Urodynamic Research Articles

Opportunity for ICS urodynamic standardization: Sensation, rectal contractions, and involuntary detrusor contractions

Introduction and Objectives:The International Continence Society (ICS) has published essential documents standardizing urodynamic technique and reporting. Currently, no consensus exists regarding patient prompts for bladder sensation, particularly in the setting of impaired bladder sensation (e.g. spinal cord injury) (SCI). Similarly, no published standardization exists for the reporting of rectal contractions or duration and amplitude of involuntary detrusor contractions (IDCs). We evaluated current practice patterns among ICS urodynamicists regarding sensation prompts, mention of rectal contractions, and the extent to which involuntary detrusor contractions are described. Methods:A Qualtrics urodynamic testing survey was distributed via email to all ICS members twice over a 2 week period. The survey included 18 questions regarding provider and practice characteristics, urodynamic practice patterns, coaching prompts given to patients regarding sensation during urodynamic testing, and documentation of rectal and involuntary detrusor contractions (IDCs). Data were analyzed using descriptive statistics. Results:Of 2859 ICS members, 614 (21%) returned surveys. Of these, 35 did not perform urodynamic testing and 142 surveys were incomplete. Thus, 437/614 (71%) surveys were included in our analysis. Participants were most commonly fellowship-trained female functional urologists (40%) and practiced in a government service hospital (46.4%). Half of the providers (56%) are present for the study 100% of the time. Most participants instructed patients on how to report sensation during testing (57%). First Sensation (86%), First Desire (85%), Strong Desire (93%), and Urgency (86%) were the parameters most utilized. Various prompts for each of the UDS sensation parameters were reported including repeating ICS definitions and real-life analogies. 45% of respondents altered instructions for patients with impaired sensation (e.g. SCI), 59% commented on the presence or absence of rectal contraction, and 70% characterized the amplitude and duration of involuntary detrusor contractions in their reports. Conclusion:Although most survey participants report they standardize urodynamic instructions, there is no consensus for sensation prompts within ICS urodynamic practice publications. Urodynamic testing practice patterns vary widely among ICS urodynamicists with respect to sensation prompts, modified instructions for those with impaired sensation, and reporting of rectal contractions and involuntary detrusor contractions. Opportunity exists for further standardization of good urodynamic practice in published guidelines.

Access to Urogynecologic Care in Federally Qualified Health Centers: A Mystery Caller Study.

Federally Qualified Health Centers (FQHCs) play an important role in providing care to underserved populations. However, little is known about the availability of urogynecology services at FQHCs. This study aimed to assess the availability of appointments for urogynecology care and to determine the prevalence of FQHCs offering urogynecologic services. A total of 362 FQHCs across the United States were randomly selected from the Health Resources and Services Administration website, based on specific inclusion criteria. Researchers called the FQHCs and requested the earliest available appointment for pelvic organ prolapse. The availability of urogynecologic services such as pessary fittings, pelvic floor physical therapy, and urodynamic studies was also inquired. A total of 362 FQHCs located in 46 states and the District of Columbia were called. On average, the 362 FQHCs had been established for 19.9 (SD ±15) years, were located in urban areas, and served a median county population of 24,573. Of the 220 FQHCs successfully contacted, 81% (180/220) reported that they could provide care for a patient with pelvic organ prolapse at an appointment 29.1 business days (SD ±30 days) from the date of the call, on average. However, only a small percentage of these FQHCs offered in-office pessary fittings (11%), complex multichannel urodynamics testing (8.6%), or pelvic floor physical therapy (5%). The availability of treatments for pelvic floor disorders at FQHCs is limited. These findings highlight a potential disparity in access to urogynecology services for individuals with public insurance.

Antibiotic prophylaxis in invasive urodynamics, a Delphi consensus of the Italian Society of Urodynamics (SIUD).

