Postvoid Residual Volume Research Articles

Positive urine culture prior to transrectal prostate biopsy was not associated with infectious complications development.

Prostate cancer is one of the most common cancers worldwide. Its histological diagnosis is based on prostate biopsy. The transrectal procedure is one of the most common procedures performed by urologists. Although it is considered safe, post-biopsy infectious complications are frequently observed in practice. The aim of this study is to investigate the value of urine culture before the transrectal biopsy. Secondly, we assessed potential risk factors for infectious complications following TR-PB. We performed a retrospective analysis of all patients who underwent urine culture tests before transrectal prostate biopsy between January 2019 and July 2020. The inclusion criteria for the study were all indications for prostate biopsy (PSA>4ng/mL or abnormal digital rectal examination). Baseline characteristics and the incidence of post-biopsy urinary tract infection were compared between patients showing positive pre-biopsy culture results and those showing negative findings. Multivariate logistic regression analyses were used to determine risk factors for infectious complications following TR-PB. Out of 163 patients included in our study, 19 patients (11.65%) had positive urine culture results before the biopsy. Age (P=0.068); history of hospitalization (P>0.999), history previous of quinolone use (P=0.75), history of UTI (P=0.64); median PSA level at diagnosis (P=0.267); prostate volume (P=0.78); post-void residual volume (P=0.374); percentage of patients testing positive for cancer on biopsy (P=0.81); and percentages of patients with a history of biopsy (P=0.889), diabetes mellitus (P=0.524), hypertension (P=0.714) and immunosuppressive medication use (P>0.999) were similar between the two groups. One patient in the positive urine culture group had post-biopsy prostatitis. However, 3.24% (five patients) of the negative urine culture group had the disease (P=0.789) (four patients with prostatitis and one with epididymitis). Among them, four patients were diagnosed by urine culture at the time of post-biopsy urinary tract infection. Multivariate logistic regression analysis demonstrated that history of hospitalization and history of previous quinolone use were risk factors for infection after transrectal prostate biopsy. Our study suggests that systematically performing urine cultures before transrectal prostate biopsy does not reduce the rate of infectious complications after biopsy. Positive pre-biopsy cultures were not associated with the development of post-biopsy infectious complications.

Outcome of Patients With Elevated Prostate-Specific Antigen and Lower Urinary Tract Symptoms Receiving Holmium Laser Enucleation of the Prostate.

PurposeThis study investigated functional outcomes in lower urinary tract symptoms (LUTS), the incidence of incidental prostate cancer (PCa), and changes in prostate-specific antigen (PSA) levels after holmium laser enucleation of the prostate (HoLEP) in patients with elevated PSA and benign prostatic hyperplasia (BPH).MethodsA retrospective review of a prospectively designed protocol for patients who underwent HoLEP at our institution from January 2010 to May 2020 was conducted. Patients were classified into low-PSA (<3.0 ng/mL) and high-PSA (≥3.0 ng/mL) groups at baseline. Follow-up for PSA was performed at the sixth postoperative month. Baseline and postoperative clinical parameters, functional parameters, PCa incidence, and postoperative changes in PSA were compared between the low- and high-PSA groups.ResultsThe baseline PSA of 1,296 patients (mean age, 69.7±6.8 years) was 4.0±4.1 ng/mL, with 712 patients (55.0%) in the low-PSA group (1.6±0.8 ng/mL), and 584 patients (45.0%) in the high-PSA group (6.9±4.7 ng/mL). Incidental PCa was detected in 82 patients (6.3%), with a similar incidence in the low-PSA (41 patients, 5.9%) and high-PSA (41 patients, 7.0%) groups (P>0.05). At 6 months postoperatively, both groups showed significant improvements in the maximum flow rate, postvoid residual volume, and all domains of the International Prostate Symptom Score (P<0.05). At postoperative 6 months, the PSA level significantly decreased by 66.6%±23.6% in all patients (54.3%±23.9% in the low-PSA group; 79.6%±14.7% in the high-PSA group) (P<0.05), and the PSA levels of 1,264 patients (97.6%) had normalized.ConclusionsIn patients with elevated PSA presenting with LUTS/BPH, our study demonstrated significant improvements in functional parameters and decreased PSA after HoLEP. The incidental PCa detection rate did not show a statistically significant difference between the low- and high-PSA groups. Timely surgery for LUTS/BPH without delay due to PSA monitoring should be considered.

