Persistent Lower Urinary Tract Symptoms Research Articles

Persistent Lower Urinary Tract Symptoms After BPH Surgery.

Lower urinary tract symptoms (LUTS) after surgical management for BPH pose a significant clinical challenge for urologists. Despite high success rates in relieving LUTS, there is a subset of patients who experience persistent symptoms after intervention. In this review article, we describe the management of patients with new or persistent LUTS after endoscopic bladder outlet surgery. Previously, the goal for BPH management was to remove as much adenomatous tissue as possible. While potentially effective, this may lead to unwanted side effects. There has been a recent paradigm shift for new minimally invasive surgical therapies (MIST) that strategically treat adenomatous tissue, adding potential complexity in managing patients with new or residual symptoms in the postoperative setting. There is a paucity of literature to guide optimal workup and care of patients with persistent LUTS after surgical management. We characterize patients into distinct groups, defined by types of symptoms, irritative versus obstructive, and timing of the symptomatology, short term versus long term. By embracing this patient-centered approach with shared decision management, clinicians can optimize outcomes efficiently improving their patients' quality of life.

Can we predict and manage persistent storage and voiding LUTS following bladder outflow resistance reduction surgery in men? ICI-RS 2023.

Lower urinary tract symptoms (LUTS) persist in up to 50% of patients after bladder outflow resistance reduction surgery (BORRS) in men. Our think tank aims to address the predictive factors for persistent LUTS after BORRS and to propose the recommendations for future research to enable improved better patient counseling and selection by more accurate prediction of treatment outcome. A think tank of ICI-RS gathered in 2023, Bristol, UK, to discuss the pre and postsurgical clinical and urodynamic evaluation of men undergoing BORRS and whether it is possible to predict which men will have persistent LUTS after BORRS. Our think tank agrees that due to the multifactorial, and still not fully understood, etiology of male LUTS it is not possible to precisely predict in many men who will have persistent LUTS after BORRS. However, severe storage symptoms (overactive bladder, OAB) in association with low volume and high amplitude detrusor overactivity and low bladder capacity in preoperative urodynamics, increase the likelihood of persistent OAB/storage symptoms after BORRS. Furthermore, patients who are clearly obstructed and have good bladder contractility on preoperative pressure flow studies do better postoperatively compared to their counterparts. However, the benefit of pressure flow studies is decreased in patients who do not acceptably void during the study. Poor voiding after BORRS may occur due to persistent obstruction or detrusor underactivity. Future research is needed to increase our understanding of why male LUTS persist after surgery, and to enable better patient selection and more precise patient counseling before BORRS.

Korean Medicine Treatment Accompaning Myofascial Trigger-Point Accupuncture for Lower Urinary Tract Symptoms after Radical Prostatectomy : A Case Report

Objectives: The purpose of this study is to report a case of Korean medicine treatment accompaning myofascial trigger-point accupuncture for severe & persistent lower urinary tract symptoms after radical prostatectomy.Materials and Methods: A prostate cancer patient with severe & persistent lower urinary tract symptoms after radical prostatectomy conducted 26 months ago, was treated with Korean medicine accompaning myofascial trigger-point accupuncture. The International Prostate Symptom Score(IPSS), the IPSS Quality of Life(IPSS-QoL) and the Overactive Bladder Symptom Score(OABSS) questionaires were administered to evaluate the effect of treatment for lower urinary tract symptoms.Results: After 5 month treatment with Korean medicine accompaning myofascial trigger-point accupuncture, IPSS, IPSS-QoL and OABSS progressed from 28 to 8, from 5 to 2 and from 12 to 4 respectively.Conclusion: This case study suggests that Korean medicine accompaning myofascial trigger-point accupuncture may contribute to treat severe & persistent lower urinary tract symptoms after radical prostatectomy.

Urinary Bladder Diverticulum: A Single-Center Experience in the Management of Refractory Lower Urinary Symptoms Using a Robotic Platform.

