Mean Postvoid Residual Volume Research Articles

Long-term urinary symptoms in adolescent and adult women with congenital adrenal hyperplasia

Congenital adrenal hyperplasia (CAH) is an autosomal recessive condition resulting in excess androgen production. Females are typically born with ambiguous genitalia and often undergo feminising genitoplasty in infancy or childhood. Recently, there has been considerable international debate as to whether distressing urinary symptoms in CAH patients are truly present and, if so, whether these urinary problems are a consequence of the feminising genitoplasty. To identify and assess any urinary symptoms in an Australian cohort of adolescent and adult women with CAH who have undergone feminising genitoplasty in infancy, childhood or adolescence as a part of their management. Females with CAH aged 12-40 years, who had undergone feminising genitoplasty, and were identified from a hospital database (n=72). Those aged 12-15 years were assessed using the Paediatric Incontinence Symptom Index questionnaire in conjunction with sections of the Bristol Female Lower Urinary Tract Symptoms Scored Form questionnaire. Those aged 16-40 years were assessed using the Bristol Female Lower Urinary Tract Symptoms Scored Form questionnaire. Uroflowmetry studies and post-void residual volume ultrasounds were also conducted. Previously published normative data were used for the control population. Responses to the questionnaire indicated that CAH patients had a higher incidence of urgency, frequency, urge incontinence, unexplained incontinence and nocturnal incontinence, when compared to previously published control data. Average and maximum urine flow rates measured by uroflowmetry were within normal range; however, the 16-40-year-old age group had significantly increased mean post-void residual volumes (P<0.001) (Summary table). The presence of lower urinary tract symptoms in these patients has previously been interpreted as a direct outcome of feminising genitoplasty; however, these results could also be accounted for by the virilisation of pelvic floor musculature. Androgens have been shown to increase skeletal muscle mass, but their exact impact on the pelvic floor musculature requires further research. Three previous studies have measured post-void residual volumes in patients with CAH, all of which found it them be raised. Patients with CAH appeared to have overall normal urinary flow but increased post-void residual volumes. The data suggested that this population of patients has an increased probability of incontinence, urgency, and frequency when compared to a control population. These results confirmed findings of other small studies; however, it remains unclear if these changes reflected the underlying diagnosis or were a consequence of management.

Preserved micturition after intradetrusor onabotulinumtoxinA injection for treatment of neurogenic bladder dysfunction in Parkinson's disease.

BackgroundTo assess the efficacy and safety of intradetrusor onabotulinumtoxinA (OnabotA) injection treatment in patients with neurogenic lower urinary tract dysfunction (NLUTD), especially for patients with Parkinson disease (PD).MethodsPD patients refractory to oral antimuscarinic participated in an off-label use study and were evaluated prior and after 200 IU OnabotA injection into detrusor muscle, including trigone. Changes due to treatment were evaluated using bladder diaries, urodynamics, and questionnaires. Statistical analysis comprised Wilcoxon rank-sum test. Values are presented as mean ± standard deviation.ResultsTen PD patients (4 female and 6 male, mean age: 67.9 ± 5.36 years) with LUTD were enrolled. All patients tolerated the treatment. Bladder diary variables decreased significantly (p ≤ 0.011) after OnabotA injection compared to variables prior injection. Desire to void and maximum bladder capacity increased significantly in urodynamics (p ≤ 0.05). Maximum detrusor pressure during voiding phase normalised from 56.2 to 18.75 cm/H20. Detrusor overactivity was less often detectable. All patients voided spontaneously. Mean post void residual (PVR) volume was 77.0 ± 119.78 mL postoperatively. No urinary retention or side effects have been observed during/after treatment. Mean follow-up time was 4 months (range of 1–12). 4 patients requested repeated injection after a mean period of 10 months between first and second injection.ConclusionsOur data confirm the efficacy and safety of 200 IU OnabotA injection in patients with neurogenic LUTD due to PD. The risk of urinary retention or high post-urinary residual volumes seems to be minor after OnabotA-injection. More research is needed with larger sample size to confirm the significance of these findings.Trial registrationTrial Number: ISRCTN 11857462, Registration Date 2016/10/08

Treatment outcomes of benign prostate hyperplasia by thulium vapoenucleation of the prostate in aging men

