Incidence Of Acute Urinary Retention Research Articles

Effect of Pressure and Nonpressure Dressings on Postoperative Complications in Patients With Mixed Hemorrhoids: A Single-blind Controlled Study

PurposeTo compare the clinical effects of nonpressure and pressure dressings on the postoperative complications of modified Milligan-Morgan hemorrhoidectomy. DesignRandomized controlled trial. MethodsA total of 186 patients with grade II to III mixed hemorrhoids who had been excluded from cardiovascular and cerebrovascular diseases and anorectal surgery were included and randomly assigned to the nonpressure dressings group and the pressure dressings group by random number table. The incidence of acute urinary retention and medical adhesive-related skin injury, pain, hemostatic effect, anal distension, anal edema, use of analgesics, length of hospital stay, and hospitalization costs were compared between the two groups. The Consolidated Standards of Reporting Trials checklist for randomized controlled trials was used in this study. FindingsThe incidence of acute urinary retention in both men and women was significantly lower in the nonpressure dressing group (relative risk [RR] = 0.20, 95% confidence interval [CI] [0.13, 0.37], P = .002); (RR = 0.47, 95% CI [0.22, 0.76], P = .015). The postoperative pain at 6 hours/18 hours/25 hours was significantly lower in the nonpressure dressing group (P < .001, P = .004 < 0.05, P = .009). The anal distension at 6 hours and the number of patients who used analgesics were significantly lower in the nonpressure dressing group (P < .001). The incidence of medical adhesive-related skin injuries was significantly lower in the nonpressure dressing group (RR = 0.061, 95% CI [0.020, 0.189], P < .001). No primary bleeding was observed in both groups. However, there were no significant differences between both groups in terms of anal edema scores, length of stay, or hospitalization expenses. No adverse events were reported in either group during the study period. ConclusionsNonpressure dressings can effectively reduce the incidence of acute urinary retention and medical adhesion-related skin injury after surgery for grade III to IV mixed hemorrhoids. They can also safely relieve pain and distension.

Acute urinary retention in men: 21-year trends in incidence, subsequent benign prostatic hyperplasia-related treatment and mortality: A Danish population-based cohort study.

To examine trends in incidence of acute urinary retention, subsequent benign prostatic hyperplasia-related treatment and mortality in the era of medical therapy for benign prostatic hyperplasia. Additionally, to compare mortality with the general population. We conducted a Danish nationwide registry-based study including 70,775 men aged 45 years or older with a first hospitalization for acute urinary retention during 1997-2017. We computed annual standardized incidence rates, subsequent 1-year cumulative incidence of benign prostatic hyperplasia-related surgical and medical treatment, and standardized 3-month and 1-year mortality rates. Finally, we compared standardized all-cause and cause-specific mortality ratios with the general population. The standardized incidence rate of acute urinary retention per 1000 person-years increased transiently from 2.34 to 3.42 during 1997-2004, but gradually declined to 2.95 in 2017. The 1-year cumulative incidence of benign prostatic hyperplasia-related surgery declined from 31.2% to 19.8% and 20.5% to 7.7% after spontaneous and precipitated acute urinary retention, respectively. During 1997-2017, the standardized 1-year mortality declined from 22.2% to 17.2%. Compared with the general population, mortality was 4-5 times higher after 3 months and 2-3 times higher after 1 year of acute urinary retention. The cause-specific standardized mortality ratios were particularly high for deaths attributable to malignancies, urogenital disease, certain infections, chronic pulmonary disease, and diabetes. During 1997-2017, we observed a transient increase in the incidence of acute urinary retention. The subsequent use of benign prostatic hyperplasia-related surgery declined considerably and mortality continued to be high, mainly because of deaths from malignancies, urogenital disease, infections,and preexisting comorbidity.

