Irritative Voiding Symptoms Research Articles

Timing of Trial of Void After Radical Hysterectomy: Long-Term Urinary Outcomes at Two Academic Tertiary Care Institutions.

Many patients develop bladder symptoms after radical hysterectomy. This study compared urinary outcomes following radical hysterectomy based on trial of void (TOV) timing (pre-discharge TOV versus post-discharge TOV). A retrospective non-inferiority study of patients at two academic tertiary referral centers who underwent radical hysterectomy between January 2010 and January 2020 was carried out. Patients were stratified according to timing of postoperative TOV: either pre-discharge or post-discharge from the hospital. Short-term urinary outcomes (including passing TOV, representation with retention) and long-term de novo urinary dysfunction (defined as irritative voiding symptoms, urgency, frequency, nocturia, stress or urgency incontinence, neurogenic bladder, and/or urinary retention) were extracted from the medical record. We hypothesized that the proportion of patients who failed pre-discharge TOV would be within a 15% non-inferiority margin of post-discharge TOV. A total of 198 patients underwent radical hysterectomy for cervical (118 out of 198; 59.6%), uterine (36 out of 198; 18.2%), and ovarian (29 out of 198; 14.6%) cancer. One hundred and nineteen patients (119 out of 198, 60.1%) underwent pre-discharge TOV, of whom 14 out of 119 (11.8%) failed. Of the post-discharge TOV patients (79 out of 198, 39.9%), 5 out of 79 (6.3%) failed. The proportion of patients who failed a pre-discharge TOV was within the non-inferiority margin (5.4% difference, p = 0.23). A greater proportion of patients in the post-discharge TOV group developed long-term de novo urinary dysfunction (27.2% difference, p = 0.005). Median time to diagnosis of de novo urinary dysfunction was 0.5years (range 0-9) in the pre-discharge TOV group versus 1.0year (range 0-6) in the post-discharge TOV group (p > 0.05). In this study, pre-discharge TOV had non-inferior short-term outcomes and improved long-term outcomes.

Intravesical Bladder Treatment and Deep Learning Applications to Improve Irritative Voiding Symptoms Caused by Interstitial Cystitis: A Literature Review.

Our comprehension of interstitial cystitis/painful bladder syndrome (IC/PBS) has evolved over time. The term painful bladder syndrome, preferred by the International Continence Society, is characterized as "a syndrome marked by suprapubic pain during bladder filling, alongside increased daytime and nighttime frequency, in the absence of any proven urinary infection or other pathology." The diagnosis of IC/PBS primarily relies on symptoms of urgency/frequency and bladder/pelvic pain. The exact pathogenesis of IC/PBS remains a mystery, but it is postulated to be multifactorial. Theories range from bladder urothelial abnormalities, mast cell degranulation in the bladder, bladder inflammation, to altered bladder innervation. Therapeutic strategies encompass patient education, dietary and lifestyle modifications, medication, intravesical therapy, and surgical intervention. This article delves into the diagnosis, treatment, and prognosis prediction of IC/PBS, presenting the latest research findings, artificial intelligence technology applications in diagnosing major diseases in IC/PBS, and emerging treatment alternatives.

