Preoperative Urinary Retention Research Articles

The Utilization of Benign Prostatic Hyperplasia and Bladder-Related Medications After a Transurethral Prostatectomy

To determine how often prostate- and bladder-specific medications for lower urinary tract symptoms are used following a transurethral prostatectomy (TURP). This study utilized several linked, routinely collected datasets from the province of Ontario, Canada to identify men older than 66 years who underwent their first TURP between April 2003 and March 2016. The primary outcome was the probability of using at least 30 days of either prostate-specific alpha blockers (AB), 5-alpha reductase inhibitors (5ARI), or anticholinergics/beta-3 agonists (AC/B3) after their TURP. We identified 58,038 men (median age 75), with a median follow-up of 4.9 years. In the 6 months prior to their TURP, AB, 5ARIs or AC/B3 were used by 62%, 32%, and 6%, respectively. Following a 90-day washout period after TURP, these medications were used by 27%, 20%, and 15% of men, respectively. The cumulative probability of using these medications within the first 10 years after TURP was 38%, 28%, and 20%, respectively. Family physicians prescribed the majority of AB, while urologists prescribed the majority of the AC/B3. Among men on AC/B3 prior to TURP, 46% used them after TURP; in multivariate cox regression analysis age ≥75, diabetes, preoperative use of AC/B3, and no preoperative urinary retention predicted postoperative utilization of AC/B3 medications. There is considerable use of AB and 5ARIs despite a lack of evidence for using these medications after a TURP. Given the well-characterized placebo response in BPH patients, this practice should be properly evaluated for clinical efficacy.

Abdominal sacrocolpopexy with Pelvicol xenograft and concomitant Burch colposuspension.

PurposeTo evaluate the efficacy of Pelvicol xenograft use during abdominal sacrocolpopexy to repair pelvic organ prolapse (POP).Patients and methodsA total of 27 consecutive women with symptomatic POP were included in this study. A POP-quantification system and International Continence Society classification were used. Functional and anatomical outcomes were assessed. Subjective outcomes and physical activity after surgery were evaluated due to modified quality of life questionnaire.ResultsMedian follow-up was 21 months (range: 16 to 41 months). Twenty-four (89%) patients were available for anatomical and subjective evaluation. Preoperative POP-quantification classification was: stage I: 11.1%, stage II: 25.9%, stage III: 48.2%, and stage IV: 14.8%. Overall, pad usage significantly decreased (mean 4.8 vs 1 pads, P=0.001). Stress urinary incontinence significantly improved after surgery in nine women (P=0.001). An additional five women were completely continent. No de-novo incontinence developed. Six women with preoperative urinary retention improved in the amount of residual urine postoperative (mean 35 vs 165 mL). Failure rate was 8.3% at 3 and 11 months after surgery, requiring a second reconstruction. There was no graft related complications or graft rejections necessitating removal occurring. Response rate of the questionnaire was 67%. Two women reported no interference in physical activity after 2 postoperative months, five women after 5 months, and five women 1 year later. Pelvic pain (vaginal pain) was partly improved in eight patients, postoperatively, and ten patients had complete resolution of pain after surgery.ConclusionThis study demonstrates that abdominal sacrocolpopexy is an effective surgical treatment in correcting POP. The use of Pelvicol is associated with a high recurrence rate and increased failure rate compared to traditional sacrocolpopexy with mesh. Larger clinical trials to evaluate the functional and anatomical outcomes are needed.

Comparison of 120 W 2-μm laser resection of the prostate outcomes in patients with or without preoperative urinary retention.

