Significant Post-void Residual Urine Research Articles

Prevalence and Distribution of Postvoid Residual Urine Volume in a Hospital-Based Sample of Men with Symptomatic Benign Prostatic Hyperplasia.

Benign prostatic hyperplasia (BPH) is a known cause of bladder outlet obstruction (BOO) in aging men. Patients present with lower urinary tract symptoms (LUTS), elevated postvoid residual urine (PVR), and reduced peak flow rate of urine. Although urodynamic study is the gold standard for diagnosing and quantifying BOO, it is invasive and as such urologists in their routine practice frequently rely on less invasive methods like PVR estimation to objectively assess BOO. To study the prevalence and distribution of PVR in a hospital-based population of men with symptomatic BPH. Patients aged 40 years and above were enrolled for the study. History was taken from each of the 170 participants recruited, and physical examination was done including digital rectal examination. Every one of them completed the International Prostate Symptom Score (IPSS) questionnaire and also had ultrasonography assessment of PVR. Relevant laboratory investigations (PSA, renal function test, full blood count, urinalysis, and urine culture) and uroflowmetry to determine the peak flow rate of urine (Qmax) were done. A total of 170 subjects who met the inclusion criteria were enrolled for this study. The mean age of the subjects was 63.70 ± 9.92 years with a range of 42-88 years. The subjects had a mean PSA of 2.68 ± 0.91 ng/ml and a mean prostate volume of 70.8 ± 39.5 ml. The prevalence of significant PVR was 57.06%. The distribution of PVR was skewed with values ranging from 4.0 ml to 382.9 ml, a median value of 60.5 ml (interquartile range, IQR, =25.0-100.76), and a mean value of 77.70 ± 69.30 ml. An IPSS range of 8 to 23 with a mean value of 13.64 ± 4.14 and a median value of 13 (interquartile range = 10.0-16.0) was observed. The Qmax range was from 5 ml/s to 50 ml/s with a mean value of 20.25 ± 9.70 ml/s, and a median value of 18.0 ml/s (interquartile range = 14.0-24.0). This study showed that the prevalence of significant PVR volume among men with symptomatic BPH in our environment is high. There was also a high variation in the distribution of PVR among the subjects. Therefore, it is essential to create more public awareness especially among men in their fourth decade of life and above to visit a urologist whenever they have BPH symptoms so as to avoid impairment in quality of life and renal function associated with neglected significant PVR.

Predictive Factors for High Post-void Residual Volume in Older Females After OnabotulinumA Treatment for Severe Overactive Bladder Using a Machine Learning Model.

Introduction Intravesical onabotulinumA injection is actively used for the treatment of overactive bladder (OAB). However, it occasionally results in significant post-void residual urine (PVR) volume, which can lead to complications and can further impair the activities of daily living in older people. Therefore, this study aimed to identify the predictors of a high post-onabotulinumA injection PVR volume in older women with severe OAB. Methods An observational study was conducted on older women who had previously received intravesical onabotulinumA injections to treat OAB between 2020 and 2022. Urodynamic studies and symptom assessments were conducted, and machine learning models, including random forest and support vector machine (SVM) models, were developed using the R code generated by Chat Generative Pre-trained Transformer 4 (ChatGPT, OpenAI, San Francisco, USA). Results Among 128 patients with OAB, 23 (18.0%) had a PVR volume of > 200 mL after receiving onabotulinumA injections. The factors associated with a PVR volume of > 200 mL were investigated using univariate and multivariate analyses. Age, frailty, OAB-wet, daytime frequency, and nocturia were significant predictors. Random forest analysis highlighted daytime frequency, frailty, and voiding efficiency as important factors. An SVM model incorporating daytime frequency, frailty, and voiding efficiency improved PVR volume prediction. Logit(p) estimation yielded an area under the receiver operating characteristic curve of 0.926294. Conclusion The study found daytime frequency, frailty, and voiding inefficiency to be significant factors associated with a PVR volume of > 200 mL, in older women with severe OAB. Utilizing advanced machine learning techniques and following the guidance of ChatGPT, this research emphasizes the relevance of considering multiple intersecting factors for predicting PVR volume. The findings contribute to our understanding of onabotulinumA injection treatment for OAB and support evidence-based decision-making using readily available information.

