Pressure-flow Studies Research Articles

ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting, Part 2: Analysis of PFS, reporting, and diagnosis

Aims:The Working Group (WG), initiated by the International Continence Society (ICS) Standardisation Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, has revised the ICS Standard for pressure-flow studies of 1997. Methods:Based on the ICS standard for developing evidence-based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in December 2022 to facilitate public discussion and the comments received have been incorporated into this final release. Results:The WG has recommended analysis principles for the diagnosis of voiding dysfunction for adult men and women without relevant neurological abnormalities. New standard terms and parameters for objective and continuous grading of urethral resistance (UR), bladder outflow obstruction (BOO) and detrusor voiding contraction (DVC) are introduced in this part 2 of the standard. The WG has summarized the theory and recommendations for the practice of pressure-flow study (PFS) for patients in part 1. A pressure-flow plot is recommended for the diagnosis of every patient, in addition to time-based graphs. Voided percentage and post void residual volume should always be included in PFS analysis and diagnosis. Only parameters that represent the ratio or subtraction of pressure and synchronous flow are recommended to quantify UR and only parameters that combine pressure and flow in a product or sum are recommended to quantify DVC. The ICS BOO index and the ICS detrusor contraction index are introduced in this part 2 as the standard. The WG has suggested clinical PFS dysfunction classes for male and female patients. A pressure-flow scatter graph including every patient’s pdet at maximum flow (pdetQmax) with maximum flow rate (Qmax) point should be included in all scientific reports considering voiding dysfunction. Conclusion:PFS is the gold standard used to objectively assess voiding function. Quantifying the dysfunction and grading of abnormalities are standardized for adult males and females.

ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting, Part 1: Background theory and practice

Aims:The working group (WG) initiated by the International Continence Society Standardization Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction has revised the (1997) ICS Standard for pressure flow studies. Methods:Based on the ICS standard for developing evidence-based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in January 2023 to facilitate public discussion and the comments received have been incorporated into this final release. Results:The WG summarizes the theory and recommends the practice and the terms used for the diagnosis of voiding dysfunction for adult female and male patients without relevant neurological abnormalities, in part 1 of this standard. The WG has also recommended standard principles and parameters for objective and continuous grading of urethral resistance and detrusor voiding contraction on the basis of pressure flow studies in part 2. The recommendations for practice in this part have also the aim to increase the understanding of the physiology as well as the psychology of voiding. The potential effects of the laboratory situation of the test on the voiding as well as the role of the urodynamicist in this regard are discussed. The WG has recommended to use for diagnosis only the voidings that are considered representative by the patient. Conclusion:A pressure flow study is the gold standard to assess voiding function and to quantify dysfunction. This part of the standard explains the clinical background, gives recommendations for the execution of a pressure flow study and lists relevant terms, parameters, and units of measurements.

Detrusor-Overactivity-Related Voiding in Women Mimics Bladder Outflow Obstruction and Conceals Underactivity.

Urodynamics of the storage phase showing detrusor overactivity is com- mon in neurogenic bladder patients. Terminal detrusor overactivity, which is defined by involuntary detrusor contraction that cannot be inhibited, causes urinary incon- tinence. Such incontinence causes a unique voiding in neurogenic bladder patients. During the voiding phase, the detrusor pressure at Qmax (Pdet.Qmax)/maximum flow rate (Qmax) (P/Q) is the gold standard for differentiating between detrusor underactiv- ity and bladder outflow obstruction. We investigated whether a valid identification of lower urinary tract dysfunction could be established from P/Q assessment of detrusor overactivity-related voiding patients. This study evaluated 2 types of voiding. Detrusor overactivity-related void- ing is involuntary detrusor contraction that results in micturition or voiding after per- mission to void when detrusor overactivity has occurred, while voluntary voiding is voiding voluntarily after permission to void and without terminal detrusor overactivity. We evaluated female patients with neurogenic bladder who could undergo micturition without catheterization. A pressure flow study compared the 2 groups. Comparison of the detrusor overactivity-related voiding group (n=20) and the voluntary voiding group (n=12) found statistically significant differences with a lower Qmax and higher Pdet.Qmax (P=.01) in the detrusor overactivity-related void- ing group. The linear regression analysis P/Q plot showed the positivity and negativity value of the slope that was reversed in the 2 groups (-0.089 vs. 0.198). Current results showed different P/Q plot patterns between 2 types of voiding in patients with neurogenic bladder. These findings suggest there is increased detrusor pressure observed in detrusor overactivity-related voiding that mimics out- flow obstruction.

