Intermittent Catheterization Research Articles

MP52-05 BLADDER MANAGEMENT IS THE TOP HEALTH CONCERN AMONG ADULTS WITH A SPINAL CORD INJURY

You have accessJournal of UrologyCME1 Apr 2023MP52-05 BLADDER MANAGEMENT IS THE TOP HEALTH CONCERN AMONG ADULTS WITH A SPINAL CORD INJURY John P. Ratanawong, Christopher J. Loftus, Jeremy B. Myers, Sara M. Lenherr, John T. Stoffel, Blayne Welk, and Sean P. Elliott John P. RatanawongJohn P. Ratanawong More articles by this author , Christopher J. LoftusChristopher J. Loftus More articles by this author , Jeremy B. MyersJeremy B. Myers More articles by this author , Sara M. LenherrSara M. Lenherr More articles by this author , John T. StoffelJohn T. Stoffel More articles by this author , Blayne WelkBlayne Welk More articles by this author , and Sean P. ElliottSean P. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder management has been shown to be the most important health concern for people with spinal cord injury (SCI), outranking even ambulation. Incontinence, urinary tract infections (UTI) and clean intermittent catheterization (CIC) compared to other bladder management methods, have been shown to predict poor urinary quality of life (QoL) in people with SCI. But, it is unclear if these factors impact ranking bladder management as a top health concern. Using the Neurogenic Bladder Research Group (NBRG) SCI registry, our objective was to confirm whether bladder management is the top health concern and whether this is associated with urinary incontinence, UTI, or CIC utilization. METHODS: Participants in the NBRG registry were asked: “What are the top 3 problems that affect you on a daily basis? (Rank top 3): bladder management/issues, bowel management/issues, pressure ulcer, mobility issues, autonomic dysreflexia, spasticity/stiffness, pain, depression/anxiety, heart problems, lung problems, sexual function, fertility, or other.” Incontinence and urinary QoL were assessed using the Neurogenic Bladder Symptom Score (NBSS). We performed a multivariate regression to identify factors related to their primary choice. RESULTS: Among our 1460 participants, 882 (60%) were men, mean age was 44.9 years, and mean time since injury was 14.4 years. 574 (39%) ranked bladder management as their primary issue, followed by pain and bowel management (Figure 1). Factors associated with choosing bladder as the top concern included more years since injury (OR 1.02 [1.00,1.03], p<0.02), worse NBSS incontinence domain score (OR 1.06 [1.02, 1.09], p<0.01), and worse NBSS QoL (OR 1.20 [1.04, 1.37], p=0.01); UTI≥1/year (OR 1.03 [0.70, 1.50], p=0.89) and CIC (OR 1.40 [0.92, 2.14], p=0.12) were not significant. CONCLUSIONS: In this group, bladder management was ranked as the top health issue, over other sequelae of SCI. The farther out from injury people are, the more important bladder management becomes. Bladder QoL and, in particular, incontinence also drive people to view bladder issues as their top health concern. By managing incontinence in people with SCI, urologists can impact the top health concern of people with SCI. Source of Funding: PCORI-1409-21348 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e704 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John P. Ratanawong More articles by this author Christopher J. Loftus More articles by this author Jeremy B. Myers More articles by this author Sara M. Lenherr More articles by this author John T. Stoffel More articles by this author Blayne Welk More articles by this author Sean P. Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

HF02-10 AT THE EPICENTER OF INNOVATION IN THE 1970S: DR. JACK LAPIDES' RIGHT-HAND MAN, DR. ANANIAS DIOKNO

You have accessJournal of UrologyCME1 Apr 2023HF02-10 AT THE EPICENTER OF INNOVATION IN THE 1970S: DR. JACK LAPIDES' RIGHT-HAND MAN, DR. ANANIAS DIOKNO Justin Refugia and Gopal Badlani Justin RefugiaJustin Refugia More articles by this author and Gopal BadlaniGopal Badlani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003242.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Dr. Jack Lapides’ research in urology is widely recognized. His mentee, Dr. Ananias Diokno, was paramount to this work. We present Dr. Diokno’s contributions to highlight his role in pioneering treatments in neuro-urology and review a portion of his innumerable accomplishments. METHODS: We reviewed literature published by Drs. Lapides and Diokno to define their collaborative efforts. Web searches were performed with Google Scholar and PubMed and internal searches of our institution’s libraries. RESULTS: Dr. Lapides’ fruitful career largely occurred at the University of Michigan (UM). During his residency under the direction of Dr. Nesbit, his academic prowess was honed. In the 1960s, he became known for sentinel works on bladder physiology and voiding dysfunction. An important young person looking up to him was Dr. Diokno, a recent graduate of the University of Santo Tomas in the Philippines. In the late 1960s, Dr. Lapides went on to mentor him, later recruiting him to the UM urology residency and then Babcock Fellowship. One influential contribution that Dr. Diokno assisted with was the controversial study of non-sterile, clean intermittent catheterization (CIC) that challenged Dr. Guttman’s sterile approach. The team successfully taught CIC to patients with voiding dysfunction to prevent increased intravesical pressures. This lead to better control of their urinary difficulties and minimized UTIs, with no additional risks. Co-residents Drs. Diokno and Silber were astonished by the results. Initially, their enthusiasm was not met with a warm reception, yet the team persisted and saw their work revolutionize medicine worldwide. With his academic vigor, Dr. Diokno continued to move the needle during fellowship by discovering new categories of detrusor sphincter dyssynergia (DSD) and went on to establish use of CIC in clinical practice. CONCLUSIONS: Beyond the 1970s, Dr. Diokno maintained a remarkable career. He pioneered the initial efforts of geriatric incontinence by leading the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) efforts on community dwelling elderly as a separate category than institutionalized elderly. He also led the Beaumont Health System to becoming a recognized center for voiding dysfunction, first as the chair of urology and later as the chief medical officer (CMO). Many American and Asian urologists have benefitted from Dr. Diokno’s contributions and for this he deserves continued recognition. Source of Funding: N/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e253 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Refugia More articles by this author Gopal Badlani More articles by this author Expand All Advertisement PDF downloadLoading ...

MP53-13 DOES THE PRESENCE OF PRESSURE "POP-OFFS" IMPACT VOIDING EFFICIENCY AND BLADDER OUTCOMES IN POSTERIOR URETHRAL VALVES?

