Multichannel Urodynamics Research Articles

170 - Transcutaneous Posterior Tibial Nerve Stimulation on Demand During Multichannel Urodynamics: A New Approach in the Management of Overactive Bladder

170 - Transcutaneous Posterior Tibial Nerve Stimulation on Demand During Multichannel Urodynamics: A New Approach in the Management of Overactive Bladder

Transcutaneous posterior tibial nerve stimulation on demand during multichannel urodynamics: A new approach in the management of overactive bladder

Background:Overactive Bladder Syndrome (OAB) affects individuals across all ages and genders, reducing quality of life. Although Transcutaneous Posterior Tibial Nerve Stimulation (TTNS) is an effective treatment, its acute effects on OAB remain underexplored. Objectives:This study aimed to assess the acute effects of TTNS on OAB through invasive urodynamics (UDI), using an intermittent, on-demand approach; with a focus on urinary urgency as the central axis for its application. Methods:A proof-of-concept trial was conducted involving patients with OAB symptoms and no previous treatment. An initial urodynamic evaluation (UDI DG) identified patients with detrusor overactivity (DO) associated with urgency, who then received on-demand TTNS during a second urodynamic study (UDI TENS). Parameters measured included the number of involuntary detrusor contractions (IDC), episodes of urge urinary incontinence (UUI), and maximum cystometric capacity (MCC). Statistical significance was assessed using Student’s t-test and Wilcoxon test, with a p-value ≤ 0.05 chosen as significance threshold. Results:Of the initial twenty-nine participants, 12 completed the study. UDI DG measurements showed an average of 3.33 ± 1.3 IDCs, 0.67 ± 0.98 UUI episodes, and MCC of 235 ± 79 ml. During UDI TENS results demonstrated a significant reduction in IDCs to 0.08 ± 0.29 (p ≤ 0.001), an absence of UUI episodes, and an increase in MCC to 315 ± 83 ml (p = 0.00012). Conclusions:Our findings suggest that an acute, on-demand TTNS protocol is effective for managing OAB symptoms and improvement of UDI parameters. However, the limited number of participants and absence of a control group highlight the need for further research through larger, controlled studies.

Access to Urogynecologic Care in Federally Qualified Health Centers: A Mystery Caller Study.

Federally Qualified Health Centers (FQHCs) play an important role in providing care to underserved populations. However, little is known about the availability of urogynecology services at FQHCs. This study aimed to assess the availability of appointments for urogynecology care and to determine the prevalence of FQHCs offering urogynecologic services. A total of 362 FQHCs across the United States were randomly selected from the Health Resources and Services Administration website, based on specific inclusion criteria. Researchers called the FQHCs and requested the earliest available appointment for pelvic organ prolapse. The availability of urogynecologic services such as pessary fittings, pelvic floor physical therapy, and urodynamic studies was also inquired. A total of 362 FQHCs located in 46 states and the District of Columbia were called. On average, the 362 FQHCs had been established for 19.9 (SD ±15) years, were located in urban areas, and served a median county population of 24,573. Of the 220 FQHCs successfully contacted, 81% (180/220) reported that they could provide care for a patient with pelvic organ prolapse at an appointment 29.1 business days (SD ±30 days) from the date of the call, on average. However, only a small percentage of these FQHCs offered in-office pessary fittings (11%), complex multichannel urodynamics testing (8.6%), or pelvic floor physical therapy (5%). The availability of treatments for pelvic floor disorders at FQHCs is limited. These findings highlight a potential disparity in access to urogynecology services for individuals with public insurance.

The Effect of Duration of Stress Urinary Incontinence on developing Signs of Bladder Outlet Obstruction in Urodynamic Study

Background: Stress urinary incontinence is a frequent urological disease in women; it has a great influence on an individual’s wellbeing and places a significant economic strain on any health service. The placement of urodynamic diagnostic tests in the evaluation route is an important clinical research concern in this field. Objective: to find out whether the duration of stress urinary incontinence is associated with the finding of bladder outlet obstruction in urodynamic study or not. Subjects and Methods: A descriptive study. With enrolled female patients had symptomatic Stress urinary incontinence as their primary complain. All the included patients were assessed thoroughly by history taking and physical examination and relevant clinical tests and investigation in addition to urodynamic evaluation consisted of multi-channel urodynamics measuring abdominal, vesical and detrusor pressures simultaneously. Results: 140 females were suffering from stress incontinence. Urodynamic study showed maximum urine flow rate (Q max) mean of (20.45±9.86) ml/second, the maximum post void volume was 500ml with 36.89ml was the mean of post void residual volume, and 90.83cm water was the mean of urethral occlusion pressure. The mean of duration have positive relationship with age category but without statically significant. Ninety-eight patients have Q max flow more than 25ml/sec with mean duration 6.04 without any statically significant (p=0.872). 37 patients were having >0 ml post void volume with mean duration more than other patients that didn’t have post void volume but without statically significant (p=0.257). All patients with urethral pressure less than 120 cm had long duration mean than others but without statically significant (p=0.335). also, no statistical significance association between mean of duration and sphincter pelvic floor electromyogram (EMG). Conclusion: there was no catechistically significant relationship between the urodynamic findings and the duration neither of stress urinary incontinence nor between the urodynamic findings and the age of the patients.