Introduction Urinary bladder diverticulum (UBD) is commonly seen in urological practice and, in most cases, does not need treatment specifically directed towards it. However, it can give rise to symptoms that are not distinct from this finding. This makes the evaluation and management of this complex patient group challenging. We present our experience with robotic bladder diverticulectomy (RBD) for acquired bladder diverticulum to assess the outcomes and safety of this procedure when patient symptoms have failed to respond to either medical or surgical treatment directed at other associated contributing factors. Methods We retrospectively collected data on all patients who underwent RBD for persistent lower urinary tract symptoms (LUTS) at Royal Surrey County Hospital, Guildford, between 2016 and 2021, including baseline characteristics, urodynamic findings, intraoperative and postoperative outcomes, and a six-month follow-up. Patients who were diagnosed with cancer in the diverticulum, associated pathology that may contribute to their symptoms, or who had concomitant procedures at the time of RBD were excluded from this study. Results We had six patients who underwent RBD; the median age and body mass index (BMI) were 63.8 years (range 48-73) and 27.1 kg/m2(range 24-32), respectively. The most common presenting symptoms were refractory LUTS and recurrent urinary tract infections (UTIs). The urodynamic evaluation revealed varying findings like bladder outlet obstruction (BOO), poor compliance, and equivocal readings in these patients. All patients reported incomplete bladder emptying and double voiding, with half practicing clean intermittent self-catheterization (CISC). Diverticulum size averaged 9.4 cm (range 8.5-12). The median operative time and blood loss were 166 mins (range 150-180) and 75 mls (range 50-100), respectively. The average length of stay was 1.6 days (range 1-3). Three patients developed UTIs within a month after surgery, requiring a course of oral antibiotics. Post-void residual (PVR) measured an average of 32.6 mls (range 0-161) postoperatively compared to a preoperative average of 249 mls (range 125-400), showing a two-tailed p-value of 0.016. The International Prostate Symptom Score (IPSS) score for these patients showed an average of 27.83 (range 24-31) preoperatively compared to the postoperative average of eight (range 7-12), showing a two-tailed p-value of 0.0001. Final histology showed no malignancy, and all patients reported symptom improvement, with none requiring CISC after surgery. Conclusion RBD is a safe and effective procedure in carefully selected patients with refractory LUTS and UTIs showing good postoperative and functional outcomes. The presence of a large diverticulum can have a complex effect on bladder dynamics. In the era of robotic surgery and enhanced recovery, discussion about diverticulectomy should be encouraged after proper evaluation and counseling for patients who have failed to improve with other measures of treatment for their symptoms.

Risk Factors for Persistent Lower Urinary Tract Symptoms 1 Month Following Convective Water Vapor Thermal Therapy (CWVTT-Rezum)

To investigate the incidence and risk factors of persistent lower urinary tract symptoms (LUTS) 1 month and later following convective water vapor thermal therapy (CWVTT) in men with LUTS secondary to benign prostatic hyperplasia (BPH). Patients who underwent CWVTT from 11/2018-5/2021 at a single institution were eligible for inclusion and retrospectively identified. Pertinent patient, operative, and outcomes data were extracted. The primary outcome was clinically significant LUTS improvement at 4 weeks following CWVTT. Persistent LUTS was defined as failure to reach a minimally clinical important difference of 25% reduction on International Prostate Symptom Score at 4 weeks. One hundred nine patients qualified. Fifty percent of patients experienced persistent LUTS at 1 month. Eighty-two percent of men ultimately reached the minimally clinical important difference. For each additional month following CWVTT, the odds of achieving clinically significant LUTS improved by 9% (Odds ratio (OR)=0.91, P=.0033). Bladder outlet obstruction index and prior surgical BPH therapy were associated with persistent LUTS on multivariate logistic regression. Every 10-unit increase in Bladder outlet obstruction index noted at baseline was associated with a 15% increased likelihood of achieving minimally clinical important difference in LUTS at 4 weeks following CWVTT (OR=0.85, P=.01). Patients receiving prior surgical BPH therapy were 3.5 times more likely to experience persistent LUTS at 1 month (OR=3.47, P=.01). Fifty percent of men experienced persistent LUTS 1 month following CWVTT. However, LUTS improved with time and the majority of men ultimately achieved clinically significant LUTS improvement. A lower baseline Bladder outlet obstruction index and prior BPH procedures are risk factors for persistent LUTS following CWVTT.

MP74-13 LONG TERM OUTCOMES OF COVID-19 ASSOCIATED CYSTITIS (CAC)

