Urodynamic Examination Research Articles

Urodynamics and diagnosis of urinary incontinence

Abstract The urinary incontinence diagnostic process should include a medical history focused on ailments related to it and their impact on the quality of patient’s life. The lack of proper control over the function of the lower urinary tract creates a lot of troubles for sufferers and prevents them from living an active professional, social, and family life. The patient with a suspicion of urinary incontinence is recommended to record in a voiding diary the number of mictions per day, the volume of urine, and episodes of incontinence. The invasive test called urodynamics is based on cystometry, profilometry, and uroflowmetry. A urodynamic examination performed in patients with incontinence allows for correct diagnosis and proposal of specific surgical or pharmacological treatment.

Effectiveness of D-mannose, Hibiscus sabdariffa and Lactobacillus plantarum therapy in prevention of infectious events following urodynamic study.

The urodynamic study is an invasive examination that allows a thorough evaluation of the functional activity of the lower urinary tract (bladder, urethra). The execution of urodynamic study exposes the patient to the risk of contracting infections of the lower urinary tract. Prevention of urinary tract infections consists in the avoidance of risk factors and prophylaxis with antimicrobial and non-antimicrobial measures. In this article, we aimed to evaluate the effectiveness of a phytotherapeutic product composed of D-mannose, Hibiscus sabdariffa, and Lactobacillus plantarum in the prevention of infectious events following invasive urodynamic examination. We selected 100 female consecutive patients (age 19-87 years) that underwent urodynamic invasive procedure. We prescribed 14-day therapy with D-mannose, H. sabdariffa, and L. plantarum to these 100 patients after urodynamic invasive test. After that, we have examined urine cultures and urinary symptoms through telephone interviews and hospital outpatient visits to evaluate the possible presence of urinary tract infections. Urinary tract infections were observed through urine culture in 13% of the selected patients; of the 13 urinary tract infections, 9 were observed in patients with urinary tract recurrent infections in the last year and the other 4 cases were associated with patients with no urinary infection in the last year. Three women reported some urinary symptoms and underwent antibiotic therapy. The other 10 cases were classified as asymptomatic bacteriuria. Three cases were related to patients presenting with pelvic organ prolapse. Eight cases were instead related to significant post-voiding residue (>100). Six patients with urinary tract infection reported constipation in the last year. All patients completed the prescribed therapy due to the affordable price of the product and no side effects have been reported. Our study about the administration of D-mannose, H. sabdariffa, and L. plantarum after invasive urodynamic examination underlined how this phytotherapeutic product can reduce the risk of bacteriuria and urinary tract infection in women.

AB058. Application of nursing pathway in urodynamic examination

BackgroundExplore the effect of nursing pathway in patients undergoing urodynamic examination.MethodsForty eight patients who underwent urodynamic examination in our department from September 2017 to January 2018 were selected as the control group and 56 patients who underwent urodynamic examination from February 2018 to May 2018 as the observation group. Compare the two groups of patients into the examination room until the start examination, abnormal abdominal pressure changes in the two groups, the situation of the artifacts, the correct rate of doctor’s instructions during the inspection process.ResultsThe time from entering the examination room to start the examination in the observation group was 19.08±10.36 s, which was lower than that in the control group 35.20±6.36 s; the abnormal abdominal pressure in the observation group was 1.28% (1/78), which was significantly lower than that in the control group 10.67% (8/75), and the difference was statistically significant (P<0.05). The pseudo-image of the observation group was significantly lower than that of the control group 33.33% (25/75), the difference was statistically significant (P<0.01). The correct rate of doctor’s instructions in the observation group (92%) was significantly higher than that of the control group (84%).ConclusionsThe application of nursing pathway in patients undergoing urodynamic examination can effectively shorten the time from entering the examination room to the smooth start of the examination, reduce abnormal abdominal pressure changes and the incidence of false images, and improve the correct rate of doctor’s instructions.

