Residual Urine Measurement Research Articles

LOWER URINARY TRACT SYMPTOMS AND FUNCTIONS AFTER RENAL TRANSPLANTATION AT OUR HOSPITAL

We investigated lower urinary tract symptoms (LUTS) and function in patients who had undergone renal transplantation (RTx). Fifty patients (34 males and 16 females; age 16-68 years) undergoing RTx at our hospital were included in this study. Average follow-up after RTx was 6.1 years (range 0.5-28). The pre-transplant dialysis period averaged 2.5 years (range preemptive-18.6 years). We conducted the evaluation of lower urinary tract symptoms (LUTS) and function using uroflowmetry (UFM) , residual urine measurement, 24h bladder diary, International Prostate Symptom Score (IPSS), QOL score, Overactive Bladder Symptom Score (OABSS) and Core Lower Urinary Tract Symptom Score (CLSS). Average first desire to void and maximum desire to void were 89.9 mL and 185 mL respectively in cystometry before RTx. Atrophy of the bladder before RTx showed a correlation with the dialysis period. UFM of post-RTx was maximum urinary flow rate of 21.8 mL/s and a voided volume of 287.6 mL. Severe cases of IPSS, QOL, OABSS and CLSS were not observed. Average 24h voided volume, urination times and nocturia were 2,329 mL, 8.2 times and 0.9 times respectively. Polyuria after RTx was observed in 21 patients (42%). Aging and vascular lesions such as diabetes and cardiovascular disease were the most important factor of LUTS. After RTx, LUTS were present in a number of cases after RTx. Patients undergoing RTx has been aging, it is considered necessary to perform the evaluation of LUTS before RTx.

Chapter 9 - Approach to the male patient with lower urinary tract dysfunction

History and physical examination are the cornerstones of evaluation of the male patient with lower urinary tract (LUT) symptoms and (suspected) neurologic disorder, both to diagnose the nervous system lesion, and to get insight into the type of LUT dysfunction (LUTD). Non-neurologic LUTD needs to be ruled out. Laboratory testing is necessary to diagnose urinary infection. In those in whom neurogenic LUTD is probable, postvoid residual urine and urinary flow measurement generally rule out significant outflow obstruction and allow for basic symptomatic management. If symptomatology is complex or severe, or the pathophysiology uncertain, or invasive treatment planned, urodynamic or videourodynamic measurements should be performed to inform on bladder sensation, detrusor contractility, pressures generated in the bladder, as well as the behavior of bladder neck, the striated urethral sphincter, and urinary flow. This information is paramount to the clinician to plan management and consider prognosis. Assessment needs to be repeated, as chronic neurogenic LUTD is not a stable condition; in progressive neurologic diseases the nature of LUTD itself may change. The upper urinary tract needs to be checked and followed up regularly, particularly in patient groups in which high intravesical pressures may be generated.

A prospective video-controlled study of genito-urinary disorders in 35 consecutive laparoscopic TMEs for rectal cancer

