Postvoid Residual Research Articles

Transurethral Incision of the Bladder Neck at Three Points with a Needle-Type Electrode for Bladder Neck Contracture.

PurposeThis study aims to evaluate the efficacy of transurethral incision of the bladder neck (TUIBN) at three points with a needle-type electrode for treatment of bladder neck contracture (BNC).Materials and MethodsBetween January 2016 and April 2021, the bladder necks of 53 patients with BNC after surgery were incised by the needle-type electrode at the 5, 7, and 12 O’clock positions. Patient’s preoperational characteristics, peri- and postsurgical outcomes, such as time of operation, postoperative bladder irrigation, and postoperative hospital stay, and data of the international prostate symptom score (IPSS), maximum flow rate (Qmax), and postvoid residual (PVR) were recorded 3 and 6 months after surgery.ResultsAll 53 cases of BNC were successfully treated in 35.00 (25.00, 45.00) min with 18.00 (14.00, 21.00) h for postoperative bladder irrigation with little intraoperative bleeding (less than 50 mL). The postoperative hospital stay ranged from 2 to 8 days, a mean of 3.50 (3.00, 5.00) days. No major intraoperative or postoperative complications were observed. All cases that underwent follow-up assessment at 3 and 6 months after the surgery showed significantly decreased IPSS and PVR and increased Qmax compared to preoperation ones (p ≤ 0.001). Of these 53 patients, there was no recurrence in severe BNC patients, but 5 of 53 (9.4%) BNC patients developed BNC again within 6 months and required repeated TUIBN. Thirty patients comprised five recurrent cases with a follow-up period of more than 1 year.ConclusionsTUIBN at three points provides a safe, effective, and reliable option in treating patients with BNC.

