Preoperative Bladder Outlet Obstruction Research Articles

Changes of lower urinary tract function after robot-assisted radical prostatectomy: An urodynamic follow-up within 1 year.

This study investigated the changes of lower urinary tract function after robot-assisted radical prostatectomy (RaRP) with 1-year urodynamic follow-up. Clinically localized prostate cancer patients receiving RaRP were prospectively enrolled. We analyzed their clinical symptoms, stress urinary incontinence (SUI) and urge urinary incontinence (UUI) status, and videourodynamic studies (VUDSs) during the postoperative 1st year. In total, 74 patients were enrolled with a mean age of 69.4 ± 8.1 years, a mean total prostate volume of 34.7 ± 15.9 mL, a ≥pT3 stage proportion of 37.8%, and a positive surgical margin rate of 18.9%. The International Prostate Symptom Score significantly reduced from 7.3 ± 6.0 before surgery to 4.1 ± 4.1 at postoperative 1 year. Significantly increased full sensation, reduced detrusor voiding pressure, increased maximal urinary flow rate, and decreased bladder outlet obstruction index were noted at 1-year VUDS follow-up. The changes of VUDS parameters were significantly different between the patients with and without preoperative bladder outlet obstruction. At postoperative 1 year, 8.1% and 6.8% of patients experienced SUI and UUI, respectively. In multivariate analysis, the factors of T stage ≥3, preoperative detrusor overactivity (DO), and positive surgical margin were the independent predictors of immediate SUI and SUI at 3 and 12 months, respectively. During the 1st year after RaRP, patients experienced significant changes of lower urinary tract function demonstrated in VUDS with the improvement in clinical symptoms. Factors of T stage ≥3, preoperative DO, and positive surgical margin were the predictors of postoperative SUI.

Predictors of further anti-incontinence interventions or transvaginal urethrolysis after a pubovaginal sling procedure in women with and without neurologic disorders

The impact of neurologic disorders on the clinical outcome of suburethral sling procedures has seldom been studied. Our aim is to elucidate factors predicting further anti-incontinence interventions or transvaginal urethrolysis after a re-adjustable pubovaginal sling procedure (PVS), especially in patients with neurologic disorders. Medical records of all consecutive women who underwent re-adjustable PVS for stress urinary incontinence (SUI) were reviewed. A total of 589 women were enrolled, 152 (25.8%) women were found to have persistent or recurrent SUI after surgery, and 39 (6.6%) women underwent further anti-incontinence interventions. Postoperative voiding dysfunction was found in 46 (7.8%) women, and 23 women (3.9%) underwent transvaginal urethrolysis. Low body mass index (hazard ratio=0.92) and low functional bladder capacity (dL, hazard ratio=0.83) were factors predicting the presence of persistent/recurrent SUI. However, the presence of spinal cord disorder (hazard ratio=8.91) and a history of prior surgery for pelvic organ prolapse (hazard ratio=2.51) were factors predicting further anti-incontinence interventions. A high post-void residual volume (PVR, dL, hazard ratio=1.52) and preoperative bladder outlet obstruction (BOO, hazard ratio=5.39) were factors predicting postoperative voiding dysfunction. Similarly, a high PVR (dL, hazard ratio=1.50) and preoperative BOO (hazard ratio=5.38) were factors predicting transvaginal urethrolysis. A PVR >1.51dL was an optimal cut-off value for predicting transvaginal urethrolysis. The presence of spinal cord disorder and prior surgery for pelvic organ prolapse were predictors of further anti-incontinence interventions after re-adjustable PVS. In addition, a large PVR and preoperative BOO were predictors of transvaginal urethrolysis after re-adjustable PVS.

Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty

BackgroundPostoperative urinary retention (POUR) in total joint arthroplasty (TJA) is common. However, risk factors for POUR and its consequences, specifically on postoperative renal function, have not been well defined. MethodsWe performed a review of prospectively collected data on consecutive adult patients undergoing primary total joint arthroplasty from August 2014 to December 2015. Catheters were placed preoperatively and removed on the first or second postoperative day. The exclusion criterion was traumatic catheter insertion or the presence of fracture or neoplasm. Univariate and multiple logistic regression identified associations with POUR and its invasive therapies. Subgroup analysis of renal function by incidence of preoperative bladder outlet obstruction (BOO) and POUR was performed with nonparametric testing. ResultsA total of 591 operations met inclusion criteria. The incidence of POUR was 6.4% and was directly related to a positive history of BOO (odds ratio [OR]: 4.15) and increased the duration of urinary catheterization (OR: 1.04). These factors, in addition to preoperative incontinence (OR: 8.36, 28.69) and lengthier hospitalizations (OR: 1.37, 1.30), were significantly associated with intermittent straight catheterization and reinsertion of an indwelling catheter to treat POUR. Serum creatinine increased with combined preoperative BOO and POUR (+0.22 mg/dL) but was preserved in others (+0.02-0.04 mg/dL) (P < 0.01). ConclusionsPreoperative BOO and longer catheterization increased the risk of POUR and were associated with the use of invasive modalities to treat POUR. POUR was associated with a longer hospitalization and impaired renal function in those with preoperative BOO; therefore, renal function should be monitored closely and nephrotoxic medications used cautiously when using urinary catheters in this patient population. Level of EvidenceRetrospective Analysis, Level IV.

Role of urodynamics in management of urethral diverticulum in females

BackgroundFew studies have focused on the urodynamic findings of urethral diverticula (UD). We characterized the symptoms and urodynamic findings in women with UD. MethodsA retrospective review of all women in a single center having surgical treatment for symptomatic UD between May 2004 and September 2014 was done. Lower urinary tract symptoms were evaluated with International Prostate Symptom Score and Overactive Bladder Symptom Score questionnaires. All patients underwent magnetic resonance imaging and videourodynamic study (VUDS) prior to surgery, and postoperative evaluation with VUDS. ResultsA total of 20 female patients were enrolled into the study. 12 (60%) UD patients presented with symptoms of stress urinary incontinence (SUI). However, there were merely 3 (15%) patients diagnosed as urodynamic SUI. 15 (75%) patients exhibited low catheter-free uroflow. Detrusor overactivity was demonstrated in 4 (20%) patients. Bladder outlet obstruction (BOO) was diagnosed in 8 (40%) cases. Postoperative VUDS revealed persistent BOO in 50% of patients with preoperative BOO. Of these, residual diverticulum was noted by VUDS in one patient. ConclusionFor UD patients with urinary incontinence or voiding dysfunction, VUDS is helpful in accurately characterizing these symptoms.

Predictors for detrusor overactivity following extensive vaginal pelvic reconstructive surgery.

This study aims to identify the predictors for detrusor overactivity (DO) in women following extensive vaginal pelvic reconstructive surgery (PRS) for advanced pelvic organ prolapse (POP). We enrolled 1503 women who had prolapse POP-Q stage ≥ 3 and underwent vaginal PRS with or without MUS from January 2006 to December 2015. All subjects completed a 72-h voiding diary, IIQ-7, UDI-6, POPDI-6, and PISQ-12. Urodynamics (UDS) was performed pre- and post-operatively. Among 1503 women, 56 patients were excluded due to incomplete data. Women who had trans-vaginal mesh were 1083 of 1447 (74.8%) and concomitant MUS were 353 (24.4%). Pre-operative DO were 245 (16.9%) and 24.5% (60/245) of them continued to have persistent DO post-operatively. Women who had normal pre-operative stable detrusor were 1202 (83.1%) and 3.5% (30/1202) developed de novo DO post-operatively. The overall incidence of post-operative DO was 6.2% (90/1447). Patients with age ≥66 year, neurological factors like Cerebrovascular accident and Parkinsonian disease, pre-operative bladder outlet obstruction (BOO) maximum urethral closure pressure (MUCP) ≥60 cmH2 O, Maximum flow rate (MFR) <15 mL/s and detrusor at maximum flow (Dmax) ≥20 cmH2 O) and post-void residue (PVR) ≥200 mL hold a significant higher risk of developing DO either persistent or de novo following PRS. Age ≥66 year, neurological factors like CVA and Parkinsonian disease, pre-operative MUCP ≥60 cmH2 O, MFR < 15 mL, Dmax ≥ 20 cmH2 O, and PVR ≥ 200 mL are independent risk factors for developing post-operative DO following vaginal PRS for advanced POP.