Although antibiotic prophylaxis (AB) demonstrated a statistically significant reduction in bacteriuria after invasive urodynamics (UDS), no significant decrease in the incidence of urinary tract infections (UTI) has been confirmed. No absolute recommendations on the use of AB in case of relevant potential risk of UTI have been reported, though some categories of patients at increased infective probability after UDS have been recognized. The aim of this study is to report the experts' consensus on the best practice for the use of AB before UDS in the main categories of patients at potential risk of developing UTI. A systematic literature review was performed on AB before UDS in males and females. A panel of experts from the Italian Society of Urodynamics, Continence, Neuro-Urology, and Pelvic Floor (SIUD) assessed the review data and decided by a modified Delphi method on 16 statements proposed and discussed by the panel. The cut-off percentage for the consensus was a ≥70% of positive responses to the survey. The study was a Delphi consensus with experts' opinions, not a clinical trial involving directly patients. The panel group was composed of 57 experts in functional urology and UDS, mainly urologists, likewise gynaecologists, physiatrists, infectivologists, pediatric urologists, and nurses. A positive consensus was achieved on 9/16 (56.25%) of the statements, especially on the need for performing AB before UD in patients with neurogenic bladder and immunosuppression. Urine analysis and urine culture before UDS are mandatory, and in the event of their positivity, UDS should be postponed. A consensus was reached on avoiding AB in menopausal status, diabetes, age, gender, bladder outlet obstruction, high postvoid residual, chronic catheterization, previous urological surgery, lack of urological abnormalities, pelvic organ prolapse, and negative urine analysis. Antibiotic prophylaxis is not recommended for patients without notable risk factors and with a negative urine test due to the potential morbidities that may result from antibiotic administration. However, AB can be used for risk categories such as neurogenic bladder and immunosuppression. The evaluation of urine analysis and urine culture and postponing UDS in cases of positive tests were considered good practices, as well as performing AB in the neurogenic bladder and immunosuppression.

Urinary retention induced by psychotropics: A case report

IntroductionNeurological bladder is considered a functional disability that has a significant impact on the quality of life and psychological state of patients. Psychotropic drugs, in turn, can worsen the urinary dysfunction caused by this disease.ObjectivesOur objective is to illustrate, through the case of a patient suffering from a neurological bladder decompensated by the treatment of a characterized depressive episode, the link between these two pathologies.MethodsWe report the case of Ms. M.W., aged 51, with a history of high blood pressure stabilized under nebivolol and a neurological bladder diagnosed 10 years ago with episodic pollakiuria, admitted to the psychiatric department for repeated suicide attempts. She had never used psychoactive substances and had no family psychiatric history. The patient presented depressive symptoms evolving for 5 months. The diagnosis of a characterized depressive episode with melancholic features was made and the patient was treated with sertraline. From the first intake of the drug, the patient presented acute urinary retention (UR) requiring the placement of a permanent bladder catheter. The urinary symptoms improved upon stopping the treatment. Sertraline was changed to olanzapine and escitalopram. The patient stopped the treatment after one month because of the worsening of urinary symptoms requiring the installation of a suprapubic catheter. The urinary problem, together with the cessation of treatment, were responsible for a worsening of psychiatric symptoms leading to multiple suicide attempts. Given the advanced stage of the neurological bladder demonstrated by the urodynamic tests, our patient was treated with paroxetine, quetiapine and oxazepam along with psychotherapeutic education. The evolution was characterized by improvement in psychiatric symptoms and the urinary symptoms were stable.ResultsThe lack of improvement after treatment discontinuation could be explained by an underlying neurological bladder manifesting with pollakiuria. The current literature on UR induced by psychotropic treatments is quite rare limited in case reports. This effect occurs especially when selective serotonin reuptake inhibitors (SSRIs) are prescribed in combination with other antipsychotics. Unlike first generation antipsychotics, atypical antipsychotics have muscarinic receptor antagonist properties which can induce UR. Among atypical antipsychotics, olanzapine has been shown to have the greatest antimuscarinic effects. Regarding SSRIs, they are associated with a lower risk of UR than other antidepressants and sertraline had the highest risk of UR.ConclusionsSSRIs can induce UR particularly in combination with atypical antipsychotics. Coordination of care across multiple specialties and understanding the side effects of psychotropic medications can enable faster diagnoses and adequate management.Disclosure of InterestNone Declared