Urodynamic Predictors for Voiding Recovery after Transurethral Resection of Prostate in Benign Prostatic Hyperplasia Patients with Significant Post-voiding Residual Urine

Urodynamic Predictors for Voiding Recovery after Transurethral Resection of Prostate in Benign Prostatic Hyperplasia Patients with Significant Post-voiding Residual Urine

An insight into the management of urinary bladder diverticulum: a retrospective observational study

Background: The aim of the study is to retrospectively analyse the best mode of treatment for patients presenting with urinary bladder diverticulum. Methods: This study includes 46 patients who presented to the outpatient department between January of 2018 to March of 2020. They had lower urinary tract symptoms (LUTS) and were later found on investigations with imaging like ultrasound and voiding cystourethrogram (VCUG) as having bladder diverticulum with some cases associated with bladder outlet obstruction. Secondary causes were treated surgically or conservatively with clean intermittent catheterisation (CIC). Diverticulum was addressed with diverticulectomy when conservative management failed with recurrent LUTS or if the diverticulum was of a large size with significant post void residual urine. Results: Most of the patients with diverticulum associated with prostatomegaly or stricture urethra fared well after treatment of the underlying cause except one who underwent subsequent diverticulectomy. Four out of 5 patients with neurogenic bladder did well with CIC alone barring one who underwent diverticulectomy for a large sized diverticulum and refractory LUTS. Two patients with bladder growth involving the neck of diverticulum underwent partial cystectomy along with diverticulectomy. Four out of the remaining 8 patients with primary diverticulum were taken up for diverticulectomy directly and one underwent subsequent diverticulectomy for failed CIC. Conclusions: Not all urinary bladder diverticulum required surgical management per se. Most fared well with treatment of the underlying cause. So only those with large size, recurrent LUTS and failed management with CIC should be considered for diverticulectomy.

The necessity of voiding cystourethrogram for the evaluation of recipient candidates in adult renal transplantation

Objective . While international guidelines necessitate Voiding Cystourethrogram (VCUG) for pediatric patients, it is unnecessary for the evaluation of adult patients without urological disorders as renal transplant candidates. The objective of this study was to evaluate the results of adult candidates who underwent VCUG before transplantation and to demonstrate the necessity for this imaging. Methods . A retrospective study of the data of 1265 adult candidates who underwent VCUG before transplantation at our center, was undertaken. VUR, the presence of Postvoiding residual urine (PVR) (>100 ml), Low bladder capacity (LBC) (<100 ml), and urethral pathologies were evaluated with VCUG. Results . The mean age was 42.3 ± 1.3. The mean dialysis period was 27.8 ± 4.2 months. According to the VCUG results, 19.2% of the patients had pathological findings. On the other hand, the rate of urological disorders was only 5.1%, according to end-stage renal disease (ESRD) etiologies. VCUG outcomes indicated bilateral high-grade reflux in native kidneys in 4.4% (n = 56) of the candidates, unilateral high-grade reflux in 4.1% (n = 52), bilateral low grade reflux in 2.1% (n = 26), unilateral low-grade reflux in 2.4% (n = 30), and reflux in rejected transplanted kidney in 2.3% (n = 29). In addition, significant LBC was noted in 4.8% (n = 61), significant PVR in 1.1% (n = 14), and urethral stricture in 0.5% (n = 6) of the candidates. Conclusion . VCUG should be considered as a part of routine evaluation in adult renal transplant recipient candidates as well as in pediatric candidates, even if their ESRD etiologies are not due to urological disorders.

Can we predict vesicoureteral reflux resolution in patients with non-neurogenic lower urinary tract dysfunction?

