Postvoid Residual Urine Volume Research Articles

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.

A meta-analysis comparing treatment of benign prostatic hyperplasia with holmium laser enucleation and photoselective greenlight vaporization

Abstract Background We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization (PVP) versus holmium laser enucleation of the prostate (HoLEP). Methods Databases (PubMed, Embase, Cochrane Library, Chinese CBM, and CNKI) were searched for eligible studies evaluating HoLEP or PVP outcomes, published until May 2022. We analyzed the incidence of relative complications and postoperative outcomes, including the international prostate symptom score, maximum flow rate (Qmax), postvoid residual urine volume, quality of life index, and prostate-specific antigen levels. Results Eleven studies involving 4763 patients were included in this meta-analysis. The significant differences in postoperative Qmax at 1 month (mean difference [MD], 3.31, 95% confidence interval [CI], 0.45–6.16, p = 0.02, I 2 = 92%), 3 months (MD, 2.78, 95% CI, 0.53 to 5.02, p = 0.02, I 2 = 89%), 6 months (MD, 2.13, 95% CI, 1.11 to 3.15, p < 0.0001, I 2 = 87%), and 12 months (MD, 3.98, 95% CI, 2.06 to 5.89, p < 0.0001, I 2 = 58%) further confirmed unique advantage of HoLEP over PVP. We used forest plots to determine significant differences in the severe complication rates among patients in the PVP and HoLEP groups (odds ratio, 0.05, 95% CI, 0.01 to 0.28, p = 0.0005). Conclusions Holmium laser enucleation of the prostate and PVP showed comparable international prostate symptom scores, quality of life index, postvoid residual urine volumes, prostate-specific antigen levels, perioperative factors, and total complication rates. Compared with PVP, HoLEP had a greater Qmax 1 year postoperatively, decreased energy expenditure, and fewer high-grade complications. These results need to be verified in long-term follow-up studies with well-structured randomized controlled trials.

Does ejaculation have an effect on urinary flow rates?

The primary objective of this investigation is to explore the impact of ejaculation on urinary flow rates in men experiencing lower urinary tract symptoms. This study involved the enrollment of 55 male patients who presented with lower urinary tract symptoms. An assessment encompassed components, including medical history, questionnaires related to sexual activity and lower urinary tract symptoms, bladder diary, physical examination, urinalysis, urine culture, ultrasound examination and measurements of serum prostate-specific antigen, free flow uroflowmetry, and post-void residual urine volume. All participants were instructed to abstain from ejaculation for 3 days before undergoing uroflowmetry (UF1). Subsequently, they were required to ejaculate. Subsequent uroflowmetry assessments were conducted at 2 to 4 h (UF2) and 48 to 50 h (UF3) after ejaculation. No further ejaculations were permitted during this timeframe. The patients had a mean age of 50.97 ± 1.47 years. Statistically significant differences were observed in the mean values of Qmax and corrected Qmax (cQmax) between UF1 and UF2 measurements (p < 0.05). These differences were only in patients with benign prostatic enlargement (BPE) (p < 0.05). Furthermore, the number of patients with Qmax <15 mL/s showed a statistically significant difference between UF1 and UF2 measurements, specifically in the BPE group (p = 0.016). In this study, we have observed a significant and temporary increase in the Qmax following ejaculation, particularly among patients with BPE. This indicates that ejaculation can potentially complicate the interpretation of uroflowmetry results. Therefore, further research is necessary to gain a more comprehensive understanding of this phenomenon.

Post-Voided Residual Ratio Does Not Predict Trifecta Outcome after Transurethral Resection of Prostate.

