Postvoid Residual Research Articles

Efficacy and safety of the Rezum system for the treatment of catheter-dependent urinary retention: Three-year real-world outcomes in a multimorbid, multiethnic population.

To evaluate the long-term real-world efficacy and safety of Rezum for the treatment of catheter-dependent urinary retention in a multimorbid, multiethnic population. A single-office, retrospective study was conducted on patients treated with Rezum between 2017 and 2019. Patients were included if they had catheter-dependent urinary retention prior to treatment and at least one follow-up within 36 months postoperatively. Patient demographics, procedural characteristics, adverse events (AEs), and outcome measures, including benign prostate hyperplasia (BPH) medication usage and postvoid residual (PVR), were collected at 3, 6, 12, and/or 36 months postoperatively. Regret was assessed at 36 months using the 5-item Decisional Regret Scale (DRS). A total of 27 patients met the inclusion criteria, with the majority being Asian (29.6%), followed by non-Hispanic Black (26.0%) and Hispanic (22.2%). Most patients (77.8%) had at least one comorbidity. Trial of void (TOV) was attempted at a median of 8 days (7, 13). Fourteen patients (51.9%) failed their initial TOV. Median time until catheter independence was 13.5 days (8.5, 28.8). Common AEs included urinary retention (51.9%), urinary tract infections (UTIs) (25.9%), and dysuria (25.9%). All cases of UTIs (7/7) and most cases of dysuria (6/7) occurred in patients who failed their initial TOV. At 36 months, there was a significant median percentage change in PVR (-100.0% [-100.0, -36.7], p = .049), and 40.4% of patients discontinued their BPH medications (p = .001). Of the 11 patients who filled out the DRS, 10 (90.9%) agreed/strongly agreed that they made the right decision. By 36 months, 4 patients (14.8%) underwent reoperation and 24 (88.9%) remained catheter-independent. At long-term follow-up, Rezum effectively treated catheter-dependent urinary retention with minimal decisional regret. In patients with urinary retention, urologists should consider delaying TOV until 2 weeks postoperatively to maximize the likelihood of a successful TOV and minimize the risk of AEs.

Water vapor thermal therapy of lower urinary tract symptoms due to benign prostatic obstruction: efficacy and safety analysis of a real-world cohort of 211 patients

PurposeThis study assessed the efficacy, safety and durability outcomes of water vapor thermal therapy with Rezum in a real-world cohort of patients with lower urinary tract symptoms due to benign prostate obstruction.MethodsConsecutive, unselected patients undergoing Rezum treatment between January 2014 and August 2022 were candidates for this pragmatic, observational, longitudinal, single-center cohort study. Pre- and perioperative data were descriptively summarized. The primary outcome was surgical efficacy, determined by International Prostate Symptom Score (IPSS), Quality of Life (QoL) Score, maximum urinary flow rate (Qmax), post-void residual (PVR) volume and prostate volume (PV) at baseline, 2 months, 6 months, 1 year, 2 years, and > 2 years.ResultsA total of 211 patients were enrolled for analysis. Overall, catheter removal was successful in 92.4% of patients after a median of 5 days. A preoperative catheter and the presence of a median lobe increased the risk of unsuccessful catheter removal. In total, 5.7% of patients were reoperated after a median of 407 days. Comparing baseline to the longest median follow-up, the postoperative IPSS decreased significantly by 65.7%, the QoL Score declined by 66.7% (both until a maximum median of 4.5 years) and Qmax improved by 66.7% (until 3.9 years). Post-void residual volume and PV were reduced by 85.7% (3.7 years) and 47% (4.0 years), respectively. Clavien–Dindo complication ≤ II occurred in 11.8%.ConclusionRezum is a safe minimally invasive treatment option in a real-world patient cohort with a beneficial improvement of micturition symptoms and voiding function during follow-up.

Drugs for Neurogenic Bladder Dysfunction

Urinary dysfunction includes an overactive bladder (OAB), post-void residual (PVR)/retention, or both entities. Brain diseases cause OAB, peripheral neuropathies are associated with significant PVR/retention, and multisystem atrophy/spinal cord diseases result in a combination of OAB and PVR/retention. Selective beta 3 adrenergic receptor agonists or anticholinergic agents are the first-choice treatment for OAB and clean intermittent self-catheterization, alpha-blocker and cholinergic stimulant therapy for significant PVR/retention. These therapies may be useful to maximize patients' quality of life and prevent serious complications, such as urosepsis or kidney dysfunction.

Protocolo de tratamiento de la disfunción del tracto urinario inferior en la esclerosis múltiple y trastornos relacionados

Lower urinary tract dysfunction (LUTD) affects between a third and the majority of patients with multiple sclerosis, its prevalence increasing with the duration of the disease and causing a great impact on quality of life. LUTD is classified into filling symptoms, voiding symptoms, or mixed symptoms. The scenario of simultaneous contraction of the detrusor and bladder sphincter is called bladder detrusor sphincter dyssynergia and requires periodic ultrasound and renal function monitoring, due to the risk of kidney impairment caused by a retrograde increase in pressure. Filling symptoms are treated with hygienic-dietary measures, antimuscarinics, mirabegron, desmopressin, botulinum toxin or neuromodulation. Symptoms of voiding (postvoid residue greater than 100mL) are treated with intermittent self-catheterization or, less commonly, indwelling bladder or suprapubic catheterization.

MP51-13 FOUR-YEAR REZUM OUTCOMES IN RELATIONSHIP TO THE NUMBER OF INJECTIONS: IS THE “LESS IS MORE” TREATMENT APPROACH DURABLE?

