Obstructive Micturition Research Articles

Pelvic floor reconstruction-update 2024: prolapse-associated symptoms and their treatment

Pelvic organ prolapse (POP) and associated symptoms of urinary incontinence, fecal incontinence, obstructive micturition, defecation, and pain are frequent and awidespread disease with relevant reduction of quality of life and high costs. New insights into functional anatomy and pathophysiology of these pelvic floor dysfunctions let us recognize how ligamentous laxities/defects lead to these dysfunctions. Results of the PROpel study (ClinicalTrials.gov-Identifier: NCT00638235) are shown in which adetailed observation of symptoms (patient-related outcome measures) pre- and postoperatively was performed. Ligamentous vaginal repair of POP enables symptom cure in high percentages for urinary urge incontinence (up to 82%), nocturia (up to 92%), obstructive micturition (up to 87%), fecal incontinence (58-72%), obstructive defecation (71-84%), and pain (53-90%), if caused by POP. Women with POP‑Q stage2 have similar symptom frequencies as women with POP‑Q stage3-4, and also similar cure rates of their symptoms. If good anatomical prolapse repair (in responders) was achieved, the cure rates for obstructive micturition, urinary urgency incontinence, and nocturia were significantly higher than in those women with less effective surgical repair. In the future, pelvic floor surgery should have symptom cure as the primary objective and should lead to improved quality of life. The different, currently performed techniques for POP repair have to be investigated concerning this matter.

Среднеуретральный синтетический слинг с возможностью ранней мобилизации в лечении недержания мочи при напряжении у женщин.

Introduction. The use of midurethral synthetic slings is currently considered to be the most widespread treatment option for stress urinary incontinence (SUI). The most difficult in the existing approaches is to achieve the optimal tension of the sling, on which the result of treatment directly depends. To solve this problem, sling systems with the possibility of tension adjustment in the early postoperative period were created. A comparative study of the effectiveness and safety of such a system and a sling without the possibility of adjustment seems to be a relevant task. Materials and Methods. The study involved 320 female patients with a mean age of 55.2±11.2 years and a confirmed diagnosis of SUI. The patients were allocated into two groups: the first group underwent a synthetic suburethral sling by the standard technique (TOT); the second group received a suburethral sling with early mobilization (TTT). All patients underwent stress test, uroflowmetry and ultrasound investigation to determine the volume of residual urine. UDI-6, ICIQ-SF, PISQ-12 questionnaires were filled out to assess subjective efficiency. Results. In the second group, 28% of the patients needed to increase the tension of the prosthesis. Due to the possibility of tightening the sling in the early postoperative period, the operation was ineffective at the delayed follow-up stage at 36 months only in 11% of the women in the TTT group and in 32% of the patients in the LTT group, p<0.001. Loosening the sling tension was required in every fourth patient in the TTT group. Signs of obstructive urination at the stage of 36 months persisted in 13 patients in the TOT group and were completely absent in the TTT group. Subjective satisfaction with treatment was higher in the TTT group and amounted to 82%. Conclusion. A synthetic mid-urethral tuneable tension tape is superior to a classic sling without adjustment capability in long-term efficacy and safety.

LUTS in COVID-19 sequelae

Objectives: The corona disease became a major public health problem leading to a pandemic. Millions of individuals were infected or led to mortality because of the disease. Apart from fever and cough, many more clinical features and indicators, post COVID-19 are still unknown. In the present study we demonstrate the onset of lower urinary tract symptoms (LUTS) after COVID-19 recovery. Methods: We retrospectively assessed 78 patients from with a minimum one month and maximum 6-month history of COVID-19 positivity. Only mild cases were selected for the present study. All the patients recovered with home quarantine. The complete symptoms and the condition of the patients were noted. All the patients were between 24-70 years of age. We analysed the prime associated symptoms and post COVID sequelae of the patients. Results: Among the 78 patients, 66 had increased urgency and frequency, 6 patients had Obstructive urination. 6 individuals had both the presentations. Out of the total patients, known diabetic were 62, non-diabetics were 16 and newly diagnosed were 3 patients. Conclusions: The present retrospective study is the first to be reported in South Indian population and which demonstrated that increased lower urinary tract symptoms are common presentation as a post COVID sequelae.