Раннее удаление уретрального катетера после робот-ассистированной радикальной простатэктомии

Robot-assisted radical prostatectomy (RARP) is a widely used treatment method for patients with clinically localized prostate cancer. Posterior reconstruction of urethrovesical anastomosis (UVA) is one of the techniques that provides early recovery of urinary continence after surgery. Changes in the technique of performing posterior reconstruction of UVA may contribute to further improvement of functional results.To evaluate the functional results of early removal of the urethral catheter (after 3 days) after RARP using a modified surgical technique of performing posterior reconstruction of UVA compared with the standard catheterization time (7 days after surgery).Patients who underwent RARP were randomly assigned to early catheter removal (3 days after surgery, main group, n=15) and standard catheterization time (7 days after surgery, control group, n=15). RARP was performed using the Da Vinci Si system. The primary end point was the rate of spontaneous voiding after catheter removal. Secondary endpoints were the incidence of urine leakage into the paravesical tissue during retrograde cystography, as well as complications according to the Clavien-Dindo system. The frequency and severity of stress urinary incontinence after catheter removal was assessed using the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF).There were no significant differences between groups in terms of baseline and perioperative parameters. After removal of the catheter, no acute urinary retention was observed in both groups. Also, there were no cases of urine leakage into the paravesical tissue during retrograde cystography. The ICIQ-UI SF questionnaire showed no significant differences between the groups at 1, 3, 6, and 12 months after surgery.The method of modified posterior reconstruction allows to remove the urethral catheter 3 days after RARP. Early removal of the urethral catheter did not adversely affect the early recovery of urinary continence, the quality of UVA, and did not increase the incidence of acute urinary retention. Further studies with longer follow-up periods are needed.

Utility of multiple core biopsies during transperineal template-guided mapping biopsy for patients with large prostates and PI-RADS 1-2 on multiparametric magnetic resonance imaging.

BackgroundWe investigated the necessity of multiple core biopsies when performing transperineal template-guided mapping biopsy (TTMB) for patients with large prostates and no suspicious lesions on multiparametric magnetic resonance imaging (mpMRI).Materials and methodsWe retrospectively analyzed 304 patients on active surveillance (AS), 212 patients with previously negative transrectal ultrasound-guided biopsy (TRUS-Bx) and 67 biopsy naïve patients who underwent TTMB between May 2017 and December 2020. The number of core biopsies and acute urinary retention (AUR) rates were analyzed in relation to the prostate volume (PV). Cancer detection rate according to the prostate volume and Prostate Imaging-Reporting and Data System (PI-RADS) scores were compared using the Pearson Chi-square test.ResultsAUR occurred more frequently in patients with PV over 39 cc (5.5% vs. 24.4%, P < 0.001). In addition, incidence of AUR was more in patients with PV over 39 cc and PI-RADS score of 1–2 on mpMRI (3.7% vs. 22.2%, P < 0.001). There was no significant difference in the detection rates of any prostate cancer or clinically significant prostate cancer (csPCA) between the patients on AS with PV < 39 cc and PV ≥ 39 cc and PI-RADS score 1–2 (57.4% vs. 50%, P = 0.507; 17% vs. 8.8%, P = 0.412, respectively). Additionally, no significant difference was found in the detection rates of any prostate cancer or csPCA between the patients with PV < 39 cc and PV ≥ 39 cc and PI-RADS score 1–2 who either had a previously negative TRUS-Bx or were biopsy naïve (27.9% vs. 16.2%, P = 0.101, 8.2% vs. 4.1%, P = 0.31, respectively).ConclusionIncreasing the number of core biopsies of prostates measuring ≥39 cc with PI-RADS 1–2 on mpMRI does not significantly increase the detection rates of any prostate cancer or csPCA.

Do weather parameters affect emergency room visits due to acute urinary retention?

