Uroflowmetry Research Articles

Analysis of urinary function and prostate volume changes in localized prostate cancer patients treated with carbon-ion radiotherapy; a prospective study

BackgroundThe potential of carbon ion radiation therapy (CIRT) as a curative treatment for localized prostate cancer (PCa) has garnered attention due to its characteristic dose distribution. We prospectively collected and analyzed over five years to investigate the outcomes of localized PCa treated with CIRT at our institution.Patients and methodsThe study included patients with histologically confirmed prostate adenocarcinoma. CIRT treatment was administered at a total dose of 57.6 Gy (RBE) in 16 fractions over four weeks. Uroflowmetry (UFM) and residual urine measurements were performed at various time points: before CIRT treatment, one month after starting CIRT, three months after treatment, and annually for five years starting from 1 year after the completion of CIRT. Prostate volume was measured using transrectal ultrasonography (TRUS).ResultsA total of 304 prostate cancer patients were analyzed. UFM parameters were significantly worsened immediately after the treatment. However, they recovered to pretreatment levels after three months and remained stable until five years post-treatment. Notably, Average flow rate showed significant improvement after three years of treatment compared to before the treatment. Prostate volume decreased to 80% of baseline in patients treated with CIRT alone and to 60–70% of baseline in those receiving combined CIRT and either short- or long-term ADT. The logistic-binomial analysis identified post-voiding residual urine volume (PVR) as a significant factor for predicting adverse events in the acute phase.ConclusionsFollowing CIRT treatment, the voiding parameters in PCa patients significantly deteriorated immediately. However, after three months, they returned to their pre-treatment levels and remained stable for five years.

Holmium laser enucleation of the prostate: Modified urethral mucosa pre-dissected technique versus traditional three-lobe technique-A retrospective study.

The aim of this study is to investigate the effect of modified holmium laser enucleation of the prostrate (HoLEP) on the function of urine control. An analysis was conducted on a cohort of 305 elderly patients in a retrospective study spanning from February 2019 to February 2023. The cohort consisted of 150 patients who underwent modified HoLEP and 155 patients who underwent traditional HoLEP. Factors such as age, length of membranous urethra, prostate volume, BMI, IPSS, Qmax, enucleated weight, enucleation time, post-operative bladder irrigation time, catheterization and hospitalization were compared between both the groups. Multivariable logistic regression was used to identify independent predictors of urinary incontinence, and receiver operating characteristic (ROC) curve was used to determine the sensitivity and specificity of urethral membrane length in the diagnosis of urinary incontinence. Postoperative Qmax,IPSS, V2 were compared between 2 groups in the 6th month. Groups were compared in terms of age, volume, BMI, IPSS, Qmax and membranous urethral length (MUL). The time of enucleation, bladder irrigation, post-operative catheterization and hospitalization was lower in the modified HoLEP group (p < 0.05). The incidence of urinary incontinence (UI) in the modified group had a statistically significant decrease at 3months (3.3% vs 9.7%, p = 0.025) and 6months (0.6% vs 5.2%, p = 0.048). The median MUL had a significant difference in the 1st month (15.07 vs 12.5mm, p < 0.001). In multivariate regression analysis, older age (OR per SD = 1.102, 95%CI: 1.077-1.136), shortened MUL (OR per SD = 0.776, 95%CI: 0.629-0.957) and increased enucleated prostate weight (OR per SD = 1.29,95%CI: 1.005-1.084) were significantly associated with UI. The ROC curve revealed the threshold value of MUL was 13.5mm, the sensitivity was 76.7%, and the specificity was 98.1%. The modified HoLEP technique is safe and effective on the function of urine control, and is superior to less residual prostate volume and higher maximum urine flow rate after surgery.

Efficacy of the Rezūm System for lower urinary tract symptoms in patients with benign prostatic hyperplasia: Long term results from a single centre prospective study.

