History Of Acute Urinary Retention Research Articles

(164) AN UPTICK IN IPP INFECTIONS WITH 0.05% CHLORHEXIDINE GLUCONATE

Abstract Introduction The optimal irrigation solution with inflatable penile prosthesis (IPP) remains controversial. Objective We sought to determine the impact of the type of fluid used for dipping and irrigation (D&I) on the risk of IPP infections. Methods This is a retrospective, consecutive cohort study that includes individuals who underwent initial Coloplast IPP insertion or revision between January 2021 and May 2024. Cases done from January 2021 to August 2022 (20 months) underwent Rifampin/Gentamycin for dipping and Vancomycin/Gentamycin for irrigation (Group 1), whereas those from October 2022 to May 2024 (20 months) utilized 0.05% chlorhexidine gluconate for both D & I (Group 2). Surgeon, operative time, age, diabetes mellitus (DM), perioperative level of HbA1C, history of acute urinary retention (AUR), positive urine culture, and oral antibiotic (AB) regimen at discharge were obtained. The rate of infection between the two study groups and the association of risk factors with developing infection were explored by t-test and chi-square analysis for continuous and discrete variables, respectively. P-value less than 0.05 was considered statistically significant. Results In comparison of two study groups, infection rate was significantly higher in group 2 at 2.5% (8/314) than group 1 which did not have any infection (0/280) (P = 0.008). There was no significant association between the study group and operative time (P = 0.45), DM (P = 0.29), HbA1C level (P = 0.20) and AUR (P = 0.87) or surgeon (Table 1). Notably, two clinical infections were from non-virulent organisms (Streptococcus Constellatus & Staphylococcus Lugdunensis). Two of three patients undergoing malleable salvage failed. Since no infection was observed in group1, infection risk predictors were only analyzed in group 2. The patients in group 2 were stratified based on their diabetes mellitus (DM) status, and analyses were conducted to investigate the effect of a positive DM history on the risk of infection. The results indicated that having DM significantly increased the risk of infection, with 75% (6/8) of patients with DM developing an infection compared to 26% (78/306) of those without DM (P = 0.006) (Table 2). Notably, three of eight infections occurred in patients discharged on Augmentin or cefdinir secondary to drug interaction warning (our typical post op prophylaxis is Bactrim or ciprofloxacin). Conclusions Type of antiseptic fluid for D&I and DM were associated with IPP infection following surgery in our patient cohort. Disclosure No.

Factors predicting indistinct plane of surgical capsule in patients underwent HoLEP procedures.

To evaluate factors that effectively predict indistinct plane (IP) in patients who underwent holmium laser enucleation of the prostate (HoLEP). Data of 208 consecutive patients from our HoLEP database were reviewed and analyzed. IP was defined in 107 cases, as the plane could be identified only depending on endoscopic beak dissection rather than laser dissection in the initial stage of HoLEP, whereas the control group consisted of 101 cases. Variables including age, body mass index, prostatic volume (PV), intravesical prostatic protrusion, prostate-specific antigen, prostate-specific antigen density, bladder stones, urinary tract infection, microscopic hematuria, prior biopsy (PB), diabetes, hypertension, history of acute urinary retention, 5-alpha reductase inhibitor treatment, catheter dependency, residual urine, region, smoking, and alcohol consumption were compared between the two groups. The risk factors for predicting the presence of IP were determined using a multivariable binary logistic regression model using a forward selection approach with a focus on improvement in the area under the receiver operating characteristic curve (AUC). The incidence of IP was 51.4% (107/208). PV (OR = 0.977, p < 0.001) and PB (OR = 0.297, p = 0.028) were identified as the independent predictors of capsule plane status. PV with a cutoff of 54ml had the best predictive effectiveness for IP based on AUC (0.727; 95% CI 0.659-0.795). The specificity and sensitivity of this cutoff were 82.2% and 53.3%, respectively. PV is the most reliable factor to predict IP during HoLEP procedures. There is a high possibility of IP in patients with a PV less than 54ml.

Acute Urinary Retention due to Hematocolpos: A Case Report

Acute urinary retention is an uncommon occurrence in the pediatric population, usually arising from a mechanical obstruction. It may result from hematocolpos, a gradual accumulation of menstrual blood in the vaginal cavity due to outflow tract disorders, with imperforate hymen being the most prevalent. Despite the simplicity of diagnosing and treating Imperforate Hymen, the occurrence of missed or delayed diagnoses is a common clinical challenge. This issue is attributed to the condition’s low incidence, the presence of nonspecific symptoms, or insufficient physical examinations. We present a case of a 16-year-old patient, presented to the emergency department with a one-day history of acute urinary retention. She had not yet begun menses, and reported a background of cyclical lower back-pain and discomfort during urination. After urethral catheterization, physical examination revealed a regular, resilient pelvic mass and the visual inspection of the external genital tract revealed a thick, bulging, and non-bluish hymen. An ultrasound scan confirmed the diagnosis of hematocolpos. She underwent a hymenectomy using a radial incision and made a good recovery postoperatively. Hematocolpos should be systematically sought in young girls with urinary symptoms and primary amenorrhea. If not managed at time, it may have devasting complication such as tubal adhesion, pelvic endometriosis, and infertility.

