Postvoid Residual Urine Volume Research Articles

Gene Therapy With URO-902 (pVAX/hSlo) for the Treatment of Female Patients With Overactive Bladder and Urge Urinary Incontinence: Safety and Efficacy From a Randomized Phase 2a Trial.

To assess efficacy and safety of URO-902, an investigational gene therapy expressing the α subunit of the large-conductance Ca2+-activated K+ channel, in a phase 2a placebo-controlled trial in women with overactive bladder (OAB). Women, 40‒79 years, with OAB and urge urinary incontinence (UUI) who were refractory to OAB medications were randomized to single-dose URO-902 24 and 48 mg or placebo administered by intradetrusor injection via cystoscopy under local anesthesia. Efficacy endpoints included change from baseline to week 12 in mean daily micturitions, urgency episodes, UUI episodes, and patient-reported outcomes. Safety assessments included adverse events (AEs) and postvoid residual urine volume. Of 80 patients randomized (URO-902 24 mg, n=26; URO-902 48 mg, n=27; placebo, n=27), 74 received treatment, and 67 reached week 24. At week 12, URO-902 24 and 48 mg were associated with significant improvement vs placebo in daily micturitions (least squares mean change from baseline, -2.3 and -2.4 vs -0.8; least square mean difference [95% confidence interval], ‒1.5 [‒2.7 to ‒0.3] and ‒1.6 [‒2.8 to ‒0.4], nominal P=0.017 and P=0.009, respectively). URO-902 48 mg was associated with significant improvements vs placebo in urgency episodes (‒3.4 vs ‒1.1; ‒2.2 [‒4.0 to ‒0.4]; nominal P=0.016) and percentage of Patient Global Impression of Change responders (58% vs 31%; nominal P=0.026). Among patients receiving URO-902 24 mg, 48 mg, and placebo, 46%, 54%, and 54%, respectively, experienced ≥1 treatment-emergent AEs, most commonly urinary tract infection (0%, 15%, 4%) and hematuria (6%, 8%, 8%). In this phase 2a trial, treatment with URO-902 was associated with improvements vs placebo in efficacy and patient-reported outcomes and was safe and well tolerated.

Clinical Trial of Gatch UP 45-Degree Positioning for Decreasing Post-Void Residual (PVR) Urine Volume

Clinical Trial of Gatch UP 45-Degree Positioning for Decreasing Post-Void Residual (PVR) Urine Volume

Analysis of urinary function and prostate volume changes in localized prostate cancer patients treated with carbon-ion radiotherapy; a prospective study

BackgroundThe potential of carbon ion radiation therapy (CIRT) as a curative treatment for localized prostate cancer (PCa) has garnered attention due to its characteristic dose distribution. We prospectively collected and analyzed over five years to investigate the outcomes of localized PCa treated with CIRT at our institution.Patients and methodsThe study included patients with histologically confirmed prostate adenocarcinoma. CIRT treatment was administered at a total dose of 57.6 Gy (RBE) in 16 fractions over four weeks. Uroflowmetry (UFM) and residual urine measurements were performed at various time points: before CIRT treatment, one month after starting CIRT, three months after treatment, and annually for five years starting from 1 year after the completion of CIRT. Prostate volume was measured using transrectal ultrasonography (TRUS).ResultsA total of 304 prostate cancer patients were analyzed. UFM parameters were significantly worsened immediately after the treatment. However, they recovered to pretreatment levels after three months and remained stable until five years post-treatment. Notably, Average flow rate showed significant improvement after three years of treatment compared to before the treatment. Prostate volume decreased to 80% of baseline in patients treated with CIRT alone and to 60–70% of baseline in those receiving combined CIRT and either short- or long-term ADT. The logistic-binomial analysis identified post-voiding residual urine volume (PVR) as a significant factor for predicting adverse events in the acute phase.ConclusionsFollowing CIRT treatment, the voiding parameters in PCa patients significantly deteriorated immediately. However, after three months, they returned to their pre-treatment levels and remained stable for five years.

