynamics. Of the 391 patients in this study, 55 (14.1%) experienced AUR, and 6 patients (1.5%) had chronic urinary retention with a median follow-up of 18.1 months. In total, 303 patients (77.5%) underwent preoperative urodynamics, and there was no significant difference between average PdetQmax (26.4 vs. 27.4 cmH2 O), Qmax (16.6 vs. 16.2 ml/s), PVR (19.9 vs. 28.1 ml), bladder contractility index (108 vs. 103) for patients with or without AUR following AdVance Sling. Impaired bladder contractility preoperatively was not predictive of AUR. Time to postoperative urethral catheter removal was predictive of AUR (odds ratio, 0.83; 95% confidence interval, 0.73-0.94; p = .003). Chronic urinary retention after AdVance Sling placement is uncommon and acute retention is generally self-limiting. No demographic or urodynamic factors were predictive of AUR. Patients who developed AUR were more likely to have their void trials within 2 days following AdVance Sling placement versus longer initial catheterization periods, suggesting that a longer duration of postoperative catheterization may reduce the occurrence of AUR.

Sacral Neuromodulation in a Pregnant Patient With Fowler's Syndrome: A Case Report

Fowler's syndrome (FS) is a condition in which females face chronic urinary retention with abnormal electromyography (EMG) findings in the absence of structural anomalies. A sacral neuromodulation (SNM) device that restores urinary discharge is often used for treatment. It is advised to turn the device off during pregnancy. This is a case report of a 37-year-old pregnant female suffering from FS. The patient was on SNM and underwent two uneventful pregnancies despite the device being kept on throughout both pregnancies. There were no complications, and a healthy term baby was born on both occasions.

P097 - Could the therapeutic response in patients with non-muscle invasive bladder cancer be affected by chronic urinary retention?

P097 - Could the therapeutic response in patients with non-muscle invasive bladder cancer be affected by chronic urinary retention?