Postoperative Lower Urinary Tract Symptoms Research Articles

Association of urodynamics and lower urogenital tract nerve growth factor after synthetic vaginal mesh implantation on a rat model.

By investigating the association of urodynamics and urogenital nerve growth factor (NGF) levels in vaginal mesh surgery, we may be able to associate the likelihood of postoperative lower urinary tract symptoms developing as a result of synthetic mesh implanted for pelvic floor reconstructive surgery. Thirty-eight female Sprague-Dawley rats were divided into three groups: mesh, sham (no mesh), and control. Urodynamic study and NGF analysis of the urogenital tissues were done and results were compared among all groups. The urodynamic studies of the mesh and sham groups were further divided into the 4th and 10th days. A P-value<0.05 was considered statistically significant. All rats survived and no complications were observed during the post-implantation period. Histological evaluation showed intense acute inflammatory reaction on days 4 and 7 in the mesh and sham groups when compared to the control. The mesh group showed a larger area of inflammation as compared to the sham. The NGF levels increased significantly in the mesh and sham groups on the 4th and 10th days when compared to the control (P < 0.001, P < 0.001, respectively). Both the mesh and sham groups had shorter voiding interval and lower voiding volume on days 4 and 10 when compared to the control group (P<0.001, P<0.001, respectively). The magnitude on increasing NGF level and decreasing voiding interval and voiding volume was significantly more on the mesh group than the sham group. A higher level of NGF in the early days post-transvaginal mesh implantation is associated with a shorter voiding interval and a smaller bladder capacity, which represents abnormal lower urinary tract symptoms following transvaginal mesh implantation.

Improvement of severe baseline lower urinary tract symptoms following robotic-assisted laparoscopic prostatectomy.

This study was designed to assess lower urinary tract symptoms (LUTS) following robotic-assisted laparoscopic prostatectomy. In a single surgeon series, 938 patients underwent robotic prostatectomy and completed International Prostate Symptom Score surveys at baseline and 6-month follow-up. Patients preoperative LUTS were categorized as mild, moderate, or severe according to the original International Prostate Symptom Score validation. Patient demographics, in addition to clinical and pathologic outcomes were obtained from an Institutional Review Board-approved database. Preoperatively, 55.8% of patients presented with mild, 36.4% with moderate, and 7.8% with severe LUTS. Increased prostate size trended with increased LUTS severity (P < 0.001). Patients who had severe preoperative LUTS witnessed a 57% reduction in International Prostate Symptom Score (from 24.1 to 10.7, P < 0.001). Men with moderate preoperative LUTS also witnessed a significant decrease in postoperative LUTS (from 12.1 to 8.3, P < 0.001). The majority of patients with moderate or severe LUTS improved significantly following robotic prostatectomy, with the largest improvements seen in the severe group. Prostate cancer patients with severe LUTS should be counseled on the beneficial role of robotic prostatectomy in an effort to improve their voiding dysfunction and as a viable cancer treatment.

Patients With Prostatic Inflammation Undergoing Transurethral Prostatic Resection Have a Larger Early Improvement of Storage Symptoms

To evaluate the association between prostate inflammation, metabolic syndrome (MetS), and postoperative lower urinary tract symptoms in patients treated with transurethral resection of the prostate (TURP). From April 2011, a consecutive series of patients treated with TURP were prospectively included in this observational study. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria. Patients were evaluated at baseline and 1month postoperative with the International Prostate Symptom Score (IPSS), including the storage IPSS (sIPSS) and voiding IPSS (vIPSS) subscores, the Overactive Bladder questionnaire (OAB-q), and uroflowmetry. Prostate volume was evaluated at baseline. Complications were classified using the modified Clavien system. TURP specimens were examined to define grade, location, and extent of the inflammatory infiltrate according to the standardized classification system of chronic prostatitis and/or chronic pelvic pain syndrome. One hundred and thirty-one subjects were enrolled, in which 54 patients (41.3%) presented with MetS. No differences were observed in terms of preoperative prostate-specific antigen, OAB score, IPSS, vIPSS, sIPSS, Qmax, post void residual, and prostate volume in subjects with and without MetS. An incidence of postoperative complications of 10.6% was recorded: 79% were classified as Clavien type I or II; 21% Clavien IIIb. Of 131 subjects, 97 (74.1%) presented with an inflammatory infiltrate. Patients with MetS presented a high proportion of inflammatory infiltrates compared to patients without MetS (45 of 54; 83% vs 52 of 77; 67%, P= .01). Patients with prostate inflammation presented a 50% risk reduction of postoperative storage urinary symptoms. We confirmed the association between MetS and prostate inflammation.Patients with inflammatory infiltrates mostly benefit from TURP, particularly regarding storage symptoms.