Finite element analysis of male lower urinary tract based on the collodion slice images

Males typically have high rates of morbidity of primary bladder neck obstruction, while the existing urodynamic examination is invasive and more likely to cause false diagnosis. To build a non-invasive biomechanical detecting system for the male lower urinary tract, a finite element model for male lower urinary tract based on the collodion slice images of normal male lower urinary tract was constructed, and the fluid-structure interaction of the lower urinary tract was simulated based on the real urination environment. The finite element model of the lower urinary tract was validated by comparing the clinical experiment data with the simulation result. The stress, flow rate and deformation of the lower urinary tract were analyzed, and the results showed that the Von Mises stress and the wall shear stress at the membrane sphincter in the normal male lower urinary tract model reached a peak, and there was nearly 1 s delay than in the bladder pressure, which helped to validate the model. This paper lays a foundation for further research on the urodynamic response mechanism of the bladder pressure and flow rate of the lower urinary tract obstruction model, which can provide a theoretical basis for the research of non-invasive biomechanical detecting system.

The value of bladder wall thickness in predicting upper urinary tract damage in patients with neurogenic lower urinary tract dysfunction

Objective To investigate correlation between bladder wall thickness(BWT) and upper urinary tract damage(UTD) in patients with neurogenic lower urinary tract dysfunction (NLUTD), and to evaluate the value of BWT in predicting UTD. Methods To retrospectively analyze clinical data of NLTUD patients admitted from January 2013 to October 2017.Of the 161 patients, 92 were male and 69 were female. The mean age was (39.5±18.4) years old, ranged from 18 to 81 years old. 83 cases had hydronephrosis, 64 cases had unilateral or bilateral ureteral dilation and 14 cases had ureteral reflux. In 30 cases, the serum creatinine was abnormal (290.7±164.0) μmol/L, ranging 125-938 μmol/L. The mean GFR in 17 cases was(45.2 ± 23.0) ml/(min·1.73 m2), ranged from 84.3 to 14.6 ml/(min·1.73 m2). According to the presence or absence of UTD, NLUTD patients were divided into experimental group and control group, 101 cases of UTD combined experimental group, and 60 cases of UTD-free control group. There were 60 male patients and 41 female patients in the experimental group with mean age of (37.9±19.1) years old. In the control group, there were 32 male patients and 28 female patients with mean age of (42.3±16.8) years old, There was no statistical difference between the two groups (P>0.05). There were 59 cases and 5 cases of hydronephrosis in the experimental group and the control group, respectively. There were 12 cases and 2 cases of ureteral dilation patients in the experimental group and the control group, respectively. The differences in BWT and urodynamic parameters between the two groups were compared. The ROC curve was used to determine the cutoff value of BWT in the diagnosis of UTD and the correlation between BWT and UTD and urodynamic parameters was analyzed. Results 161 patients had a BWT of 2 to 25 mm with a median value of 7.0 (7.1) mm.119 patients underwent urodynamic examination with bladder compliance of 0.8 to 141.5 ml/cmH2O, median value of 12.7 (22.8) ml/cmH2O. The median value of median pressure capacity (MCC) was 256 (171)ml, ranged from 49 to 700 ml. The median value of Pdetmax was34 (19.1) cmH2O, ranged from 3 to 144 cmH2O. The median BWT values of the test and control groups were 9.0(5.0) mm and 4.0(5.7) mm, respectively (Z=-5.931, P<0.001). The median bladder compliance was 9.3(15.3) ml/cmH2O and 24.2(38.7)ml/cmH2O, respectively (Z=-4.07, P<0.05). The MCC was 225.0(159.0) ml and 310.6(140.5)ml, respectively (Z=-2.22, P<0.05). The median Pdetmax during filling was 40.0(20.4)cmH2O and 29.2(18.4)cmH2O, respectively (Z=-2.92, P<0.05). Using multivariate correlation analysis, BWT was negatively correlated with bladder compliance (r=-0.419, P<0.001) and negatively correlated with maximum bladder pressure capacity (r=-0.198, P=0.031), with the largest filling period. Pdetmax was positively correlated (r=0.251, P=0.006). Using the ROC curve to determine the threshold, the sensitivity of the UTD is 86.1% and the specificity is 53.3% when BWT≥4.8 mm. Conclusions BWT thickening is one of the risk factors for UTD in patients with NLUTD. When BWT is greater than 4.8 mm, NLUTD patients are more likely to have UTD and can be used as an examination method for the diagnosis of UTD in NLUTD patients. Key words: Neurogenic lower urinary tract dysfunction; Bladder wall thickness; Upper urinary tract damage; Urodynamic examination

