Residual Urine Tests Research Articles

PD42-06 EFFECTS OF INTRAVESICAL BOTULINUM TOXIN TYPE-A INJECTION LOCATION ON SYMPTOM SCORES AND SEXUAL FUNCTIONS IN FEMALE PATIENTS WITH A DIAGNOSIS OF REFRACTORY BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS: A RANDOMIZED, PROSPECTIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023PD42-06 EFFECTS OF INTRAVESICAL BOTULINUM TOXIN TYPE-A INJECTION LOCATION ON SYMPTOM SCORES AND SEXUAL FUNCTIONS IN FEMALE PATIENTS WITH A DIAGNOSIS OF REFRACTORY BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS: A RANDOMIZED, PROSPECTIVE STUDY Murat Karaburun, Eralp Kubilay, Derya Gökmen, Mehmet İlker Gökçe, Evren Süer, and Ömer Gülpınar Murat KaraburunMurat Karaburun More articles by this author , Eralp KubilayEralp Kubilay More articles by this author , Derya GökmenDerya Gökmen More articles by this author , Mehmet İlker GökçeMehmet İlker Gökçe More articles by this author , Evren SüerEvren Süer More articles by this author , and Ömer GülpınarÖmer Gülpınar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003352.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To determine the effect of Intravesical Botulinum Toxin type-A (BTX-A) treatment with trigon included and trigone sparing on symptoms and sexual function in female patients diagnosed with Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) who did not benefit from conventional treatments. METHODS: Patients with BPS/IC who were treated with hydrodistension+BTX-A were enrolled in the study between January 2020 and April 2022. Using the stratified randomization technique, patients were randomly randomized to one of two groups: hydrodistension+trigone sparing injection (Group-1) or hydrodistension+trigone-included injection (Group-2). The study comprised a total of 27 patients. The patients were evaluated with VAS, ICSI, ICPI, FSFI questionnaires, and 3-day voiding diaries, voiding tests, and residual urine tests (uroflowmetry and residue determination) in the preoperative period and in the postoperative first and third months. RESULTS: The study comprised a total of 27 patients, 14 from Group-1 with a mean age of 40,9 (±9,25) and 13 from Group-2 with a mean age of 41.7 (±10.3). Preoperative VAS, ICSI, ICPI, and FSFI scores for 27 patients were 8.95±1.39; 16.21±2.94; 14.38±2.27 and 15.92±3.73, respectively. VAS, ICSI, ICPI, and FSFI scores were 3.47±2.94; 7.14±3.97; 6.47±3.95 and 22.41±5.02 at the first postoperative month, respectively. It was 2.69±3.18; 5.79±5.08; 5.79±4.95 and 24.41±6.06 in the third month postoperatively. Treatment led to statistically significant improvements in all four variables (p<0.001). While significant improvement was observed with treatment in both groups, no difference was found between the two groups in terms of treatment results (p: 0.89; p: 0.341; p: 0.488 and p: 0.706, respectively). In total, two patients had urinary tract infection in the postoperative period and one patient had retention, but there was no difference between the two groups in terms of adverse effects (p>0.05). CONCLUSIONS: Intravesical BTX-A treatment is an effective and safe treatment in female patients with BPS/IC unresponsive to conventional treatments. The treatment also contributes positively to sexual functions. The inclusion of trigone in the injections makes no difference to the treatment response. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1113 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Murat Karaburun More articles by this author Eralp Kubilay More articles by this author Derya Gökmen More articles by this author Mehmet İlker Gökçe More articles by this author Evren Süer More articles by this author Ömer Gülpınar More articles by this author Expand All Advertisement PDF downloadLoading ...

Outcomes of Top-Down Holmium Laser Enucleation of Prostate for Recurrent/Residual Benign Prostatic Hyperplasia: One-Year Follow-Up.

