Pressure-flow Studies Research Articles

A Velocity-Based Approach to Noninvasive Methodology for Urodynamic Analysis.

To date, invasive urodynamic investigations have been used to define most terms and conditions relating to lower urinary tract symptoms. This invasiveness is almost totally due to the urethral catheter. In order to remove this source of discomfort for patients, the present study investigated a noninvasive methodology able to provide diagnostic information on bladder outlet obstruction or detrusor underactivity without any contact with the human body. The proposed approach is based on simultaneous measurements of flow rate and jet exit velocity. In particular, the jet exit kinetic energy appears to be strongly related to bladder pressure, providing useful information on the lower urinary tract functionality. We developed a new experimental apparatus to simulate the male lower urinary tract, thus allowing extensive laboratory activities. A large amount of data was collected regarding different functional statuses. Experimental results were compared successfully with data in the literature in terms of peak flow rate and jet exit velocity. A new diagram based on the kinetic energy of the exit jet is proposed herein. Using the same notation as a Schäfer diagram, it is possible to perform noninvasive urodynamic studies. A new noninvasive approach based on the measurement of jet exit kinetic energy has been proposed to replace current invasive urodynamic studies. A preliminary assessment of this approach was carried out in healthy men, with a specificity of 91.5%. An additional comparison using a small sample of available pressure-flow studies also confirmed the validity of the proposed approach.

Importance of Urodynamic Dysfunctions as Risk Factors for Recurrent Urinary Tract Infections in Patients with Multiple Sclerosis

Objective: To analyze the role of urodynamic dysfunctions as risk factors for recurrent urinary tract infections (rUTIs) in patients with multiple sclerosis (MS). Material and methods: We conducted a prospective cohort study of 170 patients with MS who underwent a urodynamic study due to lower urinary tract symptoms. Patients were followed for one year, and 114 (84 women [74%] and 30 men [26%]; mean age 49 years) completed the study. Clinical variables and urodynamic findings (free uroflowmetry, cystometry, and pressure-flow study results) were recorded. Results indicated rUTIs was present in 37 patients (32%). Statistical analysis was performed using Fisher’s exact test, chi-square test, Student’s t-test, and multivariate regression analysis. Results: In univariate analysis, significant differences were observed between patients with and without rUTIs for the following clinical variables: symptom progression time, MS duration, Expanded Disability Status Scale score, and MS type. Regarding urodynamic findings, significant differences were observed in maximum flow rate (Qmax) (lower in patients with rUTIs), voided volume, bladder voiding efficiency, stress urinary incontinence (SUI) (greater rUTI frequency in affected patients), detrusor pressure at maximum flow, and bladder contractility index score. Multivariate analysis identified the urodynamic factors: low Qmax [Odds Ratio (OR) = 0.90 and SUI (OR = 2.95) as the independent predictors of rUTs. Conclusions: Two urodynamic variables: Qmax and SUI, are independent risk factors for rUTIs in MS patients. These two variables might be associated with Pelvic floor dysfunctions.

A High-Efficiency Consultation Improves Urological Diagnosis in Patients with Complex LUTS-A Pilot Study.

(1) Background: The diagnosis of moderate-severe lower urinary tract symptoms (LUTS) is not easy due to the complexity of the micturition act. Sequential diagnostic tests can be time consuming due to waiting lists. Thus, we developed a diagnostic model combining all the tests in a single one-stop consultation. (2) Methods: In a prospective pilot study in patients with complex LUTS, they received all diagnostic tests (ultrasound, uroflowmetry, cystoscopy, pressure-flow study) in a single consultation and by the same doctor. Patients' results were compared with those from a 2021 paired cohort that underwent the classical sequential diagnostic pathway. (3) Results: Per patient, the high-efficiency consultation saved: 175 days of waiting, 60 min doctor time and 120 nursing assistant time and over 300 euros on average. The intervention also saved 120 patient journeys to the hospital, lowering the total carbon footprint by 145.86 kg CO2. In one-third of the patients, performing all the tests within the same consultation contributed to reaching a more appropriate diagnosis and thus more effective treatment. Patients' satisfaction was high, with good tolerability. (4) Conclusions: The high-efficiency urology consultation improves waiting times, therapeutic decisions and the degree of patient satisfaction while optimizing the use of resources and generating savings for the health system.

