Results Of Urodynamic Studies Research Articles

The role of spinal cord tractography in detecting lesions following selective bladder afferent and efferent fibers injury: A novel method for induction of neurogenic lower urinary tract dysfunction in rabbit.

Neurogenic lower urinary tract dysfunction (NLUTD), a challenging disorder, is defined by lack of bladder control due to the abnormalities in neural pathways and can be classified based on the location of lesions within the nervous system, thus investigating the neural pathways can help us to know the site of the lesion and specify the class of the NLUTD. Diffusion Tensor Imaging (DTI) tractography, a noninvasive advanced imaging method, is capable of detecting central nervous system pathologies, even if routine magnetic resonance imaging shows no abnormality. Accordingly, tractography is an ideal technique to evaluate patients with NLUTD and visualize the pathology site within the spine. This study aimed to introduce a novel method of spinal cord injury (SCI) to establish NLUTD in the rabbit and to investigate the potential of tractography in tracing neural tracts of the spinal cord in an induced NLUTD animal model. An animal model of NLUTD was induced through cauterization of the spinal cord at the level T12-L1 in 12 rabbits. Then rabbits were assessed via DTI, urodynamic studies (UDS), voiding cystourethrogram (VCUG), and pathology assessments using antineurofilament 200 (NF200) antibody, anti-S100, anti-Smooth Muscle Actin, anti-Myogenin, and anti-MyoD1. The tractography visualized lesions within spinal cord fibers. DTI parameters including fractional anisotropy (FA) value and tract density were significantly decreased (FA: p-value = 0.01, Tract density: p-value = 0.05) after injury. The mean diffusivity (MD) was insignificantly increased compared to before the injury. Also, the results of UDS and pathology assessments corroborated that applying SCI and the establishment of the NLUTD model was completely successful. In the present study, we investigated the auxiliary role of tractography in detecting the spinal cord lesions in the novel established rabbit model of NLUTD. The introduced method of NLUTD induction was without the leg's neurological deficit, easily applicable, low-cost, and was accompanied by minimal surgical preparation and a satisfactory survival rate in comparison with other SCI animal models.

Urodynamic study findings and related influential factors in pediatric spastic cerebral palsy

To investigate the urodynamic study (UDS) result in pediatric patients suffering from spastic cerebral palsy (CP). Medical records of patients diagnosed CP having pre-operative UDS results underwent selective dorsal rhizotomy (SDR) from Jan. 2020 to May. 2021 were retrospectively reviewed. Fifty-seven cases diagnosed spastic CP were included in the study (mean age, 6.73 ± 2.84 years), among which, 46 were ambulatory and 11 non-ambulatory. Average gross motor function measure-66 (GMFM-66) score was 62.16 ± 11.39. Reduced bladder capacity was seen in 49.12% of these cases and cases with lower GMFM-66 score possessed a higher incidence rate of having low bladder capacity (p < 0.01). Detrusor overactivity (DO) was shown in 33.33% of the patients. Cases with younger age presented a higher prevalence of DO (p < 0.05). Meanwhile, more non-ambulant patients suffered from DO (p < 0.05). Increased post-voiding residual (PVR) was seen in 21.05% of the cases. Those with higher average threshold in sphincter-associated input spinal nerve roots (rootlets) witnessed a higher rate of having abnormal PVR (p < 0.05). Abnormal UDS results were prevalent in pediatric patients suffering from CP. Motor function, age and threshold of their sphincter-associated spinal nerve roots laid corresponding effect on the abnormal UDS results.

Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment

ABSTRACTIntroduction:Defective closure of the neural tube affects different systems and generates sequelae, such as neurogenic bladder (NB). Myelomeningocele (MMC) represents the most frequent and most severe cause of NB in children. Damage of the renal parenchyma in children with NB acquired in postnatal stages is preventable given adequate evaluation, follow-up and proactive management. The aim of this document is to update issues on medical management of neurogenic bladder in children.Materials and Methods:Five Pediatric Urologists joined a group of experts and reviewed all important issues on “Spina Bifida, Neurogenic Bladder in Children” and elaborated a draft of the document. All the members of the group focused on the same system of classification of the levels of evidence (GRADE system) in order to assess the literature and the recommendations. During the year 2020 the panel of experts has met virtually to review, discuss and write a consensus document.Results and Discussion:The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies. Clean intermittent catheterization (CIC) should be implemented during the first days of life, and antimuscarinic drugs should be indicated upon results of urodynamic studies. When the patient becomes refractory to first-line therapy, receptor-selective pharmacotherapy is available nowadays, which leads to a reduction in reconstructive procedures, such as augmentation cystoplasty.

