Post-void Residual Urine Research Articles

The outcome of nontransecting anastomotic urethroplasty in recurrent bulbar urethral stricture and its impact on sexual functions: A prospective observational study

Purpose: The management of recurrent bulbar urethral stricture had no consensus and faced many challenges such as the risk of failure, ischemia, and sexual dysfunction. Therefore, this study aimed to assess the outcome of nontransecting anastomotic urethroplasty in recurrent bulbar urethral stricture disease (USD) less than 3 cm and its impact on sexual functions. Material and methods: This is a prospective descriptive study that included patients with recurrent bulbar USD ≤ 3 cm. Full history taking and clinical examination, including International Prostate Symptoms Score (IPSS) and International Index of Erectile Function (IIEF-5), were documented. Moreover, retrograde urethrogram, uroflowmetry, and penile Doppler were undergone. The nontransecting urethroplasty techniques were performed: Heineke-Mikulicz principle stricturoplasty for stricture ≤1 cm without excision of the stricture and nontransecting excision and primary anastomosis without transecting the corpus spongiosum for stricture 1 to 3 cm. Each patient was routinely evaluated through a 12-month follow-up using IPSS and IIEF, uroflowmetry, and postvoiding residual urine. Results: Thirty-three patients were included in the study with a mean stricture length of 1.45 ± 0.7 cm. Twelve patients had failed previous urethroplasty, while 21 patients had previous visual internal urethrotomy. Nontransecting excision and primary anastomosis in 14 patients and Heineke-Mikulicz principle stricturoplasty in 19 patients were performed. There was no recurrence of stricture urethra, except for one patient, who required visual internal urethrotomy at a 3-month follow-up, with mean postoperative IPSS of 3.04 ± 2.745, Qmax 23.89 ± 2.714 mL/s, and postvoiding residual urine 26 ± 33 cc. No significant differences were reported between pre- and postoperative IIEF (18.61 ± 5.448 versus 19.33 ± 5.599, respectively, P = 0.236). Conclusion: Nontransecting urethroplasty can achieve a high success rate in short recurrent bulbar USD without the potential sexual morbidity.

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

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

Is detrusor underactivity the urodynamic characteristic of long-COVID in patients with benign prostate hyperplasia?

Although coronavirus disease 19 (COVID-19) was reported to involve with multiple organs, COVID-19 reports focusing on urinary system mostly evaluated the association between lower urinary tract symptoms and COVID-19 using questionnaire score. In this study, sonography video urodynamic studies was first conducted to explore the effects of COVID-19 on contractility of bladder detrusor of patients with benign prostate hyperplasia (BPH). Clinical data was respectively reviewed and compared between BPH patients with previous COVID-19 infection (COVID-19 group) and without previous COVID-19 (non-COVID-19 group). The incidence of detrusor underactivity (DU) was compared between 2 groups. Comparison of age and noninvasive parameters was conducted between BPH patients with DU and without DU in COVID-19 group. Correlation coefficient between noninvasive parameters and detrusor contractility was determined and receiver operating characteristic curve of noninvasive parameters was used to choose the most appropriate cutoff for detection of DU in COVID-19 group. Beside a significant increase in the incidence of DU in BPH patients of COVID-19 group, a lower detrusor contractility and a greater bladder wall thick was detected compared to that of patients in non-COVID-19 group. Post-voiding residual urine was found to have a linear correlation with detrusor contractility in COVID-19 group. It was suggested that COVID-19 infection would further exacerbate impairment of detrusor previously resulted from bladder outlet obstruction in BPH patients. DU may be a urodynamic characteristic of long-COVID.

Intralesional injection of mitomycin C following visual internal urethrotomy for recurrent urethral stricture: a randomized controlled study.

