Irritative Lower Urinary Tract Symptoms Research Articles

Use of radiofrequency ablation of the vaginal canal for genitourinary syndrome of menopause.

Genitourinary syndrome of menopause (GSM) is a prevalent condition with a constellation of symptoms including burning, dryness, dyspareunia, and irritative lower urinary tract symptoms that result from vulvovaginal atrophic changes. Though hormonal therapy is a mainstay of treatment in GSM, some patients may pursue nonhormonal therapies. To determine the efficacy of radiofrequency ablation of the vaginal canal with the MorpheusV applicator in reducing the symptoms of GSM. We conducted a multicenter prospective case series of women with GSM as confirmed by Vaginal Health Index Score (VHIS). Subjects received 3 treatments of radiofrequency ablation ~4weeks apart with follow-up to 6-month posttreatment. The primary endpoint was VHIS at 6-month posttreatment. Secondary endpoints were VHIS at 3 months, Visual analog scale (VAS) pain with each treatment, 3- and 6-month measurements of urogenital distress inventory-6 (UDI-6), and female sexual function index (FSFI) questionnaires. From 2021 to 2023, 71 women were enrolled in the study with 51 followed to the 6-month follow-up time point. Treatments were found to be low in VAS pain score with mean values of 2.13 ± 2.1, 2.55 ± 2.38, and 2.18 ± 2.14 at treatments 1, 2, and 3 respectively. An improvement in VHIS score was seen from baseline to 3 months after the last treatment (15.00 ± 5.37 vs. 19.62 ± 4.44) and sustained at 6 months (20.23 ± 4.12) (P < .001). Significant improvements in both UDI-6 and FSFI were also noted. Between baseline and 6 months after treatment (FSFI: 18.81 ± 9.57 vs. 22.81 ± 10.34, P < 0.001; UDI-6: 39.58 ± 15.98 vs. 22.42 ± 14.03, P < 0.001). No adverse events were encountered by any subject during this study. A therapy that is safe and effective in the treatment of both GSM and lower urinary tract symptoms without the use of hormonal methods is clinically impactful for the many patients who cannot receive or do not desire to receive these medications. Strengths of this study include the utilization of 3 treatment sessions, with follow-up of subjects to 6-month posttreatment with a comprehensive assessment of patient symptoms. Limitations include the unblinded nature of the study and the lack of a comparator group. The data from this study suggests that radiofrequency ablation of the vaginal canal by the MorpheusV applicator is a safe and effective intervention for GSM. It also shows subjective improvements in stress urinary incontinence, urge urinary incontinence, and sexual function.

A Rare Cause of Macroscopic Hematuria: Ureteral Fibroepithelial Polyp: A Case Report

Fibroepithelial polyps are rare, benign, non-epithelial tumors of the urinary system. They can occur throughout the entire urinary system, including the renal pelvis, ureter, bladder, and urethra, which are lined with urothelium. These polyps originate from the stromal structure, formed by the combination of mesodermal and urothelial cells. The most common clinical complaint of patients with fibroepithelial polyps is unilateral flank pain. In some cases, this pain may be accompanied by hematuria, dysuria, and pollakiuria, which are irritative lower urinary tract symptoms. In this case report, a case of a giant ureteral fibroepithelial polyp in a patient who was admitted to our clinic with macroscopic hematuria and left flank pain was presented. Following the diagnosis of a giant polyp in the left ureter, we treated the patient with endoscopic ablation using a Holmium-YAG laser device under ureteroscopy guidance.

A Comparative Analysis of Mirabegron versus Tolterodine for the Management of Irritative Symptoms Caused by Ureteral Stents

Background: The use of ureteral stents is a common practice in the management of urinary tract obstruction. However, the presence of a stent often leads to irritative lower urinary tract symptoms (LUTS), significantly impacting the patient's quality of life. Traditional management with anticholinergics is limited by side effects, whereas beta 3 agonists like Mirabegron offer a potentially more tolerable alternative. Objective: To compare the efficacy and tolerability of Mirabegron versus Tolterodine in the management of irritative symptoms associated with ureteral stents. Methods: This prospective randomized controlled trial was conducted at the Department of Urology and Renal Transplant, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, from January 2019 to August 2020. A total of 104 patients who had undergone ureteral stent placement were randomized into two groups: Mirabegron (52 patients) and Tolterodine (52 patients). Inclusion criteria included individuals aged 18 years or older without prior LUTS history. The primary outcome measured was the change in the International Prostate Symptom Score (IPSS) Irritative score from baseline to post-treatment. Data analysis was conducted using SPSS version 25, with paired and unpaired t-tests for within and between-group comparisons, respectively. Results: The mean age in the Mirabegron group was 29.44 ± 6.25 years, and 28.23 ± 5.97 years in the Tolterodine group. Pre-treatment IPSS Irritative scores were 9.19 ± 3.72 for Mirabegron and 9.88 ± 3.5 for Tolterodine. Post-treatment, scores reduced to 3.27 ± 1.34 in the Mirabegron group and 4.13 ± 1.47 in the Tolterodine group. The change in IPSS Irritative score was 5.92 ± 2.46 for Mirabegron and 5.75 ± 2.10 for Tolterodine, with no significant difference between groups (p &gt; 0.05). Conclusion: Mirabegron is as effective as Tolterodine in reducing irritative LUTS in patients with ureteral stents, with a comparable side effect profile. These findings support Mirabegron as a viable alternative for patients experiencing LUTS due to ureteral stents.