Genito-urinary disorders (GUD) for radical rectal cancer surgery range from 10 to 30%. In this study, primary endpoint is to prospectively assess their incidence in patients undergoing Laparoscopic Total Mesorectal Excision (LTME) without neoadjuvant chemo-radiation (NCR). Secondary endpoint is to detect the potential lesion site evaluating video-recordings of surgery. A study of 35 consecutive patients treated by LTME for extra-peritoneal rectal cancer not subjected to NCR, M:F = 23:12, median age 70, was evaluated preoperatively by Uroflowmetry and US postvoid residual urine measurement (PVR), International Prostatic Symptoms Score (IPSS), and International Consultation on Incontinence Modular Questionnaire (ICIQ) at 1 and 9 months post-operatively. Evaluation of sexual function was carried out by International Index of Erectile Function (IIEF) in males. Data were analyzed performing Fisher and paired samples t tests. Surgical videos of patients affected by GUD were reviewed to identify lesion sites. Urinary function:IPSS average score: baseline 6.03 ± 5.51, 8.93 ± 6.42 (p = .005) at 1 month, and 7.26 ± 5.55 (p = .041) at 9 months. ICIQ baseline 2.67 ± 5.42, 4.27 ± 6.19 (p = NS) at 1 month, and 3.63 ± 5.23 (p = NS) at 9 months. Maximum urine flow rate baseline 15.95 ± 4.78 ml/s, 14.23 ± 5.27 after 1 month (p = .041), and 15.22 ± 4.01 after 9 months (p = NS). Mean urine flow rate baseline 9.15 ± 2.96 ml/s, 7.99 ± 4.12 ml/s at 1 month (p = .044), and 8.54 ± 4.19 ml/s at 9 months (p = NS). PVR baseline 59.62 ± 54.49, 64.59 ± 58.71 (p = NS) at 1 month, and 68.82 ± 77.72 (p = NS) at 9 months. Sexual function: IIEF baseline 19.38 ± 6.25, 14.06 ± 8.65 at 1 month (p = .011), and 15.4 ± 8.41 at 9 months, (p = NS). Video review of patients with disorders showed potential damage at the site of ligation of IMA (high hypogastric plexus) in 1 case, lateral and posterior mesorectum dissection (hypogastric nerves) in 2 cases, anterior dissection of the Denonvilliers fascia from seminal vesicles in 2 cases. GUD at 1 month from LTME for rectal cancer are significant but improve at 9 months. Surgical video review of patients with GUD provides an important tool for detection of lesion sites.

Measurement of post‐void residual urine

To present the teaching module "Measurement of Post-void residual urine." This module has been prepared by a Working Group of the ICS Urodynamics Committee. The methodology used included comprehensive literature review, consensus formation by the members of the Working Group, and review by members of the ICS Urodynamics Committee core panel. In this ICS teaching module the evidence for and relevance of PVR measurement in patients with lower urinary tract dysfunction (LUTD) is summarized; in short: The interval between voiding and post-void residual (PVR) measurement should be of short duration and ultrasound bladder volume measurement is preferred to urethral catheterization. There is no universally accepted definition of a significant residual urine volume. Large PVR (>200-300 ml) may indicate marked bladder dysfunction and may predispose to unsatisfactory treatment results if for example, invasive treatment for bladder outlet obstruction (BOO) is undertaken. PVR does not seem to be a strong predictor of acute urinary retention and does not indicate presence of BOO specifically. Although the evidence base is limited, guidelines on assessment of LUTS generally include PVR measurement. Measurement of PVR is recommended in guidelines and recommendations on the management of LUTS and urinary incontinence, but the level of evidence for this measurement is not high. This manuscript summarizes the evidence and provides practice recommendations for teaching purposes in the framework of an ICS teaching module.

Guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management: Translation of French recommendations

Provide guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management. Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 13 experts quoting proposals, subsequently reviewed by an independent group of experts. In the case of patients with urinary tract infection, it must be treated and injection postponed. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by patient. The injection can be performed after local anesthesia of the bladder and urethra (lidocaine), supplemented where necessary by nitrous oxide inhalation and sometimes under general anesthesia. Injection is performed in the operating room or endoscopy suite. The bladder should not be too filled (increased risk of perforation). Treatment should be applied in 10 to 20 injections of 0.5 to 1 mL homogeneously distributed in the bladder at a distance from the urethral orifices. It is not recommended to leave a urinary catheter in place except in cases of severe hematuria. The patient should be monitored until resumption of micturition. After the first injection, an appointment must be scheduled within 3 months (micturition diary, uroflowmetry, measurement of residual urine and urine culture). Performance of self-catheterisation should be questioned in the case of a symptomatic post-void residual and/or a residue>200 mL. A new injection may be considered when the clinical benefit of the previous injection diminishes (between 6 and 9 months). A period of three months must elapse between each injection. Implementation of these guidelines may promote best practice usage of BoNTA with optimal risk/benefit ratio.

