High Post-void Residual Volume Research Articles

Predictors of the efficacy of CO2 laser therapy for female stress urinary incontinence

Background: Predictors of the efficacy of a single-session of CO2 laser therapy for female stress urinary incontinence are important for pretreatment consultation. Thus, the objective of this study was to evaluate these predictors. Methods: All consecutive women who underwent vaginal CO2 laser therapy for stress urinary incontinence were prospectively enrolled. Results: The median duration of subjective improvement (defined as ≥1 on the global response assessment) was 18.3 months (95% confidence interval (CI): 12.1 to 18.3 months, n = 75). Multivariable analysis revealed that low voided volume (dL, hazard ratio [HR] = 0.707; area under the curve [AUC] = 0.66, cutoff value of voided volume ≤4.0 dL), high postvoid residual volume (dL, HR = 2.714; AUC = 0.60, cutoff value of postvoid residual volume ≥1.0 dL), and low functional profile length (HR = 0.956; AUC = 0.58, cutoff value of functional profile length ≤2.8 cm) were predictors of subjective failure. A logit(p) = 1.0 - 0.5 x (voided volume) + 0.9 x (postvoid residual volume) can be used to predict failure (HR = 1.775; AUC = 0.71, cutoff value of logit(p) ≥0.0). Pad weights decreased at 3 and 6-month follow-up visits. At 6 months, 8 women (21%) were cured (<1 g pad weight), and 16 women (42%) showed improvement (>50% decrease in pad weight). Overactive bladder symptoms improved at 3 and 6 months. However, there was no change in female sexual function from baseline. Conclusion: A low voided volume and high postvoid residual volume can be used to predict subjective failure after one session of transvaginal CO2 laser therapy. However, the subjective therapeutic effect may diminish within a median duration of 18 months.

Evaluating the efficacy and safety of Holmium laser enucleation of the prostate in patients with obstructive uropathy attributable to bladder outlet obstruction.

To evaluate outcomes of Holmium laser enucleation of the prostate (HoLEP) in individuals presenting with obstructive-uropathy (OU) attributable to bladder outlet obstruction (BOO). We performed a retrospective review of patients who underwent HoLEP from August 2017 to January 2023 at our institution. We identified patients with preoperative OU defined by presence of chronic hydronephrosis suggestive of BOO and conducted a matched-pair analysis (1:2) with patients undergoing HoLEP without OU. Patients' demographic, perioperative and postoperative voiding parameters, serum creatinine level, and complications were analyzed up to one-year of follow-up. Preoperative OU was present in 42 patients. Demographic and preoperative parameters were comparable except median preoperative creatinine (1.245 vs. 1.065 ng/ml, p < 0.001) and catheterization rates (76.2% vs. 25%, p < 0.001) were higher in the OU group. The mean duration of postoperative catheterization was longer in the OU group (3.83 vs. 2.26 days, p = 0.048). Two patients in the OU group developed postoperative acute kidney injury. There was no difference in the rate of postoperative complications, improvement in International Prostate Symptom Score and maximum urinary flow amongst both groups except a higher post-void residual volume at 3- and 12-months (p = 0.001 and p = 0.037, respectively) in OU patients. Patients noted significant improvement in serum creatinine level at 6-12 weeks postoperatively from peak baseline level (P = 0.002). HoLEP is effective and safe in patients with OU suggestive of BOO, though they are at higher risk of postoperative acute kidney injury.

Real-Life Treatment Outcome of Botulinum Toxin A Injection on Overactive Bladder and Voiding Dysfunction in Patients with Central Nervous System Lesions.

Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with neurological lesions in the central nervous system (CNS). Medical treatment usually cannot adequately relieve NLUTD. This study reported the real-life treatment outcome of botulinum toxin A (BoNT-A) for overactive bladders (OAB) and voiding dysfunction in patients with CNS lesions. We retrospectively analyzed the first-time treatment outcome of 74 patients who received detrusor 100 U BoNT-A for OAB and 45 patients who received a urethral sphincter 100 U BoNT-A injection for voiding dysfunction. The treatment outcome, therapeutic duration, and adverse events (AE) after BoNT-A were compared among different CNS lesions and among patients with different urodynamic characteristics. The study included 74 patients receiving detrusor injections for OAB (36 with cerebrovascular accidents, 13 with Parkinson's disease, and 25 with dementia) and 45 patients receiving a urethral sphincter injection for voiding dysfunction (26 with cerebrovascular accidents, 7 with Parkinson's disease, and 12 with dementia). After detrusor BoNT-A treatment, urinary continence was achieved in 28.4% of patients with neurogenic OAB, postoperative difficult urination in 59.5%, acute urinary retention (AUR) in 9.5%, and urinary tract infection (UTI) in 14.9%, with a therapeutic duration of 6.43 months. There were no differences among subgroups or between patients with detrusor overactivity (DO) and DO with detrusor underactivity (DU) in terms of treatment outcomes and AEs. The improvement rate of urethral sphincter BoNT-A injections was 75.6% without any difference among subgroups. After treatment, 24.4% of the patients had exacerbated urinary incontinence, 33.3% had persistent difficult urination, and 15.6% had UTI. Patients with dementia had higher rates of difficult urination and UTI, higher postvoid residual volume, and a shorter therapeutic duration. Patients with DU and those without urethral sphincter dyssynergia had less favorable outcomes after their urethral sphincter BoNT-A injection. The therapeutic efficacy of detrusor BoNT-A injection for OAB due to CNS lesions is limited, with high rates of difficult urination, AUR, and UTI. Although urethral sphincter BoNT-A injection is effective in treating voiding dysfunction; however, exacerbated urinary incontinence and persistent difficult urination remain a problem, particularly in patients with dementia.

Predictive Factors for High Post-void Residual Volume in Older Females After OnabotulinumA Treatment for Severe Overactive Bladder Using a Machine Learning Model.

Introduction Intravesical onabotulinumA injection is actively used for the treatment of overactive bladder (OAB). However, it occasionally results in significant post-void residual urine (PVR) volume, which can lead to complications and can further impair the activities of daily living in older people. Therefore, this study aimed to identify the predictors of a high post-onabotulinumA injection PVR volume in older women with severe OAB. Methods An observational study was conducted on older women who had previously received intravesical onabotulinumA injections to treat OAB between 2020 and 2022. Urodynamic studies and symptom assessments were conducted, and machine learning models, including random forest and support vector machine (SVM) models, were developed using the R code generated by Chat Generative Pre-trained Transformer 4 (ChatGPT, OpenAI, San Francisco, USA). Results Among 128 patients with OAB, 23 (18.0%) had a PVR volume of > 200 mL after receiving onabotulinumA injections. The factors associated with a PVR volume of > 200 mL were investigated using univariate and multivariate analyses. Age, frailty, OAB-wet, daytime frequency, and nocturia were significant predictors. Random forest analysis highlighted daytime frequency, frailty, and voiding efficiency as important factors. An SVM model incorporating daytime frequency, frailty, and voiding efficiency improved PVR volume prediction. Logit(p) estimation yielded an area under the receiver operating characteristic curve of 0.926294. Conclusion The study found daytime frequency, frailty, and voiding inefficiency to be significant factors associated with a PVR volume of > 200 mL, in older women with severe OAB. Utilizing advanced machine learning techniques and following the guidance of ChatGPT, this research emphasizes the relevance of considering multiple intersecting factors for predicting PVR volume. The findings contribute to our understanding of onabotulinumA injection treatment for OAB and support evidence-based decision-making using readily available information.