Wünderlich Syndrome Associated with Obstructive Uropathy due to Coralliform Renal Lithiasis: Case Report and Literature Review.

Wünderlich syndrome or non-traumatic spontaneous renal hemorrhage is a rare entity, with less than 500 cases reported to date. It has multiple associated risk factors, the tumoral etiology is the principal one and the angiomyolipoma is the most frequently associated benign tumor. Other causes that are less frequent are systemic diseases such as polyarteritis nodosa, ruptured renal cysts, coralliform renal lithiasis, among others. It´s most common clinical presentation only occurs in 20% of cases and consists of Lenk's triad. Even in cases where the triad is present, the initial diagnosis is by computed tomography (CT) where the retroperitoneal hematoma is observed and sometimes evidencing the underlying etiology as in cases of renal lithiasis. Treatment depends on its severity and extension, ranging from conservative treatment in mild cases to urgent surgery in cases with hemodynamic instability. We present the case of a 58-year-old male patient with previous inpatient history of acute urinary retention and the finding of right coralliform renal lithiasis, without accepting surgical treatment and was readmitted a few weeks later presenting the characteristic clinical Lenk´s triad he undergoing to simple abdominopelvic computed tomography TC, as initial study and reporting a right perirenal hematoma secondary to obstructive uropathy due to renal lithiasis.

V.I.P. Score: A Comprehensive Grading System to Predict Difficulty of HoLEP Procedure for Small-to-Moderate Sized Prostate (

ObjectiveTo develop a comprehensive scoring system in addition to the conventionally used prostatic volume (PV), for predicting the difficulty of holmium laser enucleation of the prostate (HoLEP) that may arise with small-to-moderate sized prostate. MethodsWe retrospectively reviewed 151 consecutive patients who underwent HoLEP and had a PV less than 120 mL. Based on previous literature, a difficult procedure was defined as a prolonged operative time (OT>90 minute) in 88 cases, while the control group (OT≤90 minute) consisted of 63 patients. The clinical data, including age, body mass index, PV, intravesical prostatic protrusion (IPP), prostate specific antigen (PSA), prostate specific antigen density, urinary tract infection, microscopic hematuria, prior biopsy, diabetes mellitus, hypertension, history of acute urinary retention, catheter dependency and use of antiplatelet / anticoagulation drugs or 5-alpha reductase inhibitor were compared between the 2 groups. ResultsUnivariate analysis revealed significant differences between the 2 groups. Multivariate analysis identified 3 main independent predictors for difficulty, including volume (V) (60-90 mL OR = 9.812, P < .001) (≥90 mL OR = 18.173, P = .01), IPP (I) (OR = 3.157, P = .018), and PSA (P) (≥4 ng/ml OR = 16.738, P < .001). Therefore, a V.I.P. score was developed based on the regression model and ranged from 0 to 7 points. The area under the curve showed preferable predictive ability of the V.I.P. score compared to PV (0.906 vs 0.869). ConclusionWe developed a V.I.P. score that can accurately predict the difficulty of the HoLEP procedure for PV less than 120 mL in order to optimize clinical outcomes.

Effect of urinary retention on the surgical outcome of holmium laser enucleation of the benign prostatic hyperplasia.

To evaluate the effect of urinary retention (UR) on holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms. A retrospective analysis of a prospective cohort of patients who underwent HoLEP between January 2010 and December 2016 was performed. The perioperative factors, including the International Prostate Symptom Score, Overactive Bladder Symptom Score, prostate-specific antigen, urodynamic study results, uroflowmetry results, transrectal ultrasound prostate volume, operative time, morcellation time, enucleation weight, and complications, were evaluated. Postoperative evaluation was performed at 2, 3, and 6 months. Overall, 903 patients were identified. The mean age and follow-up were 68.3 years and 6 months, respectively. Among the patients, 135 (15.0%) patients had a history of acute UR (AUR), and 36 patients (4.0%) had chronic UR (CUR). The mean detrusor pressures at maximum flow were 64.4, 74.3, and 77.7 cmH2O (p<0.001). The mean maximum flow rates (Qmax) were 7.6, 6.6, and 4.8 mL/s (p<0.001). Additionally, the mean bladder outlet obstruction indices were 49.5, 61.1, and 69.4 (p<0.001). The postoperative Qmax improved in all three groups. The mean postvoid residual volumes (PVRs) were 55, 75, and 333 mL preoperatively; 20, 29, and 66 mL at 2 weeks; 16, 23, and 45 mL at 3 months; and 15, 22, and 52 mL at 6 months (p<0.001). Voiding symptoms, PVR, and Qmax of BPH patients with preoperative AUR and CUR significantly improved after Ho-LEP, similar to those without preoperative UR.