Impact of Bladder Wall Thickness on the Outcomes of Antimuscarinic Treatment in Women with Overactive Bladder

Aim: This study aimed to evaluate the effect of bladder wall thickness (BWT) (using transabdominal ultrasound) on the outcomes of antimuscarinic treatment in women with overactive bladder. Methods: A total of 102 female patients with symptoms of OAB were recruited. All patients completed the Overactive Bladder version 8 (OAB-V8) (Arabic validation) and the International Consultation of Incontinence Questionnaire (ICIQ-SF). Patients completed the urodynamic study (UDS) including uroflowmetry and PVR and measures of BWT by transabdominal ultrasound. The patients were classified into 2 major groups: G1 (patients with BWT <5 mm) and G2 (patients with BWT ≥5 mm). The patients were re-evaluated after 3-month medication with solifenacin 10-mg oral tablet. Results: At baseline, the results of OAB-V8 and ICIQ-SF were significantly higher in G2 than G1 (p < 0.001). Regarding UDS, volume at 1st desire to void, volume at strong desire to void, and MBC were significantly higher in group 1 compared to group 2 (p = 0.001). Intravesical pressure at strong desire and patients’ number of DO were significantly increased in G2 (p < 0.05 and p = 0.001, respectively). After treatment, there was an improvement in both groups regarding OAB-V8, ICIQ-SF, bladder volume at 1st desire to void, bladder volume at strong desire to void, bladder volume at DO, MBC, intravesical pressure at strong desire, and the patients’ number with DO (decreased), and these improvements were statistically significant in group 1 compared to group 2 (p < 0.05). Conclusion: BWT showed a significant association with both OAB symptom scores and UDS parameters. The decrease in BWT is associated with a significantly higher response to solifenacin therapy regarding the UDS results.

Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units?

ObjectivesTo assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction. Material and methodsEpidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction. ResultsA total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ = 0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p < 0.001), UUI (3dBD; p = 0.008) and nocturia (B-SAQ; p < 0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p < 0.05) according to the obstruction degree. ConclusionsApproximately 50% of male patients aged 18–65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor.

НЕЙРОУРОЛОГИЧЕСКОЕ ОБСЛЕДОВАНИЕ И ЛЕЧЕНИЕ ДЕТЕЙ, ОПЕРИРОВАННЫХ ПО ПОВОДУ СПИННОМОЗГОВОЙ ГРЫЖИ

Among the most severe consequences of spinal hernia surgery (SHG) are spinal neurogenic bladder (SNGB) and impaired bowel movement. SNGB, in addition to its main manifestations in the form of violations of the accumulative function of the bladder and the function of emptying, is dangerous for the development of complications – vesicoureteral reflux, ascending infection of the urinary system and chronic kidney disease. Clinical manifestations of SNGB do not always accurately indicate a variant of bladder dysfunction. The authors presented variants of the results of urodynamic studies in children operated on for SHG SHG. The state of the detrusor – hyperactivity or atony and the sphincter – insufficiency or hyperactivity and the selection of a pathogenetically justified treatment option are described.

¿Existe concordancia entre vejiga hiperactiva e hiperactividad del detrusor en varones con síntomas predominantemente de llenado derivados a Unidades de Urología Funcional y Urodinámica?

ObjectiveTo assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction. Material and methodsEpidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction. ResultsA total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ=0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p<0.001), UUI (3dBD; p=0.008) and nocturia (B-SAQ; p<0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p<0.05) according to the obstruction degree. ConclusionsApproximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor.

Pediatrik Posttransplantasyon Renal Greftlerdeki Vezikoüreteral Reflü ve Sonuçları: Korkmalı mıyız?