To assess the efficacy of Intralesional injection of mitomycin C (MMC) following visual internal urethrotomy (VIU) in the management of recurrent urethral stricture. Fifty male patients diagnosed with recurrent single bulbar urethral stricture measuring less than 1.5 cm previously treated with VIU were randomly allocated into two equal groups, (Group A) planned for VIU only and (Group B) planned for VIU with intralesional MMC injection using Botox injection needle. All patients were objectively evaluated pre- and post-operatively at 3, 6, and 12 months using uroflowmetry, post-void residual urine volume, and retrograde urethrography. Forty-five patients completed their follow-up in our study. Patients who underwent intralesional MMC injection showed significant improvement in uroflowmetry, post-voiding residual, and with a success rate (82.6% in Group B, compared to 50% in Group A with a highly statistically significant difference, p-value: <0.001). VIU with MMC was the only factor associated with a marked decrease in stricture recurrence (p = 0.02) as shown in the Multivariate Cox regression analysis. Intralesional injection of mitomycin C seems to be a safe and effective modality in reducing the recurrent stricture rate after VIU.

Urinary tract infections and associated factors among patients with an enlarged prostate at a tertiary hospital, Dar es Salaam, Tanzania: a hospital-based cross-sectional study

ObjectivesThe objectives are to determine the prevalence of urinary tract infection (UTI) and associated factors among patients diagnosed with benign prostatic hyperplasia and prostate cancer.DesignHospital-based cross-sectional study.SettingsUrology clinic and urology...

An Evaluation of the Postvoid Residual Urine Volume in Acute Stroke Patients.

We analyzed the time course of postvoid residual urine volume for patients with cerebrovascular diseases in the acute phase. A multidisciplinary specialized team measured postvoid residual urine volume of 65 patients (31 patients with cerebral infarction and 34 patients with cerebral hemorrhage) from September 2021 to August 2023. If a patient's postvoid residual urine volume was 100 mL or more, an indwelling urinary catheter was reinserted with or without medication, or clean intermittent catheterization was performed with or without medication. The multidisciplinary specialized team took repeated measurements of postvoid residual urine volume for a patient at every week's round until the postvoid residual urine volume was <100 mL. The cumulative incidence of the time interval between the onset of the cerebrovascular accident and the day of postvoid residual urine volume <100 mL was calculated as 1 + the Kaplan-Meier estimator. In the Kaplan-Meier estimator, the median cumulative incidence of the period between the onset of a cerebrovascular accident and the day in which postvoid residual urine volume was <100 mL was 16.5 days and 15.5 days for patients with cerebral infarction and cerebral hemorrhage, respectively. No significant difference existed between the two groups in the time interval from the onset of a cerebrovascular accident to the day in which postvoid residual urine volume was <100 mL (The P value from the Log-rank test was 0.845). The time interval between the onset of a cerebrovascular accident and the day in which postvoid residual urine volume was <100 mL was 75 days after the onset of both types of cerebrovascular accidents. Postvoid residual urine volume of patients with cerebrovascular disease was expected to become <100 mL within 75 days after the onset of the cerebrovascular accident.

Pelvic autonomic dysfunction is common in patients with pure autonomic failure.

Pure autonomic failure (PAF) presents primarily as cardiovascular autonomic failure and may phenoconvert to other neurodegenerative disorders. However, the involvement of other autonomic functions has been poorly evaluated. This study aims to characterize genitourinary and bowel dysfunction and explore their relationship with cardiovascular autonomic dysfunction. Pure autonomic failure patients underwent cardiovascular autonomic testing and an assessment of pelvic autonomic dysfunction using urinary, sexual symptoms questionnaires and a bladder diary. Demographic, clinical features and related medical comorbidities were assessed. Twenty-five patients (10 males) with PAF were included (mean age 71 ± 8 years; disease duration 13 ± 8 years). 96% (24/25) reported lower urinary tract symptoms, of which overactive bladder symptoms were most commonly reported (n = 23; 92%; median overactive subscore 8, interquartile range [IQR] 3-11), followed by voiding difficulties (n = 19; 76%; median low stream subscore 2, IQR 1-3) using the Urinary Symptom Profile; however, only four (16%) required clean intermittent self-catheterization. Sexual dysfunction was common (n = 21; 84%) using the Arizona Sexual Experience Scale. Mild faecal incontinence and constipation were reported. 86% (19/22) had nocturnal polyuria (NP) and the median NP index was 47% (IQR 38%-51%; normal range <33%). 77% (10/13) had voiding dysfunction and 31% (4/13) had post-void residual urine >100 mL. There were no significant correlations between the need for catheterization and the degree of NP with age, disease duration and cardiovascular autonomic parameters (p > 0.05). Nocturnal polyuria, genitourinary and bowel symptoms are commonly seen in PAF. The pathophysiology of NP in PAF is most likely multifactorial and may occur independent of cardiovascular autonomic failure.

