High Post-void Residual Research Articles

Urodynamic findings in children with primary refractory nocturnal enuresis: 10 years' experience of a tertiary center.

To identify correlations between urodynamic study (UDS) findings and urinary symptoms in children with refractory monosymptomatic and nonmonosymptomatic primary nocturnal enuresis. A total of 96 neurologically normal children were enrolled, 44 consecutive boys and 51 consecutive girls, aged 5-18 years, of whom 41 (38.8%) had refractory monosymptomatic nocturnal enuresis (MNE) and 55 (61.2%) had refractory non-MNE (NMNE). We assessed the urodynamics of all children to detect any underlying bladder overactivity. A comparative analysis was carried out between the two groups of patients. Detrusor overactivity (DO), low bladder capacity, low compliance, and increased postvoid residual (PVR) were identified in 70 (72.9%), 35 (36.5%), 43, and 76 (79.2%) patients, respectively. The mean bladder compliance was 21.66 ± 14.52 mL/cmH2O (2-75 cmH2O). Of the NMNE patients, 50 (90.9%) had abnormal urodynamic findings, while 40 (97.5%) had abnormal urodynamic findings in the MNE group. There was a statistically significant relationship between NMNE and both increased PVR and abnormal voiding patterns. Both high PVR and DO were significantly associated with obstructive urinary symptoms. Constipation and history of urinary tract infection (UTI) did not significantly correlate with UDS abnormality (p = 1.0 and p = 0.49, respectively). There was a high prevalence of bladder function disorders in both refractory MNE and NMNE patients in our study. This included small functional capacity, low bladder compliance, and marked DO. A nocturnal enuresis may be the only presenting symptom, however, it may be associated with bladder overactivity, UTI, and constipation; the UDS findings may aid in guiding the assessment and treatment of children suffering from primary refractory nocturnal enuresis and its association with bladder and bowel symptoms.

Predictors for adverse events following intravesical botulinum toxin injections in men.

Intravesical botulinum toxin A (BTX-A) has been long established as treatment for overactive bladder and neurogenic bladder dysfunction. However, most published data are reported amonga female cohort. Adverse events such as intermittent self-catheterization (ISC) and urinary tract infections (UTIs) play a large role in discontinuation of therapy. There is currently limited information regarding predictive factors to appropriately counsel male patients. We retrospectively collected data on male patients undergoing their first intravesical BTX-A therapy from January 2016 to July 2021 in two high-volume centers. Data included demographics, past medical and surgical history, and urodynamic parameters. Patients were excluded if they had a long-term catheter or ISC before initiation of therapy. A total of 69 men were included in the study with a median age of 66 years. There were 18 patients with neurogenic bladder dysfunction. Thirty men had urge incontinence secondary to radical prostatectomy or bladder outflow surgery. Overall rates of ISC were 43.5%. Predictors for ISC included a baseline postvoid residual (PVR) ≥ 50 mL (odds ratio [OR]: 4.2, 95% confidence interval [CI]: 1.36-13.03, p = 0.01), BTX-A dose >100 units (OR: 4.2, 95% CI: 1.36-13.0, p = 0.01). Stress urinary incontinence was protective against ISC (OR: 0.20, 95% CI: 0.04-1.00, p = 0.049) as well as history of prostatectomy/bladder outflow obstruction (BOO) surgery (OR: 0.16, 95% CI: 0.05-0.47, p < 0.001). A multivariable logistic regression model with these factors yielded a c-statistic of 0.80 (optimism-adjusted = 0.75). An enlarged prostate was the only predictor for UTI amongour male cohort (OR: 8.0, 95% CI: 2.03-31.5, p = 0.003). This is the first study assessing risk factors of adverse events amongmen following BTX-A injection. High PVR and BTX-A dose of >100U were predictors of requiring ISC after BTX-A. Stress incontinence, previous radical prostatectomy, and BOO surgery were all protective against needing ISC post-BTX-A. An enlarged prostate was associated with development of UTI. These factors can be used to assist in counseling male patients regarding their risk of ISC and UTI.

Risk Factors and Real-World Short-Term Outcomes of a Failed Trial of Void After Rezum Therapy in a Multiethnic Population.

Background: Postoperative urinary retention is a common complication following surgery for benign prostatic hyperplasia. We aimed to identify risk factors for a failed trial of void (TOV) following treatment with the Rezum system and assess the impact of a failed TOV on short-term outcomes. Methods: A single-office retrospective study was conducted on patients treated with Rezum therapy between 2017 and 2019. A urinary catheter was placed in all patients following Rezum therapy. Demographic data and outcome measures, including the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), and adverse events, were analyzed at baseline and 1, 3, and/or 6 months postoperatively. Risk factors were identified through multivariate logistic regression analysis. Results: A total of 289 patients were included. Thirty-five patients (12.1%) failed a TOV, while 254 (87.9%) had an effective TOV. All patients were given a TOV after a median of 5 days (4-5). Those who failed the TOV spent an additional mean of 13.7 ± 13.3 days with a catheter. Patients who failed the TOV were more likely to get a urinary tract infection compared with those who had an effective TOV (20.0% vs 4.7%, p < 0.001). All patients experienced significant improvements in IPSS, QoL, and Qmax at 1, 3, and/or 6 months. On multivariate analysis, a high baseline PVR was the only independent predictor of a failed TOV (odds ratio: 1.01, 95% confidence interval 1.00-1.01). A greater proportion of patients with a baseline PVR >200 mL failed the TOV (40.0%) compared with patients with a baseline PVR <200 mL (10.9%, p = 0.008). Conclusions: Approximately one in eight patients failed the TOV following Rezum therapy. Baseline PVR was the only independent risk factor for a failed TOV. Nevertheless, all patients experienced significant relief of urinary symptoms. Patients with high baseline PVR, particularly >200 mL, may require a catheter for an extended duration.