Initial observation of the urodynamic pressure flow study — characteristics of bladder-neck or prostate median lobe dynamics during micturition

Purpose:We present our observations of a urodynamic pressure flow study graph pattern that may be associated with bladder neck hypertrophy or prostate median lobe enlargement. Materials and Methods:We report 23 male patients with signs and symptoms of lower urinary tract dysfunction who underwent urodynamic testing with pressure flow study analysis. We recognized an unusual pressure flow plot curve and found that these patients had cystoscopic evidence for bladder neck hypertrophy or cystoscopic or ultrasound evidence for prostate median lobe enlargement. Results:The patients here demonstrated showed a pattern of increasing detrusor pressure on the pressure flow study — graph phase after maximum of flowrate, where a decreasing pressure pattern is expected. We contemplated that his pattern may show how bladder outflow dynamics is affected by the anatomical features of these patients and how patients may have symptoms of LUT dysfunction or significant residual urine despite a relatively good maximum flow rate. Conclusion:We present a not previously described variation of the pressure flow study graph pattern common in men with prostatic hyperplasia, in a series of patients with median lobe prostatic hyperplasia and or hypertrophy of the bladder neck.

Outcomes of Artificial Urinary Sphincter Implantation in Patients with Detrusor Underactivity and Postprostatectomy Incontinence.

There is insufficient evidence for postoperative outcomes of artificial urinary sphincter (AUS) implantation for postprostatectomy incontinence (PPI) with detrusor underactivity (DU). Thus, we assessed the impact of preoperative DU on the outcomes of AUS implantation for PPI. Medical records of men who underwent AUS implantation for PPI were reviewed. Patients who had bladder outlet obstruction surgery before radical prostatectomy or AUS-related complications that required revision of AUS within three months were excluded. Patients were divided into two groups based on the preoperative urodynamic study including pressure flow study, a DU group, and a non-DU group. DU was defined as a bladder contractility index less than 100. The primary outcome was postoperative postvoid residual urine volume (PVR). The secondary outcomes included maximum flow rate (Qmax), postoperative satisfaction, and international prostate symptom score (IPSS). A total of 78 patients with PPI were assessed. The DU group consisted of 55 patients (70.5%) and the non-DU group comprised 23 patients (29.5%). Qmax was lower in the DU group than in the non-DU group and PVR was higher in the DU group as per a urodynamic study before AUS implantation. There was no significant difference in postoperative PVR between the two groups, although the Qmax after AUS implantation was significantly lower in the DU group. While the DU group showed significant improvements in Qmax, PVR, IPSS total score, IPSS storage subscore, and IPSS quality of life (QoL) score after AUS implantation, the non-DU group showed postoperative improvement in IPSS QoL score. There was no clinically significant impact of preoperative DU on the outcome of AUS implantation for PPI; thus, surgery can be safely performed in patients with PPI and DU.

Voiding efficiency in children is significantly impaired by the presence of the urethral catheter during pressure-flow studies

Little is known about the effect of catheterization during pressure-flow studies (PFS) on voiding efficiency in children. Our objective was to determine the effect of urethral catheterization on Qmax and flow index (FI) during PFS compared to the free flow of uroflowmetry (UF). We retrospectively reviewed 63 consecutive children who underwent UF and PFS at our center on the same day (2019-2022). Voiding data was available for 46 patients. Patients first underwent a UF with full bladder, then PFS after urethral catheter insertion. Patients with urethral pathologies (n=6), on clean intermittent catheterization (CIC) (n=2) and with major comorbidities (n=2) were excluded. Indications for UF/PFS were LUTS, recurrent UTIs, incontinence or neurosurgical pre-operative evaluation. Data was collected from the UF and the PFS and compared using paired t-test. The idealized Qmax and flow index (FI) were calculated for UF and PFS using the formulas described by Franco etal.: Male Qmax=11.26+0.0701(TBC [total bladder capacity])-0.0000513(TBC); Female Qmax=10.723+0.073(TBC)-0.0000423(TBC), FI=Actual Qmax/Expected Qmax (Franco and etal., 2016; Franco etal., 2018; Franco and etal., 2016). Median age was 7 years old (IQR 5-11). Twenty-one (40%) patients were male and 32 (60%) patients were female. Of the 53 patients, 3 boys and 4 girls (n=7; 13%) were unable to void with the catheter in place during PFS but able to void after its removal. Of the remaining 46 cases, the Qmax during PFS was 5mL/s slower than the Qmax recorded on the UF without catheter, representing a decrease of 29% (12.3 vs 17.3mL/s; p<0.0001). The impact of urethral catheter during PFS was more important in males vs females (Qmax decreased by 7.7 vs 3.3mL/s, or 45 vs 19%). The mean FI during PFS was 44%, which was a 30% reduction compared to the 74% FI obtained with UF (p<0.00001). In males, the FI decreased by 37% on PFS, whereas it decreased 26% in females, similar to the Qmax decrease. Voiding efficiency, as assessed by Qmax and FI, is decreased during PFS compared to uroflow studies. Our data documents for the first time the impact of urethral catheterization on pediatric voiding efficiency. Abnormal flow rates and elevated PVRs should be used to guide patient management only if obtained by uroflow. Prospective validation comparing free flow with PFS studies will help characterize the impact of urethral catheter relative to bladder pathology, age, gender and catheter size used.