An anatomical pathogenesis of lower urinary tract definitions from the 2002 ICS report symptoms, conditions, syndromes, urodynamics.

AimTo present an anatomical pathogenesis parallel with the 2002 International Continence Society Lower Urinary Tract (LUTS) definitions standardization Report 2002.MethodsEach LUTS section is discussed using the same numbers as the Report.Results Normal function Bladder control is binary, with two reflexes alternating, either closure (dominant) or open (micturition), with the same cortical and peripheral components: three directional muscle forces contracting against pubourethral (PUL) and uterosacral (USL) ligaments for closure, two against uterosacral ligaments for micturition. Dysfunction OAB symptoms reflect a prematurely activated micturition; PUL/USL weakness prevents muscle forces from controlling afferent urothelial emptying signals. Stress urinary incontinence is a consequence of weak PULs allowing posterior muscle forces to open the urethra during effort. Lax USLs weaken contractile force of the posterior urethral opening vectors, so detrusor has to contract against an unopened urethra. This is experienced as “obstructive micturition.”ConclusionsAnatomical analysis indicates the ICS definitions are fundamentally sound, except for “OAB” which implies detrusor causation. Minor changes, OAB to “overactivated” bladder allow causation outside of bladder. This construct supports OAB and its component symptoms as a syndrome, as intuited by the Committee, (albeit as a prematurely activated micturition), retains the acronym, explains OAB cure by ligament repair, and incontinence pathogenesis from two post‐2002 syndromes which need an addition to the definitions, Posterior Fornix Syndrome (of which OAB is a component) and Tethered Vagina Syndrome, which is the basis for skin‐grafting cure of the 30%–50% of women who continue leaking urine massively after successful obstetric fistula closure.

Suburethral Synthetic Adjustment-controlled Tape Compared with Conventional Treatment for Female Stress Urinary Incontinence: A Randomized Controlled Trial

BackgroundUrinary incontinence (UI) is a urological problem in women. Currently, suburethral slings are the standard of surgical treatment for stress UI in the female population. ObjectiveTo prove the feasibility of an operating technique using suburethral adjustment-controlled tape (SACT) placement. Design, setting, and participantsA single-center comparative randomized controlled trial included patients randomized according to the CONSORT checklist from April to October 2018 and from November 2018 to April 2019. The inclusion criteria were women from 21 to 81 yr, stress and mixed UI forms, and positive cough test. The exclusion criteria were pregnancy, lactation, neurogenic bladder dysfunction, recurrent forms of UI, radiation therapy and pelvic surgery in anamnesis, genital prolapse (Pelvic Organ Prolapse Quantification system >2), urinary infection, and obstructive urination. InterventionThe first group (50 patients) was using synthetic SACT and the second group (75 patients) a transobturator tape (TOT) midurethral sling (MUS). Outcome measurements and statistical analysisSubjective efficacy of 96% was established in group 1 and 86% in group 2, with a median follow-up of 12 mo. According to gynecological examination results, the objective surgical treatment efficiency was 96% in group 1 and 90.7% in group 2. This statistically significant indicator was evaluated in each group. However, when comparing both groups, no statistical difference was revealed. According to urodynamic studies, 1 mo after surgery in group 1, terminal and phase detrusor overactivity signs were 18% (n = 9) and 12% (n = 6), respectively. In group 2, these were 14.7% (n = 11) and 12% (n = 9), respectively. Results and limitationsThe block approach was used to randomize patients into groups. A total of 125 patients (50 in the main group and 75 in the control group) were analyzed. ConclusionsOur results prove the efficacy and safety of SACT in treating UI in women. The subjective and objective effectiveness results of treating patients in the study group show the possibility of using SACT in the same row with TOT MUS. Patient summaryOur purpose was to standardize the surgery stage for urinary incontinence, and evaluate the effectiveness and safety of suburethral adjustment-controlled tape placement. We analyzed women with urinary incontinence and used two different surgical methods. Our results prove the efficacy and safety of suburethral adjustment-controlled tape in treating urinary incontinence in women.