Botulinum toxin A injection to the external urethral sphincter for voiding dysfunction in females: A tertiary center experience.

The aim of this study is to examine the functional outcomes of ona-botulinum toxin A (BTX-A) injection into the external urethral sphincter (EUS) for female patients with nonneurogenic nonrelaxing sphincter as the underlying cause of voiding dysfunction (VD). A retrospective analysis was performed for all the patients with the urodynamic findings of higher than expected maximum urethral closure pressure (MUCP) who received their first injection during the study period. All patients were evaluated with preoperative videourodynamic study and urethral pressure profilometry and received 100 U of EUS BTX-A. Patients aged less than 18 years and those with neurogenic bladder were excluded. All patients were followed up with the free flow, postvoid residuals (PVR), and patient global impression of improvement (PGI-I) scale at 6 weeks and then at 3 monthly intervals. We identified 35 female patients with a mean age of 37.5 ± 15 years (range 18-72 years) with a mean follow-up of 20 months. More than 50% of patients had a history of prior surgical intervention and 28 (80%) patients were catheter dependent, a suprapubic catheterization, or clean intermittent self-catheterization. Mean MUCP was 97.1 ± 22 cm of water. After treatment with BTX-A, 21 (60%) patients were able to void per urethral (p = 0.02). The mean maximum flow rate (Qmax) improved from 8.8 to 11 mls/s and the mean PVRdecreased from 200 to 149 mls (p &lt; 0.05). On multivariate analysis, we identified high preoperative PVR, high preoperative actualMUCP, and previous surgical intervention (urethral dilatation, sacral neuromodulation, and pelvic surgery) as predictors of successful voiding restoration. The mean duration of response was 4.7 months, 46% of patients requested repeat injection, and 29% were established on maintenance injections. On the 5-point PGI-I score, 13 (37%), 12 (34%), and 10 (29%) patients reported good, some, and no improvement, respectively. Quality of life was also improved in 60% of patients. Two patients had transient stress urinary incontinence (for&lt;6 weeks) and there were no significant long-lasting adverse events. EUS BTX-A is a valid treatment option for VD considering therapeutic options are limited. The patient must be made aware of the need for repeat treatments.

