Urodynamic Characteristics Research Articles

114 - Urodynamic characteristics of post-micturition dribble in men

114 - Urodynamic characteristics of post-micturition dribble in men

Urodynamic Abnormalities in Children with Primary Bilateral Vesicoureteral Reflux.

Bilateral vesicoureteral reflux (VUR) has been associated with poor long-term prognosis, and research focusing exclusively on its effect on urinary bladder function is lacking. This study aims to assess the urodynamic characteristics of children with bilateral VUR and identify factors influencing renal function. A retrospective analysis was performed on children diagnosed with bilateral VUR who underwent urodynamic examination in the outpatient department of our institution from January 2019 to January 2023. All patients underwent comprehensive assessments, including voiding cystourethrography, urinary system ultrasound and urodynamic examination, to analyse the urodynamic features associated with different clinical characteristics. The study included 148 children with bilateral VUR, amongst whom 92 (62.2%) exhibited urodynamic abnormalities, including idiopathic detrusor overactivity (DO) in 30 cases (20.3%) and dysfunctional voiding (DV) in 58 cases (39.2%). DV was prevalent in children under 5 years of age, whereas idiopathic DO was predominantly observed in children older than 2 years of age. Children older than 5 years of age exhibited a trend towards reduced bladder volume, whereas those younger than 2 years of age often had increased bladder volume and residual urine. Multivariate analysis identified bilateral severe VUR as an independent risk factor for abnormal estimated glomerular filtration rate. DV tends to be more common in younger children with larger bladder volumes and increased residual urine than in older children. By contrast, older children are more susceptible to idiopathic DO associated with smaller bladder volumes than younger children. Bilateral severe reflux increases the likelihood of renal functional abnormalities, which appear to be a consequence of congenital scarring rather than abnormalities in bladder function.

MEGAURETHIR IN CHILDREN: METHODS OF ENDOSCOPIC CORRECTION

Megaureter is a severe pathology of the urinary system. According to the World Health Organization, according to the number and structure of diseases, malformations of the urinary system organs in children occupy one of the leading places among pathologiesof all organs and systems. The purpose of the study was to determine the effectiveness of endoscopic methods for correcting megaurethritis in children. The study presents the results of treatment of 116 patients with refluxing and obstructive megaureter on the basis of the Department of Pediatric Surgery No. 2 Samara State Medical University for the period from 2010 to 2022. The results of the examination revealed that the urodynamic characteristics of positive results after endoscopic correction of megaureter in a period of 3-6 months indicated a clear depending on the treatment results from the method of forming a bolus in the area of the ureterovesical segment: for mild severity, the STING method was effective, for moderate severity -HITI, and for severe severity -HITII.

Real-Life Treatment Outcome of Botulinum Toxin A Injection on Overactive Bladder and Voiding Dysfunction in Patients with Central Nervous System Lesions.

Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with neurological lesions in the central nervous system (CNS). Medical treatment usually cannot adequately relieve NLUTD. This study reported the real-life treatment outcome of botulinum toxin A (BoNT-A) for overactive bladders (OAB) and voiding dysfunction in patients with CNS lesions. We retrospectively analyzed the first-time treatment outcome of 74 patients who received detrusor 100 U BoNT-A for OAB and 45 patients who received a urethral sphincter 100 U BoNT-A injection for voiding dysfunction. The treatment outcome, therapeutic duration, and adverse events (AE) after BoNT-A were compared among different CNS lesions and among patients with different urodynamic characteristics. The study included 74 patients receiving detrusor injections for OAB (36 with cerebrovascular accidents, 13 with Parkinson's disease, and 25 with dementia) and 45 patients receiving a urethral sphincter injection for voiding dysfunction (26 with cerebrovascular accidents, 7 with Parkinson's disease, and 12 with dementia). After detrusor BoNT-A treatment, urinary continence was achieved in 28.4% of patients with neurogenic OAB, postoperative difficult urination in 59.5%, acute urinary retention (AUR) in 9.5%, and urinary tract infection (UTI) in 14.9%, with a therapeutic duration of 6.43 months. There were no differences among subgroups or between patients with detrusor overactivity (DO) and DO with detrusor underactivity (DU) in terms of treatment outcomes and AEs. The improvement rate of urethral sphincter BoNT-A injections was 75.6% without any difference among subgroups. After treatment, 24.4% of the patients had exacerbated urinary incontinence, 33.3% had persistent difficult urination, and 15.6% had UTI. Patients with dementia had higher rates of difficult urination and UTI, higher postvoid residual volume, and a shorter therapeutic duration. Patients with DU and those without urethral sphincter dyssynergia had less favorable outcomes after their urethral sphincter BoNT-A injection. The therapeutic efficacy of detrusor BoNT-A injection for OAB due to CNS lesions is limited, with high rates of difficult urination, AUR, and UTI. Although urethral sphincter BoNT-A injection is effective in treating voiding dysfunction; however, exacerbated urinary incontinence and persistent difficult urination remain a problem, particularly in patients with dementia.