You have accessJournal of UrologyCME1 Apr 2023MP51-13 FOUR-YEAR REZUM OUTCOMES IN RELATIONSHIP TO THE NUMBER OF INJECTIONS: IS THE “LESS IS MORE” TREATMENT APPROACH DURABLE? Mustufa Babar, Umair Azhar, Justin Loloi, Rahman Sayed, Kevin Labagnara, Michael Zhu, Kevin Tang, Azizou Salami, Sandeep Singh, Matthew Ines, Nazifa Iqbal, and Michael Ciatto Mustufa BabarMustufa Babar More articles by this author , Umair AzharUmair Azhar More articles by this author , Justin LoloiJustin Loloi More articles by this author , Rahman SayedRahman Sayed More articles by this author , Kevin LabagnaraKevin Labagnara More articles by this author , Michael ZhuMichael Zhu More articles by this author , Kevin TangKevin Tang More articles by this author , Azizou SalamiAzizou Salami More articles by this author , Sandeep SinghSandeep Singh More articles by this author , Matthew InesMatthew Ines More articles by this author , Nazifa IqbalNazifa Iqbal More articles by this author , and Michael CiattoMichael Ciatto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Traditional treatment approach for Rezum utilizes injections based on prostate volume. Recent literature with short-term follow-up has shown that improvements in lower urinary tract symptoms (LUTS) can be achieved with less injections. We assessed the long-term durability of Rezum outcomes in relationship to the number of injections utilized during treatment. METHODS: A single office, retrospective study was conducted on men with moderate to severe LUTS who were treated with Rezum. Men were stratified into four cohorts based on the number of injections received per lateral prostatic lobe: 1, 2, 3, or 4 injections. International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), and adverse events (AEs) were collected at baseline, 1-, 3-, 6-, 12- and/or 48-months postoperatively. The impact of the number of injections on urinary outcomes and AEs were assessed using multivariate linear regression and logistic regression models, respectively, after adjusting for confounders at baseline. RESULTS: A total of 179 men were included: 58, 91, 22, and 8 men in the 1, 2, 3, and 4 injections cohorts, respectively. Compared to baseline, at 3-months, all cohorts saw significant mean changes in IPSS (-9.7±7.9, p<0.001) and QoL (-1.9±1.9, p<0.001), and improvements remained durable to 48-months (IPSS -10.8±9.0, p<0.001; QoL -2.7±1.9, p<0.001). The 2 injections cohort saw a significantly greater mean change in Qmax at 6-months (10.2±10.1 ml/s) when compared to the 1 injection cohort (0.6±4.6 ml/s, p=0.02). There were no significant differences in mean changes in IPSS, QoL, and PVR between the cohorts at any follow-up (p>0.05). The most common AE was gross hematuria (69.8%), followed by penile burning (65.8%). By 48-months, reoperation rate was 9.2%, with no significant difference in reoperation rates between the cohorts (p>0.05). Multivariate logistic regression showed that for each additional injection, the odds of gross hematuria, penile burning, penile pain, and dysuria increased by 3.8 (95% CI 1.7, 9.1), 2.6 (95% CI 1.2, 5.9), 2.2 (95% CI 1.1, 4.9), and 3.0 (95% CI 1.3, 7.5), respectively. Multivariate linear regression showed that the number of injections was not significantly associated with changes in IPSS, QoL, and PVR at any follow-up (p>0.05) but significantly associated with change in Qmax at 3-months (β=5.7, p=0.02). CONCLUSIONS: Utilizing less lateral lobe injections during Rezum treatment is a safer treatment approach that can still achieve long-term durable relief in LUTS. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e698 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mustufa Babar More articles by this author Umair Azhar More articles by this author Justin Loloi More articles by this author Rahman Sayed More articles by this author Kevin Labagnara More articles by this author Michael Zhu More articles by this author Kevin Tang More articles by this author Azizou Salami More articles by this author Sandeep Singh More articles by this author Matthew Ines More articles by this author Nazifa Iqbal More articles by this author Michael Ciatto More articles by this author Expand All Advertisement PDF downloadLoading ...

MP74-02 MEDIUM TO LONG-TERM OUTCOMES OF VENTRAL-ONLAY BUCCAL MUCOSA GRAFT SUBSTITUTION URETHROPLASTY FOR FEMALE URETHRAL STRICTURE

You have accessJournal of UrologyCME1 Apr 2023MP74-02 MEDIUM TO LONG-TERM OUTCOMES OF VENTRAL-ONLAY BUCCAL MUCOSA GRAFT SUBSTITUTION URETHROPLASTY FOR FEMALE URETHRAL STRICTURE Elizabeth Day, Helena Gresty, Anthony Noah, Richard Nobrega, Jeremy Ockrim, and Tamsin Greenwell Elizabeth DayElizabeth Day More articles by this author , Helena GrestyHelena Gresty More articles by this author , Anthony NoahAnthony Noah More articles by this author , Richard NobregaRichard Nobrega More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female urethral stricture (FUS) is rare. Urethroplasty is becoming increasingly popular however there is little to guide choice of technique as all series to date contain small numbers with limited follow-up. We report the medium to long-term outcomes of ventral-onlay buccal mucosa graft substitution urethroplasty (VOBMGSU) in treating FUS. METHODS: A retrospective review of a prospectively acquired database of 52 consecutive women (median age 51 years, range 31-71) with urethral stricture having VOBMGSU since June 2012 and a median follow up 38.2 months, range 8.1-111.9). Data was analysed for stricture recurrence, change in peak free flow rate (Qmax), post-void residuals (PVR) and Patient Global Impression of Improvement (PGII) using a 7-point Likert scale where 1=very much better and 7=very much worse). Short and longer-term complications of surgery were noted. Persistent or de-novo lower urinary tract symptoms (LUTS) were investigated to delineate their cause – and this is detailed. Statistical analysis was performed with the Wilcoxon signed rank test, Students T Test and Mann-Whitney U Test. RESULTS: At last follow-up 46/52 (88.5%) of women were stricture free. Mean Qmax significantly improved from 6 ml/s (range 0-24) to 14 ml/s (range 5-31) (p<0.05). Mean PVR significantly reduced from 112 mls (range 0-609) to 38 mls (range 9-86) (p<0.05). Short and longer-term complication rates were low. 1/48 (2.1%) patients developed mild de novo SUI, which settled with conservative measures by 6 months post urethroplasty. Frequency persisted in 6/52 (9.7%) and was managed with intravesical Botox in 2 and Sacral Neuromodulation in 1. Stricture recurrence was managed by meatotomy in 1, meatal dilatation in 2, redo-VOBMG urethroplasty in 2 and vaginal flap meatoplasty in 1 with resolution of stricture in 5. Median PGII at 12 months post VOBMG urethroplasty was 1 (1-4) and this was maintained at 36 months post-surgery. CONCLUSIONS: Medium term results in the largest series of VOBMG female urethroplasty to date are excellent with stricture free rates of 88.5%, median PGII of 1 and significantly improved Qmax and PVRs. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1069 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Day More articles by this author Helena Gresty More articles by this author Anthony Noah More articles by this author Richard Nobrega More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement PDF downloadLoading ...

MP60-15 FAVORABLE PERIOPERATIVE AND FUNCTIONAL OUTCOMES AFTER ROBOTIC-ASSISTED BLADDER DIVERTICULECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP60-15 FAVORABLE PERIOPERATIVE AND FUNCTIONAL OUTCOMES AFTER ROBOTIC-ASSISTED BLADDER DIVERTICULECTOMY Rohit Reddy, Brandon Merkert, Naveen Krishnan, and Daniel Eun Rohit ReddyRohit Reddy More articles by this author , Brandon MerkertBrandon Merkert More articles by this author , Naveen KrishnanNaveen Krishnan More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted bladder diverticulectomy (RABD) has recently emerged as a management option for patients with problematic bladder diverticula due to recurrent urinary tract infections (rUTI) or incomplete emptying. Previous literature has shown favorable outcomes for RABD when combined with other procedures such as robotic-assisted simple or radical prostatectomy (RASP/RARP), but none have assessed RABD as a stand-alone procedure. The purpose of this study is to present the largest case series of stand-alone RABD and report perioperative and functional outcomes. METHODS: A retrospective analysis of all RABDs at a single institution from 2012-2021 was performed, and the subset of stand-alone RABDs was isolated. The primary outcome of interest was the change in AUA Symptom Score (AUA-SS) and post-void residual (PVR) after stand-alone RABD. RESULTS: A total of 70 patients underwent RABD, 16 of which were stand-alone RABD (23%) (Table 1). Indications for RABD included rUTI (5/16, 31%), incomplete emptying (13/16, 81%), and diverticular tumors (2/16, 13%). The median age was 70.5 and BMI was 29.7. Median operative time was 139 minutes, and none had Clavien 3 or greater complications within 90 days. Eleven patients (69%) had a staged outlet procedure, either before or after RABD. At median 1 year follow up, there were significant improvements in AUA-SS (21.5-6, p<0.001), PVR (452-20, p=0.01), number of patients that were catheter dependent (13-2, p<0.001), and number with UTIs (5-0, p=0.04) (Table 2). CONCLUSIONS: RABD is safe and effective as a stand-alone procedure, with long-term improvement in incomplete emptying and reduction of UTIs. Source of Funding: Temple University Hospital © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e849 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohit Reddy More articles by this author Brandon Merkert More articles by this author Naveen Krishnan More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...

