Urinary Stream Research Articles

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

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

Spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty for primary hypospadias repair

Neourethral covering is an essential technique for preventing complications such as fistula and glans dehiscence in hypospadias repairs. The spongioplasty has been reported for neourethral coverage about 20 years ago. However, reports of the outcome are limited. This study aimed to retrospectively evaluate the short-term outcome of spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty (DIGU). From December 2019 to December 2020, 50 patients with primary hypospadias (median age at surgery, 37 months; range, 10 months-12 years) were treated by a single pediatric urologist. The patients underwent spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty in single stage. The penile length, glans width, urethral plate width and length, and the location of the meatus of the patients were recorded preoperatively. The patients were followed up,complications noted, and postoperative uroflowmetries at the one-year follow-up time were evaluated. The average width of glans was 12.92±1.86mm. A minor penile curvature was observed in all patients (≤30°). The patients were followed up for 12-24 months, and 47 patients (94%) were free from complications. A neourethra formed with a slit-like meatus at the tip of the glans, and the urinary stream was straight. Three patients had coronal fistulae (3/50) and no glans dehiscence, and the mean±SD Qmax of postoperative uroflowmetry was 8.13±3.8ml/s. This study estimated the short-term outcome of the DIGU covered using spongioplasty with Buck's fascia as the second layer in patients diagnosed with primary hypospadias with a relatively small glans (average width <14mm). However, only a few reports emphasize spongioplasty with Buck's fascia as the second layer and the DIGU procedure performed on a relatively small glans. The major limitations of this study were its short follow-up time and the retrospective data collection. Dorsal inlay graft urethroplasty combined with spongioplasty with Buck's fascia as coverage is an effective procedure. In our study, this combination had good short-term outcomes for primary hypospadias repair.

Principles and outcomes of gender-affirming vaginoplasty.

Vaginoplasty is the most frequently performed gender-affirming genital surgery for gender-diverse people with genital gender incongruence. The procedure is performed to create an aesthetic and functional vulva and vaginal canal that enables receptive intercourse, erogenous clitoral sensation and a downward-directed urine stream. Penile inversion vaginoplasty (PIV) is a single surgical procedure involving anatomical component rearrangement of the penis and scrotum that enables many patients to meet these anatomical goals. Other options include minimal-depth, peritoneal and intestinal vaginoplasty. Patient quality of life has been shown to improve drastically after vaginoplasty, but complication rates have been documented to be as high as 70%. Fortunately, most complications do not alter long-term postoperative clinical outcomes and can be managed without surgical intervention in the acute perioperative phase. However, major complications, such as rectal injury, rectovaginal fistula, and urethral or introital stenosis can substantially affect the patient experience. Innovations in surgical approaches and techniques have demonstrated promising early results for reducing complications and augmenting vaginal depth, but long-term data are scarce.

Flehmen, Osteophagia, and Other Behaviors of Giraffes (Giraffa giraffa angolensis): Vomeronasal Organ Adaptation.

The size of adult male giraffes (Giraffa giraffa angolensis) far exceeds the size of the females. At the Namutoni waterholes in Etosha National Park, bulls were seen many times each day screening adult females for their pending sexual receptivity by provoking them to urinate; this mainly involved sniffing their genitalia. If the female accedes to the male's invitation, she widens her hindleg stance, braces her body, and then urinates, usually for at least five seconds. The male places his muzzle and tongue in the urine stream, and then performs flehmen, often raising his head high in the air. Males never investigated urine on the ground. The bilateral papillae on the giraffe's hard palate connect with the nasopalatine ducts, which enter the bilateral vomeronasal organ (VNO). Unlike many mammals, the giraffe's VNO lacks a prominent connection to the nasal cavity and its connections to the oral cavity are primarily via the incisive papillae. Most days, some giraffes were observed searching for bones for extended periods, chewing them, and sometimes being troubled by a bone stuck in their mouth. A giraffe killed by lions was frequented for several days by a procession of giraffes investigating the carcass. A very dark-colored bull giraffe emitted loud pulsed growls that drove off most of the surrounding giraffes.