CORRELATION OF PSA, PV, AND IPP IN DETECTING BOO CAUSED BY PROSTATE ENLARGEMENT

Objective: To define the relationship between intravesical prostatic protrusion (IPP), prostate specific antigen (PSA), and prostate volume (PV), and to determine which one is the best predictor of bladder outlet obstruction (BOO) due to benign prostatic enlargement. Material & method: 95 male patients > 40 years old presenting with LUTS and BPH, between January until July 2012. They were evaluated with digital rectal examination (DRE), International Prostate Symptoms Score (IPSS), total PSA serum, uroflowmetry, post-void residual urine measurement, IPP and PV using transabdominal ultrasound. Statistical analysis included Chi-square and Spearman’s Rank correlation test.Receiver Operator Characteristic (ROC) curves were used to evaluate the correlation of PSA, PV, and IPP with BOO. Results: Mean PSA was significantly higher in obstructed patients (8.6 ng/mL; 0.76-130) compared to non-obstructed patients (6.44 ng/mL; 1.0-40.6). Mean PV was significantly larger in obstructed patients (50.33 mL ± 24.34) compared to non-obstructed patients (45.39 mL ± 23.43). Mean IPP was significantly greater in obstructed patients (7.29 ± 2.78) compared to non-obstructed patients (6.59 ± 2.93). The Spearman rho correlation coefficients were 0.617, 0.721, and 0.797, for PSA, PV, and IPP, respectively. Using ROC curves, the areas under the curve for PSA, PV, and IPP were 0.509, 0.562 and 0.602, respectively. The positive predictive values of PV, PSA, and IPP were 59.7%, 55.6% and 60.2% respectively. Conclusion: PSA, PV, and IPP measured through transabdominal ultrasonography are noninvasive and accessible method that significantly correlates with BOO in BPH patients. IPP is a better predictor for BOO than PSA or PV.Keywords: Bladder outlet obstruction, intravesical prostatic protrusion, prostate specific antigen, prostate volume, transabdominal ultrasound, benign prostate hyperplasia.

MP13-12 MIDTERM FOLLOW UP OF INTERNAL URETHROTOMY IN PATIENTS WITH RECURRENT URETHRAL STRICTURE AFTER BUCCAL MUCOSA GRAFT URETHROPLASTY

INTRODUCTION AND OBJECTIVES: To determine the success rate of internal urethrotomy (IU) in the treatment of short stricture recurrences after buccal mucosa urethroplasty (BMGU). METHODS: All patients who underwent IU for the treatment of short urethral stricture recurrence (< 1cm) after BMGU were identified from our prospective urethroplasty data base.These patients were evaluated by maximum flow rate (Qmax) and residual urine (RU) measurements. Stricture recurrence was determined when maximum flow rate (Qmax) was < 10 ml/s and a stricture verified in a combined retroand antegrade voiding cystography (VC) or cystoscopy. Endpoints of our retrospective study was to determine the success rate of IU and possible risk factors of stricture recurrence after IU. RESULTS: A total of 27 IU patients after failed BMGU were identified. Mean FU of this study cohort was 12.4 months (range 1-32). At baseline mean age was 60 years (range 19-79). A bulbar BMGU was performed in 89% and a penile urethroplasty in 11% respectively. Mean length of the graft used was 6 cm. Relapse occurred proximal to the graft in 71%, distal to the graft in 29% After IU stricture recurrence was observed in 44.4% of our study patients. Mean Qmax in FU was 16.59 ml/s, mean RU was 91 ml. According to Kaplan Meyer Analysis at 30 months the success rate of IU was about 50% (see figure 1). Neither age nor a history of radiotherapy nor number of previous urethral surgeries were statistically significantly associated with stricture recurrence after IU. In linear regression length of the graft showed borderline statistical significance (p1⁄40.078). CONCLUSIONS: At midterm FU IU after BMGU showed a fair success rate and might be a viable option in paients with very short strictures after BMGU. Longer FU is warranted. Source of Funding: none

MP13-13 PROPENSITY MATCHED COMPARISON OF MORBIDITY AND COSTS OF OPEN VS. MINIMALLY INVASIVE RADICAL NEPHROURETERECTOMY: A CONTEMPORARY POPULATION-BASED ANALYSIS IN THE UNITED STATES

