Mean Post-void Residual Urine Research Articles

Dorsal onlay buccal mucosal graft urethroplasty for female urethral stricture: Techniques and outcomes

ObjectiveFemale urethral stricture (FUS) accounts for about 4%–13% of cases of female bladder outlet obstruction. FUS was and is still managed by repeated dilatations and/or direct visual internal urethrotomy. There are many alternative options for reconstruction like buccal or vaginal mucosal graft urethroplasty. Our aim was to describe the technique of dorsal onlay buccal mucosal graft (BMG) urethroplasty for FUS and present the outcomes. MethodsBetween January 2014 and December 2021, 37 patients who underwent dorsal onlay BMG urethroplasty were included in the study. Their pre-operative diagnosis was confirmed with uroflowmetry, micturating cystourethrogram, urethral calibration, and on table cystoscopy. Bladder catheter was removed after 2 weeks. Patients were followed up at 3 months, 6 months, 1 year, and then annually with urine analysis, uroflowmetry, and post-void residual assessment. We defined success as a maximum flow rate (Qmax) above 15 mL/s without the need for an additional instrumentation. ResultsThe mean age of patients was 47.8 (standard deviation [SD] 11.3) years. Twenty patients had previously undergone urethral dilatations. The mean pre-operative Qmax was 7.79 (SD 3.73) mL/s. However, the mean Qmax improved to 23.20 (SD 8.25) mL/s after surgery. The mean post-void residual urine after surgery was 30.50 (SD 10.70) mL. This reduced from a mean value of 139.00 (SD 147.24) mL before surgery. The mean follow-up was 30.2 (SD 18.3, range 18–44) months. There was no post-operative incontinence. There were Clavien–Dindo Grade 1 complications in 6 out of 37 (16.2 %) patients during hospital stay. The only long-term complication was recurrence of stricture in 4 (10.8%) patients. ConclusionDorsal onlay BMG urethroplasty in females is a safe, effective technique which can avoid repeated painful dilatations and multiple urethrotomies. One should always consider reconstruction in FUS without any fear of incontinence.

LBA01-20 DETRUSOR ULTRASTRUCTURAL STUDY PREDICTS LONG TERM VOIDING OUTCOMES IN MALE PATIENTS WITH DETRUSOR UNDERACTIVITY WHO UNDERWENT TRANSURETHRAL RESECTION OF PROSTATE (TURP)

You have accessJournal of UrologyCME1 Apr 2023LBA01-20 DETRUSOR ULTRASTRUCTURAL STUDY PREDICTS LONG TERM VOIDING OUTCOMES IN MALE PATIENTS WITH DETRUSOR UNDERACTIVITY WHO UNDERWENT TRANSURETHRAL RESECTION OF PROSTATE (TURP) Amanda Chung, Vincent Tse, and Lewis Chan Amanda ChungAmanda Chung More articles by this author , Vincent TseVincent Tse More articles by this author , and Lewis ChanLewis Chan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with detrusor underactivity (DU) have a variable voiding outcome after TURP which may not be predicted by urodynamics. Our previous detrusor ultrastructural studies demonstrated that features of ‘myohypertrophy pattern’ were associated with bladder outlet obstruction(BOO) and poor short term voiding outcomes. We report the largest ultrastructural study on DU and correlate detrusor ultrastructure features with long term voiding outcomes in men with urodynamic proven DU who have had TURP. METHODS: Patients with urodynamic diagnosis of DU or BOO who underwent TURP were studied. Detrusor biopsies were obtained at cystoscopy and processed for electron microscopy. Detrusor ultrastructural features including myohypertrophy pattern (cell size, irregularity), degeneration and elastosis were assessed using a simplified protocol with observers blinded to clinical data. Postoperative voiding outcomes (mean 16yrs) were correlated with ultrastructural features and urodynamic parameters. RESULTS: 27 patients (mean age 78 yrs) were recruited (23 DU and 4 BOO). In DU patients, the mean postvoid residual urine (PVR) was 630ml (IQR 240-985). Postoperatively all BOO patients voided, 9 DU patients (39%) were catheter-free at 3 months, 14 patients (61%) required catheterisation. At long term follow-up, only 29% DU (6/21) patients were catheter-free. Functional parameters including PVR, Voiding efficiency and Bladder contractility index did not correlate with voiding outcomes. Ultrastructural studies of DU patients showed voiding outcome after TURP was significantly associated with myocyte irregularity/derangement (p=0.034) and collagenosis (p=0.041). Overall, moderate to severe changes of ‘myohypertrophy’ pattern (myocyte size variation, increased cell separation, increased intercellular collagen, degeneration) predicted poor long term voiding outcomes (p=0.029, OR of catheter-dependence 5.5). CONCLUSIONS: Detrusor ultrastructural features of myocyte irregularity, degeneration, collagenosis (moderate to severe ‘myohypertrophy pattern’) are associated with impaired detrusor contractility and predicted poor long term voiding outcomes and catheter dependence after TURP. Detrusor biopsy with ultrastructural analysis can be a useful diagnostic and prognostic tool in men with DU considering surgery. Source of Funding: Royal Australasian College of Surgeons Foundation Scholarship © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1185 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Chung More articles by this author Vincent Tse More articles by this author Lewis Chan More articles by this author Expand All Advertisement PDF downloadLoading ...

