Urology Outpatient Clinic Research Articles

The Impact of COVID-19 Pandemic on Urological Emergencies, 8 Months Results of a Multicenter Retrospective Study From Turkey.

Objectives:We aimed to reveal the change of urological emergencies during the COVID-19 pandemic compared to the same period of the previous year.Methods:The number of admissions to the emergency department (ED), admissions to the urology outpatient clinic, emergency urological consultations, and urological and emergency urological surgeries during the periods April-November-2019 and April-November-2020 were recorded. The data of the COVID-19 period were compared with the previous year.Results:While the number of admissions to the urological outpatient clinic was 160,447 during the COVID period, it was 351,809 during the non-COVID period. The number of admissions to the ED decreased from 3.2 million to 2.4. The number of admissions to the urology outpatient clinic significantly decreased by 54% during the pandemic (p=0.001). Percutaneous cystostomy performed due to acute urinary obstruction decreased by 27.96%, double J stent, nephrostomy decreased by 16.61%, and ureterorenoscopy decreased by 12.26%. Urogenital trauma also decreased. On the contrary, surgical procedures performed due to penile fracture, gross hematuria, Fournier gangrene, and testicular torsion increased.Conclusion:During the COVID-19 pandemic, a significant decrease was observed in non-COVID patients’ admissions to the emergency and urology department, and in urologic surgeries.

Urological Pathologies and Their Incidence Rates Determined in Cases Applied to the Health Board

Objective: Applications are made to health boards for age assessment, gender determination, employment in some occupational groups and detection of disability. The aim of our study is to determine the defined urological pathologies and their incidence rates in the patients who applied to the health board of our hospital. Materials and Methods: Our study included patients who applied to the urology outpatient clinic of the health board between January 2015 and December 2020 for the purpose of employment in some occupational groups, determination of age, gender, disabilities and obtaining a general health report. Patients were investigated in two different groups, according to their indications for their applications as detection of disabilities and other indications, and the diagnoses were classified under the subheadings of stone diseases, malignancies, neurourology-incontinence, andrology and benign prostatic hyperplasia (BPH). Results: A total of 1453 cases were included in the study. Hundred and fifty-one (10.4%) patients applied for the detection of disability. A total of 206 (17%) patients, including 70 (46.3%) cases in the disability detection group and 136 (10.4%) in the other group had a urological diagnosis. The most common pathology was malignancies with 65 (4.4%) cases, in order of frequency; testicular cancer (n=25: 38.4%), bladder cancer (n=15: 23%), prostate cancer (n=13: 20%), kidney cancer (n=11: 16.9%) and penile cancer (n=1: 1,5%). The second most frequently seen diagnostic group was the stone disease group (n=55: 3.7%), and 17 (30.9%) of them required further investigation after diagnosis. Consequently ESWL (n=6: 10.9%), and surgical intervention (n=4: 7.3%) were planned for the indicated number of patients. Conclusion: Urogenital system malignancies and urinary tract stones have been identified as the most common pathologies in patients who applied to the health board. The fact that some diseases, especially urolithiasis were followed by further examination and treatment, shows the contribution of the health board examinations to the treatment as well as the health status determination feature.