The value of urodynamic examination in treating the patient with prostatic hyperplasia accompany with dysfunction of the bladder

Objective To investigate the value of urodynamic in treating those patients with benign prostatic hyperplasia complicated with bladder dysfunction. Methods 130 patients with benign prostatic hyperplasia were retrospectively reviewed between December 2015 and December 2016. The exclusive criteria included nervous system diseases, moderate to severe diabetes, moderate to severe hypertension, urethral stricture, bladder stones, prostate cancer, etc. The patient's age is ranged 51 to 92, mean 72 years old. The previous history of disease ranged from 3 months to 15 years, mean 4 years. All patients accepted the urodynamic examination. Different treatments were considered according to urodynamic studies. Results According to the classification of bladder outlet obstruction, 130 cases were classified as bladder outlet obstruction in 109 cases, bladder suspicious obstruction in 15 cases, no bladder obstruction in 6 cases. According to the classification of bladder function, 130 cases were divided into unstable bladder in 6 cases, low compliance bladder in 7 cases, bladder atony in 15 cases, bladder without tension in 3 cases, normal bladder function in 99 cases. 3 cases without bladder tension, including BOO in 2 cases, suspected BOO in 1 case, were accepted the cystostomy. 15 cases with less detrusor contraction, including BOO in 4 cases, suspected BOO in 9 cases, were accepted the cystostomy and TURP. Conservative treatment was performed in other 2 cases without obstruction. In 6 cases with unstable bladder, 2 cases without obstruction accepted the conservative treatment, 4 cases with suspected BOO accepted the TURP. In 7 patients with low compliance bladder, 2 cases without obstruction accepted the conservative treatment, 5 cases with suspected BOO accepted the TURP. The duration of following up was 3-6 months. The symptoms of the patients in this group improved significantly during following up. Conclusion For patients with benign prostatic hyperplasia complicated with bladder dysfunction, the results of urodynamics can help to choose the right treatment and improve effect of treatment. Key words: Urodynamic; Transurethral resection of prostate; Bladder dysfunction

Combined use of pyridostigmine and Chinese medicine for treatment of benign prostatic hyperplasia with underactive detrusor after transuretheral operation

Objective To investigate the efficacy of combined use of pyridostigmine and Chinese medicine for postoperational treatment of benign prostatic hyperplasia(BPH) with underactive detrusor. Methods Forty-five patients with BPH and detrusor underactivity were divided into two groups according to urodynamic examination. Patients with severe detrusor underactivity(Pdet≤20 cm H2O) received cystostomy during operation in both group. Experiment group received combined use of pyridostigmine and Chinese medicine postoperation, control group only retested residual urine volume(RUV) after operation. The difference of International Prostate Symptom Score (IPSS), IPSS storage subscore and voiding subscore, quality of life score (QOL), maximum urinary flow rate (Qmax) and RUV pre-and post-operation between the two groups were analyzed three months later. Results There were statistically significance in IPSS, IPSS storage subscore and voiding subscore, QOL, Qmax, RUV between pre-and post-operation for each group(P<0.05). IPSS, voiding subscore and Qmax in experiment group were better than control group(P<0.05). Conclusions Combined use of pyridostigmine and Chinese medicine for patients of BPH with underactive detrusor postoperation can improve Qmax and ameliorate void symptoms. Key words: Prostatic Hyperplasia; Muscle Weakness

V05-12 FLORENCE ROBOTIC INTRACORPOREAL NEOBLADDER (FLORIN). A NEW CONFIGURATION USING STRATEGY DEVELOPED FOLLOWING THE IDEAL GUIDELINES

