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Objective: To investigate the long-term clinical and urodynamic outcomes of a small cohort of children who received short-term urotherapy for confirmed dysfunctional voiding (DV) and lower urinary tract symptoms (LUTS). Materials and Methods: This study included 26 children with confirmed LUTS and DV via video urodynamic study (VUDS) and received standard urological therapy, pelvic floor muscle training, or surgical intervention in childhood. Their current lower urinary tract conditions were assessed by chart review and direct and telephone interviews. Charts of 14 patients who underwent follow-up VUDS were reviewed to investigate their bladder and voiding dysfunction or follow-up on previous treatment results. The satisfaction of lower urinary tract status was assessed using the global response assessment (GRA) scale. Results: At initial enrolment, the mean age was 9.54 ± 3.88 years, and urological treatment was performed during the first 1–5 years thereafter. Most patients were not regularly followed in the urology clinic. Among the 14 children available for follow-up, a GRA score of 3 was reported by 10 (71.4%) after a mean follow-up period of 10.3 ± 6.74 (range, 2–20) years, indicating satisfactory bladder and voiding conditions. Four children with less favorable outcomes (GRA score of

Background Postoperative urinary retention (POUR) is a known complication in the postanesthesia care unit (PACU). The variations in catheterization thresholds contribute to unnecessary invasive procedures. Objective In the current study, we implemented an algorithm for a sterile intermittent catheterization (SIC) threshold of 800 ml with volume-dependent bladder scan intervals and compared the incidence of SIC with that of a matched patient cohort threshold of 400 ml. Design, setting, and participants This comparative study of two prospective historical cohorts represented two thresholds for POUR, set at 400 ml without a standardized bladder scan protocol and 800 ml with a volume-dependent bladder scan protocol. Outcome measurements and statistical analysis The primary outcome was the frequency of catheterization during the PACU stay. Secondary outcomes evaluated patient safety aspects in occurrence of thresholds above 400/800 ml. The study was set at the PACU under the Department of Anesthesia, Center for Cancer and Organ Diseases, Rigshospitalet, Denmark. Results and limitations In total, 741 patients were consecutively included, with 307 in the POUR-400 and 434 in the POUR-800 group, and with comparable group characteristics. Significantly fewer patients fulfilled the SIC/catheter a’ demeure (CAD) criteria in the POUR-800 (5.0%) versus POUR-400 (14.3%) group, equivalent to a 65.0% relative reduction in SIC. Conclusions Implementation of a standardized ultrasound-guided protocol with volume-dependent scan intervals and an evidence-based catheterization threshold of 800 ml decreases the need for SIC by >65%, without increasing the need for urinary catheterization at the wards. Patient summary In this study, we implemented an algorithm for a sterile intermittent catheterization threshold of 800 ml with volume-dependent bladder scan intervals. A marked reduction was seen in catheterization in the postanesthesia care unit, without increasing catheterization rates at the ward., Take Home Message An algorithm for an intermittent catheterization threshold of 800 ml, with volume-dependent bladder scan intervals during patients’ stay at the postanesthesia care unit, reduces the incidence of urinary bladder catheterization. Extensive patient-clinician communication on bladder symptomatology is a crucial prerequisite.

Objective Conventional sacral neuromodulation (SNM) has shown to be an effective treatment for lower urinary tract and bowel dysfunction, but improvements of clinical outcome are still feasible. Currently, in preclinical research, new stimulation parameters are being investigated to achieve better and longer effects. This systematic review summarizes the status of SNM stimulation parameters and its effect on urinary tract and bowel dysfunction in preclinical research. Materials and Methods The literature search was conducted using three databases: Ovid (Medline, Embase) and PubMed. Articles were included if they reported on stimulation parameters in animal studies for lower urinary tract or bowel dysfunction as a primary outcome. Methodological quality assessment was performed using the SYRCLE Risk of Bias (RoB) tool for animal studies. Results Twenty‐two articles were eligible for this systematic review and various aspects of stimulation parameters were included: frequency, intensity, pulse width, stimulation signal, timing of stimulation, and unilateral vs. bilateral stimulation. In general, all experimental studies reported an acute effect of SNM on urinary tract or bowel dysfunction, whereas at the same time, various stimulation settings were used. Conclusions The results of this systematic review indicate that SNM has a positive therapeutic effect on lower urinary tract and bowel dysfunction. Using low‐frequency‐SNM, high‐frequency‐SNM, bilateral SNM, and higher pulse widths showed beneficial effects on storage and evacuation dysfunction in animal studies. An increased variability of stimulation parameters may serve as a basis for future improvement of the effect of SNM in patients suffering from urinary tract or bowel dysfunction.

Objective Sacral neuromodulation (SNM) has been used to treat patients with lower urinary tract dysfunction and bowel dysfunction for many years. Success rates vary between 50% and 80%, indicating that there is much room for improvement. Altering stimulation parameters may result in improved outcome. This paper reports a systematic review of the clinical efficacy of nonconventional stimulation parameters on urinary tract and bowel dysfunction. Materials and Methods Three databases were used for the literature search: Ovid (Medline, Embase) and PubMed. Papers were screened by two independent reviewers, who also extracted data from these papers. Clinical papers studying SNM stimulation parameters, that is, intermittent stimulation, frequency, pulse width, and amplitude, in urinary tract and bowel dysfunction were included. Quality of included papers was assessed using standardized guidelines. Results Out of 5659 screened papers, 17 papers, studying various stimulation parameters, were included. Overall quality of these papers differed greatly, as some showed no risk of bias, whereas others showed high risk of bias. Stimulation parameters included intermittent stimulation, frequency, pulse width, amplitude, and unilateral vs. bilateral stimulation. Especially high frequency SNM and either a narrow or wide pulse width seem to improve efficacy in patients with bowel dysfunction. Additionally, implementation of short cycling intervals is promising to improve quality of life for patients with urinary tract or bowel dysfunction. Conclusion The results of our systematic review indicate that stimulation parameters may improve efficacy of SNM in treatment of both urinary tract dysfunction and bowel dysfunction.

Purpose of review Coronavirus disease (COVID-19) has caused a crisis in the entire healthcare system since its emergence. The urgency and priority of various diseases have impacted the medical and surgical treatment in this period. We aim to review the impact of COVID-19 on lower urinary tract symptoms (LUTS) and management. Recent findings There may be a relationship between COVID-19 and de novo or increased LUTS. Patients with LUTS should also be evaluated for COVID-19. Management of diseases has varied during the COVID-19 due to the density of the pandemic. Virtual consultations can mitigate patients who are postponed or cancelled, such as patients with LUTS. Patients suffering voiding dysfunction may manage with oral medications such as alpha blocker and 5-alpha reductase inhibitor via telemedicine. Minimally invasive procedures with a low risk of complications and a short hospitalization time should be considered in complicated cases such as the inability to catheterize. Summary Telemedicine should be implemented on managements of noncomplicated LUTS and voiding dysfunction. Each centre can schedule its LUTS management approach according to the density of pandemic. Virtual consultations need to be developed to compete with face-to-face consultations.

Voiding dysfunction is a common but bothersome problem in both men and women. Urethral sphincter botulinum toxin A (BoNT-A) injections could serve as an option in refractory cases. This study analyzed the efficacy and outcome predictors of the injections in patients with functional, non-neurogenic voiding dysfunction. Patients who received urethral sphincter BoNT-A injection for refractory voiding dysfunction due to detrusor underactivity (DU) or urethral sphincter dysfunction were retrospectively reviewed. A successful outcome was defined as a marked improvement as reported in the global response assessment. The study evaluated the therapeutic efficacy of urethral sphincter BoNT-A injections and measured the changes in urodynamic parameters after the procedure in the patients. A total of 181 patients including 138 women and 43 men were included. The overall success rate was 64%. A lower success rate was noted in patients with DU compared to those with urethral sphincter dysfunction in both genders. In the multivariable analysis, recurrent urinary tract infection (UTI) and bladder voiding efficiency (BVE) were positive predictors for a successful outcome, while DU was a negative predictor. Urethral sphincter BoNT-A injection is an effective treatment for refractory non-neurogenic voiding dysfunction. Baseline BVE and history of recurrent UTI positively predict a successful outcome. DU is a negative outcome predictor.

