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Background: Little is known about the effect of catheterization during pressure-flow studies (PFS) on voiding efficiency in children. Our objective was to determine the effect of urethral catheterization on Qmax and flow index (FI) during PFS compared to the free flow of uroflowmetry (UF)., Methods: We retrospectively reviewed 63 consecutive children who underwent UF and PFS at our center on the same day (2019-2022). Voiding data was available for 46 patients. Patients first underwent a UF with full bladder, then PFS after urethral catheter insertion. Patients with urethral pathologies (n = 6), on clean intermittent catheterization (CIC) (n = 2) and with major comorbidities (n = 2) were excluded. Indications for UF/PFS were LUTS, recurrent UTIs, incontinence or neurosurgical pre-operative evaluation. Data was collected from the UF and the PFS and compared using paired t-test. The idealized Qmax and flow index (FI) were calculated for UF and PFS using the formulas described by Franco et al.: Male Qmax = 11.26 + 0.0701(TBC [total bladder capacity]) - 0.0000513(TBC); Female Qmax = 10.723 + 0.073(TBC) - 0.0000423(TBC), FI = Actual Qmax/Expected Qmax (Franco and et al., 2016; Franco et al., 2018; Franco and et al., 2016)., Results: Median age was 7 years old (IQR 5-11). Twenty-one (40%) patients were male and 32 (60%) patients were female. Of the 53 patients, 3 boys and 4 girls (n = 7; 13%) were unable to void with the catheter in place during PFS but able to void after its removal. Of the remaining 46 cases, the Qmax during PFS was 5 mL/s slower than the Qmax recorded on the UF without catheter, representing a decrease of 29% (12.3 vs 17.3 mL/s; p < 0.0001). The impact of urethral catheter during PFS was more important in males vs females (Qmax decreased by 7.7 vs 3.3 mL/s, or 45 vs 19%). The mean FI during PFS was 44%, which was a 30% reduction compared to the 74% FI obtained with UF (p < 0.00001). In males, the FI decreased by 37% on PFS, whereas it decreased 26% in females, similar to the Qmax decrease., Conclusions: Voiding efficiency, as assessed by Qmax and FI, is decreased during PFS compared to uroflow studies. Our data documents for the first time the impact of urethral catheterization on pediatric voiding efficiency. Abnormal flow rates and elevated PVRs should be used to guide patient management only if obtained by uroflow. Prospective validation comparing free flow with PFS studies will help characterize the impact of urethral catheter relative to bladder pathology, age, gender and catheter size used., Competing Interests: Conflicts of interest None., (Copyright © 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Purpose: Neurogenic lower urinary tract dysfunction (NLUTD) is common among children with myelomeningocele (MMC). If NLUTD is not appropriately managed, recurrent urinary tract infection (UTI) can persist and may affect upper urinary tract function. This study investigated the usefulness of videourodynamic study (VUDS) in the urological management of MMC., Methods: We retrospectively analyzed 57 patients with MMC who underwent VUDS and received urological treatments at the hospital, including surgeries, minimally invasive therapies, and conservative management. The baseline VUDS parameters of patients who received different treatments were evaluated, and the treatment outcomes of the different treatment subgroups were compared., Results: There were 29 male and 28 female patients with a mean age of 24.1 ± 15.9 years upon enrollment. Patients had dysuria or urinary retention (n = 42, 73.7%), urinary incontinence (n = 40, 70.2%), recurrent UTI (n = 35, 61.4%), hydronephrosis (n = 27, 47.4%), and vesicoureteral reflux (n = 26, 45.6%). VUDS revealed detrusor sphincter dyssynergia in 32 (56.1%) patients, bladder neck dysfunction in 13 (22.8%), and intrinsic sphincter deficiency in 20 (35.1%). Among them, 21 (36.8%) received surgical intervention, 17 (29.8%) minimally invasive therapy, and 19 (33.3%) conservative management. After a mean follow-up of 8.5 years, the incidence rates of recurrent UTI (61.4% vs 31.6%, p = 0.001), hydronephrosis (47.4% vs 14.0%, p < 0.0001), urinary incontinence (70.2% vs 35.1%, p < 0.0001), and vesicoureteral reflux (45.6% vs 21.1%, p < 0.001) decreased. The overall global response assessment rate was 73.7%, and patients who underwent surgery had the best rate (90.5%). The predictive value of bladder compliance for treatment selection was > 20.5 ml/cm H 2 O., Conclusion: VUDS can be used to comprehensively assess lower and upper urinary tract dysfunction among patients with MMC. To improve NLUTD and prevent complications, minimally invasive therapies or surgical procedures should be recommended to patients with MMC who have low bladder compliance., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction and Hypothesis: The objective was to compare the safety and accuracy of voided volume with the standard retrograde fill approach for voiding assessment after pelvic floor surgery., Methods: This cohort represents all women in our repository who underwent postoperative voiding assessment following procedures for pelvic floor disorders between September 2011 and June 2014. One surgeon utilized a spontaneous voiding (SV) protocol and allowed any patient who voided 150 ml or more at one time to pass the trial. The other surgeon used a retrograde fill (RF) protocol. This involved instilling the bladder with 300 ml of water or until maximum capacity immediately after the outpatient procedures and on the first postoperative day for hospitalized patients. For this protocol, a voided volume of 200 ml was considered sufficient to pass the trial., Results: In this cohort, 431 women had a voiding trial with SV, and 318 with RF. The groups were similar with respect to baseline characteristics but more women in the RF group had a sling-only procedure. The failure rates of the RF (22.8%) and SV (20.0%) groups were similar (p = 0.46). Among women who passed the voiding trial, similar percentages of women returned with urinary retention and needed catheter insertion after the RF (1.6%) and SV (0.9%) methods (p = 0.65)., Conclusion: Spontaneous voiding trial based on a minimum voided volume of 150 ml is a safe and reliable alternative to the retrograde fill method after female pelvic floor procedures.