You have accessJournal of UrologyCME1 Apr 2023MP74-13 LONG TERM OUTCOMES OF COVID-19 ASSOCIATED CYSTITIS (CAC) Sina Mehraban-Far, Sorabh Dhar, Michael Chancellor, Samer Kirmiz, Steven Lucas, and Nivedita Dhar Sina Mehraban-FarSina Mehraban-Far More articles by this author , Sorabh DharSorabh Dhar More articles by this author , Michael ChancellorMichael Chancellor More articles by this author , Samer KirmizSamer Kirmiz More articles by this author , Steven LucasSteven Lucas More articles by this author , and Nivedita DharNivedita Dhar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: COVID-19 associated cystitis (CAC) is a newly-described condition associated with new onset or exacerbations of baseline urinary symptoms (e.g. overactive bladder (OAB) symptoms) that may present as a manifestation of Long COVID. Little is known on the management and long-term outcomes for patients suspected of having CAC. In this study we aim to assess the long term efficacy of conservative OAB the on their symptoms. METHODS: In this prospective cohort study, we identified patients with CAC 10-14 weeks following discharge from 2 academic downtown Detroit hospitals with new or worsening OAB during 5/22/2020 to 12/31/2020. Symptoms were assessed at baseline and at 21-28 months post-discharge using the AUA’s 5 symptom OAB assessment tool and 4 quality-of-life (QoL) symptoms, based on gender and changes in urinary symptom status. RESULTS: A total of 350 patients with CAC were identified, of which 250 (71%) had new onset, and 100 (29%) had worsening OAB symptoms after COVID hospitalization (Table 1). Follow up at 21-28 months revealed significant decreases in median OAB and QoL scores for all groups (Table 2). Overall, 270 (87%) of the 310 patients improved with standard therapies (e.g. behavioral modification), with a decrease in the OAB and Qol score from 18 and 19 to 7 and 8 respectively. Of the 250 patients with new onset symptoms, 220 (95.4%) had improvement in symptoms, whereas, of those with existing OAB symptoms only 60 (60.7%) improved. In the later, OAB and Qol scores decreased by 6 points compared with 9-10 in the new onset group, with a lack of return to baseline status. No differences were noted among improvements in symptoms between females and males. CONCLUSIONS: We hereby report the first long-term follow-up of patients who developed CAC and assessed the prognosis of CAC in Long COVID. We found that after 21-28 months, only 13% (40/310) of patients had persistent lower urinary tract symptoms. Patients with Long COVID and CAC may be reassured that symptoms resolves in vast majority of cases and that supportive and reversible treatment should be recommended. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1074 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sina Mehraban-Far More articles by this author Sorabh Dhar More articles by this author Michael Chancellor More articles by this author Samer Kirmiz More articles by this author Steven Lucas More articles by this author Nivedita Dhar More articles by this author Expand All Advertisement PDF downloadLoading ...

Follow-Up of Post-Prostatectomy Patients with Persistent Lower Urinary Tract Symptoms

Follow-Up of Post-Prostatectomy Patients with Persistent Lower Urinary Tract Symptoms

PD61-02 RE-TREATMENT FOR PERSISTENT LOWER URINARY TRACT SYMPTOMS AFTER CONVECTIVE WATER VAPOR THERMAL PROSTATE ABLATION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology IV (PD61)1 Apr 2020PD61-02 RE-TREATMENT FOR PERSISTENT LOWER URINARY TRACT SYMPTOMS AFTER CONVECTIVE WATER VAPOR THERMAL PROSTATE ABLATION Garrick Greear*, Thomas DiPina, and Seth Bechis Garrick Greear*Garrick Greear* More articles by this author , Thomas DiPinaThomas DiPina More articles by this author , and Seth BechisSeth Bechis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000978.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Convective water vapor thermal prostate ablation is a minimally invasive treatment for lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). We present data from a cohort of patients undergoing convective water vapor thermal treatment of the prostate who underwent additional treatment for relief of symptoms. METHODS: A retrospective review of patients treated with water vapor thermal therapy at a single institution from August 2017 to August 2019 was conducted. Patient demographics, relevant pre- and peri-operative data, and international prostate symptoms scores (IPSS) were evaluated. Patients who underwent a subsequent procedure were compared to the cohort who did not undergo re-treatment. Descriptive statistics and Student’s t-test were performed. RESULTS: Data from 136 consecutive patients undergoing water vapor thermal therapy were collected and analyzed. The re-treatment rate over the study period was 7.4% with a median follow up of 183 days (IQR 90.7 – 295). Longer follow up was observed in patients who underwent a subsequent procedure (median 331 days, IQR 208 – 332). Men in the re-treatment cohort tended to be older (73.0 vs. 66.7 yrs, p = 0.04). No difference in prostate size, baseline IPSS score, number of treatments, or the treatment of a median lobe appeared to be associated with re-treatment (Table 1). The modality of retreatment was: transurethral resection of prostate (n = 5), photo-vaporization (n = 3), sacral neuromodulation (1), simple prostatectomy (1). IPSS scores appeared to diverge from the main cohort around 6 months post-operatively (p < 0.02) (Table 2.). CONCLUSIONS: The re-treatment rate after water vapor thermal therapy for BPH is low. Men in this cohort tended to be older and worsening symptom scores were observed at 6 months post-operatively. These data can inform counseling as to the timing of re-intervention in men with persistent bothersome lower urinary tract symptoms following minimally invasive outlet reduction. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1280-e1280 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Garrick Greear* More articles by this author Thomas DiPina More articles by this author Seth Bechis More articles by this author Expand All Advertisement PDF downloadLoading ...