Objective: Demographical, pre-transplantation and post-transplantation features and post-treatment results of four pediatric cases, who had vesicoureteral reflux (VUR) in the graft kidney, were discussed. Methods: Transplantation age, primary diagnosis, VUR to pretransplantation in native kidneys, history of bladder dysfunction, bladder capacity, results of urodynamic studies, donor and its features, induction treatments and ongoing immunosuppressive treatments, acute rejection episodes, CMV and BK infections, VUR grade in the renal graft, DMSA results, treatment type and its outcomes, and the renal graft functions of four patients who underwent kidney transplantation at Tepecik Training and Research Hospital between 2008 and 2016 and for whom VUR was determined via voiding cystourethrography (VCUG) due to recurrent urinary tract infections, were evaluated. Results: All of four cases were female. Their mean transplantation age was 8.7 years (5-16). High grade (Grade 4) VUR was determined in the graft kidney in all but one. DMSA included multiple scar foci apart from one case having low grade VUR. Cases were primarily treated endoscopically and then by open surgery. Spontaneous recovery occurred in one case. Graft dysfunction was not observed in any of the cases. Conclusion: VUR is an important risk factor in recurrent urinary tract infections after post-transplantation. A special assessment should be done for the patient in the presence of VUR and conservative and surgical treatments should be executed together. It should be remembered that VUR can be spontaneously regressed by the bladder capacity increasing treatments and prophylaxis.

Comparison of Penile Cuff Test and Conventional Urodynamic Study Prior to Photoselective Vaporization of Prostate for Benign Prostate Hyperplasia Using a 120 W GreenLight High Performance System Laser.

Background: We compared the utility of the penile cuff test (PCT) and the conventional urodynamic study (UDS) for the preoperative assessment of patients undergoing scheduled photoselective vaporization of the prostate (PVP) for benign prostate hyperplasia (BPH). Methods: Fifty-nine patients with voiding lower urinary tract symptoms (LUTS) underwent a simultaneous PCT and conventional UDS before PVP. The modified International Continence Society (ICS) nomogram was used to confirm bladder outlet obstruction after measuring maximum urinary flow rate and highest pressure at flow interruption. The PCT and UDS results, in terms of modified ICS nomogram predictions, were compared. Their sensitivities, specificities, and positive and negative predictive values were calculated. Results: Thirty-six patients were diagnosed as obstructed and 23 as non-obstructed/equivocal using the modified ICS nomogram during the PCT. All 36 of the first group were confirmed as obstructed by UDS. Of the 23 diagnosed as non-obstructed/equivocal by the PCT, 14 were confirmed to be non-obstructed by UDS, with nine diagnosed as obstructed. The PCT showed a sensitivity of 80% and a specificity of 100%. The positive and negative predictive values were 100% and 60.9%, respectively. Conclusions: In conclusion, despite our small number of patients, the PCT’s high sensitivity and specificity suggest that it may provide diagnostic information about bladder outlet obstruction before PVP for patients with voiding LUTS. Evidently, the PCT has the potential to be used for some patients as a screening alternative to invasive UDS.

Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder.

Management of idiopathic overactive bladder (iOAB) after the failure of sacral nerve modulation (SNM) is very challenging. To the best of our knowledge, no study has evaluated the use of botulinum toxin A (BoNT-A) after SNM failure for iOAB. The aim of this study is to evaluate the tolerance and efficacy of BoNT-A injection after the failure of SNM for iOAB. We conducted a retrospective multicentric analysis of all patients who had received either onabotulinumtoxinA or abobotulinumtoxinA intradetrusor injection for iOAB after SNM failure, between January 2004 and December 2017. The primary outcome was the percentage of success of first BoNT-A injection (either resolution of their urinary incontinence or their frequency or more than 50% reduction in frequency). Secondary outcomes were results of urodynamic studies, complications, total number of injections, causes of withdrawal, and subsequent treatment. Seventy-six patients (62 female) were included. The percentage of success of first BoNT-A injection was 43.4% (n = 33). All overactive bladder symptoms were significantly improved on the 3-day bladder diary. Twenty-eight patients (36.8%) were put under clean intermittent self-catheterization transitory. After a mean follow-up of 57.7 (±38.5) months, median number of injections was 2 (1-15). Overall, 42 patients (55.2%) stopped injections during follow-up. The estimated 36-months discontinuation-free rate was 48.1%. Mean cause of discontinuation was a primary failure (n = 32; 42.1%). BoNT-A can be used in SNM nonresponders with a success rate of 43.4% but is associated with a high long-term discontinuation rate.