Grafted tubularised incised plate: A right option in the management of failed mid-penile and distal hypospadias.

Hypospadias is a common congenital anomaly of the urogenital system. The goal of the initial repair is to correct any curvature, ensuring that the penis is straight, allowing for successful intercourse, to create a functional neourethra to direct the urinary stream in a forward direction and to produce a cosmetically normal-appearing penis with a slit-like meatus at the tip of the glans. Failures and complications do occur. Failed hypospadias repair is often associated with penile skin loss or deficient local tissue, which leaves the penis short, scarred and hypovascular. Repair of a failed hypospadias surgery represents one of the most challenging and difficult tasks. We retrospectively evaluated our series of children who underwent reoperative grafted tubularised incised plate (G-TIP) repair for a mid-penile or distal penile hypospadias. With permission obtained from the university/institutional ethics committee, we retrospectively reviewed the inpatient and outpatient records of all children ≤18 years of age who underwent a reoperative G-TIP hypospadias repair. During the study period, a total of 22 children (mean age: 6.8 years) underwent reoperative G-TIP repair. The mean number of previous repairs was 1.36. Nine (40.9%) of the children had persisting chordee. Complications were noted in five (22.7%) children. G-TIP is a good option in the management of mid-penile or distal penile failed hypospadias repairs. Although complications are noted, they are easily manageable.

Foley's Catheter Balloon Avulsion of Posterior Urethral Valve in Children: How Effective?

Background: Endoscopic ablation under direct vision is the gold standard for treatment of posterior urethral valve. However, when the facilities are not available, Foley’s catheter balloon avulsion of the valve suffices. The aim of this study was to evaluate the initial outcome of management of children with posterior urethral valve treated by Foley’s catheter balloon avulsion. Materials and Methods: This was a retrospective study of children, aged 15 years and younger, who were treated for posterior urethral valves at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. The parameters evaluated included the age of the patient at presentation, duration of symptoms before presentation, time interval between presentation and intervention, presenting symptoms, procedure performed, post-intervention complications, duration of hospital stay and outcome of treatment. Results: A total of 24 children underwent catheter balloon avulsion during the study period. The mean age of the patients at presentation was 18 months and the mean duration of hospital stay was 18 days. Poor urinary stream and overflow incontinence were the most common presentations of the patients. Twenty-three out of 24 (96%) patients achieved full recovery with marked improvements in urinary stream and resolution of urinary symptoms. Patients who had hydronephrosis and vesicoureteric reflux before treatment, had resolutions of their pathologies during the period of follow up. However, one tenth of the patients each, experienced urethral injury and temporary urinary incontinence. Conclusion: In resource poor settings where the necessary facilities are not available, Foley catheter balloon avulsion of posterior urethral valve is a simple and effective modality of treatment.

Our Experience with Tension-Free Urethral Reconstruction with Urethral Plate Dorsal Slit Technique

Background Hypospadias is among the most common urogenital anomaly which is usually corrected by various surgical techniques. The global burden of hypospadias is shared among adult and pediatric urologists and plastic surgeons as well. Potential complications of the repair include meatal stenosis, urethrocutaneous fistula, urethral stricture, and urethral diverticulum. Fistula rates in large hypospadias series have been reported to range from 2% to 14% in Snodgrass repairs. Objective Our aim of this study is to identify the effectiveness of the dorsal urethral plate slit technique for tension-free hypospadias repair. Material and Methods A retrospective review was performed. A total of 53 patients presented to the plastic surgery outpatient department of Liaquat National Hospital within 2 years from January 2019 – December 2020 with congenital hypospadias, out of these 14 patients were included in the study who met the inclusion criteria. None of the patients had any prior hypospadias correction. The surgical technique involved the dorsal slit technique for tension-free repair. The patients were followed post-operatively for a total duration of 2 years to assess for any post-operative complications. Result The mean age of patients was 11 years, with the most common preoperative complaints of abnormal urinary stream. In all operated cases we observed a 7.1% rate of fistula formation. None of the subject patients developed meatal stenosis and only 1 patient developed a fistula during the study period. All other patients reported a good urinary stream and had an acceptable cosmesis postoperatively. Conclusions The urethral plate dorsal slit technique for tension-free hypospadias repair has a good outcome with relatively fewer complications and a high success rate. This modification along with careful preoperative planning during patient selection plays a key role in the outcome of the repairs.