Stones in a female urethral diverticulum

Urinary stones in female urethral diverticulum are rarely seen. We report a 52-year-old woman who presented with irritative lower urinary tract symptoms and recurrent infections. The diverticulum was approached via vaginal route and the extraction of the stone was successful. The patient has been well, with no dysuria, dyspareunia, incontinence for 3-months follow-ups.

Our experience of forgotten double-J stents in a tertiary care center

Background: Double-J (DJ) stents have become an essential tool in the field of urology. Forgotten DJ stents are associated with significant morbidity and mortality, if not intervened timely. Aims and Objectives: In this study, we report our experience of forgotten stents related complications, along with its management and steps taken by us in preventing stent-related morbidity. Materials and Methods: We retrospectively analyzed the records of patients presented to the Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna with forgotten or long-term retention of DJ stents from January 2021 to December 2022. All cases were reviewed for age, gender, symptoms, indication of stent insertion, duration of stent insertion, radiological images, and procedures performed for management. Results: The mean age of the patients was 49.23 years. The mean duration of the indwelling stent in situ was 16.61 months. Presenting complaint was flank pain, recurrent urinary tract infection, dysuria, hematuria, and irritative lower urinary tract symptoms. Common indications of indwelling stents were ureteroscopic lithotripsy, percutaneous nephrolithotomy, and Laparoscopic pyeloplasty. Cystoscopy, ureteroscopy, cystolithotripsy, percutaneous nephrolithotomy, and open surgery were done to extract the forgotten DJ stent. Conclusion: Forgotten DJ stents are a source of severe morbidity. Patients and relatives counseling before and after the procedure is necessary in reducing stent-related complications.

Anterior urethral valve with diverticulum in an adolescent

Abstract The anterior urethral valve (AUV) is a rare cause of obstructive uropathy in children; they are much rarer than posterior urethral valves. A 13-year-old male presented with obstructive and irritative lower urinary tract symptoms (LUTS). On urethrocystoscopy, an AUV with a diverticulum was noted in the ventral surface of the urethra. It was ablated endoscopically using the holmium laser. Postoperatively, the patient voided successfully without any immediate complications. AUV with diverticulum may occur in adolescents. Endoscopic holmium laser ablation of the valve and the diverticulum is associated with good outcome.

(032) A Large Retroperitoneal Schwannoma Masquerading as Genito-Urinary Syndrome of Menopause

Abstract Introduction Retroperitoneal schwannomas are extremely rare, slow growing, benign, neurogenic tumors. Their diagnosis is challenging and often incidentally found upon evaluation of vague symptoms. Extrinsic compression to nearby organs or nerves may cause pain and paresthesia. Vulvar pain as a presenting symptom of a retroperitoneal schwannoma is reported in the literature in a case with pudendal nerve involvement. Here we present a case report of a patient who presented with vulvar burning and lower urinary tract irritative symptoms which was found to have a large infra-hepatic retroperitoneal schwannoma. Objectives In this report we show case how performing a detailed neurological evaluation and having a good understanding of the vulvar, perineal, and lower extremity dermatomal innervation have assisted in early diagnosis and treatment of a large retroperitoneal schwannoma. Methods A 65-year-old menopausal woman presented to her primary provider for a 3-month-history of worsening vulvar burning sensation associated with urinary burning, frequency, and nocturia. The pain is worse at night and when sitting for more than an hour. The patient endorsed low back pain that radiated like pins down her anterior thighs. The patient underwent evaluation by her referring provider to rule out a urinary tract infections and vaginitis. She was treated with vaginal estrogen tablets with partial relief for a working diagnosis of Urogenital Syndrome of Menopause. Patient was then referred to Gynecology due to inadequate relief. A detailed pelvic examination revealed normal labia majora and minora with no erythema or swelling. The Vestibule, Bartholin and Skene glands were non tender. Q-tip testing provoked burning sensation in the left and right labia minora on the medial and lateral aspect as well as the labia majora. Pelvic Floor evaluation elicited left pelvic floor tenderness and bilateral ischial spine pain concerning for Pudendal neuralgia. Also, noted paresthesia overlying the left lower extremity at the L3 and L4 distribution at the medial thigh (Figure-1) The patient underwent a bilateral pudendal block with total resolution of her vulvar pain for 24 hours and hence, lumbar and pelvic nerve entrapment was suspected. Magnetic Resonance Imaging was requested. Evaluation revealed a 3.3x4.4cm left ovarian mass and uterine fibroids that could potentially explain L2-L5 radiculopathy. The Lumbar MRI noted a cystic mass in the right mid abdomen for which further evaluation with CT scan was recommended. (Image-1). Referral to Surgical Oncology and Gyn oncology was sought. Epithelial ovarian cancer tumor markers were normal. Catecholamine studies were nonrevealing except for unexplained increase in dopamine levels. Results Surgical excision of the retroperitoneal and ovarian tumor revealed a left ovarian Fibroma and Schwannoma with Cystic Degeneration, confirmed with Immuno-peroxidase studies for S100 and SOX10. The patient had an uncomplicated post-operative course and remains asymptomatic with total resolution of her urinary and vulvar burning symptoms. Conclusions This a case report of vulvar and urethral paresthesia caused by an exceedingly rare tumor located high in the retroperitoneum. Diagnosis was aided by detailed history, comprehensive gynecological, and neurodermatomal evaluation. Appropriate imaging and timely referral led to early diagnosis and treatment, resulting in symptom resolution. Disclosure No.

Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement.

Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate, which can lead to obstructive and irritative lower urinary tract symptoms (LUTS). The pharmacologic use of plants and herbs (phytotherapy) for the treatment of LUTS associated with BPH is common. The extract of the berry of the American saw palmetto or dwarf palm plant, Serenoa repens (SR), which is also known by its botanical name of Sabal serrulatum, is one of several phytotherapeutic agents available for the treatment of BPH. To assess the effects of Serenoa repens in the treatment of men with LUTS consistent with BPH. We performed a comprehensive search of multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Web of Science, and LILACS), trials registries, other sources of grey literature, and conference proceedings published up to 16 September 2022, with no restrictions on language or publication status. We included randomized controlled trials of participants with BPH who were treated with Serenoa repens or placebo/no treatment. Two review authors independently assessed studies for inclusion at each stage and undertook data extraction and risk of bias assessment and GRADE assessment of the certainty of the evidence. We considered review outcomes measured up to 12 months after randomization as short term, and beyond 12 months as long term. Our main outcomes included urologic symptom scores, quality of life, and adverse events. For this update, we narrowed the review question to only comparisons with placebo. We included 27 studies (of which 9 were new) involving a total of 4656 participants, 19 studies comparing Serenoa repens with placebo, and 8 studies comparing Serenoa repens in combination with other phytotherapeutic agents versus placebo. Most studies included men aged > 50 (mean age range 52 to 68) with moderate urologic symptoms (International Prostate Symptom Score [IPSS] range 8 to 19). Ten studies were funded by the pharmaceutical industry; two studies were funded by government agencies; and the remaining studies did not specify funding sources. Serenoa repens versus placebo or no intervention Results for this comparison are based on predefined sensitivity analyses limited to studies at low risk of bias. Serenoa repens results in little to no difference in urologic symptoms at short-term follow-up (3 to 6 months; IPSS score range 0 to 35, higher scores indicate worse symptoms; mean difference (MD) -0.90, 95% confidence interval (CI) -1.74 to -0.07; I2 = 68%; 9 studies, 1681 participants; high-certainty evidence). Serenoa repens results in little to no difference in the quality of life at short-term follow-up (3 to 6 months; IPSS quality of life domain range 0 to 6, higher scores indicate worse quality of life; MD -0.20, 95% CI -0.40 to -0.00; I2 = 39%; 5 studies, 1001 participants; high-certainty evidence). Serenoa repens probably results in little to no difference in adverse events (1 to 17 months; risk ratio (RR) 1.01, 95% CI 0.77 to 1.31; I2 = 18%; 12 studies, 2399 participants; moderate-certainty evidence). Based on 164 cases per 1000 men in the placebo group, this corresponds to 2 more (38 fewer to 51 more) per 1000 men in the Serenoa repens group. Serenoa repens results in little to no difference in urologic symptoms at long-term follow-up (12 to 17 months, IPSS score, MD 0.07, 95% CI -0.75 to 0.88; I2 = 34%; 3 studies, 898 participants; high-certainty evidence). Serenoa repens results in little to no difference in quality of life at long-term follow-up (12 to 17 months, IPSS quality of life, MD -0.11, 95% CI -0.41 to 0.19; I2 = 65%; 3 studies, 882 participants; high-certainty evidence). There were no data on long-term adverse events for this comparison. Serenoa repens in combination with other phytotherapy versus placebo or no intervention Different phytotherapeutic agents that include Serenoa repens may result in little to no difference in urologic symptoms compared to placebo at short-term follow-up (12 to 24 weeks, IPSS score, MD -2.41, 95% CI -4.54 to -0.29; I2 = 67%; 4 studies, 460 participants; low-certainty evidence). We are very uncertain about the effects of these agents on quality of life (very low-certainty evidence). These agents may result in little to no difference in the occurrence of adverse events; however, the CIs included substantial benefits and harms (12 to 48 weeks, RR 0.91, 95% CI 0.58 to 1.41; I2 = 0%; 4 studies, 481 participants; low-certainty evidence). Based on 132 cases per 1000 men in the placebo group, this corresponds to 12 fewer (55 fewer to 54 more) per 1000 men in the combined phytotherapeutic agents with Serenoa repens group. Serenoa repens alone provides little to no benefits for men with lower urinary tract symptoms due to benign prostatic enlargement. There is more uncertainty about the role of Serenoa repens in combination with other phytotherapeutic agents.