Bladder management practices in spinal cord injury patients: A single center experience from a developing country

Context/Objective: Inadequate bladder management in spinal cord injury (SCI) patients results in significant morbidity and even mortality. Clean intermittent catheterization (CIC) is the recommended option for SCI patients. The objective of the study was to document the bladder management practices of SCI patients in a developing country.Design: Questionnaire based cross sectional surveySetting: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, PakistanParticipants: All patients with SCI (irrespective of duration, level and etiology)Interventions: Data documentation included demographics, level, severity and time since injury, bladder management techniques used, details of CIC, results of Urodynamic studies (if available), complications resulting from bladder management technique and patient awareness of the yearly follow up. SPSS V 20 was used for analysis.Outcome Measures: Not applicableResults: Thirty four consenting patients were enrolled. All were males. Mean age was 31.24 ± 10.9. Most (17) of the patients were thoracic level paraplegics, while 12 patients had sustained a cervical SCI. Majority (23) had complete injury (ASIA A). Fifteen patients used CIC for bladder management followed by in dwelling Foley catheters in thirteen patients. Those using CIC performed the procedure every four hours and used disposable catheters. The same ‘disposable’ catheter was used for 5-7 days by half of these patients. Only Six patients independently performed CIC. Three patients on CIC reported urinary tract infection.Conclusions: In the largest spinal rehabilitation unit of a developing country; Pakistan CIC was the preferred method of bladder management followed by indwelling catheter. Re-use of disposable catheters is a common practice due to cost issues. The rate of UTI was significantly lower in patients on CIC.

Urinary dysfunction in patients with unsatisfactory results of surgical treatment of benign prostatic hyperplasia

OBJECTIVE. The study aimed to develop diagnostics and treatment of urinary dysfunction in patients with unsatisfactory results of surgery of benign prostatic hyperplasia (BPH). MATERIAL AND METHODS. The urodynamic studies were made for 93 (72,7 %) patients after transurethral resection of the prostate and 35 (27,3 %) patients after open adenomectomy. All the patients had urinary dysfunctions after surgery of BPH. RESULTS. Detrusor hyperactivity was revealed in 51 (39,9 %) patients. Detrusor hypoactivity was noted in 21 (16,4 %) patients. Combination of detrusor hyperactivity during storage phase and detrusor hypoactivity during emptying phase had 25 (19,5 %) patients. Infravesical obstruction was detected in 22 (17,2 %). Urgent incontinence was diagnosed in 10 cases. There were 9 patients with signs of stress and condition combined with predomination of stress component. Treatment depended on the causes of urination dysfunction. CONCLUSIONS. Results of urodynamic studies allowed doctors to implement pathogenically verified therapy of urinary dysfunction after surgery of benign prostatic hyperplasia and improve its efficacy.

Anorectal Manometric and Urodynamic Parameters According to the Spinal Cord Injury Lesion.

ObjectiveTo assess the correlation between the anorectal function and bladder detrusor function in patients with complete spinal cord injury (SCI) according to the type of lesion.MethodsMedical records of twenty-eight patients with SCI were included in this study. We compared the anorectal manometric and urodynamic (UD) parameters in total subjects. We analyzed the anorectal manometric and UD parameters between the two groups: upper motor neuron (UMN) lesion and lower motor neuron (LMN) lesion. In addition, we reclassified the total subjects into two groups according to the bladder detrusor function: overactive and non-overactive.ResultsIn the group with LMN lesion, the mean value of maximal anal squeeze pressure (MSP) was slightly higher than that in the group with UMN lesion, and the ratio of MSP to maximal anal resting pressure (MRP) was statistically significant different between the two groups. In addition, although the mean value of MSP was slightly higher in the group with non-overactive detrusor function, there was no statistical correlation of anorectal manometric parameters between the groups with overactive and non-overactive detrusor function.ConclusionThe MSP and the ratio of MSP to MRP were higher in the group with LMN lesion. In this study, we could not identify the correlation between bladder and bowel function in total subjects. We conclude that the results of UD study alone cannot predict the outcome of anorectal manometry in patients with SCI. Therefore, it is recommended to perform assessment of anorectal function with anorectal manometry in patients with SCI.