MP19-02 IMPACT OF PRIVATE EQUITY ACQUISITION ON UROLOGIC PROCEDURAL VOLUME

You have accessJournal of UrologyCME1 Apr 2023MP19-02 IMPACT OF PRIVATE EQUITY ACQUISITION ON UROLOGIC PROCEDURAL VOLUME Shyam Patnaik, Danielle Sharbaugh, Michael Stencel, Cameron Jones, Stephen Kisty, Divya Nateson, Charlotte Stahlfeld, Sarah Erpenbeck, Cailey Guercio, Mia Alcorn, Jonathan Yabes, Bruce Jacobs, and Benjamin Davies Shyam PatnaikShyam Patnaik More articles by this author , Danielle SharbaughDanielle Sharbaugh More articles by this author , Michael StencelMichael Stencel More articles by this author , Cameron JonesCameron Jones More articles by this author , Stephen KistyStephen Kisty More articles by this author , Divya NatesonDivya Nateson More articles by this author , Charlotte StahlfeldCharlotte Stahlfeld More articles by this author , Sarah ErpenbeckSarah Erpenbeck More articles by this author , Cailey GuercioCailey Guercio More articles by this author , Mia AlcornMia Alcorn More articles by this author , Jonathan YabesJonathan Yabes More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , and Benjamin DaviesBenjamin Davies More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Private equity firms have been increasing investment in urology in recent years. Despite the changing ownership model in urology private practice, the effect of these acquisitions on urologic practice and procedural volume has yet to be determined. We sought to investigate the impact on procedural volume in a variety of urologic procedures before and after private equity acquisition. METHODS: Private equity acquisitions of urology practices were identified via the existing literature, which utilized a compilation of financial databases cataloguing both public and private transactions. Yearly office visit and procedure volume by provider was extracted from the publicly available “Medicare Physician & Other Practitioners by Provider and Service” dataset from 2013-2019. The most commonly billed procedures were chosen for analysis: post-void residual (PVR), cystometrogram (CMG), uroflow, cystoscopy, prostate biopsy, extracorporeal shock-wave lithotripsy (ESWL), and ureteroscopy. Mixed regression model and sensitivity analyses were conducted. RESULTS: 1,564,853 office visits and 867,216 procedures were analyzed over a 5-year period. Using mixed model analysis, the number of cystoscopies, PVRs, ESWL, and ureteroscopies per physician-year showed no statistically significant change after private equity acquisition (Table 1). Prostate biopsy and complex CMG showed statistically significant increases by an average of 2.06 and 6.88 procedures per physician-year respectively after private equity. Complex uroflow had a significant decrease by an average of 13.5 procedures per physician-year after acquisition. The average number of each urologic procedure per 100 visits remained stable from before private equity acquisition to after acquisition. In terms of the average number of new patient visits, the observed trends for 30-, 45-, and 60- minute visits per 100 visits remained stable from before to after private equity acquisition. CONCLUSIONS: In this study we demonstrate the impact of private equity ownership on urologic practices before and after acquisition. We found that both prostate biopsy and complex CMG procedures rates increased significantly since private equity acquisition. The fiscal impact of these changes has yet to be determined. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e264 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shyam Patnaik More articles by this author Danielle Sharbaugh More articles by this author Michael Stencel More articles by this author Cameron Jones More articles by this author Stephen Kisty More articles by this author Divya Nateson More articles by this author Charlotte Stahlfeld More articles by this author Sarah Erpenbeck More articles by this author Cailey Guercio More articles by this author Mia Alcorn More articles by this author Jonathan Yabes More articles by this author Bruce Jacobs More articles by this author Benjamin Davies More articles by this author Expand All Advertisement PDF downloadLoading ...

MP24-17 TAMSULOSIN VERSUS TADALAFIL FOR MANAGEMENT OF SYMPTOMATIC BENIGN PROSTATIC ENLARGEMENT: ASSESSMENT OF TREATMENT DISCONTINUATION RATE AND SYMPTOMS IMPROVEMENT

You have accessJournal of UrologyCME1 Apr 2023MP24-17 TAMSULOSIN VERSUS TADALAFIL FOR MANAGEMENT OF SYMPTOMATIC BENIGN PROSTATIC ENLARGEMENT: ASSESSMENT OF TREATMENT DISCONTINUATION RATE AND SYMPTOMS IMPROVEMENT Ahmed Elqaffas, Ahmed Elshal, Adel Nabeeh, and Ahmed M Shoma Ahmed ElqaffasAhmed Elqaffas More articles by this author , Ahmed ElshalAhmed Elshal More articles by this author , Adel NabeehAdel Nabeeh More articles by this author , and Ahmed M ShomaAhmed M Shoma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003249.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: both tamsulosin and tadalafil 5 mg are used for treatment of symptomatic benign prostatic enlargement. Nevertheless, the incidence and causes of treatment discontinuation (TD) was not evaluated. A randomized trial is conducted to compare TD rate and symptoms improvement between the two drugs. METHODS: A randomized controlled trial (RCT) is conducted with estimate sample size of 160 cases. Sexually active LUTS/BPO patients with concomitant ED were included and randomly allocated in two groups: the first received tadalafil 5 mg once daily and the second one received tamsulosin for twelve months. The therapeutic outcomes are assessed at 2 weeks , 4 weeks , 12 weeks, 6 months and 12 months. The evaluation includes International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-15) questionnaire, quality of life (QoL), uroflowmetry, post voiding residual (PVR) and incidence and causes of (TD). RESULTS: In tadalafil group 5 patients lost follow up. thirty out of 80 patients showed drug discontinuation (37.5%), 6 of them developed adverse effects in view of headache and musculoskeletal pain, other 24 patients developed no response. IPSS, QoL & IIEF-15 improved in 12 months follow-up compared to baseline criteria (Table 1). In tamsulosin group, 7 patients lost follow up. Eighteen out of 80 patients showed drug discontinuation (22.5%), 5 of them developed adverse effects in view of dizziness and orthostatic hypotension, while 13 patients showed no response. IPSS, QoL & Qmax improved in 12 months follow-up compared to baseline criteria. (Table 1) CONCLUSIONS: When both groups were compared, discontinuation was higher in tadalafil group due to lack of response with significant statistical difference with comparable adverse events. IPSS & QoL were improved in both drugs. Source of Funding: mansoura urology and nephrology center (UNC) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e324 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Elqaffas More articles by this author Ahmed Elshal More articles by this author Adel Nabeeh More articles by this author Ahmed M Shoma More articles by this author Expand All Advertisement PDF downloadLoading ...

