Uroflowmetry Research Articles

Clinical observation of male bulbar urethral strictures resulting from straddle injuries associated with falling from heights and riding activities

ObjectivesTo retrospectively investigate and analyze the characteristics of male bulbar urethral strictures or occlusions resulting from straddle injuries caused by falling from heights and riding activities.MethodsThe study included 56 patients with a history of straddle injury, who were divided into two groups: the falling group (n = 29) and the riding group (n = 27). All patients underwent urethroscopy and X-ray urethrography, followed by urethrotomy and anastomotic procedure. Both urethral and suprapubic catheters were retained for one month postoperatively. Subsequent follow-up assessments were conducted within one month to one year after surgery.ResultsThe clinical data of two groups were analyzed. The average ages were 40.1 ± 11.2 (falling group, aged 18–59) and 26.8 ± 4.4 (riding group, aged 19–35), P < 0.05. In the falling group, 21 cases (72.4%) had offspring, while in the riding group, only 3 cases (11.1%) had offspring, P < 0.05. The stricture segments in the falling group were predominantly located in the proximal part of the bulbar region (89.7%), whereas in the riding group they mainly found in the distal part (96.3%), P < 0.05. In terms of urethrography results, the average lengths of stricture segments were measured as 17.6 ± 2.8 mm and 15.5 ± 4.6 mm respectively, P < 0.05. During surgery, the average lengths of stricture segments were recorded as 19.0 ± 2.5 mm and 17.4 ± 6.1 mm, P > 0.05. In the falling group, 20 cases (69.0%) involved bulbocavernosus muscle injury, P < 0.05. In the riding group, 5 cases (18.5%) involved corpus cavernosum injury, P < 0.05. After one month of the operation, all cases were able to pass through the 16Fr urethroscope without any apparent urethral strictures or complications observed in urethrography results. The maximum urinary flow rate for all cases exceeded 15 ml/s. Two months and one year after the operation, all cases experienced smooth urinary flow and ejaculation without any disorders reported. 3 cases (10.3%) in the falling group and 7 cases (25.9%) in the riding group complained of urethral stretching pain during erection, P > 0.05.ConclusionsMale bulbar urethral strictures or occlusions resulting from straddle injuries associated with falling from heights and riding activities exhibit distinct characteristics, necessitating the development of a comprehensive surgical plan tailored to the specific features of each condition and the diverse age groups affected.

Role of urine glycosaminoglycan levels in the diagnosis and follow-up in men with lower urinary tract symptoms.

The aim of this study was to investigate whether urinary glycosaminoglycans (GAG) levels reflect clinical status in men with lower urinary tract symptoms and if they could be used as a marker in management of overactive bladder (OAB). A total of 34 patients were recruited who were admitted with LUTS and diagnosed as having clinically bladder outlet obstruction (BOO) due to prostate enlargement. These newly diagnosed, never treated patients underwent routine investigation, consisting of history, physical examination, PSA, ultrasound, uroflowmetry, assessment of symptoms scored by both International Prostate Symptom Score (IPSS) and Marmara- Overactive Bladder Questionnaire (M-OBQ). The patients were divided into two groups as those with an initial M-OBQ score < 12 (group 1) and ≥ 13 (group 2). Alfa blocker was initiated in eligible patients. Further evaluations included prostate volume measurement, pre- and post-treatment urinary GAG levels, IPSS and M-QAOB values and maximum urine flow rate (Qmax). Before treatment, urinary GAG level was 21.5 mg/gCr (6.1-45.5) in Group 1, and 23.35 mg/gCr (15.6-32.6) in Group 2 (p =0.845). After the treatment, the GAG level in Group 1 and Group 2 were found to be 19.8 mg/gCr (7.4-70.5) and 18 (7.6- 41.7), respectively (p = 0.511). No difference in GAG levels was found in subgroup analysis for patients with or without OAB. In recent years, there have been many studies investigating the relationship between LUTS and urinary markers. However, in our prospective study, no relationship was found between pre- and post- treatment urinary GAG levels in patients with LUTS with or without OAB.

Comparison of laser versus cold knife visual internal urethrotomy in the treatment of urethral stricture (stricture length

There is still controversy regarding the safety and efficacy of cold knife visual internal urethrotomy and laser incisions for the treatment of urethral stricture. This study aims to compare the results of postoperative long-term and short-term maximum urinary flow rates (Qmax), surgical time, postoperative complications, and 1-year recurrence rates between the cold knife and laser surgery. We searched databases including Embase, PubMed, Cochrane, and Clinical Trials.gov to identify relevant literature published in English up to September 2023. We used Stata to compare various parameters. This study is registered in PROSPERO (CRD42023471634). Nine comparative experiments were conducted, involving a total of 659 participants. The laser group showed significantly better results compared to the cold knife group in terms of postoperative 12-month maximum urinary flow rate (mean differences [MD] 2.131; 95% [1.015, 3.249], P < .0001), postoperative bleeding (RR 0.277, 95% [0.079, 0.977], P = .046), and 1-year recurrence rate (RR 0.667, 95% [0.456, 0.976], P = .037). However, there were no significant differences in postoperative 6-month and 3-month Qmax, surgical time, urethral leakage complications, overall complications, and Visual Analog Scale (VAS) scores. The current study results suggest that laser urethral incision has greater advantages in the long-term (12 months), 1-year recurrence rate, and bleeding complications compared to cold knife urethral incision in the treatment of urethral stricture (<2 cm). Therefore, laser urethral incision may be a better choice for patients with urethral stricture.