PD45-02 UROLIFT VERSUS REZUM FOR BENIGN PROSTATIC HYPERPLASIA: A REAL-WORLD SINGLE-INSTITUTION ANALYSIS

You have accessJournal of UrologyCME1 May 2022PD45-02 UROLIFT VERSUS REZUM FOR BENIGN PROSTATIC HYPERPLASIA: A REAL-WORLD SINGLE-INSTITUTION ANALYSIS Chih Peng Chin, Evan Garden, Krishna Ravivarapu, Devki Shukla, Olamide Omidele, Micah Levy, Joseph Sewell Araya, Alexander Small, Steven Kaplan, Robert Valenzuela, Avinash Reddy, Susan Marshall, Jay Motola, Craig Nobert, Mantu Gupta, and Michael Palese Chih Peng ChinChih Peng Chin More articles by this author , Evan GardenEvan Garden More articles by this author , Krishna RavivarapuKrishna Ravivarapu More articles by this author , Devki ShuklaDevki Shukla More articles by this author , Olamide OmideleOlamide Omidele More articles by this author , Micah LevyMicah Levy More articles by this author , Joseph Sewell ArayaJoseph Sewell Araya More articles by this author , Alexander SmallAlexander Small More articles by this author , Steven KaplanSteven Kaplan More articles by this author , Robert ValenzuelaRobert Valenzuela More articles by this author , Avinash ReddyAvinash Reddy More articles by this author , Susan MarshallSusan Marshall More articles by this author , Jay MotolaJay Motola More articles by this author , Craig NobertCraig Nobert More articles by this author , Mantu GuptaMantu Gupta More articles by this author , and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: UroLift and Rezum are newer minimally invasive BPH treatment options that have grown in popularity. Research directly comparing the two is limited. We report the largest cohort to date comparing real world clinical outcomes following UroLift and Rezum. METHODS: Patients at an academic institution between 1/2017 and 1/2021 were screened, and those with preoperative prostate volume >30cc and ≤80cc were included. Patients with follow-up <30 days were excluded. Outcomes included changes in AUA symptom score (AUA-SS), Qmax, post void residual (PVR), surgical retreatment rate, changes in BPH medications use, postoperative complications, ER visits, and readmissions within 90 days. RESULTS: We identified 375 Rezum and 151 UroLift patients of which 191 Rezum (51%) and 88 UroLift (58%) patients met inclusion criteria. Median follow-up for Rezum and UroLift patients was 173 and 307 days, respectively. Compared to Rezum patients, UroLift patients were older (Rezum 67 ± 8 vs UroLift 69 ± 9 years, p=0.014) and had smaller prostates (Rezum 50.7 ± 13.5 vs UroLift 44.9 ± 12.4 cc, p<0.001). Preoperatively, UroLift patients had higher PVR (Rezum 93 ± 112 vs Urolift 156 ± 185 mL, p=0.028) and lower Qmax (Rezum 9.3 ± 5.1 vs UroLift 7.5 ± 4.6 mL/sec, p=0.004). After treatment, both Rezum and UroLift patients had significant, similar improvements in AUA-SS (Rezum -4.0 ± 6.8 vs. UroLift -5.2 ± 8.0 points, p=0.349) and PVR (Rezum -26.5 ± 91.8 vs UroLift -59.3 ± 150.3 mL, p=0.349). There was no significant improvement in Qmax (Table 1a). Both groups had decreased alpha-blocker use after treatment (Rezum 72.8% to 44.5%, UroLift 76.1% to 38.6%, both p<0.001) (Table 1b). In the postoperative 90-day period, Rezum patients experienced more hematuria, dysuria and retention, whereas UroLift patients more frequently had clot retention (Table 1c). There were no differences in 90-day ER visits, 90-day readmissions, or surgical retreatment rates (all p>0.05). CONCLUSIONS: For patients with BPH, UroLift and Rezum are similarly effective in improving urinary symptoms and function with no difference in surgical retreatment rates. The procedures differed in short-term clinical side-effect profile. Rezum patients reported more urinary retention, hematuria, and dysuria; UroLift patients had clot retention more frequently. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e782 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chih Peng Chin More articles by this author Evan Garden More articles by this author Krishna Ravivarapu More articles by this author Devki Shukla More articles by this author Olamide Omidele More articles by this author Micah Levy More articles by this author Joseph Sewell Araya More articles by this author Alexander Small More articles by this author Steven Kaplan More articles by this author Robert Valenzuela More articles by this author Avinash Reddy More articles by this author Susan Marshall More articles by this author Jay Motola More articles by this author Craig Nobert More articles by this author Mantu Gupta More articles by this author Michael Palese More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP18-16 VOIDING TIME AS A PROXY FOR URINARY OBSTRUCTION IN MEN WITH LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyCME1 May 2022MP18-16 VOIDING TIME AS A PROXY FOR URINARY OBSTRUCTION IN MEN WITH LOWER URINARY TRACT SYMPTOMS Gaurav Pahouja, Parth Patel, Enrique Blanco Martinez, and Kevin T. McVary Gaurav PahoujaGaurav Pahouja More articles by this author , Parth PatelParth Patel More articles by this author , Enrique Blanco MartinezEnrique Blanco Martinez More articles by this author , and Kevin T. McVaryKevin T. McVary More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002551.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We sought to investigate voiding time (VT) in asymptomatic and symptomatic men, and compare VT to other uroflowmetric parameters such as maximum flow rates (Qmax) as a possible solution to disparity related lack of access to more standard urodynamic testing in LUTS patients. METHODS: We conducted a controlled prospective study on a total of 30 patients. Adults age ≥18 were included. Exclusion criteria were those with ongoing medical therapy for LUTS or a history of invasive therapy for LUTS. Patients completed the International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry, and post-void residual (PVR) testing. Symptomatic LUTS was defined as an IPSS ≥8. RESULTS: On univariate analysis, men with a symptomatic LUTS had a significantly longer VT than asymptomatic men (30.60 seconds (Interquartile rage [IQR] 24.2-42.4) vs 20.50 seconds (IQR 16.6-40.5), p=0.043). When controlling for all other factors, VT was not otherwise associated with age, race, or BMI. There was no significant difference in Qmax between symptomatic and asymptomatic patients (13.40 seconds (IQR 8.7-19.9) vs 20.5 seconds (IQR 11.7-31.8), p-0.07). No differences were found based on PVR (p=0.51). Our study also demonstrated that the sensitivity of a VT ≥23.5 seconds, or probability of observing a VT exceeding 23.5 seconds when the patient has a symptomatic IPSS, is 85%. On sensitivity and specificity analysis, there was no difference between the abilities of Qmax and VT to predict that a patient would have symptomatic LUTS (p=0.80). CONCLUSIONS: We found that VT was as accurate as Qmax in predicting symptomatic IPSS scores. This novel finding can improve the ability to diagnose and treat LUTS, especially in primary care offices and underserved areas. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e302 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gaurav Pahouja More articles by this author Parth Patel More articles by this author Enrique Blanco Martinez More articles by this author Kevin T. McVary More articles by this author Expand All Advertisement PDF DownloadLoading ...