Materials and Methods We carried out a retrospective analysis of patients who underwent top-down HoLEP for the management of recurrent BPH at our institution. Patients who had previously undergone TURP were assigned to group I, while those with no history of prostate surgery were allocated to group II. Preoperative clinical characteristics, enucleation time, resected tissue weight, morcellation time, energy used, and intraoperative and postoperative complications were recorded and statistically analyzed. Patients were followed up postoperatively at 1, 3, 6, and 12 months. The evaluation included the International Prostate Symptom Score (IPSS), quality of life assessment (QoL), maximum urinary flow rate (Qmax), postvoid residual urine test (PVR), and continence status. Results Two hundred and sixty-nine patients were included in this study. Group I consisted of 68 patients with recurrent BPH, while group II included 201 patients. There were no statistically significant differences in preoperative characteristics between both groups. The median enucleation time for group I (67.5 min (25–200)) was not significantly longer than that for group II (60 min (19–165) (p=0.25)). Operative outcomes, including morcellation time, resected weight, catheter duration, and hospital stay, were comparable between both groups. At 1, 3, 6, and 12 months, all urinary functional outcomes showed significant improvement, and there were no significant differences between the two groups. At 3 months' follow-up, two patients in group I and three patients in group II experienced stress urinary incontinence (SUI). At the last follow-up visit, one patient from group I presented with persistent SUI. Conclusions For managing recurrent and nonrecurrent cases of BPH, top-down HoLEP is safe with comparable urinary functional outcomes. Patients with a history of previous prostate surgery can be counselled that their prior transurethral procedure does not reduce the benefits of HoLEP.

SHORT-TERM SURGICAL AND FUNCTIONAL OUTCOMES AFTER ROBOT-ASSISTED SACROCOLPOPEXY IN A SINGLE INSTITUTION

(Objectives) This study aimed to evaluate the surgical outcomes and functional parameters of lower urinary tract and bowel symptoms in patients who have undergone robot-assisted sacrocolpopexy (RASC) due to pelvic organ prolapse. (Patients and methods) This retrospective study included 110 consecutive RASC cases in the urology department of Ageo Central General Hospital, Japan, from November 2020 to October 2021. The medical records of these patients were retrieved. Data on uroflowmetry, post-void residual urine test, and self-administered questionnaires on urination and defecation were assessed. (Results) The mean operating time was 146 min, and the estimated blood loss was 14.8 ml. The intraoperative, postoperative, and severe complication rates of cases classified as Clavien-Dindo grade IIIa or higher were 0%, 9.1%, and 0%, respectively. The maximum flow rate and post-void residual volume of urine significantly improved after the operation. Similarly, the quality of life (QOL) scores and overactive bladder symptom score (OABSS), as well as the responses for the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Urinary Distress Inventory-6 (UDI-6), significantly improved one month after the operation and were sustained for six months. On the other hand, the total scores from the Constipation Scoring System (CSS) and the subscales of the Patient Assessment of Constipation (PAC) -QOL worsened. These scores, except for those of the PAC-QOL satisfaction subscale recovered to the preoperative levels; the PAC-QOL satisfaction subscale scores significantly improved six months postoperatively. The rates of de novo overactive bladder (OAB), stress urinary incontinence (SUI), and constipation one month postoperatively were 8%, 33%, and 10%, respectively. (Conclusions) RASC was performed safely in our institution with acceptable postoperative lower urinary tract and bowel outcomes.

Predictive factors and management of urinary tract infections after kidney transplantation: a retrospective cohort study.

