Voiding Dysfunction In Patients Research Articles

Role of Urological Botulinum Toxin-A Injection for Overactive Bladder and Voiding Dysfunction in Patients with Parkinson’s Disease or Post-Stroke

Botulinum toxin A (BoNT-A) paralyzes muscle by blocking acetylcholine release at the synaptic junction. BoNT-A has shown its therapeutic effects in neurological disorders such as Parkinson's disease (PD) and post-stroke spasticity. A high proportion of patients with PD and post-stroke develop neurogenic detrusor overactivity (nDO) and then develop urinary incontinence and overactive bladder (OAB) symptoms. This study aimed to disclose the safety and efficacy of BoNT-A injection in treating bladder and voiding dysfunction in PD and post-stroke patients by reviewing the current evidence. At present, intradetrusor injection of BoNT-A is a Food and Drug Administration (FDA)-approved third-line therapy for nDO and idiopathic OAB. Although intradetrusor injection of onaBoNT-A 200 U is already approved for nDO treatment, most researchers would like to manage PD and post-stroke patients by using onaBoNT-A 100 U intradetrusor injection to achieve long-term efficacy and reduce adverse effects. However, in contrast to its inclusion in the International Continence Society guidelines for PD treatment, the clinical use of BoNT-A for post-stroke patients is limited to experimental use due to the development of urinary retention in about one-fifth of patients. For treating urethral pseudodyssynergia, half of patients may respond to onaBoNT-A 100 U urethral injection. However, refinement is needed to reduce unwanted urinary incontinence.

Clinical Guidelines of Patient-Centered Bladder Management of Neurogenic Lower Urinary Tract Dysfunction due to Chronic Spinal Cord Injury - Part 2

Bladder management of chronic spinal cord injured (SCI) patients usually starts with conservative treatment or minimally invasive procedures. This article reports the current evidence and expert opinions on the patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among patients with chronic SCI in Taiwan. We evaluated the role of clean intermittent catheterization (CIC), cystostomy, medical treatment, and minimally invasive therapy for treating urinary incontinence and voiding dysfunction in patients with chronic SCI. The bladder management for chronic SCI patients should be individualized. A balance between upper urinary tract protection and life quality improvement should be considered. Hand dexterity, abdominal muscle power, bladder sensation, and degree of urethral sphincter dyssynergia might affect the improvement of voiding efficiency and NLUTD. Intradetrusor Botulinum Toxin Type A (BoNT-A) injection has been proven to effectively treat neurogenic detrusor overactivity in SCI patients. However, CIC is still required in some patients after treatment. The urethral sphincter BoNT-ABoNT-A injection can effectively relax the dyssynergic sphincter; however, exacerbation of urinary incontinence usually limits its application in SCI patients. Repeat BoNT-ABoNT-A injection is necessary to maintain the therapeutic efficacy; therefore, some SCI patients might discontinue the treatment and convert to a permanent bladder management by surgical intervention. Identification of high-risk SCI patients is important to prevent renal functional deterioration in those with chronic SCI-NLUTD. Avoiding renal function deterioration and improving the quality of life of SCI patients with NLUTD are the most important aspects of treatment. Annual active surveillance of bladder and renal function is necessary.

MP18-20 EVALUATION OF QUALITY OF LIFE, VOIDING, AND SEXUAL DYSFUNCTION IN PATIENTS FOLLOWING ROBOT-ASSISTED VESICOVAGINAL FISTULA REPAIR

