Voiding Function Research Articles

Robotics Total Mesorectal Excision Up To the Minute.

Surgical techniques have evolved over the past few decades, and minimally invasive surgery has been rapidly adapted to become a preferred operative approach for treating colorectal diseases. However, many of the procedures remain a technical challenge for surgeons to perform laparoscopically, which has prompted the development of robotic platforms. Robotic surgery has been introduced as the latest advance in minimally invasive surgery. The present article provides an overview of robotic rectal surgery and describes many advances that have been made in the field over the past two decades. More specifically, the introduction of the robotic platform and its benefits, and the limitations of current robotic technology, are discussed. Although the main advantages of robotic surgery over conventional laparoscopy appear to be lower conversion rates and better surgical specimen quality, oncological and functional outcomes appear to be similar to those of other alternatives. Other potential benefits include earlier recovery of voiding and sexual function after robotic total mesorectal excision. Nevertheless, the costs and lack of haptic feedback remain the primary limitations to the widespread use of robotic technology in the field.

Oncological and Functional Outcomes After Organ-Sparing Plastic Reconstructive Surgery for Penile Cancer

To describe oncological and functional outcomes in patients treated with reconstructive organ-sparing surgery (OSS) for squamous cell carcinoma of the penis. Plastic reconstructive OSS of the penis with a split thickness skin graft has been proposed as a treatment option for penile cancer, with the objective being preservation of physiological voiding and sexual function without comprising oncological control. Multicenter study reporting clinicopathological data of 57 patients with malignant lesions of the penis treated with OSS and plastic reconstructive surgery with split thickness skin graft from 2007 to 2019. Health related quality of life (HRQoL) was assessed with EuroQoL-5D-3L, urinary symptoms with the International Consultation on Incontinence Modular Questionnaire for Male Lower Urinary Tract Symptoms, and erectile function with the International Index of erectile function (IIEF)-5. Fifty-seven patients underwent OSS reconstructive surgery. Twenty underwent glans resurfacing, 23 partial penectomy, and 14 glansectomy. Median age was 55.1 years (interquartile range [IQR] 29-90), median follow-up 55.7 months (3-149). At the time of data analysis, 6 patients had died of Squamous Cell Carcinoma (SCC) (12.5%) and 10 (17.8%) had progressed. Kaplan-Meier estimates showed a 5-year survival rate of 87.5% and a 5-year progression-free survival of 83%. We assessed HRQoL and functional outcomes in 32 patients. EuroQol 5D-3L showed a mean health status of 82.5%, median Voiding score of the ICIQ-MLTUS was 4 (IQR 1-15), and median IIEF-5 19 (IQR 10.75-25). OSS of the penis remains a safe and viable option for the treatment of SCC, ensuring a favorable appearance of the penis, preserving urinary and sexual function, with good HRQoL and without comprising oncological safety in selected cases.

Management of highly recurrent bladder neck contractures via transurethral resection combined with intra- and post-operative triamcinolone acetonide injections.

To present our preliminary experience in managing patients with highly recurrent bladder neck contractures (BNCs) after transurethral resection of the prostate (TURP). Between February 2015 and March 2018, 28 patients with highly recurrent BNCs who had failed multiple prior to endoscopic treatments were managed with transurethral resection and intra- and post-operative triamcinolone acetonide injections. The scar tissue was resected to the circular fiber at the bladder neck, and triamcinolone acetonide (2mL, 40mg/mL) was injected at the incision sites (8 points) using a cystoscopic injection needle. The cystoscopy-guided injections were repeated every four weeks for total three times after surgery. The patients were followed up at 3, 6, 12months after surgery, and in July-August 2019. The recurrent interval before the treatments was 2.2 ± 1.2months, without any BNC recurrence in the first 12weeks after transurethral resection. The urinary flow rate increased significantly and was maintained during the follow-up period. Adequate voiding function was reported in 25 of 28 patients at a median follow-up of 2.8 (1.7, 3.9) years. One of the three patients with decreased urinary flow rate had underactive detrusor and no BNC recurrence. The complications were mild and tolerable. Transurethral resection of the scar tissue combined with intra- and post-operative triamcinolone acetonide injections resulted in a success rate of 92.9% in patients with highly recurrent BNC following TURP. It is a simple, safe, and effective treatment for highly recurrent BNCs.