Outcomes of women diagnosed with primary bladder neck obstruction based on video urodynamic criteria

AbstractObjectiveFunctional and anatomic bladder outlet obstruction (BOO) in women are more prevalent than previously suspected and remain a diagnostic challenge. Several urodynamic diagnostic criteria for female BOO have been proposed, but studies validating the criteria by assessing treatment outcomes are lacking. We sought to correlate video urodynamic (VUD) diagnostic criteria with symptom improvement in women with functional bladder outlet obstruction.MethodsA retrospective cohort study of women diagnosed with primary bladder neck obstruction (PBNO) by VUD criteria who underwent bladder neck incision (BNI) between 2010 and 2022 was performed. Patient demographic, clinical, and urodynamic characteristics were collected before and after treatment and analyzed.ResultsTwenty‐six women with mean age 64.7 years underwent BNI. Nineteen patients (73.1%) were cured, four (15.4%) improved, and three (11.5%) failed. After BNI the mean postoperative Qmax was significantly higher (9.4 vs. 3 mL/s, p = 0.006) and mean postvoid residual (PVR) was significantly lower (102 vs. 514 mL, p ≤ 0.001). Patients who did not require a catheter preoperatively were more likely to be cured than those who did (90% vs. 62.5%, p = 0.03). The PdetQmax of patients that were cured or improved did not differ significantly from those who were not (50.7 cm H2O vs. 32 cm H2O, p = 0.21).ConclusionsThe diagnosis of PBNO by VUD criteria for obstruction correlated with treatment outcomes with success in 88.5% and 56% becoming catheter independent. Successful treatment was independent of preoperative PdetQmax.

Dynamic simulation and analysis of the influence of urethral morphological changes on urodynamics after benign prostatic hyperplasia surgery: A computational fluid dynamics study

Background and objectiveComputational fluid dynamics (CFD) technology has been widely used in medicine to simulate and analyse urine flow characteristics in urology. In previous studies, researchers have modelled the analysis with a simple circular urethra, ignoring the effect of the patient's true urethral morphology on the urinary flow rate. Moreover, the studies tended to be steady-state simulations rather than dynamic simulations. Therefore, this study is established a relatively realistic model of the posterior urethra based on MRI data combined with the urodynamic data of patients and analysed the urodynamic characteristics of the posterior urethra model after benign prostatic hyperplasia (BPH) surgery using a CFD dynamic simulation. MethodsBased on clinical MRI data, a three-dimensional real urethral model was established for two patients with BPH after surgery. The boundary conditions were set according to the patients’ real urodynamic data, and a Reynolds averaged Navier‒Stokes model was used for transient simulations. The dynamic simulation depicted the entire urination process, and the urine flow characteristics were studied under real urethral morphology after surgery. Results1. By comparing the three-dimensional trajectory of urine and the vortex identification cloud map based on the Q criterion, we intuitively observed the distribution of the vortex in the model, and a ‘gourd-shaped’ urethra was more likely to generate a vortex than a ‘funnel-shaped’ urethra. 2. After surgery for BPH, the changes in the posterior urethral pressure were mainly concentrated in the urethral membrane, and the velocity increased while the pressure decreased. The curve of the posterior urethral pressure changes during urination was simulated and calculated. The posterior urethral pressure gradients of the two patients were 6.6 cmH2O and 5.26 cmH2O. ConclusionsThe complete urinary discharge process can be dynamically simulated using CFD techniques. By comparing the simulation results, the posterior urethral morphology can have an important impact on the urinary flow characteristics. Determining the location of vortex generation can lay a foundation for personalized surgical plans for patients in the future. Furthermore, numerical simulations can provide a new method for the study of non-invasive posterior urethral pressure gradients.

