Lower Urinary Tract Obstruction Research Articles

Predictors of advanced chronic kidney disease in infancy after definitive vesicoamniotic shunting for congenital lower urinary tract obstruction.

BackgroundSevere congenital lower urinary tract obstruction (cLUTO) is associated with poor postnatal outcomes, including chronic and end stage kidney disease, and high mortality. Studies of the impact of fetal intervention through vesicoamniotic shunting are marred by a device malfunction rate of up to 60%. In this study, we delineate the postnatal course and infant kidney function following definitive urinary diversion in utero.Materials and MethodsThis is a retrospective, single-center cohort study of 16 male infants who survived the fetal intervention to birth, from 2010 to 2014 at a single center. All had patent shunts in place at birth. Perinatal and biochemical characteristics were collected with patients followed for one year, or until demise, with serial measures of serum creatinine (SCr) and serum cystatin C (CysC).ResultsOf the 16 males, 81% were non-white (38% black, 43% Hispanic). Shunts were placed at a median of 20 weeks (IQR 19,23) gestation, with median fetal bladder volume of 39 cm3 (IQR 9.9,65). All neonates were born preterm [median 34 weeks (IQR 31,35)] and the majority with low birth weight [median 2340 grams (1,895, 2,600)]. 63% required positive pressure ventilation. Advanced chronic kidney disease stage 4–5 at 1 year of age was predicted by neonatal characteristics: peak SCr ≥2 mg/dl, time to peak SCr > 6 days, discharge SCr ≥1.0 mg/dl, CysC ≥2.5 mg/l, urine protein:creatinine ≥4.8 mg/mg, urine microalbumin:creatinine ≥2.2 mg/mg. In infancy, a nadir SCr ≥0.5 mg/dl occurring before 160 days (5.3 months) of age was also predictive of advanced chronic kidney disease stage 4–5 at 1 year. Three patients died in the neonatal period, with 1 receiving kidney replacement therapy (KRT). Three additional patients required KRT before 12 months of age.ConclusionsEven with definitive vesicoamniotic shunting for cLUTO, postnatal morbidity and mortality remain high, emphasizing the role of renal dysplasia, in spite of urinary diversion, in postnatal kidney dysfunction. Neonatal and infant biochemical parameters exhibit distinct trends that offer families and physicians a better understanding of the prognosis of childhood kidney function.

Role of Avapeedaka Snehapana in Lower Urinary Tract Obstruction: A Case Study

Lower urinary tract obstruction is defined by residual urine in the bladder after micturition or in more extreme forms by urinary retention with inability to empty the bladder at all. It presents with symptoms like frequency, noctu-ria, poor stream, hesitancy, terminal dribbling, incomplete evacuation, burn-ing sensation and weak flow. In Ayurveda this is dealt under mutraghata vika-ras and the symptoms satisfy more with vatavasthi. Avapeedaka snehapana comes under samana snehapana and is classically suggested in uthama mat-ra. In this case study, a patient with symptoms of lower urinary tract obstruc-tion is treated by method of avapeedaka snehapana with vasthyamayantha-ka ghritham for a total of ten days. After completion of treatment, significant relief of signs and symptoms were observed.

Genome-wide association study in patients with posterior urethral valves.

Congenital lower urinary tract obstructions (LUTO) are most often caused by posterior urethral valves (PUV), a male limited anatomical obstruction of the urethra affecting 1 in 4,000 male live births. Little is known about the genetic background of PUV. Here, we report the largest genome-wide association study (GWAS) for PUV in 4 cohorts of patients and controls. The final meta-analysis included 756 patients and 4,823 ethnicity matched controls and comprised 5,754,208 variants that were genotyped or imputed and passed quality control in all 4 cohorts. No genome-wide significant locus was identified, but 33 variants showed suggestive significance (P < 1 × 10−5). When considering only loci with multiple variants residing within < 10 kB of each other showing suggestive significance and with the same effect direction in all 4 cohorts, 3 loci comprising a total of 9 variants remained. These loci resided on chromosomes 13, 16, and 20. The present GWAS and meta-analysis is the largest genetic study on PUV performed to date. The fact that no genome-wide significant locus was identified, can be explained by lack of power or may indicate that common variants do not play a major role in the etiology of PUV. Nevertheless, future studies are warranted to replicate and validate the 3 loci that yielded suggestive associations.