Red blood cell distribution width values in erectile dysfunction

PurposeErectile dysfunction (ED) has increased prevalence by age and significantly affects the quality of life of men and their partners. To investigate the relationship between ED and red blood cell distribution width (RDW) values. Materials and methodBetween September 2019 and December 2019, a total of 192 individuals comprising those that were admitted to the urology outpatient clinic with ED complaints and healthy volunteers from among hospital staff were prospectively included in the study. The participants were divided into two groups according to the international erectile function index (IIEF-5) as ED group (n=148) and control group (n=44). ResultsThere was no statistically significant difference between the two groups in terms of age, smoking status, presence of hypertension, triglyceride, low-density lipoprotein, high-density lipoprotein, total cholesterol, total prostate-specific antigen and haematocrit values. Body mass index, fasting blood sugar, neutrophil–lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR) were significantly higher in the ED group (28.5±27.4kg/m2 vs 26.8±26.5kg/m2, p=.021, 109.05±49.7mg/dl vs 93.39±10.2mg/dl, p<.001, 2.18±1.3 vs 1.74±0.3, p=.031, and 113.7±47 vs 92.4±24.1, p=.004, respectively). The mean RDW values were 13.7±1.1 in the ED group and 13±0.5 in the control group (p<.001). The multivariate analysis revealed PLR [1.02 OR (1–1.04), p=.007] and RDW [2.75 OR (1.56–4.85), p<.001] as independent predictors for an ED diagnosis. ConclusionBased on the strong relationship between RDW and ED, we consider that RDW may be a new indicator in the diagnosis of ED.

Priapizm Tedavisi: Tek Merkez Sonuçları

Background: The aim of this study was to evaluate patients in our region who applied to the emergency department or urology outpatient clinic due to priapism, regarding the parameters such as the duration of priapism, treatment, age, and treatment outcomes.Materials and Methods: Thirty-nine male patients who presented with priapism between January 2010 and May 2018 were included in the study. We reviewed all data in patients’ files and recorded patients’ data including age, date of first episode of priapism, duration as well as the clinical coarse of priapism, presence of accompanying conditions associated with priapism, history of intracavernosal injections use, administration of intracavernosal injections (self-administration or by a doctor), treatment method and outcomesResults: A total of 43 episodes of priapism were recorded in 39 patients. The mean age of the patients was 46.6 (27-70) years. It was observed that priapism developed following intracavernosal injections use in all patients. In 9 (23%) patients (10 episodes), priapism developed after intracavernosal injection, which was used for treatment due to erectile dysfunction and in 30 (77%) (33 episodes) patients following penile Doppler ultrasound with intracavernosal injections. 30 patients (32 episodes) were successfully treated with drainage only, while 9 patients (11 episodes) required drainage + sympathomimetic therapy, and two of these had distal shunt due to persistent priapism.Conclusions: Drainage is enough in the majority of priapism patients. However, drainage is not sufficient with the prolongation of the patient application period. In this regard, patients should be informed about potential risks before starting an ICI therapy.Key Words: Priapism, Urological emergency, Papaverine, Pain

Correlation Between Spiritual Well-being and Quality of Life in Patients With Urinary Incontinence: A Cross-sectional Descriptive Study

This cross-sectional descriptive study investigated the correlation between spiritual well-being (SWB) and quality of life (QOL) in patients with UI. Patients with UI visiting an outpatient urology clinic of a university hospital in Turkey were invited to participate. Data were collected using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12 Item Scale (FACIT-Sp-12) (range 0-48 with higher scores indicating better SWB) and the Incontinence Quality of Life Questionnaire (I-QOL) (range 0-100 with higher scores indicating better QOL). The sample consisted of 383 patients. Most were female (235; 61%), had completed high school (169; 44%), had experienced UI for an average of 3.54 years (SD 3.44), and were between 21 and 92 years of age (mean 52.7; SD 14). The mean I-QOL score was 65.31 ± 19.71 with subscores ranging from a low of 59.69 for social embarrassment to a high of 71.44 for psychosocial impact. The average FACIT-Sp-12 score was 28.00 ± 6.08. Overall I-QOL and FACIT-Sp-12 scores were weakly positively correlated (r = .235). In this study both QOL and SWB scores were good; higher UI-specific QOL scores and some subscores were asso-ciated with higher SWB scores and subscores. Incontinence QOL should be determined together with SWB in patients with UI.

Clinical Manifestations of Overactive Bladder With Migraine as a Comorbidity: A Prospective Cross-Sectional Study.