Associated risk factors for acute urinary retention among patients presenting with benign prostatic hyperplasia at a tertiary care hospital in Nepal

Introduction: Acute urinary retention (AUR) is an important public health issue in older male population with benign prostatic hyperplasia (BPH). Various risk factors are associated with increased incidence of AUR among patients with BPH being managed conservatively. Method: A retrospective analysis was performed AUR with BPH among patients in Shree Birendra Hospital (SBH), Chhauni, Kathmandu, Nepal for a period of one year. Study variables included patient age, serum prostate specific antigen (PSA), prostate volume, history of AUR, smoking, diabetes mellitus, hypertension, cardiovascular disease, and other comorbid diseases. The SPSS was used for data analysis, X2 test to find out the association and a p&lt;0.05 considered statistically significant. The study was approved from the ethical committee. Result: Total 110 patients (out of 182 BPH) had AUR, an incidence of 60.9% (110 out of 182), with a mean (SD) age of 67.41±7.1 (p&lt;0.05). Patients with AUR had larger mean prostate volume. There were 38(34.54 %) patients with AUR having PSA &gt;4.5 ng/mL (p&lt;0.001). More number of patients with AUR had diabetes mellitus and smoker (p&lt;0.001). Consumption of alcohol, hypertension and cardiac disease were not significantly associated with AUR (p&gt;0.05). Conclusion: Our study showed that increasing age, high prostate volume, high serum PSA, diabetes and smoking had increased incidence of AUR among patients with BPH.

363 Patient-Reported Outcomes Measures From 153 Men Treated with Water Vapour Thermal Therapy (Rezūmtm) For Symptomatic Benign Prostate Hyperplasia

Abstract Background Transurethral water vapour treatment (RezumTM) is a novel minimally invasive technique (MIST) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The aim of this study was to report patient-reported outcome measures (PROMS) and adverse events from patients treated with RezumTM. Method Consecutive patients were retrospectively identified at a single tertiary centre. Exclusion criteria included a history of acute urinary retention, previous BPH surgery, prostate cancer or prostatitis. PROMS including International Prostate Symptom Score (IPSS), IPSS-quality of life (IPSS-QoL) and the International Index of Erectile Function (IIEF-5) were compared between baseline and at a single discrete follow-up period (Initial [4-6 months]; Early [7-12 months]; Medium [13-18 months]; or Late [&amp;gt; 18 months]) using student’s t-test (SPSS v26.0; p &amp;lt; 0.05). Results 153 patients were included. IPSS, IPSS-QoL and IIEF-5 at baseline were 23.4 (SD 6.8), 4.8 (SD 3.7) and 14.9 points (SD 7.1), respectively. Paired PROMS were available at: Initial 20.2% (31/153), Early 43.7% (67/153), Medium 24.8% (38/153) and Late 11.1% (17/153) follow-up. Compared to baseline, all mean IPSS and IPSS-QoL reductions were significant (p &amp;lt; 0.05). At medium follow-up, paired IPSS and IPSS-QoL reductions were significant at -14.2 points and -3.2 points (p &amp;lt; 0.0001), respectively. There was no reported de novo erectile dysfunction. One patient required re-operation due to persistent symptoms, and one patient experienced postoperative urosepsis (Clavien-Dindo II). Conclusions Our findings demonstrate real-world data that water vapour therapy for BPH confers durable patient-reported improvements in most men, with preservation of patient-reported erectile function.

MP01-07 PRESERVATION OF SEXUAL FUNCTION FOLLOWING REZUM® THERAPY FOR LUTS/BPH TOO GOOD TO BE TRUE? REAL WORLD OUTCOMES FROM 181 CASES

