Decrease In Maximum Flow Rate Research Articles

Comparison of surgical outcomes and urinary functioning after phalloplasty with versus without urethral lengthening in transgender men

Background: Phalloplasty in transgender men is performed with or without Urethral Lengthening (UL). To create clear expectations in the choice of UL, an overview and comparison of outcomes is useful. Aims: To provide and compare surgical outcomes and urinary functioning after phalloplasty with versus without UL in transgender men. Methods: A single-center, retrospective chart review was conducted among transgender men who underwent phalloplasty with or without UL between 01-2013 and 10-2020. Primary outcomes were differences in complication and reoperation rates. Secondary outcomes were end-stages of voiding at last follow-up and differences in voiding analyses pre- and postoperatively. Results: Of 136 men, 91 (67%) underwent phalloplasty with, and 45 (33%) without UL. Wound infection (31 vs. 16%, p = 0.06) and partial flap loss (35 vs. 13%, p = 0.008) were predominately seen after UL. In the UL group, 43% urethral fistulas and 60% urethral strictures were observed, relative to one man without UL who had a urethral fistula (both p < 0.001). Meatal or perineal orifice stenosis was seen in 29% with versus 11% without UL (p = 0.02). Reoperation was needed in 81% with versus 27% without UL (p < 0.001). At follow-up, 80/91 (88%) after UL reached end-stage of voiding, with 60/80 (75%) able to void while standing and 20/80 (25%) having a definitive urethrostomy. The remaining 11/91 (12%) men were awaiting further treatment for urological complications. The men able to void while standing had a median of one reoperation (range 0–6), and a significant decrease in maximum flow rate on postoperative uroflowmetry (21.4 vs. 29.8 mL/s, p < 0.001). After phalloplasty without UL, all men had a definitive perineostomy without changes in voiding analyses. Discussion: The choice for or against UL during phalloplasty has become more relevant over the years. This comparison of surgical outcomes and urinary functioning can be useful in the shared decision-making process to come to the most suitable choice of phalloplasty.

Decreased maximum flow rate during intubated flow is not only due to urethral catheter in situ

We used the Valentini-Besson-Nelson (VBN) mathematical micturition model to analyze the potential obstructive effect of a 7-F transurethral catheter on the voiding process during intubated flow (IF) in women. Our hypothesis was that incomplete sphincter relaxation leads to residual sphincter pressure. We reviewed a urodynamic database of women referred for evaluation of lower urinary tract dysfunction. Exclusion criteria were neurological disease or grade ≥2 prolapse. Eligible women underwent free uroflow (FF-1) before cystometry, an IF (7-F urethral catheter), and a second FF (FF-2) at the end of the session. Interpreted flows were restricted to voided volumes ≥100 ml and continuous flow patterns. Analysis of FF and IF was made using the VBN model. Among 472 women, 157 met the inclusion criteria. The effect of the urethral catheter was geometric only in 60 (38.2 %) patients. An additional effect, identified as incomplete sphincter relaxation, was observed in 97 (61.9 %) patients. Among this second group, the same residual sphincter excitation was found for 30 (30.97 %) patients during FF-2. When comparing IF with FF with the VBN model, the decrease in maximum flow rate (Q(max)) did not appear to result only from the geometric effect of the catheter but from incomplete sphincter relaxation during voiding, possibly because of patient's anxiety or a urethral reflex induced by the presence of the catheter. These findings emphasize the need to perform an FF before the IF to strengthen the reliability of conclusions of a urodynamic investigation.

Répercussions cliniques et urodynamiques du traitement de l’incontinence urinaire d’effort par bandelettes sous-urétrales transobturatrice

Analyse changes in voiding patterns after the treatment of female urodynamic stress incontinence (USI) with suburethral transobturator tape (TOT).Prospective study of 50 women with pure stress urinary incontinence treated between March 2004 and February 2006; mean age was 53+/-13 (34-87); parity was 2+/-0.75; mean follow-up was of 15 months (7-43). Each patient did a complete urodynamic examination and filled in two questionnaires (MHU and Contilife), before and three months after surgery.Cure rate was 94% (47/50). Three of 50 patients remained incontinent after surgery (6%). No peroperative complications occurred. Analysis of questionnaires showed that two clinical symptoms predominated postoperatively: dysuria (14%; n=7) and urgency (6%; n=3). Urodynamic profiles showed the following: a decrease in maximum flow rate from 23.6 to 18.9 ml/s (p<0.01), and an increase in urethral resistance from 0.12 to 0.23 (p<0.01). The number of patients with at least two Massey Abrams criteria defining obstruction rose from six to 19, while only seven patients had symptomatic dysuria. Quality of life improved significantly, from 2.32 to 4.63 (p<0.05).TOT is a safe, effective procedure with few complications. While urodynamic data show some obstruction, this has little impact upon clinical results or mid-term complications; it only mildly affects voiding and does not compromise patient satisfaction.