Urinary tract infection (UTI) is one of the most common infectious complications in kidney transplant recipients. The aims of our study were to identify possible predictive factors for UTI and advocate for the management of UTI after kidney transplantation (KT). Between January 2013 and December 2018, 182 adult patients with end-stage kidney disease who underwent KT were retrospectively analyzed. Patients who had urinary symptoms and positive urine culture were diagnosed with UTI. The types of urinary bacteria causing UTIs were also examined. UTIs occurred in forty-one patients (25.1%), and the median time to UTI onset (UTI-free survival) after KT was 189days. The Cox hazard regression analysis showed that the predictive factors for UTI onset were as follows: posttransplant urinary catheterization, including indwelling urinary catheterization and clean intermittent catheterization; a maximum bladder capacity before KT of less than 150ml; and a low serum albumin level at 1month after KT. The most common causative agent was Escherichia coli (56.6%), followed by Enterococcus spp. (15.6%) and Klebsiella spp. Kidney transplant recipients with prolonged postoperative malnutrition, posttransplant voiding dysfunction and/or urinary storage disorder had an increased risk of UTI. Bladder function tests, such as uroflowmetry, postvoid residual urine tests, and urodynamic tests, were needed to predict UTI. For patients with malnutrition, care should be taken to ensure sufficient calorie intake. Kidney transplant recipients who develop UTI should be treated as complicated UTI patients.

EFFECTIVENESS AND SAFETY OF TADALAFIL IN VERY ELDERLY PATIENTS WITH LOWER URINARY TRACT SYMPTOMS

(Aim) The α-1 blockers have been used as first-line therapy for benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS). A new phosphodiesterase type 5 inhibitor, tadalafil, was approved in 2014 and received a Grade A recommendation in the 2017 clinical practice guidelines for LUTS. In this study, we examined the effectiveness and safety of tadalafil in very elderly patients with LUTS. (Subjects and methods) The subjects were 84 very elderly patients, at least 75 years of age, with BPH/LUTS for which they had been administered tadalafil.Data of the 71 patients were retrospectively reviewed in terms of the International Prostate Symptom Score (IPSS), quality of life (QOL) index, overactive bladder symptom score (OABSS), maximum flow rate and postvoid residual urine volume at baseline and at weeks 4, 8, 12, and 24. We also examined the safety of tadalafil therapy. (Results) Patient characteristics were: median age 80.1±4.38 years, prostate volume 41.2±24.3 cc and IPSS 15.7±5.68. Patients who had undergone treatment for BPH/LUTS prior to tadalafil therapy accounted for 67.9% of the study population.Significant improvements occurred in IPSS, QOL and OABSS at week 4, and the improvements were maintained until week 24. As for postvoid residual urine test results, a significant improvement was seen at week 8 only.Adverse events were noted in 9 patients (10.7%), but only 5 (6.0%) needed to discontinue tadalafil therapy. (Conclusion) Tadalafil is considered to be a highly effective and safe drug in very elderly patients with LUTS.

Six weeks finasteride monotherapy before TURP: Does it improve quality of life in early post operative period?

IntroductionBenign prostatic hyperplasia (BPH) is a common disease affecting men 50 years and older. Treatment options consist of observation, pharmacological treatment, minimally invasive surgery and traditional surgery. Alpha-blockers and 5-alpha-reductase inhibitors are the primary medications used to treat BPH. Transurethral resection of the prostate (TURP) is the gold standard of surgical management of BPH. ObjectiveTo evaluate the effect of six weeks finasteride therapy before TURP on overall surgical outcomes and early postoperative quality of life (QoL). Patients and methodsBetween June 2014 and August 2016, patients with BPH at our department were randomly assigned to one of two groups: group (A) receiving 5 mg of finasteride daily for six weeks and group (B) did not receiving finasteride before TURP. All patients were assessed using a modified validated Arabic version of the International Prostate Symptom Score (IPSS). Intra operative serum hemoglobin concentration and hemoglobin concentration in irrigating fluid were recorded. One month post-surgery, IPSS, storage, voiding subscores and QoL scores were measured. ResultsOut of a total of 115 patients, 98 patients completed the study. Before surgery, there was no significant difference between the two groups in prostate size (Prostate size was 54.52 ± 7.3 g in group A and 50.19 ± 6.8 g in group B, p value = 0.72), IPSS (19.86 ± 4.68 in group A vs. 21.14 ± 4.33 in group B, p value = 0.17), maximum urinary flow rate and post-void residual urine test results. No significant difference between Qol score in both groups before surgery (p value = 0.96). Group A patients had significantly less intraoperative blood loss than group B patients (308.29 ± 48.1 ml vs. 431.11 ± 96.4 ml, p = 0.001). One month postoperatively, group A patients showed greater improvement in QoL than group B patients (p = 0.03). ConclusionsFinasteride therapy for 6 weeks before TURP reduced intraoperative blood loss and statistically improved quality of life in the early postoperative period. However, larger number of patients and longer duration of follow up is recommended to confirm its clinical significance.