Imaging and clinical findings in late presenting posterior urethral valves in a resource-constrained economy

Posterior Urethral Valve (PUV) is the commonest cause of lower urinary tract obstruction in male children. Late presentation with delayed diagnosis is common in our setting. This study aims to review the clinical, biochemical, imaging findings and parental factors in late-presenting posterior urethral valves. A retrospective analysis of patients with PUVs seen at UNTH from 2011-2019 was done. Patients who presented at or later than six months of age were considered late presenters and were studied. Patients’ sociodemographic characteristics, antenatal diagnosis, clinical features, and imaging findings at presentation were retrieved. Data analysis was done using SPSS version 22. Statistical significance was set at a p-value&lt;0.05. Twenty-four cases of PUV with complete clinical data were studied. Mean age 3.3 (SD±2.1) years had a positive association with maternal educational level (p≤0.001). Nineteen (72.9%) had antenatal care, 4 (16.7%) had prenatal Ultrasonography (USS), and were part of those who had antenatal care. None had a prenatal diagnosis. Prenatal USS was associated with higher paternal education (p=0.03). The most common clinical symptom and finding respectively were straining to pass urine 23 (95.8%) and palpable bladder 23 (95.8%). The common electrolyte derangements included hyperkalemia (50%), raised serum urea (70.8%) while postnatal hydronephrosis 23 (95.8%) was the main ultrasound and MCUG findings. Late presentation is common with urinary dysfunction and azotemia. Improved antenatal care including late trimester ultrasound and parental health education will enhance prenatal diagnosis and early presentation.

Chronic Kidney Disease in Boys with Posterior Urethral Valves-Pathogenesis, Prognosis and Management.

Posterior urethral valves (PUV) are the most common form of lower urinary tract obstructions (LUTO). The valves can be surgically corrected postnatally; however, the impairment of kidney and bladder development is irreversible and has lifelong implications. Chronic kidney disease (CKD) and bladder dysfunction are frequent problems. Approximately 20% of PUV patients will reach end-stage kidney disease (ESKD). The subvesical obstruction in PUV leads to muscular hypertrophy and fibrotic remodelling in the bladder, which both impair its function. Kidney development is disturbed and results in dysplasia, hypoplasia, inflammation and renal fibrosis, which are hallmarks of CKD. The prognoses of PUV patients are based on prenatal and postnatal parameters. Prenatal parameters include signs of renal hypodysplasia in the analysis of fetal urine. Postnatally, the most robust predictor of PUV is the nadir serum creatinine after valve ablation. A value that is below 0.4 mg/dl implies a very low risk for ESKD, whereas a value above 0.85 mg/dl indicates beneficial kidney outcome. Experimental urinary markers such as MCP-1 and TGF-β, as well as microalbuminuria, indicate progression to CKD. Until now, prenatal intervention may improve survival but yields no renal benefit. The management of PUV patients includes control of bladder dysfunction and CKD treatment to slow down progression by controlling hypertension, proteinuria and infections. In kidney transplantation, aggressive bladder management is essential to ensure optimal graft survival.

Biomarkers for Early Detection of Renal Injury in Fetuses With Congenital Urinary Tract Obstruction

ObjectiveTo investigate a selection of renal injury biomarkers in fetal congenital lower urinary tract obstruction (LUTO) and their potential to identify renal damage in significant obstructive patterns, eventually to benefit fetal intervention and predict the outcome in terms of survival.Study DesignTen fetuses with congenital LUTO were submitted to fetal urine analysis that included six renal injury biomarkers: Neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-β1), retinol-binding protein (RBP), cystatin C (uCyC), and microalbuminuria (µALB). The results were compared with urinary parameters of patients born with LUTO and healthy newborns.ResultThe majority of fetal biomarker levels showed significantly higher values when compared to all groups at birth with exception of KIM-1 and μALB. RBP and uCyC performed with 100% accuracy to identify severe renal damage in fetal LUTO.ConclusionUrine CyC, NGAL, RBP, and TGF-ß1 demonstrated high capability of identifying significant renal impairment due to severe LUTO and may contribute to currently used fetal medicine diagnostic parameters.