PurposeTo analyze the outcomes of thulium vapoenucleation of the prostate (ThuVEP) in the management of benign prostatic hyperplasia. The outcomes of this increasingly popular procedure are yet to be confirmed in patients with various prostate sizes and health status. Materials and methodsThree hundred and three patients who underwent ThuVEP were included and stratified in subgroups according to prostate size and age. We analyzed patient demographics, preoperative disease-related parameters, and perioperative and follow-up results. Correlation of prostate size and operation time were also assessed. ResultsBaseline mean prostate volume was 61.0 mL (range 19.3–226 mL), mean urinary peak flow rate (Qmax) was 8.6 mL/second (range 1.4–23.25 mL/second), mean postvoid residual volume was 126.2 mL (range 0–649 mL) and mean International Prostate Symptom Score was 25.1 (range 8–35). The mean operation time was 84.0 minutes and 88.6 minutes for total and prostate volume >80 mL, respectively. After laser surgery, there were mean reductions of 5.3 ng/mL, 7.5 ng/mL, 3.7 ng/mL, and 3.5 ng/mL (38.0%, 49.7%, 30.3%, and 36.5% change from baseline) in prostate-specific antigen level among the four groups. As for postvoid residual volume, there was a significant reduction in volume in the total, prostate volume >80 mL and prostate volume <80 mL (−73.9 mL, −70.8 mL, and −67 mL, respectively) but not in the elderly group (−31.4 mL, p = 0.068). Similarly, Qmax improved significantly in all (6.7 mL/second, 5.9 mL/second, and 6.0 mL/second, respectively) except the elderly group (2.3 mL/second, p = 0.103). The operation time was highly correlated with the prostate size. ConclusionThis study indicates that ThuVEP is an effective treatment option for benign prostatic obstruction in patients with different prostate size and age. The technique allows an efficient surgical course with operation time highly correlated with prostate size.

MP35-17 UNDERACTIVE BLADDER (UAB) SYMPTOMS AND VOIDING PARAMETERS IN ELDERLY COMMUNITY-DWELLING MALES WITH 5 YEAR FOLLOWUP

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms (LUTS) are common in older men and there is increasing awareness of the impact of the underactive bladder (UAB) in the elderly. We assessed symptoms suggestive of UAB and voiding parameters in a group of community-dwelling elderly men over a period of 5 years. METHODS: Community dwelling men aged 70 years and over were enrolled to participate in the Concord Health and Ageing in Men Project (CHAMP), a population based study of men living in a defined geographical area in metropolitan Sydney, Australia. Men were required to complete a survey including International Prostate Symptom Score (IPSS) and medical, medication and urological history, then attend a clinical assessment where uroflowmetry and post void residual volume were measured. Subjects are re-assessed after two years and five years with repeat survey and clinical assessment. UAB symptoms were assessed based on the IPSS-voiding subscore (IPSSV) and correlated with voiding parameters at baseline and five year follow-up. RESULTS: 1705 men aged 70-97 years participated; 1367 presented for follow-up assessment 2 years later and 940 at 5 years (382 (23%) had deceased). 275 men with prostate cancer and 302 men with previous surgical treatment for BPH were omitted from analyses. Men with significant overactive bladder symptoms (IPSSstorage subscore >5) were excluded leaving 870 men for analysis. 93% had low IPSS-V scores (0-6),6% intermediate IPSS-V (7-13) and 1% high IPSS-V(14-20). Mean peak flow rates at baseline for men with low, intermediate and high IPSS-V scores were 13.3 mls/sec, 10.9mls/ sec and 10.1mls/sec respectively (P<0.001) but there was no significant change at 5 years (12.5mls/s, 10.6mls/s, 10.8mls/s). Mean post void residual volume for men with low, intermediate and high IPSS-V scores at baseline were 66.9mls, 78.4mls and 92.6mls respectively (P1⁄40.001) and there was no significant change at 5 years. Increased total IPSS-V correlated with reduced peak flow and increased post void residual (P<0.001), but not with age. Only 18 (2%) men had surgery for LUTS between baseline and 5 years. The risk of undergoing surgery correlated with intermediate/high IPSS-V scores (P1⁄40.014). CONCLUSIONS: Both UAB symptoms and voiding parameters of uroflowmetry and post void residual volume remain relatively stable over a five year period in elderly, community-dwelling men. UAB symptoms correlated with elevated postvoid residual urine and reduced urinary flow rates although the number of men requiring surgical intervention was low.

MP35-18 NOT A VOLUME BUT A STRUCTURAL VARIATION OF THE PROSTATIC URETHRA WITHIN THE PROSTATE PREDICT THE DEGREE OF OBSTRUCTIVE SYMPTOM: A PROSPECTIVE MULTICENTER OBSERVATIONAL STUDY

