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Objective: To compare perioperative morbidity, functional and quality‐of‐life (QoL) outcomes in patients with partial cystectomy vs radical cystectomy as part of pelvic exenteration. Patients and Methods: Retrospective analysis of a prospectively maintained database of pelvic exenteration patients (1998–2021) was conducted in a single centre. Study outcomes included postoperative complications, quality‐of‐life, functional and stoma‐related outcomes. The 36‐item Short‐Form Health Survey Physical and Mental Health Components, Functional Assessment of Cancer Therapy‐Colorectal questionnaires and Distress Thermometer were available pre‐ and postoperatively. QoL outcomes were compared at the various time points. Stoma embarrassment and care scores were compared between patients with a colostomy, urostomy, and both. Results: Urological complications were similar between both groups, but patients with partial cystectomy experienced less wound‐related complications. Overall, 34/81 (42%) partial cystectomy patients reported one or more long‐term voiding complication (i.e., incontinence [17 patients], frequency [six], retention [three], high post‐voiding residuals [10], permanent suprapubic catheter/indwelling catheter [14], recurrent urinary tract infection [nine], percutaneous nephrostomy [three], progression to urostomy [three]). The QoL improved following surgery in both the partial and radical cystectomy groups, differences between cohorts were not significant. Patients with two stomas reported higher embarrassment scores than patients with one stoma, although this did not result in more difficulties in stoma care. Conclusions: Partial cystectomy patients have fewer postoperative wound‐related complications than radical cystectomy patients, but often experience long‐term voiding issues. The QoL outcomes are similar for both cohorts, with significant improvement following surgery. [ABSTRACT FROM AUTHOR]

Objectives: To report the British Association of Urological Surgeon's (BAUS) guidance on the assessment and management of female voiding dysfunction. Methods: A contemporary literature search was conducted to identify the evidence base. The BAUS Section of Female, Neurological and Urodynamic Urology (FNUU) Executive Committee formed a guideline development group to draw up and review the recommendations. Where there was no supporting evidence, expert opinion of the BAUS FNUU executive committee, FNUU Section and BAUS members, including urology consultants working in units throughout the UK, was used. Results: Female patients with voiding dysfunction can present with mixed urinary symptoms or urinary retention in both elective and emergency settings. Voiding dysfunction is caused by a wide range of conditions which can be categorized into bladder outlet obstruction (attributable to functional or anatomical causes) or detrusor underactivity. Guidance on the assessment, investigation and treatment of women with voiding dysfunction and urinary retention, in the absence of a known underlying neurological condition, is provided. Conclusion: Wa have produced a BAUS approved consensus on the management pathway for female voiding dysfunction with the aim to optimize assessment and treatment pathways for patients. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate whether oestrogen, selective oestrogen receptor modulators (SERMs), and growth hormone (GH) can prevent the development of voiding dysfunction in a postpartum postmenopausal rat model of voiding dysfunction.Materials and methodsImmediately after spontaneous delivery, nine primiparous Sprague-Dawley rats served as uninjured controls (sham group) and 54 underwent intravaginal balloon dilation. On day 7, the 54 subject rats underwent bilateral ovariectomy. A week later, six treatment groups of nine rats were randomized to receive: normal saline (injured control group), 17beta-oestradiol (E(2)), raloxifene, levormeloxifene, GH, or GH + E(2). The treatment groups received daily subcutaneous injections for 3 weeks. The effects of hormone treatment were examined by conscious cystometry at the end of the study. Voiding dysfunction was defined to include overactive bladder and sphincter deficiency.ResultsThe sham rats had a mean (sd) voiding frequency of 3 (0.87) times in 10 min and a bladder capacity of 0.43 (0.13) mL with smooth cystometry curves. The number of rats in each treatment group (each group contained nine rats) that had voiding dysfunction was as follows: E(2), three; raloxifene, six; levormeloxifene, four; and controls, four (P > 0.05 among the groups). Only one rat in the GH-treated group and no rats in the GH + E(2)-treated group had voiding dysfunction, which was significantly less in the GH + E(2)-treated group than in the controls (P = 0.041).ConclusionThis functional data suggest that the development of voiding dysfunction can be prevented by short-term administration of GH and GH + E(2) in our rat model. SERMs and E(2) alone seem to have no therapeutic effect.

