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Introduction: Benign prostatic hyperplasia (BPH) is a common urological condition, particularly among middle-aged and elderly men. Trans urethral resection of prostate (TURP) has some drawbacks, particularly concerning ejaculatory function. Ejaculation preserving TURP (Ep-TURP) is one such technique that aims at preserving the tissues that are primarily responsible for antegrade ejaculation. Methods and material: In this prospective study, patients with bothersome LUTS were randomized into Ep-TURP and standard TURP groups. Supramontal tissue was preserved in Ep-TURP while standard TURP group had resection of the entire prostatic tissue up to the verumontanum. The outcomes with regard to IPSS, Qmax, IIEF(Q9), Ejaculation and PVR were studied. Ejaculation projection score was separately calculated and assessed. Results: About 60 patients were studied, with 30 in each group. At 6 months' follow-up, complication rates were the same in both groups. The IPSS, Qmax, IIEF were similar and comparable. There was no change in erection in all patients (P = 0.559). The ejaculation was well preserved in Ep-TURP (p<0.001). Ejaculation projection score was maintained at 3.77 in the Ep-TURP group while in the standard group it was 0 (P<0.001). Conclusions: Ep-TURP is a safe and a cost-effective method of preserving ejaculation in patients undergoing TURP. This procedure adds a better quality of life that greatly aids in enhancing the improving his psychological outlook towards life. Ep-TURP has now emerged as the standard procedure of choice in sexually active young males needing TURP, as the degree of ejaculation is largely well preserved in patients undergoing this procedure. [ABSTRACT FROM AUTHOR]

Purpose: Four-hour voiding observation is a conventional method for evaluating bladder function in infants. However, it requires a diaper check every 5 min during the observation period, which creates an unusual environment for the infant, making the evaluation of natural urination difficult. This study aimed to investigate the parameters of urination before mature bladder function using a diaper equipped with a urination-activated alarm system. Methods: The study participants were 51 infants aged 0–4 years without bladder dysfunction. A urination-activated sensor was used to notify the inspector wirelessly when urination was detected, enabling the immediate assessment of ultrasonically measured residual urine. Bladder capacity was calculated as the sum of both residual urine volume and micturition volume, and the residual urine rate as the residual urine volume divided by bladder capacity. Results: A total of 36 boys and 15 girls were enrolled. The median (interquartile range) residual urine volume, bladder capacity, and residual urine rate were 3.0 mL (1.1–6.6), 53.0 mL (33.9–75.3), and 7.0% (2.1–15.0), respectively. Infants aged 0–1 and 2–4 years were then classified into Group A (N = 27) and Group B (N = 24), respectively. The residual urine rate was significantly higher in Group A (11.0% [5.4–21.2]) than in Group B (4.8% [0.6–8.9]; p < 0.01). Conclusions: Voiding observation using a urination-activated alarm system allowed less invasive analysis in infants and revealed that the residual urine rate decreased with mature bladder function from about 2 years of age. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Postpartum urinary retention (PUR) may cause long-term urogenital tract morbidity. The incidence ranges from 0.18 to 14.6%, but the importance of prompt diagnosis and appropriate management is often underappreciated. The paucity of data on long-term outcome after PUR contributes to these drawbacks. The aim of this study was to assess long-term persistence of elevated PVR (post-void residual urine) volume after PUR. Pathophysiology, risk factors and management of PUR are reviewed. Methods: In our tertiary referral urogynecology unit in the University Women's Hospital of Bern, Switzerland, all patients who were referred for PUR were asked to participate in this study. PVR was measured sonographically every 2 days until day 15, then after 6, 12, 24 and 36 months and, if increased, the patients were instructed to perform clean intermittent self-catheterization. If retention persisted longer than the lactation period, multichannel urodynamics was performed. Results: Sixty-two patients were included. The median PVR normalized at day 7. Long-term voiding disorders were found in 8.2%, 6.7%, and 4.9% after 1, 2, and 3 years respectively. Multichannel urodynamics confirmed in all patients with persisting retention an acontractile detrusor and de novo stress urinary incontinence in 4 cases. Quantile regression did not reveal any factor contributing to earlier recovery. Eighty-nine percent of the patients with PUR had operative vaginal deliveries, emphasizing the importance of this risk factor for PUR. Conclusions: In most cases PUR resolves early, but voiding difficulties persist more often than previously thought, and for these patients the consequences are devastating. Obstetric awareness, early active management, and developing management strategies in the postpartum period might preclude lower urinary tract morbidity. [ABSTRACT FROM AUTHOR]