You have accessJournal of UrologyBladder Oncology & Diversion1 Apr 2018V05-12 FLORENCE ROBOTIC INTRACORPOREAL NEOBLADDER (FLORIN). A NEW CONFIGURATION USING STRATEGY DEVELOPED FOLLOWING THE IDEAL GUIDELINES Andrea Minervini, Davide Vanacore, Simone Sforza, Francesco Sessa, Riccardo Campi, Andrea Mari, Martina Milanesi, Fabrizio Di Maida, Giovanni Tasso, Andrea Cocci, Agostino Tuccio, Gianni Vittori, Giampaolo Siena, and Marco Carini Andrea MinerviniAndrea Minervini More articles by this author , Davide VanacoreDavide Vanacore More articles by this author , Simone SforzaSimone Sforza More articles by this author , Francesco SessaFrancesco Sessa More articles by this author , Riccardo CampiRiccardo Campi More articles by this author , Andrea MariAndrea Mari More articles by this author , Martina MilanesiMartina Milanesi More articles by this author , Fabrizio Di MaidaFabrizio Di Maida More articles by this author , Giovanni TassoGiovanni Tasso More articles by this author , Andrea CocciAndrea Cocci More articles by this author , Agostino TuccioAgostino Tuccio More articles by this author , Gianni VittoriGianni Vittori More articles by this author , Giampaolo SienaGiampaolo Siena More articles by this author , and Marco CariniMarco Carini More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1399AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To describe our step-by-step technique for robotic intracorporeal neobladder configuration, including the stages of conception, development and exploration of this surgical innovation, according to the IDEAL Collaboration guidelines. METHODS FloRIN neobladder was performed after the following main surgical steps: isolation of 50 cm of ileum; bowel anastomosis; urethro-ileal anastomosis creating an asymmetrical U shape (30 cm distally and 20 cm proximally to anastomosis), ileum detubularisation; posterior wall reconfiguration as an L; bladder neck reconstruction; anterior folding of the posterior plate to reach the 12 o'clock position; uretero-enteral "orthotopic" bilateral anasthomosis. The idealization and development of FloRIN followed IDEAL guidelines recommended stages: Phase 1 (simulation) consisted in the neobladder robotic configuration on silicone models. Phase 2a (development) aimed to reproduce the configuration in an open fashion in one patient, and then in the first three robotic procedures. Phase 2b (exploration) consisted of the technique standardization in ten consecutive robotic approaches. Phase 2a and 2b included urodynamical and imaging assessment of patients treated. RESULTS From February 2016 to September 2017 FloRIN was performed in 18 patients. Comparing the first 3 (Phase 2a) with the subsequent 15 patients (Phase 2b), the median (interquartiles) reconstruction operating time was 260 (220-340) vs 160 (150-210) min, respectively. Postoperative complications occurred in 4/18 (22.1%) patients, including one surgical Clavien 3 and three medical Clavien 2, respectively. The urodynamic examination (available in 9 [50%] patients) showed median (interquartiles) reservoir cystometric capacity, compliance, and post-void residual of 240 (220-267) mL, 18 (12.5-19.8) ml/cmH2O, and 0 (0-50) mL, respectively. Ultrasound showed no Grade =2 vesicoureteral reflux. CONCLUSIONS We describe FloRIN neobladder, concluding its technical feasibility with acceptable time efficiency. The first cases studied showed good reservoirs capacity, low pressure with no reflux, and complete voiding. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e576 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Andrea Minervini More articles by this author Davide Vanacore More articles by this author Simone Sforza More articles by this author Francesco Sessa More articles by this author Riccardo Campi More articles by this author Andrea Mari More articles by this author Martina Milanesi More articles by this author Fabrizio Di Maida More articles by this author Giovanni Tasso More articles by this author Andrea Cocci More articles by this author Agostino Tuccio More articles by this author Gianni Vittori More articles by this author Giampaolo Siena More articles by this author Marco Carini More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Improvement of overactive bladder symptoms: Is correction of the paravaginal defect in anterior vaginal wall prolapse necessary?

BackgroundTo explore the relationship between overactive bladder (OAB) symptoms and paravaginal defects (PVDs), and to identify the necessity of PVD repair by transvaginal mesh (TVM) for the treatment of OAB symptoms. MethodsA retrospective clinical study of 30 women with advanced cystocele with limited apical and posterior vaginal wall prolapse was conducted to identify any changes in OAB symptoms following a single Perigee procedure. Prolapse was assessed using the pelvic organ prolapse quantification (POP-Q) system, and paravaginal defects were identified by sonography. Complete urodynamic examination was performed prior to and one year after operation. All patients completed the overactive bladder questionnaire pre- and postoperatively for a quantitative assessment of OAB symptoms. ResultsAll patients showed a significant improvement at points Aa and Ba in the POP-Q system. The results of the administered questionnaire revealed statistically significant improvement postoperatively. The difference of OAB symptoms between the group with PVDs and that with central defects was not statistically significant (p = 0.67). Moreover, no statistically significant improvement of OAB symptoms in the group with repaired PVDs was observed postoperatively (p = 0.42). ConclusionStatistical improvements of symptoms exist after Aa and Ba points recovery as evaluated by POP-Q system regardless of PVD existence identified by sonography. Repairing PVD did not show significantly improve the severity of OAB symptoms in objective urodynamic data or subjective questionnaire data. The superiority of TVM in PVD repair to manage OAB symptoms seems not manifest.

