Measurement Of Urinary Flow Research Articles

Flexible polydimethylsiloxane pressure sensor with micro-pyramid structures and embedded silver nanowires: A novel application in urinary flow measurement

Flexible pressure sensors are lightweight and highly sensitive, making them suitable for use in small portable devices to achieve precise measurements of tiny forces. This article introduces a low-cost and easy-fabrication strategy for piezoresistive flexible pressure sensors. By embedding silver nanowires into a polydimethylsiloxane layer with micro-pyramids on its surface, a flexible pressure sensor is created that can detect low pressure (17.3 Pa) with fast response (<20 ms) and high sensitivity (69.6 mA kPa−1). Furthermore, the pressure sensor exhibits a sensitive and stable response to a small amount of water flowing on its surface. On this basis, the flexible pressure sensor is innovatively combined with a micro-rotor to fabricate a novel urinary flow-rate meter (uroflowmeter), and results from a simulated human urination experiment show that the uroflowmeter accurately captured all the essential shape characteristics that were present in the pump-simulated urination curves. Looking ahead, this research provides a new reference for using flexible pressure sensors in urinary flow-rate monitoring.

Comparative study of mobile acoustic uroflowmetry and conventional uroflowmetry: A systematic review and meta analysis.

Uroflowmetry is a noninvasive measurement of the volume of urine excreted over time. Conventional uroflowmetry has become the main modality of urine flow measurement within time. However, this method requires the patient to be present in the hospital or healthcare setting, thus sometimes making the patients feel uncomfortable to undergo the examination. This led to multiple measurements which are inconvenient for the patients. Mobile acoustic uroflowmetry (sono-uroflowmetry) has been proposed as an alternative method of urine flow measurement due to its portability. This study aimed to evaluate the accuracy and reliability of sono-uroflowmetry as compared to conventional uroflowmetry. Electronic databases searching were done using prespecified search strategy to retrieve articles related with uroflowmetry. In addition, hand-search strategy was used to identify additional articles. Studies with participants who had undergone sono-uroflowmetry were included. Voided volume, voiding duration, maximum flow rate, and average flow rate were identified and used to determine the outcomes of measurement. The quality of included articles was conducted using checklist for Diagnostic Test Accuracy Studies by JBI. Initial search yielded 335 articles with four additional papers identified through hand-searching process. Six papers were retrieved and further used in the narrative synthesis. Five studies enrolled male participants, while only one of the papers enrolled female participants as additional subgroup analysis. Therefore, the meta-analysis was performed by using only male participants. Based on the meta-analysis results, there were strong to very strong positive correlation in voided volume, voiding time, average flow, average flow rate, and maximum flow rate between sono and conventional uroflowmetry. Sonouroflowmetry showed significant positive correlations to conventional uroflowmetry, signifying its use as an alternative of conventional uroflowmetry.

Research priorities for diagnostic instrumentation in urinary incontinence.

The International Consultation on Incontinence (ICI) captures current evidence on incontinence. The conference 'Incontinence: The Engineering Challenge XIII' in November 2021 heard an update on the most recent ICI summary on urodynamic testing. This paper summarises the ICI recommendations for future research in urodynamics, with a view to informing engineers of issues and challenges that could benefit from engineering solutions. Engineers are encouraged to contribute to the following areas of research, which will have a direct and positive effect on patients' quality of life and overall health: (a) Urine flow measurement: home- and app-based devices, machine learning analysis of flow shape, (b) Pressure measurement: normal values for and validation of new technologies, including air-filled, non-invasive and urethral pressure reflectometry, (c) Ultrasound imaging: bladder wall biomechanics, bladder shape analysis, (d) Assess normal and abnormal value ranges, and diagnostic performance and (e) Specific trials in understudied patient groups including those with symptoms resistant to treatment, children and the frail elderly.

Development of a urinometer for automatic measurement of urine flow in catheterized patients.