You have accessJournal of UrologyCME1 Apr 2023MP53-13 DOES THE PRESENCE OF PRESSURE "POP-OFFS" IMPACT VOIDING EFFICIENCY AND BLADDER OUTCOMES IN POSTERIOR URETHRAL VALVES? Adree Khondker, Priyank Yadav, Jin Kyu Kim, Michael Chua, Natasha Brownrigg, Juliane Richter, Joana Dos Santos, Armando Lorenzo, and Mandy Rickard Adree KhondkerAdree Khondker More articles by this author , Priyank YadavPriyank Yadav More articles by this author , Jin Kyu KimJin Kyu Kim More articles by this author , Michael ChuaMichael Chua More articles by this author , Natasha BrownriggNatasha Brownrigg More articles by this author , Juliane RichterJuliane Richter More articles by this author , Joana Dos SantosJoana Dos Santos More articles by this author , Armando LorenzoArmando Lorenzo More articles by this author , and Mandy RickardMandy Rickard More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The protective role of pressure pop-offs, consisting of vesicoureteral reflux (VUR) and ipsilateral kidney dysplasia, in posterior urethral valve (PUV) is controversial. While there has been significant emphasis on exploring the non-significant association between “pop-offs” and kidney function, there is paucity of data on the impact of this mechanism on bladder function. Here, we analyzed this association by examining the role of pressure pop-offs on long-term bladder outcomes in PUV patients. METHODS: A retrospective chart review was conducted for toilet-trained children with PUV managed at our institution between 2000 and 2022, only excluding cases without recorded uroflowmetry studies. Patients were stratified by the presence of pressure pop-offs (high-grade VUR+ipsilateral kidney dysplasia). Outcomes included uroflowmetry parameters and initiation of clean-intermittent catheterization (CIC). Survival analysis was conducted to calculate hazard ratios (HR). RESULTS: We identified a total of 101 patients who met study inclusion criteria, with a median follow-up of 114 months (IQR 67, 169). The median age of first and last uroflowmetry was 57 months (IQR 48, 82) and 120 months (IQR 89, 160), respectively. Patients with pressure pop-offs had similar flow velocity, post-void residuals, and bladder voiding efficiency to other PUV patients at last follow-up uroflowmetry. On survival analysis, patients with pressure pop-offs had no significant difference in risk of requiring CIC compared to patients without pop-offs (HR 1.92, p=0.06). Kidney dysplasia was independently associated with increased risk of CIC (HR 3.16, p=0.02) while VUR was not (HR 1.85, p=0.07). CONCLUSIONS: We show that boys with pressure pop-offs are not at higher risk of poorer voiding and intermittent catheterization than others with PUV. By extension, VURD syndrome does not confer protection against poorer bladder function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e717 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adree Khondker More articles by this author Priyank Yadav More articles by this author Jin Kyu Kim More articles by this author Michael Chua More articles by this author Natasha Brownrigg More articles by this author Juliane Richter More articles by this author Joana Dos Santos More articles by this author Armando Lorenzo More articles by this author Mandy Rickard More articles by this author Expand All Advertisement PDF downloadLoading ...

PD05-12 WHY AUGMENTATION CYSTOPLASTY ALONE (ACA) WORKS IN INTRACTABLE INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME (IC/BPS)?

You have accessJournal of UrologyCME1 Apr 2023PD05-12 WHY AUGMENTATION CYSTOPLASTY ALONE (ACA) WORKS IN INTRACTABLE INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME (IC/BPS)? Nagendra Nath Mishra Nagendra Nath MishraNagendra Nath Mishra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003229.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reconstructive surgery is indicated in patients of intractable IC/BPS as a last resort when all other treatment options have exausted. As per present guidelines surgical options are urinary diversion with or without cystectomy, neobladder with cystectomy and surpatrigonal cystectomy with augmentation cystoplasty. All these surgries have good results but high morbidity.The current belief is that as diseased bladder is not excised in ACA, the symtoms will not improve. The aim of this study is to present our long term results and discuss why ACA is effective? METHODS: From Jan 2012 we have performed ACA in 15 casses of intractable IC/BPS. 2 patients died due to causes unrelated to surgery so data from 13 patients(8 females and 5 males) were analysed and their present condition was assessed on a 7 point GRA scale. Patients with moderate and marked improvement were considered responders. The mean age was 47(23 -61) years at the time of surgery. Average pre surgery maximal bladder capacity(MBC)under anaesthesia was 290 ml(100-600).7 patients had Hunners lesion. Mean followup was 3.38 years and median was 3 years. 11 patients void with minimal residue and 2 patients need clean intermittent catheterisation. RESULTS: 12/13 patients are resoponders in long run with 10 patients being symptomfree and 2 patietns with marked improvement as per GRA. The efficacy of ACA is maintained even in long term with the first patient being symtomfree after 10 years. The results of surgery are not affected by MBC under anaesthesia, presence and absence of hunner's lesion, severity of symptoms and duration of illness. CONCLUSIONS: Detrusor stretch plays a very important role in micturition by mechanical stimulation the bladder tension mechanoreceptors. The normal frequency/volume relationship of afferent nerve firing is modulated by the stretch-dependent release of mediators from the urothelium. Many of these mediators are increased in patients with IC/BPS , which may lower the threshold for initiation of afferent nerve firing or increase the rate of afferent nerve firing in response to bladder filling. Following ACA, there is less tension in the bladder wall at a given bladder volume because a proportion of the bladder consists of more compliant ileum increasing the threshold for afferent nerve firing which improves the symptoms. This proportion of ileum increases as bladder capacity slowly increases post surgery. ACA should be considered as an preferred option in patients of intractable IC/BPS as results are good with minimum morbidity in comparison of other more morbid surgeries. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e154 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nagendra Nath Mishra More articles by this author Expand All Advertisement PDF downloadLoading ...

