Episode Of Acute Urinary Retention Research Articles

Urinary retention and postrenal kidney injury

In men aged 40-83years, the overall incidence of urinary retention is 4.5-6.8 cases per 1000men per year. The incidence increases significantly with age, so that aman in his 70s has a10% chance and aman in his 80s has amore than 30% chance of experiencing an episode of acute urinary retention [1]. The goal of diagnosis is to quickly reach afinding through clinical examination and ultrasound to be able to relieve the bladder. The first maneuver is catheterization, followed by, if necessary, initiation of pharmacological therapy that targets the underlying cause. Despite the high association of urinary retention with benign prostatic hyperplasia (BPH), acomprehensive history and diagnosis are crucial to identify possible rare and complex causes and to enable targeted treatment. The challenge lies in finding the balance between rapid symptomatic treatment and thorough investigation of atypical and rare pathologies to develop individually adapted and effective therapy strategies.

Comparison of outcomes in patients with and without neurologic diseases undergoing holmium laser enucleation of the prostate

Introduction: We aimed to compare holmium laser enucleation of the prostate (HoLEP) outcomes in patients with and without neurologic diseases (ND). Methods: A prospectively maintained database of patients undergoing HoLEP from January 2021 to April 2022 was reviewed. The following NDs were included: diabetes-related neuropathy/neurogenic bladder, Parkinson’s disease, dementia, cerebrovascular accident, multiple sclerosis, traumatic brain injury, transient ischemic attack, brain/spinal tumors, myasthenia gravis, spinal cord injury, and other. Statistical analysis was performed using t-tests, Chi-squared, and binomial tests (p<0.05). Results: A total of 118 ND patients were identified with 135 different neurologic diseases. ND patients were more likely to have indwelling catheters (57% vs. 39%, p=0.012) and urinary tract infections (UTIs) preoperatively (32% vs. 19%, p=0.002). Postoperatively, ND patients were more likely to fail initial trial of void (20% vs. 8.1%, p<0.001) and experience an episode of acute urinary retention (16% vs. 8.5%, p=0.024). Within 90 days postoperative, the overall complication rate was higher in the ND group (26% vs. 13%, p=0.001). Within the ND group, 30/118 (25%) had ≥1 UTI within 90 days preoperative, which decreased to 10/118 (8.7%) 90 days postoperative (p<0.001). At last followup (mean 6.7 months [ND] vs. 5.4 months [non-ND], p=0.03), four patients (4.4%) in the ND group required persistent catheter/clean intermittent catheterization compared to none in the non-ND group (p=0.002). Conclusions: Patients with ND undergoing HoLEP are more likely to experience postoperative retention and higher complication rates compared to non-ND patients. While UTI rates are higher in this population, HoLEP significantly reduced three-month UTI and catheterization rates.

Эффективность и безопасность комбинированной терапии препаратами алфузозин (Алфупрост® МР) и солифенацин (Везигамп) у больных доброкачественной гиперплазией предстательной железы и гиперактивным мочевым пузырем: первые результаты наблюдательного многоцентрового исследования «АВИАТОР».