Urethral meatus preserving ventral onlay augmentation urethroplasty for female urethral stricture: our technique with initial experience

BackgroundFemale urethral stricture (FUS) is an uncommon cause of lower urinary tract symptoms (LUTS) in women. Reconstructive techniques are being increasingly used for strictures resistant to the more conservative form of management. Most forms of reconstruction require cutting open of urethral meatus, thereby resulting in some loss of the meatus function. We hereby describe the technique of urethral meatus sparing ventral onlay mucosal graft augmentation urethroplasty with our initial experience.MethodsWe performed this procedure in 10 cases of FUS with normal meatus and prospectively studied the outcomes over a period of 6 months follow-up.ResultsThere was 90 percent success rate with one recurrence. The mean Qmax increased from 7.2 to 19.5 ml/s, mean post-void residual urine (PVRU) decreased from 96.5 to 22.7 ml and the mean IPSS decreased from 26.1 to 5.7. There were no major complications noted and the patients demonstrated significant subjective and objective improvement of symptoms in the follow-up period.ConclusionThe technique of meatus sparing ventral onlay augmentation graft urethroplasty is a promising approach with good outcomes, is reproducible and has minimal complication rate.

MP09-11 GREENLIGHT LASER PROSTATECTOMY: ARE OUTCOMES SUSTAINABLE AFTER A DECADE OF SURGERY? A SINGLE CENTER EXPERIENCE WITH UP TO 15 YEARS' FOLLOW-UP

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP09)1 Sep 2021MP09-11 GREENLIGHT LASER PROSTATECTOMY: ARE OUTCOMES SUSTAINABLE AFTER A DECADE OF SURGERY? A SINGLE CENTER EXPERIENCE WITH UP TO 15 YEARS' FOLLOW-UP Ahmed Ibrahim, Nawar Touma, Ahmad M. AlShammari, Serge Carrier, and Mélanie Aubé-Peterkin Ahmed IbrahimAhmed Ibrahim More articles by this author , Nawar ToumaNawar Touma More articles by this author , Ahmad M. AlShammariAhmad M. AlShammari More articles by this author , Serge CarrierSerge Carrier More articles by this author , and Mélanie Aubé-PeterkinMélanie Aubé-Peterkin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001982.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since its introduction in 2005, GreenLight laser has been widely adopted as a convenient source of energy for surgical treatment of benign prostatic hyperplasia (BPH). However, there is paucity in the literature quantifying long-term outcomes (>10 years) of GreenLight laser prostatectomy. Herein, we report our single-center experience with long-term outcomes over a period of 15 years. METHODS: Between 2005 and 2020, a prospectively maintained database for patients undergoing GreenLight photovaporization of the prostate (PVP) for symptomatic BPH was reviewed. Three Generations of Green Light Laser were used over this time period. Patients with ≥10-years follow-up were included. Demographic and perioperative data were collected together with the International Prostate Symptoms Score (IPSS), Quality of Life (QoL), peak flow rate (Qmax), post-void residual urine (PVR), and PSA changes. In addition, perioperative and late adverse events were recorded. RESULTS: After a mean follow-up of 12.1 years (10-15 years), 124 patients were included with a mean age of 73.9 (range: 54- 85) years and a mean preoperative prostate size of 72.4±15.3mL. Demographic and perioperative data are presented in Table 1. Blood transfusion rate was 2.4%. Development of bladder neck contracture and urethral stricture were encountered in 7 (5.6%) and 9 (4.3%) of patients. 6 (4.8%) patients required repeat surgery for adenoma regrowth. Additionally, there were significant reductions in mean IPSS, QoL and PVR (60.4% and 65%, and 72.6%, respectively) (p <0.001). Likewise, there was a significant increase in Qmax (8.2 to 17.7 ml/s, p <0.001) with PSA reduction by 64.2 % compared to its baseline value. CONCLUSIONS: Our long-term functional outcomes support the durability of the GreenLight laser prostatectomy with acceptable long-term adverse events after a decade of surgery. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e163-e164 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Ibrahim More articles by this author Nawar Touma More articles by this author Ahmad M. AlShammari More articles by this author Serge Carrier More articles by this author Mélanie Aubé-Peterkin More articles by this author Expand All Advertisement Loading ...