ТАКТИКА В ДІАГНОСТИЦІ ТА ЛІКУВАННІ ХВОРИХ З ПОЄДНАНОЮ НЕЙРОГЕННОЮ ПАТОЛОГІЄЮ НИЖНІХ СЕЧОВИХ ШЛЯХІВ ТА ДИСТАЛЬНОГО ВІДДІЛУ ТОВСТОЇ КИШКИ

Вступ. Нейрогенні розлади сечовипускання об’єднують велику групу порушень сечовипускання, що виникають при ураженні головного і спиного мозку, провідних шляхів і центрів сечового міхура. Це вказує на актуальність проблеми та необхідність розробки методів діагностики і одночасного їх лікуванняМета дослідження – Підвищення ефективності лікування жінок з поєднаною нейрогенною патологією нижніх сечових шляхів та дистального відділу товстої кишки.Матеріали та методи. Всі хворі на поєднану нейрогенну патологію нижніх відділів сечовивідної системи і нижніх відділів товстої кишки проходили комплексне обстеження з використанням як загальноприйнятих, так і спеціальних методів діагностики.Для дослідження функціонального стану м’язів які забезпечують динамічну активність нижніх сечових шляхів та дистальних відділів товстої кишки ми використовували електроміографію (ЕМГ) сечового міхура і сфінктерного апарата, анального сфінктера, м’язів тазового дна. Для підсилення біоелектричної активності м’язів нижніх відділів сечової системи та дистальних відділів товстої кишки використовувся електроміограф 4-х канальний фірми «Медікор» (Угорщина). Дані ЕМГ оцінювали за показниками середнього значення сумарної біоелектричної активності.Результати й обговорення. У статті представлені результати лікування хворих з поєднаною нейрогенною патологією нижніх сечових шляхів і дистального відділу товстої кишки. Оцінка ефективності проводилася за допомогою клінічних та уродинамических обстежень. Встановлено, що електроміографія урофлоуметрия відображають функціональний стан сечовивідних шляхів і дистальних відділів товстої кишки при їх поєднаної патології. Отримані результати були основою для обґрунтування принципів диференційованого лікування хворих з поєднаною нейрогенною патологією нижніх сечовивідних шляхів і дистальних відділів товстої кишки, що дозволило підвищити ефективність лікування. Консервативне лікування пацієнтів даної категорії за допомогою електростимуляції є ефективним.Висновки. 1. Дані електроміографічних та уродинамічних досліджень дозволили розробити та оптимізувати методи лікування в залежності від стану тонусу нервово-м’язових структур нижніх сечових шляхів та дистальних відділів товстої кишки. 2. Комплексний диференційний підхід до консервативного лікування спрямован на корекцію виявлених при електрофізіологічному та уродинамічному обстеженні порушень функціонального стану нижніх сечовивідних шляхів і дистальних відділів товстої кишки.

Vesical sequelae of transverse myelitis. Long-term urodynamics observations in adult patients

Transverse myelitis is a rare autoimmune inflammatory disease often secondary to viral infection of the spinal cord; it frequently has vesico-sphynteric complications. Between January 2000 and December 2005 we performed urodynamic examination on 13 consecutive patients (7 females and 6 males) with previous diagnosis of transverse myelitis. Mean age was 54.5 years; transverse myelitis had been diagnosed a mean of 6.3 years earlier; etiology of myelitis was viral infection in 5 cases, autoimmune in 3 cases, insect bite in 1 case, unknown in 4 cases. The neurological sequelae included paraparesis in 3 cases and tetraparesis in 2 cases. dysuria 46%, slow stream 15%, pollakiuria 23%, urgency 30%; urge incontinence 38%, stress incontinence 15%. 3 patients performed 4 clean intermittent catheterisms (CIC), 2 patients 2 CICs. Eight patients had maximum cystometric capacity above 350 mL, the others had a mean capacity of 223 mL. Four patients showed no bladder sensitivity. Voluntary micturitional reflex was observed in 4 patients. Detrusor overactivity was diagnosed in 9 patients, 10 patients had mean residual post-micturition (RPM) of 218 mL, 2 patients showed detrusor-sphincter dyssynergia, 2 patients were found to be obstructed at pressure-flow study. Urodynamic follow-up is indicated in these patients with or without neurological complications (possibility of detrusor overactivity, urinary retention, detrusor-sphincter dyssynergia); the follow-up personalizes the diagnosis and therapy, and prevents complications.