Urinary flow measurement and colorimetry are vital medical indicators for critically ill patients in intensive care units. However, there is a clinical need for low-cost, continuous urinary flow monitoring devices that can automatically and in real-time measure urine flow. This need led to the development of a non-invasive device that is easy to use and does not require proprietary disposables. The device operates by detecting urine flow using an infrared barrier that returns an unequivocal pattern, and it is capable of measuring the volume of liquid in real-time, storing the history with a precise date, and returning alarms to detect critical trends. The device also has the ability to detect the color of urine, allowing for extended data and detecting problems in catheterized patients such as hematuria. The device is proposed as an automated clinical decision support system that utilizes the concept of the Internet of Medical Things. It works by using a LoRa communication method with the LoRaWAN protocol to maximize the distance to access points, reducing infrastructure costs in massive deployments. The device can send data wirelessly for remote monitoring and allows for the collection of data on a dashboard in a pseudonymous way. Tests conducted on the device using a gold standard medical grade infusion pump and fluid densities within the 1.005 g/ml to 1.030 g/ml urine density range showed that droplets were satisfactorily captured in the range of flows from less than 1 ml/h to 500 ml/h, which are acceptable ranges for urinary flow. Errors ranged below 15%, when compared to the values obtained by the hospital infusion pump used as gold standard. Such values are clinically adequate to detect changes in diuresis patterns, specially at low urine output ranges, related to renal disfunction. Additionally, tests carried out with different color patterns indicate that it detects different colors of urine with a precision in detecting RGB values <5%. In conclusion, the results suggest that the device can be useful in automatically monitoring diuresis and colorimetry in real-time, which can facilitate the work of nursing and provide automatic decision-making support to intensive care physicians.

Lower partial pubicectomy for postoperative complicated posterior urethral stricture

ObjectiveTo report the experience of partial inferior pubicectomy in the treatment of complex posterior urethral stricture after trauma.MethodsA total of 46 patients with post-traumatic posterior urethral stricture admitted to the Department of Urology of our Hospital from January 2013 to September 2021 were selected as the research objects and underwent urethroplasty (including nine patients who had failed previous perineal repair surgery and adopted partial inferior pubicectomy approach). Retrograde urethrograph (RUG) and urine flow measurement were performed at 1, 3, 12 and 18 months after operation, and follow-up was performed when necessary. The clinical data during treatment were statistically analyzed.ResultsAll 46 patients underwent urethroplasty successfully, of which nine were treated with partial pubicectomy, accounting for 19.57% of the total. The causes of the disease were motor vehicle accident in 4 cases, falling collision injury in 2 cases, and rolling injury of military exercise tank in 3 cases. Among the 9 patients, 2 were children (22.22%), aged 8 and 12 years, and 7 were adults (77.78%), aged 19–44 (28.42 ± 1.56) years. Among the 9 patients, 6 had erectile dysfunction, accounting for 66.67%. The length of posterior urinary tract stenosis was (5.12 ± 0.57) cm. The operation time was (290.34 ± 12.35) min from anesthesia induction to skin closure. Five patients received 2 U blood transfusion during operation and three patients received 3 U blood transfusion after operation. The average hospital stay was 12–16 (14.24 ± 1.25) days, and the follow-up was 12–24 (18.24 ± 1.35) months. After surgery, one patient developed HIP abscess, which was successfully treated conservatively. One patient had dysuria 1 month after operation and was successfully treated by transurethral dilatation. One case had postoperative infection and recovered after intravenous administration of potent antibiotics. Cystourethrography was performed 3 months after operation, and there was no difference between patients with wide, long or short anastomotic stretch defects. All patients met the criteria for surgical success.ConclusionPartial inferior pubicectomy is a good surgical procedure for the repair of complicated posterior urethral stricture after operation. It is safe and reliable, can better display the prostatic apex and surgical field, shorten the length of reconstructed urethra, and has good postoperative effect. It has no direct or long-term effect on the stability of pelvis or bladder. However, further studies in a larger cohort of patients with complex posterior urethral strictures after repair are needed to demonstrate the specific indications for partial pubicectomy.

A Mathematical Simulation of the Influence a CMG Catheter’s Frequency Response on Urodynamic Diagnosis

Urodynamics comprises urine flow testing, ultrasound estimation of post-void residual, and Cystometry with filling and voiding phases [1]. Cystometry is the concurrent pressure measurement from the bladder and an abdominal control site, with parallel urine flow measurement. Using conventional water filled catheters, pressures are referenced to atmospheric pressure and the physical height of the external pressure transducer. Cystometry facilitates assessment of detrusor strength, and weakness or obstruction in the tract below.&#x0D; Video Urodynamics (VUDS) adds fluoroscopy to these physiological measurements, and allows differential diagnosis of pathology in Stress Urinary Incontinence (SUI) as well as surveillance of upper tract integrity [2]. A cysto-urethrogram is a non-invasive alternative to VUDS, allowing the whole urinary tract to be visualised during micturition. [3] It sacrifices pressure data, but can include a measurement of flow rate [4]

