Mean Postvoid Residual Volume Research Articles

Evaluation of the clinical value of a simple flowmeter in the management of male lower urinary tract symptoms

Study Type - Diagnostic (exploratory cohort) Level of Evidence 3b What's known on the subject? and What does the study add? Electronic uroflowmetry reasonably predicts the likelihood of bladder outlet obstruction (BOO) and risk of AUR. This low-cost device, Uflowmeter(™) , allows men to perform uroflowmetry at home with ease and the results are compatible with that of electronic uroflowmentry. It can also estimates risk of AUR and the need for TURP to relieve LUTS. To show the clinical value of a simple flowmeter, which has been devised to measure uroflow on an ordinal scale (<10, 10-15, 15-19 and >19 mL/s) at home, for the management of male lower urinary tract symptoms (LUTS). A total of 186 men with LUTS were enrolled in the study. The mean (range) follow-up was 220 (68-431) days. The men's mean (range) age was 65.5 (46-83) years, mean (range) maximum urinary flow rate (Qmax) 12.8 (4.3-39.5) mL/s, mean (range) voided volume 294.8 (151-686) mL; mean (range) postvoid residual urine volume (PVR) 50 (0-303) mL and mean (range) International Prostate Symptom Score (IPSS) 13.5 (1-31). The men underwent electronic uroflowmetry ('clinic uroflowmetry') and completed an IPSS questionnaire in the clinic. They then conducted 10 measurements with the device at home ('home uroflowetry'). The uroflowmetry and IPSS questionnaire were repeated 2 weeks later. Quadratically weighted Kappa analysis (κ) of the home uroflowmetry vs. clinic uroflowmetry, and of the sensitivity and specificity of the home uroflowmetry values to correspond to the mean Qmax of clinic uroflowmetry (<10, 10-15, 15-19 and >19 mL/s) was performed. Similar analyses were performed for the IPSS. Kaplan-Meier analysis was performed to evaluate whether home uroflowmetry was able to prognosticate acute urinary retention (AUR) or the need for transurethral resection of the prostate (TURP). The home uroflowmetry values (κ= 0.84, 95% confidence interval [CI]: 0.78-0.90) were superior to the IPSS (κ= 0.083; 95% CI: 0-0.173) in correlating with the mean Qmax of clinic uroflowmetry. Home uroflowmetry was most sensitive in identifying a mean Qmax of >19 mL/s (sensitivity: 0.99; 95% CI:0.97-1.00) and most specific in identifying a mean Qmax of <10 mL/s (specificity: 0.90; 95% CI:0.83-0.94). The home uroflowmetry works best in ruling out a mean Qmax of <19 mL/s (diagnostic odds ratio [DOR]= 349.3; 95% CI:40.24-3037.7), followed by a mean Qmax of <15 mL/s (DOR = 91.02; 95% CI:31.23-265.23) and a mean Qmax of <10 mL/s (DOR = 32.04; 95% CI:14.0-73.19). Men with a home uroflowmetry value ≤10 mL/s were more likely (n= 6; 8.8%) than those with a home uroflowmetry value >10 mL/s (n= 2; 1.7%) to develop AUR or require TURP (log-rank test: P= 0.017; hazard ratio:5.61(95% CI:1.10-28.64)). The IPSS failed to display the same discriminative capability. Home uroflowmetry using this simple device is a satisfactory estimation of clinic uroflowmetry using an electronic flowmeter and can predict the significant progression of male LUTS.

Techniques and Results of Urethroplasty for Female Urethral Strictures: Our Experience With 17 Patients

To report our experience with urethroplasty in women with urethral stricture and discuss the therapeutic considerations and outcomes of various flap- and graft-based techniques. A total of 17 patients with mid to distal urethral stricture (urethral caliber <14F, maximal urinary flow rate <12 mL/s, and detrusor pressure >20 cm H(2)O during voiding) underwent urethroplasty from 2004 to 2010. Of the 17 patients, 7 had undergone previous instrumentation and 10 were repaired primarily. The preoperative workup included American Urological Association symptom score assessment, uroflowmetry, voiding cystourethrography, and urethrocystoscopy. Of the 17 patients, 10 received anterior vaginal wall mucosa inlay urethroplasty. Proximally, the dilated urethral mucosa was used in 1 patient. A Martius flap reinforced ventral buccal mucosa graft (BMG) onlay urethroplasty was used in 2 patients with previous synthetic midurethral slings. Two patients with an atrophic vagina received a dorsal BMG onlay. A circular BMG reconstruction was used in 2 patients with severe distal urethral stricture. The preoperative findings were compared with the postoperative data at the last follow-up using the Wilcoxon sign test. With a median follow-up of 24 months (range 6-78), an objective and subjective cure was achieved in 17 (100%) and 15 (88%) patients, respectively. At the last follow-up, the mean maximal urinary flow rate increased from 10.8 ± 3.2 mL/s preoperatively to 28.9 ± 7.4 mL/s (P = .001), and the mean postvoid residual urine volume had decreased from 120 ± 30 mL preoperatively to 30 ± 12 mL (P = .001). The mean American Urological Association score had decreased from 27.1 ± 3.9 preoperatively to 7.1 ± 3.5 postoperatively (P < .0001). Primary urethroplasty can be considered a first-line option for treatment of female urethral strictures. Local mucosal flaps will cure the problem in most situations. BMG offers an excellent alternative when viable local tissue is absent.