Current surgical management of postprostatectomy incontinence — Workup, options and decision making

This article gives a current overview of surgical options and limits of surgical post-prostatectomy incontinence (PPI) therapy and reflects the contents of workshop 6 at the ICS meeting in Vienna, Austria 2022.The decision-making process in PPI requires consideration of various dimensions from presentation to determination of treatment. Patient factors include the severity of symptoms, age and health condition, comorbidities, and patient’s expectations. Also important are the type of prior prostate surgery, radiation therapy, and status of cure.Only an accurate diagnosis will lead to the most effective management option being chosen. An accurate history, standardized questionnaires, physical examination, and 24-hour pad-weights are essential. Transperineal ultrasound, urethrocystoscopy with a urethral repositioning test, and multichannel urodynamics are useful in assessing sphincter and bladder function, as well as the anastomotic region after radical prostatectomy.The effect of various treatment options, such as slings, balloons, and artificial hydraulic sphincters can now be evaluated with long-term studies. The most widely used type of sling is the two-arm fixed sling with a dry rate of 58% and overall improvement rate of 83% at 5 years. Prior pelvic irradiation may reduce the long-term success rate. Adjustable devices offer the opportunity of adaptation to a potentially changing degree of incontinence to meet individual patients’ needs. Adjustable male slings support the bulbar urethra with a minimal increase of urethral resistanceThe artificial urinary sphincter (AUS) is the most predictably reliable treatment for men with moderate to severe stress incontinence with social continence rates of 79%. Device revision is required for recurrent incontinence with options including cuff repositioning, downsizing, or transcorporal cuff placement. Alternative hydraulic sphincter systems offer the possibility of postoperative adjustment by changing the intra-device pressure. Recent developments include electrical and remotely controlled devices not yet commercially available. Further factors of the decision-making process are the skills of the surgeon, individual preferences, and product availability.

Clinical portrait of an "ordinary" patient with benign prostatic hyperplasia and the efficacy of treating lower urinary tract symptoms

Introduction. Benign prostatic hyperplasia (BPH) is a common condition in aging men that is often associated with lower urinary tract symptoms (LUTS).Objective. To determine the clinical portrait of an "ordinary" patient with benign prostatic hyperplasia and develop an algorithm for improving the efficacy of treating lower urinary tract symptoms in benign prostatic hyperplasia.Materials & methods. The study included 112 BPH-patients who received tamsulosin therapy or a combination of tamsulosin + solifenacin for three months. After three months of therapy, the patients were divided into two groups depending on the effectiveness of therapy: group 1 — a positive result (n = 77); group 2 — no positive effect (n = 35). Due to the lack of efficacy in patients of group 2, a multichannel urodynamics was performed, according to the results of which the patients were prescribed treatment with a subsequent assessment of the result after 3 months.Results. After 3 months of therapy in patients of group 1, a decrease in pollakiuria was noted. Regression of obstructive and irritative symptoms was also observed, and the urination-associated quality of life (QoL) improved. The maximum urine flow rate (Q max) remained unchanged mainly. By the sixth month, the frequency of urination continued to decrease (11.05 vs 9.32 episodes; p = 0.022), as well as the improvement of other parameters (IPSS, QoL, Q max and post-void residual urine volume (PVR) (80.87 vs 56.17 ml; p = 0.012). The indicators of patients of group 2 following three months of therapy remained without significant changes. Sixteen patients underwent transurethral prostate resection, 19 patients underwent therapy correction, which allowed reducing the number of episodes of daily pollakiuria. The total IPSS score decreased by 4.37 compared to baseline (IPSS (obstructive) — 13.79 vs 7.26 pts; p = 0.032). The QoL value was 2.84 pts, Q max — 14.90 mL/s, PVR — 10.58 mL.Conclusion. 19.8% of BPH-patients are resistant to drug therapy. The ineffectiveness of therapy may be due to the severe BOO. In the absence of the effect of the therapy within 3 months, it is recommended to perform multichannel urodynamics. Correction of therapy according to the multichannel urodynamics data improves its effectiveness by the sixth month of treatment. Indicators of IPSS, Q max and PVR after 3 months of therapy allow predicting the effectiveness of therapy, or suspect the need for surgical treatment.