PD33-10 NON-INVASIVE OPTICAL DETERMINATION OF DETRUSOR PRESSURE RELATED TO DETRUSOR OVERACTIVITY

You have accessJournal of UrologyCME1 Apr 2023PD33-10 NON-INVASIVE OPTICAL DETERMINATION OF DETRUSOR PRESSURE RELATED TO DETRUSOR OVERACTIVITY Lynn Stothers, Andrew Macnab, Naser Hakimi, W. N. J. M. Colier, P. Pourabbassi, and M. Maresse Lynn StothersLynn Stothers More articles by this author , Andrew MacnabAndrew Macnab More articles by this author , Naser HakimiNaser Hakimi More articles by this author , W. N. J. M. ColierW. N. J. M. Colier More articles by this author , P. PourabbassiP. Pourabbassi More articles by this author , and M. MaresseM. Maresse More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003326.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Gold standard urodynamic studies use invasive methods and artificial filling of the bladder to determine detrusor pressure, a critical physiologic measure in determining care for lower urinary tract symptoms (LUTS). The benefits of non-invasive measurement of detrusor pressure (Pdet) include natural filling observations & the potential for a homebased wearable with real time data to determine both self-care and monitoring. Aim: to develop a wearable optical based technology to relate non-invasively measured changes in Pdet during natural filling. METHODS: A 10 x 10 cm optical grid using light emitting diodes (LED’s) (750 nm – 950 nm) was engineered & positioned suprapubically during simultaneous multichannel urodynamics (UDS). LED’s were paired with photodetectors, sampling at 50Hz from long (deep) and short (superficial) channels facilitating optical output compared to variations in Pdet. Output: Arterial pulse waveform changes in chromophore concentration related to variations in detrusor oxygenation (O2Hb), & fluctuations in the absorption of photons at 950nm (H20) related to CMG volume increases. Peak & trough envelopes were computed with Hilbert transformation and a filtered moving average was used mathematically. RESULTS: N=25 (5 controls no LUTS & 20 NLUTD female=N=5 age 64-82 yrs ASIA A, B & D; male=N=15 age 33 – 79 yrs being ASIA A,B,C & D. NLUTD management included: N=4 subjects using clean intermittent catheterization (CIC), 2 condom drainage, 5 using combinations of CIC and spontaneous voiding, 4 spontaneous voiding only. No subjects used anticholinergics, B 3 agonists or prior intra detrusor botulinum toxin. Controls: natural filling and uroflow, no LUTS on IPSS or UGDI, no prior GU surgery, volumes >150cc, repeated filling & emptying for internal consistency measures. CONCLUSIONS: A prototype wearable able to derive a real-time, non-invasive measure reflecting detrusor pressure was successfully prototyped. If further research confirms the ability of an optical parameter derived in this way to mirror variations in detrusor pressure, benefits that would accrue include: more frequent assessment than is possible with invasive UDS, & the ability to monitor changes in pressure continuously in an at risk population (e.g. NLUTD at risk for autonomic dysreflexia). Source of Funding: Craig H Neilsen Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e917 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lynn Stothers More articles by this author Andrew Macnab More articles by this author Naser Hakimi More articles by this author W. N. J. M. Colier More articles by this author P. Pourabbassi More articles by this author M. Maresse More articles by this author Expand All Advertisement PDF downloadLoading ...

MP52-06 CLINICAL AND SOCIODEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH SPINAL CORD INJURY ARE INDEPENDENTLY ASSOCIATED WITH CHOICE OF BLADDER MANAGEMENT METHOD

You have accessJournal of UrologyCME1 Apr 2023MP52-06 CLINICAL AND SOCIODEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH SPINAL CORD INJURY ARE INDEPENDENTLY ASSOCIATED WITH CHOICE OF BLADDER MANAGEMENT METHOD Megan Stout, Juan Peng, Yu-Ying Chen, Huacong Wen, Jan Schwab, and Nima Baradaran Megan StoutMegan Stout More articles by this author , Juan PengJuan Peng More articles by this author , Yu-Ying ChenYu-Ying Chen More articles by this author , Huacong WenHuacong Wen More articles by this author , Jan SchwabJan Schwab More articles by this author , and Nima BaradaranNima Baradaran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical factors are known to impact choice of bladder management method (BMM) in patients with spinal cord injury (SCI) such as injury level, impairment severity, manual dexterity, as well as patient preference. The primary objective of this study was to evaluate the effect of sociodemographic characteristics of patients in this context. METHODS: From the Spinal Cord Injury Model System adult patients (>18 at time of injury) were screened. Exclusion criteria included death within one year of injury and lack of BMM data. Outcomes of interest included age, gender, race, education, marital status, household income, employment status, health insurance type, injury level, injury etiology, ventilatory status, neurological impairment category (quadriplegic vs paraplegic), composite poverty scale, and American Spine Injury Association (ASIA) impairment scale. Logistic regression models and multivariate analysis was used to determine associations between sociodemographic factors and use of indwelling catheters as primary choice of BMM. RESULTS: A total of 12,708 patients were screened and 9,097 were included. Majority of patients were male (79.4%), white (71.2%), had an average annual income of <$25,000 (33.3%) and public insurance (68.5%). Most were tetraplegic (47.3%) with ASIA score of “A” (complete impairment, 57.5%).The BMM breakdown was those that used indwelling catheters (34.4%) versus those with “other” methods (intermittent catheterization, external catheters, or urinary diversion; 65.6%). On multivariate analysis, after adjusting for disease characteristics, men were significantly more likely to be impacted by sociodemographic factors. In men, white race, non-Hispanic ethnicity, having public insurance, lower income, higher impairment severity, older age at injury and longer injury duration was associated with higher use of indwelling catheters (Figure 1). In females, only age at injury and neurologic impairment were significant. CONCLUSIONS: Sociodemographic variables are significantly associated with the choice of BMM in men with SCI. The reason for the discrepancy between genders is unknown. Further analysis utilizing this database to discern BMM choice between groups could guide future patient counseling and optimization of care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e704 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Megan Stout More articles by this author Juan Peng More articles by this author Yu-Ying Chen More articles by this author Huacong Wen More articles by this author Jan Schwab More articles by this author Nima Baradaran More articles by this author Expand All Advertisement PDF downloadLoading ...

