Postvoid Residual Research Articles

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.

Does VURD syndrome impact voiding efficiency in posterior urethral valves?

There is debate regarding the effect of VURD syndrome, consisting of vesicoureteral reflux (VUR) and ipsilateral kidney dysplasia, on long-term outcomes in boys with posterior urethral valve (PUV). Here, we assessed whether VURD syndrome played a "protective" role on long-term bladder outcomes and voiding efficiency in boys with PUV. 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 VUR status and by the presence of VURD syndrome (high-grade VUR+ipsilateral kidney dysplasia). Outcomes included initial and final uroflowmetry parameters, and initiation of clean-intermittent catheterization (CIC). We identified a total of 101 patients who met study inclusion criteria, with an overall 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 VURD syndrome 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 VURD syndrome had no significant difference in risk of requiring CIC compared to patients without pop-offs (p=0.06). Like more contemporary studies on pressure pop-offs, we show that this population is not at higher risk of poorer voiding and intermittent catheterization than others. VURD syndrome does not confer protection against poorer bladder function. Instead, our study suggests an independent association between kidney dysplasia and bladder outcomes which requires further attention. Among boys with PUV, VURD syndrome was not associated with significantly different uroflowmetry findings or rates of CIC by last follow-up.

Factors Affecting Postpartum Overt and Covert Urinary Retention After Vaginal Delivery

Objectives: The aim of this study was to investigate the factors affecting postpartum urinary retention (PPUR) following vaginal delivery. Materials and Methods: This cross-sectional analytical study measured the post-void residual (PVR) urine volume by ultrasound, at most, 15 minutes after the first urination after delivery. Women with a PVR &gt;150 mL without urinary symptoms were assigned to the postpartum covert urinary retention group. Data were analyzed with SPSS22. The chi-square and Mann-Whitney tests were used for quantitative and qualitative variables, respectively. Results: In this study, 1120 patients had a normal delivery at Ayatollahs Rouhani hospital from 21 January 2016 to 20 January 2017. Of this number, 306 (29.4%) and 734 (70.6%) cases with and without urinary retention were allocated to the case and control groups, respectively. Women with instrumental delivery had 30.19 times (P=0.003) higher odds of urinary retention. Instrumental delivery is one of the known risk factors of urinary retention. The linear effect of the total length of labor was also measured, and the results revealed that every one-minute increase in the total length of labor increases the odds of covert urinary retention by 1.008 times (P&lt;0.001). Conclusions: The findings of the study showed that various factors are involved in the incidence of urinary retention. More precisely, instrumental delivery, birth weight, gestational age, and other factors can each be a risk factor for urinary retention.

Rezum water vapor therapy for patients with mild, moderate, or severe lower urinary tract symptoms: A retrospective study in a multiethnic population.

The Rezum System (Rezum) represents a novel, minimally invasive surgical therapy used to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). We evaluated the safety and efficacy of Rezum in patients with mild, moderate, or severe LUTS. A single office, retrospective study was conducted on patients from a multiethnic population treated with Rezum between 2017 and 2019. Patients were categorized into three cohorts based on baseline International Prostate Symptom Score (IPSS) LUTS severity: mild LUTS (IPSS ≤ 7), moderate LUTS (IPSS 8-19), or severe LUTS (IPSS ≥ 20) cohorts. Outcome measures, including IPSS, quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), BPH medication usage, and adverse events (AEs) were collected and analyzed at baseline, 1-, 3-, 6-, and/or 12-months postoperatively. A total of 238 patients were included: 33 with mild LUTS, 109 with moderate LUTS, and 96 with severe LUTS. At 1-month follow-up, the moderate and severe LUTS cohorts saw significant improvements in IPSS (moderate LUTS: -3.0 [-6.0, 1.5], p < 0.001; severe LUTS: -10.0 [-16.0, -5.0], p < 0.001) and QoL (moderate LUTS: -1.0 [-3.0, 0.0], p < 0.001; severe LUTS: -1.0 [-3.0, 0.0], p < 0.001) and improvements remained durable up to 12-months (p < 0.001). The mild LUTS cohort saw significant worsening in IPSS by 2.0 (0.0, 12.0) at 1-month (p = 0.002) but returned to baseline at 3-months (p = 0.114). However, the mild LUTS cohort experienced significant improvements in QoL by -0.5 (-3.0, 0.0) at 3-months (p = 0.035) and nocturia by 0.0 (-1.0, 0.0) at 6-months (p = 0.002), both of which remained durable to 12-months (p < 0.05). Most AEs were transient and nonserious, with gross hematuria (66.5%) being most common. There were no significant differences in QoL point reduction, Qmax improvement, PVR reduction, and AE occurrence between the cohorts at 12-months (p > 0.05). At 12-months, 80.0%, 87.5%, and 66.0% of the patients in the mild, moderate, and severe LUTS cohorts discontinued their BPH medications, respectively. Rezum provides rapid and durable relief in LUTS in patients with moderate or severe LUTS and can be offered to patients with mild LUTS who have bothersome nocturia and wish to discontinue their BPH medications.

