Postvoid Residual Research Articles

Clinical Trial of Gatch UP 45-Degree Positioning for Decreasing Post-Void Residual (PVR) Urine Volume

Clinical Trial of Gatch UP 45-Degree Positioning for Decreasing Post-Void Residual (PVR) Urine Volume

Is Treating Bladder Outlet Really Needed when Removing Bladder Stones: Outcomes of Bladder Stones Removal Without Concomitant BPO Surgery.

Introduction: While surgical intervention for benign prostatic obstruction (BPO) is traditionally recommended alongside bladder stone removal in males, recent studies have questioned the necessity of this approach. This study aims to evaluate the long-term outcomes of bladder stone removal without concomitant BPO surgery. Methods: We conducted a retrospective analysis of males with BPO who underwent bladder stone removal without concomitant BPO surgery in our institution between 2017 and 2024. Clinical and functional variables were collected, and our primary endpoint during the study period was future BPO surgery (BPO surgery-free survival). Secondary outcomes included BPO-related complications, medical therapy burden, and significant increase in post-void residual (PVR). Kaplan-Meier curves, receiver operating characteristic curves, and Cox regression models were used to analyze the results and identify predictors for future BPO surgery. Results: Our cohort consisted of 63 patients with median follow-up of 34 months. During the study period, 13 patients (22%) underwent BPO surgery. The 1-year, 3-year, and 5-year BPO surgery-free survival rates were 90%, 78%, and 78%, respectively. Prostate volume >100 cc and PVR >93 mL were the most significant predictors of future BPO surgery, increasing the likelihood by nearly fourfold. In the absence of concomitant BPO surgery, 94% of patients managed their BPO with medication, and 57% experienced BPO-related adverse outcomes. Conclusion: Bladder stone removal without concomitant BPO surgery offers a high likelihood of avoiding future BPO surgery in the intermediate-term. However, careful patient selection and management of BPO-related risks are crucial. Prostate volume and PVR should be considered in the shared decision-making process.

Single-port transvesical simple prostatectomy for the surgical treatment of benign prostatic hyperplasia: functional and continence outcomes.

Robot-Assisted Simple Prostatectomy (RASP) is recommended for the treatment of large prostate glands. The introduction of the Single-Port (SP) platform in 2018 has enabled transvesical approach to SP-RASP with promising outcomes. Our aim was to describe the functional and urinary continence outcomes of SP-RASP. Clinical and surgical data from all consecutive patients who underwent transvesical SP-RASP between February 2020 and March 2024 were collected in a prospectively maintained institutional dataset and retrospectively analyzed. All procedures were performed using the da Vinci SP platform without any conversions to open surgery. Postoperative outcomes were gathered and analyzed, with a particular focus on the incidence of urinary incontinence (UI) and the time to continence recovery. Overall, 89 patients underwent SP-RASP, with a median prostate size of 110 grams (90-171.5) and a median PSA level of 5.5 mg/dl (2.77-10.93). All patients were on at least one prostate medication prior to surgery. Preoperative evaluations showed a median International Prostate Symptoms Score (IPSS) of 23 (20-27), Quality of Life (QoL) of 4 (3-5), and Post-voiding Residual (PVR) of 153 ml (60-400). The median operative time was 180 min (164-200), with a median estimated blood loss of 100 ml (30-180). Postoperatively, no patients required continuous bladder irrigation. The median postoperative opioid intake was 6.5 morphine equivalents (0-10), with over 78% not requiring narcotics after discharge. Overall, 77.5% were same day discharged. No Clavien-Dindo > 2 complications were recorded. The median follow-up time was 18 (7-35) months. At the last postoperative urological evaluation, the median IPSS was 5 (3-7), QoL was 1 (0-2), and PVR was 10 ml (0-25). Only 4 patients (4.5%) experienced UI postoperatively, and all were continent within 3 months. The UI incidence rate and functional outcomes of SP-RASP are very encouraging, likely due to precise adenoma and urethra dissection and bladder neck reconstruction. This approach also allows for same-day discharge.