White Matter Integrity in Men With Benign Prostatic Hyperplasia and Bladder Outlet Obstruction and Its Contribution to Lower Urinary Tract Symptoms.

PurposeLower urinary tract symptoms (LUTS) associated with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) can negatively impact quality of life. We evaluated the structural connectivity of the brain in men with BPH with chronic BOO using diffusion tensor imaging (DTI).MethodsAmbulatory male patients aged ≥45 years with BPH and BOO were recruited. LUTS was defined as an International Prostate Symptom Score (IPSS) ≥12 and a maximum urinary flow rate ≤15 mL/sec. Upon recruitment, uroflowmetry and validated questionnaires regarding bladder status were collected. DTI images from each subject were aligned with the ICBM-DTI-81 atlas, defining 50 white matter tracts (WMTs). The mean values of DTI parameters—fractional anisotropy and mean diffusivity—for each WMT were extracted. These measures were then utilized to compute Pearson correlation coefficients with clinical parameters. Objective clinical parameters included uroflowmetry parameters, postvoid residual (PVR) volume, and bladder capacity. Subjective clinical parameters were assessed using validated questionnaires: the IPSS, Incontinence Symptom Index, and Sexual Health Inventory for Men.ResultsThe correlation analysis revealed 15 WMTs that showed statistically significant associations (P<0.05) with objective and subjective clinical parameters. Eight tracts were associated with uroflowmetry parameters: maximum flow rate (Qmax), mean flow rate (Qmean), and PVR. Among these tracts, the middle cerebellar peduncles and left medial lemniscus were associated with Qmax; the genu of the corpus callosum, left superior corona radiata, corticospinal tract, right medial lemniscus, posterior corona radiata with Qmean; and the left posterior corona radiata with PVR. Seven tracts also demonstrated significant associations with the IPSS.ConclusionsOur results suggest correlations between the preserved white matter integrity of specific WMTs and the severity of LUTS based on objective and subjective clinical parameters, leading us to believe that a distinct pathology of the central nervous system might exist.

Median lobe vs. complete gland holmium laser enucleation of the prostate: A propensity score matching.

Benign prostatic hyperplasia (BPH) is a common condition affecting aging men. While holmium laser enucleation of the prostate (HoLEP) is one of the most effective treatments for BPH, variations of the procedure, such as median lobe HoLEP (MLHoLEP), are rarely reported. Here, we report our institution's experience with partial HoLEP. Our institutional prospective database was queried for patients having undergone median or individual lateral lobe enucleation between 2007 and 2018. A control cohort of patients who underwent standard HoLEP (sHoLEP) was identified using 1:2 propensity score matching based on age, prostate size, maximal flow rate (Qmax), postvoid residual volume (PVR), and American Urological Association symptom score (AUAss). Three and 12-month AUAss, PVR, and Qmax were compared. Forty-seven patients were identified as having undergone MLHoLEP. At three-month followup, AUAss (p<0.01) and incontinence rates (p=0.045) were lower for MLHoLEP patients, in addition to them having shorter operative (36.5 mins vs. 64.5 mins, p<0.01) and enucleation (13.8 mins vs. 37 mins, p<0.01) times as compared to sHoLEP patients. No difference was noted between MLHoLEP and sHoLEP cohorts with respect to age, prostate volume, PVR, or Qmax. Significant improvement in AUAss, PVR, and Q max from baseline to three and 12 months was noted overall in both groups. MLHoLEP could provide a surgical option with reduced operative time, quicker improvement in AUAss, and restored continence in appropriately selected patients. Ultimately, MLHoLEP represents a safe and effective treatment option to select patients who may not be eligible for or face potential morbidity concerns associated with sHoLEP.

Urodynamic assessment and quality of life outcomes of robot-assisted totally intracorporeal radical cystectomy and orthotopic neobladder for bladder cancer: a preliminary study.

