Higher Maximum Flow Rate Research Articles

Improvement of Mental Health and Quality of Life of Patients after Radical Prostatectomy through Continuous Nursing Based on Internet Technology: A Retrospective Study.

Radical prostatectomy (RP) is one of the most effective methods used to cure localised prostate cancer, but the risk of postoperative biochemical recurrence persists. This study aims to analyse the effect of continuous nursing based on Internet technology on mental health and quality of life in patients undergoing RP. The medical records of patients undergoing RP in our hospital from February 2021 to February 2023 were retrospectively analysed. From February 2021 to January 2022, 89 patients received routine postoperative nursing, and 85 cases were included in the reference group after excluding 4 patients who had missing clinical data. From February 2022 to February 2023, 86 patients received continuous nursing based on Internet technology, and 80 patients were classified as the observation group after 6 patients (5 patients with incomplete clinical data and 1 patient with cognitive impairment) were excluded. The Hospital Anxiety and Depression Scale (HADS) data were collected, and urinary control, incidence of complications, nursing satisfaction and 36-item short-form health survey (SF-36) were compared between the two groups. After management, patients in the observation group had lower Hospital Anxiety and Depression Scale-Anxiety (HADS-A) score, Hospital Anxiety and Depression Scale-Depression (HADS-D) score and postvoid residual (PVR) and higher maximum flow rate (Qmax) and detrusor pressure at the maximum flow rate (Pdet-Qmax) (p < 0.001) than those in the reference group. The observation group also had significantly lower incidence of complications (p < 0.05), higher scores of physiological function, physiological role, physical pain, general health, vitality, social function, emotional function and mental health (p < 0.01) and significantly higher total nursing satisfaction (p < 0.05). Prostate specific antigen (PSA) level was not significantly different between the two groups after management (p > 0.05). Continuous nursing based on Internet technology improves the psychological status and quality of life, reduces the occurrence of postoperative complications and obtains high clinical satisfaction for patients receiving RP.

Laparoscopic simple prostatectomy versus robot-assisted simple prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of comparative trials.

Laparoscopic simple prostatectomy (LSP) and robot-assisted simple prostatectomy (RASP) are important approaches for large benign prostatic hyperplasia (BPH), though it is still unclear which is superior. This study aimed to perform a pooled analysis to compare the safety and efficacy profiles of LSP and RASP. We systematically searched the databases of Science, PubMed, Embase, Web of Science, and Cochrane Library database for randomized controlled trials (RCTs) and non-RCTs, comparing LSP to RASP. The principal outcomes included perioperative, functional and complications variables. The results are presented as odds ratio (OR) or weighted mean difference (WMD) with 95% confidence intervals (CI) of dichotomous and continuous variables. Five comparative trials involving 1928 patients were included. RASP demonstrated a shorter length of hospital stay compared to LSP (WMD 1.20days, 95% CI 0.09, 2.32; p = 0.03). However, there was no difference between the two groups regarding operative time, estimated blood loss, catheterization time and complications. Moreover, RASP had a higher maximum flow rate (Qmax) (WMD -2.15mL/s, 95% CI -3.75, -0.55; p = 0.0009) and comparable international prostate symptom score (IPSS) and sexual health inventory (SHIM) in men with LSP. The results of this study demonstrated that RASP offered comparable efficacy and safety to LSP, while maintaining a superior perioperative and functional profile. However, treatment selection should also be based on the availability and experience of the operator.

Neurogenic Lower Urinary Tract Dysfunction in the First Year After Spinal Cord Injury: A Descriptive Study of Urodynamic Findings.