(106) Hormonally-Mediated Vestibulodynia: A Chart Review

Abstract Introduction The borders of the vestibule are Hart’s line laterally, hymen medially, frenulum of the clitoris anteriorly, and fourchette posteriorly. Provoked vestibulodynia (PVD) is characterized by severe burning pain in response to pressure localized to the vestibule. Numerous factors may negatively affect the vestibule causing PVD such as hormonal changes, infections, trauma, exaggerated immunologic or inflammatory responses, dermatologic conditions, high-tone pelvic floor dysfunction, pudendal neuropathy, and sacral radiculopathy. PVD specifically associated with hormonal changes in pre-menopausal women has been termed hormonally mediated vestibulodynia (HMV). Dense labeling of androgen receptors has been noted in the germinal layer of the vestibular epithelium and mucinous minor vestibular glands, implying a critical role of testosterone in vestibular health. Low calculated free testosterone caused by elevated sex hormone binding globulin (SHBG) in pre-menopausal women using combined hormonal contraception may thus be harmful to the vestibular epithelium and minor vestibular glands, resulting in HMV. In HMV, vulvoscopy shows diffuse vestibular tenderness of the entire vestibule, the ostia of the minor vestibular glands are frequently erythematous (Fig 1) and blood testing is consistent with a low calculated free testosterone. Objective We describe the variation in etiologies for HMV and emphasize the importance of measuring total testosterone and SHBG to monitor calculated free testosterone levels in patients with HMV. Methods This is a retrospective chart review of premenopausal patients presenting to a clinic with entrance dyspareunia who were diagnosed with HMV, and whose symptoms were alleviated by treatment. Inclusion criteria were as follows: premenopausal females with initial testosterone and SHBG blood values below the reference range, initial vulvoscopy findings significant for vestibulodynia, follow-up testosterone and SHBG approaching the reference range, and follow-up vulvoscopies demonstrating a relief from symptoms. Results A total of 9 patients met the inclusion criteria. The mean age was 32 years old, with a range of 22 years old to 39 years old. Presenting complaints in addition to dyspareunia (n=9) included recurrent irritative bladder voiding symptoms without positive urine culture (n=3) and pelvic pain (n=4). Vulvoscopic examination including cotton-tipped swab testing of the vestibule revealed signs of vestibular hypersensitivity with pain ranging from 1 to 9 in all 7 regions of the vestibule tested. Patients had histories of having taken combined hormonal contraceptives (n=6), isotretinoin (n=1), spironolactone (n=1) and/or hormonal treatment for breast cancer (n=1), all of which can decrease calculated free testosterone. All patients were treated with systemic testosterone and compounded estradiol/testosterone cream to be applied daily to the vestibule. On follow-up blood testing, all patients had calculated free testosterone values approaching 0.6-0.8 ng/dl, established by Guay et al. as the optimum range. All patients reported significantly decreased dyspareunia and significant relief of other bothersome symptoms, especially bladder symptoms. Conclusions This chart review illustrates a variety of etiologies associated with low calculated free testosterone and the diagnosis of HMV. This data emphasizes the importance of calculating free testosterone and performing vulvoscopy to establish a diagnosis in pre-menopausal patients with entrance dyspareunia. Additionally, this chart review demonstrates the efficacy of systemic testosterone and local vestibular androgen/estradiol therapies in ameliorating vestibular pain and associated symptoms in patients with HMV. Disclosure No

MP76-06 WATER VAPOR THERMAL THERAPY FOR BPH: IS LESS MORE?

You have accessJournal of UrologyCME1 Apr 2023MP76-06 WATER VAPOR THERMAL THERAPY FOR BPH: IS LESS MORE? Michelle C. Leach, Vi Nguyen, Clara Cerrato, Mimi V. Nguyen, and Seth K. Bechis Michelle C. LeachMichelle C. Leach More articles by this author , Vi NguyenVi Nguyen More articles by this author , Clara CerratoClara Cerrato More articles by this author , Mimi V. NguyenMimi V. Nguyen More articles by this author , and Seth K. BechisSeth K. Bechis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Water vapor thermal therapy is an effective treatment for lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH) but can be associated with short term post-procedural irritative voiding symptoms. We sought to evaluate the effect of a minimal approach of water vapor thermal therapy (Rezum, Boston Scientific, Marlborough, MA, USA), defined as 1 vapor treatment per prostate lobe, on urinary symptoms and quality of life (QOL) compared to patients who received multiple treatments per lobe. METHODS: We performed a single-institution retrospective review of patients who underwent water vapor therapy for the treatment of symptomatic BPH from February 2017 to September 2022. Propensity score matching was utilized to generate patient cohorts based on the number of treatments per lobe (1 per lobe including median lobe if present vs ≥2 per lobe) matched for age, BMI, and pre-operative prostate volume (cc). Primary outcome of interest was post-operative complications and irritative symptoms. Secondary outcomes included differences in International Prostate Symptom Score (IPSS) and QOL sub score at baseline and at 1, 3, 6, and 12 months after the procedure. RESULTS: 146 patients were included in the PSM with 73 patients who received one vapor treatment per lobe and 73 patients receiving 2 or more treatments per lobe. DEMOGRAPHICS TABLE (Table 1a). On MVA, an increasing number of treatments (HR 1.3, p=0.039) and treatment of the median lobe (HR 4.7, p=0.008) were significant risk factors for adverse events after REZUM. On MVA looking at risk of post-op urinary retention, only increasing number of treatments (HR 1.6, p=0.005) was an independent risk factor while use of BPH medications, prostate volume, and median lobe treatment were not (p=0.3-0.72). Patient’s with minimal treatment had improved IPSS total and voiding sub-score at 1 month and non-inferior IPSS scores at 3-, 6-, and 12- month follow-up. CONCLUSIONS: Minimal Rezum treatment approach with a single water vapor injection per lobe is a safe and effective option for patients undergoing long-term treatment for BPH and is associated with improved postoperative complications and irritative voiding symptoms. Further studies are needed to investigate the effect of this minimal approach on longer-term outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1092 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michelle C. Leach More articles by this author Vi Nguyen More articles by this author Clara Cerrato More articles by this author Mimi V. Nguyen More articles by this author Seth K. Bechis More articles by this author Expand All Advertisement PDF downloadLoading ...