Mast cells play a critical role in driving prostatic inflammation in Lower Urinary Tract Symptoms associated with Benign Prostatic Hyperplasia

Abstract Background Prostatic inflammation is a key contributor to lower urinary tract symptoms (LUTS). An intraurethral infection with a uropathogenic isolate of E. coli (CP1) results in clinical signs of benign prostatic hyperplasia (BPH) and LUTS as demonstrated by increased urinary dysfunction, prostate inflammation and fibrosis. In this study we study the importance of mast cells in driving prostate inflammation in BPH/LUTS and the therapeutic benefit of mast cell neutralization on the disease. Results We observed increased mast cell infiltration and activation associated with increased fibrosis in prostate tissues from BPH patients and CP1 infected mice as identified by toluidine blue and picrosirius staining. To assess the role of mast cell activation, inhibition was performed using a combination of a mast cell stabilizer and histamine 1 receptor (H1R) antagonist at an early and late time point post CP1 infection. Treatment with this combination resulted in a decrease of activated mast cells in prostate tissues of infected mice. Furthermore, the prostate of these mice showed decreased prostate fibrosis and inflammation as assessed by picrosirius red staining and flow cytometry for immune cell infiltrates. Finally, we observed that this combination treatment can ameliorate the urinary dysfunction previously observed in response to CP1 infection, as assessed using unconscious terminal cystometry and bladder voiding function measurements. Conclusions These results provide evidence of the critical role played by mast cells in the development of prostate inflammation in BPH/LUTS. A combination therapy of mast cell stabilizer and H1R antagonist maybe a useful target for therapeutic intervention in men with BPH/LUTS.

Intraoperative radiotherapy for resectable advanced lower rectal cancer-final results of a randomized controlled trial (UMIN000021353).

Pelvic autonomic nerve preservation (PANP) is useful to preserve voiding and sexual function after rectal cancer surgery. The aim of this study was to investigate the benefit of intraoperative radiotherapy (IORT) to have complete PANP without affecting oncological outcomes. Patients undergoing potentially curative resection of the rectum were included. They were randomized to intraoperative radiotherapy of the completely preserved bilateral pelvic nerve plexuses (IORT group) or the control group without IORT, but with limited nerve preservation. The primary endpoint was pelvic sidewall recurrence. Moreover, patients' clinicopathologic parameters, postoperative complications, voiding function, and other oncologic outcomes were compared. From 79 patients, three were excluded from analysis, resulting in 38 patients in each group. Patients' demographic and pathological parameters were well balanced between the two groups. The trial was terminated prematurely in July 2017, because distant metastasis-free survivals were found to be significantly worse in the IORT group compared to the control group (odds ratio 2.554; 95% CI, 1.041 ~ 6.269; p= 0.041). Neither overall survival nor pelvic sidewall recurrence did differ between the two groups (overall survival: odds ratio 1.264; 95% CI, 0.523~3.051; p= 0.603/pelvic sidewall recurrence; odds ratio 1.350; 95% CI, 0.302~6.034; p= 0.694). Postoperative complications did not differ between the groups; however, the urinary function was significantly better in the IORT group in the short and long term. With the aid of IORT, complete PANP can be done without increase of pelvic sidewall recurrence; however, IORT may increase the incidence of distant metastases. Therefore, IORT cannot be recommended as a standard therapy to compensate less radical resection for advanced lower rectal cancer.

Effects of vibegron, a novel β3-adrenoceptor agonist, and its combination with imidafenacin or silodosin in a rat with partial bladder outlet obstruction.

Urgency is regarded as a core symptom of overactive bladder (OAB) and may correspond to detrusor overactivity (DO). One of the causes of OAB in men is bladder outlet obstruction (BOO) associated with benign prostatic hyperplasia (BPH). Vibegron is a novel selective β3-adrenoceptor agonist recently approved for the treatment of OAB. However, in OAB patients with BPH (BPH/OAB), the effects of vibegron on storage functions, especially DO and voiding functions have not been fully investigated. In this study, we evaluated the effects of a single administration of vibegron on storage function (particularly focusing on non-voiding contractions [NVC] considered a surrogate marker for DO) and voiding functions, using a rat model of partial BOO as a model for BPH/OAB. Furthermore, the utility of vibegron in combination with imidafenacin (an antimuscarinic) or silodosin (an α1A-adrenoceptor blocker) was evaluated. Six weeks after establishment of BOO, the frequency and amplitude of NVC, evaluated by cystometrography, increased. Vibegron inhibited the frequency of NVC without affecting voiding function (micturition pressure, residual volume, and voiding efficiency). Imidafenacin and silodosin also inhibited the frequency of NVC; however, the inhibitory effects of vibegron were stronger than those of imidafenacin or silodosin. The combination of vibegron with imidafenacin or silodosin additively inhibited the frequency of NVC without worsening the voiding function. These results suggest the possibility that vibegron is effective as a single agent for the amelioration of storage symptoms in BPH/OAB patients and is useful in combination with either antimuscarinics or α1-adrenoceptor blockers.