Urinary Retention After GreenLight Laser Photoselective Vaporization of the Prostate (GLL.PVP) Surgery for Benign Prostatic Hyperplasia (BPH): A 3-6 Month Retrospective Follow-Up Study.

Objective Our study was designed to evaluate the postoperative urinary retention (UR) and success rate of the GreenLight Laser (Boston Scientific, Marlborough, MA, USA) photoselective vaporization of the prostate (GLL.PVP) procedure for Benign Prostatic Hyperplasia (BPH) patients, both with and without high-risk factors. Methodology We conducted a retrospective follow-up study of postoperative patients who underwent GLL.PVP for BPH. We collected data from clinical health records, including notes from the lower urinary tract symptoms (LUTS) clinic, trial without catheter (TWOC) clinic, and emergency department presentations with UR. The analysis examined several parameters, including the patient's age, high-risk factors, prostate volume, and both preoperative and postoperative objective voiding parameters. These voiding parameters included post-void residual (PVR) and maximum flow rate (Qmax). Additionally, the analysis looked into whether the patient had a catheter or experienced urinary retention prior to the surgery. Results A total of 50 GreenLight Laser PVP surgeries were performed over a 14-month period from May 2023 to July 2024 at West Middlesex University Hospital in London. Most of the patients were between the ages of 60 and 80. Prior to the surgery, data indicated that 17 patients (34%) were using long-term catheters, whereas 33 patients (66%) were not. Additionally, 25 patients (50%) were identified as having high-risk factors, which included being on anticoagulation therapy, a history of urinary retention, and a prostate volume exceeding 100 cc.Notably, the patient without h/o urinary retention had an average preoperative PVR of 150 mL and an averageQmaxof 7 mL/second In our 3-6 month retrospective postoperative follow-up study, we found that eight cases (16%) developed urinary retention, while 42 cases (84%) did not, with an average PVR volume of 105 mL and an average Qmax of 13.5 mL/second. In patients with preoperative urinary retention, 13 cases (76%) did not develop UR postoperatively whereas four cases (24%) developed. Conclusion Our study conclusively found that 42 cases (84%) of patients did not experience urinary retention (UR) in the follow-up after undergoing the GLL PVP operation, irrespective of any history of urinary retention or other high-risk factors. This unequivocally demonstrates the operation's efficacy. Furthermore, our findings revealed that three-quarters of patients with a preoperative history of urinary retention also did not develop UR post-surgery. The GLL.PVP procedure is safe and effective, leading to rapid improvements in voiding parameters.

Predictive Factors for Clean Intermittent Catheterization after Intravesical OnabotulinumtoxinA Injections in Women with Overactive Bladder: a Danish Retrospective Cohort Study.

We aimed to evaluate the clean intermittent catheterization (CIC) rate in women undergoing their first OnabotulinumtoxinA (BTX-A) treatment and to investigate factors predictive of initiating CIC. This was a retrospective cohort of women, who had their first BTX-A treatment for symptoms of overactive bladder (OAB) syndrome, with a pretreatment urodynamic study (UDS). We reviewed demographic, medical and gynecological history, UDS, pretreatment bladder diaries, objective examinations, BTX-A treatment details, and post-void residual (PVR) reports in the electronic medical record. Botox® Allergan 100 International Units were injected into the detrusor at 10-20 sites. Statistical analyses included univariate and multivariate logistic regression analyses. We included 397 women. Median age was 68 (Q1-Q3: 54-76) years. CIC rate was 8.6% (n = 34) following the first BTX-A treatment. Urgency urinary incontinence (UUI) reduced the risk of undergoing CIC (OR 0.30, 95% CI 0.09-0.97). A bladder capacity of 500ml or greater in the bladder diary increased the risk of CIC (OR 2.46, 95% CI 1.06-5.70), whereas reported leakages were associated with a decreased risk of CIC (OR 0.24, 95% CI 0.10-0.57). Multivariate logistic regression analysis showed that anterior colporrhaphy (OR 3.71, 95% CI 1.52-9.06) and 10-ml increments in median maximum cystometric capacity (OR 1.03, 95% CI 1.00-1.06) predicted CIC, whereas UUI was a protective factor for CIC (OR 0.23, 95% CI 0.07-0.79). A history of anterior colporrhaphy, large bladder capacity, and absence of incontinence episodes in bladder diary or UDS were risk factors for CIC after the first BTX-A treatment.