IntroductionThe 2-μm (thulium) laser is a new surgical laser for benign prostatic hyperplasia (BPH).AimTo report on the long-term outcome of 120 W TmLRP-TT in BPH patients with or without preoperative urinary retention.Material and methodsThe study was conducted from May 2013 to April 2015 among patients who were diagnosed with BPH and underwent TmLRP-TT. Patients were divided into two groups: with and without preoperative urinary retention. Pre- and post-operative data were evaluated for prostate-specific antigens (PSA), International Prostate Symptom Score (IPSS), Quality Of Life Score (QOLS), maximum flow rate (Qmax), and post-void residual urine volume (PVR).ResultsA total of 310 patients were enrolled for a follow-up period of more than 12 months. Overall 95 (30.6%) patients had urinary retention before TmLRP-TT, while 215 (69.4%) did not. We found that patients with urinary retention tended to have larger prostates and a higher PSA score. So a longer operation time and catheterization time were observed in them. Yet there was no difference in other perioperative and postoperative parameters. Postoperatively IPSS, QOLS, Qmax, and PVR showed a significant improvement in each group, but no significant difference was identified between the two groups.ConclusionsThis study represents the first direct comparison of TmLRP-TT outcomes in patients with or without urinary retention. With safe use, resultant excellent homeostasis, high cutting efficiency and rapid vaporization, 120 W 2-μm laser resection of the prostate has been proved to be safe and effective, and there was no increased risk for patients with urinary retention.

Safety and Efficacy of GreenLight XPS Laser Vapoenucleation in Prostates Measuring Over 150 mL.

The GreenLight™ XPS Laser System (GL-XPS) is a safe and efficacious treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH), but there is limited evidence on its use in prostates over 150 mL. We demonstrate the safety and efficacy of the GL-XPS system using a vapoenucleation technique in prostate glands measuring over 150 mL. We prospectively collected data on all consecutive patients with prostates measuring over 150 mL on transrectal ultrasound treated with the GL-XPS (AMS, Inc., Minnetonka, MN) at a tertiary referral center from September 2011 to October 2015. Data collected include prostate volume, International Prostate Symptom Score (IPSS) and quality of life (QoL) scores, maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate-specific antigen, complications, and reintervention rates. Seventy male patients with a median prostate size of 202 mL (range 152-376 mL) were included. There were 41 patients (59%) in preoperative urinary retention with an indwelling catheter preoperatively. Thirty-seven (53%) patients were American Society of Anesthesiologists (ASA) class 2 and 33 (47%) were class 3. Median operative time was 180 minutes, laser time 97 minutes, energy utilization 674 kJ, and energy density 3.3 kJ/mL, with median 3 fibers used per case. Median length of stay and length of catheterization were 1 day. IPSS and QoL scores demonstrated significant improvements from baseline at all endpoints, improving from 16 to 3.5 and from 4 to 1 at 24 months, respectively (p = 0.001). At 12 months, Qmax and PVR improved from 10.1 to 22.4 mL/s (p = 0.043) and from 84 to 31.4 mL (p = 0.015), respectively. Retreatment was required in two patients (2.9%). GL-XPS vapoenucleation provided durable subjective and objective improvements in symptoms and voiding parameters, with no serious adverse events in men with prostates >150 mL.

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Apr 2016This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.01.013AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Adult Urology." The Journal of Urology, 195(4 Part 1), pp. 815–816 References 1 : Unplanned hospital return for infection following ureteroscopy—can we identify modifiable risk factors?. J Urol2016; 195: 931. Link, Google Scholar 2 : Root causes and modifiability of 30-day hospital readmissions after radical cystectomy for bladder cancer. J Urol2016; 195: 894. Link, Google Scholar 3 : Multi-institutional experience with robotic nephrectomy with inferior vena cava tumor thrombectomy. J Urol2016; 195: 865. Link, Google Scholar 4 : Comorbid disease burden is independently associated with higher risk disease at prostatectomy in patients eligible for active surveillance. J Urol2016; 195: 919. Link, Google Scholar 5 : Final pathological stage after neoadjuvant chemotherapy and radical cystectomy for bladder cancer—does pT0 predict better survival than pTa/Tis/T1?. J Urol2016; 195: 886. Link, Google Scholar 6 : Comparison of holmium laser prostate enucleation outcomes in patients with or without preoperative urinary retention. J Urol2016; 195: 1021. Link, Google Scholar 7 : Outcomes of laparoscopic partial nephrectomy in patients continuing aspirin therapy. J Urol2016; 195: 859. Link, Google Scholar 8 : Natural history, complications and re-intervention rates of asymptomatic residual stone fragments after ureteroscopy: a report from the EDGE Research Consortium. J Urol2016; 195: 982. Link, Google Scholar 9 : A retrospective analysis of the effect on survival of time from diagnosis to neoadjuvant chemotherapy to cystectomy for muscle invasive bladder cancer. J Urol2016; 195: 880. Link, Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 195Issue 4 Part 1April 2016Page: 815-816 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

An appraisal of a technical modification for prevention of bladder neck stenosis in retropubic prostatectomy: An initial report.