Afferent Nerve Activity Ex Vivo and Voiding Frequency In Vivo are Driven by Bladder Filling Rate in a Mouse Model of Polydipsia‐Polyuria

The mechanisms regulating urinary voiding function are not entirely understood. Many disorders of the lower urinary tract such as overactive bladder, urinary incontinence, and underactive bladder are associated with dysfunctional voiding behavior. Developing treatments to improve voiding function in afflicted individuals has proved to be problematic, in part due to a lack of basic understanding of the mechanisms responsible for controlling voiding function.We have shown previously in an ex vivo bladder model that afferent nerve activity increases as the bladder is filled. Furthermore, transient pressure events occurring during bladder filling trigger substantial rises in afferent nerve activity, more so than would occur during a similar rise in bladder pressure associated with bladder filling. This observation suggests that localized wall deformations associated with transient pressure events could transduce important sensory information to the central nervous system as to the filling state of the bladder. In the present study, we hypothesized that bladder filling rate is an important parameter that controls voiding function in vivo. We used an acute sucrose induced polydipsia/polyuria model that allows us to determine the impact of bladder filling rate on voiding behavior noninvasively in conscious freely moving mice.Male C57Bl6 mice (6 weeks old) were placed into a UroVoid apparatus for 48 hour voiding studies. One group of mice had access to tap water while a second group of mice had access to 5% sucrose in water. All mice had access to standard rodent chow. The UroVoid apparatus allows us to quantify the time and volume for each micturition.Mice drinking 5% sucrose consumed substantially more fluid than mice consuming tap water (26.98 ± 13.12 ml vs. 7.23 ± 1.35 ml). This polydipsia was reflected in a profound polyuria in mice consuming sucrose, as these mice voided a total of 18.98 ± 13.52 ml of urine over 79 ± 42 voids compared to 3.91 ± 0.54 ml of urine over 22 ± 16 voids in mice consuming tap water. Using the voided urine volume and the intermicturition interval for each void, we calculated that the urine production rate (UPR) is ~2 μl/min in mice consuming tap water, whereas the UPR is greatly elevated to ~25 μl/min in mice consuming 5% sucrose. Voiding frequency is greatly increased in mice consuming 5% sucrose, which we believe reflects underlying sensory function.To address the impact of bladder filling rate on sensory function, we measured afferent pelvic nerve activity in ex vivo bladder preparations at filling rates of 3.3, 10, and 30 μl/min. As expected, sensory nerve activity was increased at higher filling rates. For example, at an intravesical pressure of 15–20 mmHg, afferent nerve frequency increased from 91.5 ± 43.0 Hz at 3.3 μl/min to 174.9 ± 64.1 Hz at 30 μl/min.In conclusion, sucrose‐induced polydipsia/polyuria in mice is an effective way to examine the impact of bladder filling rate on voiding behavior. Increases in bladder filling rate are associated with increases in afferent nerve outflow in the bladder, and this increase in sensory outflow may contribute to elevated voiding frequency at higher bladder filling rates.Support or Funding InformationSupported by NIH R37 DK053832

V13-01 A PRE-CLINICAL MODEL OF URODYNAMICS

You have accessJournal of UrologyFemale Pelvic Surgery (V13)1 Apr 2020V13-01 A PRE-CLINICAL MODEL OF URODYNAMICS Samuel Weprin*, Dielle Meyer, Natalie Swavely, Naveen Nandanan, John T. Roseman, and Adam Klausner Samuel Weprin*Samuel Weprin* More articles by this author , Dielle MeyerDielle Meyer More articles by this author , Natalie SwavelyNatalie Swavely More articles by this author , Naveen NandananNaveen Nandanan More articles by this author , John T. RosemanJohn T. Roseman More articles by this author , and Adam KlausnerAdam Klausner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000970.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multi-channel urodynamics is the primary tool for evaluation of storage and voiding dysfunction of the lower urinary tract. However, it is invasive and prone to artifact, which can make interpretation difficult and leads to questions of its clinical utility and ability to guide treatment. A pre-clinical model of urodynamics will advance understanding of the lower urinary tract system’s storage and voiding functions and allow for the development of more accurate diagnostic tests and more effective clinical treatments. The “Grover” ex vivo porcine model allows for a pre-clinical testing environment that simulates human bladder function. METHODS: The first phase of the porcine model is to harvest the lower urinary tract. After identification of the relevant genitourinary anatomy, proximal and distal control of the small bowel is obtained to prevent spillage of bowel contents. This is followed by entering the retroperitoneum by incising directly over the kidney and freeing up adhesions to expose the kidneys bilaterally. Attention is then turned towards the bladder and the rectum where the lateral attachments, which keep the bladder and the rectum in place, are dissected free after obtaining proximal and distal control at the level of the rectum with suture ligation. The genitourinary system can then be removed en bloc by dissecting bluntly along the retroperitoneal space, keeping the major vessels anterior and the connective tissue attachments on the posterior aspect of the dissection. Preparation of the bladder involves heparinizing the arterial tree, followed by removal of the gastrointestinal and gynecological structures and suture ligation of the ureters. The bladder can then be placed into a physiologic buffer prior to construction of the porcine model. RESULTS: The porcine models were transported to the laboratory within two hours and experiments were conducted within 48 hours. Polyethylene cannulas are placed through the aorta into the bilateral iliac arteries and advanced into the bilateral superior vesical arteries, which are then secured in place with 2-0 silk ties. The model is then fully set up in a heated and humidified chamber to replicate physiologic conditions. The result is a fully functional and physiologic bladder model that allows for evaluation of the effects of ischemic insult, retention, and many other clinical scenarios. CONCLUSIONS: An ex vivo porcine model creates a pre-clinical testing environment where the etiology of various types of bladder dysfunction can be better elucidated. This model also allows for the testing of new clinical interventions in a safe environment prior to initiating clinical trials in a human model. Source of Funding: This study was supported by National Institutes of Health award R01DK101719. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1211-e1211 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel Weprin* More articles by this author Dielle Meyer More articles by this author Natalie Swavely More articles by this author Naveen Nandanan More articles by this author John T. Roseman More articles by this author Adam Klausner More articles by this author Expand All Advertisement PDF downloadLoading ...