Tadalafil administered once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a 1‐year, open‐label extension study

• To evaluate the 1-year safety of 5 mg of tadalafil once daily in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH-LUTS); efficacy measures were included to evaluate the maintenance of efficacy after an additional year of treatment. • In total, 427 men who completed a 12-week, placebo-controlled, dose- finding study assessing once-daily tadalafil (2.5, 5, 10 or 20 mg) or placebo elected to continue into the open-label extension period. Safety and efficacy parameters were assessed after 1 month and every 3 months. • In total, 299 patients (69.9%) completed the 1-year, open-label extension period. Treatment-emergent adverse events (TEAEs) were reported by 57.6% of patients, with most TEAEs being mild (44%) or moderate (45%) in severity; the most common TEAEs (≥ 2%) were dyspepsia, gastro-oesophageal reflux disease, back pain, headache, sinusitis, hypertension and cough. Twenty-two patients (5.2%) discontinued as a result of AEs. During the open-label extension period, mean prostate-specific antigen increased from 1.6 ± 1.3 ng/mL to 1.8 ± 1.4 ng/mL. • Mean post-void residual volume was 61.1 ± 60.4 mL at study entry and 42.2 ± 64.1 mL after the open-label extension period. Changes in the total International Prostate Symptom Score (IPSS), IPSS irritative and obstructive subscores, IPSS health-related quality of life and BPH Impact Index were maintained after 1 year. In sexually-active patients with erectile dysfunction, improvements in the International Index of Erectile Function-Erectile Function domain were maintained after 1 year. • In men with BPH-LUTS, 5 mg of tadalafil once daily during 1 year of treatment was well tolerated and efficacy changes were maintained.

Functional Detrusor Myoplasty for Bladder Acontractility: Long-Term Results

We present the long-term results of a multicenter investigation with latissimus dorsi detrusor myoplasty in patients with bladder acontractility caused by lower motor neuron lesion in whom there is no treatment alternative other than lifelong clean intermittent catheterization. From 2001 to 2008, 24 patients (median age 39 years, range 13 to 63, 16 males, 8 females) requiring complete clean intermittent catheterization 4 to 7 times daily underwent latissimus dorsi detrusor myoplasty at 4 centers worldwide. Before the procedure patients were on clean intermittent catheterization for a median of 55 months (range 17 to 195). Median followup was 46 months (range 8 to 89) and was performed by urodynamics and measurement of post-void residual urine volume. Bladder contractility index was calculated. The t test was used for statistical analysis. Of the 24 patients 17 (71%) gained complete spontaneous voiding with a mean post-void residual urine volume of 25 ml (range 0 to 100). Mean bladder contractility index increased from 20.1 ± 7.6 to 176.2 ± 25.4 (p <0.001). In 3 patients (13%) the frequency of clean intermittent catheterization was reduced to 2 to 4 times daily with a mean post-void residual urine volume of 200 ml (range 150 to 250). Mean bladder contractility index was 12.0 ± 7.2 preoperatively and 68.7 ± 28.1 postoperatively (p = 0.12). Recurrent urinary tract infections (defined as the presence of clinical symptoms such as dysuria and fever, and microbiological evidence of germs) ceased in 21 of 23 patients (91%, mean preoperatively 8 per year). Four patients (17%) required clean intermittent catheterization with the same frequency as before the procedure (mean bladder contractility index preoperatively 22.5 ± 10.3 and postoperatively 26.0 ± 12.3, p = 0.83). No chronic pain at the donor site or vesicoureteral reflux was observed in any patient. The results of this multicenter analysis demonstrate that latissimus dorsi detrusor myoplasty is an effective alternative to clean intermittent catheterization in a select group of patients with neurogenic bladder acontractility.

Cannabinor, a Selective Cannabinoid-2 Receptor Agonist, Improves Bladder Emptying in Rats With Partial Urethral Obstruction

We studied the effects of chronic treatment with the novel selective cannabinoid 2 receptor agonist cannabinor (Procter & Gamble Pharmaceuticals, Cincinnati, Ohio) on bladder function in conscious rats with partial urethral obstruction and on the functional properties of isolated detrusor muscle. A total of 24 female Sprague-Dawley® rats with surgically created partial urethral obstruction received daily intraperitoneal injections of 3 mg/kg cannabinor (12) or saline as controls (12) for 2 weeks. Cystometry was done, the rats were sacrificed and the bladders were prepared for in vitro studies. Mean ± SEM bladder weight was 0.97 ± 0.15 gm in controls and 0.53 ± 0.08 gm in cannabinor treated rats (p <0.05). There was no difference between the groups in the mean micturition interval, or mean baseline, threshold, flow or maximum pressure. In controls and cannabinor treated rats mean post-void residual volume was 0.28 ± 0.07 and 0.06 ± 0.02 ml, mean micturition compliance was 0.032 ± 0.006 and 0.069 ± 0.016 ml/cm H(2)O, and mean bladder wall force at the start of flow was 950 ± 280 and 1,647 ± 325 mN/gm, respectively (each p <0.05). Nonvoiding contractions were significantly less frequent in cannabinor treated rats than in controls. We noted no difference in carbachol (Sigma®) half maximum concentration between the groups but the carbachol maximum response in detrusor strips from cannabinor treated rats was significantly higher than that in control strips. In rats with partial urethral obstruction treated daily for 14 days with cannabinor bladder weight was lower, the ability to empty the bladder was preserved and nonvoiding contraction frequency was low compared to those in controls. Detrusor preparations from cannabinor treated rats showed a higher response to nerve stimulation than those from controls. Selective cannabinoid 2 receptor activation may be a novel principle to enable improved bladder function after partial urethral obstruction.