Prostatic Artery Embolization for the Treatment of Benign Prostatic Hyperplasia: A Retrospective Single-Center Study.

Introduction The purpose of this study is to assess the effectiveness and short-term outcomes of prostatic artery embolization (PAE) in Indian patients suffering from benign prostatic hyperplasia (BPH). Methods This retrospective analysis was performed at a single center and included 25 patients with BPH who received PAE from January 2019 to June 2023. The symptoms of patients had been assessed utilizing the International Prostate Symptom Score (IPSS) and the Quality of Life (QoL) questionnaire. The prostate volume and post-void residual (PVR) volume were assessed using transabdominal ultrasonography prior to and following the embolization. The procedure occurred in the interventional radiology suite with the patient under conscious anesthesia, employing polyvinyl alcohol (PVA) particles. Prostate volume, PVR, IPSS, and QoL scores had been assessed at a follow-up three months later. Results Twenty-five males, with an average age of 76.56 years, underwent PAE. Bilateral embolization was conducted in 23 patients, whereas unilateral embolization was executed in two cases. Following a duration of three months, the average maximum improvement was as defined: IPSS, 10.44 ± 2.91; QoL score, 1.80 ± 0.81; prostatic volume decrease, 49.40 ± 24.13 cc (43% ± 13.95); and PVR volume, 70.08 ± 39.85 mL (52% ± 14.14) (p < 0.001 for all) as evaluated by the paired t-test. Conclusion PAE is a secure and efficacious intervention for BPH, yielding favorable short-term outcomes for lower urinary tract symptoms.

Water vapor thermal therapy (Rezūm System) in patients with large prostates: results from a prospective comparative study.

Rezūm is a novel minimally invasive surgical technique (MIST) useful for BPH patients with medium-sized prostate (30-80 cm3) refractory to medical treatment. The aim of this study was to evaluate the efficacy and safety of Rezūm as a treatment option in large-sized prostates (>80 cm3). We performed a prospective, comparative, single-center study from June 2022 to June 2023, including consecutive patients undergoing surgery with the Rezūm System. Enrolled men were classified into two subgroups based on prostate size: medium prostate (MP) (30-80 cm3) and large prostate (LP) (≥80 cm3). Inclusion criteria included an International Prostate Symptom Score (IPSS) Total score of ≥ 8 points. International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual (PVR), and International Index of Erectile Function 5-item version (IIEF-5) were collected at baseline and at three, six, and 12 months post-procedure. Ejaculation presence was assessed at 3 months. Post-operative complications were described using the Clavien-Dindo (CD) classification. The primary outcome was the IPSS-Total score, with intraoperative and postoperative CD grade ≥III complications as secondary outcomes. One hundred and twenty-one patients (PV 78.2±32.1 mL) were included in the study, 51 large prostate (LP) and 70 medium prostate (MP). The IPSS-Total score and Q<inf>max</inf> showed a statistically significant (P<0.0001) improvement at 3, 6, and 12 months respectively. PVR decreased at 3, 6, and 12 months; however, only at 3 months this variation was statistically significant (P<0.0001). At 3-month follow-up, anejaculation was detected in (3; 5.8% and 1; 1.4%) patients in LP and MP group respectively (P=0.86). IIEF-5 significantly improved 3 months after surgery in the LP subgroup (P<0.0001). Rezūm water vapor therapy appears to be effective for treating BPH in larger prostates. Additionally, it demonstrates a low risk of impairing sexual function, indicating a favorable safety profile.

Impact of Siponimod on Clinical and Radiological Parameters of Secondary Progressive Multiple Sclerosis: A Real-World Prospective Study.