You have accessJournal of UrologyCME1 May 2022MP18-20 EVALUATION OF QUALITY OF LIFE, VOIDING, AND SEXUAL DYSFUNCTION IN PATIENTS FOLLOWING ROBOT-ASSISTED VESICOVAGINAL FISTULA REPAIR Pawan Kaundal, Ravimohan Mavuduru, Girdhar Bora, and Shrawan K. Singh Pawan KaundalPawan Kaundal More articles by this author , Ravimohan MavuduruRavimohan Mavuduru More articles by this author , Girdhar BoraGirdhar Bora More articles by this author , and Shrawan K. SinghShrawan K. Singh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002551.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted VVF repair has the advantage of minimal surrounding tissue trauma, small cystotomy, and precise dissection, leading to a better outcome. This study aims to evaluate the quality of life, voiding, and sexual dysfunction following robot-assisted VVF repair. METHODS: Women with successful RA-VVF repair from December 2014 to June 2020 were screened using Urinary distress inventory-6(UDI-6),Incontinence impact questionnaire-7(IIQ-7), Female sexual function index(FSFI), World Health Organization quality of life(WHOQOL-BREF) questionnaires in an ambispective cohort study at 3 months of repair.Those with recto-vaginal, malignant, radiation fistulae, failed robotic repair, non-consenting, undergoing open abdominal/vaginal VVF repair and incompletely filled questionnaire were excluded.Those with urinary dysfunction were subjected to urodynamic evaluation. Appropriate Statistical test were applied using SPSS version 23.0. RESULTS: 75 women underwemt RA-VVF repair. Of these 47 were enrolled(33 in retrospective and 14 in prospective cohort). Overall, 28 (60%) women had urinary complaints. The median UDI-6 score was 4 (0-100), IIQ score 0.00 (0-23). 5 (10%) women had affect on day-to-day activity and only one patient had moderate bother. However, UDS (15 women) showed normal cystometric capacity (352 ± 98.12) ml and compliance in 14 (93%) womenwith no detrusor overactivity. Mean BOOI and DCI were 11.90 ± 7.01 and 44.25 ± 8.60 respectively. 20 (43%) women were sexually active, only 2 had sexual dysfunction (FSFI score < 26.55). Quality of life was “good” to “very good” in all domains (score >90) except for the social domain (Table1). Prospective cohort showed significant improvement in UDI-6 score (p<0.05), IIQ-7 score (p<0.5) and quality of life (p<0.5) postoperatively. CONCLUSIONS: RA-VVF repair results in minimal voiding dysfunction and significant improvement in overall quality of life. For sexual dysfunction assessment, longer follow-up is required. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e304 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pawan Kaundal More articles by this author Ravimohan Mavuduru More articles by this author Girdhar Bora More articles by this author Shrawan K. Singh More articles by this author Expand All Advertisement PDF DownloadLoading ...

Accuracy of Bladder Scanner for the Assessment of Postvoid Residual Volumes in Women With Pelvic Organ Prolapse

(Abstracted from Female Pelvic Med Reconstr Surg 2020;26:640–643) There is an increased risk of developing voiding dysfunction in patients with advanced pelvic organ prolapse (POP). An important component of evaluating these patients is assessment of postvoid residual (PVR) volumes.

Use of a symptom-based questionnaire to screen for the presence of significant voiding dysfunction in patients with multiple sclerosis and lower urinary tract symptoms: a pilot study

IntroductionLower urinary tract dysfunction is common in people with multiple sclerosis, leading to overactive bladder symptoms, voiding difficulties or a combination. First-line medications for overactive bladder symptoms are effective. Current guidelines recommend measuring post-void residual volume (PVR) before commencing these treatments, as they can potentially exacerbate voiding difficulties in those with significant underlying voiding dysfunction (pre-treatment PVR > 100 ml). However, facilities to do so are not readily available to all clinicians, potentially delaying effective therapy.AimsTo conduct a pilot study investigating the association between lower urinary tract symptoms and PVR volume in people with multiple sclerosis using a validated questionnaire and to determine if questionnaire scores can be used to exclude a significantly elevated (> 100 ml) PVR volume.MethodsPatients with multiple sclerosis referred to a tertiary hospital uro-neurology service completed the Urinary Symptom Profile questionnaire and underwent PVR measurement by bladder ultrasound. A ratio of the questionnaire low stream score/total score was calculated to standardise the relative degree of voiding symptoms compared to overall lower urinary tract symptoms.ResultsOf 40 patients (29 females, mean age 50 years), 30% had an elevated PVR volume. PVR volume was correlated with low stream score and ratio of low stream/total score. A cut-off of > 0.15 for low stream/total score ratio had 92% sensitivity and 71% specificity in predicting an elevated PVR volume.ConclusionA symptom-based questionnaire maybe a useful screening tool to distinguish patients in whom PVR measurement is required from those who could safely start on treatment for overactive bladder symptoms.