Tips and Tricks in the Management of Megameatus Intact Prepuce Variant of Hypospadias: A Review Article

Introduction: Hypospadias is congenital anomalies with various spectrum and variants, presenting with abnormal urethral meatus short of the native tip of the glans. megameatus intact prepuce is a rare variant of glanular hypospadias seen in about 3-6 % of hypospadias cases. The main features of megameatus intact prepuce are large urethral external meatus with deep with deeply grooved glans penis and the preputial skin is usually present and intact with no chordae. Seven named procedures for megameatus intact prepuce were discussed. Methodology: We use the following search engines for out study where we found the following articles and reviews as follows in Scopus search, we found 26 articles, in AJOL we there were 7 articles and in PubMed Central Search we found 32 articles, then in Google scholar the search revealed 388 articles, 45 articles were reviewed and summarised and 7 established procedures were discussed. Results: Seven named established procedures for megameatus intact prepuce variant of hypospadias were summarized and discussed and include Pyramid Procedure, Glanular Approximation Procedure, Tubularised Urethral Plate Urethroplasty, Tubularised Incised Urethral Plate Procedure, Mathieu Technique, Cutaneous advancement procedure and The Inframeatal Vascularised Flap Procedure. DISCUSSION: The Surgical procedures for repair of megameatus intact prepuce is technically challenging not only for the surgeon but the anesthethiogist alike because the patients are paediatric with small organs, therefore appropriate instruments and proper timing of the surgical intervention is paramount. Duckett and Keating et al in their study identified the first challenge is to identify those patients who truly need surgical repair. In a study by Marc Cendron et al they found out that the features identified as important in the decision-making process were (1) meatal opening close to or below the coronal margin; (2) A deep glans cleft; (3) a wide, splayed-out glans; and (4) an abnormal urinary stream if witnessed. in a study by Duckett JW, Keating MA, Hatch DA et at and Austin Hill G, Wacksman J they reported a satisfactory outcome with the various described surgical procedures. Conclusion: The tip and tricks of the surgical procedures of megameatus intact prepuce rare variant of hypospadias is a review article to aimed to improve on the surgical outcome including normal conical appearance of the glans, a urethral meatus of normal caliber, and a single, normal urinary stream with no symptoms and to minimise the complications such as urethrocutenous fistula as extracted from the expert’s vast experience and modifications of the existing techniques, in our study we summarised the experts seven established techniques and the modifications to achieve the desired objectives.

Procena uticaja vitamina D na intenzitet simptoma donjeg urinarnog trakta i kvalitet života osoba sa benignom hiperplazijom prostate

Introduction/Aaim: Older men with benign prostatic hyperplasia (BPH) are more likely to have a poor quality of life. The aim of this study was to examine the influence of serum vitamin D on the intensity of lower urinary tract symptoms and the quality of life of persons with benign prostatic hyperplasia. Methods: The study was conducted as a cross-sectional study. The study included 117 persons with benign prostatic hyperplasia (BPH) treated at the Clinical Center of Montenegro in Podgorica from May 10 th , 2022 to August 15 th , 2022. Data were collected with the help of the general questionnaire from electronic medical records, as well as with the International Prostate Symptom Score (IPSS) questionnaire. Spearman's correlation coefficient was used for the statistical analysis of data. Results: The average age of participants was 62.97±11,57. The average value of the intensity of symptoms in patients with BPH according to the IPSS questionnaire was 8.54. Of the 117 participants with BPH, 57 (48.7%) had moderate symptoms, 56 (47.9%) mild, and 4 (3.4%) severe. A significant negative correlation (r=-0.316; p=0.010) was obtained between vitamin D levels and average values of symptoms according to the IPSS questionnaire. Also, a significant negative correlation was obtained between serum vitamin D values and all individually assessed values of BPH symptoms according to the IPSS questionnaire (sensation of incomplete emptying of the bladder during urination -p=0.040; repeated urination within two hours from the previous urination -p&lt;0.001; intermittent urination -p=0.005; inability to postpone urination -p=0.036; a thin and weak urinary stream -p=0.001; straining to begin urinating with the sensation of the need to urinate -p=0.046 and nocturia -p=0.011). Based on the serum level of vitamin D, the participants had optimal levels of vitamin D in 52.1% of cases, insufficient levels in 29.1% of cases and deficit in 18,8%. An inverse relationship between the average values of serum vitamin D and quality of life according to ISPP questionnaire was observed, but this relationship was not significant (r =-0.365; p=0.160). Conclusion: The results of the study show that higher levels of vitamin D lead to the significant reduction in urological symptoms in patients with BPH, which points to the need to prevent vitamin D deficiency. Further research in this field is necessary aimed at making more detailed recommendations.

