Urodynamic Research Articles

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

Can cardiac pressure-volume catheters improve urodynamic assessment? an ex-vivo proof-of-concept

AimsTo explore the feasibility of using pressure-volume (PV) catheters for cystometry. These catheters are well-established in cardiovascular research for simultaneous pressure and volume measurements in the left ventricle.MethodsUrinary bladders with urethras were collected from domestic pigs for ex-vivo testing. Using a pump, bladders were filled up to 500ml at five different filling rates (15, 20, 25, 30, 35ml/min), and the resulting pressures and volumes were measured using a PV catheter. The bladder were compressed externally in three different areas (central, apex and outlet) to assess the PV catheter’s ability to detect local changes in bladder volume.ResultsBladder pressure remained below 10cmH2O for all bladder filling rates. Volume measurements were compared with the volumes instilled by the pump (ground truth), proving high reproducibility and accuracy of the PV catheter measurements up to 400ml. Using the different sensing units of the PV catheter, local changes in bladder volumes could be identified and quantified.ConclusionThe main advantage of PV catheters, compared to existing technology used in urology (e.g. conventional urodynamic testing), is the possibility to i) simultaneously measure bladder pressure and volumes and ii) identify local changes in bladder volume (e.g. caused by non-voiding contractions). Both could be useful in the clinical setting to improve the diagnosis and treatment of the Lower Urinary Tract Dysfunction (e.g. overactive/underactive bladder).

International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction

Introduction and hypothesisThis manuscript from Chapter 2 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) reviews the literature involving the clinical evaluation of a patient with POP and associated bladder and bowel dysfunction.MethodsAn international group of 11 clinicians performed a search of the literature using pre-specified search MESH terms in PubMed and Embase databases (January 2000 to August 2020). Publications were eliminated if not relevant to the clinical evaluation of patients or did not include clear definitions of POP. The titles and abstracts were reviewed using the Covidence database to determine whether they met the inclusion criteria. The manuscripts were reviewed for suitability using the Specialist Unit for Review Evidence checklists. The data from full-text manuscripts were extracted and then reviewed.ResultsThe search strategy found 11,242 abstracts, of which 220 articles were used to inform this narrative review. The main themes of this manuscript were the clinical examination, and the evaluation of comorbid conditions including the urinary tract (LUTS), gastrointestinal tract (GIT), pain, and sexual function. The physical examination of patients with pelvic organ prolapse (POP) should include a reproducible method of describing and quantifying the degree of POP and only the Pelvic Organ Quantification (POP-Q) system or the Simplified Pelvic Organ Prolapse Quantification (S-POP) system have enough reproducibility to be recommended. POP examination should be done with an empty bladder and patients can be supine but should be upright if the prolapse cannot be reproduced. No other parameters of the examination aid in describing and quantifying POP. Post-void residual urine volume >100 ml is commonly used to assess for voiding difficulty. Prolapse reduction can be used to predict the possibility of postoperative persistence of voiding difficulty. There is no benefit of urodynamic testing for assessment of detrusor overactivity as it does not change the management. In women with POP and stress urinary incontinence (SUI), the cough stress test should be performed with a bladder volume of at least 200 ml and with the prolapse reduced either with a speculum or by a pessary. The urodynamic assessment only changes management when SUI and voiding dysfunction co-exist. Demonstration of preoperative occult SUI has a positive predictive value for de novo SUI of 40% but most useful is its absence, which has a negative predictive value of 91%. The routine addition of radiographic or physiological testing of the GIT currently has no additional value for a physical examination. In subjects with GIT symptoms further radiological but not physiological testing appears to aid in diagnosing enteroceles, sigmoidoceles, and intussusception, but there are no data on how this affects outcomes. There were no articles in the search on the evaluation of the co-morbid conditions of pain or sexual dysfunction in women with POP.ConclusionsThe clinical pelvic examination remains the central tool for evaluation of POP and a system such as the POP-Q or S-POP should be used to describe and quantify. The value of investigation for urinary tract dysfunction was discussed and findings presented. The routine addition of GI radiographic or physiological testing is currently not recommended. There are no data on the role of the routine assessment of pain or sexual function, and this area needs more study. Imaging studies alone cannot replace clinical examination for the assessment of POP.

Correlation between obesity-related measurements and initial and initial resting intravesical and abdominal pressures in urodynamic study using air-filled catheter system.