Predictors of clinical and surgical characteristics of giant stones of the urinary bladder: a retrospective study

BackgroundGiant stones of the urinary bladder (GSBs) are rare and usually presented as case reports. We aimed to assess the clinical and surgical characteristics of GSBs and identify their predictors.MethodsA retrospective study of 74 patients with GSBs who presented between July, 2005 and June, 2020 was performed. Patients’ demographics, clinical presentations, and surgical peculiarities were studied.ResultsOlder age and male gender were risk factors for the occurrence of GSBs. The irritative lower urinary tract symptoms (iLUTS) were the main presenting symptoms (97.3%). Most patients were treated with cystolithotomy (90.1%). Univariate analyses showed that solitary (p < 0.001) and rough surface (P = 0.009) stones were significant factors for occurrence of iLUTS as the presenting symptoms. Also, the severity of symptoms (p = 0.021), rough surface (p = 0.010) and size (p < 0.001) of stones, and farmer occupation (p = 0.009) were significantly associated with adherence of the stone to the bladder mucosa at surgery. In multivariate analysis, the rough surface (p = 0.014) and solitary (p = 0.006) stones, and concomitant ureteral stones (p = 0.020) were independently associated with iLUTS as the main presentation. However, the stone size and severity of iLUTS were the independently associated factors for adherence of GSBs to the bladder mucosa.ConclusionsSolitary GSB, rough surface and the association with ureteral stones are independent risk factors for the occurrence of long-standing iLUTS. The stone size and severity of iLUTS were the independent predictors of adherence of GSBs to the bladder mucosa. Cystolithotomy is the main treatment, but it may be more difficult when there is bladder mucosa adherence.

HF01-10 EVOLUTION TO EXTINCTION?: THE SAGA OF FEMALE URETHRAL DILATION

You have accessJournal of UrologyCME1 Apr 2023HF01-10 EVOLUTION TO EXTINCTION?: THE SAGA OF FEMALE URETHRAL DILATION Jasmine Kashkoush and Brant Fulmer Jasmine KashkoushJasmine Kashkoush More articles by this author and Brant FulmerBrant Fulmer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003243.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Historically, many women have reported bothersome urinary symptoms and recurrent urinary tract infections (UTIs). The challenge in managing these symptoms led to the practice of urethral dilation in the 1920s, despite the rarity of a female urethral stricture. With little scientific data to support its efficacy, this practice should have gone to extinction; however, it is still very common. This represents a historical review of urethral dilation in women and its penetration in modern day practice patterns. METHODS: A literature review was performed to evaluate the history of female urethral dilation. RESULTS: In 1923, Stevens theorized the culprit behind bothersome urinary symptoms was a narrow urethral meatus, initially presenting the idea of urethral dilation/incision. He advocated for urethral meatotomy with a scalpel up to 30 Fr. This was refined by Davis in the 1950s with the use of an Otis urethrotome to incise the urethra up to 45 Fr. This was popularized in the 1960s when Keitzer, Lyon, and Kerr thought persistent UTIs were due to a “contraction ring in the distal urethra of little girls.” They used sounds and Otis urethrotomes in infants to dilate and/or incise the entire urethra. Eventually, this practice lost scientific backing due to complications of urinary incontinence as well as favorable outcomes with less invasive options. In fact, the last reference to using urethral dilation without a urethral stricture was in 1970. Interestingly, despite the lack of data to support its use, Medicare reimbursement still shows high utilization and cost expenditures. Almost $70 million was spent in 2000 despite only ∼40 documented cases of female urethral stricture. Furthermore, when surveying urologists, those who completed residency after 1989 rarely performed urethral dilation when compared to their predecessors who find it a useful practice. CONCLUSIONS: A wide variety of treatment modalities have been used to manage recurrent UTIs and irritative lower urinary tract symptoms. Female urethral dilation was common despite the rarity of a female urethral stricture. Urinary incontinence and a better understanding of bladder function have decreased the data in favor of female urethral dilation, putting into question its practice. Evidence based medicine supports medical management, vaginal estrogen, and pelvic floor physical therapy more favorably. One would hope that this practice would go into extinction; however, Medicare data still shows high utilization. Perhaps updated guideline statements and better education of patients that have had prior dilations will help in debunking this practice. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e259 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jasmine Kashkoush More articles by this author Brant Fulmer More articles by this author Expand All Advertisement PDF downloadLoading ...