First in Human Subjects Testing of the UroMonitor: A Catheter-free Wireless Ambulatory Bladder Pressure Monitor.

Urodynamics is the standard method of diagnosing bladder dysfunction, but involves catheters and retrograde bladder filling. With these artificial conditions, urodynamics cannot always reproduce patient complaints. We have developed a wireless, catheter-free intravesical pressure sensor, the UroMonitor, which enables catheter-free telemetric ambulatory bladder monitoring. The purpose of this study was twofold: to evaluate accuracy of UroMonitor pressure data, and assess safety and feasibility of use in humans. Eleven adult female patients undergoing urodynamics for overactive bladder symptoms were enrolled. After baseline urodynamics, the UroMonitor was transurethrally inserted into the bladder and position was confirmed cystoscopically. A second urodynamics was then performed with the UroMonitor simultaneously transmitting bladder pressure. Following removal of urodynamics catheters, the UroMonitor transmitted bladder pressure during ambulation and voiding in private. Visual analogue pain scales (0-5) were used to assess patient discomfort. The UroMonitor did not significantly alter capacity, sensation, or flow during urodynamics. The UroMonitor was also easily inserted and removed in all subjects. The UroMonitor reproduced bladder pressure, capturing 98% (85/87) of voiding and nonvoiding urodynamic events. All subjects voided with only the UroMonitor in place with low post-void residual volume. Median ambulatory pain score with the UroMonitor was rated 0 (0-2). There were no post-procedural infections or changes to voiding behavior. The UroMonitor is the first device to enable catheter-free telemetric ambulatory bladder pressure monitoring in humans. The UroMonitor appears safe and well tolerated, does not impede lower urinary tract function, and can reliably identify bladder events compared to urodynamics.

Experimental Study of Pressure Flow due to Vertical Contraction Using Particle Image Velocimetry

Pressure flow due to vertical contraction occurs under a bridge when the river water level rises above the bottom chord of the bridge. The flow accelerates inside the contraction and diverges downstream of it, resulting in increased bed shear stress in the vicinity of the contraction. The present study investigates the effect of vertical contraction on the flow field and bed shear stress inside and downstream of the contraction by conducting laboratory experiments in a smooth, rigid-bed channel. The velocity field is measured using particle image velocimetry (PIV). The effect of independent variables, namely, streamwise length of contraction, amount of contraction, and approach velocity on the velocity and turbulence fields, is studied. Bed shear stress is estimated from the measured velocity field. It is observed that the viscous stresses are amplified inside the contraction. Downstream of the contraction, increased turbulent stresses are observed close to the bed. The local bed shear stress exhibits a dual peak, one inside the contraction and the other downstream of the contraction, suggesting the possibility of two different locations for scour inception. The stochastic nature of the bed shear stress is studied and its implications on scouring are discussed.

Evaluation of a noninvasive uroflowmetry parameter (Delta Q value) in detrusor underactivity and bladder outlet obstruction

Purpose To determine the significance of the Delta Q value in discrimination between detrusor underactivity (DU) and bladder outlet obstruction (BOO) in adult male patients. Methods A total of 238 patients in this cohort study underwent pressure-flow study. Patients were divided into two groups based on UDS outcomes: DU (n = 121) and BOO (n = 117). From uroflowmetry, 5 variables including maximal flow rate (Qmax), average flow rate (Qave), voiding volume (VV), postvoid residual urine (PVR), and the difference between (Qmax) and (Qave) known as (Delta Q) were obtained. Diagnostic prediction of these variables was evaluated with DU and BOO. Results Delta Q was less in the DU group compared with the BOO group 2.9 ml/s and 6.2 ml/s, respectively. Delta Q showed a promising diagnostic value in the discrimination between DU and BOO. A cut-off value of 6.1 ml/s was found to be discriminatory between the two groups with a sensitivity of 96.58% and specificity of 92.79%. Conclusion Delta Q value has proven to be a useful noninvasive screening and diagnostic tool in differentiating between DU and BOO in men with obstructive lower urinary tract symptoms.

12 - Qmax during pressure flow study: What is the impact of the catheter?

12 - Qmax during pressure flow study: What is the impact of the catheter?

