Post-micturition Residual Urine Research Articles

Real-world experience of water vapour therapy (Rezum) in patients with benign prostatic enlargement: a retrospective single-center study.

Water vapor thermal therapy (Rezum) is a minimally invasive treatment for benign prostatic enlargement (BPE). Studies reporting urodynamic results regarding the procedure are rare. Our study aimed to assess the effectiveness of Rezum on urinary outcome parameters in a consecutive series of patients and compare urodynamic data before and after treatment. We retrospectively evaluated all the patients treated with Rezum between 07/2017 and 12/2023 at our institution. Patients who had more than one Rezum intervention, those who were unable to void (i.e., catheter-dependent patients), and those with insufficient data were excluded from the data analysis. Descriptive outcomes, such as symptom scores (IPSS, IPSS-QoL), peak flow in uroflowmetry (Qmax), post-micturition residual urine volume (PVR), and prostate volume (PVol), were analyzed. If available, preoperative and postoperative urodynamic results were evaluated. In total, 250 Rezum procedures were performed during the observational period. After applying the exclusion criteria, the data from 193 patients were included in the analysis. Patients achieved significant symptom relief as measured using the IPSS (46% reduction) and IPSS-QoL scores (41% reduction). Qmax improved by 4.8 ml/s, as the mean PVR significantly decreased by 50%. PVol and PSA values decreased by 30% and 27.5%, respectively. In 19/193 patients with a urodynamic evaluation, pre- and postoperative data analysis showed a significant reduction in the bladder outlet obstruction index (BOOI) by approximately 70%. Rezum is effective and can improve urinary symptoms. In appropriate patients, Rezum can significantly reduce the bladder outlet obstruction (BOO).

Rezum water vapor thermal therapy for treatment of lower urinary tract symptoms: A retrospective single-centre analysis from a German high-volume centre.

Rezum is a minimal invasive surgical treatment for patients with lower urinary tract symptoms (LUTS) related to benign prostatic enlargement (BPE). The aim of our study was to assess safety and efficacy of the Rezum procedure in a consecutive series of patients. A retrospective study was performed in a single tertiary care hospital in patients undergoing Rezum procedure between 2018 and 2020. All patients that underwent intervention because of drug-refractory moderate to severe LUTS were assessed. Descriptive outcomes such as symptoms scores (IPSS, IPSS-QoL), peak flow in uroflowmetry (Qmax), post-micturition residual urine volume (PVR) and prostate volume (PVol) were analysed. In total, 92 Rezum procedures were performed in the observational period. All interventions were competed without device- or procedure relates adverse events. Patients achieved a significant symptom relief as measured in IPSS (50% reduction, p<0.001, n = 35) and IPSS-QoL score (53% reduction, p<0.001, n = 35). Qmax improved by 7.3 ml/s from 10.6 ± 4.2 ml/s to 17.9 ± 9.3 ml/s (p = 0.003, n = 20) were as mean PVR significantly decreased by 136 ml from 175 ± 194.1 to 39 ± 62 ml (p = 0.007, n = 20). PVol significantly decreased by 40.3% from 73.9 ± 41.2 to 44.9 ± 29 ccm (p = 0.024, n = 17). All pre-interventional catheter-depending patients (28.3% of all patient) were catheter independent after six weeks. Rezum therapy is safe and effective and can be considered a viable treatment option for BPH related LUTS.