Success of endoscopic prostatic surgery in patients with DUA: a prospective observational and analytic study

Introduction: Detrusor underactivity (DUA) is a highly prevalent and poorly understood disease in urology practice. Conservative treatment in the form of clean intermittent catheterization (CIC) and pharmacotherapy are in use for DUA without good results. Endoscopic prostate surgery was initially considered ineffective in such patients. But a recent series of retrospective studies showed promising results of surgery in DUA. Therefore, we conducted this prospective study to evaluate success of endoscopic prostatic surgery in a patient with DUA. Materials and methods: This is prospective observational study of 50 patients, satisfying the inclusion criteria, at Ruby Hall Clinic, Pune, conducted between March 2017 and March 2019. Inclusion criteria are that the patients are male, aged &gt; 50 years; urodynamically diagnosed with DUA; a bladder contractility index &lt; 90 with associated bladder outlet obstruction index (BOOI) between 20–40 (equivocal) or &gt; 40 (obstruction), who presented with lower urinary tract symptoms and poor flow ( Qmax &lt; 10 ml/s in a voided volume of &gt;150 ml. Patients were excluded from the study if they had DUA due to neurological causes or spinal trauma, an acontractile detrusor, and were &lt; 50 years. Results: The follow-up period for each patient was 12 months. The mean international prostate specific score reduced from 24.82 ± 2.74 preoperatively to 4.4 ± 1.85 postoperatively. Mean quality of life score reduced from 4.06 ± 0.68 to 0.82 ± 0.62. Mean Qmax increased from 6.26 ±1.46 ml/s to 12.22 ±1.6 ml/s. Mean post-void residual urine volume reduced form 241.9 ±74.9 to 77.3 ±20.75. All of these were statistically significant with a p value &lt; 0.00001. Conclusion: Transurethral resection of the prostate (monopolar/laser) to reduce BOO should be considered as an alternative, viable treatment option in men with DUA. Preoperative counselling and postoperative follow-up are crucial in the management of such patients. Level of evidence:

Study of modified technique of ileal neobladder-Frog neobladder.

Purpose:Orthotopic neobladder is a well-established technique for continent urinary diversion after radical cystectomy. In this study, we evaluated a new Frog ileal neobladder technique. Since the reconstructed neobladder appears like a frog, the name Frog Neobladder was given to it. We have used two isoperistaltic ileal segments and implanted ureters in the nondetubularized proximal end of the ileal segment.Subjects and Methods:This was a prospective, single-center (tertiary care hospital) study conducted from February 2008 to January 2018. Study patients were aged 39–94 years with biopsy-proven muscle-invasive localized bladder carcinoma. One hundred and twenty patients were included in the study, who had undergone Radical Cystectomy and were offered “FROG BLADDER”– a type of neobladder. Evaluation of complications, renal function, urodynamic parameters, post-void residual urine (PVR), continence, and need for clean intermittent catheterization was done in all patients with neobladder.Results:A total of 120 patients were included in the study, the average age of the patients was 62 years. The operative mean time was 280 ± 29.8 min. There was no perioperative death, and perioperative or early and late complication rates were 31.2% and 18.7%, respectively. Six patients had uretero-enteric anastomosis stricture, of which two were managed by retrograde ureteroscopic dilatation, another three strictures were treated with antegrade approach, and one patient underwent open surgery. All patients were able to void urine, except for three patients who required self-catheterization. The mean capacity was increased to average of 398 ± 220 ml at 12 months in all patients. The mean PVR at 1 year was 46 ± 54.4 ml.Conclusion:The Frog neobladder has similar outcome similar to other neobladder technique, with added advantage of ability to accommodate shorter ureteric length and the ease of accessing ureter by retrograde approach for intervention.