PD45-02 UROLIFT VERSUS REZUM FOR BENIGN PROSTATIC HYPERPLASIA: A REAL-WORLD SINGLE-INSTITUTION ANALYSIS

You have accessJournal of UrologyCME1 May 2022PD45-02 UROLIFT VERSUS REZUM FOR BENIGN PROSTATIC HYPERPLASIA: A REAL-WORLD SINGLE-INSTITUTION ANALYSIS Chih Peng Chin, Evan Garden, Krishna Ravivarapu, Devki Shukla, Olamide Omidele, Micah Levy, Joseph Sewell Araya, Alexander Small, Steven Kaplan, Robert Valenzuela, Avinash Reddy, Susan Marshall, Jay Motola, Craig Nobert, Mantu Gupta, and Michael Palese Chih Peng ChinChih Peng Chin More articles by this author , Evan GardenEvan Garden More articles by this author , Krishna RavivarapuKrishna Ravivarapu More articles by this author , Devki ShuklaDevki Shukla More articles by this author , Olamide OmideleOlamide Omidele More articles by this author , Micah LevyMicah Levy More articles by this author , Joseph Sewell ArayaJoseph Sewell Araya More articles by this author , Alexander SmallAlexander Small More articles by this author , Steven KaplanSteven Kaplan More articles by this author , Robert ValenzuelaRobert Valenzuela More articles by this author , Avinash ReddyAvinash Reddy More articles by this author , Susan MarshallSusan Marshall More articles by this author , Jay MotolaJay Motola More articles by this author , Craig NobertCraig Nobert More articles by this author , Mantu GuptaMantu Gupta More articles by this author , and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: UroLift and Rezum are newer minimally invasive BPH treatment options that have grown in popularity. Research directly comparing the two is limited. We report the largest cohort to date comparing real world clinical outcomes following UroLift and Rezum. METHODS: Patients at an academic institution between 1/2017 and 1/2021 were screened, and those with preoperative prostate volume >30cc and ≤80cc were included. Patients with follow-up <30 days were excluded. Outcomes included changes in AUA symptom score (AUA-SS), Qmax, post void residual (PVR), surgical retreatment rate, changes in BPH medications use, postoperative complications, ER visits, and readmissions within 90 days. RESULTS: We identified 375 Rezum and 151 UroLift patients of which 191 Rezum (51%) and 88 UroLift (58%) patients met inclusion criteria. Median follow-up for Rezum and UroLift patients was 173 and 307 days, respectively. Compared to Rezum patients, UroLift patients were older (Rezum 67 ± 8 vs UroLift 69 ± 9 years, p=0.014) and had smaller prostates (Rezum 50.7 ± 13.5 vs UroLift 44.9 ± 12.4 cc, p<0.001). Preoperatively, UroLift patients had higher PVR (Rezum 93 ± 112 vs Urolift 156 ± 185 mL, p=0.028) and lower Qmax (Rezum 9.3 ± 5.1 vs UroLift 7.5 ± 4.6 mL/sec, p=0.004). After treatment, both Rezum and UroLift patients had significant, similar improvements in AUA-SS (Rezum -4.0 ± 6.8 vs. UroLift -5.2 ± 8.0 points, p=0.349) and PVR (Rezum -26.5 ± 91.8 vs UroLift -59.3 ± 150.3 mL, p=0.349). There was no significant improvement in Qmax (Table 1a). Both groups had decreased alpha-blocker use after treatment (Rezum 72.8% to 44.5%, UroLift 76.1% to 38.6%, both p<0.001) (Table 1b). In the postoperative 90-day period, Rezum patients experienced more hematuria, dysuria and retention, whereas UroLift patients more frequently had clot retention (Table 1c). There were no differences in 90-day ER visits, 90-day readmissions, or surgical retreatment rates (all p>0.05). CONCLUSIONS: For patients with BPH, UroLift and Rezum are similarly effective in improving urinary symptoms and function with no difference in surgical retreatment rates. The procedures differed in short-term clinical side-effect profile. Rezum patients reported more urinary retention, hematuria, and dysuria; UroLift patients had clot retention more frequently. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e782 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chih Peng Chin More articles by this author Evan Garden More articles by this author Krishna Ravivarapu More articles by this author Devki Shukla More articles by this author Olamide Omidele More articles by this author Micah Levy More articles by this author Joseph Sewell Araya More articles by this author Alexander Small More articles by this author Steven Kaplan More articles by this author Robert Valenzuela More articles by this author Avinash Reddy More articles by this author Susan Marshall More articles by this author Jay Motola More articles by this author Craig Nobert More articles by this author Mantu Gupta More articles by this author Michael Palese More articles by this author Expand All Advertisement PDF DownloadLoading ...

Effect of Metabolic Syndrome on Anatomy and Function of the Lower Urinary Tract Assessed on MRI

To investigate the relationship between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) with functional and anatomic changes of the lower urinary tract with MRI. The bladder and prostate of 95 subjects (56M, 39F) were segmented on T2-weighted pelvic MRI using Materialize Mimics 3D software. Bladder wall volume (BWV), post-void residual (PVR) and prostate volume (PV) were quantified from the 3D renderings. LUTS were quantified using validated questionnaires administered at the time of MRI. Wilcoxin rank sum, win ratio and chi-square tests were used to correlate symptom scores, BWV, PVR and PV in patients 1) without vs with MetS, 2) with mild (IPSS or UDI-6: 0-7) vs moderate-severe (IPSS: 8-35 or UDI-6: ≥8) and 3) normal vs enlarged prostates (>40cm3). Multivariate linear regression was used to determine predictors for BWV, PVR and PV. Men with MetS had increased BWV (66.8 vs 51.1cm3, P=.003), higher PVR (69.1 vs 50.5cc, P= .05) and increased PV (67.2 vs 40.1cm3, P= .01). Women without and with MetS had similar BWV, PVR and LUTS (P= .3-.78). There was no difference in prevalence of MetS, BWV, PVR or PV in men or women with mild vs moderate-severe LUTS (P=.26-.97). Men with enlarged prostates were more likely to have MetS (P=.003). There was no difference in BWV, PVR and LUTS for men with normal vs enlarged prostates (P= .44-.94). In men, BWV was highly correlated with MetS (P=.005) on regression analysis. MetS leads to detrusor hypertrophy and may contribute to impaired bladder function, likely related to the effect on the prostate.