Females Maintain Fluid Balance across Consecutive Workdays in Heat When Fluids are Readily Accessible

Workers should aim to fully replace fluid losses during work in the heat to maintain work productivity and minimize risk of heat illnesses, however, fluid balance of females working during consecutive days in the heat is unknown. The purpose of this study was to test the hypothesis that females would maintain fluid balance during work across two consecutive workdays. Eight healthy females (age: 29±5, body mass: 75.3±20.1, body fat: 23±8%) completed two consecutive days (Day 1, Day 2) of heavy intensity work in a hot environment (35.9±1.2°C, 24±6% relative humidity). Work consisted of repeated 45/15 work/rest cycles of treadmill walking or cycling at 398±7 W of metabolic heat production and seated rest for 4 h. Every 20 min, participants were provided 237 mL of a sport drink to consume ad libitum. Urine flow rate (UFR) was measured before work. Urine specific gravity (USG) and nude body mass were measured before and after work. Fluid volume consumed and thirst (9-point Likert scale, 1=not thirsty at all, 9=very, very thirsty) were measured during work. Two-way repeated measures analysis of variance and paired samples t-tests were used to compare differences. Significance was set at p≤0.05. Percent body mass loss was not different between Day 1 (0.69±0.82%) and Day 2 (0.96±2.25%, p=0.935). Similarly, sweat rate was not different between Day 1 (0.57±0.12 L/h) and Day 2 (0.65±0.21 L/h, p=0.312). Participants consumed less fluid on Day 1 (64±21%, 25±10 mL/kg) compared to Day 2 (74±20%, p=0.026; 29±10 mL/kg, p=0.025). Participants consumed 68±19% and 77±20% (p=0.040) of fluid offered during work and 55±27% and 66±22% (p=0.173) of fluid offered during rest on Day 1 and Day 2, respectively. Resting thirst (Day 1: 2.1±1.1, Day 2: 1.6±0.5, p=0.096), change in thirst (Day 1: -0.5±0.9, Day 2: +0.3±1.3, p=0.111) and maximum thirst (Day 1: 3.6±1.1, Day 2: 3.6±1.4, p=1.000) were not different between days. USG was not different (p=0.839) across days before (Day 1: 1.009±0.010, Day 2: 1.009±0.010) or after (Day 1: 1.012±1.010, Day 2: 1.012±0.010) work, respectively. UFR was not different between days (Day 1: 2.2±1.4 mL/min, Day 2: 2.0±1.2 mL/min, p=0.836). Females completing heavy intensity work in heat maintained fluid balance across two consecutive days when fluids were readily accessible. Ad libitum fluid consumption may be suffcient to adequately replace fluid losses in females across consecutive days of work in heat. This project was funded by the National Institute for Occupational Safety and Health (1K01OH012016-01A1). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Ad Libitum Drinking Prevents Body Mass Loss Across Consecutive Workdays in Heat

Hydration practices across consecutive days of heavy-intensity work in heat when fluid is freely available is unknown. Without this information it remains unknown whether hydration modifies heat strain under hot working conditions and whether worker recommendations adequately maintain hydration status. We hypothesized that participants would maintain hydration status including daily percent change in body mass across workdays. Fifteen healthy, unacclimated participants (7 Females, Age: 27±6 y, Body mass: 75.0±14.4 kg, Body fat: 26.6±5.8%) completed three consecutive days (Day 1, Day 2, Day 3) of 4 h of 395±10 W work to a work/rest cycle of 45/15 min in a 36.3±0.8°C, 21±5% relative humidity environment. Participants were offered 237 mL of a sport drink every 20 min to consume ad libitum. Urine flow rate (UFR) was measured before work. Urine specific gravity (USG) and nude body mass were measured before and after work. Thirst and fluid consumption were measured throughout work. USG before work was not different between Day 1 (1.013±0.010) and Day 2 (1.013±0.010, p=0.822), but was greater before work on Day 3 (1.015±0.010, p=0.046) compared to Day 2. Change in USG from before to after work was not different between Day 1 (+0.003±0.008) and Day 2 (+0.000±0.006, p=0.123), but was lower on Day 3 (-0.002±0.006, p=0.021) compared to Day 1, with no difference between Day 2 and Day 3 (p=0.058). Before work body mass was not different across days (p=0.103). Daily percent change in body mass was not different across days (p=0.366, Day 1: 0.53±1.11%, Day 2: 0.18±0.95%, Day 3: 0.18±0.81%), indicating weight gain each day. Sweat rate (p=0.790) and UFR (p=0.469) were not different among days. Participants consumed 77±18% (Day 1), 82±19% (Day 2), and 82±16% (Day 3) of fluid offered (p=0.401), equaling 31±10 mL/kg (Day 1), 33±11 mL/kg (Day 2), 33±10 mL/kg (Day 3) (p=0.370). Maximum thirst was greater on Day 1 (3.5±1.1) compared to Day 3 (2.9±1.0, p=0.045) with no difference between Day 1 and Day 2 (3.4±1.4, p=0.648) or between Day 2 and Day 3 (p=0.121). This study demonstrates consistent hydration practices and no differences in hydration status across three consecutive days of high-intensity work in heat when fluid is freely available. Under these conditions, workers can consume fluids ad libitum and worker recommendations for hydration during heat stress should be revisited. This project was funded my the National Institute for Occupational Safety and Health (1K01OH012016-01A1). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Application of Urethral Contrast Computed Tomography Three-Dimensional Imaging in the Postoperative Assessment of Prostate Hyperplasia.

