Postvoid Residual Volume Research Articles

Rezūm water vapor thermal therapy in patients with benign prostatic hyperplasia: Initial real-world data from Japan.

Benign prostatic hyperplasia (BPH) is prevalent in older men. As surgery can be high risk in this group, minimally invasive procedures are preferrable. This study aimed to assess the initial results of minimally invasive Rezūm water vapor thermal therapy (WVTT) in patients with BPH. This single-center retrospective study included 25 consecutive patients with BPH who underwent WVTT between September 2022 and July 2023. Parameters including age, Charlson Comorbidity Index and Geriatric 8 (G8) scores, operative time, and number of vapor injections were evaluated. The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, and Core Lower Urinary Tract Symptom Score (CLSS) were used to assess symptoms before the procedure, and at 1 and 3 months after it. Urinary function indicators such as single voiding volume, maximum flow rate (MFR), and post-void residual volume were assessed at the same time points. The mean patient age was 76.0 years and the mean prostate volume was 54.8 mL. The mean G8 score was 14.4 and the Charlson Comorbidity Index score averaged 1.2. The mean operative time was 6.84 min, and included a mean of 4.8 vapor injections. Three months after WVTT, significant improvements were observed in the maximum flow rate (P = .02), post-void residual volume (P = .001), and urine volume (P < .001), as well as in the IPSS incomplete emptying (P = .01) and weak stream (P = .01) domains. No significant changes were observed in the remaining IPSS domains or in the Overactive Bladder Symptom Score or CLSS. This study provides the first report on Rezūm WVTT outcomes in Japan using the CLSS assessment tool. The initial results indicate a promising experience with this new treatment method. With a rapidly aging population, the incidence of BPH is expected to increase, making the minimally invasive Rezūm system a valuable addition to BPH treatment options.

Preoperative tamsulosin effect on postoperative urinary retention following spinal surgery: A randomized controlled trial

BackgroundCurrent study aims to investigate pre-surgical medical intervention on the reduction of POUR incidence in patients undergoing spine surgery. MethodThe study was a single center double-blind randomized placebo clinical trial. Participants were individuals over 18 years old who underwent spinal surgery at the Educational and Therapeutic Hospital between 2020 and 2023. Inclusion criteria included the ability to provide informed consent and follow the study schedule, while exclusion criteria included certain medical conditions, current medication use, and inability to take oral medication after surgery. ResultsThe study enrolled 100 patients. There was no significant difference in age or gender distribution between the tamsulosin and placebo groups, but the tamsulosin group had a lower prevalence of diabetes. The duration of surgery was shorter in the tamsulosin group, and there was no significant difference in the surgical site. The tamsulosin group had significantly less post-void residual volume on the eighth day of the study, but there were no significant differences in urine output volume during surgery or residual urine volume before or after surgery. ConclusionTamsulosin may be effective in preventing postoperative urinary retention (POUR), but its effectiveness in treating established POUR is uncertain. The Tamsulosin group had significantly lower post-void residual volume after spine surgery. Considering the low risk of adverse effects, Tamsulosin could be considered for high-risk patients. However, patients should be aware of potential risks and seek medical attention if they experience adverse effects. Further research is needed to determine the best dosage and duration of treatment.

Voiding Dysfunction in Patients With Advanced Pelvic Organ Prolapse and Bladder Outlet Obstruction Following Pelvic Reconstructive Surgery: Urodynamic Profile and Predictive Risk Factors

Study ObjectiveTo determine the outcome of voiding function 1 year following Pelvic Reconstructive Surgery (PRS) in women with Bladder Outlet Obstruction (BOO). DesignRetrospective cohort study SettingTertiary Referral Hospital PatientsOne thousand eight hundred and ninety-four (1894) women underwent PRS for advanced Pelvic Organ Prolapse (POP) stage III-IV with urodynamic findings of BOO InterventionsPelvic Reconstructive Surgery MeasurementsThe primary outcome measured was the resumption of normal voiding function, defined clinically with multichannel urodynamic (UDS) testing at one year post-operatively. The secondary outcomes are to identify the different risk factors for persistence voiding dysfunction after 1 year after PRS. Main ResultsTotal of 431 women with POP-Q Stage III and IV, UDS of Qmax ≤15 ml/s and PdetQmax ≥20cmH20 were included. Resumption of normal voiding function were found in 91% (n=392/431), while 9% (n=39/431) remains to have voiding dysfunction (VD) 1 year post operatively. Those with persistent VD, 20.5%(n=8/39) remains having urodynamic diagnosis of BOO. Univariate and multivariate logistic regression reveals factors associated with post-operative VD are pre-operative MCC ≥500 ml and PVR ≥ 200ml. ConclusionVoiding Dysfunction may persist in women with BOO following PRS, particularly in those with pre-operative maximal cystometric capacity (MCC) of >500ml and post-void residual volume > 200ml.