Reproducibility evaluation of air-charged catheter for rest urethral pressure profilometry

We retrospectively included 53 (9 males, 44 females) patients who underwent rest urethral pressure profilometry (RUPP) due to lower urinary tract symptoms (LUTS) in Beijing Chaoyang Hospital from May 2021 to March 2022. The age of patients was (55±16) (25-76) years old. The clinical diagnoses of the included patients with lower urinary tract symptoms were classified as: benign prostatic hyperplasia in 9 cases, interstitial cystitis in 1 case, stress urinary incontinence in 11 cases and non-obstructive dysuria in 32 cases. The full set of urodynamic examination was composed of bladder pressure measurement during the filling period, pressure flow study (PFS) and RUPP. All the urodynamic examination was performed by air-charged catheter (ACC) and corresponding equipment. All patients underwent RUPP measurements twice. The vesical pressure (Pves) values were (35.30±6.15), (35.81±5.91) cmH2O (1 cmH2O=0.098 kPa); the Pura@max were (141.91±36.53), (145.02±38.85) cmH2O; functional urethral length were (41.70±16.34), (42.55±16.40) mm; the maximum urethral closure pressure for the two RUPP measurements were (106.57±36.44), (109.41±39.27) cmH2O. There was no statistical difference between the two RUPP measurements (P>0.05). The reproducibility of the RUPP measurements obtained by ACC is good and deserves further study.

Straining to void at preoperative urodynamic study as a risk factor for prolapse recurrence after surgery

ObjectivesStraining to void is the need to make a muscular effort in order to initiate, maintain or improve the urinary stream, through an increase in abdominal pressure. This pattern of bladder emptying is frequently observed in women with pelvic organ prolapse causing urinary obstruction, to overcome the increased resistance to urine flow. However, frequent increases in abdominal pressure are a risk factor for developing pelvic organ prolapse, and might play a role in its recurrence after surgery. The aim of this study was to investigate the role of straining identified at urodynamic study in prolapse recurrence after surgical repair. Study designThis was a retrospective study on women submitted to prolapse repair by vaginal hysterectomy with modified McCall culdoplasty and anterior colporraphy. All patients underwent a preoperative urodynamic evaluation including a pressure-flow study performed after prolapse reduction by means of a vaginal pessary; straining was defined by a simultaneous and similar increase in intravesical and abdominal pressures of at least 10 cmH2O over the baseline during bladder emptying, corresponding to intermittent peaks of urine flow. Patients were divided into two groups according to the presence or absence of straining, and they were compared for surgical results at 12 months and for the rate of anterior or central recurrence over time. ResultsWomen with straining (n = 16), compared to women with normal voiding (n = 43), showed a higher risk of anterior recurrence over time at Kaplan-Meier curves, for both stage II (p = 0.02) and stage III prolapse (p = 0.02). No difference was seen for central recurrence during the follow up period. POP-Q staging at 12 months was similar for the two groups, except for the location of the Aa point which was significantly better for women without straining (−1.6 ± 0.1 cm vs −0.8 ± 0.3 cm, p = 0.03). ConclusionsStraining to void identified in preoperative urodynamic study seems to increase the risk of anterior recurrence after surgical repair of pelvic organ prolapse.

Voiding Pressures in Boys: Pdetmax versus PdetQmax - Does it Make a Difference?

Invasive urodynamics (UDS) is a standard investigation in children. Studies measuring voiding pressures in children use varied nomenclatures and quote a wide range of voiding pressures. Thus, voiding pressures in children are not considered reliable and they do not find any place in the pediatric diagnostic armamentarium. On the contrary, adult studies have well-defined nomograms and standard values which make voiding studies indispensable in the diagnosis of voiding dysfunctions in adults. The difference primarily lies in the uniformity of parameters assessed in adults and the contrasting heterogeneity in the pediatric literature. The objective of this study was to study the voiding parameters observed during UDS in boys. We retrospectively reviewed the pressure flow data obtained during conventional invasive UDS in 106 neurologically normal boys (6 months-16 years) who had different indications for urodynamics. The values of Pdetmax and PdetQmax were analyzed and compared with the existing data of pressure flow studies in children. Pdetmax decreased with age whereas PdetQmax was independent of age. The difference between the values of Pdetmax and PdetQmax was more in the younger kids. The wide range of voiding detrusor pressure (Pdet) in the existing pediatric literature is similar to the values of Pdetmax observed in our study, whereas the value of PdetQmax is much lower. The values of Pdetmax observed in this study are similar to the values of "maximum Pdet during voiding" documented in previous studies and are determined by detrusor contractility and functional/dynamic contraction of outflow during voiding. PdetQmax has been documented in very few pediatric studies and is significantly less than Pdetmax. Further prospective studies are needed to corroborate UDS findings with radiologic/cystoscopic findings to create nomograms of voiding parameters in children. Existing literature on pediatric voiding studies mentions voiding pressures during variable phases of void (usually Pdetmax) and the values have been very heterogeneous, making voiding pressure-flow studies unreliable in children. PdetQmax values are much lower than values quoted as "standard" pressures and are age independent. The use of PdetQmax instead of PdetMax may make voiding pressures in children more reproducible and informative.

Post-voided residual urine ratio as a predictor of bladder outlet obstruction in men with lower urinary tract symptoms: development of a clinical nomogram.