Objective:To report the experience with our technical modification of the trigone-bladder neck complex management in the prevention of bladder neck stenosis (BNS) following open simple retropubic prostatectomy.Materials and Methods:It was a retrospective review of data of patients that underwent open simple retropubic prostatectomy with technical modification of the trigone-bladder neck complex in two Nigerian tertiary hospitals, by a single surgeon, from January 2007 to December 2011. The data analysed included the demographic variables, the modes of presentation, need for blood transfusion, duration of catheterization and the duration of hospital stay. The primary end-point was the development or otherwise of BNS.Results:Eighty-seven patients’ data were available for analysis from a total of 91 patients. The mean age (±standard deviation [SD]) was 65.14 years (±10.55). Preoperative urinary retention was present in 58% of the patients. The maximal flow rate (Qmax) was 12.05 ml/s among the 20 patients that had preoperative uroflowmetry. The transfusion rate was 35%, but almost two-third of them had only one unit of blood transfused. The mean weight (±SD) of the enucleated adenoma was 82.64 g (±36.63). Bladder irrigation was required in 14% of the patients, majority of the patients had urethral catheter removed after 96 h and the mean hospital stay was 6.52 days. No patient developed BNS after a mean follow-up duration of 16.39 months.Conclusion:Bladder neck stenosis can be a distressing complication of prostatectomy. The result of our technical modification of managing the trigone-bladder-neck complex looks promising for prevention or delaying the onset of BNS. A long-term observation and a prospective randomised control trial to ascertain this initial experience is needed.

Comparison of Holmium Laser Prostate Enucleation Outcomes in Patients with or without Preoperative Urinary Retention

We determine whether outcomes of holmium laser enucleation of the prostate are similar in patients with and those without preoperative urinary retention. From May 2008 to July 2014, 231 patients underwent holmium laser prostate enucleation for symptomatic benign prostatic hyperplasia. Retrospective analysis was performed to evaluate for differences in postoperative outcomes for patients with and those without preoperative urinary retention. Overall 95 patients (41%) had urinary retention before holmium laser prostate enucleation while 136 (59%) did not. Mean followup for all patients was 15.3 months. Patients with retention tended to be older, have larger prostates, and have higher scores on the AUA SS and bother questionnaires (all p<0.05). Postoperatively there was no difference in rates of complications, including urinary retention. Both groups showed significant improvement in AUA SS and bother score after the procedure at all postoperative points. Median post-void residual was less than 60 ml and median maximum flow rate on uninstrumented uroflow was greater than 18 ml per second at all postoperative points for all patients regardless of preoperative retention status. No patients required long-term catheterization and rates of postoperative complications did not differ significantly during the followup period. This study represents the first direct comparison to our knowledge of holmium laser prostate enucleation outcomes in patients with or without urinary retention. There was no increased risk of postoperative urinary retention in patients with preoperative retention, and both groups demonstrated significant postoperative improvement in subjective and objective voiding measures.

Urinary Retention After Hysterectomy and Postoperative Analgesic Use.

This study aimed to determine risk factors, including postoperative analgesic use, for the development of postoperative urinary retention (PUR) after hysterectomy for routine gynecologic indications using a case-control study design. Cases of PUR after hysterectomy were identified from billing data. Cases were those patients requiring recatheterization for inability to void. Controls were similarly identified and matched by age and date of surgery in a 3:1 control-to-case ratio. Chart review was performed to obtain demographic, medical, surgical, anesthetic, and medication data. Cumulative and interval doses of postoperative narcotic were recorded and converted into morphine equivalents. Crude odds ratios (ORs) were determined for potential risk factors for PUR using standard statistical analysis. Conditional logistic regression was used on multivariate models, including cumulative postoperative narcotic use, to determine adjusted ORs for risk factors. Twenty-six cases of PUR were matched with 78 controls. The cases had a higher body mass index (32 vs 28 kg/m2, P = 0.02), had a higher preoperative use of tricyclic antidepressants (TCA; 19.2% vs 1.3%, P = 0.004), were more likely to present preoperative urinary retention associated with fibroids (19.2% vs 0%, P < 0.01), and received a higher cumulative narcotic dose in the postoperative period (109 vs 73.6 mg, P < 0.001). In a multivariate model, preoperative TCA use (OR, 30.1; 95% confidence interval, 1.99-456; P = 0.01) and cumulative narcotic dose (OR, 2.54; 95% confidence interval, 1.44-4.56; P < 0.01) were significantly associated with PUR. Postoperative urinary retention after hysterectomy is associated with higher postoperative narcotic dose, preoperative TCA use, and preoperative urinary retention.