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms (LUTS) are common in older men and there is increasing awareness of the impact of the underactive bladder (UAB) in the elderly. We assessed symptoms suggestive of UAB and voiding parameters in a group of community-dwelling elderly men over a period of 5 years. METHODS: Community dwelling men aged 70 years and over were enrolled to participate in the Concord Health and Ageing in Men Project (CHAMP), a population based study of men living in a defined geographical area in metropolitan Sydney, Australia. Men were required to complete a survey including International Prostate Symptom Score (IPSS) and medical, medication and urological history, then attend a clinical assessment where uroflowmetry and post void residual volume were measured. Subjects are re-assessed after two years and five years with repeat survey and clinical assessment. UAB symptoms were assessed based on the IPSS-voiding subscore (IPSSV) and correlated with voiding parameters at baseline and five year follow-up. RESULTS: 1705 men aged 70-97 years participated; 1367 presented for follow-up assessment 2 years later and 940 at 5 years (382 (23%) had deceased). 275 men with prostate cancer and 302 men with previous surgical treatment for BPH were omitted from analyses. Men with significant overactive bladder symptoms (IPSSstorage subscore >5) were excluded leaving 870 men for analysis. 93% had low IPSS-V scores (0-6),6% intermediate IPSS-V (7-13) and 1% high IPSS-V(14-20). Mean peak flow rates at baseline for men with low, intermediate and high IPSS-V scores were 13.3 mls/sec, 10.9mls/ sec and 10.1mls/sec respectively (P<0.001) but there was no significant change at 5 years (12.5mls/s, 10.6mls/s, 10.8mls/s). Mean post void residual volume for men with low, intermediate and high IPSS-V scores at baseline were 66.9mls, 78.4mls and 92.6mls respectively (P1⁄40.001) and there was no significant change at 5 years. Increased total IPSS-V correlated with reduced peak flow and increased post void residual (P<0.001), but not with age. Only 18 (2%) men had surgery for LUTS between baseline and 5 years. The risk of undergoing surgery correlated with intermediate/high IPSS-V scores (P1⁄40.014). CONCLUSIONS: Both UAB symptoms and voiding parameters of uroflowmetry and post void residual volume remain relatively stable over a five year period in elderly, community-dwelling men. UAB symptoms correlated with elevated postvoid residual urine and reduced urinary flow rates although the number of men requiring surgical intervention was low.

Neurologic diseases that cause female urinary retention

Objective: The pathogenesis of female urinary retention is not well known. Hence, we systematically investigated the frequency of diseases that underlie female urinary retention in a urodynamic laboratory.Methods: We analyzed data from 450 consecutive female patients. Data registries included the diagnosis, lower urinary tract symptom questionnaires, urodynamic study results, and neurologic exam observations. Complete urinary retention is defined as mean post-void residual (PVR) urine volume &gt; 100 ml with no voluntary void at all; whereas incomplete urinary retention is defined as mean PVR urine volume &gt; 100 ml after voluntary partial void.Results: Sixty of the 450 female patients visiting our lab (13%) had urinary retention with 4 (6.7%) of these having complete retention and 56 (93.3%) having incomplete retention. The most common underlying disease in these 60 patients was lumbar spondylosis (LS), 38.3% (with 16 patients having LS alone and 7 having LS &amp; diabetic distal polyneuropathy [DPN]), multiple system atrophy (MSA), 18.3%, and DPN, 14.4% (with 2 patients having DPN alone and 7 having LS &amp; DPN), followed by drug-induced retention (e.g., by antidepressants), 8.3%, acute myelitis of possible demyelinating origin, 5.0%, and other etiologies. An underactive detrusor was the major urodynamic findings in those patients.Conclusion: The present study revealed that common etiologies for female urinary retention are neurologic, e.g., an underactive detrusor due to MSA, age-related LS, and lifestyle-related DPN. Therefore LS and DPN, both common diseases, should also become major treatment targets in order to maximize patients’ quality of life.

Transurethral Bipolar Enucleation of the Prostate Is an Effective Treatment Option for Men With Urinary Retention

To evaluate outcomes of transurethral bipolar enucleation (TuBE) of the prostate in patients with refractory lower urinary tract symptoms. A retrospective analysis was performed on patients who underwent TuBE from July 2014 to March 2015. Perioperative factors evaluated included International Prostate Symptom Score, Sexual Health Inventory for Men score, prostate-specific antigen, postvoid residual volume, transrectal ultrasound volume measurement, estimated blood loss, operative time, pathologic weight, and complications. Postoperative evaluation was performed at 6 weeks and 3 months. Forty-nine patients were identified. Mean age was 67 years and mean follow-up was 4.4 months. Twenty-eight patients (57%) were in retention. Preoperative, 6-week, and 3-month mean postvoid residual volumes were 278 mL, 66 mL, and 87 mL (P < .01); mean International Prostate Symptom Scores were 22, 9, and 8 (P < .01); mean quality of life scores were 5.0, 1.9, and 1.9; and Sexual Health Inventory for Men scores were 7.1, 8.4, and 7.0 (P = .35), respectively. Twenty-eight patients (57%) were able to have erections preoperatively and were still able to postoperatively. All (100%) of the patients in retention were able to void postoperatively. Mean operative time was 93 minutes, estimated blood loss was 49 mL, and pathologic weight was 18 g. Urinary tract infection occurred in 3 patients (6%), urethral stricture in 1 (2%), and bladder neck contracture in 2 (4%). Mean prostate-specific antigen decreased from 3.2 ng/dL to 0.9 ng/dL at 3 months (P < .01). TuBE is an effective operation for refractory urinary tract symptoms including those who are in urinary retention.