Techniques et intérêt clinique de la débitmétrie à domicile : une revue de la littérature

Urine flowmetry (UF) is a key non-invasive urodynamic test for the evaluation of the voiding phase in patients with lower urinary tract symptoms (LUTS). Traditional free urodynamic testing (FUT) performed on a one-time basis in the office is limited by difficulty in capturing normal voiding and high intrapatient variability in urine flow parameters. Home measurement of urine flow by the patient could be a way to obtain multiple data in real-life conditions, addressing its limitations. The objective of this article was to review the literature on the different techniques of home uroflowmetry (HUF) and their clinical interest in comparison with FUT. A search on the PubMed database using the key words "Urodynamics, Uroflowmetry, non-invasive urodynamics, Ambulatory urodynamics, bladder outlet obstruction, male LUTS" was performed to find articles in English or French that had been published with no time limit and March 2022. The sorting by reading the abstract allowed the selection of all articles describing and/or evaluating a HUF technique that were read entirely according to the same collection grid to propose a narrative synthesis. Thirty-one articles were identified, selected, and analyzed. Simple and inexpensive techniques by timing or use of funnels reliably and reproducibly estimate the average and maximum urine flow in relation to the FUT, without providing a complete flow curve. More sophisticated electronic or sonometric methods, some using connected mobile applications, present results that are more consistent with ICS recommendations for flow measurement. With the possibility of studying the average of several values of the maximum urinary flow (Qmax) captured during micturition in physiological conditions, some studies suggest a gain in diagnostic value in the evaluation of the emptying phase and lower urinary tract symptoms in men. However, the literature is sparse, old and the clinical benefits are not yet proven. There is a wide range of techniques for measuring urine flow in the patient's home, all of which aim to fill the gaps in conventional urine flow measurement. Further studies are needed to demonstrate the acceptability of this type of measurement by patients, the existence of a real clinical benefit, to assess the cost/benefit balance and finally to define a possible place for home uroflowmetry in daily practice, compared with traditional free flowmetry and invasive urodynamics (pressure-flow test).

MP07-04 STONE FORMATION BY ANALYSIS OF UROFLOW DYNAMICS IN THE RENAL PELVIS

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology (MP07)1 Sep 2021MP07-04 STONE FORMATION BY ANALYSIS OF UROFLOW DYNAMICS IN THE RENAL PELVIS Kengo Kawase, Shuzo Hamamoto, Shota Hattori, Ryosuke chaya, Tomoki Okada, Yutaro Tanaka, Takeru Sugino, Rei Unno, Kazumi Taguchi, Ryosuke Ando, Atsushi Okada, Masanori Nakamura, and Takahiro Yasui Kengo KawaseKengo Kawase More articles by this author , Shuzo HamamotoShuzo Hamamoto More articles by this author , Shota HattoriShota Hattori More articles by this author , Ryosuke chayaRyosuke chaya More articles by this author , Tomoki OkadaTomoki Okada More articles by this author , Yutaro TanakaYutaro Tanaka More articles by this author , Takeru SuginoTakeru Sugino More articles by this author , Rei UnnoRei Unno More articles by this author , Kazumi TaguchiKazumi Taguchi More articles by this author , Ryosuke AndoRyosuke Ando More articles by this author , Atsushi OkadaAtsushi Okada More articles by this author , Masanori NakamuraMasanori Nakamura More articles by this author , and Takahiro YasuiTakahiro Yasui More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001980.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous studies have shown that Randall's plaques are uniformly present in all renal papillae. However, we experienced cases in which the kidney stone recurrence occurred in the same position and the same renal calices. Therefore, we focused on the effect of urinary flow caused by the morphology of the renal pelvis. In this study, we used urodynamic analysis to investigate the differences in stone formation related to the morphology of the renal pelvis. METHODS: Study 1: Investigation of the site of intervening kidney stones Among the patients who visited our hospital from June 2018 to August 2019, 177 patients, diagnosed with kidney stones using CT, were included in the study. The sites of interest to the study were the upper, middle, and lower renal calyx. Study 2: A simulation analysis of urine fluid. Overall, three kidneys with no stones (NS group) and three kidneys with stones (S group) were studied. 3D models were created from the renal pelvis images obtained from contrast-enhanced CT, and a simulation analysis was performed using computational fluid dynamics. Study 3: Measurement of urine flow and analysis of flow velocity distribution. The phase-contrast method was used to measure the flow in one kidney of a healthy subject, using MRI. A cut-off value was set based on the measurement results, and the distribution of urine flow velocity was analyzed based on the results of study 2. RESULTS: Study 1: The location of intervening kidney stones in the upper, middle, and lower renal calices tended to be in 22 (12%), 92 (52%), and 63 (36%) patients, respectively. Study 2: No vortex-like stream or stagnation was observed in the renal pelvis in both the NS and S groups. Study 3: The method showed the flow velocity in the renal pelvis to be 820 μm/s. The cut-off values for the PS method were set at 400 μm/s and 800 μm/s. In the NS group, the velocity distribution was uniform, but in the S group, there was a difference in velocity in each renal calice. CONCLUSIONS: There was no vortex-like stream or stagnation in the renal pelvis, but there was a difference in the velocity of urine flow depending on the site. In previous studies of crystal growth, the velocity of solute flow has been reported to affect the growth. Differences in urine flow velocity in the renal pelvis might be involved in stone formation. Source of Funding: The authors declare no conflicts of interest associated with this manuscript © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e140-e140 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kengo Kawase More articles by this author Shuzo Hamamoto More articles by this author Shota Hattori More articles by this author Ryosuke chaya More articles by this author Tomoki Okada More articles by this author Yutaro Tanaka More articles by this author Takeru Sugino More articles by this author Rei Unno More articles by this author Kazumi Taguchi More articles by this author Ryosuke Ando More articles by this author Atsushi Okada More articles by this author Masanori Nakamura More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement Loading ...