Postoperative voiding difficulty and mesh-related complications after Total Prolift System surgical repair for pelvic organ prolapse and predisposing factors.

We aimed to evaluate the incidence and predisposing factors of postoperative voiding difficulty and mesh-related complications. In this prospective cohort study, 206 consecutive women with advanced pelvic organ prolapse underwent surgical repair with the Prolift mesh kit at Peking Union Medical College Hospital, with a mean follow-up of 4.2 years. Postoperative voiding difficulty was defined as postvoid bladder volume of 100 mL or more (or more than one third of voided volume). The International Urogynecological Association/International Continence Society joint terminology was used for mesh-related complications and pain. Symptomatic recurrence was defined as symptomatic Pelvic Organ Prolapse Quantification stage II or higher. χ test and univariate or multivariate logistic regression were used for data analysis. Fourteen (6.8%) women were lost to follow-up. Postoperative voiding difficulty occurred in 60 of 192 (31.25%) women; low preoperative average urine flow (odds ratio [OR], 4.7; 95% CI, 1.3-17.2) and residual urine volume (OR, 2.6; 95% CI, 1.3-5.0) were independent risk factors. In total, 85% (51 of 60) reported symptom resolution within 3 days. Women with a postoperative residual urine volume of 200 mL or more experienced a more difficult recovery (P = 0.01). Mesh-related complications were reported in 29 of 192 (15.1%) women, with vaginal complications (mesh exposure/contraction) accounting for 69.0% (20 of 29). Greater blood loss (OR, 5.9; 95% CI, 2.1-18.7) and past pelvic surgical operation (OR, 6.3; 95% CI, 1.3-23.8) were strongly related to these complications. Three hematomas (7A) and six skin complications (6B) were also reported. However, the small participant sample prevented pain and recurrence analyses. Low average urine flow rate and preoperative urinary retention can be used to predict postoperative voiding difficulty. Vaginal complications (mesh exposure/contraction) are the primary mesh-related complications and are predicted by greater blood loss and past pelvic surgical operation.

Preoperative Urinary Retention Increased the Risk of Urinary Retention after Photoselective Vaporization of the Prostate.

PurposeThe aim of the present study was to evaluate preoperative acute urinary retention (AUR) as a factor affecting the outcomes of patients who underwent photoselective vaporization of the prostate (PVP), both in terms of overall effectiveness and the postoperative incidence of AUR.Materials and MethodsBaseline prostate characteristics were obtained for patients who underwent PVP, including prostate-specific antigen (PSA) levels, transrectal ultrasound findings, voiding diary parameters, the International Prostate Symptoms Score (IPSS), and uroflowmetry parameters. These parameters were assessed two weeks, one month, three months, six months, and three years postoperatively. Subjects were divided into AUR and non-AUR groups based on the preoperative occurrence of AUR.ResultsOf the 476 patients, 91 had at least one episode of preoperative AUR. The AUR group was found to be significantly older and to have significantly higher PSA levels, lower body mass indices, and larger prostates. At one year of follow-up, the total IPSS was 7.6±6.8 in the AUR group and 11.4±8.2 in the non-AUR group, with the AUR group showing a more significant improvement. In the non-AUR group, 17 of the 385 patients (4.4%) experienced postoperative retention, compared to 16 of the 91 patients (17.6%) patients in the AUR group.ConclusionsAlmost all patients exhibited improvements in subjective and objective voiding parameters following PVP, regardless of the presence of preoperative urinary retention. Patients with a preoperative history of AUR had a higher risk of postoperative retention.