B-PO05-203 RISK FACTORS FOR POSTOPERATIVE URINARY RETENTION IN PATIENTS UNDERGOING ATRIAL FIBRILLATION ABLATION

BackgroundPatients undergoing atrial fibrillation (AF) ablation often undergo bladder catheterization to alleviate retention. However, it is associated with increased complications, increased length of stay and recurrent hospitalization. Identification of risk factors for retention may help prevent bladder catheterization and its complications.ObjectiveTo determine the risk factors for postoperative urinary retention (POUR) in patients undergoing AF ablation.MethodsIn a single-center, retrospective study all cases of POUR requiring urinary catheterization during January 1 to December 31, 2020 matched to age, and gender controls (n=56) were analyzed. POUR was defined as inability to void, or symptoms with high post void residuals>400ml, requiring bladder catheterization.ResultsPrevalence of benign prostate hypertrophy (BPH) was 61% in cases and 18% in controls (p=0.001). Preoperative alpha blocker use was 50% vs 21% (p=0.026). Of cases, 24% with BPH were not on an alpha blocker. In multivariable adjusted analysis, BPH [OR 13.7 (95% CI 1.7, 111, p=0.01)] and post-op diuretic use [OR 18.2 (1.7, 199, p=0.02)] were significantly associated with POUR. There was no difference in 30-day readmissions, but length of hospital stay was longer in cases (1±0.47) than in controls (0.3±0.52, p<0.001). Analgesic medications, intra-operative anesthetic agents, and procedure duration did not significantly affect POUR, Table 1.Conclusion BackgroundPatients undergoing atrial fibrillation (AF) ablation often undergo bladder catheterization to alleviate retention. However, it is associated with increased complications, increased length of stay and recurrent hospitalization. Identification of risk factors for retention may help prevent bladder catheterization and its complications. Patients undergoing atrial fibrillation (AF) ablation often undergo bladder catheterization to alleviate retention. However, it is associated with increased complications, increased length of stay and recurrent hospitalization. Identification of risk factors for retention may help prevent bladder catheterization and its complications. ObjectiveTo determine the risk factors for postoperative urinary retention (POUR) in patients undergoing AF ablation. To determine the risk factors for postoperative urinary retention (POUR) in patients undergoing AF ablation. MethodsIn a single-center, retrospective study all cases of POUR requiring urinary catheterization during January 1 to December 31, 2020 matched to age, and gender controls (n=56) were analyzed. POUR was defined as inability to void, or symptoms with high post void residuals>400ml, requiring bladder catheterization. In a single-center, retrospective study all cases of POUR requiring urinary catheterization during January 1 to December 31, 2020 matched to age, and gender controls (n=56) were analyzed. POUR was defined as inability to void, or symptoms with high post void residuals>400ml, requiring bladder catheterization. ResultsPrevalence of benign prostate hypertrophy (BPH) was 61% in cases and 18% in controls (p=0.001). Preoperative alpha blocker use was 50% vs 21% (p=0.026). Of cases, 24% with BPH were not on an alpha blocker. In multivariable adjusted analysis, BPH [OR 13.7 (95% CI 1.7, 111, p=0.01)] and post-op diuretic use [OR 18.2 (1.7, 199, p=0.02)] were significantly associated with POUR. There was no difference in 30-day readmissions, but length of hospital stay was longer in cases (1±0.47) than in controls (0.3±0.52, p<0.001). Analgesic medications, intra-operative anesthetic agents, and procedure duration did not significantly affect POUR, Table 1. Prevalence of benign prostate hypertrophy (BPH) was 61% in cases and 18% in controls (p=0.001). Preoperative alpha blocker use was 50% vs 21% (p=0.026). Of cases, 24% with BPH were not on an alpha blocker. In multivariable adjusted analysis, BPH [OR 13.7 (95% CI 1.7, 111, p=0.01)] and post-op diuretic use [OR 18.2 (1.7, 199, p=0.02)] were significantly associated with POUR. There was no difference in 30-day readmissions, but length of hospital stay was longer in cases (1±0.47) than in controls (0.3±0.52, p<0.001). Analgesic medications, intra-operative anesthetic agents, and procedure duration did not significantly affect POUR, Table 1. Conclusion

Urodynamic and clinical features in women with overactive bladder: When to suspect concomitant voiding dysfunction?

The aim of this study is to describe the prevalence and type of female voiding dysfunction (FVD) in patients with overactive bladder (OAB) who were studied by urodynamics and its relationship with voiding symptoms. This is a cross-sectional study of female adult patients with OAB syndrome who underwent UDS in a University Hospital in Chile between January 2015 and April 2020. FVD was defined either as bladder outlet obstruction (BOO) or detrusor underactivity (DU). BOO was established if the Solomon-Greenwell BOO index was higher than 18. DU was diagnosed when the invasive maximum flow rate (Qmax) was ≤15 ml/sec, detrusor pressure at Qmax (Pdet@Qmax) was ≤20 cmH2 O and postvoid residual (PVR) was greater than 10%. Urodynamic data and clinical features were compared between groups. Two hundred and ninety-nine UDS were selected and analyzed. Bladder outlet obstruction was diagnosed in 59 patients (19.7%), whereas DU was found in 10 patients (3.3%). In the multivariate analysis, the logistic regression to predict BOO demonstrated that night-time frequency, the presence of detrusor overactivity and a higher PVR were independent predictors of BOO. Instead, for DU, the only independent predictor was a smaller voided volume in the pressure-flow study. Female voiding dysfunction was found in 23% of patients with overactive bladder. BOO is more frequent than DU, and should be suspected in patients with higher night-time frequency, presence of detrusor overactivity and a high PVR. Instead, DU should be suspected in patients with a smaller voided volume.