Safety and efficacy of prostatic artery embolization for large benign prostatic hyperplasia in elderly patients.

ObjectiveTo assess the safety and efficacy of prostatic arterial embolization (PAE) for elderly patients with lower urinary tract symptoms secondary to large benign prostatic hyperplasia.MethodsTwenty-eight patients (>80 years of age) with prostate volume >80 mL were enrolled from October 2016 to October 2019. PAE was performed using microspheres and functional results were evaluated at 1, 3, 6, and 12 months postoperatively. The following data were recorded: International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urine flow rate (Qmax), post-void residual urine volume, prostate volume and total prostate-specific antigen level.ResultsSelective prostatic arterial catheterization and embolization were achieved in 27 of 28 patients. Follow-up data were available for those 27 patients until 12 months postoperatively. Significant improvements were found at all postoperative time points in terms of the mean IPSS, mean QoL score, mean Qmax, mean post-void residual urine volume, mean total prostate-specific antigen level, and mean prostate volume. The overall complication rate was 46.4%.ConclusionsPAE is an efficacious and safe treatment for elderly patients with large prostate volume; it may offer an effective approach for patients who are not candidates for open or endoscopic surgical procedures because of comorbidities.

Modified Ileal Neobladder: Experience of 37 Cases

Bladder cancer is the second most common malignancy of genitourinary tract. About 20% cases are muscle invasive and most of the non-muscle invasive bladder cancer progressed to muscle invasion with time. The standard care for organ confined muscle invasive bladder cancer is radical cystectomy followed by urinary diversion. Orthotopic bladder substitution is considered standard urinary diversion after radical cystectomy in patients who have no urethral malignancy and intact external urethral sphincter. Neobladder constructed from ileum as described by Studer is considered standard and followed by most centers worldwide since 1985. We modified the procedure to improve the outcome and minimize post-operative complications by reducing the length of ileum used for construction of neobladder in 37 patients. Voiding, storage function and complications were evaluated during follow-up period up to 24 months after surgery. Three patients died during follow-up period of which 2 from metastatic disease and one from unrelated cause. Daytime and night-time continence rates were 86.49% and 78.38% respectively. Average functional capacity (437ml), maximum flow rate(15.7ml/s) and mean post void residual urine (44ml) during the period of evaluation. Clean intermittent self-catheterization needed in 67.57% patients due to incomplete emptying during early postoperative period but after 3 months most of the patients learnt to void without any aid. Upper tract dilatation found in one patient due to stricture at urethrovesical junction and required endoscopic incision and dilatation later. 12 patients had an urodynamic study at 12 months after surgery and found low pressure reservoir with small residual urine in all cases. Modified ileal neobladder is a safe and reliable procedure with satisfactory short-term result. Bangladesh Journal of Urology, Vol. 22, No. 1, January 2019 p.20-24

Transurethral Anatomical Enucleation of Prostate (TUAEP) in Benign Prostatic Hyperplasia with Bipolar System: First Study in Thailand

Objective: To evaluate the outcomes and safety of the surgical technique transurethral anatomical enucleation of prostate (TUAEP) in patients with prostatic hyperplasia for whom surgery was indicated. Materials and Methods: The authors conducted a retrospective pilot study and analyzed the medical records of 80 patients who underwent TUAEP by a single surgeon between December 2016 and January 2018 in the Minimally-Invasive Surgery (MIS)-Urology Department in Rajavithi Hospital. Only 40 cases had complete review data, and these were included in the present study. The authors analyzed International Prostate Symptom Score, quality of life score, peak flow rate, and post-void residual urine volume preoperatively, and then 1, 3 and 6 months postoperatively. The TUERP operative time, enucleated tissue weight, catheterization time, and post-operative complications were recorded. Results: The participants’ mean age was 70.90+5.55 years. There were statistically significant differences between mean preoperative and postoperative hemoglobin (13.36+1.49 and 12.42+1.57), and hematocrit (%) (41.13+3.54 and 38.73+4.41), p&lt;0.01. Mean blood transfusion was 0.10+0.37 units, mean prostatic specific antigen (PSA) decreased from 7.50 (0.90 to 35.50) postoperatively (p&lt;0.001) to PSA 1.13+0.78 ng/ml at 3 months postoperatively (p&lt;0.02) and to PSA 1.54+0.78 ng/ml at 6 months postoperatively (p&lt;0.01). Maximum flow rate (Qmax), post void residual urine (PVR), international prostatic symptoms score (I-PSS) and quality of life (QOL) score improved significantly immediately after surgery and continued to improve up to follow-up at 6 months (p = 0.01). At 6 months, mean Qmax had increased from 9.05 to 21.19 ml/sec (p&lt;0.01) and mean PVR had decreased from 124.30 to 61 ml (p&lt;0.03). Mean I-PSS improved from 17.82 to 1.54 (p&lt;0.01) and mean QOL score improved from 3.97 to 0.92 (p&lt;0.01). There were no serious complications or incidences of TURP syndrome in any patient in the present study. Conclusion: TUAEP is a true anatomical enucleation and seems to be the best modern alternative to transurethral resection of the prostate and open prostatectomy for bladder outlet obstruction caused by benign prostatic hyperplasia. The long-term results in terms of efficacy and safety need to be validated in further prospective randomized controlled studies. Keywords: Prostate, Prostatic hyperplasia, Transurethral enucleation of prostate, Transurethral anatomical, Transurethral resection of prostate, Surgical procedures, Minimally invasive, TUAEP, TUERP