Clinical Effects of Oral Supplementation of Gamma-Cyclodextrin Curcumin Complex in Male Patients with Moderate-To-Severe Benign Prostatic Hyperplasia-Related Lower Urinary Tract Symptoms

Introduction: Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms (LUTSs) in males. Curcumin exhibits anti-inflammatory and anti-tumor properties which may be effective for BPH. This multi-arm observational study evaluated the real-world efficacy of QURMIN^® (Gamma-cyclodextrin-curcumin Complex-CAVACURMIN^®) as single or combination therapy for BPH. Methods: Men with moderate-severe LUTS/BPH, receiving a 6-month supplementation with QURMIN^® alone or in combination with BPH-specific medication were propensity score matched with patients not taking curcumin and then divided into subgroups based on concomitant baseline treatment. Cohorts were compared in the 6-month variation of IPSS, quality of life (IPSS-QoL), Benign Prostatic Hyperplasia Impact Index (BII) and uroflowmetry parameters. Curcumin tolerability was evaluated in terms of discontinuations and adverse effects. Results: The 1:1 propensity score matching resulted in a treatment-naïve (n = 152), an alpha-blocker only (AB) (n = 138) and AB + 5-alpha reductase inhibitors (5-ARIs) (n = 78) subgroup. After 6 months, drug-naïve patients taking curcumin reported significant improvement in IPSS-storage (−3.9, p < 0.001), IPSS-voiding (−2.0, p = 0.011), IPSS-total (−5.9, p < 0.001), IPSS-QoL (−3.9, p < 0.001), BII (−2.0, p < 0.001), Q_max (+3.1 mL/s, p < 0.001), Q_mean (+1.9 mL/s, p = 0.005), post-void residual volume (−7.7 mL, p < 0.001), and PSA (−0.3 ng/mL, p = 0.003), compared to controls. Patients taking ABs and curcumin showed improvement in IPSS-storage (−2.7, p < 0.001), IPSS-voiding (−1.3, p = 0.033), IPSS-total (−3.5, p < 0.001), IPSS-QoL (−1.1, p = 0.004), BII (−1.7, p = 0.006), Q_max (+1.0 mL/s, p = 0.006), and PSA (−0.2 ng/mL, p = 0.01). Patients taking curcumin and AB + 5-ARI showed improvement in IPSS-storage (−1.3, p = 0.007), IPSS-total (−1.6, p = 0.034), IPSS-QoL (−1.1, p < 0.001), and BII (−2.0, p < 0.001). No adverse reactions were reported for curcumin supplementation. Conclusion: QURMIN^® (CAVACURMIN^®) led to significant improvements in symptom burden, uroflow parameters, and QoL, without significant additional side effects, thus proving to be a potential new treatment for BPH, either as a single therapy or in addition to standard treatment.

Can we define the optimal postvoid residual volume at which intermittent catheterization should be recommended, and are there other measures that could guide an intermittent catheterization protocol: ICI-RS 2023.