Colpocleisis in elderly patients with severe pelvic organ prolapse

To study the objective and subjective therapeutic effect of total and partial (LeFort) colpocleisis in treatment of severe pelvic organ prolapsed (POP) in selected elderly patients. From Oct. 2005 to Feb. 2010, 63 severe POP patients [59-87 years, median age (75+/-6) years] with stage III and IV by POP-Q system underwent total and partial colpocleisis. The mean age was (75+/-6) years (59-87 years). Fifty-eight patients (58/63, 92%) present more than one kind of medical disease. There were 53 cases with uterus prolapse, 1 case with cervix prolapse and 9 cases with vaginal vault prolapse. Seven patients were recurrent POP from previous surgery. Twenty-three patients (36%) presented voiding difficulty. Seven patients (17%) presented obstructive bowel symptom. Three patients (5%) presented fecal incontinence, and 28 patients (44%) presented either had urinary incontinence or history of that. Among 63 patients, 48 patients (76%) underwent total colpoclesis, and 15 (24%) patients partial colpoclesis. Meanwhile, 58 (92%) patients underwent levator myorrhaphy plus perineorrhaphy and 20 (32%) patients underwent anti-urinary incontinence procedure (TVT-O), respectively. Patients were followed up to evaluate therapeutic effect at 2 months and 1 year after surgery. Objective evaluation included the POP-Q and the length of vagina, genital hiatus, perineal body. A nonvalidated Body Image and Satisfaction Questionnaire was completed for subjective evaluation. The mean operating time of 63 patients was (105+/-48) minutes, which was (128+/-58) in total and (82+/-26) minutes partial procedures, which exhibited significant difference (P<0.05). The mean blood loss was (187+/-128) ml (50-600 ml), total and partial procedures caused (232+/-159) and (101+/-54) ml, respectively, which also showed significant difference (P<0.05). No intraoperative injury or death occurred. The rate of postoperative complications was 5% (3/63). Mean follow-up time of 63 patients was 22.5 months (1-51 months). All patients had POP-Q staging score<or=I. No recurrent patient was observed. At 1 year after operation, the mean preoperative total vaginal length (TVL) and genital hiatus (GH) of (7.7+/-1.1) and (5.5+/-1.5) cm were decreased to (3.4+/-1.1) and (2.3+/-0.5) cm (P<0.01); and perineal body (PB) measurements was increased from (2.6+/-0.9) to (3.4+/-0.9) cm (P<0.01). Three (5%, 3/63) patients had mild urinary incontinence after the operation. Twenty-three patients with voiding difficulty presenting the mean postvoid residual volumes (110+/-38) ml (50-235 ml) were decreased to 12 ml after the operation. Obstructive bowel symptom was improved in 6 (54%, 6/11) patients, and fecal incontinence improved in 2 (2/3). One year after the operation, 52 (82%) patients completed the nonvalidated Body Image and Satisfaction Questionnaire. 49 (94%) patients said either 'very satisfied' or 'satisfied' with the outcome of their surgery, while 3 (6%) reported unsatisfied or not at all satisfied. The objective and subjective curative rates of colpocleisis in treatment of severe POP are high with lower morbidity and recurrence. Colpocleisis is a safe and effective management in selected elderly patients with severe POP, who no longer desire to maintain vaginal coital function.