International audience; ObjectivesIn some patients treated for urinary or fecal incontinence with sacral neuromodulation (SNM) persistence of symptoms, a reduction in efficacy or adverse effects of stimulation can occur. In such situations, further programming of the SNM device can help resolve problems. Infrequently hardware failure is detected. This article aims to provide practical guidance to solve sub-optimal outcomes (troubleshooting) occurring in the course of SNM therapy.Materials and MethodsA systematic literature review was performed. Collective clinical experience from an expert multidisciplinary group was used to form opinion where evidence was lacking.ResultsCircumstances in which reprogramming is required are described. Actions to undertake include changes of electrode configuration, stimulation amplitude, pulse frequency, and pulse width. Guidance in case of loss of efficacy and adverse effects of stimulation, developed by a group of European experts, is presented. In addition, various hardware failure scenarios and their management are described.ConclusionsReprogramming aims to further improve patient symptoms or ensure a comfortable delivery of the therapy. Initial changes of electrode configuration and adjustment of stimulation parameters can be performed at home to avoid unnecessary hospital visits. A logical and stepwise approach to reprogramming can improve the outcome of therapy and restore patient satisfaction.

Resume Objectif Mettre en evidence, une anomalie de relaxation sphincterienne (pseudo-dyssynergie vesico-sphincterienne – DVS), dans la Maladie de Parkinson Idiopathique (MPI), qui constituerait un obstacle sous vesical. Materiel et methode Une etude retrospective a ete realisee en incluant des hommes dont le diagnostic de MPI etait certain et ayant participe au programme de reeducation SIROCCO. Les patients inclus ont presente une hyperactivite vesicale et une dysurie sans obstacle prostatique echographique. Ils ont ete evalues cliniquement par le score de symptomes urinaires Urinary Symptoms Profile (USP). L’obstruction sous vesicale a ete evaluee sur le plan urodynamique par l’etude pression-debit. L’obstruction urodynamique a ete evaluee par l’index d’obstruction vesicale (BOOI). Elle a ete definie par un BOOI > 40. Resultats Le nomogramme pression-debit a pu etre analyse chez cinq patients qui repondaient aux criteres d’inclusion. Chez ce groupe de 5 patients atteints de MPI, le diagnostic a ete porte en moyenne 10,6 ans (7–14) avant la realisation des etudes pression-debit. Nos resultats ont objective 4 patients obstructifs parmi 5 et un patient equivoque. Une pseudo-DVS striee a ete retrouvee chez les 3 patients obstructifs et associee a une probable pseudo-DVS lisse chez un patient. Conclusion Nous avons observe, dans cette courte serie, une anomalie de la relaxation sphincterienne chez les patients presentant une MPI. Niveau de preuve 3.

Background: Pure conus medullaris syndrome is defined as a combination of signs and symptoms of bladder/bowel incontinence and impotence without the presence of lower limbs weakness. The purpose of the study is to assess the recovery of voiding, sexual, and sensory function in patients with isolated conus medullaris syndrome after surgical treatments. Methods: From January 2005 to December 2012, patients with a single level burst fracture with pure conus medullaris syndrome were assessed. Level of injury, use of steroid, surgical time, surgical approach, preoperative radiographic parameters, and types of neurogenic bladder were recorded. Bladder function was evaluated using urodynamic study; sexual function was assessed by self-report questionnaire. The final outcomes were focused on the recovery of voiding, sexual, and sensory function. Results: Eight patients met the criteria of pure conus medullaris syndrome with thoracolumbar burst fracture. The injury level were all located at L1 vertebra. There were 6 males and 2 females. Four patients had overactive neurogenic bladder, and the other 4 patients had underactive type. At final, five patients regained self-voiding function, and three required intermittent catheterization. Two male patients were sexually active, and four male patients had some sexual dysfunction. Two female patients could have normal sexual intercourse but the frequency decreased. One female patients had prolonged perineum numbness at final follow-up. Conclusions: Although extremely rare, pure conus medullaris syndrome may occur with L1 burst fracture. Despite surgical treatment, only one half of the patients regained normal bladder and sexual function. Keywords: Thoracolumbar burst fracture, Pure conus medullaris syndrome, Voiding dysfunction, Sexual dysfunction

Bladder cancer is a worldwide health problem, due to both its high prevalence and the cost related to the treatment. It is usually identified on the basis of visible blood in the urine or blood found on urine testing, but emergency admission is a common way for bladder cancer to present and is often associated with a poor prognosis. The contracted bladder is a rare and serious complication which is disabling. In these cases, there is a need for a neobladder, which may lead to voiding dysfunction. Physiotherapeutic avenues have demonstrated effectiveness in the treatment of voiding dysfunction; they rehabilitate the individual and improve their quality of life. This study reports the case of a male patient who underwent transurethral resection of a bladder tumour (high-grade T1 carcinoma), which developed complications during treatment with Bacillus Calmette-Guérin. He also underwent cystoprostatectomy with ileal orthotopic neobladder.

In a clinical context, there are increasing numbers of people with voiding dysfunction. To date, the methods of monitoring the voiding status of patients have included voiding diary records at home or urodynamic examinations at hospitals. The former is less objective and often contains missing data, while the latter lacks frequent measurements and is an invasive procedure. In light of these shortcomings, this study developed an innovative and contact-free technique that assists in clinical voiding dysfunction monitoring and diagnosis. Vibration signals during urination were first detected using an accelerometer and then converted into the mel-frequency cepstrum coefficient (MFCC). Lastly, an artificial intelligence model combined with uniform manifold approximation and projection (UMAP) dimensionality reduction was used to analyze and predict six common patterns of uroflowmetry to assist in diagnosing voiding dysfunction. The model was applied to the voiding database, which included data from 76 males aged 30 to 80 who required uroflowmetry for voiding symptoms. The resulting system accuracy (precision, recall, and f1-score) was around 98% for both the weighted average and macro average. This low-cost system is suitable for at-home urinary monitoring and facilitates the long-term uroflow monitoring of patients outside hospital checkups. From a disease treatment and monitoring perspective, this article also reviews other studies and applications of artificial intelligence-based methods for voiding dysfunction monitoring, thus providing helpful diagnostic information for physicians.

Objectives: The aim was to present an interdisciplinary Guideline of the Urogynecology Section of the Polish Society of Gynecologists and Obstetricians (PSGO) for the use of urodynamics (UDS) in the diagnostic process of patients with lower urinary tract symptoms (LUTS) based on the available literature, expert knowledge, and everyday practice. Material and methods: A review of the literature concerning the use of UDS in women, including current international guidelines and earlier recommendations of the PSGO Urogynecology Section, was conducted. Results: Urodynamic testing allows to make the urodynamic diagnosis which, nevertheless, remains to be the preliminary diagnosis. Medical history, physical examination, and detailed analysis of the previous test results (laboratory, imaging, endoscopic) need to be taken into consideration before making the final diagnosis. Urodynamic testing before surgical treatment of SUI is allowable, but the decision remains at the discretion of the physician. Urodynamic testing is not necessary before primary surgical treatment of uncomplicated SUI, but it has been demonstrated to optimize the therapeutic methods in complicated SUI. The significance of UDS in the diagnostic process of patients with overactive bladder symptoms, voiding dysfunction, and bladder outlet obstruction was discussed. Conclusions: Urodynamic testing is a vital element of the urogynecological diagnostic process. The scope of UDS should reflect the individual needs and symptoms of each patient and be based on the current guidelines, expert knowledge and experience of the physician, indications, and eligibility, as well as additional test results of the affected patients. Due to formal and legal requirements, PSGO, in this Guideline, wishes to emphasize the need for an individualized approach to both, test performance and result interpretation.