Few data exist regarding the functional outcomes of robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder. The aim of this study was to evaluate the urodynamic and functional outcomes in patients undergoing RARC and totally intracorporeal orthotopic neobladder for bladder cancer. In this monocentric, observational study carried out between 2016 and 2020, consecutive patients undergoing RARC and intracorporeal orthotopic neobladder in the Department of Urology, Pitié-Salpêtrière Hospital, were included. Reconstruction was totally intracorporeal Y-shaped neobladder. Main outcomes were urodynamic findings 6months post-surgery, continence and quality of life (QoL). Continence was defined by no pad or one safety pad. International Consultation on Incontinence Questionnaire (ICIQ), International Index of Erectile Function questionnaire (IIEF-5) and Bladder Cancer Index (BCI) scores were recorded. Fourteen male patients were included (median age: 64years [IQR 54-67]. Median maximal neobladder cystometric capacity was 495ml [IQR 410-606] and median compliance was 35.5ml/cm H2O [IQR 28-62]. All patients had post-void residual volume < 30ml, except for three (22%) who required clean intermittent-self catheterisation. Daytime continence was achieved in 10 patients (71%) and night-time continence in two (14.3%). Median ICIQ score was 7 [IQR 5-11]. Postoperative erectile function was present in 7% of patients (mean IIEF-5 = 5 [IQR 2-7]). Thirteen patients (93%) were satisfied with their choice of neobladder. RARC with totally intracorporeal orthotopic neobladder for bladder cancer provides satisfactory urodynamic results and good QoL. These findings should be confirmed long-term.

569 Trial Without Catheter – Are We Performing the Procedure Correctly?

Abstract Aim To assess the trial without catheter (TWOC) practice at our unit by ensuring there is accurate recording of data onto electronic records and factors affecting successful TWOC are being addressed. Method 2 months of retrospective data on TWOC practice was collected between 01/07/2019–30/08/2019. The Guy's and St Thomas’ TWOC guideline was used as the standard to compare to. Factors that could affect TWOC outcomes were checked on our electronic patient records. A re-audit was performed between 31/07/2020–30/08/2020. Results 55 sets of data were collected with 16 (42%) patients having no documentation of post void residual volume (PVR). There were 6 adverse outcomes following TWOC, 3 patients returned in acute urinary retention (AUR) and 3 had delayed discharges. 3/6 of these adverse outcomes were linked to poor TWOC practice. 4/5 patients who failed TWOC were not on Tamsulosin and 0/5 were on laxatives. Following our implemented changes the re-audit showed no adverse outcomes, and only 2 patients without PVR documented. Conclusions Our first audit demonstrated significant adverse outcomes from poor TWOC practices at our unit. We implemented changes including writing an official TWOC guideline for the trust and regional teaching from our catheter workshop that included correct TWOC practice. Following these changes, the rates of adverse outcomes following TWOC were significantly reduced.

Prostatic arterial embolization as a micro-invasive treatment option for benign prostatic obstruction: A subtle balance between short-term follow-up patient-reported outcomes and de-obstructive effectiveness

PurposeThe study evaluated the effectiveness of prostatic arterial embolization (PAE) in the relief of benign prostatic obstruction (BPO) beyond the patient-reported outcomes.MethodsRetrospective evaluation of patients who underwent PAE (March 2015–December 2019). All patients underwent prostate MRI to assess prostate volume (PVol), uroflowmetry to assess Qmax, and were administered IPSS + QoL. MRI, and IPSS were repeated 3 months postoperatively. Patients were contacted for urological consultation, including uroflowmetry with post-voiding residual volume (PVR), IPSS + QoL. Additionally, patient satisfaction was assessed. Sexual function, including ejaculation and complications, was recorded.ResultsFifty-two patients were analyzed. At baseline, PVol was 66 ml (IQR 48–67), Qmax 13.5 ml/s (IRQ 11.5–19), IPSS 23 (IQR 18–25), and QoL 4.5 (IQR 4–5). At 3-month follow-up, MRI showed a 27% (IQR 18–36) reduction in PVol (p &amp;lt;0.001). The IPSS decreased by 81% (IQR 58–91, p &amp;lt;0.001). At a median follow-up of 14 months (IQR 10.5–27.5), IPSS decreased by 40% (IQR 26–54, p &amp;lt;0.001) and QoL by 50% (IQR 20–75, p = 0.002) versus baseline. The absolute Qmax was 12.2 ml/s (IQR 9.5–14). Median %variation of Qmax vs baseline was −7.3% (IQR −33.9; +25.5, p = 0.7). All sexually active patients maintained ejaculation. Thirty-eight (73%) were satisfied with the treatment they received. One patient reported post-operative erectile dysfunction. All patients who were counseled for adjuvant endoscopic treatment refused surgery except for one.ConclusionIn our analysis, PAE provided significant improvement in the short-term follow-up patient-reported outcomes. Most patients were satisfied, and ejaculation was maintained. On the other hand, the effectiveness of PAE on the relief of BPO seemed virtually intangible in most of the cases.