To confirm the correlation between post-void residual urine ratio (PVR-R) and BOO diagnosed by pressure-flow studies (PFS) in males with lower urinary tract symptoms (LUTS) and to develop a clinical nomogram. A consecutive series of patients aged 45years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment for BOO including International Prostatic Symptoms Score, uroflowmetry, urodynamic studies, suprapubic ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BTW). PVR-R was defined as follows: PVR-R = (PVR/total Bladder Volume [BV]) × 100). Logistic regression analysis was used to investigate predictors of pathological bladder emptying (BOO) defined as Schafer > II. A nomogram to predict BOO based on the multivariable logistic regression model was then developed. Overall 335 patients were enrolled. Overall, 131/335 (40%) presented BOO on PFS. In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 2.21 per mm; 95% confidence interval [CI], 1.57-3.09; p = 0.001), PVR-R (OR: 1.02 per %; 95% CI, 1.01-1.03; p = 0.034) and prostate volume (OR: 0.97 per mL; 95% CI, 0.95-0.98; p = 0.001) were significant predictors for BOO. The model presented an accuracy of 0.82 and a clinical net benefit in the range of 10-90%. The present study confirms the important role of PVR-ratio in the prediction of BOO. For the first time, we present a clinical nomogram including PVR-ratio for the prediction of BOO.

Diagnostic value of urethral pressure profile for female bladder neck obstruction using air-charged catheters

Objective: To evaluate the measurements of urethral pressure profile (UPP) using air-charged catheters (ACC) in women with bladder neck obstruction and to preliminarily analyze the diagnostic value of UPP based on ACC for female bladder neck obstruction. Methods: Retrospective inclusion of 63 female patients with bladder neck obstruction diagnosed in the Department of Urology of Beijing Chao-yang Hospital from September 2020 to December 2021 were included as the observation group, and 45 female patients who came to the hospital due to lower urinary tract symptoms with non-bladder neck obstruction during the same period were selected as the control group. All patients received urodynamic examination and UPP examination based on ACC, and urethral pressure measurements [M (Q1, Q3)] were compared between the two groups and analyzed the predictive value of the relevant measurements for female bladder neck obstruction. Results: The age of the observation group was 61 (47, 67) years and body mass index (BMI) was 24.1 (21.6, 27.9) kg/m2, the age of the control group was 65 (58, 71) years and BMI was 25.0 (22.8, 27.6) kg/m2. The urethral pressure at the bladder neck and urinary sphincter position in the observation group were higher than control group[104.00 (83.00, 124.00) cmH2O (1 cmH2O=0.098 kPa) vs 42.00 (31.00, 65.50) cmH2O, 125.0 (107.0, 154.0) cmH2O vs 99.0 (77.0, 124.0) cmH2O, P<0.001]. The results of the receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of urethral pressure at the bladder neck position had the highest predictive value for female bladder neck obstruction (AUC: 0.946, 95%CI: 0.886-0.981, sensitivity: 87.3%, specificity: 91.1%), and the results of interaction point plot showed that the cut-off value was 72 cmH2O. The cut-off value of urethral pressure at the bladder neck position was used as positive cut-off value to predict female patients with bladder neck obstruction. Sixty-three patients with bladder neck obstruction were detected by UPP measurement using ACC in 59 cases (59/63, 93.7%) and the Kappa value was 0.774 (95%CI: 0.654-0.894), indicating that UPP had high consistency with pressure-flow study. Conclusions: UPP examination based on ACC can show the pressure values of the bladder neck and urethral sphincter position. When the urethral pressure of the bladder neck position is greater than 72 cmH2O, it is helpful for the diagnosis of female bladder neck obstruction and has guiding significance for the diagnosis and treatment of this disease.

Transurethral water vapor ablation of the prostate with the Rezūm system: Urodynamic findings.

The efficacy of the transurethral convective interstitial radiofrequency water vapor thermal ablation of the prostate with the Rezūm system for the treatment of male lower urinary tract symptom due to benign prostatic hyperplasia is well proven. The improvement of urodynamic parameters obtained from a simple uroflowmetry cannot measure the effect of water vapor injection on the bladder outlet obstruction. This monocentric retrospective pilot study analyzes the data of pressure-flow studies performed before and after 17 Rezūm procedures to answer the question whether thus obtained ablation of prostate tissue has a disobstructive effect on the bladder outlet. All the functional outcomes were consistently improved after the procedure, with a median flowrate increase of 5.1 ml/s (p = 0.0022) and a median postvoid residual urine (PVR) reduction of 100 ml (p = 0.0042). The prostate volume was reduced by 40% (p < 0.0001) and the median Bladder Outlet Obstruction Index (BOOI) reduction was 53.8 (p < 0.0001). These data show that the possibility to significantly reduce the obstruction grade with even a single Rezūm procedure is concrete and seems to be independent from the degree of the obstruction grade.

Effect of transcutaneous posterior tibial nerve stimulation and repetitive transcranial magnetic stimulation on neurogenic overactive bladder symptoms in female patients with multiple sclerosis: The study protocol of a randomized controlled study.