Objectives To assess the efficacy of transcutaneous interferential electrical stimulation ( IFES) and urotherapy in the management of non-neuropathic underactive bladder ( UAB) in children with voiding dysfunction. Patients and Methods In all, 36 children with UAB without neuropathic disease [15 boys, 21 girls; mean ( sd) age 8.9 (2.6) years] were enrolled and then randomly allocated to two equal treatment groups comprising IFES and control groups. The control group underwent only standard urotherapy comprising diet, hydration, scheduled voiding, toilet training, and pelvic floor and abdominal muscles relaxation. Children in the IFES group likewise underwent standard urotherapy and also received IFES. Children in both groups underwent a 15-session treatment programme twice a week. A complete voiding and bowel habit diary was completed by parents before, after treatment, and 1 year later. Bladder ultrasound and uroflowmetry/electromyography were performed before, at the end of treatment course, and at the 1-year follow-up. Results The mean ( sd) number of voiding episodes before treatment was 2.6 (1) and 2.7 (0.76) times/day in the IFES and control groups, respectively, which significantly increased after IFES therapy in IFES group, compared with only standard urotherapy in the control group [6.3 (1.4) vs 4.7 (1.3) times/day, P < 0.002). The mean ( sd) bladder capacity before treatment was 424 (123) and 463 (121) mL in the control and IFES groups, respectively, which decreased significantly at 1 year after treatment in the IFES group compared with the controls, at 227 (86) vs 344 (127) mL ( P < 0.01). Maximum urine flow increased and voiding time decreased significantly in the IFES group compared with controls at the end of treatment sessions and 1 year later ( P < 0.05). All the children had abnormal flow curves at the beginning of the study. The flow curve became normal in 14/18 (77%) of the children in the IFES group and six of 18 (33%) in the control group by the end of follow-up ( P < 0.007). At the end of the treatment course, night-time wetting was improved in all children who had this symptom before the treatment in the IFES group ( P < 0.01). Conclusion Combining IFES and urotherapy is a safe and effective therapy in the management of children with UAB. [ABSTRACT FROM AUTHOR]

Objective To report our long-term experience of sacral neuromodulation ( SNM) for various lower urinary tract dysfunctions but with a focus on efficacy, safety, re-interventions and degree of success. Patients and Methods This is a single tertiary referral centre study that included 217 patients (86% female) who received an implantable pulse generator ( IPG) ( Interstim™, Medtronic, Minneapolis, USA) between 1996 and 2010. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline, but was further stratified. Results The mean duration of follow-up was 46.88 months. Success and cure rates were ≈70% and 20% for urgency incontinence, 68% and 33% for urgency frequency syndrome and 73% and 58% for idiopathic retention. In those patients with an unsuccessful therapy outcome, the mean time to failure was 24.6 months after implantation. There were 88 (41%) patients who had at least one device or treatment related surgical re-intervention. The re-intervention rate was 1.7 per patient with most of them (47%) occurring ≤2 years of follow-up. Conclusions SNM appears effective in the long-term with a success rate after definitive IPG implant of ≈70% and complete cure rates ranging between 20% and 58% depending on indication. Patients with idiopathic retention appear to do best. The re-intervention rate is high with most occurring ≤2 years of implantation. It is likely that with the newer techniques used, efficacy and re-intervention rates will improve. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Ambulatory urodynamic studies (UDS) allow assessment of urinary bladder function by recording bladder events during natural filling and emptying. The International Children's Continence Society supports the use of ambulatory UDS as a test of choice in children with bladder dysfunction. There are very few studies on ambulatory UDS in children leading to a paucity of data on its clinical usefulness. The present study reports a series of ambulatory UDS in children using a Bluetooth-enabled device that allows children to remain in familiar environment without the presence of healthcare personnel. Ambulatory UDS using a Bluetooth-enabled device improved treatment outcomes by enabling a more precise diagnosis in half of the children (six of 12) with refractory bladder dysfunction. Ambualtory UDS was found to be safe and well tolerated by children of all age groups. Objectives To report the early observations of using ambulatory urodynamic studies (UDS) using a Bluetooth-enabled device in children, To evaluate the incremental value of ambulatory over conventional UDS., Patients and methods Ambulatory UDS were performed in selected children with voiding dysfunction between August 2009 and October 2010., Conventional UDS were concurrently performed wherever possible., The test results and treatment consequences of the two tests were compared., Results In all, 12 ambulatory and seven conventional UDS were performed on 10 children (five boys, median [range] age 7 [4-16] years)., Six of the seven children had a normal conventional UDS. Ambulatory UDS detected phasic detrusor overactivity (DO) in five children and generalised DO in one., Direct correlation of symptoms to DO was possible in two children during ambulatory UDS. Pressure rise during filling, seen in two children on conventional UDS, was not seen during ambulatory UDS., Five children showed clinical improvement when therapy was guided by ambulatory UDS results., Ambulatory UDS was generally well tolerated in eight children, with two complaining of discomfort. Inadequate information was obtained in two children who underwent ambulatory UDS due to technical problems in one and distress induced by the UDS in the other., Conclusions Ambulatory UDS provides useful additional information over conventional UDS and can be used to guide further therapy in selected children with voiding dysfunction., It is safe and well tolerated in children., There is a need for explicit guidance for the technical delivery and interpretation of ambulatory UDS in children. [ABSTRACT FROM AUTHOR]

OBJECTIVES: • To assess the effect of a 1-D/A adrenoceptor antagonist naftopidil on patients with neurogenic lower urinary tract dysfunction (NLUTD) and voiding difficulty. • To explore the effectiveness of naftopidil in these patients by using urodynamic variables, including pressure flow study (PFS), and to find good and simple parameters (International Prostate Symptom Score (IPSS), Post-void residual urine (PVR), and uroflowmetry (UFM) parameters) as substitution of PFS for predicting the effect of naftopidil. PATIENTS AND METHODS: • The main inclusion and exclusion criteria were, IPSS ⩾8, voiding symptoms with IPSS ⩾5, IPSS-quality of life (QOL) ⩾2, PVR ⩾50 mL, and without prostatic enlargement ⩾20 mL. • After initial assessment, patients were stepwisely administered for 12 weeks with the following: placebo for 2 weeks, naftopidil 25 mg/day for 2 weeks, naftopidil 50 mg/day for 2 weeks, and naftopidil 75 mg/day for 6 weeks. At the end of both placebo and 6 weeks' naftopidil 75 mg/day, their IPSS, UFM, PVR, and PFS were assessed. • A total of 82 Japanese patients (men 40, women 42) with lower urinary tract symptoms complicated by NLUTD, with a mean age of 63.9 years, were included from private or institutional clinics. • The lesions were spinal cord 42, and peripheral nervous system 40. The spinal cord lesions were all lumbar spine (injury or lumbar canal stenosis). RESULTS: • In all patients, pressure at maximum urinary flow rate (Pdet Qmax ) in PFS significantly decreased ( P < 0.05), and maximum urinary flow rate in UFM significantly increased ( P < 0.01). Analysis of data for men and for women also showed a significant decrease in PVR, %PVR, and total IPSS score. • The degree of improvement of voided volume, PVR (%), and IPSS in patients with PVR < 300 mL was significantly greater than those in patients with PVR ⩾300 mL. • The degree of improvement of Pdet Qmax in PFS, and IPSS in patients with bladder contractility was significantly greater than that in patients without bladder contractility. CONCLUSIONS: • a 1-D/A adrenoceptor antagonist naftopidil has a significant effect on both symptoms and urodynamic variables of patients of both genders with NLUTD in Japan. • PVR < 300 mL and bladder contractility are predictive factors for the efficacy of naftopidil on patients with NLUTD. [ABSTRACT FROM AUTHOR]