Profile of postpartum patients with urinary retention at Koja Regional Hospital, Jakarta, Indonesia

HIGHLIGHTS Maternal age and fetal birth weight are key risk factors for PPUR. Among 300 subjects, 63.7% experienced PPUR, identified using the Suskhan score, with catheterization as a useful tool for prevention and management planning. ABSTRACT Objective: Postpartum urinary retention (PPUR) is a common voiding disorder, defined as the inability to void spontaneously within 6 hours after delivery with a residual bladder volume exceeding 200 mL. High rates of PPUR in Indonesia indicate a need for greater awareness and intervention. This study aims to assess the incidence and potential contributing factors of PPUR among postpartum patients at Koja Regional Hospital in Jakarta, Indonesia. Materials and Methods: A descriptive case-control study was conducted, including women who experienced urinary retention following vaginal delivery at Koja Hospital between September and December 2022. Residual urine volume was measured by catheterization 6 hours after delivery. Data analysis, performed using SPSS version 22, included patient demographics and clinical factors such as maternal age, parity, gestational age, neonatal birth weight, and postvoid residual urine volume. These factors were analyzed to determine their association with PPUR. Results: Out of 300 subjects selected through consecutive random sampling, 63.7% experienced PPUR, while 36.3% had normal urinary function. Patients with a mean age of 26.91 ± 5.02 years (p = 0.000), primiparous status (first-time mothers) (p < 0.001), and a mean neonatal birth weight of 2980.95 ± 450.52 grams (p = 0.000) showed a higher risk of developing PPUR compared to other postpartum patients. Conclusion: The study indicates a significant association between postpartum urinary retention and maternal factors, including younger age, primiparity, and higher neonatal birth weight. Identifying these high-risk factors can enhance PPUR management, allowing healthcare providers to implement targeted monitoring and preventive measures, potentially improving postpartum outcomes in this patient population. This underscores the importance of monitoring these risk factors to better manage and potentially mitigate the incidence of PPUR.

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

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

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

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

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

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

Comparative Study between Holmium Laser and Cold Knife in Optical Internal Urethrotomy for the Management of Anterior Urethral Stricture

Abstract Background Urethral stricture is a narrowing of the urethra due to many causes including, trauma, ischaemia, spongiofibrosis, inflammation, and sexually transmitted gonococcal infections, resulting in tissue scaring in the corpus spongiosum, It can occur at any point on the male urethra. Regarding urethral stricture management, many researchers and surgeons have proposed and evaluated several methods, including urethral dilation, direct vision internal urethrotomy, laser urethrotomy and urethroplasty. Aim to compare the outcomes of Holmium: yttrium-aluminium-garnet (YAG) laser urethrotomy with the conventional cold-knife technique as regards treatment outcome, efficacy and complications in cases of urethral stricture disease. Methods This prospective randomized clinical trial was conducted at Ain Shams University hospitals and Nile hospital for insurance. This study was conducted on 30 male patients with urethral stricture assigned into two equal groups; Group A: received urethrotomy with conventional cold knife. Group B received urethrotomy with Holmium: YAG laser. Results Holmium Laser modality was associated with significantly lower postoperative postvoid residual urine volume and International Prostate Symptom Score (IPSS) at 1 &amp; 3 months postoperative and shorter operative time but there was insignificant difference as regards peak flow rate(PFR). Complications in both procedures were minor and infrequent Conclusion Holmium Laser and cold knife internal urethrotomy are effective surgical options for the treatment of anterior urethral stricture with a promising outcome after 3- months follow-up with a better success rate using the Holmium laser. Both are easy to perform, minimal invasive and safe

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

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

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

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

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

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

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

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

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

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

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

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

“Laser vaporization of the prostate: A comparative study between ejaculatory preserving and non-ejaculatory preserving technique”