To analyze factors influencing reflux resolution in patients with the coexistence of non-neurogenic lower urinary tract dysfunction and vesicoureteral reflux. The data of 153 children who were diagnosed with vesicoureteral reflux and accompanying non-neurogenic lower urinary tract dysfunction between 2010 and 2015 were retrospectively evaluated. Patients with neurogenic and anatomical malformations, monosymptomatic nocturnal enuresis, previous history of vesicoureteral reflux surgery, irregular and/or incomplete follow-up data were excluded. After exclusion of 55 patients, 98 patients were enrolled in this study. Patients were divided into two groups according to the presence of spontaneous vesicoureteral reflux resolution during the follow-up period. Group1 consisted of 54 children with spontaneous vesicoureteral reflux resolution, whereas group2 included 44 children without resolution. Medical history, physical examination, urinalysis, uroflowmetry combined with electromyography, ultrasonography, as well as the Dysfunctional Voiding and Incontinence Symptom Score questionnaire were also evaluated. The mean age at presentation was 7.57±0.23years (range 5-13years), and the mean follow-up period was 28.3months. Significant differences were noted between the two groups in terms of dysfunctional voiding and incontinence symptom score, bladder wall thickness, and the post-void residual urine volumes. In addition, lower urinary tract symptoms, namely frequency, urgency and daytime incontinence, were found to be higher in group2. In multivariate analysis, post-void residual urine volume and Dysfunctional Voiding and Incontinence Symptom Score were found to affect reflux resolution rates (P=0.002, P=0.002, respectively). The absence of significant post-void residual urine volume, and a low Dysfunctional Voiding and Incontinence Symptom Score increase the likelihood of spontaneous resolution rates of vesicoureteral reflux in children with non-neurogenic lower urinary tract dysfunction.

Surgical outcome of the transobturator tape procedure for management of female urinary incontinence: A single center experience

Background/Aim. The transobturator tape (TOT) procedure is considered as a gold standard of surgical treatment option for stress urinary incontinence (SUI). The aim of this study was to determine the efficacy of this procedure in the surgical management of SUI by analyzing a single centre short-term results. Methods. From April 2011 until January 2018, 40 patients with predominantly SUI were operated by the standard TOT procedure. A polypropylene tape was placed in the mid-urethra by a percutaneous transobturator approach. The postoperative assessment considered cough tests and post-void residual urine volume at a week following the operation with additional clinical examination and urine culture at one, three and six months. Results. The mean age of the patients was 58 (42?78) years. Predominantly SUI was present in 32 patients (80%) and mixed urine incontinence in 8 patients (20%). At the initial (one week) assessment, the cough test was positive in 3 patients (7.5%), and 4 patients (10%) needed an indwelling urethral catheter because of voiding difficulties. At the second follow-up, 2 (5%) patients still had a positive cough test, 2 patients (5%) had still the need for an indwelling catheter because of significant postvoid residual (PVR) urine volumes and 2 patients (5%) had a positive urine culture. At the three and six months, postoperative assessment. 3 patients (7.5%) still had a positive cough test. After six months 36 patients (90%) were considered as cured, 1 patient (2.5%) improved and 3 patients (7.5%) were classified as a failure. Conclusion. These results concur with the results of the other published short-term studies that analyzed the surgical outcome of the TOT procedure for female urinary incontinence. This allows us to confirm that the transobturator tape technique is a safe, effective and straightforward procedure after adequate training.

How to assess and predict success or failure of intra-detrusor injections with onabotulinumtoxinA

Intra-detrusor injection therapy with onabotulinumtoxinA is generally accepted as a highly effective, minimally invasive and well-tolerated day procedure for patients with refractory overactive bladder (OAB) and neurogenic detrusor overactivity (NDO). The aim of this study was to summarize currently available methods of assessing treatment efficacy and risk factors that may influence the therapeutic effect of this approach. We found that there are discrepancies in the assessment methods. The evaluation of intra-detrusor injections with onabotulinumtoxinA in clinical trials are not always transposable into day-to-day practice. Moreover, the primary endpoints in clinical trials do not explore the entirety of meaningful patient-centered outcomes. Therefore, in daily clinical practice with patients with overactive bladder syndrome, the therapy should be assessed with objective measures (bladder diaries) and patient-oriented outcomes analyzing the quality of life (questionnaires). In neurogenic individuals, therapeutic efficacy should be additionally evaluated with urodynamic studies. Potential risk factors that may influence the treatment outcomes include urodynamically proven detrusor overactivity, elevated maximum detrusor pressure, greater maximum cystometric capacity, impaired bladder compliance, older age, male gender, a higher baseline bother score, previous anticholinergic treatment, and repeated injections with a subsequent decline in efficacy. The risk of intermittent catheterization following injections seems to depend on the etiology of detrusor overactivity, the injected dose, the injection technique, and the definition of significant post-void residual urine requiring catheterization.