Augmented Anastomotic Urethroplasty for Long Segment Bulbous Urethral Strictures

Background: During urethroplasty, if the stricture contains a 2 to 4 cm region that is particularly narrow and/or fibrotic, anastomotic repair is not ideal, so that portion may be excised with subsequent anastomosis of the ventral aspect of the urethra to shorten, widen and optimize the urethral wall onto which an onlay graft is to be placed. This procedure is termed augmented anastomotic urethroplasty Objectives: Evaluation of the outcome of augmented anastomotic urethroplasty with dorsal onlay for long segment bulbar urethral stricture. Patients and Methods: A prospective clinical trial was carried out during the period from March 2017 to September 2019 of 55 patients underwent dorsal onlay augmented anastomosis using buccal mucosa graft for long segment bulbar urethral strictures. All patients underwent pre-operative medical history taking and physical examination, sono-urethrography and voiding cystourethrogram. Patients were followed-up and re-assessed at 3 and 6 months post-operatively. Follow-up urethrography was performed at 6 months. The primary outcome was the procedure success rate defined by the successful voiding function. Stricture recurrence was defined the presence of intractable voiding symptoms or the need for any urethral interventions. The data were analyzed using the appropriate statistical tests. Results: During the study period, 55 patients completed the follow-up protocol and included in the study. The mean age was 41.93±10.70 years. The mean intra-operative stricture length was 3.39±0.59 cm. Buccal mucosal graft was used in all cases. Mean graft length was 4.15±0.62 cm. At 6 months follow up, 51 patients had no evidence of stricture recurrence and required no further intervention with an overall success rate of 92.7%. Stricture recurrence occurred in 4 patients (7.3%). No donor site major complications were detected. The urethroplasty complication rate was 20.0%, and all were minor. No effect of urethroplasty on erectile function in adult sexually active patients. No penile shortening or chordee. Conclusions: Dorsal onlay augmented anastomosis was a useful technique for long bulbar strictures. High stricture-free rates and complications are few and minor. Although longer follow up was needed.

MP65-15 VALIDITY AND RELIABILITY OF A HOME-BASED GUARDIAN-CONDUCTED VIDEO VOIDING TEST FOR VOIDING EVALUATION AFTER HYPOSPADIAS SURGERY