Prostatic arterial embolization for the treatment of lower urinary tract symptoms as a result of large benign prostatic hyperplasia: A prospective single-center investigation.

To evaluate the effectiveness and safety of prostatic arterial embolization as a primary treatment for patients with lower urinary tract symptoms as a result of large benign prostatic hyperplasia. A total of 64 patients with prostates >80 mL were included in the study. Prostatic arterial embolization was carried out using a combination of 50-µm and 100-µm particles. Clinical follow up was carried out using the International Prostate Symptom Score, quality of life, peak urinary flow, postvoid residual volume, International Index of Erectile Function Short Form, prostate-specific antigen, and prostatic volume at 1, 3, 6 and every 6 months thereafter. Prostatic arterial embolization was technically successful in 60 of 64 patients (93.8%). Follow-up data were available for 60 patients with a mean of 18 months. A clinical improvement, defined as reduction of International Prostate Symptom Score and increase of peak urinary flow, at 1 month, 3 months, 6 months, 12 months and 24 months, was achieved in 95.0%, 95.0%, 93.3%, 92.6% and 90.5%, respectively. A total of 42 patients had completed the follow up at 24 months after prostatic arterial embolization. There was an improvement in terms of mean International Prostate Symptom Score (pre-prostatic arterial embolization vs post-prostatic arterial embolization 27.0 vs 8.0; P < 0.01), mean quality of life (5.5 vs 2.0; P < 0.01), mean peak urinary flow (7.0 vs 13.0; P < 0.01), mean postvoid residual volume (130 vs 45.0; P < 0.05) and prostatic volume (121.0 vs 71.5, reduction of 40.9%; P < 0.01) were significantly different with respect to baseline. Prostatic arterial embolization seems to be a safe and effective treatment method for patients with lower urinary tract symptoms as a result of large benign prostatic hyperplasia, and it might play an important role for patients in whom medical therapy has failed, who are not candidates for surgical treatment.

PD39-08 VOIDING PARAMETERS IN ELDERLY MALES WITH 5 YEAR FOLLOWUP- WHAT HAPPENS TO MEN WITH ELEVATED POSTVOID RESIDUAL URINE?

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology and Natural History1 Apr 2015PD39-08 VOIDING PARAMETERS IN ELDERLY MALES WITH 5 YEAR FOLLOWUP- WHAT HAPPENS TO MEN WITH ELEVATED POSTVOID RESIDUAL URINE? Giovanni Losco, Lewis Chan, Vincent Tse, Vasi Naganathan, and Robert Cumming Giovanni LoscoGiovanni Losco More articles by this author , Lewis ChanLewis Chan More articles by this author , Vincent TseVincent Tse More articles by this author , Vasi NaganathanVasi Naganathan More articles by this author , and Robert CummingRobert Cumming More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2403AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lower urinary tract symptoms (LUTS) are common in elderly men. We assessed symptom scores and voiding parameters in a group of community-dwelling elderly men over a period of 5 years with emphasis on the natural history of men with elevated postvoid residual urine at baseline. METHODS Community dwelling men aged 70 years and over were enrolled to participate in the Concord Health and Ageing in Men Project (CHAMP), a population based study of men living in a defined geographical area in metropolitan Sydney, Australia. Men were required to complete a survey including International Prostate Symptom Score (IPSS) and medical, medication and urological history, then attend a clinical assessment where uroflowmetry and post void residual volume were measured. Subjects were re-assessed after two years and five years with repeat survey and clinical assessment. We report results at baseline and five year follow-up. RESULTS A total of 1705 men aged 70-97 years participated; 1367 presented for follow-up assessment 2 years later and 940 at 5 years (382 (23%) had died). 275 men with prostate cancer were omitted from analyses. Mean IPSS was 7.4 (mild 63%, moderate 29%, severe 8%) at baseline and 7.3 (mild 64%, moderate 30%, severe 6%) at 5 years. Mean peak flow rate at baseline was 12.7 mls/sec and at 5 years was 12.0 mls/sec (P<0.0001). Peak flow rate was lower in older men (>85 years) compared to younger men (70-80 years) both at baseline (P<0.02) and 5 years (P=<0.01). Mean post void residual volume was 66.5 mls at baseline and 76.0 mls at 5 years (P=0.001). Increased total IPSS correlated with reduced peak flow and increased post void residual, but not with age. 114 (7%) men had surgery for LUTS between baseline and 5 years. In men with residual volume > 200mls at baseline the residual volume did not change significantly over 5 years (P=0.51). Ten men were using a catheter at baseline and 9 at 5 year assessment. CONCLUSIONS Both urinary symptom scores and voiding parameters of uroflowmetry and post void residual volume remain remarkably stable over a five year period in elderly, community-dwelling men. Men with elevated postvoid residual urine did not deteriorate significantly and the number of men requiring surgical intervention was low. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e833 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Losco More articles by this author Lewis Chan More articles by this author Vincent Tse More articles by this author Vasi Naganathan More articles by this author Robert Cumming More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD9-12 VIDEOURODYNAMIC EVALUATION OF INTRACORPOREALLY RECONSTRUCTED ORTHOTOPIC U-SHAPED ILEAL NEOBLADDERS