Urological Management of the Spinal Cord-Injured Patient: Suggestions for Improving Intermittent Catheterization and Reflex Voiding

Spinal cord injury can either be complete with no neural communication across the injury level or incomplete with limited communication. Similarly, motor neuron injuries above the sacral spinal cord are classified as upper motor neuron injuries, while those inside the sacral cord are classified as lower motor neuron injuries. Specifically, we provide recommendations regarding the urological management of complete upper motor neuron spinal cord injuries; however, we also make limited comments related to other injuries. The individual with a complete upper motor neuron injury may encounter five lower urinary tract conditions: first, neurogenic detrusor overactivity causing urinary incontinence; second, neurogenic detrusor underactivity resulting in high post-void residual volumes; third, detrusor sphincter dyssynergia, which is contraction of striated and/or smooth muscle urethral sphincters during detrusor contractions; fourth, urinary tract infection; and fifth, autonomic dysreflexia during detrusor contractions, which produces high blood pressure as well as smooth muscle detrusor sphincter dyssynergia. Intermittent catheterization is the recommended urinary management method because it addresses the five lower urinary tract conditions and has good long-term outcomes. This method uses periodic catheterizations to drain the bladder, but also needs bladder inhibitory interventions to prevent urinary incontinence between catheterizations. Primary limitations associated with this management method include difficulties with the multiple catheterizations, side effects of bladder inhibitory medications, and urinary tract infections. Three suggestions to address these concerns include the use of low-friction catheters, wireless, genital-nerve neuromodulation for bladder inhibition, and consideration of urine egress into the urethra as a risk factor for UTI as well as egress treatment. The second management method is reflex voiding. This program uses external condoms for urine collection in males and diapers for females. Suprapubic tapping is used to promote bladder contractions. This method is not recommended because it has high rates of medical complications. In particular, it is associated with high detrusor pressure, which can lead to ureteral reflux and kidney pathology. Botulinum toxin injection into the urethral striated sphincter can manage detrusor sphincter dyssynergia, reduce voiding pressures, and risks to the kidney. We suggest a modified method for botulinum toxin injections as well as five additional methods to improve reflex voiding outcomes. Finally, the use of intermittent catheterization and reflex voiding for individuals with incomplete spinal injuries, lower motor neuron injuries and multiple scleroses are briefly discussed.

Percutaneous Tibial Nerve Stimulation Improves Lower Urinary Tract Dysfunction and Infection Rate in a Kidney Transplant Recipient With Augmentation Cystoplasty: A Case Report and Literature Review

Almost 20% of patients with congenital posterior urethral valves (PUV) reach end-stage kidney disease requiring kidney transplantation (KT). An augmentation cystoplasty (AC) is performed to treat significant lower urinary tract dysfunction (LUTD) which can persist afterwards due to residual valve bladder and lead to recurrent urinary tract infections (UTIs) and a worse graft survival. Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive second-line neuromodulation therapy approved for the treatment of non-neurogenic LUTD performed in the outpatient setting. Herein, we reported the case of significant improvement of bladder voiding pattern and yearly UTI rates through PTNS in a 32-year-old male KT recipient with a history of congenital PUV and AC. The patient was referred to our institution at the beginning of 2019 for urgency, high post-void residual volume (PVR) and recurrent clinically significant UTIs (3 to 4/y). After assessment, the patient attended once-weekly 30-minute sessions of PTNS for 12 consecutive weeks. A significant improvement of urodynamic and infectious outcomes was observed through 3-day bladder diaries, questionnaires, and laboratory exams during the subsequent 3 years of regular follow-up. The present results might be significant for the prevention of antibiotic resistance and for better graft survival in KT recipients. We successfully treated a patient with AC, implying that the technique may be appliable also in this case. Neuromodulation in KT is still an unexplored field of research, we advocate for prospective assessment of the efficacy of PTNS in these patients, as reproducible results might lead to life-changing improvements.

Preoperative Factors to Assess Risk for Postoperative Urinary Retention in Total Joint Arthroplasty: A Retrospective Analysis.