The purpose of this study was to assess the importance of the post-void residual (PVR) ratio (PVR ratio) in achieving a favorable trifecta outcome for patients suffering from lower urinary tract symptoms and benign prostatic enlargement (LUTS-BPE) who undergo transurethral resection of the prostate (TURP). Starting from 2015, a series of patients with LUTS-BPE who underwent TURP were included in a forward-looking study. These patients were assessed using the international prostate symptom score (IPSS) screening tool, uroflowmetry, and a transrectal ultrasound to measure prostate volume (TRUS). Both the PVR urine volume and the PVR ratio (PVR-R), which is the PVR as a percentage of total bladder volume (voided volume + PVR), were measured. The assessment of outcomes was based on the trifecta favorable outcome, defined as meeting all of the following criteria: (1) absence of perioperative complications, (2) a postoperative IPSS of less than eight, and (3) a postoperative maximum urinary flow rate (Qmax) greater than 15 mL/s. A total of 143 patients were included, with a median age of 70 years (interquartile range 65-73). Of these, 58% (83/143) achieved a positive trifecta outcome. Upon conducting a multivariate analysis, both IPSS and Qmax were identified as predictors of a positive trifecta outcome, whereas the PVR-R did not prove to be an independent predictor. In summary, it was found that preoperative IPSS and Qmax are indicative of a trifecta outcome following TURP, whereas PVR-R is not.

Effect of detrusor underactivity on surgical outcomes of holmium laser enucleation of the prostate.

To evaluate the effect of detrusor underactivity (DUA) on the postoperative outcomes of holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH). Patients with BPH who underwent HoLEP between January 2018 and December 2022 were enrolled in this prospective database study. Patients were divided into DUA (bladder contractility index [BCI] <100) and non-DUA (BCI ≥100) groups. Objective (maximum urinary flow rate [Qmax], post-void residual urine volume [PVR]) and subjective outcomes (International Prostate Symptom Score [IPSS], Overactive Bladder Symptom Score [OABSS], satisfaction with treatment question [STQ], overall response assessment [ORA], and willingness to undergo surgery question [WUSQ]) were compared between the two groups before surgery, and at 3 and 6 months after HoLEP. A total of 689 patients, with a mean (standard deviation [SD]) age of 69.8 (7.1) years, were enrolled. The mean (SD) BCI in the non-DUA (325 [47.2%]) and DUA (364 [52.8%]) groups was 123.4 (21.4) and 78.6 (14.2), respectively. Both objective (Qmax and PVR) and subjective (IPSS, IPSS-quality of life, and OABSS) outcomes after surgery significantly improved in both groups. The Qmax was lower in the DUA than in the non-DUA group postoperatively. At 6 months postoperatively, the total IPSS was higher in the DUA than in the non-DUA group. There were no significant differences in surgical complications between the two groups. Responses to the STQ, ORA, and WUSQ at 6 months postoperatively demonstrated that the patients were satisfied with the surgery (90.5% in the DUA group; 95.2% in the non-DUA group), their symptoms improved with surgery (95.9% in the DUA group; 100.0% in the non-DUA group), and they were willing to undergo surgery again (95.9% in the DUA group; 97.9% in the non-DUA group). There were no significant differences in the responses to the STQ and WUSQ between the two groups. Our midterm results demonstrated that patients with BPH and DUA showed minimal differences in clinical outcomes after HoLEP compared to those without DUA. The overall satisfaction was high in the DUA group.

Prostatic Artery Embolization in Patients with Advanced Prostate Cancer: A Prospective Single Center Pilot Study.

To assess efficacy and safety of prostatic artery embolization (PAE) in patients with advanced prostate cancer (PCa). In this prospective single-center, single-arm, pilot study, 9 men with advanced PCa underwent PAE. PAE was performed with the use of 250-400µm Embozene microspheres (Boston Scientific, Natick, Massachusetts, USA). International Prostate Symptoms Score (IPSS), urinary peak flow (Qmax) and post-void residual urine volume (PVR) was assessed at 12 weeks and up to 12 months. Changes in total prostate volume (TPV) and tumor responses by PSA, changes in tumor volume and evaluation of tumor regression by multiparametric magnetic resonance imaging were assessed at 12 weeks after PAE. IPSS reduction in median 6 points (0-19) and a significant decrease in PVR from median 70 (20-600)mL to 10 (0-280)mL could be achieved within 12 weeks after PAE. Median TPV and tumor volumes (TV) increased slightly from 19.7 (6.4-110.8)mL to 23.4 (2.4-66.3)mL and 6.4 (4.6-18.3)mL to 8.1 (2.4-25.6)mL at a median of 12 weeks after the procedure. Significant tumor necrosis (≥ 50%) was found in one patient. Eight patients showed > 50% of viable tumor on post-PAE MRI according to MRI. Only one Clavien-Dindo Grade 1 adverse event related to PAE occurred. PAE with the use of 250-400 µm microspheres is feasible, safe and effective in some patients with advanced PCa regarding functional outcomes. A cytoreductive effect might be achieved in individual patients but must be further assessed. NCT03457805.