MP74-14 SUPRAPUBIC CATHETER DRAINAGE FOR THE LONG-TERM MANAGEMENT OF LOWER URINARY TRACT DYSFUNCTION: LONGITUDINAL OUTCOMES AND UTILIZATION PATTERNS FROM A TERTIARY CARE PRACTICE

You have accessJournal of UrologyCME1 Apr 2023MP74-14 SUPRAPUBIC CATHETER DRAINAGE FOR THE LONG-TERM MANAGEMENT OF LOWER URINARY TRACT DYSFUNCTION: LONGITUDINAL OUTCOMES AND UTILIZATION PATTERNS FROM A TERTIARY CARE PRACTICE Faizan Khawaja, Kevin Flynn, Mei Tuong, Charles Schlaepfer, Andrew Metzger, and Bradley Erickson Faizan KhawajaFaizan Khawaja More articles by this author , Kevin FlynnKevin Flynn More articles by this author , Mei TuongMei Tuong More articles by this author , Charles SchlaepferCharles Schlaepfer More articles by this author , Andrew MetzgerAndrew Metzger More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Suprapubic catheters (SPC) are considered to be a temporary, and often emergent, means to drain urine from the bladder. However, many individuals are managed with SPCs for longer periods of time, often because of patient choice. Our objective is to describe this population and report on the long-term outcomes of chronic SPC use for lower urinary tract dysfunction (LUTD). METHODS: An institutional review of CPT and ICD-9/10CM codes was conducted to identify a cohort of patients in which an SPC was placed at our institution over an 8-year period. Patients were then excluded if the SPC was placed emergently for lower urinary tract trauma (e.g. pelvic fracture) or for a pre-determined time-period. The final cohort was then analyzed for peri-operative and long-term complications, and for SPC survivability. RESULTS: Of 370 SPC placed from 2014-21, 190 met inclusion criteria (131 Male; 59 Female). Indications for SPC were most commonly Acquired Neurogenic Bladder (40%), Urinary Retention/Atonic Bladder (27%), Urinary Incontinence (11%) and Congenital Neurogenic Bladder (8%). Bladder management prior to SPC was indwelling urethral catheter (53%), intermittent catheterization (32%) and none (15%). There were no Clavian Grade III/IV complications with placement. Initial clinic SPC exchange was successful in 98% (4 required repeat tract dilation). Subsequent exchanges occurred in urology clinics (54%), care facilities (23%), interventional radiology (12%) and at home by patient (11%) at a median interval of 3.5 weeks. >30 day complications were common (51%), but all Clavian Grade I/II (UTI 27%, bladder spasms 13%). At median follow-up of 431 days, 74% continued to use their SPC (Figure 1), of which 53 (38%) perform daily irrigation. CONCLUSIONS: SPC is a commonly used, well-tolerated, poorly studied means of chronic bladder drainage for a wide-variety of LUTD in patients not suitable or willing to undergo surgical reconstruction. Considered to be a management method of last resort, its popularity amongst patients nonetheless suggests its use should be studied in further detail. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1075 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Faizan Khawaja More articles by this author Kevin Flynn More articles by this author Mei Tuong More articles by this author Charles Schlaepfer More articles by this author Andrew Metzger More articles by this author Bradley Erickson More articles by this author Expand All Advertisement PDF downloadLoading ...

MP46-20 EVALUATION OF URODYNAMIC OUTCOMES AND INCONTINENCE SPECIFIC HEART-RELATED QUALITY OF LIFE IN PATIENTS TREATED WITH ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL Y-MODIFIED NEOBLADDER THE BORDEAUX NEOBLADDER

You have accessJournal of UrologyCME1 Apr 2023MP46-20 EVALUATION OF URODYNAMIC OUTCOMES AND INCONTINENCE SPECIFIC HEART-RELATED QUALITY OF LIFE IN PATIENTS TREATED WITH ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL Y-MODIFIED NEOBLADDER THE BORDEAUX NEOBLADDER Erika Palagonia, Benedetta Bianchi, Marilena Gubbiotti, Valentina Giommoni, Anastasios D. Asimakopoulos, Saba Khorrami, Michele De Angelis, Richard Gaston, and Filippo Annino Erika PalagoniaErika Palagonia More articles by this author , Benedetta BianchiBenedetta Bianchi More articles by this author , Marilena GubbiottiMarilena Gubbiotti More articles by this author , Valentina GiommoniValentina Giommoni More articles by this author , Anastasios D. AsimakopoulosAnastasios D. Asimakopoulos More articles by this author , Saba KhorramiSaba Khorrami More articles by this author , Michele De AngelisMichele De Angelis More articles by this author , Richard GastonRichard Gaston More articles by this author , and Filippo AnninoFilippo Annino More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To present the urodynamic features of our intracorporeal Y-modified neobladder Bordeaux Neobladder and the incontinence specific health-related quality-of-life (HRQoL) outcomes. METHODS: We performed a prospective evaluation of a series of 26 patients who underwent robot-assisted radical cystectomy with intracorporeal Y-modified orthotropic neobladder reconstruction called the Bordeaux Neobladder, between September 2018 and November 2020 in a high-volume referral center, operated by the same surgeon. All the patients were managed following a modified ERAS protocol. Three months and 1 year after surgery, consenting patients underwent clinical evaluation and multichannel urodynamics. The incontinence quality of life (I-QoL) questionnaire was used to evaluate HRQoL. Continence was classified into day-time and night-time and clinically defined as the use of zero pads. RESULTS: The mean age at surgery was 65.4 years. The mean follow-up was 27 months. Regarding the operative time, the mean time for proximal bladder reconstruction was 192 minutes. Urodynamic outcomes data were collected in 17/23 patients for early evaluation and in 13 patients for early and dilated testing. 2/17 patients had I-II grade of hydronephrosis on the left kidney. No cases of hyperchloremic acidosis were identified in the blood gas analysis. The continence rate was 58.8% (10/17) for the day and 23.5% (4/17) for the night and the mean postoperative of the quality-of-life score was 103.3. The mean maximum bladder capacity was 430 cc (range 200-553) ant the average compliance was 33.1 ml/cm h2o. The mean post-voiding residue was 100 ml (0-310). The first sensation of bladder fullness was perceived at an average volume of 337 cm³. The mean max flow at 3 months was 15 ml/s and at 1 year was 18 ml/s. The rate of clean intermittent self catheterization was 17,6%. We did not observe significant changes in urodynamic outcomes during follow-up. Concerning the parameters of the storage phase, there was only a significant reduction in the volume of the first sensation of bladder fullness. CONCLUSIONS: The initial analysis of both invasive and non-invasive urodynamic parameters shows that the Bordeaux Neobladder has adequate functional characteristics in terms of capacity, post-voiding, residual and compliance. It is associated with a reduced chance of upper urinary tract abnormalities and metabolic complications that improve quality of life. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e641 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erika Palagonia More articles by this author Benedetta Bianchi More articles by this author Marilena Gubbiotti More articles by this author Valentina Giommoni More articles by this author Anastasios D. Asimakopoulos More articles by this author Saba Khorrami More articles by this author Michele De Angelis More articles by this author Richard Gaston More articles by this author Filippo Annino More articles by this author Expand All Advertisement PDF downloadLoading ...