New challenges of fetal therapy in Japan.

AimTo review new challenges of fetal therapy in Japan after the establishment of four existing fetal therapies as standard prenatal care with National Health Insurance coverage over the past 20 years.MethodsReported studies and our current research activities related to four fetal therapies newly performed in Japan were reviewed.ResultsFetoscopic endoluminal tracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH) aims to occlude the trachea using a detachable balloon to promote lung growth. Following the recent successful completion of an international randomized controlled trial for CDH, in which we participated, FETO is offered for severe left CDH to perform balloon insertion at 27–29 weeks and removal at 34 weeks of gestation. Fetal cystoscopy (FC) for low urinary tract obstruction was introduced to overcome the demerits of vesicoamniotic shunting. FC may provide a proper diagnosis by visual observation of the urethra and physiological treatment of the posterior urethral valve. The effectiveness of open fetal surgery for myelomeningocele (MMC), direct surgery with laparotomy and hysterotomy, for ameliorating hindbrain herniation and the motor function was demonstrated, but it was also associated with substantial maternal and fetal risks. Fetal aortic valvuloplasty (FAV), ultrasound‐guided fetal aortic balloon dilation for critical aortic stenosis with evolving hypoplastic left heart syndrome may improve left heart development and maintain biventricular circulation. Feasibility and safety studies for FC, MMC open fetal surgery, and FAV are currently ongoing.ConclusionsClinical research on FETO, FC, MMC open fetal surgery, and FAV has proceeded with careful preparations in Japan.

PD16-07 REASSESSMENT OF THE EFFECT OF LOWER URINARY TRACT OBSTRUCTION ON UROTHELIAL TISSUE: EVALUATION VIA HOLEP AND ANIMAL STUDY

