Urinary Tract Obstruction Research Articles

Indications and Outcomes of Fetal Cystoscopy for Lower Urinary Tract Obstruction: A Comprehensive Review.

Fetal lower urinary tract obstruction (LUTO) encompasses a spectrum of rare congenital anomalies affecting the fetal urinary system, leading to significant morbidity and mortality. This condition, arising from various anatomical anomalies such as posterior urethral valves (PUV), urethral atresia, and cloacal malformations, disrupts normal urine flow, resulting in secondary complications such as pulmonary hypoplasia and renal impairment. Current management strategies, including fetal vesicoamniotic shunting (VAS) and fetal cystoscopy, aim to alleviate obstruction and mitigate associated risks. While VAS has been a longstanding intervention, fetal cystoscopy presents a promising alternative by enabling direct visualization and targeted treatment of urinary tract obstructions. However, fetal cystoscopy is not without challenges, including technical complexities and risks associated with invasive procedures. This review explores the rationale, indications, technical considerations, outcomes, and future innovations of fetal cystoscopy in managing LUTO. It highlights the critical role of accurate diagnosis, patient selection, and procedural expertise in optimizing fetal and maternal outcomes. Despite existing challenges, ongoing advancements in technology and clinical practice hold the potential for further enhancing the safety and efficacy of fetal cystoscopy, underscoring its evolving role in prenatal care.

Efficacy and Safety of Two Different Approaches in the Drainage of the Upper Urinary Tract in "Acute Obstructive Uropathy": A Critical Evaluation.

Aim: To compare the results of retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) procedures for decompression in patients with acute obstructive pyelonephritis. Patients and Methods: Medical records of patients undergoing PCN or RUS for emergency urinary diversion because of obstructive pyelonephritis were evaluated retrospectively. Patients with urinary tract obstruction and concurrent fever (≥38°C), pyuria, and costovertebral angle tenderness were included and divided into two groups based on the type of emergency urinary drainage applied (PCN in Group 1) and (RUS in Group 2). Apart from the demographic data and Charlson Comorbidity Index, laboratory and radiologic examination outcomes were well evaluated. Results: A total of 155 patients including 73 patients (47.1%) undergoing PCN (Group 1) and 82 patients (52.9%) undergoing RUS (Group 2). Although no significant difference was found regarding the demographic characteristics, the operation time, as well as fluoroscopy time, was significantly shorter in Group 1 cases when compared with those in Group 2 (p < 0.0001). The success rate was similar between the two groups, and there was also a significant difference regarding the complication rates in both groups of cases (5.5% vs 7.3%). Conclusions: Our findings showed that despite similar efficacy and success rates noted between PCN and RUS applications in the emergency drainage of cases presenting with obstructive pyelonephritis, PCN application was found to be advantageous because of shorter operation and fluoroscopy durations. More importantly, this approach was associated with a significantly less need for intensive care during the postoperative period.

Use of prenatal ultrasound findings to predict postnatal outcome in fetuses with lower urinary tract obstruction.

Lower urinary tract obstruction (LUTO) is a chronic condition with a spectrum of outcomes. It is usually suspected prenatally based on ultrasound features (USFs). Given the unknown postnatal trajectory and the potential for significant morbidity and mortality, many families choose termination of pregnancy (TOP), often based on USFs alone. Herein, we sought to develop a tool that can be used to predict postnatal outcome based on combinations of USFs, which can aid prenatal counseling and parental decision-making. This was a retrospective study of cases with suspected fetal LUTO that were seen at a high-risk fetal center and a tertiary pediatric center in Canada. Data were collected on USFs, prenatal/postnatal death and postnatal need for transplantation and/or dialysis. USFs from pregnancies with a gestational age of 13-26 weeks on initial ultrasound at the high-risk fetal center that underwent TOP were collected and matched to fetuses with comparable prenatal USFs that were not terminated, which had a known postnatal outcome, to build a random forest model. The random forest model was fitted for each outcome (death, dialysis or transplantation) and tested for accuracy using leave-one-out cross-validation. Each predictor was assessed independently with combined importance when accounting for other predictors. The model was used to predict the most likely postnatal outcomes for cases of TOP had the pregnancy been continued. USF data from 85 cases of TOP and 125 cases of expectantly managed pregnancy with prenatally suspected LUTO were retrieved. For expectantly managed cases, there was a median follow-up duration of 5.7 (interquartile range, 0.2-14.5) years among the liveborn infants. There were 14 prenatal and 22 postnatal deaths in the expectantly managed cohort. The random forest model demonstrated the highest predictive accuracy for transplantation (77% accuracy, 50% sensitivity, 80% specificity), followed by death (72% accuracy, 83% sensitivity, 67% specificity) and dialysis (71% accuracy, 70% sensitivity, 71% specificity). For the TOP cohort, had the pregnancies been continued, the model predicted transplantation and dialysis in 21/85 (25%) and 37/85 (44%) cases, respectively; pre- or postnatal death was predicted in 69/85 (81%) cases. Our data suggest that it is possible to predict death and postnatal transplantation and/or dialysis from USFs in fetuses with suspected LUTO with acceptable accuracy. Predictive accuracy will improve with continued follow-up of more patients, enabling more personalized prenatal counseling and more informed decision-making for families. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Duplex Kidney with Spontaneous Intraperitoneal Rupture of the Lower Moiety Pyonephrosis: An Extremely Rare Case Report