OBJECTIVES To report our 10-year experience of sacral neurostimulation (SNS) for women in urinary retention, comparing the original one-stage with the newer two-stage technique, as SNS therapy is a well-established treatment for urinary retention secondary to urethral sphincter overactivity (Fowler’s syndrome). PATIENTS AND METHODS Between 1996 and 2006, 60 patients with urinary retention had a SNS device inserted; their case records were reviewed and data on efficacy, follow-up, need for continued clean intermittent self-catheterization (CISC), complications and operative revision rate were assessed. RESULTS Overall, 43 of 60 (72%) women were voiding spontaneously, with a mean postvoid residual volume of 100 mL; 30 (50%) no longer needed to use CISC. During a total of 2878 months of SNS experience, adverse event episodes included lead migration in 20, ‘box-site’ pain in 19, leg pain/numbness in 18 and loss of response/failure in 18 patients; 53% of the women required a surgical revision related to their implanted stimulator. The efficacy of the two-stage was similar to that of the one-stage procedure (73% vs 70%). Women with a normal urethral sphincter electromyogram had worse outcomes than women with an abnormal test (43% vs 76%). Although the efficacy was no different in those taking analgesia/antidepressant medication, this group of women had a higher surgical revision rate. Failure and complications for the one-stage procedure were not restricted to the early follow-up period. The mean battery life of the implant was 7.31 years. CONCLUSIONS SNS has sustained long-term efficacy but the procedure has a significant complication rate. At present, the two-stage technique has comparable efficacy to the one-stage technique but a longer-term follow-up is required. The National Institute of Clinical Excellence recommended the use of SNS in women with urinary incontinence who fail to respond adequately to anticholinergic therapy, but patients choosing this treatment should be made aware of the high complication rate associated with the procedure. [ABSTRACT FROM AUTHOR]

The two papers in this section evaluate different diseases in children, but the two subjects are of considerable importance: nocturnal enuresis and VUR. OBJECTIVE To identify independent factors predicting the resolution of primary vesico-ureteric reflux (VUR) in a cohort of medically managed children. PATIENTS AND METHODS Between 1977 and 2003, 506 children were diagnosed with VUR and were conservatively managed and prospectively followed. All of the children were maintained on antibiotic prophylaxis. Follow-up imaging consisted of voiding cysto-urethrography (VCUG) or a direct isotope cystogram at intervals of 2–3 years. The predictive factors used are based on the patient data at the time of entry in the protocol. The dependent variable was VUR resolution. The criterion for resolution was based on a single negative VCUG or direct isotope cystogram. A survival analysis identified variables significantly associated with VUR resolution. Cox's regression model was applied to identify variables independently associated with the dependent variable. RESULTS After adjustment, four variables remained as independent predictors of VUR resolution: nonwhite race, relative risk (95% confidence interval) of 1.5 (1.1–1.9; P = 0.009); mild grade of VUR, 3.3 (2.1–5.3; P < 0.001); absence of renal damage, 3.3 (2.4–4.5; P < 0.001); and absence of dysfunctional voiding, 2.0 (1.4–3.1; P < 0.001). For mild VUR, three variables were significantly associated: male gender, 1.7 (1.1–2.6; P = 0.012); absence of renal damage, 3.4 (1.8–6.4; P < 0.001); and unilateral VUR, 1.6 (1.1–2.3; P = 0.004). For moderate/severe VUR, three variables were significantly associated: nonwhite race, 1.7 (1.1–2.6; P = 0.01); absence of renal damage, 3.0 (2.0–4.4; P < 0.001); and absence of dysfunctional voiding, 2.8 (1.4–5.5; P = 0.004). CONCLUSION Few factors are amenable to intervention to modify the natural history of VUR. According to our findings, there are only two possible interventions: avoiding renal scars and managing voiding dysfunction. [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare interpretations of electromyographic (EMG) recordings from perineal surface patch electrodes (PSPEs) to those from urethral concentric needle electrodes (CNEs) during voiding. PATIENTS AND METHODS Consenting women underwent urodynamic testing with a 30 G, 3.8 cm