Migrating foreign body into the urinary bladder of children postperineal trauma

Foreign body (FB) in the urinary bladder (UB) is uncommon and rarely reported in pediatric patients. FB migration into the UB is an extremely rare and unpredictable condition that needs a high index of suspicion with meticulous history taking and clinical reasoning, so diagnosis may be challenging. In this study, we report two cases of male pediatric patients from Sudan with FB in the UB, with a history of penetrating perineal trauma, both were presented with irritative lower urinary tract symptoms, history of penetrating perineal trauma, and unremarkable clinical examination. Both were diagnosed by abdominal Ultrasound study (USS) and confirmed by cystoscopy. One child was treated by endoscopic extraction, while the other was treated by open surgical extraction. The outcome of treatment of both the cases was satisfactory.

Influence of vesicourethral segment reconstruction techniques in radical prostatectomy on urinary continence: evaluation of immediate and long-term outcomes

Introduction. Currently, various methods and modifications of radical prostatectomy (RP) have been developed and tested, aimed at preventing and minimizing the development of urinary incontinence (UI). However, UI remains an urgent problem in patients who undergo RP, especially at the early follow-up stages.Objective. To evaluate and compare the effectiveness of modified reconstructive techniques for vesicourethral anastomosis in radical prostatectomy for the prevention of urinary incontinence with respect to the standard technique at different follow-up periods.Materials and methods. Design: single-centre, clinical, simple, comparative, parallel-group study with retrospective and prospective material evaluation, conducted in 2017 – 2022. Patients: men with verified prostate cancer cT1a – 2cN0 – xM0 without decompensated comorbidities. Age: 45 – 78 years. Retrospective part — group (G) 1: 90 patients who underwent non-nerve-sparing open retropubic RP with a "classic" vesicourethral anastomosis (VUA). Prospective part — G2: 46 patients who underwent similar surgery with modified VUA in two variations: without and with prostatic urethra-sparing — G2a (n = 25) and G2b (n = 21), respectively. Initial examination: standard preoperative laboratory and instrumental examination, assessment of lower urinary tract symptoms (LUTS) using the IPSS-QoL questionnaire. Follow-up examination: objective evaluation of UI according to established criteria and subjective assessment using the ICIQ-SF questionnaire, tracking the dynamics of LUTS using IPSS-QoL. Follow-up periods: 0-point (after catheter removal), 1, 3, 6, and 12 months (exit-point); the dynamics of recovery of urinary continence (UC) was determined monthly. Statistical analysis: Statistica ver.10.0 (StatSoft Inc., Tulsa, OK, USA) using non-parametric methods (CL p &lt; 0.05 at a = 0.05)Results. Preoperative demographic, questionnaire and instrumental statistics did not differ (p &gt; 0.05) between the groups, confirming the homogeneity of the samples. After RP, the urethral catheter was removed in a period of 7 to 21 days. There was no difference (p &gt; 0.05) in the duration of drainage between the groups. Total urinary continence (TUC) immediately after catheter removal was detected in G1, G2a and G2b in 20.0%, 44.0% and 57.1% of cases, respectively. Subsequent objective monitoring of UC recovery from 1 month showed differences (p &lt; 0.001) between the groups in the dynamics of rehabilitation during the year. The improvement in UC over the one-year follow-up period was cumulatively achieved in G1, G2a and G2b in 48.9%, 44.0% and 33.3% of cases, respectively. Total UI persisted in G1 and G2a by month 12 in 22.2% and 8.0% of patients, respectively, and was not detected in G2b. The severity of UI by the end of the follow-up according to the ICIQ-SF data was the most pronounced (p &lt; 0.001) in patients from G1. TUC-patients in all groups from 1 month showed a marked decrease in the severity of obstructive and irritative LUTS and improved quality of life, with no differences (0.157 &lt; p &lt; 0.390) in IPSS-QoL values between groups.Conclusions. The use of modified VUA reconstruction techniques made it possible, compared with the standard one, to achieve high continence rates in patients both immediately after the removal of the urethral catheter and at subsequent follow-up periods, without the formation of severe iatrogenic obstruction. Prostatic urethra-sparing modification is the most effective technique that provided the rehabilitation of UI to a complete and/or social level in all patients within a year after surgery.