Does vaginal estriol make urodynamic changes in women with overactive bladder syndrome and genitourinary syndrome of menopause?

ObjectivesOAB is a common finding in postmenopausal women. Hypoestrogenism is the root cause of many signs and symptoms of Genitourinary Syndrome of Menopause (vaginal dryness, atrophy, dyspareunia, urinary disorders, etc.). As such the aim of this study was to evaluate the urodynamic effects of ultralowdose estriol vaginal gel formulation to treat women with Genitourinary Syndrome of Menopause and Overactive Bladder Syndrome. Study designThis open-labeled, single center, prospective study involved 37 women with OAB recruited in our Urogynecological Unit between January and July 2016. They received estriol 50 mcg/g vaginal gel, one applicator-dose per day for 3 weeks followed by one dose twice a week for 12 weeks. Objective and subjective parameters were evaluated before and after treatment through the urodynamic examination, Overactive Bladder symptom score and Short Form Health Survey-36 questionnaires. ResultsVaginal atrophy symptoms and signs as well as the overactive bladder subjective symptom parameter improved significantly. Urodynamic evaluation showed significant improvement in first desire to void and maximum cystometric capacity after estriol usage. Patients who had detrusor overactivity did not show any improvement for this parameter after treatment. The voiding function parameters did not significantly change. Short form-36 showed a better quality of life after treatment especially for the emotional role, as well as mental and general health. ConclusionsA local ultra-low dose concentration of estriol could be effective in women with vaginal atrophy and Overactive Bladder Syndrome for improving both subjective symptoms and urodynamic parameters of storage function not affecting voiding function.

Florence robotic intracorporeal neobladder (FloRIN): a new reconfiguration strategy developed following the IDEAL guidelines.

To describe our step-by-step technique for robotic intracorporeal neobladder configuration, including the stages of conception, development and exploration of this surgical innovation, according to the Idea, Development, Exploration, Assessment, Long-term follow-up (IDEAL) Collaboration guidelines. The Florence robotic intracorporeal neobladder (FloRIN) was performed employing the following main surgical steps: isolation of 50 cm of ileum; bowel anastomosis; urethro-ileal anastomosis creating an asymmetrical 'U'-shape (30 cm distally and 20 cm proximally to anastomosis), ileum detubularisation; posterior wall reconfiguration as an 'L'; bladder neck reconstruction; anterior folding of the posterior plate to reach the 12 o'clock position; uretero-enteral 'orthotopic' bilateral anastomosis. The conception and development of the FloRIN followed the IDEAL guidelines recommended stages: Phase 1 (simulation) involved the neobladder robotic configuration using silicone models. Phase 2a (development) aimed to reproduce the configuration in an open fashion in one patient, and then in the first three robotic procedures. Phase 2b (exploration) consisted of the technique standardisation in 15 consecutive robotic approaches. Phase 2a and 2b included urodynamics and imaging assessment of the patients treated. From February 2016 to September 2017 FloRIN was performed in 18 patients. Comparing the first three (Phase 2a) with the subsequent 15 patients (Phase 2b), the median (interquartile range [IQR]) reconstruction operating time was 260 (220-340) vs 160 (150-210) min, respectively. Postoperative surgical complications occurred in four of the 18 patients (22.1%), including one surgical Clavien-Dindo Grade III and three Grade I, postoperative medical Clavien-Dindo Grade II complications occurred in three (16.7%) patients. On urodynamic examination (available in nine [50%] patients) the median (IQR) reservoir cystometric capacity, compliance, and post-void residual were 240 (220-267) mL, 18 (12.5-19.8) mL/cmH2 O, and 0 (0-50) mL, respectively. Ultrasonography showed no Grade ≥2 vesico-ureteric reflux. We describe the FloRIN configuration, showing its technical feasibility with acceptable time efficiency. The first cases studied had good reservoir capacity, low pressure with no reflux, and complete voiding.