CNE at the 12 o’clock position in the striated urethral sphincter muscle, and with PSPEs placed at the 2 and 10 o’clock positions around the anus. Pressure-flow studies were conducted with simultaneous input from both EMG electrodes. Representative, de-identified paper copies of EMG signals were assembled by chronology and electrode type. Six examiners unaware of the patient details were asked to determine if the tracings were interpretable and whether there was quiescence of the urethral sphincter motor unit during voiding. The agreement between the interpretations of each tracing was assessed using McNemar and κ statistics. RESULTS Twenty-two women undergoing urodynamic testing for incontinence (16), voiding dysfunction (two) or urinary retention (four) participated in this study. CNE tracings were consistently more interpretable than PSPE tracings (mean 89% vs 67%). When tracings were interpretable, a significantly higher percentage of CNE EMG tracings (mean 79%) had urethral sphincter motor unit quiescence than PSPE EMG tracings (mean 28%). The κ values for agreement among the reviewers’ interpretations were highly variable and none were statistically significant. Reviewers unanimously agreed on only 12 of the 44 tracings, and 11 of these showed quiescence when using a CNE. CONCLUSIONS CNEs are more often interpretable than PSPEs for determining motor unit quiescence during voiding. CNE EMG appears to have greater clinical utility for central reading than PSPEs. [ABSTRACT FROM AUTHOR]

To assess the effect of antimuscarinic treatment with tolterodine combined with behavioural modification as a first-line treatment, before invasive investigation, in children with non-neurogenic voiding dysfunction but no obvious anatomical or neurogenic cause. The study comprised 44 children presenting with voiding dysfunction (30 girls and 14 boys, mean age 7 years, range 5–14); all had a noninvasive evaluation consisting of a history, urine analysis, renal and bladder ultrasonography and physical examination, with specific emphasis on the voiding pattern. Anticholinergic treatment with tolterodine (1 mg twice daily) was started in all patients; they were also informed about conservative management, including timed voiding, double voiding and relaxation of the pelvic floor during voiding. At the start and after 3 months, the dysfunctional voiding symptom score (DVSS) was completed twice by all patients. For all patients the mean ( sd) DVSS was 14.0 (2.67) and 6.68 (3.67) before and after treatment, respectively; the difference was statistically significant ( P < 0.001). The mean scores for girls and boys, respectively, were 13.8 (2.79) and 14.5 (2.44) before and 6.43 (3.79) and 7.50 (3.34) after treatment. Tolterodine combined with behavioural modification for dysfunctional voiding in children with no neurological or anatomical abnormality can be recommended as a first-line treatment before invasive evaluation. Additionally, the DVSS appears to provide accurate and objective data for monitoring the effect of treatment in such children. [ABSTRACT FROM AUTHOR]

The problem of urinary retention after hysterectomy for benign disease is extensively evaluated by authors from Ghent. Their interesting results show that it is associated with the de-afferentiation of the bladder wall and with Fowler's syndrome. These findings help our understanding of a troublesome condition. Further work is reported into the use of the tension-free vaginal tape procedure, particularly into its positive effect on quality of life. Another study reported here found that in patients with BOO associated with BPH, there is a focal compromise of the blood-urine permeability barrier, with an increase in expression of inducible nitric oxide synthase. Objective To detect prospectively neurogenic damage in patients with urinary retention responding to sacral nerve stimulation (SNS) after hysterectomy for benign disease. Patients and methods From August 1995 to February 2002, 13 of 15 patients (mean age 43 years, sd 7) with urine retention for a mean (sd, range) of 25 (22, 6–240) months after hysterectomy for benign disease, were prospectively evaluated and treated with SNS. They were assessed using urodynamics at baseline and during the test stimulation. Sensory evoked potentials (SEPs), electrical sensory threshold (EST) measurements of the pudendal nerve, bladder neck and