BackgroundPostoperative urinary retention (POUR) is a significant problem in total joint arthroplasty (TJA). Although risk factors for POUR have been well documented, they are ubiquitous in an aging total joint population, which makes risk stratification difficult. The purpose of this study was to determine if a high preoperative post-void bladder scan identifies patients at risk for POUR.MethodsA retrospective analysis was conducted on all TJAs performed at a high-volume orthopedic center between December 2019 and February 2020. A total of 585 elective TJA patients received post-void bladder scans before surgery. Bladder scan volumes were correlated with catheterization via Chi-squared tests.ResultsA high post-void residual volume (PVRV > 50 ml) was associated with an increased risk of catheterization (23% vs 34%, chi-squared statistic = 6.2638, P value = .013), as was intravenous fluid volume (>1000 ml in knee, >2000 ml in hip). Catheterization rates were higher among total knee arthroplasty patients younger than 60 years (37% vs 24%, chi-squared statistic = 4.284, P value = .0385) and total hip arthroplasty (THA) patients older than 65 years (30% vs 18%, chi-squared statistic = 3.292, P value = .0695). Multiple risk factors were additive.ConclusionsHigher PVRV and intravenous fluids were independently associated with catheterization after TJA. Younger age was associated with greater risk in total knee arthroplasty, while older age increased risk in THA. We propose that a preoperative bladder scan to detect a high PVRV may provide clinical utility to identify patients likely to develop POUR.

59 In office early release of a midurethral pubovaginal sling

In this video, we are going to demonstrate the early release of a mid urethral pubo-vaginal sling (Single Incision Sling). The patient had the sling placed nine days ago in combination with a posterior repair. Since then, she has had obstructive voiding with intermittent flow, hesitancy, and slowing of the stream. She was placed on intermittent self-catheterization with persistent, non-resolving high post void residual volumes. Because of these symptoms, we are going to perform an in office early release of the single incision sling. We are going to infiltrate with local anesthetic at the Obturator site/the superior medial notch where we know the adjustable anchor of the single incision sling is located. We will also infiltrate with local anesthetic to create hydro-dissection away from the sling so that it will be easier to move. We will then perform a diagnostic cystoscopy with retrograde filling of the bladder to 250 to 300 cc of fluid. After which, we will then perform a reverse cough test where the patient will cough and then we will move the sling millimeter at a time until the cystoscopy fluid is at the urethral meatus upon valsalva or cough. Studies show that mid urethral single incision slings are safe and effective procedures for female stress urinary incontinence with minimal postoperative complications rarely requiring early release or revision. Studies have also shown that post revision stress urinary incontinence with early release was less when compared to revision greater than two weeks. Therefore, this procedure, in office early release, should be a viable option for physicians offering mid urethral pubo-vaginal slings.

Predictors of further anti-incontinence interventions or transvaginal urethrolysis after a pubovaginal sling procedure in women with and without neurologic disorders

The impact of neurologic disorders on the clinical outcome of suburethral sling procedures has seldom been studied. Our aim is to elucidate factors predicting further anti-incontinence interventions or transvaginal urethrolysis after a re-adjustable pubovaginal sling procedure (PVS), especially in patients with neurologic disorders. Medical records of all consecutive women who underwent re-adjustable PVS for stress urinary incontinence (SUI) were reviewed. A total of 589 women were enrolled, 152 (25.8%) women were found to have persistent or recurrent SUI after surgery, and 39 (6.6%) women underwent further anti-incontinence interventions. Postoperative voiding dysfunction was found in 46 (7.8%) women, and 23 women (3.9%) underwent transvaginal urethrolysis. Low body mass index (hazard ratio=0.92) and low functional bladder capacity (dL, hazard ratio=0.83) were factors predicting the presence of persistent/recurrent SUI. However, the presence of spinal cord disorder (hazard ratio=8.91) and a history of prior surgery for pelvic organ prolapse (hazard ratio=2.51) were factors predicting further anti-incontinence interventions. A high post-void residual volume (PVR, dL, hazard ratio=1.52) and preoperative bladder outlet obstruction (BOO, hazard ratio=5.39) were factors predicting postoperative voiding dysfunction. Similarly, a high PVR (dL, hazard ratio=1.50) and preoperative BOO (hazard ratio=5.38) were factors predicting transvaginal urethrolysis. A PVR >1.51dL was an optimal cut-off value for predicting transvaginal urethrolysis. The presence of spinal cord disorder and prior surgery for pelvic organ prolapse were predictors of further anti-incontinence interventions after re-adjustable PVS. In addition, a large PVR and preoperative BOO were predictors of transvaginal urethrolysis after re-adjustable PVS.