A Novel Nomogram Based on Initial Features to Predict BPH Progression.

Objectives: The aim of this study was to establish a tool to identify patients at risk for pharmaceutical and surgical interventions for benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) over a 10 year follow-up. Methods: The data of patients with mild to moderate male LUTS undergoing phytotherapy from January to December 2010 were reviewed. Patients were followed for 10 years through medical visits and telephone consultations. The outcomes were (1) treatment switch from phytotherapy or no therapy to alpha-blockers or 5α-reductase inhibitors (5-ARI), and (2) clinical progression (acute urinary retention or need for surgery). Two calibrated nomograms (one for each outcome) were constructed on significant predictors at multivariate analysis. Results: A total of 107 patients with a median age of 55 years at presentation were included; 47% stopped or continued phytotherapy, while 53% switched to alpha-blockers and/or 5-ARI after a median time of 24 months. One-third in the second group experienced clinical progression after a median time of 54 months. Age, symptom score, peak flow rate (Qmax), prostate-specific antigen (PSA), and post-void residual volume were significantly associated with the outcomes. According to our nomograms, patients switching therapy or progressing clinically had average scores of 75% and 40% in the dedicated nomograms, respectively, as compared to 25% and <5% in patients who did not reach any outcome. Conclusions: We developed a nomogram to predict the risk of pharmaceutical or surgical interventions for BPH-related LUTS at 10 years from presentation. On the basis of our models, thresholds of >75% and >40% for high risk and <25% and <5% for low risk of pharmaceutical or surgical interventions, respectively, can be proposed.

A comparison of the efficacy of dutasteride on reducing lower urinary tract symptoms among patients with small versus large benign prostatic hyperplasia.

Only a few reports have currently studied the efficacy of dutasteride in patients with small benign prostatic hyperplasia (BPH). We investigated the efficacy of dutasteride on reducing lower urinary tract symptoms among them. A total of 81 patients with BPH who completed 52weeks of 0.5?mg dutasteride treatment were enrolled. Each patient filled out the International Prostatic Symptom Score (IPSS) and overactive bladder symptom score (OABSS) at baseline and at the 6- and 12-month follow-up visits. Total testosterone, prostate-specific antigen, adenoma/prostate volume (PV), uroflowmetry analysis, and postvoid residual volume were evaluated at baseline and at the 12-month follow-up visit. The enrolled patients were divided into 2 groups according to PV at baseline. The groups were as follows: Group A (PV ≥ 30 mL) and Group B (PV < 30 mL). Groups A and B had mean PVs of 52.1 and 23.6 mL and mean IPSS scores of 16.7 and 14.4, respectively. Group A had significantly higher OABSS and prostate-specific antigen levels at baseline than Group B, while no significant differences in any other baseline characteristics was observed. After dutasteride treatment, adenoma volume and PV decreased significantly, while testosterone level showed a significant increase in both groups. Group A showed significant improvements in the total IPSS, voiding and storage subscore of the IPSS, OABSS, maximum flow rate, and postvoid residual volume. Group B, on the other hand, also showed significant improvements only in the total IPSS, voiding subscore of the IPSS, and maximum flow rate. The present study suggests a possible beneficial effect of dutasteride treatment on the reduction of lower urinary tract symptoms in patients with small and large BPH. However, the effectiveness of dutasteride was limited compared to patients with large BPH (PV ≥ 30 mL).