Features of lower urinary tract symptoms in patients with multiple system atrophy

Background: Multiple system atrophy (MSA) is a fatally progressive neurodegenerative disease characterized by variable combinations of parkinsonism, cerebellar ataxia and autonomic dysfunction. Lower urinary tract dysfunction, as a manifestation of autonomic failure is one of core clinical features for a diagnosis of MSA, yet it is often underrecognized especially in the early stage of the disease Objective: The study aimed to describe lower urinary tract symptoms and residual urine volume in early MSA. Subjects and methods: This was a cross-sectional study including MSA patients with disease duration of less than 5 years. Demographic and clinical characteristics were collected. All participants were assessed with UMSARS, IPSS, OABSS scores, and abdominal ultrasound was performed to measure residual urine volume. Results: 32 MSA patients were recruited, all of whom reported lower urinary tract symptoms. Urge incontinence was the most common symptom (93.8%). Symptoms related to voiding were found in 85.7% of MSA-C patients and 88.9% of MSA-P patients. Postvoid residual urine volume &gt; 100 ml was recognized in 28% of patients. There is no statistically significant difference observed in the rate of PVR abnormalities between the MSA-C and MSA-P subgroups (p&gt; 0.05). Conclusion: Lower urinary tract symptoms and abnormal residual urine volume are frequently present even in the early stage of MSA with no significant differences between different clinical subtypes.

Can the parameters of penile duplex assessment predict the success of urethroplasty?

BackgroundThis work aimed to study the role of penile duplex in predicting the outcome of anastomotic urethroplasty.MethodsBetween March 2022 and February 2023, all patients presented with posterior urethral distraction defect (PUDD) underwent anastomotic end to end urethroplasty. Preoperative evaluation of sexual function was performed using international index of erectile function (IIEF-5) and penile doppler parameters (the response E1 to E5, peak systolic velocity (PSV), end diastolic velocity (EDV) and resistivity index (RI)). Each patient was, routinely, evaluated through 12 month-follow up using IIEF-5, penile doppler parameters, uroflowmetry for Qmax and pelvic ultrasound for postvoid residual urine (PVR). The procedure was considered successful if Qmax > 15 ml/s and PVR < 50 cc at the end of follow up. The correlation between the success rate of anastomotic urethroplasty and pre-operative penile Doppler parameters was the primary outcome.ResultsThirty patients with a mean age of 29.47 ± 9.79 years were evaluated. Twenty patients (66.7%) had previous orthopedic surgery. The stricture site was membranous in 6 patients (20.0%) and bubo-membranous in 24 (80.0%). The mean stricture length was 2.52 ± 0.98 cm. There was a statistically significant increase in mean end-diastolic velocity (P < 0.001) with a subsequent significant decrease in mean resistance index (P < 0.001). 14.3% of pre-operatively potent patients developed venous leakage (P < 0.001), while there was no change of arteriogenic or venogenic erectile dysfunction. In addition, of the patients who have arteriogenic erectile dysfunction, 37.5% did not require surgery, 25% had a urethrocystoscopy, and 37.5% required a repeat end to end urethroplasty. There is a significant association between pre-operative peak systolic velocity and the need for re-operation (P = 0.005).ConclusionPenile duplex may anticipate anastomotic urethroplasty efficacy in the case of PUDD.