Editorial Comment

This interesting work has the merit of bringing attention to some important aspects of prostatic pathology, which have not yet received the necessary attention. 1 De Nunzio C. Brassetti A. Gacci M. Patients with prostatic inflammation undergoing transurethral prostatic resection have a larger early improvement of storage symptoms. Urology. 2015; 86: 359-367 Abstract Full Text Full Text PDF Scopus (18) Google Scholar Patients With Prostatic Inflammation Undergoing Transurethral Prostatic Resection Have a Larger Early Improvement of Storage SymptomsUrologyVol. 86Issue 2PreviewTo evaluate the association between prostate inflammation, metabolic syndrome (MetS), and postoperative lower urinary tract symptoms in patients treated with transurethral resection of the prostate (TURP). Full-Text PDF ReplyUrologyVol. 86Issue 2PreviewEmerging evidence suggests that prostatic inflammation may play a role in benign prostatic hyperplasia (BPH) development and progression.1 Furthermore, the presence of prostatic inflammatory infiltrates may influence the expression and the severity of lower urinary tract symptoms (LUTS) and/or BPH at different stage. In particular, in naïve and/or untreated patients with BPH, metabolic syndrome (MetS), a well-established cause of systemic inflammation, is associated with an increased risk of storage symptoms2; in pharmacologically treated patients, those with low-grade inflammation presented a 3.5 higher LUTS improvement than high-grade group3; in patients undergoing transurethral resection of the prostate (TURP), we confirmed the association between MetS and prostate inflammation and demonstrated that patients with inflammatory infiltrates mostly benefit from TURP, particularly regarding storage symptoms. Full-Text PDF

Evaluation on clinical effectiveness of modified laparoscopic sacral colpopexy

To study clinical curative effect and complications of modified laparoscopic sacral colpopexy and evaluate the efficacy and safety of this procedure in treatment of pelvic organ prolapse (POP) . From Jan. 2008 to Sept. 2012, 66 patients who had undergone modified laparoscopic sacral colpopexy for POP in the first affiliated hospital of Guangzhou medical university were studied retrospectively. Primary outcomes were assessed with POP quantitation ( POP-Q) system that was measured before or after operation respectively to evaluate the objective cure rate and recurrence rate.Secondary outcomes were measured by the pelvic floor distress inventory short form (PFDI-20) to evaluate the subjective cure rate, as well as to evaluate the improvement of postoperative lower urinary tract symptoms. Sixty-three patients were followed up for 6 to 57 months, and the median follow-up time was 16 months, the overall objective cure rate was 95% (60/63). Postoperative each indicator point was reset anatomically according to POP-Q, the overall objective cure rate was 90% (57/63), and the total recurrence rate was 10% (6/63). The median postoperative vaginal length was slightly shortened than preoperative length[7.5 cm versus 8.0 cm, P < 0.01]; the median score of postoperative PFDI-20 was obviously improved compared to the preoperative (21 versus 75 scores, P < 0.05); there was no statistically significant difference in POP-Q staging and questionnaire score at more than 3 years, >2- ≤ 3 years, >1- ≤ 2 years, <0.5-1 year after operation (P > 0.05). Among 23 patients with stress urinary incontinence (SUI) and 5 patients with mixed urinary incontinence (MUI), 15 cases underwent transvaginal tension free vaginal tape-obturator (TVT-O) procedure simultaneously, 13 cases did not. The cure rate of SUI was 14/15 and 10/13, respectively. Modified laparoscopic sacral colpopexy can not only reach the anatomical replacement stage but significantly improve the postoperative quality of life with high subjective and objective cure rate and few complications. The long-term curative effect is stable.