A fuzzy logic model for differential diagnosis of lower urinary tract dysfunctions

ABSTRACTLower urinary tract dysfunctions (LUTD) restrict quality of life, resulting in decreased work productivity and emotional well‐being. However, most people are not diagnosed because they do not seek medical treatment. In addition, some facilities do not adequately train health professionals in the evaluation, diagnosis and treatment of these conditions. The study's objective was to develop a decision support system modelled on fuzzy logic that defines LUTD using the terminology of the International Continence Society. This methodological study aimed to develop a model that uses the maximum–minimum composition (max–min) of fuzzy relations that can perform differential diagnoses of LUTD. The model was tested in 100 cases (50 men and 50 women), and the data were obtained from medical records containing the clinical data and results of urodynamic studies. All medical records were reviewed by a specialist in urology. The model was capable of determining a diagnosis in full (62%) or partial (36%) agreement with the medical report. Agreement between the model and the medical report was excellent (kappa = 0·98, p ≪ 0·001, CI = 0·88–1) or substantial (kappa = 0·53, p ≪ 0·001, CI = 0·45–0·60), considering overestimative accordance (where accordance is assumed when at least one diagnosis is equal) and underestimative accordance (where accordance is assumed when all diagnoses are equal), respectively. The proposed model based on the max–min composition of fuzzy relationships is very simple and performed well. However, more tests are recommended before the model is used as a decision support system.

Lower urinary tract dysfunction in patients with dysautonomia.

With the goal of better defining the types of bladder dysfunction observed in this population, we present the chief urologic complaints, results of urodynamic studies, and treatments of patients with dysautonomia-related urinary symptoms. All patients with dysautonomia referred to our neurourology clinic between 2005 and 2015 for management of lower urinary tract dysfunction were retrospectively reviewed. Each patient's chief urologic complaint was recorded and used to initially characterize the bladder storage or voiding symptoms. Patient evaluation included history and physical examination, urinalysis, post void bladder ultrasound, and urodynamic studies. Successful treatment modalities that subjectively or objectively improved symptoms were recorded. Of 815 patients with the diagnosis of dysautonomia, 82 (10 %) were referred for evaluation of lower urinary tract dysfunction. Mean age was 47 years (range 12-83) and 84 % were female. The chief complaint was urinary urgency ± incontinence in 61 % and hesitancy in 23 % of patients. Urodynamic findings demonstrated detrusor overactivity ± incontinence in 50 % of patients, although chief complaint did not reliably predict objective findings. Successful objective and subjective treatments were multimodal and typically non-operative. Lower urinary tract dysfunction may develop in at least 10 % of patients with dysautonomia, predominantly females. Bladder storage or voiding complaints do not reliably predict urodynamic findings. Urodynamically, most patients exhibited detrusor overactivity. The majority of patients were successfully managed with medical or physical therapy.

Urodynamic Evaluation and Anorectal Manometry Pre- and Post-operative Bowel Shaving Surgical Procedure for Posterior Deep Infiltrating Endometriosis: A Pilot Study

Study ObjectiveTo analyze bowel and urinary function in patients with posterior deep infiltrating endometriosis (DIE) >30 mm in largest diameter at transvaginal ultrasound before and after surgical nerve-sparing excision. DesignProspective observational study (Canadian Task Force classification III). SettingTertiary care university hospital in Bologna, Italy. PatientsTwenty-five patients with posterior DIE were included in the study between June 2011 and December 2012. Patients did not receive hormone therapy for at least 3 months before and 6 months after surgery. InterventionsPatients underwent urodynamic studies and anorectal manometry before and after nerve-sparing laparoscopic excision of the posterior DIE nodule. Measurements and Main ResultsIntestinal and urinary function was evaluated in patients with bulky posterior DIE using urodynamic and anorectal manometry. Results of urodynamic studies and anorectal manometry were similar before and after nerve-sparing surgical excision of the posterior DIE nodule. Urodynamic studies demonstrated a high prevalence of voiding dysfunction, whereas anorectal manometry showed no reduction in rectoanal inhibitory reflex and hypertone of the internal anal sphincter. ConclusionsPatients with posterior DIE >30 mm in greatest diameter demonstrate preoperative dysfunction at urodynamic study and anorectal manometry, probably due to DIE per se. The nerve-sparing surgical approach seems not to influence the motility or sensory capacity of the bladder and the rectosigmoid colon.