V02-06 FUNCTIONAL OUTCOMES OF EXTRAPERITONEAL LAPAROSCOPIC ADENOMECTOMY

You have accessJournal of UrologyCME1 May 2022V02-06 FUNCTIONAL OUTCOMES OF EXTRAPERITONEAL LAPAROSCOPIC ADENOMECTOMY Roberto Hugo Martinez Rodriguez, Alberto Robles Samaniego, Cristina Gutierrez Ruiz, Leire Portilla Maediavilla, Alejandro Garcia Viña, and Jose H. Amon Sesmero Roberto Hugo Martinez RodriguezRoberto Hugo Martinez Rodriguez More articles by this author , Alberto Robles SamaniegoAlberto Robles Samaniego More articles by this author , Cristina Gutierrez RuizCristina Gutierrez Ruiz More articles by this author , Leire Portilla MaediavillaLeire Portilla Maediavilla More articles by this author , Alejandro Garcia ViñaAlejandro Garcia Viña More articles by this author , and Jose H. Amon SesmeroJose H. Amon Sesmero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002528.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Both prostatic enucleation and adenomectomy can be considered gold treatments for benign prostatic hypertrophy (BPH) of large volume with obstructive clinic. Nowdays trend to minimally invasive surgery and/or the anatomical impossibility for enucleation have motivated the laparoscopic approach to conventional adenomectomy. We present the objective and subjective functional outcomes of our initial series of laparoscopic adenomectomies while surgical steps are shown. METHODS: Surgical tips are shown while functional outcomes are described.We prospectively analyzed patients undergoing extraperitoneal laparoscopic adenomectomy between April - December 2020 for infravesical obstruction due to BPH. We evaluated objective functional outcomes using flowmetry and post-voiding residue and subjective with sexual and quality of life questionnaires (IPSS AND IIEF) before and after surgery. Demographic data on age, weight and height were collected; prostate size estimated by ultrasound; surgical time, intraoperative bleeding, days of hospital stay, subjective pain measured by visual EVA scale, weight and anatomy of the surgical piece, and postoperative complications according to Clavien Dindo gradation.Descriptive analysis is performed. RESULTS: 50 laparoscopic procedures were performed on patients with a mean age of 70 years (range 60-78) and a mean ultrasound prostate size of 120cc (80-180). 19 of these patients were bladder catheter carriers at the time of surgery. Mean surgical time: 90min (80-150);decreased hemoglobin test 1.2gr/dl (0.5-3.8). Postoperative pain was 0/2 according to EVA scale, and mean hospital stay 2 days (1-7). We recorded 5 complications grade 3 Clavien Dindo scale (urinary tract infections) and one grade 2 (tube obstruction). The IPSS questionnaires showed a mean decrease of 19.41 points in the questions referring to voiding symptoms and 3.92 in the quality of life index. Peak flow was increased by >10 ml/sg and no patient had significant post-voiding residue. The IIEF showed an average increase of 4.45 points. CONCLUSIONS: Functional results, objectified through the use of validated questionnaires, support the laparoscopic approach in those selected cases. Laparoscopic adenomectomy represents a reasonable, safe and effective alternative in the treatment of high-volume prostatic hypertrophy with associated voiding clinic. Decreases the rate of transfusions, postoperative analgesic requirement and hospital stay, maintaining a satisfactory functional result. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e112 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roberto Hugo Martinez Rodriguez More articles by this author Alberto Robles Samaniego More articles by this author Cristina Gutierrez Ruiz More articles by this author Leire Portilla Maediavilla More articles by this author Alejandro Garcia Viña More articles by this author Jose H. Amon Sesmero More articles by this author Expand All Advertisement PDF DownloadLoading ...

V06-12 LAPAROSCOPIC MITROFANOFF APPENDICOVESICOSTOMY: AN OPTION IN COMPLEX ADULT PATIENT TO ACCESS TO THE BLADDER

You have accessJournal of UrologyCME1 May 2022V06-12 LAPAROSCOPIC MITROFANOFF APPENDICOVESICOSTOMY: AN OPTION IN COMPLEX ADULT PATIENT TO ACCESS TO THE BLADDER Roberto Hugo Martinez Rodriguez, Cristina Gutierrez Ruiz, Leire Portilla Maediavilla, Fatima Castroviejo, and Jose H. Amon Sesmero Roberto Hugo Martinez RodriguezRoberto Hugo Martinez Rodriguez More articles by this author , Cristina Gutierrez RuizCristina Gutierrez Ruiz More articles by this author , Leire Portilla MaediavillaLeire Portilla Maediavilla More articles by this author , Fatima CastroviejoFatima Castroviejo More articles by this author , and Jose H. Amon SesmeroJose H. Amon Sesmero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002586.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Mitrofanoff principle was originally described in paediatric population as a method to provide an alternative access to the bladder. It creates a conduit to the bladder through which patients with a sensitive, absent or traumatized urethra can perform clean intermittent catheterization (CIC) easily. We report our experience with complete laparoscopic approach in an adult patient with complex urogenital malformation and multiple previous surgeries. METHODS: 39 years old female patient born with urogenital sinus plus anorectal atresia and bicornuate uterus with several reconstructive surgeries during neonatal and infant period. Previous to the surgery, the patient was performing several CIC per day with increasing difficulty, pain and urethrorrhagia. The patient was incontinent due to elevate post-voiding residue due to an ineffective evacuation by catheter. Low bladder pressure was confirmed by urodynamics. Pelvic MRI showed atypical morphology of the bladder after previous surgery plus cystic image in the right iliac fossa related to anexial cyst without visualizing the anal sphincter complex. RESULTS: A 4 port transperitoneal approach was used :2 of 10 mm laparoscopic ports and 2 of 5 mm ports. The 10 mm camera port was placed trough the umbilicus and the rest in the midline and lateral to the edge of the rectus abdominis muscle. After liberation of several abdominal adherences, we found the appendix and right hemicolon medially and cranially displaced. The appendix was harvested with preservation of the vascular supply and ligated at its base. The appendix was assessed to determine whether the length was adequate to reach the anterior abdominal wall. The bladder was filled with saline and a 3 cm vertical seromuscular incision was made in the right posterior wall of the bladder down to the mucosa. Appendicovesical anastomosis was then performed, and seromuscular layer of the bladder was closed creating a tunnel for the appendix. The tightness of the bladder anastomosis was tested by bladder filling. Care was taken to ensure absence of twisting or tension on the appendiceal mesentery. The appendix was then brought up to the abdominal wall and a catheterizable stoma was created with 8 Fr catheter left through the appendix. The operative time was 300 min and estimated blood loss was 120 cc. The patient was discharged at eighth day. CONCLUSIONS: Pure laparoscopic Mitrofanoff appendicovesicostomy is feasible in adult patients even with previous and complicated surgeries. Pure laparoscopic Mitrofanoff is associated with reasonable outcome, early recovery and good cosmesis. The main disadvantage is the long operative time due to anatomical challenges. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e568 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roberto Hugo Martinez Rodriguez More articles by this author Cristina Gutierrez Ruiz More articles by this author Leire Portilla Maediavilla More articles by this author Fatima Castroviejo More articles by this author Jose H. Amon Sesmero More articles by this author Expand All Advertisement PDF DownloadLoading ...