Benign prostatic hyperplasia (BPH) is a prevalent urological condition leading to lower urinary tract symptoms. Minimal invasive surgical treatment (MISTs) such as Rezūm System are emerging aiming to relieve symptoms. We present results from a single centre prospective study. We prospectively followed patients undergoing Rezūm between 2021 and 2023 from a single centre. International Prostate Symptom Score (IPSS), functional outcomes (maximum urinary flow rate (Qmax) and post-void urinary residual (PVR) and International Index of Erectile Function-5 (IIEF-5) were assessed at 3, 6, 12 and 24 months. Anterograde ejaculation was assessed at 12 months follow up. Linear mixed-effects models (LMMs) for repeated measures were applied to assess differences in the IPSS, maximum flow rate (Qmax), PVR, and International Index of Erectile Function-5 (IIEF-5) from baseline (t0) to 3, 6, 12 and 24 months. Results: After adjusting for prostate volume and symptoms severity, significant differences were observed at 3, 6, 12 and 24 months for IPSS (p < 0.001), Qmax (p < 0.001), PVR (p < 0.001) and IPSS-QoL (p < 0.001) from baseline. No statistically significant changes were found in the IIEF-5 scores at 3, 6, 12 and 24 months from baseline. Anterograde ejaculation remained in 98% of patients after treatment. In conclusion, the study's findings indicate that patients undergoing Rezūm treatment experience sustained improvements in IPSS, Qmax, PVR and IPSS-related quality of life up to 24 months following the intervention. Anterograde ejaculation remained in 98% of patients after treatment.

(A)voiding misdiagnosis: prediction of detrusor underactivity vs. bladder outlet obstruction using pre-urodynamic nomogram in male patients with LUTS.

Our study aimed to develop a noninvasive model using a combination of the set of clinical data and uroflowmetry (UFL) to differentiate between detrusor underactivity (DU) and bladder outlet obstruction (BOO) in non-neurogenic male patients with lower urinary tract symptoms (LUTS). Data from 229 men with LUTS, diagnosed with DU or BOO on a pressure-flow study (PFS), were retrospectively analyzed, including medical history, Core Lower Urinary Tract Symptoms score (CLSS) questionnaire, UFL and PFS. Uni- and multivariate logistic regression were utilized for the prediction analyses. Of the cohort, 128 (55.9%) patients were diagnosed with DU. A multivariate logistic regression analysis identified less prevalent nocturia (OR 0.27, p < 0.002), more prevalent intermittency (OR 2.33, p = 0.03), less prevalent weak stream (OR 0.14, p = 0.0004), lower straining points in CLSS (OR 0.67, p = 0.02), higher slow stream points in CLSS (OR 1.81, p = 0.002), higher incomplete emptying points in CLSS (OR 1.31, p < 0.02), lower PVR ratio (OR 0.20, p = 0.03), and present features of fluctuating (OR 2.00, p = 0.05), fluctuating-intermittent (OR 3.09, p < 0.006), and intermittent (OR 8.11, p = 0.076) UFL curve shapes as independent predictors of DU. The above prediction model demonstrated satisfactory accuracy (c-index of 0.783). Our 10-factor model provides a noninvasive approach to differentiate DU from BOO in male patients with non-neurogenic LUTS, offering a valuable alternative to invasive PFS.

Outcomes of Double-Face Buccal Mucosal Urethroplasty for Treating Anterior Urethral Stricture in Adult Males.

