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Objective Methods Results Conclusion Female voiding dysfunction with cystocele have been widely studied, but there are no data regarding women without cystoceles. The present study aimed to evaluate the prevalence of detrusor underactivity (DU) and bladder outlet obstruction (BOO) without cystoceles in a large sample size.This was a retrospective cohort study. Between April 1996 and September 2018, 602 neurologically intact women with voiding dysfunction without cystoceles were enrolled. Detrusor pressure (DU) at the maximum flow rate (PdetQmax) <20 cmH2O, maximum flow rate (Qmax) <15 mL/s, and a bladder voiding efficiency <90% and BOO (PdetQmax ≥40 cmH2O and Qmax <12 mL/s) were diagnosed by urodynamic study. Otherwise, a non‐DU/BOO diagnosis was made. The prevalence of DU and BOO was the primary outcome. The secondary outcomes were the analyses of the differences between these three groups in objective UDS parameters and subjective questionnaires and bladder diary parameters.This study included 100 (17%) women with DU, 60 (10%) with BOO, and 442 (73%) with a non‐DU/BOO diagnosis. DU increased with age, but BOO decreased as age increased. The women in the DU group were older, had higher parity and pad weights, and lower PdetQmax, maximum urethral closure pressure, and functional profile length than the BOO group. The urodynamic findings did not correlate well to subjective questionnaire parameters. None of the symptoms revealed a significant difference between the groups. The retrospective design was the limitation of the study.The prevalence of DU increased with age in women with voiding dysfunction without advanced cystoceles. Conversely, BOO decreased with age. Prevalence intersected in the fourth decade. Diagnosis requires urodynamic evaluation, as subjective symptoms are inconclusive. [ABSTRACT FROM AUTHOR]

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

Aim: To epidemiologically determine post‐void residual urine volume (PVR) and identify the characteristics of "potential" older adult patients with voiding dysfunction in an acute‐care hospital. Methods: A cross‐sectional study was conducted on 614 older adult patients in an acute‐care hospital between November 2018 and May 2019. Using portable ultrasound devices, nurses measured the patients' PVR three times after admission. Lower urinary tract symptoms were evaluated using the Core Lower Urinary Tract Symptom Score prior to admission. Results: A total of 107 older adult patients (17.4%) had episodes of abnormal PVR ≥100 mL. An age of over 75 years (adjusted odds ratio [aOR]: 1.899) and feeling of incomplete emptying (aOR: 4.337) were associated with having at least one episode of abnormal PVR, whereas neurological or circulatory diseases (aOR: 3.699) were associated with having two or three episodes. Conclusions: The results showed a high prevalence of abnormal PVR in older adult patients. Screening for PVR in older adult patients aged over 75 years who experience incomplete emptying or neurological or circulatory diseases may help identify those at risk for voiding dysfunction. [ABSTRACT FROM AUTHOR]

Aims: The working group (WG) initiated by the International Continence Society Standardization Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction has revised the (1997) ICS Standard for pressure flow studies. Methods: Based on the ICS standard for developing evidence‐based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in January 2023 to facilitate public discussion and the comments received have been incorporated into this final release. Results: The WG summarizes the theory and recommends the practice and the terms used for the diagnosis of voiding dysfunction for adult female and male patients without relevant neurological abnormalities, in part 1 of this standard. The WG has also recommended standard principles and parameters for objective and continuous grading of urethral resistance and detrusor voiding contraction on the basis of pressure flow studies in part 2. The recommendations for practice in this part have also the aim to increase the understanding of the physiology as well as the psychology of voiding. The potential effects of the laboratory situation of the test on the voiding as well as the role of the urodynamicist in this regard are discussed. The WG has recommended to use for diagnosis only the voidings that are considered representative by the patient. Conclusion: A pressure flow study is the gold standard to assess voiding function and to quantify dysfunction. This part of the standard explains the clinical background, gives recommendations for the execution of a pressure flow study and lists relevant terms, parameters, and units of measurements. [ABSTRACT FROM AUTHOR]

Aims: The Working Group (WG), initiated by the International Continence Society (ICS) Standardisation Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, has revised the ICS Standard for pressure‐flow studies of 1997. Methods: Based on the ICS standard for developing evidence‐based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in December 2022 to facilitate public discussion and the comments received have been incorporated into this final release. Results: The WG has recommended analysis principles for the diagnosis of voiding dysfunction for adult men and women without relevant neurological abnormalities. New standard terms and parameters for objective and continuous grading of urethral resistance (UR), bladder outflow obstruction (BOO) and detrusor voiding contraction (DVC) are introduced in this part 2 of the standard. The WG has summarized the theory and recommendations for the practice of pressure‐flow study (PFS) for patients in part 1. A pressure‐flow plot is recommended for the diagnosis of every patient, in addition to time‐based graphs. Voided percentage and post void residual volume should always be included in PFS analysis and diagnosis. Only parameters that represent the ratio or subtraction of pressure and synchronous flow are recommended to quantify UR and only parameters that combine pressure and flow in a product or sum are recommended to quantify DVC. The ICS BOO index and the ICS detrusor contraction index are introduced in this part 2 as the standard. The WG has suggested clinical PFS dysfunction classes for male and female patients. A pressure‐flow scatter graph including every patient's pdet at maximum flow (pdetQmax) with maximum flow rate (Qmax) point should be included in all scientific reports considering voiding dysfunction. Conclusion: PFS is the gold standard used to objectively assess voiding function. Quantifying the dysfunction and grading of abnormalities are standardized for adult males and females. [ABSTRACT FROM AUTHOR]

Objective: To create a reference curve for postvoid residual volume (PVRV) in asymptomatic postpartum women who are at low risk of developing postpartum urinary retention (PUR), a well‐known complication in the immediate postpartum period. Methods: This is a prospective observational study measuring PVRV after uncomplicated vaginal delivery. PVRV was assessed by transabdominal ultrasound using a portable ultrasound scanner within the first 26 h after delivery (PVRV 1) and on the day of discharge (day 2 or 3 postpartum) (PVRV 2). A PVRV of 150 mL or more was defined as the cut‐off value for covert PUR. Results: The prevalence of covert PUR was 7.1%. Primiparity, duration of second stage, and obstetric injury were correlated with higher PVRV 1. The median PVRV 1 was 21 mL and PVRV 2 was 11 mL. The subgroup of nulliparous women had a significantly higher PVRV 1 compared with multiparous women. At discharge, the majority (99.1%) of women had a PVRV of less than 150 mL. Conclusion: Asymptomatic women were at low risk of developing PUR. However, women with a prolonged second stage may benefit from a routine postpartum assessment. Our results allow for a better understanding of PVRV in the early postpartum period. Synopsis: Postpartum urinary retention is a rare finding in asymptomatic women following an uncomplicated vaginal delivery. Assessment of postvoid residual volumes facilitates diagnosis and early intervention. [ABSTRACT FROM AUTHOR]