1767 PREOPERATIVE SYMPTOM OF HESITATING URINARY STREAM IS ASSOCIATED WITH SURGICAL FAILURE AND POSTOPERATIVE VOIDING DYSFUNCTION FOLLOWING BURCH COLPOSUSPENSION OR PUBOVAGINAL RECTUS FASCIAL SLING SURGERY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy III1 Apr 20101767 PREOPERATIVE SYMPTOM OF HESITATING URINARY STREAM IS ASSOCIATED WITH SURGICAL FAILURE AND POSTOPERATIVE VOIDING DYSFUNCTION FOLLOWING BURCH COLPOSUSPENSION OR PUBOVAGINAL RECTUS FASCIAL SLING SURGERY Tatiana Sanses, Linda Brubaker, Yan Xu, Stephen Kraus, Jerry Lowder, Gary Lemack, Peggy Norton, Sharon Tennstedt, and Toby Chai Tatiana SansesTatiana Sanses Baltimore, MD More articles by this author , Linda BrubakerLinda Brubaker Maywood, IL More articles by this author , Yan XuYan Xu Watertown, MA More articles by this author , Stephen KrausStephen Kraus San Antonio, TX More articles by this author , Jerry LowderJerry Lowder Pittsburgh, PA More articles by this author , Gary LemackGary Lemack Dallas, TX More articles by this author , Peggy NortonPeggy Norton Salt Lake City, UT More articles by this author , Sharon TennstedtSharon Tennstedt Watertown, MA More articles by this author , and Toby ChaiToby Chai Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1677AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess whether pre-operative voiding symptoms correlated with post-operative voiding dysfunction (VD) or surgical failure in women who underwent Burch colposuspension or autologous fascial sling in the Stress Incontinence Surgical Treatment Efficacy Trial. METHODS Urogenital Distress Inventory (UDI) and subjects' categorical responses (yes or no) to physical accommodations in voiding and to characteristics of urinary stream were collected preoperatively (see table) along with urodynamic data. The definitions of overall surgical, stress-specific failures and VD (any catheter use after 6 weeks) were previously published. Logistic regression models associating symptoms with outcomes, controlling for treatment group, site and degree of pelvic organ prolapse, were used. Preoperative voiding symptoms No. Who Answered “Yes” % (n=651) Dribbling Stream 504 77.4 Hesitating Stream 214 32.9 Spurting Stream 208 32.0 Slow Stream 207 31.8 Bending to Urinate 179 27.5 Straining to Urinate 107 16.4 Steady Stream (No) 106 16.3 Pressing to Urinate 81 12.4 Leaning to Urinate 54 8.3 Other descriptions of Stream 49 7.5 Pushing to Urinate 41 6.3 Doing something else to Urinate 29 4.5 Standing to Urinate 22 3.4 RESULTS Percentages of subjects who answered “yes” for each of the preoperative voiding symptoms are shown in the table. Hesitating urinary stream was the only symptom associated with post-operative VD [OR 2.40 (95% CI 1.31-4.75, p=0.006)], overall [OR 1.55 (95% CI 1.02-2.35, p=0.04)], and stress-specific [OR 1.58 (95% CI 1.07-2.34, p=0.02)] treatment failures. Despite no significant association between pre-operative UDI-obstructive subscore and post-operative VD, an increase of 10 points on the pre-operative UDI-obstructive subscore was associated with overall [OR 1.10 (95% CI 1.00-1.20, p=0.049) and stress-specific [OR 1.21 (95% CI 1.10-1.32, p<0.0001)] treatment failures. Subjects with hesitating urinary stream had lower mean Qmax on non-instrumented uroflow (23.6 ± 10.7 vs. 26.4 ± 11.3 cc/sec, p=0.004) and higher mean Pdet at Qmax on pressure flow study (21.7 ± 12.9 vs. 17.7 ± 12.1 cm water, p=0.003), but no significant difference in mean post-void residual volume when compared to subjects without this symptom. CONCLUSIONS Preoperative symptom of hesitating urinary stream was associated with poorer outcomes. The prevalence of this complaint at 33% may make it more useful as a predictor than a common complaint (i.e. dribbling at 78%) or an uncommon complaint (i.e. pushing to urinate at 6%). Further studies into association of hesitating urinary stream and postoperative outcomes may be fruitful. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e684 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tatiana Sanses Baltimore, MD More articles by this author Linda Brubaker Maywood, IL More articles by this author Yan Xu Watertown, MA More articles by this author Stephen Kraus San Antonio, TX More articles by this author Jerry Lowder Pittsburgh, PA More articles by this author Gary Lemack Dallas, TX More articles by this author Peggy Norton Salt Lake City, UT More articles by this author Sharon Tennstedt Watertown, MA More articles by this author Toby Chai Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Post-Void Residual Urine as a Predictor of Urinary Tract Infection—Is There a Cutoff Value in Asymptomatic Men?

Post-void residual urine can lead to various complications, including urinary tract infection. Recently investigators calculated that a cutoff value of 180 ml has considerably high sensitivity and specificity for significant bacteriuria in asymptomatic men. We determined the association between post-void residual urine volume and urinary tract infection, and validated the suggested 180 ml cutoff in asymptomatic men. In a prospective study we analyzed certain criteria in 225 asymptomatic male patients, including prostate specific antigen, prostate volume, International Prostate Symptom Score, peak urine flow rate, urine culture results and post-void residual urine volume using transabdominal ultrasound. Using ROC analysis a cutoff predicting bacteriuria was calculated. Different cutoff values were validated. Of the study group 60% were able to completely empty the bladder and had a post-void residual urine volume of 10 ml or less. However, in 31% of the study group urine culture was positive. Patients presenting with urinary tract infection had significantly higher mean post-void residual urine volume than patients without urinary tract infection (113 vs 41 ml, p <0.001). In 29 men (13%) post-void residual volume was 180 ml or greater. Confirming urinary tract infection, this cutoff showed only 28% sensitivity and 94% specificity (AUC 0.606, p = 0.01). No cutoff value could be determined to predict positive urine culture with sufficient sensitivity and specificity. Based on the results of the current study it seems premature to recommend a cutoff value leading to therapeutic consequences.