Transcriptomics Reveals Molecular Features of the Bilateral Pelvic Nerve Injury Rat Model of Detrusor Underactivity.

The pathogenesis of detrusor underactivity (DU) is unclear, and the available therapeutic effects are unsatisfactory. We propose to find key molecules and pathways related to DU based on transcriptome sequencing. A rat model of bilateral pelvic nerve injury (BPNI) was established. Bladder tissues from the sham-operated group, 3 and 28 days after BPNI mapping, were taken for urodynamics, histopathology, and RNA-seq. An enrichment analysis of the screened differential expression genes was performed. Three days after BPNI, the results showed urodynamic features of overflow incontinence, while there was a recovery at 28 days after the operation. Masson staining revealed collagen deposition accompanied by progressive thickening of the smooth muscle layer as DU progressed. RNA-seq results suggested that a total of 1808 differentially expressed genes (DEGs) differed among the groups. RNA-seq and subsequent analysis confirmed that the cell cycle and immune response were significantly activated 3 days after BPNI, while extracellular matrix remodeling occurred 28 days after BPNI. Partial DEGs and pathways were verified by qRT-PCR. Validation of key proteins involved in cell cycle, inflammation, and fibrosis was performed by immunohistochemical staining and western blot, respectively. These molecular expression patterns at different time points after BPNI injury provide valuable insights into the search for therapeutic targets for DU.

Comparative study of two different rat models of stress urinary incontinence.

The purpose of this study was to compare the success rate and urodynamic characteristics of the rat model of stress Urinary incontinence established by ovariectomy at different times after vaginal dilation. Eighty female rats were randomly divided into three groups: the control group (n = 20), model group A (n = 30), i.e., the animals received colpectasis and bilateral oophorectomy within 1 day; model group B (n = 30), i.e., the animals received bilateral oophorectomy 1 week after colpectasis. The sneeze test and urodynamics were tested. There was no significant difference between the model group A and the model group B (p > 0.05) in the sneeze test. The leak point pressure (LPP) of model groups A and B was lower than that of the control group (p < 0.05). The LPP value of model group A was lower than that of model group B (p < 0.05). There was no significant difference in maximum bladder capacity (MBC) between model group A and the control group (p > 0.05); the MBC value of model group B was lower than that of the control group and model group A (p < 0.05). Models of stress urinary incontinence in rats can be successfully established by both modeling methods. In terms of LPP, model groups A and B had lower values than the control group, and model group A had lower values than model group B. In terms of MBC, there was no difference between model group A and the control group, and model group B had lower values than the control group and model group A.