Objective: This study aimed to describe the effects of the various climate parameters on emergency room (ER) visits due to acute urinary retention (AUR). Patients and methods: This was a single-center retrospective analysis of the ER data of visits due to AUR in males and females between 2010 and 2017. We incorporated ER registries with data from the national meteorological service. Using multivariable logistic regression analyses, we assessed associations between climate parameters and the incidence of AUR. Results: A total of 1917 patients were admitted to the ER due to AUR during the study period, of whom 1706 (89%) were males and211 (11%) were females. Most AURs occurred in patients &gt;70 years of age, with males on average being older than women (72.8 vs. 70.1 years old, p=0.01). Multivariable logistic regression analyses demonstrated that females had more AURs than men (odds ratio (OR)=1.3, 95% confidence interval (CI) 1.1–1.9, p=0.04) in spring. In all seasons except winter, a higher maximal temperature was associated with an increased risk of AUR, while in winter, a lower temperature was associated with an increased risk (OR=0.654, 95% CI 0.602–0.711, p&lt;0.0001). Additionally, the following were associated with an increased AUR risk: increased wind speed and lower heat index during the spring, increased precipitation and a lower heat index during the autumn, and a higher heat index in the winter. Conclusions: Our data suggest that weather parameters might be associated with an increased AUR incidence in a Mediterranean coastline area, with maximal ambient temperature, wind speed, heat index, and precipitation playing a potential role. Level of evidence: 6.

The risk factors of acute urinary retention after laparoscopic colorectal cancer surgery in elderly patients receiving epidural analgesia.

Urinary retention (UR) is a frequent complication following laparoscopic colorectal surgery. The aim of the present study was to investigate the risk factors for acute UR after laparoscopic surgery for colorectal cancer in patients receiving epidural analgesia. A retrospective study was conducted of 201 patients who underwent laparoscopic surgery for colorectal cancer among those receiving epidural analgesia. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with acute UR. Acute UR was defined as Clavien-Dindo classification grade ≥ 1. The overall incidence of acute UR was 17.9% (36/201). The univariate analysis showed that male gender (P = 0.043), a history of chronic heart failure (P = 0.009), an increased level of serum creatinine (P = 0.028), an increased intraoperative fluid volume (P = 0.016), and an early postoperative date of urinary catheter removal (P = 0.003) were both associated with acute UR. The multivariate logistic regression analysis revealed an increased intraoperative fluid volume (100-ml increments; odds ratio [OR]: 1.085, 95% confidence interval [CI]: 1.034-1.138, P < 0.001), history of chronic heart failure (OR: 6.843, 95% CI: 1.893-24.739, P = 0.003), and postoperative date of urinary catheter removal (OR: 0.550, 95% CI: 0.343-0.880, P = 0.013) were independent risk factors for acute UR. Our findings suggest that an increased intraoperative fluid volume, history of chronic heart failure, and early removal of the urinary catheter are risk factors of UR after laparoscopic surgery for colorectal cancer in patients receiving epidural analgesia. An assessment using these factors might be helpful for predicting acute UR.

Monotherapy versus combination therapy in the treatment of benign prostatic hyperplasia: A single center study

Background and objectives: Most benign prostatic hyperplasia patients do not present obvious indicators for surgical intervention, so most of these patients are treated initially with medical therapy. This study aimed to compare the incidence of acute urinary retention after treatment with monotherapy with the incidence after combination therapy and determine the need for surgery in both methods. Methods: This is a retrospective study of the medical records of 248 benign prostatic hyperplasia patients who had attended Rizgary Teaching Hospital from May 2012 to June 2017. These patients were divided into two groups of 138 and 110 patients who have been treated by 0.4 mg tamsulosin capsule once daily and 0.4 mg tamsulosin capsule plus 5mg finasteride tablet once daily, respectively. Benign prostatic hyperplasia outcomes (acute urinary retention, benign prostatic hyperplasia related surgery) were compared between these two groups according to prostate volume and serum prostate specific antigen. Results: The combined treatment had significantly reduced the incidence of acute urinary retention and benign prostatic hyperplasia related surgery than monotherapy (P = 0.006 and 0.044, respectively). Similarly, when prostate volume and prostate specific antigen were above the cutoff value, both acute urinary retention and benign prostatic hyperplasia related surgery were lower in the combination therapy group than the monotherapy group. Conclusion: Combined therapy (0.4 mg tamsulosin plus 5mg finasteride) was significantly superior to 0.4 mg tamsulosin alone in the reduction of the incidence of acute urinary retention and benign prostatic hyperplasia related surgery among benign prostatic hyperplasia patients. Keywords: Benign prostatic hyperplasia; Acute urinary retention; Benign prostatic hyperplasia related surgery; Prostate volume; Prostate specific antigen.