This study assesses the morphological effectiveness of benign prostatic hyperplasia (BPH) surgery using multislice spiral computed tomography three-dimensional imaging (CT3D) with urethral contrast. Twenty-five male patients with BPH and bladder outlet obstruction (BOO) who underwent bipolar transurethral resection of the prostate were selected. Preoperative and postoperative CT3D indicators of retrograde and voiding cystourethrography, including bladder neck diameter, length of the posterior urethra, and degree of prostate protrusion into the bladder and upper and lower diameter of the prostate were used to assess bladder neck and posterior urethra morphology and BOO severity. In addition, preoperative and postoperative International Prostate Symptom Scores and maximum urine flow rates were compared. Postoperative CT3D was used to evaluate changes following obstruction relief postsurgery. Preoperative CT3D indicated significant BOO, whereas postoperative imaging showed improved patency but with irregular posterior urethral lumens and varying degrees of residual glandular tissue. Comparative analysis of preoperative and postoperative bladder outlet metrics revealed significant changes (p < .05). Urethral contrast CT3D effectively visualizes the prostate, bladder neck, and prostatic urethra. It quantifies changes in the urethral lumen postsurgery, correlating the extent of posterior urethral lumen spaciousness with urinary flow rates.

Violation of Allowable Work Intensity does not Augment Acute Kidney Injury Risk During Simulated Occupational Heat Stress

We recently demonstrated that violation of the National Institute of Occupational Safety and Health (NIOSH) heat stress recommendations by exceeding the allowable wet bulb globe temperature (WBGT) for a given moderate work intensity and work:rest ratio augmented acute kidney injury (AKI) risk. However, the role of work intensity (at a fixed work:rest ratio) on AKI risk during NIOSH compliant and non-compliant scenarios remains largely unknown. This study tested the hypothesis that violating the NIOSH recommendations by exceeding the allowable work intensity at a given WBGT and fixed work:rest ratio would augment AKI risk. Twelve healthy adults completed two NIOSH recommendation compliant trials and one noncompliant trial consisting of a 4 h exposure to a fixed WBGT and work intensity. Work-rest ratio was fixed at 30 min of walking and 30 min of rest each hour. Work intensity (i.e., Hprod) was prescribed as a function of WBGT— 412±51 W (27.3±0.3°C; high intensity compliant [Chigh]), 290±75 W (31.6±0.2°C; low intensity compliant [Clow]), and 410±61 W (31.7±0.2°C; high intensity noncompliant [NChigh]). All subjects were provided 237 mL of sport drink every 15 min and drank ad libitum. TC is presented as peak across the 4 h exposure. Urine samples were collected preexposure, and immediately and 1 h postexposure. Urinary inflammatory (monocyte chemotactic protein-1 [MCP-1]), oxidative stress (thioredoxin 1 [TRX-1]), and AKI risk (the product of insulin-like growth factor-binding protein 7 and tissue inhibitor of metalloproteinase 2 [IGFBP7·TIMP-2]) biomarkers were measured and normalized to urine flow rate. Urinary biomarkers were log transformed before statistical analysis and data are presented as mean ± SD. Peak Tc was higher during the NChigh trial (38.3±0.4°C) compared to the compliant trials (Chigh: 38.0±0.3°C; Clow: 37.8±0.4°C; p≤0.0095). Body weight change from pre- to postexposure did not differ between trials (p=0.7817). MCP-1 increased from pre- to immediately postexposure in all trials (p≤0.0031) but was not different between trials (p=0.1354). TRX-1 increased from pre- to immediately postexposure in all trials (p≤0.0085) but was not different between trials (p=0.6372). [IGFBP7·TIMP-2] increased from pre- to immediately postexposure in all trials (p=0.0454) but the increase was not different between trials (Chigh: -1.7±2.6 LOG [ng/mL2]/1000; Clow: -1.6±2.4 LOG [ng/mL2]/1000; NChigh:-1.2±2.3 LOG [ng/mL2]/1000; p=0.2076). Simulated occupational heat stress elevates AKI risk, likely due to both inflammation and oxidative stress. Violating the NIOSH recommendations by exceeding either the allowable WBGT (i.e., NChigh versus Chigh) or work intensity (i.e., NChigh versus Clow) resulted in a modest elevation in peak Tc but did not modify AKI risk and/or the urinary inflammatory and oxidative stress responses. RCT: NCT04767347; Supported By: R01OH011528. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Efficacy of Phlogenzyme® in men following transurethral laser enucleation of prostate hyperplasia: results of a randomized trial