MP74-01 CHARACTERISATION OF FEMALE URETHRAL STRICTURES

You have accessJournal of UrologyCME1 Apr 2023MP74-01 CHARACTERISATION OF FEMALE URETHRAL STRICTURES Elizabeth Day, Helena Gresty, Anthony Noah, Richard Nobrega, Jeremy Ockrim, and Tamsin Greenwell Elizabeth DayElizabeth Day More articles by this author , Helena GrestyHelena Gresty More articles by this author , Anthony NoahAnthony Noah More articles by this author , Richard NobregaRichard Nobrega More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female urethral stricture (FUS) is rare. We have assessed the history, imaging and urodynamic characteristics of all women seeking urethroplasty for recurrent symptomatic strictures. METHODS: A retrospective review of 63 consecutive women (median age 50.5 years, range 25-71) with recurrent or refractory FUS undergoing urethroplasty since June 2012. Data was analysed for symptom profile, aetiology and previous therapy. MRI, videourodynamic (VUDS) and examination findings provided stricture length and site. RESULTS: Median duration of symptoms was 60 months (range 24-456). The commonest symptoms were poor flow 61 (97%), frequency 48 (76%), nocturia 46 (73%), urgency 44 (70%), recurrent UTI 41 (65%) and urethral pain 40 (63%). The commonest causes of FUS are, unknown in 37 (59.7%), urethral instrumentation/catheterisation in 7 (11.1%), urethral diverticulum excision in 4 (6%), radiotherapy in 3 (4.7%), none relaxing sphincter in 3 (4.7%) and lichen planus in 2 (3.2%). The women had had a median of 5 previous urethral dilatations (range 0-33). 38 (60%) had been performing ISC for a mean of 24 months (range 6-120) and 31 (82%) found it painful. Pre-operative MRI pelvis was performed in 56 (89%) and revealed a concentrically thickened urethra in 35 (63%), urethral diverticulum in 4 (6%), an absent/fibrotic urethra in 4 (6%), and no abnormalities in 13 (21%). Pre-operative VUDS were performed in 57 (90%). Bladder outflow obstruction (BOO) was seen in 56 (98%). Preoperatively median Qmax was 5 mls/s (range 0-24), median Pdet Q max was 70 cm H2O (range 0-165) and median Solomon-Greenwell BOOIf was 51.4 (range -24.2-156.2) (where BOOIf >5 =>50% chance of BOO). Other findings included detrusor overactivity in 22 (39%) and stress urinary incontinence in 7 (12%).Median stricture length was 2.0 cm (range 0.5-4.0 cm) and the commonest sites were mid-distal in 20 (32%) and distal in 19 (30%). 53 (84%) had ventral onlay buccal mucosal graft urethroplasty, 6 (10%) had ventral vaginal flap urethroplasty, 2 (3%) had ventral onlay labial minora flap urethroplasty and 1 (1.5%) had a ventral vaginal graft urethroplasty – with stricture free status in 55 (87%) at last follow-up (median 39 months, range 4-112). CONCLUSIONS: Poor flow is present in almost all women with FUS. The majority will also have irritative LUTS, recurrent UTIs and urethral pain. VUDS and MRI are useful pre-operatively to characterise the stricture. Definitive treatment with urethroplasty should be considered earlier once endoscopic management has failed. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1069 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Day More articles by this author Helena Gresty More articles by this author Anthony Noah More articles by this author Richard Nobrega More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement PDF downloadLoading ...

Urodynamic changes before and after endoscopic valve ablation in boys diagnosed with the posterior urethral valve without chronic renal failure

IntroductionCurrent research on the posterior urethral valve (PUV) mainly focuses on the follow-up of bladder function after valve ablation. However, few studies exist on the changes in bladder function before and after valve ablation.ObjectivesTo investigate the urodynamic changes before and after PUV ablation and determine the effect of operation on bladder function, in patients.Materials and methodsThe clinical records of 38 boys diagnosed with PUV and undergone urodynamic exams before and after valve ablation were retrospectively reviewed. In addition, differences in patients’ radiographic studies and urodynamic characteristics between pre- and post-operation were evaluated. Moreover, the urodynamic data was compared using the paired t-test and all the data was expressed as means ± SEM. Additionally, p values less than 0.05 were considered to be statistically significant.ResultsAll the patients were diagnosed with PUV and the follow-up period after operation ranged between 9 and 114 months. The urodynamic exams were performed about 6 months after operation. The results revealed that bladder compliance improved from 8.49 ± 4.73 to 13.31 ± 6.78 ml/cmH2O while the maximum detrusor pressure decreased from 95.18 ± 37.59 to 50.71 ± 21.71 cmH2O, after valve ablation. Additionally, there were significant differences in the pre- and post-operation values of bladder compliance and maximum detrusor pressure (p < 0.05). However, there were no significant differences in the pre- and post-operation values with regard to the residual urine volume, maximum bladder volume and maximum urinary flow rate (p > 0.05).ConclusionsThe adequacy of the COPUM incision is necessary. But the study showed that endoscopic valve ablation couldn’t by itself completely improve the bladder function of patients diagnosed with PUV. However, it was able to improve bladder compliance and decrease maximum detrusor pressure to a certain extent. However, bladder compliance still couldn’t reach the normal level.