Thulium laser enucleation of the prostate (ThuLEP): Results, complications, and risk factors in 139 consecutive cases

ObjectivesTo report our experience with the emerging technique of thulium laser enucleation of the prostate (ThuLEP) for the treatment for prostate hyperplasia. Patients and methodsOur inclusion criteria were an International Prostate Symptom Score (IPSS) of >15 and a quality-of-life (QoL) score of >3 in patients with confirmed bladder outflow obstruction, no longer responsive to medical therapy, with a significant post-void residual urine volume (PVR; >100 mL), with or without recurrent urinary tract infection and/or acute urinary retention. Patients with neurogenic bladder, urethral strictures, bladder stones, and previously failed transurethral prostate surgery were excluded. ResultsIn all, 139 men were included in the study. The mean age was 67.8 years. The IPSS and QoL score improved by 17.6 and 2.6, respectively. The flow rate increased from a mean of 9.6 mL to 31.2 mL and the PVR decreased from a mean of 131 mL to 30 mL. On univariate and multivariate analyses, operating time was a predictive factor for haemoglobin drop during the operation. Heparin prophylaxis was the only risk factor identified for postoperative bleeding. Two patients (0.01%) required blood transfusion. One patient (0.007%) required re-intervention for bleeding control, and two patients developed urethral and bladder neck strictures (0.01%). ConclusionThuLEP is safe and reproducible. Whilst it significantly reduces intraoperative bleeding as compared to transurethral resection of the prostate, operating time and perioperative heparin prophylaxis may still lead to a Hb drop and constitute a risk factor for postoperative bleeding. Therefore, a potential risk of deep vein thrombosis requiring heparin prophylaxis should be carefully considered and balanced with the expected clinical benefit of the operation.

PROFILE OF BOYS WITH POSTERIOR URETHRAL VALVES FROM A TERTIARY CARE CENTER IN A DEVELOPING COUNTRY

Introduction: Posterior urethral valves (PUVs) are the most common cause of obstructive uropathy in boys. While most patients&nbsp;in developed countries are diagnosed in the antenatal period, our patients often present late which adversely affects their outcome.&nbsp;This retrospective study was aimed to study the clinical profile of boys with PUV at follow-up. Methods: Records of 45 boys&nbsp;&nbsp;with PUV who were in follow-up for at least 1-year were retrieved between February and December 2015. Age of presentation,&nbsp;signs and symptoms, anthropometry, radiological findings, surgical interventions, and biochemical investigations were recordedin a pre-structured pro forma. The data were later analyzed on an Excel spreadsheet. Results: The mean age at the diagnosis&nbsp;of PUV was 16±2.8 months, and the mean age at enrollment was 70.6±53.5 months. The condition was detected antenatally in&nbsp;5 (10.9%) subjects only. At the time of data collection, the mean height and weight standard deviation scores were ?1.7 and ?1.5,&nbsp;respectively. Hypertension was present in 29% of patients. 44.5% of subjects had moderate-to-severe malnutrition and 42.2% had&nbsp;short stature. Mean GFR of the subjects was 66.3 ml/min/1.73m². Bilateral hydronephrosis was present on ultrasound in 26 (57.8%)&nbsp;subjects. Mean anteroposterior diameter on ultrasound was 22.1 mm for the right kidney and 20.8 mm for the left kidney. Significant&nbsp;post-void residue was detected in 54.6% of patients. Bilateral reflux was seen in 21.7% of subjects on micturating cystourethrogram.&nbsp;Urodynamic studies were available for 16 patients, and 31.3% had significant post-void residual urine. Detrusor instability was&nbsp;present in 18.8% of subjects. 35.6% of subjects underwent valve fulguration alone as the surgical procedure while 19 (42.2%) had&nbsp;a diversion procedure&nbsp; (vesicostomy/ureterostomy) along with valve fulguration. Conclusions: Most of the patients with PUV arestill diagnosed postnatally and have significant renal damage at presentation. Urinary diversion procedures are required in almost&nbsp;half of these patients. All these contribute to a poor long-term outcome.