Transperineal Laser Ablation for Benign Prostatic Enlargement: A Systematic Review and Pooled Analysis of Pilot Studies.

Transperineal laser ablation (TPLA) of the prostate is a new minimally invasive treatment option in men with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE). The aim of this systematic review was to investigate the efficacy and safety of TPLA in the management of BPE. The primary outcomes were the improvement in urodynamic parameters (maximum urinary flow (Qmax) and postvoiding residue (PVR)) and LUTS relief, assessed using the IPSS questionnaire. The secondary outcomes were the preservation of sexual and ejaculatory functions, assessed with the IEEF-5 and MSHQ-EjD questionnaires, respectively, and rates of postoperative complications. We reviewed the literature for prospective or retrospective studies evaluating the use of TPLA in the treatment of BPE. A comprehensive search in PubMed, Scopus, Web of Science, and ClinicalTrials.gov was performed for English language articles published between January 2000 and June 2022. Pooled analysis of the included studies with available follow-up data for the outcomes of interest was additionally performed. After screening 49 records, six full-text manuscripts were identified, including two retrospective and four prospective non-comparative studies. Overall, 297 patients were included. All the studies independently reported a statistically significant improvement, from baseline, in Qmax, PVR, and IPSS score at each timepoint. Three studies additionally demonstrated that TPLA did not affect sexual function, reporting no change in the IEEF-5 score, and a statistically significant improvement in MSHQ-EjD score at each timepoint. Low rates of complications were recorded in all the included studies. Pooled analysis showed a clinically meaningful improvement in both micturition and sexual outcomes mean values at 1, 3, 6, and 12 months of follow-up, compared with baseline. Transperineal laser ablation of the prostate for the treatment of BPE showed interesting results in pilot studies. However, higher level and comparative studies are needed to confirm its efficacy in relieving obstructive symptoms and preserving sexual function.

Transverse myelitis following bivalent COVID‐19 booster vaccine and quadrivalent seasonal influenza vaccine

Transverse myelitis following bivalent <scp>COVID</scp>‐19 booster vaccine and quadrivalent seasonal influenza vaccine

The effect of pelvic floor muscle training in women with functional bladder outlet obstruction.

Female voiding dysfunction is often due to bladder outlet obstruction (BOO). We investigated pelvic floor muscle training (PFMT) effectiveness in women with functional BOO. This is a prospective study recruiting 63 women functionally obstructed, over 18yo, maximum flow rate (Qmax) less than 12ml/sec, naïve of voiding treatment. Exclusion criteria were anatomical BOO, neurological condition, pelvic intervention, psychiatric or anticholinergic medication, diabetes mellitus and affected upper urinary tract. At baseline, women underwent uroflow, post void residual (PVR) measurement, cystoscopy, cystogram and urodynamic study (UDS) with pelvic electromyography (EMG). Blaivas-Groutz nomogram has been used to define obstruction. After diagnosis, patients underwent six-month PFMT. Re-evaluation was offered four weeks after end of treatment. Data were analyzed with SPSSv22.0. 63 women were recruited and 48 finally included. At baseline, 20 reported 3 urinary tract infections (UTIs) during last year, and 12 had one episode of urine retention. Median Qmax was 7.5ml/sec and median PVR 110ml. 40 women were obstructed. 16 (40%) had mild, 16 (40%) moderate and 8 (20%) severe obstruction. All subjects had an overactive pelvic floor on EMG. Obstructed women were re-evaluated. Median Qmax was 8.5ml/sec, close to baseline (p = 0.16). Median PVR was 65ml, reduced to baseline (p = 0.02). 33 (82.5%) remained obstructed, 22 (66.67%) with mild, 8 (24.24%) moderate and 3 (9.09%) severe obstruction. 7 (17.5%) were non-obstructed. 4 patients reported one UTI episode with no cases of retention. A 6month PFMT reduced UTIs and PVR in women with functional BOO. Additionally, most patients had a de-escalation to milder obstruction.