Four-Year Outcome of a Prospective Randomised Trial Comparing Bipolar Plasmakinetic and Monopolar Transurethral Resection of the Prostate

BackgroundNo data have been published on the midterm efficacy of bipolar transurethral resection of the prostate (TURP). ObjectiveTo evaluate 4-yr results from a prospective randomised trial comparing bipolar TURP with standard monopolar TURP. Design, setting, and participantsSeventy patients with symptomatic benign prostatic hyperplasia were enrolled in this prospective randomised controlled trial in a tertiary-care institution. Inclusion criteria were age >50 yr, good performance status, urinary retention, International Prostate Symptom Score (IPSS) ≥18, and maximal flow rate (Qmax) ≤15ml/s. Exclusion criteria were prostate volume <30cm3, documented or suspected prostate cancer, neurogenic bladder, bladder stone or diverticula, urethral stricture, and maximal bladder capacity >500ml. InterventionPatients underwent standard or bipolar plasmakinetic TURP performed by the same surgeon using the same surgical technique. MeasurementsTreatment efficacy was evaluated at 1, 2, 3, and 4 yr by comparing urinary flow rates, IPSS, and estimated postvoid residual (PVR) urine volume. Midterm complications were also recorded. Results and limitationsThe number of dropouts was not statistically significantly different in the two groups (p=0.2). The significant improvements in both groups were maintained at 4 yr for the IPSS, quality of life score, Qmax, and PVR versus baseline values. The main outcome variables at 4 yr for bipolar and monopolar TURP were mean IPSS 6.9 and 6.4 (p=0.58); mean Qmax 19.8ml/s and 21.2ml/s (p=0.44), and mean PVR volume 42ml and 45ml (p=0.3). Overall, 2 of 32 (6.2%) and 3 of 31 (9.6%) patients required reoperation because of late complications (p=0.15). The major study limitation was the small sample size. ConclusionsThis study represents the secondary, midterm analysis of a previously published trial. Our 4-yr data confirm our initial positive findings for the efficacy and safety of bipolar plasmakinetic TURP. Larger well-designed studies are needed to corroborate these findings.

Initial Experiences with a New 120 W GreenlightTMHigh-Power System for Photoselective Vaporization of the Prostate for the Treatment of Benign Prostatic Hyperplasia in Korea

Purpose: After successful launches of a 120 W high-power system for photoselective vaporization of the prostate (HPS-PVP), several studies in the United States and Europe have reported good short-term data. Here we report the initial efficacy and side effects of the 120 W HPS-PVP in Korea. Materials and Methods: Between January 2008 and January 2009, we performed a retrospective clinical analysis of 133 patients treated by HPSPVP. Results: The mean age at surgery was 68.4±8.0 years. The mean prostate size was 44.2±22.6 ml. The mean operation time was 58.9±33.5 minutes, and the mean total applied energy was 103,108±74,362 J. The mean duration of catheterization was 21.5±10.8 hours. The blood loss was minimal, and there were no transfusions. The baseline mean peak urinary flow rate (Qmax) was 10.4±5.0 ml/s, mean postvoid residual volume (PVR) was 77±91.3 ml, the mean International Prostate Symptom Score (IPSS) was 20.7±9.0, and the mean quality of life (QoL) score was 4.2±1.3. At 6 months, Qmax was 17.5±9.9 ml/sec, PVR was 49.0±56.0 ml, the IPSS was 8.0±9.0, and the QoL score was 1.6±1.5. During the first postoperative month, irritative urinary symptoms were reported in 18 cases, urge incontinence in 7, mild hematuria in 5, urinary tract infection in 2, and temporary recatheterization in 13. Conclusions: The new 120 W HPS-PVP showed good short-term safety and efficacy for the treatment of Korean patients with benign prostatic hyperplasia. (Korean J Urol 2009;50:1089-1094) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Evaluating Inter-fractional Changes in Volume and Position during Bladder Radiotherapy and the Effect of Volume Limitation as a Method of Reducing the Internal Margin of the Planning Target Volume

Aims To quantify the inter-fractional variation in bladder volume and position during a course of bladder radiotherapy, and to assess the feasibility of reducing the planning target volume (PTV) internal margin using an empty bladder protocol. Materials and methods Weekly computed tomography scans were taken immediately after micturition on 15 patients undergoing radical radiotherapy for bladder cancer. Bladder volume and positional variation were compared by co-registration of the serial computed tomography scans with the initial planning scan and a single ‘full’ scan at the onset of treatment for each patient. A PTV was generated on the initial planning scan using both our departmental standard of 1.5 cm and a reduced 1 cm isotropic internal margin around the target (whole bladder) and the relative proportion of the bladder breaching the PTV using both margins compared. Results The mean post void residual volume from the planning scan was 112 cm 3 (standard deviation 42 cm 3). The mean weekly variation in bladder volume relative to the planning volume was 0–12% (standard deviation 20–34%) with no observable trends over time. No statistically significant differences were seen in the proportion of bladder breaching the 1.5 and 1 cm internal margin ( P = 0.18). Regression analysis showed that it is possible to ensure complete coverage of the bladder with a 1 cm margin, providing the volume did not exceed over 50% of the initial planning scan volume. Conclusion Using an empty bladder protocol and where on-line imaging is available it is feasible to reduce the internal margin of the PTV from 1.5 to 1cm, providing the volumes do not exceed >50% of the planning scan volume.