Background Lower urinary tract symptoms are one of the most common groups of non-movement symptoms in patients with Parkinson’s disease (PD). Storage symptoms are well-acknowledged, but neurogenic voiding dysfunction caused by PD remains a knowledge gap. This study aimed to evaluate the neurogenic bladder outlet obstruction in male patients with PD and its clinical significance. Methods Male patients who were diagnosed with PD and underwent urodynamic studies were retrospectively reviewed. The patients with prostate size Results Six patients were included in the final analysis. The mean age was 68.2 and the mean movement symptom duration was 70.7 months. The patients had a mean IPSS of 12.5 and mean PVR volume of 70.8 ml. All patients had slow stream but none of them reported significant voiding difficulty. Urodynamic studies showed the delayed urinary sphincter relaxation and the special trace pattern. After a mean follow-up of 20 months, they had a mean IPSS of 12.5 and mean PVR volume of 73.3 ml. None of them complained of significant voiding difficulty at follow-up. Conclusion The delayed urinary sphincter relaxation is a rare but repeatable phenomenon in male patients with PD. It is unlikely to cause disturbing voiding dysfunction, as reported by the patients, and does not progress prominently during the course of PD. Further studies are needed to investigate the nature of this special type of neurogenic BOO and whether it is peculiar to PD in a larger patient cohort.

Background: This survey was designed and conducted during the lockdown period to assess its effect on urology practice dealing with patients with voiding dysfunction and their care in the Gulf Cooperation Council (GCC) region. Methods: An online survey was sent across to urologists managing patients with voiding dysfunction in countries of the GCC region through various social media platforms. All valid responses were tabulated and analyzed. Results: A total of 202 responses were received. Higher proportion of urologists in private sector (98.2%) were treating patients in comparison to those in public or governmental hospitals (82.7%); (P = 0.007). Telemedicine was used by 72% of the respondents. Telephone calls were preferred With regard to perception of risk while examining patients, 65% of the respondents felt that their risk was equal to other specialties. Their preferred prevention strategy would be pre-operative screening. Financial impact affected only 10% claimed major catastrophic effect. There was a significant difference between private and public government urology services provided, with a higher proportion of patients seen, operations performed, fees charged for telemedicine, and financial effect in the private sector with P = 0.012, P = 0.037, P = 0.004, and P = 0.001, respectively. Conclusion: Our survey showed that majority of urologists in the GCC region were seeing patients during COVID-19 lockdown. Emergency services were prioritized. A large proportion of urologists had switched over to telephonic communication. Most of the responding urologists were uncertain about when and how to resume surgical procedures upon easing of the COVID-19-related restrictions.

Background Voiding dysfunction (VD) is a common neurogenic lower urinary tract dysfunction (NLUTD) in multiple sclerosis (MS) patients. Currently, the only effective management for VD and urinary retention in MS patients is catheterization, prompting us to look for novel therapeutic options beyond the bladder, such as the brain. Transcranial rotating permanent magnet stimulator (TRPMS) is a non-invasive, portable, multifocal neuromodulator that simultaneously modulates multiple cortical regions, enhancing or attenuating strengths of functional connections between these regions. The objective of this pilot clinical trial is to evaluate the feasibility of a TRPMS trial to address lower urinary tract symptoms in MS patients, through investigating the therapeutic effects of TRPMS in modulating brain regions during voiding initiation and mitigating VD in female MS individuals. Methods Ten adult female MS patients with VD (defined as having %post-void residual/bladder capacity (%PVR/BC) ≥ 40% or Liverpool nomogram percentile < 10%) will be recruited for this study. Concurrent urodynamic and functional MRI evaluation with a bladder filling/emptying task repeated three to four times will be performed at baseline and post-treatment. Predetermined regions of interest and their blood-oxygen-level-dependent (BOLD) activation at voiding initiation will be identified on each patient’s baseline anatomical and functional MRI scan, corresponding to the microstimulators placement on their individualized TRPMS treatment cap to either stimulate or inhibit these regions. Patients will receive 10 40-min treatment sessions. Non-instrumented uroflow and validated questionnaires will also be collected at baseline and post-treatment to evaluate clinical improvement. Discussion Despite the crucial role of the central nervous system in urinary control and its sensitivity to MS, there has been no treatment for urinary dysfunction targeting the brain centers that are involved in proper bladder function. This trial, to our knowledge, will be the first of its kind in humans to consider non-invasive and individualized cortical modulation for treating VD in MS patients. Results from this study will provide a better understanding of the brain control of neurogenic bladders and lay the foundation for a potential alternative therapy for VD in MS patients and other NLUTD in a larger neurogenic population in the future. Trial registration This trial is registered at ClinicalTrials.Gov (NCT03574610, 2 July 2018.) and Houston Methodist Research Institute IRB (PRO00019329)

Purpose Transient postoperative urinary retention (POUR) is common after pelvic floor surgery. We aimed to determine the association between peri-operative variables and POUR and to determine the number of voids required for post-void residuals (PVRs) to normalize postoperatively. Methods We conducted a retrospective cohort study of 992 patients undergoing pelvic floor surgery at a tertiary referral centre from January 2015 to October 2017. Variables assessed included: age, BMI, ASA score, anaesthesia type, type of surgery, length of postoperative stay, surgeon, bladder protocol used, and number of PVRs required to “pass” the protocol. Results Significant risk factors for POUR included: placement of MUS during POP surgery, anterior repair and hysterectomy with concomitant sacrospinous vault suspension. A total of 25.1% were discharged requiring catheterization. Patients receiving a concomitant mid-urethral sling (MUS) were 2.2 (95% CI1.6–2.9) and 2.3 (95% CI 1.8–3.1) times more likely to have elevated PVR after their second TOV and third TOV (p 2 and placement of MUS were associated with increasing number of voids needed to pass protocol. Conclusions While many women passed protocol by the second void, using the 3rd void as a cut point to determine success would result in fewer women requiring catheterization after discharge. Prior to pelvic floor surgery, women should be counselled regarding POUR probability to allow for management of postoperative expectations.

Rationale: Herpes zoster (HZ) involving sacral dermatome is very rare, which can sometimes cause voiding dysfunction. Patient concerns: A 52-year-old man presented with acute pain and voiding dysfunction, following HZ in his right sacral dermatomes. Diagnoses: Twenty two days before presentation HZ occurred and 9 days after the onset of the HZ, he had trouble with starting urination and weak urine stream which was managed with tamsulosin 0.4 mg orally once a day and intermittent urinary catheterization. He was treated with 150 mg of pregabalin 2 times a day, tramadol 50 mg 2 times, and acetaminophen 600 mg 2 times a day. However, his pain intensity was 5 on the numerical analogue scale (NRS) from 0 (no pain) to 10 (worst pain imaginable). Interventions: Fluoroscopy guided caudal block was performed with a mixture of 0.5% lidocaine 10 mL and triamcinolone 40 mg. Outcomes: One day after the procedure, the pain decreased to 1 on the NRS score. In addition, voiding difficulty greatly improved. Three days after the intervention, the patient reported complete resolution of pain and voiding dysfunction. He currently remains symptom free at a 3-month follow-up. Lessons: A caudal block with steroid can be an effective option for treatment of acute voiding dysfunction and pain following sacral HZ.

During herpes zoster infection, immunocompromised hosts are especially vulnerable to complications, which include visceral organ involvement. Voiding dysfunction secondary to herpes zoster infection is an uncommon clinical presentation and has numerous enigmatic mechanisms. This case of herpes-zoster-associated voiding dysfunction occurred in a patient with nephrotic syndrome treated with immunosuppressives (prednisolone and mycophenolate mofetil). The patient presented with acute urinary retention and extensive lumbosacral herpetic infection. He responded positively to treatment and completely recovered following a 14-day course of intravenous acyclovir and intermittent self-catheterization (two to three times daily) for four weeks.

