Uroflowmetric Data Research Articles

Safety and effectivity of open simple prostatectomy in octogenarians: A single center experience

Objective: This study aimed to investigate the safety and effectiveness of open simple prostatectomy (OSP) in patients older than 80 (i.e., octogenarians). Materials and Methods: Patients who underwent OSP in our center between January 2012 and January 2018 constituted this study's target population. The patients were evaluated by dividing the entire cohort into three age groups: 50-64, 65-79, and ≥80. The study groups were compared regarding demographic features, preoperative clinical data, operative parameters, postoperative first-month and third-month uroflowmetric data, and short-term complication rates. Results: Preoperative persistent acute urinary retention and urethral catheterization rates were significantly higher in octogenarians than in the other patients. The groups were similar concerning intraoperative estimated blood loss, blood transfusion, Clavien-Dindo Class≥3 complication rates and the general complication rate statistically. The comparative analysis revealed that the duration of catheterization was significantly longer in Group 2 and 3 than Group 1 (p=<0.001). The length of hospital stay was also significantly higher in octogenarians than the patients in Group 1 (p=0.003). Conclusion: Although OSP is an effective and safe surgical treatment method in octogenarians, each patient should be managed by an individualized approach for lowering the procedure-related morbidity and mortality rates. Keywords: Benign prostatic hyperplasia, Open simple prostatectomy, Octogenarians

Use of Nordic walking in the complex treatment of lower urinary tract symptoms in chronic prostatitis

Lower urinary tract symptoms (LUTS) caused by chronic prostatitis (CP) are a common condition. Standard antibiotic therapy is often not justified, since bacterial prostatitis is presented in up to 10% of the cases, while there is no effect on the risk factors for the development and relapse of the disease. This study is aimed at one of the main risk factors for LUTS - a sedentary lifestyle. To increase the effectiveness of treatment for LUTS in men using the Nordic Walking technique. 84 patients with CP were examined, which were divided into 3 groups. The 1st group (control) included 32 patients who received standard antibacterial therapy. In the 2nd group (primary) - 32 patients who received complex therapy (antibiotic therapy + 4-week course of Nordic walking). The third group (comparison) included 20 patients who were prescribed monotherapy - Nordic walking for 4 weeks. The dynamics of clinical manifestations was assessed using CP Symptom Scale (NIH-CPSI) and the international symptom index for diseases of the prostate IPSS; the volume of residual urine, uroflowmetric data, and the level of leukocytes in the secretion of the prostate gland were estimated. Laboratory studies showed a significantly faster decrease in the number of leukocytes in the secretion of the prostate gland on the 7th and 14th day in the primary (2nd) group (p<0.001). Clinical symptoms according to the NIH-CPSI and IPSS scales significantly regressed in the primary group on the 14th and 28th days of therapy. Uroflowmetric data and the volume of residual urine improved more significantly in the primary group by the 14th and 28th days. Patients receiving combined therapy showed significantly better treatment results in the form of faster normalization of prostate secretion, regression of clinical symptoms, improved urine flow rate and a decrease in residual urine volume after 4 weeks of therapy. When choosing management algorithm for patients with LUTS, it is advisable to use an integrated approach: in addition to antibiotic therapy, Nordic walking is recommended 3 times a week for at least 4 weeks.

Effects of an EP2 and EP3 Receptor Dual Agonist, ONO-8055, on a Radical Hysterectomy-Induced Underactive Bladder Model in Monkeys.

The objective was to develop an underactive bladder (UAB) model in primates and to evaluate the potential of prostanoid EP2 and EP3 receptor dual agonist ONO-8055 to become a therapeutic agent for UAB. A surgical procedure resembling radical hysterectomy was performed on female cynomolgus monkeys. Subsequently, in vitro muscle strip studies were performed using bladder muscle strips from normal monkeys and monkeys that underwent surgery. In addition, uroflowmetric data were obtained at specified days after the surgery. To evaluate the effects of ONO-8055 and distigmine (DIS) on voiding function in the UAB monkey model, uroflowmetry was performed approximately 1 week after the surgery, before and after the cumulative intravenous administration of the compounds at 2 h intervals. In the bladder muscle strip studies, the responses to potassium chloride at 2 months, and carbachol and electrical field stimulation from 2 weeks decreased significantly. Voided volume (VV), maximum flow rate (Qmax), and average flow rate (Qave) decreased after surgery, while voiding time (VT) increased. In this model, ONO-8055 and DIS significantly increased VV and Qmax. DIS prolonged VT, while ONO-8055 had no effect. The results also showed that ONO-8055 increased Qave. We developed a neurogenic UAB model in primates. As ONO-8055 improved voiding function in this model to at least the same degree as DIS, this EP2 and EP3 receptor dual agonist has the potential to be a candidate for neurogenic UAB pharmacotherapy.