Introduction. Combination therapy of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) with the use of α1-adrenoblockers and anticholinergic drugs has become the standard of treatment and is widely used in clinical practice. Materials and methods. An observational prospective multicenter study was conducted to evaluate the efficacy and safety of combined alfuzosin (Alfuprost ® MR) 10 mg/day and solifenacin (Vesigamp) 5 mg/day in patients with BPH and overactive bladder (OAB) with moderate and severe symptoms in real outpatient practice. The study included 208 patients with LUTS/BPH 60.7±6.4 years old with the following average indicators: international prostate symptom score (IPSS) – 20.2±4.9 points; obstructive symptoms – 10.8±4.2 and irritative symptoms – 9.4±2.1 (nocturia 2.8±1.0); quality of life (QoL) - 4.8±0.5; the prostate volume is 49.9±12.0 cm3 ; intravesical prostatic protrusion < 10 mm; overactive bladder symptom score (OABSS) – 10.5±2.4; patient perception of intensity of urgency scale (PPIUS) – 2.5±0.7; maximum flow rate (Qmax) – 11.5±2.1 ml/s; average flow rate (Qave) – 6.6±1.5 ml/s; urinary volume (Vcomp) – 204.1±51.4 ml; residual urine (Vres) – 49.7±35.3 ml. Control examinations were performed 1 and 3 months after the start of treatment. Results. The overwhelming number of patients achieved a statistically reliable and pronounced effect on most subjective and objective clinical indicators, which was registered a month after the start of combination treatment and intensified by the third month of follow-up. A significant improvement in LUTS according to IPSS was after 1 and 3 months, respectively: total score -45.5% and -72.3%; irritative symptoms -45.7% and -73.4%; obstructive -45.4% and -72.2%; nocturia -46.4% and -71.4%; QoL -50.0% and -79.1%. A statistically significant decrease in OAB symptoms according to the OABSS questionnaire was -50.5% and -80.9% after 1 and 3 months, respectively, including imperative urinary incontinence -50.0% and -83.3%. There was also a significant decrease in the severity of urgency according to the PPIUS questionnaire: by -52.0% and -88.0%. Combination therapy led to a rapid and significant improvement in the objective parameters of urination after 1 and 3 months, respectively: Qmax - by 32.2% and 52.2%; Qave - by 24.2% and 37.9%; Vcomp - by 4.6% and 6.5% (not significant). Vres decrease by -49.5% and -75.6%. It was not only the improvement in digital uroflowmetry (UFM) indicators, but also in the type of the UFM curves. If, before the start of treatment UFM curves close to normal were observed in only 5.3% of patients, then at the end of study already in 44.2%. Combination therapy demonstrated a high degree of safety, although 26.9% of patients had concomitant diseases. During 3 months of treatment, only 5 adverse events were registered in 5 (2.5%) patients: dry mouth – 4 (2.0%), retrograde ejaculation – 1 (0.5%). Nobody interrupted treatment due to adverse events. There were no episodes of acute urinary retention. The program showed high satisfaction of doctors with the clinical effectiveness of treatment (4.5±0.9 on the Likert scale), as well as satisfaction of both doctors and patients with the tolerability of therapy (4.5±0.9 and 4.5±0.9 on the Likert scale), respectively. Conclusion. This study is original, both in terms of the combination of the used drugs and in terms of its design features. This is the first study of alfuzosin and solifenacin combination treatment in patients with LUTS/BPH with OAB and urgency. Also, this is the first study in which the factor of intravesical prostatic protrusion > 10 mm was applied as a non-inclusion criterion. The therapy demonstrated: high and significant efficacy in relation to LUTS (irritative and obstructive), objective voiding parameters and impact on patient’s quality of life; high adherence to treatment, safety, tolerability and satisfaction with its results by doctors and patients. The effectiveness and safety of treatment in this study was achieved due to the combination of drugs used for the first time, careful selection of patients and exclusion of persons with severe mechanical bladder outlet obstruction from the observation group.

Primary clear-cell adenocarcinoma in women

Objectives: A literature review of clear cell adenocarcinoma (CCA) of the female urethra, which is a urinary tract neoplasm of low prevalence that can affect the urethra in rare occasions. Material and methods: A case report of CCA in a 59-year-old female with low urinary tract symptoms associated with two episodes of acute urinary retention and recurrent urinary tract infection (UTI) with the finding of a periurethral tumor in magnetic resonance image (MRI). Results: After cystectomy, double adnexectomy, urethrectomy, bilateral iliac-obturator lymphadenectomy, and ureteroileal deviation, the diagnosis of urethral CCA spread to lymph nodes was made. The case was discussed in the Urologic Oncology committee, indicating external radiotherapy and cisplatin as adjuvant treatment. Conclusions: Because of its aggressiveness, CCA is a rare tumor that requires radical surgery.

Early vs Delayed Transurethral Surgery in Acute Urinary Retention: Does Timing Make a Difference?

To compare outcomes of early vs delayed transurethral surgery for benign prostatic hyperplasia after an episode of acute urinary retention vs men without preoperative acute retention. We conducted a retrospective cohort analysis using data from the New York Statewide Planning and Research Cooperative System from 2002-2016. We identified men ≥40 years old who underwent primary ambulatory transurethral resection or photoselective vaporization of the prostate, assessing surgical failure as time to reoperation or recatheterization. We categorized presurgical acute urinary retention by number of episodes: none (reference), 1, or ≥2 precatheterizations, and time from first retention episode to surgery: none (reference), 0-6 months, and >6 months. We used Fine-Gray competing-risk models to predict surgical failure at 10 years, with presurgical acute retention as the primary predictor, adjusted for age, race, insurance, Charlson Comorbidity Index score, preoperative urinary infection, and procedure type, with death as the competing risk. Among 17,474 patients undergoing transurethral surgery, 10% had preoperative acute retention with a median time to surgery of 2.4 months (IQR: 1-18). Among men with preoperative retention, 37% had ≥6 months of delay to surgery. The 10-year cumulative treatment failure rate was 17.2% among catheter naïve men vs 34.0% with ≥2 precatheterizations and 32.9% with ≥6 months delay to surgery. Delays from catheterization to surgery were associated with higher rates of treatment failure (<6 months SHR 1.49, P < .001; ≥6 months SHR 2.11, P < .001) vs catheter naïve men. Preoperative acute urinary retention and delay to surgery once catheterized are associated with poorer long-term postoperative outcomes after surgery for BPH.