Urodynamic study findings and related influential factors in pediatric spastic cerebral palsy

To investigate the urodynamic study (UDS) result in pediatric patients suffering from spastic cerebral palsy (CP). Medical records of patients diagnosed CP having pre-operative UDS results underwent selective dorsal rhizotomy (SDR) from Jan. 2020 to May. 2021 were retrospectively reviewed. Fifty-seven cases diagnosed spastic CP were included in the study (mean age, 6.73 ± 2.84 years), among which, 46 were ambulatory and 11 non-ambulatory. Average gross motor function measure-66 (GMFM-66) score was 62.16 ± 11.39. Reduced bladder capacity was seen in 49.12% of these cases and cases with lower GMFM-66 score possessed a higher incidence rate of having low bladder capacity (p < 0.01). Detrusor overactivity (DO) was shown in 33.33% of the patients. Cases with younger age presented a higher prevalence of DO (p < 0.05). Meanwhile, more non-ambulant patients suffered from DO (p < 0.05). Increased post-voiding residual (PVR) was seen in 21.05% of the cases. Those with higher average threshold in sphincter-associated input spinal nerve roots (rootlets) witnessed a higher rate of having abnormal PVR (p < 0.05). Abnormal UDS results were prevalent in pediatric patients suffering from CP. Motor function, age and threshold of their sphincter-associated spinal nerve roots laid corresponding effect on the abnormal UDS results.

Nontarget Radiopaque Embolic Deposition during Prostatic Artery Embolization

This study evaluated detectable nontarget embolization (NTE) during prostatic artery embolization (PAE) and the safety and efficacy of using radiopaque particles in PAE. Ten patients aged >40 years with prostate glands of >50 mL and refractory lower urinary tract symptoms were analyzed. Unenhanced computed tomography scans at baseline and at 3 months after PAE, using 40–90-μm radiopaque spherical embolic beads, were compared to assess the NTE. Growth models evaluated changes from baseline to 3, 6, and 12 months in International Prostate Symptom Score (IPSS), peak urine flow rate (Qmax), quality of life (QoL), International Index of Erectile Function (IIEF), and postvoid residual (PVR). The IPSS, QoL, and Qmax improved at all time points (P < .05), with no trend in PVR or IIEF. Adverse events that occurred were minor. Radiographic NTE was seen in all patients, correlating at times with postprocedural symptoms (eg, rectal pain). Symptoms were not correlated with the NTE in some patients, whereas other patients remained asymptomatic despite NTE.

Contemporary Management of Male Anterior Urethral Strictures by Reconstructive Urology Experts-Results from an International Survey among ESGURS Members.

Assessment of anterior urethral stricture (US) management of European urology experts is relevant to evaluate the quality of care given to the patients and plan future educational interventions. We assessed the practice patterns of the management of adult male anterior US among reconstructive urology experts from European countries. A 23-question online survey was conducted among European Association of Urology Section of Genito-Urinary Reconstructive Surgeons (ESGURS) members. A total of 88 invitations were sent by email at two different times (May and October 2019). Data were prospectively collected from May 2019 to December 2019. The response rate was 55.6%. Most of the responders were between 50 and 59 y.o. and mainly from University Public Teaching/Academic Hospitals. A total of 73.5% treated ≥20 patients/year with US. Retrograde urethrogram (RUG) was the commonest diagnostic tool, followed by uroflowmetry (UF) +/− post-void residual (PVR). Urethroplasty using grafts was the most frequent treatment (91.8%). Of responders, 55.3% performed >20 urethroplasties/year. Anastomotic urethroplasties were performed by 83.7%, skin flap repairs by 61.2%, perineal urethrostomy by 77.6% and non-transecting techniques by 63.3%. UF was the most common follow-up tool. Most of the responders considered urethroplasty as the primary option when indicated. Male anterior US among ESGURS members are treated mainly using urethroplasty graft procedures. RUG is preferred for diagnosis, and UF for follow-up.