The postvoid residual (PVR) volume of urine in the bladder is widely used in clinical practice as a guide to initiate treatment, including clean-intermittent self-catheterization (CISC). It is often believed that an elevated PVR causes complications such as recurrent urinary tract infections (UTI) and renal failure. However, evidence for this is limited and identifying alternative measures to guide treatment decisions may optimize patient care. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2023 a Think Tank addressed the question of whether we can define the optimal PVR at which CISC should be recommended, and whether there are other measures that could guide a CISC protocol. The Think Tank conducted a literature review and expert consensus meeting focusing on current limitations in defining and measuring PVR, and highlighting other measures that may optimize selection for, and persistence with, CISC. There is no consensus on the threshold value of PVR that is considered "elevated"or "significant." There is a lack of standardization on terminology, and the normal range of PVR in different populations of different ages remains to be well-studied. The measurement of PVR is influenced by several factors, including intraindividual variation, timing and method of measurement. Furthermore, the evidence linking an elevated PVR with complications such as UTI and renal failure is mixed. Other measures, such as bladder voiding efficiency or urodynamic parameters, may be better at predicting such complications, and therefore may be more relevant at guiding a CISC protocol. There is a lack of high quality evidence to support PVR as a predictor for complications of UTI or renal failure. Threshold values for normal PVR in different populations are unknow, and so threshold values for "elevated"or "significant"PVR cannot be determined. Other factors, such as urodynamic findings, may be better at predicting complications and therefore guiding management decisions, and this remains to be studied. Areas for further research are proposed.

Prostatic Artery Embolization as a Treatment Option for Symptomatic Benign Prostatic Hyperplasia: Results from the Prospective Follow-Up Study in Lithuania.

Background: The endovascular treatment of symptomatic benign prostate hypertrophy (BPH) by prostatic artery embolization (PAE) is one of the new treatments proposed. PAE is a minimally invasive alternative that has been shown to successfully treat lower urinary tract symptoms in BPH patients by causing infarction and necrosis of hyperplastic adenomatous tissue, which decompresses urethral impingement and improves obstructive symptoms. The aim of this study was to evaluate the effectiveness and efficacy of PAE in relieving symptoms in patients with symptomatic BPH. Materials and Methods: The material for the study was collected from 2019 to 2022. A total of 70 men with BPH and PAE were studied. Patients underwent an urological examination to measure the International Prostate Symptom Score (IPSS), Quality of Life score (QoL), International Index of Erectile Function short form (IIEF-5), uroflowmetry with Qmax, prostatic volume (PV), and post-void residual volume (PVR) measurements. Statistical analysis for dependent samples was applied. Measured parameters at 2 months and 6 months follow-up were compared to baseline. Results: At baseline, the age of the male (N = 70) subjects was 74 ± 9.6 years with a median of 73.8, but fluctuated from 53 to 90 years. The mean of PV was almost 111 mL and the Qmax was close to 7.7 mL/s. The average PVR was 107.6 mL. The IPSS score mean was 21.3 points and the QoL score was 4.53 points. The IIEF-5 questionnaire score was almost 1.8 points, which shows severe erectile dysfunction. The mean value of the PSA level was 5.8 ng/mL. After 2 and 6 months of PAE, all indicators and scores except erectile function significantly improved. Conclusions: The outcomes of our study show promising results for patients with benign prostatic hyperplasia after PAE. The main prostate-related parameters (PV, Qmax, PVR, IPSS) improved significantly 6 months after embolization.

Clinical Efficacy and Safety of Transurethral Plasma Enucleation in the Treatment of Benign Prostatic Hyperplasia

Objective: This paper aims to analyze the effectiveness and safety of transurethral plasma enucleation in clinical treatment of benign prostatic hyperplasia. Methods: A total of 100 patients with benign prostatic hyperplasia who received surgical treatment in our hospital from January 2022 to January 2023 were randomly divided into groups by envelope method. 50 patients who received transurethral plasma resection of the prostate were selected as the control group and 50 patients who received transurethral plasma enucleation of the prostate were the study group. The effective rate of treatment, incidence of complications, postvoid residual (PVR) volume, maximum urinary flow rate (Qmax), and international prostate symptom score (I-PSS) were compared between the two groups. Results: By comparison, the effective rate of treatment in the study group was higher (P &lt; 0.05). By comparison, the incidence of complications in the study group was lower (P &lt; 0.05). Before treatment, there was no significant difference in PVR, Qmax, and I-PSS scores between the two groups (P &gt; 0.05). After treatment, the PVR and I-PSS scores of the study group were lower, and Qmax was higher (P &lt; 0.05). Conclusion: In the treatment of benign prostatic hyperplasia, the application of transurethral plasma enucleation can improve the clinical efficacy and clinical symptoms, with high safety and application value.