To assess the results of double-face buccal mucosal graft urethroplasty (BMG) for treating anterior urethral stricture in adult males. An observational study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from 2021 to 2022. The inclusion criteria were adult males, aged 15 to 70 years, with a previous surgical procedure for hypospadias and the presence of long penile and bulbar strictures measuring over 2 cm, resulting from a straddle injury. Forty-three patients were selected who underwent urethroplasty in 2021 and completed a one-year follow-up in 2022. Uroflowmetry (UFM) and the International Index of Erectile Function (IIEF) assessment data were obtained from the patients' medical records. Success was defined as the patient attaining catheter freedom and achieving a maximum flow rate exceeding 15 ml/sec after one year. The mean UFM at one year was 20.89 ml/s. Four patients underwent endo-urological intervention (direct visual internal urethrotomy), and one patient needed a second double-face urethroplasty. After one year, the double-face BMG urethroplasty achieved an overall success rate of 88.4%. Double-face BMG urethroplasty is a reliable and effective surgical technique for the treatment of near obliterative or obliterative long anterior urethral strictures. Buccal mucosal graft urethroplasty, Direct visual internal urethrotomy, Anterior urethral stricture, Buccal mucosal graft, Urethral dilatation.

Outcomes of Double-Face Buccal Mucosal Urethroplasty for Treating Anterior Urethral Stricture in Adult Males.

To assess the results of double-face buccal mucosal graft urethroplasty (BMG) for treating anterior urethral stricture in adult males. An observational study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from 2021 to 2022. The inclusion criteria were adult males, aged 15 to 70 years, with a previous surgical procedure for hypospadias and the presence of long penile and bulbar strictures measuring over 2 cm, resulting from a straddle injury. Forty-three patients were selected who underwent urethroplasty in 2021 and completed a one-year follow-up in 2022. Uroflowmetry (UFM) and the International Index of Erectile Function (IIEF) assessment data were obtained from the patients' medical records. Success was defined as the patient attaining catheter freedom and achieving a maximum flow rate exceeding 15 ml/sec after one year. The mean UFM at one year was 20.89 ml/s. Four patients underwent endo-urological intervention (direct visual internal urethrotomy), and one patient needed a second double-face urethroplasty. After one year, the double-face BMG urethroplasty achieved an overall success rate of 88.4%. Double-face BMG urethroplasty is a reliable and effective surgical technique for the treatment of near obliterative or obliterative long anterior urethral strictures. Buccal mucosal graft urethroplasty, Direct visual internal urethrotomy, Anterior urethral stricture, Buccal mucosal graft, Urethral dilatation.

Water vapor thermal therapy (Rezūm System) in patients with large prostates: results from a prospective comparative study.

Rezūm is a novel minimally invasive surgical technique (MIST) useful for BPH patients with medium-sized prostate (30-80 cm3) refractory to medical treatment. The aim of this study was to evaluate the efficacy and safety of Rezūm as a treatment option in large-sized prostates (>80 cm3). We performed a prospective, comparative, single-center study from June 2022 to June 2023, including consecutive patients undergoing surgery with the Rezūm System. Enrolled men were classified into two subgroups based on prostate size: medium prostate (MP) (30-80 cm3) and large prostate (LP) (≥80 cm3). Inclusion criteria included an International Prostate Symptom Score (IPSS) Total score of ≥ 8 points. International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual (PVR), and International Index of Erectile Function 5-item version (IIEF-5) were collected at baseline and at three, six, and 12 months post-procedure. Ejaculation presence was assessed at 3 months. Post-operative complications were described using the Clavien-Dindo (CD) classification. The primary outcome was the IPSS-Total score, with intraoperative and postoperative CD grade ≥III complications as secondary outcomes. One hundred and twenty-one patients (PV 78.2±32.1 mL) were included in the study, 51 large prostate (LP) and 70 medium prostate (MP). The IPSS-Total score and Q<inf>max</inf> showed a statistically significant (P<0.0001) improvement at 3, 6, and 12 months respectively. PVR decreased at 3, 6, and 12 months; however, only at 3 months this variation was statistically significant (P<0.0001). At 3-month follow-up, anejaculation was detected in (3; 5.8% and 1; 1.4%) patients in LP and MP group respectively (P=0.86). IIEF-5 significantly improved 3 months after surgery in the LP subgroup (P<0.0001). Rezūm water vapor therapy appears to be effective for treating BPH in larger prostates. Additionally, it demonstrates a low risk of impairing sexual function, indicating a favorable safety profile.