Secondary progressive multiple sclerosis (SPMS) presents with a challenging clinical phenotype, and siponimod has a potential to treat the active clinical phenotype of this disease. This single-center longitudinal study aimed to determine the therapeutic effects of siponimod in patients with active SPMS over 12 months. The clinical and radiological parameters of 50 patients with active SPMS treated using siponimod were assessed at baseline and after a 1-year follow-up period using the annual relapse rate (ARR), the Expanded Disability Status Scale (EDSS), the occurrence of gadolinium-enhanced lesion (GdE+), the Modified Fatigue Impact Scale (MFIS), and the Symbol Digit Modalities Test. The urine bladder postvoid residual (PVR) volume was also measured in a subcohort of 39 participants. Participants with an EDSS score ≥5.0 at baseline were finally assessed separately in prespecified subgroup analyses. There were significant reductions in ARR (p<0.001), GdE+ (p<0.001), and MFIS score (p=0.001) during the follow-up period. The progression of physical and cognitive disabilities remained stable (p>0.05). The PVR-volume analysis revealed a significant decrease in urine bladder PVR volume (p<0.001). These observations were consistent for the subgroup with EDSS score ≥5.0. Siponimod demonstrated efficacy in reducing ARR, GdE+, fatigue levels, and PVR volume, while maintaining stability in the cognitive and physical disability statuses of patients with SPMS. Similar findings were documented in the subgroup with EDSS score ≥5.0.

Retrospective Assessment of Post-Transurethral Resection of the Prostate Complications in Benign Prostatic Hyperplasia Patients: Impact of Acute Urinary Retention.

Background Benign prostatic hyperplasia (BPH) is the most common urological condition affecting older men, leading to lower urinary tract symptoms (LUTS) and complications such as acute urinary retention (AUR), which can significantly impact quality of life. This study aims at comparing the postoperative outcomes and complication rates of monopolar transurethral resection of the prostate (TURP) in BPH patients with and without AUR. By examining the differences in postoperative outcomes, the study seeks to highlight the impact of AUR on complications such as UTIs, prolonged catheterization, and extended hospital stays, and assess the potential clinical implications for improving treatment strategies in these patients. Methodology An observational retrospective study was conducted at a tertiary care hospital in central India, over a period of two years. The study included 150 men aged 45 to 70 years with LUTS due to BPH, and participants were equally divided between two groups: Group A (AUR positive) and Group B (AUR negative). Wide-ranging assessments were performed on all patients, including history, physical examination, digital rectal examination, ultrasound, and post-void residual (PVR) urine assessment. Postoperative outcomes and complications were determined, and statistical analyses were conducted using Student's t-test with a level of significance of p < 0.05. Results The findings of the study indicated that patients in Group A, who experienced AUR, had significantly higher postoperative complications compared to Group B, who did not have AUR. Specifically, the mean complication rate was 60% in Group A compared to 30% in Group B. Common complications included urinary tract infections and prolonged hospital stays. In terms of urodynamic parameters, Group A exhibited a significantly lower maximum flow rate (Qmax) at 7.5 mL/s compared to 9.8 mL/s in Group B (p < 0.01). The average PVRvolume was also notably higher in Group A at 150.4 mL, compared to 90.2 mL in Group B (p < 0.01). These differences highlight the impact of AUR on surgical outcomes. Conclusion The findings of this study highlight the increased risks of complications associated with AUR in patients undergoing monopolar TURP. These results underscore the need for careful patient selection and management strategies to optimize outcomes. Future research should focus on expanding the sample size and incorporating multicenter data to enhance the generalizability of the results. Additionally, further investigation into long-term outcomes and the effectiveness of different management protocols for patients with AUR will be essential for improving the quality of care in the management of BPH.