To establish the initial (before pressure equilibrium) and initial resting intravesical and abdominal pressure in the sitting position using air-filled catheters, to assess the correlation between these pressures and obesity-related measurements, and to estimate if obesity-related measurements can be a guide to interpret initial and initial resting pressures in urodynamic testing. Patients with non-neurogenic lower urinary tract symptoms referred for urodynamic testing in our center were consecutively enrolled in a prospective study from August 2022 to October 2022. The correlation between the initial and initial resting pressures (before and after pressure equilibrium) and obesity-related measurements were analyzed using Pearson's correlation coefficient and multiple linear regression analysis. Ninety-eight patients aged 56 ± 16 were studied. The 95% range of the initial intravesical and abdominal pressure were 18-42 cmH2 O and 21-60 cmH2 O, respectively. The initial resting intravesical, abdominal, and detrusor pressure in the 95% range were 17-41, 16-42, and -5 to 4 cmH2 O, respectively. Over the multiple analysis, abdominal fat thickness, and body mass index (BMI) correlated independently with initial intravesical pressure, and only visceral fat grade correlated with initial abdominal pressure. BMI correlated independently with initial resting intravesical pressure. Our results determined the ranges of values of both initial and initial resting pressures in the air-charged system. Meanwhile, the present study indicated the obesity-related measurements may be used as a guide to interpret the initial and initial resting pressures in urodynamic testing, and may provide a reference for the quality control of these pressures.

Research priorities for diagnostic instrumentation in urinary incontinence.

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

Parental perception of contrast enhanced voiding ultrasonography urodynamics vs fluoroscopic urodynamics

Contrast enhanced voiding ultrasonography (ceVUS) has not been widely reported to be used during video urodynamics (UDS). We previously reported on the feasibility of this. In this study, we aimed to understand how parents perceived their child's experience of undergoing ceVUS during UDS compared to fluoroscopic (fluoro) UDS. Children who underwent both fluoro UDS and ceVUS UDS were recruited. Parents were asked to complete a questionnaire to evaluate their experience with both studies. Demographics including gender, age at study, and diagnosis were collected to account for differences in perception. Statistical analysis was performed. 53 patients were included: 31 girls, 22 boys. Diagnoses included myelomeningocele (67.9%), low/tethered cord (13.2%), closed spinal dysraphism (9.4%), posterior urethral valve (1.9%), cloacal anomaly (1.9%), caudal regression (1.9%), myeloschisis (1.9%), and cerebral palsy (1.9%). There was no statistical difference in mean age at fluoro UDS and ceVUS UDS (77.3 months vs 99.7 months respectively, p=0.09). All 53 parents (100%) were satisfied/very satisfied with their ceVUS experience; 48 parents (90.6%) preferred ceVUS, 3 parents (5.7%) preferred fluoro UDS, and 2 (3.8%) were neutral. On average, parents perceived ceVUS to be more comfortable (72.7%) and produce better results (67.4%) than fluoro UDS. The majority felt that both studies allowed the same contact with their child (52.3%) and took the same amount of time (50.0%). However 29.5% felt ceVUS was faster and 34.1% felt ceVUS allowed more contact with their child (Fig.1). 26 parents (49.1%) specifically noted no radiation as the reason why they preferred ceVUS over fluoro. The average age at ceVUS UDS was younger in those who preferred ceVUS UDS compared to those who preferred fluoro UDS (94.6 months vs 180.0 months, p=0.03). The average age at fluoro UDS was younger in those who preferred ceVUS UDS vs fluoro UDS (73.1 months vs 144 months, p=0.03). Gender's influence on preference approached significance (p=0.07); all 3 parents who preferred fluoro UDS had male children. The majority of parents preferred ceVUS over fluoro UDS. ceVUS was perceived to be more comfortable and provide better results. Many parents highlighted no radiation and no fluoroscopic machinery as factors in preference of ceVUS over fluoro. The parents who preferred ceVUS UDS had children who had both studies done at an earlier age compared to the parents who preferred fluoro UDS.