Objectification of the evaluation of a pharmacological test with alpha-adrenergic blocking agents during uroflowmetry

The tactics of treating dysuric disorders are largely determined by the pathophysiological and morpho-clinical basis: infravesical obstruction, impaired bladder contractility, complex neurogenic urination disorders, etc. Among the diseases that most often cause infravesical obstruction in men, the most common pathologies are benign prostatic hyperplasia, prostate cancer, prostate sclerosis, obstructive processes of the bladder neck (contractures, fibrosis), urethral strictures of various etiologies. The use of a comprehensive urodynamic study makes it possible to differentiate the causes of urinary disorders. One of the most common and non-invasive methods used in the urologist’s clinical practice is uroflowmetry. The use of the fuzzy logic algorithm described in the article for making a decision on the presence of obstructive urination allows one to assess the urodynamic situation using the home uroflow monitoring technique. Analytical urodynamics in conjunction with the fuzzy logic block increases the accuracy of describing the examination results, and the introduction of the proposed model into the software simplifies the work with diagnostic urological equipment and increases the efficiency of the examination.

Can we predict continued pessary use as primary treatment in women with symptomatic pelvic organ prolapse (POP)? A prospective cohort study.

The objective of this study was creating a prediction model for continued pessary use in patients with symptomatic pelvic organ prolapse (POP) and evaluating the percentage of continued pessary use after 12months. We performed a prospective cohort study in patients with symptomatic POP stage ≥ 2. All patients received a pessary as primary treatment. Factors for continuation were identified from baseline characteristics and data from validated disease-specific quality of life (DSQOL) questionnaires. Univariate and multivariate analyses for predictors were performed and a prediction model was made. Improvement of POP was measured using the Patient Global Impression of Improvement (PGI-I) and DSQOL at 12months' follow-up. Primary outcome was factors related to continued use. Secondary outcomes were the percentage continued pessary use after 12months, improvement of complaints and DSQOL. Two hundred ninety-one patients were included; 184 (63%) patients continued pessary use after 12months. Factors related to continuation following the univariate analysis were age, sexual activity, POP-Q point c ≥ 0 and obstructive micturition. GH < 4 was not significant but added significantly to the prediction model. After multivariate analysis, age, point c ≥ 0 and GH < 4cm remained predictors for continuation. The ROC showed an AUC of 0.65 (95% CI 0.58-0.71). PGI-I showed 83% perceived their prolapse complaints much or very much improved. Continued pessary use was found in 63%. Main predictors for continued pessary use were higher age, more prominent apical compartment prolapse (c ≥ 0) and a GH<4cm.

Symptoms of voiding dysfunction and other coexisting pelvic floor dysfunctions: the impact of transvaginal, mesh-augmented sacrospinous ligament fixation.

The objective was to investigate the prevalence for voiding dysfunction and if symptom improvement can be achieved by adequate pelvic floor surgery. We evaluated the Propel Study data from 281 women with pelvic organ prolapse (POP) stage 2-4. Bother caused by obstructive micturition, voiding dysfunction, and coexisting pelvic floor symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI) preoperatively and 6, 12, and 24months after vaginal prolapse repair. Successful reconstruction (Pelvic Organ Prolapse Quantification [POP-Q] stage 0-I throughout the 2-year follow-up at all compartments, "responders"), was compared with all others ("non-responders"). Prevalence of voiding dysfunction was significantly reduced after surgery for all patients with "moderate" to "quite a bit" of bother ("R2") regarding all examined PFDI questions. Defects of the posterior/apical compartment and lower stage defects were found to cause obstructive micturition, which improved significantly after POP surgery. Sixmonths after surgery, the prevalence of R2 for voiding dysfunction symptoms was reduced significantly for responders compared with non-responders. Significant reduction of R2 in patients with rectoceles could be shown for some PFDI questions, whereas the rate was lower in patients with cystoceles. Other pelvic floor symptoms often coexisted in patients with voiding dysfunction symptoms and improved significantly after surgery as well. Symptoms of voiding dysfunction are frequent in female patients with POP and can significantly improve after vaginal mesh-augmented prolapse repair even for posterior and minor defects. Before counseling patients to undergo POP surgery because of their obstructive symptoms, other causes of voiding dysfunction must first have been ruled out.