You have accessJournal of UrologyCME1 May 2022PD16-07 REASSESSMENT OF THE EFFECT OF LOWER URINARY TRACT OBSTRUCTION ON UROTHELIAL TISSUE: EVALUATION VIA HOLEP AND ANIMAL STUDY Young-Min Yang, Katsumi Shigemura, Koki Maeda, Yuzo Nakano, and Masato Fujisawa Young-Min YangYoung-Min Yang More articles by this author , Katsumi ShigemuraKatsumi Shigemura More articles by this author , Koki MaedaKoki Maeda More articles by this author , Yuzo NakanoYuzo Nakano More articles by this author , and Masato FujisawaMasato Fujisawa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002548.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is a debate that the volume and morphology of the prostate do not completely correlate with the micturition status. That is, Schafer nomogram, asessing lower urinary tract obstruction and the severity, may not be directly lead to good outcome of urination status after Holmium-Laser Enucleation of the Prostate (HoLEP). So, we re-assessed Schafer nomogram in HoLEP. And we created a benign prostatic hyperplasia model mouse, and evaluated how the increase in prostate volume affects inflammtion and function in prostate and bladder, and searched for new marker to evaluate bladder function. METHODS: We collected 320 patients who underwent HoLEP from April 2005 to March 2021 in Kobe university hospital. We retrospectively assess the relationship between Schafer nomogram and surgical outcome such as change of maximum flow rate (MFR, ml/s), average flow rate (AFR, ml/s) and residual urine volume (RUV, ml) from pre- to post-operation, and prostate volume (ml) and resected prostate weight (g). Next, we made a mouse prostatic hyperplasia model by testosterone propionate after castration, we evaluated to correlation between prostate volume, and the expressions of α1 -adrenoreceptor and TGF-β in prostate glands and those of β-3 receptor and Rho in bladder membrane. RESULTS: As to the HoLEP data, there was no significant difference of change of MFR (p=0.1044), AFR (p=0.2186) and RUV (p=0.5978) from pre- to post-HoLEP. However, there was significant difference of prostate volume and resected prostate weight among Schafer nomogram: prostate volume (p=0.009) and resected prostate weight (p=0.0007). In animal study, there was no difference in body weight among the individuals. The mean prostate weight was 75 ± 27 mg in the control group, 101.9 ± 1.7 mg in the castration group, and 130 ± 19 mg in the testosterone propionate group. There was no significant prostate volume difference between the castration group and the control group (p = 0.5) but was between the testosterone propionate group and the control group (p<0.05). Immunostaining showed a significant correlation between prostate volumes, and α1-adrenoreceptor expression in prostate gland, and expressions of β3 receptor and Rho in bladder. CONCLUSIONS: Our study demonstarted that he Schafer classification has not completely evaluated the degree of obstruction, so a new index for evaluating the degree of obstruction is required. And animal study showed that Rho expression in baldder membrane may reflects the degree of obstruction. Further evaluation needs to be performed for a definitive conclusion. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e271 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Young-Min Yang More articles by this author Katsumi Shigemura More articles by this author Koki Maeda More articles by this author Yuzo Nakano More articles by this author Masato Fujisawa More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP11-05 FACTORS ASSOCIATED WITH PERIOPERATIVE COMPLICATIONS FOLLOWING AUGMENTATION CYSTOPLASTY: A CONTEMPORARY POPULATION-BASED ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP11-05 FACTORS ASSOCIATED WITH PERIOPERATIVE COMPLICATIONS FOLLOWING AUGMENTATION CYSTOPLASTY: A CONTEMPORARY POPULATION-BASED ANALYSIS Hriday Bhambhvani, Kritika Sharma, and Kunj Sheth Hriday BhambhvaniHriday Bhambhvani More articles by this author , Kritika SharmaKritika Sharma More articles by this author , and Kunj ShethKunj Sheth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002533.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Augmentation cystoplasty (AC) is a major urologic operation, and previous data suggest a high perioperative complication rate of approximately 30%; however, more contemporary data are lacking. We assessed clinical characteristics of patients undergoing AC as well as perioperative complication rates using a national database. METHODS: The Pediatric Health Information System (2004-2021) was queried to identify children (≤21 years of age) who underwent AC using the appropriate International Classification of Diseases procedure code. Likewise, indication for AC, type of AC, and perioperative complications were identified. Multivariable logistic regression identified factors associated with the presence of at least one perioperative complication. RESULTS: 2596 patients were included. Baseline characteristics are detailed in Table 1. The most common indication for AC was spina bifida (50.9%). Small bowel cystoplasty was utilized in 56.7% of ACs, and a catheterizable stoma was created in 53.9% of ACs. 22.2% of patients had at least one perioperative complication; individual complication rates are given in Table 1. In multivariable regression, a primary indication of lower urinary tract obstruction (LUTO) was associated with a higher risk of complication (OR 2.18, 95% CI 1.20-3.87, p = 0.009) as compared to spina bifida. Performance of small bowel cystoplasty (OR 1.29, 95% CI 1.04-1.60, p = 0.02) or large bowel cystoplasty (OR 1.40, 95% CI 1.00-1.95, p = 0.047) was associated with increased risk of perioperative complications, as compared to the absence of each respective procedure. Lastly, AC’s with catheterizable stoma creation were associated with a higher risk of perioperative complications (OR 1.26, 95% CI 1.04-1.53, p = 0.02) as compared to AC’s without catheterizable stoma creation. Age, sex, race, year of AC, and ureterocystoplasty were unassociated with perioperative complications (p >0.05). CONCLUSIONS: This population-level study provides contemporary data on the perioperative complication rate of AC and identifies LUTO as well as enterocystoplasty and concomitant channel creation as risk factors for perioperative complications. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e158 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hriday Bhambhvani More articles by this author Kritika Sharma More articles by this author Kunj Sheth More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD28-11 VALUE OF ROUTINE PRE-OPERATIVE CYSTOSCOPY PRIOR TO INSERTION OF PENILE PROSTHESIS