PurposeThe aim of this study was to investigate the clinical manifestations of overactive bladder (OAB) with migraine as a comorbidity and to shed light on possible new treatment strategies.MethodsThis study included patients aged 18 years and older who were admitted to urology and neurology outpatient clinics between March 1, 2019 and March 1, 2020 for OAB and migraine. The study questionnaire contained 3 sections: (1) questions on demographic characteristics, (2) a migraine ID test, and (3) the Overactive Bladder Inquiry Form - V8 (OAB-V8) form.ResultsA total of 265 patients participated in the study. The average age of the participants was 39.75±11.93 years. The patients were divided into 3 groups according to the coexistence of OAB with migraine: group 1, OAB(+)/migraine(+); group 2, OAB(+)/migraine(-); and group 3, OAB(-)/migraine(+). The mean OAB-V8 score was 22.82 ±8.15 in group 1 and 25.64±7.49 in group 2. The mean OAB-V8 score of OAB patients with migraine as a comorbidity was statistically significantly lower than that of OAB patients without migraine (P=0.015). The median visual analogue scale (VAS) score was 7.11 (range, 2–10) in group 1 and 5.95 (range, 2–10) in group 3. This finding indicates that in patients with migraine, having OAB was associated with significantly higher VAS scores (P<0.001).ConclusionsOAB and migraine may be comorbid conditions coexisting in a single patient. This comorbidity may lead to a lower perception of OAB symptoms in OAB patients or, conversely, to a higher perception of migraine pain. Further studies are needed to elucidate how treatments for each of these diseases can affect the other disease.

Variations in the Number of Patients Presenting With Andrological Problems During the Coronavirus Disease 2019 Pandemic and the Possible Reasons for These Variations: A Multicenter Study.

IntroductionCoronavirus disease 2019 (COVID-19) pandemic caused unprecedented restrictions in outpatient services and surgical practices in urology as in other medical branches as well as in all areas of life.AimTo investigate whether there have been variations in the presentations of male patients with sexual and reproductive health problems to the outpatient urology clinics during the COVID-19 pandemic and to understand the underlying factors for these variations, if any.MethodsMale patients aged ≥18 years who presented to the outpatient urology clinics in 12 centers across Turkey from February 1, 2020 to June 1, 2020 were retrospectively evaluated. The patients were divided into 2 groups: those who presented to the outpatient clinic from February 1, 2020 to March 11, 2020 comprised the “pre–COVID-19 pandemic period” group, whereas those who presented to the outpatient clinic from March 12, 2020 to June 1, 2020 comprised the “COVID-19 pandemic period” group and compared with each other.Main Outcome MeasuresThe main outcome of this study was the number and diagnose of patients presented to urology outpatient clinics.ResultsAndrological problems were detected in 721 of 4,955 male patients included in the study. During the COVID-19 pandemic period, there was a significant increase in andrological diagnosis in these patients compared with the pre–COVID-19 pandemic period (n = 293 [17%] vs n = 428 [13.2%], P < .001, respectively). Similarly, there was a statistically significant increase in the number of patients diagnosed with male reproductive or sexual health problems during the COVID-19 pandemic period (n = 107 [6.2%] vs n = 149 [4.6%], P = .016 and n = 186 [10.8%] vs n = 279 [8.6%], P = .013, respectively). The number of patients diagnosed with erectile dysfunction during the pandemic was also significantly higher than the pre–COVID-19 pandemic period (n = 150 [8.7%] vs n = 214 [6.6%], P = .008).ConclusionPresentations to the outpatient urology clinics owing to andrological problems markedly increased during the pandemic period. Although these problems are of multifactorial origin, psychogenic factors are also considered to significantly trigger these problems.Duran MB, Yildirim O, Kizilkan Y, et al. Variations in the Number of Patients Presenting With Andrological Problems During the Coronavirus Disease 2019 Pandemic and the Possible Reasons for These Variations: A Multicenter Study. Sex Med 2021;9:100292.

Relationship between atherogenic indices and acquired premature ejaculation.