MP76-12 PROSTATIC URETHRAL LIFT EFFICACY IN PATIENTS WITH PRIOR BENIGN PROSTATE HYPERTROPHY TREATMENT AND PRIOR RADIATION THERAPY

You have accessJournal of UrologyCME1 Apr 2023MP76-12 PROSTATIC URETHRAL LIFT EFFICACY IN PATIENTS WITH PRIOR BENIGN PROSTATE HYPERTROPHY TREATMENT AND PRIOR RADIATION THERAPY Young Son, Emma Troyer, Ryan Moriarty, Sage Grenz, Maya Sengha, Dayna DeVincentz, Benjamin Fink, and Thomas Mueller Young SonYoung Son More articles by this author , Emma TroyerEmma Troyer More articles by this author , Ryan MoriartyRyan Moriarty More articles by this author , Sage GrenzSage Grenz More articles by this author , Maya SenghaMaya Sengha More articles by this author , Dayna DeVincentzDayna DeVincentz More articles by this author , Benjamin FinkBenjamin Fink More articles by this author , and Thomas MuellerThomas Mueller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lower urinary tract symptoms (LUTs) caused by benign prostatic hyperplasia (BPH) in men is one of the most frequently encountered complaints in the urologist's office. Prostatic urethral lift (PUL) has been shown to be an efficacious and a minimally invasive treatment for BPH. There is a paucity of data with salvage PUL in BPH. The aim of the study is to determine the effect of PUL in patients with previously treated BPH and radiation therapy. METHODS: A retrospective chart review was performed on 445 patients between 6/2016 to 5/2022 of a single surgeon’s experience with PUL. Patients were subgrouped into those that had previous transurethral resection of prostate (TURP), transurethral needle ablation (TUNA), PUL, or radiation therapy (external beam radiation or brachytherapy). The previously treated groups were then compared to those undergoing primary PUL (no previous treatment for BPH). Patient demographics, international prostate symptom score (IPSS) and quality of life (QOL) were assessed through 24 months. RESULTS: A total of 444 patients were retrospectively reviewed. The previous prostatic urethral lift group consisted of 8 (1.8%) patients, previous TUNA had 12 (2.7%) patients, previous TURP had 15 (3.3%) patients and the previous radiation group had 14 (3.1%) patients of the total cohort. The previous urolift group were older (80.9 years) and had larger prostate volume (69.9 grams). The previous TURP group had the largest post void residual (PVR) at 276.1ml. The decrease in IPSS was seen in all groups that were noninferior to primary PUL (no prior treatment group). There was statistical significance for IPSS for the prior radiation group compared to primary PUL at 18 months (4.97 vs. 3.0). CONCLUSIONS: Efficacy of PUL has not been well studied in patients with previous prostatic treatments. Our study is one of the largest single surgeon’s experiences with patients with PUL. We show that repeated PUL in patients that had previous PUL, TUNA, TURP, or radiation can be effective. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1095 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Young Son More articles by this author Emma Troyer More articles by this author Ryan Moriarty More articles by this author Sage Grenz More articles by this author Maya Sengha More articles by this author Dayna DeVincentz More articles by this author Benjamin Fink More articles by this author Thomas Mueller More articles by this author Expand All Advertisement PDF downloadLoading ...

MP76-05 PERI-URETHRAL PROSTATIC CAVITY FORMATION FOLLOWING WATER VAPOR THERMAL THERAPY: AN UNRECOGNIZED COMPLICATION CAUSING PERSISTENT LUTS?

You have accessJournal of UrologyCME1 Apr 2023MP76-05 PERI-URETHRAL PROSTATIC CAVITY FORMATION FOLLOWING WATER VAPOR THERMAL THERAPY: AN UNRECOGNIZED COMPLICATION CAUSING PERSISTENT LUTS? Leo D. Dreyfuss, Kevin Alter, Adithya Balasubramanian, Barry Zisholtz, Kevin C. Zorn, Naeem Bhojani, Dean Elterman, and Bilal Chughtai Leo D. DreyfussLeo D. Dreyfuss More articles by this author , Kevin AlterKevin Alter More articles by this author , Adithya BalasubramanianAdithya Balasubramanian More articles by this author , Barry ZisholtzBarry Zisholtz More articles by this author , Kevin C. ZornKevin C. Zorn More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Dean EltermanDean Elterman More articles by this author , and Bilal ChughtaiBilal Chughtai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Water vapor thermal therapy (WVTT) causes tissue necrosis secondary to release of thermal energy within the collagen networks of the prostate transition zone. Some men experience worsening of LUTS following treatment. We report 3 patients with persistent LUTS following WVTT who were found to have anatomic abnormalities in the prostate, ultimately requiring repeat procedures. METHODS: WVTT (Rezum, NxThera, Inc, Maple Grove, MN) was offered to patients with bothersome LUTS and prostate volume less than 80 cc’s. WVTT was performed outpatient at a high-volume academic urology clinic. Patients were treated under local anesthesia with 1-3 sticks in bilateral lateral lobes. Patients underwent trial of void on post-procedure day 1 and were followed at regular intervals with post-operative surveys, post-void residual (PVR), and uroflowmetry. RESULTS: All 3 patients successfully underwent WVTT and passed trial of void with minimal post-void residual. Patient 1 experienced persistent bothersome LUTS despite medical therapy. Urodynamics revealed high pressure with low urinary flow. Cystoscopy revealed urethral cavities filled with debris causing obstruction (Figure 1A). Transurethral unroofing was performed leading to resolution of symptoms. Patient 2 experienced persistent LUTS, slow urinary stream, and elevated PVR’s to 100 mL following procedure. After 5 months of persistent symptoms, they began to experience watery ejaculate. CT Urogram revealed cystic dilation of prostatic urethra with urethral stones requiring cystoscopy and stone removal. Patient 3 experienced LUTS for 2.5 months following WVTT, at which time they developed watery ejaculate. Cystoscopy revealed prostatic urethral diverticulum (Figure 1B) and MRI showed 2.4×2.4×2.5 cm cystic cavity in prostatic transition zone contiguous with prostatic urethra (Figure 1C, D). Photoselective vaporization of the prostate was performed 14 months following index procedure with resolution of symptoms. At last follow up, all patients are voiding well with resolution of LUTS. CONCLUSIONS: WVTT may be associated with atypical tissue necrosis and cavity formation within prostatic transition zone. Patients with worsening or persistent LUTS following WVTT may benefit from further workup to exclude anatomic defects. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1092 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leo D. Dreyfuss More articles by this author Kevin Alter More articles by this author Adithya Balasubramanian More articles by this author Barry Zisholtz More articles by this author Kevin C. Zorn More articles by this author Naeem Bhojani More articles by this author Dean Elterman More articles by this author Bilal Chughtai More articles by this author Expand All Advertisement PDF downloadLoading ...