Investigation on clinical risk factors of bladder lesion by machine learning based interpretable model

Bladder lesion commonly occurs in patients with benign prostatic hyperplasia (BPH), and the routine screening of bladder lesion is vital for its timely detection and treatment, in which the risk of bladder lesion progression can be effectively alleviated. However, current clinical methods are inconvenient for routine screening. In this study, we proposed a convenient routine screening method to diagnose bladder lesions based on several clinical risk factors, which can be obtained through non-invasive, easy-to-operate, and low-cost examinations. The contribution of each clinical risk factor was further quantitatively analyzed to understand their impact on diagnostic decision-making. Based on a cohort study of 253 BPH patients with or without bladder lesions, the proposed diagnostic model achieved high accuracy using these clinical risk factors. Bladder compliance, maximum flow rate (Qmax), prostate specific antigen (PSA), and postvoid residual (PVR) were identified as the four most important clinical risk factors. To the best of our knowledge, this is the innovative research to predict bladder lesions based on the risk factors and quantitatively reveal their contributions to diagnostic decision-making. The proposed model has the potential to serve as an effective routine screening tool for bladder lesions in BPH patients, enabling early intervention to prevent lesion progression and improve the quality of life.

An Alternative Approach for Treating Female Underactive Bladders with Chronic Urine Retention: A Pilot Study on Combined Transvaginal Ultrasound-Guided Botulinum Toxin A External Sphincter Injection and Transurethral Incision of the Bladder Neck.

Background: Treating an underactive bladder (UAB) is challenging. Previously, we introduced a more precise method of transvaginal ultrasound-guided botulinum toxin A (BoNT-A) injection into the external urethral sphincter as a treatment option for patients with UABs. Although many patients experience good results, those with an UAB and excessive residual urine still require catheterization. Therefore, we developed a new method that combines transvaginal ultrasound-guided BoNT-A injection with a transurethral bladder neck incision. Methods: A prospective study was conducted on 16 patients who experienced symptoms of UAB and chronic urine retention. The treatment consisted of a combination of transvaginal ultrasound-guided BoNT-A injection and a transurethral incision of the bladder neck (TUI-BN). The primary objective was to assess the efficacy of this combined treatment in improving symptoms in women with UABs. Results: Our study demonstrated significant improvements after treatment, including increased voiding volume, decreased post-void residual (PVR) urine, and improved voiding efficiency. The frequency of clean intermittent catheterization (CIC) decreased at 1 and 3 months post-surgery, along with improvements in the AUA symptoms score and the Patient Perception of Bladder Condition (PPBC) score. Conclusions: Our study showed significant improvements in the surgical treatment of UABs using a combination of transvaginal ultrasound-guided BoNT-A and TUI-BN.

Остаточная моча: вопросы диагностики.

Introduction. To date, the problem of the presence of post voiding residual (PVR) in children remains urgent. PVR is the amount of urine remaining in the bladder after its voluntary emptying. The following conditions are associated with this, requiring the participation of a specialist: urinary tract infection, urolithiasis, bladder dysfunction. Materials and methods. A group of 125 children who were treated at medical centre «Alenka» for bladder dysfunction was under observation. In 42 of them, PVR was detected during uroflowmetric monitoring (UM) for 2 days on the SIGMA model uroflowmeter device, option F. Results. Processing and analysis of the data obtained allowed us to conclude that the reliability of the ultrasound diagnostic method is low (x2 =0.013; p&gt;0.05) when detecting PVR and high during voiding cystourethrography (x2= 3.889; p&lt;0.05). During uroflowmetric monitoring, there was a tendency to decrease the frequency of PVR with age. The average effective volume was reduced in 34 children (20 boys and 14 girls), was within the age norm in 3 boys and increased in 5 children (3 boys and 2 girls). Thus, PVR occurred almost 7 times more often with a decrease in the volume of the bladder than with an increase in it, which changes the idea of the nature of residual urine. Conclusion. According to the conducted research, it becomes clear that the symptom of residual urine is a common sign in pediatric urological practice. The most accurate method for determining PVR is two-day uroflowmonitoring, followed by miction cystography in terms of accuracy. Ultrasound examination reveals residual urine unreliably.