The Effect of Preoperative Phenazopyridine on Urinary Retention Following Midurethral Sling.

The aim of this study was to determine the effect of preoperative oral phenazopyridine on short-term voiding dysfunction in patients undergoing a retropubic midurethral sling. We conducted a retrospective cohort study in subjects undergoing a retropubic midurethral sling comparing those who received preoperative oral phenazopyridine with those who did not. We included all women who underwent a retropubic midurethral sling without concomitant procedures under general anesthesia at our institution. Slings were placed by either suprapubic or transvaginal approach, per surgeon's preference. Demographics and intraoperative data on preoperative dose of phenazopyridine and medications linked to voiding dysfunction were captured. One hundred seventy-four subjects were identified. Twenty-five subjects failed to meet inclusion and exclusion criteria and were excluded, and 149 subjects comprised the final groups. Eighty-two subjects (55.03%) received phenazopyridine, and 67 (44.97%) did not. Most subjects received a 200-mg dose (97.6%). Except for surgical approach, both groups receiving and not receiving phenazopyridine had similar demographic characteristics. Eighty-eight percent of the subjects who received phenazopyridine passed the voiding trial versus 73.1% (odds ratio, 2.98; 95% confidence interval, 1.23-7.17). After adjusting for medications, estimated blood loss, number of trocar passages, or bladder perforation, the patients receiving phenazopyridine were still more likely to pass the postoperative voiding trials compared with those who did not (odds ratio, 2.97; 95% confidence interval, 1.10-7.98). Our findings suggest that the preoperative administration of phenazopyridine may improve postoperative voiding function after a retropubic midurethral sling. Additional prospective trials are needed to confirm this finding.

Points Aa and Ba are factors associated with preoperative voiding dysfunction in patients with cystocele

ObjectiveIt has been hypothesized that women with significant pelvic organ prolapse (POP), particularly of the anterior vaginal wall, may have voiding dysfunction (VD). Rarely, different compartments of the vagina have been examined closely for VD. This study attempts to further elucidate the correlation between POP and VD by using the standardized Pelvic Organ Prolapse Quantification (POP-Q) staging system. Study designThe clinical records of 66 women who underwent cystocele (≥POP-Q stage III) repair with concomitant midurethral sling were reviewed. Urodynamic study and POP-Q examination were performed preoperatively. The subjects were divided into two groups according to the presence of VD, which was defined as the presence of at least one of the following criteria: maximal flow rate below 15mL/s or postvoid residual urine volume (PVR) above 50mL on preoperative uroflowmetry. Age, parity, uroflowmetry and urodynamic parameters were compared between the two groups. ResultsOf 66 women, 36 had VD preoperatively. In the VD group, failure in the postoperative voiding trial was more frequent (p=0.040), with lower maximal flow rate (p=0.007) and higher PVR (p=0.034). POP-Q stage was significantly higher (p=0.018), and points Aa and Ba were significantly longer (p=0.005 and p=0.006, respectively) in the VD group. POP-Q stage with points Aa and Ba were significantly correlated with the presence of preoperative VD, and moderately correlated with PVR. ConclusionThe prevalence of VD in patients with cystocele is high (55%). Points Aa and Ba of POP-Q stage had positive correlations with VD in patients with cystocele.

625 Is a single voiding trial enough to predict post-operative voiding dysfunction in patients receiving TOT?

625 Is a single voiding trial enough to predict post-operative voiding dysfunction in patients receiving TOT?

Defining the role of urodynamics in predicting voiding dysfunction after anti-incontinence surgery: a work in progress

To evaluate the role of preoperative urodynamics in predicting postoperative voiding dysfunction in patients undergoing anti-incontinence surgery. Voiding dysfunction after anti-incontinence procedures is not an uncommon finding, along with being a difficult one to treat. Many patients undergo preoperative urodynamics in an attempt to further characterize their incontinence preoperatively and possibly provide information regarding prognosis postoperatively. However, the role of routine urodynamics in patients undergoing anti-incontinence surgery is somewhat controversial, with mixed findings in regard to support of this practice being found in the literature. The literature on the role of preoperative urodynamics in predicting voiding dysfunction after anti-incontinence surgery is reviewed.