V07-09 URETHRAL PSEUDOANEURYSM CAUSING UNCONTROLLED URETHRORRHAGIA

You have accessJournal of UrologyCME1 Apr 2023V07-09 URETHRAL PSEUDOANEURYSM CAUSING UNCONTROLLED URETHRORRHAGIA Fábio Franco de Oliveira, André Canettieri Rubez, João Marcos Ibrahim de Oliveira, Caio de Oliveira, Natalia Dalsanter Avilez, Jefferson Douglas Camargos Moreira, Gabriel Chahade Sibanto Simões, Ivan Borin Selegatto, Bruno Ricardo Di Domenico, Arthur Degani Ottoiano, Lucas Mira Gon, and Cássio Luís Zanettini Riccetto Fábio Franco de OliveiraFábio Franco de Oliveira More articles by this author , André Canettieri RubezAndré Canettieri Rubez More articles by this author , João Marcos Ibrahim de OliveiraJoão Marcos Ibrahim de Oliveira More articles by this author , Caio de OliveiraCaio de Oliveira More articles by this author , Natalia Dalsanter AvilezNatalia Dalsanter Avilez More articles by this author , Jefferson Douglas Camargos MoreiraJefferson Douglas Camargos Moreira More articles by this author , Gabriel Chahade Sibanto SimõesGabriel Chahade Sibanto Simões More articles by this author , Ivan Borin SelegattoIvan Borin Selegatto More articles by this author , Bruno Ricardo Di DomenicoBruno Ricardo Di Domenico More articles by this author , Arthur Degani OttoianoArthur Degani Ottoiano More articles by this author , Lucas Mira GonLucas Mira Gon More articles by this author , and Cássio Luís Zanettini RiccettoCássio Luís Zanettini Riccetto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral pseudoaneurysm is a rare condition, the few case reports available relate its occurrence to pelvic trauma and related to the chronic use of a urinary catheter, in which the prolonged contact of the device to the mucosa, leads to necrosis and subsequent vascular injury. This condition usually manifests as persistent urethral bleeding, the presentation of uncontrollable urethrorrhagia is even rarer. Transurethral coagulation and superselective embolization are possible options to treat these patients, but the best management option is still not well established. The objective of this video is to present an effective treatment for urethral pseudoaneurysm in a patient undergoing chronic use of an indwelling urinary catheter (IUC). METHODS: A 37-year-old male with a neurogenic lower urinary tract dysfunction after spinal cord injury 5 years ago, using an IUC since the accident and no follow-up with urology. He was referred to the emergency after an episode of profuse urethral bleeding. It started after the routine catheter replacement. On clinical examination, there was gross hematuria in the collection bag. At first, we managed him conservatively with intravenous fluids and tranexamic acid injections, bed rest, and perineal compression dressing, but no sustained response was obtained. Transfusion of 4 red blood cell concentrates was required. We referred the patient to the operating room for flexible urethroscopy, which showed a friable hyperemic nodular lesion on the right lateral wall of the bulbar urethra. Magnetic resonance imaging (MRI) was performed considering the possibility of neoplastic injury and identified a hypervascularized polypoid lesion compatible with a pseudoaneurysm. Due to persistent bleeding, the patient was referred for arteriography, which visualized arterial blush arising from the transition between the internal pudendal artery and the bulbourethral artery. Selective embolization of the internal pudendal artery was performed with micro coils and cyanoacrylate successfully. RESULTS: There was a sustained improvement in bleeding after the procedure. The patient was discharged after 24 hours of observation, the IUC was removed in seven days and the patient started clean intermittent catheterization. On our follow-up for more than two months with no fresh bleeding. CONCLUSIONS: In the case of a pseudoaneurysm of the internal pudendal artery causing urethrorrhagia, endovascular embolization is an effective method to control the bleeding if conservative management fails. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e598 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fábio Franco de Oliveira More articles by this author André Canettieri Rubez More articles by this author João Marcos Ibrahim de Oliveira More articles by this author Caio de Oliveira More articles by this author Natalia Dalsanter Avilez More articles by this author Jefferson Douglas Camargos Moreira More articles by this author Gabriel Chahade Sibanto Simões More articles by this author Ivan Borin Selegatto More articles by this author Bruno Ricardo Di Domenico More articles by this author Arthur Degani Ottoiano More articles by this author Lucas Mira Gon More articles by this author Cássio Luís Zanettini Riccetto More articles by this author Expand All Advertisement PDF downloadLoading ...

MP52-09 PUDENDAL NEUROMODULATION IN SPINA BIFIDA PATIENTS WITH NEUROGENIC BLADDER AND BOWEL DYSFUNCTION

You have accessJournal of UrologyCME1 Apr 2023MP52-09 PUDENDAL NEUROMODULATION IN SPINA BIFIDA PATIENTS WITH NEUROGENIC BLADDER AND BOWEL DYSFUNCTION Hailey Eisner, Bernadette Zwaans, Priya Padmanabhan, and Kenneth Peters Hailey EisnerHailey Eisner More articles by this author , Bernadette ZwaansBernadette Zwaans More articles by this author , Priya PadmanabhanPriya Padmanabhan More articles by this author , and Kenneth PetersKenneth Peters More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Spina bifida is a congenital defect resulting in incomplete closure of the neural tube in the sacrum. It is the primary cause of congenital urinary dysfunction with symptoms ranging from frequency, urgency and urge incontinence to urinary retention. Patients often have concomitant bowel dysfunction with both constipation and fecal incontinence resulting in a significantly decreased quality of life. Because of the resulting sacrococcygeal deformity typical techniques for placement of a tined lead at the S3 foramen are ineffective. Neuromodulation has long been used to treat bladder and bowel dysfunction and evidence suggests that pudendal neuromodulation has a role in the treatment of symptoms secondary to spinal pathology. Our objective was to assess the effectiveness of pudendal neuromodulation in treating bowel and lower urinary tract symptoms (LUTS) in spina bifida. METHODS: We investigated the effect of pudendal nerve stimulation on LUTS and bowel symptoms in four spina bifida patients. All four patients failed behavioral modification and anticholinergics. They underwent staged neuromodulation with placement of a tined lead at the pudendal nerve for the treatment of refractory LUTS and bowel symptoms. Relevant medical history, physical exams, symptoms prior to treatment and symptom improvement were assessed. RESULTS: One male and three female patients with a mean age of 45.8 years (39-53) were included in the study. Mean follow-up was 68 months (43-83). All three females had urgency, frequency, urge incontinence and fecal incontinence at baseline. At the most recent follow-up, all have maintained a clinical improvement of more than 50% for all symptoms compared with baseline. The male patient, with urinary retention prior to treatment, reported improved bladder sensation yet did not have improvement in intermittent catheterization volumes. CONCLUSIONS: A 2022 SUFU white paper described the potential risk of dementia in anticholinergic dependent spina bifida patients. The 2021 AUA/SUFU guidelines recommended against sacral neuromodulation in this population due to sacral deformities. Pudendal neuromodulation is a promising treatment for patients with both bowel and bladder symptoms secondary to spina bifida. More research is needed to elucidate this potential and will help to expand the indications for pudendal neuromodulation and neuromodulation in potential alternative locations. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e706 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hailey Eisner More articles by this author Bernadette Zwaans More articles by this author Priya Padmanabhan More articles by this author Kenneth Peters More articles by this author Expand All Advertisement PDF downloadLoading ...