Bilan urodynamique : tout ce que l’infirmier(e) doit savoir

Urodynamic (UD) is an exam intended to explore the mechanisms underlying lower urinary tract symptoms (LUTS) or urinary incontinence (UI). It involves the measurement of bladder and sphincter pressures using uretrovesical and rectal catheters with pressure transducers, but also the measurement of urinary flow and bladder sensation during filling. UD is far from being systematic in the assessment of LUTS or UI and must seek to tackle a specific clinical or therapeutic question. Thus, history taking, physical examination, voiding diary and questionnaires are essential prerequisites to UD per se. UD steps include a free (unintubated) uroflowmetry, a cystometry, post-void residual measurement±an urethral profilometry, a pressure-flow study or sensitization tests. The pressures are set to zero before to start the study and the validity of the equipment is tested. This control is continued throughout the procedure to ensure the quality of the recording. Any event (e.g., urine leakage, change of position, urgency) is noted during the study. A final report is made by the doctor. The competence of the nurse ensures the reliability, reproducibility and interpretability of the UD study and the nurse's humanity guarantee f an atmosphere as favourable as possible for this uncomfortable and invasive test.

Urinary flow measurement in hypospadias correlated to surgical procedure and risk of development of urethra-cutaneous fistula

To explore the correlation between fistula development and urinary flow measurements after hypospadias repair with emphasis on patients with urethrocutaneous fistula complications and to identify risk factors for fistula development. Urinary flow was examined in boys operated on for hypospadias. Outcome of maximum urinary flow (ml/s) (Qmax), voided volume for age (ml) (Volume), and pathological flow pattern (n) (Curve) was compared between the Byars, Mathieu, and Tubularized Incised Plate (TIP) surgical repair methods and between the groups of those who had and had not developed a fistula. Logistic regression analysis was performed for age at operation, genetics, comorbidity, or urinary flow measurements regarding the development of urethrocutaneous fistula. Seventy-three boys underwent hypospadias repair. Overall, the urinary flow measurements differed significantly between the three reconstructive methods, being favorable for the Mathieu procedure regarding Qmax (p<0.01), volume (p=0.04), and frequency of pathological voiding curve (p<0.01; Table). The frequency of urethrocutaneous fistula was 18% (13/73) and did not differ significantly between the three different reconstructive surgery methods (Byar 33%, Mathieu 32%, and TIP 12%; p=0.22). Urinary flow measurements did not differ between patients with and without fistula complications regarding Qmax 10ml/s (4-16) vs. 8ml/s (2-18), voided volume 74ml (35-171) vs. 71ml (9-270), or abnormal urinary flow pattern (23% vs. 30%). On logistic regression analysis, age at operation, genetics, comorbidity, and urinary flow measurement parameters did not turn out to be independent risk factors for development of urethrocutaneous fistula after hypospadias repair. The study demonstrated significant differences between the urinary flow measurement results between the three different repair methods, favoring the Mathieu procedure. A low Qmax was a common postoperative finding. Urinary flow measurements did not differ between boys developing fistula and those who did not. No risk factors for fistula development were identified. The study did not support that it would be possible, at an early postoperative stage, to identify those with an upcoming postoperative fistula neither with urinary flow measurements nor through risk factors. No similar reports have studied the possibility of using postoperative urinary flow measurements to determine patients at risk of fistula development after hypospadias repair. Urinary flow measurements were favorable after hypospadias reconstruction with Mathieu compared with Byars and TIP. Furthermore, urinary flow measurements did not differ between reconstructed with and without a fistula complication. No risk factor for fistula development was identified.