MP46-20 EVALUATION OF URODYNAMIC OUTCOMES AND INCONTINENCE SPECIFIC HEART-RELATED QUALITY OF LIFE IN PATIENTS TREATED WITH ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL Y-MODIFIED NEOBLADDER THE BORDEAUX NEOBLADDER

You have accessJournal of UrologyCME1 Apr 2023MP46-20 EVALUATION OF URODYNAMIC OUTCOMES AND INCONTINENCE SPECIFIC HEART-RELATED QUALITY OF LIFE IN PATIENTS TREATED WITH ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL Y-MODIFIED NEOBLADDER THE BORDEAUX NEOBLADDER Erika Palagonia, Benedetta Bianchi, Marilena Gubbiotti, Valentina Giommoni, Anastasios D. Asimakopoulos, Saba Khorrami, Michele De Angelis, Richard Gaston, and Filippo Annino Erika PalagoniaErika Palagonia More articles by this author , Benedetta BianchiBenedetta Bianchi More articles by this author , Marilena GubbiottiMarilena Gubbiotti More articles by this author , Valentina GiommoniValentina Giommoni More articles by this author , Anastasios D. AsimakopoulosAnastasios D. Asimakopoulos More articles by this author , Saba KhorramiSaba Khorrami More articles by this author , Michele De AngelisMichele De Angelis More articles by this author , Richard GastonRichard Gaston More articles by this author , and Filippo AnninoFilippo Annino More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To present the urodynamic features of our intracorporeal Y-modified neobladder Bordeaux Neobladder and the incontinence specific health-related quality-of-life (HRQoL) outcomes. METHODS: We performed a prospective evaluation of a series of 26 patients who underwent robot-assisted radical cystectomy with intracorporeal Y-modified orthotropic neobladder reconstruction called the Bordeaux Neobladder, between September 2018 and November 2020 in a high-volume referral center, operated by the same surgeon. All the patients were managed following a modified ERAS protocol. Three months and 1 year after surgery, consenting patients underwent clinical evaluation and multichannel urodynamics. The incontinence quality of life (I-QoL) questionnaire was used to evaluate HRQoL. Continence was classified into day-time and night-time and clinically defined as the use of zero pads. RESULTS: The mean age at surgery was 65.4 years. The mean follow-up was 27 months. Regarding the operative time, the mean time for proximal bladder reconstruction was 192 minutes. Urodynamic outcomes data were collected in 17/23 patients for early evaluation and in 13 patients for early and dilated testing. 2/17 patients had I-II grade of hydronephrosis on the left kidney. No cases of hyperchloremic acidosis were identified in the blood gas analysis. The continence rate was 58.8% (10/17) for the day and 23.5% (4/17) for the night and the mean postoperative of the quality-of-life score was 103.3. The mean maximum bladder capacity was 430 cc (range 200-553) ant the average compliance was 33.1 ml/cm h2o. The mean post-voiding residue was 100 ml (0-310). The first sensation of bladder fullness was perceived at an average volume of 337 cm³. The mean max flow at 3 months was 15 ml/s and at 1 year was 18 ml/s. The rate of clean intermittent self catheterization was 17,6%. We did not observe significant changes in urodynamic outcomes during follow-up. Concerning the parameters of the storage phase, there was only a significant reduction in the volume of the first sensation of bladder fullness. CONCLUSIONS: The initial analysis of both invasive and non-invasive urodynamic parameters shows that the Bordeaux Neobladder has adequate functional characteristics in terms of capacity, post-voiding, residual and compliance. It is associated with a reduced chance of upper urinary tract abnormalities and metabolic complications that improve quality of life. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e641 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erika Palagonia More articles by this author Benedetta Bianchi More articles by this author Marilena Gubbiotti More articles by this author Valentina Giommoni More articles by this author Anastasios D. Asimakopoulos More articles by this author Saba Khorrami More articles by this author Michele De Angelis More articles by this author Richard Gaston More articles by this author Filippo Annino More articles by this author Expand All Advertisement PDF downloadLoading ...