Comparison of combination therapy with tamsulosin and dutasteride or finasteride in patients with benign prostatic hyperplasia: a randomized clinical trial

BackgroundBased on our observations at the largest outpatient urology clinic in Iran, patients for whom finasteride is prescribed as a secondary drug to tamsulosin tend to experience earlier and more severe sexual side effects without any difference in the amelioration of symptoms. This study aimed to compare the time lag, efficacy, and side effects of combination therapy with varying doses of dutasteride or finasteride added to tamsulosin for benign prostatic hyperplasia (BPH) treatment.MethodsIn this study 165 were randomized into 5 groups (each N = 33); receiving tamsulosin 0.4mg plus either of A: finasteride 3mg, B: placebo, C: dutasteride 0.25mg, D: finasteride 5mg or E: dutasteride 0.5mg. During the 6-month period of the study, International Prostate Symptom Score (IPSS), post-void residual urine (PVR), International Index of Erectile Function (IIEF-5), prostate volume (PV), prostate specific antigen (PSA) and maximum urinary flow rate (Qmax) were evaluated at baseline and at the 1st, 3rd and 6th month. The differences between each time point and baseline were then compared between groups.ResultsAt 3-month follow-up, group E exhibited a higher decrease in PSA but a greater increase in Qmax compared to group A (p = 0.047 and 0.006, respectively). Group C showed higher Qmax increase compared to group A at 3 and 6 months (p = 0.003 and 0.014) and concurrently a more pronounced PV decrease at 1 and 3 months (p = 0.047 and 0.003, respectively). Group D had a significantly more decrease in their IIEF-5 compared to group A at one-month visit (p = 0.006).ConclusionsIn summary, at the sixth-month follow-up, dutasteride demonstrated superiority over finasteride solely in enhancing Qmax. Therefore, dutasteride may be marginally more beneficial as a secondary component of combination therapy in BPH.Trial registration IRCT, IRCT20120516009772N2. Registered 18 January 2021 Retrospectively registered, https://irct.behdasht.gov.ir/search/result?query=IRCT20120516009772N2.

Urinary disorders in patients diagnosed with organic brain pathology

Introduction. This study is relevant due to the high prevalence of organic brain pathology and the negative influence of urination disorders on the quality of life.Objective. To analyse the impaired function of lower urinary tracts in patients with organic brain pathology.Materials &amp; methods. We analysed 607 patients with severe organic brain pathology (105 had traumatic spinal cord injury (TSCI) and 457 had consequences of acute stroke (AS)). We performed clinical urological examinations. During the survey, attention was paid to the presence of urinary tract pathology at the examining time and anamnesis. Structural changes in the urinary tract were objectively assessed. We objectively assessed structural changes in urinary tracts including prostate adenoma in men, insufficiency of pelvic floor muscles in women and strictures of the urethra or ureters. The degree of the spastic syndrome was assessed with the Ashworth Scale. The neurourological examination included cystometry with the measurement of bladder volume and post-void residual urine. The cognitive status of the patients was assessed with the MMSE (Mini-Mental State Examination) questionnaire. The correlation analysis between the degree of spastic syndrome measured with the Ashworth Scale and urination disorders was performed with Spearman rank correlation.Results. All patients had neurogenic dysfunction of the lower urinary tract. A combination of bladder retention and emptying disorders was found in 62 men older than 45yo with benign prostate hyperplasia (10,2% of all cases). An impaired accumulation function in history was found in 45 women older than 45yo (7,4% of all observations). The level of spasticity was 3 or 4 points on the Ashworth Scale in patients with TSCI and 2 to 4 points in those with AS. The analysis of correlations between the degree of spasticity and urination disorders showed a moderate relationship (r = 0,4) in patients with TSCI and a medium relationship (r = 0.65) in patients with AS.Conclusion. Neurogenic dysfunction of the lower urinary tract accompanies patients with severe organic brain pathology throughout their life and requires adequate correction.