The Effects of Age, Gender, and Postvoid Residual Volume on Catheterization Rates After Treatment with OnabotulinumtoxinA for Overactive Bladder

BackgroundTransient increases in postvoid residual urine volume (PVR) requiring clean intermittent catheterization (CIC) have occurred with onabotulinumtoxinA treatment for overactive bladder (OAB). ObjectiveTo evaluate onabotulinumtoxinA safety and the effect of age, gender, and maximum PVR (PVRmax) on CIC initiation in adults with OAB and urinary incontinence (UI). Design, setting, and participantsThis was a pooled post hoc analysis of four placebo-controlled, multicenter randomized trials that included adults with idiopathic OAB after first onabotulinumtoxinA treatment (NCT00910845, NCT00910520, NCT01767519, NCT01945489). Patients had at least three urgency UI episodes over 3 d and at least eight micturitions per day, had inadequate management with at least one anticholinergic agent, and were willing to use CIC. Outcome measurements and statistical analysisWe measured the following outcomes: PVRmax within 12 wk after first treatment; CIC incidence; estimated functional capacity; PVR ratio (PVR/estimated functional capacity). Results and limitationsOf 1504 patients, 87.7% were women and 88.8% were White. The mean age was 60.5 yr across 10-yr age groups, baseline PVR was 13.8–35.0 ml, and estimated functional capacity was 293.5–475.7 ml. Mean baseline PVR was 21.3 ml overall versus 34.0 ml in the group that started CIC. The CIC incidence was 6.2% for women (range 1.1–8.4%) and 10.5% for men (range 0–14.6%). Higher CIC rates were observed for PVRmax >350 ml (women 91.9%, men 84.6%) in comparison to PVRmax of 201–350 ml (women 32.5%, men 17.4%) and PVRmax <200 ml (women 1.2%, men 1.6%). Overall, 2/1504 patients (both women) were unable to void spontaneously. The mean PVR ratio was highest at week 2. Some subgroups had small sample sizes. ConclusionsCIC incidence was low overall, was less frequent for women, was rare with PVRmax ≤200 ml, and did not appear to correlate with baseline PVR. Patient summaryAfter onabotulinumtoxinA treatment for OAB, patients sometimes insert a catheter to help in emptying their bladder after urinating. In this study, few patients needed a catheter, especially when less urine volume remained after urination.

Evaluation of functional, perioperative outcomes and common complications of robot-assisted vs open construction of orthotopic neobladder following a radical cystectomy in patients with bladder cancer: A systematic review

Introduction: Orthotopic neobladder (ONB) reconstruction following radical cystectomy for bladder cancer is a viable alternative to the formation of an ileal conduit. Although robotic surgery is gaining popularity, neobladder reconstruction is still most commonly done extra-corporeally (eONB) with a lower midline-laparotomy rather than intra-corporeal ONB (iONB) reconstruction. The novelty of a robotic approach has made several centres apprehensive to adopt this. This systematic review aims to compare functional outcomes as well as perioperative outcomes and common complications of robotic-assisted radical cystectomy with iONB versus eONB reconstruction. Materials and methods: A search of the literature from 2011 to 2021 was performed through PubMed, EMBASE, Medline and Scopus to identify articles comparing eONB formation with iONB formation. Urodynamic (UDS) outcomes (bladder volume, flow rate, post-voiding residual volume, continence rates and rate of clean intermittent catheterization (CIC) use) and perioperative outcomes (estimated blood loss, length of stay and operative time) were extracted as endpoints of interest. This review was registered with PROSPERO on 19 October 2022 (CRD42022366667). Results: Our searches identified 84 abstracts, of which 4 articles with 410 patients were eligible. Our results showed patients undergoing iONB had a higher bladder capacity and continence rate and achieved full continence much sooner than eONBs. iONBs, however, seemed to be left with higher residual volumes and a higher percentage of patients who needed CIC to void. Conclusion: Both perioperative outcomes and complications favoured the iONB technique; however, eONB seemed to give better functional outcomes. Level of evidence: Not applicable

Effects of pumpkin on benign prostatic hyperplasia: a systematic review and meta- analysis

