Uroflow Studies Research Articles

Combination of 180-W GreenLight XPS laser and bipolar transurethral resection of prostate for the treatment of large prostates beyond 100ml: a novel hybrid technique.

The aim of this study was to evaluate the safety and efficacy of the 180-W GreenLight laser (GL) XPS™ plus bipolar transurethral resection of the prostate (TURP) for the treatment of a prostate volume (PV) beyond 100ml. From January 2014 to December 2022, 79 patients with PV > 100ml who underwent GL-XPS plus bipolar TURP were enrolled. The median follow-up time was 13.7months. The International Prostate Symptom Score (IPSS), PV, uroflow study, post-void residual (PVR) volume, and prostate-specific antigen (PSA) before and after the operation were recorded. Subgroup analysis was performed to compare the outcomes between the patients with follow-up times of < 36months and > 36months. Statistically significant improvements in all the postoperative parameters were observed in both < 36months and > 36months groups. There was no blood transfusion or transurethral resection (TUR) syndrome in this series. Most of all, a second TURP was unnecessary during the follow-up. Only one (1.3%) Clavien-Dindo grade 3b complication was noted. The hybrid technique of 180-W XPS™ GreenLight laser plus bipolar TURP can be safely and efficiently performed on patients with a prostate volume of > 100ml.

Voiding efficiency in children is significantly impaired by the presence of the urethral catheter during pressure-flow studies

Little is known about the effect of catheterization during pressure-flow studies (PFS) on voiding efficiency in children. Our objective was to determine the effect of urethral catheterization on Qmax and flow index (FI) during PFS compared to the free flow of uroflowmetry (UF). We retrospectively reviewed 63 consecutive children who underwent UF and PFS at our center on the same day (2019-2022). Voiding data was available for 46 patients. Patients first underwent a UF with full bladder, then PFS after urethral catheter insertion. Patients with urethral pathologies (n=6), on clean intermittent catheterization (CIC) (n=2) and with major comorbidities (n=2) were excluded. Indications for UF/PFS were LUTS, recurrent UTIs, incontinence or neurosurgical pre-operative evaluation. Data was collected from the UF and the PFS and compared using paired t-test. The idealized Qmax and flow index (FI) were calculated for UF and PFS using the formulas described by Franco etal.: Male Qmax=11.26+0.0701(TBC [total bladder capacity])-0.0000513(TBC); Female Qmax=10.723+0.073(TBC)-0.0000423(TBC), FI=Actual Qmax/Expected Qmax (Franco and etal., 2016; Franco etal., 2018; Franco and etal., 2016). Median age was 7 years old (IQR 5-11). Twenty-one (40%) patients were male and 32 (60%) patients were female. Of the 53 patients, 3 boys and 4 girls (n=7; 13%) were unable to void with the catheter in place during PFS but able to void after its removal. Of the remaining 46 cases, the Qmax during PFS was 5mL/s slower than the Qmax recorded on the UF without catheter, representing a decrease of 29% (12.3 vs 17.3mL/s; p<0.0001). The impact of urethral catheter during PFS was more important in males vs females (Qmax decreased by 7.7 vs 3.3mL/s, or 45 vs 19%). The mean FI during PFS was 44%, which was a 30% reduction compared to the 74% FI obtained with UF (p<0.00001). In males, the FI decreased by 37% on PFS, whereas it decreased 26% in females, similar to the Qmax decrease. Voiding efficiency, as assessed by Qmax and FI, is decreased during PFS compared to uroflow studies. Our data documents for the first time the impact of urethral catheterization on pediatric voiding efficiency. Abnormal flow rates and elevated PVRs should be used to guide patient management only if obtained by uroflow. Prospective validation comparing free flow with PFS studies will help characterize the impact of urethral catheter relative to bladder pathology, age, gender and catheter size used.