INTRODUCTION AND OBJECTIVES: To determine the success rate of internal urethrotomy (IU) in the treatment of short stricture recurrences after buccal mucosa urethroplasty (BMGU). METHODS: All patients who underwent IU for the treatment of short urethral stricture recurrence (< 1cm) after BMGU were identified from our prospective urethroplasty data base.These patients were evaluated by maximum flow rate (Qmax) and residual urine (RU) measurements. Stricture recurrence was determined when maximum flow rate (Qmax) was < 10 ml/s and a stricture verified in a combined retroand antegrade voiding cystography (VC) or cystoscopy. Endpoints of our retrospective study was to determine the success rate of IU and possible risk factors of stricture recurrence after IU. RESULTS: A total of 27 IU patients after failed BMGU were identified. Mean FU of this study cohort was 12.4 months (range 1-32). At baseline mean age was 60 years (range 19-79). A bulbar BMGU was performed in 89% and a penile urethroplasty in 11% respectively. Mean length of the graft used was 6 cm. Relapse occurred proximal to the graft in 71%, distal to the graft in 29% After IU stricture recurrence was observed in 44.4% of our study patients. Mean Qmax in FU was 16.59 ml/s, mean RU was 91 ml. According to Kaplan Meyer Analysis at 30 months the success rate of IU was about 50% (see figure 1). Neither age nor a history of radiotherapy nor number of previous urethral surgeries were statistically significantly associated with stricture recurrence after IU. In linear regression length of the graft showed borderline statistical significance (p1⁄40.078). CONCLUSIONS: At midterm FU IU after BMGU showed a fair success rate and might be a viable option in paients with very short strictures after BMGU. Longer FU is warranted. Source of Funding: none

神経因性膀胱の診断・治療・医療連携

Neurogenic bladder (NB) is a lower urinary tract dysfunction (LUTD) caused by underlying neural diseases that affect the central nervous system and peripheral nerves. LUTD includes urine storage dysfunction and voiding dysfunction. LUTD causes various lower urinary tract symptoms (LUTS) and has a negative impact on patients' quality of life. In addition, urinary tract infection and upper urinary problems can be associated with LUTD, especially with NB. Thus, the diagnosis and management of NB in patients with underlying neural diseases are very important in patient care. LUTD can be screened by a careful history taking of LUTS and simple, non-invasive measures such as postvoid residual urine measurement and uroflowmetry. A urodynamic study is required for precise evaluation of urine storage function and voiding function. Urine storage dysfunction is predominantly caused by detrusor overactivity (involuntary detrusor contractions during bladder filling) and occasionally caused by sphincter deficiency, while voiding dysfunction is caused by detrusor-sphincter dyssynergia (DSD) and/or impaired detrusor contraction. Urodynamic evaluation is mandatory for proper management of NB. Management of detrusor overactivity includes pharmacotherapy using anticholinergics and selective β3-receptor agonist, and neuromodulation. For refractory cases, surgery such as bladder augmentation can be a treatment option. Pharmacotherapy for voiding dysfunction includes α-blockers for DSD and cholinergic agents for impaired detrusor contraction. However, their efficacy has been limited, and not a few patients with NB need urinary management by clean intermittent catheterization (CIC). The goals of urinary management in patients with NB are to render patients free from significant urinary problems, maintain continence, and provide better quality of life. For this purpose, close collaboration between physicians involved in rehabilitation medicine and urology is very important and should be promoted.

OnabotulinumtoxinA Office Treatment for Neurogenic Bladder Incontinence in Parkinson's Disease

To evaluate safety and effectiveness of low-dose (100 U) onabotulinumtoxinA (onabotA) bladder injections as an office procedure with topical anesthesia only for patients with Parkinson's disease (PD) and incontinence. Qualified patients who failed oral antimuscarinic agents participated in an open-label study. They discontinued antimuscarinics, provided a King's Health Questionnaire (KHQ), voiding symptom score, and 3-day voiding diary. Free uroflowmetry with post-void ultrasounds and cystometrogram pressure/flow studies were performed. Patients underwent flexible cystoscopy and injections of onabotA 100 U (10 U/mL) dispersed into 10-20 submucosal/detrusor sitesof the bladder, including the trigone. Voiding diaries, questionnaires, and free uroflowmetry with post-void ultrasound residual urine measurements were repeated after 1, 3, and 6 months. Twelve men and 8 women were treated: mean age, 70.4 years; duration of disease, 10.6 years; median bladder contraction volume, 115 mL; maximum bladder pressure, 62 cm; and post-void volume, 9 mL. Moderate to marked symptom relief at 3 months and a 50% incontinence decrease over 6 months relative to pretreatment was reported in 59% patients (P≤.02); 5 patients failed to complete the 6-month endpoint. No urinary retention required catheterization. Office cystoscopy with low-dose onabotA injection treatment is a potential long-term management strategy for patients with PD and urinary incontinence who fail oral antimuscarinic agents. The treatment seems to be safely utilized for older men with BPH as well as women with potential hypoactive detrusor function.