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

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

Ideal timing of indwelling catheter removal after robot-assisted radical prostatectomy with a running barbed suture technique: a prospective analysis of 425 consecutive patients

ObjectiveTo compare prospectively early outcome and complications of catheter removal after robot-assisted radical prostatectomy (RARP) on the 4th or 7th day with a standardized running barbed suture technique.IntroductionThe time point of removing the indwelling catheter after RARP mainly depends on institute’s/surgeon’s preferences. Removal should be late enough to avoid urinary leakage and complications such as acute urinary retention (AUR) but early enough to avoid unnecessary catheter indwelling.Materials and methodsA consecutive single-institutional series of patients underwent RARP between July 2015 and August 2017 and were entered in a prospectively maintained data base. Between July 2015 and December 2016 a cystogram was performed on 7th postoperative day (group A), thereafter the cystogram was performed on 4th postoperative day (group B). Incidence of acute urinary retention (AUR), urinary tract infections (UTI) and adverse events between the two cohorts was compared.Results425 patients were analyzed (group A: n = 231; group B: n = 194). Both cohorts were comparable regarding demographic and oncological parameters. Watertight anastomosis was present in 84.8% in group A and in 82.5% in group B, respectively. AUR within 4 weeks after RARP occurred in 2.2% (n = 3) in A and 9.4% (n = 15) in B (p = 0.001). AUR within 72 h after catheter removal occurred in group A: 1% (n = 2) and in group B: 6.3% (n = 10) (p = 0.005). Symptomatic urinary tract infections occurred in 8.2% (n = 16) in group A and in 6.9% (n = 11) in group B. There were no differences in the rate of secondary anastomosis dehiscence. Age, BMI, prostate size, surgeon, or intraoperative bladder neck reconstruction were not correlated to the occurrence of AUR or UTI.ConclusionsThe removal of indwelling catheter on day 4 after a RARP with a running barbed suture shows similar anastomosis leakage rates as on the 7th postoperative day. However, AUR rates are higher for early removal. Patients scheduled for early removal should be carefully informed about the increased risk for AUR. Catheter indwelling time does not represent a risk factor for UTI.

Comparison of the clinical effect of dutasteride therapy for benign prostatic hyperplasia when initiated at different time points: A multicentre, observational, retrospective chart review study.

To evaluate the effects of early (≤6months after starting any medical treatment [baseline] for benign prostatic hyperplasia [BPH]), intermediate (between >6months and 2years from baseline) and late (2years after baseline) initiation of add-on dutasteride therapy on the incidence of acute urinary retention (AUR) and BPH-related surgery in Japanese patients with moderate-to-severe BPH. This multicentre, observational, retrospective chart review study used anonymised data from Japanese medical records. Eligible patients (≥50years) were followed from baseline until first AUR, BPH-related surgery or Year 4. Overall, 1206 patients were included (early initiation: n=793; intermediate: n=233; late: n=180). Early dutasteride initiation was not superior to late initiation in reducing the risk of first AUR or BPH-related surgery from baseline (hazard ratio [HR] 0.733; 95% confidence interval [CI] 0.468-1.150) but was superior in reducing the risk of first AUR alone (HR 3.449; 95% CI 1.796-6.623). One year after initiation, the cumulative incidence of first AUR rose rapidly in the late vs early and intermediate initiation groups. Incidences of all parameters (first AUR/BPH-related surgery, first AUR alone and BPH-related surgery alone) in patients undergoing BPH-related surgery in low incidence sites (ie clinical sites with≤16% incidence of first AUR or BPH-related surgery) were significantly lower in the early vs late initiation groups. Early dutasteride initiation reduced the risk of AUR in a Japanese real-world setting. A randomised controlled trial is warranted to evaluate the benefit of early initiation in preventing BPH-related surgery in Japanese patients.