The prostatic urethra as a Venturi effect urine-jet pump to drain prostatic fluid

Several experiments show that prostatic fluid is continuously produced and it is drained from the prostate during urination and ejaculation. The mechanism which causes prostatic fluid to drain from the prostatic acini during urination is currently unclear. Also in current opinion such structures of the prostatic urethra as the urethral crest and the colliculus seminalis have no apparent functional significance. This article describes a mechanism for the draining of the prostatic acini that involves these prostatic urethral structures. It is hypothesized that the prostatic urethra works as a pump using the Venturi effect, in which urine is the carrying or motive liquid during voiding, in order to drain prostatic fluid (the carried liquid) from the acini. The urethral crest and the colliculus seminalis take part in controlling flow rates and liquid pressures for this pump to be effective. The calculated estimation of a pressure drop in the region of the colliculus seminalis during micturition was obtained using morphometric and uroflowmetric data and was used to confirm this hypothesis of prostatic acini drainage. As a consequence of this, a previously unknown function for these intra-prostatic urethral structures is described.

Uroflowmetry in a Large Population of Brazilian Men Submitted to a health check up program and its correlation with ipss and prostate size

The aim of this study was to assess the uroflowmetry data in a large population of asymptomatic Brazilian men submitted to a health check up program and their correlation to IPSS and prostate size. Asymptomatic men underwent a health check-up program between January and December 2012. The inclusion criteria were men between 40 and 70 years, IPSS ≤ 7, without bladder, prostate, urethral surgery, neurological diseases, urinary tract infection, PSA < 4.0 ng/dL and urinary volume higher than 150 mL. Urological assessment consisted of clinical history, IPSS, digital rectal examination (DRE), prostate specific antigen (PSA), urinalysis, ultrasonography and uroflowmetry. A total of 1041 asymptomatic men were included in this study. The average age was 49 years and average maximum flow rate was 17.4 mL/s. In spite of IPSS and prostate size increase with aging, they had a weak correlation with Qmax cutoffs (10 mL/s and 15 mL/s). A total of 85 men (8.3%) had more than 60 years, and even in this group, Qmax was higher than 15 mL/s. Out of 1041 men, 117 had IPSS less than 8 and Qmax less than 10 mL/s. In asymptomatic men there is a weak correlation between IPSS, prostate size and uroflowmetric data. The establishment of different normal cutoffs seems to be complicated and uroflowmetry data should be interpreted with caution in order to avoid misdiagnosis.

2273 STANDARDIZED INTERPRETATION OF UROFLOWMETRIC PARAMETERS RESULTS IN HIGH INTER-OBSERVER CONCORDANCE AND OBSERVATIONAL REPRODUCIBILITY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamics Testing1 Apr 20132273 STANDARDIZED INTERPRETATION OF UROFLOWMETRIC PARAMETERS RESULTS IN HIGH INTER-OBSERVER CONCORDANCE AND OBSERVATIONAL REPRODUCIBILITY Diane B. Young, Edwin E. Morales, Xiayou Shi, and Stephen R. Kraus Diane B. YoungDiane B. Young San Antonio, TX More articles by this author , Edwin E. MoralesEdwin E. Morales San Antonio, TX More articles by this author , Xiayou ShiXiayou Shi San Antonio, TX More articles by this author , and Stephen R. KrausStephen R. Kraus San Antonio, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2202AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The International Continence Society (ICS) established its “Good Urodynamics Practices” and “Standardization of Terminology of Lower Urinary Tract Function” guidelines in 2002; both of these provided for standardized descriptive terminology for urodynamic studies. While interpretative reproducibility of other urodynamic components have been studied, a scientific assessment of the reproducibility of uroflowmetry interpretation has, to our knowledge, not been performed. The aim of this study was to determine whether use of these standardized criteria resulted in concordance and reproducibility between two separate observers. METHODS Utilizing the ICS 2002 definitions for the standardization of Lower Urinary Tract Symptoms (LUTS), uroflowmetric data sets from 67 different females who originally presented with stress incontinence were evaluated by two separate blinded urodynamicists using the following criteria: urine flow pattern, maximum and mean flow rates, time to maximum flow rate, voided volume, and post-void residual volume (PVR). Description of uroflow pattern was standardized using ICS terminology and could only be categorized as continuous, intermittent, or fluctuating. Patients were excluded if uroflow voided volume was below 150 ml or if any of the reported criteria were missing. Data was analyzed for the Pearson correlation coefficient (CC) and the free-marginal kappa coefficient. Agreement for continuous numerical variables was pre-defined as a Pearson CC greater than 0.6. For qualitative values, the kappa statistic was pre-defined successful if also greater than 0.6. RESULTS The Pearson CC for each continuous variable and the kappa interobserver variability for the categorical variable of uroflowmetric flow pattern are reported below. The ICS uroflowmetric criteria demonstrated substantial inter-observer concordance with respect to flow pattern. The Pearson CC for the five independent variables show very high correlation. CONCLUSIONS Using ICS definitions and standardized terminology, our study demonstrates that interpretation of office uroflowmetry can be highly reproducible between clinicians and serve to guide collaboration between urologists and pelvic floor practitioners without reproduction of costly studies. Correlation Between Observers for Specific Uroflowmetric Parameters Uroflowmetric Parameter Pearson Correlation Coefficient / Weighted Kappa Value 95% Confidence Interval p-Value Maximum Flow Rate 0.9972 ±.0028 < .0001 Average Flow Rate 0.9996 ±.0003 < .0001 Time to Maximum Flow 0.9999 ±.00004 < .0001 Voided Volume 0.9959 ±.0041 < .0001 Post-Void Residual 0.9996 ±.0004 < .0001 Flow Pattern Classification 0.7357 ±.2755 < .0001 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e932 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Diane B. Young San Antonio, TX More articles by this author Edwin E. Morales San Antonio, TX More articles by this author Xiayou Shi San Antonio, TX More articles by this author Stephen R. Kraus San Antonio, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urinating in the Standing Position: A Feasible Alternative for Elderly Women With Knee Osteoarthritis