MP25-16 EVALUATING THE LEARNING CURVE FOR IN-OFFICE COGNITIVE FREEHAND TRANSPERINEAL PROSTATE BIOPSY

You have accessJournal of UrologyCME1 Apr 2023MP25-16 EVALUATING THE LEARNING CURVE FOR IN-OFFICE COGNITIVE FREEHAND TRANSPERINEAL PROSTATE BIOPSY Sofia Gereta, Michael Hung, and Jim C. Hu Sofia GeretaSofia Gereta More articles by this author , Michael HungMichael Hung More articles by this author , and Jim C. HuJim C. Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In-office MRI-ultrasound cognitive fusion targeted transperineal biopsy (CTPB) is a cost-effective approach to a percutaneous, clean wound classification approach to biopsy. However, because transrectal biopsy remains the predominant U.S. approach to CTPB, the barriers to the adoption of the relatively novel CTPB include the learning curve to proficiency and comparative detection rates of clinically significant prostate cancer (csPC, Gleason Grade Group (GG) ≥2). Therefore, our study objective was to define the CTPB learning curve, which is heretofore unstudied, by assessing cancer detection, biopsy core quantity, procedure times, and adverse events (AEs) over time. METHODS: We performed a retrospective review for 110 consecutive CTPB performed using PrecisionPoint (Cumberland, MD) without antibiotic prophylaxis between March 2021 and September 2022, excluding biopsies performed after focal therapy. All CTPB were performed by a single urologist (JCH) without prior experience with the platform. The cohort was divided into quarters and analyzed by univariate methods. RESULTS: There was no significant difference in demographic or MRI characteristics between quarters. There was no difference in the detection of csPC (Q1 50%, Q2 52%, Q3 50%, Q4 48%, p=0.99) or GG upgrading by targeted biopsy across quarters (Figure 1B, 1D). The median number of cores sampled per biopsy significantly decreased after approximately 28 cases (Q1 18, Q2 16, Q3 16, Q4 15, p=0.01). There was no change in the proportion of fibromuscular (non-prostate) cores sampled across quarters (Figure 1B). Total procedure time decreased from a median of 4:06 min in Q3 to 3:00 min in Q4 (p=0.04). Rates of AEs did not differ and remained low across quarters. A single patient reported UTI with irritative voiding symptoms was found to have a negative urine culture (Figure 1C). CONCLUSIONS: Our novel study demonstrates that MRI-ultrasound cognitive fusion targeted transperineal biopsy is safe and effective without a significant learning curve, as shown by consistent csPC detection across the study period. There was a significant decrease in the number of cores obtained after approximately 28 cases with a shorter procedure time, suggesting greater procedural efficiency or refinement in the core sampling approach. Source of Funding: There was no direct funding from an outside organization or sponsor. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e349 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sofia Gereta More articles by this author Michael Hung More articles by this author Jim C. Hu More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-12 "LESS IS MORE" REZUM: A PROPENSITY SCORE MATCHED COMPARISON