Neurogenic bladder is frequently seen in patients with multiple sclerosis (MS). Electrical stimulation methods (neuromodulation) can be used for patients that have persistent symptoms despite pharmacological treatment. This study aims to compare the effects of two different neuromodulation techniques used in the treatment of neurogenic bladder. This is a single-center randomized controlled trial for MS patients with neurogenic bladder. Patients determined to be eligible according to the study criteria will be randomized into two treatment groups: the transcutaneous posterior tibial nerve stimulation (PTNS) and repetitive transcranial magnetic stimulation (rTMS) groups. Each group will include eight patients. The patients will be treated for a total of 10 sessions for two consecutive weeks. The pressure-flow study will be used to compare the initial and final urodynamic results as the primary outcome. All the participants will fill in a 3-day bladder diary before and after the treatments in each group. Patients will also be asked to complete specific questionnaires for incontinence and quality of life (QOL): Overactive Bladder Questionnaire-V8 score (OAB-V8), Incontinence Severity Index (ISI), Incontinence Quality of Life Scale score (I-QOL), International Incontinence Questionnaire (ICIQ-SF) score, and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score) as the secondary outcomes. An ethical approval number was obtained from the Non-Invasive Clinical Research Ethics Committee of Istanbul Medipol University (ethical approval number: 768). Support was received within the scope of the Istanbul Medipol University Scientific Research Project with project number 2020-2017. The result of this study will be published in a peer-reviewed journal. NCT05312138.

Neurogenic Lower Urinary Tract Dysfunction in the First Year After Spinal Cord Injury: A Descriptive Study of Urodynamic Findings.

We aimed to provide a real-world description of neurogenic lower urinary tract dysfunction within the first year after spinal cord injury with a focus on unfavorable urodynamic parameters that are associated with urological morbidity. Urodynamic investigations from 97 patients with traumatic or ischemic acute spinal cord injury and managed according to the European Association of Urology Guidelines on Neuro-Urology were analyzed at a single university spinal cord injury center at 1 month, 3 months, 6 months, and 12 months after injury. Unfavorable urodynamic parameters were defined as detrusor overactivity in combination with detrusor sphincter dyssynergia, maximum storage detrusor pressure of 40 cm H2O or higher, bladder compliance less than 20 mL/cm H2O, and vesicoureteral reflux of any grade. One or more unfavorable urodynamic parameter was observed in 87 out of 97 patients (90%) within the first year after spinal cord injury. Eighty-eight percent of the patients showed detrusor overactivity with detrusor sphincter dyssynergia, 39% a maximum storage detrusor pressure of 40 cm H2O or higher, and 7% vesicoureteral reflux. No patient developed a low-compliance bladder. Using a standardized urodynamic follow-up schedule, we found unfavorable urodynamic parameters in a majority of the population within the first year after spinal cord injury. As early treatment based on urodynamic findings might reduce the risk of deterioration of upper and lower urinary tract function, thereby improving long-term outcomes, there is need for further research regarding recommendations for a urodynamic follow-up schedule during the first year after spinal cord injury.

"Glycogen deposition in the detrusor muscle of patients with bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH); correlation with the urodynamic parameters.''.

A prospective case-control study was conducted to evaluate glycogen deposition within the detrusor and its correlation with the urodynamic findings in patients with bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH). Data from 50 patients with BPH (Study Group) and 20 controls (Control Group) were analyzed. BOO was confirmed by pressure-flow studies. The main outcome was glycogen deposition within the bladder wall. Bladder tissue biopsies were obtained from all patients, and histological assessment of the detrusor glycogen content was performed using Periodate Acid Schiff's (PAS) stain. The obtained glycogen score ranged from 0 (no staining of glycogen granules) to 3 (staining of glycogen granules within the detrusor adjacent to the urothelium). Fifty patients and 20 controls were included. Increased glycogen deposition was observed in 37 (74%) and 2 (10%) patients in the Study and Control Group, respectively (p < 0.01, OR 25.6, 95% CI 5.2-125.8). In the subgroup analysis, no statistically significant difference was found between glycogen deposition score and IPSS, maximum detrusor pressure at maximum flow (PdetQmax) and duration of LUTS. In multivariate logistic regression, history of retention was the only variable which could predict high glycogen deposition (p = 0.019). Our results demonstrate increased detrusor glycogen deposition in patients with BOO due to BPH, but the amount of deposition did not seem to correlate with symptom severity and duration or urodynamic findings.

SC259 - Role of post voided residual ratio in patients with detrusor underactivity: a pressure flow study analysis

SC259 - Role of post voided residual ratio in patients with detrusor underactivity: a pressure flow study analysis

The pressure flow study investigation of pathophysiology of post-micturition dribble in male patients.