Nurse performed bladder ultrasound: a clinical quality improvement initiative

Background: Bladder ultrasound (BUS) provides an accurate measurement of post-void residual (PVR) volume and bladder assessment. Access to BUS is dependent on practitioner availability with delays resulting in poor symptom management, delayed discharge and dissatisfaction. Developing nursing practice to perform BUS can address these patient’s needs. Aims: Through a quality improvement initiative the aims were (1) to develop theoretical knowledge and practical competence of nurses to perform BUS, (2) to evaluate nursing activity in relation to BUS, (3) to evaluate stakeholders perceptions of the initiative. Methods: Based on the Deming Plan-Do-Study-Act (PDSA) cycle, an interprofessional team was created and a theoretical/practical based education program was devised. Activity in relation to the nurse-performed BUS was collected and analysed descriptively. Stakeholder perceptions were evaluated via patient and physician questionnaires subject to descriptive analysis and a focus group with nurses analysed descriptively. Results: The team developed a training program to perform BUS, certifying 11 nurses. Investigation of nursing activity related to BUS (n = 202) showed its use for PVR evaluation, and symptom and catheter assessment. It aided decision-making and nurse-physician communication. Stakeholders were satisfied with the initiative. Patients (n = 30) felt nurses were competent, clearly explaining the procedure, results and inspiring confidence. Physicians (n = 2) saw BUS as enhancing efficiency and care quality, while nurses (n = 7) felt this new skill enhanced nursing care providing a more holistic approach. Team reflection on the results of the evaluation confirmed BUS utility and activity, while nurses requested continuing education and a post-certification refresher course. Conclusion: Through reflection on clinical practice areas for improvement to enhance patient care were identified by the nursing team. Application of the PDSA cycle provided a structured approach to guide the quality improvement initiative. Improvements in nursing care and patient care processes have been observed and this has been a positive experience for stakeholders.

The examination of detrusor underactivity in multiple system atrophy.

The urinary dysfunction in multiple system atrophy (MSA) is characterized by large post-void residuals (PVR) due to impaired bladder contractility. However, the evaluations of bladder contractility are not well validated in MSA. Because the bladder contractility index can be generally represented as Pdet Qmax (detrusor pressure at maximum urinary flow rate) + kQmax (maximum urinary flow rate), we aim to examine which "k" value is suitable for representing bladder contractility concerning its correlations to PVR and voided percentage (VOID%). We retrospectively reviewed 133 patients with MSA (74 males, 59 females, mean disease duration 3.2 years) who underwent an urodynamic study. We calculated bladder contractility using the formula PIPk = Pdet Qmax + kQmax by increasing the "k" value from 0.1 to 10 by increments of 0.1. We calculated the correlations between each PIPk (k = 0.1-10.0) and PVR and VOID%. The correlational coefficients between PIPk and VOID% were larger than those between PIPk and PVR. The correlational coefficients between PIPk and VOID% reached a plateau level at a "k" value >5.0 in male patients, suggesting that currently used formulas such as Pdet Qmax + 5Qmax for males might be appropriate for male MSA patients. However, the correlational coefficients between PIPk and VOID% reached a plateau level in female patients when the "k" values were >6.0, which might overestimate bladder contractility in female patients. Although currently used formulas such as Pdet Qmax + 5Qmax might be appropriate for male MSA patients, formulas for female patients need further evaluation.

COMPARISON OF PRE AND POST-TURP EVALUATION IN BPH PATIENTS USING IPSS AND UROFLOWMETRY IN TERTIARY HOSPITAL

Objective: To present the data about LUTS using International Prostatic Symptoms Score (IPSS) and uroflowmetry on BPH patients following TURP. Material &amp; Methods: This retrospective study reviewed patients diagnosed as BPH with LUTS undergone TURP from Dr. Saiful Anwar General Hospital medical records from January 2021 to January 2023. The basic clinical characteristics, IPSS, and uroflowmetry results were collected. Furthermore, the comparison of IPSS score and uroflowmetry prior and 7 days after surgery were analyzed. Results: From a total of 286 patients, 94 patients met the inclusion criteria. Improvement of LUTS and quality of life (QoL) obtained from IPSS were observed before and after TURP (19.13 vs 2.78, p&lt;0.001; 4.38 vs 0.33, p&lt;0.001). Similar improvement was also showed for maximum flow rate (QMax) and post-void residual (PVR) volume obtained from uroflowmetry result (7.90 vs 17.85, p&lt;0.001; 66.25 vs 27.05, p&lt;0.001) with 90.43% patients had Qmax &gt;15 ml/sec after the procedure. Conclusion: This study showed the evidence of early improvement of IPSS and uroflowmetry results in BPH patients after TURP. The indicators were sufficient to evaluate the satisfaction result of patient complaining LUTS. Keywords: BPH, IPSS, uroflowmetry, TURP.