Urodynamic characteristics of adult men with mixed detrusor overactivity with detrusor underactivity: A database analysis

Objective: To examine the urodynamic characteristics of men with mixed detrusor overactivity with detrusor underactivity (DODU) across the entire adult-age spectrum. Materials and Methods: Data included all adult men who underwent urodynamics for refractory non-neurogenic lower tract symptoms between 2011 and 2019. DODU was defined as the concomitant presence of detrusor overactivity (DO) during storage with underactivity (bladder contractility index, BCI &lt; 100) during voiding. Nonparametric tests with multiple hypothesis correction were used (SPSS 25.0). Results: DODU was noted in 199/1596 men (12.5%; median, 62 years). Men with DODU were older than men with detrusor underactivity (DU) or DO alone (median, 62, 48 and 56 years, respectively). DODU was commoner in older men but was noted across all age groups. As compared to men with isolated DU, men with DODU were more likely to be obstructed (38.7% versus 23.6%) and had better contractility (median BCI 81 versus 75). Peak detrusor contraction pressure during overactivity was lower in men with DODU than men with isolated DO. Conclusion: DODU should not be regarded as an exclusively geriatric disease. Differences in urodynamic characteristics suggest that this condition might not just be the coincidental occurrence of DO and underactivity in the same individual. Level of evidence: III

Usefulness of Urinary Biomarkers for Assessing Bladder Condition and Histopathology in Patients with Interstitial Cystitis/Bladder Pain Syndrome.

This study investigated the usefulness of urinary biomarkers for assessing bladder condition and histopathology in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). We retrospectively enrolled 315 patients (267 women and 48 men) diagnosed with IC/BPS and 30 controls. Data on clinical and urodynamic characteristics (visual analog scale (VAS) score and bladder capacity) and cystoscopic hydrodistention findings (Hunner’s lesion, glomerulation grade, and maximal bladder capacity (MBC)) were recorded. Urine samples were utilized to assay inflammatory, neurogenic, and oxidative stress biomarkers, including interleukin (IL)-8, C-X-C motif chemokine ligand 10 (CXCL10), monocyte chemoattractant protein-1 (MCP-1), brain-derived neurotrophic factor (BDNF), eotaxin, IL-6, macrophage inflammatory protein 1 beta (MIP-1β), regulated on activation, normal T cell expressed and secreted (RANTES), tumor necrosis factor-alpha (TNF-α), prostaglandin E2 (PGE2), 8-hydroxy-2′-deoxyguanosine (8-OHdG), and 8-isoproatane, and total antioxidant capacity. Further, specific histopathological findings were identified via bladder biopsy. The associations between urinary biomarker levels and bladder conditions and histopathological findings were evaluated. The results reveal that patients with IC/BPS had significantly higher urinary MCP-1, eotaxin, TNF-α, PGE2, 8-OHdG, and 8-isoprostane levels than controls. Patients with Hunner’s IC (HIC) had significantly higher IL-8, CXCL10, BDNF, eotaxin, IL-6, MIP-1β, and RANTES levels than those with non-Hunner’s IC (NHIC). Patients with NHIC who had an MBC of ≤760 mL had significantly high urinary CXCL10, MCP-1, eotaxin, IL-6, MIP-1β, RANTES, PGE2, and 8-isoprostane levels and total antioxidant capacity. Patients with NHIC who had a higher glomerulation grade had significantly high urinary MCP-1, IL-6, RANTES, 8-OHdG, and 8-isoprostane levels. A significant association was observed between urinary biomarkers and glomerulation grade, MBC, VAS score, and bladder sensation. However, bladder-specific histopathological findings were not well correlated with urinary biomarker levels. The urinary biomarker levels can be useful for identifying HIC and different NHIC subtypes. Higher urinary inflammatory and oxidative stress biomarker levels are associated with IC/BPS. Most urinary biomarkers are not correlated with specific bladder histopathological findings; nevertheless, they are more important in the assessment of bladder condition than bladder histopathology.