Balloon dilation for the treatment of male urethral strictures: a systematic review and meta-analysis

ObjectiveThe use of minimally invasive endoluminal treatment for urethral strictures has been a subject for debate for several decades. The aim of this study was to review and discuss the...

Evaluation of Tamsulosin 0.4 mg versus 0.8 mg in management of lower urinary tract symptoms due to benign prostatic enlargement

PurposeTo 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 obstruction.Patients and MethodsA prospective interventional, double-blinded, controlled study was carried out on 93 patients who met the criteria and divided randomly into two 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.ResultsBoth study groups showed a significant reduction in storage sub-score but only frequency was significantly reduced in group B (P < 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 versus group A (P < 0.001). Furthermore, maximum flow rate and post-void residual urine volume were notably improved in Group B as compared to Group A (P < 0.001). Of all adverse events only dizziness was noted to be statistically significant in Group B versus Group A (P < 0.001).ConclusionTamsulosin 0.8 mg has shown better outcomes in treating patients who suffer from lower urinary tract symptoms due to benign prostatic enlargement than Tamsulosin 0.4 mg, and besides that, it is well tolerated.Trial registration numberM S 292/2020, SID: 373, date: 22/4/2020.

Intravesical Injection of OnabotulinumtoxinA (Botulinum Toxin Type A) in Japanese Patients With Refractory Overactive Bladder.

Botulinum toxin intravesical injection therapy (hereafter, botulinum therapy) is approved in Japan for treating urinary urgency, frequency, and urinary incontinence due to refractory overactive bladder or neurogenic bladder. Although botulinum therapy is classified as urinary incontinence surgery, it is minimally invasive, effective, and safe. However, there are few reports on the actual use of botulinum therapy and examination of its effects and side-effects. Herein, we report real-world data on botulinum therapy. Patients who received botulinum therapy for refractory overactive bladder at the Nara Medical University and affiliated facilities from May 2020 to May 2022 were enrolled. The patient background, treatment efficacy, and safety were retrospectively reviewed. Twenty-three cases of refractory overactive bladder (age: 68.4±14.1 years; 7 males, 16 females; 17 outpatient, 6 hospitalized) were enrolled. Pretreatment, the overactive bladder symptom score (OABSS) was 10.1±2.7, and post-void residual urine volume was 27.1±31.6 ml. Botulinum was administered once, twice, thrice, and four times in 11, eight, three, and one cases, respectively. OABSS decreased to 6.1±3.2 2 weeks after botulinum therapy (p<0.0001), and the effect persisted at 6.6±3.2 after 12 weeks (p<0.0001). Post-void residual urine volume increased to 74.6±79.2 ml after 2 weeks (p=0.0010), but subsequently improved to 33.9±42.0 ml after 12 weeks (p=0.0002). Adverse events included post-void residual urine volume of 200 ml or more in three patients (7.5%) and urinary retention grade 2 in two (5.0%). Botulinum therapy is effective and relatively safe for refractory overactive bladders.