Clinical outcome after laparoscopic assisted vaginal hysterectomy with transvaginal uterosacral ligament fixation

ObjectiveWe report here the clinical outcome of a simplified method to suspend the vaginal cuff during laparoscopic assisted vaginal hysterectomy. Materials and MethodsThis is a retrospective study. Fifty patients underwent laparoscopic assisted vaginal hysterectomy and received transvaginal uterosacral ligament fixation for vaginal cuff support (LAVHUS). Follow-up examinations were conducted for at least 24 months and included vaginal examination with prolapse grading using the POP-Q system. Subjective outcomes were measured using a questionnaire that asked patients to describe postoperative lower urinary tract symptoms and satisfaction with the procedure. ResultsThe mean follow-up duration was 106 weeks (range 102–120 weeks).The postoperative POP-Q point C and total vaginal length were effectively sustained during this period. There were no intraoperative or postoperative complications, and no adverse postoperative lower urinary tract symptoms were reported. ConclusionThe present study demonstrated satisfactory subjective and objective clinical outcomes following LAVHUS.

Management of the Failed Transurethral Resection of the Prostate

Transurethral resection of the prostate (TURP) is the gold standard for treatment of symptomatic benign prostatic enlargement. Failure of TURP and other similar procedures may occur when a patient has poor bladder emptying postoperatively or has persistent or de novo bothersome postoperative lower urinary tract symptoms. Reasons for failure include inadequate resection, clot retention, anesthesia-related side effects, postoperative pain, hypo- or acontractile bladder, and/or poor patient selection. Patients initially can be managed conservatively or proactively. When clinically significant storage or voiding dysfunction persists, evaluation is necessary and may include cystoscopy and/or urodynamics. Depending on the diagnosis and etiology, patients can then be managed with an array of therapies, including urethral catheterization, oral medications, intravesical botulinum A toxin, neuromodulation, or further surgery as indicated.

Correlation of introital ultrasound with LUTS after sling surgery

This study aims to assess the role of the introital ultrasound in the evaluation of patients with low urinary tract symptoms after sling surgery for incontinence. From 2000 till 2007, a total of 31 patients underwent sub-urethral tape placement for stress urinary incontinence and developed thereafter lower urinary tract symptoms. The urological evaluation consisted of a detailed medical history, a urogynecologic examination, a complete urodynamic exam, a measurement of the post-void residue, and an introital ultrasound. All patients filled up the MHU (Mesure du Handicap Urinaire) questionnaire. These patients had a transvaginal tape lysis under local anesthesia. We correlated the ultrasound findings with postoperative clinical success and failure. Thirty-one patients with low urinary tract symptoms (LUTS) secondary to sling placement underwent a tape lysis. Median age was 63.1 +/- 10.9 years, and the median time between the anti-incontinence surgery and the tape lysis was 21.5 +/- 16.2 months. Seven patients had only obstructive symptoms, 15 patients had obstructive and overactive bladder symptoms, and nine patients had overactive bladder symptoms. Introital ultrasound revealed an abnormality of the tape in 26 patients. Ten patients had a position abnormality, five patients had a urethral distortion by the tape, and 11 patients had the previous two abnormalities. After tape lysis, the obstructive symptoms disappeared in 19 out of 22 patients (86%), and the overactive bladder symptoms disappeared in 16 out of 24 patients (66%). In case of ultrasound anomaly, the tape lysis was efficient in 23 out of 26 patients (89%), while in the absence of ultrasound anomaly (five patients) the tape lysis was not useful in treating LUTS in all patients. Ultrasonography is a useful tool in investigating postoperative lower urinary tract symptoms and in the selection of patients who will benefit from tape lysis.