Purpose: This study established the prognostic significance of the uroflowmetry flow curve shape in the presence of voiding dysfunction following transvaginal mesh surgery. Methods: This is a retrospective study of 439 symptomatic cystocele patients who underwent anterior wall repair with transvaginal mesh surgery. Uroflowmetry and postvoid residual were used to evaluate voiding function both preoperatively and 12 months postoperatively. The patients were divided into two groups: those with and without postoperative voiding dysfunction, and the predictors of postoperative voiding dysfunction were analyzed. The shape of the urine flow curve was analyzed for its influence on the presence of postoperative voiding dysfunction. Results: Thirty‐five participants were in the voiding dysfunction group, while 404 were in the nonvoiding dysfunction group. Multivariate analysis was conducted by adding an interrupted‐shaped curve to age, Qmax, and postvoid residual, which showed significant differences in univariate analysis, found that age 68 years or older (odds ratio [OR]: 7.68, 95%CI 1.02–58, p = 0.048), postvoid residual ≥110 mL (OR: 2.8, 95%CI 1.25–6.29, p = 0.013) and interrupted‐shaped curve (OR: 2.47, 95%CI 1.07–5.69, p = 0.034) were discovered to be independent risk factors for the presence of voiding dysfunction after transvaginal mesh surgery. Conclusions: Following transvaginal mesh surgery for cystocele, three variables were found to be predictive of voiding dysfunction: the old age, excessive postvoid residual, and an interrupted‐shaped flow curve. The uroflowmetry flow curve shape has the potential to be a new predictor of postoperative voiding dysfunction. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to examine the functional outcomes of ona‐botulinum toxin A (BTX‐A) injection into the external urethral sphincter (EUS) for female patients with nonneurogenic nonrelaxing sphincter as the underlying cause of voiding dysfunction (VD). METHOD: A retrospective analysis was performed for all the patients with the urodynamic findings of higher than expected maximum urethral closure pressure (MUCP) who received their first injection during the study period. All patients were evaluated with preoperative videourodynamic study and urethral pressure profilometry and received 100 U of EUS BTX‐A. Patients aged less than 18 years and those with neurogenic bladder were excluded. All patients were followed up with the free flow, postvoid residuals (PVR), and patient global impression of improvement (PGI‐I) scale at 6 weeks and then at 3 monthly intervals. Result: We identified 35 female patients with a mean age of 37.5 ± 15 years (range 18–72 years) with a mean follow‐up of 20 months. More than 50% of patients had a history of prior surgical intervention and 28 (80%) patients were catheter dependent, a suprapubic catheterization, or clean intermittent self‐catheterization. Mean MUCP was 97.1 ± 22 cm of water. After treatment with BTX‐A, 21 (60%) patients were able to void per urethral (p = 0.02). The mean maximum flow rate (Qmax) improved from 8.8 to 11 mls/s and the mean PVR decreased from 200 to 149 mls (p < 0.05). On multivariate analysis, we identified high preoperative PVR, high preoperative actual MUCP, and previous surgical intervention (urethral dilatation, sacral neuromodulation, and pelvic surgery) as predictors of successful voiding restoration. The mean duration of response was 4.7 months, 46% of patients requested repeat injection, and 29% were established on maintenance injections. On the 5‐point PGI‐I score, 13 (37%), 12 (34%), and 10 (29%) patients reported good, some, and no improvement, respectively. Quality of life was also improved in 60% of patients. Two patients had transient stress urinary incontinence (for <6 weeks) and there were no significant long‐lasting adverse events. Conclusion: EUS BTX‐A is a valid treatment option for VD considering therapeutic options are limited. The patient must be made aware of the need for repeat treatments. [ABSTRACT FROM AUTHOR]

Objectives: Cervical myelopathy (CM) and lumbar canal stenosis (LCS) are common degenerative spinal diseases among the elderly, and the major associated complaints include lower urinary tract symptoms (LUTS). The aim of this study was to investigate subjective and objective urological parameters of patients undergoing decompression surgery for CM and LCS. Methods: We retrospectively reviewed patients who underwent evaluation by the International Prostate Symptom Score (IPSS) and uroflowmetry before decompression surgery for CM and LCS. Patients with comorbidities that can affect LUTS were excluded. Postoperative changes were evaluated in patients followed up within 1 month. Results: Among referrals to urological consultations for LUTS, 231 patients were evaluated preoperatively. Moderate‐severe urinary symptoms (IPSS ≥ 8) were present in 59.8% of 92 CM patients and 64.0% of 139 LCS patients. Poor voiding patterns defined as maximum urinary flow rate <12 mL/s or postvoid residual volume >100 mL were identified in 26.1% of CM and 25.2% of LCS. While IPSS did not associate with disease severity, poor voiders presented with worse Japanese Orthopedic Association scores. Moreover, poor voiders suffered for a longer period of time from orthopedic symptoms due to LCS. In followed‐up patients (CM, n = 32; LCS, n = 47), total IPSS, storage subscores, and voiding subscores were significantly improved after surgery, as was voiding time from uroflowmetry. Conclusions: This study demonstrated high prevalence of lower urinary tract dysfunction of CM and LCS as well as short‐term effectiveness of decompression surgery. These results would encourage urologists to consider an orthopedic consultation when lower urinary tract dysfunction is identified in patients with degenerative spinal diseases. [ABSTRACT FROM AUTHOR]

Objectives: A number of neurourology imaging studies have mainly focused on investigating the brain activations during micturition in healthy and neuropathic patients. It is, however, also necessary to study brain functional connectivity (FC) within bladder‐related regions to understand the brain organization during the execution of bladder function. This study aims to identify the altered brain network associated with bladder function in multiple sclerosis (MS) women with voiding dysfunction through comparisons with healthy subjects via concurrent urodynamic study (UDS)/functional magnetic resonance imaging (fMRI). Materials and Methods: Ten healthy adult women and nine adult ambulatory women with clinically stable MS for ≥6 months and symptomatic voiding phase neurogenic lower urinary tract dysfunction (NLUTD) underwent UDS/fMRI evaluation with a task of bladder filling/emptying that was repeated three to five times. We quantitatively compared their FC within 17 bladder‐related brain regions during two UDS phases: "strong desire to void" and "(attempt at) voiding initiation." Results: At "strong desire to void," the healthy group showed significantly stronger FC in regions involved in bladder filling and suppression of voiding compared to the patient group. These regions included the bilateral anterior cingulate cortex, right supplementary motor area, and right middle frontal gyrus. During "(attempt at) voiding initiation," healthy subjects exhibited stronger FC in the right inferior frontal gyrus compared to MS patients. Conclusion: Our study offers a new way to identify alterations in the neural mechanisms underlying NLUTD and provides potential targets for clinical interventions (such as cortical neuromodulation) aimed at restoring bladder functions in MS patients. [ABSTRACT FROM AUTHOR]

Aims: Transient receptor potential melastatin 8 (TRPM8) has a role in the abnormal sensory transduction of the bladder and is involved in the pathophysiology of hyperactivity bladder disorders. The aim of this study is to examine the effects of KPR‐5714, a novel and selective TRPM8 antagonist, on voiding dysfunction induced by bladder afferent hyperactivity via mechanosensitive C‐fibers in rats. Methods: The effects of intragastric administration of KPR‐5714 on bladder overactivity induced by intravesical instillation of 10 mM ATP were investigated using cystometry in conscious female rats. We examined the effects of oral administration of KPR‐5714 on voiding behavior using a metabolic cage in normal male rats and rats with an intratesticular injection of 3% acetic acid. Results: In cystometry measurements, the intercontraction interval was decreased by intravesical ATP instillation. KPR‐5714 (0.1, 0.3, and 1 mg/kg) dose‐dependently prolonged the shortened intercontraction interval provoked by ATP. In voiding behavior measurements, intratesticular injection of acetic acid decreased the mean voided volume and increased voiding frequency. KPR‐5714 (0.1 and 0.3 mg/kg) dose‐dependently increased the mean voided volume and decreased voiding frequency without affecting the total voided volume in these rats. However, KPR‐5714 (1 and 10 mg/kg) did not influence the voiding behavior in normal rats. Conclusion: The present results suggest that KPR‐5714 improves voiding dysfunction by inhibiting the enhanced activity of mechanosensitive bladder C‐fibers in rats with bladder overactivity and shows no significant change in voiding behavior in normal rats. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated male voiding dysfunction (VD) or lower urinary tract function in rectal cancer (RC) patients after laparoscopic or open total mesorectal excision with pelvic autonomic nerve preservation (PANP). Methods: One hundred and eighty‐seven male RC patients admitted between January 2016 and May 2019 were enrolled in this study, 112 of whom underwent laparoscopic total mesorectal excision (LTME) and 75 underwent open total mesorectal excision (OTME). The International Prostatic Symptom Score (IPSS) was compared between the two groups. Results: The postoperative IPSS in patients with RC was elevated on day 7 and gradually decreased during the first month after surgery. Compared with the OTME group, the IPSS scores decreased less in the LTME group at week 1, and months 1 and 3 postoperatively (6.82 ± 2.13 vs 10.15 ± 3.86, 5.70 ± 2.45 vs 7.21 ± 2.0, and 5.01 ± 2.09 vs 5.75 ± 2.55, respectively; P < 0.05). The VD rate was significantly lower in the LTME group than the OTME group at 1, 2, and 3 weeks postoperatively (21.4% vs 26.8%,13.4% vs 25.3%, and 9.8% vs18.6%, respectively; P < 0.05); however, there was no major difference in the incidence of VD 6 months postoperatively between the two groups (P > 0.05). VD was more frequent in the OTME group than the LTME group 6 months postoperatively, but the difference was not statistically significant (odds ratio = 1.857, 95% CI, 0.964‐3.645, P = 0.064). Conclusions: LTME may be superior to OTME with respect to PANP of lower urinary tract function in males with RC. [ABSTRACT FROM AUTHOR]