Introduction: Spontaneous intraperitoneal rupture of pyonephrosis is an extremely rare condition. It leads to generalized peritonitis that mimics an acute abdomen caused by intraperitoneal visceral pathology. In most cases, the underlying cause is obstructive urinary tract stones, followed by pelviureteric junction obstruction, tumors, or connective tissue diseases. We report the first case of spontaneous intraperitoneal fistulization of pyonephrosis from a duplex kidney. Case Presentation: A 56-year-old female presented with an acute abdomen and was diagnosed with a right incomplete duplex kidney and intraperitoneal rupture of lower renal moiety pyonephrosis secondary to an obstructive ureteric calculus located proximal to the confluence of the two ureters. She was successfully managed with initial percutaneous drainage and nephrostomy, followed by a delayed lower moiety nephrectomy. Conclusions: This case highlights the importance of considering renal etiology in the differential diagnosis of generalized peritonitis and underscores the rarity of such occurrences.

The effect of urinary diversion on kidney function in posterior urethral valves and ureterovesical obstruction.

Posterior urethral valves (PUV) and ureterovesical junction obstruction (UVJO) are common etiologies of lower urinary tract obstruction. The primary objective of therapy is to alleviate the obstruction in the urinary system. Temporary urinary diversion may be necessary in certain situations, such as Urinary tract infection (UTI), sepsis, and unchanging hydronephrosis. This study, aims to assess kidney parameters after urinary diversion (either pyelostomy or ureterostomy) in patients with PUV and UVJO. We conducted a retrospective analysis of all patients diagnosed with PUV or UVJO and treated with urinary diversion following urinary undiversion at our facility between 2015 and 2020. The following variables were collected: demographic details, surgical interventions (type of diversion), serum creatinine throughout follow-up, anterior-posterior diameter of the pelvis (APP), anterior-posterior diameter of the ureter (APU), and sonographic findings of renal parenchymal thickness (PT) as documented by a pediatric radiologist. Additionally, before and after urinary diversion, a Dimercapto succinic acid (DMSA) nuclear renal scan was conducted to assess renal function. We analyzed 67 patients, with a mean follow-up of 38.3months, undergoing either ureterostomy (42 patients) or pyelostomy (25 patients). This included 38 patients with PUV and 29 with UVJO. In PUV patients, significant improvements were observed in APP (MD = 5.56 ± 11.6, p = 0.0194), APU (MD = 5.57 ± 7.28, p < 0.001), and PT (MD = 3.66 ± 2.75, p < 0.001). Similarly, UVJO patients experienced significant improvements in APP (MD = 12.18 ± 18.63, p = 0.005), APU (MD = 7.82 ± 8.98, p = 0.001), and PT (MD = 2.79 ± 3.33, p = 0.001). DMSA scores did not significantly change in either group (p > 0.05). Notably, APP improved more in UVJO patients compared to PUV patients (p = 0.047). Our study suggests that urinary diversion could improve APP, APU, and renal parenchymal thickness in PUV and UVJO patients. The improvement of APP in UVJO patients was greater than in the PUV group. We propose further multi-center studies with longer durations of follow-up and more detailed additional data to support and confirm our results.

Brunn’s cyst presenting as a rare cause of lower urinary tract symptoms – A case report

Brunn’s cyst in the region of the bladder neck is a rare cause of lower urinary tract obstruction. This case describes the ultrasonography and computed tomography urography findings of Brunn’s cyst as causing lower urinary tract symptoms and urinary retention.

Interlabial masses in newborn girls.