Predictors of persistence of preoperative urgency incontinence in women following pelvic organ prolapse repair

ObjectiveTo investigate the predictors of persistence or resolution of preoperative urgency urinary incontinence (UUI) in women following transvaginal mesh (TVM) repair for advanced pelvic organ prolapse (POP). Material and methodsPatients with advanced POP undergoing TVM repair between 2008 and 2013 in a tertiary hospital were recruited. All patients underwent evaluation including a structured urogynecological questionnaire, voiding diary, pelvic examination using the POP-quantitation system, and urodynamic testing before and after surgery, and intraoperative cystoscopy. Patient demographics, lower urinary tract symptoms, urodynamic findings, and severity of prolapse were analyzed between women with and without preoperative UUI. ResultsOf 174 patients who underwent TVM repair, 49 (28.2%) had preoperative UUI; after operation, 23 (13.2%) were found to have postoperative UUI and 13 (7.5%) developed de novo UUI. For those 49 patients with preoperative UUI, 10 (20.4%) had persistent UUI and 19 (38.8%) developed de novo stress urinary incontinence postoperatively. The prevalence of preoperative bladder outlet obstruction, preoperative maximal cystometric capacity (MCC) < 300 mL, preoperative severe bladder trabeculation, and duration of POP symptoms > 60 months were significantly higher in patients with persistent UUI than without it. Logistic regression demonstrated that preoperative MCC<300 mL, severe bladder trabeculation, and duration of POP symptoms > 60 months were associated with persistent UUI after prolapse repair. ConclusionFor women with identified preoperative risk factors, including MCC<300 mL, severe bladder trabeculation, and POP symptoms > 60 months, preoperative counseling should consist of a discussion about persistent UUI symptoms following TVM repair and the development of de novo stress urinary incontinence.

Nonspecific genitourinary pain improves after prostatectomy using holmium laser enucleation of prostate in patients with benign prostatic hyperplasia: a prospective study.

ObjectiveTo investigate changes in nonspecific genitourinary discomfort or pain (GUDP) before and after holmium laser enucleation of prostate (HoLEP). GUDP associated with lower urinary tract symptoms (LUTS) is a common complaint among benign prostatic hyperplasia (BPH) patients, but very little is known about this clinical entity.MethodsFrom February 2010 to August 2011, 100 HoLEP patients with complete clinical data at a single institution were enrolled in the study to analyze the degree of GUDP with a visual analog scale (VAS) from 0 to 10 points at baseline and at 3 and 6 months postoperatively, and to investigate any relationships between GUDP and urodynamics, uroflowmetry, and scores from the International Prostate Symptom Score (IPSS) questionnaire.ResultsFifty-six patients had LUTS only, while the remaining 44 had both LUTS and GUDP. Pain was located in the suprapubic (42.0%), perineal/penile (33.0%), back (17.0%), and perianal (8.0%) regions. During the post-operative period, at six months, the VAS, IPSS, peak flow rate and post-void residual volume had improved significantly in 44 GUDP patients (p<0.010). GUDP had completely resolved in 40 (90.9%) patients and had decreased in four (9.1%) patients, while seven (12.5%) patients developed GUDP with voiding in the urethral and perineal areas by the third month postoperatively. When compared to patients with complete resolution, those with persistent GUDP were found to have a significantly higher preoperative presence of bladder outlet obstruction (BOO) as an independent risk factor (OR 6.173, 95% CI 1.132–1.323).ConclusionBoth GUDP and LUTS improved significantly after HoLEP. Patients with significant preoperative BOO tended to have persistent GUDP after surgery.