Transurethral balloon dilation safety and efficacy in patients with recurrent bladder neck contracture after transurethral interventions

Introduction. Currently, urologists are divided on which method is most effective for treating bladder neck contracture (BNC) after surgery: transurethral resection (TUR) or incision.Objective. The study aimed to assess the balloon dilation safety and success in patients with recurrent bladder neck contracture (BNC) after endoscopic surgery for benign prostatic hyperplasia (BPH).Materials &amp; Methods. This study involved 110 patients with recurrent BNC after transurethral interventions for BPH. All patients underwent TUR of the bladder neck and were divided into 2 groups: group A (n = 45) included men who, after TUR, additionally underwent repeated balloon dilation, while the control group B (n = 65) included men who were treated with alpha-blockers alone.Results. In 9 months after TUR and 3 months after the fourth balloon dilation procedure in group A, the mean international prostate symptom score (IPSS) decreased from 20.1 ± 8.4 to 17.2 ± 7.4, and the IPSS-quality of life (QoL) was 4.2 ± 1.2 (p &gt; 0.05). In group B, they were 21.7 ± 7.7 and 4.7 ± 1.1 (p &gt; 0.05), respectively. Additionally, the mean flow rate in group A was 13.2 ± 5.4 ml/s, while in group B, it was 8.7 ± 4.9 ml/s (p &lt; 0.05). There was a significant decrease in the post-void residual urine volume (PVR) from 76.2 ± 96.1 ml to 37.6 ± 55.1 ml in group A, whereas, in group B, it increased from 63.0 ± 36.9 ml to 79.4 ± 71.6 ml (p &gt; 0.05). Also, 28.0% of patients of group B, and 13.3% of patients of group A underwent repeated TUR of the bladder neck in 9 months follow-up period (p &lt; 0.05).Conclusion. Balloon dilation procedure is a relatively safe less invasive procedure and can reduce the BNC recurrence rate and consequently the rate of repeated transurethral interventions.

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

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

HoLEP for BPH Patients With Large Pre-operative Postvoid Residual Urine: Caution and Care

HoLEP for BPH Patients With Large Pre-operative Postvoid Residual Urine: Caution and Care

Inheritance patterns of lower urinary tract symptoms in adults: a systematic review.

To compile and evaluate the heritability and inheritance patterns of lower urinary tract symptoms (LUTS) in adult cohorts. Searches of five databases (PubMed, Embase, APA PsycInfo, Global Health, and OVID Medline) commenced on 6 July 2024, resulting in 736 articles retrieved after deduplication. Studies evaluating heritability patterns, gene frequencies, and familial aggregation of symptoms were included for review. Screening and predefined eligibility criteria produced 34 studies for final review. A descriptive analysis of synthesised data was performed, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Cochrane Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool and the Johanna Briggs Institute checklist were used to evaluate these studies. Ten of the 34 studies (29%) described general LUTS, 14 (41%) described symptoms due to benign prostatic enlargement (BPE), nine (26%) described urinary incontinence (UI; urge UI [UUI], stress UI [SUI] and mixed UI [MUI]), four (12%) described nocturia alone, two (6%) described overactive bladder (OAB), and four (13%) described other specific symptoms (frequency, postvoid residual urine volume). BPE symptoms, UI (MUI and UUI), nocturia alone, and frequency alone were associated with genetic predisposition, whilst OAB and SUI had more modest inheritance. The pathogenetic and pharmacological mechanisms fundamental to LUTS manifestation are highly heterogeneous. Further work is required to evaluate the inheritance patterns of LUTS more extensively.

Do peri-operative changes in voiding function and pelvic organ mobility predict improvement in urgency urinary incontinence following prolapse surgery?