Penile glans amputation and caverno-spongiosal disjunction following a dog bite: a case report

 Traumatic penile amputation is a rare surgical emergency. Successful surgical reimplantation is very challenging even in the hands of experience surgeons. We report the case of 13-year-old boy who presented with traumatic penile amputation with complete urethral section and caverno-spongiosal disjunction. This resulted from a dog bite injury which occurred 2 hours before consultation. Following primary and secondary surveys, the emergency management consisted of resuscitation, broad spectrum antibiotics and tubulisation of the sectioned urethra. Urethroplasty and subsequently a caverno-spongioplasty were then performed. The post-operative follow-up was uneventful and immunisation against rabies was done. Erection with the catheter in place was normal upon control. Patient was re-evaluated 8 years later and had a cosmetically acceptable penis and void with a good urinary stream. Microscopic penile reimplantation remains the gold standard though challenging and unavailable especially in resource limited settings. However, non-microscopic genital reconstruction is possible with satisfactory cosmetic and functional outcomes.

Sensor-based evaluation of a Urine Trap toilet in a shared bathroom.

Urine diversion in a No-Mix Toilet is a promising approach for sustainable fertilizers and reduction of the nutrient load for wastewater treatment; however, user adoption remains a challenge. This study evaluates the Urine Trap, a passive No-Mix toilet design based on the teapot effect, wherein the urine stream inlet is invisible to the user and therefore it does not impact the user experience for increased adoption. This study evaluated the nutrient separation performance of a Urine Trap flush toilet in a bathroom shared by women in two sites in India. Over three different testing periods, 841 uses of this squat plate were recorded in 50 days. Analytical measurements found 36 % separation efficiency for total nitrogen (TN). While effective, the Urine Trap under test by users did not yield a 70-80 % TN separation efficiency observed under engineering characterization. High temporal resolution data from sensors on waste collection tanks, the opening of the bathroom door, and cleansing water flow were used to gain insights into hygiene practices. The data showed a frequent habit of wetting the squat plate during physiological excretion, a hygienic practice that eases cleaning but degrades the teapot separation effect of the Urine Trap design. By using sensors, we demonstrate a method to non-invasively gain quantitative insights into hygiene practices to inform sanitation technologies deployment strategies for improved outcomes.

Neonatal Posterior Urethral Valves as a cause of Acute Abdominal Distention

Introduction: An 18-day-old term, male presented to the emergency department (ED) for 1-2 days of progressive abdominal distention. Case Report: Over the past week the infant had been spitting more, but it was non-bilious and non-projectile. He had no fevers. On examination, he was ill appearing with a distended abdomen. A flat-plate of his abdomen was obtained that was concerning for possible partial small bowel obstruction, which led to extensive imaging with an upper and lower gastro-intestinal contrast studies that were negative. Ultimately, an ultrasound was performed that revealed marked bladder distention with hydronephrosis. A urinary catheter was placed to relieve his bladder obstruction. Avoiding cystourethrogram confirmed a diagnosis of posterior urethral valves. Conclusion: Posterior urethral valves (PUVs) as a cause of abdominal distention in the neonate is a rare presentation. PUVs have an incidence of 1/4000 male births; of which 1/3rd are detected in-utero, 1/3rd in the first year of life. Most infants with PUVs will present with a urinary tract infection, others present with failure to thrive, poor urine stream and or grunting while urinating. The neonate with acute abdominal distention warrants a thorough and expedited evaluation for possible acute surgical etiologies, such as midgut volvulus due to malrotation. Early identification of bladder obstruction by point of care ultrasound would have helped focus the evaluation and lead to earlier relief of his bladder obstruction. PUVs should be considered on all male infants with urinary tract infection, failure to thrive, poor urinary stream or abdominal distention.