MP07-11 IMPACT OF PREOPERATIVE URODYNAMICS ON THE SURGICAL TREATMENT OF ADVANCED PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyCME1 Apr 2023MP07-11 IMPACT OF PREOPERATIVE URODYNAMICS ON THE SURGICAL TREATMENT OF ADVANCED PELVIC ORGAN PROLAPSE Susane Hwang, Luis Gustavo Toledo, Silvia Carramao, Raphael Moreira, Carolina Jesus, Sarah Carvalho, Raquel Richetti, and Antônio Auge Susane HwangSusane Hwang More articles by this author , Luis Gustavo ToledoLuis Gustavo Toledo More articles by this author , Silvia CarramaoSilvia Carramao More articles by this author , Raphael MoreiraRaphael Moreira More articles by this author , Carolina JesusCarolina Jesus More articles by this author , Sarah CarvalhoSarah Carvalho More articles by this author , Raquel RichettiRaquel Richetti More articles by this author , and Antônio AugeAntônio Auge More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One quarter of women without urinary incontinence can develop de novo stress urinary incontinence (SUI) after surgery for pelvic organ prolapse (POP). This condition has been reported more frequently in women with occult SUI. However, studies are diverse as far as the investigation of occult SUI is concerned, and it has not been possible to reach a consensus on the benefits of preoperative urodynamics (UDS). The aim of this study was to investigate the impact of preoperative UDS on the surgical treatment of POP by analyzing whether performing UDS added diagnoses, modified surgical planning, and changed postoperative outcomes in women with advanced POP. METHODS: Retrospective observational study including women having POP stages III and IV, without symptoms of SUI, undergoing surgery for POP, between May 2015 and January 2020, with a minimum three-month follow-up period. Preoperative evaluation included the patients' standard clinical history, a physical examination (PE) to quantify genital prolapse, and stress testing with and without prolapse reduction at PE. Multi-channel UDS was performed when the surgeon so indicated. Postoperative outcomes were measured by excluding women with occult SUI on PE, and analyzing the incidence of de novo SUI, and need for a second approach for midurethral sling or urethrolysis. RESULTS: A total of 226 patients met the inclusion criteria, and 102 (45.1%) performed UDS. UDS added diagnoses in 64/102 (62.6%), having added 21/102 (20.6%) occult SUI cases. After UDS, there was a change in surgical procedure in 20/102 (19.6%) cases (18 indications for sling and two contraindications for it). The overall rate of occult SUI in the 226 patients was 28.8% (65/226). Among the 182 patients that were continent upon physical examination (PE), 68 (37.4%) underwent UDS. Postoperatively, patients in the UDS group maintained more urge incontinence (p=0.006) and storage symptoms (p<0.001) than the PE group. No statistical difference was found in the incidence of de novo SUI between the UDS group 6/68 (8.8%) and the PE group 11/114 (9.6%) (p=0.853), nor in the need of postoperative sling: 4/68 (5.9%) and 5/114 (4.4%), respectively. CONCLUSIONS: Preoperative UDS in women with POP stages III and IV increments diagnoses, changes surgical planning, increases the number of concomitant slings placement and does not change outcome in continent women upon PE. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e88 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Susane Hwang More articles by this author Luis Gustavo Toledo More articles by this author Silvia Carramao More articles by this author Raphael Moreira More articles by this author Carolina Jesus More articles by this author Sarah Carvalho More articles by this author Raquel Richetti More articles by this author Antônio Auge More articles by this author Expand All Advertisement PDF downloadLoading ...

PD33-10 NON-INVASIVE OPTICAL DETERMINATION OF DETRUSOR PRESSURE RELATED TO DETRUSOR OVERACTIVITY

You have accessJournal of UrologyCME1 Apr 2023PD33-10 NON-INVASIVE OPTICAL DETERMINATION OF DETRUSOR PRESSURE RELATED TO DETRUSOR OVERACTIVITY Lynn Stothers, Andrew Macnab, Naser Hakimi, W. N. J. M. Colier, P. Pourabbassi, and M. Maresse Lynn StothersLynn Stothers More articles by this author , Andrew MacnabAndrew Macnab More articles by this author , Naser HakimiNaser Hakimi More articles by this author , W. N. J. M. ColierW. N. J. M. Colier More articles by this author , P. PourabbassiP. Pourabbassi More articles by this author , and M. MaresseM. Maresse More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003326.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Gold standard urodynamic studies use invasive methods and artificial filling of the bladder to determine detrusor pressure, a critical physiologic measure in determining care for lower urinary tract symptoms (LUTS). The benefits of non-invasive measurement of detrusor pressure (Pdet) include natural filling observations & the potential for a homebased wearable with real time data to determine both self-care and monitoring. Aim: to develop a wearable optical based technology to relate non-invasively measured changes in Pdet during natural filling. METHODS: A 10 x 10 cm optical grid using light emitting diodes (LED’s) (750 nm – 950 nm) was engineered & positioned suprapubically during simultaneous multichannel urodynamics (UDS). LED’s were paired with photodetectors, sampling at 50Hz from long (deep) and short (superficial) channels facilitating optical output compared to variations in Pdet. Output: Arterial pulse waveform changes in chromophore concentration related to variations in detrusor oxygenation (O2Hb), & fluctuations in the absorption of photons at 950nm (H20) related to CMG volume increases. Peak & trough envelopes were computed with Hilbert transformation and a filtered moving average was used mathematically. RESULTS: N=25 (5 controls no LUTS & 20 NLUTD female=N=5 age 64-82 yrs ASIA A, B & D; male=N=15 age 33 – 79 yrs being ASIA A,B,C & D. NLUTD management included: N=4 subjects using clean intermittent catheterization (CIC), 2 condom drainage, 5 using combinations of CIC and spontaneous voiding, 4 spontaneous voiding only. No subjects used anticholinergics, B 3 agonists or prior intra detrusor botulinum toxin. Controls: natural filling and uroflow, no LUTS on IPSS or UGDI, no prior GU surgery, volumes >150cc, repeated filling & emptying for internal consistency measures. CONCLUSIONS: A prototype wearable able to derive a real-time, non-invasive measure reflecting detrusor pressure was successfully prototyped. If further research confirms the ability of an optical parameter derived in this way to mirror variations in detrusor pressure, benefits that would accrue include: more frequent assessment than is possible with invasive UDS, & the ability to monitor changes in pressure continuously in an at risk population (e.g. NLUTD at risk for autonomic dysreflexia). Source of Funding: Craig H Neilsen Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e917 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lynn Stothers More articles by this author Andrew Macnab More articles by this author Naser Hakimi More articles by this author W. N. J. M. Colier More articles by this author P. Pourabbassi More articles by this author M. Maresse More articles by this author Expand All Advertisement PDF downloadLoading ...