Urological dysfunctions in patients with Parkinson\u2019s disease: clues from clinical and non-invasive urological assessment

BackgroundAutonomic nervous system dysfunction, common in patients with Parkinson’s disease (PD), causes significant morbidity and it is correlated with poor quality of life. To assess frequency of urinary symptoms in patients with PD, without conditions known to interfere with urinary function.MethodsNon-demented PD patients were consecutively enrolled from the outpatients clinic of our department. Scales investigating motor and non-motor symptoms were carried out. Evaluation of urinary dysfunctions was carried out using the AUTonomic Scale for Outcomes in Parkinson’s disease (SCOPA-AUT) questionnaire. Patients underwent noninvasive urological studies (nUS), including uroflowmetry and ultrasound of the urinary tract.ResultsForty-eight (20 women, 42%) out of 187 PD patients met the inclusion criteria and were enrolled in the study. Mean SCOPA-AUT score was 14.1 ± 6.9 (urinary symptoms subscore 5.2 ± 3.8). Among those evaluated by the SCOPA-AUT scale, the urinary symptoms were among the most common complaints (93.8%). At nUS mean maximum flow rate (Qmax) was 17.9 ± 9.1 ml/s, and mean postvoid residual (PVR) urine volume was 24.4 ± 44.1 ml. Ultrasound investigation documented prostate hypertrophy in 12 male patients (42.8%). Urinary items of the SCOPA-AUT (SCOPA-U subscore) correlated with measures of disease severity only in female patients.ConclusionUrinary symptoms and abnormal findings in nUS are common in PD. Though nigrostriatal degeneration might be responsible for urinary symptoms also in the early-intermediate stage of the disease, when urinary dysfunction occurs other medical conditions need to be excluded.

Intratrigonal OnabotulinumtoxinA Improves Bladder Symptoms and Quality of Life in Patients with Bladder Pain Syndrome/Interstitial Cystitis: A Pilot, Single Center, Randomized, Double-Blind, Placebo Controlled Trial

We compared the efficacy and safety of trigonal injections of onabotulinumtoxinA and saline in patients with bladder pain syndrome/interstitial cystitis. This phase II study enrolled women who had had bladder pain syndrome/interstitial cystitis for more than 6 months and pain for 4 months or longer on a visual analogue scale of 0 to 10, which were refractory to common treatment. OnabotulinumtoxinA 100 U in 10 or saline as placebo in 9 was administered as 10 trigonal injections of 1 ml. The primary study end point was the change from baseline pain intensity reported at week 12. Additional end points included O'Leary-Sant scores, micturition frequency, quality of life at week 4, 8 and 12, and the treatment benefit scale at week 12. Safety assessments included urinary tract infection, post-void residual urine and the initiation of clean intermittent catheterization. At week 12 onabotulinumtoxinA had significantly reduced pain compared with saline (mean ± SD -3.8 ± 2.5 vs -1.6 ± 2.1, p <0.05). The proportion of patients who achieved a 50% or greater reduction in the pain visual analog scale was 60% for onabotulinumtoxinA vs 22% for placebo. OnabotulinumtoxinA significantly improved O'Leary-Sant scores and quality of life over placebo at weeks 4, 8 and 12. Important numerical reductions in voiding frequency were also observed with the toxin. OnabotulinumtoxinA was well tolerated. Urinary tract infections developed in 3 patients who received onabotulinumtoxinA vs 2 who received saline. Mean post-void residual urine at week 12 was 5 ± 13 ml for onabotulinumtoxinA vs 0 ml with saline. This study had the limitations inherent to a single center trial with a small number of patients enrolled. OnabotulinumtoxinA 100 U caused significant and clinically relevant improvements in bladder pain and quality of life in patients with bladder pain syndrome/interstitial cystitis refractory to common therapy. It was also well tolerated.