: An interlabial mass in newborn girls is diagnosed usually after birth or during the first days or weeks of life. According to various studies, its prevalence ranges between 1 : 500 and 1 : 7,000 newborn girls. A mass in the vaginal introitus or between the labia majora can cause a diagnostic dilemma and may be suspected even of ambiguous genitalia. Interlabial masses of different etiologies present clinically similar, and therefore, can be misdiagnosed. The most common causes of an interlabial mass in a newborn are hymenal and paraurethral cysts, both of which present as thin-walled spherical formations filled with golden fluid. When diagnosing a cystic interlabial tumor, it is necessary to particularly exclude a non-perforated hymen with hydrocolpos and prolapse of an ectopic ureterocele. In the differential diagnosis, prolapse of the urethra, rhabdomyosarcoma of the vagina or cervix, urethral or vaginal polyps, and extremely rare conditions such as genital prolapse or duplicate rectum cannot be omitted. A newborn girl with an interlabial formation should be examined by a pediatrician, gynecologist, surgeon, or urologist depending on the nature of the clinical findings. Once the etiology of an interlabial mass is identified, expectant management or surgery should be chosen. Early surgical treatment of hydrocolpos and prolapse of a ureterocele can prevent lower urinary tract obstruction and life-threatening renal damage.

A new spectrum of neonatal urethral pathologies in the era of early vesicoamniotic shunting?

Intrauterine vesicoamniotic shunting (VAS) was shown to affect survival of male fetuses with megacystis in suspected lower urinary tract obstruction (LUTO). Data on postnatal management are largely lacking. We aim to describe the pathologies diagnosed in children born after vesicoamniotic shunt placement in early pregnancy for megacystis. All newborns with previous intrauterine VAS treated in our institution were analyzed retrospectively. We evaluated the clinical spectrum of urethral pathologies. We also compared patients who received a shunt before the 17th gestational week with those who received it later. Between 2014 and 2023, 26 patients (all male) with a history of VAS for suspected LUTO were treated in our institution postnatally. Five fetuses with dislocated shunts underwent re-implantation in utero. Overall, premature birth before the 38th week of gestation was observed in 14 patients. Seven patients received a Harrison® shunt whereas 19 received a Somatex® shunt. Twelve patients required surgical shunt removal under general anesthesia due to shunt migration/embedding. Posterior urethral valves were found in 10/26 patients, 10/26 patients showed a urethral hypoplasia [Fig.1] and two patients had urethral duplications. In two patients, we identified a prune belly syndrome. One patient had posterior and anterior urethral valves. One patient had a high grade bilateral vesicoureteral reflux without LUTO. The 11 patients shunted early (before 17GW) showed a trend towards a higher proportion of urethral hypoplasia in the early shunt group (54% vs. 26%) without statistical significance. In our observation, patients treated with VAS had a noticeable high proportion of complex urethral pathologies such as urethral hypoplasia. These data should be taken into consideration for prenatal counselling of parents and planning of postnatal management.

Risks of Renal Anomalies and Urinary Tract Infections in Neonates With Single Umbilical Artery.

Background Our study aims to evaluate the characteristics of congenital anomalies of kidneys and urinary tracts (CAKUT) and urinary tract infection (UTI) in babies with single umbilical artery (SUA) and to identify factors associated with these outcomes. Methods We performed a 15-year retrospective analysis on babies who were born ≥34 weeks with SUA between 2006 and 2020. Relevant clinical information on obstetrics and neonatal examinations, UTIs, and imaging of the urinary systems was evaluated. Results The frequency of SUA in newborns was 3.28 per 1,000 deliveries. The majority (271/291; 93.1%) of patients had kidney ultrasound, and 19 (7.0%) had CAKUT. Hydronephrosis (n = 11, 57.9%) was the commonest CAKUT, followed by unilateral kidney agenesis (n = 3, 15.8%), horseshoe kidney (n = 2, 10.5%), and right low-lying kidney (n = 2, 10.5%). Most significant CAKUT (including solitary kidney and urinary tract obstruction) could be detected during the antenatal period. Congenital heart defect (OR 4.93, 95% CI 1.59-15.34), limbs (OR 9.77, 95% CI 1.53-62.44), and sacral abnormalities (OR 5.06, 95% CI 1.25-20.55) were associated with CAKUT. Six (2.1%) developed UTIs during the study period, with the majority below two years old. The presence of CAKUT was associated with the development of UTI after adjustment (adjusted HR 10.28, 95% CI 1.86-56.83). Conclusions The overall prevalence of CAKUT was 7.0% in patients with SUA, and the majority of significant CAKUT was identified during the antenatal period. Congenital heart defects, limbs, and sacral abnormalities were associated with CAKUT. UTI occurred in 2.1% of patients.