Postoperative pelvic dysfunctions associated with the reconstruction of the pelvic floor.

The authors were aiming to conduct the comparative analysis of the frequency of formation of pelvic dysfunctions after surgical correction of genitalia prolapse in women by a vaginal approach using native tissue repair of the vaginal paries and synthetic implants. The study included 546 patients with stage II-IV genitalia prolapse according to the POP-Q classification. The quality of life was assessed using PD-QL and PFIQ-7 questionnaires. The 1st group included patients after native tissue repair (N.=314), the 2nd - after surgery with the use of synthetic implants (N.=232). In the 1st group de-novo dysfunctions were revealed as follows: stress urinary incontinence: in 4.9% of women, urgency: in 2.2%, obstructive urination: in 8.0%; constipation or fecal and flatal incontinence: none. The index of pelvic floor dysfunction decreased from 50±14% to 8±2%. The index of influence on the quality of life decreased from 81±14% to 9% after 12 months. In the 2nd group, de-novo dysfunctions were revealed as follows: stress urinary incontinence: in 9.5% of women, urgency: in 9.1%, obstructive urination: in 23.7%; constipation or fecal and flatal incontinence: 1 patient (0.4%). In patients of the 2nd group, there was a decrease in the pelvic floor dysfunction index from 48±12% to 10±2%. The index of influence on the quality of life decreased from 79±15% to 5% after 12 months. The use of synthetic implants causes the formation of de novo pelvic dysfunctions more often than the native tissue repair.

Gender affirmation female to male-metaidoioplasty

Description of an improved technique of metaidoioplasty (clitoris penoid) and presentation of the follow-up of our own patients in comparison to results in the literature. To reduce the complication rate of urethral strictures and urethrocutaneous fistula, the technique of metaidoioplasty was modified: After elongation of clitoris by incision of chorda the urethra-including the clitoral hood-was reconstructed by distally, broadly based flap of labia minora. In aretrospective follow-up study over 4years, 75patients completed questionnaires to assess complications and satisfaction/quality of life and urinary symptoms (ICIQ-FLUTS questionnaire). The same questionnaires were completed by 25patients pre- and 3months postoperatively. In the retrospective study, urethral strictures were detected in 1.4% of patients and urethrocutaneous fistulas in 9.4% of patients, which could be repaired in all cases. Furthermore, 39.5% of patients did not decide for phalloplasty and were satisfied with the appearance of the clitoris penoid in 85% and with their function in 88%. Asmall proportion of the patients developed urinary symptoms, which were mainly of minor severity and significantly dependent on age. In the prospective study, postoperative-versus preoperative-symptoms of urinary incontinence, nocturia, and obstructive micturition were slightly elevated, but mainly of minor severity. The improved technique of metaidoioplasty using distally broadly based labia-minora flaps resulted in high satisfaction with low urethral complication rates.