A 40-Year Litigation Review of Transurethral Surgeries for Benign Prostatic Hyperplasia

ObjectiveTo describe litigation patterns of transurethral surgery in the treatment of benign prostatic hyperplasia including verdicts, types of lawsuits, plaintiff claims, and timing of the claims. MethodsData was gathered by searching for litigation cases between January 1, 1980 and December 1, 2021 in the Westlaw legal database using keywords for transurethral surgeries for benign prostatic hyperplasia. Extracted data included case type, general description of the plaintiffs and defendants, plaintiff claims, and whether the claim involved preoperative, perioperative, or postoperative management, verdict, and indemnity awards. ResultsThe Westlaw search yielded 44 unique cases after removing duplicate and irrelevant cases. The most common surgery resulting in a lawsuit was transurethral resection of the prostate (70%) and urologists were the most frequently named defendant (80%). The most common plaintiff claims were sexual dysfunction (36%), irritative lower urinary tract symptoms (32%), and lack of consent (27%). Among malpractice cases, the verdict was in favor of the defendant in most cases (71%) and among Eighth Amendment violation cases, the verdict was in favor of the defendant in every case. The average indemnity payment was $565,845 and the highest indemnity payment was $1,020,000. ConclusionComplications of transurethral surgeries and lack of consent are common reasons for patient's filing a lawsuit. Healthcare providers should ensure patient understanding of surgical risks and thoroughly document the conversation. Providers should be aware of the causes for litigation among transurethral surgeries for benign prostatic hyperplasia and of the possibility of Eighth Amendment violation lawsuits when treating prison inmates.

PD45-08 SELECTIVE MEDIAN LOBE LASER ENUCLEATION OF THE PROSTATE: PRESERVING SEXUAL FUNCTION WITHOUT COMPROMISING URINARY OUTCOMES

You have accessJournal of UrologyCME1 May 2022PD45-08 SELECTIVE MEDIAN LOBE LASER ENUCLEATION OF THE PROSTATE: PRESERVING SEXUAL FUNCTION WITHOUT COMPROMISING URINARY OUTCOMES Benjamin Press, David Kim, Eric Ghiraldi, Michael Siev, and Daniel Kellner Benjamin PressBenjamin Press More articles by this author , David KimDavid Kim More articles by this author , Eric GhiraldiEric Ghiraldi More articles by this author , Michael SievMichael Siev More articles by this author , and Daniel KellnerDaniel Kellner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is recommended for prostate glands of all sizes and is becoming a popular alternative to the transurethral resection of the prostate (TURP). Side effects of the procedure include stress incontinence, irritative lower urinary tract symptoms, and sexual function, most commonly retrograde ejaculation. We sought to evaluate perioperative outcomes related to sexual function and urinary function in patients who underwent selective laser enucleation of the prostate. METHODS: We conducted a retrospective review of the first 300 cases of HoLEP was performed from April 2019 – August 2021. Thirty-two patients within our cohort underwent selective enucleation of the median lobe of the prostate. Criteria for choosing to treat patients with selective enucleation were intravesical-prostatic protrusion or high bladder neck without obstructing lateral lobes. Patients were asked to comment on whether they had retrograde ejaculation during their follow up appointment. Urinary function was assessed using the American Urological Association Symptom Score (AUA-SS) and subjective evaluation of urinary incontinence. RESULTS: Mean age of our cohort was 65.9 years of age. Average peri-operative AUA-SS scores significantly improved (21.7 vs 6.8, p < 0.001). Average peri-operative quality of life scores significantly improved (4.1 vs 1.4, p < 0.001). Average peri-operative post void residual volumes were significantly improved (228.8 cc vs 45.7 cc, p = 0.001). No patients reported stress urinary incontinence. Of the 32 patients who underwent selective enucleation of the median lobe, 26 were sexually active. Of those men, 22 reported normal ejaculation, 2 men had retrograde ejaculation that was unchanged from pre-op. Data was missing for 2 men. CONCLUSIONS: In our case series of selective laser enucleation of the median lobe, urinary function significantly improved in short term follow-up with preservation of ejaculation in approximately 90% of men. A larger series is necessary with a longer follow up period to further investigate the durability of these findings. Further investigation is needed to define objective criteria to identify ideal candidates for selective median lobe enucleation. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e785 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Press More articles by this author David Kim More articles by this author Eric Ghiraldi More articles by this author Michael Siev More articles by this author Daniel Kellner More articles by this author Expand All Advertisement PDF DownloadLoading ...