Nerve-Sparing Radical Hysterectomy Made Easy by Laparoscopy

Study ObjectiveTo evaluate the technical feasibility of nerve-sparing radical hysterectomy performed laparoscopically. PatientsThirty-five women with cervical cancer stage Ia1 or Ib1. InterventionsAll patients underwent laparoscopic nerve-sparing hysterectomy. Measurements and Main ResultsOncologic results were comparable to those of conventional laparoscopic radical hysterectomy. There was complete recovery of bladder function after removal of the Foley catheter. Results of urodynamic studies at 3 weeks after surgery were normal. ConclusionOncologic and functional results are comparable to those of conventional laparoscopic radical hysterectomy. Magnification enabled by laparoscopy is helpful in better dissection and preservation of nerve anatomy.

Abnormal urodynamic findings in children with nocturnal enuresis

Reduced nocturnal bladder capacity has been suggested in the pathogenesis of nocturnal enuresis. This study was conducted to define frequency of bladder dysfunction in enuretic children and determine parameters which might predict bladder dysfunction. 60 children were enrolled. Full urodynamic study (UDS) was done in case of abnormal uroflowmetry, abnormal bladder ultrasound, daytime incontinence and age 10 years. Of 60 patients ultrasound 48 underwent complete UDS. In 11, results of UDS were unreliable. The results were normal in 10 (20.8%) and 27 (56.2%) had abnormal UDS .The study revealed that abnormal UDS is common in enuretic children and overactive bladder is the most common findings. No clinical feature were found, which could identify children requiring UDS.

Evaluation of the Lower Urinary Tract before Renal Transplantation: To Which Patients? How?

Purpose: The evaluation of lower urinary tract (LUT) before transplantation is not required, except in patients with a history of LUT disfunction (LUTD). In this study, we adressed the necessity for lower urinary system evaluation in transplantation candidates classified according to their etiology. Materials and Methods: Sixty-two patients were prospectively evaluated. The patients were evaluated at 2 months preoperatively and at 6 months post transplantation using questionnaires, bladder diary and urodynamic studies. The end stage renal disease (ESRD) etiologies of the patients were divided into three groups as follows: patients with a parenchymal disease, patients with LUTD and those with unknown etiology and the obtained results were evaluated accordingly. Results: The evaluation of 50 patients revealed significant differences in ICIQ-SF (p < 0.001), IPSS (p < 0.001), daily urine volumes (p = 0.05), maximum urinary flow rate (p = 0.03), PVR, the number of patients with VUR and all cystometric parameters between the patient groups divided according to the etiology. The comparison of the groups to each other revealed no statistically significant differences in all parameters between the LUTD group and the patient groups with unknown etiology. Considering that the results from questionnaires of patients with a single voided volume of 100 cc or greater on the bladder diary would be scientifically more significant, they were evaluated separately. Thus, even though the results from questionnaires did not differ between the group with unknown etiology and the LUTD group, there were significant differences when compared to patients who developed ESRD due to a parenchymal disease. Similar findings were found between the results of urodynamic study. Conclusions: The evaluation of lower urinary tract in patients with a history of LUTD and in those with unknown etiology should be initially evaluated by noninvasive methods such as questionnaires and uroflowmetry.

Role of urodynamic studies in the diagnosis and treatment of lower urinary tract symptoms

Urodynamic studies (UDSs) encompass a series of clinical tests, such as uroflowmetry, filling cystometry, pressure-flow studies and assessment of urethral closure (including urethral pressure profilometry and measurement of the leak-point pressure). Lower urinary tract symptoms are not always well correlated with the results of UDSs. Such studies are indicated in the following situations: (1) when conservative treatment is ineffective; (2) when invasive treatment is being considered; (3) for protection of the upper urinary tract by creating a low-pressure reservoir and control of urinary incontinence; (4) for evaluation of the effects of treatment; and (5) for biofeedback training. Video urodynamics is described as the gold standard of conventional UDSs. Characteristic features of various types of lower urinary tract symptoms, including urinary incontinence, bladder outlet obstruction and neurogenic bladder, can be identified by UDSs.