MP05-18 DO PREOPERATIVE DEMOGRAPHICS OR SYMPTOMS PREDICT RECURRENCE IN PATIENTS FOLLOWING COMBINED SURGICAL REPAIR FOR PELVIC ORGAN PROLAPSE AND RECTAL PROLAPSE?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse (MP05)1 Apr 2020MP05-18 DO PREOPERATIVE DEMOGRAPHICS OR SYMPTOMS PREDICT RECURRENCE IN PATIENTS FOLLOWING COMBINED SURGICAL REPAIR FOR PELVIC ORGAN PROLAPSE AND RECTAL PROLAPSE? Raveen Syan, Shannon Wallace*, Brooke Gurland, and Ekene Enemchukwu Raveen SyanRaveen Syan More articles by this author , Shannon Wallace*Shannon Wallace* More articles by this author , Brooke GurlandBrooke Gurland More articles by this author , and Ekene EnemchukwuEkene Enemchukwu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000819.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Growing evidence suggests combined surgical repair for pelvic organ prolapse (POP) and rectal prolapse (RP) is safe and effective, however recurrence rates of POP and/or RP following combined surgery are poorly described. We sought to characterize demographics and presenting symptoms in patients undergoing combined repair and determine pre-operative predictors of recurrence. METHODS: We performed a retrospective review of women who underwent combined RP and POP surgery at a single tertiary center from 2008-2019. Patient demographic data and preoperative symptoms were collected. Patients with recurrent POP (Stage 2 anatomic prolapse) and/or RP on examination were identified. RESULTS: Sixty-three women with a mean follow up time of 1.1 years were evaluated. Five patients were lost to follow up. Mean age at the time of surgery was 65, and the majority patients were Caucasian (62%) and non-smokers (51%) (Figure 1A). The most commonly reported symptoms related to POP were overactive bladder (OAB) (73%) and vaginal bulge (79%), while the most commonly reported symptoms related to RP were obstructive defecation (51%) and fecal incontinence (FI) (68%) (Figure 1A). Postoperatively, 71% of patients with OAB and 87% of patients with vaginal bulge symptoms reported improvement in symptom. Similarly, 81% of patients with obstructive defecation and 79% of patients with FI reported improvement in symptoms. Of thirteen patients (22%) with recurrent POP and/or RP, 7 patients had recurrent POP and 10 had recurrent RP. Increasing age, pulmonary disease, obesity, obstructive urination and obstructive defecation were associated with recurrent POP and/or RP (Figure 1B). After adjusting for confounders, age (OR 1.10 [1.03-1.22]), obesity (OR 25.97 [2.56-623.14]), and obstructive defecation (OR 6.57 [1.03-69.57]) remained statistically significant (Figure 1B). CONCLUSIONS: Though majority of patients who undergo combined POP and RP surgery have improvement in symptoms related to RP and POP, our study suggests that older, obese, women with pre-operative obstructive defecation may have a higher risk of prolapse recurrence. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e48-e49 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raveen Syan More articles by this author Shannon Wallace* More articles by this author Brooke Gurland More articles by this author Ekene Enemchukwu More articles by this author Expand All Advertisement PDF downloadLoading ...

The clinical signifi cance of urethral sphincter hyperkinesis in the treatment of benign prosta???? c hyperplasia

Introduction.Today there is many highly effective surgical approaches in the treatment of benign prostatic hyperplasia (BPH). New technologies in the treatment of BPH continue to be implemented. Despite this in some patients the results of surgical treatment for short-term and long-term monitoring is unsatisfactory.Purpose of research.Тo improve the results of treatment of patients with benign prostatic hyperplasiaMaterials and methods.The functional state of the urethral sphincter was studied in 123 patients with symptomatic BPH. According to the treatment method, all patients were separated into groups. Group 1 - patients with established standard indications for surgical treatment. After surgery, patients with persistent obstructive urination received therapy with a central muscle relaxant for three months. Group 2 - patients with uncomplicated BPH, having hypertonic urethral sphincter and receiving drug therapy according to the established urodynamic patterns.Results.Our analysis of the efficacy of surgical treatment of patients with BPH demonstrates a significant correlation between negative outcomes of surgery for BPH with increased tone of the external urethral sphincter. So, in 70.1% of cases, symptomatic obstructive Low Urinary Tract Symptoms (LUTS) in BPH were accompanied by increased tone of the urethral sphincter from standard parameters. We believe that these changes were related to the anatomical characteristics of nodular hyperplasia.Conclusions.Exactly this fact, that these patients had urethral sphincter dysfunction in 14.5% of cases made for poor effect of surgical treatment of BPH. Use of muscle relaxants centrally acting drug therapy in these cases, significantly improves the urodynamics of lower urinary tract, which is accompanied by regression of LUTS.