Introduction: Benign prostatic hyperplasia (BPH) is a common condition affecting aging men worldwide. Pumpkin and its extracts are enriched with antioxidant, anti-androgenic and anti-inflammatory properties.Objectives: To systematically review the effect of pumpkin on the reduction of lower urinary tract symptoms (LUTS) due to bladder outflow obstruction in BPHMethods: The review (PROSPERO ID: CRD42020181395) perused PubMed, EMBASE, Cochrane Library, CINAHL and AGRICOLA databases in two rounds independently by two reviewers according to three screening questions: being a pumpkin related human study, having BPH related outcomes and including quantifiable measurements. Risk of bias assessments were done with GRADE and ROBINS-I Criteria. After assessing the clinical, methodological and statistical heterogeneity, meta-analysis was performed for one outcome with mean difference (MD) using Inverse Variance Method with Review Manager 5.4 software.Results: Out of the 242 articles with de-duplication and screening questions, 10 based on interventional studies among adult males with LUTS were selected in ??third round (8 on pumpkin seeds alone; 2 on pumpkin combined products). International Prostate Symptoms Score (IPSS) was described in nine articles. Other outcomes assessed were quality of life (QOL), prostate volume, Prostate Specific Antigen (PSA), uroflow rate, post-voidal residual volume, frequency of micturition during day and night, nocturia and erectile dysfunction. Meta-analysis of three studies (650 and 631 subjects in experimental and control groups) was performed for IPSS reduction. Pooled MD (I2=0%) was -1.41 (95% CI: -1.97, -0.85) with random effect assumption. In all relevant studies, the intervention group demonstrated significant IPSS reduction and increased QOL. One study each demonstrated significant reduction in prostate volume and residual volume; three studies in uroflow rate; and none on PSA improvement.Conclusions &amp; Recommendations: Pumpkin seeds may be beneficial in reducing IPSS and to some extent in improving prostate and residual volume, uroflow rate and QOL in BPH. Further studies are needed to strengthen the hypothesis.

Shifting Trends in Prostate Treatment: A Systematic Review Comparing Transurethral Resection of the Prostate and Holmium Laser Enucleation of the Prostate.

Our systematic review aimed to assess the effectiveness and suitability of holmium laser enucleation of the prostate (HoLEP) as a treatment for benign prostatic hyperplasia (BPH) in comparison to transurethral resection of the prostate (TURP). We analyzed 12 studies involving male participants aged 45-85 years, all of whom had BPH. In our analysis, we compared HoLEP and TURP, with a focus on several primary outcomes, including postoperative International Prostate Symptom Score (IPSS), postvoid residual (PVR) volume, maximum flow rate (Qmax), and changes in sexual function post-treatment. HoLEP demonstrated advantages in certain aspects when compared to TURP. HoLEP generally resulted in an improved postoperative IPSS in some studies, but not all studies showed a significant difference when compared to TURP. HoLEP was associated with improved Qmax in most studies, but one study found no significant difference between HoLEP and TURP.Patients who underwent HoLEP showed improvement in the PVR volume in some studies, while others found no significant change in the PVR volume with either HoLEP or TURP. Some studies reported a reduction in orgasm and ejaculatory scores following TURP, while no significant changes were observed in erectile function, intercourse satisfaction, and overall satisfaction scores. It is worth noting that previous reviews and meta-analyses had limited data on the effects of HoLEP and TURP on sexual dysfunction. TURP is associated with a higher risk of morbidity and mortality, which has led to its replacement with HoLEP as the gold standard for treating BPH, particularly due to its size-independent applicability. HoLEP also demonstrated greater efficacy in the postoperative period.

Impaired nitric oxide mechanisms underlying lower urinary tract dysfunction in aging rats.

The study aimed to investigate the bladder and urethral activity and nitric oxide (NO)-related molecular changes in aging rats. Rats were divided into two groups: Group Y (young rats; 12 wk) and Group A (aging rats; 15 mo). A 24-h voiding assay was performed, and the urodynamic parameters were evaluated using awake cystometry (CMG) and urethral perfusion pressure (UPP) recordings under urethane anesthesia. The mRNA expression levels of NO-, ischemia-, and inflammation-related markers in urethra and bladder tissues and cGMP levels in the urethra were assessed. Body weight was significantly higher in Group A than in Group Y. Voiding assay results (24 h) were insignificant. In the CMG, the number of non-voiding contractions per voiding cycle and post-void residual volume were significantly higher in Group A than in Group Y; voiding efficiency was significantly lower in Group A than in Group Y. In the UPP recordings, the urethral pressure reduction and high-frequency oscillation (HFO) amplitude were significantly lower in Group A than in Group Y. The mRNA expression levels of Hif-1α, Vegf-a, and Tgf-β1 in the bladder were significantly higher in Group A than in Group Y. The mRNA expression levels of Nos1 and Prkg1 and the cGMP concentrations in the urethra were significantly lower in Group A than in Group Y. Aging rats can be useful models for studying the natural progression of age-related lower urinary tract dysfunctions, for which impaired NO-mediated transmitter function is likely to be an important mechanism.NEW & NOTEWORTHY Aging rats can be useful models for studying the natural progression of age-related lower urinary tract dysfunctions, for which impaired nitric oxide-mediated transmitter function is likely to be an important mechanism.