Transurethral incision of the bladder neck in recurrent bladder neck stenosis

BACKGROUND: Transurethral incision of the bladder neck is one of the main methods of correction of bladder neck stenosis that occurred after treatment of patients with benign prostatic hyperplasia. This technique involves endoscopic dissection in the area of the stenosed area without removing scar tissue. Taking into account the emergence of new reconstructive methods of surgical intervention in patients with recurrent bladder neck stenosis the expediency of using transurethral incision of the bladder neck in recurrent cases remains a subject of discussion.&#x0D; AIM: The aim of the study is to evaluate the effectiveness of the use of transurethral incision of the bladder neck in patients with recurrent bladder neck stenosis.&#x0D; MATERIALS AND METHODS: The study included 30 patients with a diagnosis of recurrent bladder neck stenosis who were treated in the period from 2012 to 2022. in Clinical Hospital of St. Luke and was performed transurethral incision of the bladder neck using bipolar electrosurgical energy. The diagnosis of bladder neck stenosis was established on the basis of complaints, anamnesis, uroflowmetry with determination of the volume of residual urine, ureteroscopy, retrograde urethrography. Recurrence was recorded when the maximum urination rate below 12 ml/s, there was an episode of acute urinary retention, or the need for additional surgical intervention for bladder outlet obstruction.&#x0D; RESULTS: All 30 patients underwent transurethral incision of the bladder neck using bipolar electrosurgical energy. The average duration of surgery was 22.9 minutes. The degree of postoperative complications did not exceed grade II according to the Clavien scale. The frequency of de novo stress urinary incontinence was detected only in one patient, which resolved spontaneously within 6 weeks. The maximum urination rate after 3 months was 14.73 3.61 ml/s, while after 6 months there was a significant decrease to 10.91 6.92 ml/s, and after 12 months to 9.4 7, 65 ml/s. The absence of recurrence in patients after TUI BN during the observation period was noted in 17 (56.67%) patients.&#x0D; CONCLUSIONS: Transurethral incision of the bladder neck using a bipolar electrode is a safe method for correcting bladder neck stenosis, but in recurrent cases it has limited efficacy. In this regard, in patients with a large number of endoscopic interventions in history, other methods of bladder neck reconstruction should be chosen.

Characteristics of recurrent acute urinary retention in BPH patients in the United States: Retrospective analysis of US-based insurance claims database.

The objective of this study is to analyze characteristics of recurrent acute urinary retention (AUR) in patients with benign prostatic hyperplasia (BPH), utilizing a population based data set. Also, we sought to report on how AUR was treated, specifically regarding the need and length of catheterization and types of procedures utilized for mitigation. A retrospective observational cohort study was performed using Optum's deidentified Clinformatics® Data Mart Database. We compared twogroups, BPH patients with AUR (n = 180,737) and BPH patients without AUR (n = 1,139,760) from January 1, 2003 to December 31, 2017. Also, we analyzed the factors affecting the development of multiple episodes of AUR through age-adjusted multivariate analysis. In contrast to the 47.7% of patients who had a single AUR episode, 33.5% of AUR patients developed 3 or more subsequent episodes of retention. For age matched patients, the risks of additional episodes of retention increase significantly with older age, Caucasian race, diabetes, neurologic conditions, or low income. Overall, the rate of BPH surgery in AUR patients over the study period decreased and the most common procedure was transurethral resection of the prostate. Risk factors for multiple episodes of AUR included age (60 and older), Caucasian race, lower income socioeconomic status, diabetes, and neurological disorders. Patients with a high probability of developing recurrent episodes of AUR are recommended to receive preemptive BPH medication before such AUR occurrences. Also, more expeditious surgical treatment should be considered rather than temporary catheterization when AUR occurs.