Sacral neuromodulation for Organophosphate-induced delayed neuropathy neurogenic lower urinary tract dysfunction: a case report

BackgroundOrganophosphate-Induced Delayed Neuropathy (OPIDN) is a rare neurological disorder triggered by exposure to organophosphorus compounds. These compounds exert their neurotoxic effects by impacting the nervous system, leading to systemic manifestations. Urinary system symptoms are infrequently observed in clinical settings. Currently, effective therapeutic interventions for OPIDN-related urinary symptoms are lacking. Sacral nerve modulation therapy, an FDA-approved approach for managing lower urinary tract symptoms, presents as a promising option. Herein, we present a case of OPIDN-induced lower urinary tract obstruction successfully treated with sacral nerve modulation therapy, resulting in substantial symptom relief.Case reportA 27-year-old male patient presented with severe bilateral hydronephrosis, attributed to low bladder compliance and accompanied by a fever persisting for 6 days. The patient’s medical history revealed accidental ingestion of organophosphate pesticide (Dimethoate) with no concomitant underlying diseases. In consideration of the potential for OPIDN, surgical intervention in the form of sacral neuromodulation (phase I) was undertaken. Subsequent evaluation one month post-surgery revealed notable improvements in both bladder compliance and bilateral hydronephrosis, necessitating sacral neuromodulation (phase II). Presently, following a 5-month follow-up period, the patient remains asymptomatic and in favorable health.ConclusionThis patient achieved long-term relief using sacral neuromodulation.

Clinical case: intraluminal incision and tandem ureteral stenting in obstructive upper urinary tract uropathy

One of the common causes of urinary retention and pain symptom in urological practice is ureteric stricture. Surgery remains the only effective method of treatment. Currently, the modern minimally invasive operations are the most relevant. Minimally invasive high-tech surgery: percutaneous endoureterotomy followed by the installation of tandem stents demonstrates effectiveness in treatment of recurrent strictures of the upper urinary tract.

MIP Assay-Based Targeted Gene Resequencing Identifies 22 Novel and Extremely Rare Variants in Known and Putative New Candidate Genes in Lower Urinary Tract Obstruction

MIP Assay-Based Targeted Gene Resequencing Identifies 22 Novel and Extremely Rare Variants in Known and Putative New Candidate Genes in Lower Urinary Tract Obstruction

Watermelon Derived Urease Immobilized Gold Nanoparticles-Graphene Oxide Transducer for Direct Detection of Urea in Milk Samples.

Urea contamination in milk poses significant health risks, including kidney failure, urinary tract obstruction, fluid loss, shock, and gastrointestinal bleeding. This highlights the need for sensitive, rapid, and reliable methods to detect traces amount of urea in milk. In this study, we designed an electrochemical transducer for urea detection by utilizing purified watermelon urease (Urs), gold nanoparticles (AuNPs), and graphene oxide (GO). The nanomaterials and biosensor probe were characterized using UV-vis spectroscopy, XPS, TEM, XRD, FTIR, AFM, CV, EIS, and DPV. The engineered probe (GCE/AuNPs/GO/Urs) demonstrated a broad linear detection range of 5 to 90 mg/dL and a low limit of detection (LOD) of 0.037 (±0.012) mg/dL (RSD < 3.7%). The biosensor was tested for potential interferents that may be present in adulterated milk and an exceptionally low coefficient of selectivity (ksel <0.1) was obtained. Evaluation of milk samples from a local dairy farm showed good recovery rates from 93.13% to. 98.79% (RSD < 4.28%, n = 3), indicating reliable detection capabilities. Stability tests confirmed the sensor's reproducibility and consistent performance. Additionally, a comparison study of the system was carried out using the purified watermelon urease and the commercially available urease. Herein, the results obtained using the sensor probe was finally validated with the gold standard method.