Comparison of the results of bipolar transurethral enucleation and resection of the prostate with and without morcellation in treatment of benign prostatic hyperplasia

Objective: To compare the result of bipolar transurethral enucleation and resection of the prostate with morcellation (B-TUERP-M) and without morcellation (B-TUERP) in treatment of benign prostatic hyperplasia. Materials and Methods: This was a prospective single centre cohort study of 101 patients with prostate enlargement of more than 60 ml who underwent B-TUERP by a single surgeon between January 2020 and June 2022. Patients were divided into two groups, a B-TUERP group of 49 patients and a second group of 52 patients classed as B-TUERP-M. The perioperative outcomes followed up at 1, 3 and 6 months after surgery were evaluated. Results: There were no significant differences in the preoperative parameters of the two groups. Comparisons between the two groups showed a shorter operative time (63.94 ± 12.01 vs 77.77 ± 11.80 min, p-value 0.000), more resected prostate tissue (65.73 ± 14.67 vs 60.73 ± 5.45 gm, p-value 0.027) and a higher post-operative hematocrit level (35.16 ± 3.97 vs 33.18 ± 3.22%, p-value 0.007) in the patients who underwent B-TUERP with morcellation. At 6 months after the procedure, better results were found in patients who had undergone B-TUERP-M regarding urine flow rate (26.33 ± 5.33 vs 20.66 ± 5.08 ml/sec, p-value 0.000), post-void residual urine volume (24.19 ± 10.93 vs 36.04 ± 16.90 ml, p-value 0.000), post-operative PSA (0.72 ± 0.43 vs 1.22 ± 0.54 mg/ml, p-value 0.000) and International Prostate Symptom Scores (5.01 ± 1.36 vs 5.71 ± 1.33, p-value 0.001). Conclusion: Better outcomes occurred following B-TUERP with morcellation with regard to operative time, resection weight of prostatic adenoma, post-operative urine flow rate, Post-void residual urine volume, PSA and International Prostate Symptom Score than in patients treated with B-TUERP without morcellation.

Clinical outcomes of Holmium Laser Enucleation of the Prostate (HoLEP) in benign prostatic hyperplasia patients in Rajavithi Hospital

Objective: To evaluate the outcomes and safety of the surgical technique holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) for whom surgeryis indicated. Materials and Methods: The demographic characteristics, duration of surgery, blood transfusion rate, weight of tissue removed, catheterization time and complica- tions were recorded in 25 patients who underwent HoLEP surgery between January 2021 and May 2022 in Rajavithi Hospital. The International Prostate Symptom Score (IPSS), quality of life score (QoL), peak flow rate (Q-max), post-void residual urine volume (PVR), hematocrit (Hct) and prostate-specific antigen (PSA) levels were comparedbefore and after surgery. Results: The mean age of the patients was 71.28±7.54 years. There were statistically significant differences between mean preoperative and postoperative Hct (%) (40.5± 5.9 and 38.4±5.1), p = 0.001. Only 1 in 25 patients had 1 unit of blood transfusion. One month postoperatively the mean PSA had decreased from 4.55 to 1.2 ng/ml (p &lt; 0.001); mean IPSS had improved from 21.0 to 7.0 (p &lt; 0.001); mean QoL score had improved from 4.47 to 1.10 (p &lt; 0.001); mean PVR had decreased from 98.0 to 39.7 ml (p = 0.002) and the mean Q-max had increased from 8.0 to 17.8 ml/sec (p = 0.015). The mean catheterization time was 2.40±0.57 days. There were no serious complications or incidence of TUR syndrome in this study. Conclusion: HoLEP is a safe alternative to the current gold standard transurethral resection of the prostate for BPH patients as there are fewer complications with similar functional outcomes

Diode laser surgery for benign prostate hyperplasia: a comparative analysis of the efficacy and safety of two techniques