PD23-03 IMPAIRED NITRIC OXIDE MECHANISMS UNDERLYING LOWER URINARY TRACT DYSFUNCTION IN AGING RATS

You have accessJournal of UrologyCME1 Apr 2023PD23-03 IMPAIRED NITRIC OXIDE MECHANISMS UNDERLYING LOWER URINARY TRACT DYSFUNCTION IN AGING RATS Daisuke Gotoh, Kenta Onishi, Yosuke Morizawa, Shunta Hori, Yasushi Nakai, Makito Miyake, Kazumasa Torimoto, Fujimoto Kiyohide, and Naoki Yoshimura Daisuke GotohDaisuke Gotoh More articles by this author , Kenta OnishiKenta Onishi More articles by this author , Yosuke MorizawaYosuke Morizawa More articles by this author , Shunta HoriShunta Hori More articles by this author , Yasushi NakaiYasushi Nakai More articles by this author , Makito MiyakeMakito Miyake More articles by this author , Kazumasa TorimotoKazumasa Torimoto More articles by this author , Fujimoto KiyohideFujimoto Kiyohide More articles by this author , and Naoki YoshimuraNaoki Yoshimura More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003296.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nitric oxide (NO) promotes the intracellular production of cyclic guanosine monophosphate (cGMP) in smooth muscles, reduces the intracellular calcium concentration, and enhances smooth muscle relaxation. However, it remains unknown whether changes in the expression of NO-related molecules are associated with the development of lower urinary tract dysfunction (LUTD) with age. Therefore, we examined changes in bladder and urethral activities, and in NO-related molecule expression using aging rats. METHODS: Fourteen Female Sprague–Dawley rats were divided into two age groups: (A) young rats (12 weeks old, n=8) and (B) aging rats (15 months old, n=6). In both groups, 24 h voiding assay was performed, and the urodynamic parameters were evaluated using cystometry (CMG) and urethral perfusion pressure (UPP) recordings. mRNA expression levels of NO-, ischemia-, and inflammation-related markers in bladder and urethra tissues were assessed, and the cGMP level in the urethra was measured. RESULTS: There was no significant difference in the 24-h voiding assay results between the groups. In CMG, the number of non-voiding contractions (NVCs) per voiding cycle and post-void residual (PVR) were significantly higher, and voiding efficiency (VE) was significantly lower in Group B than in Group A (Figure 1A, B). In the UPP recordings, urethral pressure (UP) reduction and high frequency oscillation (HFO) amplitudes were both significantly lower in Group B than in Group A (Figure 1C, D). In molecular studies, mRNA expression levels of HIF-1α, VEGF, and TGF-β1 in the bladder were significantly higher in Group B than in Group A (Figure 2A). mRNA expression levels of NOS1 and PKG were significantly lower in Group B than in Group A (Figure 2B). In addition, the concentration of cGMP in the urethra was significantly lower in Group B than in Group A (Figure 2C). CONCLUSIONS: Aging rats would be a useful model for the study of the natural progression of age-related LUTD, for which impaired NO-mediated transmitter function is likely to be an important mechanism. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e671 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daisuke Gotoh More articles by this author Kenta Onishi More articles by this author Yosuke Morizawa More articles by this author Shunta Hori More articles by this author Yasushi Nakai More articles by this author Makito Miyake More articles by this author Kazumasa Torimoto More articles by this author Fujimoto Kiyohide More articles by this author Naoki Yoshimura More articles by this author Expand All Advertisement PDF downloadLoading ...

LBA01-19 LONG-TERM EFFICACY AND SAFETY OF URO-902 (PVAX/ HSLO ) IN WOMEN WITH OVERACTIVE BLADDER AND URGE URINARY INCONTINENCE: FINAL RESULTS OF A PHASE 2A TRIAL

You have accessJournal of UrologyCME1 Apr 2023LBA01-19 LONG-TERM EFFICACY AND SAFETY OF URO-902 (PVAX/HSLO) IN WOMEN WITH OVERACTIVE BLADDER AND URGE URINARY INCONTINENCE: FINAL RESULTS OF A PHASE 2A TRIAL Kenneth M. Peters, Ekene A. Enemchukwu, Susan Kalota, Kaiser Robertson, Sijian Ge, Jingmei Lu, Hanh Badger, and Salim Mujais Kenneth M. PetersKenneth M. Peters More articles by this author , Ekene A. EnemchukwuEkene A. Enemchukwu More articles by this author , Susan KalotaSusan Kalota More articles by this author , Kaiser RobertsonKaiser Robertson More articles by this author , Sijian GeSijian Ge More articles by this author , Jingmei LuJingmei Lu More articles by this author , Hanh BadgerHanh Badger More articles by this author , and Salim MujaisSalim Mujais More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: URO-902 is an investigational gene therapy for overactive bladder (OAB) consisting of a plasmid vector expressing the large-conductance Ca2+-activated K+channel α subunit. URO-902 showed improved efficacy and quality of life (QoL) vs placebo in a 12-week interim analysis of a phase 2a trial. Here we report final safety and efficacy results from the trial. METHODS: This 48-week multicenter, double-blind, placebo-controlled, dose-escalation trial (NCT04211831) randomized women 40–79 years old with OAB, urge urinary incontinence (UUI), and inadequate pharmacologic OAB management to single-dose URO-902 24 or 48 mg or placebo administered by intradetrusor injection via cystoscopy under local anesthesia. Patients could request additional OAB treatments starting at week 24, after which they were not included in efficacy analyses. Exploratory efficacy endpoints were change from baseline (CFB) in mean daily micturitions, urgency episodes, and UUI episodes. Safety was assessed by adverse events (AEs) and postvoid residual (PVR) urine volume. RESULTS: Of 80 patients randomized, 74 were treated (intent-to-treat exposed [ITT-E] population), and 67 completed the trial. In the ITT-E population, mean age was 64.7 years; 13.5% had prior onabotulinumtoxinA treatment. URO-902 24 and 48 mg were associated with reductions from baseline starting at week 2 in daily micturitions, urgency episodes, and UUI episodes; reductions were durable through week 48. Overall, 45.5%, 53.8%, and 53.8% of patients receiving URO-902 24 mg, URO-902 48 mg, and placebo, respectively, experienced ≥1 treatment-emergent AE; the most commonly occurring (24 mg/48 mg/placebo) were urinary tract infection (0%/15.4%/3.8%) and hematuria (4.5%/7.7%/7.7%). One patient receiving URO-902 48 mg had asymptomatic elevated PVR urine volume, which resolved spontaneously without catheterization. CONCLUSIONS: URO-902 24 or 48 mg showed durable, meaningful improvements from baseline in micturitions, urgency episodes (dose dependent), and UUI episodes, consistent with previously reported QoL improvements at 12 weeks, and was safe and well tolerated in this phase 2a trial. Interpretation of efficacy vs placebo was limited by use of additional OAB treatments after week 24. Source of Funding: Urovant Sciences © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1184 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenneth M. Peters More articles by this author Ekene A. Enemchukwu More articles by this author Susan Kalota More articles by this author Kaiser Robertson More articles by this author Sijian Ge More articles by this author Jingmei Lu More articles by this author Hanh Badger More articles by this author Salim Mujais More articles by this author Expand All Advertisement PDF downloadLoading ...