Spatiotemporal laser speckle flowmetry based on elastic-walled U-shaped tubing apparatus: optical method for urinary flow measurement

We propose an optical method for uroflowmetry, exploiting the laser speckle contrast imaging (LSCI) technique onto an intermediate tubing apparatus having an elastic wall that can sensitively respond to flow-induced shedding vortices. Based on the method, we devised and fabricated an elastic-walled U-shaped tubing apparatus (EWUSTA), using the three-dimensional printing technique. We utilized the spatiotemporal contrast scheme for the LSCI as a fast and reliable computational algorithm. We investigated three different materials of flex-vinyl, ninja-flex, and natural rubber latex for the elastic wall of the EWUSTA in steady flow conditions, and verified that their optimal operational ranges could extend up to 7, 15, and 25 ml/s, respectively. We characterized the natural-rubber-latex-based EWUSTA in dynamic flow conditions in comparison with a commercial reservoir-weight-transducer-based gravimetric flowmeter, and verified its feasibility. We stress that the proposed method can offer precise and accurate information on flow dynamics. In addition, we found that the upper limit of the optimal operational range of the proposed apparatus had strong correlation with the tensile strength of the elastic-wall material. We reckon that the proposed and demonstrated method has great potential not only for uroflowmetry but also for other flow-related medical and industrial applications.

Lower urinary tract symptoms and sexual functions after endorectal pull-through for Hirschsprung disease: controlled long-term outcomes

Background/purposeTo define the prevalence of lower urinary tract symptoms (LUTS) and outcomes for sexual function after endorectal pull-through (EPT) for Hirschsprung disease (HD) compared to controls. To date, similar controlled studies are lacking. MethodsPatients aged ≥4years (n=123) operated on for HD at our center between 1987 and 2011 were invited to answer questionnaires on LUTS and sexual function (aged ≥16years). Patients with an intellectual disability and patients with a definitive endostomy were excluded. Patients were matched to three controls and also invited to a clinical follow-up for urological investigations including urine flow measurement, renal tract ultrasound, and urinalysis. ResultsAltogether, 59 responses concerning LUTS and 24 responses concerning sexual functions were analyzed. No significant differences were demonstrated in the overall prevalence of LUTS between patients (67%) and controls (80%), nor in the prevalence of frequent LUTS (14% vs. 16%; P=NS for both). One patient (2%) had a urethral stricture after laparotomy-assisted EPT. Male patients reported sexual satisfaction and erectile function similar to controls (P>0.10). Female patients were currently less in stable relationships compared to controls (25% vs. 83%, P=0.005). ConclusionsOur results support the safety of EPT in patients with HD with regard to preservation of the integrity and functioning of the genitourinary tract.

Evaluation of bladder capacity in children with lower urinary tract symptoms: Comparison of 48-hour frequency/volume charts and uroflowmetry measurements