Prevalence and Risk Factors of Urinary Incontinence and Bladder Retention in Gastric Bypass Surgery: a Cross-Sectional Study

Morbid obesity is a known risk factor for developing symptoms of urinary incontinence. However, it is not known if this leads to a high prevalence of perioperative incontinence and bladder retention after bariatric surgery because routine use of bladder catheterization is usual during this kind of surgery. The study was conducted at a general hospital in the Netherlands. Sixty morbidly obese female patients undergoing laparoscopic gastric bypass surgery were included in the present study. Preoperative urinary incontinence and risk factors were investigated by use of questionnaires. The following perioperative parameters were collected: operation time, total amount of intravenous fluids, preoperative urinary retention on the ward measured by bladder scan, postoperative urinary incontinence on the recovery room, postoperative urinary retention on the ward after passing urine measured by bladder scan, and observed urination on the ward. The prevalence of preoperative incontinence was 43%. Nine patients (15%) had postoperative urinary incontinence including four patients with known incontinence and five patients without. There were no differences between the patients with and without postoperative incontinence with relation to age, body mass index, diabetes mellitus, operation time, received amount of intravenous fluids and pre- and postoperative bladder scan residual volumes. Although the prevalence of urinary incontinence is high among morbidly obese female patients seeking bariatric surgery, postoperative incontinence was only present in 15% of patients, and there was no need for catheterization for bladder retention. Preoperative risk factors for developing this kind of complications could not be identified.

Outcome of Surgery for Benign Prostatic Hyperplasia-Is It Predictable?

The study was done to evaluate the pre-operative and intra operative factors which influence the post-operative outcome in patients undergoing surgery for Benign Prostatic Hyperplasia (BPH). It was carried out prospectively at a university college hospital in northern India. The study was carried out prospectively in 31 patients who underwent surgery for BPH (TURP - 50, Open Prostatectomy - 10). Various pre-operative and intra-operative parameters were studied by means of a detailed history and examination, IPS score, urodynamic evaluation & cystoscopic examination. Their effect on post-operative outcome was evaluated by measuring changes in IPSS, maximum and average flow rates, and fall in PSA values. Repeated measure ANNOVA was applied to calculate the significance of preoperative factors on post operative outcome (IPSS, Q max and Q av). All parameters studied in the patients improved significantly following surgery. Patients who had pre-operative urinary retention and catheter at the time of surgery had significant improvement in both subjective (IPSS ,p=.oo4) and objective (maximum & average flow rates p=.04) parameters studied. Patients with larger prostrate had a significantly better maximum flow rate (p=.03) and IPSS at 3 months post-operatively. Similarly, patients with larger bladder capacity (more than 150 ml), better compliance (more than 6 ml per cm of water) and lower post-voidal residue (less than 60ml) had better post-operative outcome. Patients with pre-operative urinary retention, shorter duration of bladder catheterization, lower post voidal residue, high IPSS score, larger prostrate, larger bladder capacity and compliance had a significantly better outcome following surgery for BPH as assessed by various parameters studied.

Experience With More Than 1,000 Holmium Laser Prostate Enucleations for Benign Prostatic Hyperplasia

Holmium laser prostate enucleation is a contemporary treatment for benign prostatic hyperplasia. We report our experience with more than 1,000 procedures. From June 1998 to March 2009 we performed 1,065 holmium laser prostate enucleations. After receiving institutional review board approval we retrospectively reviewed the database. Reported short-term, intermediate term and long-term results are 0 to 6, 6 to 12 and greater than 12 months, respectively. Bladder stones were present in 50 patients (4.7%) and 87 of the 717 (12.1%) with laboratory studies available had renal insufficiency. Preoperative urinary retention was present in 411 cases (38.7%). Significant preoperative stress and urge incontinence was noted in 8 and 16 patients, respectively. Mean transrectal ultrasound prostate volume was 99.3 gm (range 9 to 391). Mean preoperative American Urological Association symptom score was 20.3 (range 1 to 35) and maximum urinary flow was 8.4 cc per second (range 1.1 to 39.3). Intraoperative or postoperative complications occurred in 24 cases (2.3%). Mean followup was 287 days (range 6 to 3,571). At short-term, intermediate term and long-term followup the mean symptom score was 8.7, 5.9 and 5.3, and maximum urinary flow was 17.9, 19.5 and 22.7 cc per second, respectively. At the most recent followup 3 patients (0.3%) were in urinary retention. One patient with maximum urinary flow 20 cc per second required a second procedure for bleeding prostatic regrowth. Urethral stricture was noted in 9 (0.9%), 11 (1.3%), 4 (1.3%) and 0 patients, and bladder neck contracture was found in 0, 7 (0.8%), 4 (1.3%) and 5 (6.0%) at short-term, intermediate term, long-term and greater than 5-year followup, respectively. At the most recent followup significant stress and urge incontinence was noted in 9 and 6 patients, respectively. Holmium laser prostate enucleation is safe and effective for benign prostatic hyperplasia. The complication rate is low, and incontinence and the need for ancillary procedures are rare for holmium laser prostate enucleation with durable long-term results.