Recommandations pour l’utilisation de la toxine botulinique de type A (Botox®) dans l’hyperactivité vésicale réfractaire idiopathique

Provide guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic Overactive Bladder management. Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 13 experts quoting proposals, subsequently reviewed by an independent group of experts. In the case of patients with urinary tract infection, it must be treated and injection postponed. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by patient. The injection can be performed after local anesthesia of the bladder and urethra (lidocaine), supplemented where necessary by nitrous oxide inhalation and sometimes under general anesthesia. Injection is performed in the operating room or endoscopy suite. The bladder should not be too filled (increased risk of perforation). Treatment should be applied in 10 to 20 injections of 0.5 to 1mL homogeneously distributed in the bladder at a distance from the urethral orifices. It is not recommended to leave a urinary catheter in place except in cases of severe hematuria. The patient should be monitored until resumption of micturition. After the first injection, an appointment must be scheduled within 3 months (micturition diary, uroflowmetry, measurement of residual urine and urine culture). Performance of self-catheterisation should be questioned in the case of a symptomatic post-void residual and/or a residue>200mL. A new injection may be considered when the clinical benefit of the previous injection diminishes (between 6 and 9 months). A period of three months must elapse between each injection. Implementation of these guidelines may promote best practice usage of BoNTA with optimal risk/benefit ratio.

Urethral pressure reflectometry, a novel technique for simultaneous recording of pressure and cross-sectional area in the prostatic urethra: Testing in men without bothersome lower urinary tract symptoms

Objective. Urethral pressure reflectometry (UPR) was introduced in 2005, for simultaneous measurement of pressure and cross-sectional area in the female urethra. It has shown to be more reproducible than conventional pressure measurement. Recently, it has been tested in the anal canal and the prostatic urethra. The primary aim of this study was to describe UPR in men without bothersome lower urinary tract symptoms. Material and methods. The study investigated 18 men, median age 59 (range 50–77) with UPR and pressure–flow analyses (PQ), the International Prostate Symptom Score and the Danish version of Prostate Symptom Score, flow rate, residual urine measurements, transrectal ultrasound, urethral pressure profilometry and visual analogue scale (Discomfort). UPR parameters measured were opening and closing pressure, opening and closing elastance and hysteresis, from the bladder neck to the sphincter region. Results. All UPR parameters increased significantly from the bladder neck to the sphincter region, except for the opening pressure between the prostate and the sphincter region. Seven men were obstructed according to PQ, but with no significant differences in any other standard urodynamic parameters. The hysteresis in the sphincter region was significantly lower in the obstructed group (p = 0.005). Discomfort was significantly lower with PQ compared to UPR (p = 0.04). Nine men had slight bleeding from the urethra during measurement with UPR. Conclusions. The increase in all parameters from the bladder neck to the sphincter region is consistent with previous studies measuring the same parameters. The hysteresis may explain why seven men were obstructed according to PQ.

Clinical significance of Qmax and residual urine in benign prostatic hyperplasia

Objective To investigate the significance of Qmax and residual urine in evaluation of bladder function in the patients with benign prostatic hyperplasia (BPH).Methods The clinical data of 61 patients with BPH and 20 healthy persons in control group were evaluated.Bladder function,uroflowmetry and ultrasonic residual urine measurement were performed in the 2 groups.The correlation between Q max and residual urine in BPH group was investigated.Results There was significant difference in Qmax between the BPH group and control group (8 vs.21 ml/s,u=-6.090,P=0.007).There was significant difference in residual urine between the 2 groups (60 vs.9 ml,u =-6.718,P=0.005).And there was a negtive correlation between residual urine and Qmax in BPH group (r=-0.366,P=0.009).Conclusion It is useful to measure the Qmax and residual urine in evaluation of bladder function affected by bladder outlet obstruction caused by BPH. Key words: Prostatic hyperplasia; Bladder outlet obstruction; Qmax; Residual urine; Bladder remodeling