Can feeling of incomplete bladder emptying reflect significant postvoid residual urine? Is it reliable as a symptom solely?

PurposeThe main objective of this study was to reveal the relationship between lower urinary tract symptoms (LUTS) and post-void residual (PVR) urine volume.Materials and MethodsBetween October 2014 and February 2015, older than 40 years patients were included in this study. Volunteers filled out a questionnaire consisted of demographic characteristics, comorbidities, medications, history of surgery and LUTS. Volunteers were undergone PVR measurement with transabdominal ultrasonography. The relationship between symptoms, demographic characteristics and PVR were analyzed.ResultsA total of 939 patients (756 men and 183 women) were enrolled in this study. There was a positive correlation between the sensation of incomplete bladder emptying and PVR volume in all age groups of women (p=0.0001). However such a relationship was found only over the age of 60 in the subgroup analysis of men (p=0.001). PVR volume increased in men by age (0.65 mL per year of age, p=0.011). In men, voiding symptoms and urgency were associated with a high PVR volume. In women, storage and voiding symptoms (except slow stream and terminal dribble) did not correlate with PVR volume.ConclusionsOur study showed that all men over the age of 60 years and all women with the complaint of feeling of incomplete emptying should undergone PVR measurement. Women with the complaint of poor stream and men mainly with voiding symptoms are other candidates in whom PVR measurement would be considered as an important tool in the clinical management and follow-up.

Single-stage Female Epispadias Repair by Combined Infrasymphyseal Bladder Neck Plication and Urethrogenitoplasty: A Novel Technique

To evaluate the role of infrasymphyseal bladder neck plication and suspension from the pubic bone along with urethrogenitoplasty as a single-stage procedure for treating isolated cases of female epispadias. Six patients with female epispadias having grade 3 urinary incontinence were treated through bladder neck plication and suspension from the pubic bone along with urethrogenitoplasty from December 2013 to March 2016. Of the 6 patients with a mean age of 5.91 years (3-10 years) and a mean postoperative follow-up of 13.17 months (4-29 months), 5 patients stopped wearing diapers and were fully continent with a dry period of more than 3 hours from the first week of catheter removal. One patient experienced urine leakage while playing or crying in the initial postoperative period. However, this patient became continent with a dry period of more than 3 hours after 4 months of follow-up. All patients had an excellent cosmetic outcome without any considerable postoperative complications. All patients were voiding well without significant postvoid residual urine. The present technique is simple, safe, and effective for achieving urinary continence in patients with female epispadias.

An exploratory study for bladder dysfunction in atypical antipsychotic-emergent urinary incontinence.

Introduction:This is an exploratory study, which aimed to analyze urodynamic findings in patients who are on atypical antipsychotics and present with urinary incontinence (UI) in order to understand the mechanisms of antipsychotic-emergent UI.Patients and Methods:Eight patients (34 ± 7.6 years; five males and three females) diagnosed with schizophrenia or other psychotic disorders, who were on risperidone, olanzapine, or clozapine monotherapy and having UI were recruited. Urodynamic study was performed in all patients.Results:Six out of eight (75%) patients had abnormal urodynamic findings. Three of them had detrusor overactivity (DO) without detrusor-sphincter dyssynergia (DSD); two had DO with DSD; and one had hypoactive detrusor with nonrelaxing sphincter during void phase. The common urinary symptoms were urgency, enuresis, and straining to void urine. Significant postvoid residual urine was found in two patients.Conclusion:The evidence of bladder dysfunction in atypical antipsychotic-emergent UI is similar to that present in patients with neurological disorders. Urinary complaints in patients on antipsychotics thus need to be evaluated and managed systematically using the protocol followed for neurological conditions.