Influence of transurethral catheters on urine pressure-flow relationships in males: A computational fluid-dynamics study

Background and ObjectiveIn the field of urology, the pressure-flow study (PFS) is an essential urodynamics practise which requires the patient's transurethral catheterization during the voiding phase of micturition to evaluate the functionality of the lower urinary tract (LUT) and reveal the pathophysiology of its dysfunctionality. However, the literature evidences confusion regarding the interference of the catheterization on the urethral pressure-flow behaviour. MethodsThe present research study represents the first Computational Fluid-Dynamics (CFD) approach to this urodynamics issue, analysing the influence of a catheter in the male LUT through case studies which included the inter-individual and intra-individual dependence. A set of four three dimensional (3D) models of the male LUT, different in urethral diameters, and a set of three 3D models of the transurethral catheter, diverse in calibre, were developed leading to 16 CFD non-catheterized either catheterized configurations, to describe the typical micturition scenario considering both urethra and catheter characteristics. ResultsThe developed CFD simulations showed that the urine flow field during micturition was influenced by the urethral cross-sectional area and each catheter determined a specific decrease in flow rate if compared to the relative free uroflow. ConclusionsIn-silico methods allow to analyse relevant urodynamics aspects, which could not be investigated in vivo, and may support the clinical PFS to reduce uncertainty on urodynamic diagnosis.

ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting. Part 2: Analysis of PFS, reporting, and diagnosis.

The Working Group (WG), initiated by the International Continence Society (ICS) Standardisation Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, has revised the ICS Standard for pressure-flow studies of 1997. Based on the ICS standard for developing evidence-based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in December 2022 to facilitate public discussion and the comments received have been incorporated into this final release. The WG has recommended analysis principles for the diagnosis of voiding dysfunction for adult men and women without relevant neurological abnormalities. New standard terms and parameters for objective and continuous grading of urethral resistance (UR), bladder outflow obstruction (BOO) and detrusor voiding contraction (DVC) are introduced in this part 2 of the standard. The WG has summarized the theory and recommendations for the practice of pressure-flow study (PFS) for patients in part 1. A pressure-flow plot is recommended for the diagnosis of every patient, in addition to time-based graphs. Voided percentage and post void residual volume should always be included in PFS analysis and diagnosis. Only parameters that represent the ratio or subtraction of pressure and synchronous flow are recommended to quantify UR and only parameters that combine pressure and flow in a product or sum are recommended to quantify DVC. The ICS BOO index and the ICS detrusor contraction index are introduced in this part 2 as the standard. The WG has suggested clinical PFS dysfunction classes for male and female patients. A pressure-flow scatter graph including every patient's pdet at maximum flow (pdetQmax ) with maximum flow rate (Qmax ) point should be included in all scientific reports considering voiding dysfunction. PFS is the gold standard used to objectively assess voiding function. Quantifying the dysfunction and grading of abnormalities are standardized for adult males and females.

Oncological and functional outcomes of female reproductive organ-sparing radical cystectomy and ileal neobladder construction.

To examine the oncological and urinary functional outcomes of reproductive organ-sparing radical cystectomy (ROS-RC) and U-shaped ileal neobladder construction in females compared with male patients. We retrospectively examined 357 patients (281 male and 76 female) with muscle-invasive bladder cancer who were treated with RC plus U-shaped ileal neobladder construction between May 1996 and July 2021. All female patients were treated with ROS-RC. We compared disease-free survival (DFS), cancer-specific survival (CSS), overall survival (OS), and urinary functional outcomes between male and female patients. We evaluated the effect of gender on DFS, CSS, and OS. Furthermore, urinary functional outcomes were evaluated in 140 males and 48 females using a pressure-flow study at 3, 6, 9, and 12 months postoperatively. Female patients were considerably older than male patients at the time of radical cystectomy. No significant difference was noted in the tumor stage preoperatively. The multivariable Cox regression analysis with an inverse probability treatment weighted model revealed that the female gender was not significantly related to DFS, CSS, and OS. Moreover, urinary functions at 12 months were not markedly different between males and females, except for the capacity of the neobladder, detrusor pressure, and maximum urethral closure pressure. This study demonstrates that female patients with ROS-RC and U-shaped ileal neobladder construction did not significantly correlate with worse oncological outcomes. The combination of ROS-RC and U-shaped ileal neobladder construction might attain adequate urinary function without sacrificing oncologic outcomes.

ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting. Part 1: Background theory and practice.

The working group (WG) initiated by the International Continence Society Standardization Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction has revised the (1997) ICS Standard for pressure flow studies. Based on the ICS standard for developing evidence-based standards, the WGdeveloped this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in January 2023 to facilitate public discussion and the comments received have been incorporated into this final release. The WG summarizes the theory and recommends the practice and the terms used for the diagnosis of voiding dysfunction for adult female and male patients without relevant neurological abnormalities, in part 1 of this standard. The WG has also recommended standard principles and parameters for objective and continuous grading of urethral resistance and detrusor voiding contraction on the basis of pressure flow studies in part 2. The recommendations for practice in this part have also the aim to increase the understanding of the physiology as well as the psychology of voiding. The potential effects of the laboratory situation of the test on the voiding as well as the role of the urodynamicist in this regard are discussed. The WG has recommended to use for diagnosis only the voidings that are considered representative by the patient. A pressure flow study is the gold standard to assess voiding function and to quantify dysfunction. This part of the standard explains the clinical background, gives recommendations for the execution of a pressure flow study and lists relevant terms, parameters, and units of measurements.