Urogynecology

Urogynecology

MP41-01 EVALUATION OF URINARY CONTINENCE FOLLOWING OPEN RADICAL CYSTECTOMY WITH ORTHOTOPIC NEOBLADDER IN FEMALES USING A VALIDATED QUESTIONNAIRE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-01 EVALUATION OF URINARY CONTINENCE FOLLOWING OPEN RADICAL CYSTECTOMY WITH ORTHOTOPIC NEOBLADDER IN FEMALES USING A VALIDATED QUESTIONNAIRE Seyedeh-Sanam Ladi Seyedian*, Wesley Yip, Zhoobin Bateni, Saum Ghodoussipour, Jie Cai, Gus Miranda, Sumeet Bhanvadia, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Seyedeh-Sanam Ladi Seyedian*Seyedeh-Sanam Ladi Seyedian* More articles by this author , Wesley YipWesley Yip More articles by this author , Zhoobin BateniZhoobin Bateni More articles by this author , Saum GhodoussipourSaum Ghodoussipour More articles by this author , Jie CaiJie Cai More articles by this author , Gus MirandaGus Miranda More articles by this author , Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Orthotopic neobladder (ONB) following radical cystectomy (RC) is less frequent in female patients compared to males, due to unclear functional outcomes. We prospectively evaluated the continence outcomes in female patients undergoing open RC and ONB with a validated pad usage questionnaire. METHODS: From May 2012 onwards, we prospectively followed patients after open RC with ONB with a validated, pictorial, pad usage questionnaire that assesses the number, size, and wetness of pads, as well as catheter use, at follow-up clinic visits. In our IRB approved database, 42 ONB were performed for female patients after open RC from May 2012 to May 2018 (38% of all urinary diversions in female patients). 32 patients had complete data from interval clinic visits with at least 1 year of follow-up. Daytime continence was defined as no pad usage or an almost dry pad. RESULTS: A total of 32 female ONB patients with median age of 65 years (range: 42-81) and BMI of 25.6 (range: 18-35) were included. Median follow-up was 3 years (range: 1-7). The need to catheterize was noted in 10 patients (36%), either due to complete retention (7%), high post-void residuals (25%), or to empty their neobladder prior to sleeping (4%). Neobladder-vaginal fistulae developed in 4 patients (14%), with 1 ultimately converting to a continent cutaneous diversion after failed conservative management and the other 3 undergoing primary repairs. Daytime continence rates with and without intermittent catheterization increased from 64% and 36% at 4 months post-operatively, to 90% and 60% at 4 years, respectively. Nighttime continence rates with and without catheterization increased from 57% and 24% at 4 months, to 90% and 60% at 4 years, respectively (Figure1). Daytime continence rate was significantly less in females compared to males (P=0.024), while there was no significant difference in nighttime continence rate between them (P=0.58). CONCLUSIONS: Open RC and ONB in selected female patients can have good functional outcomes. Day and nighttime continence improve over time and majority of patients achieve continence by 2 years. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e595-e595 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seyedeh-Sanam Ladi Seyedian* More articles by this author Wesley Yip More articles by this author Zhoobin Bateni More articles by this author Saum Ghodoussipour More articles by this author Jie Cai More articles by this author Gus Miranda More articles by this author Sumeet Bhanvadia More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...

Low dose, targeted alpha blockers for refractory bladder dysfunction in children – a single centre experience

In children with refractory bladder dysfunction, the use of alpha blockers is being explored; although it remains off-label in Australia. We report subjective and objective outcomes of low dose targeted alpha blocker therapy in refractory bladder dysfunction. A retrospective chart review at John Hunter Children’s Hospital between March 2015 and March 2019 was performed. Children with high post-void residuals (PVR) or frequency-urgency symptoms, who had failed or were intolerant to standard treatments, and were given additional alpha blocker therapy were included in this study. Data collected included; patient characteristics, medication used with its dose and duration, side effects, subjective outcomes in the form of symptomatic response and objective outcomes measured by PVR and uroflowmetry. Fifteen patients (male=13, median age=8 years) were trialled on alpha blockers, with a median follow-up of 12 months. Alpha blockers were commenced due to ongoing high PVR (n=11) or overactive bladder syndromes (n=4) (Table 1). Alpha blockers used included: Tamsulosin (n=6), Terazosin (n=7) and Prazosin (n=2). Partial resolution of symptoms was achieved in 60% (9/15), and complete resolution in 33% (5/15) of patients. In the high PVR cohort, mean PVR decreased from 100mls to 23.1mls post-alpha blocker use. Severe nausea was noted in one patient on Terazosin, necessitating discontinuation.Table 1Symptomatic response to alpha blockers for different bladder syndromes based on ICCS definitionsIndication for Alpha blockersComplete responsePartial responseNo responseValve-bladder syndrome (high PVR)21Dysfunctional voiding (high PVR)13Bladder neck dysfunction (high PVR)1Underactive detrusor (high PVR)2Voiding postponement (high PVR)1Overactive bladder syndrome121Total:591 Open table in a new tab Low dose alpha blocker therapy may provide symptomatic improvement in children with refractory bladder symptoms. The results appear less encouraging in children with overactive bladder syndrome.