In 2000, the World Health Organization (WHO) published an ultrasound field protocol for assessing morbidity due to schistosomiasis. The present study aims to review the acceptance of the WHO protocol for Schistosoma haematobium. A PubMed literature research using the keywords 'ultrasound OR ultrasonography (US) AND schistosomiasis,' 'US AND S. haematobium,' 'US AND urinary schistosomiasis' from 2001 through 2014 was performed. Thirty-eight eligible publications reporting on 17,861 patients from 13 endemic and 2 non-endemic countries were analysed. Of these, 33 referred to field studies on 17,317 patients. The Niamey protocol was applied to 15,367/17,317 (88.74 %) patients in 23/33 (69.70 %) of field studies (all studies: 15,649/17,861 [87.61 %] patients (25/38 [68.42 %] studies). The acceptance of the protocol by single country in field studies varied from 0 to 100 %. It varied over time between 55.56 % (5/9) in the period from 2001 to 2004, to 87.50 % (7/8) from 2005 to 2008, to 62.50 % (5/8) from 2009 to 2011 and 75.00 % (6/8) from 2012 through 2014 (all studies: 50 % [5/10], 88.89 % [8/9], 62.50 % [5/8], 63.64 % [7/11], respectively). The Niamey protocol was applied also in 2/5 hospital studies in 282/544 (51.84 %) patients. The usefulness of the WHO protocol for S. haematobium infections is confirmed by its worldwide acceptance. Some simplifications might facilitate its use also for focused ultrasound examinations performed by less skilled examiners. Organ abnormalities due to schistosomiasis detectable by ultrasonography not yet covered by the WHO protocol should be added to the additional investigations section. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The relationship between free flow (FFS) and pressure flow (PFS) voiding studies remains uncertain and the effect of a urethral catheter on flow rates has not been determined. The relationship between residuals obtained at FF and PFS has yet to be established. Methods: This was a prospective cohort study based on 474 consecutive women undergoing cystometry using different sized urethral catheters at different centres. FFS and PFS data were compared for different conditions and the relationship of residuals analysed for FFS and PFS. The null hypothesis was that urethral catheters do not produce an alteration in maximum flow rates for PFS and FF studies. Results: Urethral catheterisation results in lower flow rates ( p < 0.01) and this finding is confirmed when flows are corrected for voided volume ( p < 0.01). FFS and PFS maximum flow rates are lower in women with DO than USI ( p < 0.01). A 6-F urethral catheter does not have a significantly greater effect than a 4.5-F urethral catheter. A mathematical model can be applied to transform FFS to PFS flow rates and vice versa. There was no significant difference between the mean residuals of the two groups (FFS vs PFS-two-tailed t = 0.54, p = 0.59). Positive residuals in FFS showed a good association with positive residuals in the PFS ( r = 0.53, p < 0.01) Conclusions: Urethral catheterisation results in lower maximum flow rates. The relationship can be compared mathematically. The null hypothesis can be rejected. [ABSTRACT FROM AUTHOR]

Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We evaluated the parameters of preoperative pressure-flow for predicting the postoperative voiding difficulties in women with stress urinary incontinence. The preoperative urodynamic study records of 14 women treated using the tension-free vaginal tape (TVT) procedure were retrospectively analyzed. Of the patients treated with the TVT procedure, urinary retention occurred in one patient, and three had a residual urine volume of more than 30 ml. All patients became completely free of stress urinary incontinence postoperatively. The lowest Pdet max (5 cmH2O) in the preoperative pressure-flow study was found in a patient with a remarkable postoperative residual urine volume of more than 50 ml. The second lowest Pdet max value (8 cmH2O) was seen in a patient with postoperative urinary retention, whose residual urine volume, however, decreased to almost zero 1 year after the operation. The preoperative Pdet max×Qave values were remarkably low for these three patients, including the one with the lowest Pdet max, with a post-void residual urine volume of more than 30 ml. The plots of Pdet max×Qave versus the age of patients show that the Pdet max×Qave values tend to decrease with aging. The preoperative Pdet max×Qave value can be an important parameter for predicting increased residual urine after TVT sling surgery. [ABSTRACT FROM AUTHOR]