Comparison of early loosening vs delayed section of mid-urethral slings for postoperative voiding dysfunction.

Bladder outlet obstruction (BOO) is a common occurrence after midurethral sling (MUS) insertion and can result in acute or chronic urinary retention or de novo lower urinary tract symptoms (LUTS). However, the management of BOO after MUS is not standardised. The objective of this study was to compare two therapeutic strategies for suspected BOO after MUS. Patients who had surgical revision for voiding dysfunction with a post-void residual (PVR) ≥100ml after MUS in five centres between 2005 and 2020 were included in a retrospective study. Patients were divided into two groups: early sling loosening (EL) vs delayed section/excision of the sling (DS). Seventy patients were included: 38 in the EL group and 32 in the DS group. The postoperative complication rate was comparable in both groups (10.5% vs 12.5%; p = 0.99). At 3months, the rate of withdrawal from self-catheterisation was similar in the two groups (92.1% vs 100%; p = 0.25) as was the PVR (57.5 vs 63.5ml; p = 0.09). After a median follow-up of 9months, there were significantly more patients with resolved voiding dysfunction in the EL group (63.2% vs 31.3%; p = 0.01). The rate of persistent/recurrent stress urinary incontinence (SUI) was higher in the DS group (21% vs 43.7%; p = 0.04). In multivariate analysis, the main predictive factor of recurrent SUI was DS (OR 2.87, 95% CI 1.01-8.60, p = 0.048). Early loosening of MUS in the case of postoperative voiding dysfunction offers better efficacy than DS of the sling, with a lower risk of recurrent/persistent SUI.

Is there a correlation between meatal stenosis severity, lower urinary tract symptoms and uroflowmetry?

We have recently validated a meatal Stenosis (MS) severity grading system that is based on physical examination. The study objective was to examine the correlation between this grading system, patients' urinary symptoms, uroflowmetry and postvoid residual parameters. Patients referred for our clinic for urinary and non-urinary complaints, were prospectively enrolled. Urinary symptoms questionnaire, uroflowmetry parameters and post-voiding residuals (PVR) were assessed, and photographs of the urethral meatus were taken for each patient. The photographs were graded blindly according to the previously validated grading system and correlated with urinary symptoms, uroflowmetry parameters and PVR. Overall, 75 patients were assessed (20 grade 0, 23 grade 1 and 32 grade 2). When using grade 0 as a reference, the odds ratio (OR) for reporting narrow stream was 6.4 (95%CI 1.65-24.77) and 4 (95%CI 1.18-14.16) for grade 1 and 2 respectively. OR for prolonged urination was 6 (95% CI 1.47-24.89) for Grade 1 and 2; OR for upward stream deviation was10.08 (95%CI -2.43-41.82) for grade 1 and 15.12 (95%CI-3.74-61.17) for grade 2. Uroflowmetry results showed lower Qmax from 16.8(SD±8.0) ml/sec in grade 0-9.6ml/s on grade 1 and 2 (p<0.001) (Figure1). PVR was not statistically different in the three groups. Our main findings were that meatal stenosis severity grade is associated with narrow stream as reported by parent, prolonged urination, and upward deviation of urinary stream, with increasing severity with worsening stenosis. MS grade was also associated with significant worsening of uroflow measures: a lower Qmax, Qmean and a longer time-to-Qmax. Post-void residual volume was not significantly different between the different severity grades. This study showed the clinical significance of the grading system. With subjective and objective measures. The implementation of this grading system in clinics, may aid in decision making regarding surgical intervention in the appropriate patients, and avoid unnecessary procedures. The Severity of MS seen on physical examination correlates well with obstructive symptoms and decrease of urine stream seen on uroflowmetry. These findings confirm the importance of the grading system in the evaluation of patients with MS and may be additional measure that assist in consulting parents on the indications to meatotomy.

Non-invasive diagnosis of under active bladder: A pilot study.

We assessed the efficacy of voiding efficiency (VE) to distinguish between underactive bladder (UB) and bladder outlet obstruction (BO) without using pressure flow studies (PFS). in male patients, uroflowmetry and post-void residual (PVR) urine data and subsequent pressure flow studies (PFS) data were examined retrospectively. Bladder outlet obstruction index (BOI) and bladder contractility index (BCI) were calculated from patients' PFS values. Patients with BCI < 100 and BOI < 40 were grouped as UB group and patients with BCI > 100 and BOI > 40 were grouped as BOO group. VE was computed as a percentage of volume voided compared to the pre-void bladder volume. In total we examined 93 patients, 44 in UB and 49 in BO group. There was no statistically significant difference between the two groups in relation to Qmax value (p = 0.38). However, total voiding time, time to reach the maximum urinary flow rate and voided volume showed statistically significant difference between the two groups (p < 0.001). Average VE was 63.6 + 2.43% and 46.2 + 2.63%) for UB and BO groups respectively and the difference was statistically significant (p < 0.001). UB can be diagnosed with at least 95% sensitivity and 88% specificity in men over age 80. Non-invasive uroflowmetry and VE measurements were able to differentiate between UB and BOO patients, presenting with identical clinic features, but different findings of PFS.