Outcomes for Intravesical Abobotulinumtoxin A (Dysport) Treatment in the Active Management of Overactive Bladder Symptoms—A Prospective Study

ObjectiveTo present the results our active management protocol for bothersome overactive bladder (OAB) symptoms using abobotulinumtoxinA (Dysport) over a 9-year period. Material and MethodsData from consecutive patients with OAB symptoms due to urodynamically-proven idiopathic detrusor overactivity who had failed maximum-dose pharmacotherapy and bladder drill were reviewed. All patients completed the Overactive Bladder Symptom Score (OABSS) and Likhart quality of life indices before treatment and again at review 6 weeks post-treatment. Two hundred and fifty units of abobotulinumtoxinA were injected under general anaesthesia. Repeat treatment was offered only after failed resumption of pharmacotherapy with bladder drill. ResultsThe results of 299 treatments in 170 patients were reviewed. OABSS and quality of life indices improved by a mean of 35% (P ˂.001) and 41% (P ˂.001), respectively, with the OABSS improving by 2 or more points in 65% of cases. While urgency incontinence was completely abolished in 26%, the severity of incontinence was reduced in 44%. Pharmacotherapy was resumed after a mean of 10.2 months, and the mean interval between repeat abobotulinumtoxinA injection treatments was 21.3 months. De-novo self-catheterization was required in 18.2% of cases due to high postvoid residuals. ConclusionThe use of abobotulinumtoxinA is safe and highly effective treatment option for patients with refractory OAB symptoms. Our data show similar outcomes to onabotulinumtoxinA in terms of symptom score improvement and self-catheterization rates.

Increasing Age Predicts Increasing Residual Urine Volume.

To determine reference values for postvoid residual (PVR) volume for patients referred to a tertiary urogynecology center. After Institutional Review Board approval, we performed a retrospective chart review of all new patients presenting to our referral center. We assessed associations between PVR and patient demographics, pelvic floor symptoms, and physical examination by Wilcoxon rank sum or Kruskal-Wallis tests as appropriate. A multivariable logistic regression model was used to calculate odds ratios for patient characteristics associated with PVR in the top age range-specific decile. Three hundred sixty-one patients were included in the analysis. The median PVR was 20 mL (interquartile range, 1st, 3rd quartiles, 10, 50). Older age was associated with higher PVR (P < 0.001). The median PVR in participants younger than 40 years was 10 mL, ages 40 to 49 years was 18 mL, 50 to 69 years was 20 mL, 70 to 79 years was 38 mL and in women older than 79 years was 50 mL. A multivariable analysis showed that prolapse stage (odds ratio [OR], 3.46 with prolapse stage 2-4 vs stage 0-1; P = 0.001), history of stroke (OR, 7.62; [95% CI 2.17-26.77, P = 0.002]), narcotic use (OR, 2.45; [95% CI 1.01-5.92; P = 0.047]), and urinary frequency (OR, 2.61; [95% CI, 1.14-5.98; P = 0.024]) were risk factors for increased PVR (as defined at >90%ile for age), independent of the age-related elevation. The majority of patients presenting for urogynecologic evaluation had a low PVR with a median of 20 mL. Postvoid residual was higher for older age groups but nearly all volumes were less than 100 mL. The utility of a PVR measurement is highest for patients with pelvic organ prolapse, urinary frequency, narcotic use, or history of stroke.

Robotic-assisted laparoscopic ureteral re-implant (RALUR): Can post-operative urinary retention be predicted?

Urinary retention following robotic-assisted laparoscopic extravesical ureteral reimplantation (RALUR) is proposed to be due to traction or injury of the pelvic parasympathetic nerve plexus during distal ureteral dissection. Nerve-sparing techniques have been employed to avoid injury to the pelvic plexus, either directly or indirectly. This single-center study assessed postoperative urinary retention rates after extravesical RALUR and investigated whether demographic or operative factors could predict this occurrence. All RALUR cases entered into an Institutional Review Board-approved registry were retrospectively reviewed, and the rate of postoperative retention was determined. Postoperative urinary retention was defined as the need for catheterization at any time in the postoperative period during hospital admission or within 1 week after the operation. This included acute urinary retention episodes (AUR) as well as high post-void residuals (>50% of expected bladder capacity). Univariate analysis was performed to analyze for predictors of postoperative retention. Factors assessed included age, gender, clinical presentation, bowel bladder dysfunction (BBD), pre-operative urinary tract infection (UTI), procedure length, grade of vesicoureteral reflux (VUR), and operative laterality. A total of 128 patients underwent extravesical RALUR in 179 ureters during the study period 2012-2016. Male:female ratio was 1:2.6. Median age at surgery was 4 years. Bilateral RALUR was performed in 52 cases (40.6%), and unilateral in 76 (59.4%). Urinary retention requiring catheterization occurred in 11 cases (8.59%). Of these, seven were post-bilateral RALUR, while the remaining four were unilateral. In seven cases, postoperative retention occurred within 24h following RALUR. The remaining four instances occurred within 1 week, despite successful voiding in the immediate postoperative period. Univariate analysis revealed male gender (P=0.009) and operating room time (P=0.029) as predictors of retention. No association was found with age, weight, BBD, pre-operative UTI, grade of VUR, or laterality. Urinary retention after RALUR was an infrequent complication. When it did occur, urinary retention appeared to be secondary to covariates such as male gender and length of surgical time - possibly an indication of technical difficulty - rather than laterality of repair.