The aim of this study is to evaluate blood lipid parameters and level of atherogenic indices in acquired premature ejaculation (PE) patients. Between 2020 January and June 2020, 96 patients diagnosed with PE in our clinic and 84 control patients who applied to the urology outpatient clinic for other urological reasons were included in the study. Detailed medical and sexual histories of the patients were taken, and physical examination findings were recorded. In addition, 5-question premature ejaculation diagnostic tool (PEDT) was applied to patients and estimated intravaginal ejaculation latency times (IELT) were recorded. The mean values of lipid parameters; Risk Index of Castelli-1 (CRI-1 (Total cholesterol/ HDL)), CRI-2 (LDL/ HDL), Atherogenic Index of Plasma (AIP (log10 (triglyceride/ HDL)) and Atherogenic Coefficient (AC (HDL/ non-HDL)) were calculated. The average PEDT score was 7.68+5.05 (2-22), and the IELT arithmetic mean was 150.39+121.53 (5-900) seconds. In the APE group, triglyceride and AIP values were found to be higher than the control group (triglyceride: 188.75+76.39 versus 157.20+87.45; p=.049; AIP: 0.46+0.33 versus 0.35+0.35; p=.040). A fair positive correlation was found between PEDT scores and AIP values (r=.355, p<.001). AIP was found to be related to APE, and it was also found to be related to symptom severity.

Flank Pain as a Symptom of COVID-19

The COVID-19 disease is spreading rapidly worldwide, and no vaccine or very effective drug has been found yet. However, the transmission rate of the disease can be reduced by taking precautions. Therefore, it is essential to detect the patients early to prevent the spread of the disease.1,2 We report a case of 26-year-old male patient who was admitted to our urology outpatient clinic with the complaint of flank pain and had incidental findings of COVID-19 in the lung bases on abdominal CT.

Cardiac Arrest Due to Hypocalcemia

Fifty-nine-year-old male patient had a sudden cardiac arrest (CA) while waiting for his appointment at the urology outpatient clinic. The local staff and the rapid response team (RRT) promptly started cardiopulmonary resuscitation maneuvers. Initial CA rhythm was ventricular fibrillation (VF) and the collapse-shock interval was five minutes. Return of spontaneous circulation (ROSC) occurred on the following cycle, comprising six minutes of arrest. There was not enough time to administer epinephrine or any other drugs. After ROSC, a definitive airway was [...]

Efficacy of Percutaneous Nephrolithotomy in the Treatment of Renal Calculi of 10 to 20 MM Size: A Comparison With Extracorporeal Shock Wave Lithotripsy

Background: Stones in the urinary tract is a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) is also widely applied. There is a trend of using ESWL for treatment of renal stones smaller than 1 cm and PCNL in those with stones greater than 2 cm. Nevertheless, no consensus regarding treatment of renal stones between 1 to 2 cm stones. The objective of this prospective study was to compare the results of ESWL and PCNL for treatment of 1 to 2 cm renal stones. Method : This is a quasi experimental study. This study was conducted to compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) in treating 10 to 20 mm sized renal stone among the Bangladeshi population. This prospective study conducted between the periods of September, 2011 to August, 2012 in the department of urology, Bangabandhu Sheikh Mujib medical university (BSMMU) Hospital. All the patients attending the urology outpatient clinic with 10 to 20mm renal calculi were the study population. A total of 70 subjects were enrolled for this study and they were equally divided into two groups so that each group had 35 subjects. The one group received PCNL whereas the other group received ESWL. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-15). Results: There is no statistically significant difference in regarding age, sex, stone side(lt. or rt.), the distribution of stone (upper, middle and lower calyx) and size between the groups (p&gt;0.05). At 3 month follow up among the patients in ESWL group stone cleared and not cleared were 25(71.4%) and 10(28.6%) respectively and at 3 month follow up among the patients in PCNL group stone cleared and not cleared were 33(94.3%) and 2(5.7%)respectively. There is statistically significant difference in stone clearance rate at 3 month follow up between the groups (p&lt;0.05). All patients in ESWL group developed post procedure haematuria 35(100.0%). Other post procedure complications among the ESWL group pain, fever and steinstrasse were 12(34.3%), 07(20.0%) and 03(08.6%) respectively. Common post procedure complications among the patients of PCNL group pain, haematuria and fever were 11(31.4%), 33(94.3%) and 13(37.1%) respectively. Other post procedure complications in PCNL group were vomiting (8.6%), urinary leakage (5.7%), wound infection (11.4%) and urinary cutaneous fistula (5.7%). There was no statistically significant difference post procedure pain, haematuria and fever between the groups (p&gt;0.05), but statistically significant difference observed in steinstrasse and wound infection between the groups (p&lt;0.05). Mean±SD of hospital stay among the patients of ESWL group and PCNL group was 1.37±0.65 and 4.34±1.43 days respectively. There is statistically significant difference in hospital stay between the groups (p&lt;0.05). Conclusion: Though some specific complications which can be treated conservatively are more in PCNL group it may be concluded that the treatment with PCNL is better option than ESWL among the patients having renal calculi 10 to 20 mm. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.98-104