Commentary to “Is it time to reconsider how we document pediatric uroflow studies?: A study from the SPU voiding dysfunction task force”

Commentary to “Is it time to reconsider how we document pediatric uroflow studies?: A study from the SPU voiding dysfunction task force”

Is it time to reconsider how we document pediatric uroflow studies?: A study from the SPU Voiding Dysfunction task force

Uroflowmetry is a non-invasive study used in the diagnosis and monitoring of treatment response for lower urinary tract disorders. For optimal clinical utility, uroflow studies rely on careful clinical interpretation by a trained provider, but currently there is a lack of accepted standardized normal values for the measured uroflow parameters in children. The International Children's Continence Society proposed standardizing the terminology for uroflow curve shapes. However, the patterning of curves is largely at the physician's subjective discretion. The aims of this study were to understand inter-rater reliability in interpreting uroflow curves and to define characteristics of uroflow curves that could be used to provide definitive criteria for uroflowmetry parameters. All members of the SPU Voiding dysfunction Task Force were invited to contribute deidentified uroflows to a centralized HIPAA complaint receiving database. All studies were then distributed to all raters for review. Each observer's findings were recorded according to ICCS criteria (ICCS), additional readings were done using a previously reported system which defined curves as smooth or fractionated (SF) and whether the shape resembled a bell, tower, or plateau (BTP). Flow indexes (Qact/Qest) (FI) for Qmax and Qavg were generated using formulas previously reported for children 4-12 and for patients≥12 years. A total of 119 uroflow studies were read by 7 raters and curves were contributed from 5 sites. Kappa scores for the 5 readers from different institutions were 0.34 and 0.28 for the ICCS and BTP methods, respectively (both considered fair agreement). Kappa for smooth and fractionated curves was 0.70 (for each; considered substantial agreement), which were the two highest agreement scores obtained throughout the study. Discriminant analysis (DA) revealed that the FI Qmax was the dominant vector, and that the ICCS uroflow parameters have a total of 42.8% prediction rate in the training sample. Using DA of a smooth/fractionated system, the total prediction rates were 72% and 65.5% for smooth and fractionated, respectively. Given the poor inter-rater agreement for analyzing uroflow curve pattern based on ICCS criteria in this study and others, one may find it reasonable to consider alternative approaches to describing and characterizing uroflow curves. Our study is limited by lack of EMG and post-void residual data. For a more objective uroflow interpretation and comparison of studies among different centers, we recommend using our proposed system (based on FI, and smooth vs. fractionated curve pattern), which is more reliable.

Toxicity and outcomes after external beam irradiation for prostate cancer in patients with prior holmium laser enucleation of the prostate: Early experience.

Holmium laser enucleation of the prostate (HoLEP) is commonly performed in patients with significant bladder outlet obstruction. However, there are few reports on the toxicity of external beam irradiation (RT) for prostate cancer in patients after prior HoLEP. In this study, we evaluate the side effects and treatment outcomes of RT after HoLEP. Eighteen patients who had HoLEP and subsequently received RT for prostate cancer were included. Data collected included patient and disease characteristics, urinary function, and radiation dose. Acute and late urinary (GU) and gastrointestinal (GI) side effects were evaluated. Disease control and survival rates were calculated using Kaplan-Meier method. Median follow-up was 18 months (range: 4-46 months). Median prostate volume was 107 ml before HoLEP and 24 ml after HoLEP. Median International Prostate Symptom Score (IPSS) was 17 (range: 5-32) before HoLEP. Median decline in IPSS score after HoLEP was 7 (range: -2-21). On uroflow study, peak flow rate, and post-void residual were significantly improved after HoLEP. After radiation, peak flow rate and average flow rate showed a decline but remained significantly improved compared to pre-HoLEP measurements. Maximum acute Common Terminology Criteria for Adverse Events (CTCAE) adverse events were 12 grade 1 and 3 grade 2 for GU, and 3 grade 1 for GI, respectively. Maximum late adverse events were 13 grade 1 and 2 grade 2 for GU, and all grade 0 for GI, respectively. At last follow-up, there were 8 grade 1 and 1 grade 2 late GU, and 3 grade 1 late GI adverse events, respectively. There was no significant increase in urinary incontinence after RT compared to before RT. The 18-month biochemical control, local control, distant control rates were 78%, 94%, and 80%, respectively. Patients who received RT as definitive treatment for prostate cancer after prior HoLEP had low risk of serious acute and late side effects. HoLEP can be safely performed and should be considered in patients with significant bladder outlet obstruction and large prostate volume before RT.