Эффективность и безопасность интермиттирующей катетеризации для купирования острой задержки мочи: проспективное сравнительное рандомизированное исследование

of the study: to evaluate the effectiveness and safety of intermittent catheterization in the management of acute urinary retention and to identify factors influencing the resume normal voiding and the development of adverse events.129 patients admitted to urology department with acute urinary retention due to BPH were randomized into two groups. Group I had indwelling bladder catheterisation using Foly catheter. Group II was catheterized intermittently.Success rate, time to resume normal voiding, number of episodes of fever, pain, urgency and gross hematuria. Factors influencing the probability of AUR resolution and adverse events were also analyzed.Normal voiding was resumed in 25 (35.7%) patients in group I, and in 26 (44%) patients in group II. The probability of AUR resolution in group II was 1.5 times higher than in group I. However, this difference was not statistically significant. In group II normal voiding was restored within 1 day in 1 (3.8%) patient, in 12 (46.2%) - within 2 days, and in 13 (50%) - within 3 days. On the 7th day relapse of AUR occurred in 3 (2.3%) patients, in 2 (2,8%) patients in group I and in 1 (1.7%) patient in group II. Logistic regression analysis showed statistically significant association between the probability of developing gross hematuria and the age of the patient, as well as between possible urethrorrhagia and episodes of acute urinary retention previous to the last AUR episode. Statistically significant associations were revealed between age and the use of a-blockers at the time of the acute urinary retention episode and the probability AUR resolution. An increase in the patients age by 1 year was associated with decrease in the chances of voiding resumption by 1.07 times, and a-blockers therapy at the time of acute urinary retention increased these chances by 2.8 times. Urgency rate was statistically significantly higher in group I (30% vs. 3.4%), the chances of developing urgency were also 12 times higher in group I.Intermittent catheterization is an effective method of AUR management. The major advantages of this method are the possibility of outpatient treatment, maximum preservation of patients social and sexual activity, earlier resumption of voiding and significantly less common catheter-associated lower urinary tract symptoms.

COVID-19-associated Guillain–Barrè Syndrome and Urinary Dysfunction: A case report

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection can cause multiple systemic and neurological complications, including Guillain- Barrè Syndrome (GBS). In this report we describe for the first time, urinary dysfunction in a patient with COVID- 19. We reported a 41-years- old female patient with complaints of an increased generalized muscular weakness associated with progressive difficulty in walking. Four days earlier, patient complained of fever, diarrhea, and general weakness, and the RT-PCR was positive for COVID-19 infection. Due to the worsening of neurological symptoms, a neurophysiological examination on nervous conduction was performed and the diagnosis was suggestive of GBS. Two weeks later, patient developed two consecutive episodes of acute urinary retention that requested the placement of indwelling transurethral catheter. Patient started assuming selective alpha-1 adrenergic antagonist in association with 4 clean intermittent catheterization/ die. Four months later, women continued the therapy and the ultrasound evaluation revealed non- pathologic post- void residual volume. Therefore, patient started to void spontaneously again and alpha- blockers were discontinued. We report for the first time a case of severe voiding disorder in a patient with COVID-19 associated GBS. Timely bladder drainage should be adopted to avoid irreversible detrusor damage.

The Efficacy and Safety of a Conservative Management Approach to Radiation-Induced Male Urethral Strictures in Elderly Patients With Comorbidities

Objectives To assess the outcomes of a conservative management approach to radiation-induced urethral stricture disease (R-USD) in an elderly population with comorbidities. Methods Patients with R-USD managed with endoscopic procedures and/or clean intermittent catheterization (CIC) between 2007 and 2019 were included. Patients were excluded if they had an obliterative stricture, prior urethral reconstruction/urinary diversion surgery, or &lt; 3 months follow-up. Primary outcome measures were urinary tract infection (UTI), acute urinary retention (AUR), serum creatinine, uroflowmetry/post-void residual, and urinary incontinence (UI). Failure was defined as progression to reconstructive surgery or permanent indwelling catheterization. Results Ninety-one men were analyzed with a median follow-up of 15.0 months (IQR 8.9 to 37.9). Median age was 75.4 years (IQR 70.0 to 80.0), body mass index was 26.5 kg/m2 (IQR 24.8 to 30.3), and Charlson comorbidity index was 6 (IQR 5 to 8). Median stricture length was 2.0 cm (IQR 2.0 to 3.0). Stricture location was bulbar (12%), bulbomembranous (75%), and prostatic (13%). A total of 90% underwent dilation, and 44% underwent direct visual internal urethrotomy (DVIU). For those that underwent these procedures, median number of dilations and DVIUs per patient was 2 (IQR 1 to 5) and 1 (IQR 1 to 3), respectively. Forty percent used CIC. Thirty-four percent developed a UTI, and 15% had an AUR episode requiring urgent treatment. Creatinine values, uroflowmetry measurements, and UI rates remained stable. Eighty percent avoided reconstructive surgery or indwelling catheterization. Conclusion Most elderly patients with comorbidities with R-USD appear to be effectively managed in the short-term with conservative strategies. Close observation is warranted because of the risk of UTIs and AUR. The potential long-term consequences of repetitive conservative interventions must be considered.