A Case of Malakoplakia Mimicking Prostatic Malignancy

Malakoplakia is a granulomatous inflammatory condition commonly involving the urogenital tract. Principally it involves the urinary bladder, prostate is a rare site. Clinical and radiological examination sometimes mimics malignancy. Histology remains confirmatory modality for the diagnosis. Hereby we report a case of prostatic malakoplakia in an elderly male who presented with lower urinary tract symptoms in the past fifteen days. Urine routine microscopy showed pus cells; culture report was positive for E. coli. Serum Prostate Specific antigen (PSA) was 4.6 ug/ml. Magnetic Resonance Imaging (MRI) showed a bulky prostate. A 12-core biopsy was done to rule out malignancy and the histopathology showed benign prostatic glands and the stroma with a predominant population of epithelioid histiocytes and the characteristic Michealis-Gutmann bodies. After a course of antibiotic Nitrofurantoin, transrectal ultrasound was repeated which showed reduction in the prostatic volume. Subsequently Trans-Urethral Resection of Prostate (TURP) was done to relieve the persistent lower urinary tract symptoms. Histology showed similar features. Special stains – Von kossa and Prussian Blue highlighted the Michealis-Gutmann bodies.

Dorsolateral Onlay Buccal Mucosal Urethroplasty for Anterior Urethral Strictures by Unilateral Urethral Mobilization

Purpose: Complete urethral mobilization may endanger the lateral vascularity of the urethra in buccal mucosal graft (BMG) urethroplasty in stricture urethral disease. The present study aimed to evaluate the outcomes of BMG urethroplasty by dorsolateral onlay technique in patients with anterior urethral stricture. Materials and Methods: This was a prospective interventional study conducted at the Department of Urology at PSG Institute of Medical Sciences and Research between January 2015 and December 2018. Patients diagnosed with anterior urethral stricture who underwent dorsolateral onlay urethroplasty were included in this study. Results were considered satisfactory with the Qmax between 8 mL/s and 15 mL/s. Failed outcome was defined as persistent lower urinary tract symptoms, stricture on retrograde urethrogram, Qmax &lt;8 mL/s, and requiring repeated urethra intervention. Results: A total of 54 patients underwent BMG urethroplasty by dorsolateral onlay graft with a mean age of 47.6 years. The patients with a range of stricture length 3–14 cm were included in this study. Short-term success rate (Qmax &gt;15 mL/s) was achieved in 42 patients, while satisfactory results (Qmax 8–15 mL/s) were observed in nine patients and failure (Qmax &lt;8 mL/s) occurred in three patients. Oral and perineal complications were treated conservatively with oral antibiotics and analgesia. None of the patients in this study had a postoperative perineal hematoma, graft infection, and scrotal swelling. Conclusion: Overall observations suggest that dorsolateral onlay BMG urethroplasty with unilateral urethral mobilization for an anterior urethral stricture is a feasible and effective option with favorable outcomes.

Utility of DNA Next-Generation Sequencing and Expanded Quantitative Urine Culture in Diagnosis and Management of Chronic or Persistent Lower Urinary Tract Symptoms.

Many patients suffer from chronic, irritative lower urinary tract symptoms (LUTS). The evaluation and management of these patients have proven difficult with the use of standard diagnostic tools, including urinalysis and urine culture. The growing body of literature on the urinary microbiome has looked at the possible implications of the bladder microbiome and dysbiosis, or perturbations in the microbiome, in conditions associated with chronic LUTS. Disorders such as recurrent urinary tract infections (UTIs) and interstitial cystitis have been studied utilizing 16S rRNA rapid next-generation gene sequencing (NGS) and expanded quantitative urine culture (EQUC). In this article, we first present a brief review of the literature describing the current understanding of the urinary microbiome and the features and applications of NGS and EQUC. Next, we discuss the conditions most commonly associated with chronic, persistent LUTS and present the limitations of current diagnostic practices utilized in this patient population. We then review the limited data available surrounding treatment efficacy and clinical outcomes in patients who have been managed based on results provided by these two recently established diagnostic tools (DNA NGS and/or EQUC). Finally, we propose a variety of clinical scenarios in which the use of these two techniques may affect patients' clinical outcomes.