A serious voiding disorder or urinary incontinence represent indications for long-term catheterization of the urinary bladder. Treatment by a transurethral or suprapubic bladder catheter for life-long bladder drainage is accompanied by technical short-term complications and long-term sequelae. The mortality risk associated with inserting a suprapubic catheter is approximately 2% due to an incorrect bladder puncture. Long-term consequences of life-long bladder drainage are hematuria, infection, spasms, stone formation, obstruction, catheter loss, risk of falls and automanipulation especially in cognitively impaired persons. These constitute frequent reasons for emergency treatment or hospitalization. Further problem areas are dependency on caregivers to perform the catheter change and dermal problems in the area of the fistula stoma. To what extent this limits the quality of life of those affected remains unclear up to now. The acute complications and the long-term consequences of life-long bladder drainage make careful decision-making necessary after other therapeutic options have failed, are not appropriate or not desired.

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., (© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)

Background: Feminizing genitoplasty techniques have diversified to encompass the spectrum of atypical genitalia in 46,XX congenital adrenal hyperplasia (CAH) patients. However, long-term outcomes evaluating postoperative continence following complex vaginoplasty remain scarce., Objective: The aim was to review our surgical experience and assess postoperative urinary continence outcomes in CAH patients following complex, primary vaginoplasty., Study Design: We retrospectively reviewed CAH patients who underwent complex, primary vaginoplasty at a single center by a single surgeon from 1996 to 2013. We collected data on clinical characteristics, surgical techniques and postoperative urinary continence outcomes. In patients who had reached toilet-training age, continence outcomes were reviewed., Results: Twenty-four patients met the inclusion criteria. The median age at the time of surgery was 8 months (interquartile range [IQR] 1 year-6 months). The median length of follow up was 6 years (IQR 10 years-3 years). These patients required complex reconstruction because of more extensive virilization: total urogenital mobilization (TUM, 10), pull-through vaginoplasty (9), partial urogenital mobilization (3), or pull-through vaginoplasty with partial urogenital mobilization (2). After surgery, 15 out of 24 (62.5%) reported age appropriate toilet-training without further complaints. Seven (29.2%) patients reported daytime incontinence or enuresis that resolved with conservative management. Two patients reported day and night incontinence requiring urethral bulking procedures following TUM., Discussion: Twenty-two (91.7%) of our patients achieved continence without further surgical intervention. Of these patients, the TUM patients had serious incontinence issues. Our study represents a review of clinically significant cases from the female CAH population. The limitations of our study include a relatively small sample size and retrospective design., Conclusion: Females with CAH and urogenital virilization most often achieved age appropriate toilet-training following vaginoplasty. Daytime incontinence and enuresis resolved without operative management in the vast majority of cases. TUM carries a risk of severe incontinence and may require further procedures to achieve urinary continence., (Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Introduction and Hypothesis: A significant proportion of patients develop voiding dysfunction after