Residual Urinary Volume and Urinary Tract Infection—When are They Linked?

Large post-void residual urinary volume may be related to the development of urinary tract infection. However, the maximum post-void residual volume that predisposes patients to a higher risk of urinary tract infection is not known. In this prospective study we determined the cutoff value for post-void residual volume that places adult men at risk for bacteriuria. Data were obtained from 196 consecutive healthy adult men (median age 62 years) who came for prostate evaluation without symptoms of acute urinary tract infection. Right after spontaneous voiding, bladder catheterization was performed under normal aseptic conditions, and the post-void residual volume measured. Urine samples were collected for culture from each patient and the results were compared to the various post-void residual volume. Overall 27% of the patients presented with a positive urine culture. The mean post-void residual volume in this group was 257 ml (range 150 to 560) compared to 133 ml (range 10 to 340) for the group with negative culture (p <0.001). The post-void residual volume value of 180 ml was determined to have the best specificity and sensitivity. The positive predictive value for bacterial growth at a post-void residual volume of 180 ml or greater was 87.0% and the negative predictive value was 94.7%. Clinically asymptomatic adult men with a post-void residual volume of 180 ml are at a high risk for bacteriuria. Such cases require close medical attention since it may be necessary to introduce early drug therapy or surgical intervention to improve the bladder emptying.

Functional Outcome Following Photoselective Vaporisation of the Prostate (PVP): Urodynamic Findings Within 12 Months Follow-Up

ObjectivesWe determined the impact of potassium-titanyl-phosphate (KTP) laser therapy of the prostate on urodynamic results, voiding function, quality of life, and sexual function. Design, Setting, and ParticipantsForty-five patients complaining of symptomatic benign prostatic hyperplasia (BPH) and urodynamically proven obstructive voiding were included in the prospective study. Follow-up exams were repeated 3 mo and 12 mo after the treatment. InterventionAll patients underwent photoselective 80-Watt KTP laser vaporisation of the prostate performed by two experienced surgeons. MeasurementsDisease-specific quality of life and sexual function were assessed using the International Prostate Symptom Score (IPSS) and International Inventory of Erectile Function (IIEF). Video-urodynamics were carried out to determine changes in pressure flow and bladder function. Results and LimitationsThe average preoperative prostate volume was 47.63ml (range 30–75m). The mean preoperative PSA-value, which had been 3.5ng/ml (range 0.13–7ng/ml) initially, dropped by 34.2% after 3 mo and 37.1% after 12 mo. Despite transient micturition complaints (40%), all patients showed significant improvement in the IPSS in urinary peak flow and detrusor pressure at peak flow. The mean post-void residual urine volume decreased, while erectile function and libido scores remained unaffected by the procedure according to the IIEF. Detrusor contractility was also not affected in any of the patients. The single-centre study design and small number of patients may have limited the study results. ConclusionsKTP laser therapy of the prostate achieves significant improvements both symptomatically as well as with respect to objective micturition parameters. The procedure leads to a functional deobstruction of the lower urinary tract with steady improvement results throughout the follow up period.

Photoselective Laser Vaporization Prostatectomy for Acute Urinary Retention in China

To assess the clinical efficacy and safety of photoselective laser vaporization of the prostate (PVP) in the treatment of patients with acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH). Forty-two patients (mean age 72 +/- 5 years, range 65-89) with AUR because of BPH were treated with a prospective trial of PVP with the potassium-titanyl-phosphate (KTP) 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), disease-specific quality of life (QoL) score, postvoid residual (PVR) urine volume, and maximum urinary flow rate (Qmax). The International Index of Erectile Function questionnaire and a self-designed ejaculatory questionnaire were completed at different follow-up times to determine patient satisfaction and changes in sexual function. After preliminary urine drainage and adequate preoperative preparation, PVP was performed and bladder outlet obstruction was effectively relieved. The mean prostate volume was 62.5 +/- 11.7 cc, and the mean residual volume with retention was 650 mL (range 240-1200 mL). Mean operative time was 28.6 +/- 5.7 minutes. Mean catheterization duration was 5.6 days (range 3-14 d). There was significant subjective improvement of symptoms and objective improvement in urinary flow rates at 12 months. The mean IPSS and QoL score decreased significantly (P < 0.05). Mean PVR volume also decreased. The mean Qmax was 16.2 +/- 4.6 mL/sec after treatment. Only two patients had recurrent urinary retention during follow-up. There were no intraoperative or postoperative adverse events. The early clinical results suggest that the PVP is a promising safe, effective, and less-invasive treatment with minimal morbidity for patients with urine retention secondary to BPH.