Defining bladder outlet obstruction and detrusor underactivity in females with overactive bladder: Are we forgetting about the free uroflowmetry?

Both detrusor underactivity (DU) and bladder outlet obstruction (BOO) can coexist in patients with overactive bladder. Definitions of both DU and BOO are based on pressure-flow study (PFS) data. However, invasive urodynamics study can differ from a natural micturition, in fact, discrepancies between free uroflowmetry (UFM) and PFS have been largely described. Our goal is to assess the correlation of free-flowmetry and PFS among patients with OAB and to evaluate how different definitions of DU/BOO are able to discriminate patients with different free UFMs. A retrospective review of urodynamics performed at a single institution was conducted. Females with OAB who voided more than 150 mL in both UFM and PFS were included. Parameters from both voiding episodes were compared with nonparametric test. Two definitions of DU were applied; PIP1: Pdet@Qmax+Qmax < 30 and Gammie: Pdet@Qmax < 20 cmH2 O, Qmax < 15 mL/s, and BVE < 90% (Bladder voiding efficiency). Also,two definitions of obstruction were chosen; Defretias: Pdet@Qmax ≥25 cmH2 O and Qmax ≤ 12 mL/s and Solomon-Greenwell female BOO index ≥ 18. Patients who matched with each definition were compared to those who did not, to assess if any definitions were able to discriminate different noninvasive uroflowmetries. A total of 195 patients were included. Overall, mean age was 55 ± 12 years, 90.8% had mixed urinary incontinence, and 39% complained of at least one voiding symptom. Globally, Qmax and BVE correlated poorly between UFM and PFS, showing that most of the variation corresponded to a systematic error. Twenty-two individuals were found to have DU, they had a difference of 13 mL/son both maximum flows. Fifty-four patients showed BOO, with a difference between their Qmax of 19 mL/s. Among the four definitions analyzed, only PIP1 and Defreitas were able to discriminate patients with actually a lower Qmax on the free UFM. Patients with overactive bladder seem to have a systematic discordance between the urine flow of the free and invasive studies. Current definitions of DU and BOO, which are based on the PFS parameters, are not consistently able to discriminate patients who actually void deficiently on the free UFM.

Autologous adipose-derived mesenchymal stem cell therapy reverses detrusor underactivity: open clinical trial

BackgroundDetrusor underactivity is a disease that can cause chronic urinary tract infection, urinary tract infection, urinary retention and kidney failure and has no effective treatment in traditional medicine. The present research evaluated the effects of cell therapy with adipose tissue-derived stem cells on the treatment of detrusor underactivity in men.MethodsNine male patients diagnosed with a clinical and urodynamic diagnosis of detrusor underactivity were evaluated and underwent two transplants via cystourethroscopy, with 2 × 106 cells/transplant, performed by intravesical injection at five points on the bladder body above the vesical trigone.ResultsCell therapy increased the maximum flow from 7.22 ± 1.58 to 13.56 ± 1.17, increased the mean flow from 3.44 ± 0.74 to 5.89 ± 0.45, increased the urinated volume from 183.67 ± 49.28 to 304.78 ± 40.42 and reduced the residual volume in the uroflowmetry exam from 420.00 ± 191.41 to 118.33 ± 85.51; all of these changes were significant (p < 0.05). There were also significant increases (p < 0.05) in maximum flow (from 7.78 ± 0.76 to 11.56 ± 1.67), maximum detrusor pressure (from 20.22 ± 8.29 to 41.56 ± 5.75), urinary volume (from 244 ± 27.6 to 418.89 ± 32.73) and bladder contractility index (from 44.33 ± 4.85 to 100.56 ± 8.89) in the pressure flow study. Scores on the International Consultation on Incontinence Questionnaire decreased from 11.44 ± 1.43 to 3.78 ± 0.78 after cell therapy, which indicates an improvement in quality of life and a return to daily activities. No complications were observed in the 6-month follow-up after cell therapy. Before treatment, all patients performed approximately five intermittent clean catheterizations daily. After cell therapy, 7/9 patients (77.78%) did not need catheterizations, and the number of catheterizations for 2/9 patients (22.28%) was reduced to two catheterizations/day.ConclusionsThe results indicate that stem cell therapy led to improvements in voiding function. Cell therapy with adipose tissue-derived stem cells is safe and should be considered a new therapeutic option for the treatment of detrusor underactivity.Trial registration ISRCTN, ISRCTN23909398; Registered 15 March 2021—Retrospectively registered, https://doi.org/10.1186/ISRCTN23909398