midurethral tape (MUT) insertion, which reduces patient satisfaction. The study's purpose was to identify predictive factors of voiding dysfunction after a retropubic MUT procedure., Methods: This was a retrospective study of 100 patients who underwent only a retropubic MUT procedure between January 2010 and December 2011. Early voiding dysfunction was defined when patients required a Foley catheter within 48 h. Data including demographic information, urogenital symptoms, previous surgery, preoperative uroflowmetry and urodynamic parameters were analysed using SPSS v22. Univariate analysis of all demographic variables was performed; those significant at 10 % were entered into a multivariate logistic regression., Results: Fourteen patients required Foley catheter insertion, with a median age of 58 years (26-83 years), median BMI 28 kg/m(2) (20-48 kg/m2), and median parity 2 (0-4). Univariate analysis revealed peak flow rate <15 ml/s (OR 3.79; 1.07, 13.4; p = 0.046), bladder capacity (p = 0.044), stress incontinence versus mixed or urge incontinence (p = 0.064) and previous surgery (OR 4.39; 1.34, 14.41; p = 0.015) to be associated with voiding dysfunction. Multivariate analysis showed only previous pelvic floor surgery to be independently associated (OR 3.76; 1.14, 12.23, p = 0.029)., Conclusions: Only previous pelvic-floor surgery was found to be a strong predictive factor of voiding dysfunction. The rate of voiding dysfunction was similar to those of published data. Previous studies revealed different predictive factors. A larger cohort is needed to provide a definite answer. Those with previous surgery appear to be those most at risk and pre-surgical counselling for these women could be suggested., Competing Interests: Compliance with ethical standards Conflicts of interest None.

Introduction and Hypothesis: There is a paucity of literature on resumption of normal voiding predictors after synthetic retropubic sling insertion and lack of a standardized method of determination. Our goals were to determine the incidence of a successful voiding trial; whether clinical, operative, or urodynamic variables predict discharge with a catheter; and incidence of later retention in those who were initially successful., Methods: We performed an internal-review-board (IRB)-approved retrospective chart review of 229 consecutive patients who underwent retropubic sling (TVT, Boston Scientific, Natick, MA, USA)) from 2001 to 2010. Exclusions were concomitant surgery or cystotomy at the time of retropubic sling insertion. All participants underwent a voiding trial in recovery consisting of 300 cc sterile-water retrograde fill and were discharged home without a catheter after single void of at least 200 cc following catheter removal., Results: Of 170 patients, 136 (80 %) passed the voiding trial the same day, with 165 (97 %) passing within 1 day. Factors associated with delayed voiding were age ≥65 years (p < 0.05), presence of Valsalva voiding (p < 0.01), lower body mass index (BMI) (p < 0.05), and higher gravidity (p < 0.05) and parity (p < 0.01). Age ≥65 years [adjusted odds ratio (aOR) 3.72, 95 % confidence interval (CI) 1.40-9.90, p < 0.01] and Valsalva voiding (aOR 3.89, 95 % CI 1.56-9.69, p < 0.01) remained significant independent predictors in multivariate analysis., Conclusions: The majority of patients with retropubic sling can be safely discharged home the same day without a catheter after retrograde fill. Women >65 years or Valsalva voiders had nearly four times the odds of being discharged with a catheter. Most patients resume normal voiding within 24 h after retropubic sling insertion, but >65 years and Valsalva voiding are risk factors for voiding inability at discharge.