You have accessJournal of UrologyPediatrics: Hypospadias and Penile Surgery (MP65)1 Apr 2020MP65-15 VALIDITY AND RELIABILITY OF A HOME-BASED GUARDIAN-CONDUCTED VIDEO VOIDING TEST FOR VOIDING EVALUATION AFTER HYPOSPADIAS SURGERY Jae Hyeon Han, Sangmin Lee, Sang Hoon Song, Sungchan Park, Kun Suk Kim, and Jang Hui Lee* Jae Hyeon HanJae Hyeon Han More articles by this author , Sangmin LeeSangmin Lee More articles by this author , Sang Hoon SongSang Hoon Song More articles by this author , Sungchan ParkSungchan Park More articles by this author , Kun Suk KimKun Suk Kim More articles by this author , and Jang Hui Lee*Jang Hui Lee* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000940.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We studied the validity and reliability of a home-based guardian-conducted video voiding test in investigating postoperative voiding function to evaluate voiding pattern in hypospadias patients. METHODS: In a single center, patients who had undergone urethroplasty by a single surgeon and postoperative uroflowmetry and video voiding tests conducted between 2008 to 2016 were retrospectively reviewed. We excluded children who were not available to undergo a video voiding test, children who did not return for follow-up, and children with <50 ml of voided volume during the uroflowmetry test. Voiding flow was categorized into 5 grades (very poor, poor, fair, good, and very good) by 3 urologists trained in pediatric urology (a: resident doctor, b: fellowship doctor, and c: pediatric urology professor) who viewed the videos on a desktop computer monitor. The relationship between the stream grade of video and maximum urinary flow was studied to evaluate patients' postoperative voiding function. RESULTS: Patients’ average ages were 12.3 ± 3.2 (8–21) months and 42.8 ± 3.9 (35–48) months at the time of surgery and uroflowmetry and voiding video tests. Thirty-one patients with hypospadias were enrolled. Patients' average ages were 12.3 months and 42.8 months at the time of surgery and video voiding tests, respectively. Hypospadias was anterior, penile, and posterior in 1 (3.2%), 18 (58.1%), and 12 (38.7%) patients, respectively. The numbers of patients for each stream grade were 4, very poor; 4, poor; 13, fair; 4, good; and 6, very good. All intraclass correlation coefficients of the stream grade among the 3 observers were > 0.95. Correlation between the maximum flow rate obtained by the conventional uroflowmetry and video voiding stream grade was validated (rho = 0.511, P = 0.003). CONCLUSIONS: Home-based guardian-conducted video voiding test is a validated and reliable method for evaluating children’s voiding stream with ease and repeatability at home. This test will serve as a supportive tool to the conventional uroflowmetry test and help physicians assess children’s post-urethroplasty urination. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e979-e979 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jae Hyeon Han More articles by this author Sangmin Lee More articles by this author Sang Hoon Song More articles by this author Sungchan Park More articles by this author Kun Suk Kim More articles by this author Jang Hui Lee* More articles by this author Expand All Advertisement PDF downloadLoading ...

PD41-03 MORE THAN 30 YEARS OF EXPERIENCE WITH THE ILEAL NEOBLADDER: FUNCTIONAL AND METABOLIC OUTCOMES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (PD41)1 Apr 2020PD41-03 MORE THAN 30 YEARS OF EXPERIENCE WITH THE ILEAL NEOBLADDER: FUNCTIONAL AND METABOLIC OUTCOMES Bjoern Volkmer*, Kassel Germany, and Richard Hautmann Bjoern Volkmer*Bjoern Volkmer* More articles by this author , Kassel GermanyKassel Germany More articles by this author , and Richard HautmannRichard Hautmann More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000921.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The ileal neobladder (INB) has now been performed on a regular basis for more than 30 years at our institution. This study aims to assess the long term functional outcomes including near normal voiding function, continence, incidence of UTI and metabolic requirements. METHODS: From our consecutive series of 893 male patients who underwent radical cystectomy (RC) and urinary diversion with the INB from 1986 to 2009 we only included those with minimum follow-up of 5 years. We excluded patients with previous irradiation therapy of abdomen or pelvis, with previous other forms of urinary diversion, and with postoperative tumor recurrence. Between 10/08 and 03/09 questionnaires were sent to the remaining 303 patients, with telephone-interviews in those, who did not respond. 44 patients were not available: Death with NED in n=43, living abroad n=6, and n=5 with Alzheimer’s. The remaining 259 patients formed the study population. Continence was defined as use of not more than 1 pad/daytime or nighttime. Patients were asked for the number of feverish UTI within the last 5 years, problems with mucus production, and requirement of (self)catheterization. RESULTS: The mean age at the time of surgery was 60.6±10y ranging from 23y to 81y. The mean time of follow-up in this series was 131±56mon ranging from 60mon to 267mon. The mean age at the time of the survey was 73±10y ranging from 43y to 92y. While the risk of urinary retention and bicarbonate therapy decreased over time, the changes in the rate of daytime and nighttime incontinence seemed to be attributed more to age than to the length of follow-up (Table 1). Transurethral catheters were required in 1 case after 12, in 2 cases after 16 and 17 years postoperatively. Three patients are on substitution of vitamin B12, one patient is on colestyramine therapy for short bowel syndrome. One patient developed end stage renal failure 5 years after surgery. CONCLUSIONS: INB patients who survived more than 5 years after RC and diversion enjoy acceptable urinary continence and retain their ability to void spontaneously in >90 % of patients. The percentage of recurrent UTI and the need of bicarbonate therapy are not negligible. Especially in young patients with favourable pathologic findings an ileal neobladder provides excellent results even after 20 years and more. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e821-e822 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bjoern Volkmer* More articles by this author Kassel Germany More articles by this author Richard Hautmann More articles by this author Expand All Advertisement PDF downloadLoading ...