2271 THE EFFECT OF HOLMIUM LASER ENUCLEATION OF PROSTATE ON NONSPECIFIC GENITOURINARY PAIN IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA: A PROSPECTIVE STUDY WITH URODYNAMIC CORRELATION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamics Testing1 Apr 20132271 THE EFFECT OF HOLMIUM LASER ENUCLEATION OF PROSTATE ON NONSPECIFIC GENITOURINARY PAIN IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA: A PROSPECTIVE STUDY WITH URODYNAMIC CORRELATION Sung Han KIM, Hahn-Ey Lee, Min Soo Choo, Jungbum Bae, Jin-Kyu Oh, and Seung-June Oh Sung Han KIMSung Han KIM Seoul, Korea, Republic of More articles by this author , Hahn-Ey LeeHahn-Ey Lee Seoul, Korea, Republic of More articles by this author , Min Soo ChooMin Soo Choo Seoul, Korea, Republic of More articles by this author , Jungbum BaeJungbum Bae Seoul, Korea, Republic of More articles by this author , Jin-Kyu OhJin-Kyu Oh Seoul, Korea, Republic of More articles by this author , and Seung-June OhSeung-June Oh Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2200AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with benign prostatic hyperplasia (BPH) often experience nonspecific genitourinary discomfort or pain (GUDP). To our knowledge, very little is known about the characteristics or natural history of GUDP. We investigated changes of GUDP before and after holmium laser enucleation of prostate (HoLEP) in patients with BPH. METHODS We analyzed the clinical data of 100 consecutive patients who underwent HoLEP from February 2010 to August 2011 from the prospectively collected BPH Database Registry. We assessed the degree of GUDP with a visual analog scale (VAS) from 0 to 10 points preoperatively, 3 and 6 months postoperatively. RESULTS The average age was 68.4 (±6.5, SD) years. The mean prostate volume was 69.5 (±32.7) mL and the average volume of the enucleated prostate was 25.4 (±21.0)mL. Among 100 patients, 56% had only LUTS and 44% had LUTS combined with GUDP. The locations of pain were suprapubic (42%), perineal/penile (33%), back (17%), and anal (8%) areas.During postoperative 6-month follow-up, the VAS (3.2±1.9 →> 0.2±0.8),IPSS scores (18.5 ±7.6 →5.1 ±5.1),Qmax(10.0 ±5.3→> 24.6 ±11.5ml/sec) and PVR (52.8±73.6 →17.6±26.5ml) showed significant improvement after HoLEP in 44 GUDP patients(p<0.010).The GUDP disappeared in 40 (90.9%) and decreased in 4 (9.1%) patients, while de novo postoperative GUDP developed in 7 (12.5%) patients at postoperative third month. The 7 de novo GUDP patients complained of voiding pain at urethral (4 patients) and perineal (3 patients) areas. When compared with the patients with persistent GUDP, those who experienced disappearance of GUDP had significantly higher scores in all IPSS categories and bladder outlet obstruction (BOO) preoperatively (p<0.05).A multivariate analysis showed that only preoperative presence of BOO proved to be a significant risk factor for baseline GUDP (OR 6.173, 95% CI 1.132-13.230, p=0.04). Compared with no GUDP patients (n=49), the de novo GUDP group (n=7) had lower PSA and smaller transitional zone volume, larger bladder capacity and detrusor overactivity (p<0.05).However, no parameters were significant in multivariate analysis. CONCLUSIONS Our study demonstrated that preoperative BOO was responsible for GUDP. Both GUDP and LUTS improved significantly after HoLEP in this cohort. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e931 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sung Han KIM Seoul, Korea, Republic of More articles by this author Hahn-Ey Lee Seoul, Korea, Republic of More articles by this author Min Soo Choo Seoul, Korea, Republic of More articles by this author Jungbum Bae Seoul, Korea, Republic of More articles by this author Jin-Kyu Oh Seoul, Korea, Republic of More articles by this author Seung-June Oh Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Is there a correlation between the outcome of transurethral resection of prostate and preoperative degree of bladder outlet obstruction?