SHORT-TERM SURGICAL AND FUNCTIONAL OUTCOMES AFTER ROBOT-ASSISTED SACROCOLPOPEXY IN A SINGLE INSTITUTION

(Objectives) This study aimed to evaluate the surgical outcomes and functional parameters of lower urinary tract and bowel symptoms in patients who have undergone robot-assisted sacrocolpopexy (RASC) due to pelvic organ prolapse. (Patients and methods) This retrospective study included 110 consecutive RASC cases in the urology department of Ageo Central General Hospital, Japan, from November 2020 to October 2021. The medical records of these patients were retrieved. Data on uroflowmetry, post-void residual urine test, and self-administered questionnaires on urination and defecation were assessed. (Results) The mean operating time was 146 min, and the estimated blood loss was 14.8 ml. The intraoperative, postoperative, and severe complication rates of cases classified as Clavien-Dindo grade IIIa or higher were 0%, 9.1%, and 0%, respectively. The maximum flow rate and post-void residual volume of urine significantly improved after the operation. Similarly, the quality of life (QOL) scores and overactive bladder symptom score (OABSS), as well as the responses for the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Urinary Distress Inventory-6 (UDI-6), significantly improved one month after the operation and were sustained for six months. On the other hand, the total scores from the Constipation Scoring System (CSS) and the subscales of the Patient Assessment of Constipation (PAC) -QOL worsened. These scores, except for those of the PAC-QOL satisfaction subscale recovered to the preoperative levels; the PAC-QOL satisfaction subscale scores significantly improved six months postoperatively. The rates of de novo overactive bladder (OAB), stress urinary incontinence (SUI), and constipation one month postoperatively were 8%, 33%, and 10%, respectively. (Conclusions) RASC was performed safely in our institution with acceptable postoperative lower urinary tract and bowel outcomes.

Single-port transvesical versus open simple prostatectomy: a perioperative comparative study.

To compare the initial perioperative outcomes of single-port transvesical simple prostatectomy (SP RASP) patients to those of open simple prostatectomy (OSP). Perioperative data from 42 consecutive patients with BPH who underwent SP RASP were prospectively reviewed. Similarly, data from forty-three consecutive patients who underwent the standard OSP, were retrospectively collected. Through direct suprapubic bladder access, prostatic enucleation was performed using the prostatic capsule as a landmark. Then a complete vesicourethral mucosal advancement flap was accomplished. OSP was performed according to the standard approach. Demographics, Intra- and perioperative data were analyzed and assessed with a descriptive analysis. Baseline characteristics were comparable between the two groups, except for the preoperative median post-void residual volume, which was higher in the OSP group (p = 0.004). The SP RASP group had less intraoperative estimated blood loss (p < 0.001), no need for continuous bladder irrigation (p < 0.001), and less in-hospital opioid use (p < 0.001). Patients in the SP RASP group were discharged on postoperative day zero, compared to a median of 2 days for OSP (p < 0.001). The median Foley catheter duration was 7 days for SP RASP, compared to a median of 10 days for OSP (p < 0.001). SP RASP group had fewer postoperative complications, however, this did not reach statistical significance. SP RASP is an alternative approach in treating surgical BPH. It may offer patients less morbidity in comparison to OSP.

Does urination position have an effect on evaluation of lower urinary tract function ın children? A uroflowmetric study

BackgroundWe aimed to determine whether different urination positions had significant impact on the parameters of uroflowmetry performed by healthy individuals and children with voiding dysfunction.MethodsThe study was conducted with a prospective and comparative design. Children between 5 and 15 years of age who met the inclusion–exclusion criteria of the study were enrolled. Children in the study were divided into two groups. Participants whose voiding dysfunction symptom score was ≥ 9 points were classified in group 1 and the remaining individuals were classified in group 2. Girls urinated in two different positions as sitting and squatting while boys urinated in three different positions as sitting, squatting and standing. Also, habitual urination position was asked and recorded for each individual participated in the study. Uroflowmetry parameters were compared for different urination positions in two groups separately and a p value of ≤ .05 was accepted for statistical significance.ResultsVoided volume, maximum flow rate (Qmax), time to reach Qmax, urination time and postvoid residual volume measured by abdominal ultrasound were recorded in every participant for each urination position in both groups. In group 1, girls with voiding dysfunction presented a significantly higher postvoid residual volume in squatting position compared to sitting position (the p value = 0.02). In group 2, healthy boys presented a significantly higher Qmax in standing position compared to sitting and squatting positions (the p value = 0.01). All participants provided a better uroflowmetry pattern in their habitual urination positions.ConclusionUrination position may affect uroflowmetry results; however, its impact on lower urinary tract function requires further research.

Surgical outcome of male patients with chronic central nervous system disorders and voiding dysfunction due to bladder outlet obstruction.