Objective: To report our long-term experience of sacral neuromodulation (SNM) for various lower urinary tract dysfunctions but with a focus on efficacy, safety, re-interventions and degree of success., Patients and Methods: This is a single tertiary referral centre study that included 217 patients (86% female) who received an implantable pulse generator (IPG) (Interstim™, Medtronic, Minneapolis, USA) between 1996 and 2010. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline, but was further stratified., Results: The mean duration of follow-up was 46.88 months. Success and cure rates were ≈70% and 20% for urgency incontinence, 68% and 33% for urgency frequency syndrome and 73% and 58% for idiopathic retention. In those patients with an unsuccessful therapy outcome, the mean time to failure was 24.6 months after implantation. There were 88 (41%) patients who had at least one device or treatment related surgical re-intervention. The re-intervention rate was 1.7 per patient with most of them (47%) occurring ≤2 years of follow-up., Conclusions: SNM appears effective in the long-term with a success rate after definitive IPG implant of ≈70% and complete cure rates ranging between 20% and 58% depending on indication. Patients with idiopathic retention appear to do best. The re-intervention rate is high with most occurring ≤2 years of implantation. It is likely that with the newer techniques used, efficacy and re-intervention rates will improve., (© 2013 The Authors. BJU International © 2013 BJU International.)

Clean intermittent self-catheterisation (CISC) is considered the preferred option to an indwelling catheter for emptying the bladder in people with a range of voiding dysfunctions. CISC has a lower risk of complications and urinary tract infections. This narrative review of previous qualitative research explores the quality-of-life impacts and highlights the challenges that men face. It will provide nurses who teach CISC with some useful insights into the male experience and the issues of concordance and adherence. This will help to better inform and guide clinical practice in this specialist area of nursing practice. [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]

Aim: This study evaluated the long-term effectiveness of transurethral incision of the bladder neck (TUI-BN) with or without an additional procedure for female voiding dysfunction. Methods: Women with voiding difficulty who underwent TUI-BN in the last 12 years were included. All patients underwent a videourodynamics study (VUDS) at baseline and after TUI-BN. A successful outcome was defined as having a voiding efficiency (VE) increase by ≥50% after treatment. Patients with insufficient improvement were chosen for repeated TUI-BN, urethral onabotulinumtoxinA injection, or transurethral external sphincter incision (TUI-ES). The current voiding status, surgical complications, and additional surgeries were evaluated. Results: A total of 102 women with VUDS evidence of a narrow bladder neck during voiding were enrolled. The long-term success rate of the first TUI-BN was 29.4% (30/102) and increased to 66.7% (34/51) after combining TUI-BN and an additional procedure. The overall long-term success rates were 74.6% in women with detrusor underactivity (DU), 52.0% in detrusor overactivity and low contractility, 50.0% in bladder neck obstruction, 20.0% in hypersensitive bladder, and 75% in stable bladder (p = 0.022). Patients with a lower maximum flow rate (Qmax), (p = 0.002), lower voided volume (p < 0.001), lower corrected Qmax (p < 0.001), lower ladder contractility index (p = 0.003), lower voiding efficiency (p < 0.001), but larger post-void residual volume (p < 0.001) had a satisfactory surgical outcome. Spontaneous voiding was achieved in 66 (64.7%) patients, de novo urinary incontinence in 21 (20.6%), and vesicovaginal fistula in 4 (3.9%), all were repaired. Conclusions: TUI-BN alone or in combination with an additional procedure was safe, effective, and durable in patients with DU to resume spontaneous voiding. [ABSTRACT FROM AUTHOR]