A Novel Noninvasive Topological Mathematical Nomogram for Diagnosing Male Bladder Outflow Obstruction

Currently the pressure–flow (P/Q) study is considered as the golden standard for diagnosing bladder outflow obstruction (BOO), with clear invasion. In this study we established a novel topological mathematical nomogram with noninvasive free uroflow metry for predicting BOO. Based on the Hill model of topological mathematics, the detrusor contractility (DC) and, the rates of detrusor contraction velocity variation (RDCVV) of the bladder were acquired. An RDCVV less than 0.2 were considered suitable for the DC/maximum uroflow (C/Q) study. A C/Q nomogram was established via 233 cases (22 unobstructed, 49 equivocal, and 162 obstructed according to an invasive pressure/ uroflow study) with an RDCVV less than 0.2. Moreover, the C/Q nomogram was verified with 522 suitable cases with RDCVV less than 0.2 (328 obstructed, 106 equivocal, and 88 unobstructed according to an invasive pressure/uroflow study). A C/Q nomogram was successfully established and verified that have a high precision. A novel topological mathematical C/Q nomogram with noninvasive free uroflowmetry was successfully established for predicting BOO in male, with relatively high accuracy.

The effects of antimuscarinic agents on the activity of the cardiac autonomic nervous system in children with functional overactive bladder

Functional overactive bladder disorder is one of the most prevalent presentations of bladder and bowel dysfunction in children, and it is associated with lower overall cardiac autonomic and parasympathetic activity. Antimuscarinics are the most frequently used pharmacological agents for treatment of children with functional overactive bladder disorder; however, there is a gap in the literature in describing the effect of antimuscarinics on the autonomic profile of this population. The aim of the study was to assess the cardiac parasympathetic activity before and after 12 weeks of oxybutynin treatment in children with overactive bladder. This was a single-institution prospective cohort study. Cardiac autonomic activity was assessed during storage and voiding phases of the bladder function via spectral analysis of heart rate variability and impedance cardiography. The primary outcome measure was high frequency, a proxy for parasympathetic nervous system activity. Parameters of uroflow study, severity of symptoms, and quality of life outcomes were also assessed. Ten children (7 females) diagnosed with overactive bladder with a median age of 10 years (range = 6-14) were followed up for a median treatment duration of 11.8 weeks (range = 6-19.4). After treatment, there was a significant reduction in high frequency during the storage phase (median change=-24.17%, p=0.047). No change was observed in the other outcome measures except for the overall Symptom Score for Dysfunctional Elimination Syndrome after treatment (5-point decrease, p=0.034) (Summary Table). The findings of the present follow-up study suggest that the use of oxybutynin in children with overactive bladder is associated with a significant reduction in the activity of the parasympathetic nervous system. The clinical implications of this finding are important because similar autonomic profiles (as markers of chronic stress) have been shown to be associated with increased inflammation and are found in major chronic diseases. The authors caution making a clinical connection between the heart rate variability profile of the patients in this study and patients with chronic diseases because oxybutynin is usually not administered as long-term treatment for overactive bladder. Use of oxybutynin was associated with reduction in cardiac parasympathetic activity of children with functional overactive bladder. Further investigation into the role of the autonomic nervous system as a treatment target in the management of these children is warranted.

Can a quantitative means be used to predict flow patterns: Agreement between visual inspection vs. flow index derived flow patterns

Uroflowmetry is a first-line tool in the evaluation of children with lower urinary tract symptoms. Unfortunately, there is a tremendous amount of intra- and interobserver variation in defining the shape of curves. Regrettably, one observer can see one flow as a tower and the other can call it a bell. Here lies the major flaw with the interpretation of uroflow shapes. Previously, we have shown that there is a good correlation between the calculated flow index (FI) and the shape of a flow curve (bell, tower and plateau) in normal children. Our hypothesis was to show that the FI-defined shapes were as good or better than the present system of grading flow curves. If so this would help remove subjectivity from the field of uroflow assessment and make studies objective and easily compared. Consecutive uroflows of children who were being evaluated for lower urinary tract symptoms from two centers were reviewed and compared alongside those of presumed normal voiders; the shape of the curves were read by the same experienced readers at each institution. Only curves that were read as bell, plateau, and tower were compared with the curve patterns derived from the quantitative methods derived by one of the authors. FI was derived by taking the actual Qmax/estimated Qmax. There were 591 males and 1039 females who had uroflow studies, of these 409 and 819, respectively were read as either bell, towers, or plateaus The highest kappa value for males was 0.71 (CI 0.64-0.79) using a 3×3 matrix indicating substantial agreement. In females the highest kappa was 0.52 (CI 0.46-0.59) in the group 2 patients using the receiver operating characteristic cutoffs but the 1 SD cutoff was close with a kappa value of 0.51, which indicates moderate agreement (Table). Using the FI method we saw that there was substantial to moderate agreement using a quantitative method to define flow shapes based on the kappa values that were obtained in this study. The one fundamental flaw with shape determination in both visual and FI-derived methods is that the cutoffs are arbitrary since the visual defined shapes are the basis for the FI shapes. Our findings clearly showed that a FI-derived method of defining shapes is as accurate as visual inspection or more depending on the study. The greatest disagreement occurs in those grey or transition zones between plateau, bell and tower. This system could be useful in removing much of the ambiguity and difficulty in reading flows.