Does urodynamics study help in evaluation and prognosis of treatment in benign prostatic hyperplasia with diabetes mellitus

Aims: The aim is to study the clinical significance of urodynamics study (UDS) in patients of benign prostatic hyperplasia (BPH), with and without diabetes mellitus (DM) and to predict the outcome of surgical depending on UDS findings. Materials and Methods: A total of 120 BPH patients were studied and divided into two groups, BPH with DM and without DM. Initial evaluation, diagnostic tests, and urodynamic examination were done in all patients, and results were statistically analyzed. Results: There was no significant difference of age and prostate volume in both groups (P > 0.05), but there was a significant increase in symptom score in patients of BPH associated with DM (P

Long-term urodynamic findings following radical prostatectomy and salvage radiotherapy

Objective: Lower urinary tract symptoms (LUTS) are common following radical prostatectomy (RP) or intended curative radiotherapy in prostate cancer patients. One-quarter of those treated with RP experience biochemical failure and are subsequently offered salvage radiotherapy (SRT) to the prostatic bed. The aim of this study was to elucidate long-term LUTS after surgery and SRT.Materials and methods: Urodynamic parameters from 16 patients treated with RP and subsequent SRT in the period 2000–2010 were evaluated with uroflowmetry, filling cystometry, pressure–flow and urethral pressure profile (UPP). In conjunction with the urodynamic examination, all patients completed the Danish Prostatic Symptom Score (DAN-PSS) questionnaire, which evaluates the grade of LUTS.Results: Median time from SRT to urodynamic examination was 7.7 years (range 5.8–10.0 years). The following urodynamic parameters were affected: bladder volume at maximal cystometric capacity, bladder compliance, bladder function, bladder outlet obstruction and UPP. The total DAN-PSS index combining all symptoms and their corresponding impact on patients was mild in six patients (≤ 7 points), moderate in seven patients (8–19 points) and severe in three patients (≥ 20 points).Conclusions: This urodynamic study is one of the first to evaluate long-term urodynamic characteristics in patients treated with SRT. Several urodynamic parameters were affected. This indicates that SRT primarily affects bladder compliance, maximal cystometric capacity and bladder outlet obstruction. LUTS were proven to be strongly related to urodynamic parameters.

One-year Surgical Outcomes of Complete or Incomplete Enucleation of Prostate by Monopolar Electrocoagulation, Photoselective Vapoenucleation of 120-W GreenLight Laser, and Holmium Laser

To evaluate surgical outcomes of patients who underwent complete or incomplete enucleation technique during a short-term postoperative period. Patients having intractable lower urinary tract symptoms/benign prostatic hyperplasia and prostates >30 g with obstructed pattern in the urodynamic examinations were included. They underwent transurethral resection of prostate (TUR-P), 120 W GreenLight laser high power system-photoselective vapoenucleation of prostate (HPS-PVEP), or holmium laser enucleation of prostate (HoLEP). Patients with the size of remnant prostates minus surgical defects <25 g were grouped into the completely enucleated group (group C), and others were grouped into the partially enucleated group (group P). Mean prostate-specific antigen value was 3.5 ± 4.5 ng/mL, and mean prostate volume was 58.4 ± 31.0 mL. Complete enucleation rates in TUR-P, HPS-PVEP, and HoLEP groups were 39% (37 out of 95), 54.6% (83 out of 152), and 54.4% (31 out of 57), respectively. Complete enucleation rate of the TUR-P was significantly lower than those of the other 2 groups. Compared with group C, group P had lower maximal flow rate, higher bladder outlet obstruction index, and higher overactive bladder symptom scores. Multivariate logistic regression analyses showed that smaller prostate, presence of intravesical prostatic protrusion, HoLEP operation, and surgeons' experience were significant predictors for achieving complete enucleation of prostate. Voiding subscores of group C were significantly higher than those of group P at postoperative 12 months. The performance of HoLEP was superior to other surgical techniques. However, HPS-PVEP with vapoenucleation showed the comparable enucleation rate with that of HoLEP. Complete enucleation was effective in maintaining outcomes of prostate resection, especially voiding subscores.