Objectives: Muscarinic M3 (M3) receptors mediate cholinergic smooth muscle contraction of the bladder. Current drugs targeting bladder M3 receptors for micturition disorders have a risk of cholinergic side effects due to excessive receptor activation and insufficient selectivity. We investigated the effect of ASP8302, a novel positive allosteric modulator (PAM) of M3 receptors, on bladder function in rats. Methods: Modulation of carbachol‐induced increases in intracellular Ca2+ was assessed in cells expressing rat muscarinic receptors. Potentiation of bladder contractions was evaluated using isolated rat bladder strips and by measuring intravesical pressure in anesthetized rats. Conscious cystometry was performed to investigate the effects on residual urine volume and voiding efficiency in rat voiding dysfunction models induced by the α1‐adrenoceptor agonist midodrine and muscarinic receptor antagonist atropine, and bladder outlet obstruction. To assess potential side effects, the number of stools and tracheal insufflation pressure were measured in conscious and anesthetized rats, respectively. Results: ASP8302 demonstrated PAM effects on the rat M3 receptor in cell assays, and augmented cholinergic bladder contractions both in vivo and in vitro. ASP8302 improved voiding efficiency and reduced residual urine volume in two voiding dysfunction models as effectively as distigmine bromide, but unlike distigmine bromide did not affect the number of stools or tracheal insufflation pressure. Conclusions: Our results in rats indicate that ASP8302 improves voiding dysfunction by potentiating bladder contraction with fewer effects on cholinergic responses in other organs, and suggest a potential advantage over current cholinomimetic drugs for treating micturition disorders caused by insufficient bladder contraction. [ABSTRACT FROM AUTHOR]

Neurogenic lower urinary tract dysfunction (NLUTD) caused by spinal cord injury (SCI) is challenging for urologists. NLUTD not only affects the quality of life but also endangers the upper urinary tract of patients with chronic SCI. Considering that the bladder and urethral function change with time, regular follow‐up of NLUTD is necessary, and any complication should be adequately treated. The first priority of bladder management in patients with chronic SCI manifesting NLUTD should be renal function preservation, followed by the normalization of lower urinary tract function. The quality of life should also be assessed. Patients who have a high risk for impaired renal function should be more frequently identified and investigated. Conservative treatment and pharmacological therapy should be started as early as possible. Intravesical or urethral injections of botulinum toxin A is an alternative treatment for refractory NLUTD. When surgical intervention is necessary, less invasive and reversible procedures should be considered first. Improving patients' quality of life and willingness to undergo bladder management is the most important aspect of treatment. [ABSTRACT FROM AUTHOR]

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

Objectives: To evaluate more comprehensively the presence of an association between childhood lower urinary tract symptoms and development of adulthood overactive bladder, to determine the group at most risk of overactive bladder in adulthood, and to assess its effects on daily life. Methods: A total of 264 patients who were followed up for lower urinary tract symptoms in childhood between 2000 and 2005 were included in this retrospective, cohort study. After a median period of 20 years, these patients with a median current age of 29 (27–35) years were re‐evaluated and divided into two groups: those currently with overactive bladder (n = 102, 23.0%), and those without overactive bladder (n = 162, 36.5%). In addition, 180 age‐matched overactive bladder patients without a history of childhood lower urinary tract symptoms (n = 180, 40.5%) were included. The primary endpoint was to determine which children are at higher risk of adulthood overactive bladder. The secondary endpoint was to evaluate the effect of history of childhood lower urinary tract symptoms on quality of life in adulthood. The eight‐item Overactive Bladder questionnaire, the Pittsburgh Sleep Quality Index, and the Short‐Form 36‐item Health Survey were administered to all participants. Voiding Dysfunction Symptom Score was evaluated according to childhood medical records. Results: Overactive bladder in adulthood was observed in 38.6% of patients recovering from childhood lower urinary tract symptoms. They had worse overactive bladder symptom scores and quality of life than those without childhood lower urinary tract symptoms (P < 0.001). Voiding Dysfunction Symptom Score ≥13 (odds ratio 2.54), daytime incontinence (odds ratio 2.01), holding maneuvers (odds ratio 1.82), nocturnal enuresis (odds ratio 1.75) in the pediatric period, and recovery age from all these symptoms of ≥12 years (odds ratio 1.95) were the most unfavorable determinants of development of adulthood overactive bladder. Conclusions: Our findings show that children with the above characteristics are at risk of developing overactive bladder later in their lives even if their symptoms improve in childhood. [ABSTRACT FROM AUTHOR]

Objective: Symptoms of male overactive bladder (OAB) may be caused by several systemic pathophysiological factors rather than a single‐source etiology. We investigated the clinical factors associated with the severity of OAB symptoms in treatment‐naïve men with coexisting benign prostatic hyperplasia. Methods: We obtained records from a health promotion center database of male patients who visited between March 2019 and February 2020. Men without a history of treatment for lower urinary tract symptoms were evaluated using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, transrectal ultrasonography, medical history, and carotid duplex ultrasound for the evaluation of atherosclerosis. Benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) was defined as an IPSS of eight points or higher. Patients with comorbidities that may affect their voiding function were excluded. Results: A total of 764 patients were divided into two groups based on their diagnosis: an OAB group and a non‐OAB group. The non‐OAB group consisted of 627 patients (82.1%) and the OAB group consisted of 137 patients (17.9%). Using multivariable analysis BPH/LUTS was identified as an independent risk factor for OAB. In the OAB group without BPH/LUTS, carotid atherosclerosis was significantly associated with the severity of OAB symptoms. A history of diabetes mellitus was the only variable that was associated with the severity of urinary urgency. Systolic blood pressure was associated with severity of urinary urgency in the OAB group with BPH/LUTS. Conclusions: Factors associated with male OAB exhibit different pathophysiology in the severity of symptoms depending on the presence of BPH/LUTS. Treatment for atherosclerosis and associated systemic pathophysiological factors could lower OAB symptom severity in male patients without BPH/LUTS. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to describe the prevalence and type of female voiding dysfunction (FVD) in patients with overactive bladder (OAB) who were studied by urodynamics and its relationship with voiding symptoms. Methods: This is a cross‐sectional study of female adult patients with OAB syndrome who underwent UDS in a University Hospital in Chile between January 2015 and April 2020. FVD was defined either as bladder outlet obstruction (BOO) or detrusor underactivity (DU). BOO was established if the Solomon‐Greenwell BOO index was higher than 18. DU was diagnosed when the invasive maximum flow rate (Qmax) was ≤15 ml/sec, detrusor pressure at Qmax (Pdet@Qmax) was ≤20 cmH2O and postvoid residual (PVR) was greater than 10%. Urodynamic data and clinical features were compared between groups. Results: Two hundred and ninety‐nine UDS were selected and analyzed. Bladder outlet obstruction was diagnosed in 59 patients (19.7%), whereas DU was found in 10 patients (3.3%). In the multivariate analysis, the logistic regression to predict BOO demonstrated that night‐time frequency, the presence of detrusor overactivity and a higher PVR were independent predictors of BOO. Instead, for DU, the only independent predictor was a smaller voided volume in the pressure‐flow study. Conclusion: Female voiding dysfunction was found in 23% of patients with overactive bladder. BOO is more frequent than DU, and should be suspected in patients with higher night‐time frequency, presence of detrusor overactivity and a high PVR. Instead, DU should be suspected in patients with a smaller voided volume. [ABSTRACT FROM AUTHOR]