Prevalence and Pattern of Urinary Tract Obstruction in Patients with Urolithiasis in Southeast Nigeria

Abstract Background: Urolithiasis is a global problem and its prevalence is steadily increasing. This trend is also true in tropical and sub-Saharan Africa. Urinary tract obstruction is a common complication of untreated urolithiasis. Data on the prevalence and pattern of this obstruction are limited in the literature. Objectives: The objective of this study is to determine the prevalence and pattern of urinary tract obstruction in patients with urinary stone disease. Materials and Methods: This is a retrospective study carried out over 9 years between April 2013 and June 2022. Records of patients who had abdominopelvic computerized tomography scans done at Hansa Clinics Enugu were retrieved for this study. From the medical records, the age and gender of the patients were extracted. The pattern and degree of obstruction noted on the imaging were recorded. Data were described using frequencies and proportions in tables and graphs. Analysis was done using Statistical Package for Social Sciences for Windows, version 26.0. Results: Out of 2467 subjects reviewed, urinary tract stones were identified in 356 subjects (14.4%). The mean age of the subjects was 49 ± 15.7 years. The majority were males (57.0%). In those with urinary tract obstruction, the majority had hydronephrosis (67.9%) followed by hydroureter (43.0%) and pelvocaliectasis (37.6%). Conclusion: Urinary tract obstruction with stones is common, and often associated with hydronephrosis and hydroureter. Therefore, early detection and management using relevant imaging techniques will go a long way in reducing the burden of renal failure which is a serious possible sequelae.

Exploring retroperitoneal fibrosis: Insights, challenges, and treatment approaches.

Retroperitoneal fibrosis (RPF) is a rare fibro-inflammatory condition characterized by abnormal tissue growth around the abdominal aorta and iliac arteries, usually encasing adjacent structures like the ureters. Its etiology remains most of the time idiopathic, but secondary causes, including malignancies and medication use, account for a minority of cases. This review aims to consolidate recent advancements in understanding RPF, focusing on its pathophysiology, diagnosis, and treatment. Literature search was conducted using databases like PubMed, with emphasis on recent publications. Biomarkers such as elevated CRP levels and imaging techniques like CT scans and MRI play pivotal roles in diagnosis and monitoring. Medical management primarily revolves around corticosteroids, with adjunctive therapies like tamoxifen and immunosuppressants showing promise. Surgical intervention, typically ureterolysis, becomes necessary in cases of urinary tract obstruction. This review studies the importance of a comprehensive approach to RPF management, integrating medical and surgical modalities for optimal patient outcomes.

Management of Labial Adhesion of Childhood: A Case Report at Rural General Hospital

Labial adhesion is a common gynecologic problem in childhood. It is defined as fusion of the labia minora in the midline or are termed vulvar adhesions when they occur below the labia minora. Although they frequently show no symptoms, patients may come with genitourinary problems such as post-void dripping, vaginal irritation, dysuria, urinary tract infection or obstruction. When a patient shows no symptoms, conservative care is the cornerstone of treatment, along with parental reassurance and close attention to vulvar hygiene. Topical therapy with estrogen and/or steroid cream is frequently beneficial for symptomatic individuals. Recent advancements in surgical techniques have demonstrated favorable outcomes in managing labial adhesion. Among these, the application of the Heineke-Mikulicz suturing technique has emerged as an effective minimally invasive approach. Hence, follow up of these children is important to ensure complete resolution without residual adhesion or recurrence.

Intra-Abdominal Hemorrhage Due to Spontaneous Urinary Bladder Diverticulum Rupture in a Female: An Autopsy Case Report and Brief Review of the Literature

Urinary bladder diverticula are formed by the herniation of the mucosa into the muscle layer of the bladder wall, often ending with a narrow neck that communicates with the bladder lumen. They may be congenital or acquired, and they most often affect males. Urinary bladder diverticula discovery during autopsy incidence described in the literature is approximately 5–10%. Various causative factors have been described, including urinary tract obstruction (e.g., benign prostate hyperplasia) and neurogenic and iatrogenic causes. The most described site of occurrence is adjacent to the ureteral orifice. Their clinical presentation does not often facilitate diagnosis, as most are small and asymptomatic. Complications of urinary bladder diverticulosis include infections, lithiasis, neoplasia, pressure on adjacent tissues, obstruction, and rupture. Indeed, urinary bladder diverticula may lead to spontaneous bladder rupture in extremely rare cases. This paper presents the case of an 87-year-old female suffering from atrial fibrillation and under anticoagulant therapy who was pronounced dead in a hospital and was subsequently referred to our department for medico-legal examination. Upon macroscopic examination of the body, intra-abdominal hemorrhage was observed in the vicinity of the urinary bladder, extraperitoneally. A meticulous examination excluded the possibility of injury as the cause of this finding, and tissue samples were collected for histopathological examination. A ruptured urinary diverticulum was discovered and confirmed histopathologically. Death was attributed to intra-abdominal hemorrhage after rupture of urinary bladder diverticulum. A forensic pathologist should be aware of this diagnosis, as although extremely rare, such pathology may lead to death, especially when the patient is under anticoagulant therapy.