Comparison of maximum voided volume and maximum bladder capacity in voiding diary, uroflowmetry and cystometrography in children with non-neurogenic lower urinary tract dysfunction

BackgroundMaximum voided volumes (MVV) and maximum bladder capacities (MBC) are important parameters in the evaluation of lower urinary tract functions in children. However, consistency of MVV and MBC measurements between voiding diary (VD), uroflowmetry (UF) and cystometrography (CMG) in children with non-neurogenic lower urinary tract dysfunction (LUTD) has not been addressed specifically. ObjectiveWe aimed to compare the MVV in VD and UF and MBC in CMG in children with non-neurogenic LUT dysfunction and investigate for possible factors for discrepancies. Materials and MethodsChildren with non-neurogenic LUTD were retrospectively evaluated with a focus on VD, UF, and CMG. VD applied for 2 days and MVV recorded except for first urine in morning. UF repeated in children with < 50% of expected bladder capacity (EBC) for age. Highest value and post voiding residual urine (PVR) was recorded. CMG was performed if these conditions were present: High PVR or LUT dysfunction resistant to standard urotherapy (conservative management with biofeedback) and medical therapy (oral anticholinergics) or LUT dysfunction accompanied by VUR or recurrent UTI. MBC in CMG was recorded according to International Children Continence Society (ICCS) standards. MVV and MBC in VD, UF, CMG were compared and possible factors for discrepancy were investigated. Results54 children (median age: 10 (4-17) years) were included in the study. 39 (72.2%) were girls, 15 (27.8%) were boys. Median MVV was 232.50 (20-600) ml in VD, 257.50 (69-683) ml in UF and MBC was 184 (31-666) ml in CMG (p= 0.012) (Summary Table). In the subgroup analysis, it was shown that the bladder capacities obtained from all three tests were not compatible with each other in children younger than 10 years of age, in girls, in those with recurrent urinary tract infection, detrusor overactivity, high PVR and normal flow pattern (p=0.003, p=0.016, p=0.029, p<0.001, p=0.045, p=0.03, respectively). DiscussionThere is a discrepancy between bladder capacities obtained from VD, UF and CMG In children with non-neurogenic LUT dysfunction. In particular, the lower capacity obtained from invasive urodynamic tests may be related to the poor compliance of children during the procedure. Therefore, when invasive urodynamics is required in these cases, we recommend that maximum cystometric capacity to be evaluated by comparing with voided volumes at UF, VD and other clinical signs and symptoms, and urodynamic parameters in more detail. ConclusionMVV in VD and UF are comparable, but MBC in CMG is lower in children with non-neurogenic LUTD selected for invasive urodynamic studies. More attention should be paid to bladder capacity obtained from urodynamic studies in children exhibiting the characteristics identified in the subgroup analysis. We believe that evaluating bladder capacity values, especially obtained from invasive studies, in conjunction with clinical findings can prevent misdiagnosis, over investigation and overtreatment in children with non-neurogenic LUTD.

Use of the International Prostate Symptom Score in men with Multiple Sclerosis

Objective : Men with multiple sclerosis (MS) tend to present with urinary symptoms potentially translating to significant findings on urodynamics (UDS). We sought to assess the reliability and prognostic value of the International Prostate Symptom Score (IPSS) and Quality of Life (QoL) in patients with MS. Methods : A prospective study between July 2014 and August 2016 included 40 consecutive men with MS and lower urinary tract symptoms (LUTs) referred for video UDS. All participants completed the IPSS and QoL assessments. Results were compared and correlated to UDS parameters. Results : Mean (±SD) age, IPSS, and QoL were 53.7 ± 13.5 years, 16.7 ± 8.9 and 4.1 ± 1.4, respectively. The most common presenting symptom and UDS finding were urinary frequency (79%) and detrusor overactivity (68%). 72% had moderate-severe symptoms base on the IPSS. Reduced bladder compliance on UDS was associated with intermittency and straining answers on IPSS (p = 0.02 and p = 0.03). QoL did not predict UDS parameters. Conclusion : QoL and total IPSS scores are likely insufficient for MS and LUTs patient assessment due to the variability of UDS findings. However, in these patients, IPSS storage symptom questions had significant correlation with UDS. Furthermore, presenting symptoms in MS &amp; LUTs did not correlate with UDS findings. Therefore, in patients with MS and LUTs, UDS must be performed for adequate disease assessment