Aim: The aim of this systematic review is to provide an updated report on the efficacy and complications of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic nonobstructive urinary retention (CNOUR), with a focus on the contemporary technique of SNM utilizing the percutaneous placement of tined leads. Methods: This systematic review was conducted with the use of PRISMA guidelines and registered with PROSPERO (CRD42020208052). A systematic literature search was conducted in Embase, PubMed, and Cochrane databases. Inclusion criteria include English language and human participants. Exclusion criteria include SNM studies involving less than 10 CNOUR patients, studies containing data obtained using open, surgical implantation of nontined leads, and studies that only reported the test phase success rate with no long‐term efficacy data. The risk of bias assessment was conducted using the National Institutes of Health study quality assessment tool. Results: A total of 16 papers studies were included (11 SNM and 5 PTNS) in this review. The success rate for SNM ranges between 42.5% and 100% (median = 79.2%) for the test stimulation phase and 65.5%–100% (median = 89.1%) in the long term. Most SNM studies reported revision and explantation rates of lesser than 20%. The success rate was much lower for PTNS, in the 50%–60% range and complications were minimal. Conclusion: SNM using the contemporary percutaneous tined lead implantation technique appears to be an effective treatment for CNOUR and is durable in the long term. Compared to SNM, PTNS appears less efficacious with less evidence supporting its use in CNOUR. Further prospective studies are required to define the role of PTNS in the treatment of CNOUR. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether a response to hydrogen sulfide donors (GYY4137 and sodium hydrosulfide) and the endogenous hydrogen sulfide system (hydrogen sulfide level and expression of cysteine aminotransferase, cystathionine β‐synthase, cystathionine γ‐lyase, and 3‐mercaptopyruvate sulfurtransferase) in the spontaneously hypertensive rat bladder differ with age, we compared the responses of hydrogen sulfide donors to micturition and bladder relaxation, and the endogenous hydrogen sulfide system in the bladder of 18‐week versus 12‐week‐old spontaneously hypertensive rats. Methods: GYY4137 was intravesically administered and cystometry was performed in anesthetized rats. The responses of sodium hydrosulfide were evaluated in carbachol‐mediated precontracted bladder strips. Bladder hydrogen sulfide levels and expression levels of each enzyme were investigated using the methylene blue method and Western blotting, respectively. Results: GYY4137 treatment significantly prolonged intercontraction intervals only in 12‐week‐old rats. Sodium hydrosulfide‐induced bladder relaxation was significantly attenuated in the strips of 18‐week‐old rats compared with that in 12‐week‐old rats. In the bladder dome, significant increases in hydrogen sulfide levels and in the expression of cystathionine β‐synthase, 3‐mercaptopyruvate sulfurtransferase, and cysteine aminotransferase were observed in 18‐week‐old rats compared with 12‐week‐old rats. However, cystathionine γ‐lyase bands were not detected in bladder tissues of either group. Conclusions: Bladder relaxation induced by hydrogen sulfide may be attenuated in spontaneously hypertensive rats in an age‐dependent manner. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the incidence and assess clinical factors that can predict the occurrence of postpartum urinary retention (PPUR). PPUR is a puerperal condition defined as the inability to void over 6 hours after birth or after catheter removal in case of cesarean section, requiring catheterization. Lack of prompt diagnosis of this condition may lead to severe sequelae, including infection, chronic voiding difficulties, and renal failure. Methods: This retrospective cohort study analyzed all deliveries from January 2011 to December 2017 in a single Italian university hospital. We used multivariate logistic regression to develop a predictive score for PPUR. Results: By multivariate logistic regression, our analysis shows as minor (odds ratio [OR] < 2) risk factors for PPUR: non‐Caucasian ethnicity (OR = 1.46, CI = 1.05‐2.03), nulliparity (OR = 1.47, CI = 1.01‐2.14), body mass index (BMI) at the end of the pregnancy <30 kg/m2 (OR = 1.54, CI = 1.10‐2.17). On the other hand, epidural analgesia (OR = 3.93, CI = 2.96‐5.22), meconium‐stained amniotic fluid (OR = 2.07, CI = 1.54‐2.77), nonoperative vaginal birth vs cesarean section (OR = 6.25, CI = 2.16‐18.13), vacuum extraction vs cesarean section (OR = 8.80, CI = 2.86‐27.01), pushing stage ≥60 minutes (OR = 3.00,CI = 2.26‐3.97), and perineal tear (OR = 2.87, CI = 1.86‐4.43) proved to be major (OR > 2) risk factors for PPUR. Using our final model (area under curve = 0.84), we created a nomogram for PPUR absolute risk calculation. Specifically, a 116‐point cutoff might be used to identify high‐risk patients who deserve more intensive micturition monitoring. Conclusions: Our study identified non‐Caucasian ethnicity, nulliparity, and a BMI <30 kg/m2 at the end of the pregnancy as minor and epidural analgesia, meconium‐stained amniotic fluid, vaginal nonoperative birth, vacuum extraction, pushing stage ≥60 minutes, and perineal tear as major independent risk factors for PPUR. [ABSTRACT FROM AUTHOR]

Objectives: Post‐void residual urine volume (PVR) and bladder voiding efficiency (BVE) are widely used as clinical parameters to evaluate patients with voiding dysfunction. The present study was conducted to assess the variability of PVR and BVE determinations in patients with underactive bladder (UAB). In addition, we focused on the bladder volume prior to voiding (BVvoid) that may influence PVR and BVE, and investigated a correlation between PVR and BVvoid, and between BVE and BVvoid. Methods: Ten patients with a symptom complex of UAB, who had PVR of 50 mL or greater, were admitted to hospital during a 24‐hour period for the measurement of voided volume (VV) and PVR. PVR was measured by transabdominal ultrasonography. BVE was expressed by a fraction (%) of bladder volume evacuated ([VV/BVvoid] × 100). Results: Ten patients, five men (mean age of 65.0 years) and five women (mean age of 70.2 years), participated in this study. Regardless of gender, there was a large variation in repeated measurements of PVR in an individual patient. PVR increased with an increase in BVvoid, and there was a significant linear relationship between PVR and BVvoid. BVE was approximately constant after every voiding in each patient, and there was no significant linear relationship between BVE and BVvoid. Conclusions: Measurement of PVR was unreliable because of wide variation in the same individual. The variation of BVE was much smaller than PVR. BVE would be a reliable parameter with good reproducibility for the assessment of emptying function. [ABSTRACT FROM AUTHOR]

Objective: To investigate bladder neck dysfunction (BND) in women with voiding dysfunction by video‐urodynamic study (VUDS) and to examine the therapeutic results of different BND subtypes. Materials and Methods: We retrospectively reviewed consecutive women who had undergone VUDS for investigation of voiding dysfunction at our institution. The diagnosis of BND was made based on a nonfunneling bladder neck with or without high voiding detrusor pressure. Patients diagnosed as BND were retrieved, and the urodynamic parameters were compared with patients with dysfunctional voiding (DV) and other bladder outlet obstructions (BOO). Results: Among 810 women with bladder outlet dysfunction, BND was noted in 100 (12.3%), poor pelvic floor relaxation in 336 (41.5%), DV in 325 (40.1%), cystocele in 19 (2%), and urethral stricture in 30 (4%). Compared with the normal tracing group, BND patients had a significantly smaller volume of bladder filling sensation (included first sensation of filling, full sensation and cystometric bladder capaicity) and a greater BOO index (BOOI) (all P <.05). Detrusor overactivity was noted in 46 (46%) BND patients. These urodynamic parameters in BND were not significantly different from patients with DV or other BOO. High‐pressure BND had a greater BOOI, but low‐pressure BND had a lower voiding efficiency. Both alpha‐blocker therapy and transurethral incision of the bladder neck improved uroflow parameters in BND patients. Conclusions: BND includes 12.3% of women with bladder outlet dysfunction. High‐pressure BND can cause anatomical BOO, whereas low‐pressure BND is likely to affect micturition through inhibiting detrusor contractility. VUDS is the mainstay diagnostic tool to diagnose BND in women. [ABSTRACT FROM AUTHOR]

Aims: Evaluation and treatment of functional conditions of the lower urinary tract (fcLUT), a subset of benign urinary tract conditions, is highly subjective due to overlapping symptomatology. Despite high prevalence and socioeconomic cost, there has been little improvement in their treatment and lack of progress in understanding their pathophysiology. This study investigates trends in quantity, monetary amounts, and awardees' characteristics of federally funded research awards for fcLUT compared to nonurologic benign conditions (NUBCs) and urologic malignancies. Methods: Data were extracted from the National Institutes of Health (NIH) and federal RePORTER databases in December 2019. We identified currently active awards in fcLUT, NUBC, and malignant urologic conditions and the associated demographic features of awardees. The authors also examined temporal funding trends for such awards. Results: These database searches revealed that there are consistently fewer awards and funding dollars for the study of fcLUT compared to other benign conditions with similar prevalences. While most research topics have received increased funding in awards and overall funding dollars over time, fcLUT funding has remained relatively flat. Urologists are also underrepresented; only 11 of the 86 recipients of NIH R01 awards to study fcLUT have clinical training in urology. Conclusions: Even when compared to NUBC, funding for the study of fcLUT remains low and has stagnated over time. Further, investigators who are clinicians in the field of urology are in the minority of those doing this study. Given the need for clinical perspectives in fcLUT research, the lack of urologist representation will inhibit discovery and translational advances. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate lower urinary tract dysfunction (LUTD) in women with recurrent urinary tract infections (UTIs). One hundred consecutive female patients with recurrent UTIs who underwent videourodynamic study (VUDS) were included. Another 25 women free from recurrent UTIs served as controls. All the underlying diseases, urine analysis and culture results, VUDS findings, and treatment outcomes of voiding dysfunction were carefully reviewed and analyzed. The mean age of the recurrent UTIs patients was 64.0 ± 16.0 years. Storage and voiding dysfunctions were found in 90 (90%) patients, including bladder neck dysfunction in 19 (19%), detrusor hyperactivity with impaired contractility in 6 (6%), detrusor overactivity in 5 (5%), detrusor underactivity in 10 (10%), dysfunctional voiding in 25 (25%), hypersensitive bladder in 6 (6%), and poor relaxation of the pelvic floor muscle in 20 (20%). Only 10 (10%) patients had normal urodynamic tracings. Compared with the controls, the recurrent UTI patients had significantly smaller cystometric bladder capacity, lower maximum flow rate, smaller voided volume, higher detrusor pressure, and larger PVR volume. However, only 6 (11.3%) patients with recurrent UTIs were free from subsequent UTIs following individualized treatment for their voiding dysfunction. A high incidence of vide urodynamic LUTD was identified in women with recurrent UTIs. Despite receiving individualized treatments based on their VUDS findings, only a small portion of these patients were subsequently free from UTIs. [ABSTRACT FROM AUTHOR]