Voiding dysfunction is common in patients with chronic central nervous system (CNS) diseases and has great impact on quality of life. Patients with chronic CNS disorders might have concomitant detrusor overactivity, detrusor underactivity, and voiding dysfunction. Although bladder outlet surgeries could relieve bladder outlet obstruction (BOO), patients might have persistent or exacerbated storage symptoms. This study investigated surgical outcome of patients with chronic CNS disorders after bladder outlet surgery. A total of 63 male patients with cerebrovascular accident (CVA, n = 44), Parkinson's disease (PD, n = 11), and early-stage dementia (n = 8), had received bladder outlet surgery after videourodynamic proven BOO refractory to medical treatment. The preoperative and postoperative lower urinary tract symptoms (LUTS) and uroflowmetry parameters were assessed. If the storage symptom subscore decreased or increased by 1, the outcome was considered improved or exacerbated after treatment. When patients had improvement in maximum flow rate (Qmax) and voiding efficiency (VE) and decreased voiding symptom subscore, they were considered having improvement of voiding dysfunction. The mean age was 71.1 ± 9.8years and mean duration from diagnosis of BOO to surgical intervention was 15.1 ± 25.0months. Overall, there was significant improvement in voiding LUTS and urinary retention after surgery. The post-void residual volume (PVR), corrected Qmax (cQmax), and VE significantly improved after surgery. In subgroup analysis, although voiding symptoms improved in CVA patients, urgency and exacerbated urgency incontinence persisted after surgery. In PD patients, there was improvement in voiding condition such as PVR, cQmax and VE, but the storage symptoms did not change after surgery. Patients with dementia had no improvement both in storage and voiding symptoms. Bladder outlet surgeries are effective to relieve voiding dysfunction in patients with CVA and PD, but have little effect on storage LUTS in patients with chronic brain lesions.

Zika-Related Microcephaly and Its Repercussions for the Urinary Tract: Clinical, Urodynamic, Scintigraphic and Radiological Aspects.

Aims: Describing the urodynamic parameters of children aged 3 to 5 years with microcephaly related to congenital Zika syndrome and verifying the association with clinical, imaging and neurological characteristics. Methods: From October 2018 to March 2020, children with Zika-related microcephaly underwent urological, ultrasonographic and urodynamic evaluation. In selected cases, complementary exams such as urethrocystography and scintigraphy were performed. The children also underwent a complete neurological evaluation. To compare frequency between groups, we used Pearson’s chi-squared test or Fisher’s exact test. Results: This study evaluated 40 children, of whom 85% were 4 years old, and all had abnormalities on the urodynamic study, with low bladder capacity (92.5%) and detrusor overactivity (77.5%) as the most frequent findings. Only three children had ultrasound abnormalities, but no child had cystographic or scintigraphic abnormalities, and the postvoid residual volume was normal in 80% of cases. In spite of a frequency of 67.5% of intestinal constipation, there was no record of febrile urinary tract infection after the first year of life. All children presented severe microcephaly and at least one neurological abnormality in addition to microcephaly. The homogeneity of the children in relation to microcephaly severity and neurological abnormalities limited the study of the association with the urodynamic parameters. Conclusions: Urodynamic abnormalities in children aged 3 to 5 years with Zika-related microcephaly do not seem to characterize a neurogenic bladder with immediate risks for the upper urinary tract. The satisfactory bladder emptying suggests that the voiding pattern is reflex.

The effect of duration between sessions on biofeedback treatment in children with dysfunctional voiding.

Biofeedback is an effective treatment in children with standard urotherapy-resistant dysfunctional voiding (DV). However, the duration of the session intervals is not standardized. We aimed to compare the effectiveness of daily and weekly sessions of biofeedback treatments. The data of children who received biofeedback due to DV between March 2018 and May 2019 were retrospectively evaluated. The children were divided into two groups, one with daily and the other with weekly sessions. The voiding patterns in uroflowmetry (UF), maximum flow rate (Qmax), electromyography activity, postvoid residual volume (PVR), the ratio of voided volume to expected bladder capacity (EBC) (%), and Dysfunctional Voiding and Incontinence Scoring System (DVISS) were compared between the two groups. A total of 45 children (39 girls [86.6%] and 6 boys [13.3%]) were included in the study. The daily group consisted of 27 (60%) children and the weekly group of 18 (40%). Qmax, PVR, number of abnormal UF patterns, voiding volume/EBC, and DVISS scores were similar between the two groups before treatment. Voiding parameters improved statistically significantly in both groups following biofeedback, but there was no difference between the two groups. A statistical difference was found between the results of DVISS after treatment (P= .03). Both types of biofeedback treatment (daily and weekly) are effective methods that improve voiding parameters and DVISS values in children with DV. Therefore, the duration between sessions can be determined according to the suitability of the patient and the biofeedback unit.