Ongenital Medullary Malformations and Urinary Disorders: The Contribution of Urodynamic Assessment in the Diagnostic, Prognostic and Theurapeutic Approach in the Light of Recommendations and The Literature

Congenital medullary malformations or spinal dysraphisms are anomalies in the closure of the neural tube affecting the spinal column and the spinal cord. The cause is usually multifactorial. The main cause of morbidity and mortality in these children is renal deterioration. This is the main cause of neurological bladder in children. Urinary management must begin early, from the neonatal period, with the aim of preserving the urinary tract and renal function, as vesico-sphincter imbalance is the cause of renal deterioration and may therefore be life-threatening for these children. Urodynamic investigation is the key examination for analysing the functioning of the lower urinary tract and proposing a course of treatment based on the mechanisms of vesicosphincter dysfunction. There are still very few publications on urodynamics in children. Although urodynamic exploration techniques differ little from those used in adults, the pathophysiology of bladder and bowel function in infants is specific to this age group. This article reviews the literature to demonstrate the value of urodynamic testing in the diagnosis and treatment of urinary disorders in congenital medullary malformations.

Novel use of contrast enhanced ultrasonography with urodynamics in children: A comparison study to fluoroscopy.

Video urodynamics (UDS) has classically been performed using fluoroscopy (fluoro). Contrast enhanced voiding ultrasonography (ceVUS) has rarely been reported for use with UDS. This is the first study to compare the imaging characteristics of ceVUS versus fluoro UDS. Children were enrolled for ceVUS UDS who previously underwent fluoro UDS. Demographics, imaging data for ceVUS and fluoro UDS, time between studies, and clinical data between studies were recorded. Changes in clinical status included implantation/cessation of catheterization or anticholinergic medications, leakage between, urinary tract infections, hydronephrosis and neurologic changes. Comparison testing was performed using McNemar's Chi-Squared and Wilcoxon matched-pairs signed rank test. Seventy-five children were recruited. Median time between studies was 1.3 years (IQR 0.9-2.9). There were no differences for bladder shape (p = 0.59), vesicoureteral reflux (p = 0.10), bladder neck (p = 0.59) or urethra (p = 1.0) between studies. In 5 cases, the bladder neck could not be visualized adequately due to layering of the microbubble contrast against urine. Benefits to ceVUS included ability to visualize the exact moment the bladder neck opened. Following exclusion of patients with clinical changes that might affect imaging findings, an analysis of 28 patients demonstrated no differences between the two studies. CeVUS can be used adequately in conjunction with UDS. Limitations to ceVUS include more granular imaging for bladder shape versus fluoro and inability to visualize bladder neck if residual urine is in the bladder, mitigated by bladder emptying. Benefits include ability to visualize the dynamic activity of the bladder neck due to constant imaging with ceVUS.

Effect of tamsulosin on urethral tone in healthy male cats.

Alpha-adrenergic antagonists are commonly used to prevent recurrent urethral obstruction in cats with mixed reports of efficacy. No published data on tamsulosin use in cats are available. The objective of this study was to measure changes in urodynamic parameters and blood pressure in five healthy male cats before and after administration of tamsulosin orally for 4 and 10 days. Five young healthy adult male cats from a research colony were administered tamsulosin at 0.1 mg/cat PO q24h for 10 days. Urethral pressure profile and blood pressure measurements were performed before treatment and approximately 6 h after treatment on days 4 and 10. Maximum urethral closure pressure (MUCP) for the prostatic and penile urethra, functional urethral length (FPL), functional area (FA) and systolic blood pressures were recorded and compared between the time points. Significant changes in blood pressure on day 4 (121.1 mmHg ± 20.2 mmHg) and on day 10 (112.6 mmHg ± 14.9 mmHg) compared with day 0 (141.1 mmHg± 33.4 mmHg) were not detected (P = 0.18) in anesthetized cats. No significant difference in MUCP, FA or FPL measurements were detected among baseline, day 4 and day 10 of treatment. Hematuria and transient pollakiuria were induced in two cats with 3.5 Fr urethral catheters. Tamsulosin at 0.1 mg/cat PO q24h did not induce hypotension in healthy cats. Urodynamic testing performed 6 h after the tamsulosin pill was administered did not detect consistent decreases in urodynamic functions induced by tamsulosin. Repeated catheterization of tom cats with 3.5 Fr catheters may induce significant urethral trauma.