AB180. 131. A strategy to reduce the incidence of acute urinary retention post inguinal hernia repair in males

Background: Post-operative urinary retention (POUR) is a common complication following inguinal hernia repair resulting in prolonged hospital stay and increased costs. The aim of this study was to determine the incidence of POUR in our study group, to identify at risk groups and lastly to develop a strategy that may improve this outcome.

Evaluation the efficacy of prophylactic tamsulosin in preventing acute urinary retention and other obstructive urinary symptoms following colporrhaphy surgery.

Background and Aim:Postoperative urinary retention (POUR) is defined as a disability in urinary excision after surgery. There are several strategies to prevent POUR, such as tamsulosin, which is a selective antagonist at alpha-1A and alpha-1B-adrenoceptors which reduces the bladder outlet resistance. The aim of this study was to investigate the efficacy of prophylactic tamsulosin in preventing acute urinary retention and other obstructive urinary symptoms following colporrhaphy surgery.Materials and Methods:This study was a randomized, double-blind clinical trial. A total of 130 patients who were candidates for colporrhaphy were divided into two groups: the intervention group (65 subjects received 0.4 mg tamsulosin in a single dose at the time of sleeping) and the control group (65 subjects received placebo at the same time as the intervention group). The incidence of acute urinary retention and other obstructive urethral symptoms and the mean urination volume after catheterization were recorded 24 h after operation. Patients’ demographic and clinical data were analyzed using SPSS version 20 software using Chi-square and Fisher's tests.Results:There was a significant difference in the incidence of acute urinary retention, decrease in urine flow diameter, and the mean residual urine volume Post Void Residual (PVR) in the bladder, and the incidence of these symptoms decreased in the tamsulosin recipient group. The incidence of other symptoms of acute urinary retention was not significantly different when compared between both the groups.Conclusion:It seems that the use of prophylactic tamsulosin is more effective in decreasing the incidence of acute urinary retention, decreasing the PVR in the bladder, and decreasing the diameter of the urine flow in patients after colporrhaphy.

The role of bladder diverticula in the prevalence of acute urinary retention in patients with BPH who are candidates to surgery.

ABSTRACTIntroduction:The urinary bladder diverticula (BD) secondary to benign prostatic hyperplasia (BPH) is a complication that can lead to urinary stasis, stone, urinary tract infection (UTI) and tumors. It's role in acute urinary retention (AUR) is not totally understood.Objectives:To determine the effect of BD size on AUR rates in patients with BPH candidates to surgery.Subjects and Methods:We performed a retrospective cohort study of 47 patients with BPH and BD who underwent BPH surgery associated to complete bladder diverticulectomy from 2006 to 2016. We analyzed risk factors for AUR in patients with BD using univariate, multivariate and correlation analysis.Results:There was a difference in the size of the diverticula, with 6.8 cm vs. 4.5 cm among patients with and without AUR respectively (p=0.005). The ROC curve showed a correlation between the size of BD and the risk of AUR. The value of 5.15 cm presented a sensitivity of 73% and a specificity of 72%. The area under the curve was 0.75 (p=0.01). Comparing groups with BD >5.0 cm vs. ≤5.0 cm, the AUR incidence was 74% and 27.8% respectively with an OR of 2.65 (1.20-5.85) (p=0.005). In the multivariate analysis, only the size of the diverticula reached statistical significance (p=0.012).Conclusions:The diameter of BD is an independent risk factor for AUR in patients with BPH and BD who are candidates to surgery. A diameter greater than 5.15 cm increases the risk of AUR.

The risk of urinary retention following robot-assisted radical prostatectomy and its impact on early continence outcomes.