Triglyceride-Glucose Index (TyG) is associated with erectile dysfunction: A cross-sectional study.

Erectile dysfunction (ED) is often associated with endocrine metabolic diseases such as metabolic syndrome (MetS) and diabetes mellitus (DM), in which insulin resistance (IR) plays a decisive role in pathology. Triglyceride-glucose index (TyG), a simple, inexpensive and easily accessible IR marker, is calculated by fasting serum glucose and triglyceride values. We aimed to reveal the relationship between TyG index and ED. Of 152 male patients, aged between 24-80years, admitted to the urology outpatient clinic with complaining erectile insufficiency were evaluated. Liver function tests, complete blood count, fasting serum triglyceride, serum testosterone, fasting glucose, fasting insulin, and hemoglobinA1c (HbA1c) were analyzed. TyG index was calculated. All patients were requested to fill in the validated Turkish version of the 5-item International Index of Erectile Function (IIEF-5) survey. A total of 142 patients were included the study. ED was detected in 91 (64.1%) of the patients. BMI, fasting insulin level, fasting glucose level, IR, GGT, HDL, HbA1c, Triglyceride, TyG, DM, HT, and MetS status of the patients in ED group were statistically significantly higher compared to non-ED group (all P < .05). It was found that the cutoff value of TyG index for ED was 8.88 (AUC=0.739, sensitivity 67%, specificity=68.6%). In multivariate logistic regression analysis, age (OR=1.07, 95% CI=1026-1115, P=.002) and TyG index above 8.88 (OR=3.865, 95% CI=1686-8859, P=.001) were found as independent predictors of ED after accounting for BMI, serum total T and IR. TyG index might be useful in the diagnosis and follow-up of ED.

Erişkin Yaşta Sünnet Olmak Üzere Başvuran Erkeklerle Çocukluk Çağında Sünnet Olan Erkeklerin Benlik Saygısı, Duygu Durum ve Seksüel Fonksiyonlar Açısından Karşılaştırılması