Background Urinary dysfunction is a common symptom during the course of multiple sclerosis (MS). Long-term follow-up of the natural history of bladder dysfunction in MS has been seldom addressed. Objective To identify the type and the course of voiding dysfunction in MS patients in relation to the urodynamic changes of the lower urinary tract (LUT) Subjects and methods An observational prospective study including 120 MS patients with urinary dysfunction rated by the American Urological Association (AUA) symptoms questionnaire and assessed by urodynamic studies and followed for 1 year. Results Irritative symptoms were the most frequently encountered symptoms (90%), whereas overactive bladder was recorded by urodynamic studies in 35% of subjects. Urinary symptoms severity score was higher in patients with initial urodynamic abnormalities by the end of the 1-year follow-up period (P < 0.001). A statistically significant relationship was found between urinary symptoms severity score and each of expanded disability status scale (EDSS) and urodynamic pattern of abnormalities (P < 0.01). Conclusion Irritative symptoms and overactive bladder seem to be the most frequent urinary dysfunction in MS patients. Urinary symptoms are related to the degree of disability. The initial urodynamic abnormalities are associated with worse urinary dysfunction outcome after 1 year.

Introduction: Urinary tract infection (UTI) in children leads to renal scarring in 10-15% of patients. Urinary tract anomalies and bladder and bowel dysfunction (BBD) are documented risk factors for recurrent UTIs. Estimates of baseline prevalence of BBD in children with UTI will help the clinician in the management strategy. Hence, a systematic review and meta-analysis was conducted to estimate the pooled prevalence of BBD. Methods: MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) databases were searched for articles related to UTI, primary vesicoureteral reflux (VUR), and BBD. We included studies that provided prevalence of BBD in toilet-trained patients aged 1-18 years with UTI and/or VUR. BBD was defined based on clinical history or questionnaire or urodynamic studies. Two authors independently reviewed, assessed, and abstracted data from studies. Pooled prevalence was calculated based on a random effects model. Results: Forty-three studies fulfilling the eligibility criteria were selected from a total of 1,731 studies. Among patients presenting with UTI without primary VUR, pooled prevalence of BBD was 41% (95% CI: 26-55; nine studies, 920 patients, I 2 = 96.0%), whereas its prevalence in patients with primary VUR was 49% (43-56; 30 studies, 5,060 patients, I 2 = 96.0%). Weighting by the study design and quality did not affect the prevalence. In patients with primary VUR, prevalence of BBD was higher in females (53%; 42-65) than in males (44%; 15-73). In studies where urodynamic study was used for the diagnosis of BBD, prevalence was 63%. The presence of BBD in patients with primary VUR increased risk of recurrent UTIs [relative risk (RR): 2.1; 1.7-2.5]. In five studies that reported separate data on constipation, pooled prevalence of constipation was 27% (16-37). Conclusion: Almost half of the patients with primary VUR have BBD, and its presence increases the risk of recurrent UTIs. Trends of high BBD prevalence were also observed in patients presenting with UTI without VUR. These prevalence estimates suggest that all toilet-trained children presenting with UTI with or without VUR should be assessed for BBD, which will help in their further management.

Congenital urethral polyps are a rare anomaly of the urethra seen primarily in male children that present most commonly with features of voiding dysfunction or urinary obstruction. We report a case of a young boy with a posterior urethral polyp presenting with urinary retention, hematuria, and constipation. We also report a new treatment approach to this rare and challenging clinical finding.

BACKGROUND: Improvement of bladder emptying by modulating afferent nerve activity is an attractive therapeutic strategy for detrusor underactivity. Transient receptor potential vanilloid 4 (TRPV4) is a sensory ion channel in urothelial cells that contribute to the detection of bladder filling. OBJECTIVE: To investigate the potential benefit of intravesical TRPV4 agonists in a pelvic nerve injury rat model for detrusor underactivity. DESIGN, SETTING, AND PARTICIPANTS: Female wild-type and Trpv4 knockout rats underwent sham surgery or bilateral pelvic nerve injury (bPNI). Four weeks later, rats underwent cystometry with infusion of the TRPV4 agonist GSK1016790A. Bladders were harvested for in vitro pharmacological studies, quantitative reverse polymerase chain reaction and immunohistochemistry. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Data are expressed as median ± interquartile range. Statistical comparisons were made using the Mann-Witney U test and Wilcoxon signed rank test as appropriate. RESULTS AND LIMITATIONS: Rats with bPNI showed a phenotype characteristic of detrusor underactivity with lower-amplitude voiding contractions, decreased voiding frequency, and increased postvoid residual. Intravesical application of GSK1016790A increased voiding frequency and reduced postvoid residual in wild-type, but not Trpv4-/-, rats. In isolated bladder strips, GSK1016790A did not induce relevant contractions, indicating that the observed improvements in bladder function are the result of increased afferent signalling through TRPV4 activation, rather than a local effect on the detrusor. The altered urinary phenotype of Trpv4-/- mice was not apparent in the Trpv4-/- rat model, suggesting species-related functional variations. Our results are limited to the preclinical setting in rodents. CONCLUSIONS: Intravesical activation of TRPV4 improves bladder dysfunction after bPNI by increasing afferent signalling. PATIENT SUMMARY: We demonstrate that the sensory protein transient receptor potential vanilloid 4 (TRPV4) can be targeted to improve bladder function in animals that have iatrogenic injury to the nerves innervating the bladder. Further research is required to determine whether these results can be translated to patients with an underactive bladder. ispartof: EUROPEAN UROLOGY vol:74 issue:3 pages:336-345 ispartof: location:Switzerland status: published

BACKGROUND Overactive bladder is a chronic condition affecting lower urinary tract function that has a significant negative impact on QoL. OBJECTIVE Evaluation of the BlueWind implantable tibial nerve system performance and safety in refractory OAB. DESIGN, SETTING, AND PARTICIPANTS INTERVENTION A 6-month multi-center prospective intervention study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Objective assessment was done by voiding diary parameters including voids/day, volume voided/day, urgency assessment, leaking episodes/day, pads used/day, leak severity, and clinical success defined as a ≥50% reduction in the number of leaks/day or number of voids/day or number of episodes with degree of urgency >2 or a return to

AimsUrinary retention in women is poorly understood, compared to the equivalent condition in men, and was the subject of a dedicated session organized at the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, United Kingdom, 2017. MethodsThe current understanding of the pathophysiological correlates of idiopathic voiding dysfunction in women, the role of urodynamics, neurophysiology, and non-invasive tests in characterizing functional bladder outlet obstruction due to a non-relaxing urethral sphincter, and poorly defined diagnosis of detrusor underactivity were reviewed. ResultsPutative factors underlying the pathogenesis of urinary retention following urinary tract infections were discussed. Further research is required to explore the association between bladder wall inflammation and alterations in detrusor contractile functions. The complex interrelationship between urinary retention and psychological co-morbidities and sexual trauma were explored, and the overlap between these and psychological co-morbidities and functional neurological problems with functional urological problems were recognized. Understanding the mechanism of action of sacral neuromodulation, often a successful treatment for urinary retention, would provide insight into the underlying factors that may be responsible for urinary retention. Specifically, there is a need to understand the role of the endogenous enkephalinergic system in the pathogenesis of urinary retention and to identify predictors of successful treatment with sacral neuromodulation. Based on current understanding and potential directions of research in the future, an algorithm for the evaluation of women with voiding dysfunction was proposed. ConclusionsIn the future, recommendations for research should lead to a better understanding of urinary retention in women and its treatment.

Background Vaginal abscess is a treatable disease and should be considered in female patients with voiding difficulties and perineal tenderness. There are no reported cases of vaginal abscess causing voiding dysfunction in the absence of a previous surgery. Early diagnosis and drainage of vaginal abscesses may lead to excellent outcomes. Case summary We presented a case of vaginal abscess that caused voiding dysfunction without surgery history. A 64-year-old woman had a past history of type 2 diabetes mellitus. She came to our clinic following urinary difficulty with perineal tenderness. Bladder ultrasonography revealed a pelvic cystic lesion with a mass effect on the bladder. The presence of a vaginal abscess was suspected following pelvic examination and transvaginal ultrasound. After transvaginal drainage of the vaginal abscess and a full course of antibiotic treatment, she recovered well without any urination symptoms. Conclusion Voiding dysfunction caused by vaginal abscess is rare but should be considered in female patients with perineal tenderness.