Inhibition of integrin receptors reduces extracellular matrix levels, ameliorating benign prostate hyperplasia

Although a high prevalence of benign prostate hyperplasia (BPH) has been documented, the risk factors are poorly understood. Metabolic syndrome increases the risk of BPH. Succinylation, a type of posttranslational modification, mostly targets metabolic processes. The level of succinylation was investigated in 4 BPH patients and 4 healthy controls. Additionally, 176 patients with BPH were analyzed by using pan-antisuccinyllysine antibody blotting. TMT-labeling proteomic and sc-RNAseq Cellchat analyses were employed to identify key signaling factors involved in the development of BPH. In vivo and in vitro experiments were used to confirm the role of integrin receptors. The global succinylation level in BPH was higher than that in the healthy prostate. Positive correlations of prostate volume with IHC score sand urodynamics testing were found in large clinical cohorts. The extracellular matrix (ECM), metabolic processes and immune signaling were involved in succinylation in BPH, as indicated by using TMT-labeling proteomic analysis, and this finding was also confirmed by sc-RNAseq CellChat analysis. The proteins upregulated in SIRT5 knockout WPMY-1 cells were also enriched in the extracellular matrix and metabolic processes. More importantly, integrin receptor inhibition in a mouse model of BPH significantly ameliorated prostate hyperplasia. High levels of succinylation modifications were found in BPH, and succinylated proteins influenced the activation of the ECM. Inhibition of ECM signaling further ameliorated prostate hyperplasia in mice.

Four-hour voiding observation: Normative data from term Indian neonates

BackgroundThe four-hour voiding observation is an important non-invasive urodynamic test for infants and young children before toilet training. The study was performed to generate normative data for term Indian neonates. MethodsThe study was a descriptive study performed in the Department of Paediatrics of a secondary care hospital in South India with patients having nationwide representation from August 2018 to August 2020. Term neonates, appropriate for gestational age on days 4–14 of life were included. Neonates at risk of oliguria or abnormal bladder functions were excluded. Four-hour voiding observation was performed by direct observation of voids, pre- and post-void diaper weight and measurement of post-void residue (PVR) by ultrasonography using two formulae within five minutes of voiding. ResultsA total of 102 neonates (166 voids) were studied. Important results were (a) Eight neonates did not void; (b) median (fifth–95th percentile) of important test outcomes as follows: voided volume: 15 (7.5–33.5) ml, maximum voided volume (MVV) 16.5 (8.0–38.7) ml, PVR 3.2 (0.5–10.2) ml, PVR% 17.0 (2.9–46.4) % functional bladder capacity 19.7 (9.6–38.0) ml, and diuresis: 1.7 (0.0–5.1) ml/kg/hour; (c) four (4.3%) neonates had one interrupted void each; (d) linear regression yielded the following formulae: MVV (ml) = 8.1019 + 4.8702 ∗Diuresis (ml/kg/hr) and PVR % (max) = 14.2312 + 3.2682∗ Diuresis (ml/kg/hr). ConclusionNormative data on the four-hour voiding observation study for Indian term exclusively breast-fed neonates are reported.

The Effect of Duration of Stress Urinary Incontinence on developing Signs of Bladder Outlet Obstruction in Urodynamic Study

Background: Stress urinary incontinence is a frequent urological disease in women; it has a great influence on an individual’s wellbeing and places a significant economic strain on any health service. The placement of urodynamic diagnostic tests in the evaluation route is an important clinical research concern in this field. Objective: to find out whether the duration of stress urinary incontinence is associated with the finding of bladder outlet obstruction in urodynamic study or not. Subjects and Methods: A descriptive study. With enrolled female patients had symptomatic Stress urinary incontinence as their primary complain. All the included patients were assessed thoroughly by history taking and physical examination and relevant clinical tests and investigation in addition to urodynamic evaluation consisted of multi-channel urodynamics measuring abdominal, vesical and detrusor pressures simultaneously. Results: 140 females were suffering from stress incontinence. Urodynamic study showed maximum urine flow rate (Q max) mean of (20.45±9.86) ml/second, the maximum post void volume was 500ml with 36.89ml was the mean of post void residual volume, and 90.83cm water was the mean of urethral occlusion pressure. The mean of duration have positive relationship with age category but without statically significant. Ninety-eight patients have Q max flow more than 25ml/sec with mean duration 6.04 without any statically significant (p=0.872). 37 patients were having >0 ml post void volume with mean duration more than other patients that didn’t have post void volume but without statically significant (p=0.257). All patients with urethral pressure less than 120 cm had long duration mean than others but without statically significant (p=0.335). also, no statistical significance association between mean of duration and sphincter pelvic floor electromyogram (EMG). Conclusion: there was no catechistically significant relationship between the urodynamic findings and the duration neither of stress urinary incontinence nor between the urodynamic findings and the age of the patients.

Quantifying bladder outflow obstruction in men: A comparison of four approximation methods exploiting large data samples.