Robot assisted radical cystectomy with Florence Robotic Intracorporeal Neobladder (FloRIN): Functional and urodynamic features compared with a contemporary series of open Vescica Ileale Padovana (VIP)

IntroductionFloRIN reconfiguration technique was introduced in 2016 according to the IDEAL-Collaboration Guidelines, with the attempt to conjugate the advantages of both intracorporeal neobladder and robotic assistance. Herein we report functional outcomes of FloRIN reservoir, specifically focusing on urodynamic features. Materials and methodsConsecutive patients treated with RARC and FloRIN reconstruction were prospectively collected from February 2016 to June 2020. Only patients with a minimum 6-month follow up were analyzed to obtain a stable grade of neobladder maturation before performing the urodynamic study (UDS). The FACT-BL and the QLQ-C30 EORTC questionnaires were used to evaluate urinary function and health-related QoL. Results were compared with a contemporary series of patients treated at the same Institution with open radical cystectomy (ORC) and Vescica Ileale Padovana (VIP). ResultsOne hundred patients entered the study and 69 patients had complete functional data. Overall, 52 (75.4%) patients reached the daytime continence. Among these, 28 (40.6%) were dry (no pads during daytime), while 24 (34.8%) used one pad/12 h. Night-time continence was achieved by 45 (65.2%) patients. Complete UDS findings were available for 28 patients. No statistically significant differences were found with the VIP-ORC group except for neobladder compliance, being higher in the FloRIN group (p = 0.03). When evaluating QoL scores, RARC with FloRIN reconfiguration showed a better continence recovery, as well as a higher improvement in urgency domain (p = 0.01), psychological status (0.02) and physical self-acceptance (p = 0.02), compared to the VIP-ORC group. ConclusionsThe FloRIN technique showed excellent functional outcomes when compared to the referral VIP-ORC procedure.

Feasibility of a Transcutaneous Tibial Nerve Stimulation Device Use in Overactive Bladder Patients: A Pilot Study From a Single Tertiary Care Center.

PurposeTo evaluate the preliminary efficacy, safety, and acceptability of a transcutaneous tibial nerve stimulation (TTNS) device in overactive bladder (OAB) patients.MethodsTwenty OAB patients who failed with conservative treatments were recruited consecutively. All patients received 60 min of daily unilateral stimulation for 4 weeks using a smart wearable transcutaneous tibial nerve stimulation device and the stimulations were at 20 Hz frequency, 200 μs pulse width. OAB symptoms were observed at baseline and week 4, using a 3-days voiding diary, the overactive bladder symptom score (OABSS), the perception of bladder condition (PPBC), and the American Urological Association Symptom Index Quality of Life Score (AUA-SI-QoL). Urodynamic characteristics were measured to determine the pilot efficacy of the device during the treatment comparing the baseline parameters to the post-treatment parameters.ResultsAmong the patients, 15 cases were OAB-dry and five cases were OAB-wet. All patients were evaluated at the end of the study and no significant side effects were found during the treatment. The daily micturition frequency and the number of incontinence episodes per day were reduced from 15.10 ± 1.61 to 12.00 ± 4.56, and 3.20 ± 0.80 to 0.47 ± 0.38, respectively. The mean voiding volume was increased from 130.10 ± 53.07 to 157.30 ± 66.95 mL. The OABSS, AUA-SI-QoL, and PPBC were reduced from 9.35 ± 1.39 to 5.9 ± 2.36, 5.70 ± 0.47 to 3.85 ± 1.04, and 5.70 ± 0.47 to 4.35 ± 0.86, respectively. The first sensation of bladder filling (1st SBF), maximal bladder capacity (MBC), and mean compliance were increased from 87.50 (60.00–167.50) to 150.00 (104.00–211.30) mL, 175.00 (120.30–354.00) to 255.00 (151.50–491.50) mL, and 36.67 (12.44–39.69) to 40.00 (20.00–52.50) mL/cmH2O, respectively. The maximum detrusor pressure (Pdet. max) was reduced from 14.50 (5.00–35.25) to 11.00 (6.00–20.00) cmH2O.ConclusionThe preliminary results demonstrated that the TTNS device was safe, effective, and acceptable to use in OAB patients, but the results need to be substantiated by conducting more randomized controlled studies further.