ABSTRACT Introduction and objectives Laser vaporization techniques have emerged as a prominent alternative to transurethral prostate resection in managing benign prostatic obstruction (BPO). This study focuses on assessing the effectiveness of the ejaculatory preserving laser vaporization of the prostate technique compared to the conventional non-ejaculatory approach in managing BPO. Patients and Methods Our study was performed between August 2022 and September 2023. The study included 120 patients with bladder outlet obstruction, due to benign prostatic hyperplasia (BPH). Patients were randomly assigned to two groups: the first underwent conventional non-ejaculatory preserving laser vaporization of the prostate (n = 80), while the second group underwent the innovative ejaculatory preserving laser vaporization technique using diode laser (n = 40). We assessed baseline International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), post voiding residual urine volume (PVRU), semen volume (semen analysis). Parameters were re-evaluated 3 months post-surgery and the change in sexual satisfaction was evaluated using a scale from 1 (much less satisfied) to 5 (much more satisfied) in response to a question. Results The mean age (±SD) of participants was 59.6 (±7.9) and 57.6 (±7.8) for the non-ejaculatory preserving and ejaculatory preserving groups, respectively, with no statistical difference between groups. Both groups showed significant reduction in IPSS (p < 0.001), improvement in Qmax (p < 0.001), and decline in PVRU (p < 0.001), postoperatively. However, the ejaculatory preserving technique led to a significant improvement in antegrade ejaculation, postoperative semen volume and sexual satisfaction compared to the non-ejaculatory preserving technique (p < 0.001). Conclusions The ejaculatory preserving technique effectively preserved antegrade ejaculation, semen volume and sexual satisfaction compared to the non-ejaculatory preserving technique. However, the later yielded better outcomes in terms of IPSS and urine flow. Both techniques demonstrated significant improvements across all parameters compared to baseline. Further research with extended follow-up periods is needed to fully understand the long-term postoperative effects with this technique.

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

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

Long-term outcomes after treatment with Optilume BPH Four-year results from the EVEREST study.

The purpose of this study was to gather initial safety and efficacy data with the Optilume® BPH Catheter System for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). A total of 80 men with moderate-to-severe LUTS secondary to BPH were enrolled and treated with the Optilume BPH Catheter System. Symptoms were evaluated using the International Prostate Symptom Score (IPSS) and Benign Prostatic Hyperplasia-Impact Index (BPH-II). Improvement in urinary flow and relief of obstruction was evaluated by way of peak urinary flow rate (Qmax) and postvoid residual urine volume (PVR). Subjects were prospectively queried for adverse events at each study visit, and relatedness to the study device was evaluated by the investigators, as well as centrally adjudicated by the study principal investigator. Previous reports of symptom improvement in this cohort were maintained through four-year followup, with a significant reduction in IPSS and IPSS quality of life maintained through four years (-12.1, -2.8, respectively). Clinically meaningful improvement in Qmax was maintained in the majority of subjects, with an average improvement from baseline of +5.6 mL/sec. No treatment-related adverse events were reported in the long-term followup period. Long-term followup through four years for subjects treated with the Optilume BPH Catheter System indicates durable outcomes in symptom improvement and functional improvement in flow rate. These results indicate the unique mechanism of action for Optilume BPH successfully achieves an immediate mechanical effect that is maintained long-term through incorporation of paclitaxel to maintain patency.

Efficacy and durability of holmium laser enucleation of the prostate in the management of acute and chronic urinary retention A retrospective study.

Our study aimed to assess the efficacy and durability of holmium laser enucleation of the prostate (HoLEP) in managing acute urinary retention (AUR), neurogenic chronic urinary retention (NCUR), and non-neurogenic chronic urinary retention (NNCUR). We also sought to compare outcomes in patients with preoperative urinary retention (UR) to those without. We conducted a retrospective analysis using prospectively gathered data from men who underwent HoLEP at our institution between October 2017 and 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 HoLEP. Chronic urinary retention (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. NCUR and NNCUR were differentiated based on the presence of any significant illness or injury with a neurologic impact on the bladder. 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. Three hundred sixty-eight males who underwent HoLEP were included in our study. The UR group consisted of 189 patients (70 AUR, 42 NCUR, and 77 NNCUR), and the lower urinary tract symptoms (LUTS) group was comprised of 179 individuals. There were no statistically significant differences between the NCUR and NNCUR subgroups regarding demographics and outcomes. At 12 months postoperative, the AUR group had a higher catheter-free rate than the CUR group (p=0.04), and other outcome variables were comparable between the two cohorts. The UR group had a significantly lower QoL score at one month (p=0.01) and a significantly lower IPSS score at one and 12 months (p=0.034 and p=0.018, respectively) than the LUTS cohort. During all followup visits, the UR group had a significantly higher PVR than the LUTS cohort. The successful first trial of void (TOV) rate for the UR and LUTS groups was 81% and 83.2%, respectively. At 12 months postoperative, the catheter-free rate for the UR and LUTS cohorts was 96.3% and 99.4%, respectively. HoLEP is an effective and durable treatment for UR with a high catheter-free rate and comparable outcomes when performed to manage LUTS.