Introduction. The most advanced and effective method of surgical treatment for benign prostatic hyperplasia (BPH) is transurethral laser enucleation of the prostate (tLEP). Recently, there has been a growing interest in exploring new approaches to reduce the risk of complications following tLEP.Objective. To evaluate the efficacy of using Phlogenzym® as part of a comprehensive treatment plan for patients following tLEP to reduce dysuria (urinary discomfort), leukocyturia (white blood cells in urine), and prevent infectious and fibrosis-related complications.Materials &amp; methods. An open-label, randomized trial enrolled 105 patients undergoing tLEP. The patients were randomly assigned to two groups: the study group (n=50) received standard postoperative care in combination with Phlogenzym® for 30 days, while the control group (n=55) received standard care (α1-adrenergic blocker for 28 days) only. uring the follow-up period, which lasted for 1, 3, and 6 months postoperatively, complaints were evaluated using the IPSS-QoL, and IIEF-5 questionnaires, as well as indicators of urinalysis and urine culture, prostate volume measurements, residual urine volume, and uroflowmetry data.Results. Among all patients, the median preoperative values for prostate volume, IPSS, QoL score, and median peak urine flow rate were 90 cc, 18 points, 5 points, and 7.9 mL/s, respectively, with no significant differences between the groups. One month after surgery, in the study group, there was a more significant decrease in prostate volume (57% vs. 41%), although this difference was not statistically significant (p &gt; 0.05). At the 6-month follow-up, bacteriuria was less common in the study group (42% vs. 67%), and there was a consistent trend toward a reduction in the incidence of fibrous complications, although these differences were not statistically significant either (p &gt; 0.05). No adverse events occurred during the follow-up period.Conclusion. Our experience suggests that the use of Phlogenzym® is safe during the postoperative period following tLEP surgery. The use of this drug leads to a reduction in prostate volume postoperatively and significantly reduces the bacteriuria by the six-month follow-up. Additionally, there is a persistent positive trend towards reducing the overall incidence of fibrotic complications in the surgical site. The results achieved and the absence of significant side effects characterize Phlogenzym® as having a favorable clinical profile.

Two-year long-term follow-up of treatment with the Optilume BPH catheter system in a randomized controlled trial for benign prostatic hyperplasia (The PINNACLE Study)

BackgroundPatient outcomes were assessed 2 years after treatment with the Optilume BPH Catheter System, a minimally invasive surgical therapy for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).MethodsOne-hundred forty-eight adult males with symptomatic BPH were enrolled and randomized in a 2:1 fashion to Optilume BPH or Sham (100 Optilume BPH; 48 Sham). Long-term measures include International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), Post-Void Residual Urine (PVR), quality of life measures and sexual function. Follow-up beyond one year was limited to those treated with Optilume BPH.ResultsAt 2 years, 67.5% (56/83 CI 56.3%, 77.4%) of participants in the Optilume BPH arm were symptomatic responders as defined by ≥30% improvement in IPSS without medical or surgical retreatment. IPSS significantly improved from 23.4 ± 5.5 (n = 100) to 11.0 ± 7.0 (n = 74). Qmax improved by 116.8.% (8.9 ± 2.2 (n = 97) to 19.0 ± 16.3 (n = 65)), while PVR showed a slight reduction (83.7 ± 70.3 (n = 99) to 65.9 ± 74.5 (n = 65)). Improvement in uroflowmetry measures was consistent across all prostate volumes. BPH-II improved from 7.0 ± 2.9 (n = 98) to 2.3 ± 2.5 at 1 year (n = 89) and remained consistent at 2.3 ± 2.9 at the 2-years (n = 74), representing a 53.9% improvement. IPSS QoL also improved from 4.6 ± 1.3 (n = 100) at baseline to 2.2 ± 1.5 (n = 74). The most common adverse events reported in the Optilume BPH arm were hematuria and urinary tract infection (UTI). No device and/or treatment related serious adverse events were reported occurring beyond 12 months post-procedure. There was no impact to sexual function.ConclusionsIn the PINNACLE study, participants treated with the Optilume BPH Catheter System demonstrated continued and durable results at 2 years, affirming tolerability, safety, and the enduring effectiveness. The Optilume BPH Catheter System provides lasting results that are comparable to the more invasive therapies, while preserving the advantages with being a minimally invasive therapy.RegistrationClinicalTrials.gov NCT04131907.