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP01)1 Sep 2021MP01-07 PRESERVATION OF SEXUAL FUNCTION FOLLOWING REZUM® THERAPY FOR LUTS/BPH TOO GOOD TO BE TRUE? REAL WORLD OUTCOMES FROM 181 CASES Martin John Connor, Amar Rai, Charlie Khoo, Mariana Bertoncelli Tanaka, Edward J. Bass, David Eldred-Evans, Sanjiv Agarwal, Ranan Dasgupta, Mathias Winkler, Hamid Abboudi, Tamer El-husseiny, and Hashim U. Ahmed Martin John ConnorMartin John Connor More articles by this author , Amar RaiAmar Rai More articles by this author , Charlie KhooCharlie Khoo More articles by this author , Mariana Bertoncelli TanakaMariana Bertoncelli Tanaka More articles by this author , Edward J. BassEdward J. Bass More articles by this author , David Eldred-EvansDavid Eldred-Evans More articles by this author , Sanjiv AgarwalSanjiv Agarwal More articles by this author , Ranan DasguptaRanan Dasgupta More articles by this author , Mathias WinklerMathias Winkler More articles by this author , Hamid AbboudiHamid Abboudi More articles by this author , Tamer El-husseinyTamer El-husseiny More articles by this author , and Hashim U. AhmedHashim U. Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001962.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Preservation of sexual function whilst alleviating bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is a major attraction for men consenting to transurethral water vapourtreatment (Rezum®). There is limited understanding of this. We report on de novo erectile dysfunction, retrogradeejaculation (Rej), anejaculation (Anej), painful ejaculation (Pej), decreased volume of ejaculate (DVe) and patient-reported outcomes measures (PROMS) of erectile function. METHODS: Consecutive patients were identified at a single tertiary centre, who underwent Rezum® therapy (Aug/2017-Dec/2019). Patients with a history of acute urinary retention, previous BPH surgery, clinically significant prostate cancer (>/= Gleason 3+4), long-term catheter or prostatitis were excluded. IIEF-5 was completed at baseline and a single discrete follow-up period (Initial [4-6 months]; Early [7-12 months]; Medium [13-18 months]; or Late [> 18months]). Clavien-Dindo reported complications. Wilcoxon signed-rank test (SPSS v26.0). RESULTS: 181/310 (58.4%) patients met inclusion criteria. Pre-operative median age, PVol, QMax (ml/s) and PVR (ml) were 69 yrs (IQR 11.5), 55 cc (IQR 29), 9.4 (IQR 5.5), 137.5 (IQR 125), respectively. De novo erectile dysfunction was not reported (0/181). Ejaculatory function results were: 3/181 Rej (1.7%), 5/181 Anej (2.8%), 2/181 Pej (1.1%), 2/181 DVe (1.1%), respectively. Pre-operative IIEF-5 was 14.9 points (SD 7.1). In 153/181 (84.5%) paired IIEF-5 were available. These were reported at: Initial 20.2% (31/153), Early 43.7% (67/153), Medium 24.8% (38/153) and Late 11.1% (17/153) follow-up, respectively. No significant reduction in paired IIEF-5 occurred at follow-up intervals (p>0.05). Clavien-Dindo >/= Grade II post-operative urosepsis was reported in four (2.2%; 4/181) patients. CONCLUSIONS: These findings support previous trial data suggesting no evidence of post-operative de novo erectile dysfunction, whilst preservation of aspects of ejaculatory function in up to 97%. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e3-e3 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Martin John Connor More articles by this author Amar Rai More articles by this author Charlie Khoo More articles by this author Mariana Bertoncelli Tanaka More articles by this author Edward J. Bass More articles by this author David Eldred-Evans More articles by this author Sanjiv Agarwal More articles by this author Ranan Dasgupta More articles by this author Mathias Winkler More articles by this author Hamid Abboudi More articles by this author Tamer El-husseiny More articles by this author Hashim U. Ahmed More articles by this author Expand All Advertisement Loading ...

Building a Nomogram for Prediction of Prostate Cancer in Patients With Preoperatively Suspected Prostate Cancer.

Expanded indications for patients with preoperatively suspected prostate cancer (PC) undergoing theranostic robotic-assisted laparoscopic radical prostatectomy (T-RARP) are reported. We aimed to build a nomogram of T-RARP to predict final pathologically proven PC. This study reviewed data of 153 patients that underwent T-RARP for suspected PC performed by the same surgeon. Patients' preoperative demographic and clinical characteristics included age, prostate-specific antigen (PSA) level, PSA density (PSAD), history of acute urinary retention (AUR), abnormal digital rectal examination (DRE) of the prostate, and Prostate Imaging Reporting and Data System (PI-RADS) classification at 3-T multiparametric magnetic resonance imaging (MRI). Logistic regression with backward elimination was used to select potential risk factors. Based on Harrell's guidelines, we chose seven variables for our final model: Age, DRE corresponding with MRI, AUR, PSAD, prostate-specific antigen velocity (PSAV), PI-RADS, and biopsy pathology. A nomogram for prediction of adenocarcinoma was developed. The original C-index for the nomogram was 0.80 (95% confidence interval=0.74-0.89). The cut-off of the nomogram score for predicting PC was 50 (sensitivity=55.4%; specificity=91.9%). The receiver operating characteristic curve of the model analysis showed an area under the curve of 0.801. A nomogram was produced using age, DRE-corresponding MRI, AUR, PSAD, PSAV, PI-RADS, and biopsy pathology. A preoperative nomogram prediction of prostate adenocarcinoma can help the patient and his family understand the possibility of PC and assist them in their decision-making.