Use of statistical shape modeling to enhance the fluoroscopic evaluation of the bladder

IntroductionVideo urodynamic studies (VUDS) use fluoroscopic imaging to visualize the bladder and multichannel urodynamics to assess its function. Qualitative assessment of bladder shape is used to identify abnormal features (e.g., diverticula) that correspond with pathophysiology; however, this assessment is limited in its ability to predict bladder function. Therefore, we developed a novel quantitative approach to assess bladder shape obtained from fluoroscopic VUDS images utilizing statistical shape modeling. This method was compared to existing binary and continuous shape quantification methods and used to identify relationships between bladder shape and measures of bladder physiology categorized as related to sensation, incontinence, or emptying.MethodsThis was a retrospective, cross-sectional study of 49 participants. Bladder walls were segmented from fluoroscopic images at rest with the bladder filled to approximately 300 mL. Bladder shape was evaluated in three ways: 1) binary categorization as typical or atypical based on clinical assessment, 2) quantification of height-to-width ratios, and 3) quantification by statistical shape modeling. Independent t-tests and correlations were used to assess associations between the three shape evaluation methods and to define relationships between shape and physiologic measures: 3 volumetric measures describing sensation, 2 dichotomous variables addressing incontinence, and 1 volumetric measure representing emptying.ResultsThe statistical shape model generated 5 modes of variation. Mode 1 corresponded with height-to-width ratio (r=0.920, p&amp;lt;0.001), modes 2 and 3 with diagonal height-to-width ratio (r=0.66 and -0.585, p&amp;lt;0.001 and &amp;lt;0.001), and mode 3 with binary shape categorization (p&amp;lt;0.001). In terms of function, those with atypical bladder shape had impaired emptying (p=0.010), modes 4 and 5 were significantly associated with measures of bladder sensation, mode 3 with urodynamic stress urinary incontinence, and mode 3 with emptying in those able to void (r=0.368, p=0.021). The relationship between mode 3 and emptying across all patients is best fitted by a quadratic function (p&amp;lt;0.001).DiscussionOur results demonstrate that binary shape categorization and bladder shape quantified by statistical shape modeling correspond with measures of bladder physiology. This foundational study establishes statistical shape modeling as a robust bladder shape quantification method that can be used to relate bladder shape with physiology.

Ultrasound-Measured Urethral Length Does Not Change following Minimally Invasive Sacrocolpopexy for Pelvic Organ Prolapse.

To compare urethral length (UL), as measured by three-dimenstional transvaginal ultrasound, before and after minimally invasive sacrocolpopexy (SCP). Secondary analysis of a prospective cohort study of women undergoing SCP for prolapse beyond the hymen with or without a concomitant anti-incontinence procedure. Participants underwent ultrasound at baseline and 14 weeks postoperatively. UL was measured in a reconstructed sagittal plane from the bladder neck to the urethral meatus. All of the participants underwent multichannel urodynamics preoperatively. Data were analyzed in SPSS using independent or paired t tests as indicated for continuous variables and the McNemar test for paired dichotomous variables. Correlations including nonparametric data are reported as Spearman rho. A total of 28 participants, with a mean ± standard deviation age of 56 ± 10 years and median (interquartile range) preoperative prolapse stage of 3 (3-3), were analyzed. There was no change in UL between the baseline and 14-week visits (29.8 ± 11.0 mm vs 29.3 ± 10.0 mm, P = 0.83). There was no difference in baseline UL (29.4 ± 11.8 mm vs 30.9 ± 8.9 mm, P = 0.74) in those with and without preoperative stress urinary incontinence (SUI), nor was there a difference in baseline functional UL on multichannel urodynamics between these groups. In total, 21 participants (75%) had preoperative SUI and 19 (90%) underwent a concomitant anti-incontinence procedure. UL at 14 weeks was similar in those with and without SUI symptoms (26.5 ± 10.9 mm vs 31.1 ± 11.3 mm, P = 0.32) when controlling for those who underwent anti-incontinence procedures. UL does not change following suspension of the anterior vaginal wall with SCP.