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion I1 Apr 2015PD9-12 VIDEOURODYNAMIC EVALUATION OF INTRACORPOREALLY RECONSTRUCTED ORTHOTOPIC U-SHAPED ILEAL NEOBLADDERS Antonio Luigi Pastore, Giovanni Palleschi, Luigi Silvestri, Andrea Ripoli, and Antonio Carbone Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Giovanni PalleschiGiovanni Palleschi More articles by this author , Luigi SilvestriLuigi Silvestri More articles by this author , Andrea RipoliAndrea Ripoli More articles by this author , and Antonio CarboneAntonio Carbone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.939AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To study the functional outcomes of 30 patients who had previously undergone laparoscopic radical cystectomy (LRC) with intracorporeal orthotopic ileal neobladder reconstruction using videourodynamic (VUDM) assessment 180 days post-operatively. METHODS Between November 2010 and December 2013, 30 male patients had undergone LRC with bilateral standard pelvic lymphadenectomy and pure laparoscopic orthotopic ileal U-shaped neobladder diversion. The demographic data were: median age, 67 years (range: 62–79); body mass index (BMI), 22.3 (16–26.1); and mean American Society of Anaesthesiologists (ASA) score 2.2 (1–3). Functional outcomes were assessed performing a standard VUDM study combined with perineal floor electromyography 180 days post-operatively. RESULTS Videourodynamic evaluations showed good functional outcomes of the reservoirs. Mean maximal neobladder capacity was 287 mL (210–335 mL). Residual peristaltic activity was observed in all the individuals evaluated; however, only 9/30 (30%) individuals displayed severe peristaltic activity. Six of these nine (66.6%) individuals experienced urinary leakage during these contractions. Mean post-void residual volume was 44 mL (0–105 mL), and peak flow rate was 13.9 mL/s (9.7–29.2 mL/s). The Valsalva manoeuvre was positive in 5/30 (17%) subjects. Bladder morphology assessed during contrast cystography showed the desired U-shape in all cases. Ureteral reflux was observed in 7/30 (23.3%) of individuals. CONCLUSIONS Based on VUDM, our study shows that U-shaped ileal neobladders achieved by a totally laparoscopic approach obtained good functional outcomes. These findings support the evidence that a minimally invasive approach does not impose technical limitations that negatively impact the surgical results. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e199-e200 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonio Luigi Pastore More articles by this author Giovanni Palleschi More articles by this author Luigi Silvestri More articles by this author Andrea Ripoli More articles by this author Antonio Carbone More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Videourodynamic Evaluation of Intracorporeally Reconstructed Orthotopic U-shaped Ileal Neobladders

To study the functional outcomes of 30 patients who had previously undergone laparoscopic radical cystectomy with intracorporeal orthotopic ileal neobladder reconstruction using videourodynamic (VUDM) assessment 180days postoperatively. Between November 2010 and December 2013, 30 male patients had undergone laparoscopic radical cystectomy with bilateral standard pelvic lymphadenectomy and pure laparoscopic orthotopic ileal U-shaped neobladder diversion. The demographic data were as follows: median age, 67years (range, 62-79); body mass index, 22.3 kg/m(2) (range, 16-26.1 kg/m(2)); and mean American Society of Anesthesiologists score 2.2 (range, 1-3). Functional outcomes were assessed performing a standard VUDM study combined with perineal floor electromyography 180days postoperatively. VUDM evaluations showed good functional outcomes of the reservoirs. Mean maximal neobladder capacity was 287mL (range, 210-335mL). Residual peristaltic activity was observed in all the individuals evaluated; however, only 9 of 30 individuals (30%) displayed severe peristaltic activity. Six of these 9 individuals (66.6%) experienced urinary leakage during these contractions. Mean postvoid residual volume was 44mL (range, 0-105mL), and peak flow rate was 13.9mL/s (range, 9.7-29.2mL/s). The Valsalva maneuver was positive in 5 of 30 subjects (17%). Bladder morphology assessed during contrast cystography showed the desired U-shape in all cases. Ureteral reflux was observed in 7 of 30 individuals (23.3%). Based on VUDM, our study shows that U-shaped ileal neobladders achieved by a totally laparoscopic approach obtained good functional outcomes. These findings support the evidence that a minimally invasive approach does not impose technical limitations that negatively impact the surgical results.