Teverelix is a potential treatment option for the prevention of acute urinary retention recurrence in men suffering from benign prostatic hyperplasia.

To evaluate the efficacy and safety of teverelix in treatment naïve patients aged over 50years with symptomatic benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), and to explore teverelix' potential in preventing AUR secondary to BPH with the aim to inform a planned Phase 2 trial. This Phase 2, multicenter, randomized, double-blind, placebo-controlled study involved BPH patients with an International Prostate Symptom Score (IPSS) ≥ 13 and uroflow < 13mL/sec. After a 4-week single-blind placebo run-in, patients were randomized to receive teverelix 60mg (n = 41) or placebo (n = 40) subcutaneously on day 1 and day 3. The primary endpoint was IPSS reduction at end of treatment period (Week 16); secondary endpoints included uroflow, prostate volume (PV), pharmacokinetics, pharmacodynamics, quality of life (QoL), and safety. Data were analyzed using analysis of covariance with α set at 0.05. At Week 16, teverelix significantly reduced IPSS by a mean of 6.3 (SD: ± 3.9) versus 1.1 (SD: ± 2.9) for placebo. By Week 2, teverelix showed a mean IPSS reduction of 13.0% compared to 3.8% for placebo, reaching 34.5% by Week 16 versus 5.2% for placebo. Clinically relevant IPSS reductions were observed in 44% of teverelix patients by Week 2, increasing to 83% by Week 12. Teverelix also achieved a significant 11% reduction in PV within 4weeks, improved maximum urinary flow rate, and enhanced QoL scores. Teverelix shows potential as an effective, well-tolerated treatment for LUTS secondary to BPH, with rapid and sustained benefits. The significant prostate volume reduction suggests that teverelix may help prevent recurrent AUR, warranting further dedicated studies.

Comparative Analysis of Holmium Laser Enucleation of the Prostate (HoLEP) and Robotic-Assisted Simple Prostatectomy (RASP) in BPH Management: A Systematic Review and Meta-Analysis.

As the prevalence of benign prostatic hyperplasia (BPH) increases, the demand for surgical interventions that optimize patient outcomes while minimizing complications grows. This systematic review compares the efficacy, efficiency, and safety of holmium laser enucleation of the prostate (HoLEP) with robotic-assisted simple prostatectomy (RASP), providing insights for evidence-based surgical decision-making in BPH treatment. Adhering to PRISMA guidelines, the study protocol was registered with Prospero [CRD42024509627]. Searches were conducted in Medline, Embase, Web of Science, Scopus, and CINAHL up to February 1, 2024, to include studies that compare HoLEP and RASP in patients with BPH. Risk of bias was evaluated using the Newcastle Ottawa Scale. HoLEP and RASP demonstrated equivalent effectiveness in treating BPH, as shown by similar functional outcomes such as maximum urinary flow rate and postvoid residual volume. However, HoLEP outperformed RASP in several operational efficiency metrics, reducing operative time by 49.48 minutes, hospitalization duration by 1.5 days, and catheterization period by 3.8 days. HoLEP also significantly reduced the risk of blood transfusions by 75%. Patients undergoing RASP were 1.87 times more at risk for grade 2 complications and 3.41 times more at risk for developing grade 3 or above complications. HoLEP and RASP are effective for managing BPH. HoLEP shows advantages in recovery metrics and lower blood transfusion rates, while RASP benefits from ease of implementation in robotic-equipped facilities. Optimizing surgical outcomes will depend on reducing disparities in technique adoption, improving surgical training, and aligning with evidence-based guidelines.

Predictors of symptomatic relief in water vapor thermal therapy for prostatic hyperplasia: 36-month prospective study.