Supracervical Hysterectomy

ObjectiveThis guideline reviews the evidence relating to the potential benefits of the vaginal hysterectomy (VH) and supracervical hysterectomy (SCH) versus total abdominal hysterectomy (TAH) with respect to postoperative sexual function, urinary function, and peri- and postoperative complications. Laparoscopic options are not included in this guideline. OptionsWomen considering hysterectomy for benign disease can be given the option of retaining the cervix or proceeding with a total hysterectomy. OutcomesThe outcomes measured are postoperative sexual function and urinary function, and peri- and postoperative complications. EvidenceThe Cochrane Library, Medline, and Embase were searched for articles published in English from January 1950 to March 2008 specifically comparing VH and SCH with TAH in the prevention of sexual dysfunction, urinary dysfunction, and peri- and postoperative complications. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Additional publications were identified from the bibliographies of these articles. Randomized controlled trials were considered evidence of the highest quality, followed by cohort studies.Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. ValuesThe quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Recommendations1.Vaginal hysterectomy is generally considered the first choice of surgical approach for most benign indications for hysterectomy, as it is associated with lower rates of morbidity, fewer postoperative complications, and a faster recovery time than abdominal hysterectomy. (I-A)2.Women contemplating a vaginal, laparoscopic, or abdominal hysterectomy for the management of benign uterine disease should be reassured that hysterectomy is usually associated with improved quality of life, including improved sexual function, whether or not the cervix is removed. (I-B)3.Supracervical hysterectomy should not be recommended as a superior technique to total abdominal hysterectomy for the prevention of postoperative lower urinary tract symptoms. (I-B)4.Although supracervical hysterectomy may be associated with less blood loss and a shorter surgical time, these parameters have not been found to be clinically significant, and supracervical hysterectomy should not be recommended as a superior technique to total abdominal hysterectomy for the prevention of peri- and postoperative complications. (I-B)5.Women considering a supracervical hysterectomy should be counselled that they may continue experiencing cyclic vaginal bleeding following the surgery. (I-B)6.Women must be advised that they require routine cytological screening following a supracervical hysterectomy. (II-B)7.Women who require a hysterectomy and who have a current or significant history of abnormal cervical cytological results should be counselled on the advantages of vaginal hysterectomy or total abdominal hysterectomy over supracervical hysterectomy. (I-B)

Prospective Randomized Evaluation of Periureteral Botulinum Toxin Type A Injection for Ureteral Stent Pain Reduction

The use of ureteral stents for ureteral obstruction and after ureteroscopy can result in substantial deterioration in patient quality of life due to pain, frequency and urgency. We postulated that many stent related symptoms may be related to detrusor muscle spasm in and around the intramural ureter, and evaluated the effect of botulinum toxin type A (Botox) in patients with indwelling stents after ureteroscopy. A total of 51 patients between December 2007 and March 2009 were enrolled in an institutional review board approved, prospective, randomized, single-blind study comparing botulinum toxin type A injection at a concentration of 10 U/ml to 3 locations around the ureteral orifice (30) vs no injection after unilateral ureteral stent insertion (21). Pain and urinary symptoms after stent placement were evaluated through the Ureteral Stent Symptom Questionnaire, which was completed on postoperative day 7. In addition, patients were required to maintain a log of narcotic use after stent placement until removal. The Wilcoxon rank sum and Fisher exact tests were used for nonparametric and categorical data, respectively, with p <or=0.05 considered significant. No complications or adverse events occurred in this study. There was a significant decrease in the reported postoperative pain score between the botulinum toxin type A and control group at 3.4 vs 6.0 (p = 0.02). Postoperative narcotic use was also significantly less in the botulinum toxin type A group at 7.7 pills during an average of 2.7 days vs 24.7 in an average of 7.0 days in control patients (p = 0.03). With respect to postoperative lower urinary tract symptoms there was no significant difference between cohorts using the individual index scores within the Ureteral Stent Symptom Questionnaire. Stent related emergency room visits were reported by 1 patient treated in the botulinum toxin type A group vs 2 in the control group. Periureteral botulinum toxin type A injection improves ureteral stent tolerability by significantly decreasing postoperative pain and narcotic requirements. Improvement in irritative symptoms was not observed.