Urinary ATP may be a biomarker for bladder outlet obstruction and its severity in patients with benign prostatic hyperplasia.

BackgroundUrothelial cells release ATP into the urine in response to bladder stretch. Urinary ATP concentration in benign prostatic hyperplasia (BPH) patients was higher compared with asymptomatic controls. In this study, we aimed to explore the possibility that the urinary ATP level could be a non-invasive biomarker for bladder outlet obstruction (BOO) and its severity in BPH patients.MethodsWe included 117 BPH patients who underwent urodynamic studies and 109 asymptomatic controls. Urine samples at normal desire (from patients and controls), instilled fluids at maximum cystometric capacity (capacity fluid), and voided fluids during a pressure-flow study (only from patients) were collected. The ATP concentration in collected samples was measured using a luciferin-luciferase bioluminescence assay and normalized to urine creatinine (ATP/Cr). The degree of BOO was quantified using the BOO index (BOOI). Correlation between urodynamic parameters and urinary ATP concentration was analyzed in BPH patients.ResultsUrinary ATP concentration of BPH patients was significantly higher compared with controls (P<0.001). For BPH patients, a significant positive correlation was found between urinary ATP concentration and BOOI (P<0.0001). Although BPH patients with detrusor overactivity or a history of acute urinary retention had increased urinary ATP, a significant positive correlation between ATP and BOOI was also observed in these patients. When BOOI >40 was set as a cutoff point to differentiate BOO from non-BOO patients, the area under the receiver operating characteristic (ROC) curve was 0.77 (P<0.001).ConclusionsBPH patients with BOO released higher amounts of ATP into the urine. Urinary ATP can be used as a non-invasive biomarker of BOO, and its level may also have a predictive value for the degree of obstruction.

Multivariate Analysis of the Failure of Removal of the Urinary Catheter within 48 Hours after Transurethral Enucleation and Resection of the Prostate.

Objective To assess the value of clinically relevant data for predicting the failure of removal of the urinary catheter within 48 hours after TUERP. Materials and Methods. We retrospectively analyzed the medical records of 357 patients who underwent TUERP between January 2015 and July 2018, all of whom stopped bladder irrigation and removed urinary catheter within 48 hours after the operation. According to whether the removal of the catheter was successful, the patients were classified into 2 groups: Group A was successful and group B was a failure. Univariate analysis was performed to determine the association between the failure of removal of the catheter and the patients' preoperative clinical characteristics. Logistic regression analysis and receiver operating characteristic analysis (ROC) were conducted to establish the prediction model. Then the area under the curve (AUC) and the cut-off value were calculated. Results 357 patients were divided into group A (n = 305, 85.4%) and group B (n = 305, 85.4%) and group B (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (Conclusion This study demonstrated that IPSS, QoL, drug medication, history of AUR, TPV, and IPP are independent factors associated with the failure of removal of the urethral catheter within 48 hours after TUERP.

Recurrent acute urinary retention following a female genital mutilation in an 11-year-old-girl

Acute urinary retention is a urological emergency presenting with a sudden inability to pass urine due to mechanical or functional reason characterized by suprapubic pain and distension requiring urgent bladder drainage. Acute urinary retention is ten times more common in males than females. Female genital mutilation comprises all surgical procedures involving partial or total removal of the female external genitalia or other injuries to the female genital organ for cultural and other non-therapeutic reasons. We present an 11 year old girl who was referred from a primary health centre with recurrent history of acute urinary retention following a female genital mutilation done 5 days prior to presentation, she was said to have been having suprapubic tapping of the urine to relive her of the retention as the health providers were unable to identify the urethral orifice for catheterization. On examination; she was in painful distress with complain of suprapubic pain and urge to pass urine, there is tender suprapubic distention, the left upper labia majora, minora and clitoris were severed, the urethral meatus distorted. Examination under anaesthesia with suprapubic cystostomy and urethral catheterisation was done and the patient was placed on sitz bath and genital toileting. We report a case of acute urinary retention in an 11 year old girl following a female genital mutilation five days earlier.

A Phase II Study of Stereotactic Body Radiation Therapy for Low-Intermediate-High-Risk Prostate Cancer Using Helical Tomotherapy: Dose-Volumetric Parameters Predicting Early Toxicity.