INFLUENCE OF INTRAVESICAL POTASSIUM ON PELVIC FLOOR ACTIVITY IN WOMEN WITH OVERACTIVE BLADDER SYNDROME: COMPARATIVE URODYNAMICS MIGHT PROVIDE BETTER DETECTION OF DYSFUNCTIONAL VOIDING

BJU InternationalVolume 101, Issue 3 p. 394-395 INFLUENCE OF INTRAVESICAL POTASSIUM ON PELVIC FLOOR ACTIVITY IN WOMEN WITH OVERACTIVE BLADDER SYNDROME: COMPARATIVE URODYNAMICS MIGHT PROVIDE BETTER DETECTION OF DYSFUNCTIONAL VOIDING Paul Irwin, Paul Irwin Michael Heal Department of Urology, Mid Cheshire Hospitals NHS Trust, Crewe, UKSearch for more papers by this authorJoe Philip, Joe Philip Michael Heal Department of Urology, Mid Cheshire Hospitals NHS Trust, Crewe, UKSearch for more papers by this author Paul Irwin, Paul Irwin Michael Heal Department of Urology, Mid Cheshire Hospitals NHS Trust, Crewe, UKSearch for more papers by this authorJoe Philip, Joe Philip Michael Heal Department of Urology, Mid Cheshire Hospitals NHS Trust, Crewe, UKSearch for more papers by this author First published: 03 January 2008 https://doi.org/10.1111/j.1464-410X.2007.07417_6.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume101, Issue3February 2008Pages 394-395 RelatedInformation

Sacral neurostimulation for urinary retention: 10‐year experience from one UK centre

To report our 10-year experience of sacral neurostimulation (SNS) for women in urinary retention, comparing the original one-stage with the newer two-stage technique, as SNS therapy is a well-established treatment for urinary retention secondary to urethral sphincter overactivity (Fowler's syndrome). Between 1996 and 2006, 60 patients with urinary retention had a SNS device inserted; their case records were reviewed and data on efficacy, follow-up, need for continued clean intermittent self-catheterization (CISC), complications and operative revision rate were assessed. Overall, 43 of 60 (72%) women were voiding spontaneously, with a mean postvoid residual volume of 100 mL; 30 (50%) no longer needed to use CISC. During a total of 2878 months of SNS experience, adverse event episodes included lead migration in 20, 'box-site' pain in 19, leg pain/numbness in 18 and loss of response/failure in 18 patients; 53% of the women required a surgical revision related to their implanted stimulator. The efficacy of the two-stage was similar to that of the one-stage procedure (73% vs 70%). Women with a normal urethral sphincter electromyogram had worse outcomes than women with an abnormal test (43% vs 76%). Although the efficacy was no different in those taking analgesia/antidepressant medication, this group of women had a higher surgical revision rate. Failure and complications for the one-stage procedure were not restricted to the early follow-up period. The mean battery life of the implant was 7.31 years. SNS has sustained long-term efficacy but the procedure has a significant complication rate. At present, the two-stage technique has comparable efficacy to the one-stage technique but a longer-term follow-up is required. The National Institute of Clinical Excellence recommended the use of SNS in women with urinary incontinence who fail to respond adequately to anticholinergic therapy, but patients choosing this treatment should be made aware of the high complication rate associated with the procedure.

Assessing intra-fractional bladder motion using cine-MRI as initial methodology for Predictive Organ Localization (POLO) in radiotherapy for bladder cancer

Aim To assess the feasibility of using cine-MR to study intra-fractional time–volume and volume-deformity patterns of the bladder during radiotherapy as initial methodology for Predictive Organ Localization (POLO). Methods Nine patients receiving radiotherapy for localized muscle invasive bladder cancer were prospectively studied. Each had an MR scan performed on an empty bladder using a T1 weighted cine sequence over a period of 20 min. Scans were taken prior to, and repeated towards the end of, radiotherapy treatment. Time–volume sequences were determined and compared before and during radiotherapy. Absolute bladder volumes were then correlated with changes in bladder wall position. Results The mean post void residual bladder volume prior to radiotherapy at time 0 was 113 cm 3 [SD 53] and this did not differ significantly during radiotherapy −106 cm [SD 40] ( p = 0.24, paired t-test analysis). A linear relationship was observed for the rate bladder filling over a 20 min period, which did not significantly change on the cine-MR during radiotherapy (regression coefficient 2.1 vs 1.6, respectively, p = 0.51). Significant positive relationships were seen between volume and anterior ( p = 0.02), superior ( p < 0.001), and inferior ( p = 0.03) wall motion. These relationships were complex, though linearity was observed for volumes up to 150 cm 3. The 1.5 cm CTV–PTV margin was sufficient to account for expansion in the majority of cases with the only breach occurring on the anterior wall in one patient. Conclusions This study confirms the feasibility of using cine-MR for POLO. The development of such predictive methodology may compensate for the need to use an isotropic CTV–PTV margin to simply cover bladder filling when using image-guided radiotherapy.