The outcome of Y-V plasty as a final option in patients with recurrent bladder neck sclerosis following failed endoscopic treatment.

IntroductionBladder neck sclerosis is a rare late complication of transurethral resection of the prostate (TURP). Endoscopic resection or incision of the bladder neck is usually successful in the management of such cases. In some cases, even repeated endoscopic management always followed with recurrent sclerosis. In these cases, the Y-V plasty of the bladder neck provides a final option of treatment.Material and methodsRetrospective evaluation of 24 patients who underwent Y-V plasty of the bladder neck from 2007 to 2014 was performed. All patients had TURP once and presented after at least 2 failed attempts of endoscopic management. The principle of this technique is to insert a V-shaped part of the bladder wall into the fibrosed bladder neck. The patient evaluation included measuring Q max, residual urine volume and asking about their satisfaction. All patients were operated in the same center by the same surgeon.ResultsThe mean age of patients at surgery was 66.8 years (range 56–74 years). All patients presented preoperatively with obstructive micturition with mean Qmax 2.2 ml/s (SD ±1.9) and mean residual urine volume of 381 ±169 ml. After a mean follow-up of 46 months (SD ±22), the mean Qmax reached 16.4 ml/s (SD 3.3) while the mean residual urine volume was 18 ml (SD ±6). Recurrent sclerosis occurred in three patients (12.5%). A total of 94.1% of patients reported satisfactory micturition with significant improvement in the quality of life.ConclusionsThe Y-V plasty can provide a final option with a high success rate for patients with bladder neck sclerosis after failed endoscopic treatment.

Urodynamic characteristics of lower urinary tract of patients with idiopathic overactive bladder.

Aims:The aims of this study were to determine the frequency and clinical significance of individual urodynamic signs, which revealed on the basis of the results of comprehensive urodynamic examination of patients with the idiopathic overactive bladder (IOAB), to produce definitions of these features, and to describe any necessary remedial action.Materials and Methods:To identify the most common features and artifacts, we conducted a combined urodynamic examination of 137 patients with IOAB (105 women and 32 men). Age, comorbidities, and urodynamic parameters were analyzed to determine the association between bladder sensation and contractility.Results:It was found that most patients suffer from the same type of bladder function impairment, often related to the decrease in the average effective capacity of the bladder, frequent urination, urgency urination, and urgent urinary incontinence events. Imperative nature of urination in patients with IOAB leads to the reduction maximum cystometric capacity in 75.9% of patients, increased bladder sensitivity threshold in 70.8%, detrusor overactivity in 35.8%, change in bladder compliance in 43.1%, and urethral instability in 24.8% of patients.Conclusions:Decreased ability of the bladder to accumulate and hold the urine under the normal or low intravesical pressure and frequent association of bladder instability with signs of obstructive urination are major peculiarities of the impaired urodynamics of the lower urinary tract in patients with IOAB.