High Rates of Inadequate Urine Volume Cause Failure of Clinic Based Uroflowmetry in Men with Lower Urinary Tract Symptoms

IntroductionClinic based uroflowmetry is commonly used in the diagnosis and management of lower urinary tract symptoms. AUA (American Urological Association) guidelines recommend 2 separate uroflowmetry tests with a voided volume greater than 150 ml for accurate interpretation. We characterized the interpretability of a series of uroflowmetry tests done at our institution and hypothesized that a significant number were noninterpretable because of inadequate urine volume. MethodsUroflowmetry results were collected from male patients at the UH (University of Utah Hospital) and VAMC (George Wahlen Veterans Affairs Medical Center) urology clinics between August 31, 2014 and September 30, 2014. Average time to perform uroflowmetry was determined. Tests with a volume of 150 ml or less were classified as noninterpretable. Data were characterized using descriptive statistics. ResultsDuring the study period 169 tests were collected, including 104 at UH and 65 at VAMC, of which 107 (63%) were noninterpretable. An estimated total of 1,452 tests were performed at UH and VAMC within a 12-month period. Average time to perform uroflowmetry by health care workers was 2 minutes 18 seconds. The estimated time loss per year for medical personnel due to noninterpretable uroflow studies was 35 hours. ConclusionsMore than 50% of clinic based uroflowmetry tests at our institution had a voided volume of 150 ml or less and were deemed noninterpretable per AUA guidelines. Current clinic based uroflowmetry testing strategies are inefficient and wasteful. Reliable, accurate alternatives to clinic based uroflowmetry for the diagnosis and management of lower urinary tract symptoms should be explored.

Single uroflow study as a tool in predicting the possibility of abnormal voiding symptoms after the administration of antimuscarinic agents in treating overactive bladder syndrome

The aim of this study was to evaluate the efficacy of uroflowmetry in predicting the possibility of abnormal voiding symptoms following antimuscarinic treatment for overactive bladder syndrome (OAB) in Taiwanese women.A retrospective study was conducted on women with OAB. Forty-five women with abnormal voiding patterns shown by urodynamic study comprised the main group and 38 women with normal voiding patterns comprised the control group. All patients were prescribed two mg tolterodine once daily for one week. Follow-up on complaints of abnormal voiding symptoms was done one week later.One woman in control group and 12 women in main group complained of abnormal voiding symptoms. There was a significant difference in the occurrence of abnormal voiding symptoms after antimuscarinic administration between main study group and control group (26.7 % vs 2.6 %, p = 0.02). CONCLUSIOn: Uroflowmetry is a non-invasive and simple tool to predict the occurrence of abnormal voiding symptoms after antimuscarinic use.