Parkinson’s disease (PD), caused by degeneration of dopaminergic neurons, leads to motor and autonomic symptoms. A large proportion of PD patients experience lower urinary tract symptoms (LUTS) and voiding dysfunction, associated with poor quality of life. Deep brain stimulation (DBS) is an adjunctive therapy used in combination with medication for Parkinsonian motor symptoms and is currently being explored to treat PD-related LUTS. This review discusses the current literature on the effects of DBS on lower urinary tract function and whether this modality can be used to modulate PD-related LUTS and voiding dysfunction.

Primary bladder neck obstruction (PBNO) represents an inappropriate or inadequate relaxation of the bladder neck during micturition. Based on the observation of an increased rate of postural imbalances in male patients with PBNO, we hypothesized a possible role of an unbalanced biomechanics of the pelvis on urethral sphincters activity. Our aim was to identify kinematic imbalances, usually disregarded in PBNO patients, and which could eventually be involved in the etiopathogenesis of the disease. Seven male adult patients (39.6±7.1years) were recruited; in all patients, PBNO was suspected at bladder diary and uroflowmetry, and was endoscopically confirmed with urethroscopy. Participants gait was recorded with a motion capture system (BTS Spa, Italy) to obtain three-dimensional joint angles and gait parameters. Multivariate statistics based on a Principal Component model allowed to assess the similarity of patients' gait patterns with respect to control subjects. The main finding is that patients with PBNO showed significant discordance in the observations at the ankle and pelvis level. Additionally, 6/7 patients demonstrated altered trunk positions compared to normal curves. We suggest that the identified postural imbalances could represent the cause for an anomalous activation of pelvic floor muscles (hypertonia). The consequent urinary sphincters hypercontraction may be responsible for the development of voiding dysfunction in male patients with no significant morphological alterations. Results reinforced the hypothesis of an etiopathogenetic role of postural imbalances on primary bladder neck obstruction in male patients.

Objective: The aim of this study was to determine the effectiveness of the voiding dysfunction symptom score (VDSS) in evaluation of children with nocturnal enuresis. Materials and Methods: Four hundred children with nocturnal enuresis were included in the study. They were evaluated with VDSS, physical examination, urinalysis and 2-day voiding diary. All children with nocturnal enuresis symptoms were treated with desmopressin and/or urotherapy. However, children with overactive bladder symptoms were also treated with anticholinergics. Treatment success and change in VDSS were compared and assessed between different treatment methods. Results: Two hundred forty-five children (61.25%) were male and 155 (38.75%) were female. The mean age was 7.6 +/- 3.0 years (range: 5-18). The mean VDSS was 9.2 +/- 6.3. 35% of children with nocturnal enuresis had concomitant daytime symptoms. 126 children (31.5%) had a VDSS of nine or above and majority of these children were treated with anticholinergic therapy. VDSS questionnaire could not help determine treatment success in children with non-monosymptomatic nocturnal enuresis. However, children treated with urotherapy and desmopressine showed significant difference in VDSSs according to their treatment response. Conclusion: VDSS has shown to decrease after treatment in children with mono-symptomatic nocturnal enuresis. The treatment strategies should be checked and modified if VDSS does not decrease after proper therapy as this would increase the success of treatment.

Objective: To evaluate the use of percutaneous tibial nerve stimulation (PTNS) in an elderly population, as PTNS is a third-line treatment in the management of overactive bladder (OAB) and affects 10-26% of adult males and 8-42% of adult females, increasing in prevalence with age. Patients and methods: We performed a chart review of patients aged ≥65years undergoing PTNS at a single institution over 6years. We examined clinicopathological variables potentially associated with the outcomes of interest. Results: In total, 52 patients aged ≥65years underwent an induction course of PTNS between 2011 and 2017, comprising 23 men and 29 women. The mean age of the patients was 75.75years and the mean body mass index (BMI) was 26.33 kg/m2. In all, 36 patients used anticholinergic treatments prior to PTNS, five used a β3-adrenoceptor agonist, and three had Botox injections. After PTNS, 37 patients reported improvement of their symptoms, with 21 using combined therapy during PTNS. Only seven patients used an anticholinergic after PTNS, six used a β3-adrenoceptor agonist, five had Botox injections, and two had sacral neuromodulation. When looking at variables such as age, gender, race, BMI, and comorbidities, we found that an obese BMI was the only statistically significant variable predicting failure of response. A sub-analysis of only women did not demonstrate any predictors of failure. Conclusion: Our subjective response rate of 70% was within the success rates reported in literature. In all, 39% of patients used a concomitant treatment during PTNS and 13.2% required alternative treatment after PTNS. Abbreviations: BMI: body mass index; OAB: overactive bladder; PTNS: percutaneous tibial nerve stimulation; UI: urinary incontinence.

Summary Introduction and objective Syringocele is a rare cystic dilatation of the duct of Cowper's gland, afflicting mostly the pediatric population. Syringoceles have a wide range of symptoms and may cause urethral obstruction. The authors analyzed to clarify the clinical manifestation, diagnostic approach, management, and incidence in the pediatric population. Materials and methods All patients (122 cases) diagnosed with a syringocele at the department of Pediatric Urology in a tertiary referral university children's hospital between August 1991 and October 2016 were analyzed retrospectively by assessing medical charts. Results The clinical manifestation, diagnostic findings, and follow-up are summarized in the table. Half of the patients (50.0%) also had typical posterior urethral valves (PUVs) and/or a single valve in the 12 o'clock position (flap-valve). The symptoms of open and closed syringoceles showed no significant difference. Treatment consisted of incision of the syringocele with a diathermia hook. The incidence of urinary tract infection (UTI) before and after surgery in the group that had a syringocele only was significant different. The overall incidence of syringoceles seen at urethrocystoscopy in this series was 3.0%. Discussion This series suggests that the presenting age is strongly related to the consequences of syringoceles, as the youngest half of the patients had significantly more UTIs at presentation than older patients, who presented with significantly more obstructive voiding symptoms, postvoiding residuals, and incontinence. In addition, the younger group had a significantly higher incidence of vesicoureteral reflux and dilatation of the upper urinary tract. The found association between syringoceles and PUV may be due to overgrowth of epithelium, as possible origin in both anomalies. Conclusion With an incidence of 3.0%, syringoceles, in this tertiary referral series, should be considered in the differential diagnosis of obstructive urethral lesions. The presentation ranges between signs of severe obstructions in the prenatal and postnatal period to mild urinary incontinence problems at later age. Urethrocystoscopy proved to be useful in confirming the diagnosis and allows for immediate transurethral incision. Summary Table . Clinical manifestation Most frequent presenting symptoms Urinary tract infection (UTI) (50.0%), Obstructive voiding symptoms (45.9%) Postvoiding residual urine (13.9%) Median age at diagnosis 3.0 (IQR: 0.0–9.0) years Diagnostics (UCS) − 83 closed syringoceles and 31 open syringoceles. − 8 patients had two coexisting syringoceles. − 22 patients had a syringocele without additional urethral abnormalities. Follow-up Median follow up 24.0 (IQR: 7.00–52.50) months 42 (34.4%) patients were symptom-free directly after surgery. 23 (18.9%) patients needed a second incision of the rim of the opened syringocele.