The T-plasty as therapy for recurrent bladder neck stenosis: success rate, functional outcome, and patient satisfaction.

To determine success rate (SR), functional outcome, and patient satisfaction of a modified YV-plasty for reconstruction of the bladder neck in case of recurrent bladder neck stenosis (BNS) after transurethral surgery of the prostate: the T-plasty. We identified all patients who underwent T-plasty at our center between December 2008 and July 2016. Patients' charts were reviewed. Patients were queried by telephone and by mail at time of follow-up (FU). Primary endpoint was SR. Secondary endpoints were complications, continence, satisfaction, and changes in quality of life measured by validated questionnaires. Thirty patients underwent the T-plasty. Median age at surgery was 69 (IQR 62-73)years. Most patients had BNS due to TUR-P [n=25 (83.3%)]. No severe blood loss or severe complications occurred perioperatively. Median FU was 45 (IQR 18-64)months. Three patients were lost to FU. Success rate was 100%. Compared to pre-OP Q max, mean Q max post-OP improved significantly [pre-OP 6.79 (SD±4.76) ml/s vs post-OP was 24.42 (SD±12.61)ml/s; (t(5)=4.12, p=0.009)]. Mean post-void residual urine decreased significantly [pre-OP 140.77 (SD±105.41)ml vs post-OP 14.5 (SD±22.42)ml; (t(9)=-3.86, p=0.004)]. One patient developed a de-novo-incontinence post-OP. Mean ICIQ-SF Score was 1.2 (SD±2.27). 88.5% of patients were pleased or delighted by surgery. 75% of patients claimed their quality of life has been (strongly) improved. The T-plasty is a valuable option as treatment of recurrent BNS. SR, rates of continence, and high patient satisfaction are very encouraging.

Dorsal Onlay Buccal Urethroplasty in the Female is Associated with High Quality of Life Using Validated Lower Urinary Tract Symptom Instruments

IntroductionFemale urethral stricture is rare and decreases quality of life. Buccal mucosa has become the most popular graft material for male urethroplasty but little is written about females. Rare case reports of buccal mucosa grafting in the female appear in the literature as an alternate method to more commonly performed vaginal flap urethroplasty (Blandy-style flap) or free vaginal mucosa graft urethroplasty. The hypothesis is that dorsal onlay buccal mucosa grafting will improve quality of life scores and provide acceptable recurrence-free rates. MethodsWe compiled a retrospective case series from 2009 to 2013 to identify female patients treated with dorsal onlay buccal urethroplasty via a suprameatal approach. All patients underwent pelvic exam as well as a supine stress test. Study end points included stricture recurrence verified by cystoscopy, uroflow, post-void residual urine, presence of urinary tract infection, pain, fistula formation, incontinence, and complications at the donor site and the vagina. ResultsSix patients were identified. Mean followup was 18.6 months. No stress incontinence was noted preoperatively and none developed postoperatively. No fistulas were noted. Mean stricture length was 1.2 cm and mean graft length was 2.75 cm. Two stricture recurrences (33%) were noted, requiring dilation. Mean pain score went from 7.2 to 0 on a 10-point Likert scale (p = 0.004). The number of urinary tract infections per year decreased from 4.3 to 0.3 (p = 0.038). Maximum voided velocity increased from 5.6 to 13.1 ml per second (p = 0.003) and mean post-void residual urine decreased from 270 to 34 ml (p = 0.094). No urethral or vaginal complications were reported. Two patients reported donor site morbidity but no clitoral anesthesia or pain was reported. ConclusionsDorsal onlay buccal urethroplasty provided acceptable but not improved cure rates compared with the published failure rates of alternative methods. Patients experienced significant improvements in pain, urinary flow and quality of life. It can be safely considered instead of ventral onlay vaginal flap urethroplasty or serial dilation in females with stricture.

Asymptomatic urinary retention in elderly women upon admission to the Internal Medicine department: A prospective study.