Objective: To investigate the long-term clinical and urodynamic outcomes of a small cohort of children who received short-term urotherapy for confirmed dysfunctional voiding (DV) and lower urinary tract symptoms (LUTS). Materials and Methods: This study included 26 children with confirmed LUTS and DV via video urodynamic study (VUDS) and received standard urological therapy, pelvic floor muscle training, or surgical intervention in childhood. Their current lower urinary tract conditions were assessed by chart review and direct and telephone interviews. Charts of 14 patients who underwent follow-up VUDS were reviewed to investigate their bladder and voiding dysfunction or follow-up on previous treatment results. The satisfaction of lower urinary tract status was assessed using the global response assessment (GRA) scale. Results: At initial enrolment, the mean age was 9.54 ± 3.88 years, and urological treatment was performed during the first 1–5 years thereafter. Most patients were not regularly followed in the urology clinic. Among the 14 children available for follow-up, a GRA score of 3 was reported by 10 (71.4%) after a mean follow-up period of 10.3 ± 6.74 (range, 2–20) years, indicating satisfactory bladder and voiding conditions. Four children with less favorable outcomes (GRA score of <3) had significantly more post-void residual urine volume at baseline, and 75% of these patients had central nervous system diseases. Daytime incontinence and enuresis rates were significantly decreased at follow-up compared with the baseline. Significantly increased bladder capacity and sensation and significantly decreased voiding detrusor pressure were found on follow-up VUDS. Conclusions: Children with DV who received standard urotherapy upon diagnosis exhibited improved LUTS at a 10-year follow-up. Of the 14 children available for follow-up, 10 (71.4%) reported satisfactory bladder and voiding status without further medication or urotherapy, with significantly decreased voiding detrusor pressure. [ABSTRACT FROM AUTHOR]

Botulinum toxin A (Botox) had been considered a promising drug that has an effect on functional disorders of the lower urinary tract. Because Botox exhibits anti-inflammatory and antispasmodic effects, Botox injection into the bladder can decrease detrusor contractility, reduce bladder hypersensitivity, and eliminate painful sensations. Injecting Botox into the bladder outlet can relax the hyperactivity of the bladder neck, and of the urethral smooth and striated muscles. Based on these therapeutic effects, Botox has been widely applied to treat lower-urinary-tract dysfunctions (LUTDs) such as overactive bladder and neurogenic detrusor overactivity. However, this treatment has not been licensed for use in other LUTDs such as interstitial cystitis, voiding dysfunction due to benign prostatic hyperplasia in men, and dysfunctional voiding in women. Botox has also not been approved for the treatment of children with overactive bladder and dysfunctional voiding; in patients with spinal cord injuries with detrusor sphincter dyssynergia and autonomic dysreflexia; or for poorly relaxed external sphincter in non-neurogenic patients. This article reviews the current knowledge regarding Botox treatment for LUTDs and discusses the potential clinical applications of Botox, as well as work that can be conducted in the future. [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]