the bladder (2 Hz, 0–300 V), and needle electromyography of the external urethral sphincter (EUS) were undertaken in all patients. Results De-afferentiation (EST ≥ 200 V) was limited to the bladder in four of the 13 patients and extended to the bladder neck in one other, and was matched by no response at the SEP. Relative ESTs of the bladder neck correlated inversely with residual urine (r = - 0.76, P = 0.01, x = 546, fx = 1.22) and bladder capacity (r = - 0.77, P = 0.01, x = 611, fx = 1.26) at diagnosis. Complex repetitive discharges and decelerating bursts of the EUS were seen in these five patients. Unilateral SNS was applied in 10 patients (bilateral in... [ABSTRACT FROM AUTHOR]

Objective To determine whether sacral root neuro‐modulation (a promising therapeutic modality in patients with refractory voiding and storage problems) has its effect through the blockade of C‐afferent fibres that form the afferent limb of a pathological reflex arc responsible for the dysfunction of bladder storage. Materials and methods The study comprised 39 female Sprague Dawley rats divided into three equal groups: normal controls (group 1); spinally transected at T10 (group 2); spinally transected and electrically stimulated bilaterally at S1 for 6 h daily (group 3). Three weeks after transection the rats were assessed using urodynamics; substance P, neurokinin A and calcitonin gene‐related peptide (CGRP) were extracted from the dorsal root ganglia (DRG) of the L5 and L6 roots and quantified by radioimmunoassay. Results Spinally transected rats developed urinary bladder hyper‐reflexia after 3 weeks. This was associated with a significant increase in the neuropeptide content of the DRG of L6. Electrostimulation of S1 significantly decreased the neuropeptide content of L6. In contrast, transection and S1 neurostimulation did not affect the neuropeptide content of the L5 DRG, except for CGRP, which increased after spinal transection and decreased with neurostimulation. Conclusions In spinally transected rats, sacral root neurostimulation abolished bladder hyper‐reflexia and attenuated the rise in neuropeptide content of the L6 DRG. These results suggest that the blockade of C‐afferent fibre activity is one of the mechanisms of action of sacral root neuromodulation. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effects of increased intra‐abdominal pressure (IAP) on the contractility of the rabbit bladder, as the dynamics of the bladder may be impaired in conditions associated with a high IAP, e.g. constipation and pregnancy. Material and methods The study comprised 22 adult male New Zealand rabbits; six served as the control group, eight had an IAP of 7 cmH2O imposed for 10 days by instilling air into the abdominal cavity and this IAP was maintained for 60 days in a further eight rabbits. After treatment, the rabbits were killed, and the bladders removed and cut into 3 × 12 mm strips. The contractile activity of the muscle strips was then recorded isometrically. Electrical field stimulation (EFS) was applied using a pair of platinum ring electrodes in trains of 3 s duration every 100 s (1 ms, 100 V, 2–100 Hz). Contractile responses to carbachol and isotonic KCl were also evaluated. Results EFS induced a frequency‐dependent increase in contractile activity in all bladder strips. Ten days of high IAP resulted in an increased responsiveness to EFS, but high IAP for 60 days reduced the EFS‐induced responses to the control levels. Carbachol (10-9–10-3 mol/L) elicited concentration‐dependent contractions in all groups. From the concentration‐response curves of carbachol, the log EC50 values (the concentration producing half the maximum effect) of the control and 60‐day treated animals were comparable, at -6.24 (0.05) and -6.25 (0.04), respectively. However, the log EC50 of the 10 day‐treated group was -4.97 (0.08) and significantly (P < 0.01) lower than that of both groups. Isotonic KCl produced contractions in all preparations; these contractions in the control and 60‐day treated animals were similar, while the 10 day‐treated group had significantly (P < 0.05) higher contraction amplitudes. Conclusion Increased IAP alters the contractile properties of the bladder and its responsiveness to carbachol and KCl. As the intravesical pressure closely reflects the IAP, both should be increased in the present experimental design. [ABSTRACT FROM AUTHOR]