Prostate abscess with acute urinary retention as the initial presentation of granulomatosis with polyangitis

A 50-year-old male presented with acute urinary retention. He also had a history of cough, haemoptysis, exertional dyspnoea, loss of appetite, generalised weakness and left-ear discharge of 1-month duration. Prior episode of acute urinary retention had occurred 2 months ago; diagnostic evaluation revealed prostate abscess, and he had received treatment elsewhere for the same. He also had a history of hypertension. Physical examination revealed fever, pallor, bilateral parotid enlargement and left-ear serous discharge. Clinical examination, imaging of chest revealed consolidation with cavitation on the left side, bilateral pleural effusion. Laboratory testing revealed normocytic normochromic anaemia (haemoglobin 6.6 g/dL); neutrophilic leucocytosis (total leucocyte count 13,100 cells/mm3; polymorphs 87%); raised erythrocyte sedimentation rate (110 mm at the end of the first hour); elevated serum creatinine (2.69 mg/dL) and an active urine sediment. Flexible fibreoptic bronchoscopy showed alveolar haemorrhages. Bronchoalveolar lavage fluid Xpert MTB/RIF testing, cytopathology were negative. Computed tomography-guided biopsy from the lesion was suggestive of granulomatous vasculitis. Cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) tested positive. The patient was diagnosed to have granulomatosis with polyangitis (GPA). As arterial hypoxaemia was evident, tracheal intubation and mechanical ventilatory support were initiated. Renal replacement therapy, intravenous (iv) methyl prednisolone and cyclophosphamide pulse therapy and five sessions of plasmapheresis were administered. As remission could not be achieved, iv rituximab was started. On the 36th day of admission, the patient developed septic shock and died. The present case documents the uncommon association of GPA with prostate abscess, acute urinary retention.

255 Relationship Between Acute Urinary Retention Episode and Risk of Death in Men

Abstract Introduction Acute urinary retention (AUR) is a urological emergency, with incidence increasing with age, being highest amongst men over 70 years. Such adverse events need to be managed properly to avoid complications. Studies have highlighted the association between urinary retention and death. Advancing age and co-morbidities are the two significant factors determining the outcomes of these patients. Aim The main outcome measure will be the death rate within 12 months of retention episode, irrespective of if first or subsequent episodes of retention. Method A total of 231 patients attended emergency department from January to June in the years of 2016 to 2018 with AUR. A total of 42 patients died following episode of urinary retention. Hospital records of these patients were examined with regards to their age at retention, date of retention and date of death. Co-Morbidities, details of any resulting admission and outcome of trial without catheter were also recorded. Results A total of 42 (17.9%) had died. 24 out of 42 (10.2%) died within twelve months of their episode of urinary retention; this represents 57% of all total death relating to this cohort. 16 (66.7%) cases of the 24 that died within 12 months were noted to have ASA of 3 and Charlson co-morbidity index of &amp;gt; 1. 15 (62.5%) cases of that died within 12 months also had long term catheter. Conclusions The management of AUR whilst aimed at immediate relief of retention and preventing possible complications, holistic patient approach should be adopted. Multi-disciplinary team involvement should be instituted as appropriate.

MP17-07 COSTS AND OUTCOMES ASSOCIATED WITH THE MANAGEMENT OF PATIENTS ACUTELY PRESENTING WITH NONNEUROGENIC URINARY RETENTION