V04-04 ROBOTIC BLADDER NECK PLICATION FOR INCONTINENCE TREATMENT: TECHNICAL IMPROVEMENTS

You have accessJournal of UrologyCME1 Apr 2023V04-04 ROBOTIC BLADDER NECK PLICATION FOR INCONTINENCE TREATMENT: TECHNICAL IMPROVEMENTS Dario Guido Minoli, Carolina Bebi, Michele Gnech, Erika Adalgisa De Marco, Irene Paraboschi, Giancarlo Albo, Filippo Molinari, Emanuele Montanari, Gianantonio Manzoni, and Alfredo Berrettini Dario Guido MinoliDario Guido Minoli More articles by this author , Carolina BebiCarolina Bebi More articles by this author , Michele GnechMichele Gnech More articles by this author , Erika Adalgisa De MarcoErika Adalgisa De Marco More articles by this author , Irene ParaboschiIrene Paraboschi More articles by this author , Giancarlo AlboGiancarlo Albo More articles by this author , Filippo MolinariFilippo Molinari More articles by this author , Emanuele MontanariEmanuele Montanari More articles by this author , Gianantonio ManzoniGianantonio Manzoni More articles by this author , and Alfredo BerrettiniAlfredo Berrettini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this video we describe our experience in bladder neck plication, robotically assisted, to achieve continence in selected patients. METHODS: In the last three years we performed three robotically assisted bladder neck plication procedures: two females with persistent total incontinence following previous surgeries for ectopic ureters and epispadias and one isolated epispadias in an adolescent male. For all a laparoscopic robotically-assisted bladder neck plication was electively selected. The first two procedures were successfully conducted with Da Vinci SI, while in the third case the Da Vinci XI was used. The progressive narrowing of the proximal urethra was always confirmed with combined endoscopic view. RESULTS: All the patients were discharged on 4th post-operative day without complications. A follow-up MCUG confirmed fully preserved spontaneous voiding without post-void residuals and renal US showed persistence of normal upper urinary tracts. CONCLUSIONS: Bladder neck plication has been described successfully as complementary technique in other procedures as robotic radical prostatectomy. Open bladder neck plication, combined with endoscopic control of the urethral lumen, has been used to reach continence in epispadiac females, too. The anatomical access to the bladder neck region is extremely difficult in open surgery especially in adolescent patients. Robotic access allows a perfect combined endoscopic-laparoscopic approach to the bladder neck area and the firefly vision mode is an extremely useful addition for the correct and precise identification of the urethral segment to be plicated. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e339 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dario Guido Minoli More articles by this author Carolina Bebi More articles by this author Michele Gnech More articles by this author Erika Adalgisa De Marco More articles by this author Irene Paraboschi More articles by this author Giancarlo Albo More articles by this author Filippo Molinari More articles by this author Emanuele Montanari More articles by this author Gianantonio Manzoni More articles by this author Alfredo Berrettini More articles by this author Expand All Advertisement PDF downloadLoading ...

MP53-13 DOES THE PRESENCE OF PRESSURE "POP-OFFS" IMPACT VOIDING EFFICIENCY AND BLADDER OUTCOMES IN POSTERIOR URETHRAL VALVES?