We aimed to provide a real-world description of neurogenic lower urinary tract dysfunction within the first year after spinal cord injury with a focus on unfavorable urodynamic parameters that are associated with urological morbidity. Urodynamic investigations from 97 patients with traumatic or ischemic acute spinal cord injury and managed according to the European Association of Urology Guidelines on Neuro-Urology were analyzed at a single university spinal cord injury center at 1 month, 3 months, 6 months, and 12 months after injury. Unfavorable urodynamic parameters were defined as detrusor overactivity in combination with detrusor sphincter dyssynergia, maximum storage detrusor pressure of 40 cm H2O or higher, bladder compliance less than 20 mL/cm H2O, and vesicoureteral reflux of any grade. One or more unfavorable urodynamic parameter was observed in 87 out of 97 patients (90%) within the first year after spinal cord injury. Eighty-eight percent of the patients showed detrusor overactivity with detrusor sphincter dyssynergia, 39% a maximum storage detrusor pressure of 40 cm H2O or higher, and 7% vesicoureteral reflux. No patient developed a low-compliance bladder. Using a standardized urodynamic follow-up schedule, we found unfavorable urodynamic parameters in a majority of the population within the first year after spinal cord injury. As early treatment based on urodynamic findings might reduce the risk of deterioration of upper and lower urinary tract function, thereby improving long-term outcomes, there is need for further research regarding recommendations for a urodynamic follow-up schedule during the first year after spinal cord injury.

DIODE LASER ABLATION OF PROSTATE VERSUS MONOPOLAR TRANSURETHRAL ELECTRO-RESECTION OF PROSTATE FOR TREATING SYMPTOMATIC BPH: A PROSPECTIVE STUDY

Background: Benign prostate hyperplasia (BPH) can be treated with endoscopic urological procedures, which includes both laser ablation of prostate and transurethral resection of the prostate (TURP). Objective: To determine the advantages and disadvantages of using diode laser procedure in treating patients with BPH in contrast to TURP treatment. Methods: In a prospective non-randomized study at a single center, 40 patients presenting with symptoms of lower urinary tract symptoms attributable to BPH between the ages of 50 to 90 years were enrolled from November 2014 to June 2015. TURP was used in Group A, and transurethral laser ablation of prostate (TULAP) was used in Group B. Outcomes, including International Prostate Symptom Score (IPSS) and higher maximum flow rate (Qmax) were compared at 3 months. Results: At 3 months, patients treated with TULAP had a significantly Qmax than those treated with TURP (p&lt;0.001). There was a significantly lower hospital stay for BPH patients treated with the TULAP technique (p&lt;0.001). Patients treated with the TULAP procedure had a significantly shorter catheter time (p=0.001). There was a non-significant difference in procedure time between the two methods (p=0.2). There was a significant increase in prostate-specific antigen (PSA) among those treated with the TURP technique (p=0.01). Conclusion: Lower urinary tract problems induced by BPH can be successfully treated by diode laser ablation of prostate. Our findings suggest that diode laser is reliable and efficient when patients are carefully chosen for surgery. Keywords: BPH, Ablation of Prostate, TULAP, TURP Citation: Sami AKM, Bajalan DH. Diode laser ablation of prostate versus monopolar transurethral electro-resection of prostate for treating symptomatic BPH: A prospective study. Iraqi JMS. 2022; 20(1): 26-34. doi: 10.22578/IJMS.20.1.4

Relevant predisposing factors for voiding in a sitting position among Japanese male adult patients

Purpose:We investigated the proportion of male patients who urinate in a sitting position and their reasons for doing so. Furthermore, we analyzed relevant predisposing factors for voiding in a sitting position using voiding questionnaires and uroflowmetric parameters. Material and methods:Study participants included 370 male patients who underwent examination of uroflowmetry and measurement of post-void residual urine volume. We asked the participants to urinate in a standing or sitting position as they would usually do at home and their reasons for the voiding posture selected. Results:Among the participants, 38.6% (143/370 cases) urinated in a sitting position. The most common reason for voiding in a sitting position was to keep the bathroom clean (54.5%, 78/143 cases). Compared with the participants who urinate in a standing position, significantly lower body mass index, and longer times of hesitancy and voiding were observed in the participants who urinate in a sitting position. Relevant predisposing factors for voiding in a sitting position were higher maximum flow rate and longer times of hesitancy and voiding. Conclusions:Uroflowmetric parameters, including maximum flow rate and longer times of hesitancy and voiding, were associated with the preference of a sitting voiding position in Japanese male adult patients.

Therapeutic Effects of Botulinum Toxin A, via Urethral Sphincter Injection on Voiding Dysfunction Due to Different Bladder and Urethral Sphincter Dysfunctions.

