Median Residual Urine Volume Research Articles

Vesicostomy: An alternative approach for complicated adult patients with urinary retention

Purpose:Patients with permanent urethral catheterization for chronic urinary retention frequently experience several complications, such as bladder stones and/or urinary tract infections. In this study, we performed vesicostomy in adult patients with urinary retention who developed complications during long-term indwelling catheterization. Methods:Patients with a permanent bladder catheter for urinary retention, and bladder stones and/or urinary tract infection between April 2019 and October 2021 were enrolled in this retrospective study. Vesicostomy and additional surgeries, such as vesicolithotomy, were performed if necessary. Residual urine volume was measured with computed tomography 7 days after the operation. We followed-up all patients 3 months postoperatively to identify complications. Results:Nine patients were included in this study; eight were male and one was female. The median age at operation was 65 (range, 23–92) years. Concurrent operations were lithotomy in five, cystostomy closure in one, removal of a bladder foreign body in one, and nephrectomy in one. The postoperative median residual urine volume in the bladder was 32 (range, 5–51) ml. Perioperative complications comprised delirium (Clavien–Dindo grade II) in two patients and stomal bleeding (Clavien–Dindo grade II) in one patient. There were no complications of bladder stones, febrile urinary tract infection, or stomal stenosis postoperatively. Conclusions:Vesicostomy for adult patients with urinary retention was useful and safe. Our results suggest that vesicostomy could be a bladder drainage option for select adult patients who are not candidates for permanent indwelling catheterization.

Serum Uromodulin and All-Cause Mortality in Peritoneal Dialysis Patients: A Chinese Cohort Study

Serum Uromodulin and All-Cause Mortality in Peritoneal Dialysis Patients: A Chinese Cohort Study

Postsurgical urodynamic study of total laparoscopic nerve-sparing radical hysterectomy for uterine cervical cancer.

To evaluate the impact on urodynamic results between the laparoscopic nerve-sparing radical hysterectomy (LRH) following a step-by-step procedure and abdominal nerve-sparing radical hysterectomy (ARH) for patients with uterine cervical cancer. This retrospective study enrolled 76 patients with cervical cancer: 35 in the LRH group and 41 in the ARH group. We analyzed their postoperative bladder function in a urodynamics study and examined the volume of resected pelvic nerves contained in parametrial sections using S-100 antibody staining. Estimated blood loss and hospital stay after operation for the LRH group were significantly better than those in the ARH group (p < 0.0001). As well, the number of harvested lymph nodes was significantly higher in the LRH group (p=0.044). There was no difference in perioperative complications between the two groups in this study. The 5-year disease-free survival rates and overall survival rates were 91.2% and 94.0% in the LRH group and 87.8% and 95.1% in the ARH group, both respectively. Although the median residual urine volume were no statistical differences between the LRH group and the ARH group, the recovery of postoperative bladder function (uroflowmetry) in the LRH group rapidly reached presurgery levels at 1month, and the LRH group had a smaller number of s-100 antibody stained nerves contained the parametrial sections. We demonstrated that LRH following a step-by-step procedure could achieve a higher level of prevention of damage to the bladder branch of the pelvic splanchnic nerve plexus and thus restore bladder function more rapidly.

Validity of a disposable catheter to drain urine overnight in neurogenic bladder.

Overnight catheter drainage (OCD) is introduced to avoid overdistention of the bladder at night-time when clean intermittent catheterization proves ineffective for daytime management of neurogenic bladder. We adopted OCD using disposable silicone no-balloon (DSnB) catheters, with the distal end outside the body opening into diapers. OCD using DSnB catheter, however, had risks of retrograde bacterial contamination. Therefore, in this study, the validity of equipping DSnB catheters with check valves to prevent retrograde bacterial contamination was examined. For the invitro study, excised saline-filled swine bladders were drained using DSnB catheters with or without check valves, and the time required for intravesical pressure to reach 5cmH2 O was measured. For the invivo study, in cross-over experiments comparing DSnB catheters with and without check valves, OCD using DSnB catheters for 10h was performed in rabbits under analgesia. Bacterial growth from urine samples before and after OCD and residual urine volume were examined. For the invitro experiment, the median drainage time was 368.2s (range, 88-1,085s) and 344.7s (range, 28-840s) with and without check valves, respectively (n = 6), which was not significantly different. For the invivo experiment, in cross-over experiments (n = 8) new bacterial growth rates after OCD did not differ, and median residual urine volume was 17.1mL (range, 0-75mL) and 1.2mL (range, 0-5mL) with and without check valves, respectively (P = 0.055). Installing a check valve in the DSnB catheter did not decrease new bacterial growth, while tending to increase residual urine volume. DSnB catheters without check valves appear to be better for continuous drainage of urine from bladder.