In this study, we aimed to elucidate the pathophysiology of post-micturition dribble (PMD) through analyzing several variables including pressure flow study (PFS) findings and symptoms questionnaire. We retrospectively analyzed male patients who visited our department between 2010 and 2020. We used modified international prostate symptom score (m-IPSS), which consists of eight sub-score related to lower urinary tract symptoms (Incomplete Emptying, Frequency, Intermittency, Urgency, Weak Stream, Straining, Nocturia, and PMD) and one question related to quality of life (QOL). Multivariate regression analysis was conducted to evaluate the relationship between PMD and the variables, including age, prostate volume (PV), body mass index, bladder outlet obstruction index (BOOI), bladder contractility index, and bladder voiding efficiency, which were obtained by PFS. A total of 143 male patients were analyzed. The patients with PMD showed significantly larger PV and higher BOOI, and worse IPSS total and QOL score than those without PMD. Multivariate regression analysis showed that large PV and BOOI were significantly associated with PMD. In Spearman's correlation analysis, PMD and each m-IPSS sub-score except nocturia had significant positive correlation. Furthermore, Spearman's correlation analysis showed that PMD and QOL had significant strong positive correlation. PMD was significantly associated with large PV and BOO evaluated by PFS. Furthermore, PMD significantly exacerbated QOL. The severity of PMD and the other m-IPSS sub-score except nocturia could have intercorrelation with each other.

Pressure Measurement in a Bladder Phantom Using Contrast-Enhanced Ultrasonography-A Path to a Catheter-Free Voiding Cystometrogram.

The long-term goal of this study is to investigate the efficacy of a novel, ultrasound-based technique called subharmonic-aided pressure estimation (SHAPE) to measure bladder pressure as a part of a cystometrogram (CMG) in a urodynamic test (ie, pressure-flow study). SHAPE is based on the principle that subharmonic emissions from ultrasound contrast microbubbles (MBs) decrease linearly with an increase in ambient pressure. We hypothesize that, using the SHAPE technique, we can measure voiding bladder pressure catheter-free. This is of importance because the CMG catheter, due to its space-occupying property and non-physiological effects, can undermine the reliability of the test during voiding and cause misdiagnosis. In this study, we tested this hypothesis and optimized the protocol in a controlled benchtop environment. A bladder phantom was designed and built, capable of simulating clinically relevant bladder pressures. Laboratory-made lipid-shelled MBs (similar in composition to the commercial agent, DEFINITY) was diluted in 0.9% normal saline and infused into the bladder phantom using the CMG infusion system. A typical simulated CMG consists of 1 filling and 4 post-filling events. During CMG events, the bladder phantom is pressurized multiple times at different clinically relevant levels (small, medium, and large) to simulate bladder pressures. Simultaneous with pressurization, MB subharmonic signal was acquired. For each event, the change in MB subharmonic amplitude was correlated linearly with the change in bladder phantom pressure, and the SHAPE conversion factor (slope of the linear fit) was determined. In doing so, a specific signal processing technique (based on a small temporal window) was used to account for time-decay of MB subharmonic signal during a simulated CMG. A strong inverse linear relationship was found to exist between SHAPE and bladder phantom pressures for each of the CMG filling and post-filling events ( r2> 0.9, root mean square error < 0.3 dB, standard error <0.01 dB, and P < 0.001). SHAPE showed a transient behavior in measuring bladder phantom pressure. The SHAPE conversion factor (in dB/cm H 2 O) varied between filling and post-filling events, as well as by post-filling time. The magnitude of the SHAPE conversion factor tended to increase immediately after filling and then decreases with time. Microbubble subharmonic emission is an excellent indicator of bladder phantom pressure variation. The strong correlation between SHAPE signal and bladder phantom pressure is indicative of the applicability of this method in measuring bladder pressure during a CMG. Our results suggest that different SHAPE conversion factors may be needed for different events during a CMG (ie, at different time points of a CMG). These findings will help us better protocolize this method for introduction into human subjects and allow us to take the next step toward developing a catheter-free voiding CMG using SHAPE.

Stress and Urgency Urinary Incontinence: Clinical-Urodynamic Correlation and Rehabilitation Management in Daily Clinical Practice