Associations between maternal serum and urinary metal concentrations and birthweight

Subjective measures of success after urethroplasty have become increasingly valuable in postoperative monitoring. We examined patient reported satisfaction following anterior urethroplasty using objective measures as a proxy for success.Men 18 years old or older with urethral strictures undergoing urethroplasty were prospectively enrolled in a longitudinal, multi-institutional urethroplasty outcomes database. Preoperative and postoperative assessment included questionnaires to assess lower urinary tract symptoms, pain, satisfaction and sexual health. Analyses controlling for stricture recurrence (defined as the inability to traverse the reconstructed urethra with a flexible cystoscope) were performed to determine independent predictors of dissatisfaction.At a mean followup of 14 months we found a high 89.4% rate of overall postoperative satisfaction in 433 patients and a high 82.8% rate in those who would have chosen the operation again. Men with cystoscopic recurrence were more likely to report dissatisfaction (OR 4.96, 95% CI 2.07–11.90) and men reporting dissatisfaction had significantly worse uroflowmetry measures (each p <0.02). When controlling for recurrence, multivariate analysis revealed that urethra and bladder pain (OR 1.71, 95% CI 1.05–2.77 and OR 2.74, 95% CI 1.12–6.69, respectively), a postoperative decrease in sexual activity (OR 4.36, 95% CI 2.07–11.90) and persistent lower urinary tract symptoms (eg straining to urinate OR 3.23, 1.74-6.01) were independent predictors of dissatisfaction.Overall satisfaction after anterior urethroplasty is high and traditional measures of surgical success strongly correlate with satisfaction. However, independently of the anatomical appearance of the reconstructed urethra, postoperative pain, sexual dysfunction and persistent lower urinary tract symptoms were predictors of patient dissatisfaction.

Higher neural contribution underlying persistent lower urinary tract symptoms in men with Benign Prostatic Hyperplasia undergoing bladder outlet procedures

Introduction and BackgroundBenign Prostatic Hyperplasia (BPH) affects the micturition cycle. Lower urinary tract symptoms (LUTS) refers to storage symptoms such as urinary frequency, urgency, urge urinary incontinence and nocturia. Surgical options for bladder outlet obstruction (BOO) are currently offered for symptomatic improvement. However, 30% of patients report persistent LUTS after BOO procedures. Neuroplasticity induced by BPH and BOO can be contributory in these men, having different brain activation patterns during the micturition cycle. Our multimodal functional Magnetic Resonance Imaging (fMRI) study will identify for the first time, structural and functional brain contributions to LUTS in men with BPH and BOO at baseline and following BOO procedures. We hypothesize that men with symptomatic BPH with persistent LUTS following BOO procedures have a distinct brain activation pattern in regions of interest (ROIs) of the micturition cycle. MethodsMale patients older than 45 years of age undergoing BOO procedures will be enrolled and categorized in two groups. Group 1: patients with BPH with significant improvement in storage symptoms after BOO procedures. Group 2: patients with BPH with persistent storage symptoms after BOO procedures. Our control group are male patients without LUTS undergoing radical prostatectomy. Patients will complete subjective questionnaires and post void residual at clinic visits. BOLD signals at full urge will be measured at baseline and following BOO procedures. All patients will undergo fMRI studies at baseline and at 6 months. Clinical data will be correlated to BOLD signal changes as well as to structural changes in white matter tracts. Ethics and disseminationAfter IRB approval, patients will be recruited and properly consented before enrolling to this study. Results of neural contribution to lower urinary tract symptoms will be presented at national and international meetings and will be published in scholarly journals.

Impact of transcutaneous interferential electrical stimulation for management of primary bladder neck dysfunction in children