Transurethral incision of the bladder neck to treat bladder neck dysfunction and voiding dysfunction in patients with high‐level spinal cord injuries

Detrusor-sphincter dyssynergia (DSD) and bladder neck dysfunction (BND) may cause voiding dysfunction in patients with spinal cord injury (SCI). We report the surgical outcomes in patients with high-level SCI who underwent transurethral incision of the bladder neck (TUI-BN). Twenty-two patients with SCI at or above the mid-thoracic level who presented with voiding dysfunction due to BND with different types of DSD received TUI-BN. Surgical outcome was determined by comparing preoperative with postoperative urodynamic parameters and clinical presentations. Satisfactory outcome was defined as having improvement of AUA/IPSS quality-of-life (QoL) index by >or=2. Among the patients, 19 (86.4%) were men and 3 (13.6%) were women. Thirteen patients had cervical and nine had thoracic SCI. Postoperatively, spontaneous voiding by abdominal triggering with an open urethral sphincter was noted in 19 patients (86%) and AD had resolved in 15 patients (88.2%). Detrusor pressure decreased significantly in 9 patients who had a high voiding pressure at baseline, and increased significantly in 13 patients who showed impaired detrusor contractility preoperatively. Eighteen patients (82%) reported satisfactory outcome, increased maximum flow rate (Q(max)), decrease in postvoid residual (PVR) postoperatively. In addition, 82% of the patients were catheter free or reported a decrease in the frequency of clean intermittent catheterization after TUI-BN. TUI-BN is effective in restoring spontaneous voiding, increasing Q(max), and decreasing PVR in high-level SCI patients. TUI-BN also leads to improvement in reducing bladder outlet resistance, reduction in occurrence of AD episodes, and improvement in QoL.

VOIDING DYSFUNCTION IN PATIENTS WITH DYSAUTONOMIA

You have accessJournal of Urology1 Apr 2009VOIDING DYSFUNCTION IN PATIENTS WITH DYSAUTONOMIA Anand Shridharani, Michael L. Guralnick, Alexandru C. Barboi, Safwan S. Jaradeh, Thomas E. Prieto, Mary Yellick, and R. Corey O'Connor Anand ShridharaniAnand Shridharani More articles by this author , Michael L. GuralnickMichael L. Guralnick More articles by this author , Alexandru C. BarboiAlexandru C. Barboi More articles by this author , Safwan S. JaradehSafwan S. Jaradeh More articles by this author , Thomas E. PrietoThomas E. Prieto More articles by this author , Mary YellickMary Yellick More articles by this author , and R. Corey O'ConnorR. Corey O'Connor More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)60975-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "VOIDING DYSFUNCTION IN PATIENTS WITH DYSAUTONOMIA." The Journal of Urology, 181(4S), p. 343 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 343 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Anand Shridharani More articles by this author Michael L. Guralnick More articles by this author Alexandru C. Barboi More articles by this author Safwan S. Jaradeh More articles by this author Thomas E. Prieto More articles by this author Mary Yellick More articles by this author R. Corey O'Connor More articles by this author Expand All Advertisement PDF downloadLoading ...

Voiding Symptoms and Urodynamic Findings in Patients with Modified Ileal Neobladde

The aim of our study was to find the cause of urinary incontinence and voiding dysfunction in patients undergoing radical cystectomy and orthotopic bladder replacement with modified ileal neobladder (Reddy). Twenty-eight incontinent patients (operated on between 1988 and 2004) were involved in our examination. Based on the complaints of the patients, continence status was evaluated and divided into two groups: group I: partially incontinent (only night-time incontinence) n = 11 (39.3%) and group II: totally incontinent (night-time and daytime incontinence) n = 17 (60.7%). Detailed urodynamic examination (enterocystometry and urethral pressure profile) in addition to involuntary neobladder contractions and capacity detection were carried out on all patients. Furthermore resting pressure and maximal voluntary contraction ability of the sphincter were determined and statistically analyzed in both groups. Significant difference was noticed in resting pressure and maximal voluntary contraction ability of the sphincter among the partially incontinent and totally incontinent patients. Frequency, intensity and duration of involuntary neobladder contractions also showed significant differences between the two groups. Incontinence of neobladder depends not only on the destruction of resting and contraction capability of the urethral sphincter, but also on the presence or absence of involuntary contractions in the wall of the neobladder and decreased capacity of the neobladder.