You have accessJournal of UrologyCME1 May 2022PD28-11 VALUE OF ROUTINE PRE-OPERATIVE CYSTOSCOPY PRIOR TO INSERTION OF PENILE PROSTHESIS Leonid Aksenov, Zachary Dionise, Faysal Yafi, and Aaron Lentz Leonid AksenovLeonid Aksenov More articles by this author , Zachary DioniseZachary Dionise More articles by this author , Faysal YafiFaysal Yafi More articles by this author , and Aaron LentzAaron Lentz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002576.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile prosthetic implants have been used for almost 50 years for refractory erectile dysfunction, with approximately 20,000 annual implants in the United States alone. Historically, some urologists have advocated for routine pre-operative cystoscopy to evaluate for the presence of lower urinary tract obstruction prior to prosthesis placement. The rationale being that the treatment of lower urinary obstruction should supersede prosthetic placement and management of these conditions may be complicated with a prosthetic in place. Anecdotally, the risk of such significant asymptomatic urethral pathology is quite low. Cystoscopy, in addition to carrying the risk of peri-procedural infection, does have a substantial associated cost. Thus, our objective was to retrospectively evaluate the prevalence and cost of incidentally discovered urethral pathology during inflatable penile prosthesis (IPP) placement. METHODS: We retrospectively identified all inflatable IPP insertions (CPT 54405 or 54410) performed or aborted by a single surgeon (ACL) from 1/1/14 to 9/15/21. Of those, we then identified and reviewed patients who underwent intraoperative urethral dilation (CPT 52281), direct vision internal urethrotomy (CPT 55276), or cystoscopy (CPT 52000). Costs were calculated based on our institution’s cost data. Total and average cost of routine office cystoscopy for each IPP was compared to total cost of aborted IPPs. RESULTS: A total of 726 inflatable IPP placement cases were identified. An intraoperative cystoscopy was performed in 13 (1.8%) cases. Of those, 5 (0.7%) cystoscopies were planned and 8 (1.1%) were unplanned. Of the IPP cases with unplanned cystoscopies, 4 cases were aborted (0.5%); 3 cases were aborted due to a urethral stricture and 1 case was aborted due to a urethral perforation following corporal dilation. Unplanned intraoperative cystoscopies and interventions had an average supply cost of $216, totaling $1,732. The total supply cost of aborted IPPs due to urethral stricture was $4,182, an average of $1,394 per case. If every IPP case underwent a pre-operative cystoscopy, the estimated total cost would have been $234,498 ($323 per case). CONCLUSIONS: Given the rarity of incidental urethral strictures requiring aborted IPP and intervention, the cost of routine pre-operative cystoscopy far exceeded the cost of aborted IPP procedures. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e502 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leonid Aksenov More articles by this author Zachary Dionise More articles by this author Faysal Yafi More articles by this author Aaron Lentz More articles by this author Expand All Advertisement PDF DownloadLoading ...

Vesicoamniotic Shunting before 17 + 0 Weeks in Fetuses with Lower Urinary Tract Obstruction (LUTO): Comparison of Somatex vs. Harrison Shunt Systems.

(1) Background: The aim of this study was to compare perinatal outcomes and complication rates of vesicoamniotic shunting (VAS) before 17 + 0 weeks in isolated LUTO (lower urinary tract obstruction) with the Somatex® intrauterine shunt vs. the Harrison fetal bladder shunt. (2) Methods: This is a retrospective cohort study in two tertiary fetal medicine centers. From 2004–2014, the Harrison fetal bladder shunt was used, and from late 2014–2017, the Somatex shunt. Obstetrics and pediatric charts were reviewed for complications, course of pregnancy, perinatal outcome, and postnatal renal function. (3) Results: Twenty-four fetuses underwent VAS with a Harrison (H) shunt and 33 fetuses with a Somatex (S) shunt. Live birth rates and survival to last follow-up were significantly higher in the Somatex group, at 84.8% and 81.8%, respectively, vs. 50% and 33.3% in the Harrison group (p = 0.007 and p < 0.001). The dislocation rate in the Somatex group (36.4%) was significantly lower than in the Harrison group (87.5%) (p < 0.001). The median time to dislocation was significantly different, at 20.6 days (H) vs. 73.9 days (S) (p = 0.002), as was gestational age at dislocation (17 (H) vs. 25 (S) weeks, p < 0.001). Renal function was normal in early childhood in 51% (S) vs. 29% (H) (p = 0.11). (4) Conclusions: VAS before 17 + 0 weeks gestational age with a Somatex shunt improves perinatal survival significantly and might even have a positive effect on renal function, probably due to the lower dislocation rates. A normal amount of amniotic fluid in the third trimester was the best predictor of normal renal function in early childhood.