Aims: Multiple sclerosis (MS) is characterized by demyelinated white matter plaque throughout the central nervous system. Plaque involvement in regions that regulate micturition may be associated with urinary symptom severity in patients with MS. The aim of this prospective study is to investigate the relationship between cerebral plaque volume (PV), location, and urinary symptoms in women with MS. Methods: We conducted a case‐control pilot study of women with MS undergoing routine yearly brain MRI. Women were administered the American Urologic Association‐Symptom Index (AUA‐SI) and divided into two groups: severe urinary symptoms (AUA‐SI ≥20) and mild symptoms (AUA‐SI ≤7). PV and location in the brain were determined using a validated automated white matter lesion segmentation algorithm. Results: This study of 36 women found that the median total PV did not differ between groups. Women with severe urinary symptoms had larger median PV in the left frontal lobe (LFL) and right limbic lobe (RLL) compared with women with mild urinary symptoms. Within the RLL, women with severe symptoms had a larger median PV in the right cingulate gyrus (RCG). There was a moderate correlation between LFL lesion volume and RLL lesion volume with the AUA emptying subscore; however, these regions did not correlate with the storage subscore. Conclusions: This preliminary study found urinary symptom severity in women with MS is associated with PV in the RCG and LFL, and not total cerebral PV. These findings may explain why disease burden alone is not a predictor of severity or type of voiding dysfunction in patients with MS. [ABSTRACT FROM AUTHOR]

Aim: To examine the location of midurethral slings (MUS) at the time of excision to determine associations between presenting symptoms and sling location at explant. Methods: We performed an IRB approved, retrospective review of MUS explants between January 2011 and March 2016. Symptoms and physical examination findings were compared between women with slings explanted from the mid‐urethra (MU) and women with slings explanted from the proximal urethra/bladder neck (PU/BN). Results: We included 95 consecutive women who underwent MUS explant in the analysis. Presenting symptoms included pain in 69 women (72.6%), urinary urgency in 66 (66.5%), voiding dysfunction in 55 (57.9%), urge urinary incontinence (UUI) in 41 (43.2%), stress urinary incontinence in 34 (35.8%), and recurrent urinary tract infections in 22 (23.2%). At sling explant, 2 (2.1%) slings were found at the distal urethra, 33 (34.7%) at the MU and 60 (63.2%) at the PU/BN. Women with slings explanted from the PU/BN were more likely to present with urgency (78.3% vs 54.5%; P = 0.017) and UUI (53.3% vs 27.3%; P = 0.015) and less likely to present with pain on examination (48.3% vs 75.8%; P = 0.01). Conclusions: The majority of MUS requiring explant in this cohort were found at the PU/BN. The most common presenting symptom before MUS explant was pain, followed by urgency and voiding dysfunction. PU/BN location of MUS is likely a factor in the development of urgency and UUI in women who ultimately undergo explant. [ABSTRACT FROM AUTHOR]

Aim: To determine the optimal degree of pubovaginal slings (PVS) tension, measured by lax sling dimensions to minimize the risk of urinary retention. Methods: This prospective study analyzed female patients undergoing PVS for stress urinary incontinence (SUI) by two surgeons over 24 months from January 2016. Intra‐operative measurements of lax sling dimensions tented over rectus fascia were recorded. Logistic regression was used to analyse the likelihood of urinary retention (more than 3 months of intermittent self‐catheterisation (ISC) or surgical revision) for given PVS dimensions. The secondary analysis assessed for an association between PVS measurements and persistent SUI. Results: Fifty‐one patients were recruited with a median age of 53 (34‐78) and follow‐up of 11 (3‐20) months. All but one patient reported improvement of SUI. Ten (19.6%) patients developed postoperative urinary retention. Five (9.8%) resolved after a temporary period of ISC. The other five (9.8%) required ongoing ISC or sling division. A strong association existed between short sling height and prolonged urinary retention (P = 0.00). Receiver operating characteristic (ROC) curve analysis showed a sling height of 40 mm had a sensitivity of 100% and specificity of 51% for retentive complications (area under curve [AUC]  = 0.90). Lax sling height up to 60 mm was not associated with persistent SUI. Conclusions: Stretching the sling suspension sutures at least 40 mm above the rectus fascia was associated with a lower risk of urinary retention than less than 40 mm. This simple technique would appear to be worth evaluating in a larger sample. A looser sling did not compromise the cure of SUI at a mean follow‐up of 11 months. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the functional and molecular alterations of contractile and relaxant machinery in the bladder and urethra that lead to the underactive bladder (UAB) in old female mice. Methods: Female young (3‐months) and old (18‐months) C57BL/6 mice were used. Urodynamic was assessed in awake and anaesthetized mice. Electrical‐field stimulation (EFS) and concentration‐response curves to contractile and relaxing agents in isolated bladders and urethras were performed. Messenger RNA (mRNA) expressions of muscarinic, adrenergic, and transient receptor potential vanilloid‐4 (TRPV4), and of the enzymes tyrosine hydroxylase and neuronal nitric oxide synthase (nNOS) were determined. Bladder cyclic adenosine monophosphate (cAMP) levels were measured. Results: Cystometry in old mice showed incapacity to produce bladder emptying. On filter paper, old mice showed reduced urinary spots. Compared to the young group, bladder contractions induced by EFS and carbachol were lower in old mice. The β3‐adrenoceptor agonist mirabegron promoted higher bladder relaxation and elevation of cAMP levels in old mice. In old mice urethras, the α1a‐adrenoceptor agonist phenylephrine produced higher contractions, but no differences were found for the NO donor sodium nitroprusside‐induced relaxations. In old mice, increased mRNA expressions of β3‐ and α1a‐adrenoceptors in bladder and urethra were found, respectively, whereas the muscarinic M2 and M3 receptors and β2‐adrenoceptors did not change between groups. Reduced mRNA expressions of tyrosine hydroxylase and nNOS were found in old mouse urethras. Additionally, TRPV4 expression was reduced in bladder urothelium from old mice. Conclusion: Age‐associated mouse UAB is the result of autonomic dysfunction at multiple levels leading to the less sensitive and overrelaxed bladder, along with urethral hypercontractility. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the changes in uroflowmetric values of male patients following elective inguinal hernia repair. Methods: The study group comprised patients treated with open or laparoscopic inguinal hernia repair. Patients who underwent surgery due to various diseases such as cataract, multinodular goiter, choledocholithiasis, thyroid and breast cancer, hydrocele, or spermatocele were recruited to the control group. Perioperative characteristics, including pain assessed using the visual analog scale (VAS), uroflowmetric values, and post‐void residual urine volumes (PVR), were recorded preoperatively and on Postoperative Days (POD) 1 and 30. Uroflowmetry, VAS, and PVR values were also recorded for the control group on Study Days 1, 3, and 30. Results: There were 103 subjects in this study (52 treated with elective inguinal hernia repair in the study group, 51 in the control group). Preoperative VAS, maximum and average flow rate, and PVR were similar in the 2 groups (P > .05 for all), whereas comparisons of these 3 factors on POD 1 revealed significant differences (P < .001 for all). Linear regression analysis demonstrated that preoperative maximum and POD 1 VAS values of patients who underwent elective inguinal hernia repair could significantly predict acute urinary retention or voiding dysfunction (P = .001 for all). Conclusion: Postoperative pain affect parameters and cause urinary retention after open or laparoscopic inguinal hernia repair. [ABSTRACT FROM AUTHOR]