Urinating while standing is a possible alternative for elderly women with knee osteoarthritis when a sitting toilet is unavailable. We evaluated uroflowmetric characteristics and post-void residual urine volume in elderly women with knee osteoarthritis who urinated while standing. We recruited 21 women with a mean±SD age of 65.0±4.6 years who had a knee osteoarthritis Lequesne index score of at least 6 points and were unable to maintain or found it difficult to stand up from a squat or crouch. Participants used a homemade auxiliary appliance to collect urine and drain it forward while stand voiding. Uroflowmetric data, including voided volume, and maximal and average flow rates, were recorded. Post-void residual urine volume was detected using an ultrasound bladder scanner. Participants completed a questionnaire to evaluate their attitude toward stand voiding and using the auxiliary device. Maximal and average flow rates, and voided and post-void residual urine volumes were not statistically different while sitting and standing. No learning curve was noted for stand voiding. Uroflowmetry patterns while standing were smooth. Of the 21 participants 17 (81%) experienced no difficulty while stand voiding. All expressed willingness to urinate while standing position if they did not have access to a satisfactorily clean toilet seat. Urinating while standing is a feasible option for elderly women with knee osteoarthritis who have difficulty crouching or squatting to void in public restrooms.

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.

A new approach to urinary system dynamics problems: Evaluation and classification of uroflowmeter signals using artificial neural networks

Uroflowmetry is a measuring method, which provides numerical and graphical information about patient’s lower urinary tract dynamics by measuring and plotting the rate of change in urine volume. The main purpose of this study is to analyze the uroflowmetric data and to assist physicians for their diagnosis. An expert pre-diagnosis system is implemented for automatically evaluating possible symptoms from the uroflow signals. The system uses artificial neural networks (ANN) and produces a pre-diagnostic result. The outputs of ANN are classified into three groups, which are, “healthy”, “possible pathologic” and “pathologic”. The ANN is trained using back-propagation method and the inputs of the ANN are the extracted features, which are selected according to the suggestions of urology specialists. The proposed system is trained and validated using a dataset of patients, who have already diagnosed by the specialists.

Safety, Efficacy and Impact on Patients’ Quality of Life of a Long–Term Treatment with the α1–Blocker Alfuzosin in Symptomatic Patients with BPH

Objective: The aim of this study was to assess the impact of a 12–month treatment period with alfuzosin, 2.5 mg t.i.d, on symptomatic patients with BPH (n = 355) by means of the International Prostate Symptom Score (I–PSS), the Symptom Problem Index (SPI), the BPH Impact Index (BII), and the single Quality of Life (QoL) question proposed by the WHO.Study Design: This was a naturalistic study, carried out under conditions of normal practice by 22 centres of urology.Methods: At baseline and on a quarterly basis up to 12 months of treatment, subjective and objective (uroflowmetry and residual urine volume) responses of the patients were evaluated. The appearance of adverse medical events (AMEs) was carefully monitored and recorded throughout the trial.Results: Both the BII and the Qol question improved gradually over time (60 and 54.6%, respectively, after 12 months of treatment). At any visits, the improvements were statistically significant versus the baseline (p<0.01). Alfuzosin was able to improve the BPH symptoms progressively and significantly over time: total mean score I–PSS: 3rd month = 22.7%, 6th month = 38.4%, 9th month 0.50%, 12th month = 61.6%. The improvement was more marked in patients with severe symptoms at baseline (I–PSS score 20–35, 63.6%). A progressive and marked improvement over time of the problems due to symptoms (SPI) was observed in the whole population (61.7% after 12 months of treatment). After 12 months of treatment, uroflowmetric data showed a significant increase in peak (+5.5 ml/s) flow rate, associated with a marked decrease in residual volume: –31 ml (–53.5%). Twenty–five patients (7.1%) experienced one or more AMEs (total AMEs n = 44). Globally, 14 vasodilatory events and 30 non–vasodilatory events were reported. Fifteen (4.3%) patients dropped out prematurely from the study for safety reasons. Seven serious AMEs were reported during the study period.Conclusions: This study showed that long–term treatment with alfuzosin in usual clinical practice had a continued and positive impact on the patients’ QoL.