Prevention of Postpartum Urinary Retention with Peppermint Oil Vapor

Urinary retention in the postpartum period (PPUR) is one of the health problems commonly handled using catheterization and antibiotic prophylaxis. This study aimed to look at the influence of peppermint oil on PPUR prevention. This quasi-experimental study with a control group design included 60 postpartum subjects (29 in the control group and 31 in the intervention group) with vaginal delivery (ages 17-50 years). The intervention group obtained treatment by giving 2 mL of peppermint oil, while the controlled group used mineral water in the closet before subjects sat on it for 5-10 minutes and voided. The bladder condition was further checked subjectively and manually by palpation before and after the exposure to peppermint oil (distention or no distention). The relationships between variables were analyzed using the Fisher Exact statistical test, obtaining no significant effect of peppermint oil administration variables on PPUR prevention (p = 0.495, CI 95%). PPUR is related to oxidative stress, tissue inflammation, and nerve impulse blocks. Peppermint oil is estimated to be one of the modalities in preventing health problems through antioxidant, anti-inflammatory, and antispasmodic effects. Further research is needed to validate the effect of peppermint oil on PPUR prevention. In addition, support of screening information on the condition of the bladder objectively using a bladder scanner is also needed to measure the post-void residual volume (PVRV). This study showed that peppermint oil on PPUR prevention has no significant effect and may require further investigation.

The role of Tadalafil in the treatment of benign prostatic hyperplasia and erectile dysfunction

The aim of this study is to investigate the effectiveness of a single 5 mg daily dose of Tadalafil in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) accompanied by erectile dysfunction (ED). The data of patients who applied to the urology outpatient clinic between 2014 and 2019 and were diagnosed with BPH and ED were retrospectively analysed. Before and after the treatment with 5 mg tadalafil daily for 12 weeks; maximum flow rate (Qmax), average flow rate (Qave), postvoid residual volume (PVR), prostate volume (PV), PSA values, IPSS and IIEF scores of the patients were compared. The mean age of 66 male patients diagnosed with ED and BPH was 48.1±6.9 years. The mean IPSS score of the patients before the treatment was 9.85 which represents moderate LUTS. After the treatment, the mean score decreased to 5.7 which represents mild LUTS. Before the treatment, the mean IIEF score showed mild ED with 18.79. After the treatment, the mean IIEF score increased to 29,9. The treatment statistically significantly decreased ED and increased the IIEF score (p=0.000). While the mean Qmax and Qave were increased statistically significantly (p=0.000). A statistically significant decrease was observed in the mean PVR from 60.1 ml to 37.6 ml (p=0.000). The decrease in PV was not statistically significant (p=0.321). The decrease in PSA values before and after treatment was found to be statistically significant with p=0.046. It has been shown that the daily use of 5 mg Tadalafil alone for 12 weeks can be a preferable treatment option, especially in younger patients with BPH / LUTS and ED.

Intravesical Instillation of OnabotulinumtoxinA in the Treatment of Refractory Overactive Bladder in Participants with Urinary Incontinence.

Intradetrusor injections of onabotulinumtoxinA are efficacious for the treatment of overactive bladder with urgency urinary incontinence in adults refractory to or intolerant of anticholinergics. Delivery of onabotulinumtoxinA via instillation would reduce the need for intradetrusor injections. The objective of this trial was to assess the efficacy and safety of intravesical instillation of an onabotulinumtoxinA + hydrogel admixture. After review of a stage 1 safety phase by an independent committee, participants were recruited into stage 2 and randomized to either onabotulinumtoxinA 100, 300, 400, or 500 U, or placebo, all with hydrogel admixture. End points included change from baseline to week 12 in the number of urinary incontinence episodes (primary); micturition, urgency urinary, and nocturia episodes/day; volume voided per micturition; proportion of participants with a ≥50% decrease from baseline in urinary incontinence episodes/day; and Overactive Bladder Questionnaire total score. Adverse events were reported. Change from baseline to week 12 in number of urinary incontinence episodes was -2.72 with placebo and ranged from -0.89 to -1.85 in the onabotulinumtoxinA + hydrogel treatment groups. No difference from placebo was observed for any efficacy end point. The proportions of participants with treatment-emergent adverse events were similar among all groups, with asymptomatic bacteriuria the highest reported (6.7%-15.5%). There were no reports of urinary retention or elevated post-void residual volume. Intravesical instillation of an onabotulinumtoxinA + hydrogel admixture for the treatment of refractory overactive bladder was well tolerated, but it showed no improvement over placebo.