(a) To correlate the clinical with the urodynamic diagnosis in a series of patients with UUI (urgency urinary incontinence) and SUI (stress urinary incontinence); (b) establish age, clinical and urodynamic differences; and (c) demonstrate the effectiveness of individualized rehabilitation treatment based on the clinical-urodynamic diagnosis in patients with SUI and UUI in the daily clinical practice of a third-level rehabilitation service. Retrospective study of 60 patients with SUI and UUI. Urodynamic study: (a) free flowmetry; (b) filling cystomanometry; (c) pressure-flow study. Outcome variables: daytime (DUF) and nighttime (NUF) urinary frequency, strength of the pelvic floor muscles (PFM) measured by manometry (maximum and mean pressure), and use of absorbents/day. Rehabilitation treatment: (a) pelvic floor muscle training (PFMT); (b) biofeedback (BFB), transcutaneous neuromodulation of the posterior tibial nerve (TTNM). Age, clinical, and urodynamic differences have been observed between patients with UUI versus SUI. UUI is more frequent in older patients (UUI 67.3 ± 10.19 years vs SUI 58.6 ± 8.54 years), p = 0.0028. Patients with UUI, when compared with patients with SUI, present more episodes of DUF (7.7 ± 5.1 vs 5.5 ± 3.99) and NUF (2.51 ± 1.67 vs 1.46 ± 1.42). Patients with SUI use more absorbents/day than patients with UUI (2.7 ± 1.53 vs 1.37 ± 1.5), p = 0.0243. The urodynamic study (UDS) confirmed the clinical diagnosis in UUI in 64.7%, while in SUI, it was only confirmed in 35.1%. In the urodynamic analysis (free flowmetry), patients with UUI have smaller bladders than patients with SUI (voiding volume in UUI 275.8 ± 178.95 vs 411.03 ± 203.62 in SUI), p = 0.083. The maximum flow (Qmax) is higher in patients with SUI compared to UUI (19.6 ± 7.07 vs 16.06 ± 8.54), p = 0.0836. In filling cystomanometry, the bladders of patients with UUI are smaller than those with SUI (bladder capacity UUI 266.3 ± 52.76 vs 308.6 ± 49.72 ml in SUI), p = 0.023. In SUI, the BFB/PFMT significantly improved DUF, NUF, PFM pressure, and absorbent use. In UUI, the BFB plus TTNM improved DUF, NUF, and the maximum and mean PFM pressure with statistical difference, while the use of absorbents decreased with a tendency to significance. There are age, clinical, manometric, and urodynamic differences in patients with UUI when compared with patients with SUI. UUI occurs in older patients; they present a greater number of daytime and nocturnal urinary frequency episodes and use fewer absorbents than patients with SUI. Patients with UUI evacuate a smaller urine volume have a lower peak flow (in flowmetry) and a lower bladder capacity (in cystomanometry) than patients with SUI. The rehabilitation treatment proposed in daily clinical practice (PFMT/BFB with or without TTNM improves SUI and UUI). In this study, the UDS has shown a greater clinical-urodynamic correlation in UUI than in SUI.

PD39-03 POST-VOIDED RESIDUAL URINE RATIO IS A PREDICTOR OF BLADDER OUTLET OBSTRUCTION IN MEN WITH LOWER URINARY TRACT SYMPTOMS: DEVELOPMENT OF A CLINICAL NOMOGRAM