Prostatic Artery Embolization: Technical Pearls.

Benign prostatic hyperplasia (BPH) is a condition that primarily affects men between the fourth and seventh decades of life, occurring due to enlargement of the prostate which subsequently causes compression of the prostatic urethra causing chronic obstruction of the urinary outflow tract. BPH can cause significant quality-of-life issues such as urinary hesitancy, intermittency, decreased urinary stream, a sensation of incomplete emptying, dysuria, urinary retention, hematuria, and nocturia. Several medical and surgical treatment modalities are available for the treatment of lower urinary tract symptoms and other BPH-related sequela; however, increasingly prostate artery embolization is being utilized in this patient population. Technical demands for this procedure in this population can be significant. This article describes the optimal techniques, tricks, and advanced imaging techniques that can be used to achieve desired technical outcomes.

POST-PROSTATECTOMY INCONTINENCE AND NURSING CARE: AN INTEGRATIVE REVIEW

Objective: To identify nursing actions corresponding to assistance in post-prostatectomy urinary incontinence (PPUI). Method: This is an integrative review conducted in PubMed Central, ScienceDirect, Scopus and Web of Science, using the English terms “post-prostatectomy incontinence” and “nursing care,” combined with the Boolean operator AND. Articles published as full text or articles in press, within the open access system, without distinction of languages or year of publication, were included. Results: The initial search found 477 papers, but only six met the eligibility criteria. The five types of nursing actions identified were pelvic floor muscle training; urine stream interruption test with Unit Under Test timer; psychological nursing intervention program;telephone nursing support;and continuous post-prostatectomy nursing care, together with the previous interventions. Most studies showed good methodological quality and low risk of bias. Conclusion: The present review allowed the identification of different types of management of PPUI by nursing, even considering that the scenario of studies on the area is still scarce. It is expected that this review may be useful for the development of quality nursing care protocols for PPUI.

A comparative study of distal hypospadias repair combined with preputioplasty vs repair using conventional circumcision technique

Background: Hypospadias is one of the most common congenital anomalies characterised by underdevelopment of the ventral anatomical structures of the penis including skin, urethra, corpora spongiosum and prepuce and urethral opening can occur anywhere from the perineum to the ventral aspect of penis. This study evaluated and compared short-term cosmetic and functional outcomes and complications of distal hypospadias repair combined with preputioplasty with the repair using circumcision. Materials &amp; Methods: Patients were divided in two groups with 25 patients in either group. Group A patients underwent urethroplasty with circumcision whereas Group B patients were offered preputioplasty as an additional procedure. Clinical examination included location of the urethral meatus on the ventral aspect of the penis, presence or absence of associated chordee, stretched penile length, penile circumference, glans girth, depth of the navicular fossa or glans groove, urethral plate width, status of the preputial hood and testicular examination. Post-operatively, penis was examined for the location and shape of the neo-meatus, any complications in the form of meatal stenosis, urethrocutaneous fistula, preputial dehiscence and phimosis. Results: Both the groups were comparable with respect to the age at presentation and status of the urinary stream. Distal penile hypospadias predominated in both the groups and it was present in 21 patients in group A and 24 patients in group B. Rest of the babies had sub-coronal hypospadias. Preputial hood and navicular fossa/glans groove were good in either group. Mean stretched penile length in group A was 5.14 cm and it was 4.78 cm in group B children (p value- 0.141). Mean penile circumference of group A and group B patients ware 3.88 cm and 3.68 cm respectively (p value- 0.139). Girth of the glans and mean urethral plate width were also comparable (p values- 0.258 and 0.621 respectively). Final meatal appearance was slit shaped and wide in 22 patients in group A and 21 patients in group B. Urethro-cutaneous fistula was observed in two babies in group A and a single child in group B. One of the children was noted to have preputial dehiscence after two weeks. Prepuce was retracting well in 24 children during the 3rd follow up whereas one patient developed phimosis and thus results of the preputioplasty as an adjunct procedure were found to be satisfactory. Conclusion: Preputioplasty is a safe procedure and should be offered to all children undergoing single-stage distal penile hypospadias repair as it provides a near normal penile appearance at the cost of additional approximately 8% foreskin related complication rate.