To assess the incidence and associated risk factors of asymptomatic urinary retention in elderly women upon admission to the Internal Medicine department. Two hundred and two consecutive elderly women (mean age 84.4 ± 5.7 years) who were admitted to four Internal Medicine departments at a tertiary medical center were prospectively enrolled. All patients underwent post-void residual urine (PVR) measurements on the morning following the admission day. The measurements were undertaken by using a portable ultrasound bladder scan. Asymptomatic urinary retention was defined as PVR ≥ 200 ml without lower urinary tract symptoms, or abdominal pain, in two consecutive measurements. Asymptomatic urinary retention was diagnosed in 29 (14.4%) women (mean PVR: 353.1 ± 155.2 ml; range: 200-712 ml). The mean age, prevalence of chronic diseases, and the use of opioid and antimuscarinic drugs were similar in women with versus without asymptomatic urinary retention. A binary logistic regression analysis showed that asymptomatic urinary retention was significantly and independently associated with low mobility, measured by the functional independence measure (FIM) scale (odds ratio = 0.7, 95% confidence interval 0.6-0.9, P = 0.026), and hypothyroidism (odds ratio = 2.4, 95% confidence interval 1.0-5.8, P = 0.049). Among 174 (86.1%) patients in whom thyroid-stimulating hormone (TSH) serum levels were measured, a statistically significant correlation was demonstrated between TSH values and PVR measurements. Asymptomatic urinary retention in elderly women upon admission to the Internal Medicine department is not infrequent and is independently associated with hypothyroidism and low mobility. PVR measurements should, therefore, be considered in all women with a low level of mobility and/or hypothyroidism upon admission to the Internal Medicine department. Neurourol. Urodynam. 36:794-797, 2017. © 2016 Wiley Periodicals, Inc.

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.

Reconstruction of Female Urethra with Tubularized Anterior Vaginal Flap.

Female urethral injury is a rare disease. Causes of urethral injuries are prolonged obstructed labour, gynaecological surgeries like vaginoplasty and post traumatic urethral injuries. The present study was conducted to evaluate outcome of female urethral reconstruction using tubularized anterior vaginal wall flap covered with fibroadipose martius flap and autologous fascia sling in patients with urethral loss. Aim of study was to evaluate outcome of reconstruction of female urethra with tubularized anterior vaginal flap. Retrospective analysis of all the patients with complete urethral loss was done from August 2008 to July 2015. Total seven patients were included in study. All patients presenting with total urethral loss were included. These patients were treated with tubularized anterior vaginal flap. Neourethra was covered with Martius labial flap and autologous fascia lata or rectus abdominis fascia sling. Most common cause of urethral loss was obstructed labour (57.1%). Postoperatively patients were assessed for continence, urine flow rate, ultrasound for upper urinary tract and post void residue. Mean operative time was 180 minutes (160-200 minutes) and Intraoperative blood loss was 220ml (170-260 ml). Mean postoperative hospital stay was eight days (seven to nine days) Mean post surgery maximum urine flow rate was more than 15ml/sec (6.7-18.2ml/sec) and mean post void residual urine was 22.5ml (10-50ml). Median follow-up time was 35 months. All patients were catheter free and continent post three weeks of surgery except one patient who developed mild stress urinary incontinence. One patient developed urethral stenosis which was managed by intermittent serial urethral dilatation. Female neourethral reconstruction with tabularized anterior vaginal flap and autologous pubovaginal sling is feasible in patients of total urethral loss with success rate of approximately 86%. It should be considered in patients of complete urethral loss with adequate healthy vaginal tissue.

Effect of post-voiding urine volume on progression of renal function decline in patients with type 2 diabetes

Diabetic bladder dysfunction (DBD) is a common complication of type 2 diabetes mellitus (T2DM). The association between DBD and progression of diabetic nephropathy has not been clarified. In this study, we investigated the relationship between post-voiding residual urine (PVR) with decline in renal function in patients with type 2 diabetes.This retrospective study included 164 patients at a single center. We collected medical histories and laboratory findings of patients undergoing uroflowmetry from January 1, 2008 to October 30, 2013. Renal function was assessed by calculating the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) study equation. We evaluated whether greater PVR was a risk factor for faster decline of GFR during a 1-year follow-up. The subjects’ mean age was 65±12 years, duration of diabetes 12.8±8.8 years, baseline serum creatinine level 106.1±53.0μmol/L, and eGFR was 64.6±25.2mL/min/1.73m2. Mean PVR was 69.8±96.3mL and in 17.7% of subjects, PVR>100mL. In linear regression analysis, PVR was independently associated with GFR decrease (standardized β coefficient=0.2, P=0.009). Multiple logistic analysis showed that subjects with PVR>100mL had a 2.8-fold higher risk of an eGFR change during 1 year higher than the median value of all subjects (95% confidence interval, 1.1–6.8; P=0.03).Increased PVR was independently associated with a more rapid decline in renal function in patients with type 2 diabetes.