MP40-19 NON-OBSTRUCTIVE SLINGS (NOS) FOR STRESS URINARY INCONTINENCE AFTER PROSTATE SURGERY. ANALYSIS OF OUTCOMES IN DIFFERENT SUBGROUPS OF PATIENTS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I (MP40)1 Apr 2020MP40-19 NON-OBSTRUCTIVE SLINGS (NOS) FOR STRESS URINARY INCONTINENCE AFTER PROSTATE SURGERY. ANALYSIS OF OUTCOMES IN DIFFERENT SUBGROUPS OF PATIENTS Giovanni Tasso*, Elodie Beels, Lina Del Favero, Simone Morselli, Mauro Gacci, Sergio Serni, Dirk De Ridder, and Frank Van der Aa Giovanni Tasso*Giovanni Tasso* More articles by this author , Elodie BeelsElodie Beels More articles by this author , Lina Del FaveroLina Del Favero More articles by this author , Simone MorselliSimone Morselli More articles by this author , Mauro GacciMauro Gacci More articles by this author , Sergio SerniSergio Serni More articles by this author , Dirk De RidderDirk De Ridder More articles by this author , and Frank Van der AaFrank Van der Aa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000889.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The efficacy of NoS for treatment of stress urinary incontinence (SUI) after prostatic surgery (PS) has been well established in patients not exposed to radiotherapy (RT) and with mild to moderate SUI. In a non-ideal population the evidence is less solid. Nevertheless, patients opt for sling surgery, even if they have bad prognostic factors. We analysed the outcomes of AdVance (AdV) and AdVance XP (AdV-XP) slings on our cohort of patients with different preoperative features and we calculated the risk factors for failure. METHODS: A consecutive series of patients treated since 2007 was analysed. Pads/day use defined the SUI grade: mild ≤2 pads/day, moderate and severe (SSUI) respectively ≤4 pads/day or >4 pads/day. A urodynamic study (UDS) was performed before the implant. During follow up (FU), social continence (SC) defined the use of 1 pad/day, totally dry (TD) was used for no pad use. Success described a reduction in pad use ≥ 50%. A time-to-event model identified the risk factors, uni- and multi-variate analysis provided the Hazard Ratio (HR). RESULTS: Of 216 implanted slings, 43% had at least one risk factor: RT (n=41), SSUI (n=44), previous surgery for incontinence (IS) and urethral stricture (US) (n=39). 57% were ideal candidates: 81% of them achieved SC at last FU, 51% were TD. SC and TD outcomes were significantly less after RT (resp. 47%-18%), in SSUI patients (resp. 51%-32%), after IS (resp. 56%-44%) and after US (44%-9%). No erosions were observed. A high post-void residual volume (hPVR) after catheter removal was seen in 46 cases (21,3%) but spontaneously resolved in 94%. Two cases required sling transection due to persistent hPVR. Multivariate analysis showed 3 significant factors for impaired SC outcome: RT (HR:3,4), US (HR:2,4) and detrusor overactivity at UDS (HR:2,6). The analysis for the TD outcome showed again RT (HR:1,7) and leaking during UDS (HR:1,8) as factors for failure. An increased cystometric capacity was protective (HR: 0,9). For the risk of PVR, increasing age (OR: 0.68) was protective, history of US was a risk factor (OR: 2.59). CONCLUSIONS: Implantation of NoS is effective and safe. The undesired events are rare also on comorbid patients, most of these events are transient. RT and US should be carefully considered as they significantly impair outcomes. Source of Funding: NO © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e593-e593 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Tasso* More articles by this author Elodie Beels More articles by this author Lina Del Favero More articles by this author Simone Morselli More articles by this author Mauro Gacci More articles by this author Sergio Serni More articles by this author Dirk De Ridder More articles by this author Frank Van der Aa More articles by this author Expand All Advertisement PDF downloadLoading ...