Acceptable Postvoid Residual Urine Volume after Vaginal Delivery and Its Association with Various Obstetric Parameters.

Background Urinary retention and voiding dysfunction is a distressing event and relatively common in immediate postpartum period. This study aims at investigating the range of postvoid residual urine volume after vaginal delivery and its association with various obstetric parameters. Methods This was a prospective observational study of women who delivered vaginally in Universiti Kebangsaan Malaysia Medical Centre from March 2017 to September 2017. Those who were able to void within 6 hours after delivery, the voided volume measurements were taken at their second void followed by measurement of residual urine using a transabdominal ultrasound scan. For those unable to void at 6 hours postpartum, the bladder volume was measured. If the bladder volume was 500 ml or more, an indwelling catheter would be inserted and kept for 24 hours. Results A total of 155 patients who fulfilled the inclusion were recruited. There were 143 (92.3%) patients who had residual urine volume of less than 150 ml at second void. Out of these 143 patients, 138 (96.5%) had residual urine volume of less than 100 ml, and among the 138 patients, 119 (86.2%) had residual urine volume of less than 50 ml. The median residual urine volume was 10 ml (2, 42). The overall rate of postpartum urinary retention (PPUR) was 7.7%; 6 (3.85%) had overt retention and 6 (3.85%) had covert retention. Primiparity, duration of active phase of labour, duration of second stage of labour, epidural analgesia, episiotomy, instrumental delivery, and perineal pain score were independent risk factors associated with postpartum urinary retention. Conclusion Postpartum urinary retention complicates approximately 7.7% of vaginal deliveries. Majority (86.2%) of them had residual urine volume less than 50 ml. Obstetrics factors independently associated with PPUR include primiparity, duration of active phase of labour, duration of second stage of labour, epidural analgesia, episiotomy, instrumental delivery, and degree of perineal pain.

Residual urine volumes after intermittent catheterization in men with spinal cord injury

Prospective cross-sectional study. To investigate residual urine volumes after intermittent catheterization (IC) in men with spinal cord injury (SCI) and the effect of residual urine on the rate of symptomatic urinary tract infections (UTIs). Single SCI rehabilitation center in Switzerland. Sixty men experienced in IC (≥ 6 months) emptied their bladder twice by IC. Immediately after catheterization, residual urine was determined by ultrasonography. Personal characteristics and bladder diary details (annual UTI rate, catheter type) were also collected. The median residual urine volume was 7.0 ml (lower quartile (LQ): 0.0, upper quartile (UQ): 20.3 ml). No residual urine was observed after 42% (n=50) of all catheterizations (n=120). Unsatisfactory residual volumes (that is, >50 ml) were observed after 9% (n=11) of all catheterizations. There was no significant (P=0.95) difference between the median residual urine volume of men with recurrent (>2 UTIs per year) UTIs (2.5 ml, LQ: 0.0, UQ: 29.3 ml) and the volume of those with sporadic (≤ 2 UTIs per year) UTIs (6.0 ml, LQ: 0.0, UQ: 20.0 ml). Bladder evacuation by IC is an efficient method, resulting in zero or small residual urine volumes. The small residual urine volumes generally observed after IC do not predispose for UTIs.