Relationship between desire to void and bladder capacity and rectal sensory function in patients with multiple sclerosis and anorectal disorders.

The primary aim of this study was to assess the relationship between a strong desire to void (SDV) and rectal sensory function in patients with multiple sclerosis (PwMS) and anorectal disorders. The secondary aim was to identify clinical, urodynamic or manometric factors associated with greater rectal sensory function impairment in this population. Thirty PwMS (mean age 49.2 ± 10.9 years) with anorectal disorders (constipation and/or fecal incontinence) participated in this observational study. Rectal sensory parameters during anorectal manometry were recorded at a strong desire to void and after urination (PV, post-void). The primary outcome was the desire to defecate volume. Secondary outcomes were first perception and maximum tolerated threshold volumes, presence and modulation of recto-anal inhibitory reflex. The mean desire to defecate volume was 125 ± 59 mL at SDV and 104 ± 64 mL at PV (P < .001). The mean maximum tolerated volume was 167 ± 61 mL at SDV vs 141 ± 64 mL after urination (P = .01). The other parameters were not different between SVD and PV conditions. No predictive factors for greater impairment of rectal sensory function were identified. This study suggests a relationship between bladder sensation and thus bladder capacity, and rectal sensory function in PwMS and with anorectal disorders.

Multi Discrete Laguerre Wavelets Transforms with The Mathematical aspects

The Linear approximation, means the order of smoothness of the void function. As for non-linear approximation, when compared to linear approximation, a significant improvement in the arrangement of approximation can be observed.&#x0D; In this paper the theorems of linear approximation and non-linear approximation are demonstrated, Moreover, some hypotheses were orthogonal theorem is proven&#x0D; many important theorems will be proven and proven in formation Multi Discrete Laguerre Wavelets Transform (MDLWT) so that they take their role in signal or image processing, this makes them possess properties like those they have those used for the same purpose and with high efficiency.&#x0D; In second part in this paper, the new wavelet MDLWT was used after extracting the filter high pass filter and low pass filter by extracting the decision trees for the transactions where the new wavelet was used in image processing and mean square error (MSE), Peak signal-to-noise ratio (PSNR), Bits per pixel ratio (BPP) and Compression ratio (CR) were calculated, and the applications were done on 4 samples which good results have been found to prove the efficiency of the new wavelet

Long-term Voiding and Sexual Function in Male Patients After Robotic Total Mesorectal Excision With Autonomic Nerve Preservation for Rectal Cancer: A Cross-Sectional Study.

Robotic surgery can help to identify and preserve the autonomic nerves during total mesorectal excision (TME) compared with open surgery or laparoscopy due to the 3-dimensional image and high dexterity of the robotic system. Therefore, this study aimed to assess voiding and sexual function after robotic TME with autonomic nerve preservation. In particular, we focused on the long-term results in male patients operated by a single experienced surgeon. We surveyed male patients aged 50 years and below at the time of robotic rectal cancer surgery between November 2011 and July 2018. Patients who died and those who had a recurrence and underwent abdominoperineal resection were excluded. The questionnaire covered the International Prostate Symptom Score (IPSS) and the 5-item version of the International Index of Erectile Function (IIEF-5) for voiding and sexual function, respectively. Thirty-nine patients (median age, 44 y) were surveyed. IPSS and IIEF-5 scores were 5.7±5.3 and 14.7±8.4, respectively. Only 6 patients (15.4%) complained of poor quality of life due to their urinary symptoms. In sexual function, 10 patients (25.6%) complained severe reduction compared with their preoperative status. The average of postoperative days defined from surgery to the questionnaire was 37.8 months. A significant change in the IIEF-5 score was observed between 1 and 2 years postoperatively (5.8±6.9 vs. 16.5±8.8; P=0.027). As we only included male patients who were operated by a single experienced surgeon, the results of robotic TME with pelvic autonomic nerve preservation showed acceptable data in preserving both voiding and sexual functions. Although related clinical factors for poor functional outcomes was not statistically significant due to the small sample size, we could observe an improvement in sexual function between 1 and 2 years after surgery with long-term functional results.