Morbidity of a Single Incision Transvaginal Mesh to Correct Apical Prolapse

To determine complications and related reintervention rates associated with use of the Uphold Vaginal Support System (Boston Scientific, Boston, MA) for symptomatic vaginal apical prolapse. A multicenter retrospective study. Two teaching hospitals. Fifty-nine women with symptomatic vaginal apical prolapse. Vaginal apical prolapse surgery using the Uphold Mesh Kit system with or without other concomitant procedures. A chart review was performed, including the following parameters: perioperative and postoperative complications, repeat surgery, and recurrence rate. A total of 59 patients met the criteria for inclusion in the study. Bladder perforation occurred perioperatively in 1 patient. Postoperative voiding difficulties were observed in 16 patients (27.1%), including 9 women (15.2%) who left the hospital with an indwelling catheter in place. There were 5 cases (8.5%) of transient groin pain, all of which resolved spontaneously. One patient developed a vaginal hematoma. Nine women (15%) required reoperation, including 4 (6.7%) because of recurrent prolapse and 1 (2%) for pelvic pain considered related to the mesh. Three patients (5%) required release of a midurethral sling (MUS) that had been placed concomitantly with the Uphold system. Two patients (3%) required a MUS for de novo stress incontinence. Use of the Uphold Vaginal Support System for symptomatic vaginal apical prolapse was associated with a significant risk of obstructed micturition. In our study population, 15% required repeat surgery, mainly for recurrent pelvic organ prolapse and de novo stress urinary incontinence. No surgical-related complication resulted in long-term morbidity.

MODERN METHODS OF TREATING DISEASES OF THE BULBO-MEMBRANOUS PART OF URETHRA

Strictures of the bulbous-membranous urethra are a common cause of obstructive urination disorder. Modern trends in the development of medicine lead to a wider application of endoscopic method, a more frequent cause of iatrogenic injury of the urethra. At present, conservative, endourologic and reconstructive methods of care are used to treat urethral strictures. There are several conservative, endourological and reconstructive methods for treating patients with urethral stricture. Conservative methods include interventions that do not involve the destruction of urethral stricture or its reconstruction, such as stenting, blind dilatation, and recanalization of the urethra. Performing blind dilatation strictures of the bulbo-membranous urethra is not recommended because of the high risk of false path formation and low efficiency. Endourological operations refer to surgical methods of care and suggest the natural restoration of urethral tissues after the destruction of stricture. Because of the low effectiveness of correction of strictures of the posterior urethra (more than 90 % of relapses in five years), this method is a variant of temporary or palliative care. Currently, two approaches to the reconstruction of the bulbo-membranous urethra are used: anastomotic and replacement operations. Anastomotic surgery involves excision of the affected area and juxtaposition of healthy urethral tissues without tension. Replacement plastic allows to restore patency of the urethra by increasing the diameter of the lumen due to the implantation of various grafts. The article shows that, based on international clinical studies, the most effective method of reconstructing the bulbomembranous urethra is reconstructive surgical methods.

Primary female epispadias: Perineal approach or Kelly repair?

Primary female epispadias encompasses a spectrum of disease, presenting with a variable degree of incontinence. We hypothesized that although perineal urethrocervicoplasty can be a successful first-line procedure in patients with normal bladder, a more radical reconstruction was necessary to achieve continence in cases lying at the most severe end of the spectrum. Our aim was to assess the results of a surgical management using perineal approach in girls with normal bladder capacity, and Kelly radical soft-tissue mobilization (RSTM) in patients with inadequate bladder, based on the assumption that bladder capacity (BC) is a reliable marker of epispadias severity. Prospective inclusion of incontinent girls with female epispadias referred to a single institution. Patients with normal BC were treated with perineal urethrocervicoplasty (PUCP, group 1). Patients with small bladder underwent RSTM (group 2). Follow-up was at 1, 3, 6, and 12 months postoperatively, then annually, including physical examination, renal ultrasound at each visit, continence status, and estimation of functional/maximal BC. The main study outcome was continence status at the age of 5 years or later, if postoperative follow-up was >12 months. From 2006 to 2017, 16 consecutive children were prospectively included in this study, at a median age of 39 months (5-102 months). Seven girls were included in group 1 and underwent PUCP; at the last follow-up, five out of seven were dry by day (4/5 day and night), although three out of five required bladder-neck injection after perineal reconstruction due to stress incontinence. Two patients with persistent incontinence and absence of BC increase after PUCP subsequently underwent RSTM. Eleven patients with low BC (56% [10-94%] of expected BC) were included in group 2 (9 without prior surgery, 2 after PUCP failure). Among the eight evaluable patients, eight out of eight achieved diurnal continence, and 3/8 were fully continent. One girl with obstructive micturition required clean intermittent catheterization. The traditional approach of female epispadias based on staged reconstruction (urethroplasty followed by bladder-neck reconstruction) raised concerns regarding the risk of non-physiological obstructive micturition. The perineal approach was suggested as an alternative, with reported diurnal continence rates of 60-80%, but less than 50% of nocturnal continence, presumably in relation with limited bladder capacity. In cases selected within the most severe end of the epispadias spectrum, the Kelly RSTM seems to offer excellent continence rates. A tailored approach to female epispadias, based on perineal reconstruction in favorable cases, and radical soft-tissue mobilization in severe cases, seems to yield good continence outcomes in the long term.