You have accessJournal of UrologyCME1 Apr 2023MP51-12 "LESS IS MORE" REZUM: A PROPENSITY SCORE MATCHED COMPARISON Clara Cerrato, Mimi V. Nguyen, Dean Elterman, Kevin Zorn, Naeem Bhojani, Bilal Chughtai, and Seth K. Bechis Clara CerratoClara Cerrato More articles by this author , Mimi V. NguyenMimi V. Nguyen More articles by this author , Dean EltermanDean Elterman More articles by this author , Kevin ZornKevin Zorn More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , and Seth K. BechisSeth K. Bechis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We sought to evaluate the effect of a minimal approach of water vapor thermal therapy (Rezum), defined as 1 vapor treatment per prostate lobe, on postoperative outcomes and symptoms compared to patients who received multiple treatments per lobe. METHODS: We performed a multi-institutional retrospective review of patients who underwent Rezum procedure for symptomatic BPH from 2018 to 2022. Propensity score matching (PSM) was utilized to generate patient cohorts based on the number of treatments per lobe (1 per lobe including median lobe if present vs ≥2 per lobe) matched for age, BMI, and pre-operative prostate volume. Primary outcome of interest was post-operative complications and irritative symptoms. We then conducted a non-PSM independent T-test to analyze the differences in International Prostate Symptom Score (IPSS), QOL sub-score, and flow rates both before and after the procedure. Patients with existing urinary retention were excluded. RESULTS: 146 patients were included in the PSM with 73 patients in each arm. The ≥2 treatment group showed higher post-operative de-novo retention (p=0.009) and UTI (p=0.003) and had their median lobe more frequently treated (p=0.021) (Table 1a). On MVA, an increasing number of treatments (HR 1.3, p=0.039) and treatment of the median lobe (HR 4.7, p=0.008) were significant risk factors for post-procedure irritative symptoms (Table 1b). Mean IPSS and IPSS sub-scores were similar by 3 months up to 12 months after the procedure (Figure 1). At 6 months, patients treated with 1 injection per lobe showed comparable Qmax and voided volumes and better post-void residual volumes (Table 1d). CONCLUSIONS: Minimal Rezum treatment approach with a single water vapor injection per lobe, including median lobe, is a safe and effective option for patients undergoing treatment for BPH and is associated with improved postoperative complicationsand irritative voiding symptoms, and with comparable IPSS and flow outcomes. Further studies are needed to investigate the effect of this minimal approach on longer-term outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e697 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clara Cerrato More articles by this author Mimi V. Nguyen More articles by this author Dean Elterman More articles by this author Kevin Zorn More articles by this author Naeem Bhojani More articles by this author Bilal Chughtai More articles by this author Seth K. Bechis More articles by this author Expand All Advertisement PDF downloadLoading ...

A retrospective observational study of presentation, diagnosis, and management of patients with genitourinary tuberculosis in a tertiary care hospital of India

Objectives: To study the clinical features, diagnostic methods, and management of genitourinary tuberculosis (GUTB). Methods: This retrospective study included 117 patients with GUTB admitted over a period of 10 years. The analysis of the patients was done in terms of presentation, organ involved, diagnostic methods, and management. The 6-month anti-tubercular treatment (ATT) was given to all patients, which included isoniazid, rifampicin, and ethambutol/pyrazinamide. Follow-up period was 1–10 years. Results: The mean age of the patients was 32.5 ± 6.4 years with a male: female ratio of 1:1.51. The majority of the patients presented with irritative voiding symptoms (66.47%) and hematuria (47.6%). The common infected organs were kidney (64.9%), ureter (27.35%), urinary bladder (17.09%), prostate (3.4%), and epididymis (5.19%). 25.6% of patients had positive chest X-ray, and 61.2% of the patients had positive Mantoux test. The diagnostic positivity rate for polymerase chain reaction, urine Mycobacteriumtuberculosis culture test, and urine acid-fast bacilli test was 67.7%, 35.4%, and 21.6%, respectively. 71 (60.13%) of the patients needed surgical intervention. After medical therapy, the adverse reactions noted were abnormal liver function in four cases, pruritus in three cases, and skin eruption in one case. Among the total of 117 patients followed over a period of 1 year to 10 years, none recurred. Conclusion: In a retrospective study of 117 patients with GUTB, majority had bladder symptoms, 60.13% needed surgery, and all were treated with 6-month course of ATT regimen consisting of isoniazid, rifampicin, and ethambutol/pyrazinamide, with none showing recurrence during the period of 1–10 years of follow-up.

Unexpected Finding Inside a Urachal Mass

A 61-year-old female without relevant past medical history was referred to Urology complaining of irritative voiding symptoms and occasional diffuse abdominal pain for 3 months. The clinical examination was unremarkable, without palpable masses, inflammatory signs, or purulent abdominal wall discharge.

Microhematuria in Women Presenting for Overactive Bladder.