4:06 PM, Abstract No. 300 - Prostatic arteries embolization for benign prostatic hyperplasia, with nonspherical PVA particles 150 µm - 250µm and 250 µm -355µm in 90 patients - preliminary results

To evaluate the outcome of prostate arteries embolization (PAE) with nonspherical PVA particles, in 90 patients with benign prostatic hyperplasia (BPH). Between November 2012 and September 2013 90 patients with BPH and moderate to severe lower urinary tract symptoms (LUTS) refractory to medical therapy for at least 6 months underwent PAE with nonspherical polyvinyl alcohol (PVA) particles. By randomization the patients were divided in 2 groups. In group A the patients were embolized with nonspherical PVA particles 150µm - 250µm and in group B the patients were embolized with the same size particles plus 250µm -355µm particles. Baseline values included mean prostate volume of 74.6 mL, a mean International Prostate Symptom Score (IPSS) of 22.7points, a mean quality of life (QoL) score of 4.2 points, a mean PSA of 4.9ng/dL, a mean post-void residual urine (PVR) of 140 mL, a mean Peak flow-rate (Qmax) of 12.5mL/s and a mean International Index of Erectile Function (IIEF) of 18 points. There were no significant differences of the different parameters at baseline. Control follow-up was made at 1 and 3 months and included revaluation of baseline clinical parameters. There were 2 (2.2%) technical failures, 1 in each group. There were 12 patients who were lost to follow up, 5 in group A and 7 in group B, therefore there were 39 patients controlled in group A and 37 in group B. At 1 month after PAE, there were 7 (17.9%) initial failures in group A and 5 (13.5%) in group B. At 6 months after PAE the number of failures were 8 (20.5%) in group A and 6 (16.2%) in group B, therefore the clinical success, at 6 months, was 79.5% in group A and 83.8% in group B. The differences were not statically significant. There was not any major complication. PAE for BPH with nonspherical PVA 150µm - 250µm and 250µm - 355µm is a safe and efficient outpatient procedure, with good preliminary results. The clinical success was slightly better with a misture of particles of different sizes.

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.

Total cystectomy and W-shaped orthotopic ileal neobladder for bladder cancer

To investigate the clinical effect of total cystectomy and W-shaped orthotopic ileal neobladder for bladder cancer. Total cystectomy and W-shaped orthotopic ileal neobladder were performed on 29 male patients and 3 female patients. After the cystectomy, 35-40 cm terminal ileal segment was isolated to make W-shaped orthotopic ileal neobladder. Bilateral uretero-ileal anastomoses were constructed by nipple technique, urethral stump was sutured to the lowest portion of the ileal pouch. All surgeries were completed successfully. Patients were able to void by increasing the abdominal pressure, daytime continence rate was 87.5% and nighttime continence rate was 78.1%. The mean neobladder capacity was 410.6 mL and the mean postvoid residual urine was 22.7 mL at 6 months. After the surgery, ileal neobladder leakage occurred in 3 (9.4%) patients, mild ileus occurred in 2 (6.3%) patients, ileo-urethral anastomosis stricture developed in 1(3.1%) patient, and dysuria occurred in 3 (9.4%) patients because of the mucus. THe complications were treated properly and satisfactory results were obtained. Erection was preserved in 5 of the 9 male patients with normal erectile function, and normal sexual function was preserved in 1 female patient who underwent uterus-sparing cystectomy. The mean follow-up was 15 months. One patient died of distant metastasis and pneumonia, while other patients survived without tumor. Total cystectomy and W-shaped orthotopic ileal neobladder have the advantages of voiding through the native urethra, satisfactory continence, low complication rates of upper urinary tract damage and electrolyte imbalance. W-shaped orthotopic ileal neobladder may be considered as the first option of urinary diversion after cystectomy. Postoperative management should focus on complications and follow-up.