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures I (MP17)1 Sep 2021MP17-07 COSTS AND OUTCOMES ASSOCIATED WITH THE MANAGEMENT OF PATIENTS ACUTELY PRESENTING WITH NONNEUROGENIC URINARY RETENTION David Friedlander, Davis Viprakasit, and Matthew Nielsen David FriedlanderDavid Friedlander More articles by this author , Davis ViprakasitDavis Viprakasit More articles by this author , and Matthew NielsenMatthew Nielsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002002.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) is a common and costly clinical condition effecting men worldwide. The most severe sequela of progressive BPH is nonneurogenic acute urinary retention (AUR), affecting 33% of men >80 years of age. Little is known about non-clinical factors that influence rates of BPH progression and overall clinical outcomes following an episode of AUR. We sought to identify clinical and non-clinical predictors of post-AUR patterns of care and associated costs. METHODS: All-payer data from the 2016 Healthcare Cost and Utilization Project State Databases from Florida and New York were used to identify 30,827 men ≥40 years of age acutely presenting with AUR and track subsequent acute care encounters over a 1-year period. Patient demographics, regional data, and procedural information were collected, and episode-based costs were calculated. Multivariable logistic and gamma generalized linear regression were utilized to identify predictors of acute care revisit/subsequent bladder outlet procedure and episode-based costs, respectively. RESULTS: Of the 30,827 patients presenting with AUR, 5,409 (7.5%) experienced at least one additional hospital revisit for AUR, whereas 1,987 (6.4%) subsequently underwent a bladder outlet procedure. Older age (≥80 vs. <70: OR 1.31, 95% CI 1.20-1.42; p <0.001), Medicare vs. private insurance (OR 1.16, 95% CI 1.05-1.29; p=0.005), Black vs. White race (OR 1.18, 95% CI 1.07-1.30; p=0.001), and higher education level (OR 1.13, 95% CI 1.01-1.26; p=0.03) were all associated with increased odds of hospital revisit for recurrent AUR. Regarding subsequent bladder outlet procedure, increasing number of revisits (OR 4.39, 95% CI 3.94-4.89; p <0.001), age (≥80 vs. <70: OR 0.53, 95% CI 0.44-0.63; p <0.001), comorbidity status (CCI ≥3 vs. 0: OR 0.31, 95% CI 0.26-0.36; p <0.001), and insurance type (Medicaid vs. private: OR 0.52, 95% CI 0.36-0.73; p <0.001) all influenced odds of subsequent surgery. Mean unadjusted costs associated with an outlet procedure and revisit were $6,245.58 and $15,675.90, respectively. Mean episode-based costs were higher among individuals who did not undergo a subsequent bladder outlet procedure ($16,223.38, 95% CI $15,423.61-$17,023.15 vs. $17,690.54, 95% CI $17,402.93-$17,978.15; p=0.04). CONCLUSIONS: AUR is a common and costly sequela of BPH, and both clinical and non-clinical factors influence the frequency and type of follow-up care received by patients with AUR. Surgical intervention following AUR may be protective against costly revisits resulting from recurrent AUR. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e310-e310 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Friedlander More articles by this author Davis Viprakasit More articles by this author Matthew Nielsen More articles by this author Expand All Advertisement Loading ...

Postoperative medical treatment of lower urinary tract symptoms after benign prostatic hyperplasia surgery. Are we underestimating the problem?

The aim of this study was to determine whether well timed start of medical and surgical treatment of benign prostatic obstruction (BPO) influences the treatment's effectiveness and thus the patients' overall functional outcomes and quality of life. Pharmacological therapy even in high-volume (>80 cm3) BPH typically begins with α-blockers sole and only subsequently are 5ARI added. Several studies showed that acute urinary retention (AUR) developed more frequently in men who suffered severe lower urinary tract symptoms (LUTS) and who did not start combination therapy immediately. Moreover, there are no strict criteria which determine the right time for performing surgery in patients with mild and moderate LUTS, especially when pharmacological therapy fails. However, sometimes, the surgery does not eliminate all the symptoms, as it deals effectively with BPO, but does not treat an overactive bladder. Also, data show that surgery should be performed as soon as possible and be more radical after the first episode of AUR. A combination of α-blockers and 5ARI makes for a good starting point where the treatment of high volume BPH is concerned. Ideally, surgery should be performed immediately or as soon as possible in patients with the first episode of AUR and 'anatomic' BPH tissue removal is preferable (dissection of tissue along the prostate capsule to remove its maximum volume).

Acute urinary retention in pediatric cerebral palsy: Is there an optimal management strategy?