English

Transurethral resection of the prostate (TURP) has been the prime procedure for decenniums to treat benign prostatic hyperplasia (BPH), but is mainly predicated on historic data that lacks utilization of validated measures. It is noteworthy that TURP done nowadays significantly differs from that performed 30 years ago. Men who had undergone TURP between 2013 and 2018 were reviewed. 50 patients presented in the Department of Urology, Lahore General Hospital, Pakistan, with lower urinary tract symptoms (LUTS) due to BPH (without retention) were recruited in the study. Related/required investigations were done and patients were operated for TURP after noting certain parameters. They were advised for follow up at 3 intervals (1st, 4th and 12th week postoperatively) and post-operative parameters were compared with pre-operative ones. International Prostate Symptom Score (IPSS), Quality of Life (QOL) and peak urinary flow rate (Qmax), and Post-Void Residual (PVR) were recorded. Operative details and postoperative complications were documented. Patients were then invited to attend for repeat assessment. Out of 50, 43(86%) patients had severe symptom score and 07 (14%) had moderate symptoms score (pre-operative). Out of total 50, 36 (72%) patients had Qmax less than 10 ml/s and 14 (28%) patients had Qmax between 10 and 15 ml/s as well as Post Micturition Residual Urine (PMRU) more than 50 ml pre-operatively. After 3 months of successful TURP, 49 (98%) patients&rsquo; conditions improved and they developed a normal flow rate of more than 20 to 25 ml/s. All the 50 patients remained with a PMRU of less than 50 ml.&nbsp; There was an improvement in 47 patients and only 3 patients did not improve to their satisfaction. TURP is very effective and still considered a gold standard treatment for BPH with LUTS without retention of urine. Key words: TURP, BPH, LUTS, PMRU &nbsp

The outcomes of transurethral incision/resection of the prostate (TUIP/TURP) performed early after renal transplantation.

In the early period after renal transplantation, urinary retention stemming from bladder outlet obstruction (BOO) may directly affect graft success. The aim of this study was to evaluate the early and long-term outcomes of transurethral resection of the prostate (TURP) and transurethral incision of prostate (TUIP) procedures performed in the first month following RT due to BOO. Between February 2009 and March 2016, 38 male patients underwent TURP/TUIP due to BOO within the first 30 days of renal transplantation. The urodynamic and renal function assessment results of all patients were collected during the pre-and postoperative periods. All patients were followed up for a minimum of 12 months for short and long-term complications. The results were evaluated retrospectively. The mean age of the patients who underwent operations was 59.2±12 years. The median duration of dialysis was 41 months (range 0-180). Before the operation the mean serum creatinine (sCr) level was 1.8±0.7 mg/dL, the mean total PSA level was 1.6±1.1 ng/mL. Of the voiding parameters, the mean Qmax and Qave were measured as 8.2±4.5 mL/sec and 4.6±2.5 mL/sec, respectively. The median post-micturition residual urine (PMR) was 105 mL (range 10-400). TURP/TUIP operations were performed at a median of 19 days (range 8-30) after renal transplantations. None of the patients experienced major complications. In the early postoperative period, 5 patients (13.1%) developed urinary tract infection. The mean decrease in sCr in the first month following TURP/TUIP was 1.4±0.4 mg/dL (p<0.001). The mean Qmax (22.4±11.1 mL/sec), and Qave (11.7±5.4 mL/sec) increased significantly (p<0.001), while the median PMR (15 mL, range 0-205) decreased significantly (p<0.001). The mean follow-up period after the procedure was 46.8±23.3 months. During the follow-up period, 3 (7.8%) patients suffered from urethral stricture and 2 (5.2%) patients from bladder neck obstruction. In the surgical treatment of urinary retention arising from BOO in the first month following renal transplantation, TURP/TUIP yield safe and successful results. In addition, regarding the short and long term outcomes, these procedures may be safely performed with low morbidity.

Effects of Benign Prostate Hyperplasia on Allografts in Kidney Transplant.