Assess the Mean Change in Outcomes of Sildenafil in the Treatment of Lower Urinary Tract Symptoms and Erectile Dysfunction Due to Benign Prostatic Hyperplasia

Objective: To assess the mean change in outcomes of sildenafil in the treatment of lower urinary tract symptoms and erectile dysfunction due to benign prostatic hyperplasia.&#x0D; Study Design: This is a quasi experimental study.&#x0D; Setting: The study was carried out at OPD of Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from January 26, 2018 to July 26, 2018.&#x0D; Materials and Methods: 50 patients fulfilling selection criteria were included in the study through OPD of Department of Urology, Jinnah Postgraduate Medical Centre, Karachi Informed consents were obtained. Demographics (name, age and contact) were also be obtained. All patients were subjected to detailed history and clinical examination for BPH and ED according to the IPSS and IIEF. Mean change in urine flow rate assessed through uroflowmetry and Mean change in post-void residual (PVR) urine was assessed through an ultrasound on the same day and on follow-up after 10th weeks in OPD before and after the tablet sildenafil 50 mg OD at night to every patient.&#x0D; Results: Mean age of patients was 58.42±9.76 (45-80) years. pre and post treatment International prostate symptom score (IPSS) score mean 17.78±2.91 and 12.94±2.79 (p-value=0.0001) respectively, erectile function score (IIEF) score mean 17.64±2.69 and 21.86±4.47 (p-value=0.0001) respectively, Urinary flow rate (UFR) pre and post treatment mean 8.32±1.62 and 12.46±1.83 (p-value=0.0001) respectively, Post-void residual (PVR) urine pre and post treatment mean 62.64±6.29 and 54.72±5.04 (p-value=0.0001) respectively.&#x0D; Conclusion: Improvement of erectile dysfunction and reduction of urinary tract symptoms in men with sildenafil was associated with improved quality of life and satisfaction with treatment. Daily doses of sildenafil can improve lower urinary tract symptoms.

Treatment outcomes of detrusor underactivity in women based on clinical and videourodynamic characteristics.

Treatment of voiding dysfunction due to detrusor underactivity (DU) remains challenging. This study sought to determine the characteristics of video urodynamic study (VUDS) in female DU and outcomes after active treatment. A total of 409 female patients with VUDS-proven DU were recruited. All patients received conservative bladder management, with others receiving active treatment, such as oral medication, transurethral incision of bladder neck (TUI-BN), surgery for prolapse, and urethral botulinum toxin A (BoNT-A) injection, according to their VUDS characteristics. Treatment outcomes were then analyzed by different VUDS characteristics. Satisfactory treatment outcomes were noted in 123 patients (30.0%), among whom 35 and 88 had a VE of > 90% and > 66.7%, respectively. A total of 165 patients (40.3%) had voiding efficiency (VE) of 33.3-66.7%, whereas 121 (29.6%) remained unable to void (12.5%) or had a VE of < 33.3% (17.1%). Conservative treatment had the worst outcome. Patients with normal or slightly reduced bladder sensation (49.3%) and those with a post-void residual (PVR) of < 250mL (59.4%) displayed better satisfactory outcome after treatment; while TUI-BN and urethral BoNT-A injection promoted better treatment results. Patients with detrusor acontractility and a PVR of ≥ 500mL still achieved high VE rates (> 66.7%) after TUI-BN. A 56.3% satisfactory outcome was achieved after TUI-BN, whereas 58.1% satisfactory outcome was noted in those with a tight external sphincter after medical treatment. Female patients with DU exhibited VE improvement after active treatment. Patients with very low detrusor contractility and absent bladder sensation generally exhibited poor treatment outcomes.

Correlation between urinary symptoms and urodynamic findings: Is the bladder an unreliable witness?

ObjectiveThe role of urodynamics as the gold standard to investigate bladder function has recently been questioned. We aimed to evaluate the agreement of lower urinary tract symptoms and urodynamic diagnosis and to build predictive models. Study designPatients who underwent urodynamics for pelvic floor disorders between 2008 and 2016 were retrospectively analyzed. Clinical evaluation investigated the presence of genital prolapse, stress urinary incontinence (SUI), overactive bladder (OAB), urge urinary incontinence (UUI), voiding symptoms (VS), and bulging symptoms. The degree of concordance/agreement between symptoms and corresponding urodynamic findings was measured. Multivariate models to predict specific urodynamic findings were built. Results1972 women were analyzed. The best agreement was found for SUI and urodynamic SUI, with a proportion of agreement of 0.68 and a Cohen’s Kappa of 0.37. Very poor agreement was found for OAB/UUI and detrusor overactivity, voiding dysfunction, and positive post-void residuals. Multivariate models resulted in poor accuracy for all urodynamic findings (AUC range 0.64–0.72). ConclusionLower urinary tract symptoms and gynecological examination are poor predictors of urodynamic findings. This confirms the role of urodynamic assessment in defining bladder function and providing precious information to counsel patients and establishing optimal clinical guidance.