You have accessJournal of UrologyCME1 May 2022PD39-03 POST-VOIDED RESIDUAL URINE RATIO IS A PREDICTOR OF BLADDER OUTLET OBSTRUCTION IN MEN WITH LOWER URINARY TRACT SYMPTOMS: DEVELOPMENT OF A CLINICAL NOMOGRAM Cosimo De Nunzio, Riccardo Lombardo, Antonio Nacchia, Antonio Cicione, Beatrice Turchi, Giacomo Gallo, Carmen Gravina, Alessandro Guercio, Jordi Stira, Lorenzo Maria Rivesti, Antonio Franco, Giorgio Guarnotta, Elisa Mancini, Olivia Alessandra Voglino, Valeria Baldassarri, Simone D'Annunzio, Sara Riolo, Simon Carter, Carlo Vicentini, and Andrea Tubaro Cosimo De NunzioCosimo De Nunzio More articles by this author , Riccardo LombardoRiccardo Lombardo More articles by this author , Antonio NacchiaAntonio Nacchia More articles by this author , Antonio CicioneAntonio Cicione More articles by this author , Beatrice TurchiBeatrice Turchi More articles by this author , Giacomo GalloGiacomo Gallo More articles by this author , Carmen GravinaCarmen Gravina More articles by this author , Alessandro GuercioAlessandro Guercio More articles by this author , Jordi StiraJordi Stira More articles by this author , Lorenzo Maria RivestiLorenzo Maria Rivesti More articles by this author , Antonio FrancoAntonio Franco More articles by this author , Giorgio GuarnottaGiorgio Guarnotta More articles by this author , Elisa ManciniElisa Mancini More articles by this author , Olivia Alessandra VoglinoOlivia Alessandra Voglino More articles by this author , Valeria BaldassarriValeria Baldassarri More articles by this author , Simone D'AnnunzioSimone D'Annunzio More articles by this author , Sara RioloSara Riolo More articles by this author , Simon CarterSimon Carter More articles by this author , Carlo VicentiniCarlo Vicentini More articles by this author , and Andrea TubaroAndrea Tubaro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002597.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recently some authors have suggested a possible role of post-void residual ratio to predict bladder outlet obstruction (BOO). Aim of our study is to confirm the correlation between post-void residual urine ratio (PVR-R) and BOO diagnosed by pressure-flow studies (PFS) in males with lower urinary tract symptoms (LUTS) and to develop a clinical nomogram. METHODS: A consecutive series of patients aged 45 years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment for BOO including International Prostatic Symptoms Score, uroflowmetry, urodynamic studies (cystometry and pressure-flow studies), suprapubic ultrasound of the prostate and ultrasound measurements of the bladder wall thickness (BTW). PVR urine and the percentage of PVR to bladder volume (voided volume+PVR) (PVR-R) were evaluated. Logistic regression analysis was used to investigate predictors of pathological bladder emptying (BOO) defined as Schafer >II. Correlations were evaluated with Pearson test. A nomogram to predict BOO based on the multivariable logistic regression model was then developed. Discrimination and net benefit of the model was evaluated. RESULTS: Overall 335 patients with a mean age of 66±11 years were enrolled. Overall, 131/335 (40%) presented BOO on PFS. Shaefer class was correlated with PVR-ratio with a Pearson coefficient of 0,297 (Figure). In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 2,21 per mm; 95% confidence interval [CI], 1,57-3,11; p=0.001), PVR-R (OR: 1,01 per mL/s; 95% CI, 1,00-1,03; p=0.046) and prostate volume (OR: 1,03 per mL/s; 95% CI, 1,03-1,06; p=0.001) were significant predictors for BOO. The model presented an accuracy of 0.82 and a clinical net benefit in the range of 10-90%. Figure: A Nomogram, B: ROC curve, C: Decision Curve Analysis, D: Median PVR_ratios in different Shaffer classes. CONCLUSIONS: The present study confirms the important role of PVR-ratio in the prediction of BOO. For the first time we present a clinical nomogram including PVR-ratio for the prediction of BOO. Eternal validation is needed before clinical implementation. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e652 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cosimo De Nunzio More articles by this author Riccardo Lombardo More articles by this author Antonio Nacchia More articles by this author Antonio Cicione More articles by this author Beatrice Turchi More articles by this author Giacomo Gallo More articles by this author Carmen Gravina More articles by this author Alessandro Guercio More articles by this author Jordi Stira More articles by this author Lorenzo Maria Rivesti More articles by this author Antonio Franco More articles by this author Giorgio Guarnotta More articles by this author Elisa Mancini More articles by this author Olivia Alessandra Voglino More articles by this author Valeria Baldassarri More articles by this author Simone D'Annunzio More articles by this author Sara Riolo More articles by this author Simon Carter More articles by this author Carlo Vicentini More articles by this author Andrea Tubaro More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP01-09 RISK FACTORS FOR A DELAYED IMPROVEMENT IN LOWER URINARY TRACT SYMPTOMS FOLLOWING CONVECTIVE WATER VAPOR THERMAL THERAPY

You have accessJournal of UrologyCME1 May 2022MP01-09 RISK FACTORS FOR A DELAYED IMPROVEMENT IN LOWER URINARY TRACT SYMPTOMS FOLLOWING CONVECTIVE WATER VAPOR THERMAL THERAPY Sarang Janakiraman, Michael Felice, Aya Bsatee, Gaurav Pahouja, and Kevin T. McVary Sarang JanakiramanSarang Janakiraman More articles by this author , Michael FeliceMichael Felice More articles by this author , Aya BsateeAya Bsatee More articles by this author , Gaurav PahoujaGaurav Pahouja More articles by this author , and Kevin T. McVaryKevin T. McVary More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Convective water vapor thermal therapy (CWVTT) is a minimally invasive surgical therapy (MIST) for LUTS/BPH that has been shown to produce clinically significant results up to 5 years. We aimed to identify the incidence and risk factors for delayed improvement in LUTS and retreatment following CWVTT in men with LUTS/BPH. METHODS: Patients who underwent CWVTT from 1/2018 to 12/2020, at a single institution, were identified by CPT code. Pertinent patient, treatment, and outcomes data were extracted. Pressure flow studies were done in 73% of eligible patients. Patients missing pre- or immediate post- operative International Prostate Symptom Score (IPSS) were excluded. Delayed LUTS improvement was defined as failure to reach a minimally important clinical difference (MCID) of 25% on the IPSS after 4 weeks following CWVTT. Potential risk factors of delayed LUTS improvement were assessed by logistic regression. RESULTS: 109 patients were qualified for analysis. 50% of patients experienced delayed LUTS improvement (failure to reach MCID at 4 weeks), although, 82% of men reached the MCID by 12 months. Time from CWVTT, bladder outlet obstruction index (BOOI), and prior surgical BPH therapy were associated with delayed LUTS improvement on multivariate logistic regression. For each additional month following CWVTT, the odds of achieving MCID in LUTS increases by 9% (OR=0.91, 95% CI 0.86-0.97, p=.003). Every 10-unit increase in BOOI was associated with a 15% chance increase in achieving MCID in LUTS at 4 weeks following CWVTT (OR=0.85, 95% CI 0.75-0.96 , p=.01). Patients receiving prior surgical BPH therapy were 3.5 times more likely to experience a delayed improvement in LUTS (OR=3.47, 95% CI 1.36-8.90, p=.01). CONCLUSIONS: 50% of men undergoing CWVTT experienced delayed LUTS improvement (failure to reach MCID at 4 weeks). The odds of reaching a MCID increases by 9% with each subsequent month. Men with a high BOOI indicative of more severe obstruction are more likely to reach the MCID. Men with failed prior BPH surgery are at risk of failing to reach MCID. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e4 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarang Janakiraman More articles by this author Michael Felice More articles by this author Aya Bsatee More articles by this author Gaurav Pahouja More articles by this author Kevin T. McVary More articles by this author Expand All Advertisement PDF DownloadLoading ...