Voiding Patterns and Urodynamics After a Tension-Free Vaginal Tape Procedure

Objective: To evaluate changes in urodynamic parameters, therapeutic success, and complication rates after a tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence (SUI).Methods: Sixty-three women who underwent a TVT procedure for SUI, between June 1999 and December 2001 at Mount Sinai Hospital in Toronto, Ontario, were prospectively followed. Pre- and postoperative clinical data were analyzed using the Mann-Whitney, chi-square, paired t-test, and Wilcoxon signed ranks tests.Results: The range of follow-up was 6 weeks to 3 years. Short-term voiding dysfunction occurred in 49% of the women but was completely resolved in all women by the 12-week follow-up.For the 45 women who completed their follow-up at 6 months or 1 year after TVT, the success rate was 85%. Provocative urodynamics at 1-year follow-up compared to preoperative data showed a decrease in maximum flow rate (P < 0.001), and increase in post-void residual urine volume (P < 0.001).Conclusion: TVT is associated with a good short-term success rate at 6 months and 1 year. A low long-term complication rate and morbidity may be expected, but significant temporary voiding dysfunction, higher than previously reported, was observed.

Age Related Urodynamic Changes in Patients with Benign Prostatic Hyperplasia

Purpose We determined age related urodynamic changes in patients with untreated symptomatic benign prostatic hyperplasia (BPH). Materials and Methods A total of 222 patients (mean age 67.3 years, range 45 to 90) with the clinical diagnosis of symptomatic BPH was entered into a prospective protocol evaluating the international prostate symptom score (I-PSS), prostate volume, noninvasive uroflowmetry, residual volume and a pressure-flow study. To obtain a homogeneous study population only patients with a noninvasive maximum flow rate of 15 ml. per second or less and an I-PSS of 7 or more were eligible. Results There was no correlation between age and I-PSS (p greater than 0.05) but there was a statistically significant decrease in maximum flow rate (p = 0.045) and voided volume (p = 0.0013) with age. Prostate volume increased constantly from 31.3 to 64.4 ml. in patients 45 to 50 and older than 80 years, respectively (p less than 0.0001). Pressure-flow studies revealed an age related decrease in cystometric bladder capacity (p = 0.0003) and invasive maximum flow rate (p = 0.0057) but no changes in detrusor pressure at maximum flow rate (p greater than 0.05), maximum detrusor pressure (p greater than 0.05) and linear passive urethral resistance relation (p greater than 0.05). The incidence of urodynamically proved bladder instability increased from 20 to 47 percent in men 45 to 50 and older than 80 years, respectively. Conclusions The well established age related decrease in maximum flow rate and voided volume in patients with prostatism cannot be attributed to an increase in bladder outflow obstruction or impaired detrusor function. Because 60 percent of all men older than 80 years did not have urodynamic obstruction despite a decreased maximum flow rate of 10 to 15 ml. per second, all patients meeting these criteria and having symptoms bothersome enough to justify surgery should undergo pressure-flow studies before surgical intervention.

Spontaneous versus intubated flow in male patients

The spontaneous flow rate was compared with the flow rate obtained during a pressure-flow study with two 5F catheters in the urethra, in 57 male patients with various lower urinary tract disorders. Intubation caused a median decrease in maximum flow rate of 1 mL/sec (95 % confidence limits 0–2 mL/sec). In patients with infravesical obstruction a significant decrease in maximum and mean flow rates was found whereas the flow rate was unchanged in the group of patients without obstruction. It seems that changes inflow rate due to intubation of the urethra is of minor importance compared with other factors and intubation may actually provide diagnostic information in diagnosing mechanical obstruction. It is concluded that the transurethral technique for pressure-flow studies offers a simple and reliable method for obtaining simultaneous pressure-flow values. It can be performed without further invasion in conjunction with cystometry. Therefore this technique is recommended in the urodynamic testing of male patients with lower urinary tract disorders.