Chronic Low Back Pain: Prevalence, Impact on Quality of Life, and Predictors of Future Disability.

In primary healthcare settings, chronic low back pain (cLBP) is a widespread health issue with a great global impact. A cross-sectional analytical study was performed on 918 adults attending primary healthcare settings in Makkah, Saudi Arabia, to estimate the cLBP prevalence, its effect on health-related quality of life (QOL), and predictors of subsequent disability. The visual analog scale of pain(VAS), World Health Organization Quality of Life Scale (WHO-QOL), and Oswestry low back pain disability index (ODI) were used to assess back pain severity, impact on QOL, and physical disability, respectively. The prevalence of cLBP among adults attending primary care settings in Makkah City was 25.9%, and 88.6% of them had a limited range of motion of the spine. About 58.1% had abnormal radiological findings detected by MRI. Based on the VAS scale, most patients (83.8%) had mild pain. The median (IQR) QOL score was 70 (60-80). Minimal and moderate disability scores were prevalent among 16.2% and 65.7% of patients, respectively. Disability scores were independently predicted by a lower QOL score (beta = -0.39, 95%CI = -0.49 to -0.29, p < 0.001) and higher VAS scores (beta = 0.47, 95%CI = 0.38-0.56, p < 0.001). Furthermore, disability was independently associated with having post-void residual volume (PVRV) (beta = 5.84, 95%CI = 1.97-9.72, p = 0.004) and abnormal X-ray findings (beta = 7.10, 95%CI = 1.77-12.4, p = 0.010). cLBP is common among adults attending primary care settings in Makkah City; it is associated with moderate disability and lower health-related QOL.

Cervi Parvum Cornu complex for men with lower urinary tract symptoms: a multicenter, randomized, double-blind, placebo-controlled trial

BackgroundTo evaluate the efficacy and safety of Cervi Parvum Cornu, Angelicae Gigantis Radix and Glycyrrhizae Radix complex (CAG) in men with moderate lower urinary tract symptoms (LUTS). Materials and methodsFrom November 2020 to January 2022, participants with International Prostate Symptom Score (IPSS) of 12–19 in two centers were recruited and randomize into three groups: a CAG 500 mg/day group (CAG 500), a CAG 1000 mg/day group (CAG 1000), and a placebo group (PG). They were treated for 12 weeks. The primary endpoint was change of IPSS at the end of study from baseline. Secondary end points included change of prostate specific antigen (PSA), testosterone, dihydrotestosterone (DHT), maximum urinary flow rate (Q max), post-void residual volume (PVR), International Index of Erectile Function (IIEF), and drug safety. ResultsA total of 103 patients were able to finish the study according to the study protocol. Total IPSS and sub-scores (residual urine sensation, frequency, weak stream, hesistancy, nocturia, and quality of life) in CAG 500 and CAG 1000 were significantly improved at the 12th week compared to those of the PG. Changes of serum PSA, DHT, and testosterone levels at the 12th week from baseline did not show significant differences among the three groups. Q max and PVR changes did not show significant differences among the three groups either. Total IIEF and sub-scores (erectile function, orgasmic function, sexual desire, intercourse satisfaction) in CAG 1000 were significantly improved at 12th week compared to those in PG. No significant adverse events were found. ConclusionsCAG is well tolerated in patients with moderate LUTS. Treatment with CAG for 12 weeks has a therapeutic effect on moderate LUTS.