Existing literature lacks an analysis of factors predicting the achievement of minimum clinically important differences (MCID) after water vapor thermal therapy (WVTT) for prostatic hyperplasia. This study aims to identify these predictors over a 36-month post-WVTT period. This prospective single surgeon case series assessed male patients receiving WVTT. Eligibility criteria included being at least 45 years old, having an estimated prostate volume (EPV) of 30-80cc, an International Prostate Symptom Score (IPSS) of 12 points or more, and a maximum urinary flow rate (Qmax) under 16 mL/sec. MCID, representing the smallest symptomatic improvement perceived by patients, was calculated using the distribution-based method, considering half a standard deviation of baseline IPSS scores. Correlation and linear regression analyses assessed MCID attainment. Multivariable logistic regression evaluated MCID achievement, considering multicollinearity, heteroskedasticity, and normality. Of 206 men with a median 29.1-month follow-up (Range: 24-36), 13.6% didn't achieve MCID for IPSS, and 7.2% for QoL scores. Significant hindrances to MCID attainment for IPSS were a large median lobe (> 10mm protrusion) (OR = 3.01, 95% CI: 2.3-3.72), increased median lobe treatments (OR = 1.73, 95% CI: 1.23-2.35), and high preoperative irritative IPSS scores (OR = 1.25, 95% CI: 1.13-1.38). Factors for QoL MCID non-achievement included age over 75 (OR = 1.25, 95% CI: 1.13-1.38), a large median lobe (OR = 1.87, 95% CI: 1.62-2.01), and EPV over 60cc (OR = 1.55, 95% CI: 1.16-1.97). A 6.3% surgical re-intervention rate was noted. The characteristics of the median lobe as well as the severity of lower urinary tract symptoms are crucial for treatment success. These should be integral to preoperative assessments and patient discussions on treatment options.

Does size matter? A single institution's comparison of Aquablation in prostates greater than or less than 150 mL.

Surgical management options for lower urinary tract symptoms due to benign prostatic hypertension have remained limited in prostates of large volume. The advent of the Aquablation has created a potential minimally invasive option for treatment in prostates of all volumes. Thus, this study aims to evaluate outcomes and complications of Aquablation in clinical practice based on prostate volume. Collected variables included adverse events with Clavien-Dindo classifications, transfusion rates, surgical retreatment rates, continued medication use postoperatively, and International Prostate Symptom Score (IPSS) with Quality-of-Life indicator. Aquablations were stratified by preoperative prostate volume. One hundred seventy-four men were included in the study. The average postop decrease in IPSS was 10.28, with a 2.02 point decrease in Quality-of-Life at 1 year. Postop increase in peak urinary flow rate was 7.65 mL/s for an average of 16.44 mL/s. Hemoglobin drop average was 1.78 g/dL, but only 2.3% of patients required a transfusion. 12.9% of patients required surgical retreatment. Six months after Aquablation, 22.9% and 12.9% of patients continued taking Alpha-blockers and Androgen receptor inhibitors, respectively. Adverse events occurred in 33 patients (19.0%). Eighteen patients were excluded from secondary analysis due to unrecorded prostate volume, leaving 123 with volumes <150 mL and 33 with volumes ≥150 mL. Groups were comparable with respect to length of stay, adverse events, blood transfusion, IPSS with Quality-of-Life indicator preoperative and postoperative, postop peak urinary flow, and postop alpha-blocker use. Larger prostates had a higher rate of adverse events, retreatment, postop hemoglobin drop, and postop use of finasteride. Aquablation is a viable treatment option for benign prostatic hyperplasia. Efficacy, safety, subjective outcomes, and adverse event rates were not impacted by prostate volume. However, size does matter as prostates ≥150 mL had higher surgical retreatment rates and postop finasteride use.

Recent Advancements in Prostate Catheters and Stents for Management of Benign Prostatic Hyperplasia.