Endpoint: To assess early urinary (GU) and rectal (GI) toxicities after helical tomotherapy Stereotactic body radiation therapy (SBRT), and to determine their predictive factors.Methods: Since May 2012, 45 prostate cancer patients were treated with eight fractions of 5.48 (low risk, 29%) or 5.65 Gy (intermediate-high risk, 71%) on alternative days over 2.5 weeks. The exclusion criteria were Gleason score 9–10, PSA >40 ng/mL, cT3b-4, IPSS ≥20, and history of acute urinary retention. During the follow-up, a set of potential prognostic factors was correlated with urinary or rectal toxicity.Results: The median follow-up was 13.8 months (2–25 months). There were no grade ≥3 toxicities. Acute grade 2 GU complications were found in a 22.7% of men, but in 2.3% of patients at 1 month, 0% at 6 months, and 0% at 12 months. The correspondent figures for grade 2 GI toxicities were 20.4% (acute), 2.3% (1 month), 3.6% (6 months), and 5% (12 months). Acute GI toxicity was significantly correlated with the rectal volume (>15 cm3) receiving 28 Gy, only when expressed as absolute volume. The age (>72 years old) was a predictor of GI toxicity after 1 month of treatment. No correlation was found, however, between urinary toxicity and the other analyzed variables. IPSS increased significantly at the time of the last fraction and within the first month, returning to the baseline at sixth month. Urinary-related quality of life (IPSS question 8 score), it was not significantly worsen during radiotherapy returning to the baseline levels 1 month after the treatment. At 12 months follow-up patient’s perception of their urinary function improved significantly in comparison with the baseline.Conclusion: Our scheme of eight fractions on alternative days delivered using helical tomotherapy is well tolerated. We recommend using actual volume instead of percentual volume in the treatment planning, and not to exceed 15 cm3 of rectal volume receiving ≥25 Gy in order to diminish acute GI toxicity.

PD21-11 DEVELOPMENT OF BLADDER OUTLET OBSTRUCTION NOMOGRAM AND SPLIT-SAMPLE VALIDATION AMONG MEN WITH LUTS AGED 50 OR MORE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology & Natural History1 Apr 2014PD21-11 DEVELOPMENT OF BLADDER OUTLET OBSTRUCTION NOMOGRAM AND SPLIT-SAMPLE VALIDATION AMONG MEN WITH LUTS AGED 50 OR MORE Jung Keun Lee, Jeong Hyun Kim, Choong Hee Noh, Kwang Mo Kim, Ha Rim Kook, Jin-Woo Jeong, Yong hyun Park, Sangchul Lee, Sung Kyu Hong, Seok-Soo Byun, Sang Eun Lee, and Seong Jin Jeong Jung Keun LeeJung Keun Lee More articles by this author , Jeong Hyun KimJeong Hyun Kim More articles by this author , Choong Hee NohChoong Hee Noh More articles by this author , Kwang Mo KimKwang Mo Kim More articles by this author , Ha Rim KookHa Rim Kook More articles by this author , Jin-Woo JeongJin-Woo Jeong More articles by this author , Yong hyun ParkYong hyun Park More articles by this author , Sangchul LeeSangchul Lee More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , Seok-Soo ByunSeok-Soo Byun More articles by this author , Sang Eun LeeSang Eun Lee More articles by this author , and Seong Jin JeongSeong Jin Jeong More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1688AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Urodynamic study has been considered as a gold standard for diagnosis of bladder outlet obstruction (BOO) among men. However, performing the urodynamic study is invasive, expensive and time consuming.We aimed to develop a nomogram predicting BOO among men with lower urinary tract symptoms (LUTS) aged 50 or more using only clinical parameters other than those from urodynamic study. Methods Urodynamic and clinical data were collected from men with LUTS aged 50 or more at our institution between May 2003 and June 2013. After excluding individuals who had a possible neurogenic bladder or a temporary voiding dysfunction and who had insufficient data, a total of 873 men were included in the analyses. Parameters assessed were age at urodynamic study, PSA, IPSS, transrectal ultrasound, history of acute urinary retention, maximum flow rate (Qmax) and post-void residual (PVR) volume. BOO was defined as AG number ¡Ã40 determined in a pressure-flow study. Among men assessed, 75% and 25% were randomly assigned to sub-cohorts for the development of nomograms and for the split-sample validation. The final regression model was selected through the stepwise procedure, and the regression coefficient-based nomograms were developed according to final models. Results Among all the patients, 182 (20.8%) men were detected to have BOO. In a multivariable regression analysis of the development cohort, Qmax was only the parameter that was independently associated with BOO (OR 0.861, 95%CI 0.820-0.905). To improve the predicting power, the nomogram was developed based on Qmax and additional parameters such as PVR volume and transitional zone index which met the minimum requirements for being incorporated into the nomogram (Fig. 1). The discrimination performance of the nomogram was evaluated using the calculated area under the receiver-operating characteristic curve, which demonstrated 0.720 for prediction of BOO. The developed nomogram was reasonably well fitted to the ideal line of the calibration plot. The split-sample external validation of nomograms indicated 68.3% accuracy. Conclusions We developed a nomogram for predicting BOO, and validated adequately. The proposed nomogram based on Qmax, PVR volume, and transitional zone index may be useful for surgical treatment decision in men with LUTS aged 50 or more. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e610 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jung Keun Lee More articles by this author Jeong Hyun Kim More articles by this author Choong Hee Noh More articles by this author Kwang Mo Kim More articles by this author Ha Rim Kook More articles by this author Jin-Woo Jeong More articles by this author Yong hyun Park More articles by this author Sangchul Lee More articles by this author Sung Kyu Hong More articles by this author Seok-Soo Byun More articles by this author Sang Eun Lee More articles by this author Seong Jin Jeong More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Efficacy and safety of 120-W GreenLight High-Performance System laser photo vaporization of the prostate: 3-year results with specific considerations