Development of a Predictive Model for the Diagnosis of Lower Urinary Tract Obstruction in Men

We sought to develop and validate a bladder outlet obstruction predictive model for men with nonneurogenic lower urinary tract symptoms. We retrospectively included 1,148 patients who underwent a urodynamic study in the Urology Service of the Burgos University Hospital from January 2007 to December 2019. Obstruction was defined using the Abrams-Griffiths number. A multivariable logistic regression analysis was conducted to determine the predictors of bladder outlet obstruction. We transferred these data to a model to calculate the individual probability of obstruction. A first group with 563 patients randomly divided was selected for the design of the predictive risk model and a second group of 585 patients for the validation. A total of 331 patients (58.8%) in the development group and 381 (65.1%) in the validation group had a diagnosis of obstruction. A multivariable logistic regression model showed that age, history of previous surgical intervention, presence of voiding symptoms, preserved anal tone, maximum urinary flow rate and voiding efficiency were significant for predicting obstruction. The model had an area under the receiver operating characteristic curve of 0.78 (95% CI 0.75-0.82) and a model validation of 0.78 (0.72-0.83). Our proposed model based on clinical and noninvasive urodynamics parameters allows us to predict the risk of presenting bladder outlet obstruction in patients with lower urinary tract symptoms.

Epirubicin-loaded beads transarterial prostatic arterial chemoembolization is a promising treatment for advanced prostate cancer with lower urinary tract obstruction or hematuria-a case series report.

BackgroundProstatic arterial embolization (PAE) is an effective minimally invasive treatment for lower urinary tract obstruction and hematuria in patients with benign prostatic hyperplasia (BPH). This study was aim to evaluate the safety and short-term efficacy of drug epirubicin-loaded beads transarterial prostatic arterial chemoembolization (DEB-PACE) for the treatment of advanced prostate cancer (PC) with lower urinary tract obstruction or hematuria.MethodsA total of 8 patients with advanced PC undergoing DEB-PACE from August 2020 to February 2022 were retrospectively enrolled. The patients were followed up at 1 week, 1, 3, 6 and 12 months after DEB-PACE. The origin of prostatic arteries, technical success, clinical success rate, duration of the indwelling urinary catheter, International Prostate Symptom Score (IPSS), QoL score (quality of life), prostate volume (PV), prostate-specific antigen (PSA) level and complications were recorded. The short-term efficacy (changes in IPSS, PV and QoL value from baseline to 3 months) were analysed.ResultsThere were 17 prostatic arteries in 8 patients, which mainly originated from internal pudendal artery (11/17, 64.7%), the technical success rate is 100%. After treatment, the symptoms of lower urethral obstruction in 8 patients were significantly improved that PSA, PV, IPSS and QoL level were significantly reduced. The catheter was successfully removed within 1 week on average, and 2 patients with hematuria disappeared within 5 days. The clinical success rate is 100%. At 1 month postoperatively, mean PV reduction was 30.28±6.963 cm3 (P=0.0457), mean IPSS reduction was 21.13±2.887 points (P=0.0042), mean QoL reduction was 3.75±0.366 points (P=0.006). At 3 months postoperatively, mean PV reduction was 46.14±8.906 cm3 (P=0.0112), mean IPSS reduction was 24.5±2.398 points (P=0.0003), mean QoL reduction was 4.25±0.25 points (P=0.0003). There were no serious complications occurred in all patients.ConclusionsDEB-PACE is a promising treatment for advanced PC with lower urinary tract obstruction or hematuria. However, the efficacy and safety of DEB-PACE for advanced PC is needed to validated by prospective large sample randomized controlled study.