Do uroflowmetry and post - void residual urine tests necessary in children with primary nocturnal enuresis?

ABSTRACTObjectives:To examine the benefits of repetitive uroflowmetry and post void residual urine (PVR) tests in children with primary nocturnal enuresis (PNE).Material and methods:Children aged ≥6 years with PNE who visited our clinics for management of enuresis were included for study. Patients were requested to complete a questionnaire including baseline characteristics and Dysfunctional Voiding Symptom Score (DVSS), 2-day bladder diary, and Rome III criteria for constipation. Two uroflowmetry and PVR tests were requested. Children with congenital or neurogenic genitourinary tract disorders were excluded. All children underwent urotherapy and desmopressin combined with anticholinergics or laxatives if indicated. The definition of abnormal flow patterns (≥1 abnormal), elevated PVR (≥1 abnormal), small maximal voided volume (MVV), nocturnal polyuria (NP) and response to treatment complied with the ICCS standardization document. Kaplan-Meier survival analysis and Cox proportional-hazards regression tests were used to evaluate the predictors of response.Results:In total, 100 children aged 8.5±2.3 years were enrolled for study (M: F=66:34) with 7.3±7.4 months of follow-up. Poor correlation was observed between DVSS/small MVV and PVR (p>0.05). Univariate analysis revealed that elevated PVR is associated with significantly less hazard of complete response to medical treatment (HR: 0.52, p=0.03), while not significantly associated with abnormal flow patterns, NP, constipation or small MVV. Multivariate analysis revealed that only elevated PVR (HR 0.30, 95% CI 0.12-0.80) and NP (HR 2.8, 95% CI 1.10-7.28) were significant predictors for complete response.Conclusions:In managing pediatric enuresis, elevated PVR is a significant predictor for lower chance of complete response to treatment whether they had high DVSS or not.

Auriculotherapy for lower urinary tract symptoms in older men: a 4-week, randomised controlled pilot study