MP74-17 PENILE CUFF TEST SHOWS POOR ACCURACY FOR DIAGNOSIS OF BLADDER OUTLET OBSTRUCTION FOR MEN: A PRAGMATIC ANALYSIS WITHIN A HIGH VOLUME UROLOGIC CLINIC

You have accessJournal of UrologyCME1 Apr 2023MP74-17 PENILE CUFF TEST SHOWS POOR ACCURACY FOR DIAGNOSIS OF BLADDER OUTLET OBSTRUCTION FOR MEN: A PRAGMATIC ANALYSIS WITHIN A HIGH VOLUME UROLOGIC CLINIC Leo D. Dreyfuss, Maria Lee, Joseph Moryousef, Christina Sze, Lina Posada-Calderon, Dean Elterman, Naeem Bhojani, Kevin C. Zorn, Bilal Chughtai, Steven A. Kaplan, and Alexis E. Te Leo D. DreyfussLeo D. Dreyfuss More articles by this author , Maria LeeMaria Lee More articles by this author , Joseph MoryousefJoseph Moryousef More articles by this author , Christina SzeChristina Sze More articles by this author , Lina Posada-CalderonLina Posada-Calderon More articles by this author , Dean EltermanDean Elterman More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Kevin C. ZornKevin C. Zorn More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Steven A. KaplanSteven A. Kaplan More articles by this author , and Alexis E. TeAlexis E. Te More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There has been a recent shift in the management offerings for treatment of benign prostatic hyperplasia (BPH). Patients desire minimally invasive therapies with lower risks of complications, side effects and discomfort. Penile cuff test (PCT) is a non-invasive bladder pressure manometer use to measure detrusor pressure and urine flow. Recently, PCT has demonstrated noninferiority compared to the gold standard pressure flow studies (PFS), which require placement of catheters within urethra and rectum. We sought to compare the accuracy of PCT to PFS in the real world setting of a high volume academic voiding dysfunction clinic. METHODS: Adult men with BPH underwent PCT and PFS from April 2018-October 2021. PFS and PCT were obtained by trained technologists. All patients participated in urodynamic evaluation which included measurement of vesicular and abdominal pressures at time of filling and voiding as well as post-void residual. The diagnosis of bladder outlet obstruction was determined by ICS and PCT nomogram for UDS and PCT, respectively. RESULTS: 74 male patients were included. The PCT nomogram classified 21 patients as obstructed and 53 as un-obstructed. Out of the 53 individuals classified as unobstructed by PCT, 29 were identified as non-obstructive/equivocal on UDS and 24 were identified as unobstructed on UDS. With UDS as gold standard, PCT showed a sensitivity of 0.31 and specificity of 0.75. The positive predictive value (PPV) was 0.62 and negative predictive value (NPV) was 0.45. Detrusor pressure at Qmax for UDS and cuff pressure at interruption during PCT was correlated with AUA symptoms score (AUA SS) (p<0.05, Table 2). CONCLUSIONS: Our single-center experience with penile cuff testing demonstrates poor accuracy in diagnosis of bladder outlet obstruction when compared to pressure flow studies, in contrast to recent meta-analysis comparing similar modalities. PCT is associated with AUA SS, demonstrating possible clinical utility. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1077 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leo D. Dreyfuss More articles by this author Maria Lee More articles by this author Joseph Moryousef More articles by this author Christina Sze More articles by this author Lina Posada-Calderon More articles by this author Dean Elterman More articles by this author Naeem Bhojani More articles by this author Kevin C. Zorn More articles by this author Bilal Chughtai More articles by this author Steven A. Kaplan More articles by this author Alexis E. Te More articles by this author Expand All Advertisement PDF downloadLoading ...

PD02-11 THE EXTENT OF CHRONIC PROSTATIC INFLAMMATION WAS NEGATIVELY AND POSITIVELY CORRELATED WITH THE DURATION OF ALPHA-1 BLOCKERS AND 5 ALPHA REDUCTASE INHIBITORS BEFORE SURGICAL TREATMENT