Safety, efficacy and functional outcomes of photoselective vaporisation of the prostate: A single-centre experience

Objective: The objective of this study was to report the safety, efficacy and functional outcomes following photoselective vaporisation of prostate (PVP) with GreenLight laser for benign prostatic enlargement (BPE). Material and methods: We retrospectively analysed men who underwent PVP from April 2011 to August 2019 for BPE. Preoperative, intraoperative and postoperative details were retrieved from electronic data software. The perioperative and functional outcomes were analysed. Results: A total of 147 patients, with a mean age of 65.4 years, underwent PVP (51 patients – high performance system (HPS), 120 Watts; 96 patients – xcelerated performance system (XPS), 180 Watts). In 20 (13.6%) patients, antiplatelet or anticoagulant were continued in the perioperative period. The mean operative time, lasing time, catheterization time and hospital stay were 54.4 minutes, 38.0 minutes, 48.7 hours and 2.73 days, respectively. Postoperatively, all the functional outcomes IPSS (international prostate symptom score), QOL (quality of life), Qmax (maximum flow rate) and PVR (postvoid residue) were significantly improved from the baseline. The most common complication was dysuria (36.7%). There was no significant perioperative bleeding complications in high-risk men who were on antiplatelet or anticoagulant therapy. Conclusion: PVP is a safe, efficacious and durable surgical option in BPE including patients on antiplatelet or anticoagulant therapy. Level of evidence: Level 4

Sacral neuromodulation in patients with detrusor underactivity: Is biological sex an indicator?

This study aimed to report sacral neuromodulation (SNM) outcomes in detrusor underactivity (DU). A multicentric, multinational, retrospective case series was conducted between March 2017 and June 2021 in three different referral centers. Initial test phase stimulation included either a percutaneous nerve evaluation (PNE) or an advanced lead evaluation test phase (ALTP) before permanent SNM implantation. The test phases were performed under local anesthesia, either in the outpatient (PNE) or operating room (ALTP), in the prone position, which was implanted in the third or fourth sacral foramina under fluoroscopic guidance. Patients with favorable response to the initial test phase during the first 2 weeks underwent the implantable pulse generator (IPG) implantation (Medtronic neurostimulation generator device InterStim™). Favorable response was defined as ≥ 50% improvement in symptoms, frequency of clean intermittent catheterization (CIC) and/or decrease in postvoid residual (PVR), increase in voided volume, or improvement in bladder voiding efficiency (BVE) based on the bladder diary. Fifty-eight patients were recruited with a mean age of 39.95 ± 15.28 years. Among the 58 cases, 36 (62.1%) patients responded to the initial stage. Of these, 12 patients (30.8%) with non-neurogenic etiology and nine patients (52.9%) with neurologic etiology did not respond to the initial test phase; thus, they did not undergo full implantation (p = 0.141). Voided volume, PVR, and the median maximum flow rate (Qmax) improved significantly (p < 0.001) in both sexes; however, there was no statistical difference between both genders. Most female cases (78.3%), and nearly half of the men (51.4%), responded to the test phase and were candidates for the IPG phase. Among the 35 cases who underwent IPG, 27 patients (72.2% of males, and 77.8% of females; p = 0.700) had a favorable response to IPG. 46.6% of patients had a successful outcome at the end of the study. This multicentric study showed that SNM effectively and safely provided symptom improvement in refractory DU in males similar to females which is an important finding as previously it has been suggested that SNM works better in nonobstructive urinary retention in women and not in women.

Pilot Study of “Less is More” Rezum for Treatment of BPH

ObjectiveTo assess the outcomes of a “less is more” treatment approach consisting of a single water vapor treatment per prostate lobe for benign prostatic hyperplasia (BPH). MethodsRetrospective cohort study in a single urologic clinic of men with moderate to severe symptomatic BPH with and without median lobes undergoing thermal water vapor therapy. Single injection of thermal water vapor was given in each prostate lobe. The primary endpoint compared maximum urine flow rate (Qmax), post-void residual (PVR), International Prostatism Symptom Score (IPSS), and the IPSS Quality of Life scale (IPSS QoL) at baseline and at 1, 3, 6, and 12 months. ResultsThe study included 52 men with mean prostate volume and IPSS of 52.8cc and 20.3cc, respectively. IPSS was reduced by -3.95 ± 7.5 at 3 months (P = .02875), -8.5 ± 9.3 at 6 months (P = .01767), and -11.63 ± 8.4 at 12 months (P = .005908). IPSS QoL improved by -1.75 ± 1.2 t 12 months (P = .003799) and QMax by 5.36 ± 3.7 mL/s at 12 months (P = .008445). Time to post-operative catheter removal was 3.5 ± 1.3 days. One patient reported ejaculatory dysfunction. All other adverse events were mild to moderate in severity and resolved quickly. ConclusionThermal water vapor therapy with single injection per lobe is both an effective and safe treatment for BPH that provides comparable improvements in lower urinary tract symptoms and quality of life to the traditional approach that employed variable number of injections by prostate volume.