Botulinum toxin A (BoNT-A) urethral sphincter injections have been applied in treating voiding dysfunction but the treatment outcome is not consistent. This study analyzed treatment outcomes between patients with different bladder and urethral sphincter dysfunctions. Patients with refractory voiding dysfunction due to neurogenic or non-neurogenic etiology were treated with urethral sphincter 100 U BoNT-A injections. The treatment outcomes were assessed by a global response assessment one month after treatment. The bladder neck opening and urodynamic parameters in preoperative videourodynamic study were compared between successful and failed treatment groups. A total of 80 non-neurogenic and 75 neurogenic patients were included. A successful outcome was noted in 92 (59.4%) patients and a failed outcome in 63 (40.6%). The treatment outcome was not affected by the gender, voiding dysfunction subtype, bladder dysfunction, or sphincter dysfunction subtypes. Except an open bladder neck and higher maximum flow rate, no significant difference was noted in the other variables between groups. Non-neurogenic patients with successful outcomes had a significantly higher detrusor pressure, and patients with neurogenic voiding dysfunction with successful results had higher maximum flow rates and smaller post-void residuals than those who failed the treatment. However, increased urinary incontinence was reported in 12 (13%) patients. BoNT-A urethral sphincter injection is effective in about 60% of either neurogenic or non-neurogenic patients with voiding dysfunction. An open bladder neck during voiding and a higher maximum flow rate indicate a successful treatment outcome.

Therapeutic effect of urethral sphincter onabotulinumtoxinA injection for urethral sphincter hyperactivity

Urethral sphincter hyperactivity resulting in voiding dysfunction is frequently encountered. Medical treatment might not achieve a satisfactory result. OnabotlinumtoxinA urethral sphincter injection relaxes sphincter tonicity and possibly resumes efficient voiding. This study analyzed the treatment outcomes and predictor for successful onabotulinumtoxinA treatment on these patients. Patients with voiding dysfunction due to urethral sphincter hyperactivity and treated with injections of 100 U onabotulinumtoxinA into the urethral sphincter were retrospectively reviewed. Treatment outcomes were assessed 1 month after injection using the Global Response Assessment and were analyzed by demographic and baseline video-urodynamic characteristics. Of the 95 patients included, satisfactory outcomes were reported in 58 (61.1%) patients. Treatment outcome was not related to age, gender, or voiding dysfunction subtype. Patients with satisfactory outcomes had a significantly smaller volume at first sensation of filling (P = 0.046), greater detrusor pressure (P = 0.027), higher maximum flow rate (P = 0.017), and smaller post-void residual (P = 0.006). In multivariate analysis, an open bladder neck during voiding was the only predictor for successful outcome (88% in satisfactory outcome, 12% in failure outcome, P < 0.001). Patients with non-neurogenic voiding dysfunction had a significantly longer therapeutic duration than those with neurogenic voiding dysfunction (9.55 ± 4.18 vs 7.44 ± 2.91 months, P = 0.033). Increased urinary incontinence was reported in 18 patients, including 6 with stress urinary incontinence and 12 with urgency urinary incontinence. Subjective improvement was reported in 61.1% of patients with voiding dysfunction due to urethral sphincter hyperactivity after onabotulinumtoxinA urethral sphincter injection. An open bladder neck during voiding at baseline predicts a successful outcome.

Role of poor urethral sphincter relaxation in men with voiding dysfunction refractory to α‐blocker therapy: Clinical characteristics and predictive factors

This study evaluates the diagnostic value of poorly relaxed external sphincter (PRES) in men with voiding dysfunction. We analyzed clinical and video-urodynamic characteristics to identify predictive factors of PRES in patients with lower urinary tract symptoms (LUTS) refractory to α-1 adrenoceptor blocker (α-blocker) therapy. This retrospective study included 3379 men with LUTS in whom the initial 1-month α-blocker therapy failed. Clinical parameters and video-urodynamic results were analyzed. Patients with bladder outlet disorders including bladder neck obstruction (BNO), benign prostatic obstruction (BPO), urethral stricture (US), or PRES were categorized according to video-urodynamic findings. Predictive factors for PRES were analyzed. A total of 3379 men were included in this study. Among the patients with voiding dysfunction, 905 (43.6%) had BPO, 624 (30.0%) had BNO, 487 (23.4%) had PRES, and 62 (3.0%) had US. Patients with PRES were younger and had a higher maximum flow rate, larger bladder capacity, smaller total prostate volume (TPV) and transition zone index, and a lower rate of LUTS of urgency or urge urinary incontinence (UUI) than other groups. On multivariate analysis, only small TPV and lower urgency/UUI rate were predictive factors of PRES. A scale composed of voided volume, TPV, and urgency/UUI predicted PRES with high specificity. PRES was the etiology of voiding dysfunction in 23.4% of the men with LUTS refractory to α-blocker therapy. A simple scale composed of voiding volume, TPV, and urgency/UUI was useful in predicting the presence of PRES before video-urodynamic studies.