Benign prostate hyperplasia is frequently diagnosed in elderly chronic renal failure patients. Although it is asymptomatic because urine flow declines in those with chronic renal failure, it may become symptomatic when urine flow increases after renal transplant. Untreated benign prostate hyperplasia may lead to several complications that adversely affect the kidney allograft. Our retrospective study investigated data from 286 male transplant patients. Data obtained included medical history, clinical examination, prostate-specific antigen, prostate volume, and residual urine volume results. Patients had completed an International Prostate Symptom Score questionnaire to assess the low urinary symptoms. Creatinine level, residual urine volume, International Prostate Symptom Score, and uroflow-metry results were reviewed. The average age of patients in our group was 54.8 years. Seven patients were diagnosed with benign prostate hyperplasia, and transurethral resection of the prostate was performed. The average creatinine levels before and after transurethral resection were 2.53 ± 0.76 mg/dL and 1.66 ± 1.12 mg/dL, respectively. Creatinine levels measured 6 months after transurethral resection versus before resection were statistically significant (P < .018). Furthermore, there was a statistically significant difference (P < .017) in the postmicturition residual urine volume between the preoperative and postoperative values, which were 132.14 ± 19.33 and 47.6 ± 18.6 mL, respectively. Maximum urine flow rates before and after transurethral resection were also significantly different (P < .017). Although the main reasons for graft function loss after renal transplant are rejection and infections, obstructive pathologies should also be considered. Especially for elderly patients, anamnesis, uroflowmetry, and digital rectal examination play critical roles in the evaluation of benign prostate hyperplasia before and after transplant.

Short-term “double natural orifice catheterization”: Nonoperative management of hydrocolpos in persistent cloaca patients – case series

Management of hydrocolpos in cloaca patients is of clinical importance. We report a nonoperative method for the management of hydrocolpos in the form of initial catheter decompression, followed by an endoscopy with catheters placement into both the bladder and vagina, and leaving these catheters for 9 and 14days respectively. The medical records of six cloaca patients with hydrocolpos in the last 12years were reviewed. The outcomes measured were the renal function, bladder emptying, the presence/resolution of hydronephrosis, and the recurrence of hydrocolpos. Complete drainage of hydrocolpos was achieved in four out of six cases and partial drainage in two. On common channel endoscopy, in four patients the structures were identified and balloon catheters inserted. After catheter removal, the vagina and urinary tract remained adequately drained through the natural cloacal opening with no post-micturition residual urine, resolution of hydroneprosis within 60days, preserved renal function, and no hydrocolpos reaccumulation. Initial decompression and short time catheterization can be the definite solution for some cloaca patients with hydrocolpos. Our case-series showed a success rate in two-thirds of patients by achieving the three main goals; permanent hydrocolpos derivation, undisturbed voiding, and preservation of renal function. Study can be classified as a Treatment Study, LEVEL IV Case series with no comparison group.

Thulium laser vaporesection of the prostate: Can we operate without interrupting oral antiplatelet/anticoagulant therapy?

PurposeThulium vaporesection of the prostate (ThuVARP) is a new and safe approach for patients receiving anticoagulant therapy in whom transurethral resection of the prostate (TURP) may possess a high bleeding risk. We aimed to demonstrate the efficacy and safety of ThuVARP in patients receiving oral antiplatelet/anticoagulant (OAP/OAC) therapy.Materials and MethodsA total of 103 patients who underwent ThuVARP between 2011 and 2013 were enrolled in the study. Patients were divided into 2 groups. Group A consisted of 47 patients who underwent low molecular weight heparin (LMWH) bridging and group B consisted of 56 patients who were operated on while receiving OAP/OAC therapy.ResultsThe drop in hemoglobin levels in the pre- and postoperative periods was significantly higher in group A than in group B. When subgroups were analyzed, the mean drop in hemoglobin was significantly lower in the warfarin and ticlopidine subgroups of group B than in group A. International Prostate Symptom Scores were significantly lower 3, 12, 18, and 24 months after surgery in group A than in group B. Quality of life scores, maximal flow rate values, and postmicturition residual urine volumes (mL) were similar between the 2 groups. A total of 38 and 41 patients in groups A and B, respectively, had no complications.ConclusionsOur study showed the safety profile of continuing different OAP/OAC therapies in terms of bleeding problems in patients undergoing ThuVARP. We strongly recommend abandoning LMWH bridging and maintaining the OAP/OAC regimen patients are already receiving.