A Case Report to Study The Effective Role of Varunadi Kashaya and Dashmool Churna in the Causes of Increased Post Void Residual Urine

Post-Void Residual (PVR) volume of urine is the amount of urine retained in the bladder after a voluntary void that is measured by catheterization or non-invasively by ultrasonography. The increased value of PVR act as a diagnostic tool in a urological pathology such as a neurological disease/injury to the bladder, mechanical obstruction, infection or medication induced urinary retention. A PVR less than 50ml signifies adequate bladder emptying. The present case is of 3.1mm non-obstructing left renal calculus and Grade III prostatomegaly with increased Post Void Residual urine (91ml). Renal calculi and prostatomegaly, both are common obstructive uropathies which interferes with the normal outflow of urine. Treatment is aimed at relieving the symptoms and to treat the underlying cause as well. The treatment strategies that can be followed are catheterization, stenting, surgery, lithotripsy, hormonal therapy and antibiotic therapy. The Ayurvedic formulation, Varunadi Kashaya and Dashmool Churna are Vata kapha pacifying drugs. With its Mutrala, Deepana, Anulomana, Shothghana, Shoolghana properties, it had successfully eliminated renal calculus, decreased the prostate size and ultimately, lowered the PVR value as evidenced in USG report. There is a considerable relief in the troublesome urological symptoms- dysuria, dribbling micturition, weak urine stream, inadequate bladder emptying and abdominal pain.

A multicenter retrospective study of transurethral prostate split for benign prostate hyperplasia.

BackgroundTransurethral split of the prostate (TUSP) is effective in treating benign prostatic hyperplasia (BPH). However, there is still a lack of research focusing on the optimal target population for TUSP. This study aimed to compare the efficacy of TUSP in patients with different prostate volumes or ages.MethodsThe study was a multicenter retrospective study. The outcomes of TUSP in BPH patients with different prostate volumes or different ages were compared. A total of 439 patients were included in the study. Patients were divided into two groups according to prostate volume, with a cut-off value of 50 mL. Similarly, the cut-off value for the age groups was 70 years. Baseline patient characteristics and perioperative outcomes were recorded. Follow-up was performed at 1, 6, and 12 months after surgery.ResultsThe mean age of the patients was 73.4 years, and the mean prostate volume was 51.2 mL. At 12-month follow-up after TUSP treatment, the patients’ International Prostate Symptom Scores (IPSS), quality of life (QoL) scores, and postvoid residual (PVR) volumes decreased significantly, while peak urinary flow rate (Qmax) increased significantly. Intraoperative hemoglobin (Hb) reduction was significantly lower in the small volume group than in the large volume group. The incidence of postoperative urinary urgency and transient incontinence was lower in the small volume group. IPSS score, PVR, and Qmax in the small volume group showed more remarkable changes at several time points compared to the preoperative period. Postoperative pain scores were higher in the small volume group than in the large volume group. There were no differences between the two groups in terms of long-term complications. The younger group showed greater variation in PVR and Qmax at some time points but less variation in QoL than the older group.ConclusionsTUSP is overall safe and effective in treating BPH. This study showed differences in the outcomes of TUSP in treating different prostate volumes or ages of BPH patients. The optimal surgical approach for BPH patients might be selected clinically based on a combination of prostate volume or patient age.

A Cost-Effectiveness Analysis of Post-Void Residual Bladder Scan Thresholds in the Postoperative Setting.

To identify the optimal cost-effectiveness threshold of post-void residual (PVR) by bladder scan in postoperative urogynecologic patients. A cost-effectiveness analysis was performed as a secondary analysis of a previously published study of patients undergoing urogynecologic procedures with planned voiding trials, setting thresholds for postoperative PVR bladder scan volumes at 100ml, 150ml, and 200ml. Patient-based scenarios were modeled for ambulatory office or emergency department (ED) resource utilization and to determine the cost-effectiveness of each threshold. Costs were obtained from a southeastern academic medical center, only utilizing direct medical costs and hospital costs, not including societal costs. Quality-adjusted life years (QALY's) were used as health outcomes determining the incremental cost-effectiveness ratio (ICER). A total of 151 patients from the original study were included. A willingness to pay threshold of $100,000 per QALY was assumed. A PVR of 100ml exceeded this at $373,824. A PVR threshold of 150ml was dominant (-$1,211,716), while minimizing ED visits for postoperative urinary retention (POUR) and unnecessary clinic appointments. While a PVR of 200ml appeared a cost-effective strategy (-$488,389), there was increased ED utilization and under-detection of postoperative urinary retention (POUR). A PVR threshold of 100ml created a healthcare system burden due to increased office voiding trials. Both PVR thresholds of 150ml and 200ml were cost-effective strategies; however, ED utilization for POUR increased with 200ml. Utilizing 150ml as the PVR cut-off proved the most cost-effective strategy, avoiding POUR under-detection and undue health costs.