Bladder outlet obstruction in women: Advanced evaluation.

Herein, we provide a review of the indications, practical considerations, and interpretation of urodynamics (UDS) with or without fluoroscopy, as well as cystourethroscopy, for women with suspected bladder outlet obstruction (BOO). A narrative review was performed focusing on the current primary literature and society guidelines around advanced diagnostic modalities for female BOO patients. UDS studies help diagnose BOO by identifying high-pressure low-flow voiding patterns and/or the characteristic radiographic appearance of the bladder neck and urethra during micturition. Cystourethroscopy aids in evaluating structural aberrations of the bladder outlet, and in surgical planning. UDS studies and cystourethroscopy are useful adjuncts in carefully-selected female patients with suspected BOO.

Efectos sobre la presión máxima de cierre uretral durante la contracción voluntaria de los músculos del suelo pélvico en mujeres

Introduction: Pelvic floor muscle exercises represent voluntary contractions and relaxations of the levator ani muscles. This muscle group gives support to the vagina, bladder, and urethra. Urethral profilometry is a study that assesses the closing function of the urethral sphincter. There is limited scientific evidence regarding the changes in pressure values of the Maximum Urethral Closing Pressure (MUCP) during a voluntary contraction of the pelvic floor muscles (C-MUCP). Objective: During a urodynamic test, evaluate the change in MUCP at rest and during voluntary contraction after verbal command, in patients from two tertiary referral hospitals. Material and methods: Retrospective and cross-sectional study of two tertiary referral hospitals in Mexico. This study focused on reviewing hospital records of adult patients who underwent a urodynamic study from January 2016 to February 2022. Obstetric clinical history data and MUCP results at rest and in C-MUCP during urodynamics were taken. IBM SPSS Statistics version 22 statistical program was used. Results: 928 patients with a mean age of 58 years were evaluated. Eighty three percent were postmenopausal women. An inverse relationship was observed between age and MUCP both at rest (p=&lt;0.001) and in C-MUCP (p=0.009). Neurogenic disease and postmenopausal status had no significant relationship with the ability to increase MUCP. Sixty five percent ​​of the population achieved a clinically significant increase of the MUCP. Conclusion: There is a direct negative relationship between age, resting MUCP and C-MUCP. In patients with both neurogenic and non-neurogenic pathology, the rate of clinically significant increase in MUCP was low.

Persistent and De Novo Stress Urinary Incontinence After Minimally Invasive Sacrocolpopexy.

Data on stress urinary incontinence (SUI) after minimally invasive sacrocolpopexy (SCP) with or without midurethral sling placement are limited. The aim of the study was to determine the incidence of SUI after minimally invasive sacrocolpopexy. This was a secondary analysis of 2 randomized clinical trials of participants undergoing SCP. Participants completed symptom assessment and urodynamic testing. Participants underwent SCP with or without midurethral sling placement. Preoperatively, participants were defined as having symptomatic SUI, occult SUI, or no SUI. Participants completed the Pelvic Floor Distress Inventory-20 at 6 and 12 months postoperatively and were categorized as having persistent SUI in the setting of symptomatic or occult SUI or de novo SUI. Eighty-one participants were included. Sixty-one participants met inclusion criteria for the persistent SUI analysis: 42 participants with symptomatic SUI and 19 participants with occult SUI. There were 20 participants in the de novo SUI group. The overall incidence of persistent SUI was 26.2% (95% confidence interval [CI], 15.8%-39.1%) with 33.3% (95% CI, 19.6%-49.6%) of symptomatic and 10.5% (95% CI, 1.5%-33.1%) of occult participants. Bothersome symptoms were defined as "moderately" or "quite a bit" bothered postoperatively. Of participants with symptomatic SUI, 14.3% participants were bothered and no participants underwent retreatment. No patient with occult SUI was bothered; however, 1 patient underwent retreatment. The incidence of de novo SUI was 45% (95% CI, 23.1%-68.5%). No patient in the de novo SUI group was bothered or underwent SUI treatment. Approximately 1 in 4 participants reported persistent SUI. Almost 50% reported de novo SUI. However, few participants were bothered or underwent treatment.