Comparative randomized study on the efficaciousness of endoscopic bipolar prostate resection versus monopolar resection technique. 3 year follow-up

Transurethral resection of the prostate (TURP) is the current optimal thera- py for the relief of bladder outflow obstruction, with subjective and objective success rate of 85 to 90%. Aim of this study was to evaluate efficacy and safety of Plasmakinetic ener- gy (Gyrus electro surgical system), which produces vaporization of tissue immersed in isotonic saline against standard monopolar transurethral resection of the prostate. From January 2002 to April 2002, 160 consecutive patients, who had low urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH) were enrolled in this study. Patients were randomised to undergo bipolar TURP (80 patients) or monopolar TURP (80 patients). Preoperative work-up was assessed by administering IPSS, IIEF-5 and Qol questionnaires. All patients were submitted to uroflowmetry, transrectal ultrasound (TRUS), post-voidal residual urine measurement and PSA determination. In the two groups, IPSS, IIEF-5 and Qol, uroflowme- try, TRUS, post-voidal residual urine measurement, PSA determination and number of reopera- tions were evaluated at 1, 3, 6, 12, 18, 24, 30 and 36 months follow up, and then every year. Furthermore, in both groups operative time, resected tissue weight and perioperative complica- tions were analysed. Total postoperative catheter time, total post-operative hospital stay, haemo- globin loss were also recorded in the two groups. Comparative data on IPSS symptom score, IIEF-5, Qol, PSA, peak urinary flow rate and post-void residual urine volume were similar in the two groups but showed a significant improve- ment respect to baseline values. The postoperative haemoglobin levels, postoperative catheteri- zation time, hospital stay and 3-year overall surgical re-treatment-free rate were significantly better in the bipolar group. Bipolar TURP has a comparable outcome to standard monopolar TURP at short and medium term regard to subjective and objective outcome measurements. Its impact on blad- der outlet function is also similar to that of monopolar TURP. Improvement in IPSS, Qol index, IIEF-5, Qmax and post-void residual urine volume were comparable in both group denoting sim- ilar efficacy of the techniques.

Intravesical Residual Urine of Patients with Benign Prostate Hyperplasia, Sonography Accuracy

Measurement of intravesical residual urine is experimentally a diagnostic, therapeutic and follow-up criterion in patients with benign prostate hyperplasia. The study aims at evaluating sonography accuracy in measuring intravesical residual urine in comparison with standard and accurate way of measurement through bladder catheterization. The study was conducted on 60 patients hospitalized for benign prostate hyperplasia. Mean age of the patients was 67.10 +/- 8.33 years. In all patients with full bladder and after urination, the post void residue was initially measured by sonography at supine position and then immediately through bladder catheterization. This study evaluated 60 patients with mean age of 67.10 +/- 8.33 years. The difference between measuring through sonography and catheterization was 7.89 +/- 0.86, 14.46 +/- 1.87 and 32.73 +/- 2.99 mL in postvoid residue less than 50, 51-100 and more than 100 mL, respectively. In patients with benign prostate hyperplasia, transabdominal sonography is a non-invasive method to determine postvoid residue amount.

Photovaporisation prostatique avec le laser KTP chez les patients sous traitement antithrombotique. À propos d’une étude rétrospective sur 120 cas