To compare the impact of transurethral resection of prostate (TURP) on symptom scores and maximal flow rates (Qmax) in patients with equivocal bladder outlet obstruction (BOO) and definite BOO and to assess the relationship between the surgical outcomes and degree of preoperative BOO, we prospectively evaluated men with lower urinary tract symptoms and bladder outlet obstruction index (BOOI) greater than 20, who were refractory to conventional medical treatment and underwent TURP. Urodynamic evaluation, International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual volume (PVR) check and transrectal ultrasound were performed. 20<BOOI<40 was defined as equivocal BOO and BOOI≥40 as definite BOO. Changes of IPSS, Qmax, PVR and correlation analysis was performed between the degree of improvement of Qmax, subdomains of IPSS and BOOI. Fifty-four patients showed equivocal BOO and 80 patients showed definite BOO. Preoperatively equivocal BOO group and definite BOO group showed significant differences in maximal bladder capacity and prevalence of detrusor overactivity, whereas no difference was noted in prostate volume. Postoperatively both groups showed improvements in Qmax, obstructive (IPSSO) and irritative (IPSSI) subdomain of IPSS, but the degree of improvement in Qmax and IPSSI subdomain was statistically significantly greater in definite BOO group. The degree of improvement of Qmax and IPSSI showed weak correlation with preoperative BOOI. As a weak correlation was identified between preoperative degree of BOO and outcome of TURP, other factors other than BOOI such as severity of patients' symptoms should be considered in deciding treatment modality.

The Influence of Preoperative Bladder Outlet Obstruction on Continence and Satisfaction in Patients with Stress Urinary Incontinence after Midurethral Sling

PurposeWe studied the influence of preoperative bladder outlet obstruction (BOO) on postoperative continence rates and patient satisfaction after the midurethral sling procedure.MethodsA total of 159 women who underwent the midurethral sling procedure were evaluated. Using the Blaivas-Groutz nomogram, we assigned the patients were assigned to Group I (n=37, no obstruction), Group II (n=89, mild obstruction), or Group III (n=33, moderate to severe obstruction). Continence rates, patient satisfaction, urinary sensation scale and uroflowmetry were evaluated postoperatively.ResultsThere were no significant differences in continence rates, satisfaction, or postoperative maximal flow rate between the 3 groups. Postoperative urgency was improved after surgery in Groups I and II (P<0.05) but not in Group III.ConclusionsBOO does not seem to be a risk factor for failure after the midurethral sling procedure. However, BOO may be considered as a potential factor for persistent storage symptoms after the midurethral sling.

The Influences of Bladder Outlet Obstruction on Improvement of Storage Symptoms in Patients Who Underwent Transurethral Resection of Prostate

Purpose: To investigate the influences of preoperative bladder outlet obstruction (BOO) to be adjusted by age and prostate volume on improvement of storage symptoms in patients who underwent transurethral resection of prostate (TURP) in a long term follow up. Materials and Methods: We performed retrospective study of 75 patients with benign prostatic hyperplasia (BPH) who had undergone TURP and preoperative urodynamics from July 2004 to December 2006. 18 patients of them were lost follow up in this period, so we analyzed 57 patients in this study. The degrees of BOO were measured by the Abrams-Griffiths (AG) number calculated according to the preoperative urodynamic data. International Prostate Symptom Score (IPSS) questionnaire were used to evaluate improvement of symptoms. Especially IPSS questions number 2, 4 and 7 were used to evaluate storage symptoms. Partial correlation analysis was done between the AG numbers and the degree of storage symptoms improvement, adjusted by the age and the prostate volume. Results: There were significant decreases of the IPSS (p=0.029), storage symptom score (p=0.024) and frequency score (p=0.017) in BOO group compared to the non-BOO group. The changes of IPSS (γ=−0.338, p=0.012), storage symptoms score (γ=−0.292, p=0.031) and frequency symptom score (γ=−0.305, p=0.023) were significantly correlated with AG number. Conclusions: These results suggested that the preoperative AG number derived from urodynamics was an important factor in predicting the postoperative results. It would be expected that the patients with high AG numbers might be more improved storage symptom after TURP. (Korean J Urol 2008;49:912-916) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