A prospective analysis of thulium laser enucleation in benign prostatic hyperplasia comparing low- and high-power approaches for prostates exceeding 80 g

Introduction and objectivesTo compare the perioperative and functional outcomes of low-power and high-power thulium:YAG VapoEnucleation (ThuVEP) of the prostate for the treatment of large-volume benign prostatic hyperplasia (BPH) (> 80 ml).Patients and methodsA prospective analysis of 80 patients with symptomatic BPO and prostatic enlargement (more than 80 ml) was conducted. They were divided randomly into two groups (40 patients in each group). One group was treated with low-power ThuVEP, and the other group was treated with high-power ThuVEP.All patients were assessed preoperatively and early postoperatively, and 12-month follow-up data were analyzed. The complications were noted and classified according to the modified Clavien classification system.ResultsThe mean age at surgery was 68 (± 6.1) years, and the mean prostate volume was 112 (± 20.1) cc, and there were no differences between the groups (p = 0.457). The mean operative time was 88.4 ± 11.79 min for group A and 93.4 ± 16.34 min for group B, while the mean enucleation time was 59.68 ± 7.24 min for group A and 63.13 ± 10.75 min for group B. There were no significant differences between the groups regarding catheterization time and postoperative stay. The quality of life (QoL), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoiding residual urine (PVR), and prostate volume improved significantly after treatment and were not significantly different between those treated with the different energies. The incidence of complications was low and did not differ between both the groups.ConclusionLow-power ThuVEP is feasible, safe, and effective with comparable results with high-power ThuVEP in the treatment of BPO.

SGLT-2 Inhibitors and Their Correlation With Kidney Stones. A Systematic Review

Background: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have emerged as a valuable class of medications for managing Type 2 Diabetes Mellitus (T2DM) due to their efficacy in glycemic control and cardiovascular and renal benefits. However, concerns have been raised regarding their potential association with an increased risk of kidney stone formation. Objective: This systematic review aimed to comprehensively evaluate the existing literature to determine the association between SGLT-2 inhibitors and kidney stone formation, elucidate potential underlying mechanisms, and discuss implications for clinical practice. Methods: A systematic search of databases including PubMed, Google Scholar, Web of Sciences, Medline, and Scopus was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant research articles investigating the utilization of SGLT-2 inhibitors in humans and their potential correlation with kidney stones were included. Data extraction and quality assessment were performed, and a mixed-methods synthesis approach was used for data analysis. Results: The systematic review identified several studies examining the association between SGLT-2 inhibitors and kidney stones. Overall, SGLT-2 inhibitors were found to be associated with a potential protective effect against kidney stone formation. Mechanistically, SGLT-2 inhibitors promote glycosuria and natriuresis, leading to increased urine flow rate and enhanced urinary volume, which may help dilute and flush out stone-forming substances. However, certain limitations and considerations, including potential adverse events and variations in study designs, were also highlighted. Conclusion: This systematic review provides valuable insights into the potential correlation between SGLT-2 inhibitors and kidney stones. While the observed protective effect against kidney stone formation is promising, further research with longer follow-up durations and larger sample sizes is warranted to establish a more conclusive understanding of this relationship. Nonetheless, clinicians should remain vigilant in monitoring patients using SGLT-2 inhibitors and carefully assess individual risk factors when prescribing these medications.

Does ejaculation have an effect on urinary flow rates?

The primary objective of this investigation is to explore the impact of ejaculation on urinary flow rates in men experiencing lower urinary tract symptoms. This study involved the enrollment of 55 male patients who presented with lower urinary tract symptoms. An assessment encompassed components, including medical history, questionnaires related to sexual activity and lower urinary tract symptoms, bladder diary, physical examination, urinalysis, urine culture, ultrasound examination and measurements of serum prostate-specific antigen, free flow uroflowmetry, and post-void residual urine volume. All participants were instructed to abstain from ejaculation for 3 days before undergoing uroflowmetry (UF1). Subsequently, they were required to ejaculate. Subsequent uroflowmetry assessments were conducted at 2 to 4 h (UF2) and 48 to 50 h (UF3) after ejaculation. No further ejaculations were permitted during this timeframe. The patients had a mean age of 50.97 ± 1.47 years. Statistically significant differences were observed in the mean values of Qmax and corrected Qmax (cQmax) between UF1 and UF2 measurements (p < 0.05). These differences were only in patients with benign prostatic enlargement (BPE) (p < 0.05). Furthermore, the number of patients with Qmax <15 mL/s showed a statistically significant difference between UF1 and UF2 measurements, specifically in the BPE group (p = 0.016). In this study, we have observed a significant and temporary increase in the Qmax following ejaculation, particularly among patients with BPE. This indicates that ejaculation can potentially complicate the interpretation of uroflowmetry results. Therefore, further research is necessary to gain a more comprehensive understanding of this phenomenon.

Comparative analysis of holmium: YAG laser internal urethrotomy versus Cold-Knife optical internal urethrotomy in the management of urethral stricture - a systematic review and meta-analysis.