Tunneled Buccal Mucosa Tube Grafts for Repair of Proximal Hypospadias

Buccal mucosa is the favored graft material for patients with long urethral defects and a paucity of skin. Since 2007, we have used the novel tunneled buccal mucosa tube graft urethroplasty technique in these patients. We describe this operative technique and report our surgical and functional outcomes. Between 2007 and 2013, 37 males with proximal hypospadias underwent tunneled buccal mucosa tube graft urethroplasty. After the penile shaft was optimized at a prior stage a free buccal graft was tubularized and tunneled under the intact ventral shaft skin and into the glans. We retrospectively reviewed all charts to report our results. We assessed uroflowmetry and bladder ultrasound for post-void residual urine. The overall complications rate in 34 patients with more than 1-year followup was 32% (11), including fistula in 5, proximal stricture in 4 and meatal stenosis in 2. In the first 10 patients a total of 7 complications (70%) developed but there were only 4 complications in the next 24 (16%). Surgeon experience was the only significant predictor of complications (p = 0.003). We obtained uroflow and post-void residual urine data on 13 of 37 patients, of whom 9 achieved a normal flow pattern and post-void residual urine, and 4 had a blunted flow pattern. The novel technique of the tunneled buccal mucosa tube graft in patients with proximal hypospadias represents a good alternative for a long urethroplasty in patients with a paucity of skin. After the learning curve plateaus the rate and degree of complications decrease. Furthermore, voiding function is adequate, as assessed by uroflow studies and post-void residual urine measurement.

ONE-YEAR EVALUATION OF OVERALL URETHRAL STRICTURE MANAGEMENT USING QUESTIONNAIRES AND UROFLOWMETRY

Objective: To evaluate the overall outcomes of patients who get definitive treatment of urethral stricture. Material &amp; Method: All patients who underwent various urethral stricture management in Cipto Mangunkusumo Hospital were evaluated over 1 year period. Patient demographics, type of surgery, International Prostate Symptoms Score (IPSS), quality of life (QoL) score, flow rate (FR) and post void residual urine (PVR) of all patients were evaluated at 3 months, 6 months and 1 year after surgery. Results: Out of 230 urethral stricture patients, 65 patients were eligible this study. Mean patient age was 41.19 ± 20.44 years. 37Direct Vision Internal Urethrotomy (DVIU), 20 end-to-end anastomosis, and 8 graft urethroplasties were performed. All patients underwent urethral stricture management showed improvement of IPSS (-22.64, p &lt; 0.001), QoL (-3.36, p &lt; 0.001), FR (16.72 ml/s, p &lt; 0.001) and PVR (-126.23 ml, p &lt; 0.001). Compliant patients showed better improvement of IPSS and FR than non compliant patient after DVIU procedure. Overall, open surgery give better improvement of IPSS and FR than DVIU procedure. These differences were more pronounced in recurrent and long (≥ 2 cm) urethral stricture disease. In open surgery group, end-to-end anastomosis give better improvement in FR compared to graft urethroplasty. Conclusion: Patients undergoing urethral stricture management experienced a significant improvement in self-reported outcomes and functional uroflow studies. Overall, open surgery gives better improvement in FR and IPSS than DVIU procedure. In open surgery group, end-to-end anastomosis give better improvement compares to graft urethroplasty.Keywords: International Prostate Symptoms Score, quality of life, flow rate, post void residual urine, urethral stricture.

Analysis of uroflow patterns in children with dysfunctional voiding

ObjectiveAlthough a staccato uroflow pattern is considered representative of dysfunctional voiding (DV), we recently found that only a third of children with staccato flow had an active pelvic floor electromyography (EMG) during voiding. Here, we analyzed the reverse, that is, how often a staccato flow pattern occurs in children with documented DV. In addition, we reviewed what other flow patterns are prevalent in this condition. Materials and methodsWe reviewed our LUT dysfunction registry for children with EMG-confirmed DV. Uroflow patterns were categorized as staccato, interrupted, mixed (i.e., staccato and interrupted patterns), or grossly normal. ResultsOf 596 children who underwent a uroflow/EMG examination, 121 had an active pelvic floor EMG during voiding, that is a finding consistent with the diagnosis of DV. The flow patterns identified in those diagnosed with DV were staccato in 70 (58%), interrupted in 22 (19%), mixed in 12 (10%), and a bell-shaped or depressed curve in 17 (14%). Staccato pattern became normal in 96% following successful treatment with biofeedback. ConclusionsWhile a staccato uroflow pattern was the most common pattern seen in children diagnosed with DV by a uroflow/EMG, nearly a third had an interrupted or mixed flow pattern underscoring the importance of performing simultaneous pelvic floor EMG during a uroflow study, especially when trying to rule out DV. Failure of the staccato flow pattern to normalize after therapy strongly suggests either inadequate therapy or an incorrect diagnosis.