Objective: In this study, we aimed to evaluate the self-esteem, mood, and sexual functions of men who applied to the Urology outpatient clinic voluntarily for circumcision. Material and Methods : We assessed 20 adult male patients who admitted to our outpatient clinic for circumcision and 20 control group patients between 2016 and 2019. All patients were filled out Rosenberg self-esteem scale, Hospital anxiety and depression test and Arizona sexual experiences scale forms. Patients circumcised in adulthood were named as Group I and those who were circumcised in childhood were named as Group II. It was investigated whether there was a statistically significant difference between the two groups in terms of Rosenberg self-esteem scale, Hospital anxiety and depression test and Arizona sexual experiences scale (ASEX) scores. P <0.05 was considered significant. Results : The mean age of 40 patients included in the study was 21.32 ± 1.62. Mean Rosenberg self esteem score was 2.15 ± 2.10, mean anxiety score was 6.70 ± 4.83, mean depression score was 6.27 ± 4.21 ant mean ASEX score was 12.37 ± 3.51. Mean Rosenberg self-esteem scores were 1.9+/-1.58 in Group I and 2.4+/-2.54 in Group II. Mean anxiety scores were 6.4+/-5.13 in Group I and 7+/-4.63 in Group II. Mean depression scores were 6.3+/-3.43 in Group I and 6.25+/-4.96 in Group II. Mean ASEX scores were 12.85+/-3.71 in Group I and 11.9+/-3.32 in Group II. There was no statistically significant difference between the two groups in terms of the Rosenberg self-esteem, anxiety, depression and ASEX scores (p=0.08, p=0.64, p=0.50, and p=0.40; respectively). Conclusion : The self-esteem of men applying for circumcision in adulthood is not affected. This situation does not affect the emotional state and sexual life of the people.

&lt;p&gt;Comparison of Outcome and Success Rate of Onlay Island Flap and Dorsal Inlay Graft in Hypospadias Reconstruction: A Prospective Study&lt;/p&gt;

BackgroundChordee correction, urethroplasty, and tissue reconstruction are performed to correct and retain standard functionality of the penis in hypospadias. Conventional reconstruction techniques, such as onlay island flap and the dorsal inlay graft, can be performed based on the classification of hypospadias. However, the outcomes and complication rates have not been widely studied. Thus, we aimed to provide preliminary evidence regarding the efficacy and safety of both approaches in hypospadias reconstruction.Patients and MethodsA prospective study with two time evaluations of 14 and 180 days post-operatively was performed at the Urology outpatient clinic from October 2014 to September 2019. A proportion comparison of success rate, time to the complication, operation time, catheterization duration, uroflowmetry parameter post-surgery, and mean scores comparison of PPPS were measured as the intended outcomes.ResultsIn a total of 59 pediatric hypospadias, patients who had undergone reconstruction are included in this study. Higher subjects’ age and severe chordee severity were more common in the dorsal inlay graft group (age=7.50 [1–26] months; severe chordee 45.8%) compared to the onlay island flap group (age=4.0 [1–67] months; severe chordee 31.4%), both groups showed similar satisfaction regarding meatal shape and position (P=0.618), glands shape (P=0.324), penile skin shape (P=0.489), and general cosmetic appearance (P=0.526). Complication occurrence and time to complication duration of both groups were also not statistically significant (P=0.464 and P=0.413). There are no significant differences in Qmax, Qmean, voided volume, and PVR of both groups (P=0.125, 0.136, 0.076, 0.260, respectively). Significant differences in operation times and catheterization duration are found in this study (P<0001).ConclusionOutcome evaluation regarding functional, complication and patient satisfaction comparing onlay flap and dorsal inlay graft for hypospadias patients is scarce. This study found that both procedures can be considered safe with comparable incidence of complications.

Characterizing voiding experiences of men choosing seated and standing positions

Voiding positions and preferences in men are not well characterized. In this study, we aim to understand the interplay of voiding characteristics and their impact on voiding position. We designed a 27-item survey to assess voiding characteristics and lower urinary tract symptoms (LUTS) severity in men seen in urology and other outpatient clinics. Participants included adult men patients and adult men accompanying patients at our institution's outpatient clinics. Data collected included demographics, International Prostate Symptom Score questionnaire, stream type (single, split, and dribble), voiding behavior, positional stream quality, and voiding bother. We received 195 completed surveys (80% response rate). Of men queried, 18% (35/195) preferred to sit while voiding. Overall, men who sit had a higher proportion of LUTS (66% [23/35]vs. 41% [66/160];p = .01), more physical limitations affecting voiding choice (20% [7/35]vs. 3% [5/160]; (p = .001), and a lower desire to stand (6% [2/35]vs. 24% [38/160];p = .02), compared to men who stand. Men who sit while voiding reported nearly double the amount of voiding associated bother (34% [12/35]) compared to men who stand (18% [28/160];p = .04). Older aged men reported a similar rate of seated urination compared to younger men. The most common reasons to void seated included comfort and avoidance of spraying. Our findings discourage the use of anecdotal beliefs founded on generalizable characteristics, such as age and stream type, to infer a patient's voiding characteristics. Open dialog with patients regarding voiding preferences may garner important information regarding overall urologic health and better inform urologic care.