THE USE OF BOTULINUM TOXIN IN WOMEN WITH FOWLER'S SYNDROME

<h3>Background</h3> Urinary retention in young women due to a disorder of external urethral sphincter relaxation, known as Fowler9s syndrome, is characterised by elevated urethral pressure profile (UPP) and abnormal urethral sphincter EMG. Sacral neuromodulation is the only effective treatment currently. The aim of this study was to assess the efficacy of botulinum toxin in Fowler9s Syndrome. <h3>Methods</h3> Ten women with Fowler9s Syndrome (obstructed voiding (n=5), complete urinary retention (n=5) were recruited at a tertiary referral centre. Baseline and post-treatment symptoms were assessed using the International Prostate Symptom Score (IPSS) questionnaire, and urinary flow and post-void residual volumes were measured. Patients were reviewed at weeks 1, 4 and 10 post-treatment. <h3>Results</h3> There was a significant improvement in symptom scores on the IPSS questionnaire at week 10. In women with obstructed voiding, mean flow rate improved from 8.12mls/sec (3–10) to 12.6mls/sec (6–27), whereas four women in complete retention voided spontaneously. Mean post-void residual volume decreased from 315mls (40–700) to 112 mls (0–230). No serious side effects were reported. <h3>Conclusion</h3> In this pilot study, urethral sphincter injections of Botulinum toxin was shown to be safe and effective in the management of urinary retention in women due to Fowler9s syndrome.

İrritable Bağırsak Sendromu (İBS) Tanısı Almış Erkek Hastalarda Alt Üriner Sistem Semptomları ve Erektil Fonksiyonların Değerlendirilmesi

Objectives: Irritable bowel syndrome (IBS) affects as many as 5-20% of individuals worldwide and causes a reduced quality of life. Approximately 50% of IBS patients have at least one co-morbid somatic complaint and many IBS patients meet diagnostic criteria for other functional disorders. In this study we aimed to evaluate lower urinary tract symptoms (LUTS) and erectile function in men with IBS. Material and Methods: Between January 2012 and March 2013 fifty men diagnosed with IBS in gastorenterology clinic and 50 healhty male voulanters without any gastrointestinal disorders were included in this study. After routine urological examination, the IPSS, IIEF, OAB-V8 and BECK depression scale scores of the patients were evaluated. All patients underwent uroflowmetric evaluation. Qmax values and postvoidal residual urine volumes, measured with suprapubic USG, were recorded. The results were compared statistically. Results: Mean age of the patients was 44.1±14.3 in group 1 and 46.76±8.58 in group 2. Mean Qmax values and mean postvoid residual urine volumes in group 1 and group 2 were 20.52±8.69, 25.4±38.5 cc and 19.10±9.23, 15.6±19.29 cc, respectively. Mean IPSS scores were 10.61±6.15 in group 1 and 10.50±6.08 in group 2. While mean OAB-V8 scores of the groups were 9.1±5.78 and 5.24±3.28, mean IIEF scores were 19.92±7.08 ve 18.92±7.13, respectively. Overactive bladder was determined in 48% (n=24) in group 1 and 12% (n=12) in control group. There were no statistically significant difference between groups in terms of mean age, IIEF scores, IPSS scores, mean Qmax and mean postvoidal residual urine volumes (p>0.05). However, mean OAB-V8 scores and mean BECK depression scores were significantly higher in Group 1 in comparision with control group (p<0.001). Conclusion: IBS, is a major health problem with serious psychosocial side effects and significantly reduces patients quality of life. LUTS and ED may be seen frequently in patients with IBS. Therefore, during menagement of these patients multydiciplinary assesment should be kept in mind.

Free uroflowmetry versus "Do-It-Yourself" uroflowmetry in the assessment of patients with lower urinary tract symptoms.

We investigated the possibility that patients could carry out a urine flow assessment at home by themselves, in comfort, without expense and without the use of equipment. We compared this strategy of "Do-It-Yourself" (DIY) uroflowmetry with traditional, hospital uroflowmetry. One hundred and twenty patients were enrolled. The patients underwent conventional, free uroflowmetry in hospital. Subsequently, the patients were asked to carry out the following procedure at home: urinate into a graduated container to quantify the total voided volume and determine the flow time by measuring the duration of miction with a stopwatch or simply with the second hand of a clock. This procedure had to be performed three times without preparation. Hundred patients completed the study. The mean age of the patients analysed was 64.12 years. Their free uroflowmetry values were as follows: the mean voiding time was 44.28 s, the mean voided volume was 290.92 ml, the mean Qmax was 15.17 ml/s, the mean Qmean was 7.87 ml/s, and the mean post-void residual volume was 78.44 ml. The mean Qmean measured by the "DIY-uroflowmetry" was 8.33 ml/s, which was not statistically significantly different (P = 0.12). Assuming that pathological hospital uroflowmetry values are equivalent to a DIY-Qmean ≤10 ml/s and that normal hospital values are equivalent to a DIY-Qmean >10 ml/s, the concordance was 100 %. Our proposed DIY evaluation of urine flow, together with the International Prostatic Symptom Score (IPSS), provides a good estimate of the results of free uroflowmetry, enabling unnecessary hospital investigations to be avoided.