Cerebral palsy (CP) patients commonly have lower urinary tract dysfunction. Urinary retention (UR), which has been associated with dysfunctional voiding in CP can correlate to chronic upper tract dysfunction. We sought to provide insight into the pediatric presentation of acute UR in patients with CP and subsequent outcomes in this at-risk population. All children with perinatally acquired CP presenting to a regional health network were identified from 2009 to 2019. Retrospective analysis of a hospitalized subset concurrently diagnosed with a first episode of acute UR was performed. Factors associated with new-onset UR are described, as well as management. Using follow-up data, we also assessed the risk for recurrent UR and/or abnormal renal imaging after an initial UR presentation. 3404 CP patients were analyzed with only 33 fulfilling inclusion criteria. Median age was 10(IQR 7.5-16; range 1-22) years, 87.9% were GMFCS-V. 39.4% had a reported history of decreased urinary frequency. At presentation, median maximal time without void prior to catheterization was 13h, and catheterized volume was a median 120% expected capacity-for-age. 84.8% of presentations were associated with a known transient/reversible etiology. 51.5% were post-anesthesia at median 3.5 days, 33.3% had associated constipation, 30.3% had received exacerbating medications. 11/33 were taught clean intermittent catheterization (CIC) after the initial presentation (all pro re nata [PRN] except one). At a median follow-up of 37 months: 50% of those without a CIC PRN no void plan had a repeat episode, at a median of 10.8 months later. Of the patients who had follow-up renal imaging at a median 22.0 months after presentation, 45% had abnormalities: 7 with debris or suspected stones and 2 with collecting system dilation. No factors associated with the initial UR presentation were found to be significantly predictive of recurrence or abnormal follow-up imaging. Patients with CP presenting with acute UR are often those with the most severe limitations and have a history of decreased urinary frequency. They usually have transient or reversible factors associated with UR presentation, however UR recurrence and abnormal imaging in this population subset is common. Pediatric patients with CP who present with acute UR usually present in the context of recent anesthesia and in the setting of exacerbating factors. They are at risk for recurrence and may be best managed with caretaker education of CIC PRN no void to address recurrent episodes. Providers should consider surveillance of these patients for the development of abnormal renal imaging.

Dutasteride 5α-reductase Inhibitor in the Treatment of Benign Prostatic Hyperplasia: Systematic Review and Meta-analysis

Dutasteride is a competitive inhibitor of the enzyme 5-alpha-reductase and is commonly used to treat the symptoms of benign prostatic hyperplasia (BPH).&#x0D; Objective: to determine the efficacy and safety of dutasteride in terms of indicators that are important in clinical practice.&#x0D; Data sources. The literature was searched using the search terms «prostate hyperplasia», «prostate hypertrophy», «dutasteride», «quality of life», and «adverse drug reaction». Articles were obtained from Embase, PubMed, the Kokhranov Central Register of Controlled Trials, with a search till December 2020.&#x0D; Study selection and data recovery. Randomized controlled trials, quasi-randomized trials, and systematic reviews evaluating the efficacy of dutasteride, both in monotherapy and in combination with alpha-blockers for the treatment of men with BPH were included in the analysis. Indicators were the need for prostate surgery, episodes of acute urinary retention, discontinuation of therapy due to side effects, the number of patients who had serious side effects, mortality and sexual dysfunction.&#x0D; Data analysis. Four studies involving 1,879 patients were evaluated. All studies have shown significant clinical efficacy of dutasteride to the need for prostate surgery, with episodes of acute urinary retention that was higher than finasteride with equal safety profiles.&#x0D; Conclusion. No statistically significant differences between the two 5AR inhibitors finasteride and dutasteride in terms of safety profile were found, based on the studies included in this system review. This determines the best clinical efficacy of dutasteride in terms of the number of cases of acute urinary retention and the need for surgery.

“Non-Parasitic” and “Non-Iatrogenic” Chyluria: Its Diagnosis and Treatment

Chyluria occurs in all its forms with milky urine, recurrent episodes of acute urinary retention, left renal colic and proteinuria. In non-parasitic or iatrogenic diseases, it is secondary to communicate between the cisterna system of the chyli and the lymphatics of the calyx system of the left urinary tract with a retrograde passage of a kilo and its appearance in the urine which therefore take on a milky appearance [1, 2]. Sometimes, episodically, especially after the ingestion of a high-fat meal, the quantity of kilo is so abundant that it can cause obstruction of the upper urinary tract and of the bladder, resulting in renal colic or acute urinary retention that may require their unblocking with double J stent or bladder catheter [3, 4]. After conservative attempts with a fat-free diet or with the parenteral diet, in case of their failure, surgery must be performed by performing a para-aortic and renal hilum lymphadenectomy and, in severe cases, with intraperitonealization of the kidney and left ureter. This is the case of the patient reported below and successfully treated recently with an innovative “open” surgical technique.