PD23-06 FELINE AMBULATORY BLADDER PRESSURE AND VOLUME TRANSMITTED BY A CATHETER-FREE WIRELESS INTRAVESICAL MONITOR

You have accessJournal of UrologyCME1 Apr 2023PD23-06 FELINE AMBULATORY BLADDER PRESSURE AND VOLUME TRANSMITTED BY A CATHETER-FREE WIRELESS INTRAVESICAL MONITOR Steve Majerus, Brett Hanzlicek, Dario Cabal, Mohamed Elazab, Margot Damaser, and Dennis Bourbeau Steve MajerusSteve Majerus More articles by this author , Brett HanzlicekBrett Hanzlicek More articles by this author , Dario CabalDario Cabal More articles by this author , Mohamed ElazabMohamed Elazab More articles by this author , Margot DamaserMargot Damaser More articles by this author , and Dennis BourbeauDennis Bourbeau More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003296.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As with clinical urodynamics, investigations into lower urinary tract physiology using animal models require catheter-based systems to measure bladder pressure while filling the bladder, often under anesthesia. However, anesthesia, and rapid catheter filling of the bladder can affect filling pressures, urinary leakage and voiding reflexes. To enable recordings representative of normal physiology, we developed a catheter-free, wireless, intravesical sensor which is implanted in the feline bladder lumen and wirelessly transmits bladder pressure and volume data. We validated sensor function by recording volume and pressure over 4-week implantations in felines. METHODS: The Urological Monitor of Conscious Activity (UroMOCA) measured 18×12×5.6mm and transmitted data to a radio placed worn by the animal. The UroMOCA battery was recharged wirelessly via a charging mat placed under the subject. Platinum electrodes measuring urine concentration and conductance estimated urine volume and were paired with an onboard pressure sensor. Under anesthesia, a UroMOCA was implanted into the bladder lumen via cystotomy in male felines. Baseline cystometry was performed. Anesthetized cystometry with UroMOCA recording and imaging were repeated 2 and 4 weeks post-implantation. Ambulatory recordings of up to two hours were performed multiple times during the four weeks prior to device explantation. Sham surgeries and sham devices were implanted in some animals to assess the impact of the UroMOCA on the bladder. Bladder tissue was saved for histology. RESULTS: Ten feline cats were enrolled: 3 were sham implants (no device), 1 received an inactive device, and 6 received a functional UroMOCA. Non-anesthetized recordings were performed for more than 73 hours over 33 ambulatory data collection sessions. After 2 weeks, all animals resumed normal voiding volume. Urinary retention requiring intermittent catheterization was seen in 1 feline; there was no evidence of obstruction. Wireless pressure data linearly correlated with anesthetized cystometry (R2=0.96). Volume measurement was variable but decreased during voiding and increased during filling. Histology showed normal bladder tissue. CONCLUSIONS: A small, wireless, catheter-free, intravesical sensor enabled conscious recordings of bladder function in felines during natural bladder filling over 4 weeks. The volume sensor enabled detection of bladder filling and emptying phases. Source of Funding: This work was funded by the NIH Stimulating Peripheral Activity to Relieve Conditions (SPARC) program, NIH grant number OT2OD023873 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e672 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steve Majerus More articles by this author Brett Hanzlicek More articles by this author Dario Cabal More articles by this author Mohamed Elazab More articles by this author Margot Damaser More articles by this author Dennis Bourbeau More articles by this author Expand All Advertisement PDF downloadLoading ...

Periprocedural antibiotics for urodynamic studies of pediatric neurogenic bladder, empiric or culture-guided? A retrospective cohort study

Urodynamic studies are fundamental in the care of children with neurogenic bladder. Children with neurogenic bladder who perform clean intermittent catheterization (CIC) are considered a high-risk group for infection after urodynamic studies. Current guidelines are not uniform regarding the duration, type, the need of prophylactic antibiotic treatment or performance of urine culture before urodynamic studies. To assess whether antibiotic prophylactic therapy before urodynamic studies should be empiric or culture-guided in children with neurogenic bladder who perform CIC. Urine samples were collected from children with neurogenic bladder who require CIC before undergoing a urodynamic study. Urine cultures were collected via sterile urethral catheterization one week before urodynamic studies between 2010 and 2018. Children with signs of urinary tract infection (UTI) or children with bladder augmentation were excluded. Resistance to commonly prescribed periprocedural antibiotic treatments was documented. The probability of antibiotic resistance according to sex, vesicoureteral reflux (VUR) status, consumption of prophylactic antibiotics, and self/caregiver performed CIC was determined by a χ2-test. A total of 278 urine cultures were collected from 185 children with neurogenic bladder. The median age was 8 years (IQR 5-12). The most common etiology for neurogenic bladder was spinal dysraphism (n=146, 77%). Bacterial growth was detected in 216 (78%) cultures, and the most commonly detected bacterial species was Escherichia. coli (n=155, 72%). Thirty-six (19%) children had VUR, and 14 of them received continuous prophylactic antibiotics. The probability of resistance to oral antibiotics was amoxicillin (22%), cephalexin (21%), cefuroxime (14%), ciprofloxacin (10%), nitrofurantoin (21%), and sulfamethoxazole/trimethoprim (SMX/TMP) (23%) (See "summary table") No significant differences were found by χ2-test in the probability of resistance to antibiotics according to sex, VUR status, continuous antibiotic prophylaxis or self/caregiver performed CIC. The study reveals high resistance level to commonly prescribed oral antibiotic treatments (20-30%). Several studies have challenged the need of routine urine cultures before urodynamic studies due to low risk of post-procedural infection. However, it should be mentioned that not all the patients participating in those studies were with neurogenic bladder or routinely performed CIC. Hence, in this specific group of children, routine urine cultures should not be abandoned. The limitations of the study are: Single-center, retrospective study with no data availability regarding the development of UTI after the urodynamic studies. Urine cultures of children with neurogenic bladder who require CIC demonstrate significant levels of resistance to commonly prescribed oral antibiotics. These findings support culture-guided periprocedural antibiotic prophylaxis.