Long-Term Outcome of Prostatic Artery Embolization for Patients with Benign Prostatic Hyperplasia: Single-Centre Retrospective Study in 1072 Patients Over a 10-Year Period.

Assess long-term outcomes of prostatic artery embolization (PAE) for patients with benign prostatic hyperplasia (BPH). Single centre retrospective study from 2009-2019 including 1072 patients who received PAE and had available follow-up. Patients were evaluated yearly at 1-10years post PAE using the International Prostate Symptom Score (IPSS) and quality of life (QoL), prostate volume (PV), prostate-specific antigen (PSA), peak urinary flow rate (Qmax) and postvoid residual (PVR) volume. The need for prostatic medication, re-intervention rates, repeat PAE and prostatectomy rates were assessed with Kaplan-Meier survival analysis and compared between different embolic agents using Cox regression analysis. Mean follow-up time was 4.39 ± 2.37years. At last follow-up visit, mean IPSS and QoL improvements were -10.14 ± 8.34 (p < .0001) and -1.87 ± 1.48 (p < .0001) points, mean PV reduction was -6.82 ± 41.11 cm3 (p = 0.7779), mean PSA reduction was -1.12 ± 4.60ng/mL (p = 0.9713), mean Qmax increase was 2.72 ± 6.38mL/s (p = 0.0005), mean PVR reduction was -8.35 ± 135.75mL (p = 0.6786). There were 335 patients (31.3%) needing prostatic medication after PAE. Re-intervention rates were 3.4%at 1year, 21.1%at 5years and 58.1%at 10years. Repeat-PAE rates were 2.3%at 1year, 9.5%at 5years and 23.1%at 10years. Prostatectomy rates were 1.1%at 1year, 11.6%at 5years and 35.0%at 10years. No significant differences were found between polyvinyl alcohol particles, Bead Block, Embospheres and Embozenes. PAE induces durable long-term LUTS relief, with re-intervention rates of 20% in the first 5years and 30%-60% > 5years post-PAE.

SAFETY AND EFFICACY OF SILODOSIN-DUTASTERIDE IN THE MANAGEMENT OF BENIGNPROSTATIC HYPERPLASIA

Background Information: Currently alpha1-adrenoreceptor blockers with the combination of 5- alpha reductase inhibitors are widely used as first-line therapy to improve Lower urinary tract symptoms (LUTS) associated with Benign Prostatic Hyperplasia (BPH). Aims And Objectives:The aim of this study was to evaluate the Efficacy of combination drug Silodosin and Dutasteride in Benign Prostatic Hyperplasia patients with mild to severe symptoms. Materials And Methods:Thepresent hospital based Prospective Interventional Observational study was conducted in Department of Urology and Surgery out and inpatient Department,Lalitha Super Speciality Hospital during the time period of 1st October 2020 to 31st March 2021 and 70 cases of BPH with mild to severe symptoms and prostate volume of greater than30cc were included in the study All the patients were administered the drug which is a combination of Silodosin (8mg) and Dutasteride (0.5mg) once daily for 3 months after obtaining ethical clearance and administering informed consent .The patients condition was done followupfor the changes in Prostate Size,PVR,IPSS which were recorded and analysed using appropriate statistical tools. Results: The study showed that there was a significant decrease in prostate size when compared with before treatment i.e.11.31±5.99and a significant decrease in PostVoidResidual volume when compared with before treatment i.e 43.95±1.091.During therapy the IPSS score was improved to 9.5±1.567 which was found to be statistically significant (p&lt;0.05).After 2 months of the treatment there was improvement in the patient condition ,as we saw the significant change in prostate size, post void residual volume and IPSS score after treatment.The patient with severe, moderateand mild benign prostate hyperplasia was improved by the treatment . Conclusion: There is statistically significant improvement in PVR ,IPSS and prostate size .Thus Silodosin 8mg and dutasteride 0.5mg can be used for effective relief of LUTS caused due to BPH in mild to severe cases.