MP33-12 THE NATURAL HISTORY OF VOIDING EFFICIENCY FOLLOWING CORRECTION OF PARTIAL BLADDER OUTLET OBSTRUCTION IN WOMEN WITH PROLAPSE (2009-2015)

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse1 Apr 2018MP33-12 THE NATURAL HISTORY OF VOIDING EFFICIENCY FOLLOWING CORRECTION OF PARTIAL BLADDER OUTLET OBSTRUCTION IN WOMEN WITH PROLAPSE (2009-2015) Amy D. Dobberfuhl, Robyn K. Shaffer, Steven N. Goodman, and Bertha Chen Amy D. DobberfuhlAmy D. Dobberfuhl More articles by this author , Robyn K. ShafferRobyn K. Shaffer More articles by this author , Steven N. GoodmanSteven N. Goodman More articles by this author , and Bertha ChenBertha Chen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1083AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The diagnosis of partial bladder outlet obstruction (pBOO) in women with prolapse has largely relied on subjective complaints and long term urodynamic (UDS) predictors of outcomes in this population have been poorly characterized. We report our 6-year experience in women following prolapse repair. METHODS We identified 592 women who underwent anterior and/or apical prolapse repair at our institution from 2009 to 2015 and reviewed the records of 266 women with preoperative UDS evaluation. Primary outcome was postoperative voiding efficiency (VE = voided volume ÷ capacity) and/or post void residual (PVR) after surgery. Data were analyzed in SAS using repeated measure mixed effects models to assess within and between group changes over time. RESULTS All 266 women (mean age 61 years) had preoperative UDS tracing, surgical and follow-up data available for analysis. There were 519 PVRs recorded at up to 2,949 days (mean 364, σ=639) and 9 time points (median 2, IQR 1-3) after surgery. Preoperative UDS revealed a mean: [email protected] 22 cmH2O (IQR 12-30), Qmax 18 mL/s (IQR 11-23), capacity 529 mL (IQR 370-659), PVR 120 mL (IQR 5-160). Women with prolapse [POP-Q Stage: I (n=14), II (n=120), III (n=118), IV (n=14)] underwent anterior-only (n=115), apical-only (n=41) or combination anterior-apical (n=110) prolapse repair. Using mixed effects models, significant UDS cutpoints associated with worsening postoperative PVR and/or VE over time were identified: BCI < 60 (11% reduction VE, p<0.05), capacity > 600 mL (59 mL higher PVR, p=0.01); preoperative PVR > 200 mL (93 mL higher PVR, p<0.01; 8% reduction VE, p<0.05). The Qmax < 10 mL/s cutpoint approached significance (7% reduction VE, p=0.053). Sling placement was associated with a 49 mL higher PVR (ref 99 mL, p<0.05) and non-significant 5% lower VE (ref 82%, p=0.058). High grade (Stage III or IV) prolapse was paradoxically associated with 6% higher VE (ref 78%, p<0.05). Urinary tract infections (n=120) were associated with a 77 mL higher PVR (ref 78 mL, p<0.01) and 13% reduction in VE (ref 86%, p<0.01). Factors not significantly predictive of worse PVR and/or VE include: all BOOI and [email protected] cutpoints, anterior versus apical repair, diabetes (n=37, p=0.92), hyperlipidemia (n=91, p=0.08), neuropathy (n=17, p=0.33), and obesity (n=44, p=0.76). CONCLUSIONS BOOI and [email protected] are poorly predictive of VE and/or PVR following prolapse surgery. Women with a BCI < 60, capacity > 600 mL or PVR > 200 mL are at risk of worsening VE and/or PVR following prolapse repair and should be considered for earlier pBOO intervention. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e433 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Amy D. Dobberfuhl More articles by this author Robyn K. Shaffer More articles by this author Steven N. Goodman More articles by this author Bertha Chen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Relationship between Bladder, Periarterial and Somatic Neuropathy in Diabetes.

Objective Diabetes commonly affects the bladder nerves. However, the relationship among bladder, periarterial and somatic neuropathy in diabetes is not well known. In the present study we investigated these relationships. Methods A total of 110 diabetic subjects were enrolled in the study. All were referred for screening for diabetic neuropathy, irrespective of their symptoms. The patients included 61 men and 49 women; the mean age was 59.3 years (31-85 years); the mean disease duration was 14.0 years (5-30 years); and the mean HbA1c value was 10.1% (5.1-16.3%). We performed a nerve conduction study (NCS, A-alpha/beta and B fiber), ultrasound-based measurement of the post-void residual (PVR) volume (abnormal, >50 mL, mainly A-delta/C fiber) and postural blood pressure measurement (abnormal, >-20 mmHg, A-delta/C fiber). Fisher's exact probability test and Student's t-test were used to analyze the significance of differences. Results NCS abnormality, an abnormal PVR volume, and postural hypotension were noted in 74, 19, and 36 of the subjects, respectively. There were clear relationships between NCS and an abnormal PVR volume (p<0.05), postural hypotension and an abnormal PVR volume (p<0.05), or NCS and postural hypotension (p<0.01). There were also subjects who had NCS abnormality alone, a high PVR volume alone or postural hypotension alone. An abnormal PVR volume was not associated with the HbA1c value, but was clearly related to the duration of diabetes (p<0.05). Conclusion Bladder dysfunction was correlated with somatic and periarterial neuropathy. On the other hand, 16% of the cases of bladder dysfunction occurred in patients without somatic or periarterial neuropathy; thus, the regular measurement of the PVR volume is necessary.