Confronting hidden COVID-19 burden: a telemedical solution for elective urological outpatient clinics

Maintaining high-quality care for urological patients is a challenge during and after the Coronavirus disease 2019 (COVID-19) pandemic. We observe an increasing volume of postponed elective visits at our tertiary care hospital, holding the risk for deterioration of non-emergency disease conditions. As it is unclear for how long the pandemic will last, we propose to implement telehealth as a solution to provide regular symptom monitoring compatible with social distancing guidelines during the pandemic and beyond. Telemedical assessment and prioritizing of high-risk patients for individual consults at outpatient services will have to be aligned with available outpatient capacity and local outbreak severity.

Oral 30 - Evaluating a “virtual” urology out-patient clinic to address delays in review patients

Introduction: Ireland has the one of the lowest urologist per population ratios in Europe1 Out-patient department (OPD) visits are time consuming, costly and frequently patients cannot be reviewed in the intended timeframe2 With the COVID-19 crisis innovative virtual models of care are essential Methods: Patients for OPD review were assessed by a Consultant in a “virtual” clinic using electronic records (letters, imaging, blood results) and chart review if required Patients were either discharged, discharged for GP testing with specified re-referral criteria, phone/letter follow up by a LUTS clinical nurse specialist, investigated and reviewed by phone/letter, or returned for face-to-face consultation Results: 400 patients were assessed The majority were seen previously by SHO or junior registrar 160 (40%) patients were discharged directly via letter and advice 121 (30%) required further imaging and could be contacted by phone with the results 79 (20%) could be contacted by the LUTS clinical nurse specialist for phone/written review 40 (10%) necessitated face-to-face OPD review for clinical assessment or investigation review In 47 patients there was insufficient information available in the electronic platforms, thus requiring formal chart review Overall, 360 patients could be managed via “virtual” means The potential out-patient cost savings were estimated at €27,000 Conclusion: With this COVID-19 pandemic, innovative models of care are necessitated Introduction of a “virtual” OPD clinic allows reliable review of patients with reduced face-to-face follow-up attendances Further study of staff training and patient satisfaction is required

A randomized, intervention parallel multicentre study to evaluate duloxetine and innovative pelvic floor muscle training in women with uncomplicated stress urinary incontinence-the DULOXING study.

The aim of our study was to evaluate the effect of a combination of innovative pelvic floor muscle training (iPFMT) and duloxetine compared with the use of duloxetine alone on women with stress urinary incontinence (SUI) after 12weeks of treatment. We conducted a parallel multicentre study with randomized intervention in 45 national urological outpatient clinics. Patients with an enrolment ratio of 1:1 were divided into the experimental and control groups. The following were used for evaluation: incontinence episode frequency (IEF)/week, the International Consultation on Incontinence Questionnaire (ICIQ-SF), the Urinary Incontinence Quality of Life Scale (I-QoL) and the Patient Global Impression of Improvement (PGI-I). The experimental group received oral treatment with duloxetine (a daily dose of 40mg BID) and innovative pelvic floor muscle training (iPFMT). The control group received only oral treatment with duloxetine at a daily dose of 40mg BID. The number of women who were evaluated was 158. The control group comprised 79 women with an average age of 56.8 ± 13.8 years and the experimental group comprised 79 women with an average age of 53.4 ± 11.9 years. There were no significant differences in pre-treatment parameters. For the intent-to-treat analysis after 12weeks' treatment, significant differences were observed between the experimental vs. control group (p < 0.001) for the following variables: IEF/week decrease (66.7% vs. 50.0%); ICIQ-UI SF decrease (8.3 ± 3.8 vs. 9.7 ± 4.2); PGI-I (70.8% vs. 65.6%); I-QoL score increase (19.3% vs. 6.6%). The addition of iPFMT to duloxetine treatment improves SUI syndrome in women compared with duloxetine treatment alone. Clinical Trials.gov NCT04140253.