Predictive Factors for the Successful Outcome of Urethral Sphincter Injections of Botulinum Toxin A for Non-Neurogenic Dysfunctional Voiding in Women.

Dysfunctional voiding (DV) is not uncommon in women with non-neurogenic voiding dysfunction. Because of its unknown pathophysiology, effective and durable treatment is lacking. This study aimed to analyze the results of treatment and predictive factors for a successful outcome of botulinum toxin A (BoNT-A) treatment in female patients with DV. In total, 66 women with DV confirmed by a videourodynamic study (VUDS) were treated with a BoNT-A injection into the urethral sphincter once (n = 33) or several times (n = 33). VUDS was performed before (baseline) and after the BoNT-A treatment. Patients with a global response assessment of the voiding condition of 2 or 3 and a voiding efficiency (VE) of >20% than baseline were considered to have a successful outcome. The baseline demographics, VUDS parameters, and VUDS DV subtypes were compared between the successful and failed groups. Predictive factors for a successful outcome were investigated by logistic regression analyses. Successful and failed outcomes were achieved in 27 (40.9%) and 39 (59.1%) women, respectively. After BoNT-A injections, the maximum flow rate (Qmax), voided volume, and VE all significantly increased, and the postvoid residual (PVR) was slightly improved. No significant difference in the number of injections and medical comorbidity was found between the groups. However, the successful group had a higher incidence of previous pelvic surgery. No significant difference in the treatment outcome was found among patients with different urethral obstruction sites. Significant improvements in Qmax, voided volume, PVR, VE, and the bladder outlet obstruction (BOO) index were noted in the successful group. A lower VE at baseline and a history of surgery were identified as predictive factors for a successful outcome of BoNT-A injections for treating DV. BoNT-A injections into the urethral sphincter can effectively improve VE in 40.9% of women with DV. Women with higher BOO grades and previous pelvic surgery are predicted to have a successful treatment outcome.

Evaluation of efficacy of cholecalciferol and silymarin in improving lower urinary tract symptoms of benign prostatic hyperplasia: A double-blind, randomized, controlled trial.

Benign prostatic hyperplasia (BPH) mainly leads to lower urinary tract symptoms (LUTS) in aging men. The present study investigates the role of cholecalciferol, Silymarin, and their combined administration in patients with BPH suffering from LUTS. This double-blind, randomized, controlled trial enrolled 80 participants (50-80 years) diagnosed with BPH, from March 2019 to March 2020. Based on serum 25-(OH) vitamin D levels we formed subgroups, each receiving specific interventions. Measurements of International Prostate Symptom Score (IPSS), Maximal Urinary Flow Rate (Q-max), Prostate Volume (PV), Post-Void Residual (PVR), and Prostate-Specific Antigen (PSA) were recorded at baseline and following 3 months of follow-up. Participants with serum concentration of 25-(OH) vitamin D below 20 ng/ml simultaneously received cholecalciferol and Silymarin that significantly improved IPSS, irritation, obstruction, PV, and PVR. In those with concentrations ⩾20 ng/ml, a single use of Silymarin significantly reduced IPSS, irritation, obstruction, and PVR. Adjustment of confounding variables revealed independent and significant effects of both cholecalciferol and Silymarin on PVR, IPSS, and obstruction. Cholecalciferol also improved irritation, while Silymarin reduced prostate volume. These findings highlight potential therapeutic benefits for BPH-associated LUTS, encouraging further exploration and clinical consideration. In this investigation, combination therapy with cholecalciferol at 50,000 IU/w for 8 weeks and Silymarin at a dosage of 480 mg for 3 months resulted in a notable improvement in the IPSS score, PV, and PVR, as well as both irritative and obstructive symptoms. However, the total PSA and free PSA amounts did not reach a significant difference.