Long-Term Bladder Function after Ureterocele Decompression in Children

There is limited knowledge of long-term bladder function after ureterocele decompression. We studied bladder function in patients who underwent surgery in childhood for duplex system ureteroceles. Toilet trained children treated for duplex system ureteroceles between 1990 and 2010 were included in study. We evaluated voiding dysfunction by the valid DVSS questionnaire and noninvasive studies, including uroflowmetry, electromyogram and post-void residual urine measurement. Urodynamics were done only in patients with abnormal DVSS or abnormal noninvasive studies. Patients were divided into group 1-ureterocele decompression (endoscopic incision), upper pole partial nephrectomy and ureteropelvic anastomosis, and group 2-primary or secondary bladder surgery (ureterocelectomy, ureterovesical reimplantation and bladder floor reconstruction). Of 62 operated patients 17 were lost to followup and 45 were fully studied at a mean followup of 9.5 years (range 3 to 20). Initial surgery was done at mean age of 5.1 months (range 6 days to 48 months). In the 33 group 1 patients, of whom 70% underwent endoscopic incision, the mean DVSS score was 1.5 (range 0 to 6), 7 patients (22%) had abnormal uroflowmetry or significant post-void residual urine and none had abnormal DVSS results. In the 12 patients in group 2 the mean DVSS score was 4 (range 0 to 11), 8 patients (66%) had abnormal uroflowmetry and significant post-void residual urine, and 3 had abnormal DVSS findings (p = 0.036). All group 2 patients underwent bladder surgery after decompression, including endoscopic incision in 2 and upper pole partial nephrectomy in 1. Only 1 child needed clean intermittent catheterization at age 3 years for hypocontractile megacystis and repeat febrile urinary tract infections. Ureterocele decompression alone in early childhood does not leadtomajor bladder dysfunction at long-term evaluation. Even if secondary bladdersurgery is needed, significant bladder dysfunction is rare.

Bilateral ureteral obstruction revealing a benign prostatic hypertrophy: a case report and review of the literature.

IntroductionProstatic hyperplasia is the most frequent tumor in men older than 50 years of age. Bilateral hydronephrosis secondary to benign prostatic hypertrophy is a rare condition most often due to vesicoureteral reflux. Herein we report a case of a patient with bilateral hydronephrosis with distal ureter obstruction caused by detrusor hypertrophy due to prostatic hyperplasia, our analysis of the clinical data and a review of the relevant published literature.Case presentationWe report a case of a 65-year-old Berber man with clinically significant storage, bladder-emptying symptoms and bilateral low back pain with renal biologic failure and bilateral ureterohydronephrosis, distal ureteral stenosis, detrusor hypertrophy and prostate hyperplasia without significant post-void residual urine volume visualized by abdominal sonography. The patient underwent bilateral JJ stent insertion with transurethral resection of the prostate. The patient was discharged 3 days after surgery without any obvious complications. At his 3-month follow-up examination, the JJ stent was removed and the patient had comfortable urination without renal failure.ConclusionThis is an extremely rare condition that has important diagnostic considerations because of the possibility of comorbid severe obstructive uropathy and chronic renal failure.