Objective: To evaluate changes in urethral mobility and configuration after prolapse repair.Methods: This was a retrospective study of 92 patients who were examined between 2005 and 2016 before and after surgery for pelvic organ prolapse (POP) without concomitant anti-incontinence surgery. All patients were assessed with an interview, POP quantification and translabial four-dimensional ultrasound. Urethral mobility was evaluated using semi-automated urethral motion profile software in which x- and y-coordinates of six equidistant points along the length of the urethra were determined both at rest and on Valsalva, relative to the posteroinferior margin of the pubic symphysis. Urethral kinking was measured by placing tangents distal and proximal to any visually identified change in the urethral axis. Imaging data obtained before and after prolapse surgery were compared.Results: Mean age was 58 years and mean follow-up was 5.8 months. Prolapse symptoms had resolved in 85% of patients. Highly significant reductions in urethral mobility and urethral kinking were seen after surgery (all P ≤ 0.001). Similar changes were observed after anterior vaginal repair with or without apical repair, without concomitant posterior repair (n = 23; all P < 0.05).Conclusions: POP surgery was associated significantly with 'straightening' of the urethra and reduction in urethral mobility. The effect seems to be due largely to cystocele repair. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluates the diagnostic value of poorly relaxed external sphincter (PRES) in men with voiding dysfunction. We analyzed clinical and video‐urodynamic characteristics to identify predictive factors of PRES in patients with lower urinary tract symptoms (LUTS) refractory to α‐1 adrenoceptor blocker (α‐blocker) therapy. Methods: This retrospective study included 3379 men with LUTS in whom the initial 1‐month α‐blocker therapy failed. Clinical parameters and video‐urodynamic results were analyzed. Patients with bladder outlet disorders including bladder neck obstruction (BNO), benign prostatic obstruction (BPO), urethral stricture (US), or PRES were categorized according to video‐urodynamic findings. Predictive factors for PRES were analyzed. Results: A total of 3379 men were included in this study. Among the patients with voiding dysfunction, 905 (43.6%) had BPO, 624 (30.0%) had BNO, 487 (23.4%) had PRES, and 62 (3.0%) had US. Patients with PRES were younger and had a higher maximum flow rate, larger bladder capacity, smaller total prostate volume (TPV) and transition zone index, and a lower rate of LUTS of urgency or urge urinary incontinence (UUI) than other groups. On multivariate analysis, only small TPV and lower urgency/UUI rate were predictive factors of PRES. A scale composed of voided volume, TPV, and urgency/UUI predicted PRES with high specificity. Conclusions: PRES was the etiology of voiding dysfunction in 23.4% of the men with LUTS refractory to α‐blocker therapy. A simple scale composed of voiding volume, TPV, and urgency/UUI was useful in predicting the presence of PRES before video‐urodynamic studies. [ABSTRACT FROM AUTHOR]

Aims: Urinary 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. Methods: The 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. Results: Putative 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. Conclusions: In the future, recommendations for research should lead to a better understanding of urinary retention in women and its treatment. [ABSTRACT FROM AUTHOR]

The American Geriatrics Society, with support from the National Institute on Aging and other funders, held its ninth Bedside‐to‐Bench research conference, entitled “Urinary Incontinence in the Older Adult: A Translational Research Agenda for a Complex Geriatric Syndrome,” October 16 to 18, 2016, in Bethesda, Maryland. As part of a conference series addressing three common geriatric syndromes—delirium, sleep and circadian rhythm disturbance, and urinary incontinence—the series highlighted relationships and pertinent clinical and pathophysiological commonalities between these conditions. The conference provided a forum for discussing current epidemiology, basic science, and clinical and translational research on urinary incontinence in older adults; for identifying gaps in knowledge; and for developing a research agenda to inform future investigative efforts. The conference also promoted networking involving emerging researchers and thought leaders in the field of incontinence, aging, and other fields of research, as well as National Institutes of Health program personnel. [ABSTRACT FROM AUTHOR]

Aims: To examine the outcomes of lower urinary tract symptoms (LUTS) and urodynamic test results after cerebrospinal fluid (CSF) shunt surgery in idiopathic normal pressure hydrocephalus (iNPH). Methods: Records of 48 patients (33 men; 15 women), who met the definite iNPH criteria and underwent CSF shunt surgery, were retrospectively analyzed. LUTS and their impact on quality of life (QOL) were evaluated using an all‐or‐none questionnaire targeting four symptoms, the Overactive Bladder Symptoms Score (OABSS), and the QOL index. Urodynamic investigations included filling cystometry and pressure‐flow studies performed before and after surgery. Results: Forty‐seven (98%) patients complained of LUTS, 41 (87%) patients of whom experienced LUTS improvement after surgery. The OABSS and QOL index, which before surgery were 6.8 ± 0.7 and 4.1 ± 0.4, respectively, significantly decreased to 4.6 ± 0.6 and 3.2 ± 0.3, respectively, after surgery. The maximum cystometric capacity (174.9 ± 13.3 mL to 222.4 ± 14.7 mL) and bladder compliance (35.8 ± 4.4 ml/cmH2O to 52.1 ± 5.4 ml/cmH2O) significantly increased after surgery. Detrusor overactivity, which was observed in 37 (77%) patients preoperatively, became undetectable in 7 patients postoperatively. Voiding dysfunction (defined as maximum flow rate <10 mL/s or post‐void residual >100 mL) was observed in 29 (60%) patients, 22 (75%) of whom had detrusor underactivity before surgery. None of the voiding urodynamic parameters significantly improved postoperatively. Conclusions: iNPH is often associated with LUTS and both storage and voiding dysfunctions. CSF shunt surgery improved LUTS and storage dysfunction, with limited effects on voiding dysfunction. [ABSTRACT FROM AUTHOR]

Aims: Women with functional voiding dysfunction often experience a “catching” sensation when catheterising and are in general investigated with both urethral pressure profilometry (UPP) and sphincter electromyography (EMG). It is unknown whether the pattern of the UPP trace correlates with this sensation of “catching” or with sphincter EMG findings. Methods: We reviewed the database of all women with voiding dysfunction who had undergone both sphincter EMG and UPP to assess for any relationship between pattern of UPP trace and “catching” on catheterization and/or sphincter EMG findings. UPP traces were classified as smooth or pulsatile and the EMG was classified as normal or abnormal. Statistical analysis was by Chi squared test for pulsatile UPP trace as a predictor of abnormal EMG. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a pulsatile UPP trace for predicting abnormal EMG were also determined. These patients were asked to complete a telephone interview assessing discomfort on catheterization, particularly on catheter removal (“catching”). Results: A total of 107 women of mean age 35.8 years underwent both sphincter EMG and UPP between 2011 and 2015. There was no significant association between “catching” on catheterization and pattern of UPP. There was a significant association between the presence of a pulsatile UPP and the finding of an abnormal EMG (P < 0.0001) The PPV of pulsatile UPP for abnormal EMG was 0.82 and the NPV of pulsatile UPP for abnormal EMG was 0.74. Conclusions: A pulsatile UPP trace is a sensitive predictor for abnormal EMG in patients with voiding dysfunction. There is no obvious correlation between a pulsatile UPP trace and a reported “catching” sensation on catheterization. [ABSTRACT FROM AUTHOR]