Transurethral GreenLight Laser Enucleation of the Prostate—A Feasibility Study

GreenLight laser vaporization is established as a minimally invasive procedure to treat patients with benign prostatic hyperplasia. Despite good functional results, it may be difficult to achieve adequate tissue removal for large prostates. In this study, we evaluated whether a transurethral enucleation technique is feasible with the GreenLight laser as a possible way to improve the amount of tissue removed. Following the technique described by Gilling for the holmium laser, we carried out transurethral enucleation of prostate adenoma with the 120W HPS GreenLight laser in 21 consecutive patients. Preoperative data were collected prospectively; prostate volume, International Prostate Symptom Score (IPSS), postvoid residual (PVR), prostate-specific antigen level, peak urinary flow rate, operative time, catherization period, length of hospitalization, and perioperative complications were recorded as well as the weight of the enucleated tissue and the applied laser energy. For follow-up, IPSS and PVR were recorded. Data are presented as mean±standard deviation. Fifty-two percent of the patients had preoperative urinary retention. Preoperative prostate volume was 74.6±21.7 cc; 34.7±21.7 g of tissue were enucleated. IPSS was reduced from 25±6 to 5±9 (P=0.0001), PVR from 126±80 to 11±18 (P=0.002) by GreenLight laser enucleation. Serious complications were not observed. Operative time was 112±27 minutes. Catheter time was 1.2±0.4 days. The length of hospitalization was 3.6±0.9 days. GreenLight laser enucleation is feasible and safe. Tissue reduction is complete, and good functional results are achieved. All patients were able to void properly. Major complications were not observed. The procedure is technically demanding, resulting in long operative times at the first interventions.

Experience With More Than 1,000 Holmium Laser Prostate Enucleations for Benign Prostatic Hyperplasia

Holmium laser prostate enucleation is a contemporary treatment for benign prostatic hyperplasia. We report our experience with more than 1,000 procedures. From June 1998 to March 2009 we performed 1,065 holmium laser prostate enucleations. After receiving institutional review board approval we retrospectively reviewed the database. Reported short-term, intermediate term and long-term results are 0 to 6, 6 to 12 and greater than 12 months, respectively. Bladder stones were present in 50 patients (4.7%) and 87 of the 717 (12.1%) with laboratory studies available had renal insufficiency. Preoperative urinary retention was present in 411 cases (38.7%). Significant preoperative stress and urge incontinence was noted in 8 and 16 patients, respectively. Mean transrectal ultrasound prostate volume was 99.3 gm (range 9 to 391). Mean preoperative American Urological Association symptom score was 20.3 (range 1 to 35) and maximum urinary flow was 8.4 cc per second (range 1.1 to 39.3). Intraoperative or postoperative complications occurred in 24 cases (2.3%). Mean followup was 287 days (range 6 to 3,571). At short-term, intermediate term and long-term followup the mean symptom score was 8.7, 5.9 and 5.3, and maximum urinary flow was 17.9, 19.5 and 22.7 cc per second, respectively. At the most recent followup 3 patients (0.3%) were in urinary retention. One patient with maximum urinary flow 20 cc per second required a second procedure for bleeding prostatic regrowth. Urethral stricture was noted in 9 (0.9%), 11 (1.3%), 4 (1.3%) and 0 patients, and bladder neck contracture was found in 0, 7 (0.8%), 4 (1.3%) and 5 (6.0%) at short-term, intermediate term, long-term and greater than 5-year followup, respectively. At the most recent followup significant stress and urge incontinence was noted in 9 and 6 patients, respectively. Holmium laser prostate enucleation is safe and effective for benign prostatic hyperplasia. The complication rate is low, and incontinence and the need for ancillary procedures are rare for holmium laser prostate enucleation with durable long-term results.