Objective Voiding dysfunction following a midurethral sling procedure is still a relevant consequence that can affect patients' quality of life. Various invasive methods have been described to manage this problem. We hypothesize that we if we could diagnose the condition early using noninvasive tools, we would be able to offer appropriate effective management. We sought to study the effectiveness of attaching a tension-releasing suture on a single-incision sling (SIS) tape as a prophylactic measure for the treatment of immediate postoperative voiding dysfunctions, and secondarily, to evaluate the objective and subjective cure rates of the treatment for stress urinary incontinence. Materials and Methods It is a prospective observational study. A tension-releasing suture was prepared by appending a polyglactin suture to one end of the MiniArc sling tip fiber, which could be used to manipulate the sling tip when postoperative voiding dysfunction was identified. Primary outcome measure was the number of patients requiring tension-releasing suture manipulation to treat postoperative voiding dysfunctions successfully. Results Twelve of the 131 (9.2%) patients who underwent SIS procedure for urodynamic stress incontinence surgery required tension-releasing suture manipulation due to voiding dysfunction during the immediate postoperative period with a good outcome. Postoperative overall objective and subjective cure rates were 90.5% and 88.9% (126 available patients at 1-year follow up, mean 19.2 ± 8.0 months), respectively. The subanalysis of the objective and subjective cure rates of the group with tension-releasing suture manipulation were 91.7% (11/12) and 91.7% (11/12), and those of the group without tension-releasing suture manipulation were 90.4% (103/114) and 88.6% (101/114), respectively, at 1-year follow up. Conclusion Tension-releasing suture is effective in the management of immediate postoperative voiding dysfunction in an SIS procedure. SIS operation has good short-term objective and subjective cure rates for female urodynamic stress incontinence.

I-Hung Shao,1,* Chia-Chen Wu,2,* Hsiao-Jung Tseng,3 Ta-Jen Lee,2 Yu-Hsiang Lin,4 Yuan-Yun Tam5 1Division of Urology, Department of Surgery, Lotung Poh-Ai Hospital, Yilan County, 2Department of Otorhinolaryngology – Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, 3Biostatistical Center for Clinical Research, Chang-Gung Memorial Hospital, Taoyuan City, 4Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, 5Department of Otorhinolaryngology – Head and Neck Surgery, Lotung Poh-Ai Hospital, Yilan County, Taiwan *These authors contributed equally to this work Background: Pseudoephedrine is a sympathomimetic drug widely used as a nasal decongestant. However, it can cause adverse effects, such as voiding dysfunction. The risk of voiding dysfunction remains uncertain in patients without subjective voiding problems.Methodology: We prospectively enrolled patients with nasal congestion who required treatment with pseudoephedrine from May to August 2015. All patients denied concomitant subjective voiding problem. The International Prostate Symptom Score (IPSS) questionnaire was used to evaluate voiding function before and 1 week after the pseudoephedrine treatment. The results of the IPSS questionnaire were analyzed as the total (IPSS-T), voiding (IPSS-V), storage (IPSS-S), and quality of life due to urinary symptom scores.Results: We enrolled 131 males with a mean age of 42.0±14.3 years. The IPSS-T, IPSS-V, and IPSS-S scores slightly increased after the medication (IPSS-T increased from 6.49 to 6.77, IPSS-V from 3.33 to 3.53, and IPSS-S from 3.17 to 3.24). The quality of life due to urinary symptom score nonsignificantly decreased from 2.02 to 1.87. We observed that older age and a higher premedication IPSS-V score yielded significant differences (P50 years, even without subjective voiding symptoms. Keywords: pseudoephedrine, nasal congestion, voiding dysfunction, IPSS

Introduction and hypothesis A significant proportion of patients develop voiding dysfunction after midurethral tape (MUT) insertion, which reduces patient satisfaction. The study’s purpose was to identify predictive factors of voiding dysfunction after a retropubic MUT procedure. Methods This was a retrospective study of 100 patients who underwent only a retropubic MUT procedure between January 2010 and December 2011. Early voiding dysfunction was defined when patients required a Foley catheter within 48 h. Data including demographic information, urogenital symptoms, previous surgery, preoperative uroflowmetry and urodynamic parameters were analysed using SPSS v22. Univariate analysis of all demographic variables was performed; those significant at 10 % were entered into a multivariate logistic regression. Results Fourteen patients required Foley catheter insertion, with a median age of 58 years (26–83 years), median BMI 28 kg/m2 (20–48 kg/m2), and median parity 2 (0–4). Univariate analysis revealed peak flow rate

Male lower urinary tract symptoms (LUTSs) are highly prevalent in men and the incidence increases with aging. The pathophysiology of male LUTSs might be bladder outlet dysfunctions such as bladder neck (BN) dysfunction, benign prostatic obstruction, and poor relaxation of external sphincter and bladder dysfunctions such as detrusor overactivity (DO), detrusor underactivity, DO, and inadequate contractility. Male LUTSs include voiding and storage symptoms, and precision diagnosis should not be done based on the symptoms alone. Videourodynamic study provides a thorough look at the bladder and bladder outlet and can clearly demonstrate the underlying pathophysiology when the initial medication fails to relieve LUTS. Medical treatment should be given based on the underlying pathophysiology of LUTS, and surgical intervention to remove prostate should only be performed when a definite bladder outlet obstruction due to prostatic obstruction has been confirmed by invasive urodynamic study.

Objectives : To identify patients at risk for postoperative outlet obstruction after the tension-free vaginal tape obturator (TVTO) procedure in order to allow for better counseling and possible treatment alternatives. Subjects and methods : This prospective study was carried out on 85 women who underwent the TVTO procedure for treatment of stress urinary incontinence (SUI). Preoperatively, a detailed medical history was taken from all patients, and all were subjected to physical examination, routine labs, abdominal and pelvic ultrasound and urodynamic studies (cystometry and assessment of the detrusor leak point pressure (DLPP), abdominal leak point pressure (ALPP), pressure flow and post-void residual (PVR) urine). The TVTO procedure was carried out by the same surgeon in all cases. Postoperative voiding dysfunction in this study was defined as the subjective feeling of difficult voiding, a weak stream and/or incomplete evacuation, and a PVR urine volume >100 ml, a urine flow rate

As the population ages the prevalence of long-term urinary catheters, especially in the elderly, is going to increase. Urinary catheters are usually placed to manage urinary retention or incontinence that cannot be managed any other way. There is significant morbidity associated with an indwelling catheter. The commonest problems are catheter blockages, infection and bladder stones. These will occur with a similar incidence with either a suprapubic or a urethral catheter. Urethral complications such as strictures, scrotal infection and erosion are less common with suprapubic catheterization (SPC). However the benefit of having a SPC needs to be balanced against the risks involved in inserting the catheter suprapubically. Patient reported symptoms show that a SPC is more comfortable and better tolerated than a urethral catheter. However there needs to be more research into developing better catheters that reduce the frequency of urinary infections and blockages and hence catheter morbidity.

Purpose of Review: Urinary diversion (UD) remains the last option for improving quality of life in patients with treatment-refractory urinary incontinence (UI) or voiding dysfunction after cancer treatment. We aim to critically review the utility of UD for UI and voiding dysfunction in patients previously treated for malignancy. Recent Findings: UD patients are at high risk given their oncologic treatment and multiple procedures prior to UD. The severe impact of UI and voiding dysfunction on quality of life is significant. Despite the risk of complications after UD, men reported significant improvement of their urinary symptoms and were confident that they would have sought UD sooner. Summary: UD remains a last option for some men dealing with severe urinary symptoms after treatment of pelvic malignancy in both men and women. Further investigation is needed to better characterize the burden of disease and potential gains surrounding management of these men.

ResumenLa neuromodulación de raíces sacras (NRS) utiliza un generador de impulsos implantable, éste representa una opción terapéutica para pacientes con diversas formas de disfunción miccional refractaria a tratamiento conservador.Se presenta el caso de una paciente femenina de 47 años de edad, con incontinencia urinaria de 5 años de evolución refractaria a tratamiento conservador y farmacológico; su evaluación diagnóstica cumplía con criterios de inclusión para este tratamiento.La cirugía se llevó a cabo sin complicaciones, se colocó el implante definitivo, presentando disminución significativa en los índices de gravedad de la incontinencia urinaria (Sandvik Severity Index) y en el cuestionario de impacto de la incontinencia urinaria en la calidad de vida (Potenziani).La NRS con implante de un generador de impulso es una opción terapéutica que puede mejorarlas condiciones clínicas de pacientes con incontinencia urinaria refractaria.AbstractSacral neuromodulation (SNM) utilizes an implantable pulse generator and is a therapeutic option for patients with different types of voiding dysfunction that are refractory to conservative treatment.A 47-year-old woman presented with urinary incontinence of 5-year progression that was refractory to conservative and pharmacologic treatment. Her diagnostic evaluation met the inclusion criteria for SNM treatment.The surgery was performed with no complications. The device was placed definitively, resulting in a significant decrease in the Sandvik Severity Index and an improvement in the impact of urinary incontinence on quality of life measured by the Potenziani questionnaire.