Management of Elevated Post-Void Residual Volume

Management of Elevated Post-Void Residual Volume

Prostatic Artery Embolization Using Polyethylene Glycol Microspheres: A 1-Year Follow-up Prospective Study Including 30 Patients

PurposeTo evaluate safety and effectiveness of prostatic artery embolization (PAE) using polyethylene glycol (PEG) microspheres in patients with moderate-to-severe benign prostatic hyperplasia (BPH). Materials and MethodsA single-center, prospective study of 30 patients who underwent PAE from August 2020 to December 2021 using PEG 400-μm microspheres was conducted. Patient evaluation data using International Prostate Symptom Score (IPSS), quality of life (QoL) score, prostate-specific antigen (PSA), peak urinary flow rate (Qmax), postvoid residual volume (PVR), and prostate volume (PV) at baseline and 3 and 12 months after PAE were obtained. ResultsBilateral PAE was performed in all patients. One patient had early clinical failure (3.3%) and another presented with lower urinary tract symptoms (LUTSs) recurrence (3.3%) at the 12-month follow-up. Twenty-eight patients (93.3%) experienced significant and durable LUTS improvement. Mean absolute (and relative) improvement at 3 and 12 months were: IPSS, 14.6 points (−69%) for both; QoL, 3.3 points (−70%) and 3.5 points (−74%); Qmax, 6.3 mL/s (+78%) and 8.6 mL/s (+100%); PSA reduction, 1.2 ng/mL (−22%) and 1.0 ng/mL (−15%); PVR reduction, 48 mL (−56%) and 58.2 mL (−49%); PV reduction, 23.4 cm3 (−29%) and 19.6cm3 (−25%); (P < .05 for all). No major adverse events were observed. Minor adverse events included urinary tract infection (4/30, 13.3%), prostatic tissue elimination (3/30, 10%), penile punctiform ulcer (1/30, 3.3%), and urinary retention (1/30, 3.3%). ConclusionsPAE using PEG microspheres was observed to be effective with sustained LUTS improvement at the 12-month follow-up. The incidence of urinary infection and prostatic tissue elimination was higher than previously reported for other embolics.

The Effect of Duration of Stress Urinary Incontinence on developing Signs of Bladder Outlet Obstruction in Urodynamic Study

Background: Stress urinary incontinence is a frequent urological disease in women; it has a great influence on an individual’s wellbeing and places a significant economic strain on any health service. The placement of urodynamic diagnostic tests in the evaluation route is an important clinical research concern in this field. Objective: to find out whether the duration of stress urinary incontinence is associated with the finding of bladder outlet obstruction in urodynamic study or not. Subjects and Methods: A descriptive study. With enrolled female patients had symptomatic Stress urinary incontinence as their primary complain. All the included patients were assessed thoroughly by history taking and physical examination and relevant clinical tests and investigation in addition to urodynamic evaluation consisted of multi-channel urodynamics measuring abdominal, vesical and detrusor pressures simultaneously. Results: 140 females were suffering from stress incontinence. Urodynamic study showed maximum urine flow rate (Q max) mean of (20.45±9.86) ml/second, the maximum post void volume was 500ml with 36.89ml was the mean of post void residual volume, and 90.83cm water was the mean of urethral occlusion pressure. The mean of duration have positive relationship with age category but without statically significant. Ninety-eight patients have Q max flow more than 25ml/sec with mean duration 6.04 without any statically significant (p=0.872). 37 patients were having &gt;0 ml post void volume with mean duration more than other patients that didn’t have post void volume but without statically significant (p=0.257). All patients with urethral pressure less than 120 cm had long duration mean than others but without statically significant (p=0.335). also, no statistical significance association between mean of duration and sphincter pelvic floor electromyogram (EMG). Conclusion: there was no catechistically significant relationship between the urodynamic findings and the duration neither of stress urinary incontinence nor between the urodynamic findings and the age of the patients.