Minimally invasive prostatic urethral lift (PUL) efficacious in TURP candidates: a multicenter German evaluation after 2\xa0years

IntroductionSuccessful outcomes have been reported for the treatment of lower urinary tract symptoms (LUTS) with the prostatic urethral lift (PUL) in a number of clinical investigations. Our aim was to investigate PUL outcomes in patients treated in a day-to-day clinical setting without the rigid exclusion criteria of clinical studies.Materials and methodsWe investigated the outcome of the PUL procedure at five German departments during the initial period when PUL was approved for the clinic (10/2012–06/2014). All candidates for transurethral resection of the prostate (TURP) received PUL information and were given the choice of procedures. The only exclusion criterion was an obstructive median lobe. No patients were excluded because of high post-void residual volume (PVR), prostate size, retention history or LUTS oral therapy. Maximum urinary flow (Qmax), PVR, International Prostate Symptom Score (IPSS) and Quality of Life (QOL) were assessed at baseline, 1, 6, 12, and 24 months after surgery.ResultsOf 212 TURP candidates, 86 choose PUL. A mean of 3.8 (2–7) UroLift implants were implanted in patients of 38–85 years with a prostate size of 17–111 ml over 57 (42–90) min under general or local anesthesia. Thirty-eight (38.4%) patients had severe BPH obstruction and would have been denied PUL utilizing previously reported study criteria. Within 1 month 74 (86%) reported substantial symptom relief with significant improvements in Qmax, PVR, IPSS, and QOL (p < 0.001) that was maintained within the follow-up. Sexual function including ejaculation was unchanged or improved. No Clavien–Dindo Grad ≥ 2 was reported postoperatively. Eleven (12.8%) patients were retreated over 2 years. Twelve (86%) of 14 patients presenting with chronic urinary retention were catheter free at last follow-up.ConclusionPUL is a promising surgical technique that may alleviate LUTS, even in patients with severe obstruction.

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.

Reflux Pancreatitis: Expect the Unexpected in Urinary Retention

Introduction: Pancreatic transplant is a newer modality for treatment of insulin dependent diabetes mellitus (DM). When diabetic nephropathy progresses to end stage renal disease (ESRD), combined pancreas and kidney transplant improves post-transplant survival and outcomes. Patients can often develop unusual complications due to post surgical anatomical changes. We present an unusual case of transplanted pancreatic graft pancreatitis secondary to urinary retention. Case: A 44 year old male with past medical history of type 1 DM, ESRD on HD due to diabetic nephropathy s/p simultaneous kidney and pancreas transplant in 2010 on maintenance immunosuppression therapy, now with CKD II presented with fever, RLQ abdominal pain and urinary complaints of hesitancy, frequency, straining and incomplete evacuation. He denied any nausea, vomiting, changes in bowel movement or abdominal distention. His transplant pancreas has exocrine excretion in urine with no evidence of graft rejection. Lab studies revealed elevated serum lipase, amylase and acute kidney injury. Initial abdominal ultrasound revealed mild hydronephrosis of the transplanted kidney, high post-void residual volume and enlarged prostate. Abdominal CT scan showed pancreatic transplant in the RLQ with peripancreatic fluid and stranding consistent with graft pancreatitis. His urinary amylase was elevated (>7500U/L). He was treated with urinary catheterization to relieve retention, hydration and urology evaluation for management of prostate hypertrophy. Discussion: Graft pancreatitis from urinary reflux is one of the complications of pancreas transplant with urinary exocrine drainage. Chemical cystitis and urethritis, recurrent hematuria and bladder stones are common because alkaline pancreatic enzymes are a source of irritation to the urogenital epithelium. The advantage of exocrine bladder drainage is the ability to use urine amylase to monitor for rejection after pancreatic transplant. Enteric exocrine drainage is superior in terms of complications but survival remains the same in both. A urologic condition like prostatic hypertrophy should be managed promptly due to potential risk of rejection of both kidney and pancreatic grafts.