Pathological and sonographic review of early isolated severe lower urinary tract obstruction and implications for prenatal treatment.

To identify favorable renal histology in fetuses with early severe lower urinary tract obstruction (LUTO) and determine the best timing and selection criteria for prenatal surgery. This multicenter, retrospective study included male fetuses with severe LUTO which died before 24 weeks of gestation during the period January 2000 to December 2018. Age-matched controls were used as reference standard for renal histology. Prenatal ultrasound features and fetal serum and/or urine β2microglobulin level were retrieved and kidney histology slides (hematein-eosin-safran and α-smooth-muscle-actin (αSMA) immunostaining) were prepared and reviewed. αSMA-positive staining of the blastema is due to its aberrant differentiation into myofibroblastic cells. Cases were sorted into histopathologic groups (favorable or unfavorable) according to the blastema's morphology and αSMA labeling and the data of these groups were compared. Included in the study were 74 fetuses with a median gestational age at outcome of 17 + 6 (range, 13 + 0 to 23 + 5) weeks. Parenchymal organization was preserved in 48% of the kidneys. A blastema was present in 90% of the kidneys, but it was morphologically normal in only 9% and αSMA-negative in only 1% of them. Most (82%) fetuses had an unfavorable prognosis, and 36% of fetuses died ≤ 18 weeks and had severe renal lesions detected on histology (early unfavorable prognosis). A favorable renal prognosis was associated with an earlier gestational age (P = 0.001). Fetuses with LUTO had a significantly lower number of mature glomeruli (P < 0.001) compared with controls. However, there was no significant difference in the number of glomeruli generations between the early-unfavorable-prognosis group (≤ 18 weeks) and the group with a favorable prognosis (P = 0.19). A comparison of prenatal ultrasound features and biochemical markers between groups could not identify any prenatal selection criteria. Before 18 weeks, around 30% of fetuses with severe LUTO still have potential for kidney development. Identification of these cases would enable them to be targeted for prenatal therapy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Holmium laser enucleation of the prostate in patients with preexisting inflatable penile prostheses

This retrospective study evaluated the safety and efficacy of holmium laser enucleation of the prostate (HoLEP) in patients with an inflatable penile prosthesis (IPP). Five men with a preexisting IPP underwent HoLEP for obstructive lower urinary tract symptoms at Baylor Scott and White Medical Center between January 2016 and September 2020. None of the patients had preexisting prostate malignancy or urethral strictures. Minimal blood loss was seen during HoLEP, with an average length of hospital stay of 1.4 days and an average time of catheterization of 1.4 days. None of the patients had any known postoperative complications, including need for transfusions, return to the operating room for postoperative bleeding, or clot evacuation. In conclusion, there was no increased risk of perioperative or postoperative complications for HoLEP in this group compared with the general population. HoLEP appears to be a safe and efficacious method for the treatment of lower urinary tract symptoms in patients with a preexisting IPP.

Today's Conviction, Tomorrow's Mistake

I got my Appa (father) evaluated at my hometown in Kerala for lower urinary tract obstruction in 2008. I was in the final year of medical school then. I took him to my surgery professor, who did a digital rectal examination on him. His examination revealed a hard nodule on the prostate. However, the prostate-specific antigen (PSA) level was within normal limits. Nevertheless, due to high suspicion, a biopsy was taken from the prostatic nodule, and the report showed atypical cells, no malignant cells.

Vesico-amniotic shunt insertion prior to the completion of 16 weeks results in improved preservation of renal function in surviving fetuses with isolated severe lower urinary tract obstruction (LUTO)

This retrospective study by Kohl et al. highlights the feasibility of vesico-amniotic shunting (VAS) before 16 weeks gestation using a Cook pigtail catheter, or the Somatex® nitinol wire mesh shunt. The authors report a technical success rate of 80% before 16 weeks, which they state is similar to the success rates of VAS later in pregnancy. Fetal intervention before 16 weeks is known to be hazardous due to an increased risk of chorioamniotic separation or shunt dislodgement into the fetal abdominal cavity, that can occur with fetal growth, resulting in fetal ascites and requiring further urgent intervention.