Objective evaluation of bladder capacity (BC) in children with lower urinary tract symptoms (LUTS) is important for recognizing types of bladder dysfunction. Bladder capacity is evaluated from 48-hour frequency/volume (48-h F/V) charts or by uroflowmetry with ultrasound post-void assessment. There are limited data on the reliability of both methods of assessment in children. The aim of the study was to compare two modalities of assessment, (F/V chart and uroflowmetry) in cohorts of children with bladder dysfunctions. Maximum bladder capacity (MBC) obtained from 48-h F/V charts was compared with volumes calculated from uroflowmetry in a cohort of 86 children with different bladder dysfunctions. The BC obtained by the two modalities was compared for the three most frequent subtypes of bladder dysfunction: monosymptomatic nocturnal enuresis (MNE), overactive bladder (OAB), and dysfunctional voiding (DV). Considering a 48-h F/V chart as standard, the sensitivity, specificity, negative and positive predictive values of uroflowmetry measurements were calculated for detecting low bladder capacity. The mean maximal bladder capacity (188±99.42ml) obtained from home 48-h F/V chart measurement was 17ml lower than the mean value obtained from uroflowmetry (205±112.11ml) (P=0.58). The differences between bladder capacities estimated by 48-h F/V chart and uroflowmetry for subjects were not significant (Figure). Concordance between 48-h F/V chart and uroflowmetry categorization of BC was present in 64 (74%) subjects. The sensitivity and specificity of uroflowmetry, in comparison with 48-h F/V chart evaluation, for recognizing low bladder capacity were 75.5% and 73.17%. The sensitivity and specificity for the different types of LUTS achieved 68.42% and 58.83% for OAB, 80% and 83% for MNE, and 50% and 83.3% for DV. According to the International Children's Continence Society, the management of MNE in children can be made without uroflowmetry. History and MBC evaluation by 48-h F/V charts yields sufficient information. Nevertheless, in situations where F/V charts are unreliable or unavailable, uroflowmetry can be used as an alternative method. The highest discrepancy between both methods of BC evaluation was found in DV; this was mainly due to the mean PVR of 31ml. For children with MNE, both 48-hour frequency/volume charts and triplicate urine flow measurement with PVR evaluation are reliable methods of maximum bladder capacity evaluation. For children with OAB or DV, both methods may be necessary for accurate evaluation of decreased BC, as F/V chart and uroflow results may not be comparable.

Urodynamic studies in children: Standardized transurethral video-urodynamic evaluation

The aim was too demonstrate standardized video-urodynamic study (VUDS) in children using a transurethral catheter and pressure transducers. Data necessary to obtain urodynamic evaluation of bladder sphincter function were gathered by concomitant measurement of bladder, urethral, and abdominal pressure. A 7F transurethral triple-lumen water-filled catheter was used for measuring the bladder and sphincter pressures and a water-filled 8F catheter connected to a pressure transducer was inserted into the rectum for pressure measurement. Cystometry was combined with fluoroscopy, providing simultaneous voiding cystourethrography information. Detrusor activity, bladder sensation, capacity, and compliance were measured during filling cystometry. Voiding cystometry consisted of recording pressures in the bladder sphincter and abdomen with simultaneous urinary flow measurement. Transurethral VUDS was safely and easily performed in a clinical setting adapted to children. A good and reproducible UDS is mandatory for correct therapeutic decisions. A standardized study associated with fluoroscopic assessment is presented in this video.

Chapter 9 - Approach to the male patient with lower urinary tract dysfunction

History and physical examination are the cornerstones of evaluation of the male patient with lower urinary tract (LUT) symptoms and (suspected) neurologic disorder, both to diagnose the nervous system lesion, and to get insight into the type of LUT dysfunction (LUTD). Non-neurologic LUTD needs to be ruled out. Laboratory testing is necessary to diagnose urinary infection. In those in whom neurogenic LUTD is probable, postvoid residual urine and urinary flow measurement generally rule out significant outflow obstruction and allow for basic symptomatic management. If symptomatology is complex or severe, or the pathophysiology uncertain, or invasive treatment planned, urodynamic or videourodynamic measurements should be performed to inform on bladder sensation, detrusor contractility, pressures generated in the bladder, as well as the behavior of bladder neck, the striated urethral sphincter, and urinary flow. This information is paramount to the clinician to plan management and consider prognosis. Assessment needs to be repeated, as chronic neurogenic LUTD is not a stable condition; in progressive neurologic diseases the nature of LUTD itself may change. The upper urinary tract needs to be checked and followed up regularly, particularly in patient groups in which high intravesical pressures may be generated.

An Observational Analysis of Provider Adherence to AUA Guidelines on the Management of Benign Prostatic Hyperplasia

We retrospectively evaluated urologist adherence to the AUA guidelines on the management of new patients with benign prostatic hyperplasia related lower urinary tract symptoms in a large university urology group. All first time benign prostatic hyperplasia/lower urinary tract symptom visits to the urology clinic at the Northwestern Medical Faculty Foundation between January 1, 2008 and December 31, 2012 were evaluated using an institutionally managed electronic medical record data repository. Clinical documentation and orders from each encounter were assessed to determine the rate of performance of guideline measures. Approximately 1% of all results were manually reviewed in a validation process designed to determine the reliability of the electronic medical record based system. A total of 3,494 eligible encounters were evaluated in the final analysis. Provider adherence rates with the 9 measures recommended in the guidelines varied by measure from 53.0% to 92.8%. The rate of performance of 5 not routinely recommended measures was 10.2% or less. Post-void residual and urinary flow measurement were optional measures, and were performed on 68.1% and 4.6% of new encounters respectively. Manual validation revealed theelectronic medical record data extraction was concordant with manual review in 96.7% of cases (95% CI 94.8-98.5). Using electronic medical record based data extraction techniques, we reliably document a baseline adherence rate with AUA guidelines on the management of benign prostatic hyperplasia. Establishing this benchmark willbe important for future investigation into patient outcomes related to guideline adherence and into methods for improving provider adherence.