Chronic urinary retention in men: How we define it, and how does it affect treatment outcome

What's known on the subject? and What does the study add? Chronic urinary retention (CUR) is a poorly defined entity, as the key element of definition, significant postvoid residual urine volume (PVR), has not a worldwide and moreover evidenced-based definition. There is no agreement on which is the threshold value to define a significant PVR and different society produced guidelines with different thresholds ranging from 300 mL to 1000 mL. Diagnosis is difficult, and management has not been defined yet. There is a lack of studies on the best management of these patients, as this group of patients has always been considered at high risk of failure. Only one study compares conservative with the surgical management but it is not a randomised controlled trail. This review offers a systematic appraisal of the most recent publications on CUR. It indicates the absence of a real worldwide agreed definition, as the two keys element of it are not satisfactorily defined yet: significant PVR, is suffering from a lack of evidenced-based definition, and percussable or palpable bladder is a very nebulous concept as it is not a criteria of certainty as different individual variables affect it. This has an important effect on management which is not structured. Most of the trials involving benign prostatic hyperplasia treatments (either medical or surgical) tend to exclude this group of patients, which is a clinically important group, comprising up to a quarter of men undergoing TURP in the UK. Urinary retention describes a bladder that does not empty completely or does not empty at all. Historically, urinary retention has been classified as either acute or chronic the latter is generally classified as high pressure or low pressure according to the bladder filling pressure on urodynamic. A MEDLINE® search for articles written in English and published before January 2010 was done using a list of terms related to urinary retention: 'urinary retention', 'chronic urinary retention' and 'PVR'. Chronic urinary retention (CUR) is defined by the International Continence Society as 'a non-painful bladder, which remains palpable or percussable after the patient has passed urine'. Abrams was the first to choose a residual urine volume >300 mL to define CUR as he considered it the minimum volume at which the bladder becomes palpable suprapubically. The UK National Institute for Health and Clinical Excellence lower urinary tract symptoms (LUTS) guidelines define CUR as a postvoid residual urine volume (PVR) of >1000 mL. No studies have specifically addressed the problem of quantifying the minimum amount of urine present in the bladder to define CUR. Nor did we find any publications objectively assessing at what amount of urine a bladder can be palpable. The ability to feel a bladder may rely on variables (i.e. medical skills and patient habitus). There is a marked variability of PVR, so the test should be repeated to improve precision. As defining CUR is difficult, structured management is challenging. Nearly all prospective trials exclude men with CUR from analysis, possibly anticipating a poor outcome and a high risk of complications. However, men with CUR are a clinically important group, comprising up to 25% of men undergoing transurethral resection of the prostate. Definition of CUR is imprecise and arbitrary. Most studies seem to describe the condition as either a PVR of >300 mL in men who are voiding, or >1000 mL in men who are unable to void. This confusion leads to an inability to design and interpret studies; indeed most prospective trials simply exclude these patients. There is a clear need for internationally accepted definitions of retention to allow both treatment and reporting of outcomes in men with LUTS, and for such definitions to be used by all investigators in future trials.

Decision making in the management of benign prostatic enlargement and the role of transabdominal ultrasound

Benign prostate enlargement (BPE) is a common disease affecting elderly men. It can present clinically in many ways including, but not exclusively, lower urinary tract symptoms (LUTS) and acute urinary retention (AUR). Therefore, in managing men with BPE, a correct diagnosis in the outpatient setting is important. Diagnosis of BPE in the clinic can be aided by simple, non-invasive, transabdominal ultrasound (TAUS). In our practice, a normal prostate is generally defined as less than 20 mL, and shows no intravesical prostatic protrusion (IPP) to distort the normal funneling bladder neck on TAUS, with a maximum flow rate of more than 15 mL/s. The degree of IPP can be measured non-invasively in the midsagittal plane, and can be graded accordingly. Studies have shown that the grade of IPP correlates well with the degree of bladder outlet obstruction (BOO). In addition, TAUS can also be used to measure prostate volume (PV) and post-void residual urine (PVR). There is a good correlation between IPP and PV, but IPP is a better predictor for BOO. Patients with low-grade IPP, no significant PVR (<100 mL) and no bothersome symptoms (low stage) can generally be watched; whereas those with high-grade IPP, significant PVR (>100 mL) and bothersome symptoms (higher stage) will need more aggressive management. The final decision for management can then be tailored and individualized to achieve cost-effectiveness.