Upon feeling the urge to urinate, the urinary bladder contracts, the urethral sphincters relax and urine flows through the urethra. These actions are mediated by the micturition reflex. We investigated the hypothesis that vesical contraction is maintained by positive feedback through continuous flow of urine through the urethra, and that the cessation of urine flow aborts detrusor contraction. Normal saline was infused into the urinary bladders of 17 healthy volunteers (age 35.2 years±4.2(SD); ten women and seven men) at a rate of 100 ml/min. On urge, which occurred at a mean volume of 408.6 ml±28.7of saline, the subject micturated while the vesical and urethral pressures during voiding were being recorded; residual urine was measured. The test was repeated after anesthetizing the urethra with xylocaine gel or, on another occasion, after applying a bland gel . On micturition, the urine was evacuated as a continuous stream without straining; no residual fluid was collected. After urethral anesthetization, the fluid came out of the urethra in multiple intermittent spurts and only with excessive straining. There was a large amount of residual fluid (184.6 ml±28.4). The results of bland gel application showed no significant difference (P>0.05) from those without gel. Detrusor contraction during micturition is suggested to be maintained by positive urethrovesical feedback elicited by the continued passage of urine through the urethra. This feedback seems to be effected through the urethrovesical reflex, which produces vesical contraction on stimulation of the urethral stretch receptors. Abortion of this reflex by urethral anesthetization resulted in failure of detrusor contraction and excessive straining was needed to achieve bladder evacuation in multiple spurts. The urethrovesical reflex is thus assumed to constitute a second micturition reflex responsible for the continuation of detrusor contraction and urination. The role of this reflex in the pathogenesis of micturition disorders needs to be studied. [ABSTRACT FROM AUTHOR]

Purpose: Apart from the urethral sphincters, the electric activity of the urethra has not been fully addressed in the literature. We investigated the hypothesis that also the non-sphincteric part of the urethra possesses electric activity which may have clinical significance. Materials and methods: Urethral electric activity was studied in 24 healthy volunteers (mean age 40.6 ±: 13.6 years, 14 women). Two electrodes in women and three in men were applied to the urethral mucosa distal to the striated urethral sphincter. A manometric catheter was placed into the penile urethra in men and distal to the striated sphincter in women. Results: Monophasic negatively deflected slow waves were recorded. Their frequency, amplitude and conduction velocity were identical in the electrodes of the individual subject and were reproducible. The slow waves were followed or superimposed by fast activity spikes or action potentials which occurred randomly and were associated with urethral pressure rise. The pattern of electric activity was stable in the same subject on all test sessions. Conclusions: A normal electrourethrogram could be identified. It consisted of slow waves and action potentials. The waves had a regular rhythm. The action potentials appear to have a motor activity and are suggested to clear the urethra of the residual urine and secretions that may exist in the urethra after micturition. The clinical significance and diagnostic role of the electrourethrogram need to be further investigated. [ABSTRACT FROM AUTHOR]