The prevalence of benign prostatic hyperplasia (BPH) is rising, however, current treatment options present severe complications and limit patient's quality of life. Accordingly, advancements in prostatic catheter and stent designs for use in treating lower urinary tract symptoms (LUTS) in BPH patients have largely expanded in the past five years and we aim to provide an exhaustive summary of recent outcomes. The dual dilation and paxlitaxel eluting Optilume BPH Catheter System enhances promise in catheter-based treatments, providing the longest sustained increase in max urinary flow rate and decrease in post-void residual volume compared to alternative MISTs. Additionally, use of iTiND, along with recent advancements in temporary (EXIME, Prodeon Urocross) and permanent (Zenflow Spring, Butterfly, and ClearRing) stent designs, have demonstrated rapid, lasting, and low-cost LUTS relief with sustained sexual function. Minimally invasive solutions that offer in-office treatment, rapid symptom relief, shorter recovery times, and preservation of sexual function hold great promise in improving outcomes in managing BPH patients with LUTS.

Comparison of the Role of Anticholinergics and α-1 Adrenergic Blockers in Bladder Management in Posterior Urethral Valves: A Pilot Randomized Control Trial

Introduction: Posterior urethral valve (PUV) is a major cause of congenital bladder dysfunction, often persisting despite treatment. Emerging therapies, including anticholinergics and α-1 blockers, offer potential but lack clear guidelines. This study evaluates their effectiveness in improving bladder function after valve fulguration. Methods: Twenty PUV patients, aged ≥3 years, were randomized into anticholinergic (group A, n = 11) and α-1 adrenergic blocker (group B, n = 9) groups post-fulguration. Follow-up included clinical, radiological, and urodynamic assessments 6 months posttreatment initiation. Results: In group A, the mean maximum detrusor pressure (Pdet) decreased from 30.17 to 23.45 cm H2O (p = 0.033). Two patients normalized from high detrusor pressure (>40 cm H2O). In group B, 1 patient retained high detrusor pressure posttreatment. Group B improved in average urinary flow (Q avg) and maximum flow rate (Q max), with all patients having initially low Q avg (<10 mL/s). Two group B patients showed improved average flow rates posttreatment (p = 0.016); three in group A showed improvement but were not statistically significant (p = 0.197). Q max/flow time ratio was abnormal in all group B patients pretreatment. Two of the nine improved posttreatment, while only one in group A did. Conclusions: Anticholinergic medications positively impact cystometric parameters and are effective for detrusor instability and low compliance bladder. α-Adrenergic blockers influence uroflow parameters and can help treat bladder outflow obstruction. Consideration for a larger study with extended follow-up is warranted.

66 - Relative phase of abdominal pressure and urine flow rate could diagnose male bladder outflow obstruction

66 - Relative phase of abdominal pressure and urine flow rate could diagnose male bladder outflow obstruction

A randomized, active-controlled, multicenter, phase 3 clinical trial to evaluate the efficacy and safety of GV1001 in patients with benign prostatic hyperplasia