A pressure flow study (PFS), part of the International Continence Societystandard urodynamic test, is regarded gold standard for the classification and quantification of the urethral resistance (UR), expressed in the bladder outflow obstruction(BOO). For men with benign prostatic hyperplasia, the minimum urethral opening pressure (pmuo ), found at the end of the passive urethral resistance relation is considered the relevant parameter describing BOO. However, in clinical practice, direct measurements of pmuo are easily confounded by terminal dribbling. For that reason, alternative methods were developed to derive pmuo , and thereby assess BOO using the maximum urine flow rate (Qmax ) and the corresponding pressure (pdetQmax ) instead. These methods were never directly compared against a large data set. With the increasing variety of treatments becoming available more precise grading of UR may become of relevance. The current study compares four well-known methods to approximate pmuo and examines the relation between pmuo and pdetQmax . In total, 1717 high-quality PFS of men referred with lower urinary tract symptoms between2003 and 2020 without earlierlower urinary tractsurgery were included. From these recordings, pmuo was calculated according to three one-parameter methods. In addition, a three-parameter method(3PM) was used, based on a fit through the lowest pressure flank of the pressure-flow plot. The estimated pmuo 's were compared with a precisely assessed pmuo . A difference of <10 cmH2 O between an estimate and the actual pmuo was considered accurate. A comparison between the four approximation methods and the actual pmuo was visualized using a Bland-Altman plot. The differences between the actual and the estimated slope were assessed and dependency on pmuo was analyzed. A total of 1717 studies were analyzed. In 55 (3.2%) PFS, 3PM analysis was impossible because all pressures after Qmax were higher than pdetQmax . The 3PM model was superior in predicting pmuo , with 75.9% of the approximations within a range of +10 or -10 cmH2 O of the actual pmuo . Moreover, pmuo according to urethral resistance A(URA) and linearized passive urethral resistance relation (linPURR) appear equally reliable. Bladder outflow obstruction index (BOOI) was significantly less accurate when compared to all others. Bland-Altman analysis showed a tendency of BOOI to overestimate pmuo in men with higher grades of UR, while URA tended to underestimate pmuo in those cases. The slope between pmuo and pdetQmax -Qmax increased with larger pmuo , as opposed to the constant relation proposed within BOOI. Although significant differences were found, the clinical relevance of those differences is not known. Of the four methods to estimate pmuo and quantify BOO, 3PM was found the most accurate and BOOI the least accurate. As 3PM is not generally available and performance in lower quality PFS is unknown, linPURR is (for now) the most physiologically accurate.

Predictive values of spinal cord diffusion magnetic resonance imaging to characterize outcomes after contusion injury.

To explore filtered diffusion-weighted imaging (fDWI), in comparison with conventional magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI), as a predictor for long-term locomotor and urodynamic (UD) outcomes in Yucatan minipig model of spinal cord injury (SCI). Additionally, electrical conductivity of neural tissue using D-waves above and below the injury was measured to assess correlations between fDWI and D-waves data. Eleven minipigs with contusion SCI at T8-T10 level underwent MRI at 3T 4 h. post-SCI. Parameters extracted from region of interest analysis included Daxial from fDWI at injury site, fractional anisotropy and radial diffusivity from DTI above the injury site along with measures of edema length and cord width at injury site from T2 -weighted images. Locomotor recovery was assessed pre- and weekly post-SCI through porcine thoracic injury behavior scale (PTIBS) and UD were performed pre- and at 12 weeks of SCI. D-waves latency and amplitude differences were recorded before and immediately after SCI. Two groups of pigs were found based on the PTIBS at week 12 (p < 0.0001) post-SCI and were labeled "poor" and "good" recovery. D-waves amplitude decreased below injury and increased above injury. UD outcomes pre/post SCI changed significantly. Conventional MRI metrics from T2 -weighted images were significantly correlated with diffusion MRI metrics. Daxial at injury epicenter was diminished by over 50% shortly after SCI, and it differentiated between good and poor locomotor recovery and UD outcomes. Similar to small animal studies, fDWI from acute imaging after SCI is a promising predictor for functional outcomes in large animals.

A grading system for evaluation of bladder trabeculation.