Development and validation of a prediction model for postoperative urinary retention after prolapse surgery: A retrospective cohort study

BackgroundPostoperative urinary retention (POUR), a common condition after prolapse surgery with potential serious sequelae if left untreated, lacks a clearly established optimal timing for catheter removal. This study aimed to develop and validate a predictive model for postoperative urinary retention lasting > 2 and > 4 days after prolapse surgery.MethodsWe conducted a retrospective review of 1,122 patients undergoing prolapse surgery. The dataset was divided into training and testing cohorts. POUR was defined as the need for continuous intermittent catheterization resulting from a failed spontaneous voiding trial, with passing defined as two consecutive voids ≥ 150 mL and a postvoid residual urine volume ≤ 150 mL. We performed logistic regression and the predicted model was validated using both training and testing cohorts.ResultsAmong patients, 31% and 12% experienced POUR lasting > 2 and > 4 days, respectively. Multivariable logistic model identified 6 predictors. For predicting POUR, internal validation using cross-validation approach showed good performance, with accuracy lasting > 2 (area under the curve [AUC] 0.73) and > 4 days (AUC 0.75). Split validation using pre-separated dataset also showed good performance, with accuracy lasting > 2 (AUC 0.73) and > 4 days (AUC 0.74). Calibration curves demonstrated that the model accurately predicted POUR lasting > 2 and > 4 days (from 0 to 80%).ConclusionsThe proposed prediction model can assist clinicians in personalizing postoperative bladder care for patients undergoing prolapse surgery by providing accurate individual risk estimates.

Comparative study of tamsulosin, tadalafil, and combination of tamsulosin with tadalafil in the treatment of patients with lower urinary tract symptoms

Purpose: Benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) commonly coexist in aging men. Tamsulosin and tadalafil are widely used for lower urinary tract symptoms (LUTS) and ED, respectively. A combination of these 2 drugs might be useful to design new management strategies, as treatment of LUTS might affect ED. Furthermore, the effect of tadalafil alone or in combination with tamsulosin on LUTS has not been widely studied, especially in our country. We conducted a study to compare the effects of tamsulosin, tadalafil, and a combination of tamsulosin and tadalafil in patients with LUTS with or without ED. Materials and methods: In this observational study, 81 men with LUTS due to BPH were included. Patients were divided into 3 groups of 27 patients each. Group A received tamsulosin 0.4 mg/d alone, group B tadalafil 5 mg/d alone, and group C combination therapy (tamsulosin and tadalafil both). All patients were evaluated for the International Prostate Symptom Score (IPSS), the International Index of Erectile Function 5 score, the maximum urinary flow rate, and postvoid residual urine volume. Results: IPSS improvement was seen in all groups (−50.90%, P &lt; 0.05; −28.57%, P &lt; 0.05; and −54.83%, P &lt; 0.05, respectively). An improvement in International Index of Erectile Function 5 was also seen in all 3 groups (+39.28%, P &lt; 0.05; +45.9%, P &lt; 0.05; and +55.4%, P &lt; 0.05, respectively). Maximum urinary flow rate and postvoid residual also showed improvement in all 3 groups (33.9%, P &lt; 0.05; 29.92%, P &lt; 0.05; and 39.71%, P &lt; 0.05 and −60.60%, P &lt; 0.05; −48.51%, P &lt; 0.05; and −62.18%, P &lt; 0.05, respectively). Conclusion: In patients with LUTS due to BPH, tadalafil and tamsulosin, either alone or in combination, significantly reduce LUTS. In addition, these drugs significantly enhance erectile function in males with LUTS, whether taken alone or in combination. We found no statistically significant improvement in either the IPSS or the ED scores when comparing the combination group to the tamsulosin-alone and the tadalafil-alone groups.