Intermittent catheterization: A patient-centric approach is key to optimal management of neurogenic lower urinary tract dysfunction

The value of disposable, single-use catheters has come under scrutiny in recent years with a growing attention on environmental sustainability. Intermittent catheterization (IC) is a widely available and minimally invasive technique for management of lower urinary tract dysfunction. Effective IC for individuals with neurogenic lower urinary tract dysfunction can promote their independence and improve quality of life. Are there alternative options within IC that could minimize environmental impact without compromising the safety and effectiveness of single-use catheters? How does the future of IC look – environmentally friendly, biodegradable, disposable catheters may be complementary to certified reusable catheters? In the midst of this debate, it is important to emphasize that individuals have the right to choose the best evidence-based treatment available. Here we consider the current landscape for IC with a focus on chronic use in individuals with neurogenic lower urinary tract dysfunction.

Complications of different methods of urological management in people with neurogenic bladder secondary to spinal cord injury

Objective To investigate the association between multiple types of urological management and urological complications in patients with spinal cord injury (SCI). Design A retrospective cohort study. Setting Single medical center. Methods Medical records of SCI patients with regular follow-up of more than two years were reviewed. Urological management was classified into five groups: indwelling urethral catheter (IUC), clean intermittent catheterization (CIC), reflex voiding, suprapubic catheter (SPC), and self-voiding. We analyzed the incidence of urinary tract infection (UTI), epididymitis, hydronephrosis, and renal stone across the different urological-management groups. Results Of 207 individuals with SCI, the most common management type was self-voiding (n = 65, 31%) followed by CIC (n = 47, 23%). The IUC and SPC groups included more people with complete SCI than the other management groups. Compared with the IUC group, the SPC and self-voiding groups had lower risks of developing UTI (relative risk [RR] = 0.76, 95% CI, 0.59-0.97 and RR = 0.39, 95% CI, 0.28-0.55, respectively). The SPC group tended to have a lower risk of epididymitis than the IUC group (RR = 0.55, 95% CI, 0.18-1.63). Conclusion Long-term IUC use was associated with a higher incidence of UTI in people with SCI. As compared to those with IUC, a lower risk of UTI was found in persons with SPC. These findings may have implications for shared clinical decision-making.

Проблемні питання стану здоров’я дітей зі spina bifida в Україні

Spina bifida is one of the most common congenital neural tube defects, which leads to dysfunction of many organs and systems and to disability. Purpose - to conduct a comprehensive analysis of the health status of children with spina bifida and hydrocephalus in Ukraine based on questionnaires of parents and their children, study of medical documentation and online counseling to improve the multidisciplinary support to children of this group. Materials and methods. A program of multidisciplinary online support for children with spina bifida in Ukraine was launched in June 2022 at the initiative of the patient organization «Association of parents of children with spina bifida and hydrocephalus «Lights of Spirit» and with the support of the international organization «Child Help». At the first stage, parents of children with spina bifida filled out a questionnaire to participate in the project, where demographic data and data on the child’s health were indicated. A total of 149 children with spina participated in the project. Girls predominated among the children (63.1%). The age of the patients ranged from 1 month to 24 years. At the next stages, online counseling was conducted with the participation of doctors of the multidisciplinary team and the head of the «Light of Spirit» NGO. Results. Impaired motor function was observed in 87.2% of children with spina bifida. Only 32.9% of children could walk independently, 14.1% needed outside help or aids, and 42.3% used a wheelchair or wheelchair to get around. Orthopaedic pathology was observed in 75.2% of patients, and hydrocephalus in 65.8% of children. A neurogenic bladder was noted in 79.9% of patients at the time of the questionnaire, and urinary tract infections (UTIs) in 77.9%. Clean intermittent catheterization was regularly performed in only 51.7% of patients. The study showed that early initiation of catheterisation was associated with a lower incidence of UTIs. Constipation was observed in 81.9% of children, faecal micturition and/or faecal incontinence in 58.4% of children. Bowel cleansing was performed in 49.7% of patients, and only 26.8% regularly. Skin damage (wounds and bedsores) was observed in 12.8% of children, and allergic manifestations in 21.8% of patients. Only 15% of children were immunized in accordance with the national vaccination schedule, and 70% of children were not vaccinated at all. Body weight disorders were observed in 43% of children, most often overweight/obesity (32.2%). Conclusions. A comprehensive analysis of the health status of children with spina bifida and hydrocephalus in Ukraine made it possible to outline a number of problems of children with this pathology, which affect quality of life and require a multidisciplinary approach to treatment and rehabilitation. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Does VURD syndrome impact voiding efficiency in posterior urethral valves?