Introduction. The urgency of the issues evaluating the effectiveness of various laser surgery techniques in patients with benign prostatic hyperplasia (BPH) is determined by the presence of a significant number of various complications.Objective. To conduct a comparative analysis of the efficacy and safety of two methods of diode laser surgery for benign prostate hyperplasia.Materials &amp; methods. Retrospective study by monitoring and analysing histories included 52 patients with BPH to compare the efficacy and safety of two techniques of diode laser surgery of BPH. The surgical intervention (prostate enucleation — DiLep or vaporization — DiVap) was performed using diode laser with power of 150 W and wavelength of 980 nm ("MILON" Ent., St. Petersburg, Russian Federation). The efficacy of laser technologies was evaluated according to the following criteria: surgery time (min), prostate volume (cx), post-void residual urine volume (ml), severity of LUTS and quality of life related to urination according to the IPSS-QoL scale (points).Results. The DiLep time for prostate volume 71.3 ± 20.2 cc was 62 - 95 min (71.3 ± 12.6 min), whereas for prostate volume 70.4 ± 21.3 cc the DiVap duration was 50 – 67 min (59.8 ± 8.6 min) with a significant difference between the groups (p = 0.0001). The mean length of hospital stay for patients in the DiLep group was 3.4 ± 1.2 bed-days, whereas in the DiVap patient group it was significantly shorter and averaged 2.2 ± 1.1 bed-days (p = 0.008).Conclusion. Diode laser vaporization (DiVap) requires significantly less surgery time and length of hospital stay than hyperplasia enucleation (DiLep).

Modified laparoscopic simple prostatectomy combined with temporary internal iliac arteries clamping and urethrocystoanastomosis for large-volume benign prostatic hyperplasia: evaluation of efficacy and safety

Introduction. Laparoscopic simple prostatectomy is the method of choice for surgical treatment of large-volume benign prostatic hyperplasia (BPH). However, the existing limitations of standard approaches are the reason for the development of new modifications.Objective. To evaluate the efficacy and safety of a modified laparoscopic simple prostatectomy (LSP), supplemented by temporary internal iliac arteries (IIA) clamping and vesicourethral anastomosis (VUA).Materials &amp; methods. This multicenter open study included 195 patients (mean age 68.1 ± 6.4 years) who underwent LSP combined with temporary IIA clamping and VUA. The primary efficacy criterias during one follow-up year were the severity of urinary symptoms (IPSS), quality of life, maximum flow rate and post-void residual volume. All complications that developed during the 12-month postoperative follow-up period were registered. Statistical calculations were performed using IBM SPSS 23.2 software.Results. The average surgery time was 91.5 ± 23.2 minutes. Complications of Clavien-Dindo I, II, III grades were noted in 1.0%, 1.0% and 3.6% of patients, respectively; no complications of group IV developed. The mean bed-days were 5.2 ± 1.5 days, the decrease in hemoglobin was 0.6 ± 1.1 g/dL. No patient needed to use an irrigation system. Based on the results of 12 months postoperative follow-up, positive dynamics was established for average IPSS score (p = 0.003), QoL (p = 0.035), maximum urine flow rate (p = 0.012), residual urine volume (p = 0.004). The maximum urine flow rate one year after surgery reached 24.6 ± 2.8 ml/s, the post-void residual urine volume was 15.1 ± 11.9 ml, the average IPSS score was 9.1 ± 1.5, and the QoL score – 1.0 ± 0.7. During the 12-month follow-up period, a low amount of long-term complications was noted in 4 (2.1%) cases: 3 (1.6%) patients had stress urinary incontinence, 1 (0.5%) patient had bladder neck contracture.Conclusion. Modified LSP combined with temporary IIA clamping and VUA is associated with favorable efficacy and safety profile of the intervention in patients with large-volume BPH.

Efficacy of GreenLight laser prostatectomy in urinary retention.