Microscopic hematuria and overactive bladder are two common urologic conditions. The objective of this review is to provide an overview of current literature as well as highlight important guidelines that will aid physicians in the diagnostic workup of microscopic hematuria in patients experiencing symptoms of overactive bladder. Updated microscopic hematuria guidelines provide a structured and appropriate workup for women based on risk factors, which stratifies patients to prevent unnecessary procedures and imaging. Women presenting with microscopic hematuria in the setting of overactive bladder should undergo microscopic hematuria workup according to their risk stratification while receiving appropriate treatment for their overactive bladder. The physician should consider the presence of irritative voiding symptoms during the investigation and management of microscopic hematuria in patients with overactive bladder and should not delay overactive bladder treatment due to the presence of microscopic hematuria.

Evaluation of quality of life in patients with ureteral double J stent

Purpose: To evaluate quality of life and related factors in patients with ureteral stents. Materials and Methods: The clinical description study was performed on 83 patients with ureteral DJ stent placement follow-up of 1 month at the Department of Urology, Hue University of Medicine and Pharmacy Hospital from June, 2019 to April, 2020. Results: Average age: 49.55 ± 12.19 years. Female/male 1.13. Stone-free rate: 49.4%. Average point of the quality of life: 0.833 ± 0.137. The factors related to quality of life of patients with JJ stent: age, sex, types of operations. Conclusion: the majority of the patients with ureteral double j stent were well tolerated, pain and irritative voiding symptoms have a significant impact on health related quality of life Key words: JJ stent, quality of life, EQ-5D-5L, USSQ

ASSOCIATION OF INTERNATIONAL PROSTATE SYMPTOM SCORE (IPSS SCORE) WITH TRANSURETHRAL PROSTATECTOMY (TURP) OUTCOME IN PATIENTS OF BENIGN PROSTATIC HYPERPLASIA.

INTRODUCTION: The enlargement of the prostate gland having proliferation in the connective tissue and/ or glandular epithelium is known as Benign Prostatic Hyperplasia or BPH. The patient has either obstructive or irritative voiding symptoms or both. Not much studies have been carried out regarding the correlation between the outcome of IPSS score with TURP and its outcome in the patients of BPH. 5 As the international prostate symptoms score acts as a subjective scoring system for reading and understanding the symptoms it is going to help us for accessing the methods of subjective improvement in the symptoms of BPH along with developing the quality of life in the patients who are undergoing TURP. 6 The aim of the study is to nd theAIMS AND OBJECTIVES: association of IPSS score to predict the outcome of TURP surgery in patients of BPH and thereby study predictive correlation between IPSS score before and after TURP surgery. Study is conducted on 96 patients of benign prostatic hyperplasia with IPSSMATERIALS AND METHODS: score >8 requiring surgery , attending the surgical opd and emergency of TMMC&RC, Moradabad. Relevant examination was done and IPSS score was noted for the patients preoperatively and postoperatively. The patients then are classied in to groups of mild, moderate and severe based on the IPSS score at presentation. Following the patient underwent TURP surgery and post-operatively the IPSS score was re-evaluated and the changes in the score and quality of life was noted at 12 weeks of surgery. The international prostate symptoms score is a veryConclusion: signicant tool for grading as well as evaluating the outcome of Trans urethral prostatectomy and its outcome in the patients.

Peripheral T-Cell Lymphoma of Urinary Bladder Presenting With Just Irritative Voiding Symptoms

Peripheral T-cell lymphoma (PTCL) of the urinary bladder is rare. PTCL can either be primary or secondary and is difficult to differentiate from other inflammatory bladder lesions. We report a case of PTCL involving the bladder in a 63-year-old man who complained of dysuria without gross hematuria. In this report, we focus on the cystoscopic and histologic findings of urinary bladder lymphoma and its differential diagnosis.

PD32-02 POPULATION BASED STUDY ON THE INCIDENCE AND RISKS OF MULTIDRUG-RESISTANT ORGANISMS IN PATIENTS WITH URETERIC STENTS