Treatment of beneficial prostate hyperplasia of large sizes: traditional surgical, low-invasive and laser technologies (literature review)

Benign prostatic hyperplasia – one of the most common diseases in older men. The treatment strategy for benign prostatic hyperplasia consists in its drug therapy, or active surgical tactics. The indication for planned surgical treatment of benign prostatic hyperplasia is the progression of symptoms of the lower urinary tract, which are not amenable to drug correction. Men with a large prostate volume of more than 80 m3, with severe symptoms of the lower urinary tract, with a history of acute urinary retention episodes, represent a difficult group of patients in terms of choosing the tactics of surgical treatment. This article discusses the most common operations that are used in the treatment of benign prostatic hyperplasia (especially of large sizes): open adenectomy, transurethral resection of the prostate gland, enucleation of benign prostatic hyperplasia using a holmium laser, embolization of an artery of the prostate gland. Surgical treatment of benign prostatic hyperplasia requires an individual approach to the patient, taking into account his age, concomitant pathology and clinical symptoms.

A-blockers for the management of lower urinary tract symptoms in patients with prostate cancer treated with external beam radiotherapy: a randomized controlled study.

This is a prospective study aiming to assess the efficacy of α-blockers in treating radiotherapy-induced symptoms of the lower urinary tract and its possible prophylactic role on acute urinary retention (AUR) in patients undergoing radical external beam radiotherapy (EBRT) for localized prostate cancer (PCa). Overall, 108 patients with localized PCa were recruited and randomly assigned in to two groups; 54 patients of Group 1 received tamsulosin 0.4mg once daily with the initiation of EBRT and for 6months and 54 patients of Group 2 served as the control group. All patients received radical EBRT and had post-void volume (Vres) assessment. The International Prostate Symptom Score (IPSS) questionnaire and evaluation of episodes of AUR were performed after the end of radiotherapy, at 3 and at 6months. The incidence of AUR was significantly (p = 0.027) lower in group 1 compared to group 2. No independent predictive factors for AUR were identified in regression analysis. The IPSS changes in univariate and multivariate analysis at 3months showed significant correlation with α-blockers only, while at 6months showed significant correlation with Vres assessments (at 3 and 6months) and with α-blockers. Side effects due to medication were mild and none of the patients discontinued the treatment. The selective use of α-blocker appears to prevent AUR in EBRT-treated patients. Although the administration of α-blockers might relieve patient-reported symptoms, there are no established independent predictive factors to distinguish patients who may benefit.

MP35-03 CONSERVATIVE MANAGEMENT OF LICHEN SCLEROSUS-INDUCED MALE URETHRAL STRICTURES

INTRODUCTION AND OBJECTIVE: Lichen sclerosus-induced urethral stricture disease (LS-USD) creates surgical challenges for the reconstructive urologist due to the high risk of stricture recurrence and disease progression. We reviewed the outcomes of such patients at our institution to determine if conservative management can be an effective strategy. METHODS: We retrospectively identified patients with LS-USD who were managed with urethral balloon dilation or clean intermittent catheterization (CIC) +/- intraurethral steroids. Any patient who had an obliterative stricture, underwent urethral reconstruction as the primary means of USD treatment, or had less than 3 months follow-up was excluded. Primary outcome measures were urinary tract infection (UTI), acute urinary retention (AUR), serum creatinine, and uroflowmetry values. Secondary outcome measures were Sexual Health Inventory for Men (SHIM) and Male Sexual Health Questionnaire (MSHQ) scores. RESULTS: A total of 109 men met inclusion criteria between 2005-2019 with a median follow-up of 24 months (IQR 8-49). Median age was 52.2 years, body mass index was 35.5 kg/m2, and Charlson comorbidity index was 1. Median stricture length on retrograde urethrogram was 10 cm (IQR 2-20). Stricture location was: meatus/fossa navicularis (33%), pendulous (9%), and bulbopendulous (58%). The most common urinary symptoms were slow flow (50%), sitting to void (25%), and spraying (23%). A total of 77 (71%) patients underwent subsequent urethral dilation. Median number of dilations per patient was 1 (IQR 1-3). CIC was utilized in 32% of patients, with 32% of this subgroup applying steroids intraurethrally via CIC. Uroflowmetry values and sexual health questionnaires showed no significant change between first and last visits (Table 1). Median serum creatinine at first and last visits remained unchanged at 1.0 mg/dL. Eight (7%) patients had an AUR episode requiring urgent treatment and 20 (18%) had a stricture-related UTI. CONCLUSIONS: Although certain patients will desire or require urethral reconstruction, many patients with LS-USD, across a wide range of stricture lengths and locations, appear to be safely managed with urethral dilation or CIC +/- intraurethral steroids. Close observation is warranted due to the risk of stricture-related UTIs and AUR episodes.Source of Funding: None