Several studies have revealed that electrical stimulation is an effective modality for treatment of lower urinary tract (LUT) dysfunction via raising the capacity or compliance of the bladder or maybe by pelvic floor relaxation and reducing detrusor pressure as well. This study aimed to assess the efficacy of transcutaneous interferential (IF) electrical stimulation on LUT symptoms as well as urine flow parameters in children with primary bladder neck dysfunction (PBND). We reviewed the charts of all children with persistent LUT symptoms who underwent IF electrical stimulation between 2010 and 2017. Twenty-three neurologically and anatomically normal children (mean age: 7.7years, range: 5-13) with LUT symptoms were included in this study. Children had different LUT symptoms such as hesitancy, straining, urinary incontinence and constipation with no sufficient response to medical treatment (α -blocker) for at least 6months. IF electrical stimulation was performed for 15 sessions, two times per week. All children were symptomatic and had abnormal urine flow pattern with an electromyographic (EMG) lag time of more than 6s on uroflowmetry with EMG. A voiding chart, uroflowmetry with EMG and kidney and bladder ultrasounds were performed before and after the treatment for all children. Maximum and average urine flow rates, EMG lag time and postvoid residual volume were analyzed. In addition, alpha blocker therapy was continued during IF therapy. Mean maximum and average urine flow rates improved from 14.1 to 7.6-19.7ml/s and 9.5ml/s, respectively, while mean EMG lag time decreased from 11.7 to 5.2s after the treatment (all P<0.05). Also postvoid residual volume decreased significantly from 35.6 to 7.6mlat the end of treatment courses. Pelvic floor EMG lag time, a documented parameter on uroflowmetry with EMG, defined as the time from the start of pelvic floor relaxation during a volitional voiding effort (the first stage of normal voiding) to the start of urine flow. Results showed that IF therapy decreased pelvic floor EMG lag time in children with PBND. In addition, increase in mean maximum and average urine flow rates in our patients indicated that pelvic IF therapy and behavioral modification improved voiding dysfunction in most of the patients and probably decreased bladder neck activity during voiding. Future studies with larger sample size are needed to support this finding. IF therapy appears safe, effective and reproducible in improvement of PBND in children.

Patient-reported outcomes and urodynamic findings in men with persistent lower urinary tract symptoms following robot-assisted radical prostatectomy.

To evaluate the patient-reported outcome measures (PROMs) and urodynamic findings in men seeking intervention for lower urinary tract symptoms (LUTS) after robotic-assisted radical prostatectomy (RARP) in a regional referral center for continence surgery. Consecutive men with post-RARP LUTS, who were referred for specialist evaluation and urodynamics between December 2012 and October 2017, were evaluated. Men were invited to complete the International Consultation on Incontinence Questionnaire on Male Lower Urinary Tract Symptoms Long Form (ICIQ-MLUTS) pre-operatively and at 6, 12 and 18 months post-RARP. In total 64/860 (7.4%) men post-RARP were referred for specialist evaluation. There was a significant increase in total ICIQ-MLUTS and bother scores at 6, 12 and 18 months compared with the baseline in these men (P < 0.001 and P < 0.05, respectively). Urodynamics identified 41/64 (64%) had urodynamic stress incontinence (USI) only, 2/64 (3%) had detrusor overactivity (DO) only and 11/64 (17%) had a combination of USI and DO. Of those referred to a continence specialist 29/64 (45%) underwent a continence procedure. Patients with bothersome LUTS post-RARP have higher baseline ICIQ-MLUTs scores and significant worsening of total scores at all time points compared with the baseline. Routine use of PROMs may identify patients at risk of bothersome symptoms after RARP and prompt earlier referral for further management of their LUTS. Urodynamic evaluation revealed that the most common finding was pure stress incontinence but the range of urodynamic diagnoses highlights the need to perform urodynamics before making treatment decisions for men with LUTS post-RARP.

Assessment of lower urinary symptom flare with overactive bladder symptom score and International Prostate Symptom Score in patients treated with iodine-125 implant brachytherapy: long-term follow-up experience at a single institute

BackgroundThe aim of this study was to evaluate the combined use of the overactive bladder symptom score (OABSS) and International Prostate Symptom Score (IPSS) as an assessment tool for urinary symptom flare after iodine-125 (125I) implant brachytherapy. The association between urinary symptom flare and prostate-specific antigen (PSA) bounce was investigated.MethodsChanges in the IPSS and OABSS were prospectively recorded in 355 patients who underwent seed implantation. The percentage distribution of patients according to the difference between the flare peak and post-implant nadir was plotted to define significant increases in the scores. The clinicopathologic characteristics, treatment parameters, and post-implant dosimetric parameters were compared between the non-flare and flare groups. PSA bounce was defined as an elevation of ≥0.1 ng/mL or ≥0.4 ng/mL compared to the previous lowest value, followed by a decrease to a level at or below the pre-bounce value.ResultsA clinically significant increase required an IPSS increase of at least 12 points and an OABSS increase of at least 6 points based on a time-course analysis of total scores and the QOL index. Assessment only by IPSS failed to detect 40 patients (11%) who had urinary symptom flare according to the OABSS. Univariate and multivariate analyses revealed that patients treated with higher biologically effective doses and those without diabetes mellitus had higher risks of urinary flare. There was no statistical correlation between the incidence and time of urinary symptom flare onset and that of a PSA bounce.ConclusionsTo our knowledge, this is the first report to prove the clinical potential of the OABSS as an assessment tool for urinary symptom flare after seed implantation. Our findings showed that persistent lower urinary tract symptoms after seed implantation were attributed to storage rather than to voiding issues. We believe that assessment with the OABSS combined with the IPSS would aid in decision-making in terms of timing, selection of a treatment intervention, and assessment of the outcome.