Cystitis glandularis- rare cause of urinary bladder mass: case report and literature review

BackgroundCystitis glandularis a rare benign proliferative disease of the urinary bladder mucosa is usually a microscopic finding and manifests rarely as a large visible macroscopic lesion of urinary bladder. Only few cases of cystitis glandularis presenting as urinary bladder mass in female patients have been reported in the literature. We are reporting a case of cystitis glandularis presenting as a urinary bladder mass in a very young female patient.Case presentation.Our patient, a young female 25 years of age presented in the Urology OPD with complaints of irritative lower urinary tract symptoms for two years and intermittent hematuria for one year. On evaluation, she was found to have a urinary bladder mass. Transurethral resection of her urinary bladder mass was done and on histopathological examination, it came out to be cystitis glandularis.ConclusionClinical presentation of cystitis glandularis is variable. It may remain asymptomatic or could present as irritative lower urinary tract symptoms, hematuria, or mucus in the urine. It is normally a microscopic finding but could also present as an overt urinary bladder mass however this has been reported rarely in the literature.

Urachal mucinous cystic tumor of low malignant potential in a polymorbid female: a case report and review of the literature

Neoplasms of the urachus are exceedingly rare, representing 0.17% of all bladder cancers. The mucinous cystic tumor of low malignant potential (MCTLMP) subtype is particularly rare with just 25 previous cases reported in the literature. Although rare, MCTLMPs are important to identify due to potential devastating complications and good cure rates with surgical removal. We present a 43 year old female with a nuanced constellation of comorbidities and confirmed MCTLMP following a workup for abdominal pain and irritative lower urinary tract symptoms. Notably, this tumor did not change in size over a 3-year course of serial imaging prior to surgical excision. This urachal MCTLMP represents roughly the 26th and one of the smallest of its subtype reported in the literature. This case illustrates the diagnosis and management of this rare urachal MCTLMP. Individual patient medical history, clinical considerations, and neoplasm characteristics are examined. Although rare, the potential for increased malignancy and potential complications necessitates surgical management and further investigation by the academic community.

Hyperbaric oxygen therapy for the treatment of radiation-induced cystitis

Radiation-induced cystitis (RIHC) is a late complication of pelvic radiation therapy defined by irritative lower urinary tract symptoms with recurrent and sometimes refractory hematuria. Conservative or endoscopic treatments are the first lines, but cystectomy in required in refractory cases. Hyperbaric oxygen therapy (HOT) has recently emerged in the management charts for recurrent and refractory hematuria. Thanks to its neoangiogenic and stem-cell stimulation properties, HOT achieves a complete resolution of hematuria in almost two third of patients and appears to be a good therapeutic alternative for this fragile population. However, its geographical availability is currently limited in Switzerland and its implementation can sometimes require long hospital stays.

Comparative study to evaluate the effect of tamsulosin and solifenacin on dj stent related symptoms

Background: On patient quality of life, stent-associated symptoms can have a significant impact. Related to indwelling ureteral stents, hematuria, urgency, frequency, dysuria, and both bladder and flank pain are the most prevalent symptoms. Among them low back pain and irritative lower urinary tract symptoms and are more frequent. Because of its importance stent is being kept in situ with varieties of medication despite the stent related symptoms. To relief these symptoms like Tamsulosin, Solifenacin, Alphazosin etc, several alpha-adrenergic blocker and antimuscarinic drugs are used. Tamsulosin and Solifenacin both are not costly as use daily single dose. So combination of Tamsulosin and Solifenacin cost effective and may act as a reliever of stent related symptoms also Objectives: To evaluate the effect of Tamsulosin and Solifenacin in relieving DJ stent related symptoms. Methodology: This prospective quassi experimental study was performed from November 2016 to April 2018. Patients who placed DJ stent after endoscopic stone management in the Department of Urology, Dhaka Medical College & Hospital recruited as study population. A total of 47 patients who were stented following ureteroscopic lithotripsy were included, allocated purposively into two groups. Group A (Tamsulosin) 24 and and Group B (Solifenacin) 23 patients were selected by purposive sampling technique according to inclusion and exclusion criteria for the study. Results: In the current study, the mean age of the patients was 39.08(±8.798) and 38.84(±11.063) in group A and group B respectively. Male patients were leading in both groups. Total IPSS, irritative subgroup of IPSS, QOL score and VAS on T1 assessment done on 3rd postoperative day were evaluated in both the groups and no statistically significant difference (P>0.05) in all scores were noted. In the study, the mean value of total IPSS, irritative subgroup of IPSS and QOLS was significantly improved in group-A in comparison to that of group B, 6.28, 3.2, 2.4 and 7.40, 4.04, 2.8 respectively (P