Purpose:High-Performance System (HPS) laser photo vaporization of the prostate (PVP) is a widely used procedure nowadays. The safety and efficacy of the procedure has been affirmed in general patients with benign prostatic hyperplasia (BPH), but data on the safety and efficacy in specific situations, such as in patients with a large prostate, patients taking anticoagulant or 5-alpha reductase inhibitor (5-ARI) medication, and patients with a history of acute urinary retention (AUR) or previous transurethral resection of the prostate (TURP), is lacking. We investigated the safety and efficacy of HPS laser PVP in these unique patient groups.Methods:The study was conducted from March 2009 to February 2012 among patients for lower urinary tract symptoms. Patients in whom BPH was diagnosed and who were treated with 120-W HPS GreenLight PVP were selected. Patients were divided into groups of prostate size above and below 80, anticoagulant medication, 5-ARI medication, AUR history, and TURP history on the basis of the preoperative history and physical examination.Results:A total of 533 patients observable for a follow-up period of more than 6 months were enrolled as the study population. The patients’ mean preoperative prostate size was 51.0±32.7 mL and their mean prostate-specific antigen was 4.5±27.9 ng/mL. The average operating time was 24.5±12.2 minutes and the average applied energy during surgery was 152,184±89,495 J. Postoperative objective and subjective parameters in all groups were significantly improved compared with preoperative values.Conclusions:Laser resection of the prostate is safe and effective. The results of HPS laser PVP were not influenced by prostate size, the use of anticoagulants, the intake of 5-ARI for BPH management, a history of AUR, a history of TURP, or other factors. Thus, this study was able to reconfirm the efficacy and safety of laser resection of the prostate.

Initial experience with stereotactic body radiation therapy for localized prostate cancer using helical tomotherapy

Single-institution single-arm prospective study. Endpoint: To assess whether there are more than 5 % of men having grade 3 GU or any grade 3 GI acute toxicity during stereotactic body radiation therapy (SBRT) for prostate cancer using helical tomotherapy. Since May 2012, 17 prostate cancer patients were treated with helical tomotherapy. The exclusion criteria used are the following: Gleason score ≥8, PSA >20 ng/ml, cT3b-4, IPSS ≥20 and history of acute urinary retention. CTV included the prostate gland and 1 cm of seminal vesicles in the low-risk group (LR) or the seminal vesicles completely in the intermediate (IR) and high-risk (HR) NCCN groups. CTV margins ranged from 2 to 8 mm, while PTV margins were 2 to 9 mm. Patients received eight fractions of 5.48 Gy (LR) or 5.65 Gy (IR, HR) on alternate days. Total equivalent doses at 2 Gy per fraction are 87.4 for LR and 92.3 Gy for IR-HR using an α/β value of 1.5. Correspondent figures for a α/β of 3 are 74.3 Gy and 78.2 Gy, respectively. Megavoltage CT (MVCT) for on-line correction was taken before every fraction. The patient distribution by risk group is 29, 47 and 24 % for LR, IR and HR, respectively. 82 % received neoadjuvant-concomitant hormonal therapy. Acute GU toxicity grade 1, 2 and 3 was found in 70, 6 and 0 % of men. GI toxicity was observed in 50, 0 and 0. After 136 MVCT, the standard deviation of the mean individual corrections in the anterior-posterior direction was 2.5 mm. SBRT for prostate cancer using helical tomotherapy is feasible. Initial results show an early toxicity profile no worse than SBRT delivered with robotic radiosurgery or conventionally fractionated radiotherapy.