There is debate regarding the effect of VURD syndrome, consisting of vesicoureteral reflux (VUR) and ipsilateral kidney dysplasia, on long-term outcomes in boys with posterior urethral valve (PUV). Here, we assessed whether VURD syndrome played a "protective" role on long-term bladder outcomes and voiding efficiency in boys with PUV. A retrospective chart review was conducted for toilet-trained children with PUV managed at our institution between 2000 and 2022, only excluding cases without recorded uroflowmetry studies. Patients were stratified by VUR status and by the presence of VURD syndrome (high-grade VUR+ipsilateral kidney dysplasia). Outcomes included initial and final uroflowmetry parameters, and initiation of clean-intermittent catheterization (CIC). We identified a total of 101 patients who met study inclusion criteria, with an overall median follow-up of 114 months (IQR 67, 169). The median age of first and last uroflowmetry was 57 months (IQR 48, 82) and 120 months (IQR 89, 160), respectively. Patients with VURD syndrome had similar flow velocity, post-void residuals, and bladder voiding efficiency to other PUV patients at last follow-up uroflowmetry. On survival analysis, patients with VURD syndrome had no significant difference in risk of requiring CIC compared to patients without pop-offs (p=0.06). Like more contemporary studies on pressure pop-offs, we show that this population is not at higher risk of poorer voiding and intermittent catheterization than others. VURD syndrome does not confer protection against poorer bladder function. Instead, our study suggests an independent association between kidney dysplasia and bladder outcomes which requires further attention. Among boys with PUV, VURD syndrome was not associated with significantly different uroflowmetry findings or rates of CIC by last follow-up.

Minimally invasive techniques of urethral stricture treatment and their use in patients of pediatric age (literature review)

Urethralstricture remains one of the most discussed problemsin pediatric urology. Despite a significant number of articles and the existence of a wide variety of methods for treating urethral strictures and their modifications, every new generation of urologists encounters this problem.Treatment of urethralstricture often takes a long time and requires multiple surgical interventions. Treatment techniques continuously improve, therefore it is appropriate to regularly summarize new data. Such methods as bougienage, balloon dilation and urethralstenting are still being used, although as early asin the beginning of the 19th century the first types of such modern method as optical internal urethrotomy were developed. In relation to optical internal urethrotomy, discussions on indications, techniques, duration of catheterization, necessity of combination with intermittent catheterization, use of hormonal drugs continue. The question of the number of attempts to perform urethrotomy also remains controversial.In this review, we tried to clarify the problem of use of minimally invasive techniques for urethral stricture treatment in children in the context of current scientific data and historical aspects.

A cost-effectiveness analysis of bladder management strategies in neurogenic lower urinary tract dysfunction after spinal cord injury: A publicly funded health care perspective.

Economic evaluation study. To investigate the long-term cost-effectiveness of clean intermittent catheterization (CIC) compared with suprapubic catheters (SPC) and indwelling urethral catheters (UC) among individuals with neurogenic lower urinary tract dysfunction (NLUTD) related to spinal cord injury (SCI) from a public healthcare perspective. University affiliated hospital in Montreal, Canada. A Markov model with Monte Carlo simulation was developed with a cycle length of 1 year and lifetime horizon to estimate the incremental cost per quality-adjusted life years (QALYs). Participants were assigned to treatment with either CIC or SPC or UC. Transition probabilities, efficacy data, and utility values were derived from literature and expert opinion. Costs were obtained from provincial health system and hospital data in Canadian Dollars. The primary outcome was cost per QALY. Probabilistic and one-way deterministic sensitivity analyses were performed. CIC had a lifetime mean total cost of $ 29,161 for 20.91 QALYs. The model predicted that a 40-year-old person with SCI would gain an additional 1.77 QALYs and 1.72 discounted life-years gained if CIC were utilized instead of SPC at an incremental cost savings of $330. CIC confer 1.96 QALYs and 3 discounted life-years gained compared to UC with an incremental cost savings of $2496. A limitation of our analysis is the lack of direct long-term comparisons between different catheter modalities. CIC appears to be a dominant and more economically attractive bladder management strategy for NLUTD compared with SPC and/or UC from the public payer perspective over a lifetime horizon.

Time trade-off study to establish utility decrements in individuals with a spinal cord injury who perform intermittent catheterization

AimsTo generate utility decrements for three attributes associated with catheterization for individuals with a spinal cord injury (SCI): the process of catheterization, the physical impact of urinary tract infections (UTIs) and worry associated with hospitalization.Materials and methodsHealth state vignettes comprising various levels of the three attributes were developed. Two cohorts of respondents, corresponding to people with SCIs and a sample broadly representative of the UK population, were presented with nine vignettes (three vignettes for the mild, moderate and severe health states in addition to a random set of six vignettes). It was assumed no or a nominal decrement was associated with the mild health state. Utility decrements were derived from analysing the data obtained from the online time trade-off (TTO). A proportion of the SCI cohort (n = 57) also completed the EQ-5D-5L questionnaire.ResultsUtility decrements were generated using statistical models for the general population (n = 358), the SCI population (n = 48) and the two populations combined (merged model, n = 406). Results from the two cohorts showed minimal differences. For the merged model, SCI status was not statistically significant. All interaction terms, excluding SCI and the severe level of the physical attribute, were not statistically significant. Compared to the mild level, the greatest utility decrement calculated was the severe level of the emotional (worry) attribute (0.09, p < .001) for the SCI population. A significant decrement of 0.02 (p < .001) was calculated for the moderate level of the emotional attribute for all models. The mean utility score for those with SCI having completed the EQ-5D-5L was 0.371.LimitationsModest sample size of respondents from the SCI population (n = 48).ConclusionsWorry associated with hospitalization had the greatest impact on patients’ health-related quality of life (HRQoL). The catheterization process, such as the lubrication and repositioning of the catheter, also impacted on patients’ HRQoL.

The Efficacy of Transvaginal Ultrasound-Guided BoNT-A External Sphincter Injection in Female Patients with Underactive Bladder.

Owing to the diverse treatment outcomes after a botulinum toxin A (BoNT-A) injection to the external sphincter, this study aimed to develop a new technique: an ultrasound-guided BoNT-A external sphincter injection. This single-center prospective cohort study was conducted at a tertiary medical center in Taichung, Taiwan. From December 2020 to September 2022, 12 women were enrolled. The patients were evaluated for lower urinary tract syndrome using patient perception of bladder condition (PPBC), international prostate symptom score (IPSS), uroflowmetry, post-void residual volume (PVR), cystometry, and external sphincter electromyography. We evaluated the patients the day before surgery and 1 week after the BoNT-A injection. For the patients requiring self-catheterization, we recorded the number of times they required clean intermittent catheterization (CIC) per day before the procedure and 1 month after the procedure. The IPSS, PPBC, and PVR were significantly better after the transvaginal ultrasound-guided BoNT-A external sphincter injection. The number of times the patients required daily CIC was also reduced after the injection. Only one patient developed de novo urge urinary incontinence. Our results demonstrated that a transvaginal ultrasound-guided BoNT-A injection was efficacious and safe in the treatment of underactive bladder.