Aims: Lumbar to sacral rerouting surgery can potentially allow voiding via a skin‐central nervous system‐bladder reflex pathway. Here, we assessed if this surgery was effective in treating neurogenic bladder dysfunction/sphincter in felines. Methods: Eight cats underwent spinal cord transection (SCT) at thoracic level 10/11. Unilateral L7 to S1 ventral root anastomosis was performed 1 month later in six cats. Two cats served as transection‐only controls. Electrical and manual stimulation of L6‐S1 dermatomes, and urodynamics were performed at 3, 5, 7, and 9/10 months post transection. At 9/10 months, cats were also evaluated by direct electrophysiological testing of anastomosed roots with urodynamics, then tissue collection and examination of the root anastomosis site and lumbosacral cord ventral horns for cells retrogradely labeled from tracer dye injected 2 weeks earlier into the bladder wall. Results: At 9/10 months, four of six rerouted cats exhibited increased detrusor pressure provoked by cutaneous stimulation, one cat bilaterally. Two cats presented with a voiding stream after ipsilateral cutaneous stimulation at 7 and 9 months. All six rerouted animals showed regrowth of axons from the L7 ventral horn to the bladder, although some aberrant axonal regrowth was also observed. Conclusion: L7 to S1 ventral root rerouting below the level of SCT showed successful axonal regrowth to the bladder from the L7 spinal cord segment in all rerouted animals, and induced increased detrusor pressure response to cutaneous stimulation in a subset. This feasibility study paves the way for future animal studies for bladder reinnervation. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate a nomogram for assessing bladder outlet obstruction (BOO) in women derived from concurrent Pdet.Qmax and Qmax based on radiographic evidence of increased urethral resistance. Patients and Methods: Retrospective analysis of prospectively acquired video‐urodynamics and clinical data of 185 women (development cohort) was performed. The Pdet.Qmax were plotted against Qmax and cluster analysis was performed to determine an axis that best divided the definitively obstructed and unobstructed. Using data from a further 350 women (validation cohort), the sensitivity and specificity of the derived criterion was calculated. Finally, the data from both groups was pooled together and using binary logistic regression analysis, a nomogram was produced. Results: Of the 535 patients in the two cohorts, (122 [22.8%]) demonstrated radiographic evidence of BOO. Cluster analysis identified the axis that best separates the radiographically obstructed and unobstructed as Pdet.Qmax = 2*Qmax. Using the data from the validation cohort, the sensitivity and specificity for this was calculated as 0.94 and 0.93, respectively. A nomogram, representing the probability of BOO for concurrent Pdet.Qmax and Qmax measurements was derived by pooling data from both cohorts. Alternatively, a female BOO index (BOOIf) may be calculated mathematically using the formula BOOIf = Pdet.Qmax − 2.2*Qmax, that is, BOOIf < 0, <10% probability of obstruction, BOOIf > 5 likely obstructed (50%) and If BOOIf > 18, obstruction almost certain (>90%). Conclusion: A female BOO nomogram (the SG nomogram) with high sensitivity and specificity is proposed. The nomogram can be used to stratify the degree of BOO or assess response to treatment. [ABSTRACT FROM AUTHOR]

Aims Voiding dysfunction due to dysfunctional voiding (DV) and poor relaxation of the external sphincter (PRES) are commonly found among adult women with lower urinary tract symptoms (LUTS) during videourodynamic study (VUDS). This study analyzed the VUDS characteristics of DV and PRES in female voiding dysfunction. Methods This retrospective study involved 1914 women aged >18 years with refractory LUTS. The medical records and the VUDS parameters were reviewed. Patients diagnosed with DV and PRES participated in the study. The VUDS characteristics and urethral sphincter activities were compared with those of urodynamically normal women. Results Of the 1914 women, 325 (17.0%) and 336 (17.6%) were diagnosed with DV and PRES, respectively. Detrusor overactivity (DO) occurred in 60% of the women with DV and in 5.7% of the women with PRES. Patients with DV had significantly increased bladder sensation, lower cystometric bladder capacity (CBC), lower bladder compliance, higher voiding detrusor pressure, smaller voided volume (VV), larger post-void residual volume (PVR), lower voiding efficiency (VE), and higher bladder outlet obstruction index (BOOI) than the women with PRES and the control individuals. Patients with PRES had significantly increased bladder sensation, lower CBC, lower maximum flow rate, smaller VV, larger PVR, and lower VE than the control individuals. Conclusions DV and PRES were highly prevalent among the adult women with voiding dysfunction. Patients with DV had VUDS characteristics of BOO and urodynamic DO. The clinical symptoms of PRES were similar to those of DV, but the patients had low detrusor contractility and low DO rates. [ABSTRACT FROM AUTHOR]

Aim To assess the incidence and associated risk factors of asymptomatic urinary retention in elderly women upon admission to the Internal Medicine department. Methods Two hundred and two consecutive elderly women (mean age 84.4 ± 5.7 years) who were admitted to four Internal Medicine departments at a tertiary medical center were prospectively enrolled. All patients underwent post-void residual urine (PVR) measurements on the morning following the admission day. The measurements were undertaken by using a portable ultrasound bladder scan. Asymptomatic urinary retention was defined as PVR ≥ 200 ml without lower urinary tract symptoms, or abdominal pain, in two consecutive measurements. Results Asymptomatic urinary retention was diagnosed in 29 (14.4%) women (mean PVR: 353.1 ± 155.2 ml; range: 200-712 ml). The mean age, prevalence of chronic diseases, and the use of opioid and antimuscarinic drugs were similar in women with versus without asymptomatic urinary retention. A binary logistic regression analysis showed that asymptomatic urinary retention was significantly and independently associated with low mobility, measured by the functional independence measure (FIM) scale (odds ratio = 0.7, 95% confidence interval 0.6-0.9, P = 0.026), and hypothyroidism (odds ratio = 2.4, 95% confidence interval 1.0-5.8, P = 0.049). Among 174 (86.1%) patients in whom thyroid-stimulating hormone (TSH) serum levels were measured, a statistically significant correlation was demonstrated between TSH values and PVR measurements. Conclusions Asymptomatic urinary retention in elderly women upon admission to the Internal Medicine department is not infrequent and is independently associated with hypothyroidism and low mobility. PVR measurements should, therefore, be considered in all women with a low level of mobility and/or hypothyroidism upon admission to the Internal Medicine department. Neurourol. Urodynam. 36:794-797, 2017. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Thus, there are four categories: detrusor overactivity, detrusor sphincter dyssynergia, inefficient bladder contractility, and bladder hypoactivity with spinal cord involvement. Keywords: multiple sclerosis; neurogenic bladder; voiding dysfunction EN multiple sclerosis neurogenic bladder voiding dysfunction 109 110 2 03/03/22 20220301 NES 220301 A 40-year-old female patient presenting with bilateral blindness of 1 day of onset was admitted. The most common type is the overactive bladder that lead to symptoms of urge incontinence.[3] The Christmas tree bladder (CTB), also known as pine cone bladder, is a term used to describe the hypertonic bladder on cystography or CT scan.[[4]] The bladder appears vertically oriented with a wide base that narrows superiorly and could be associated with irregular walls from trabeculations. [Extracted from the article]

Background Children with urinary incontinence ( UI) have associated functional constipation ( FC) and fecal incontinence ( FI). The physiology between lower urinary tract ( LUT) and anorectum in children has not been elucidated. Aims: Observe the effect of rectal distention ( RD) on LUT function, and bladder filling and voiding on anorectal function. Methods Children with voiding dysfunction referred to Boston Children's Hospital were prospectively enrolled in combined urodynamic ( UDS) and anorectal manometry ( ARM). Anorectal and urodynamic parameters were simultaneously measured. Patients underwent two micturition cycles, first with rectal balloon deflated and second with it inflated ( RD). Lower urinary tract and anorectal parameters were compared between cycles. Key Results Ten children (seven UI, four recurrent UTIs, nine FC ± FI) were enrolled. Postvoid residual ( PVR) increased ( p = 0.02) with RD. No differences were observed in percent of bladder filling to expected bladder capacity, sensation, and bladder compliance with and without RD. Bladder and abdominal pressures increased at voiding with RD ( p < 0.05). Intra-anal pressures decreased at voiding ( p < 0.05), at 25% ( p = 0.03) and 50% ( p = 0.06) of total volume of bladder filling. Conclusions & Inferences The PVR volume increased with RD. Stool in the rectum does not alter filling cystometric capacity but decreases the bladder's ability to empty predisposing patients with fecal retention to UI and UTIs. Bladder and abdominal pressures increased during voiding, demonstrating a physiological correlate of voiding dysfunction. Intra-anal pressures decreased during bladder filling and voiding. This is the first time intra-anal relaxation during bladder filling and voiding has been described. [ABSTRACT FROM AUTHOR]

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

Aim To investigate the efficacy and urodynamic effects of baclofen in women with functional bladder outlet obstruction. Methods Between January 2011 and December 2012, women who underwent baclofen treatment for functional bladder outlet obstruction, defined as <15 mL/s maximum flow rate and >20 cmH2O detrusor pressure at maximum flow rate, but without significant anatomic causes, were retrospectively reviewed. Urodynamic variables at baseline and after 12 weeks of treatment were compared. Results Twenty women with functional bladder outlet obstruction underwent 12 weeks of baclofen treatment (oral baclofen 5 mg, three times daily). All patients reported improvement in voiding dysfunction symptoms after treatment, and no significant adverse effects were found on review of medical records. All patients underwent urodynamic studies after 12 weeks' treatment. Voided volume, voiding efficiency and maximum flow rate at voiding cystometry were significantly improved (mean, 273 vs. 368 mL, P = 0.002; 62.8% vs. 73.6%, P <0.001, and 10.3 vs. 11.6 mL/s, P = 0.046; respectively). Moreover, baclofen did not affect continence function, as indicated by non-significant changes in the parameters of urethral pressure profiles. Conclusions Oral baclofen can improve symptoms of voiding dysfunction, voided volume, voiding efficiency and maximum flow rate in women with functional bladder outlet obstruction. None of the patients experienced intolerable side-effects. Thus, oral baclofen may be used as an initial treatment for women with symptoms of voiding dysfunction. [ABSTRACT FROM AUTHOR]