Transurethral resection of the prostate achieves favorable outcomes in stroke patients with symptomatic benign prostate hyperplasia

Objectives: To evaluate the surgical outcomes of stroke patients with symptomatic benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP) and compare the clinical outcomes between patients with stroke and those without stroke receiving this procedure.Methods: This retrospective cohort study analyzed claims data collected during the period of 1997–2012 from Taiwan National Health Insurance Research Database. We enrolled 6625 patients who had persistent lower urinary tract symptoms and underwent TURP for BPH. They were categorized into a stroke (n = 577) and nonstroke (n = 6048) group. Patient characteristics, postoperative clinical outcomes, medication records, and medical expenses were compared.Results: Compared with the stroke group patients, those in the nonstroke group were younger, had fewer comorbidities, and more favorable postoperative clinical outcomes. Nevertheless, TURP achieved favorable outcomes in stroke patients with symptomatic BPH. In the stroke group, the rate of urinary tract infection (UTI) decreased from 34.7% during 1 year preoperatively to 29.8% during 1 year postoperatively (p = .05). The rate of urinary retention (UR) also decreased from 55.5% during 1 year preoperatively to 22.5% during 1 year postoperatively (p = .05). TURP reduced the overall medical expenses of patients with stroke. Annual patient medical expense during 1 year preoperatively, 1 year postoperatively, 2 years postoperatively, and 3 years postoperatively was NT$659,000, NT$646,000, NT$560,000, and NT$599,000, respectively.Conclusions: In patients with stroke, TURP reduces the risks of UTI and UR and annual total medical expense.

Multidetector CT urography in urogenital tuberculosis: use of reformatted images for the assessment of the radiological findings. A pictorial essay.

Urogenital tuberculosis (UGTB) is the most common form of extrapulmonary TB and is responsible for a destructive inflammation of the renal parenchyma and urinary tract often leading to the loss of kidney function. For these reasons, the early diagnosis of this disease, once considered disappeared in developed countries, is very important to establish a prompt and efficient treatment. However, the subtle and non-specific symptoms, often represented by recurrent and persistent lower urinary tract symptoms, can confound and delay the diagnosis. Therefore, an adequate and comprehensive imaging study is necessary in patients with persistent urinary tract infections not responding to the antibiotics and can suggest the hypothesis although bacteriological and/or histologic analysis is required for a definitive diagnosis. In the past years, intravenous urography (IVU) has allowed a comprehensive study of the urinary excretory tract, promoting the knowledge of the radiological findings of this disease. Nowadays, computed tomography urography (CTU), with the implementation of multidetector (MD) technology, has replaced IVU in all its indications; the MDCTU improves the assessment of renal and urinary tract lesions using reformatted images [such as multiplanar reconstruction (MPR) and maximum intensity projection (MIP)]. Therefore, our paper aims to provide a guide for radiologist for searching the classic signs of UGTB on MDCTU, encouraging the use of the MPR and MIP reformatted images.

V5-01 HOLMIUM LASER ENUCLEATION OF THE PROSTATE AS RETREATMENT AFTER UROLIFT DEVICE: FEASIBILITY AND TECHNICAL CONSIDERATIONS