How do we make progress in phenotyping patients with lower urinary tract such as overactive bladder and underactive detrusor, including using urine markers and microbiome data, to personalize therapy? ICI-RS 2023-Part 2.

Overactive bladder (OAB) and underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction. The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment. A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU using urodynamic tests, functional neuro-imaging, urinary markers, and microbiome. The article emphasizes the critical significance of adopting a comprehensive yet tailored approach to phenotyping patients with lower urinary tract (LUT) symptoms, such as OAB and UAB. The intricate interplay between the LUT and various factors, metabolic, neurological, psychological, and gastrointestinal can define unique LUT profiles, enabling personalized therapies to replace the one-size-fits-all approach.

Catheter-Free Urodynamics Testing: Current Insights and Clinical Potential.

Lower urinary tract dysfunction not only interferes with the health-related quality of life of patients but may also lead to acute kidney injury and infections. To assess the bladder, urodynamic studies (UDS) have been implemented but the use of catheters leads to discomfort for the patient. Catheter-free long-term UDS would be useful and a potential solution could be ambulatory wireless devices that communicate via telemetry. Such sensors can detect pressure or volume. Numerous types of potential catheter-free sensors have been proposed for bladder monitoring. Despite substantial innovation in the manufacturing of implantable biomedical electronic systems, such sensors have remained at the laboratory stage due to a number of critical challenges. These challenges primarily concern hermeticity and biocompatibility, sensitivity and artifacts, drift, telemetry, and energy management. Having overcome these challenges, catheter-free ambulatory urodynamic monitoring could combine a synchronized intravesical pressure sensor with a volume analyzer but only the steps of cystometry and volume measurement are currently sufficiently reproducible to simulate UDS results. The measurement of volume by infrared optical sensors, in the form of abdominal patches, appears to be promising and studies are underway to market a telemetric ambulatory urodynamic monitoring system that includes an intravesical pressure sensor. There has been considerable progress in wearable and conformable electronics on many fronts, and continued collaboration between engineers and urologists could quickly overcome current challenges. In addition, to the diagnosis of UDS, such sensors could be useful in the development of a long-term closed-loop neuromodulation system. In this review, we explore the various types of catheter-free bladder sensors, inherent challenges and solutions to overcome these challenges, and the clinical potential of such long-term implantable sensors.

Urodynamic assessment of detrusor function in the very acute phase of traumatic spinal cord injury: A prospective cohort study.

The bladder is believed to be acontractile due to the phase of spinal shock and there is a lack of data on the detrusor function within the first few days after spinal cord injury (SCI). This study intended to assess the detrusor function with invasive urodynamics (UDS) during the first 15 days of SCI. This prospective observational study was carried out from January 2020 to June 2021 and consecutive stable patients older than 18 years of age who had a history of traumatic SCI within the past 15 days were screened for inclusion. For each patient, the International Standards for Neurological Classification of SCI Worksheet was filled. All patients underwent bedside invasive UDS within 15 days of injury. There were a total of 41 patients with a mean age of 35 years. The thoracic cord was most commonly involved (46.3%) with Type A AISA grade being the most common (68.2%). The mean duration of injury at the time of UDS was 6 days. Abnormality in the filling phase could be identified in six patients. Three patients had neurogenic detrusor overactivity (NDO), with one having a high-pressure phasic NDO and one having a sustained NDO. Two patients had poor compliance and one had borderline poor compliance. None of the patients generated any detrusor pressure during voiding cystometry. In patients with SCI, 14.5% of the patients had abnormal findings during the filling phase on the UDS performed within 15 days of the injury. These findings are in stark contrast to the traditional understanding that the detrusor is acontractile during the early phase of the SCI and merit further evaluation.