Incidence, risk factors and diagnostic accuracy of clinical palpation in picking up post-void residual urine in postnatal women.

To determine the incidence of covert and overt postpartum urinary retention after vaginal delivery and the associated risk factors for postpartum urinary retention. To determine how well clinical examination by abdominal palpation correlates with ultrasound findings of urinary retention. Patients after delivery were screened with ultrasound and examined clinically to check for retention of urine after voiding. A total of 822 of women were recruited in the study of which 86 (10.5%) women had significant post-void residue of urine. 33 (38.4%) had overt retention, while 53 (61.6%) had covert retention. Duration of labour and an increased VAS score were found to be significantly higher among those with urinary retention. Using clinical examination to diagnose postpartum urinary retention had a sensitivity of 66.1%, specificity of 88.6%, positive predictive value of 76.5% and negative predictive value of 82.3%. Clinical examination by abdominal palpation is not a very sensitive test in diagnosing PPUR.

Investigating the Prevalence of Autonomic Neuropathy in Diabetic Patients with Urinary Irritation Symptoms Without a Known Cause.

Evaluating pseudomotor performance can be a valuable tool for investigating the peripheral autonomic nervous system in diabetic patients. Sudoscan, a simple and non-invasive method for assessing pseudomotor performance, has been developed in recent years. This study aimed to investigate autonomic neuropathy using Sudoscan in diabetic patients with lower urinary tract symptoms (LUTS) of unknown cause. In this cross-sectional study conducted from April 2022 to April 2023, we included 195 patients with type 2 diabetes who were referred to the urology clinic. We extracted demographic, clinical, and laboratory data from the patient files and evaluated urinary symptoms using the International Prostate Symptom Score (IPSS) questionnaire. Patients underwent Sudoscan testing to evaluate autonomic neuropathy in the physical medicine and rehabilitation clinic. To further assess urinary irritative symptoms, patients underwent urodynamic studies (UDS) and ultrasonography. The Sudoscan test results showed that autonomic neuropathy was present in 77 patients (40%), with 43 (22.1%) having moderate and 44 (22.6%) having severe neuropathy. Patients with autonomic neuropathy were found to be older, had longer diabetes durations, higher average blood glucose levels, and higher creatinine levels. Additionally, we found a significant correlation between autonomic neuropathy and signs of high post-void residue on ultrasound and detrusor contraction disorders on UDS (p-value < 0.05). Our study found a higher prevalence of autonomic neuropathy in diabetic patients with LUTS using Sudoscan (40%). Longer diabetes duration and poor glycemic control were associated with an increased risk of autonomic neuropathy linked with LUTS, such as urge incontinence.

One hundred cases of Rezum water vapor thermal therapy for benign prostatic hyperplasia: Real-world data at a single institution in Japan.

The objective of our study was to assess the efficacy of Rezum, a minimally invasive surgical treatment, for patients with lower urinary tract symptoms related to benign prostatic hyperplasia (BPH) in real-world clinical practice at a single institution in Japan. We conducted a prospective study involving 100 patients who underwent the Rezum procedure between October 2022 and February 2024. We analyzed patient backgrounds that are compliant with Japanese regulations and assessed descriptive outcomes such as symptom scores, peak flow in uroflowmetry, post-void residual (PVR) volume, and prostate volume (PVol). These data were collected at 1 and/or 3 months postoperatively. On average, 4.7 water vapor injections were administered during the Rezum procedures, with a mean operative time of 6.3 min. Patients experienced significant relief in symptoms, with reductions of 55% in International Prostate Symptom Score, 53% in quality of life score, and 30% in Overactive Bladder Symptom Score. There was also a significant decrease in mean PVR volume (50% reduction) and PVol (27% reduction). Among the subgroup of 23 pre-interventional catheter-dependent patients, 91% achieved catheter independence. Our single-center analysis demonstrates that Rezum is an effective and safe minimally invasive therapeutic option for patients with BPH. This promising novel technique can be particularly beneficial for patients at an augmented risk of bleeding or those considered high risk for anesthesia.