Single-stage repair of hypospadias using longitudinal dorsal island flap: Single-surgeon experience with 102 cases

Purpose:There are many techniques of harvesting vascularized skin flaps from penile skin for hypospadias repairs. Here, we review our experience with the use of longitudinal dorsal island flap (LDIF) for mid- and proximal hypospadias repairs and to assess the results and complications of onlay and tubularized repairs.Materials and Methods:We retrospectively reviewed the data of all children with hypospadias operated by a single surgeon using the LDIF technique. The severity of hypospadias, technique, complications, and follow-up were assessed.Results:Over a 9.4-year period, 102 children (mean age 4.2 years, range 6 months to 11 years) were operated for primary hypospadias using the LDIF technique. All children had poorly formed urethral plates and hence were considered unsuitable for tubularized incised plate repair. The hypospadias was classified as midpenile, proximal penile/penoscrotal or perineal in 29, 64, and 9 children respectively. Onlay LDIF repair was done in 85 children, while in 17 children, tubularized LDIF repair was performed. At a mean follow-up of 1.8 years, complications occurred in 12 (12%) children. Complications were more common after tubularized repairs than onlay repairs (24% vs. 9.5%). All glans dehiscences occurred after onlay repairs, while meatal stenosis and diverticulum occurred after tubularized repairs. No child had urethral stenosis after onlay repair, and uroflow studies in 16 children demonstrated normal curves and flow rates.Conclusions:We report the use of LDIF for single-stage mid and proximal hypospadias repair with good success and an acceptable complication rate. Onlay repairs had fewer complications than tubularized repairs. Our results indicate that the specific advantages and versatility of LDIF make it a good option to consider in cases of hypospadias with poorly developed urethral plates where onlay or substitution urethroplasty is indicated.

Overactive bladder (OAB) and its association with prostatic parameters

Background Overactive bladder (OAB) is an idiopathic condition characterized by urgency with or without urge incontinence often associated with frequency or nocturia. In this study, we hypothesized that prostatic parameters might be responsible for symptoms seen in OAB patients. Methods This is a cross-sectional study involving 1007 men ≥40 years old; with a response rate of 53.6%. Face-to-face interviews were carried out with semi-structured questionnaires which included socio-demography, self reported medical illness and an OAB questionnaire using a 6-point Likert scale. OAB was defined as ‘quite a bit’ to ‘a very great deal’ in either questions: “An uncomfortable urge to urinate”, “A sudden urge to urinate with little or no warning”, “An uncontrollable urge to urinate” and “Urine loss associated with a strong desire to urinate”. Prostatic parameters were assessed using transrectal ultrasound, International Prostate Symptom Score (IPSS) questionnaire, urinalysis and uroflow studies. Results Results from 537 men with a mean age of 58.2±8.1 years were analysed. The prevalence of OAB was 16.9% (n = 91). The prevalence of lower urinary tract symptoms or LUTS (IPSS moderate-severe) was 36.1% (n = 195). Men with OAB were significantly more likely to score worse on IPSS (OAB: 30%, non-OAB: 4.7%, p≤0.001) (mild-moderate VS severe). Prostate calcification (OAB: 70.3%, non-OAB: 58.4%, p = 0.035), prostate volume (≥30cc) (OAB: 35.2%, non-OAB: 19.5%, p = 0.002), and urine white cell count or WCC (>5WCC/μL) (OAB: 5.5%, non-OAB: 1.3%, p = 0.025) were significantly associated with OAB. Multivariate regression analysis revealed that men with severe LUTS (p ≤ 0.001, OR: 6.7, CI 95%: 3.4–13.4) and prostate volume ≥30cc (p = 0.07, OR: 2.0, CI 95%: 1.2–3.4) were independently associated with OAB. Conclusions OAB was significantly associated with prostate calcification, larger prostate volume (≥30cc) and urinary WCC (>5WCC/μL). However, only severe LUTS and prostate volume ≥30cc were independently associated with OAB.