You have accessJournal of UrologyCME1 May 2022PD32-02 POPULATION BASED STUDY ON THE INCIDENCE AND RISKS OF MULTIDRUG-RESISTANT ORGANISMS IN PATIENTS WITH URETERIC STENTS Runhan Ren, Zoe Hsu, Erik Youngson, and Shubha De Runhan RenRunhan Ren More articles by this author , Zoe HsuZoe Hsu More articles by this author , Erik YoungsonErik Youngson More articles by this author , and Shubha DeShubha De More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002583.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteric stents can lead to irritative voiding symptoms which mimic UTIs. This population is thought to be at high risk of antibiotic over-exposure. Therefore, our objective was to assess local trends in antibiotic and multidrug-resistant organism (MDRO) patterns in patients with ureteric stents. METHODS: A population level retrospective cohort of patients undergoing ureteric stent insertion was created using provincially curated inpatient, ambulatory, and primary care data, through the Data Integration, Management and Reporting unit (DIMR) in Alberta (2013-18). Those with concurrent extirpative and reconstructive surgeries were excluded. Data 1 year pre- and post-stent insertion (SI) were collected, and descriptive analyses done on demographics, cultured organisms, prescriptions, and health care utilization. MDRO were defined as urine cultures (UC) with at least 3 resistances or known resistant species. Patients with post-SI MDRO were analyzed based on pre-SI urine culture results [no growth (NG), sensitive organisms (SO), and MDRO]. RESULTS: Over the study period, 13,820 SI were completed. 78% (n=10,786) had a single stent placement. 58% were placed for stones and 18% for hydronephrosis. 7,436 UC were completed post-SI, and 35.4% were positive. Organisms with any resistance increased from 16% of all cultures pre-SI to 23.6% post-SI, with E. coli being most common. Ciprofloxacin resistance for E. coli significantly increased from 35% to 50% (p<0.05) after SI. MDRO increased from 1.2% (n=164) to 5.9% (n=815) after SI. 42% of these stents were placed for hydronephrosis and 21% for stones. 40% of these patients underwent repeat SI in the following year. 217 patients with NG and 434 with SO developed MDRO post-SI, within 2.9 and 2.7 prescriptions respectively. Patients with pre-SI MDRO were more likely to receive antibiotic prescriptions in the following year (NG 5.5 vs SO 5.7 vs MDRO 7.0) and received Ciprofloxacin 24% of time. Unplanned emergency visits were similar post-SI for the three groups (4.0 vs 4.0 vs 4.7, p=0.23), but pre-SI MDRO had significantly more emergency visits in the year prior to SI (2.6 vs 3.1 vs 4.3, p<0.0001). CONCLUSIONS: An increase in MDRO was observed after SI which was associated with an increased number of antibiotic prescriptions and increasing ciprofloxacin resistance. Unplanned emergency visits were significantly higher in patients with pre-SI MDRO, but similar post-SI. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e547 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Runhan Ren More articles by this author Zoe Hsu More articles by this author Erik Youngson More articles by this author Shubha De More articles by this author Expand All Advertisement PDF DownloadLoading ...

V02-12 LARGE VOLUME STONE EXTRACTION FOR THE TREATMENT OF CHRONIC PROSTATITIS

You have accessJournal of UrologyCME1 May 2022V02-12 LARGE VOLUME STONE EXTRACTION FOR THE TREATMENT OF CHRONIC PROSTATITIS George Koch, and Sarah Flury George KochGeorge Koch More articles by this author , and Sarah FlurySarah Flury More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002528.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic bacterial prostatitis can be a difficult condition to treat due both the variable tissue penetrance of antibiotics in the prostate, as well as the sometimes uncertain interaction between bacteria and prostatic stones. We present this video as both a demonstration of the atypical nature of this patient’s stone burden, as well as the multiple strategies employed to treat the stones. This patient presented with seven years of irritative voiding symptoms refractory to alpha-adrenergic blockers, long-term courses of antibiotics and serial prostatic message. His preoperative American Urological Association Symptom Index (AUASI) was 22 and his Quality of Life Score (QoL) was 4. MRI demonstrated a very large prostatic stone burden. METHODS: The procedure was performed using a 26 French Storz Resectoscope with both a Collins Knife electrocautery device and a 365 micron Holmium laser fiber via a laser bridge. The patient underwent unroofing of a large cavity within the prostate using the Collins Knife, and then stone fragmentation, further cavity resection, and hemostasis using the Holmium laser. Given the difficulty of removing stones with the resectoscope directly from the prostatic cavity, an Ellik evacuator was used to blow the stones into the bladder from which they were then easily drained through the sheath. RESULTS: The patient was discharged with a short course of antibiotics and a urethral catheter from the ambulatory surgery center and recovered well postoperatively. His catheter was removed on postoperative day seven and he passed a voiding trial. At his six-week follow-up appointment, he was voiding well and symptom free. His follow-up AAUSI was 14 and his QoL was 0. CONCLUSIONS: We found the use of both the Collins Knife electrocautery device and Holmium laser to be effective tools in the armamentarium to treat prostatic stones associated with chronic prostatitis. Our results demonstrate the importance of imaging and the role of nidus removal in the treatment of refractory chronic bacterial prostatitis. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e114 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information George Koch More articles by this author Sarah Flury More articles by this author Expand All Advertisement PDF DownloadLoading ...