The most practical and accurate method to measure residual urine volumes in women is yet to be determined. The practicality of transvaginal ultrasound in measuring the range of residuals typically encountered in a group of 100 symptomatic women attending for urodynamic investigations was tested and compared with urethral catheterization. Transvaginal ultrasound was found to be more comfortable, less invasive and quicker. In ideal circumstances for both techniques, mean time from voiding until residual assessment was 47 seconds for transvaginal ultrasound and 270 seconds for urethral catheterization. Transvaginal ultrasound was applicable to 99% of women, with accurate assessment of residuals possible in 96% (100% for urethral catheterization). Eighty-five percent of women were found to have a residual under the level of likely clinical significance (30 ml). Transvaginal ultrasound permits the avoidance of catheterization in these women. Transvaginal ultrasound allows for immediate retesting of the residual, a feature not possible if there is bladder drainage by urethral catheterization. Of the 22 women with residuals initially over 30 ml, 11 (50%) were able to lower this by an average of 69%, 7 (32%) of these to under 30 ml, with an immediate further attempt at voiding. In terms of practicality, transvaginal ultrasound is the method of choice for residual determination in the vast majority of women attending for urodynamic investigations. While it is not possible to directly compare the accuracy of the two techniques, a theoretical comparison is possible by summation of their respective sources of error. This comparison showed that the two techniques, in ideal circumstances, have similar accuracies over the range 0-175 ml. In non-ideal circumstances, urethral catheterization has more potential sources of error. [ABSTRACT FROM AUTHOR]

The electronic evaluation of volume differences of residual urine determination following cysto-uroflow metering takes place in three stages: 1. Integration of the bladder filling volume. 2. Integration of the micturition volume. 3. Electronic differentiation of the integrated volumes (bladder filling volume minus micturition volume equals residual urine volume). The residual urine volume can be read directly from the recorder. [ABSTRACT FROM AUTHOR]

Residual urine volume, though clinically important as a diagnostic tool, is reported to be variable and unreliable. Variability was examined among 14 geriatric patients, mean age 77 years. Residual urine was measured by ultrasound at three different times of day on each of two visits separated by 2-4 weeks. Results were examined by analysis of variance. Mean residual urine was 154 ml. Between-patient variability was large [standard deviation (SD) 246 ml]. There was no significant difference between values in men and women, nor between visits. Within-patient variability was large because of a large systematic variation with time of day (SD 128 ml), with greatest volumes in the early morning. The inherent, random variability of the measurement was much smaller than this (SD 44 ml). If the physiological factors causing the temporal variation could be controlled more reproducible measurements would be possible. [ABSTRACT FROM AUTHOR]

Copyright of Archiv für Psychiatrie und Nervenkrankheiten is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The occurrence of bladder disorders, such as increase in vesical volume, incomplete vesical evacuation, and increase in first morning micturition, as well as its association with certain clinical factors, such as duration of diabetes, age at onset, degree of metabolic control, and symptoms of vesical autonomic neuropathy, were studied in a group of 55 diabetic children using vesical echography. Morning diuresis and vesical volume for age were previously determined in a group of 40 non-diabetic children used as controls. The echographic measurements permitted the estimation of maximum normal vesical volume for each age group, yielding the following distribution: 6-8 years, up to 263.7 ml; 9-11 years, up to 375.7 ml; 12-14 years, up to 445.3 ml. Analyzing first morning micturition by age in the control group, we found the following maximum values: 6-8 years, up to 263.5 ml; 9-11 years, up to 380.1 ml; 12-14 years, up to 394.6 ml; 67.27% of all diabetic children had bladder disorders. It was demonstrated that routine determination of the first morning micturition in the diabetic child would be an excellent index for detecting early disorders of vesical function. The existence of a statistically significant association (p<0.05) of poor metabolic control to development of these disorders, as well as to symptoms referred at this level, was confirmed. No other statistically significant association was found between the occurrence of these bladder disorders and other factors such as duration and age at onset of the disease. [ABSTRACT FROM AUTHOR]

This study aimed to test the recommendation in the Agency for Health Care Policy and Research Practice Guideline on urinary incontinence that postvoid residual volume PVR estimates can be done by palpation. Postvoid residual volumes were obtained on 50 consecutive women presenting for evaluation of incontinence. Volumes were first estimated by bimanual examination and were then immediately measured by catheterization. Of 7 women who had a positive PVR, defined as greater than 50 ml, only 1 was estimated at greater than 50 ml on bimanual examination. The sensitivity of bimanual examination compared to catheterization to detect a positive PVR was 14%; specificity was 67%. Based on this assessment, the AHCPR guideline's inclusion of palpation estimates of PVR cannot be endorsed, unless a given practitioner has repeated a similar type of evaluation in his or her practice to determine whether the sensitivity is higher than that found in this study. [ABSTRACT FROM AUTHOR]