Botulinum toxin therapy for nonneurogenic overactive bladder: first experience

The paper presents early experience in the treatment of 20 patients with botulinum toxin injections into the detrusor muscle for the treatment of non-neurogenic overactive bladder (OAB) resistant to anticholinergic drugs. Background. Botulinum toxin, a presynaptic neuromuscular blocking agent, reduces the involuntary bladder contractions that cause urgency, frequency and urge incontinence. We present our early experience with Dysport® injections into the detrusor for the treatment of non–neurogenic overactive bladder (OAB) resistant to anticholinergic drugs. Materials and methods. Using intravenous anaesthesia, 20 patients (18 female and 2 male) with non-neurogenic OAB were injected with botulinum toxin A (Dysport®250 IU diluted in 4 ml normal saline) under cystoscopic visualization in 20 sites in the detrusor muscle, sparing the trigone. The urethral catheter was removed 24 hours after the procedure. Follow-up at 3 and 6 months after the injection included the Urogenital Distress Inventory UDI-6, the Incontinence Impact Questionnaire IIQ-7, clinical parameters and ultrasound measurement of bladder capacity and post-void residual urine volume. Results. All 20 patients completed questionnaires and were examined after 3 and 6 months. At the 3-month follow-up, the median daytime micturation frequency decreased from 10.4 to 4.6 times (p &lt; 0.0001) and at the 6 months follow-up 5 times (p &lt; 0.0001), while nocturia decreased from 4.2 to 1.3 times after 3 months (p &lt; 0.0001) and after 6 months to 2 times (p &lt; 0.0001). Urgency decreased from 6 to 1.5 times after 3 months (p &lt; 0.0001) and to 2 times after 6 months (p &lt; 0.0001), and incontinence decreased from 4.2 times to 1.5 times after 3 months (p &lt; 0.0001) and to 2.1 times after 6 months (p &lt; 0.0001). The median maximum bladder capacity increased from 250 to 420 ml after 3 months (p &lt; 0.0001) and decreased to 350 ml after 6 months (p &lt; 0.0001). The post-void median residual urine volume was 10 ml. Only one patient mentioned a post-operative obstructive voiding difficulty. Eighteen (90%) patients were satisfied with the treatment. In two patients (10%), the amelioration of symptoms lasted for one month only, and later OAB symptoms reappeared. Analysis of the UDI-6 and IIQ-7 questionnaires revealed that botulinum toxin A intradetrusor injection had decreased discomfort for patients and ameliorated their quality of life. Conclusions. Botulinum toxin A injections in the detrusor are effective for the treatment of non-neurogenic OAB. Botulinum toxin A injections are a minimally invasive therapy and offer an alternative treatment for non–neurogenic OAB dysfunction resistant to conservative treatment. The durability of the treatment effect is the objective of the further investigation. Keywords: botulinum toxin, overactive bladder, urinary incontinence

Laparoscopic nerve-sparing radical hysterectomy: Description of the technique and patients’ outcome

Objective The radical hysterectomy type three can be accompanied by postoperative morbidity, such as dysfunction of the lower urinary tract with loss of bladder or rectum sensation. We describe the technique of laparoscopic nerve-sparing radical hysterectomy and patient's outcome. Methods Thirty-two patients underwent laparoscopic nerve-sparing radical hysterectomy with pelvic lymphadenectomy. Both the hypogastric and the splanchnic nerves were identified bilaterally during pelvic lymphadenectomy. Results The median age of the patients was 52 years, and the average operating time was 221 min. There were no intraoperative or postoperative complications considering the nerve-spring radical hysterectomy. Postoperatively, in all patients spontaneous voiding was possible on the third postoperative day with a median residual urine volume of < 50 ml. Conclusions Laparoscopic identification (neurolysis) of the inferior hypogastric nerve and inferior hypogastric plexus is a feasible procedure for trained laparoscopic surgeons who have a good knowledge not only of the retroperitoneal anatomy but also of the pelvic neuro-anatomy as this qualification could prohibit long-term bladder and voiding dysfunction during nerve-sparing radical hysterectomy.

Laparoscopic identification of pelvic nerves in patients with deep infiltrating endometriosis.

Nerve sparing is suggested for cancer surgery, but no experience is available for deep endometriosis. The aim of this study was to laparoscopically identify the pelvic nerves in the posterior pelvis. A total of 24 patients operated for deep endometriosis were considered. During surgery and on videotapes of the procedures, we evaluated single- or double-sided resection of the uterosacral ligaments and other structure's visualization of the inferior hypogastric and the splanchnic nerves. The most important objective criteria for resection of the nerves was urinary retention after surgery, which was compared to surgical resection on the videotapes. Visualization of the inferior hypogastric nerves was possible in 20 of 22 patients (90.1%). Eight of the 24 patients had at least one inferior hypogastric nerve resected (33.3%). In seven patients (29.2%) resection of the uterosacral ligaments was bilateral, and in three of these the nerves were resected. Postoperatively, the median residual urine volume after the first spontaneous voiding was 40 ml (range, 20-400). Seven of eight patients (29.2%) with resection of the nerves had urinary retention and self-catheterization at discharge. The difference in urinary residuum after first voiding between patients undergoing self-catheterization and patients released without the catheter was significant ( p < 0.01). The median time to resume the voiding function in patients with self-catheterization was 18 days (range, 9-45). Nerve visualization is possible by means of laparoscopic surgery for deep endometriosis in a high rate of patients. Careful technique is necessary, but the laparoscopic approach may help. Even single-sided radical dissection can induce important urinary retention.