The objective of our study was to evaluate the efficacy and durability of GreenLight laser prostatectomy for the management of acute urinary retention (AUR) and chronic urinary retention (CUR) and to determine outcomes compared to patients without preoperative urinary retention (UR). We conducted a retrospective study of prospectively collected data from individuals who underwent GreenLight laser prostatectomy at our institution from May 2018 to July 2022. Patient demographics and outcome measures were recorded, including indications for the procedure, median urinary volume drained, or median postvoid residual urine volume (PVR) before catheterization or GreenLight laser prostatectomy. CUR was defined as PVR >300 mL in males able to void and initial catheter drainage >1000 mL in males unable to void in the absence of pain. All patients had postoperative followup visits at one, three, six, and 12 months. Our evaluation included the International Prostate Symptom Score (IPSS), quality-of-life (QoL) assessment, maximum urinary flow rate (Qmax), PVR, and catheter-free status. One hundred sixty-eight males who underwent GreenLight laser prostatectomy were included in our study. The UR group consisted of 88 patients (50 AUR and 38 CUR), and the lower urinary tract symptoms (LUTS) group was comprised of 80 individuals. There were no statistically significant differences between the AUR and CUR subgroups regarding demographics. The UR group had a significantly higher age and a significantly higher postoperative catheterization time compared to the LUTS cohort. The CUR subgroup had a significantly higher PVR at one, three, and six months compared to the AUR subgroup, although other outcome measures were similar between the two cohorts. During three- and six-month followup visits, the UR group had a significantly higher PVR than the LUTS cohort. At 12 months postoperative, the LUTS group had a higher catheter-free rate than the UR group (p=0.001). The successful first trial of void (TOV) rate for the UR and LUTS groups were 83% and 80%, respectively. At 12-month followup, the catheter-free rate for the UR and LUTS cohorts was 87.5% and 100%, respectively. GreenLight laser prostatectomy is an effective and durable treatment for UR, with a high catheter-free rate and comparable outcomes when performed to manage LUTS.

Transcutaneous electrical acupoint stimulation for prevention of postoperative urinary retention: A systematic review

IntroductionTranscutaneous electrical acupoint stimulation (TEAS) has been proposed for postoperative urinary retention (POUR). This meta-analysis evaluated the effect of TEAS in preventing POUR. MethodsDatabases were searched until February 6, 2023. Randomized controlled trials (RCTs) about TEAS for preventing POUR were included. The primary concern was the incidence of POUR, with post-void residual urine volume as a secondary outcome. ResultsFourteen studies with 2865 participants were identified. TEAS reduced the incidence of POUR (RR = 0.44, 95%CI = 0.33 to 0.58, P < 0.00001) and decreased the post-void residual urine volume (MD = −75.41 mL, 95%CI = −118.76 to −32.06, P = 0.0007). The preventive effect on POUR was found in patients receiving anorectal, gynecologic, orthopedic and biliary surgery, but not urinary surgery. Dilatational- and continuous-wave TEAS had a great outcome in preventing POUR. Intraoperative TEAS, preoperative and intraoperative TEAS, and postoperative TEAS were beneficial, and TEAS was more beneficial when compared with sham TEAS and blank control. It is nevertheless difficult to rule out publication bias. ConclusionsTEAS could prevent POUR. Due to insufficient evidence, multicenter, large-sample and high-quality RCTs should be conducted. (Registration:INPLASY202320095).

Minimally invasive connective water vapor energy method for benign prostatic hyperplasia

The Rezūm system has emerged as a promising treatment option for benign prostatic hyperplasia (BPH) by employing endoscopic removal of prostate tissue. This meta-analysis aimed to evaluate the benefits and drawbacks of Rezūm therapy in recent studies. A systematic literature search was conducted in EMBASE, PubMed, and the Cochrane Library databases until December 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search utilized keywords such as water vapor thermal therapy, Rezūm, convective water vapor thermal therapy, and convective radiofrequency water vapor thermal therapy. A total of 21 studies were included in the analysis, comprising 5 prospective randomized studies, 2 case series, 2 randomized controlled trials, 1 crossover study, and 11 retrospective studies. The collective sample involved 2090 patients with a mean follow-up period of 14.42 ± 18.08 (1–72) months and a mean age of 68.12 ± 4.79 years. Significant improvements were reported in the International Prostate Symptom Score (IPSS), quality of life (QoL), maximal flow rate (Qmax), postvoid residual urine volume (PVR), prostate volume (PV), and International Erectile Index Function (IIEF) values. Unlike other BPH treatments that often require general or regional anesthesia, the connective water vapor energy system can be administered with sedo-analgesia and local anesthesia, potentially leading to improved sexual function scores. Considering the relief of symptoms, Rezūm therapy may serve as a viable alternative to transurethral surgery for patients with prostate volumes ranging from &lt;30 to &gt;80 cc.