Long-term functional results after unilateral mid-urethral sling transection for voiding dysfunction

ObjectiveTo investigate the long-term outcomes of unilateral mid-urethral sling transection to treat voiding dysfunction after synthetic mid-urethral sling placement for stress urinary incontinence. Study designTwenty-three patients who underwent an unilateral sling transection were analyzed retrospectively. Patient records were analyzed for subjective outcome, and pre- and postoperative flow patterns were used as objective outcome parameters. ResultsAt the first postoperative follow-up, 77.3% of the patients remained dry. After a mean follow-up of 42 months, 73.9% of patients were continent. The flow pattern after lateral sling transection was significantly better than pre-operatively, with higher maximum flow rate (24.2ml/s, p=0.001), higher mean flow rate (10.4ml/s, p=0.001), higher voided volume (308.5ml, p=0.002) and lower residual volume (28.7ml, p=0.003). At final postoperative follow-up, eight patients (34.8%) reported urgency and six patients (26.1%) were incontinent; four of these patients (17.4%) mainly had urge incontinence. ConclusionsUnilateral mid-urethral sling transection is a safe, effective technique to treat voiding symptoms with good preservation of continence. The technique repairs the obstructive flow effectively. Urgency and urge incontinence after mid-urethral sling placement are difficult to treat with transection alone.

PD5-04 CAN WE PREDICT WHICH PATIENTS WILL PRESENT RESOLUTION OF DETRUSOROVERACTIVITY (DO) AFTER TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)?

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2015PD5-04 CAN WE PREDICT WHICH PATIENTS WILL PRESENT RESOLUTION OF DETRUSOROVERACTIVITY (DO) AFTER TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)? Alexandre Iscaife, Sabrina T. Reis, Aline Albertini, Marco A. Nunes, Antonio M. Lucon, Willian C. Nahas, Miguel Srougi, and Alberto A. Antunes Alexandre IscaifeAlexandre Iscaife More articles by this author , Sabrina T. ReisSabrina T. Reis More articles by this author , Aline AlbertiniAline Albertini More articles by this author , Marco A. NunesMarco A. Nunes More articles by this author , Antonio M. LuconAntonio M. Lucon More articles by this author , Willian C. NahasWillian C. Nahas More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , and Alberto A. AntunesAlberto A. Antunes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.303AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detrusor overactivity (DO) is one of the most frequent consequences of bladder outlet obstruction (BOO) due to BPH. The aim of the present study is to determine which clinical and urodynamic variables may be related to the persistence of DO after transurethral resection of the prostate. METHODS Analysis of 46 patients with BOO due to BPH who underwent TURP from 2011 to 2012. All patients underwent urodynamic analysis pre and post operatively after 12 months. The clinical and urodynamic variables in the preoperative were correlated with the resolution of DO in the postoperative period. RESULTS Patients with DO in the preoperative period were older (65.2 vs 61.1 years; p = 0.041), had higher IPSS score (25.2 vs 19; p = 0.014) and higher maximum flow rates (8.6 vs 6.6 ml/s; p = 0.039). Patients who persisted with DO were statistically older than those with resolution (69 vs 63 years; p = 0.043 ng/ml). Among patients with a MCC under 250 ml, 63.6% persisted with DO against only 20% among those with a MCC over 250 ml (p = 0.024). Analyzing urodynamic variables together, we found that patients presenting a MCC < 250 ml and a amplitude of DO over 40 cmH2O resulted in a 66.7% chance of persistence of DO (p = 0.041). When the patient has these characteristics associated with an early DO, the chance of persistence of DO reached 83.3% (p = 0.013) (Table). CONCLUSIONS Advanced patient age together with a low MCC and an early and high amplitude of DO are the most important predictors for persistence of DO after relief of BOO. Analysis of urodynamic variables grouped as predictor of persistence of DO after TURP Resolution Persistence p Low MCC+High BCI absent 81.30% 18.8% 0.004 present 22.20% 77.80 Low MCC+High amplitude absent 75.00% 25.0% 0.041 present 33.30% 66.70% Low MCC+High amplitude+High BCI absent 76.50% 23.50% 0.014 present 25.00% 75.00% High amplitude+early DO absent 75.00% 25.00% 0.041 present 33.30% 66.70% Low MCC+high amplitude+early DO absent 73.70% 26.30% 0.013 present 16.70% 83.30% multiple and early DO absent 60.00% 40.00% 1.00 present 60.00% 40.00% © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e93 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandre Iscaife More articles by this author Sabrina T. Reis More articles by this author Aline Albertini More articles by this author Marco A. Nunes More articles by this author Antonio M. Lucon More articles by this author Willian C. Nahas More articles by this author Miguel Srougi More articles by this author Alberto A. Antunes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Lung perfusion studies after percutaneous closure of patent ductus arteriosus using the Amplatzer Duct Occluder in children