Immediate Foley removal after laparoscopic and vaginal hysterectomy: Determinants of postoperative urinary retention

Study objective We sought to evaluate the incidence of postoperative voiding dysfunction in patients undergoing vaginal hysterectomy (VH) or total laparoscopic hysterectomy (TLH) and to identify risk factors for the development of postoperative urinary retention after uncomplicated total hysterectomy. Design Prospective cohort study (Canadian Task Force classification II-2). Setting Gynecology department of a university hospital. Patients Two hundred thirty-three consecutive women undergoing TLH or VH for benign gynecologic disease. Interventions A regimen of immediate catheter removal after the operation was instituted. A strict voiding trial protocol was used during the study period. Postoperative voiding dysfunction was defined as failure of first voiding trial after surgery (urinary retention) or postvoid residual volume of greater than 150 mL necessitating recatheterization. Measurements and main results A total of 49 women (21%) developed postoperative voiding dysfunction, of which 32 (13.7%) had complete urinary retention and 17 (7.3%) had a postvoid residual volume greater than 150 mL. None of these patients experienced voiding dysfunction beyond 48 hours. There was no statistical correlation between development of postoperative voiding dysfunction and demographic, historic, preoperative, and postoperative variables collected. The only factor with significant impact on postoperative voiding dysfunction was vaginal approach to hysterectomy (OR 2.8; 95% CI 1.5–5.4). Hospital stay was significantly longer for women experiencing voiding difficulties than for those who voided efficiently (2.2 ± 0.8 [95% CI 1.5–1.9] vs 1.7 ± 1.2 [95% CI 1.9–2.4] days; p <.0001). Voiding dysfunction was an independent predictor of postoperative urinary tract infection (OR 4.9; 95% CI 1.6–15.4). Conclusion Patients undergoing VH are more likely to develop postoperative voiding dysfunction than those who undergo TLH, when a policy of immediate catheter removal after surgery is used.

MP-21.21: The 2 micron CW laser, a new era for the ablation of prostate obstruction

The Revolix laser emits continuous wave radiation at 2.0 micron wavelength resulting in true vaporization of the prostate. This quality of disobstruction produces an immediate improvement in the voiding dysfunction in patients with obstructive BPH.

Uretrolisis transvaginal tras cirugía correctora de la incontinencia urinaria de esfuerzo

PurposeTo analyse the success of transvaginal urethrolysis in resolving voiding dysfunction in patients following an anti-incontinence procedure. Materials and MethodsA retrospective chart review was performed on 20 patients who had undergone transvaginal urethrolysis for urethral obstruction following an anti-incontinence procedure. Preoperatively, a history was taken, pelvic examination and urodynamic were done. Mean patient age was 48 years, and the median time between the anti-incontinence procedure and the urethrolysis was nine months. Four patients had urinary retention and had irritative voiding symptoms. Previous surgery included pubovaginal sling in eleven patients, retropubic urethropexy in three and bladder neck suspension in six cases. Mean length of follow up after urethrolysis was 14 months. The urodynamic study demonstrated voiding flow rate of 9,9ml/s and detrusor pressures at maximum flow of 48cmH2O. ResultsOf the 20 patients 14 (70%) had relief of symptoms after a single urethrolysis, while two patients underwent a second transvaginal urethrolysis, with placement of a Martius flap between the urethra and the symphysis. There was no correlation between preoperative parameters examined and the outcome from urethrolysis. ConclusionOur data support transvaginal urethrolysis for the treatment of urethral obstruction after anti-incontinence surgery. It is effective and minimally invasive technique with good results that should be considered if voiding dysfunction does not resolve spontaneously.