We aimed to evaluate the risk factors of acute urinary retention (AUR) following robot-assisted radical prostatectomy (RARP), as well as the relationship of AUR with early continence outcomes. The records of 740 consecutive patients who underwent RARP by two experienced surgeons at our institution were retrospectively reviewed from a prospectively collected database. Multiple factors, including age, body mass index (BMI), international prostate symptom score (IPSS), prostate volume, presence of median lobe, nerve preservation status, anastomosis time, and catheter removal time (Day 4 vs. 7), were evaluated as risk factors for AUR using univariate and multivariate analysis. The relation between AUR and early return of continence (one and three months) post-RARP was also evaluated. The incidence of clinically significant vesico-urethral anastomotic (VUA) leak and AUR following catheter removal were 0.9% and 2.2% (17/740), respectively. In men who developed AUR, there was no significant relationship with regards to age, BMI, IPSS, prostatic volume, median lobe, nerve preservation, or anastomosis time; however, the incidence of AUR was significantly higher for men with catheter removal at Day 4 (4.5% [16/351]) vs. Day 7 (0.2% [1/389]) (p=0.004). Moreover, patients with early removal of the catheter (Day 4) who developed AUR had an earlier one-month return of 0-pad continence 87.5% (14/16) compared to patients without AUR 45.6% (153/335), with no significant difference at three months. While AUR is an uncommon complication of RARP, its incidence is much higher than VUA leakage. Further, it is often not well-discussed during patient counselling preoperatively. Moreover, earlier return of urinary continence was observed in patients experiencing AUR following RARP exclusively with catheter removal at Day 4. Future studies are warranted to validate the long-term impact of AUR on continence outcomes.

Effect of Climatic Parameters on Acute Urinary Retention Incidence

We investigated the effect of daily climatic parameters on spontaneous acute urinary retention (sAUR) and evaluated the risk factors for refractory/recurrent AUR. A total of 4194 patients older than 40 years were diagnosed with AUR in the emergency department at Gangnam Severance Hospital, Seoul, from January 2007 to May 2016. To evaluate climatic parameters at sAUR onset, we included individuals living in the area around the hospital. We excluded patients with fever, who did not return to the hospital after the AUR episode or with AUR occurring within 2 weeks following admission for surgery or chemotherapy. Among 818 patients living in the two districts around the hospital, winter and October had the highest seasonal and monthly rates of sAUR development, respectively, and sAUR incidence increased with age. Daily temperature range and mean wind speed were significant risk factors for sAUR development. Several daily climatic parameters had seasonal effects on sAUR incidence. Over a mean follow-up of 0.98 years, 122 patients (14.9%) developed refractory/recurrent AUR. Transitional zone index (TZI; HR = 1.03; P = 0.002) and prostate-specific antigen (PSA) at the time of sAUR (HR = 1.01; P = 0.030) were significant predictors of refractory/recurrent AUR. Benign prostate hyperplasia medication and transurethral prostatectomy after sAUR were not risk factors for refractory/recurrent AUR. Cold temperature provoked sAUR in patients with higher age and International Prostate Symptom Score. Patients with higher TZI and PSA level at the time of sAUR had a greater risk of developing refractory/recurrent AUR.

Vesico-urethral anastomosis (VUA) evaluation of short- and long-term outcome after robot-assisted laparoscopic radical prostatectomy (RARP): selective cystogram to improve outcome.

The role of a cystogram to assess the vesico-urethral anastomosis (VUA) after robot-assisted laparoscopic radical prostatectomy (RARP) has been debated. Early catheter removal without cystogram was reported to be associated with a trend towards an increased risk of acute urinary retention (AUR). In two cohorts we studied the effects of VUA leakage on cystogram and functional outcome after RARP. Cohort A contained 1390 consecutive men that routinely underwent a cystogram after RARP. Transurethral catheter (TUC) was removed in the absence of VUA leakage or minimal leakage on subsequent repeat cystogram. Outcome was compared to a group of 120 men that underwent cystography 7-10days after RARP but had the TUC removed independent of cystography findings (cohort B). Outcome was assessed by early clinical follow-up and quality of life (QOL) questionnaires at 6months. Men in cohort B had an increased risk of AUR and 6months voiding complaints when compared to cohort A. The incidence of AUR and voiding complaints was associated with grade 2-3 leakage on cystography in cohort B but not in cohort A. Grade 2-3 leakage on cystogram was more likely in men with larger prostates larger and preoperative voiding complaints. Selective cystogram in men with larger prostates and preoperative lower urinary tract symptoms (LUTS) may prevent early AUR and voiding complaints after RARP when prolonged TUC use is applied.