The results of three times repeated filling cystometry and pressure flow studies in children with non-neurogenic lower urinary tract dysfunction.

We previously reported that some urodynamic parameters change with repetitive filling in children with neurogenic lower urinary tract dysfunction (LUTD). In this study, we aimed to search if three-times repeated filling cystometries (FC) and pressure-flow studies (PFS) would change the urodynamics parameters in children with non-neurogenic LUTD. All children with three repeated FC and PFS between June 2017 and December 2018 were included in the study. Urodynamic reports and charts were evaluated retrospectively. The first sensation of bladder filling (FSBF), maximum cystometric capacity (MCC), detrusor pressure at the FSBF (Pdet.first.sens ), maximum detrusor pressure during filling (Pdet.fill.max ), presence of detrusor over activity, compliance, maximum urine flow (Qmax), detrusor pressure at the maximum urine flow (PdetQmax), residual urine and presence of detrusor sphincter dyssynergy (DSD) were compared among three-times repeated urodynamic studies. Forty children were included in the study. 27 (67.5%) were girls and 13 (32.5%) were boys. Median age was 9 (3.4-17) years. Indications were LUTD with low grade vesicoureteral reflux in 19 (47.5%), LUTD refractory to conservative management in 13 (32.5%), urinary tract infection with LUTD in 6 (15%) and secondary enuresis in 2 (5%). Pdet.first.sens , presence of DO, MCC, Qmax, PdetQmax, residual urine, flow pattern, and presence of DSD were comparable in all three repeated tests. The third FC may show decreased filling detrusor pressures and increased compliance with no change on capacity. In children with non-neurogenic LUTD, three-times repeated FC and PFS present comparable results except FSBF, Pdet.fill.max, and compliance at the third test.

Muscarinic-3-receptor positive allosteric modulator ASP8302 in patients with underactive bladder. A randomized controlled trial.

The aim of this study is to evaluate safety and efficacy of ASP8302, a novel positive allosteric modulator for the muscarinic M3 receptor (M3-PAM), in patients with underactive bladder (UAB). A randomized, double-blind, placebo-controlled multicenter study was performed in adult male/female subjects with UAB, defined as incomplete bladder emptying (postvoid residual volume [PVR] > 100 ml) without significant bladder outlet obstruction and/or overactive bladder. Subjects were randomized (1:1) to receive 4-week oral once-daily administration of 100 mg ASP8302 or matching placebo. Primary endpoint was a change from baseline in PVR measured by catheterization after standardized bladder filling (PVRC2 ). Other endpoints included PVR and bladder voiding efficiency (BVE) measured in various ways, uroflowmetry, bladder diary, and questionnaires. Pressure-flow studies were performed in a subgroup. One hundred and thirty-five patients were randomized (ASP8302 group: 65 patients, placebo group: 70 patients). The median change in PVRC2 was -40.0 ml (ASP8302) versus -35.0 ml (placebo) and the difference between groups was -5.0 ml (p = 0.960). In males, functional and symptomatic outcomes improved, for example, maximum urine flow rate (Qmax ) and detrusor pressure at Qmax (Pdet.Qmax ) increased (mean difference in change ASP8302 vs. placebo: 3.8 ml/s, p = 0.031 and 12.7 cm H2 O, p = 0.034, respectively). Urinary incontinence episodes/24 h decreased in males with preexisting incontinence (mean difference: -0.35; p = 0.028). The incidence of adverse events was similar between study groups (ASP8302: 33.3%, placebo: 31.4%). In the included subjects, both baseline urine flow and bladder voiding pressure was low. Compared with PVR, simultaneous BVE measurements were more consistent between various methods (spontaneous vs. standardized bladder filling, catheterization vs. ultrasound [US]). ASP8302 was safe and well tolerated in patients with UAB identified by nonurodynamic clinical criteria, but it did not show efficacy in the primary endpoint. However, in males it showed improvement of symptoms and functional parameters. BVE (using US) is a more optimal outcome measure than PVR in UAB.