Postpartum urinary retention: what are the sequelae? A long-term study and review of the literature

Introduction and hypothesisPostpartum urinary retention (PUR) may cause long-term urogenital tract morbidity. The incidence ranges from 0.18 to 14.6%, but the importance of prompt diagnosis and appropriate management is often underappreciated. The paucity of data on long-term outcome after PUR contributes to these drawbacks. The aim of this study was to assess long-term persistence of elevated PVR (post-void residual urine) volume after PUR. Pathophysiology, risk factors and management of PUR are reviewed.MethodsIn our tertiary referral urogynecology unit in the University Women’s Hospital of Bern, Switzerland, all patients who were referred for PUR were asked to participate in this study. PVR was measured sonographically every 2 days until day 15, then after 6, 12, 24 and 36 months and, if increased, the patients were instructed to perform clean intermittent self-catheterization. If retention persisted longer than the lactation period, multichannel urodynamics was performed.ResultsSixty-two patients were included. The median PVR normalized at day 7. Long-term voiding disorders were found in 8.2%, 6.7%, and 4.9% after 1, 2, and 3 years respectively. Multichannel urodynamics confirmed in all patients with persisting retention an acontractile detrusor and de novo stress urinary incontinence in 4 cases. Quantile regression did not reveal any factor contributing to earlier recovery. Eighty-nine percent of the patients with PUR had operative vaginal deliveries, emphasizing the importance of this risk factor for PUR.ConclusionsIn most cases PUR resolves early, but voiding difficulties persist more often than previously thought, and for these patients the consequences are devastating. Obstetric awareness, early active management, and developing management strategies in the postpartum period might preclude lower urinary tract morbidity.

How Does the Urethra Respond to Bladder Filling in Continent and Incontinent Women?

The objective of this study was to describe mean urethral pressure (MUP) during filling cystometry in continent and incontinent women. Incontinent women were recruited from a urogynecology clinic if they answered "sometimes" or "always" to 1 of the items on the Medical, Epidemiologic, and Social Aspects of Aging questionnaire. Participants were categorized by Medical, Epidemiologic, and Social Aspects of Aging scores into stress urinary incontinence (SUI) or urgency urinary incontinence (UUI) groups. Continent women were recruited from the community. Multichannel urodynamics were performed using microtip catheters. Urethral pressure profiles were obtained with an empty bladder and at 100-mL increments during filling. Data were analyzed in SPSS. Continuous variables were compared with independent t test or analysis of variance, categorical variables with the χ2 test, and multivariable comparisons were made with linear regression. Eighty-six women (30 continent, 56 incontinent: 37 SUI, 19 UUI) with a mean ± SD age of 48 ± 15 years and a body mass index (BMI) of 31 ± 9 participated. Sixty-nine percent were White, 43% were postmenopausal, and 80% were parous. Continent women were younger (P < 0.001) and had a lower BMI (P = 0.004). Mean cystometric capacity was higher in women with SUI and continent women than in women with UUI (430 ± 142, 448 ± 101, and 332 ± 160, P = 0.04). Continent women had higher MUP at baseline when controlling for age, BMI, and parity (84 ± 35 cmH2O vs 62 ± 28 cmH2O; aR2 = 0.2, P = 0.02) compared with incontinent women. During filling, MUP in continent women was 20-30 cmH2O higher at all bladder volumes than incontinent women. Mean urethral pressure increased significantly between baseline and 300 mL in continent women (P < 0.005) and women with SUI (P = 0.04), but not in women with UUI (P = 0.48). Continent women have greater baseline MUP and greater increases in MUP during bladder filling than incontinent women.

Evaluation and management of neurogenic bladder after spinal cord injury: Current practice among physical medicine and rehabilitation specialists in Turkey.

Objectives This study aims to determine the current trends in evaluation and management of neurogenic bladder secondary to spinal cord injury (SCI) among Physical Medicine and Rehabilitation (PMR) specialists in Turkey. Materials and methods Between September 2013 and November 2013, a total of 100 PMR specialists from 18 different provinces of Turkey were included in the study. A 23-item questionnaire was developed to evaluate the current practice on assessment and follow-up of upper and lower urinary tract dysfunction. The questionnaire was delivered via e-mail to the participants routinely providing care for patients with SCI and all responses were obtained electronically. Results For surveillance of the upper urinary tract dysfunction, 93% of the participants preferred ultrasonography. A total of 59% of the participants favored an annual assessment and 36% preferred six-month intervals. Multichannel urodynamics, voiding cystourethrography combined with urodynamics, and video-urodynamics were preferred by 62%, 25%, and 10% of the participants, respectively for surveillance of the lower urinary tract. Urodynamic evaluation was performed annually by 51% of the participants. In patients with detrusor overactivity unresponsive to the combination of intermittent catheterization (IC) and anticholinergic agents, 66% preferred to increase the dose and 22% preferred to switch to another medication. For treatment of areflexic bladder, 78% preferred IC and 12% preferred the Credé' or Valsalva maneuvers. Treatment of asymptomatic bacteriuria was not favored in patients on IC and indwelling urethral catheter by 33% and 44% of the participants respectively. Totally, 84% participants preferred to administer antibiotics for 10 to 14 days for the treatment of symptomatic urinary tract infection. Conclusion Our study results indicate that there are some differences in the current practice of PMR specialists for surveillance and management of SCI patients with neurogenic bladder. These results also emphasize the need for development of guidelines and implementation of continuous medical education activities in this field.

Lavender Aromatherapy for Anxiety and Pain During Multichannel Urodynamics: A Randomized Controlled Pilot Trial.