ObjectivesTo evaluate whether peri-operative changes in voiding function, pelvic organ descent and urethral mobility predict improvement in urgency urinary incontinence (UUI) following prolapse surgery. MethodsA retrospective study of women undergoing prolapse surgery without a history of or without a concomitant anti-incontinence surgery at a tertiary unit between 2005 and 2019. All patients underwent a pre- and post-operative standardised interview, POP-Q examination, uroflowmetry and 4D translabial ultrasound. Post processing of ultrasound volume data was performed to assess pelvic organ descent and functional urethral anatomy. ResultsThe datasets of 123 women were analysed. Mean follow-up was 5.5 months (SD 3.2). Mean age was 61 years (SD 11.7). UUI was reported by 68 before and 44 after operation (p = 0.001 for the reduction). Among those with pre-operative UUI, 34 reported cure of UUI, 20 improvement, 9 no change and 5 worsened UUI after their operation. De novo UUI was reported in 11. Fifty-seven women reported voiding dysfunction before and 32 after operation (p = 0.09 for the reduction). Abnormal uroflowmetry was noted in 63 women before and 37 after operation (p = 0.003 for change). On binary logistic regression, improved/cured UUI was associated with improved subjective voiding function (p = 0.003) and reduced residual urine volume (p = 0.02), but not with peri-operative changes in pelvic organ descent or functional urethral anatomy. ConclusionProlapse surgery resulted in short- to medium- term improvement in UUI. This was associated with subjective improvement in voiding function and with a reduction in post-void residual urine volume. SummaryProlapse surgery was associated with improvement in UUI which in turn was associated with subjectively improved voiding and reduced residual urine volume.

Intraoperative pelvic neuromonitoring based on bioimpedance signals: a new method analyzed on 30 patients

PurposeIncreasing importance has been attributed in recent years to the preservation of the pelvic autonomic nerves during rectal resection to achieve better functional results. In addition to improved surgical techniques, intraoperative neuromonitoring may be useful.MethodsThis single-arm prospective study included 30 patients who underwent rectal resection performed with intraoperative neuromonitoring by recording the change in the tissue impedance of the urinary bladder and rectum after stimulation of the pelvic autonomic nerves. The International Prostate Symptom Score, the post-void residual urine volume and the Low Anterior Resection Syndrome Score (LARS score) were assessed during the 12-month follow-up period.ResultsA stimulation-induced change in tissue impedance was observed in 28/30 patients (93.3%). In the presence of risk factors such as low anastomosis, neoadjuvant radiotherapy and a deviation stoma, an average increase of the LARS score by 9 points was observed 12 months after surgery (p = 0,04). The function of the urinary bladder remained unaffected in the first week (p = 0,7) as well as 12 months after the procedure (p = 0,93).ConclusionThe clinical feasibility of the new method for pelvic intraoperative neuromonitoring could be verified. The benefits of intraoperative pelvic neuromonitoring were particularly evident in difficult intraoperative situations with challenging visualization of the pelvic nerves.

Evaluation of learning curves for contact laser vaporization of the prostate using the 980 nm diode laser for benign prostatic hyperplasia.

We investigated the background of patients who underwent contact laser vaporization of the prostate (CVP) surgery and the learning curve of the operators. A total of 207 patients who underwent CVP surgery for benign prostatic hyperplasia between August 2018 and March 2023 were included in this study. Patient background, perioperative results, pre- and postoperative urinary flow tests, and complications were collected retrospectively. We enrolled 12 doctors who were divided into expert (five doctors) and novice (seven doctors) groups based on the number of TURP experiences before CVP. The median patient age was 73 years (51-92 years) and prostate volume was 56 cc (15-190 cc) with no difference between the expert and novice groups. Complications included urinary retention (eight cases), hematuria (four), urinary tract infection (four), intraoperative perforation (two), and postoperative stricture (one). Both cases of intraoperative perforation occurred in the novice group. The expert group had a significantly shorter operative time (38 vs. 66 min) and a higher operative efficacy of prostate volume divided by operative time (1.43 vs. 0.88 cc/min). Postoperatively, IPSS, quality of life scores, and postvoid residual urine volume decreased, and maximal flow rate increased; however, there was no significant difference between the groups. The expert group showed stable operative time and operative efficacy after about five to eight cases, while the novice group showed stable after about 15 cases. Our findings suggest that CVP was safely performed at our hospital, and operators with limited experience in TURP can achieve stable perioperative results.