Urogynaecological dysfunction after radical hysterectomy

Aims To identify self-reported urogynaecological dysfunctions in women treated by radical hysterectomy, and predict risk factors. Methods A survey using questionnaires. Questionnaires were mailed to 396 patients. Results Symptoms of urinary incontinence and urinary retention were reported by more than one-third, respectively. One-third of the patients reported cystitis and dysuria. However, 78% of the women did not consider their symptoms as a problem. Analyses identified body mass index, at least one delivery, pre-operative urinary incontinence, and pulmonary disease as predictors for development of post-operative urinary incontinence. Predictive variables for urinary retention symptoms were age, cystitis and/or dysuria, previous rupture of the anal sphincter, fetal weight at delivery ≥4000 g, sensation of vaginal dryness, and pre-operative urinary retention symptoms. Considering post-operative cystitis and/or dysuria, fetal weight ≥4000 g, sensation of vaginal dryness, cystitis and/or dysuria before the operation, and physical activity were predictive variables. Conclusions Patients can be informed and advised about possible urinary tract symptoms. Special attention in the pre- and post-operative period can be paid to a subgroup of patients at high risk of later urogynaecological problems.

La resección transuretral de la próstata de baja presión hidráulica, resultados en 340 pacientes con adenomas grandes

Introductionthe transurethral resection of prostate TURP is the elective treatment for the small and medium adenomas. In this study they analyse the effectiveness, the results and the postoperative morbidity in the resection of the great adenomas. Patients and MethodWe study 340 patients with great adenomas and symptomatic infravesical obstruction that were operated with the low hydraulic pressure RTUP between August of 1999 and June of 2006. ResultsAverage Age of the patients 69 years (range 51-89). Prostate volume by TRUS, 107 ml (70-204). PSA 7,94 ng/ml (0,71-26,4). Weight of the resected fragments: 74,5gr. (50-160), time of the intervention 65 min. (35-155), postoperative urethral catheterisation 1.7 days (1-8), suprapubic derivation 6.5 days (5-15), the duration of hospital stay after surgery were 8 days (7-16), peak flow pre-op.11.2 ml/sec. (5-15,7), post-operative 19.7 ml/sec. (7-41,3). There were no cases of TURP syndrome in this group. Operative complications: Urinary infection without fever (bacteria >100.000) 95 patients (27.9%), bladder derivation by preoperative urinary retention 53 patients (15,6%). 18 patients (5,3%) with postoperative urinary retention. 11 patients (3,2%), with infection and fever >38°C. 7 patients (2%) with postoperative bladder bleeding, 2 patients (0,6%) with urethral lesion. 1 patient (0.3%), with massive scrotal hematoma (after vasectomy). Control of the pre and post operative hemoglobin: Hemoglobin pre-op 15 g/dl (12-19,3), hemoglobin post-op 11,5 g/dl (7,6-16,4), difference of (- 3,5g/dl) 23,3%. In only 29 patients (8.5%) it was necessary to carry out a sanguineous transfusions (heterolog) of 2 to 4 EC (500ml), the TRUS was 125 ml, weight of the fragments 90 gr. (52-140), the hemoglobin pre-op was 14,72g/dl and post-op of 8,8g/dl with a difference of (- 5,92g/dl) 40.2%. ConclusionsThe video assisted low hydraulic pressure TURP, is an effective method in the surgical treatment of great prostate adenomas. The severe postoperative complications are little, and in 311 patients (91.5%) it was not necessary sanguineous transfusion. The stationary treatment and the urethral catheterisation is smaller in comparison with the open adenomectomy.