ObjectivesTo determine and compare the efficacy and safety of GV1001 and 5 mg finasteride for benign prostatic hyperplasia (BPH) patients. Patients and methodsThis randomized, active-controlled, multicenter, phase 3 clinical trial enrolled 423 patients aged ≥50 years with a prostate volume (PV) >30 mL. Patients were randomized into Group 1 (GV1001 0.56 mg + finasteride placebo), Group 2 (GV1001 1.12 mg + finasteride placebo), or Group 3 (GV1001 placebo +5 mg finasteride). The patients received the study drug during clinic visits every 2 weeks at weeks 0–22. Changes in the international prostate symptom score (IPSS), PV, maximum urinary flow rate (Qmax), prostate-specific antigen (PSA) level, residual urine volume, testosterone and dihydrotestosterone (DHT) levels, and international index of erectile function (IIEF) were assessed. ResultsWe included 408 (96.45%) patients (Group 1, n = 138; Group 2, n = 134; Group 3, n = 136) in full analysis set for primary efficacy evaluations. All groups showed significant decreases and increases in the IPSS and Qmax, respectively (Groups 1, 2, and 3, IPSS: −4.78 ± 6.50, −4.99 ± 6.66, and −5.51 ± 6.42, respectively; P < 0.0001; Qmax: P = 0.0005, P = 0.0039, and P < 0.0001, respectively). PV reductions were observed in Groups 2 and 3 (−0.75 ± 8.21 mL [P = 0.3280] and −2.47 ± 7.92 mL [P = 0.0010], respectively). The PSA and testosterone levels of Group 3 significantly decreased and changed, respectively (−0.90 ± 1.25 ng/mL, P < 0.0001 and P < 0.0001, respectively). No significant differences were observed in the residual urine volume. DHT significantly decreased in all groups (Groups 1, 2, and 3: −71.41 ± 244.06 ng/mL [P = 0.0025], −73.84 ± 249.26 ng/mL [P = 0.0019], and −106.60 ± 178.29 ng/mL [P < 0.0001], respectively). Only Group 3 exhibited a significantly decreased IIEF (−3.06 ± 15.34; P = 0.0323). Acute urinary retention occurred in one patient in Group 2. No patients underwent prostate surgery or minimally invasive procedures during the study. ConclusionsGV1001 exhibited corresponding efficacy and tolerability, providing evidence of amelioration in urinary symptoms among patients with BPH in comparison to the use of 5 mg finasteride.

112 - Videoflow: Exploiting Standard Care Video Urodynamic Imaging for urine flowrate measurements in children

112 - Videoflow: Exploiting Standard Care Video Urodynamic Imaging for urine flowrate measurements in children

Uroflowmetry: nomograms in healthy young Pakistani men.

To create a nomogram based on urine volume and flow of males without lower urinary tract symptoms. The prospective, cross-sectional study was conducted at the Department of Urological Surgery and Transplantation, Jinnah Postgraduate Medical Centre, Karachi, from November 1, 2020, to October 31, 2022, and comprised healthy young males without lower urinary tract dysfunction who were recruited from the hospital as well as a large textile mill. They were asked to void on their normal desire. Uroflowmetry was done to determine maximum flow rate, average flow rate, and void volume values. A best-fit regression model was used to formulate uroflowmetry nomogram using average and maximum urine flow rate over voided volume. The sample size was calculated using PASS 2020 Power Analysis and Sample Size Software (2020). NCSS, LLC. Kaysville, Utah, USA. The database was developed on NCSS 2020 Statistical Software (2020). NCSS, LLC. Kaysville, Utah, USA for the data analysis. Of the 468 male subjects enrolled, data was analysed related to 432(92.3%). The mean age was 25.59±4.32 years. Mean maximum flow rate, average flow rate and void volume were 25.28±8.70mL/s, 14.77±4.79mL/s and 405.48±163.86mL, respectively. The association of age was noted with maximum flow rate (r=0.1435, p=0.004), average flow rate (r=0.1135, p=0.004) and void volume (r=0.0619, p=0.004). The best-fitted model for maximum and average flow rate was subsequently developed which was statistically significant (p<0.05). The nomograms developed could reliably predict the maximal flow rate in young Pakistani men.

Combined strategy of device-based contrast minimization and urine flow rate-guided hydration to prevent acute kidney injury in high-risk patients undergoing coronary interventional procedures.