BackgroundLower urinary tract symptoms, which commonly occur among older men, include urinary retention, voiding difficulty, frequent feeling of urinary urgency, and nocturia. Auriculotherapy, a Chinese medicine approach, is a therapeutic method in which specific points in the auricle are stimulated to achieve specific therapeutic purposes. This randomised controlled pilot study aimed to determine whether magneto-auriculotherapy alone or in combination with laser auriculotherapy is more effective than placebo for symptom relief and enhancement of quality of life. MethodsMen aged at least 60 years with an International Prostate Symptom Score of 12 or greater (moderate to severe) were recruited from a residential home in Zhengzhou province, China. We recruited 40 men and randomly allocated to three groups decided by computer-generated randomised table: Group 1, combined auriculotherapy (laser auriculotherapy followed by magneto-auriculotherapy on six auricular points, N=14); Group 2, magneto-auriculotherapy only (placebo laser auriculotherapy followed by magneto-auriculotherapy, N=13); and control (placebo laser auriculotherapy followed by placebo magneto-auriculotherapy, N=13). To achieve the effect of evaluator blinding, another researcher who did not know the type of treatment modality received by the participants evaluated the treatment effect. Treatment was done on one ear at a time. The experimental objects were replaced every second day. Participants were assessed at baseline and after completion of the four-week treatment course. Outcome measures included International Prostate Symptom Score (IPSS); Quality of life due to urinary symptoms (0=delighted to 6=terrible); maximum urinary flow rate (Qmax per second); post-void residual urine test (mL); and Pittsburgh sleep quality index. This trial is registered at ClinicalTrials.gov, number NCT02330107 Ethical approval was obtained from the Human Research Ethics Review Committee, The Hong Kong Polytechnic University. FindingsThe mean age of participants was 74·90 years [SD 6·30], with a mean duration of lower urinary tract symptoms of 4·89 years [SD 5·08]. In Group 1, improvements were seen from baseline in lower urinary tract symptoms (mean 20·50 [SD 7·44] vs 13·08 [8·28], p=0·028), quality of life (4·64 [0·50] vs 3·17 [1·53], p=0·016), post-void residual urine (190·43 [117·20] vs 106·75 [79·72] mL, p=0·019) and sleep quality (7·86 [4·58] vs 2·92 [2·58], p=0·009). For patients in Group 2, significant improvement was noted from baseline in lower urinary tract symptoms (20·54 [7·86] vs 13·92 [6·76], p=0·007), quality of life (4·38 [1·19] vs 3·46 [1·33], p=0·01), and sleep quality (mean 8·46 [2·93] vs 5·08 [2·96]). Although patients in the control group also reported improvement in lower urinary tract symptoms (26·08 [8·14] vs 19·00 [8·29], p=0·003) and sleep quality (mean 7·38 [4·79] vs 4·75 [4·09], p=0·008), no significant differences were found for quality of life (4·54 [0·66] vs 4·42 [0·79], p=0·739) or post-void residual urine (157·08 [90·98] vs 158·33 [124·08] mL, p=0·583). We found no effect on Qmax in any group. No adverse events were reported. InterpretationMagneto-auriculotherapy alone or in combination with laser auriculotherapy can improve lower urinary tract symptoms, quality of life, and sleep quality in men aged 60 years or older with lower urinary tract symptoms. Future studies with a larger sample size could be done to investigate a causal relationship between treatment and effect. FundingBlock Grant 1-ZVD4, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.

Urinary Incontinence and Physician's Attitude

Urinary Incontinence and Physician's Attitude

Variability, Related Factors and Normal Reference Value of Post-Void Residual Urine in Healthy Kindergarteners

We report intra-individual variability, related factors and the normal reference value of post-void residual urine in children. Healthy kindergarteners were enrolled for the evaluation of post-void residual urine, which was assessed by ultrasound within 5 minutes after voiding when voided volume was greater than 50 ml. Bladder over distention was arbitrarily defined as a bladder capacity (voided volume plus post-void residual urine) of 115% or greater of expected bladder capacity. The Pearson correlation method was used to evaluate the correlation between post-void residual urine and related factors. More than 1 post-void residual urine value was recorded in 219 children with a mean +/- SD age of 4.9 +/- 0.9 years. Mean post-void residual urine was 12.2 +/- 20.3 ml (median 5.5). The correlation for consecutive post-void residual urine was low in all children and negligible in the 129 without bladder over distention (r = 0.34 and 0.13, respectively). Repeat post-void residual urine greater than 20 ml and greater than 10% bladder capacity was observed in 2.3% and 7.8% of children, respectively, without bladder over distention. Post-void residual urine increased as bladder capacity increased (r = 0.38, p <0.01). Excluding those with bladder over distention, post-void residual urine decreased as the age of the child increased. Children who drank more fluids before voiding had a higher rate of bladder over distention for each micturition than those who drank regularly (13.8% vs 4.9%, p = 0.04). Because of the significant intra-individual variability of post-void residual urine, a single post-void residual urine test is not reliable for assessing pediatric voiding function. Two post-void residual urine tests are recommended. Post-void residual urine is affected by bladder over distention, age of the child and possibly extra hydration before assessment. Abnormal post-void residual urine could be defined as post-void residual urine greater than 20 ml, rather than as greater than 10% bladder capacity, on repeat micturitions without bladder over distention.