Urine Biochemistry of a Human Fetus with Urinary Tract Obstruction – A Case Report

Introduction Fetal lower urinary tract obstruction (LUTO) can be mild or severe with oligohydramnios, renal dysplasia and pulmonary hypoplasia. Fetal urine biochemical markers correlate with fetal prognosis and, if favorable, surgical intervention is feasible. Methods We report a patient in her 18th gestational week whose fetus was diagnosed with LUTO and underwent fetal urine sampling for calcium, sodium, chloride, beta2-microglobulin and total protein of the routine LUTO panel, with the addition of creatinine, glucose, phosphate, urea, ammonia, albumin, and NGAL. Results Although the routine fetal urine biochemistry seemed to be favorably trending favorably, sodium, beta2-microglobulin, glucose, and urea did not decrease to the reference ranges, and ammonia and creatinine were lower than the reference ranges. Ultrasound demonstrated no improvement of the obstruction. Conclusions This case highlights the need to acquire further experience with biochemical fetal urine markers in order to better manage LUTO.

Late diagnosis of posterior urethral valves: a case report and the literature review

Posterior urethral valves (PUV) are the most common cause of lower urinary tract obstruction in boys. They are usually suspected antenatally or soon after the birth as the cause of severe hydronephrosis, oligohydramnios, renal hypodysplasia, and kidney failure. In milder forms of PUV, the uncharacteristic symptoms occur later in childhood, adolescence, or even adulthood and cause diagnostic problems. The final diagnosis and causative treatment of PUV are possible due to cystourethroscopy. Nevertheless, as a consequence of the defect, valve bladder syndrome (VBS) occurs and requires long-term treatment. The authors present a case of a 14-year-old boy with a late diagnosis of PUV at the age of 7. Recurrent pyelonephritis and nonspecific voiding dysfunction were the first symptoms. Ultrasounds(US) were initially normal while videocystometry(VCM) showed the 3rd-grade right-sided vesicoureteral reflux (VUR), bladder diverticulum as well as discrete detrusor overactivity, and reduced bladder capacity without any signs of bladder obstruction. Bilateral post-inflammatory nephropathy completed the clinical picture. In urethrocystoscopy surprisingly PUV were found and incised. Due to recurrent urinary tract infections (UTIs) one year later the STING procedure was performed which resulted in the resolution of VUR. Despite this, the features of bladder dysfunction, requiring regular urodynamic evaluation and pharmacotherapy, persisted. Recurrent UTIs in boys may suggest urinary tract obstruction and PUV should be considered regardless of the patient's age. Early diagnosis and appropriate management may improve the prognosis.

Definition, diagnosis and management of fetal lower urinary tract obstruction: consensus of the ERKNet CAKUT-Obstructive Uropathy Work Group.

Fetal lower urinary tract obstruction (LUTO) is associated with high mortality and postnatal morbidity caused by lung hypoplasia and impaired kidney function. Specific diagnostic features that can guide clinical approach and decisions are lacking; thus, the European Reference Network for Rare Kidney Diseases established a work group to develop recommendations regarding the clinical definition, diagnosis and management of prenatally detected LUTO. The work group recommends the use of antero-posterior diameter of renal pelvis as the most reliable parameter for suspecting obstructive uropathies and for suspecting prenatal LUTO in the presence of fetal megacystis. Regarding prenatal and postnatal prognosis of fetuses with LUTO, the risk of fetal and neonatal death depends on the presence of oligohydramnios or anhydramnios before 20 weeks' gestation, whereas the risk of kidney replacement therapy cannot be reliably foreseen before birth. Parents of fetuses with LUTO must be referred to a tertiary obstetric centre with multidisciplinary expertise in prenatal and postnatal management of obstructive uropathies, and vesico-amniotic shunt placement should be offered in selected instances, as it increases perinatal survival of fetuses with LUTO.