Urethral stricture management has posed enduring challenges in urology, demanding innovative and effective treatment modalities. This study addresses the persistent issues associated with urethral strictures, focusing on the comparative evaluation of two contemporary treatment modalities: Ho: YAG Laser Internal Urethrotomy (HIU) and Cold Knife Optical Internal Urethrotomy (CIU). A comprehensive search of PubMed, Embase, Web of Science, Cochrane Library, and ResearchGate was conducted to identify relevant studies up to November 2023. Inclusion criteria encompassed comparative studies evaluating HIU and CIU in patients with urethral stricture. Data extraction, quality assessment, and subgroup analyses were performed using standardized methods. Outcome measures included preoperative and postoperative mean the maximum urine flow rate (Qmax), mean surgical time, recurrence rates, and perioperative complications. Nine articles met the inclusion criteria, and their data were analyzed using RevMan 5.4.1. Forest plots were generated for preoperative and postoperative mean Qmax, mean surgical time, recurrence rates, and perioperative complications. While postoperative mean Qmax (MD -0.06; 95% CI: -0.28-0.16; P =0.60, I2 =75%) and mean surgical time (MD 2.16; 95% CI: -1.66-5.99; P =0.27, I2 =98%) showed no significant differences between HIU and CIU, a trend towards lower recurrence rates (RR 0.71; 95% CI: 0.48-1.06; P =0.09, I2 =46%) was observed with HIU but without statistical significance. Perioperative complications, particularly bleeding (RR 0.21; 95% CI: 0.08-0.53; P =0.001, I2 =0%), favored HIU over CIU. The subanalysis indicates that for the treatment of complex urethral strictures, the two surgical methods differ in terms of mean Qmax at 6 months postoperatively (MD -2.51; 95% CI: -4.10--0.91; P =0.002, I2 =59%) and 12 months postoperatively (MD 2.62; 95% CI: 0.93-4.30; P =0.002, I2 =0%). The HIU group shows a significant decrease in recurrence rate at 12 months postoperatively (RR 0.44; 95% CI: 0.21-0.92; P =0.03, I2 =0%). For short-segment urethral strictures with a length ≤1.5cm, CIU had a shorter operative time compared to the HIU (MD 4.49; 95% CI: 3.87-5.10; P <0.00001, I2 =44%). Overall, both interventions demonstrated similar efficacy in improving postoperative mean Qmax, mean surgical time, and recurrence rates. However, subanalysis indicates that in the short-term, CIU is more effective than HIU in improving Qmax after complex urethral stricture surgery. In long-term Qmax follow-up after surgery, HIU is significantly higher than CIU, and HIU has a low recurrence rate. In addition, for short-segment urethral stricture (≤1.5cm), CIU requires less time. In terms of complications, HIU has a lower risk of bleeding.

The Efficacy of Rezum Water Vapor Therapy Among Malaysian Men with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia

Purpose: This study investigates the efficacy and safety of Rezǔm water vapor in the management of Malaysian men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).&#x0D; Material and methods: A total of 60 men with symptoms of moderate to severe BPH were enrolled in pilot studies at Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia. All patients were treated with transurethral delivery of water vapor. International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow (Qmax), postvoid residual, and International Index of Erectile Function (IIEF-5) were evaluated at 1 week and 1, 3, and 6 months post-treatment. Safety was also assessed.&#x0D; Results and discussion: The mean age of our study population was 64.57 ± 9.37 years old with mean prostate volume of 59.98 ± 22.06 cc. Our findings revealed statistically significant improvements throughout the 6 months of follow-up for IPSS score (17.45 ± 6.10 score to 7.53 ± 4.28), the QoL scores (3.52 ± 1.19 to 1.53 ± 0.70) and the urinary flow rate, Qmax (9.74 ± 3.39 mL/s to 17.40 ± 5.92 mL/s). There was no significant difference (p&gt;0.05) was observed in sexual function (IIEF-5 scores) when compared to preoperatively. No adverse events (AEs) related to endoscopic instrumentations were observed. Two cases of urinary retention were classified as procedure-related AE.&#x0D; Conclusion: The Rezǔm water vapor therapy is safe and provides effective relief of symptoms and it should be considered as one of the treatment options in patients with LUTs associated with BPH especially for patients who are keen to preserve sexual function as part of the added benefit in this treatment modality.&#x0D; &#x0D; Keywords: Benign prostatic hyperplasia, lower urinary tract symptoms, water vapor therapy, minimally invasive&#x0D; &#x0D; &#x0D;

Surgical Outcomes and Predictive Factors in Patients With Detrusor Underactivity Undergoing Bladder Outlet Obstruction Surgery.

This study was conducted to evaluate the efficacy of bladder outlet surgery in patients with detrusor underactivity (DU) and to identify factors associated with successful outcomes. We conducted a retrospective review of men diagnosed with DU in urodynamic studies who underwent bladder outlet surgery for lower urinary tract symptoms between May 2018 and April 2023. The International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry (UFM), and multichannel urodynamic studies were administered. Successful treatment outcomes were defined as either an IPSS improvement of at least 50% or the regaining of spontaneous voiding in patients urethral catheterization prior to surgery. The study included 93 male patients. Men diagnosed with significant or equivocal bladder outlet obstruction (BOO) experienced significant postoperative improvements in IPSS (from 20.6 to 6.0 and from 17.4 to 6.5, respectively), maximum urine flow rate (from 5.0 mL/sec to 14.4 mL/sec and from 8.8 mL/sec to 12.2 mL/sec, respectively) and voiding efficiency (from 48.8% to 86.0% and from 61.2% to 85.1%, respectively). However, in the group without obstruction, the improvements in IPSS and UFM results were not significant. The presence of detrusor overactivity (odds ratio [OR], 3.152; P=0.025) and preoperative urinary catheterization (OR, 2.756; P=0.040) were associated with favorable treatment outcomes. Conversely, an unobstructed bladder outlet was identified as a negative prognostic factor. In men with DU accompanied by equivocal or significant BOO, surgical intervention to alleviate the obstruction may enhance the IPSS, quality of life, and UFM results. However, those with DU and an unobstructed bladder outlet face a comparatively high risk of treatment failure. Preoperative detrusor overactivity and urinary catheterization are associated with more favorable surgical outcomes. Consequently, active deobstructive surgery should be considered for patients with DU who are experiencing urinary retention.