The closure of patent ductus arteriosus with multiple devices has been associated with a reduction in lung perfusion. We evaluated the pulmonary perfusion after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder device using perfusion lung scan. Thirty patients underwent successful percutaneous patent ductus arteriosus occlusions using the Amplatzer Duct Occluder device were included in this study. Lung perfusion scans were preformed 6 months after the procedure. Peak flow velocities and protrusion of the device were analyzed by Doppler echocardiography. A left lung perfusion<40% was considered abnormal. The device implantation was successful in all patients. Average perfusion of left lung was 44.7±4.9% (37.8-61.4). Five patients (16.6%) showed decreased perfusion of the left lung. Age, low weight, the length of the ductus arteriosus and the minimum and maximum diameter/length of the ductus arteriosus ratio were statistically significant in patients with abnormalities of lung perfusion. It was observed protrusion the device in 6 patients with a higher maximum flow rate in the left pulmonary artery. The left lung perfusion may be compromised after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder. The increased flow velocity in the origin of the left pulmonary artery can be a poor indicator of reduction in pulmonary perfusion and can occur in the absence of protrusion of the device.

Can We Predict Which Patients will Experience Resolution of Detrusor Overactivity after Transurethral Resection of the Prostate?

We determined which clinical and urodynamic variables may be related to persistent detrusor overactivity after transurethral resection of the prostate. We studied 46 patients with bladder outlet obstruction due to benign prostatic hyperplasia who were treated with transurethral prostate resection from 2011 to 2012. All patients underwent urodynamic analysis preoperatively and 12 months postoperatively. Clinical and urodynamic variables in the preoperative period were correlated with the resolution of detrusor overactivity postoperatively. Patients with detrusor overactivity in the preoperative period were older (65.2 vs 61.1 years, p = 0.041) and had a higher I-PSS (International Prostate Symptom Score) (25.2 vs 19, p = 0.014) and higher maximum flow rate (8.6 vs 6.6 ml per second, p = 0.039). Patients with persistent detrusor overactivity were statistically older than those with resolution (69 vs 63 years, p = 0.043). Detrusor overactivity persisted in 63.6% of patients with maximum cystometric capacity less than 250 ml compared to 20% of those with greater than 250 ml (p = 0.024). When analyzing urodynamic variables together, we found a 66.7% chance of persistent detrusor overactivity in patients with maximum cystometric capacity less than 250 ml and detrusor overactivity amplitude greater than 40 cm H2O (p = 0.041). When these characteristics were associated with early detrusor overactivity, the chance of persistent detrusor overactivity was 83.3% (p = 0.013). Advanced patient age together with low maximum cystometric capacity, and early and high detrusor overactivity amplitude are the most important predictors of persistent detrusor overactivity after relief of bladder outlet obstruction.