Comparison of actual height and height estimated by using tibial length in an individual

Since 1987, 30 patients with bladder cancer underwent cystoprostatectomy with bladder replacement via ileocecourethrostomy. Multiple transverse teniamyotomies were made in the cecum to assure a large capacity reservoir with low pressures. The particular anatomy and physiology of the cecum, short length of the intestinal segment needed and teniamyotomies are the 3 factors that have allowed for good functional and metabolic results. All patients achieved daytime continence. After 3 years of followup 67% of the patients were continent at night if they voided every 3 or 4 hours and 22% if they voided every 2 or 3 hours, while 11% experienced enuresis. Urodynamic data after 1 year showed a mean capacity of 396 ml. for the new bladder, a mean full filling pressure of 28 cm. water and a mean maximum pressure of 55 cm. water. Post-micturition residual urine volume was consistently less than 55 ml. These results indicate that the ileocecal segment can be enlarged with myotomies through the tenia to produce an adequate capacity and a low pressure bladder replacement without the need for formal detubularization.

Transrectal elastographic monitoring of the transurethral balloon pressure in urethral dilation for catheter-dependent patients with benign prostatic hyperplasia

BackgroundFoley’s catheter indwelling gives temporary relief for lower urinary tract obstruction, especially in case of severely symptomatizing benign prostatic hyperplasia (BPH). Several complications of long-term or frequent catheter indwelling have been reported in catheter dependent patients, specifically to those who are unfit for operative intervention. ObjectivesOur aim was to find a safe, non-invasive relief from symptom severity, as well as, incapacitating complications of Foley’s catheter in catheter-dependent patients. MethodsA total of 107 catheter-dependent men, or who had frequent Foley’s catheter indwelling in case of BPH, participated in the present study. Preliminary estimation of the post-micturition residual urine was obtained. Ultrasound elastography was used to assess the transurethral balloon pressure of the double balloon silicon-coated catheter, adjudicated by ureteromat, and maintained in situ for 6days in all patients. Basic follow up once-a-month has been performed up to 6months. ResultsEffectual urethral patency was noted in 89.7% patients at the end of the third month. The procedure was repeated for 11 patients shortly after 3months, for 7 patients after 4months and for 28 patients after 5months, with no reported prostatic urethral injury. No stricture recurrence was noted in 61 patients up to 6months. ConclusionsPreliminary results indicate that prostatic urethral balloon dilation in BPH catheter-dependent patients is inexpensive, safe, and would be a potentially effective option in maintaining the prostatic urethral patency. Elastographic justification of the transurethral balloon has proved to be helpful.

The Clinical Analysis of General Paresis With 5 Cases

The Clinical Analysis of General Paresis With 5 Cases

Xanthogranulomatous prostatitis: a mimic of carcinoma of prostate

BackgroundXanthogranulomatous prostatitis is an unusual benign inflammatory process of prostate. Clinically it mimics prostatic carcinoma, requiring pathological examination for diagnosis.Case presentationA 60-year-old patient presented with 6 months history of increasing difficulty in micturition. On digital rectal examination prostate was hard and nodular and estimated weight was 50-gram. His serum prostate specific antigen (PSA) was 150 ng/ml. Clinically a locally advanced carcinoma of prostate was suspected. In view of severe obstructive urinary symptoms and significant post-micturition residual urine, transurethral resection of prostate was carried out. Histopathological examination of resected prostatic tissue revealed xanthogranulomatous prostatitis with no evidence of malignancy. Patient remains symptom free at 16 months follow-up and serum PSA has decreased to 6 ng/ml.ConclusionXanthogranulomatous prostatitis is a benign inflammatory disorder of prostate that can clinically and even biochemically mimic prostatic carcinoma. A high degree of suspecion and close co-operation with pathologist is necessary for the diagnosis of xanthogranulomatous prostatitis.