Cedecea lapagei an Extremely Rare Uropathogen: A Case Report

Background: Centers for Disease Control (CDC) Laboratories discovered Cedecea lapagei in 1977, and the first case of Cedecea lapagei in humans was reported in 2006. A literature search revealed only one case report of prior isolation of Cedecea lapagei from urine culture, and this is the second case of Cedecea lapagei as an uropathogen reported in the world.&#x0D; Case presentation: A 55 years old man with chronic renal failure, poorly controlled Diabetes mellitus, and Hypertension presented with acute exacerbations of renal failure and irritative voiding symptoms. After stabilization and empirical antibiotic therapy with Ceftriaxone, the patient’s condition was not improved and deteriorated progressively. After the request of urine culture, the culture was isolated, an extremely rare uropathogen; the Cedecea lapagei. Cedecea lapagei identification has been done using Eosin Methylene Blue agar (EMB). Gram-negative lipase positive bacteria with bacillus in shape, motile in nature that is non-spore-forming, and non-encapsulated Enterobacteria with the final result of &gt;100,000 colony-forming units per ml of Cedecea lapagei were isolated. Mueller-Hinton agar had been used to perform antimicrobial sensitivity and resistance. The pathogen revealed antimicrobial resistance against Ceftriaxone, Cephazolin, Ceftazidime, Cefixime, Ampicillin, and Amoxicillin-Clavulanic Acid while Carbapenems, Fluoroquinolones, Aminoglycosides, and Trimethoprim-Sulfamethoxazole showed a higher sensitivity rate.&#x0D; Conclusion: This is the second case of Cedecea lapagei as an uropathogen reported in the world. Cedecea lapagei is a rare bacterial infection in humans and has an emerging antimicrobial resistance. Antimicrobial treatment should be aligned with the culture findings once available.

Association between pelvic nodal radiotherapy and patient-reported functional outcomes through 5 years among men undergoing external-beam radiotherapy for prostate cancer: An assessment of the comparative effectiveness analysis of surgery and radiation (CEASAR) cohort.

The role of pelvic irradiation in men receiving external beam radiotherapy (EBRT) for prostate cancer is unclear, in part due to a lack of data on patient-reported outcomes. We sought to compare functional outcomes for men receiving prostate and pelvic versus prostate-only radiotherapy, longitudinally over 5 years. We performed a population-based, prospective cohort study of men with clinically-localized prostate cancer undergoing EBRT. We examined the effect of prostate and pelvic (n = 102) versus prostate-only (n = 485) radiotherapy on patient-reported disease-specific (using the Expanded Prostate Cancer Index Composite[EPIC]-26) and general health-related (using the SF-36) function, over 5 years. Regression models were adjusted for outcome-specific baseline function, clinicopathologic characteristics, and androgen deprivation therapy (ADT). 587 men (median [quartiles] age 69 [64-73] years) met inclusion criteria and completed ≥1 post-treatment survey. More men treated with prostate and pelvic radiotherapy had high-risk disease (58% vs. 18%, P < 0.01) and received ADT (75% vs. 41%, P < 0.01). These men reported worse sexual (6 months-5 years), hormonal (at 6 months), and physical (6 months-5 years) function. Accounting for baseline function, patient and tumor characteristics, and use of ADT, pelvic irradiation was not associated with statistically or clinically significant differences in bowel function, urinary incontinence, irritative voiding symptoms or sexual function through 5-years (all P > 0.05). Marginally clinically important differences were noted in hormonal function at 3-years (adjusted mean difference 4.7, 95% confidence interval [1.2-8.3]; minimally clinically important difference (MCID) 4 to 6) and 5-years (4.2, [0.4-8.0]) following treatment. After adjustment, there was a transient statistically significant, but not clinically important, difference in emotional well-being at 6 months (3.0, [0.19-5.8]; MCID 6) that resolved by 1 year and no differences in physical functioning or energy and fatigue. This prospective, population-based cohort study of men with localized prostate cancer treated with EBRT, showed no clinically important differences in disease-specific or general health-related quality of life with the addition of pelvic irradiation to prostate radiotherapy, supporting the use of pelvic radiotherapy when it may be of clinical benefit, such as men with increased risk of nodal involvement.