Use of the subcutaneous ureteral bypass device and urethral stenting for treatment of malignant urinary outflow tract obstructions in cats.

The aim of this study was to describe the technical success and outcomes of ureteral and urethral decompression using the subcutaneous ureteral bypass (SUB) device and transurethral self-expanding metallic stents (SEMS) as a palliative treatment option for feline malignant urinary outflow tract obstructions. A retrospective study was conducted of 14 cats with ureteral and/or urethral obstructions secondary to diagnosed or suspected transitional cell carcinoma (TCC). In all cats, a SUB device and/or a SEMS was placed to relieve the obstruction(s). Group 1 consisted of cats with ureteral obstructions, with or without concurrent urethral obstructions, and group 2 consisted of cats with only urethral obstructions. Eight cats were included in group 1 (seven with concurrent urethral obstructions) and six cats were included in group 2. TCC was confirmed in 8/14 cats. Repeat urethral obstruction due to tumor in growth occurred in 6/13 (46%) cats with a SEMS, and no cats developed recurrent ureteral obstructions after placement of the SUB device. Three cats had additional covered stents placed after urethral re-obstruction. The median survival time (MST) from the time of device placement was 52 days in group 1 (mean 92; range 14-349) and 80 days in group 2 (mean 96; range 7-209). The MST from the time of mass identification of the cats that did and did not receive adjunctive therapy was 349 days (mean 358; range 124-602) and 43 days (mean 113; range 14-423), respectively. The use of bypass devices for feline malignant urinary outflow tract obstructions is a viable option to provide immediate renal and urinary bladder decompression. TCC in cats is locally aggressive and can result in urethral re-obstruction, prompting consideration for placing a covered urethral stent. The use of adjunctive therapies for malignant neoplasia should be considered to improve overall survival once the obstruction has been relieved.

Fluorimetric Tool to Discriminate Glomerular and Tubular Injuries In Vivo.

The etiology and pathological complexity of acute kidney injury (AKI) pose great challenges for early diagnosis, typing, and personalized treatment. It is an important reason for poor prognosis and high mortality of AKI. In order to provide a relatively noninvasive diagnostic and typing method for AKI, we proposed the pathological changes of albumin permeability after glomerular injury and reabsorption efficiency after tubular injury as potential entry points. Thus, a renal tubule labeling fluorescent dye which features albumin concentration-related fluorescence intensity was used to fit these pathological changes. Utilizing this fluorescence assay, we realized urinary tract obstruction imaging as early as 12 h after morbidity. For glomerular and tubular injury discrimination, compared to a healthy control, membranous nephropathy as a representative glomerular injury resulted in enhanced fluorescence intensity of the kidney due to increased albumin penetration, while renal tubular injury caused insufficient dye reabsorption to exhibit weakened fluorescence intensity. The significant differences demonstrated the feasibility of this approach for fluorescence imaging-based AKI typing in vivo.

Videourodynamics - role, benefits and optimal practice.

Videourodynamics (VUDS) is an advanced diagnostic procedure that simultaneously combines functional and anatomical evaluation of the lower urinary tract. The goal of this synchronous assessment is to promote accurate diagnosis of the aetiology responsible for patient symptoms, improving therapeutic decision-making. Overall, high-quality VUDS is advocated when other tests such as traditional urodynamics might not provide sufficient data to guide therapy, particularly in patients with complex, persistent or recurrent dysfunctions of the lower urinary tract. Additionally, VUDS is often crucial in the follow-up monitoring of many patients with these dysfunctions. A VUDS study is frequently considered a gold standard in patients with neurogenic lower urinary tract dysfunction, female bladder outlet obstruction or congenital anomalies of the lower urinary tract. Nevertheless, this specialized test should be limited to patients in whom VUDS data add value. Particularly, reliable studies comparing the effect of diagnosis with and without imaging on management outcomes are lacking, and no standardized procedures for undertaking VUDS are available. Additionally, patients should be carefully selected for VUDS evaluation, considering the increased cost and risks associated with radiological imaging. In routine practice, clinicians should balance the additional value of synchronous imaging and the enhanced diagnostic precision of VUDS against the limitations of this approach, which mainly include an uncertain effect of VUDS on final treatment outcomes.