Bethanechol chloride for the prevention of bladder dysfunction after radical hysterectomy in gynecologic cancer patients: a randomized controlled trial study.

Bethanechol chloride is considered as a treatment in patients with high postvoid residual urine (PVR). It enhances detrusor muscle contraction, resulting in higher maximum flow rate, higher detrusor pressure at maximum flow, and lower PVR. The efficacy of this agent in patients after radical hysterectomy is unclear. We aim to evaluate the efficacy of bethanechol chloride compared with placebo for the prevention of bladder dysfunction after type III radical hysterectomy. Gynecologic cancer patients who underwent type III radical hysterectomy were randomized by computer-generated schedule to assign patients in a 1:1 ratio into 2 groups. The treatment group received bethanechol chloride (Ucholine 20 mg 3 times a day on the third to seventh postoperative day), and the control group received placebo. Patients and physicians were masked to treatment allocation. The primary end point was the rate of urethral catheter removal at 1 week postoperatively. If PVR was more than 30% of voided volume, the urethral catheter was reinserted, and medication would be continued but not for more than 1 month. This study was registered as ISRCTN92687416. There were 31 patients in each group without significant difference in baseline characteristics. Twenty-one patients (67.7%) in the treatment group and 12 patients (38.7%) in the control group had the urethral catheter removed at 1 week postoperatively (P = 0.04). Median duration of urethral catheterization was shorter in the treatment group (7 and 14 days, P = 0.03). However, the PVR and the incidence of urinary tract infection at 1 month postoperatively were not significantly different. Nine patients (29%) in the treatment group had adverse events such as nausea, abdominal distension, and abdominal cramping, which was higher than the control group (1 patient, 3.2%; P = 0.01). However, no patients required any medical treatments. Bethanechol chloride decreases the duration of urethral catheterization in patients who underwent type III radical hysterectomy with manageable adverse events.

Clinical and demographic factors associated with valsalva leak point pressure among women undergoing burch bladder neck suspension or autologous rectus fascial sling procedures

Many parameters have been utilized to try to estimate severity of stress urinary incontinence (SUI). Valsalva leak point pressure (VLPP) measurements, have been proposed as a reliable means of gauging the severity of SUI during urodynamic studies (UDS). Certain, non-invasive, measures of incontinence severity have been proposed, but the correlation of these measures with VLPP is not known. In addition, the correlation of other important UDS measures and VLPP has not been evaluated. In this study we sought to define the relationship between demographic characteristics, physical exam findings, and non-sphincteric UDS measures with VLPP in a large multicenter randomized surgical trial comparing Burch urethropexy and fascial sling for the treatment of SUI. Pre-surgical, standardized urodynamic measures were obtained in all participants in the Stress Incontinence Treatment Efficacy Trial (SISTEr) trial. All UDS were assessed for quality assurance and protocol compliance. VLPP was assessed using a <8 Fr water transducer catheter during graded Valsalva maneuvers at 200 ml, and then at 100 ml intervals and bladder capacity if no SUI was noted earlier. Only data from women who had SUI on at least two of three consecutive valsalva maneuvers was utilized for this analysis. Delta VLPP was determined as the average value, and the baseline vesical pressure was subtracted from the absolute vesical pressure to arrive at the reported VLPP value. Independent variables studied to assess their relationship to VLPP value included demographic characteristics (age, number of pregnancies, # vaginal deliveries, hormone usage, previous hysterectomy, previous SUI surgery), physical exam parameters [body mass index--BMI, Pelvic Organ Prolapse-Quantified POPQ stage, POPQ Aa measurement, Q-tip angle (rest) and Q-tip angle (strain), and change in angle], and other urodynamic parameters (volume of first leakage, volume at first sensation, presence of detrusor overactivity, maximum cystometric capacity--MCC, maximum flow rate--Q(max), and detrusor pressure at maximum flow rate--pdet.Q(max)). Among the 655 women randomized, 424 were found to have evaluable VLPPs. Thirty-four had stage 3 or 4 prolapse and were excluded from the VLPP analysis. The remaining 390 women had a mean VLPP of 81.1 cm H(2)O. On bivariate analysis, there were significant positive associations with VLPP and BMI (P = 0.026), Q-tip straining angle (P = 0.0002) change in Q-tip angle (P = 0.0046), MCC (P < 0.0001) and pdet.Q(max) (P = 0.0003). Age was negatively associated with VLPP (P < 0.0001). For categorical values, lower POPQ stage (0/1), post menopausal status, and use of hormones were all associated with lower VLPP values. For example, patients with stage 2 had, on the average, VLPP values that were more than 10 cm H(2)O greater than those with stage 0/1. On multivariate analysis, however, only lower age, greater BMI, greater MCC, greater pdet.Q(max), and lower Q(max) were found to be independent associated with higher delta VLPP. Advancing age, lower BMI, higher maximum flow rate, and lower voiding pressures are all independently associated with lower VLPP in women undergoing surgery for SUI. Lower voiding pressures and higher flow rates among women with more severe SUI may reflect the chronic loss of urethral resistance associated with SUI. Interestingly, urethral hypermobility as assessed by Q-tip testing angle does not achieve a statistically significant association with VLPP on multivariate testing when controlling for POP-Q stage. Thus, as clinically suspected, the Q-tip test is not predictive of VLPP in women with urethral hypermobility and SUI.