Augmentation Cystoplasty in Patients with Multiple Sclerosis

Introduction: Augmentation cystoplasty is an effective approach to the detrusor hyperreflexia which is refractory to conservative treatment. Sporadic data have been published in patients with progressive diseases such as multiple sclerosis (MS). Materials and Methods: Augmentation ileocystoplasty (Goodwin ‘cup-patch’) was performed in 9 patients (7 females, 2 males). The average Expanded Disability Status Scale score was 4.1 (range 3.0–6.5); 7 patients had relapse-remitting MS and 2 patients secondary-progressive MS. The indication was a detrusor hyperreflexia refractory to conservative treatment in 8 patients and a detrusor hyperrefluxia with third degree bilateral vesico-ureteral reflux and renal insufficiency in 1 patient. Pre- and postoperative objective parameters were evaluated by urodynamic examination, imaging methods and laboratory examination. Subjective evaluation was performed using a questionnaire on micturition symptoms (score 0–5) and on quality of life (score 0–6). Results: With a follow-up of 6–19 months, we recorded an average increase of the maximum detrusor capacity from 105 to 797 ml and decrease of maximum detrusor pressure from 53 to 30 cm H₂O. Postmicturition residual urine >25% of the maximum capacity was present in 6 patients who performed clear intermittent autocatheterization postoperatively (2 patients preoperatively). In all patients there was a significant improvement in the irritation micturition symptomatology (pollakisuria, nycturia, urgency and urge incontinence) and the quality of life score improved on average from 5 to 0.7. In the case of the patient with renal insufficiency, the creatinine level decreased from 286 to 150 µmol/l; in the other patients renal function remained normal. Conclusions: Augmentation cystoplasty is a safe and effective method for indicated patients, which significantly enhances their quality of life.

Referral for 'prostatism': developing a 'performance indicator' for the threshold between primary and secondary care?

We aimed to define a performance indicator at the gateway between primary and secondary care. We carried out an analysis of referral letters sent to an urological department within the catchment area of a teaching hospital in Cardiff, Wales. The subjects were 221 sequential referral letters from 221 GPs. The main outcome measures were the information content of referral letters analysed. Letters were stratified into referral threshold groups by the presence of history, examination, routine investigations and specialized investigations. Three distinct categories of referral practice were identified: referrals which contained history alone; those providing history examination and a selection of routine investigations; and those providing history, examination data and the results of routine and specialized investigations. The study demonstrated that more than a third of GPs do not report the results of digital rectal examination in their referrals and only 4% record urinary flow rates and post-micturition residual urine volume. The majority (60%) of generalist referrals to an urology department for prostatism provide enough information for specialists to be able to prioritize appointments, but more than a third (36%) of the referrals contain inadequate information. The method has the potential of being developed into a gateway performance indicator in clinical practice.

Characterisation of detrusor contractile function in relation to old age.

This report describes an age-related clinical study of detrusor muscle function using urodynamic data obtained from 1391 women and 324 men of different age groups who were free from overt neurological disease and diabetes. Isometric detrusor function during unstable activity was assessed by integrating the calculated force of unstable detrusor activity during filling of the bladder. Isotonic voiding activity was measured by calculating the velocity constant Q*, which reflects the speed of detrusor muscle shortening. In addition, the change in detrusor pressure on initiation of voiding and the post-micturition residual urine volume were recorded. Older patients of both sexes had higher residual urine volumes. Older women showed lower detrusor shortening velocities. There were no age-related differences in isometric detrusor function. Older women showed a tendency for the detrusor contraction to fail on initiation of voiding, whereas older men did not demonstrate this difference. Voiding dysfunction in late life was more marked amongst women and seemed to be related to a failure of isotonic detrusor function with no related changes in isometric function.