Neurogenic lower urinary tract dysfunction: evaluation and management.

The lower urinary tract (LUT) in health is regulated by coordinated multi-level neurological inputs which require an intact central and peripheral nervous system. Lower urinary tract dysfunction is, therefore, a common sequelae of neurological disease and the patterns of bladder storage and voiding dysfunction depend upon the level of neurological lesion. Evaluation includes history taking, bladder diary, urological examination when relevant, ultrasonography and urodynamic testing when indicated. Antimuscarinic agents are the first line treatment for patients with storage dysfunction. Alternative treatments include intradetrusor injection of onabotulinumtoxinA, which has been shown to be of benefit in patients with neurogenic detrusor overactivity (NDO), and neuromodulation. Intermittent catheterization remains the option of choice in patients with significant voiding dysfunction resulting in high post-void residual volumes.

The relationship between the sensation of incomplete voiding and a high postvoid residual volume

BackgroundStudies have shown that voiding symptoms do not correlate with a high postvoid residual volume. It is important to have clinical tools that help make early and effective decisions during the initial consultation. ObjectiveTo assess the validity and degree of concordance between the sensation of incomplete voiding and high postvoid residual volume. Materials and methodsCross-sectional study of patients who underwent uroflowmetry (UFM) and postvoid residual volume (PVR) measurement due to lower urinary tract symptoms, with simultaneous scoring of International Prostate Symptom Score (IPSS), the International Consultation on Incontinence Questionnaire – Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) or Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) during 2014–2015. We analyzed the relationship between these data and the postvoid residual volume. ResultsThe study included 303 patients, 75 (24.8%) of whom were women and 228 (75.2%) of whom were men. The mean age was 60.9 years (SD, 15.8), and the mean Qmax was 14.47mL/s (SD, 9.6). Sixty (19.8%) patients had a high PVR. We detected 240 (79.2%) patients with sensations of incomplete voiding (SIV), but its presence was not associated with a high PVR in the population. For the SIV, the sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were 81.6%, 21.3%, 20.4%, 82.5%, 1.03 and 0.85, respectively. The area under the curve for the frequency of SIV was 0.52 (95% CI, 0.44–0.60, p=0.5). The degree of concordance between SIV and high PVR was 0.014 (p=0.6). In the ICIQ-MLUTS, PVR correlated with intermittence (Rho=0.132, p=0.043) but not with SIV (Rho=0.09, p=0.15). In the ICIQ-FLUTS, the frequency of urinary incontinence was positively correlated with PVR (Rho=0.216, p=0.026). ConclusionsThe sensation of incomplete voiding is not associated with a high postvoid residual volume. Other variables such as symptom severity, urinary effort and total score for voiding symptoms can be associated with a high residual urine volume.

La relación entre la sensación de vaciado incompleto y un residuo posmiccional elevado