Contrast-associated acute kidney injury (CA-AKI) is a major complication following coronary procedures. We aimed to evaluate the effectiveness of a combination of urine flow rate-(UFR) guided hydration (RenalGuardTM) and device-based contrast media (CM) reduction (DyeVertTM) in CA-AKI prevention. Stable high-risk patients undergoing coronary procedures with the use of DyeVertTM and RenalGuardTM were prospectively included (Combined group) and matched with a similar cohort of patients treated only with RenalGuardTM in whom CM volume was controlled by operator-dependent strategies (Control group). CA-AKI was defined as a serum creatinine increase ≥0.3 mg/dL at 48 h. Overall, 55 patients were enrolled and matched with comparable controls. Patients in the Combined group were exposed to a lower CM dose (Control: 55 [30-90] mL vs. Combined: 42.1 [24.9-59.4] mL; p = 0.024). A significant interaction was found between treatment allocation and serum creatinine changes (p = 0.048). CA-AKI occurred in five (9.1%) patients in the Combined group and in 14 (25.4%) patients in the Control group (OR 0.29, 95% CI [0.09-0.88]). A combined strategy of device-based CM reduction plus UFR-guided hydration is superior to operator-dependent CM sparing strategies plus UFR-guided hydration in preventing CA-AKI in high-risk patient.

Association between dietary mineral intakes and urine flow rate: data from the 2009-2018 National Health and Nutrition Examination Survey.

Minerals play an important role in human health, but their effect on urinary function remains controversial. The aim of this study was to assess the association between dietary intake of minerals (Ca, P, Mg, Fe, Zn, Cu, Na, K, Se) and urine flow rate (UFR). We conducted a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES, 2009-2018) database. Multivariate regression and smooth curve fitting were used to investigate the association between dietary mineral intakes and UFR. Subgroup analyses and interaction tests were used to investigate whether this association was stable in the population. Our study involving 10,229 representative adult NHANES participants showed an association between Mg intake and UFR in a linear regression model for continuous variables. And in the model analysis of tertile categorical variables, we observed a positive association between six mineral intakes (Ca, Mg, Zn, Cu, Na, and K) and UFR. Smoothed curve fitting and threshold effect analysis further support the nonlinear relationship between mineral intakes and UFR. Subgroup analyses and interaction tests ensured the reliability and robustness of the findings. This study examined the effects of nine dietary minerals on UFR and found that intake of Ca, Mg, Zn, Cu, Na, and K were positively correlated with UFR, suggesting that these minerals may have a positive effect on improving urinary function. In particular, Mg showed a more significant positive correlation with UFR in women, while Na showed a stronger positive correlation in diabetics. However, P, Fe and Se did not show significant correlations. In summary, although these findings provide a preliminary understanding of the relationship between dietary minerals and urinary function, further prospective studies are still necessary to validate these relationships and explore the physiologic mechanisms underlying them.

The examination of detrusor underactivity in multiple system atrophy.

The urinary dysfunction in multiple system atrophy (MSA) is characterized by large post-void residuals (PVR) due to impaired bladder contractility. However, the evaluations of bladder contractility are not well validated in MSA. Because the bladder contractility index can be generally represented as Pdet Qmax (detrusor pressure at maximum urinary flow rate) + kQmax (maximum urinary flow rate), we aim to examine which "k" value is suitable for representing bladder contractility concerning its correlations to PVR and voided percentage (VOID%). We retrospectively reviewed 133 patients with MSA (74 males, 59 females, mean disease duration 3.2 years) who underwent an urodynamic study. We calculated bladder contractility using the formula PIPk = Pdet Qmax + kQmax by increasing the "k" value from 0.1 to 10 by increments of 0.1. We calculated the correlations between each PIPk (k = 0.1-10.0) and PVR and VOID%. The correlational coefficients between PIPk and VOID% were larger than those between PIPk and PVR. The correlational coefficients between PIPk and VOID% reached a plateau level at a "k" value >5.0 in male patients, suggesting that currently used formulas such as Pdet Qmax + 5Qmax for males might be appropriate for male MSA patients. However, the correlational coefficients between PIPk and VOID% reached a plateau level in female patients when the "k" values were >6.0, which might overestimate bladder contractility in female patients. Although currently used formulas such as Pdet Qmax + 5Qmax might be appropriate for male MSA patients, formulas for female patients need further evaluation.