Cystometrography of meningitis-retention syndrome

Although the combination of acute urinary retention and aseptic meningitis has not been well recognised, this combination can be referred to as meningitis-retention syndrome (MRS). We report a case of...

Early treatment improves urodynamic prognosis in neurogenic voiding dysfunction: 20 years of experience

ObjectiveTo evaluate the association between early treatment and urodynamic improvement in pediatric and adolescent patients with neurogenic bladder. MethodologyRetrospective longitudinal and observational study (between 1990 and 2013) including patients with neurogenic bladder and myelomeningocele treated based on urodynamic results. The authors evaluated the urodynamic follow‐up (bladder compliance and maximum bladder capacity and pressure) considering the first urodynamic improvement in two years as the outcome variable and early referral as the exposure variable, using a descriptive and multivariate analysis with logistic regression model. ResultsAmong 230 patients included, 52% had an early referral. The majority were diagnosed as overactive bladder with high bladder pressure (≥40cm H2O) and low bladder compliance (3mL/cmH2O) and were treated with oxybutynin and intermittent catheterization. Urodynamic follow‐up results showed 68% of improvement at the second urodynamic examination decreasing bladder pressure and increasing bladder capacity and compliance. The percentage of incontinence and urinary tract infections decreased over treatment. Early referral (one‐year old or less) increased by 3.5 the probability of urodynamic improvement in two years (95% CI: 1.81–6.77). ConclusionTreatment onset within the first year of life improves urodynamic prognosis in patients with neurogenic bladder and triplicates the probability of urodynamic improvement in two years. The role of neonatologists and pediatricians in early referral is extremely important.

Prevalence of female urinary incontinence in the state of Roraima, Brazil

Urinary incontinence (UI) is a significant health problem leading to physical, psychological and social discomfort, especially in elderly women. A study of prevalence and classification of UI in the Roraima state was taken up to aid in formulation of healthcare policy and improvement of patient referral facilities. A retrospective study of 765 female patients who have undergone urodynamic examination between November 2013 and December 2014 has been conducted. Subjects were classified in to diagnostic classes: normal, stress incontinence, mixed incontinence, sensitive emergency, overactive bladder, and others. The overall prevalence of UI was 58.4%. The highest prevalence was observed in the menopausal age group (45- 49 years). Among the etiologies of UI, stress incontinence ranked highest at 30.9%, followed by overactive bladder at 6.9%. In the 25-55 years age group, stress incontinence was predominant (50-63%), while overactive bladder became significant (14-44%) in later years. The prevalence of UI in women in the state of Roraima, was high, in line with its prevalence in Brazil, as well as other western countries.

Trends of treatment for posterior urethral valves

Posterior urethral valves(PUV) is the most common cause of lower tract obstruction in boys. With the understanding of the prognostic factors of PUV in depth, PUVs can have a profound effect on the function of bladder and upper urinary tract though valves are completely resected.The treatments of PUV include prenatal intervention, the antenatal vesicoamniotic shunt and fetal cystoscopy can be considered in selected patients with oligohydramnios. But the role of antenatal intervention is unclear. The gold standard for postnatal treatment of PUV is valve ablation. Vesicostomy is reserved primarily for the children with PUV whose urethra cannot accommodate an endoscope, as well as have severe urinary tract infections. Circumcision should be encouraged as a prophylactic measure for children with PUV who should have high rate of urinary tract infection. Vesicoureteral reflux is very common in PUV patients, and life-long monitoring of these patients is mandatory, as bladder dysfunction and valve bladder may be found during follow-up. These factors contribute toward the devolution of a bladder into dysfunction status are high voiding pressures and increased residual urine. Medication and clean intermittent catheterization are two main interventions, for the children who difficult to treat, an appendicovesicostomy utilizing the Mitrofanoff principle presents an useful option. Renal transplantation is an alternative for patients with PUV who progress to end-stage renal disease. Bladder dysfunction plays an important role in the development of PUV and urodynamic examination can be used to assess the function of the bladder to achieve timely and effective intervention. Key words: Posterior urethral valves; Obstruction; Urethra