Establishing a Mean Postvoid Residual Volume in Asymptomatic Perimenopausal and Postmenopausal Women

To estimate mean postvoid residual (PVR) volumes among perimenopausal and postmenopausal women without significant lower urinary tract or pelvic organ prolapse symptoms. Patients presenting for well-women encounters were offered study participation. Women with a history of urinary incontinence greater than twice per week, urinary retention, symptomatic pelvic organ prolapse, or neurologic disorders were excluded. Pelvic relaxation, if present, was characterized according to the pelvic organ prolapse quantification system. Within 10 minutes of spontaneously voiding, PVR volume was assessed with bladder ultrasonography. A total of 96 patients were enrolled; mean age was 60+/-11 years. The majority (80%) were postmenopausal; 30% had a previous hysterectomy. Most women (92%) had some degree of prolapse; the median stage was one, most commonly involving the anterior compartment (70%). The median PVR volume was 19 mL (range 0-145 mL); the mean PVR volume was 24+/-29 mL. Only 15% of patients had a PVR volume greater than 50 mL, and 95% had a PVR volume 100 mL or less. Only age 65 years or older was associated with a higher mean PVR volume; hormone therapy, vaginal atrophy, parity, and stage of asymptomatic prolapse did not affect PVR volumes. Most asymptomatic perimenopausal and postmenopausal women had a PVR volume less than 50 mL, which was unaffected by multiple factors that were thought to potentially affect bladder function. Establishing "normal" volumes in this population may aid in developing recommendations regarding appropriate bladder function and retention criteria for women who are symptomatic or those who have had pelvic floor surgery.

Comparison of the Complications and Urodynamic Parameters for Orthotopic Bladder Substitution with using Ileocolic or Ileal Segments after Radical Cystectomy

Purpose: The objective of this study was to compare the complications and urodynamic parameters of the patients who underwent orthotopic bladder substitution with using ileocolic or ileal segments after radical cystectomy for treating invasive bladder cancer. Materials and Methods: Between January 1990 and April 2006, 260 patients with invasive bladder cancer underwent radical cystectomy and construction of the urinary diversion; ileal conduit, indiana pouch, ileocolic neobladder, ileal neobladder were all done at St. Mary's Hospital. The mean age of the patient was 61.8 years (range: 46-86). The ratio of male and female was 88%/12%. Forty nine patients received an orthotopic ileocolic neobladder and 45 patients received an orthotopic ileal neobladder. The complications and urodynamic parameters were compared in both groups. Results: The orthotopic ileocolic neobladder after radical cystectomy for treating invasive bladder cancer has been performed between 1990 and 1996 and the orthotopic ileal neobladder has been performed between 1996 and 2006. Ileocolic neobladder related complications developed in 10 patients; neobladder leakage in 1 (2%), neobladder rupture in 1 (2%), stricture of the ureteroenteric anastomosis site in 4 (8.2%), and stricture of the urethral anastomosis site in 4 (8.2%). Ileal neobladder related complications developed in 11 patients; ureteroenteric stricture in 7 (15.5%), stricture of the urethral anastomosis site in 3 (6.6%) and acute pyelonephritis in 1 (2.2%). The results of the mean maximal flow rate and mean postvoid residual volume were better in the ileal neobladder group than those in the ileocolic neobladder group. Conclusions: There were no significant differences in complications between ileocolic neobladder and ileal neobladder. The maximal uroflow and residual urine volume of the ileal neobladder were superior to those of the ileocolic neobladder on urodynamic study. (Korean J Urol 2007; 48:494-499)

99mTc-MAG3 Renography: Normal Values for MAG3 Clearance and Curve Parameters, Excretory Parameters, and Residual Urine Volume

Specific quantitative measurements have been recommended to assist in the interpretation of technetium-99m mercaptoacetyltriglycine (MAG3) renal studies. Our objective was to define the sex- and age-specific normal ranges for these recommended parameters. Data were obtained from a retrospective analysis of 106 subjects who were evaluated for kidney donation. The MAG3 clearance was calculated using a common camera-based method. The relative uptake, prevoid/postvoid and postvoid/maximum count ratios were determined using whole-kidney regions of interest (ROIs). Time to peak, time to half-peak, 20 min/maximum and 20 min/2-3 min count ratios were determined for cortical and whole-kidney ROIs. Residual urine volume was calculated on the basis of the pre- and postvoid bladder counts and voided urine volume. The mean camera-based MAG3 clearance was 321 +/- 69 mL/min/1.73 m2, essentially the same as the mean plasma sample MAG3 clearance in comparable populations. The percentages of relative uptake in the right and left kidneys were 49% and 51% +/- 4%, respectively; no difference was seen between men and women. Cortical values were lower than the whole-kidney values (p < 0.001); the mean cortical 20 min/maximum count ratio was 0.19 (SD, 0.07 and 0.04 for right and left kidneys, respectively). The mean postvoid/maximum whole-kidney count ratio was < 0.1, and the mean postvoid residual bladder volume was < 30 mL. Normal limits adjusted for age and sex have been established. Applying normal ranges to quantitative MAG3 parameters may assist in the interpretation of MAG3 scintigraphy and facilitate appropriate patient management.