Can feeling of incomplete bladder emptying reflect significant postvoid residual urine? Is it reliable as a symptom solely?

PurposeThe main objective of this study was to reveal the relationship between lower urinary tract symptoms (LUTS) and post-void residual (PVR) urine volume.Materials and MethodsBetween October 2014 and February 2015, older than 40 years patients were included in this study. Volunteers filled out a questionnaire consisted of demographic characteristics, comorbidities, medications, history of surgery and LUTS. Volunteers were undergone PVR measurement with transabdominal ultrasonography. The relationship between symptoms, demographic characteristics and PVR were analyzed.ResultsA total of 939 patients (756 men and 183 women) were enrolled in this study. There was a positive correlation between the sensation of incomplete bladder emptying and PVR volume in all age groups of women (p=0.0001). However such a relationship was found only over the age of 60 in the subgroup analysis of men (p=0.001). PVR volume increased in men by age (0.65 mL per year of age, p=0.011). In men, voiding symptoms and urgency were associated with a high PVR volume. In women, storage and voiding symptoms (except slow stream and terminal dribble) did not correlate with PVR volume.ConclusionsOur study showed that all men over the age of 60 years and all women with the complaint of feeling of incomplete emptying should undergone PVR measurement. Women with the complaint of poor stream and men mainly with voiding symptoms are other candidates in whom PVR measurement would be considered as an important tool in the clinical management and follow-up.

Holmium laser enucleation of the prostate is an effective treatment in patients with concomitant bladder diverticula and outlet obstruction.

Bladder diverticula can be congenital or secondary to benign prostatic hyperplasia with bladder outlet obstruction, and be a source of high postvoid residuals prompting surgical intervention. We sought to evaluate the outcomes of patients with bladder diverticula undergoing holmium laser enucleation of the prostate (HoLEP) for bladder outlet obstruction. We retrospectively reviewed HoLEP patients with at least one bladder diverticulum at two high volume institutions. All cases were performed in similar fashion. Preoperative, perioperative, and postoperative patient variables were obtained and assessed. Of 2746 HoLEP patients, 51 were diagnosed with bladder diverticula before surgery. Mean prostate size was 80.8±50.0g and mean diverticulum size (largest if multiple) was 5.5±2.6cm. Preoperatively, urinary retention requiring catheterization was present in 28 (55%) patients. In the remainder, mean preoperative AUASI was 19.7, peak flow 7.2ml/s, and post-void residual (PVR) 365ml. At most recent follow-up (mean 12.2months), mean total AUASI was 8.6, peak flow 27.1ml/s, and PVR 145ml with 71, 276, and 221% improvement, respectively. All patients were voiding and none required catheterization. Only three (6%) patients required diverticulectomy at a mean of 15.2months after HoLEP for the following indications: hematuria (one patient)and urinary retention(two patients). HoLEP is an effective method of outlet obstruction treatment in patients with bladder diverticula. Most patients, even with large diverticula, do not require further treatment after the outlet obstruction has been relieved and can avoid more invasive surgical interventions.

Surgical management of recurrent urinary tract infections: a review.

There are many causes of recurrent urinary tract infections (rUTI) which are amenable to surgical management. This usually follows a lengthy trial of conservative management. Aetiological classification of rUTI requiring surgical management may be divided into congenital or acquired. Predisposing factors are classified into two groups; those providing a source for organisms, or by maintaining favourable conditions for the proliferation of organisms. Sources of infections include calculi, fistulae or abscesses. Conditions which predispose to bacterial proliferation include malignancies, foreign bodies, high post void residuals, and neuropathic bladders. Removal of identified sources, treating the obstruction, and improving urinary drainage, are all goals of surgical management. Surgical options for rUTI management can range from minimally invasive procedures such as endoscopic or percutaneous, through to more invasive requiring laparoscopic or an open approach. Surgery remains a very important and viable solution.

Analysis of the incidence and risk factors of male urinary tract infection following urodynamic study.

The purpose of this study was to investigate the incidence and risk factors of male urinary tract infection (UTI) after urodynamic study (UDS). A total of 854 consecutive male patients, who underwent UDS at Peking Union Medical College Hospital from January 2010 to March 2016, were recruited in this study. Two to four weeks before the examination, urinalysis with bacterial culture was performed. Patients with negative results were selected for UDS. Immediately before the examination, urinalysis was repeated to rule out any preoperative UTI. Between 48 and 72h after the exam, urine culture was performed again to determine the incidence of UTI. The incidence of UTI and patients' baseline characteristics, including age, medical history, urodynamic parameters, current diagnosis and pathogen type, were analyzed. Among the 854 patients undergoing UDS, urinary infection was found in 84 cases after the examination, the incidence was 9.83%. Comorbidity with diabetes, post void residual (PVR), volume of prostate (Vp), and two urodynamic parameters, maximal flow rate (Qmax) and average flow rate (Qav) were found to be the independent risk factors for UTI after UDS. The most common pathogens were Escherichia coli (54.76%) and Enterococcus faecalis (19.05%). The incidence of UTI after UDS in male patients was 9.83%. Patients who suffered from comorbidity of diabetes, high PVR, high Vp, low Qmax or Qav may need to be treated with prophylactic antibiotics to prevent postoperative UTI.