You have accessJournal of UrologyCME1 Apr 2023PD02-11 THE EXTENT OF CHRONIC PROSTATIC INFLAMMATION WAS NEGATIVELY AND POSITIVELY CORRELATED WITH THE DURATION OF ALPHA-1 BLOCKERS AND 5 ALPHA REDUCTASE INHIBITORS BEFORE SURGICAL TREATMENT So Inamura, Tomochika Shinagawa, Hisato Kobayashi, Manami Tsutsumiuchi, Masaya Seki, Minekatsu Taga, Masato Fukushima, Osamu Yokoyama, and Naoki Terada So InamuraSo Inamura More articles by this author , Tomochika ShinagawaTomochika Shinagawa More articles by this author , Hisato KobayashiHisato Kobayashi More articles by this author , Manami TsutsumiuchiManami Tsutsumiuchi More articles by this author , Masaya SekiMasaya Seki More articles by this author , Minekatsu TagaMinekatsu Taga More articles by this author , Masato FukushimaMasato Fukushima More articles by this author , Osamu YokoyamaOsamu Yokoyama More articles by this author , and Naoki TeradaNaoki Terada More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003219.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Alpha 1 blockers (ABs) and 5 alpha-reductase inhibitors (5ARIs) have been used for the medical treatment of benign prostatic hyperplasia (BPH) and the patients resistant to these therapies receive surgical treatment. We previously reported that the extent of chronic prostatic inflammation was positively correlated with the obstruction of BPH patients in pressure flow study (Inamura et al. Prostate 2018). This study investigated the correlation of the duration of ABs and 5ARIs with the extent of chronic inflammation by evaluating the expression levels of high endothelial venule (HEV) in prostate tissue. METHODS: Tissue samples were obtained from BPH patients who underwent transurethral resection of the prostate (TURP) or holmium enucleation of the prostate (HoLEP). All the patients received pressure flow study before the surgery. HEV is associated with the migration of lymphocytes and is used as a marker of chronic inflammation. The magnitude of prostatic inflammation was quantified histologically by the ratio of HEV and endothelial cells using the immunohistochemistry of MECA-79 and CD34. The type and duration of medical treatment before surgery were examined on medical records. The correlation of MECA-79/CD34 ratio with the duration of ABs and 5ARIs was evaluated. RESULTS: In 148 patients, 143 patients (97%) received ABs and 33 patients (22%) received 5ARIs adding to ABs. The median duration ABs was 14 months, and the median duration of 5ARIs was 7 months. The duration of ABs was significantly negatively correlated with Bladder Outlet Obstruction Index (BOOI) in pressure flow study (correlation coefficient=-0.270 p=0.029). The duration of ABs was significantly negatively correlated with MECA-7/CD34 ratio (correlation coefficient=-0.194, p=0.030). However, the duration of 5ARIs was positively correlated with MECA-7/CD34 ratio (correlation coefficient=0.501, p=0.001). CONCLUSIONS: These results indicated that the patients who received longer treatment by ABs before surgery had lower level of obstruction and lower extent of chronic prostatic inflammation. However, the patients who received longer treatment of 5ARIs had higher extent of chronic prostatic inflammation. The long-term therapy by 5ARIs might have potential to enhance chronic inflammation in prostate tissue. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e72 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information So Inamura More articles by this author Tomochika Shinagawa More articles by this author Hisato Kobayashi More articles by this author Manami Tsutsumiuchi More articles by this author Masaya Seki More articles by this author Minekatsu Taga More articles by this author Masato Fukushima More articles by this author Osamu Yokoyama More articles by this author Naoki Terada More articles by this author Expand All Advertisement PDF downloadLoading ...

PD41-09 RANDOMIZED CONTROLLED TRIAL COMPARING PROSTATE ARTERY EMBOLIZATION VS OPEN PROSTATECTOMY: CLINICAL AND URODYNAMIC ASSESSMENT IN A ONE YEAR FOLLOW UP

You have accessJournal of UrologyCME1 Apr 2023PD41-09 RANDOMIZED CONTROLLED TRIAL COMPARING PROSTATE ARTERY EMBOLIZATION VS OPEN PROSTATECTOMY: CLINICAL AND URODYNAMIC ASSESSMENT IN A ONE YEAR FOLLOW UP Bruno Lebani, André Silva, Eduardo Silveira, Milton Skaff, and Fernando Almeida Bruno LebaniBruno Lebani More articles by this author , André SilvaAndré Silva More articles by this author , Eduardo SilveiraEduardo Silveira More articles by this author , Milton SkaffMilton Skaff More articles by this author , and Fernando AlmeidaFernando Almeida More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Open Prostatectomy (OP) remains one of the gold standard treatments for Benign prostate enlargement larger than 80 ml. The Prostate Artery embolization (PAE) is a minimally invasive procedure that interrupts the blood flow, shrinking the prostatic adenoma. There is no randomized controlled trials assessing PAE for prostates larger than 80 ml in patients with bladder outlet obstruction (BOO) and good detrusor function. The aim of this study is to evaluate PAE in prostates larger than 80 ml, comparing the results to patients underwent to open prostatectomy. METHODS: A non-inferiority, randomized, open label-controlled trial was developed in a single center, between January 2020 and May 2022. OP was indicated according to prostate weight (larger than 80 ml measured by MRI) and symptoms, urodynamics parameters meeting Bladder Outlet Obstruction (defined by BOOI >40) and good detrusor function (defined by Bladder contractility index - BCI >100). The patients were randomized to OP and PAE. The primary endpoint was urodynamic comparisons, embracing changes on Maximum urinary flow rate in pressure-flow studies (Qmax-QxP), Detrusor pressure at maximum flow rate (PdetQmax) and Bladder outlet obstruction index (BOOI) from baseline to 6 months. Secondary endpoints include clinical assessment, laboratory and ultrasonography . Analyses between groups of all schedule visits at 1, 3, 6 and 12 months were performed. RESULTS: 23 patients were evaluated in PAE arm and 25 were evaluated in OP arm. Groups are similar, without differences in clinical, radiological or urodynamic parameters. In baselinte, PAE group presented Qmax of 3,78±3,32, IPSS of 27,4±5,65, BOOI of 93,7±30,9 and BCI of 128±25,3. OP presented Qmax of 3,78±3,32, IPSS of 30±4,95, BOOI of 116±53,8 and BCI of 147±50,4. After 6 months, both groups presented significant improvement in Qmax compared to their respective baseline (8,3±4,17 for PAE group vs 15,1±8,04 for OP group), nonetheless the effectiveness was greater in OP arm, with a statistical difference reaching 7.8 ml/second. The decrease from baseline to month 6 in PDetQmax was lower in PAE than in OP group, despite Qmax improvement (-5,17 vs -79,92 cm H2O). Similar findings were observed in BOOI (PAE – 9,03 vs OP -95 cm H2O, p<0,001). It was observed a large reduction in IPSS (more than 15 points) in both groups, with no difference between them. CONCLUSIONS: Both procedures resulted in significant clinical improvements in the treatment of BPH. However, PAE is inferior compared to OP, assessing urodynamic parameters. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1062 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bruno Lebani More articles by this author André Silva More articles by this author Eduardo Silveira More articles by this author Milton Skaff More articles by this author Fernando Almeida More articles by this author Expand All Advertisement PDF downloadLoading ...