Our objective was to determine if there is a difference in anxiety during urodynamics in women given lavender aromatherapy (lavender) versus placebo. This was a randomized, controlled trial of women scheduled for urodynamic testing with baseline anxiety. Participants rated their anxiety and pain immediately before the examination and then were randomized to lavender or placebo. Anxiety and pain were assessed immediately after catheter placement and 15 minutes after termination of the study. Data for 40 women who received lavender and 38 women who received placebo were available for analysis. Decrease in anxiety from baseline to catheter placement (-2 vs -0.5, P = 0.01) and 15 minutes post procedure was significantly greater in the lavender group. Postprocedure anxiety was lower in the lavender group compared with controls (0 vs 0.5, P = 0.001). No differences were seen in pain. Lavender aromatherapy reduces anxiety during urodynamics.

Artifacts and abnormal findings may limit the use of asymptomatic volunteers as controls for studies of multichannel urodynamics.

Multichannel urodynamics is the gold standard for the evaluation of lower urinary tract symptoms (LUTS). When performing studies to validate new adjuncts to urodynamic testing with control patients undergoing urodynamic investigation, there is difficulty in the interpretation of urodynamic results in the asymptomatic patient due to artifacts and the invasive nature of the procedure. The purpose of this investigation was to examine urodynamics in asymptomatic volunteers in order to better understand the role of control participants in urodynamic research studies. Asymptomatic volunteers with no LUTS were recruited to undergo standard urodynamic testing as a comparison group in a study evaluating novel urodynamic techniques. To be eligible, participants had to report no LUTS, score ≤1 on all symptom questions of the International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIq-OAB) survey, have no medical conditions or to undergo any medications that affect bladder function. The urodynamics was done according to ICS standards. All tracings were evaluated by an expert neuro-urologist. Data were analyzed categorically for the presence or absence of low compliance (<30 mL/cmH<inf>2</inf>0), detrusor overactivity, bladder outlet obstruction (Bladder Outlet Obstruction Index [BOOI]>40), weak contractility (bladder contractility index [BCI]<100), straining to void, poorly sustained detrusor contraction, uncoordinated EMG activity, and intermittent flow. A total of 24 participants completed the study including 10 men and 14 women. All participants had at least 1 urodynamic abnormality/artifact with an average of 4.43±1.28 abnormalities/participant. The most common abnormalities included uncoordinated electromyography (EMG) activity (87.50%), straining to void (79.17%), and intermittent flow (70.83%). There were no significant differences for sex, age, Body Mass Index. This study demonstrated that healthy, asymptomatic volunteers have high rates of abnormal urodynamic findings, suggesting that asymptomatic participants are not the ideal controls in research studies that involve urodynamic testing.

The Argument For and Against the Use of Multichannel Urodynamics in the Assessment of Post-Prostatectomy Incontinence

Prostate cancer is a common male malignancy. Radical prostatectomy is a common treatment option in patients with localised disease. Post-prostatectomy incontinence (PPI) is not uncommon, with a significant impact on the quality of life. However, it is often under-reported and undertreated. There are no standard international guidelines specifically for investigation and diagnosis of PPI. The routine use of urodynamic studies (UDS), with an attempt to assess urinary incontinence aetiology and to predict success prior to invasive surgical treatment, has been widely adopted but remains controversial. Literature concerning the pros and cons of pre-operative UDS is reviewed. There are conflicting results on UDS findings post-prostatectomy. Few studies demonstrated that UDS findings are not predictive of outcomes of the artificial urinary sphincter (AUS). Other studies have shown the presence of detrusor overactivity (DO) to be an adverse prognostic factor, especially for PPI patients treated with male sling success. Currently, there is no consensus on the indication for UDS in patients with PPI. Despite conflicting results on the usefulness of UDS prior to PPI surgery, the majority of surgeons still routinely perform UDS pre-operatively. Further prospective and randomised controlled studies would be beneficial in determining if routine UDS is required before surgical treatment for PPI. The authors also gave their perspective on the application of personalised UDS in investigating patients PPI prior to treatment.