The effects of bethanechol and cisapride on urodynamic parameters in patients undergoing radical hysterectomy for cervical cancer. A randomized, double-blind, placebo-controlled study

To evaluate the effects of bethanechol and cisapride on urodynamic parameters in patients undergoing radical hysterectomy for cervical cancer. In this double-blind, placebo-controlled study, 79 patients with cervical cancer were randomized to receive bethanechol (30 mg/day), cisapride (30 mg/day), bethanechol combined with cisapride (same doses) and placebo. Urodynamic study was performed, including flowmetry, cystometry, pressure-flow study and urethral pressure profile before radical hysterectomy. Medication was administered postoperatively during 30 days. At the end of this period, urodynamic evaluation was repeated. There was an increase in both the maximum cystometric capacity and bladder capacity at first desire to void in the placebo group compared to the other groups. The rate of detrusor instability was higher in the group that used bethanechol combined with cisapride. Detrusor pressure at maximum flow was significantly higher when cisapride was used. There was a significant increase in postvoid residual volume in the placebo group. In patients undergoing radical hysterectomy, bethanechol and cisapride determined lower cystometric capacity and decreased bladder capacity at first desire to void, a higher maximum flow rate and higher detrusor pressure at maximum flow, with lower postvoid residual volumes. The early use of bethanechol and cisapride after radical hysterectomies positively modified urodynamic parameters, determining a more efficient detrusor function.

Contoured elastic-membrane microvalves for microfluidic network integration.

A contoured elastic-membrane microvalve is presented that enables integrated microfluidic processing at the network level. This method takes advantage of two ideas to improve performance: flexible elastic membranes (which enable high-performance shutoff and reduced footprint), and three-dimensionally contoured valve geometries (which reduce dead volume, improve fluidic priming, and reduce susceptibility to cavitation at high fluid velocities). We describe the use of laser-induced etching for microfluidic manifold fabrication, discuss the nonlinear load-deflection behavior of elastic membranes that can occur below 30 psi, and present flow-rate data for microvalves under inlet pressures of 0-20 psi with zero applied membrane pressure. Valve-closure data for inlet pressures of 0-30 psi are presented for fully assembled microvalve structures. The microvalve structures under test were capable of turning off flows of > 20 microL/s. These flow rates were shown to be limited by inlet and outlet flow resistances and not by the valve structure itself, so that higher maximum flow rate capabilities should be readily achieved.

Normal Pediatric Uroflow Rates in a Nonclinical Setting

Uroflow parameters were measured for 30 pediatric subjects who had voided in their own home setting. Maximum and average flow rates for the home group were compared to the uroflow parameters of a normal pediatric group of 1,014 subjects who had voided in a clinical setting. Generally, the 336 uroflow observations were in the norm of the uroflow nomogram based on the outpatient clinic study. However, we observed that larger subjects voided larger volumes and had higher maximum flow rates than the clinic group but there was not much difference with respect to average flow rate.