Impact of Spinal Defects on Urinary and Sexual Outcome in Adults With Anorectal Malformations—A Cross-sectional Study

To examine the impact of spinal defects on urinary function, sexual outcome and quality of life in adult patients born with anorectal malformations. A prospective cohort study at Odense University Hospital in Denmark was conducted. From 1985 to 2000, 93 patients were found eligible for participation. Twenty-seven (29%) consented to participate. One patient refrained from clinical examinations. Patients were examined with magnetic resonance imaging, uroflowmetry, and validated questionnaires on urinary function, sexual function, and quality of life. There were 14 were females and 13 were males, median age of 25 (range 19-31) years and 23 (18-32) years, respectively. The type of anorectal malformations in females were vestibular fistula (n=6), anocutaneous fistula (n=4), anal stenosis (n=3), and cloaca (n=1). In males the type of malformations were anocutaneous fistula (n=4), bulbar fistula (n=4), rectovesical fistula (n=2), anal stenosis (n=1), rectal atresia (n=1), and anal atresia with no fistula (n=1). Patients with spinal defects had a lower average voiding rate compared to patients with normal spinal anatomy (P .03), a lower voiding-related quality of life (P .02), and a tendency was observed toward a worse total urinary incontinence-related quality of life score (P .06). Moreover in patients with spinal defect a tendency was seen toward a worse general quality of life (P .09). Spinal defects detected by magnetic resonance imaging in adults with anorectal malformations were found to be associated with urinary voiding function.

Multipl Skleroz Hastalarında Ürolojik Semptom Sıklığının Hastalık Progresyonu İle İlişkisinin Değerlendirilmesi

Purpose : Our aim is to determine the relationship between Multiple Sclerosis (MS) disease progression and urological symptoms Method: We enrolled patients with Newly Diagnosed MS (n: 11), RRMS (n: 9), SPMS (n:6) and healthy control subjects (n:10). Neurological examination was done in all groups. Furthermore patient groups were evaluated with EDSS (Expanded Disability Status Scale) and MSFC (functional capacity in multiple sclerosis scale). Routine blood biochemistry were done. All patients and the subjects in the control group were evaluated in regard to lower urinary tract symptoms by the following questionnaires: incontinence and sexual function in terms of IPSS (International Prostate Symptom Score), ICIQ -SF (International Incontinence Questionnaire), IIEF (International Index of Erectile Dysfunction Test) and FSFI (Female Sexual Function Index). In addition all the patients were evaluated by urodynamic studies in order to examine the voiding function. Results : There were no differences between the group in respect to age, years of education and gender. As the disease duration increase, the frequency of incontinence was found to increase. PSS, IPSS-QOL, ICIQ-SF scores of newly diagnosed MS, RRMS, SPMS and healthy control groups were statistically significant. There was a correlation between EDSS score and urological symptoms. There was no relationship between disease duration and urological symptoms. Due to inadequate number of male patients in the study, IIEF score did not differ significantly between the groups. There was no relationship between EDSS score, disease duration and IIEF .Due to inadequate number of the female patients in the study, FSFI score did not differ significantly between the groups. There was no relationship between EDSS score, disease duration and FSFI. The most attractive result of our study is the urodynamic detrusor overactivity (DO) .Bladder capacity was found to be low in SPMS. EDSS score and 25 step walk score increases while bladder capacity has been reduced. There was no relationship shown between duration of disease and bladder capacity. Conclusion: Patients with Multiple Sclerosis (MS) have a very high prevalence of lower urinary tract symptoms. These symptoms have a great impact on patient quality of life. Therefore early recognition and treatment is an important step in care of MS patients

Radiation cystitis modeling: A comparative study of bladder fibrosis radio-sensitivity in C57BL/6, C3H, and BALB/c mice.

A subset of patients receiving radiation therapy for pelvic cancer develop radiation cystitis, a complication characterized by mucosal cell death, inflammation, hematuria, and bladder fibrosis. Radiation cystitis can reduce bladder capacity, cause incontinence, and impair voiding function so severely that patients require surgical intervention. Factors influencing onset and severity of radiation cystitis are not fully known. We tested the hypothesis that genetic background is a contributing factor. We irradiated bladders of female C57BL/6, C3H, and BALB/c mice and evaluated urinary voiding function, bladder shape, histology, collagen composition, and distribution of collagen‐producing cells. We found that the genetic background profoundly affects the severity of radiation‐induced bladder fibrosis and urinary voiding dysfunction. C57BL/6 mice are most susceptible and C3H mice are most resistant. Irradiated C57BL/6 mouse bladders are misshapen and express more abundant collagen I and III proteins than irradiated C3H and BALB/c bladders. We localized Col1a1 and Col3a1 mRNAs to FSP1‐negative stromal cells in the bladder lamina propria and detrusor. The number of collagen I and collagen III‐producing cells can predict the average voided volume of a mouse. Collectively, we show that genetic factors confer sensitivity to radiation cystitis, establish C57BL/6 mice as a sensitive preclinical model, and identify a potential role for FSP1‐negative stromal cells in radiation‐induced bladder fibrosis.