Bladder Outlet Obstruction due to an Unusual Prostatic Midline Cyst in an Adolescent Male

Most prostatic midline cysts, i.e., Müllerian duct cysts or prostatic utricular cysts, probably result from incomplete regression of the Müllerian duct remnant. Congenital cysts may be associated with other urogenital anomalies. Related symptoms include bladder outlet obstruction, hemospermia, ejaculatory-fertility impairment, and recurrent epididymitis. We report an adolescent male who presented with difficulty urinating that lasted for 2 months. After a complete survey with a urodynamic study, ultrasonography, urethrography, urethrocystoscopy, and computed tomography, a prostatic midline cyst with bladder outlet obstruction was identified. Using transurethral cyst unroofing, urination conditions improved according to the International Prostate Symptom Score and a uroflow study. Although there are various surgical interventions for a prostatic midline cyst near the urethra, endoscopic procedures are a safe and elegant alternative compared with other procedures.

Lower urinary tract symptoms and erectile dysfunction associated with depression among Japanese patients with late-onset hypogonadism symptoms

The aim of this study was to investigate the relation between lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and depression in Japanese patients with late-onset hypogonadism (LOH) symptoms. The study comprised 87 Japanese patients with LOH symptoms (>27 points on the Aging Males Symptoms Scale). Thirty-four patients were diagnosed as having depression and the remaining 53 patients were diagnosed as not having depression by the Mini International Neuropsychiatric Interview. We compared the International Index of Erectile Function (IIEF) 5, International Prostate Symptom Score (IPSS), IPSS quality-of-life (QOL) index, King's Health Questionnaire (KHQ), endocrinological data, and free uroflow study between depression and non-depression patients and performed multiple logistic regression analysis. IIEF5 scores of depression patients were significantly lower than those of non-depression patients. In KHQ, only the category of general health perceptions was significantly higher in depression patients than non-depression patients. However, IPSS, QOL index, and endocrinological and uroflowmetric data showed no significant difference between the groups. Multiple logistic regression analysis revealed moderate and severe ED to be risk factors for depression. However, LUTS are not related to depression. Moderate and severe ED is correlated with depression, whereas LUTS are not related to depression in Japanese LOH patients.

Reduction of Prostate-specific Antigen After Tamsulosin Treatment in Patients With Elevated Prostate-specific Antigen and Lower Urinary Tract Symptoms Associated With Low Incidence of Prostate Cancer at Biopsy

To evaluate the effect of tamsulosin on reducing the serum levels of prostate-specific antigen (PSA) in patients with lower urinary tract symptoms and an elevated PSA level. From June 2004 to July 2006, patients with lower urinary tract symptoms, a PSA level of >or=4 ng/mL, and a maximal flow rate of <15 mL/s received tamsulosin 0.4 mg daily for 2 months. They were then scheduled for 12-core prostate biopsy. PSA determination and a uroflow study were performed before biopsy. A total of 80 patients completed the present study. The mean patient age was 66.3 years, and the mean PSA level was 7.8 +/- 8.4 ng/mL at baseline and 7.1 +/- 9.1 ng/mL after treatment (P < .001). A total of 29 patients (36.25%) were diagnosed with prostate cancer from the biopsy findings. A significant increment in the PSA level was observed in patients with prostate cancer (6.7 versus 7.9 ng/mL; P = .002). A significant decrease in the PSA level was observed in patients with negative biopsy findings (6.9 versus 5.1 ng/mL, P = .000). Of the 38 patients with a decrease in the PSA level, 1 (2.6%) was diagnosed with prostate cancer and 37 (97.4%) with an benign prostatic hyperplasia/prostatitis. Of the 42 patients with no change in the PSA level, 28 (66.7%) had prostate cancer and 14 (33.3%) had negative findings. A change in PSA level after treatment gave a sensitivity of 96.6%, specificity of 72.5%, and diagnostic accuracy of 81% for prostate cancer. Treatment with tamsulosin seemed to reduce the PSA levels and identified patients at high risk of prostate cancer.