Decline in acute urinary toxicities with increased institutional experience: 15-year experience of permanent seed prostate brachytherapy in a single Australasian institution

PurposeTo evaluate the incidence of acute urinary toxicity after permanent seed prostate brachytherapy (BT) over a 15-year period. Methods and MaterialsThe study consisted of 782 prostate cancer patients treated with BT. All patients completed self-administered International Prostate Symptoms Score (IPSS) at baseline and during regular follow-up. We evaluated the risk of acute urinary retention (AUR) up to 3 months post-BT and lower urinary tract symptom (LUTS) resolution (defined as return to within two points of baseline IPSS score) at regular intervals, up to 24 months post-BT. Univariate and multivariate logistic regressions were used to evaluate the effect of various patient, tumor, and treatment factors on the risk of AUR and the likelihood of LUTS resolution. ResultsNinety-six patients (12%) developed AUR at a median of 1 day post-BT. Increased peak urinary flow is independently associated with lower risk of AUR (odds ratio [OR] = 0.94; 95% confidence interval [CI] = 0.91–0.97). Decline in incidence of AUR was observed over time with increased institutional experience (p = 0.03). Of the 646 patients with a minimum of 24-month follow-up, 29%, 49%, and 72% had LUTS resolution at 6, 12, and 24 months, respectively. Patients who had pre-BT transurethral resection of prostate (OR = 2.4; 95% CI = 1.5–4.0), cytoreductive neo-adjuvant androgen deprivation (OR = 2.0; 95% CI = 1.0–4.0), and higher baseline IPSS (OR = 1.1; 95% CI = 1.07–1.19) are more likely to report LUTS resolution at 24 months. ConclusionsWe reported decline in AUR over time with increased institutional experience in one of the largest Australasian BT series. Approximately three-quarters of patients achieved LUTS resolution at 24-month follow-up.

The role of chronic prostatitis in the pathogenesis and progression of benign prostatic hyperplasia

Objectives To investigate the role of chronic prostatic inflammation in the pathogenesis and progression of benign prostatic hyperplasia (BPH). Methods We enrolled 356 patients with BPH from May 2011 to December 2014 in our hospital were analyzed retrospectively. According to the pathological results, all patients were divided into the BPH with prostatitis group and BPH group. Age , prostate volume (PV), PSA, IPSS, and acute urinary retention (AUR) of the two groups were analyzed. Results In the BPH with prostatitis group, 121/356(34.0%) patients were be confirmed as BPH with prostatitis, the other 48/121(39.7%) patients were be confirmed as acute urinary retention (AUR). In the BPH group, 235/356(66.0%) patients were be comfirmed as simple BPH. and there were 60 (25.5%) patients with AUR. There was no significant difference in patient's age between the two groups (P>0.05), but PV , PSA, IPSS and incidence of AUR in the BPH with prostatitis group were higher than BPH group (P<0.05). Conclusions The patients with BPH and prostatitis have some characteristics of bigger volume, higher PV, PSA, IPSS and incidence of AUR. Chronic prostatic inflammation may be has important role in the pathogenesis and progression of BPH. Key words: Prostatic Hyperplasia; Prostatitis

Prospective trial comparing intraoperative flexible, rigid, and no cystoscopy after ultrasound-guided transperineal permanent seed prostate brachytherapy