Antithrombotic (AT) medications are more and more prescribed, so complicating the surgery of benign prostatic hyperplasia (BPH). KTP laser is an alternative to the transurethral resection of the prostate thanks to its haemostatic properties. To study the functional outcomes and complications of KTP 80W laser treatment in patients taking AT, comparing with patients without AT (nAT). A single-center retrospective study has been conducted in the department of Urology of Nice Teaching Hospital, in patients with uncomplicated symptomatic BPH, treated with the KTP 80W laser treatment, between November 2005 and October 2009. The cohort was divided into two matched groups AT/nAT. In the AT group patients, treatment with aspirin and vitamin K antagonist (VKA) were maintained, whereas clopidogrel was discontinued. The urinary flowmetry, measurement of residual urine, International Prostate Symptom Score (IPSS) and question 8 of the IPSS score were analyzed. The duration of intervention, the amount of laser energy delivered, duration of catheterization and postoperative hospitalization, and the rate of blood transfusion have been evaluated. Clavien classification was used to characterize the postoperative complications. A total of 120 patients were included in two groups (50 AT/70 nAT), with a median follow-up of 24 months. The two study groups were comparable except for age which was significantly higher in patients on AT (P=0.001). The average duration of operation, of catheterization and hospital stay were significantly longer in patients receiving AT. Seven complications were reported in the AT group versus three complications in the nAT. No significant difference was reported on the evaluation of voiding parameters and IPSS score. Photovaporisation of the prostate using KTP 80W laser treatment provided functional outcomes comparable in patients on AT and untreated patients, with minimal risk of complication.

Preputial/penile skin flap, as a dorsal onlay or tubularized flap: a versatile substitute for complex anterior urethral stricture

Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? For long complex anterior urethral stricture augmentation urethroplasty is considered the standard procedure but the best substitute material is still to be ascertained. Preputial/penile skin is a very good substitute especially when used as a dorsal onlay. It demonstrates exceptional functional and cosmetic results even in patients with unsuitable oral mucosa. • To present our experience of single-stage reconstruction of urethral stricture with preputial/penile skin flap, as a dorsal onlay flap (DOF) where there is an adequate urethral plate and as a tubularized flap (TF) where there is a compromised urethral plate, in cases of complex anterior urethral strictures. • We retrospectively reviewed 144 patients, who underwent single-stage repair of pendular /bulbar urethral strictures with preputial/penile flap as either a DOF or a TF, between January 2001 and December 2008. • Patients were divided into three groups: Group 1 consisted of patients who underwent transverse preputial DOF; Group 2 consisted of those who underwent tube urethroplasty; and Group 3 consisted of those patients who were circumcised and for whom the penile skin was used as a DOF (circumpenile flap). • Patients were followed up by physical examination, retrograde urethrography, uroflowmetry and post-void residual urine measurement. • The mean follow-up was 40.1 months (range 36-84 months). • The primary success rates at 1 year follow-up were 90, 85 and 93.3% for Groups1, 2 and 3, respectively, and at 3-years follow-up they were 85, 75 and 86.7%, respectively. • Half of the recurrences were successfully managed with a single visual internal urethrotomy or dilatation. • The secondary success rate was defined as recurrent stricture managed by a single endoscopic procedure and was 5, 10 and 6.8% in Groups 1, 2 and 3, respectively. The overall success rate was 90.85 and 93.3%, respectively. • A total of 75% of the patients in the study completed 60 months of follow-up with no additional recurrence. • A preputial/penile flap for complex anterior urethral stricture is a good treatment option, with results similar to other techniques, has acceptable donor site morbidity and is effective even in circumcised patients and for those patients with unsuitable oral mucosa. • A DOF is less likely to lead to diverticula formation and post-void dribbling. TFs have a higher failure rate than DOFs but, when combined judiciously with secondary endoscopic procedures, can provide good results.

Measurement of Postvoid Residual Urine in Conscious Mice Using High-Frequency Transrectal Ultrasound

The aim of this study was to develop a novel technique for a minimally invasive ultrasound measurement of postvoid residual urine (PVR) in conscious mice using a miniature ultrasound probe and a transrectal approach. The PVR was determined by the ellipsoid formula in the maximum sectional image of the bladder visualized with a 20-MHz ultrasound probe (2 mm in diameter) inserted into the rectum. The accuracy, including the intra- and interobserver reproducibilities, of the ultrasonic PVR measurements (in 10 5- to 50-week-old mice) was evaluated, which revealed excellent internal consistency. In M3 muscarinic acetylcholine receptor knockout male mice, a chronological evaluation of the PVR identified abnormal urinary retention present at infancy and exacerbated with aging, suggesting significant voiding dysfunction. Our technique for the measurement of PVR in conscious mice was accurate and useful for identifying the voiding dysfunction in mice.