Prevalence and Distribution of Postvoid Residual Urine Volume in a Hospital-Based Sample of Men with Symptomatic Benign Prostatic Hyperplasia.

Benign prostatic hyperplasia (BPH) is a known cause of bladder outlet obstruction (BOO) in aging men. Patients present with lower urinary tract symptoms (LUTS), elevated postvoid residual urine (PVR), and reduced peak flow rate of urine. Although urodynamic study is the gold standard for diagnosing and quantifying BOO, it is invasive and as such urologists in their routine practice frequently rely on less invasive methods like PVR estimation to objectively assess BOO. To study the prevalence and distribution of PVR in a hospital-based population of men with symptomatic BPH. Patients aged 40 years and above were enrolled for the study. History was taken from each of the 170 participants recruited, and physical examination was done including digital rectal examination. Every one of them completed the International Prostate Symptom Score (IPSS) questionnaire and also had ultrasonography assessment of PVR. Relevant laboratory investigations (PSA, renal function test, full blood count, urinalysis, and urine culture) and uroflowmetry to determine the peak flow rate of urine (Qmax) were done. A total of 170 subjects who met the inclusion criteria were enrolled for this study. The mean age of the subjects was 63.70 ± 9.92 years with a range of 42-88 years. The subjects had a mean PSA of 2.68 ± 0.91 ng/ml and a mean prostate volume of 70.8 ± 39.5 ml. The prevalence of significant PVR was 57.06%. The distribution of PVR was skewed with values ranging from 4.0 ml to 382.9 ml, a median value of 60.5 ml (interquartile range, IQR, =25.0-100.76), and a mean value of 77.70 ± 69.30 ml. An IPSS range of 8 to 23 with a mean value of 13.64 ± 4.14 and a median value of 13 (interquartile range = 10.0-16.0) was observed. The Qmax range was from 5 ml/s to 50 ml/s with a mean value of 20.25 ± 9.70 ml/s, and a median value of 18.0 ml/s (interquartile range = 14.0-24.0). This study showed that the prevalence of significant PVR volume among men with symptomatic BPH in our environment is high. There was also a high variation in the distribution of PVR among the subjects. Therefore, it is essential to create more public awareness especially among men in their fourth decade of life and above to visit a urologist whenever they have BPH symptoms so as to avoid impairment in quality of life and renal function associated with neglected significant PVR.

Can we define the optimal postvoid residual volume at which intermittent catheterization should be recommended, and are there other measures that could guide an intermittent catheterization protocol: ICI-RS 2023.

The postvoid residual (PVR) volume of urine in the bladder is widely used in clinical practice as a guide to initiate treatment, including clean-intermittent self-catheterization (CISC). It is often believed that an elevated PVR causes complications such as recurrent urinary tract infections (UTI) and renal failure. However, evidence for this is limited and identifying alternative measures to guide treatment decisions may optimize patient care. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2023 a Think Tank addressed the question of whether we can define the optimal PVR at which CISC should be recommended, and whether there are other measures that could guide a CISC protocol. The Think Tank conducted a literature review and expert consensus meeting focusing on current limitations in defining and measuring PVR, and highlighting other measures that may optimize selection for, and persistence with, CISC. There is no consensus on the threshold value of PVR that is considered "elevated"or "significant." There is a lack of standardization on terminology, and the normal range of PVR in different populations of different ages remains to be well-studied. The measurement of PVR is influenced by several factors, including intraindividual variation, timing and method of measurement. Furthermore, the evidence linking an elevated PVR with complications such as UTI and renal failure is mixed. Other measures, such as bladder voiding efficiency or urodynamic parameters, may be better at predicting such complications, and therefore may be more relevant at guiding a CISC protocol. There is a lack of high quality evidence to support PVR as a predictor for complications of UTI or renal failure. Threshold values for normal PVR in different populations are unknow, and so threshold values for "elevated"or "significant"PVR cannot be determined. Other factors, such as urodynamic findings, may be better at predicting complications and therefore guiding management decisions, and this remains to be studied. Areas for further research are proposed.