Role of Uttarabasti in the management of Functional Bladder Outlet Obstruction: A Case Study

Bladder outlet obstruction (BOO) produces compression or resistance upon the bladder outflow channel at any location from the bladder neck to urethral meatus. It may be induced by specific functional and anatomic causes. Functional obstruction may be caused by detrusor-sphincter dyssynergia (DSD) and anatomic obstruction most commonly from benign prostatic enlargement (BPH) or urethral stricture. Obstructive symptoms include hesitancy, sensation of incomplete bladder emptying, diminished urinary stream. The combination of PVR, urinary flow measures, and symptom appraisal has been generally accepted as the initial screening and evaluation paradigm for BOO. In, Ayurveda, BOO is similar to Mutraghata means obstruction in the urine flow. Uttarbasti is the prime treatment of Mutraghata. Present case is diagnosed as a functional bladder outlet obstruction (BOO) on the basis of symptoms, normal reports of USG and ascending urethrogram and diminished flow of urine in Uroflowmetry. Total 7 Uttarbasti with 50ml Sahcharadi Tailam was given along with Rasayana and Mutraghatahara medicine. Patient has complete relief in his obstructive urine complains and has normal urine flow without taking Tab. AFDURA after 7 years. And also improvement appear in Uroflowmetry.

Urodynamic Patterns of the Idiopathic Overactive Bladder

The aim of study was the investigation of frequency and clinical significance of selected stereotypical recurring urodynamic patterns, which are manifested by the results of a complex urodynamic study in patients with idiopathic overactive bladder. The combined urodynamic study (CUS) was conducted in 137 patients with IOAB. The standard cystotonometry allowed to observe the maximum cystometric capacity. It also allowed to determine the bladder sensitivity (BS) and detect the presence of detrusor overactivity (DO). The results of retrograde cystotonometry established three variants of detrusor overactivity: phase DO, terminal DO, and stress-induced DO. The study of the bladder function using methods of UFM and EMG of anal sphincter in the emptying phase, confirmed the association of obstructive urination with incomplete discharge of the urethra from the effects of the sphincter. The coordination of function of the detrusor and external sphincter were assessed according to the results of CUS and sphincteric EMG. The EMG analysis in Work / Rest Assessment mode allowed to reveal the characteristic changes in the biopotential indices of the pelvic sphincter and indicated their correlation with the clinical features of the disease course. The imperative character of urination was established in 137 patients with IOAB during CUS characterized by hyperactivity and hypertensity of bladder, depending on the severity of the violation of the integrative function of LUT.

Prevention of stricture recurrence following urethral internal urethrotomy: routine repeated dilations or active surveillance?

Strictures of the urethra are the most common cause of obstructed micturition in younger men and there is frequent recurrence after initial treatment. Currently, routine repeated dilations, including intermittent self-catheterisation (ISC) are prescribed by urologists to prevent urethral stricture recurrence. There is, however, no high level evidence available supporting the effectiveness of practicing these painful techniques. Balancing efficacy, adverse effects and costs, we hypothesize that active surveillance is a better option for preventing stricture recurrence as compared with routine repeated dilations. However, well designed, adequately powered multi-center trials with comprehensive evaluation are urgently needed to confirm our hypothesis.&nbsp.