You have accessJournal of UrologyCME1 Apr 2023MP53-13 DOES THE PRESENCE OF PRESSURE "POP-OFFS" IMPACT VOIDING EFFICIENCY AND BLADDER OUTCOMES IN POSTERIOR URETHRAL VALVES? Adree Khondker, Priyank Yadav, Jin Kyu Kim, Michael Chua, Natasha Brownrigg, Juliane Richter, Joana Dos Santos, Armando Lorenzo, and Mandy Rickard Adree KhondkerAdree Khondker More articles by this author , Priyank YadavPriyank Yadav More articles by this author , Jin Kyu KimJin Kyu Kim More articles by this author , Michael ChuaMichael Chua More articles by this author , Natasha BrownriggNatasha Brownrigg More articles by this author , Juliane RichterJuliane Richter More articles by this author , Joana Dos SantosJoana Dos Santos More articles by this author , Armando LorenzoArmando Lorenzo More articles by this author , and Mandy RickardMandy Rickard More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The protective role of pressure pop-offs, consisting of vesicoureteral reflux (VUR) and ipsilateral kidney dysplasia, in posterior urethral valve (PUV) is controversial. While there has been significant emphasis on exploring the non-significant association between “pop-offs” and kidney function, there is paucity of data on the impact of this mechanism on bladder function. Here, we analyzed this association by examining the role of pressure pop-offs on long-term bladder outcomes in PUV patients. METHODS: A retrospective chart review was conducted for toilet-trained children with PUV managed at our institution between 2000 and 2022, only excluding cases without recorded uroflowmetry studies. Patients were stratified by the presence of pressure pop-offs (high-grade VUR+ipsilateral kidney dysplasia). Outcomes included uroflowmetry parameters and initiation of clean-intermittent catheterization (CIC). Survival analysis was conducted to calculate hazard ratios (HR). RESULTS: We identified a total of 101 patients who met study inclusion criteria, with a median follow-up of 114 months (IQR 67, 169). The median age of first and last uroflowmetry was 57 months (IQR 48, 82) and 120 months (IQR 89, 160), respectively. Patients with pressure pop-offs had similar flow velocity, post-void residuals, and bladder voiding efficiency to other PUV patients at last follow-up uroflowmetry. On survival analysis, patients with pressure pop-offs had no significant difference in risk of requiring CIC compared to patients without pop-offs (HR 1.92, p=0.06). Kidney dysplasia was independently associated with increased risk of CIC (HR 3.16, p=0.02) while VUR was not (HR 1.85, p=0.07). CONCLUSIONS: We show that boys with pressure pop-offs are not at higher risk of poorer voiding and intermittent catheterization than others with PUV. By extension, VURD syndrome does not confer protection against poorer bladder function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e717 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adree Khondker More articles by this author Priyank Yadav More articles by this author Jin Kyu Kim More articles by this author Michael Chua More articles by this author Natasha Brownrigg More articles by this author Juliane Richter More articles by this author Joana Dos Santos More articles by this author Armando Lorenzo More articles by this author Mandy Rickard More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-18 NEW MINIMALLY INVASIVE TECHNIQUES VERSUS GOLD STANDARD TREATMENT FOR MIDDLE VOLUME (30-80 ML) PROSTATES: A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP51-18 NEW MINIMALLY INVASIVE TECHNIQUES VERSUS GOLD STANDARD TREATMENT FOR MIDDLE VOLUME (30-80 ML) PROSTATES: A PROSPECTIVE RANDOMIZED STUDY Antonio Luigi Pastore, Yazan Al salhi, Andrea Fuschi, Alessia Martoccia, Alessandro Sciarra, Stefano Salciccia, De Nunzio Cosimo, Andrea Tubaro, Costantino Leonardo, Giorgio Franco, Paolo Pietro Suraci, Onofrio Antonio Rera, and Antonio Carbone Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Yazan Al salhiYazan Al salhi More articles by this author , Andrea FuschiAndrea Fuschi More articles by this author , Alessia MartocciaAlessia Martoccia More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Stefano SalcicciaStefano Salciccia More articles by this author , De Nunzio CosimoDe Nunzio Cosimo More articles by this author , Andrea TubaroAndrea Tubaro More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Giorgio FrancoGiorgio Franco More articles by this author , Paolo Pietro SuraciPaolo Pietro Suraci More articles by this author , Onofrio Antonio ReraOnofrio Antonio Rera More articles by this author , and Antonio CarboneAntonio Carbone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the last years minimally invasive endoscopic approaches have been proposed and introduced with the aim to reduce the morbidity related to TURP, such as: convective water vapor energy (Rezum) and heat free water-jet ablation (Aquablation).The aim of this prospective randomized study is to compare the perioperative and functional outcomes between gold standard surgery (TransUrethral Resection of Prostate, TURP) and these two new minimally invasive approaches (Rezum and Aquablation). METHODS: Patients with benign prostatic obstruction were prospectively enrolled and randomized for the three surgical approaches between January 2021 and September 2022. All patients were preoperatively evaluated with digital rectal examination, PSA value and abdominal ultrasound for prostate volume measurement. Preoperatively and 6 months after surgery, patients were studied as follows: Uroflowmetry (Qmax and Qave) with postvoid residual (PVR), International Prostatic Symptoms Score (IPSS), Male Sexual Health Questionnaire (MSHQ) and International Index of Erectile Function (IIEF-5). All patients were also investigated by urodynamics. Operating time, days of hospital stay, intraoperative and postoperative bleeding, postoperative catheterization time were evaluated for each procedure. RESULTS: 252 patients with mean age of 64.6 years old were included in the study. Patients were prospectively randomized to the following treatment groups: 61 subjects underwent Rezum (group A), 92 patients Aquablation (group B), and 99 patients bipolar TURP (group C). Postoperative IPSS resulted lower in patients underwent TURP and AQUABEAM than Rezum (p<0.001). Postoperative IIEF5 mean scores significantly increased in groups A and B (25 and 24, respectively) than in group C (18, p<0.001). The antegrade ejaculation was spared in all Rezum and Aquablation subjects, whereas all TURP patients reported retrograde ejaculation. The TURP group reported mean flowmetry parameters significantly better when compared to Aquabeam and Rezum groups (p<.005). Operating time and length of hospital stay were longer after TURP (respectively 75 min, 3 days) when compared to the other two groups (8 min, 0.6 days; 5.2 min, 1 day, in group A and B, respectively). The mean estimated blood loss (evaluated as postoperative drop in Hb) was significantly higher in group C (DHb 1.2 mg/dl) than in the other two groups (DHb 0.1 mg/dl observed in both groups, p<.005). CONCLUSIONS: This prospective randomized study is the first to compare new endoscopic approaches to gold standard surgery in the treatment of non-neurogenic LUTS secondary to BPH for prostate volumes 30-80 ml. Our results condrm that Rezum and Aquablation are safe and effective. Postoperative outcomes are better in new approaches in terms of sexual function and overall satisfaction, especially related to the preservation of the antegrade ejaculation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e700 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonio Luigi Pastore More articles by this author Yazan Al salhi More articles by this author Andrea Fuschi More articles by this author Alessia Martoccia More articles by this author Alessandro Sciarra More articles by this author Stefano Salciccia More articles by this author De Nunzio Cosimo More articles by this author Andrea Tubaro More articles by this author Costantino Leonardo More articles by this author Giorgio Franco More articles by this author Paolo Pietro Suraci More articles by this author Onofrio Antonio Rera More articles by this author Antonio Carbone More articles by this author Expand All Advertisement PDF downloadLoading ...

LBA01-18 COMPARISON OF MIRABEGRON AND VIBEGRON FOR CLINICAL EFFICACY AND SAFETY IN FEMALE PATIENTS WITH OVERACTIVE BLADDER: A MULTICENTER, PROSPECTIVE RANDOMIZED CROSSOVER TRIAL

LBA01-18 COMPARISON OF MIRABEGRON AND VIBEGRON FOR CLINICAL EFFICACY AND SAFETY IN FEMALE PATIENTS WITH OVERACTIVE BLADDER: A MULTICENTER, PROSPECTIVE RANDOMIZED CROSSOVER TRIAL

Modified Martius Flap Urethroplasty: A New Technique

Introduction: Female urethral strictures are rare, and there is no consensus on proper surgical treatment. The literature is primarily limited to case reports and small case series. Surgical treatment has frequently been extrapolated from male urethroplasty techniques. However, female urethroplasty differs significantly from male urethroplasty because it is performed directly across the urinary sphincter.1 We describe our rationale and technique for female ventral urethroplasty utilizing a modified Martius flap. Materials and Methods: Two female patients, aged 46 and 58 years, with chronic urethral strictures underwent a ventral modified Martius flap urethroplasty. After guidewire and open-ended ureteral stent placement across the stricture, an inverted U-flap incision was made from the distal urethra to the bladder neck. A full thickness incision into the urethral lumen was made, extending past the bladder neck, and sounded with a 30F urethral sound. An ~5 × 2 cm portion of nonhair bearing inner labia tissue was harvested and mobilized on the anterior pedicle of a Martius flap. This was then tunneled under the vaginal wall and rotated over the area of the urethral defect. The flap was sutured in place with two 4-0 polyglactin running suture lines, covering the entire gap in the urethra with good mucosal apposition. The remaining fatty tissue of the Martius flap was rotated over the suture lines, adding an extra layer to the repair. The inverted U flap incision was closed over the repair and the skin edges of the Martius flap harvest site were closed in two layers with a deep 2-0 polyglactin layer and a superficial 4-0 poliglecaprone subcuticular suture, resulting in a cosmetic closure. Results: Postoperative voiding cystourethrogram revealed an open bladder neck and no recurrent stricture for both patients. Average Uroflow peak flow was 18 mL/s. The patients had no complaints of stress incontinence (SUI) and a negative cough leak test at 1 month follow-up. At 6 months follow-up, both patients continued to deny any SUI and had no obstructive voiding complaints with minimal post-void residuals. Conclusions: Our technique using a ventral approach to urethroplasty in women with a Martius flap is effective in the management of female urethral stricture disease. This approach offers lower risk of damage to the sphincter, avoids possible clitoral nerve injury, allows for better maintenance of urethral support, and is an approach familiar to most female pelvic medicine and reconstructive surgeons. Music utilized in video obtained royalty-free from (www.bensound.com). No competing financial interests exist. The authors have received and archived patient consent for video recording and publication in advance of video recording procedure. Runtime of video: 6 mins 33 mins This project was presented at the following academic conferences: Arizona Urological Society, August 1, 2021; Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), February 25, 2022; American Urological Association (AUA) General Meeting, May 14, 2022 (https://doi.org/10.1097/JU.0000000000002586.08).