Associations between nighttime and daytime maximum voided volumes: Relevance for nocturia?

The relationship between maximum voided volumes (MVV) during the night and day is poorly understood. Such measurements are important because they are often used to indicate functional bladder capacity (FBC), a relevant parameter for nocturia. This study examined the association of such nighttime and daytime measurements in men with nocturia. We retrospectively analyzed 356 24-hour voiding diaries showing ≥2 nocturnal voids from 220 men at an outpatient urology clinic. We defined small FBC as MVV ≤ 200 mL. A total of 131 entries demonstrated a nocturnal MVV ≤ 200 mL, of which a majority (98 [74.8%]) also showed a 24-hour MVV ≤ 200 mL (ie, global small FBC), and 33 (25.2%) exceeded the 200 mL threshold during the day (ie, nocturnal-specific small FBC). Correspondingly, among voiding diaries without global small FBC (n = 258), most (225/258 [87.2%]) showed a nocturnal MVV > 200 mL. Data were similar when analyzing only the first complete voiding diary per case, when limiting analyses to those without benign prostatic obstruction, and when limiting analyses to cases with nocturnal polyuria. Nocturia may be attributable to nocturnal-specific small FBC or global small FBC. Although the etiology of nocturnal-specific small FBC remains unclear, it was present in a significant minority of patients with small FBC, thus necessitating more directed research. Conversely, diminished nocturnal MVV was nevertheless relatively uncommon in the absence of global small FBC, such that nocturnal-only voiding diaries may provide a rational alternative for follow-up evaluation in patients with nocturia due to global small bladder capacity.

A prospective study analyzing both inflation and deflation preference for commonly available inflatable penile prostheses.

Despite popularity, satisfaction rates of inflatable penile prosthesis (IPP) use can be improved by evaluating the ability to operate devices in the preoperative setting. The purpose of this study was to prospectively analyze the preference of three commonly available IPPs. In total, 125 IPP-naïve men 60 years of age or older were prospectively recruited from an outpatient Urology clinic from June 2019 to January 2020. A questionnaire standardized to all encounters was utilized to collect demographics, selected medical information, and key pinch strength. Participants were then asked to rank three models in terms of preference (from 1 to 3, 1 representing most preferred) for each inflation and deflation in a double-blinded manner. Statistical analysis was performed using ANOVA, a Chi-square test and multivariable logistical regression analysis. The results demonstrated preference for Coloplast Titan (44%) for inflation, and preference for AMS 700 (40%) for deflation. Men who preferred the Coloplast Titan inflation had a lower chance of preferring the AMS 700 MS deflation (OR = 0.29; p = 0.010) and Coloplast Titan Touch deflation (OR = 0.27; p = 0.012). Preference for Coloplast Titan was weakly associated with participant history of coronary artery disease (OR = 5.96, p = 0.006) and osteoarthritis (OR = 3.04, p = 0.044). Neither key pinch strength nor age was associated with preference for a particular model. IPP-naïve men over 60 years favor Coloplast Titan for inflation and AMS 700 for deflation, and men who preferred the Coloplast Titan for inflation were less likely to choose the AMS 700 MS or Coloplast Titan Touch for deflation. Further studies should aim to confirm these findings.