The Fate of Double J Stent Used in Pyelolithotomy and Uretero Lithotomy

Background: In Bangladesh there is no complete data which would reflect the idea about the fate of double J stent used in pyelolithotomy and ureterolithotomy. Methods: This was a prospective observational study, conducted at the Department of Surgery, Comilla Medical College Hospital, Comilla, during the 6-month period of June 2013 to November 2013. Fifty patients diagnosed with Nephrolithiasis &amp; ureterolithiasis admitted at the respective hospital were selected as the study sample. Proper informed consent was taken before the data collection from the concerns. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Result: Among the 50 patients studied, &gt;50% of the patients were distributed among the age group of 31-40 years and next was 21-30 years. 35 patients of the series were male (70%) and 15 were female (30%). In this series, male to female ratio was 2.33:1. Among the 50 stented patients, stone was located in kidney in 30 pts (60%), in upper ureter in 10 pts (20%), in mid and lower ureter in 4(8%) and 6(12%) patients respectively. In this study, the commonest indications of D J stenting were after pyelolithotomy, following ureteroscopy for obstructive uropathy due to ureteric stone. In this study, irritative voiding symptoms like dysuria, frequency/urgency occurred in 20% and 24% respectively, and haematuria in 10% of patients. Stent encrustation in 1 (2%), stent migration in 3 (6%), stent fracture in 1 (2%), urinary infection in 2(4%) and stent colic in 1(2%) were the complications noted. Conclusion: Ureteral stents are a convenient means of drainage for the upper urinary tract. However, their use is not devoid of side effects. Stent placement results in considerable morbidity in the form of irritative lower urinary tract symptoms. The side effects associated with ureteral stents must be kept in mind when deciding on stent placement and dwell time. ............

MP09-13 RETROSPECTIVE MATCH-PAIR ANALYSIS OF PRIMARY HOLMIUM ENUCLEATION OF PROSTATE (HoLEP) VERSUS ROBOT ASSISTED SIMPLE PROSTATECTOMY (RASP) FOR PROSTATES MORE THAN 100 cc

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP09)1 Sep 2021MP09-13 RETROSPECTIVE MATCH-PAIR ANALYSIS OF PRIMARY HOLMIUM ENUCLEATION OF PROSTATE (HoLEP) VERSUS ROBOT ASSISTED SIMPLE PROSTATECTOMY (RASP) FOR PROSTATES MORE THAN 100 cc Abhishek Bhat, Ruben Blachman-Braun, Quinn Rainer, Daniel Pulido, Hemendra Shah, and Ramgopal Satyanarayana Abhishek BhatAbhishek Bhat More articles by this author , Ruben Blachman-BraunRuben Blachman-Braun More articles by this author , Quinn RainerQuinn Rainer More articles by this author , Daniel PulidoDaniel Pulido More articles by this author , Hemendra ShahHemendra Shah More articles by this author , and Ramgopal SatyanarayanaRamgopal Satyanarayana More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001982.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: HoLEP and RASP are established surgical modalities for management of bothersome lower urinary tract symptoms (LUTS) secondary to gross prostatomegaly. Our objective was to compare the peri-operative and short-term voiding outcomes of HoLEP versus RASP for treatment of large prostates >100 cc. METHODS: A retrospective review was performed for all patients who underwent primary RASP between 2017-2020 and these patients were matched 1:2 for HoLEP patients based on age and prostate size. Baseline demographics, pre-operative questionnaire based, intraoperative and post-operative data was recorded. Statistical analysis was performed with SPSS V.24. RESULTS: A total of 50 HoLEP and 25 RASP patients were included (table 1). Pre-operative Sexual Health Index in Men (SHIM) score was similar but voiding symptoms were significantly worse in men undergoing RASP (p <0.001). Duration of surgery and catheter insitu were significantly longer in RASP group. There were no intra-operative complications and no significant difference in length of hospital stay or post-operative complication rate. Hematuria was the most common complication in the HoLEP arm (n=10) & UTI (n=5) in the RASP arm. The HoLEP arm therefore had a higher number of re-catheterizations than RASP (p=0.0294). Three-month PSA was similar in both arms. There was a significant difference in voiding symptoms at 3 months with IPSS = 2 in the HoLEP arm and IPSS = 7 (p <0.001) in the RASP arm, mainly irritative LUTS. CONCLUSIONS: Both HoLEP and RASP are feasible and safe procedures for prostatomegaly >100 cc. HoLEP is associated with significantly lesser duration of surgery, post-operative indwelling catheter and hospital stay. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e164-e165 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abhishek Bhat More articles by this author Ruben Blachman-Braun More articles by this author Quinn Rainer More articles by this author Daniel Pulido More articles by this author Hemendra Shah More articles by this author Ramgopal Satyanarayana More articles by this author Expand All Advertisement Loading ...