To establish a parameter-based grading system for evaluating bladder trabeculation (BT). A retrospective analysis was conducted on children diagnosed with posterior urethral valve (PUV) or neurogenic bladder (NB) who underwent voiding cystourethrogram (VCUG), urodynamic testing, and urological ultrasonography between January 2016 and October 2022. Cases involving urologic surgery, secondary bladder pathology, and an interval of more than 12months between examinations were excluded. A parameter named Bladder Dispersion (BD) was calculated through fluoroscopic images, and the grading system was developed as follows: BD < 40 (Grade 0), 40 ≤ BD < 60 (Grade 1), 60 ≤ BD < 90 (Grade 2), BD ≥ 90 (Grade 3). Grades 0-1 were classified as low-risk group, while grades 2-3 were classified as high-risk group. Analysis of variance, Kruskal-Wallis test, and Chi-square test were performed to compare urodynamic results and complications across different grades and groups. A total of 74 patients were eligible to participate, which included 46 boys (62.2%) and 28 girls (37.8%), the mean age was 75.18 ± 48.39months. Among them, 11 (14.9%) were PUV, 50 (67.6%) were NB, and 13 (17.5%) were PUV and NB. Significant differences were observed in maximum detrusor pressure, post-void residual urine ratio, and compliance among grades 0-3. Severe hydronephrosis and histories of urinary tract infection were more prevalent in the high-risk group. A reliable grading system with objective standards was proposed which could aid in the assessment of BT severity.

Initial observation of the urodynamic pressure flow study — characteristics of bladder-neck or prostate median lobe dynamics during micturition

Purpose:We present our observations of a urodynamic pressure flow study graph pattern that may be associated with bladder neck hypertrophy or prostate median lobe enlargement. Materials and Methods:We report 23 male patients with signs and symptoms of lower urinary tract dysfunction who underwent urodynamic testing with pressure flow study analysis. We recognized an unusual pressure flow plot curve and found that these patients had cystoscopic evidence for bladder neck hypertrophy or cystoscopic or ultrasound evidence for prostate median lobe enlargement. Results:The patients here demonstrated showed a pattern of increasing detrusor pressure on the pressure flow study — graph phase after maximum of flowrate, where a decreasing pressure pattern is expected. We contemplated that his pattern may show how bladder outflow dynamics is affected by the anatomical features of these patients and how patients may have symptoms of LUT dysfunction or significant residual urine despite a relatively good maximum flow rate. Conclusion:We present a not previously described variation of the pressure flow study graph pattern common in men with prostatic hyperplasia, in a series of patients with median lobe prostatic hyperplasia and or hypertrophy of the bladder neck.

Do or Don't: Results of a Multinational Survey on Antibiotic Prophylaxis in Urodynamics.

Antibiotic prophylaxis contributes substantially to the increase in antibiotic resistance rates worldwide. This investigation aims to assess the current standard of practice in using antibiotic prophylaxis for urodynamics (UDS) and identify barriers to guideline adherence. An online survey using a 22-item questionnaire designed according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was circulated among urologists and gynecologists in Austria, Germany, and Switzerland between September 2021 and March 2022. A total of 105 questionnaires were eligible for analysis. Out of 105 completed surveys, most responders (n = 99, 94%) regularly perform dipstick urine analysis prior to urodynamics, but do not perform a urine culture (n = 68, 65%). Ninety-eight (93%) participants refrain from using antibiotic prophylaxis, and sixty-eight (65%) use prophylaxis if complicating factors exist. If asymptomatic bacteriuria is present, approximately 54 (52%) participants omit UDS and reschedule the procedure until antimicrobial susceptibility testing is available. Seventy-eight (78%) participants do not have a standard procedure for antibiotic prophylaxis in their department. Part of the strategy against the development of bacterial resistance is the optimized use of antibiotics, including antibiotic prophylaxis in urodynamics. Establishing a standard procedure is necessary and purposeful to harmonize both aspects in the field of urological diagnostics.

First in Human Subjects Testing of the UroMonitor: A Catheter-free Wireless Ambulatory Bladder Pressure Monitor.