Early and late urodynamic assessment of the orthotopic N-shaped neobladder

The present study aimed to report the urodynamic data from 46 male patients who underwent an orthotopic N-shaped neobladder replacement following a radical cystectomy during a 12-month period and to provide urodynamic evidence for the improvement of this technique. A total of 46 consecutive male patients underwent a radical cystectomy and orthotopic N-shaped neobladder substitution due to muscle-invasive bladder cancer. Uroflowmetry, cystometry and urethral pressure profilometry were analyzed at 3–12 months following the surgery. The mean pressure of the neobladders was <15 cm H2O at volumes of <400 ml and 22.4 cm H2O at 100% capacity at 6 months. The mean pressure of the contractions was <40 cm H2O at 6 months. The mean filling pressure following the surgery at 3 months was higher compared with that at 6 months. No difference was observed at the other time-points. When comparing the 9- and 12-month urodynamic characteristics, no significant changes were observed in the cystometric capacity. The mean post-void residual (PVR) urine volume was 58 ml. A mean voiding peak of 16.2 ml/sec was obtained using the Valsalva maneuver. The daytime continence rate was 90% at 12 months while the night-time continence rate was 60%.

Difference of free voiding parameters between male and female newborns

Objective To investigate the effects of gender on the newborn's voiding patterns. Methods One hundred and two healthy, single birth newborns[54 cases were preterm(26 male, 28 female) and 48 cases were full term(30 male, 18 female)] without low urinary tract pathological diseases, hospitalized in NICU from Mar.2010 to Mar.2011 were recruited in this study.Twelve hours(9∶00 Am-9∶00 Pm) observation of free voiding was performed.The voiding interval time(VIT), bladder emptying rate(BER), voiding volumes(VV), post-void residual volumes(PRV), bladder capacity(BC), voiding times, state of consciousness at voiding and the number of defecate simultaneously at voiding(DSV) as well as fluid intake were recorded and analyzed, retrospectively. Results The total times of voiding and DSV of the preterm neonates were 318 and 40 times, respectively.VIT and BC between male and female preterm newborns had no statistical significance.The mean PRV of the male was larger[(1.9±0.9) mL vs (0.9±0.8) mL] and the BER was lower(8.3% vs 44.1%) than those of the female newborns(all P 0.05). Conclusion Compared with female, male newborns are more likely to have post-void residual volumes. Key words: Gender; Voiding pattern; Newborn

Photoselective Laser Vaporization of the Prostate in the Treatment of Bladder Outlet Obstruction in Advanced-Stage Prostate Cancer: A Single-Center Experience

The study in China is the first on photoselective vaporization of the prostate (PVP) applied to bladder outlet obstruction (BOO) or urinary retention from advanced-stage prostate cancer (PCa). The aim is to evaluate the efficacy and safety of PVP in the treatment of patients with BOO secondary to advanced-stage PCa. Forty-five patients (mean age 76.13±5.88 years, range 62-89 years) with BOO or urinary retention secondary to advanced-stage PCa received PVP with a potassium-titanyl-phosphate laser. The treatment outcome was evaluated with subjective and objective tests at 1, 3, 6, and 12 months after PVP using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, postvoid residual (PVR) urine volume, and maximum urinary flow rate (Qmax). The operative time, indwelling catheterization time, and operative complications were also observed. All 45 patients recovered without incident. The mean operative time was 50±7.6 minutes. The catheterization duration was 3.2 days (range 2-7 days). There was significant improvement in Qmax from 7.29±0.93 to 12.16±2.75 mL/sec after treatment at 12 months. Mean PVR volume decreased from 210.94±179.49 to 54.45±33.16 mL. Mean IPSS score decreased from preoperative 28.19±3.64 to postoperative 14.61±2.81 (P<0.05), QoL score decreased from 5.03±0.69 to 3.66±0.65 (P<0.05). There were no intraoperative adverse events. Postoperative complications included mild transient hematuria in 12 (26.7%) patients and mild dysuria in 11 (24.4%) patients within 4 weeks. The clinical results suggest that PVP is a safe, efficient, and less-invasive treatment for patients with BOO or urinary retention secondary to advanced-stage PCa.