2305 NOVEL USE OF MRI TO DETECT REFLUX IN A BLADDER MODEL WITHOUT CATHETERS, IONIZING RADIATION, OR CONTRAST… OH MY!

You have accessJournal of UrologyImaging/Radiology: Uroradiology1 Apr 20112305 NOVEL USE OF MRI TO DETECT REFLUX IN A BLADDER MODEL WITHOUT CATHETERS, IONIZING RADIATION, OR CONTRAST… OH MY! Bhavin Patel, Gordon McLorie, Anthony Atala, Robert Kraft, and Steven Hodges Bhavin PatelBhavin Patel Winston Salem, NC More articles by this author , Gordon McLorieGordon McLorie Winston Salem, NC More articles by this author , Anthony AtalaAnthony Atala Winston Salem, NC More articles by this author , Robert KraftRobert Kraft Winston Salem, NC More articles by this author , and Steven HodgesSteven Hodges Winston Salem, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2551AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Novel scanning and processing protocols have been developed to augment the diagnostic ability of magnetic resonance imaging (MRI). Single Shot Fast Spin Echo pulse sequencing (SSFSE) is one such technology. It allows one to image directional flow independent of contrast. We propose that using this technology, unenhanced urine can be used as an endogenous tracer, allowing for the measurement of urine flow back to the kidney. This could allow for the diagnosis of reflux without a catheter, contrast agent, or ionizing radiation. METHODS A model of the urinary tract was created with a “bladder” (reservoir and pump) designed to move normal saline along two 3mm diameter plastic tubes “ureters” at a rate mimicking urine flow, 3–5 mm/sec. In the MRI scanner, the protons of the fluid in the ‘bladder' were excited in a 90 degree axial spin. As the urine moved into the ureters a 180 degree pulse was performed along the sagittal plane. With reflux present (flow up the tubes), the fluid excited by the 90 degree pulse would leave the reservoir, but since it is constrained by the tubes it would also be excited by the 180 degree pulse. Only fluids that “see” both RF pulses are visible in the SSFSE sequencing, so only refluxing urine would enhance. RESULTS Performing the described modification of SSFSE MRI, we were able to excite the fluid in the model bladder for approximately 4 seconds, allowing the visualization of fluid reflux up the model urinary tract without the use of contrast agents. The temporal resolution was in the millisecond range. CONCLUSIONS Using a modification of a SSFSE, we were able to detect retrograde flow in a model ureter and bladder system using MRI. We hope to apply this technology to allow us to detect reflex in children without contrast, catheterization or ionizing radiation. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e924 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bhavin Patel Winston Salem, NC More articles by this author Gordon McLorie Winston Salem, NC More articles by this author Anthony Atala Winston Salem, NC More articles by this author Robert Kraft Winston Salem, NC More articles by this author Steven Hodges Winston Salem, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Traitement de l’hyperplasie bénigne de prostate par Prostiva ® : à propos d’une série de 76 patients