Nueva técnica de fijación de dartos en la reparación de hipospadias

ObjectiveThis study investigates the impact of the use of dartos covering to augment the neourethra on functional and cosmetic results. To evaluate a novel technique demonstrating how to fix dartos flap to cover the neourethra as a barrier in hypospadias repair. Patients and methodsThis study comprised 204 male patients with different degree of hypospadias (DPH: 132, coronal hypospadias: 46, MPH: 26). Their ages ranged from 1-23 ys (mean age: 2ys). Penile chordee was in (DPH: 45, coronal hypospadias: 33, MPH: 26). All patients had abnormal downward directed urinary stream. Hypospadias repair was performed by the classic TIP technique in addition to our novel modification of dartos covering. Patients were submitted to 5 years of follow-up including clinical examination of the functional and cosmetic parameters. ResultsSuccess rates were reported in 200 patients, 3 patients had complications with subcoronal urethrocutaneous fistula and one patient with complete repair disruption. ConclusionTriple dartos fixation is a simple technique for all hypospadiologists to minimize urethrocutaneous fistula as common complication of hypospadias repair with good functional and cosmetic results.

Congenital anterior urethral valves and diverticula

Aims of StudyAnterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. The present study highlights the clinical approach in identifying the condition and its treatment options. MethodSingle centre, retrospective study of children. ResultOver a 16 year duration, 14 children were diagnosed with AUVs and diverticula with a mean age of 15 months. Clinical features included straining at micturation and a palpable penile swelling. Diagnosis was confirmed with voiding cystourethrogram and cystoscopy. An open surgical procedure was performed in 12 cases and endoscopic intervention done in one. On follow up 13 patients showed restoration of a normal voiding stream and normal renal function. One child died of chronic renal failure due to a delayed presentation, severe back-pressure changes, urinary ascites, and urosepsis. One patient developed a small urethrocutaneous fistula that healed spontaneously. ConclusionAUV, though rare, should be recognizable due to the combination of a poor urinary stream and visible swelling in the ventral aspect of penis. Open surgical excision is the method of choice, and the outcome is excellent. Level of EvidenceLevel IV.

Comparison of Outcome of Unilateral Modified Bladder Neck Incision and Tamsulosin Therapy in the Treatment of Primary Bladder Neck Obstruction in Young Men

Background: Primary bladder neck obstruction (PBNO) is a condition in which the bladder neck does not open appropriately or completely during voiding. Symptoms caused by primary bladder neck obstruction includes storage symptoms (Frequency, Urgency, Urge incontinence, nocturia) and voiding Symptoms (Poor urinary stream, hesitancy, incomplete emptying of bladder). Objective: To compare outcome of unilateral modified bladder neck incision with tamsulosin therapy in primary bladder neck obstruction in young men. Materials and Methods: This hospital based quasi-experimental study was conducted in the department of urology, Sir Salimullah Medical College Mitford Hospital. Patients with the diagnosis of primary bladder neck obstruction included in this study. Total 44 cases were included. Among them 18 were treated with unilateral modified BNI (Group A) and 26 were treated with tamsulosin therapy (Group B). Results: The mean age was found 31.11±4.77 years in group A and 34.15±5.42 years in group B. At 3rd and 6th month mean uroflowmetry (Qmax) was statistically significant (p&lt;0.05) when compared between two groups. However, in group A and group B uroflowmetry (Qmax) was significantly increased when compared initial vs 3rd month and initial vs 6th month respectively. The study observed that after 3rd month following the treatment the retrograde ejaculation was not found in group A and 1(3.8%) found in group B. At 6th month retrograde ejaculation was not also found in group A and found 2(7.7%) in group B. At 3rd and 6th month retrograde ejaculation was not statistically significant (p&gt;0.05). Conclusion: The outcome of unilateral modified BNI is better than tamsulosin therapy. All others adverse effect of both medical and surgical treatment was mild and transient that was acceptable in clinical practice. Sir Salimullah Med Coll J 2022; 30: 155-160