Urodynamic Differences Between Dysfunctional Voiding and Primary Bladder Neck Obstruction in Women

To determine the clinical and urodynamic differences in the presentation and the value of simultaneous fluoroscopy in dysfunctional voiding (DV) and primary bladder neck obstruction (PBNO); the 2 most common causes of non-neurogenic "functional" bladder outlet obstruction in women. A review of our urodynamic study database (March 2003 to August 2009) was conducted. DV was diagnosed when increased external sphincter activity was found during voluntary voiding on electromyography (EMG) or fluoroscopy. PBNO was diagnosed when a failure of bladder neck opening was noted on fluoroscopy during voiding. The demographics, symptoms, and urodynamic study parameters were collected. Comparisons were done using chi-square and 2-tailed t-tests. DV was diagnosed in 34 women and PBNO in 16. The patients with DV were younger than those with PBNO (40.9 vs 59.2 years, P < .001). Women with DV showed a clinical trend toward having more storage symptoms than those with PBNO and fewer voiding symptoms. Patients with DV had a greater mean maximal flow rate (12 vs 7 mL/s, P = .027) and lower mean postvoid residual urine volume (125 vs 400 mL, P = .012). No significant differences were found in maximal detrusor pressure, detrusor pressure at maximal flow rate, or detrusor overactivity. EMG showed increased activity during voiding in 79.4% of those with DV and 14.3% of those with PBNO (P < .001). Clinically, women with DV and PBNO had similar presentations, although those with PBNO had poorer emptying. The flow rates and patterns seemed to differ between those with DV and PBNO, although the voiding pressures were similar. EMG alone would have given the wrong diagnosis in 20.6% of those with DV (false negative) and 14.3% of those with PBNO (false positive). When fluoroscopy is used to define these entities, the accuracy of EMG to differentiate them is questionable.

Modified Transurethral Incision for Primary Bladder Neck Obstruction in Women: A Method to Improve Voiding Function Without Urinary Incontinence

To describe the modified surgical technique and report the long-term outcomes of modified transurethral incision for the treatment of primary bladder neck obstruction in women. A total of 30 women were diagnosed with primary bladder neck obstruction from the videourodynamic study findings according to the Blaivas-Groutz nomogram for female bladder outlet obstruction. Patients with neurogenic, traumatic, anatomic, or iatrogenic causes of obstruction were excluded. The transurethral incision of the bladder neck was performed in all patients, with the modification of incising at 4 different sites on the bladder neck, at the 3-, 6-, 9-, and 12-o'clock positions. The urodynamic results and clinical improvement in voiding symptoms were assessed before surgery and 3, 48, and 60 months after treatment. Follow-up data were available for 30 (100%), 28 (93%), and 25 (83%) of the 30 patients at 3, 48, and 60 months postoperatively, respectively. During the 5-year follow-up, the mean International Prostate Symptom Score decreased from 23.3 to 5.9. The mean quality of life scores decreased from 4.4 to 2.1. The mean peak urinary flow rate increased from 7.61 to 17.53 mL/s. The mean postvoid residual urine volume decreased from 185.11 to 28.75 mL. The mean voiding detrusor pressure decreased from 62.12 to 21.92 cm H2O. All 25 patients had improvement in both objective and subjective voiding functions 5 years after this modified treatment. Only 1 woman (3%) had mild stress incontinence postoperatively and was cured after the patient performed levator ani exercises. The modified transurethral bladder neck incision is effective in the long term in relieving voiding difficulties owing to primary bladder neck obstruction in women without urinary incontinence.

Prospective Randomised Controlled Trial Comparing Trigone-Sparing versus Trigone-Including Intradetrusor Injection of AbobotulinumtoxinA for Refractory Idiopathic Detrusor Overactivity

BackgroundBotulinum toxin A is effective for treatment of idiopathic detrusor overactivity (IDO). The trigone is generally spared because of the theoretical risk of vesicoureteric reflux (VUR), although studies assessing injection sites are lacking. ObjectiveEvaluate efficacy and safety of trigone-including versus trigone-sparing intradetrusor injections of abobotulinumtoxinA in patients with IDO. Design, setting, and participantsTwenty-two patients from one centre were randomised to trigone-including or trigone-sparing injections. InterventionInjection of 500 U abobotulinumtoxinA diluted to 20ml into 20 trigone-including or trigone-sparing sites. MeasurementsThe primary outcome measure was total overactive bladder symptom score (OABSS) at 6 wk. The OABSS questionnaire was completed at 0, 6, 12, and 26 wk. Baseline and postinjection urodynamic studies and micturating cystourethrograms were performed. Baseline values and subsequent time points were compared by t test. A mixed-effect model was used for repeated measures in time. Results and limitationsFor symptom scores at baseline compared with scores at 6 wk postinjection, the mean total OABSS improved from 22.4 to 8.7 (p<0.001) in the trigone-including group compared with 22.7 to 13.4 (p<0.03) in the trigone-sparing group. The difference in mean change from baseline was 4.4 points in favour of the trigone-including group (p=0.03). The total OABSS at 12 and 26 wk and the urgency subscale scores at 6, 12, and 26 wk showed significant improvement in favour of the trigone-including group. Mean postvoid residual volumes and clean intermittent self-catheterisation rates between the two groups were similar. No patients developed VUR. Performing injections under general anaesthetic was a limitation, as tolerability under local anaesthetic was not assessed. A further limitation is the lack of a trigone-only arm. ConclusionsTrigone-including injections are superior to trigone-sparing injections for the treatment of refractory IDO and did not cause VUR in this study.