Aims Validated questionnaires are increasingly the preferred method used to obtain historical information. Specialized questionnaires exist validated for patients with neurogenic disease including neurogenic bladder. Those currently available are systematically reviewed and their potential for clinical and research use are described. Methods A systematic search via Medline and PubMed using the key terms questionnaire(s) crossed with Multiple Sclerosis (MS) and Spinal Cord Injury (SCI) for the years 1946 to January 22, 2014 inclusive. Additional articles were selected from review of references in the publications identified. Only peer reviewed articles published in English were included. Results 18 questionnaires exist validated for patients with neurogenic bladder; 14 related to MS, 3 for SCI, and 1 for neurogenic bladder in general; with 4 cross-validated in both MS and SCI. All 18 are validated for both male and female patients; 59% are available only in English. The domains of psychological impact and physical function are represented in 71% and 76% of questionnaires, respectively. None for the female population included elements to measure symptoms of prolapse. Conclusion The last decade has seen an expansion of validated questionnaires to document bladder symptoms in neurogenic disease. Disease specific instruments are available for incorporation into the clinical setting for MS and SCI patients with neurogenic bladder. The availability of caregiver and interview options enhances suitability in clinical practice as they can be adapted to various extents of disability. Future developments should include expanded language validation to the top 10 global languages reported by the World Health Organization. Neurourol. Urodynam. 35:354-364, 2016. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Impaired bladder emptying is a well-recognized cause of lower urinary tract symptoms. However, the symptoms produced do not always relate to voiding, and may include frequency, urgency and incontinence. Conversely, the etiology of symptoms of disturbed voiding is not necessarily dependent upon objectively impaired voiding. Terms including underactive bladder, detrusor underactivity, and impaired contractility describe aspects of these problems, and have been used somewhat interchangeably. It is possible that the present lack of effective therapy in many cases relates to both etiologic and diagnostic uncertainty stemming from terminologic imprecision. Detrusor underactivity has a standardized definition, unlike underactive bladder and impaired contractility. The relationships of symptoms, function, and cause were the focus of a 2014 ICI-RS Think Tank entitled Does Detrusor Underactivity Exist, and if so it is neurogenic, myogenic, or both? This review presents a summary of the problem and the Think Tank conclusions. A terminologic hierarchy and specific research goals are presented. Neurourol. Urodynam. 35:312-317, 2016. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Aims: To compare urodynamic parameters in two groups of older women who have overactive bladder (OAB) symptoms: those with normal and those with elevated post-void residual (PVR). Methods: Secondary data analyses were conducted on medical record data from 203 women who were 65 years or older and who completed urodynamic testing. Of these, 151 (74%) medical records met the study criteria. A PVR of 100 ml or greater during the pressure-flow study was considered elevated for this study. Maximal flow rate (Qmax) and detrusor pressure at Qmax, bladder capacity, voiding volume, and voiding pattern were compared between these two groups. Results: The mean Qmax and detrusor pressure at Qmax were 19.63 ml/sec (SD=8.74) and 16.15 cmH2O (SD=11.19) for the overall sample, respectively. The elevated PVR group (n=54) had significantly higher detrusor pressure at Qmax and bladder capacity than the normal PVR group (n=97) (P<0.05, P<0.01, respectively). An interrupted voiding pattern accounted for 47.4% of the normal PVR group and 77.4% of the elevated PVR group, respectively (P<0.01). Conclusions: Older women with an elevated PVR required on average a higher detrusor pressure at Qmax and greater bladder capacity than women with a normal PVR. Although an interrupted voiding pattern was more prevalent in the elevated PVR group, many women in the normal PVR group also had an interrupted voiding pattern. These findings indicate that many women may habitually strain to void as well as strain due to inadequate detrusor function. [ABSTRACT FROM AUTHOR]

Objective To analyze the video-urodynamic results of voiding dysfunction in men of all ages with bothersome lower urinary tract symptoms ( LUTS) after α-1 adrenoceptor blocker therapy. Methods A total of 930 consecutive men over 45 years of age with LUTS who were failure treated with α-1 blocker therapy for at least one month were retrospectively studied. Patients underwent video-urodynamic studies to evaluate the cause of lower urinary tract dysfunction ( LUTD). Clinical symptoms, prostatic measurements, and video-urodynamic findings were compared among different LUTD groups. Results After video-urodynamic studies, 653 (70.2%) men were diagnosed with voiding dysfunction and 277 (29.8%) were with bladder dysfunction. Among patients with voiding dysfunction, bladder neck dysfunction ( BND) occurred in 242 (37.1%), benign prostatic obstruction ( BPO) in 298 (45.6%), and poor relaxation of the external sphincter ( PRES) in 113 (17.3%). The symptom score did not differ significantly among the three subgroups. The mean age, total prostate volume ( TPV), transition zone index, and prostate-specific antigen were also significantly higher in BPO patients compared with the other two subgroups, but no difference was noted between BND and PRES patients. BPO patients had significantly higher voiding pressure, higher Abrams-Griffiths number, lower Qmax, and a higher rate of detrusor overactivity than did patients in the other two subgroups. Conclusion Bladder neck dysfunction and PRES play important roles in male LUTS. In men younger than 70 years with small TPV and persistent LUTS after α-1 blocker therapy, video-urodynamic studies should be performed to make an accurate diagnosis before invasive surgery is planned. [ABSTRACT FROM AUTHOR]

Aims Dyssynergic contractions of the external urethral sphincter prevent efficient bladder voiding and lead to numerous health concerns. Patterned electrical stimulation of the sacral dermatomes reduces urethral sphincter spasms and allows functional bladder emptying in cats after chronic SCI. Reflex suppression in animals is strongly dependent on stimulus location and pattern. The purpose of this study was to determine whether the stimulation patterns and locations effective in animals suppress urethral sphincter spasms in humans with SCI. Methods Ten subjects with chronic SCI underwent bladder filling to elicit distention-evoked contractions. During reflex contractions patterned electrical stimulation was applied to the S2 or S3 dermatome in random 25-sec intervals. Bladder and sphincter pressures were simultaneously recorded and compared between control and afferent stimulation periods. Results Six of the 10 subjects demonstrated both reflex bladder and sphincter contractions with bladder filling. No significant reduction in urethral pressure was observed during stimulation for any stimulus locations and patterns tested. Conclusions Stimulation parameters and locations effective in SCI animals did not suppress reflex sphincter activity in these human subjects. It is likely that a broader set of stimulus patterns and dermatome locations will need to be tested to find the effective combination in humans. Neurourol. Urodynam. 34:219-223, 2015. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Introduction Detrusor underactivity (DU) is currently a topic that receives major attention within functional urology. Urologists are often confronted with men who present with voiding dysfunction without bladder outlet obstruction (BOO) or after desobstructive or neuromodulation treatment. Their impaired bladder emptying is suspected to be related to failure of detrusor contractile function. Earlier research indicated that patients with non-obstructive urinary retention (NOR), for example, detrusor underactivity (DU), have a lower success rate after sacral neuromodulation (SNM) compared to patients treated with SNM for storage dysfunction. However, predicting factors for treatment success in the NOR group have not yet been defined. Methods and Evidence The aim of this study was to assess whether the use of the new BOO-contractility (Maastricht-Hannover) nomogram can identify and predict SNM non-responders. Our results in 18 men showed that only 20% of patients below the 10th percentile, but 86% of men between the 10 and 25th percentiles of the nomogram can be treated successfully with SNM. All successfully treated patients voided without needing self- catheterisation. Conclusions This pilot study showed for the first time that SNM treatment response in male patients with impaired bladder emptying can be predicted with the BOO-contractility (Maastricht-Hannover) nomogram. Men below the 10th percentile are likely to be treatment non-responders, whereas the majority of men above the 10th percentile are responders. Neurourol. Urodynam. 36:808-810, 2017. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]