528 THE UTILITY OF UROFLOWMETRY IN THE LONG-TERM FOLLOW UP OF DISTAL HYPOSPADIAS REPAIR

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia1 Apr 2010528 THE UTILITY OF UROFLOWMETRY IN THE LONG-TERM FOLLOW UP OF DISTAL HYPOSPADIAS REPAIR Richard Ashley, Ahmed BaniHani, Julia Barthold, and T. Ernesto Figueroa Richard AshleyRichard Ashley More articles by this author , Ahmed BaniHaniAhmed BaniHani More articles by this author , Julia BartholdJulia Barthold More articles by this author , and T. Ernesto FigueroaT. Ernesto Figueroa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.727AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Uroflowmetry has been utilized as an objective measure of successful distal hypospadias repair. However, no guidelines exist for how to use uroflow data in order to identify those patients who need repeat intervention. We sought to determine if this test could be used as a predictive tool for which patients would require a repeat operation. METHODS A retrospective chart review was conducted to identify patients with at least 36 months of follow-up after distal hypospadias repair. Additional inclusion criteria included successful potty-training and one complete uroflow study with post-void residual. Uroflow parameters for each child were compared to the previously published Miskolc nomograms. Univariate and multivariate analyses were performed to determine factors associated with the need for repeat intervention with p<0.05 considered significant RESULTS A total of 329 patients underwent distal hypospadias repair from 2000-2006. 107 patients met inclusion criteria for the study and had median follow-up of 63 months (range 36-146mo). The median age at surgery was 7mo (range 3-149mo) and median age at post-operative uroflow was 5.7y (range 3-17yr). Several hypospadias repair techniques were utilized: tubular incised plate (TIP, 12/107, 11%), Theirsh-Duplay (TD, 44/107, 41%), Mathieu (Ma, 31/107, 29%), sleeve advancement (SA, 11/107, 10%), MAGPI (M, 9/107, 8%). When the entire cohort was analyzed and the Qmax was compared to the published norms on the Miskolc nomograms, 38% (41/107) of the patients had Qmax below the 5th percentile. However, only 13% (14/107) of the cohort had elevated post void residual (PVR, >10% of the voided volume). A total of 26% (28/107) of the cohort required repeat intraoperative intervention and assessment. Multiple preoperative factors and postoperative parameters were analyzed to determine if they predicted need for repeat intervention. No urodynamic parameter (Qmax, voided volume, PVR, or shape of uroflow curve) could successfully predict the need for repeat urethral intervention after multivariate analysis. However, the presence of symptoms at follow-up (dysuria, stranguria, etc.) and the subjective assessment of a stenotic meatus successfully predicted the need for repeat intervention (OR = 6 and OR = 7, both p<0.001, respectively) CONCLUSIONS Uroflow parameters did not assist in determining which patients required repeat intervention. History and physical exam findings were more important in identifying patients who required intraoperative assessment and possible intervention Wilmington, DE© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e208-e209 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Richard Ashley More articles by this author Ahmed BaniHani More articles by this author Julia Barthold More articles by this author T. Ernesto Figueroa More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Primary Bladder Neck Dysfunction in Children and Adolescents III: Results of Long-Term α-Blocker Therapy

Primary bladder neck dysfunction is a nonneurogenic voiding disorder frequently overlooked in pediatrics. The diagnosis classically is made by videourodynamics but can also be made with noninvasive uroflow studies with pelvic floor electromyography. We report our long-term results using alpha-blocker therapy in patients with primary bladder neck dysfunction. We reviewed 51 neurologically normal children (mean age 11.6 years, range 3.5 to 17.8) meeting criteria for primary bladder neck dysfunction who underwent alpha-blocker therapy for at least 1 year. All patients were symptomatic with abnormal flow parameters and an electromyogram lag time of 6 seconds or more on initial uroflow/electromyography. Pretreatment and on-treatment uroflow/electromyogram studies were performed in all patients. Average and maximum uroflow rates, electromyogram lag times and post-void residual volumes were compared. After a mean followup of 46.2 months (range 12 to 124) mean average and maximum uroflow rates improved from 7.0 to 12.4 cc per second and from 12.4 to 20.3 cc per second, respectively, while mean electromyogram lag time decreased from 30.8 to 5.8 seconds (all p <0.01). Of the patients 85% reported subjective symptomatic relief. A total of 15 patients (29%) stopped alpha-blocker therapy for various reasons, none related to side effects. Repeat off-treatment uroflow/electromyogram studies showed that measured parameters reverted to pretreatment values (all p <0.05). Eight of these 15 patients eventually resumed alpha-blocker therapy, while only 3 remained asymptomatic off of the alpha-blocker. alpha-Blocker therapy continues to benefit children with primary bladder neck dysfunction even after 3 years of treatment. Few patients can come off of alpha-blocker therapy without returning to their pretreatment state, suggesting the condition is likely chronic in most patients.