BackgroundStudies have shown that voiding symptoms do not correlate with a high postvoid residual volume. It is important to have clinical tools that help make early and effective decisions during the initial consultation. ObjectiveTo assess the validity and degree of concordance between the sensation of incomplete voiding and high postvoid residual volume. Material and methodsCross-sectional study of patients who underwent uroflowmetry (UFM) and postvoid residual volume (PVR) measurement due to lower urinary tract symptoms, with simultaneous scoring of International Prostate Symptom Score (IPSS), the International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) or Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) during 2014-2015. We analysed the relationship between these data and the postvoid residual volume. ResultsThe study included 303 patients, 75 (24.8%) of whom were women and 228 (75.2%) of whom were men. The mean age was 60.9 years (SD, 15.8), and the mean Qmax was 14.47mL/s (SD, 9.6). Sixty (19.8%) patients had a high PVR. We detected 240 (79.2%) patients with sensations of incomplete voiding (SIV), but its presence was not associated with a high PVR in the population. For the SIV, the sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were 81.6%, 21.3%, 20.4%, 82.5%, 1.03 and 0.85, respectively. The area under the curve for the frequency of SIV was 0.52 (95%CI, 0.44-0.60, P=.5). The degree of concordance between SIV and high PVR was 0.014 (P=.6). In the ICIQ-MLUTS, PVR correlated with intermittence (Rho=0.132, P=.043) but not with SIV (Rho=0.09, P=.15). In the ICIQ-FLUTS, the frequency of urinary incontinence was positively correlated with PVR (Rho=0.216, P=.026). ConclusionsThe sensation of incomplete voiding is not associated with a high postvoid residual volume. Other variables such as symptom severity, urinary effort and total score for voiding symptoms can be associated with a high residual urine volume.

The prevalence of urinary incontinence and factors associated with urinary incontinence in community dwelling older Turkish people

PurposeUrinary incontinence (UI) is very common problem in older problem. This study evaluates the prevalence of UI, and associated factors with UI in community dwelling older people in Turkey. Materials and methodsThis was a cross-sectional study as part of a health survey conducted with community dwelling older people. Demographic, clinical data, UI and its types were obtained by interview. Post-void residual (PVR) volume was measured with ultrasound. ResultsThe prevalence of UI was 43.9%. The most common type was urge UI (23.7%). Associated factors with UI were gender, low income, low education level, chronic diseases, chronic constipation, chronic cough, number of deliveries, benign prostatic hyperplasia, past genitourinary surgery and lower urinary tract symptoms. PVR volume was not related with UI. ConclusionsUI is very common in older people in Turkey. PVR volume is not related to the presence of UI in our study due to the lower prevalence of significantly high PVR volumes and lack of individuals with overflow UI.

Frequency of recurrent urinary tract infection in patients with pelvic organ prolapse.

PurposeThe aim of the study was to investigate the existence of a relationship between pelvic organ prolapse (POP) and recurrent urinary tract infection (UTI).Materials and methodsThe hospital database was searched for women diagnosed with pelvic floor disorders and all medical records were reviewed for recurrent UTI, diagnosed by two or more positive urine cultures taken within 12 months of each other. The control group was created using one-to-one matching for age and menopausal status. The prevalence of recurrent UTI in these patients were compared.ResultsThe mean age of the 210 participants was 54.64±5.15 years. We found no association between POP and recurrent UTI. In the prolapse group, 22 women (21%) had recurrent UTI compared with 19 women (18%) in the control group (P=0.316). Post-void residual (PVR) volumes >50 mL were associated with increased prevalence of recurrent UTI.ConclusionPOP is not a risk factor for recurrent UTI, but women with POP are more likely to have high PVR volumes. High PVR volumes increase the risk of recurrent UTI. Clinical examination and ultrasound assessment of PVR should be performed in all women presenting with prolapse and UTI. Elevated PVR is the most significant risk factor, linking POP with recurrent UTI.

The Incarcerated Gravid Uterus

Incarcerated uterus is a rare but serious complication. Two women presented with second trimester urinary retention. Neither received a pelvic examination at presentation, which led to a delay in diagnosing the incarcerated uterus. Patient 1 had development of acute renal failure, hypertension, and edema. After uterine reduction there was rapid normalization of renal function, hypertension, and edema, but spontaneous rupture of membranes and intrauterine death occurred 12 hours later. Patient 2 had reduction under anesthetic and subsequently underwent cesarean delivery at term. However, at 7 months postpartum, the patient continued to have high postvoid residual volumes. Women presenting with urinary retention in the second trimester should have a pelvic examination performed to exclude uterine incarceration. Earlier recognition and appropriate treatment may have altered the outcome for the two patients presented.