Urodynamics is the standard method of diagnosing bladder dysfunction, but involves catheters and retrograde bladder filling. With these artificial conditions, urodynamics cannot always reproduce patient complaints. We have developed a wireless, catheter-free intravesical pressure sensor, the UroMonitor, which enables catheter-free telemetric ambulatory bladder monitoring. The purpose of this study was twofold: to evaluate accuracy of UroMonitor pressure data, and assess safety and feasibility of use in humans. Eleven adult female patients undergoing urodynamics for overactive bladder symptoms were enrolled. After baseline urodynamics, the UroMonitor was transurethrally inserted into the bladder and position was confirmed cystoscopically. A second urodynamics was then performed with the UroMonitor simultaneously transmitting bladder pressure. Following removal of urodynamics catheters, the UroMonitor transmitted bladder pressure during ambulation and voiding in private. Visual analogue pain scales (0-5) were used to assess patient discomfort. The UroMonitor did not significantly alter capacity, sensation, or flow during urodynamics. The UroMonitor was also easily inserted and removed in all subjects. The UroMonitor reproduced bladder pressure, capturing 98% (85/87) of voiding and nonvoiding urodynamic events. All subjects voided with only the UroMonitor in place with low post-void residual volume. Median ambulatory pain score with the UroMonitor was rated 0 (0-2). There were no post-procedural infections or changes to voiding behavior. The UroMonitor is the first device to enable catheter-free telemetric ambulatory bladder pressure monitoring in humans. The UroMonitor appears safe and well tolerated, does not impede lower urinary tract function, and can reliably identify bladder events compared to urodynamics.

Possibilities of early diagnosis of localized prostate cancer in outpatient practice of a urologist at the regional level in the stavropol territory

Aim. To develop and implement an algorithm for early diagnosis of a localized form of prostate cancer based on the determination of the specificity of the prostate-specific antigen (PSA) marker in different age groups.Materials and methods. In the framework of a screening program for early detection of diseases of the urogenital system developed at the Stavropol Regional Clinical Specialized Uroandrological Center, middle-aged and elderly men were examined using the following characteristics: IPSS (International Prostate Symptom Score), serum PSA level, digital rectal exam, transrectal prostate ultrasound, urodynamic tests, as well as transrectal ultrasound-guided prostate biopsy in cases of elevated total PSA. The data (for 2010–2021) on the frequency of detection of localized prostate cancer depending on patient age (40–59 years, 60–69 years, ³70 years) and total PSA level were analyzed.Results. With an increase in total blood PSA &gt;4 ng/ml, there is a clear trend towards a decrease in the detection of benign prostatic hyperplasia and an increase in the detection of adenocarcinoma, which is confirmed by the data of histological examinations of biopsy specimens. In 81 % of cases, transrectal multifocal biopsy of the prostate gland (adenocarcinoma and prostatic intraepithelial neoplasia was detected) under transrectal ultrasound control is justified, including when PSA values are in the “gray zone”, which shows a rather high value of this method.Conclusion. Total serum PSA level is a readily available indicator for differential diagnosis of prostate diseases including detection of localized prostate cancer in out-patient conditions. The obtained data points at high specificity of this marker in men over 40 years old. Measurement of serum PSA level at the age of 40–49 years is necessary for early detection of oncological pathology. For total serum PSA level &gt;4 ng/mL, mandatory transrectal multifocal prostate biopsy is recommended at any age.

Sacral Tarlov cysts: Neurophysiology abnormalities and correlation with pelvic sensory and visceral symptoms.

Recent studies suggest a possible association between Tarlov cysts (TCs), usually considered as incidental radiological findings, and neurological symptoms such as pain, numbness and urogenital complaints. The aim was to explore the relationship between TCs and sacral nerve root functions using pelvic neurophysiology tests, and to correlate changes with clinical symptoms and magnetic resonance imaging (MRI) findings. Consecutive patients with sacral TCs, referred for pelvic neurophysiology testing and presenting with at least one symptom related to the pelvic area, participated in a cross-sectional review of symptoms using validated questionnaires. Findings of pelvic neurophysiology (pudendal sensory evoked potentials, sacral dermatomal sensory evoked potentials, external anal sphincter electromyography) and urodynamics testing were collected retrospectively. The relationship between neurophysiology, MRI findings and patients' symptoms was assessed using Fisher and ANOVA tests. Sixty-five females were included (mean age 51.2 ± 12.1 years). The commonest symptom was pain (92%). Urinary (91%), bowel (71%) and sexual (80%) symptoms were also frequently reported. Thirty-seven patients (57%) had abnormal neurophysiology findings reflecting sacral root dysfunction. No association was seen between MRI findings (size, location of the cysts, severity of compression) and neurophysiology. A negative association was observed between neurophysiology abnormalities and occurrence of urgency urinary incontinence (p = 0.03), detrusor overactivity (p < 0.01) and stress urinary incontinence (p = 0.04); however, there was no association with voiding difficulties. Contrary to current understanding, TCs are associated with injury to the sacral somatic innervation in the majority of patients with presumed symptomatic cysts. However, urinary incontinence is unlikely to be related to TC-induced nerve damage.