FIRST EXPERIENCE IN VIDEOURODYNAMIC STUDY AT CIPTO MANGUNKUSUMO HOSPITAL IN 2012-2014

Objective: Accuracy of diagnosis is a fundamental thing in terms of plan of treatment. Nowadays, symptoms from lower urinary tract can be diagnosed accurately with videourodynamic study (VUDS). Videourodynamic combines a fluoroscopic voiding cystourethrogram with multichannel urodynamics, allowing anatomic and functional assessment of the bladder and outlet. Material &amp; Methods: This research is a descriptive retrospective. Data was taken from the patients who underwent VUDS at Department of Urology Cipto Mangunkusumo Hospital from 2012 to 2014. Patient’s characteristics were gender, age, chief complaint, working diagnosis pre investigation, and diagnosis after VUDS was performed. Then, data was analyzed in a descriptive fashion and presented using tables and narative form. Results: There were 8 male patients (67%) and 4 female (33%) who underwent VUDS. Most of the patients were children (75%). Five patients (42%) complained about incontinence with or without other LUTS, only 1 patient (8%) had LUTS and disuria. Overall, working diagnosis pre investigation was neurogenic bladder with various causes. We found a variable diagnoses after VUDS. At filling phase, we found 7 patients (58%) with small bladder capacity, 5 patients (42%) with low bladder compliance then followed respectively by overflow incontinence (33%), detrusor overactivity (17%) and urethral sphincter incompetence (8%). At voiding phase, the most common abnormality detected were detrusor underactivity (42%), followed by infravesical obstruction (8%). VUR was found both at filling phase (42%) and voiding phase (33%). Conclusion: VUDS could be the first choice of modality for diagnosing dysfunction of lower and upper urinary tract especially in neurogenic cases.

37: Towards reducing adult female urinary incontinence (UI) burden: opportunities to improve UI guidelines

To systematically review UI evaluation guidelines. We performed a systematic literature search using strategies for the concept of UI guidelines in 8 medical search engines, including Ovid-Medline and Embase. Major organizational websites were searched. After abstract and full-text screening, UI evaluation guidelines written for medical providers in English after 1/1/2008 were included. Exclusion criteria were guidelines for children, men, institutionalized women, and peripartum and neurologic-related incontinence. Twenty-five guidelines met criteria. Most (96%) recommended history taking or at least one history component, but varied in detail. Two summarized history taking by descriptors (i.e., good, proper), whereas most explicitly specified ≥1 component (Table 1). Excluding other disease processes was recommended (4%), mentioned (12%), listed with examples (32%), or inferred (24%); 44% recommended referral to a specialist if indicated. Similar variability was observed for physical examination (PE) with 96% recommending ≥ 1 PE component. Some (12%) provided no further guidance, whereas others recommended (R), recommended in certain situations (CS), or listed (L) components (see Table 1). Evidence or recommendation levels for history or PE components were largely based on clinical principle, expert opinion, or panel consensus. Additional evaluation components were urinalysis (19 R, 1 CS, 1 L), urine culture (2 R, 10 CS, 1 L, and 4 were unclear), post void residual (10 vs 11 R, 13 CS), and bladder diary (9 R, 1 CS, 8 L). Multichannel urodynamics, cystoscopy, and imaging were typically reserved for use in certain situations (20, 13, & 6 respectively). While several exemplary UI evaluation guidelines exist, many others lack detail, are not evidence-based, and are variable. This variability may lead medical providers to perform inconsistent evaluations in the work up and diagnosis of UI. Opportunities to advance UI guidelines include improving clarity, consistency, and individualization.

Комплексное уродинамическое исследование у пациентов с недержанием мочи после оперативного лечения локализованного рака предстательной железы

Radical treatment of prostate cancer (PCa) is often associated with the development of urinary incontinence (UI). The etiology of UI after prostatectomy is multifactorial and can be caused by both urethral sphincter deficiency and bladder dysfunction. To date, there are no comparative studies of the development of UI in patients after either organ-preserving treatment or radical prostatectomy (RP). Considering this fact, our aim was to carry out the comparative assessment of urodynamic changes in these categories of patients. A retrospective study (n=158) was conducted. All patients were divided into three groups, depending on the method of treatment, HIFU (Group 1, n=32), retropubic RP (Group 2, n=46); robot-assisted RP (Group 3, n=80). The mean age was 71.8+/-3.68, 69.5+/-4.63 and 65.8+/-3.4 years in Group 1, 2 and 3, respectively (p<0.01). The average score was ICIQ-SF-14 points. The median follow-up was 2.7 years. In all cases a multi-channel urodynamics study in accordance with ICS standards was performed. Detrusor overactivity (DO) was detected in 22 (68.7%), 24 (52.1%) and 64 (80%) patients in Group 1, 2 and 3, respectively (p<0.001). In 14% of patients with DO (18%, 12% and 12% Group 1, 2 and 3, p<0.05), leakage test with stress provocative maneuver was negative. The decrease in the bladder compliancy was revealed in 75.9% of patients, and in 8.8% cases (n=14) it was associated with anatomical changes (12.5%, 8.6% and 7.5% in Group 1, 2 and 3, respectively, p<0.01). The mean maximum detrusor pressure was reduced in all patients. Bladder outlet obstruction was detected in 46.6%, 21.7% and 12.5% cases (p<0.001). There was no significant difference in the level of maximum urethral pressure in all groups, but it was significant in patients with negative breakdown at the threshold of abdominal pressure and DO (p<0.05, k=0.87). The high incidence of postoperative bladder dysfunction in patients of the studied groups revealed by us differs from the existing literature data, which dictates the need for a detailed assessment of bladder dysfunction when choosing a tactic for treating UI. In connection with the above, we consider it necessary to conduct further studies with a mandatory pre- and postoperative urodynamic assessment of the lower urinary tract in patients after surgical treatment of prostate cancer without UI.