Application of support vector machine algorithm for early differential diagnosis of prostate cancer

Prostate cancer (PCa) symptoms are commonly confused with benign prostate hyperplasia (BPH), particularly in the early stages due to similarities between symptoms, and in some instances, underdiagnoses. Clinical methods have been utilized to diagnose PCa; however, at the full-blown stage, clinical methods usually present high risks of complicated side effects. Therefore, we proposed the use of support vector machine for early differential diagnosis of PCa (SVM-PCa-EDD). SVM was used to classify persons with and without PCa. We used the PCa dataset from the Kaggle Healthcare repository to develop and validate SVM model for classification. The PCa dataset consisted of 250 features and one class of features. Attributes considered in this study were age, body mass index (BMI), race, family history, obesity, trouble urinating, urine stream force, blood in semen, bone pain, and erectile dysfunction. The SVM-PCa-EDD was used for preprocessing the PCa dataset, specifically dealing with class imbalance, and for dimensionality reduction. After eliminating class imbalance, the area under the receiver operating characteristic (ROC) curve (AUC) of the logistic regression (LR) model trained with the downsampled dataset was 58.4%, whereas that of the AUC-ROC of LR trained with the class imbalance dataset was 54.3%. The SVM-PCa-EDD achieved 90% accuracy, 80% sensitivity, and 80% specificity. The validation of SVM-PCa-EDD using random forest and LR showed that SVM-PCa-EDD performed better in early differential diagnosis of PCa. The proposed model can assist medical experts in early diagnosis of PCa, particularly in resource-constrained healthcare settings and making further recommendations for PCa testing and treatment.

Prevalence and Bother of Postvoid Dribbling and Urine Spraying or Splitting: Survey of a General Gynecology Population.

Postvoid dribbling is described well for men in urologic literature but is poorly defined for women, especially in those not presenting for urogynecologic care. The objective was to assess prevalence and bother of postvoid dribbling, urine spraying (ie, deviation of the urine stream), and other bothersome voiding/storage symptoms in a general gynecology population. This was an anonymous cross-sectional survey study of women presenting to academic general gynecology practices for benign gynecologic care or well-woman visits; patients were not presenting for urinary incontinence or voiding dysfunction. A questionnaire was used to assess the presence and perceptions of voiding behavior and urinary symptoms with an emphasis on postvoid dribbling and urine spraying. The questionnaire included both the validated Questionnaire for Urinary Incontinence Diagnosis and nonvalidated questions. Nonpregnant adult women (N = 355) were surveyed. The median age was 43 years (interquartile range, 33-51 years). The sample was 45% White, 23% Black, 3% Asian, and 13% other. Furthermore, 39% were Latina; 68%, parous; and 28%, postmenopausal. The prevalence (95% confidence interval) of immediate postvoid dribbling was 186 of 327 or 57% (51-62%), and of these, it was at least somewhat bothersome in 37% but moderately-to-quite-a-bit bothersome in 8%. Urine spraying occurred in 222 of 333 or 67% (61-72%), and of these, it was at least somewhat bothersome in 53% but moderately-to-quite-a-bit bothersome in 17%. Approximately 20% reported stress and/or urgency urinary incontinence; both postvoid dribbling and urine spraying were highly associated with these symptoms. This study of women seeking benign gynecologic care shows a high prevalence of postvoid dribbling and urine spraying symptoms. However, moderate-or-greater bother was relatively uncommon.