Comparison of Early Versus Late Urethral Catheter Removal After Transurethral Resection of the Prostate in Patients with Benign Prostate Hyperplasia

Objective: Transurethral resection of the prostate (TURP) is considered the standard in the surgical therapy of lower urinary tract symptoms related to benign prostate hyperplasia (BPH). However, there is no consensus on the timing of catheter removal. In this study, we aimed to compare the long-term effects of early and delayed removal of urethral catheters who underwent TURP. &#x0D; Methods: We prospectively analyzed a total of 91 patients who underwent TURP. Patients were randomized into two groups; the early (postop 1st-2nd days) and delayed (7th day) removal of the urethral catheter. After the surgery in 1, 3, and 6th months, we evaluated all patients regarding treatment success. In addition, international prostate symptom score (IPSS), quality of life (QoL), maximum flow rate, postvoid residual urine volume, and morbidities (hematuria, infection, urethral stricture, irritative symptoms, need for re-operation) were assessed at all visits.&#x0D; Results: After TURP, there was no statistical difference in urodynamic parameters, complications, IPSS, and QoL in both groups. Only in the 3rd-month, the maximum flow rate was higher in favor of the early group. Despite similar results in both groups, strictures occurred earlier in the early group than delayed group (respectively 1 and 3 months). &#x0D; Conclusion: These results suggest that there are no differences in efficacy and complications in groups of early or delayed urethral catheter removal after TURP. The results of long-term studies with large series should be awaited to reach a more definite conclusion. We have tried to shed light on a topic without consensus on the time of urethral catheterization after TURP.

The Effects of Age, Gender, and Postvoid Residual Volume on Catheterization Rates After Treatment with OnabotulinumtoxinA for Overactive Bladder

BackgroundTransient increases in postvoid residual urine volume (PVR) requiring clean intermittent catheterization (CIC) have occurred with onabotulinumtoxinA treatment for overactive bladder (OAB). ObjectiveTo evaluate onabotulinumtoxinA safety and the effect of age, gender, and maximum PVR (PVRmax) on CIC initiation in adults with OAB and urinary incontinence (UI). Design, setting, and participantsThis was a pooled post hoc analysis of four placebo-controlled, multicenter randomized trials that included adults with idiopathic OAB after first onabotulinumtoxinA treatment (NCT00910845, NCT00910520, NCT01767519, NCT01945489). Patients had at least three urgency UI episodes over 3 d and at least eight micturitions per day, had inadequate management with at least one anticholinergic agent, and were willing to use CIC. Outcome measurements and statistical analysisWe measured the following outcomes: PVRmax within 12 wk after first treatment; CIC incidence; estimated functional capacity; PVR ratio (PVR/estimated functional capacity). Results and limitationsOf 1504 patients, 87.7% were women and 88.8% were White. The mean age was 60.5 yr across 10-yr age groups, baseline PVR was 13.8–35.0 ml, and estimated functional capacity was 293.5–475.7 ml. Mean baseline PVR was 21.3 ml overall versus 34.0 ml in the group that started CIC. The CIC incidence was 6.2% for women (range 1.1–8.4%) and 10.5% for men (range 0–14.6%). Higher CIC rates were observed for PVRmax >350 ml (women 91.9%, men 84.6%) in comparison to PVRmax of 201–350 ml (women 32.5%, men 17.4%) and PVRmax <200 ml (women 1.2%, men 1.6%). Overall, 2/1504 patients (both women) were unable to void spontaneously. The mean PVR ratio was highest at week 2. Some subgroups had small sample sizes. ConclusionsCIC incidence was low overall, was less frequent for women, was rare with PVRmax ≤200 ml, and did not appear to correlate with baseline PVR. Patient summaryAfter onabotulinumtoxinA treatment for OAB, patients sometimes insert a catheter to help in emptying their bladder after urinating. In this study, few patients needed a catheter, especially when less urine volume remained after urination.