1114 Safety and Efficacy of Enbloc Low-Power HoLEP for Large Prostate Glands: A Single Centre Prospective Series

Abstract Aim HoLEP is the preferred technique for management of prostates &amp;gt;80cc in men with lower urinary tract symptoms. While evidence has shown that Low-Power (LP) HoLEP is comparable to High-Power HoLEP, the use of LP-HoLEP in enbloc enucleation for large prostates has not been demonstrated. We report a prospective series assessing the safety and feasibility of the technique. Method Data was prospectively collected on 105 patients who underwent LP-HoLEP from 12/02/2020 to 17/08/2022. A 50W Ho:YAG laser was used at 39.6W (2.2J, 18Hz). Prostate volume and uroflowmetry were assessed preoperatively, and patients were reviewed at three and 12 months postoperatively. Results The mean age of participants was 72 years with a median prostate volume of 117cc. Median enucleation time was 39 minutes, with a median enucleated weight of 73.0g and a median enucleation efficiency of 2.1g/min. Of the 105 patients, 60% were discharged on the same day with 94.3% of patients home by Day 1. Mean IPSS and QoL scores improved from 20.8 to 8.5 (p&amp;lt;0.001) and 4.2 to 2.0 (p&amp;lt;0.001) respectively. Qmax improved by 16.7ml/s (p&amp;lt;0.001) and post-void residual volume reduced by 144.8mL (p&amp;lt;0.001). Complications occurred in 27 (25.7%) patients [Clavien-Dindo 1: n = 23; 2: n = 2; 3A: n = 0; 3B: n = 2]. Conclusions In the hands of an experienced operator, enbloc LP-HoLEP is technically feasible and effective for the treatment of large prostates which can be delivered safely as a daycase procedure.

Hyperbaric treatment deviations for U.S. Navy divers: Spinal DCS

Introduction The United States Navy (USN) developed and refined standardized oxygen treatment tables for diving injuries, but USN tables may not address all situations of spinal decompression sickness (DCS). We describe a detailed recompression treatment regimen that deviated from standard USN protocol for an active-duty USN diver with a severe, delayed presentation of spinal cord DCS. Case Report A USN diver surfaced from his second of three dives on a standard Navy ‘no-Decompression’ Air SCUBA dive (Max depth 101 fsw utilizing a Navy Dive Computer) and developed mid-thoracic back pain, intense nausea, paresthesias of bilateral feet, and penile erection. Either not recognizing the constellation of symptoms as DCS and after resolution of the aforementioned symptoms, he completed the third planned dive (essentially an in-water recompression). Several hours later, he developed paresthesias and numbness of bilateral feet and legs and bowel incontinence. He presented for hyperbaric treatment twenty hours after surfacing from the final dive and was diagnosed with severe spinal DCS. Based on the severity of clinical presentation and delay to treatment, the initial and follow-on treatments were modified from standard USN protocol. MRI of the spine four days after initial presentation demonstrated a 2∙2 cm lesion at the T4 vertebral level extending caudally. Follow-up examinations over two years demonstrated almost complete return of motor and sensory function; however, the patient continued to suffer fecal incontinence and demonstrated an abnormal post-void residual urinary volume. An atypical presenting symptom, a discussion of MRI findings, and clinical correlations to the syndrome of spinal DCS are discussed throughout treatment and long-term recovery of the patient.

ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting, Part 2: Analysis of PFS, reporting, and diagnosis

Aims:The Working Group (WG), initiated by the International Continence Society (ICS) Standardisation Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, has revised the ICS Standard for pressure-flow studies of 1997. Methods:Based on the ICS standard for developing evidence-based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in December 2022 to facilitate public discussion and the comments received have been incorporated into this final release. Results:The WG has recommended analysis principles for the diagnosis of voiding dysfunction for adult men and women without relevant neurological abnormalities. New standard terms and parameters for objective and continuous grading of urethral resistance (UR), bladder outflow obstruction (BOO) and detrusor voiding contraction (DVC) are introduced in this part 2 of the standard. The WG has summarized the theory and recommendations for the practice of pressure-flow study (PFS) for patients in part 1. A pressure-flow plot is recommended for the diagnosis of every patient, in addition to time-based graphs. Voided percentage and post void residual volume should always be included in PFS analysis and diagnosis. Only parameters that represent the ratio or subtraction of pressure and synchronous flow are recommended to quantify UR and only parameters that combine pressure and flow in a product or sum are recommended to quantify DVC. The ICS BOO index and the ICS detrusor contraction index are introduced in this part 2 as the standard. The WG has suggested clinical PFS dysfunction classes for male and female patients. A pressure-flow scatter graph including every patient’s pdet at maximum flow (pdetQmax) with maximum flow rate (Qmax) point should be included in all scientific reports considering voiding dysfunction. Conclusion:PFS is the gold standard used to objectively assess voiding function. Quantifying the dysfunction and grading of abnormalities are standardized for adult males and females.