MP46-20 EVALUATION OF URODYNAMIC OUTCOMES AND INCONTINENCE SPECIFIC HEART-RELATED QUALITY OF LIFE IN PATIENTS TREATED WITH ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL Y-MODIFIED NEOBLADDER THE BORDEAUX NEOBLADDER

You have accessJournal of UrologyCME1 Apr 2023MP46-20 EVALUATION OF URODYNAMIC OUTCOMES AND INCONTINENCE SPECIFIC HEART-RELATED QUALITY OF LIFE IN PATIENTS TREATED WITH ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL Y-MODIFIED NEOBLADDER THE BORDEAUX NEOBLADDER Erika Palagonia, Benedetta Bianchi, Marilena Gubbiotti, Valentina Giommoni, Anastasios D. Asimakopoulos, Saba Khorrami, Michele De Angelis, Richard Gaston, and Filippo Annino Erika PalagoniaErika Palagonia More articles by this author , Benedetta BianchiBenedetta Bianchi More articles by this author , Marilena GubbiottiMarilena Gubbiotti More articles by this author , Valentina GiommoniValentina Giommoni More articles by this author , Anastasios D. AsimakopoulosAnastasios D. Asimakopoulos More articles by this author , Saba KhorramiSaba Khorrami More articles by this author , Michele De AngelisMichele De Angelis More articles by this author , Richard GastonRichard Gaston More articles by this author , and Filippo AnninoFilippo Annino More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To present the urodynamic features of our intracorporeal Y-modified neobladder Bordeaux Neobladder and the incontinence specific health-related quality-of-life (HRQoL) outcomes. METHODS: We performed a prospective evaluation of a series of 26 patients who underwent robot-assisted radical cystectomy with intracorporeal Y-modified orthotropic neobladder reconstruction called the Bordeaux Neobladder, between September 2018 and November 2020 in a high-volume referral center, operated by the same surgeon. All the patients were managed following a modified ERAS protocol. Three months and 1 year after surgery, consenting patients underwent clinical evaluation and multichannel urodynamics. The incontinence quality of life (I-QoL) questionnaire was used to evaluate HRQoL. Continence was classified into day-time and night-time and clinically defined as the use of zero pads. RESULTS: The mean age at surgery was 65.4 years. The mean follow-up was 27 months. Regarding the operative time, the mean time for proximal bladder reconstruction was 192 minutes. Urodynamic outcomes data were collected in 17/23 patients for early evaluation and in 13 patients for early and dilated testing. 2/17 patients had I-II grade of hydronephrosis on the left kidney. No cases of hyperchloremic acidosis were identified in the blood gas analysis. The continence rate was 58.8% (10/17) for the day and 23.5% (4/17) for the night and the mean postoperative of the quality-of-life score was 103.3. The mean maximum bladder capacity was 430 cc (range 200-553) ant the average compliance was 33.1 ml/cm h2o. The mean post-voiding residue was 100 ml (0-310). The first sensation of bladder fullness was perceived at an average volume of 337 cm³. The mean max flow at 3 months was 15 ml/s and at 1 year was 18 ml/s. The rate of clean intermittent self catheterization was 17,6%. We did not observe significant changes in urodynamic outcomes during follow-up. Concerning the parameters of the storage phase, there was only a significant reduction in the volume of the first sensation of bladder fullness. CONCLUSIONS: The initial analysis of both invasive and non-invasive urodynamic parameters shows that the Bordeaux Neobladder has adequate functional characteristics in terms of capacity, post-voiding, residual and compliance. It is associated with a reduced chance of upper urinary tract abnormalities and metabolic complications that improve quality of life. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e641 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erika Palagonia More articles by this author Benedetta Bianchi More articles by this author Marilena Gubbiotti More articles by this author Valentina Giommoni More articles by this author Anastasios D. Asimakopoulos More articles by this author Saba Khorrami More articles by this author Michele De Angelis More articles by this author Richard Gaston More articles by this author Filippo Annino More articles by this author Expand All Advertisement PDF downloadLoading ...

Age- and gender-specific normal post void residual urine volume in healthy adolescents

Elevated post void residual (PVR) is a significant risk factor for urinary tract infections (UTI). It is also a significant predictor of treatment outcomes in cases of vesicoureteral reflux, pediatric enuresis, and non-neurogenic LUT dysfunction. However, the absence of age-specific nomograms for adolescents may limit PVR's use in clinical practice. To establish age- and gender-specific normal PVR urine volume in adolescents. Healthy adolescents aged 12-18 years were recruited to undergo two uroflowmetry and PVR studies whenever they felt the urge to urinate. Adolescents with neurological disorders, known LUT dysfunction or UTI were excluded. A total of 1050 adolescents were invited, but only 651 consented. Fourteen participants were excluded due to low bladder volume (BV<100ml) in both assessments (n=12), BV<100ml in one assessment (n=1), or failure to provide relevant history (n=1). From the 1084 uroflowmetry and PVR obtained from 637 adolescents, 190 results were further excluded due to artefacts (n=152), BV<100ml (n=27), PVR >100ml (n=5) and missing information (n=6). Ultimately, 894 uroflowmetry and PVR from 605 adolescents (mean age 14.6±1.5 years) were analyzed. PVRs were higher in adolescents aged 15-18 years than in those aged 12-14 years (P<0.001). Moreover, they were higher in females than in males (P<0.001). Multivariate analysis revealed that PVR was positively influenced by age (P=0.001) and BV (P<0.001). The age- and gender-specific percentiles of PVR in ml and percentage of BV were calculated. We recommend a repeat PVR and close monitoring if PVR is above the 90th percentile, i.e., PVR >20ml (7% BV) for males of both the age groups, and PVR >25ml (9% BV) and PVR >35ml (>10% BV) for females aged 12-14 and 15-18 years, respectively. Further investigation may be warranted if the repeat PVR is above the 95th percentile, i.e., PVR >30ml (8% BV) and >30ml (11% BV) for males aged 12-14 and 15-18 years, respectively, and PVR >35ml (11% BV) and >45ml (13% BV) for females aged 12-14 and 15-18 years, respectively. PVR increases with age and varies by gender; thus, age-and gender-specific reference values should be used. Further data from other countries is required to determine whether the study's recommendations can be applied globally.