Retropubic Transvesical Prostatectomy for Significant Prostatic Enlargement Must Remain a Standard Part of Urology Training

In recent years, open prostatectomy for benign enlargement has again become an issue of interest. We evaluated our experience with this procedure. Special attention was paid to the effect of the experience of the surgeon on operative outcome. The patient files of 201 patients were evaluated retrospectively for operation outcome parameters. Statistical analysis was performed where appropriate. The different parameters were also analyzed separately for patients operated on by the head of the department and those operated on by residents. We found significant differences in pre- and postoperative median residual urine volume (85 vs 0.0 ml; p < 0.001) and pre- and postoperative median urinary flow (6.0 vs 20.8 ml/s; p < 0.001). There was a moderate correlation between preoperative determination of the prostate volume by means of transrectal ultrasound and postoperative histological weight. Patients operated on by the head of the department had a significantly shorter operation time. Postoperative complications were rarely seen in either group. The rates of postoperative complications were as follows: permanent incontinence, 0.5%; endoscopic revision (bleeding), 3%; open revision, 1%; urinary tract infection, 13%; and secondary wound healing, 5.5%. We feel that open prostatectomy remains an excellent technique for large prostate adenomas and should always be offered in such cases as a true alternative to endoscopic techniques. Having a well-trained urologist perform the procedure is the best guarantee of minimal blood loss and minimal complication rates. Therefore, open prostatectomy should be part of the education program of all prostate centers and urological departments.

Transurethral Incision of the Prostate Following Renal Transplantation

Urinary retention in male patients after renal transplantation may cause serious complications in terms of graft function and even patient survival. Only few data concerning the management and outcome of these patients are reported in the literature. Therefore, we retrospectively analyzed the outcome of patients who underwent transurethral incision of the prostate immediately after renal transplantation. Between 1990 and 1993, we performed 259 renal transplantations and 15 patients had symptoms of urinary retention postoperatively. These patients underwent a midline transurethral incision of the prostate from the bladder neck to the verumontanum. Median peak flow preoperatively was 7 ml. per second (range 0 to 11.4) and median residual urine volume was 100 ml. (range 30 to 500). Median prostate volume was 28 ml. (range 12 to 45). After transurethral incision of the prostate a significant improvement (p less than 0.001) in peak flow rates (19.6 ml. per second, range 8 to 49) as well as a significant decrease in residual urine volumes (40 ml., range 20 to 80) could be achieved. After a median followup of 19 months the effect was still present.

Long Term Experience with the Prostatic Spiral for Urinary Retention due to Benign Prostatic Hyperplasia

Twenty high risk patients with benign prostatic hyperplasia and urinary retention were treated by insertion of an intraprostatic spiral. The device was positioned under fluoroscopic guidance using a technique developed by us. The procedure required only local anaesthesia and successfully relieved the obstruction in all patients. At the six-month follow-up full continence had been achieved in 15 patients (75%). Three patients (15%) complained of mild stress incontinence but this was not severe enough to require removal and repositioning of the spiral. A 92-year-old patient reported severe incontinence despite correct positioning of the spiral. Removal of the spiral was necessary in one of the continent patients who was receiving anti-coagulant drugs because of sudden, severe macrohaematuria with subsequent acute urinary retention. The spiral became displaced and required repositioning in one patient. Median residual urine volume was constantly lower than 50 ml and the median maximal flow rate at six-month follow-up was 13.2 ml/s. Our long term follow-up study shows the effectiveness and safety of the prostatic spiral as an alternative treatment for selected patients with urinary retention caused by benign prostatic hyperplasia.