Background No study has compared the bothersomeness of all lower urinary tract symptoms (LUTS) using a population-based sample of adults. Despite this lack of evidence, investigators have often cited their LUTS of interest as the “most bothersome” or “one of the most bothersome.” Objective To compare the population- and individual-level burden of LUTS in men and women. Design, setting, and participants In this population-based cross-sectional study, questionnaires were mailed to 6000 individuals (18–79 yr of age) randomly identified from the Finnish Population Register. Outcome measurements and statistical analysis The validated Danish Prostatic Symptom Score questionnaire was used for assessment of bother of 12 different LUTS. The age-standardized prevalence of at least moderate bother was calculated for each symptom (population-level burden). Among symptomatic individuals, the proportion of affected individuals with at least moderate bother was calculated for each symptom (individual-level bother). Results and limitations A total of 3727 individuals (62.4%) participated (53.7% female). The LUTS with the greatest population-level burden were urgency (7.9% with at least moderate bother), stress urinary incontinence (SUI) (6.5%), nocturia (6.0%), postmicturition dribble (5.8%), and urgency urinary incontinence (UUI) (5.0%). Burden from incontinence symptoms was higher in women than men, and the opposite was true for voiding and postmicturition symptoms. At the individual level, UUI was the most bothersome for both genders. Although the response proportion was high, approximately a third did not participate. Conclusions Both men and women with UUI report moderate or major bother more frequently than individuals with other LUTS. At the population level, the most prevalent bothersome symptoms are urgency, SUI, and nocturia. Patient summary Urinary urgency was the most common troubling symptom in a large population-based study; however, for individuals, urgency incontinence was the most likely to be rated as bothersome., Take Home Message Population-based study assessing bother of individual lower urinary tract symptoms (LUTS) found the highest age-standardized prevalence for bothersome urgency. However, among individuals affected by LUTS, urgency incontinence was the most likely to cause significant bother. LUTS were generally well tolerated across ages and genders.

Objectives: The study aimed to evaluate whether the duration of complaints in patients with overactive bladder syndrome or non-obstructive urinary retention predicts the outcome of sacral neuromodulation (SNM). Methods: All patients that underwent a SNM test period evaluation between 2011 and 2014, were included in this study. The duration of complaints was listed in 3 categories: (a) 0-5 years, (b) 5-10 years and (c) 10 years or longer. Analyses with chi square tests were performed to evaluate whether the duration of complaints are associated with outcome of SNM. Results: In total, 130 patients were included. Most patients had a complaint duration of 0-5 years (n = 60). The test period was successful in 56% (n = 74) of the total group. Analyses showed that the duration of complaints is not significantly associated with outcome of SNM (p = 0.752), even when subdivided per indication, and also when possible confounders such as age at test and indication are taken into account (p = 0.720). Conclusion: Based on the results of this study, there is no relationship between duration of complaints and SNM outcome. SNM seems to remain a feasible treatment option, despite of possible anatomical or physiological changes within the lower urinary tract.

Overactive bladder (OAB) symptoms of urgency, frequency, and urge incontinence currently affect a substantial portion of the population, especially as age increases. Sacral neuromodulation has become a popular option for refractory OAB symptoms over the past 2 decades. Studies have demonstrated that it is an effective treatment for OAB and urge incontinence as indicated by decreased number of voids, increased bladder capacity, and fewer leakage events. In addition, the effects have proved to be durable to multiple years following implantation. These benefits come at the expense of a high rate of adverse events, although with comparable long-term cost-effectiveness to botulinum toxin A. We aimed to review the literature that demonstrates that sacral neuromodulation continues to be an efficacious treatment for refractory OAB wet and dry patients, with continuously expanding indications.

ObjectiveTo study the effect of acupuncture on rabbit bladder with urodynamic indexes.MethodsNew Zealand male rabbits were divided into control group, model group, treatment group 1 treated by acupuncture at Shenshu (BL 23) and treatment group 2 treated by acupuncture at Zhongji (CV 3). The urine dynamic parameters through the urethral catheter were detected in each group in order: fluctuation of pressure at filling phase of urinary bladder and flow rate in urination phase, which were used as quantification indexes of urinary bladder function. The urinary bladder abnormal model was prepared by administration of cholinergic stimulant; Regulatory effects of acupuncture at Shenshu (BL 23) and Zhongji (CV 3) on the abnormal state of the urinary bladder were respectively observed.Results1) In the filling phase of urinary bladder and in the urination phase, the intravesical pressure wave in infilling (IPWI) and intravesical discharge rate (IDR) could be respectively recorded. 2) IPWI and IDR could become abnormality by neostigmine methyl sulfate [stability type IPWI: the control group (n=20, 80%) vs the model group (n=15, 14.3%), P 0.05; the instability type IPWI wave: the model group (n=13, 85.7%) in vs the treatment group 2 (n=6, 60%), P>0.05]; 4) Abnormal IDR also could be turned to normality by acupuncture at Shenshu (BL 23) and Zhongji (CV 3), respectively [IDR and the time regression equation: the model group (n=15, y=40.0 – 5.15x) vs the treatment group 1 (n=10, y= 18.9 – 0.499x), P

Primary bladder neck obstruction (PBNO) is a frequent under-investigated urological condition in which the bladder neck fails to open adequately during voiding. In the majority of cases no known etiological factor can be found. In this study we propose a new hypothesis to explain the origin of the disease in young male patients with no neurological disorders. We suggest a possible role of an unbalanced biomechanics of the pelvis on urethral sphincters activity and on functional bladder capacity. To support the proposed hypothesis, we present pilot gait analysis data of young male patients with primary bladder neck obstruction.

Acute renal failure is characterized by rapidly disruption in kidney function and postrenal causes typically result from obstruction of urinary flow. Multiple etiologies were described for acute renal failure, but labial fusion in postmenopausal female is a quite rarely encountered pathology among postrenal causes. Only a few cases have been presented in postmenopausal women presenting with urinary retention. We present a case with acute renal failure due to complete labial fusion in a postmenopausal woman and its treatment.