Effect of Intravesical Prostatic Protrusion on the Characteristics of Lower Urinary Tract Symptom Change after 12-Week Drug Medication: A Prospective Analysis.

The aim of this study was to identify whether intravesical prostatic protrusion (IPP) is related to the characteristics of voiding symptoms improvement after drug treatment in benign prostatic hyperplasia patients. Ninety male patients with more than 30 g prostate volume were prospectively enrolled. All patients were evaluated with International Prostate Symptoms Score (IPSS), uroflowmetry, postvoid residual urine (PVR), prostate volume and IPP measurement by transrectal ultrasound. Treatment response was evaluated again by IPSS after 12 weeks of medication. We evaluated the correlation of IPP and IPSS, quality of life (QoL) score, maximum urinary flow rate (Qmax) and PVR, and compared IPPS and IPSS subscale score change between the IPP and non-IPP groups. IPP was significantly correlated with total IPSS, voiding/storage symptom subscore and PVR. IPP was inversely correlated with Qmax. IPP showed a significant correlation with storage symptoms after an adjustment of prostate volume. After 12 weeks of medication, the IPP group showed persistently high storage symptoms than the non-IPP group. BPH patients with IPP showed less improvement of storage symptoms after 12 weeks of medication. This study suggests that IPP may be a possible cause of intractable storage symptoms in early treatment.

589 A PROSPECTIVE STUDY ON THE CONSISTENCY AND REPRODUCIBILITY OF UROFLOWMETRY STUDIES AND POST VOID RESIDUAL MEASUREMENTS AT A BLADDER VOLUME OF 50-100% ESTIMATED BLADDER CAPACITY IN CHILDREN

You have accessJournal of UrologyPediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfnction, Enuresis1 Apr 2012589 A PROSPECTIVE STUDY ON THE CONSISTENCY AND REPRODUCIBILITY OF UROFLOWMETRY STUDIES AND POST VOID RESIDUAL MEASUREMENTS AT A BLADDER VOLUME OF 50-100% ESTIMATED BLADDER CAPACITY IN CHILDREN Ma. Fluorence Flores and David Bolong Ma. Fluorence FloresMa. Fluorence Flores Manila, Philippines More articles by this author and David BolongDavid Bolong Manila, Philippines More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.666AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Uroflowmetry and post void residual studies are considered fundamental, noninvasive diagnostic tools in Pediatric Urology. Parameters are frequently used in the evaluation and reassessment of children with lower urinary tract dysfunction. Often the therapeutic decisions are based on a single or on a few determinations.Therefore, it is crucial to know whether these tests are reproducible to a clinically acceptable degree. Since current nomograms have been constructed from 1 to 2 voids per child, variability of flow parameters is unknown. This leads us to the question of “How many times should uroflowmetry and post void residual urine measurements be done to a single patient in order to get a reliable and consistent result?” In this study, we set the prevoid volume at 50 to 100% of the estimated bladder capacity of each child. OBJECTIVE To assess the repeatability and consistency of uroflowmetry and post void residual urine (PVR) determination in children at a bladder volume of 50-100% of the estimated bladder capacity (EBC). METHODS From April 2011- September 2011, twenty-five (25) children, ages 3-8 years, underwent uroflowmetry and post void urine measurements. Values were taken for 3 consecutive micturitions at a bladder volume of 50-100% of the estimated bladder capacity, as measured by transabdominal ultrasound. A total of 75 micturitions were studied. Uroflowmetry parameters and PVR were recorded and analyzed. RESULTS There were no significant differences in the measurements across three trials for maximum flow rate (Qmax) and prevoid urine volume. There were significant differences in the measurements of PVR and uroflowmetry curves. PVR urine volumes were not related to prevoid urine volumes. Age, height and weight were related to the prevoid volumes. CONCLUSIONS Uroflowmetry and post void residual tests will give informative and reliable values at a bladder volume of 50-100% estimated bladder capacity. In cases of any abnormal flow curve or pattern at this bladder capacity, a repeat examination is prudent; despite normal maximum flow rate (Qmax) and negligible post void residual urine. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e240 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ma. Fluorence Flores Manila, Philippines More articles by this author David Bolong Manila, Philippines More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...