Prospective Open Label Study of Solifenacin for Overactive Bladder in Children

We evaluated the effect of solifenacin for urinary incontinence in children with overactive/neurogenic bladder refractory to oxybutynin or tolterodine. Pediatric patients presenting with refractory overactive bladder with incontinence were offered the opportunity to enter a prospective, open label protocol using adjusted dose regimens of 1.25 to 10 mg solifenacin. Study inclusion criteria were absent correctable neurological anomalies on magnetic resonance imaging, failure of symptoms to improve on intensive behavioral and medical (oxybutynin or tolterodine) therapy, and/or significant side effects of those agents. Followup consisted of a voiding diary, post-void residual urine measurement, urine culture, ultrasound and urodynamics. Families were questioned about continence, side effects, compliance, behavior change and quality of life. The primary end point was efficacy for continence and secondary end points were tolerability and safety. Enrolled in the study were 42 girls and 30 boys. Of the patients 27 with neurogenic bladder, of whom 11 were on clean intermittent catheterization, and 45 with overactive bladder completed a minimum 3-month followup. Patients were on solifenacin a mean of 15.6 months. Mean age at study initiation was 9.0 years. Mean ± SD urodynamic capacity improved from 146 ± 64 to 311 ± 123 ml and uninhibited contractions decreased from 70 ± 29 to 20 ± 19 cm H(2)O (p <0.01). Continence improved in all patients, including 24 who were dry, and 42 and 6 who were significantly and moderately improved, respectively. Of the patients 50 reported no side effects while 15 had mild and 3 had moderate side effects. Four patients withdrew from the protocol due to intolerable side effects. Four patients had significant post-void residual urine (greater than 20 ml). In children with overactive bladder refractory to oxybutynin or tolterodine solifenacin is an effective alternative to improve symptoms. Tolerability was acceptable and the adjusted dose regimen appeared safe.

Vaginal Flap Urethroplasty for Wide Female Stricture Disease

As in men, female urethral stricture disease is often treated with repeat urethral dilation or internal urethrotomy but not always with good results. In nonresponsive cases surgical treatment may be useful but only a few cases are reported in the literature. We present our single institution experience with urethral reconstruction in 6 patients using an alternative vaginal inlay flap technique inspired by the Orandi technique. We treated 6 women with urethral stricture. In 5 patients stricture involved the entire middle and distal urethra, and in 1 it also involved the proximal urethra with bilateral hydronephrosis. Patients underwent urethral reconstruction using a vaginal flap with a lateral vascular pedicle that maintains the vascular axis. The flap was partially de-epithelialized to favor tissue cicatrix formation where the sutures are placed and avoid fistula formation. Mean followup was 70.8 months. Normal micturition was achieved after catheter removal in all patients. Post-void residual urine was measured postoperatively in 3 patients. One patient had significant post-void residual urine and required intermittent self-catheterization. The remaining 5 patients required no additional treatment. Using the vaginal wall to reconstruct large segments of the female urethra is simple and appears to have good results. Our technique preserves the vascular axis of the flap and protects the sutures. More contributions to the existing literature are needed before any further conclusions can be drawn.

Role of alpha adrenergic blocker in the management of posterior urethral valves

To evaluate the effect of Terazosin (alpha1 adrenergic blocker) on bladder emptying in children with posterior urethral valves. Forty-two children with significant post void residual urine after valves ablation were placed on Terazosin ranging from 0.25 to 2 mg. Post void urine at the commencement and at follow up was monitored with abdominal ultrasound. Post void residual urine significantly reduced in 40 patients (95%) who were put on Terazosin. Mean pretreatment PVR was 15.7 ml and mean PVR at the last follow up was 2.4 ml (P = 0.000). This was a reduction of 85% in the pretreatment post void residual urine volume. All the patients had improvement in urinary stream. One patient reacted to Terazosin with hypotension necessitating its withdrawal. Mean follow up was 17 months. Terazosin has proved to be safe and results in significant improvement in bladder emptying in our patients with posterior urethral valves. Randomized controlled trial and long-term follow up are necessary to further define the role of alpha1 adrenergic blocker therapy in children with posterior urethral valves. This study will become the justification for such a study.