Effectiveness of Wobenzym in combined therapy of chronic bacterial prostatitis. Results of systematic review and meta-analysis

A systematic review and meta-analysis of research data on the effectiveness of the drug Wobenzym in the treatment of chronic bacterial prostatitis was performed. The aim of this study to evaluate the effectiveness of Wobenzym in the complex therapy of chronic bacterial prostatitis. The analysis included randomized and non-randomized controlled studies of the effectiveness of Wobenzim in the complex therapy of chronic bacterial prostatitis. The search was carried out in the databases CENTRAL, PubMed, ICTRP, eLibrary, ClinicalTrials.gov., Google Scholar, CyberLeninka, search engines. The meta-analysis was conducted using the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Statistical heterogeneity was assessed using the Cochran test and visually when constructing forest plots. A random effects model and a fixed effect model were used. Works published over the entire period were analyzed, 712 publications were identified, of which 9 fully met the stated criteria, all studies were non-randomized controlled. The final analysis included the results of 1292 patients. According to the meta-analysis, it was possible to establish the superiority of complex therapy including Wobenzym compared to therapy without Wobenzym in all studied parameters: eradication of the pathogen, decrease in the number of points on the Quality of Life (QoL) scale, an increase in the linear speed of blood flow in the veins and peak systolic blood flow velocity in the arteries of the prostate gland, maximum urine flow rate, reduction in the number of points of the NIH-CPSI “Pain” subscale (difference 5 points) and NIH-CPSI “Quality of Life” subscale. The use of therapy including Wobenzym in patients with chronic prostatitis leads to a greater increase in the number of CD4+, CD8+ lymphocytes, phagocytic activity of lymphocytes, the level of complement CH-100 and immunoglobulins M, G, A. A systematic review/meta-analysis revealed an objective, statistically significant, positive effect of the drug Wobenzym in the complex therapy of patients with chronic bacterial prostatitis, which is associated with its pathogenetic orientation in relation to this group of patients.

Троспия хлорид у детей: динамика симптома остаточной мочи при коррекции расстройств мочеиспускания

Background. A significant place among pediatric urination disorders is occupied by overactive bladder (OAB). Treatment involving the use of M-anticholinergics is aimed to suppress detrusor overactivity. The side effects of treatment include urination problems, incomplete bladder emptying (residual urine), and acute urinary retention. Methods. We monitored 20 children aged 5–15 years, among them 12 boys and 8 girls. The average age (М±δ) was 8.47 ± 3.46 years. The 2-day uroflow monitoring revealed residual urine (RU) in 9 patients (1–15 times per monitoring period). The urination volume and rate, as well as RU, were assessed by uroflow monitoring conducted at home using the SIGMA F uroflowmeter (RZN registration certificate No. 2020/11522 of 5.08.2020). One of the components of combination therapy was trospium chloride (Spasmex) in a dose of 10–15 mg per day, depending on the age and disorder. Statistical data processing was performed using the STATISTICA 10 (StatSoft, Inc., USA) and Excel (Microsoft Office 2016) software packages. The differences were considered significant at p&lt;0.05. The descriptive statistics were presented as М±δ (where М was median, δ was standard deviation). Results. The average effective volume (AEV) of urination in the group was reduced by 10–86.5% relative to the age norm. Furthermore, incomplete bladder emptying was reported in 9 patients. After treatment, the minimum urine output volume and the maximum urine flow rate increased significantly, while the urination rate decreased. There were no significant changes in the urine output volume (average and maximum), however, an upward trend of the urine output volume was observed. No increase in the number of RU cases following prescription of trospium chloride was reported. In fact, the decrease in their number was recorded. Conclusion. Pediatric micturition cycle abnormalities also include the RU symptom. The M-anticholinergic drug, trospium chloride (Spasmex), in a daily dose of 10-15 mg represents a safe and effective medication option. Therapy lasting up to 2 months results in the significant increase in minimum bladder volume and maximum urine flow rate, the decrease in pollakiuria severity, but never changes the rate and amount of residual urine.

Post-Voided Residual Ratio Does Not Predict Trifecta Outcome after Transurethral Resection of Prostate.