MP74-18 DETRUSOR VOIDING CONTRACTION VELOCITY IS RELEVANT TO PATIENTS WITHOUT BLADDER OUTFLOW OBSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023MP74-18 DETRUSOR VOIDING CONTRACTION VELOCITY IS RELEVANT TO PATIENTS WITHOUT BLADDER OUTFLOW OBSTRUCTION Peter F. W. M. Rosier Peter F. W. M. RosierPeter F. W. M. Rosier More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder outflow obstruction (BOO) is prevalent in male patients >45 y with LUTS but much less in women. Detrusor voiding contraction underactivity (DVC-DU) is (equally?) prevalent in in both sex. BOO affects DVC through 'compensation'; muscle training, to gain force, which is represented in DVC-detrusor- pressure. DVC-muscle shortening velocity (muscle function Hill equation) is less known/studied and is potentially relevant as an element of DVC-DU. We analysed DVC parameters including contraction velocity in a large cohort of adult men and women without BOO. METHODS: Patients without relevant neurological or anatomical abnormalities, voiding (pressure flow studies PFS) >100 mL and <800 mL with PVR <500 mL, representative, after ICS (quality) standard UDS, for all usual/possible indications, with 7F double lumen water fill cystometry, were included. All known DVC parameters were analysed and DVC-velocity is calculated: (bladder circumference (based on mL) at begin voiding minus circumference at end) / voiding time (tQ>0). All patients had BOO<3 linPURR (ICS- noOBS). 2488 patients were 63.5 y (sd 16.8) men (n1511) 66.3 y (15.1) and women (n977) 59.2 y (18.3). They voided 359 mL with PVR 47 mL; void% 89.3. RESULTS: PFS-voided volumes were not different Void% was slightly lower in men (88.6 vs 90.4). Men's Qmax 12.5 mL/s; pdetQmax 43.3 cm H2O; BOOI 18.1; and Wmax 12.3 W/m2 differed signific. from women Qmax 19.9 mL/s; pdetQmax 25.7 cm H2O; BOOI -14.1; and Wmax 13.0 W/m2. DVC-velocity was 0.37 cm/s in men vs 0.56 cm/s (p.000). 58.4% of men had void%100 62.2% of women. The Figure 1 demonstrates the relevance of DVC-velocity to predict incomplete voiding, in absence of BOO. CONCLUSIONS: Men with LUTS have somewhat higher outflow resistance than women even when they are all within the no BOO -category. Anatomical differences likely the cause. Only a small percentage of all female patients has outflow obstruction (>grade 2) and diagnosing DVC especially in cohorts of female patients (but also in men without BOO) requires a parameter that includes detrusor contraction velocity. Most of the currently available parameters to represent the contraction force or -strength of the DVC include detrusor pressure -with a certain weight- in a mathematical product. If there is no or low grade outflow resistance however, not contraction power (≈pressure), but contraction speed (velocity or (flow)rate) is more important. This is now supported by this analysis showing that, in patients without BOO (<grade3) DVC-velocity, has the highest predictive value to predict incomplete micturition. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1077 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter F. W. M. Rosier More articles by this author Expand All Advertisement PDF downloadLoading ...