ObjectiveThis is a prospective trial comparing the impact of intraoperative flexible, rigid, and no cystoscopy on dysuria immediately after permanent seed prostate brachytherapy (PB). It prospectively documents the time course and characteristics of dysuria, as well as the rates of urinary retention post-PB. Furthermore, this study attempts to establish the utility of routine, post-PB cystoscopy, by documenting the incidence of finding significant pathology on cystoscopy. Materials and methodsBetween January 2003 and January 2007, 225 patients deemed by their physician to be candidates for PB alone were recruited to the study. Patients who had external beam radiation therapy and/or androgen deprivation therapy were excluded. Preimplant International Prostate Symptom Score (IPSS), urinary quality of life score, urine leakage score, Sexual Health Inventory for Men score, and Radiation Therapy Oncology Group Bowel Health Inventory Scores were obtained. Patients were assigned to one of the following three groups: intraoperative rigid cystoscopy, flexible cystoscopy, or no cystoscopy following PB. Patient self-administered questionnaires were given to the patient in the recovery room after PB. These questionnaires evaluated the intensity, type, and duration of urinary symptoms associated with the first four urinations post-PB. All patients were seen on postoperative Day 1 when the surveys were retrieved. Patients were then followed up every 3 months. Acute urinary retention (AUR) was documented in the follow ups. Frequencies of significant pathology (defined as bladder tumor, urethral stricture, or large blood clots) were documented at the time of cystoscopy. AUR rates were also evaluated by the isotope used (I125, Pd103, or Cs131). ResultsA total of 225 patients were enrolled into this study, but only 194 patients could be analyzed for dysuria. Thirty-one patients were excluded from analysis (6, 13, and 12 patients from the rigid, flexible, and no cystoscopy groups, respectively). These patients did not return the questionnaire, or were in retention, and thus did not have dysuria scores to report. Baseline characteristics for the 194 patients in terms of preimplant IPSS, quality of life, prostate volume, and isotope used were well balanced between all three groups. There were no significant differences in dysuria between the three cystoscopy groups at any time point following PB. The mean dysuria score across all time points was 5.5 of 10, with 0 representing “no pain” and 10 representing “the worst possible pain.” Pain was most often characterized as “burning” (78%), whereas dysuria most commonly was “only during urination” (56%). AUR rates (6.8–9.5%) and duration of catheter dependence (10.5–19 days) were not found to be significantly different between the assigned groups. When results were stratified by isotope, patients treated with I125, Pd103, and Cs131 seeds experienced a 6%, 14%, and 0% retention rate, respectively. The I125 and Pd103 patients had similar pretreatment IPSS and prostate volumes. Seven percent of patients undergoing cystoscopy had significant findings. The most common finding was “clots thought too large to void” (3%). Seeds in the bladder/urethra occurred in 1% of cases. Only 0.7% of patients were found to harbor unsuspected bladder tumors. ConclusionThere was no significant difference in dysuria in the first four urinations post-PB between patients in the rigid, flexible, and no cystoscopy groups. Larger blood clots that may have been difficult to void, seeds in the bladder and/or urethra, and other abnormalities were found in 7% of patients who had cystoscopy. This may suggest that cystoscopy may be worthwhile post-PB. The incidence of AUR was not significantly different between the three cohorts.

Tolterodine in the Treatment of Male LUTS.

Storage lower urinary tract symptoms (LUTS) in men are usually chronic, with a high prevalence and a substantial impact on quality of life; therefore, adequate therapies are desirable and crucial for these men. First line treatment for all patients with storage LUTS should always be behavioral. The gold standard for pharmacological treatment of overactive bladder/storage symptoms is a muscarinic receptor antagonist such as tolterodine. First-marketed antimuscarinics were limited by several adverse events such as dry mouth, constipation, tachycardia, accommodation disorder, and cognitive dysfunction, resulting in poor compliance and early treatment discontinuation in a large number of patients. In order to improve compliance with oral drug treatment, tolterodine was developed, providing a better efficacy/adverse event profile. Tolterodine is available in the following two formulations: the intermediate release (IR) and extended release form (ER). Tolterodine ER 4 mg administered once daily is pharmacokinetically equivalent to tolterodine IR 2 mg twice daily but has a lower incidence of adverse events and increased efficacy. Combination therapy of tolterodine and an alpha-blocker is significantly more efficacious than either monotherapy. Even when compared and added to tamsulosin, tolterodine shows a good safety profile. The incidence of acute urinary retention requiring catheterization and treatment withdrawals due to adverse events are low in all the studies included in the present review.