EINLEITUNG: Die weibliche Harnblasenentleerungsstörung ist ein relativ häufiges Krankheitsbild. Die Genese ist oft habituell bedingt oder Folge von Operationen. Die neurogene Genese wird dagegen in der Praxis und Diagnostik oft wenig beachtet oder gar übersehen. In großen Studien wurde sie selten untersucht. Wir haben in dieser Studie die Wertigkeit und Interpretation der Messung der elektrisch stimulierten Pudenduslatenz (ESPL) und der Elektromyographie (EMG) untersucht. METHODIK: Es wurden 184 Patientinnen untersucht. Bei allen konnte eine mechanische oder anatomische Ursache für die Harnblasenentleerungsstörung ausgeschlossen werden. Bei allen Patientinnen wurde ein neurologischer Status erhoben, eine ESPL und EMG durchgeführt. Die ESPL wurde auf der rechten und linken Seite jeweils transvaginal und transanal durchgeführt. Eine pathologische Latenz wurde für Werte von >2,4 ms festgelegt. Die EMG stellt ein invasives Verfahren dar. Eine festgestellte Spastik oder Spontanaktivität wurde immer als pathologisch gewertet. Die neurogene Schädigung in Form von Denervierungszeichen wurde in keine, leichte, mittlere oder schwere neurogene Schädigung eingeteilt. Die statistische Analyse wurde mit SPSS für univariate und multivariate Analysen durchgeführt. ERGEBNISSE: In der ESPL konnten wir verschiedene signifikante Latenzzeitverlängerungen bei Patientinnen mit bestimmten Komorbitäten und Risikofaktoren für neurogene Schäden nachweisen. Besonders Faktoren, die für eine Polyneuropathie verantwortlich sein können, wie der Diabetes mellitus (p= 0,022), Chemotherapeutika (p=0,009), aber auch Patientinnen nach einer Radiotherapie ohne/mit radikaler Operation im kleinen Becken (p=0,003), wiesen eine signifikante Latenzzeitverlängerung auf. Für Erkrankungen oder Schäden des zentralen Nervensystems konnten wir keine signifikante Korrelation nachweisen. Eine in der EMG aufgezeichnete Spastik war für Patientinnen mit Multipler Sklerose signifikant (p=, INTRODUCTION: The female voiding dysfunction is a relatively common disease. The genesis is often habitual or a result of operations. The neurogenic origin, however, is little observed in diagnostic investigations or even overseen. It has rarely been investigated in large studies. In this study we have examined the significance and interpretation of measurement in electronically stimulated pudendal nerve latency (ESPL) and electromyography (EMG). MATERIALS AND METHODS: 184 patients were included. All patients with mechanical or anatomical cause of voiding dysfunction were excluded. We performed a neurological status, ESPL and EMG. The ESPL was carried out transvaginally and transanally on the right and left side. A pathological latency was defined for values of > 2.4 milliseconds. The EMG is an invasive procedure. A determined spasticity or spontaneous activity was always considered as pathological. The neurogenic damage in form of a denervation was divided into non-existent, light, medium or severe. Statistical analysis was performed with SPSS for univariate and multivariate analysis. RESULTS: In ESPL we demonstrated several significant latency extensions on patients with certain comorbidities and risk factors for neurogenic damage. Particular factors that may be responsible for a polyneuropathy as diabetes mellitus (p = 0.022), chemotherapy (p = 0.009), as well as patients after radiotherapy and/or radical surgery in the pelvis (p = 0.003) showed a significant latency prolongation. For diseases of or damage to the central nervous system, no significant correlation was found. For patients with multiple sclerosis we showed a significant spasticity in the EMG (p =

Objective The objective of this study was to demonstrate the diversity of urodynamic findings and temporal effects on bladder dysfunction in diabetes as well as to evaluate the predisposing factors that attenuate the storage and voiding function of diabetic women. Material and Methods In this prospective study, 181 women with type 2 diabetes mellitus (DM) and lower urinary tract dysfunction underwent complete urogynecological evaluations and urodynamic studies. The patients' histories of DM and the treatment agents used were documented from chart records and interviews. The urodynamic diagnoses were recategorized into two groups for comparison, namely overactive detrusor (detrusor overactivity and/or increased bladder sensation as well as mixed incontinence) and voiding dysfunction (detrusor hyperactivity with insufficient contractility and detrusor underactivity with poor voiding efficiency) in order to evaluate the temporal effect of DM on diabetic bladder dysfunction. Results The development of bladder dysfunction showed a trend involving time-dependent progression, beginning with storage problems (i.e. advancing from urodynamic stress incontinence to detrusor overactivity and/or increased bladder sensation) and eventually led to impaired voiding function. The duration of DM relative to the urodynamic diagnoses of these women was longer in women with voiding dysfunction (6.8 ± 2.8 years with urodynamic stress incontinence, 7.3 ± 6.5 years with detrusor overactivity and/or increased bladder sensation, and 10.4 ± 8.3 years with women with voiding dysfunction). Notwithstanding these findings, stepwise logistic regression analysis indicated that age and recurrent urinary tract infections were the two independent factors associated with developing voiding dysfunction. Conclusion The urodynamic study revealed a temporal effect on bladder function, and women with diabetic voiding dysfunction were found to have had a longer duration of DM than women with an overactive detrusor. However, aging and recurrent urinary tract infections are the two independent factors that contribute to impaired voiding function and diabetic bladder dysfunction.

Objectives: To determine whether sacral neuromodulation (SNM) for urinary symptoms or fecal incontinence gives improvement of female sexual function and whether improvement is due to physiological or psychological factors. Methods: Between 2002 and 2008, 8 patients had an array of questionnaires before and after SNM implantation. The questionnaires were: the Questionnaire for Screening for Sexual Dysfunctions, the Golombok Rust Inventory of Sexual Satisfaction, the Symptom Checklist-90, the Maudsley Marital Questionnaire and the McGill-Mah Orgasm Questionnaire. Three of these 8 patients underwent vaginal plethysmography before and after implantation. Results: No statistically significant changes were found, although there seems to be a trend toward improvement in orgasm scores. In plethysmography all 3 patients showed increased vaginal pulse amplitude with the stimulator turned on with both erotic and non-erotic stimuli. Conclusions: This study does not show a clear effect of SNM on sexual function, although there seems to be an improvement in orgasm scores. The lack of response on psychological questionnaires and the increase in vaginal pulse amplitude after SNM implantation indicate that there might be a physiological response.

Giannantoni A, Silvestro D, Siracusano S, Azicnuda E, D'Ippolito M, Rigon J, Sabatini U, Bini V, Formisano R. Urologic dysfunction and neurologic outcome in coma survivors after severe traumatic brain injury in the postacute and chronic phase. Objectives To investigate voiding dysfunction and upper urinary tract status in survivors of coma resulting from traumatic brain injury (TBI), and to compare clinical and urodynamic results with neurologic and psychological features as well as functional outcomes. Design Observational study focused on urologic dysfunction and neurologic outcome in coma survivors after traumatic brain injury in the postacute and chronic phase. Setting A postcoma unit in a rehabilitation hospital. Participants Consecutive patients (N=57) who recovered from coma of traumatic etiology and who were admitted during a 1-year period to a postcoma unit of a rehabilitation hospital. Interventions Patients underwent clinical urologic assessment, urodynamics with the assessment of the Schafer nomogram and the projected isovolumetric detrusor pressure to evaluate detrusor contractility, ultrasound assessment of the lower and upper urinary tract and voiding cystourethrography, routinely performed, according to the International Continence Society Standards. Neurologic variables assessed were brain injury and disability severity, and neuropsychological status. Neuroimaging identified the site of cerebral lesions. Main Outcome Measures Urinary symptoms, disability by means of the Glasgow Outcome Scale (GOS), and neuropsychological status by means of the Neurobehavioral Rating Scale (NBRS), and the relationships among them. Results Of the 57 patients studied, 30 had overactive bladder (urge incontinence ) symptoms, 28 had detrusor overactivity, and 18 had detrusor underactivity with associated pseudodyssynergia in 15 of these patients. Eleven patients had hypertrophic bladder; 3, bilateral pyelectasia; and 2, vesicoureteral reflux. Disability measured by GOS was severe in 8 patients and moderate in 27, while recovery was good in 22 patients. The mean NBRS total score indicated a mild cognitive impairment. Neuroimaging showed diffuse brain injury in all patients. Statistically significant relationships were found between urge incontinence, detrusor overactivity, and poor neurologic functional outcome, between detrusor overactivity and right hemisphere damage ( P =.0001), and between impaired detrusor contractility and left hemisphere injuries ( P =.0001). Conclusions Most patients who recovered from coma resulting from TBI have symptoms of overactive bladder syndrome and voiding difficulties. These urinary problems correlate with cerebral involvement and neurologic functional outcome.

Sacral neuromodulation is increasingly used for the treatment of voiding dysfunction, pelvic pain syndromes, and gastrointestinal disorders. While increased use of this technology has led to a greater understanding of its potential as well as its limitations, difficulty persists in identifying the patients that will benefit most. Either of two trial stimulation techniques is performed before placement of a permanent neuromodulator: the monopolar percutaneous nerve evaluation and the tined quadripolar staged trial. The preponderance of recent literature asserts the superior sensitivity of the staged trial over percutaneous nerve evaluation. However, the techniques offer disparate advantages, and other issues, such as cost-effectiveness, remain largely unexplored. The role of sacral neuromodulation will continue to expand as physicians and patients become increasingly aware of its therapeutic potential. Widespread adoption of this clinically superior technique will most rapidly help the greatest number of patients.