Single system ectopic ureters: Adult presentation of a congenital anomaly

Objective:To retrospectively review a cohort of adult patients with single ectopic ureter, a rare congenital abnormality where one ureter terminates in an abnormal position outside of the trigone of the bladder. Methods:We identified 5 patients diagnosed with a single ectopic ureter over a single surgeon’s career over 35 years and 2 institutions. Clinical symptoms, medical history, interventions, available radiologic imaging, and urodynamic features were analyzed. Results:Median age at diagnosis was 53 years (range 18–85 years). The majority were male (80%). All patients were noted to have a solitary functioning kidney. A diminutive contralateral kidney and ureter was found in 1 (20%) patient. All patients were symptomatic, with the most common presenting symptoms being chronic dysuria (60%) and chronic prostatitis (40%). Physical examination findings were identified in 3 (60%) patients. Interventions were principally dependent upon the type and severity of each patient’s symptoms, and included observation, drainage of ectopic structures, vaginal marsupialization, and laparoscopic nephroureterectomy. The 3 (60%) patients that underwent intervention remained symptom free and the 2 (40%) patients that decided on observation were minimally symptomatic. Conclusions:Single ectopic ureter is a complex embryological abnormality that can result in a wide array of anatomic variations and clinical findings in both men and women. Given the rarity of this entity in adult patients, a high index of suspicion must be held by the clinician for this diagnosis. Ultimately, treatment options for these patients will be dependent upon symptom severity, anatomic presentation, and patient quality of life.

Diagnostic Value of the Maximum Urethral Closing Pressure in Women With Overactive Bladder Symptoms and Functional Bladder Outlet Obstruction.

PurposeOveractive bladder (OAB) is observed in women with functional bladder outlet obstruction (FBOO), as are lower urinary tract symptoms (LUTS). Therefore, we evaluated the urodynamic characteristics of women with storage LUTS and FBOO diagnosed by urodynamic studies (UDS).MethodsWomen (n=108) with storage LUTS and FBOO diagnosed by UDS were included in this study. The urodynamic characteristics of women with FBOO were compared with those of women with OAB (n=34) and stress urinary incontinence (SUI, n=78). FBOO was defined as a maximum flow rate (Qmax) < 15 mL/sec, combined with detrusor pressure at a Qmax (PdetQmax) > 20 cm H2O in a pressure-flow study. The UDS included uroflowmetry, postvoid residual volume determination, a cystometrogram, and a pressure-flow study.ResultsWomen with FBOO who had storage symptoms showed a higher PdetQmax and maximum urethral closing pressure (MUCP) than women with OAB and SUI. Interstitial cystitis/bladder pain syndrome (IC/BPS) was observed in 17.6% of women with FBOO. MUCP was significantly higher in women with BOO than in women with BOO and IC/BPS (115.6±27.4 and 96.6±14.1 cm H2O, P=0.00). The receiver operating characteristic curve analysis showed that the cutoff values of MUCP in women with FBOO compared to women with OAB and SUI were 87 cm H2O (sensitivity=81.5%, specificity=73.5%) and 36 cm H2O (sensitivity=92.6%, specificity=84.4%), respectively. The cutoff value of MUCP in women with FBOO compared to women with FBOO and IC/BPS was 92 cm H2O (sensitivity=85.4%, specificity=78.9%).ConclusionsMUCP could have predictive value for identifying FBOO in women with complex LUTS.

Therapeutic outcome of active management in male patients with detrusor underactivity based on clinical diagnosis and videourodynamic classification

Detrusor underactivity (DU) could be resulted from many different etiologies. Patients with DU might have reduced bladder sensation, low detrusor contractility, and large post-void residual volume. This study analyzed therapeutic outcome of active management for male DU patients, based on clinical and urodynamic characteristics. Male DU patients aged > 18 years old were retrospectively reviewed from the videourodynamic study (VUDS) records in recent 10 years. The patients’ demographics, VUDS results, treatment modalities, and treatment outcome were analyzed. The treatment outcomes were compared among patients with different DU subgroups, clinical diagnosis and treatment modalities. Patients with voiding efficiency of > 66.7% were considered having a successful treatment outcome. For comparison, 30 men with normal VUDS finding served as the control arm. Most of the DU patients had reduced bladder sensation. The reduced bladder sensation is closely associated with low detrusor contractility. After active treatment, a successful outcome was achieved in 68.4% of patients after bladder outlet surgery, 59.1% after urethral botulinum toxin A injection, and 57.6% after medical treatment, but only 18.2% after conservative treatment. A successful treatment outcome was achieved in patients with an intact detrusor contractility, either low (69.2%) or normal voiding pressure (81.8%), and in patients with a normal or increased bladder sensation (78.1%). However, patients with detrusor acontractile (41.3%) or absent bladder sensation (17.9%) had less favorable treatment outcome after any kind of urological management. This study revealed that active management can effectively improve voiding efficiency in patients with DU. The normal bladder sensation, presence of adequate detrusor contractility, and bladder outlet narrowing during VUDS provide effective treatment strategy for DU patients. Among all management, BOO surgery provides the best treatment outcome.