The purpose of this study was to assess the importance of the post-void residual (PVR) ratio (PVR ratio) in achieving a favorable trifecta outcome for patients suffering from lower urinary tract symptoms and benign prostatic enlargement (LUTS-BPE) who undergo transurethral resection of the prostate (TURP). Starting from 2015, a series of patients with LUTS-BPE who underwent TURP were included in a forward-looking study. These patients were assessed using the international prostate symptom score (IPSS) screening tool, uroflowmetry, and a transrectal ultrasound to measure prostate volume (TRUS). Both the PVR urine volume and the PVR ratio (PVR-R), which is the PVR as a percentage of total bladder volume (voided volume + PVR), were measured. The assessment of outcomes was based on the trifecta favorable outcome, defined as meeting all of the following criteria: (1) absence of perioperative complications, (2) a postoperative IPSS of less than eight, and (3) a postoperative maximum urinary flow rate (Qmax) greater than 15 mL/s. A total of 143 patients were included, with a median age of 70 years (interquartile range 65-73). Of these, 58% (83/143) achieved a positive trifecta outcome. Upon conducting a multivariate analysis, both IPSS and Qmax were identified as predictors of a positive trifecta outcome, whereas the PVR-R did not prove to be an independent predictor. In summary, it was found that preoperative IPSS and Qmax are indicative of a trifecta outcome following TURP, whereas PVR-R is not.

Does sacral ratio have any impact on success rate of biofeedback therapy in children with lower urinary tract dysfunction?

To evaluate the possible impact of patients' sacral ratios (SRs) on response to biofeedback (BF) therapy in pediatric patients with lower urinary tract dysfunction (LUTD). In this retrospective cohort conducted from 2016 to 2018 in our tertiary medical center, we included the medical records of all pediatric patients with LUTD who were nominated for BF due to having abnormal uroflowmetry patterns and simultaneous increase in electromyography (EMG) activity. Ten sessions of weekly animated BF were performed for each patient. All patients underwent a complete urological evaluation, uroflowmetry with simultaneous EMG and post-void residual measurement before and after treatment. SRs were calculated based on plain anteroposterior lumbosacral radiographs. Patients were then divided into normal SR (≥0.74) and low SR (<0.74) and outcomes were compared between them. Of the total 86 patients included in our study, 48 (55.8%) had a normal SR (≥0.74), while 38 (44.2%) had a low SR (<0.74). Our data revealed that BF therapy significantly improved maximum and average urinary flow rates, urine volume, daytime urinary incontinence, enuresis, urinary urgency and constipation; irrespective of the patients' SRs (all P<0.001). Our between-groups analyses showed that after the completion of BF, the SR≥0.74 group had significantly higher maximum urinary flow rate (mean difference [95%CI]: 7.7 [5.4, 10.0], P<0.001) (Figure) and urine volume (mean difference [95%CI]: 49.9 [19.5, 80.4], P=0.002) and significantly lower diurnal urinary incontinence (4.2% vs. 21.1%, P=0.020), enuresis (4.2% vs. 18.4%, P=0.040) and constipation (2.1% vs. 23.7%, P=0.004) compared to the SR<0.74 group. SR has been proposed as a reliable indicator of bony pelvis growth and subsequent lumbosacral neurodevelopment. Additionally, larger SR values are associated with better postoperative sphincter function in children with urological and anorectal malformations. Our results demonstrated that after completion of BF, the normal SR group had a significantly better improvement of some of the uroflowmetry indicators and LUTD-associated symptoms compared to the low SR group. Our findings implied that although BF therapy is an efficient treatment for children with LUTD, irrespective of their sacral development; children with enhanced sacral development may benefit from better clinical response, especially in terms of LUTD-associated symptoms.

Effect of detrusor underactivity on surgical outcomes of holmium laser enucleation of the prostate.

To evaluate the effect of detrusor underactivity (DUA) on the postoperative outcomes of holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH). Patients with BPH who underwent HoLEP between January 2018 and December 2022 were enrolled in this prospective database study. Patients were divided into DUA (bladder contractility index [BCI] <100) and non-DUA (BCI ≥100) groups. Objective (maximum urinary flow rate [Qmax], post-void residual urine volume [PVR]) and subjective outcomes (International Prostate Symptom Score [IPSS], Overactive Bladder Symptom Score [OABSS], satisfaction with treatment question [STQ], overall response assessment [ORA], and willingness to undergo surgery question [WUSQ]) were compared between the two groups before surgery, and at 3 and 6 months after HoLEP. A total of 689 patients, with a mean (standard deviation [SD]) age of 69.8 (7.1) years, were enrolled. The mean (SD) BCI in the non-DUA (325 [47.2%]) and DUA (364 [52.8%]) groups was 123.4 (21.4) and 78.6 (14.2), respectively. Both objective (Qmax and PVR) and subjective (IPSS, IPSS-quality of life, and OABSS) outcomes after surgery significantly improved in both groups. The Qmax was lower in the DUA than in the non-DUA group postoperatively. At 6 months postoperatively, the total IPSS was higher in the DUA than in the non-DUA group. There were no significant differences in surgical complications between the two groups. Responses to the STQ, ORA, and WUSQ at 6 months postoperatively demonstrated that the patients were satisfied with the surgery (90.5% in the DUA group; 95.2% in the non-DUA group), their symptoms improved with surgery (95.9% in the DUA group; 100.0% in the non-DUA group), and they were willing to undergo surgery again (95.9% in the DUA group; 97.9% in the non-DUA group). There were no significant differences in the responses to the STQ and WUSQ between the two groups. Our midterm results demonstrated that patients with BPH and DUA showed minimal differences in clinical outcomes after HoLEP compared to those without DUA. The overall satisfaction was high in the DUA group.