The effect of alpha blocker treatment prior to prostate biopsy on voiding functions, pain scores and health-related quality-of-life outcomes: A prospective randomized trial

To evaluate the effect of alpha-blocker treatment prior to transrectal ultrasound-guided prostate biopsy (TRUS-Bx) on voiding functions, pain scores and health-related quality-of-life outcomes. From January 2018 to April 2019, a total of 112 patients underwent TRUS-Bx due to elevated prostate-specific antigen (PSA) or abnormal digital rectal examination findings. Patients were divided into 2 groups depending on whether they received pharmacological treatment before biopsy. Group 1 consisted of patients with no alpha-blocker treatment prior to biopsy and Group 2 consisted of patients who received Tamsulosin for one week before biopsy continuing for one week after biopsy. Voiding function was evaluated three times using the validated International Prostate Symptom Score (IPSS) and uroflowmetry (maximal flow rate (Qmax) and residual volume (PVR)). The Turkish version of the Medical Outcomes Study Short Form 36-item Questionnaire (SF-36) was used to assess health-related quality of life. Pain scores were rated according to the Visual Analogue Scale (VAS) just after the biopsy procedure. Mean IPSS and Qmax on the post-biopsy 7 day were significantly in favor of Group 2 (P<0.001, P=0.004). Although post-biopsy day 7 PVR was similar between the groups, Δ1 PVR was significantly in favor of Group 2 (P=0.004). Mean VAS score was 2.7±2.3 for the Tamsulosin group and 4.2±2.2 for the control group (P=0.001). There was no significant difference between two groups according to baseline and postoperative 1st month SF-36 scores. Alpha-blocker therapy prior to TRUS-Bx is effective in preventing voiding dysfunction and biopsy-related pain in patients undergoing TRUS-Bx. 2.

Validity and reliability of a home-based, guardian-conducted video voiding test for voiding evaluation after hypospadias surgery.

PurposeTo investigate the validity and reliability of a home-based, guardian-conducted video voiding test for assessing postoperative voiding function after hypospadias surgery.Materials and MethodsIn a single center, patients who had undergone urethroplasty by a single surgeon and postoperative uroflowmetry and video voiding tests conducted between 2008 and 2016 were retrospectively reviewed. Urinary stream was categorized into five grades by three pediatric urologists in a blinded manner. The primary outcome was statistical correlation across raters as measured by Spearman correlation coefficient to validate the interpretation of the video voiding test. The secondary outcome was the reliability of the voiding video test compared with maximum urinary flow rate assessed by uroflowmetry.ResultsThirty-one patients with hypospadias were enrolled. The patients' average ages were 12.3±3.2 months (range, 8–21 months) and 42.8±3.9 months (range, 35–48 months) at the time of surgery and voiding video tests, respectively. Hypospadias was anterior, penile, and proximal in 1 (3.2%), 18 (58.1%), and 12 (38.7%) patients, respectively. The number of patients with each voiding stream grade was as follows: very poor, 4; poor, 4; fair, 13; good, 4; and very good, 6. All intraclass correlation coefficients of the stream grade among the three observers were >0.95. Correlation between the maximum flow rate obtained by use of conventional uroflowmetry and the video voiding stream grade was validated (rho 0.778, p<0.001).ConclusionsThe home-based guardian-conducted video voiding test is easy to perform and the present results demonstrate its validity and reliability for assessing patients' post-urethroplasty voiding pattern.

Is there a role for oxidative stress and mitochondrial dysfunction in age-associated bladder disorders?

Millions of individuals worldwide are affected by age-related lower urinary tract symptoms (LUTSs), including impaired detrusor contractility, detrusor overactivity, decreased bladder sensation, as well as increased bladder capacity often resulting in incomplete bladder emptying. Yet, the underlying factors that contribute to these symptoms are not known and there are few therapies to treat these disorders. Because of the complex pathophysiology, a number of animal models have been studied over the years to better understand mechanisms underlying patient symptoms. Such animal models can aid in the investigation of aspects of age-associated LUTSs that cannot be pursued in humans as well as to develop and test potential therapies. In addition, the search for urinary factors that may be a causative agent has resulted in the discovery of a number of potential targets that could serve as predictive biomarkers which can aid in early diagnosis and treatment of these chronic disorders. Recent evidence has supported a role for chronic changes in mitochondrial function and oxidative stress (along with production of reactive oxygen species) and abnormal urodynamic behavior in older patients. This review discusses new insights into how aging alters fundamental cellular processes that impair signaling in the bladder wall, resulting in abnormal voiding function.