Tadalafil vs Tamsulosin for the Management of Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia: A Randomised Clinical Trial

Introduction: Tadalafil and tamsulosin have both been approved for use in the management of Lower Urinary Tract Symptoms (LUTS). Limited studies have shown the efficacy of tadalafil in terms of maximum urinary output flow (Qmax) and post-void residual (PVR). Aim: To compare the efficacy of tadalafil 5 mg and tamsulosin 0.4 mg in patients with Benign Prostatic Hyperplasia (BPH). Materials and Methods: A prospective, open-label, Randomised clinical study was conducted in the Department of Urology at Kurnool Medical College, Kurnool, Andhra Pradesh, India. The study duration was one year and five months, from February 2015 to July 2016. A total of 83 patients clinically diagnosed with BPH were included, but 23 patients were excluded from the analysis due to lost follow-up. The remaining 60 patients were randomly assigned to two groups: one receiving tadalafil 5 mg (n=30) and the other receiving tamsulosin 0.4 mg (n=30) for 12 weeks. Demographic characteristics, total International Prostate Symptom Score (IPSS), individual IPSS, Quality of Life (QoL) score, Qmax, PVR, and differences in symptoms were analysed. Data were analysed using the Wilcoxon signed-rank test and Mann-Whitney U test. A p-value&lt;0.05 was considered statistically significant. Results: The mean age for group I (tadalafil 5 mg) and Group II (tamsulosin 0.4 mg) was 62.7 and 61.0 years, respectively (p=0.147). Patients who received tadalafil showed significantly higher efficacy in all measures from baseline to 12 weeks, including increased Qmax (12.0 mL/sec vs 15.1 mL/sec), reduced QoL scores (4.2 vs 3.7), and PVR (26.5 mL vs 15.8 mL), compared to tamsulosin where the increase in Qmax was 11.6 mL/sec vs 13.6 mL/sec, reduction in QoL scores was 4.1 vs 2.4, and PVR was 24.0 mL vs 16.2 mL, between baseline and 12 weeks. Conclusion: Tadalafil 5 mg is a recent drug option available for the treatment of LUTS-BPH. The efficacy and safety of tadalafil 5 mg and tamsulosin 0.4 mg are comparable.

Patterns and Predictors of Optimal Surgical and Functional Outcomes after Holmium Laser Enucleation of the Prostate (HoLEP): Introducing the Concept of "Trifecta".

The present study sought to provide reproducible and patient-oriented metrics to assess the rate of "successful" outcomes (Trifecta) following holmium laser enucleation of the prostate (HoLEP). Clinical and surgical predictors of failure to achieve Trifecta were investigated. We queried our prospectively collected database of all patients treated with HoLEP between March 2017 and January 2021. Trifecta was defined as the contemporary presence of: (1) no postoperative complication within 3 months; (2) no urinary incontinence at 3-months follow-up; and (3) 3-month postoperative max flow-rate >15 mL/s. Cases were grouped according to Trifecta achievement. All surgical procedures were carried out by a single surgeon. Surgical experience was divided into two different eras according to the number of procedures conducted (surgical era). Multivariate logistic regression analysis was performed to assess predictors of Trifecta failure. Overall 305 patients were included. Of these, 192 patients (63.0%) achieved Trifecta. Preoperative patient-related features were comparable between the two groups, except for a higher post-void residual (PVR) in non-Trifecta patients (median 180 vs. 130 mL, p=0.003). A significant proportion of Trifecta patients (88.5%) were treated in the second surgical era and in 126 (65.6%) cases an en-bloc enucleation was performed. Multivariate analysis confirmed PVR ≥250 mL, first surgical era and standard three-lobes enucleation technique as independent predictors of Trifecta failure. In our experience the rate of "successful" HoLEP, defined according to our newly introduced Trifecta metric, was 63.0%. We demonstrated that surgical strategy together with rising experience and baseline PVR are key elements to forecast the outcomes.