Preoperative Factors Affecting Postoperative Early Quality of Life During the Learning Curve of Holmium Laser Enucleation of the Prostate

PurposeThe aim of this study was to investigate the preoperative factors related to early quality of life (QoL) in patients with benign prostatic hyperplasia after holmium laser enucleation of the prostate (HoLEP) during the surgeon's learning curve.MethodsThe medical records of 82 patients with a follow-up period of at least 3 months who were treated with HoLEP during the time of a surgeon's learning curve were analyzed retrospectively. We divided the patients into two groups on the basis of the QoL component of the International Prostate Symptom Score (IPSS) 3 months after HoLEP: the high QoL group (IPSS/QoL≤3) and the low QoL group (IPSS/QoL≥4). Preoperative factors in each group were compared, including prostate volume, prostate-specific antigen, history of acute urinary retention (AUR), urgency incontinence, IPSS, and urodynamic parameters. Detrusor underactivity was defined as a bladder contractility index less than 100 on urodynamic study.ResultsA total of 61 patients (74.3%) had a high QoL, whereas 21 (25.7%) had a low QoL. A history of AUR, detrusor pressure on maximal flow (PdetQmax), bladder outlet obstruction grade, bladder contractility index, and detrusor underactivity were associated with postoperative QoL in the univariate analysis. In the multivariate analysis, a history of AUR and PdetQmax were independent factors affecting postoperative QoL.ConclusionsA history of AUR and bladder contractility affect early QoL, and preoperative urodynamic study plays an important role in the proper selection of patients during the HoLEP learning curve.

A Rare Presentation of Imperforate Hymen: A Case Report

Introduction. Acute urinary retention in a child is rare. Haematocolpos can cause a mechanical obstruction, resulting in acute urinary retention. Case Report. A 12-year-old girl presented to the surgical department with a one-day history of acute urinary retention and suprapubic tenderness. She had not started menses but had described period-like pains every month for the past six months. On examination, she had a palpable bladder with over 500 mls of residual urine and a bluish-grey bulge posterior to her urethral meatus. An US scan showed a large mass posterior to her bladder resembling a haematocolpos, and this was confirmed with an MRI scan. She was catheterised and eventually underwent a hymenectomy using a cruciate incision. She made a good recovery postoperatively. Conclusion. In the case of a peripubertal female presenting with acute urinary retention, haematocolpos should be considered as a diagnosis.

Acute urinary retention increases the risk of complications after transurethral resection of the prostate: a population‐based study

Study Type--Prognosis (cohort) Level of Evidence 2a. What's known on the subject? and What does the study add? Higher mortality and morbidity rates in men presenting with AUR have been reported in previous studies. This study has comprehensive comparisons of post-TURP complications between patients with and without AUR. Furthermore, it shows that AUR is associated with increased risk of complications after TURP. • To assess the association between a history of acute urinary retention (AUR) and complications after transurethral resection of prostate (TURP). • We conducted a retrospective, national, population-based study using Taiwan's National Health Insurance Research Database. • We included men > 50 years old, diagnosed with benign prostatic hyperplasia (BPH) and divided these into two groups: an AUR(+) group--those with AUR who underwent TURP between 2002 and 2004; and an AUR(-) group--those without AUR who underwent TURP between those dates. • Prostate cancer, Parkinsonism and multiple sclerosis were exclusion criteria. • Postoperative complications, e.g. re-catheterization, haematuria or urinary tract infection (UTI), were compared using crude odds ratios (ORs), 95% confidence intervals (CIs), and Student's t-test. • A chi-squared test was used for potential confounding factors: preoperative UTI and anticoagulant use. • Univariate and multivariate analysis on medical expenses were conducted. • The AUR(+) group contained 3305 men; the AUR(-) group contained 1062. • Re-catheterization (13.8%), septicaemia (1.1%) and shock (0.3%) were found only in the AUR(+) group. • The AUR(+) group had more UTIs (18.9% vs. 15.6%, OR: 1.26, 95% CI: 1.05-1.52), more lower urinary tract symptoms (22.8% vs. 16.9%, OR: 1.45, 95% CI: 1.21-1.73), fewer blood transfusions (3.2% vs. 1.5%, OR: 2.19, 95% CI: 1.29-3.72) and higher medical expenses. • There were no significant differences in haematuria, lower urinary tract stricture, or re-surgical intervention of the prostate and second-line antibiotic use. • Patients in Taiwan with BPH with AUR who were treated by TURP were associated with a higher risk of complications, longer hospital stay and more comorbidities than those without AUR and a preoperative warning is warranted for these patients.