Urinary levels of neurotrophic factors (NGF and BDNF) in patients with detrusor overactivity

Overactive bladder refers to a group of urinary symptoms involving urinary urgency accompanied by pollakiuria or day time and nocturnal enuresis. Urodynamic testing is the gold standard for diagnosing the most frequent form of overactive bladder that is detrusor overactivity. Neurotrophins (nerve growth factor – NGF, brain-derived neurotrophic factor – BDNF, neurotrophin 3 – NT-3, and neurotrophin 4 – NT-4) are proteins secreted by the nervous system, found in many tissues, including bladder cells. They are bound by two types of receptors: low- and high-affinity receptors, two of which, i.e. tropomyosin receptor kinase A (TrkA) and p75 receptor, are located in the epithelial cells of the urinary bladder. The detrusor muscle was shown to secrete NGF in response to stretching of the urinary bladder. In addition, numerous studies have shown an increase in the urinary levels of NGF and BDNF in patients with overactive bladder and their decrease after the introduction of anticholinergic therapy. Therefore, the assessment of urinary levels of neurotrophins NGF and BDNF seems to be useful as a potential biomarker of detrusor overactivity. Unfortunately, the sensitivity of these parameters in the diagnosis of detrusor overactivity is low due to the possible overlapping of other conditions, especially bladder pain syndrome, which affects mainly adults. Additionally, previous studies have been conducted in small groups of patients, therefore studies in a larger population are needed. Confirming the usefulness of these biomarkers in the future opens the opportunity to replace the urodynamic test with the analysis of urinary markers, which would significantly simplify diagnosis and increase patient’s comfort.

Italian multicenter mid-term analysis of laparoscopic lateral suspension in women with pelvic organ prolapse: clinical, sexual and Quality of Life assessment after surgical intervention.

The aim of this study was to evaluate effectiveness and safety of laparoscopic lateral suspension in women affected by high grade uterine prolapse associated to anterior defect. The secondary endpoint is to evaluate mid-term impact on Quality of Life and sexual function. A multicenter retrospective study on women undergoing laparoscopic lateral suspension for uterine prolapse ≥III stage was performed. We included 174 women, but due to exclusion criteria, 134 patients were enrolled for this study. Preoperative evaluation consisted of an urogynecological interview, clinical exam, 3-day voiding diary and urodynamic testing; the prolapse Quality of Life Questionnaire was used to quantify the impact of prolapse symptoms on Quality of Life and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form, the Female Sexual Function Index and the Female Sexual Distress Scale were administered to evaluate sexual function before surgical intervention and at median follow-up of 3.8 years. We included 134 women with uterine prolapse ≥III stage. All patients underwent laparoscopic lateral suspension, 8 also posterior colporrhaphy and 5 also transobturator tape insertion. POP-Q classification score for anterior and apical compartment showed a significant average decrease. The surveys administered to patients showed an improvement in Quality of Life, an increase in the number of monthly intercourses and a significant improvement in sexual life after surgery. Laparoscopic lateral suspension for pelvic organ prolapse correction is a safe and effective technique for uterine and anterior associated defect. Quality of Life and sexual function significantly improved after surgery.

Voiding Dysfunction in Patients With Advanced Pelvic Organ Prolapse and Bladder Outlet Obstruction Following Pelvic Reconstructive Surgery: Urodynamic Profile and Predictive Risk Factors