Urethrolysis with martius labial fat pad graft for iatrogenic bladder outlet obstruction

This article evaluates treatment outcomes of urethrolysis with the Martius labial fat pad graft for patients with outlet obstruction after incontinence surgery. A total of 23 women were diagnosed with iatrogenic bladder outlet obstruction by urinary retention, urodynamic criteria, physical examination findings, and/or temporal relation of voiding dysfunction to anti-incontinence surgery. The urodynamic definition of female outlet obstruction was a maximum flow rate <12 mL/sec and a detrusor pressure at maximum flow >20 cm of water. Surgical treatment consisted of urethrolysis with complete circumferential urethral mobilization. A Martius labial fat pad graft was used to circumferentially wrap the urethra. No concurrent resuspension procedures were performed. Procedure efficacy was determined by retrospective review and phone interview. Mean patient age was 55 years (range, 37 to 85 years). Mean postoperative follow-up time was 15 months (maximum, 44 months). All patients related voiding dysfunction symptoms to their anti-incontinence surgery. In all, 17 of 23 (74%) patients had preoperative urinary retention requiring catheterization, and 63% of patients met urodynamic criteria for obstruction. After urethrolysis with a Martius labial fat pad graft, 20 of 23 (87%) patients had complete resolution of their obstruction; 3 patients required persistent catheterization. Postoperative stress incontinence was reported by 6 of 23 (13%) patients. Urodynamically documented detrusor instability occurred in 6 of 23 (26%) patients with de novo detrusor instability occurring in 3 of 15 (20%) patients.

Voiding dysfunction following TVT procedure.

The aim of the study was to assess the incidence of abnormal voiding in patients who had undergone tension-free vaginal tape (TVT) placement. Women who had undergone a TVT sling procedure for stress or mixed incontinence more than 3 months previously reported their voiding habits (frequency, urgency, nocturia, urinary stream quality and incontinence) over the previous 3 days. A pelvic examination and ultrasound postvoid residual (PVR) were performed. Normal voiding was classified as a PVR <100 ml, frequency of six or fewer voids per day and two or fewer per night, and a urinary stream considered normal by the patient. Subjects were classified as either 'normal' (group 1) or 'abnormal' (group 2) voiders. Demographic factors, pre-operative urodynamic testing and concomitant surgical procedures were compared between groups. From September 1999 to November 2000, 59 women underwent a TVT procedure. Two were excluded from analysis [cervical malignancy (1), interstitial cystitis (1)]. There were no healing abnormalities and no patients displayed a positive empty bladder stress test. Forty-two (74%) women were included in group 1 and 15 (26%) in group 2. Urinary continence was reported by 49 (86%): 93% in group 1 and 67% in group 2. Factors highly correlated with postoperative voiding dysfunction included abnormal preoperative uroflow pattern and configuration (P = 0.007), preoperative low peak flow rate <15 ml/s (P = 0.049), preoperative vault prolapse or enterocele (P = 0.001), concurrent vault suspension surgery (P = 0.03) and postoperative urinary tract infection (UTI) (P = 0.0006). Preoperative urinary retention (postvoid residual >100 ml) or detrusor instability, age and body mass index differences were not statistically significant. Multivariate analysis revealed that preoperative abnormal uroflow and postoperative UTI were related to group 2 (P = 0.02). Our conclusions were that the TVT sling procedure has success and voiding dysfunction rates similar to those of other proven anti-incontinence procedures. Various factors were shown to be associated with postoperative voiding difficulties. Tension-free placement of the tape may not prevent the development of post-operative voiding dysfunction.

A prospective study of urinary retention and risk of death after proximal femoral fracture.

Older age, dementia syndrome and impaired mobility are well recognized risk factors for fatality after fracture of the proximal femur. Urinary retention is recognized as a common complication of elective total hip replacement. In this investigation, we estimated the incidence of urinary retention associated with hip fracture in older women and assessed its relationship to 2-year post-operative fatality. Over a 7-month period, 309 women aged 65 and over were admitted to one trauma unit with hip fracture. Readings of post-voiding residual volume were taken on admission (pre-operative), within 24 hours of operation (post-operative) and 5-7 days post-operatively (recovery). Of the 309 patients, 244 (79%) had readings of post-voiding residual volume taken on admission; 90/244 (37%) had retention pre-operatively, 122/216 (56%) post-operatively and 40/183 (22%) in the recovery phase. One year after operation 305 patients were traced and median follow-up was 2 years. Older age, cognitive impairment, polypharmacy, impaired mobility and urinary retention on admission and during recovery were associated with a higher fatality in the first post-operative year. Pre-operative urinary retention is common among older women with proximal femoral fracture and affects over half post-operatively. Retention is one of several factors associated with higher fatality.