Tip/Trick 4: Voiding Dysfunction in Patients With TVT Slings Adjusted Using an Alternative Method of Tensioning

Tip/Trick 4: Voiding Dysfunction in Patients With TVT Slings Adjusted Using an Alternative Method of Tensioning

EFFECTS OF DIABETES ON FEMALE VOIDING BEHAVIOR

We studied voiding behavior in women with type 2 diabetes vs nondiabetic female controls and examined factors associated with voiding dysfunction in patients with diabetes. After eliminating coexisting medical factors that could affect voiding function we evaluated voiding behaviors in 194 female patients with diabetes treated regularly at a diabetic clinic and 162 control women using a lower urinary tract symptom questionnaire based mainly on the American Urological Association Symptom Index questionnaire and free flow analyses with post-void residual urine estimates. Emptying efficiency was defined as 100% x volume voided/(volume voided + post-void residual urine). Compared with controls patients with diabetes had significantly higher nocturia scores (p = 0.003), weaker urinary streams (p = 0.02), less voided volumes (220 +/- 97 vs 280 +/- 104 ml, p = 0.04) and lower maximal flow rates (19.4 +/- 8.4 vs 25.9 +/- 8.5 ml per second, p <0.001). Remarkable residual urine (100 ml or greater) was detected in 1.8% of controls vs 13.9% of patients. After controlling for age and voided volume diabetes was significantly associated with a decrease in baseline maximum flow of 4.5 ml per second (95% CI 2.9 to 6.2). In patients with diabetes peripheral neuropathy was an independent factor associated with the decrease in emptying efficiency (p = 0.03). Diabetes significantly altered voiding patterns in a significant proportion of women treated at the diabetic clinic. Peripheral neuropathy is an important factor associated with diabetic voiding dysfunction.

Voiding Dysfunction in Patients with Human T-Lymphotropic-Virus-Type-1-Associated Myelopathy

Voiding dysfunction in patients with human T-lymphotropic-virus-type-1-associated myelopathy (HAM) was studied. All the patients were diagnosed as having HAM by neurologists. We have already reported on 16 consequent patients with HAM. Almost all of these patients had frequency, and many had urge incontinence of urine and difficulty on voiding. Urodynamic study revealed that their voiding symptoms seemed to be due to detrusor hyperactivity and detrusor-sphincter dyssynergia. However, we have recently treated 2 patients who had a different bladder function. They had both frequency and difficulty in voiding but without urgency. In the urodynamic study both patients did not have involuntary bladder contraction during the filling phase and could not void voluntarily. The reason why these 2 patients had an underactive detrusor is unclear. The fact that the average duration of HAM in the 16 patients previously mentioned was longer than that of the latter 2 patients may suggest that overactivity of the bladder is not prominent in the early phase of this disease.

脊椎椎間板ヘルニアにおける尿流動態検査成績

Thirty-one patients with intervertebral disc prolapse (IDP) underwent urodynamic study before surgical operation. The lesion was located between C4 and T10 in 14, T11 and L2 in 2 and L2 and S1 in 15 patients. Preoperative urinary symptoms were obstructive in 11 (36%), irritative in 5 (16%) and both obstructive and irritative in 5 (16%) patients, and the remaining 19 patients (32%) had no symptoms. Preoperative urodynamic abnormalities were noted in 23 cases (74%): abnormal urinary uroflow in 6 of 14 cases (43%), residual urine of more than 30 ml in 9 of 31 cases (29%), abnormal cystometrogram and/or external sphincter EMG in 16 of 31 cases (52%). These urodynamic abnormalities were closely correlated with perineal hyposensitivity. Voiding function was re-examined in 22 patients after operation: improved in 14 (64%), unchanged in 1 (4%), worsened in 2 (9%) and normal in 5 (23%) before and after operation. Therefore the above results could indicate that the presence of perineal hyposensitivity should be suspected to have voiding dysfunction in patients with IDP. Orthopedic surgery may improve voiding dysfunction in the majority of patients.