Study ObjectiveTo determine the outcome of voiding function 1 year following Pelvic Reconstructive Surgery (PRS) in women with Bladder Outlet Obstruction (BOO). DesignRetrospective cohort study SettingTertiary Referral Hospital PatientsOne thousand eight hundred and ninety-four (1894) women underwent PRS for advanced Pelvic Organ Prolapse (POP) stage III-IV with urodynamic findings of BOO InterventionsPelvic Reconstructive Surgery MeasurementsThe primary outcome measured was the resumption of normal voiding function, defined clinically with multichannel urodynamic (UDS) testing at one year post-operatively. The secondary outcomes are to identify the different risk factors for persistence voiding dysfunction after 1 year after PRS. Main ResultsTotal of 431 women with POP-Q Stage III and IV, UDS of Qmax ≤15 ml/s and PdetQmax ≥20cmH20 were included. Resumption of normal voiding function were found in 91% (n=392/431), while 9% (n=39/431) remains to have voiding dysfunction (VD) 1 year post operatively. Those with persistent VD, 20.5%(n=8/39) remains having urodynamic diagnosis of BOO. Univariate and multivariate logistic regression reveals factors associated with post-operative VD are pre-operative MCC ≥500 ml and PVR ≥ 200ml. ConclusionVoiding Dysfunction may persist in women with BOO following PRS, particularly in those with pre-operative maximal cystometric capacity (MCC) of >500ml and post-void residual volume > 200ml.

The protein kinase A signaling pathway mediates the effect of electroacupuncture on excessive contraction of the bladder detrusor in a rat model of neurogenic bladder.

Neurogenic bladder (NB) is a form of neurological bladder dysfunction characterized by excessive contraction of the bladder detrusor. Protein kinase A (PKA) signaling is involved in the contraction of the detrusor muscle. To investigate whether PKA signaling mediates the effect of electroacupuncture (EA) on the excessive contraction of the bladder detrusor in NB. Sixty rats were randomly divided into control, sham, NB, NB + EA, and NB + EA + H89 (a PKA receptor antagonist) groups. The modified Hassan Shaker spinal cord transection method was used to generate a NB model. After EA intervention for one week, urodynamic tests were used to evaluate bladder function, hematoxylin and eosin staining was conducted to assess morphological changes, enzyme-linked immunosorbent assay (ELISA) was performed to measure the concentration of PKA, and Western blotting was conducted to measure the protein levels of phosphorylated myosin light chain kinase (p-MLCK)/p-MLC. The results showed that NB resulted in morphological disruption, impairment of urodynamics, and decreases in the concentration of PKA and the protein levels of p-MLCK/p-MLC. EA reversed the changes induced by NB dysfunction. However, the improvement in urodynamics and the increases in the concentration of PKA and the protein levels of p-MLCK/p-MLC were inhibited by H89. Our findings indicate that the PKA signaling pathway mediates the beneficial effect of EA on excessive contraction of the bladder detrusor in a rat model of NB.

Effect of transurethral resection of prostate on Uroflowmetry parameters on patients having benign prostatic hyperplasia

Objective: To determine improvement in uroflowmetry after Transurethral resection ofprostateStudy design: A prospective observational Study Place and Duration of the Study: January 2014 to June 2016 Department at urology POF HospitalWah Cantt, Pakistan INTRODUCTION:Lower urinary tract problems affect 15%–60% of men over 40. Complex symptoms include frequency, urgency, nocturia, problems commencing urination, insufficient bladder emptying, low steam force, and steam stoppage. BPH frequently causes male LUTS. Benign prostatic enlargement Chronic BOO may induce urine retention, renal insufficiency, recurrent UTIs, extensive hematuria, and bladder calculi. It involves prostate histopathological cellular element proliferation. BPH and LUTS rise considerably with age. BPH affects 70% of US men aged 60–69 and 80% over 70. Autopsy examinations indicated 8%, 50%, and 80% histological frequency in the 4". and 9*decades. LUTS risk factors and larger prostates cause benign prostatic enlargement. Formerly, TURP was the best BPH procedure. Higher disease pathophysiology knowledge and digital rectal examination, transabdominal, and transrectal ultrasounds are the second most prevalent interventions in adult male patients worldwide. Urodynamic and serum PSA tests may misdiagnose the condition and require surgery. Uroflowmetry records voiding time from urinal pee. It would assess average flow and obstruction severity. For boys 14–45, the average flow rate is 21 mL/s, 46–65 mL/s, and 66–80 mL/s. Uroflowmetry in post-TURP benign hypertrophic hyperplasia patients will be examined after transurethral prostate removal. keywords: transurethral resection , prostate Uroflowmetry parameters, prostatic hyperplasia