Role of percutaneous tibial nerve stimulation in the management of the detrusor overactivity

IntroductionPercutaneous tibial nerve stimulation (PTNS) is a technique that was developed a decade or more ago, but it does not seem to have become widely adopted into clinical practice.AimThe purpose of this study is focused on the efficacy of PTNS for the treatment of an overactive bladder.Patients and methodsBetween September 2016 and October 2019, this study included 40 patients who are complaining of irritative voiding symptoms, such as frequency, urgency, nocturia, enuresis, and urge incontinence. Those patients are divided into two equal groups subjected to PTNS and sham groups.ResultsOnly 40 patients completed the study, and they were divided into two groups A and B. Group A included 20 patients, 17 females and three males with a mean age of 24 years (SD 5.09) subjected to PTNS. Group B included 20 patients, 16 females and four males with a mean age of 27.65 (SD 7.10) as a placebo group. There was a highly significant change in frequency along the treatment course among PTNS. Urge incontinence manifestations in group A (PTNS): at 3 months, 57% of the patients (8/14) showed improvement. At 1 year: 50% of the patients (7/14) showed improvement. Group B (sham): at 3 months, 27% (5/18) only showed improvement. At 1 year, 22% of the patients (4/18) only showed improvement.ConclusionPosterior tibial nerve stimulation (PTNS) is an effective, minimally invasive option for the treatment of patients complaining of an overactive bladder with an easily accessible stimulation site and minimal side effects.

The efficacy and safety of silodosin-a review of literature

Background: Benign prostatic hyperplasia is a compilation of irritative voiding and obstructive symptoms which are consistent with reduced emptying of urine from and defective storage of urine in the bladder. Medications are a common method of treatment to delay complications and reduce symptoms. Silodosin is a highly selective alpha-1A adrenoceptor blocker that has 162 times more affinity for alpha-1a than alpha 1b, thus resulting in high uroselectivity and decreased side effects. Aim: In this review article our aim was to elucidate the clinical effects, safety and tolerability profile of silodosin in the treatment of benign prostatic hyperplasia. Method: Literatures were retrieved by a PubMed search, using different combinations of pertinent keywords (e.g., silodosin, hypotension, benign prostatic hyperplasia), without any limitations in terms of publication date and language. Papers which assessed the therapeutic efficacy and tolerability of silodosin were selected for inclusion according to their relevance for the topic, as judged by the authors. Overv?ew of clinical data: Silodosin is indicated for the treatment of the signs and symptoms of benign prostatic hyperplasia. It has a rapid onset of effect in men with lower urinary tract symptoms and improvements were seen in voiding and storage symptoms, maximum urinary flow rate and health-related quality of life. The efficacy of silodosin was maintained in several controlled studies and also non-interventional real-world setting. Silodosin was generally well tolerated. Conclusion: Silodosin is the most uroselective α-blocker. Silodosin has been emphasized in the 2021 European Association of Urology Conservative treatment of non-neurogenic male LUTS guidelines and it has been reported that the hypotensive effect of silodosin is comparable with placebo and has favorable safety and tolerability profile. Dosing of silodosin does not need to be adjusted according to age, concurrent medication with antihypertensives and phosphodiesterase type 5 inhibitors.

Association Between Ureteral Double J Stent Colonization and Lower Urinary Tract Symptom Severity: A Cross-Sectional Study

IntroductionDouble J stents (DJS) are commonly used in urological practice, but they do have a risk of complications, such as infection and hematuria. This study explored the association between ureteral double J stent colonization and lower urinary tract symptom (LUTS) severity.MethodologyThis cross-sectional study was conducted from January 2021 to June 2021 in patients admitted to a tertiary care hospital in Karachi, Pakistan, who required double J stent (DJS) insertion. Patients who came to the site for stent removal were invited to participate in the study and enrolled using a consecutive sampling technique between January 15, 2021, and March 15, 2021.ResultsThe study enrolled 176 patients, of whom 73.33% had colonization and the remaining had no colonization. The factors significantly associated with symptom severity included colonization of the DJS (P-value = 0.001) and the patients’ ages (P-value = 0.046). The two groups have significantly different symptoms, which included incontinence (P-value = 0.001), polyuria (P-value = 0.001), and nocturia (P-value = 0.001).ConclusionOur study found more severe symptoms in DJS patients with colonization than in those without colonization. Irritative voiding symptoms, including nocturia and dysuria, are more common in DJS patients with colonization.

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. ............