You have accessJournal of UrologyBPH and Voiding Dysfunction1 Apr 2017V5-01 HOLMIUM LASER ENUCLEATION OF THE PROSTATE AS RETREATMENT AFTER UROLIFT DEVICE: FEASIBILITY AND TECHNICAL CONSIDERATIONS Sean McAdams and Mitchell Humphreys Sean McAdamsSean McAdams More articles by this author and Mitchell HumphreysMitchell Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1406AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this video we demonstrate the feasibility of Holmium laser enucleation of the prostate (HoLEP) for retreatment of persistent lower urinary tract symptoms (LUTS) after previous treatment with the UroLift device. Technical considerations with regards to both enucleation and morcellation of resected tissue are discussed. Benign prostatic hyperplasia (BPH) affects millions of men worldwide. The UroLift system (NeoTract Inc., Pleasanton, CA) was recently introduced as a means to perform prostatic urethral lift (PUL) procedure for lateral lobe hypertrophy in patients with obstructive voiding symptoms. Urolift has been associated with a retreatment rate of 7% at 2 years and 14% at 4 years. Retreatment with TURP, photovaporization of the prostate and repeat UroLift has been described without notable issue, but retreatment with HoLEP has not yet been described. METHODS We included two patients who had undergone PUL with UroLift system at outside institutions and presented with recurrent LUTS. Patients were evaluated by cystoscopy, uroflowmetry, transrectal ultrasound of the prostate, and urodynamics to define the etiology of their urinary symptoms and determine appropriate therapy. HoLEP was performed under general anesthesia as previously described. Morcellation of the resected adenoma was performed with the VersaCut reciprocating morcellator (Lumenis Inc, Santa Clara, CA). RESULTS Enucleation was successfully completed in both patients. Monofilament sutures of the Urolift device were easily visualized and transected with the holmium laser. At the bladder neck, both patients were unexpectedly found to have the outer nitinol tab portions of UroLift devices located within the capsule of the prostate, rather than in the intended extracapsular location. Auxiliary maneuvers were required for removal of these nitinol tabs. The inner stainless steel portions of the UroLift device were encountered during morcellation of the resected adenoma. In each instance, the metal tabs became lodged in the reciprocating blades of the morcellator, requiring withdrawal of the morcellator instrument and manual removal of the tab from the morcellator blade. This resulted in brief disruptions in the procedure. There were no operative complications. CONCLUSIONS To our knowledge, we present the first description of HoLEP with morcellation of adenoma tissue after previous prostatic urethral lift surgery with the UroLift device. HoLEP can be performed safely and effectively post Urolift, however morcellation of the adenoma tissue is complicated by the metallic implants of the Urolift device. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e599 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sean McAdams More articles by this author Mitchell Humphreys More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP27-01 CHARACTERISTICS OF PATIENTS WITH PERSISTENT LOWER URINARY TRACT SYMPTOMS AFTER HOLEP IN BPH

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2017MP27-01 CHARACTERISTICS OF PATIENTS WITH PERSISTENT LOWER URINARY TRACT SYMPTOMS AFTER HOLEP IN BPH Kang Sup Kim, Yong Sun Choi, Hong Jin Suh, Hyun Woo Kim, Joon Chul Kim, and Donh Hwan Lee Kang Sup KimKang Sup Kim More articles by this author , Yong Sun ChoiYong Sun Choi More articles by this author , Hong Jin SuhHong Jin Suh More articles by this author , Hyun Woo KimHyun Woo Kim More articles by this author , Joon Chul KimJoon Chul Kim More articles by this author , and Donh Hwan LeeDonh Hwan Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.793AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Holmium laser enucleation of the prostate (HoLEP) in BPH is widely used and the effects are known to be equivalent or better than traditional TUR-P with low incidence of complications. However, some patients who underwent HoLEP still have the lower urinary tract symptoms(LUTS) after surgery. We evaluated the characteristics of patients who visited our clinics due to persistent LUTS and required additional medications after HoLEP in BPH patients. METHODS The medical records of the patients who underwent HoLEP from March of 2011 to June of 2015 were reviewed retrospectively. The analysis was performed in patients who have been followed for more than 6 months after surgery. The patients were divided into 2 groups. Group A is the patients with persistent obstructive symptoms and group B is with irritation symptoms. Age, prostate specific antigen, International prostate symptom score (IPSS), prostate volume, transition zone volume of prostate, peak flow rate, maximum cystometric capacity, post voided residual volume, resected weights, operation time were analyzed. RESULTS Among the 482 patients who underwent the HoLEP, the numbers of patients who required the medicine for lower urinary tract symptoms were 138 (28.6%). Among the patients, 53 patients (40.2%) were enrolled in Group A and 85 patients (59.8%) were enrolled in Group B. The mean age, total IPSS, PSA, total prostate volume, peak flow rate, maximum cystometric capacity, post voided residual volume, and operation time between two groups were statistically insignificant. However, transition zone volume and resected weights were significantly different between group A and B. (p=0.017, p=0.010 respectively) CONCLUSIONS More than 25% of the patients were still taking the medicines for lower urinary tract symptoms after HoLEP. Among the patients who required the medicine, 60% of patients have complained of irritation symptoms. Bigger transition zone with resection weights were correlated with remaining of postoperative irritation symptoms. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e328 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kang Sup Kim More articles by this author Yong Sun Choi More articles by this author Hong Jin Suh More articles by this author Hyun Woo Kim More articles by this author Joon Chul Kim More articles by this author Donh Hwan Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...