Lower Urinary Tract Symptoms in Older Adults Undergoing Hip Arthroplasty

We undertook a feasibility study to explore the prevalence of preoperative and postoperative lower urinary tract symptoms (LUTS) in older adults undergoing elective hip arthroplasty and to determine whether a larger prospective study was warranted. Subjects awaiting elective hip arthroplasty were recruited preoperatively from an orthopedic office and preadmission clinic at 1 university-affiliated hospital. LUTS and related quality of life were measured prehospitalization and 6 weeks postoperatively using the American Urological Association Symptom Index and quality-of-life score. Postvoid residual urine and the 24-hour pad test were used to assess bladder emptying and continence status. Sixteen participants (9 males, 7 females, mean age 74 years) completed the study. Preoperatively, 15 participants reported at least 1 symptom and none had discussed these with a healthcare professional. The most common LUTS were nocturia, frequency, and urgency. Postoperatively, all reported symptoms, with 8 (53%) experiencing increased symptoms with a negative impact on quality of life for 3. Recruitment was a major barrier in conducting the study and would need to be taken into account in further studies of the topic. Despite recruitment issues, we suggest larger studies of LUTS in older adults undergoing surgery are warranted to further understand potential problems and risks in transition from hospital to home. Future studies should include identification of potential reasons for increased LUTS, including urinary tract infection.

Concluding Remarks: Optimal Treatment for Women With Ovarian Cancer

This guideline reviews the evidence relating to the potential benefits of the vaginal hysterectomy (VH) and supracervical hysterectomy (SCH) versus total abdominal hysterectomy (TAH) with respect to postoperative sexual function, urinary function, and peri- and postoperative complications. Laparoscopic options are not included in this guideline.Women considering hysterectomy for benign disease can be given the option of retaining the cervix or proceeding with a total hysterectomy.The outcomes measured are postoperative sexual function and urinary function, and peri- and postoperative complications.The Cochrane Library, Medline, and Embase were searched for articles published in English from January 1950 to March 2008 specifically comparing VH and SCH with TAH in the prevention of sexual dysfunction, urinary dysfunction, and peri- and postoperative complications. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Additional publications were identified from the bibliographies of these articles. Randomized controlled trials were considered evidence of the highest quality, followed by cohort studies.Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table).1.Vaginal hysterectomy is generally considered the first choice of surgical approach for most benign indications for hysterectomy, as it is associated with lower rates of morbidity, fewer postoperative complications, and a faster recovery time than abdominal hysterectomy. (I-A)2.Women contemplating a vaginal, laparoscopic, or abdominal hysterectomy for the management of benign uterine disease should be reassured that hysterectomy is usually associated with improved quality of life, including improved sexual function, whether or not the cervix is removed. (I-B)3.Supracervical hysterectomy should not be recommended as a superior technique to total abdominal hysterectomy for the prevention of postoperative lower urinary tract symptoms. (I-B)4.Although supracervical hysterectomy may be associated with less blood loss and a shorter surgical time, these parameters have not been found to be clinically significant, and supracervical hysterectomy should not be recommended as a superior technique to total abdominal hysterectomy for the prevention of peri- and postoperative complications. (I-B)5.Women considering a supracervical hysterectomy should be counselled that they may continue experiencing cyclic vaginal bleeding following the surgery. (I-B)6.Women must be advised that they require routine cytological screening following a supracervical hysterectomy. (II-B)7.Women who require a hysterectomy and who have a current or significant history of abnormal cervical cytological results should be counselled on the advantages of vaginal hysterectomy or total abdominal hysterectomy over supracervical hysterectomy. (I-B)

MP-14.01: Brachytherapy for prostate cancer: is pre-treatment prostate volume important?

Brachytherapy for prostate cancer is associated with temporary urethritis and lower urinary tract symptoms. There is concern that patients with large prostates may develop more troublesome symptoms. The aim of this study was to assess the influence of prostate volume upon post-operative lower urinary tract symptoms.