To evaluate the efficacy and morbidity of BPH treatment by radiofrequency in the general population and attempt to identify factors of prognostic value for this technique. This retrospective study examined 76 consecutive patients of mean age 68.9 years with symptomatic BPH in failure of medical treatment and treated at University Hospital of Caen between April 2004 and October 2008. Urine status was assessed before and after treatment with radiofrequency by the international prostate symptom score (IPSS), the quality of life (QOL) score related to urinary symptoms, the measurement of maximum urinary flow (Qmax) and residual postvoid volume (RPV). Erectile function was assessed by the International Index of Erectile Function (IIEF-5). The primary endpoint was treatment failure by radiofrequency regarded as the reintroduction of medical treatment or the need for surgical treatment. The secondary endpoints were the improvement of IPSS and QOL score, Qmax and RPV. Morbidity per and post-operative was also evaluated. A significant improvement in voiding status was observed with an average IPSS score from 24.7 to 15.1 (P<0.0001), and a QOL score from 5.2 to 2.9 (P<0,0001) in all patients. The Qmax and the RPV were significantly improved from 8.6 to 13.1ml/s (P<0.0001) and 177 to 100ml (P=0.0002) respectively. The IIEF-5 score was improved from 9.04 to 9.97 (P=0.0164). Twenty-five percent of acute urinary retention, 7.9% of haematuria and 1.3% of prostatitis were observed postoperatively. The overall retreatment rate was 46% after 14.6 months mean follow-up. When stratified into groups, patients with the inclusion criteria to this treatment showed a treatment rates of 34.8% after 16.2 months mean follow-up against 51% after 13.8 months of monitoring patients outside the inclusion criteria. Without showing significant difference between retentionist and no retentionist concerning subjective and objective parameters, the rate of retreat was more important for retentionist (51.2% after 11.8 months of mean follow against 39.4% after 18.4 months) with a significant difference on the actuarial cumulative survival curve without reprocessing. There was no significant difference found in patients with a median lobe. The results showed an improvement in Qmax significantly greater in the group with prostates less than 60 g without being able to demonstrate significant differences in other parameters. The retreatment rates in this group was 44.4% after 14.7 months of follow-up against 53.8% after 13.8 months of follow-up in the group of patients with prostate over 60 g. Moreover, the irritative component made a better initial response to treatment with a need for retreatment delayed compared to the group of patients with obstructive symptom, without noting significant differences in terms of improvement of objective and subjective parameters. The rate of retreatment was 63.6% after 16.4 months of mean follow and 51.6% after 11.2 months in the "obstructive" group. High rates of reprocessing are observed in the treatment of BPH by radiofrequency if inclusion criteria are not respected.

Bipolar Transurethral Resection of Anastomotic Strictures After Radical Prostatectomy

The efficacy of the bipolar endoscopic resection for anastomotic stricture was assessed and compared with holmium laser treatment. We studied a cohort of 39 patients with anastomotic strictures in years 1999 to 2007. Twenty-two patients had undergone bipolar resection, and 17 patients had undergone holmium laser treatment. The mean age of the bipolar cohort was 63.8 years; initial prostate-specific antigen (PSA) level was 10.7 ng/mL. The mean age of the laser cohort was 64 years; initial PSA level was 7.8 ng/mL. The results were evaluated by measurement of the maximum urinary flow (Qmax) and the postvoid residual volume of urine (PVR) before surgery, and at 6 weeks and 6 months after surgery. The Wilcoxon rank-sum test was used for statistical analysis, and a P value <0.05 was considered significant. The mean follow-up period was 42 (14-74) months. Improvements in Qmax and PVR were recorded in the two cohorts. In the bipolar cohort, the mean values of Qmax were 3.9 mL/s, 14 mL/s, and 13 ml/s, while PVR values were 46 mL, 10 mL, and 11 mL. The mean values of Qmax in the laser cohort were 3.7 mL/s, 11 mL/s and 6.1 mL/s; PVR were 25 mL, 16 mL, and 19 mL. Statistically significantly better results of Qmax over 6 months were in the bipolar cohort (P < 0.001). No perioperative complications and no deterioration of urinary continence were recorded. The bipolar resection of an anastomotic stricture is a highly effective method that produces better long-term results than the holmium laser treatment.

Interobserver Agreement for Noninvasive Bladder Pressure Flow Recording With Penile Cuff

We assessed variability in interpreting noninvasive measurements of bladder pressure and urine flow between experienced and novice users of the penile cuff. Urodynamicists at 6 sites were asked to use the penile cuff test as part of clinical assessment in 30 men presenting with lower urinary tract symptoms. After a short training period they measured maximum flow rate and cuff interruption pressure from penile cuff test recordings to enable categorization of bladder outlet obstruction using a nomogram. Similar measurements were then made on the same traces by 2 expert observers from the originating center. Interobserver differences were assessed. Complete agreement on obstruction categorization was seen in 77% of subjects, which increased to 86% when plots positioned on category boundary lines were allocated to the favored category. The 95% confidence limits of interobserver variability in maximum flow rate and cuff interruption pressure measurements were +/- 1.7 ml per second and +/- 13 cm H(2)O, respectively, although a small number of studies yielded discrepancies between observers that were larger than expected. They arose from complex recordings but were equally likely between experts as between expert and novice. Investigation of the causes suggested in some cases how such discrepancies may be avoided in the future. The excellent level of agreement in measurement and categorization after a short training period suggests that introducing the penile cuff test as part of assessment in men with lower urinary tract symptoms would be straightforward.