Long-term results of multimodal treatment of the prostate using the Thulium Laser.

To evaluate a novel multimodal treatment (TLP) that integrates the use of a thulium laser, bipolar transurethral resection of the prostate (TURP), and "button-type" bipolar plasma vaporization for the endoscopic treatment of benign prostatic hyperplasia (BPH). From March 2018 to December 2021, we prospectively evaluated 220 patients with symptomatic BPH who underwent TLP. Patients were assessed based on the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), and postvoid residual urine (PVR). Perioperative and postoperative follow-up data were analyzed. The mean age at surgery was 66.74 years (SD 8.21). The median prostate size was 80 (IQR 70 - 110). The median operative time was 45 (IQR 35 - 55) minutes and the hospital stay was 2 (IQR 1 - 2) days. Patients were discharged with the urinary catheter in place, which was removed approximately 7 days after surgery when the histopathological result was discussed with the patient. Postoperatively, IPSS, QoL, Qmax and PVR showed a significant improvement starting at 3 months and continued through the postoperative follow-up visits (6-12-24-36-48-60 months). Urethral stricture and bladder neck contracture occurred in 1 (0.45%) and 2 (0.91%) patients, respectively. Recurrence of BPH occurred in 2 patients (0.91%) who underwent a second procedure. In conclusion, we report that the multimodal surgical treatment of BPH consisting of combining Thulium laser vaporization, bipolar TURP and plasma vaporization (TLP) represents an efficient and durable therapeutic method for BPH patients with low a complication rate at 5-year follow-up.

Evaluation of Tamsulosin 0.4 mg versus 0.8 mg in Management of Patients Suffering from Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia

Abstract Introduction Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are common among older men. Beside watchful waiting and surgery, medical therapy includes alpha adrenergic blockers, 5 alpha reductase inhibitors, and phytotherapy. Alpha blockers are considered to be the main treatment for BPH-associated LUTS depending on the evidence that prostatic smooth muscle contraction is responsible for bladder outlet obstruction via alpha adrenergic receptor- mediated mechanism. Tamsulosin is a super selective alpha blocker. Improvement of LUTS can be assessed by maximum flow rate (Qmax), average flow rate (Qavg), post void residual (PVR) urine volume and international prostate symptom score questionnaire (IPSS). Objectives To compare the efficacy and the safety of Tamsulosin 0.4 mg/day and 0.8 mg/day in patients suffering from lower urinary tract symptoms due to benign prostatic hyperplasia. Patients and Methods A Prospective Interventional, double-blinded, controlled study was carried out on 93 patients who met the criteria and divided randomly into 2 groups; group A for Tamsulosin 0.4 mg/day and group B for Tamsulosin 0.8 mg/day. International prostate symptom score, Post void residual urine volume, and maximum flow rate of urine were assessed before and after 4 weeks of treatment. Results Both study groups showed a significant reduction in storage sub-score but only frequency was significantly reduced in group B (P &amp;lt; 0.001). On the other hand, Tamsulosin 0.8 mg was superior to Tamsulosin 0.4 mg regarding voiding sub score except for straining (P = 0.325). Accordingly, the total international prostate symptom score was significantly improved in group B (P &amp;lt; 0.001). Furthermore, maximum flow rate and post-void residual urine volume were notably improved with Tamsulosin 0.8 mg compared to Tamsulosin 0.4 mg (P &amp;lt; 0.001). Although the adverse events; such as headache, orthostatic hypotension, and retrograde ejaculation were more frequent, but not significant, to occur with Tamsulosin 0.8 mg, only dizziness was noted to be significant. Conclusion Tamsulosin 0.8 mg has shown better outcomes in treating patients who suffer from lower urinary tract symptoms due to benign prostatic hyperplasia than Tamsulosin 0.4 mg, and besides that, it is well tolerated.