Results of 4 Years of Experience with Bladder Replacement Using an Ileocecal Segment with Multiple Transverse Teniamyotomies

Since 1987, 30 patients with bladder cancer underwent cystoprostatectomy with bladder replacement via ileocecourethrostomy. Multiple transverse teniamyotomies were made in the cecum to assure a large capacity reservoir with low pressures. The particular anatomy and physiology of the cecum, short length of the intestinal segment needed and teniamyotomies are the 3 factors that have allowed for good functional and metabolic results. All patients achieved daytime continence. After 3 years of followup 67% of the patients were continent at night if they voided every 3 or 4 hours and 22% if they voided every 2 or 3 hours, while 11% experienced enuresis. Urodynamic data after 1 year showed a mean capacity of 396ml. for the new bladder, a mean full filling pressure of 28cm. water and a mean maximum pressure of 55cm. water. Post-micturition residual urine volume was consistently less than 55ml. These results indicate that the ileocecal segment can be enlarged with myotomies through the tenia to produce an adequate capacity and a low pressure bladder replacement without the need for formal detubularization.

Does Residual Urine Predispose to Urinary Tract Infection?

The relationship between the presence of post-micturition residual urine and urinary tract infection is unclear. We have performed a retrospective analysis of 342 studies on bladder emptying and compared the incidence of bacterial infection and pyuria in patients with residual urinary volumes of more or less than 100 ml. In patients with a residual volume > 100 ml 49/219 studies showed evidence of pyuria and 28/198 studies of patients whose residual urine was less than 100 ml showed evidence of infection. In cases where the residuals were > 100 ml 33/123 had evidence of pyuria and 19/109 infection. There was no significant increase in the rate of infection in patients with large residual urinary volumes, suggesting that there is no definite correlation between post-micturition residues and urinary tract infection.

Voiding Dysfunction due to Neurosyphilis

Three patients with neurosyphilis presenting with urinary frequency, incontinence and voiding dysfunction were investigated. Unlike the previously reported finding of areflexia in tabes dorsalis, all 3 had hypocompliant detrusor hyper-reflexia with detrusor-sphincter dyssynergia and post-micturition residual urine. One patient also had bladder neck dyssynergia treated by bladder neck incision. The other 2 patients were initially managed by intermittent catheterisation but 1 ultimately underwent urinary diversion. The clinical relevance of these findings and the treatment of this condition are discussed.

Obstruction or no obstruction

The authors review critically such parameters as symptomatology, post-micturition residual urine, bladder trabeculation and uroflowmetry that in the actual state of the art appear more accredited in the evaluation of lower urinary tract obstruction. All have some interpretative limits. However, uroflowmetry appears to be the most reliable and for this reason it is the first step in the study of suspected infravesical obstruction. It can discover equivocal situations in which pressure-flow studies only supply diagnostic help in order to avoid false diagnosis of infravesical obstruction and useless therapeutic approaches.

Direct Recording of Urethral Resistance Using the “Urethroresistance”

Observations on urethral resistance during micturition in non-obstructed men and in patients with bladder outlet obstruction owing to benign prostatic hypertrophy are presented. The “Urethroresistance”, a new instrument, was used for the direct recording of urethral resistance.The upper limit for the minimum urethral resistance during micturition for normal non-obstructed men was 0.5 units. Two patterns of urethral resistance were observed solely in non-obstructed subjects and 3 other patterns, which were found solely in patients with a moderate or severe degree of bladder outlet obstruction, were shown to be characteristic of bladder outlet obstruction. While direct recording of urethral resistance is a better test for bladder outlet obstruction than the recording of urinary flow rate the recording of urinary flow is a simple urodynamic test, which remains a useful screening test for bladder outlet obstruction. With the ! exception of severe obstructive symptoms none of the other clinical methods for the assessment of bladder outlet obstruction—the size of the prostate gland, the volume of post-micturition residual urine and the degree of bladder trabeculation—is reliable to determine the degree of bladder outlet obstruction.