Clinical and urodynamic features of secondary tethered cord syndrome: How can they be found longitudinally?

Secondary tethered cord syndrome (TCS) can be diagnosed with signs of progressive deterioration in urological or neuro-orthopedic systems following primary untethering surgery. Though urological deterioration is a common secondary TCS manifestation, a paucity of diagnostic criteria makes diagnoses challenging. A detailed description of urological deterioration may help diagnose secondary TCS. Thus, the clinical and urodynamic features of the current secondary TCS cases were described. Fifty-one patients who had undergone reuntethering for secondary TCS experienced improvement or stabilization of progressive problems. Moreover, their clinical and videourodynamic changes were longitudinally described. Loss of postoperative spontaneous voiding was the first urological secondary TCS sign for those who could void spontaneously. Urological problems mostly occurred during elementary school (6-12 years). Major urological presentations were recalcitrant urinary tract infection or urinary incontinence. Follow-up videourodynamic studies revealed typical changes, from acontractile bladder to overactive and low-complaint bladders. While detrusor overactivity did not always occur during the progression, detrusor sphincter dyssynergia was always present in all patients with urological deterioration. All patients postoperatively showed significant urodynamic improvement regardless of preoperative bladder dysfunction. This included four cases of restoring spontaneous voiding. Nine patients experienced newly appearingnonprogressive neuro-orthopedic complications despite their urological improvement. Urological deterioration should prompt secondary TCS suspicion, and changes in clinical patterns and videourodynamic studies helped diagnose it. However, reuntethering can effectively address urological problems at the cost of some neuro-orthopedic functions in some patients.

Urodynamic studies and features of anaesthesia during intradetrusor botulinum therapy in the context of the COVID-19 pandemic (literature review)

The coronavirus pandemic has had a severe impact on the health care system. It is also changing the appointment and conduct of diagnostic procedures, emergency and routine medical care. According to the medical guidelines of the European Society of Urology (EAU) for the provision of urological care during the current epidemic situation, various levels of urgency have been proposed for diagnostic and therapeutic measures depending on the type of disease. Urodynamic studies refer to studies with a priority level from P2 (for neurogenic dysfunction of the urinary tract) to P4 (for lower urinary tract dysfunction without the risk of damage to the upper urinary tract). The question arises regarding the safety of these studies, both for patients and medical staff, and possible measures to reduce the risk of infection in a viral pandemic. Because of the increased workload of hospitals that have not been redesigned for the fight against coronavirus infection and provide routine and emergency urological care, an even greater need has arisen to find effective and safe methods of local anaesthesia for performing urodynamic studies and intradetrusive injections of botulinum toxin type A under local anesthesia in outpatient and outpatient settings (for example, in a short-term hospital). This article presents a literature review on the principles and features of performing urodynamic studies in the context of the Covid-19 pandemic and the effectiveness and safety of using various methods of local anaesthesia when performing intradetrusor injections of botulinum toxin with detrusor hyperactivity of a neurogenic and non-neurogenic nature. There were evaluated forms of local anaesthesia such as intradetrusor instillation of lidocaine, electrophoresis, and the use of alternative solutions for urinary bladder irrigation (for example, Ringer’s solution).

SC171 - Robot assisted radical cystectomy with florence robotic intracorporeal neobladder (FloRIN): a six-month assessment of functional and urodynamic features compared with a contemporary series of open vescica ileale padovana (VIP)

SC171 - Robot assisted radical cystectomy with florence robotic intracorporeal neobladder (FloRIN): a six-month assessment of functional and urodynamic features compared with a contemporary series of open vescica ileale padovana (VIP)