Background: Mesh-related complications resulting from pelvic organ prolapse (POP) reconstruction operations may be a devastating experience leading to multiple and complex interventions. Objectives: The aim of the study was to describe the experience and time frame of management of mesh-related complications in women treated for POP or stress urinary incontinence in a tertiary center. Methods: 1,530 cases of mesh-related complications were accessed regarding their clinical presentation, number of surgeries, and timeline of surgical treatments to treat multiple clinical complaints until the ultimate operation where all the meshes were removed in a single tertiary center. Results: The studied population revealed to be a highly referred one with only 10.2% of the cases implanted at our center. Clinical presentation varied widely with 48.7% referring pain as the chief complaint, while 31.3% complained of voiding dysfunctions, 2.5% reported genital prolapses, 2.2% complained of vaginal problems, and 1.2% noted intestinal problems as the main clinical complaint. Only 4.8% of the cases presented mesh erosion at examination; 57.8% of the cases required more than 1 operation to address the mesh-related problems. Sixty-eight cases had more than 10 operations up to complete removal. Three clusters of patients could be identified: (i)–those from whom the mesh was promptly removed after clinical problems emerged, (ii) those with slowly evolving problems, and (iii) those with escalating problems despite treatment attempts. Conclusions: Mesh-related complications after pelvic floor reconstruction are an evolving disease with diverse clinical presentation. The identified time-related problems and the multiple failed attempts to treat their complications warrant attention with continuous monitoring of these patients and aggressive removal of the mesh if the clinical complaint cannot be swiftly managed. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence is any involuntary loss of urine on effort, physical exertion, or sneezing, or coughing, and urinary leakage due to increased abdominal pressure. This article focuses on surgical interventions with midurethral slings as an option for stress urinary incontinence, and management of sling complications. [ABSTRACT FROM AUTHOR]

Background: Lower urinary tract dysfunction (LUTD) is the most common problem of the referral children to the pediatric urology clinics. If this condition does not treat early in life, it will be a lifelong problem. During recent decades, electrical stimulation therapy has been expanded and extensively used for the treatment of LUTD in both adults and children. The aim of this review is to suggest clinicians an updated understanding of effects of interferential (IF) electrical stimulation therapy in management of LUTD in children.Materials and Methods: The search was performed in databases of Medline, PubMed, Google Scholar, ,and Scopus for information about  IF electrical stimulation and its application using search words such as " IF electrical stimulation", "transcutaneous IF electrical stimulation" ,  "IF therapy " , " electrical stimulation", "voiding dysfunction" , " LUTD", " urinary incontinence" and " children". As this review focuses on the answer of this question "Does transcutaneous IF electrical stimulation has effect on management of LUTD in children?" we included the reference list of articles identified by this search strategy and selected those we judged relevant according to our keywords. Clinical trial studies that publishing in English were included. Categorical data were reported as frequencies and percentages.Results: Eleven studies were included in this review. The success rate of IF therapy in these studies has been reported from 61% to 90% of children with LUTD and urinary incontinence.Conclusion: IF electrical stimulation is an effective, safe and reproducible option to manage LUTD and urinary incontinence in children. [ABSTRACT FROM AUTHOR]

Objectives: Pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS) usually coexist and are common among women. Since the efficacy of urodynamic studies (UDS) in evaluating these conditions is subject to controversy, this study aimed to assess the accordance between urodynamic findings and LUTS and to determine the importance of UDS in women with POP.Methods: This cross-sectional study was conducted on women over 18 years with symptomatic POP referred to the female urology clinic of Kerman University of Medical Sciences, Kerman, Iran, during 2017-2018. Patients who met the inclusion criteria were included in the study with informed consent. The Pelvic Floor Disability Index (PFDI-20) was completed for each patient. Pelvic examination was performed using the Pelvic Organ Prolapse Quantification System (POPQ). Subsequently, multi-channel UDS was performed, and the findings were analyzed in SPSS 20, using Chi-square or Fisher's test.Results: A total of 200 women with symptomatic POP were included in the study. Stress, urge, and mixed urinary incontinence showed significant accordance with the urodynamic findings (urodynamic stress incontinence and/or detrusor overactivity). However, there was no significant relationship between urinary voiding LUTS and urodynamic findings.Conclusion: UDS should be performed for selective patients with POP. According to the results of the present study, UDS can help us provide consultation for POP patients with voiding LUTS. However, in POP patients with urinary incontinence, this test cannot provide further information and should be performed based on the patient's condition. [ABSTRACT FROM AUTHOR]

Objective: Health-related quality of life and its influencing factors in pediatric patients with voiding dysfunction and their families were assessed. Method: The patients who were admitted with urinary incontinence for at least 6 months to the clinics of pediatrics and pediatric nephrology were enrolled in the study. The patients were divided into three groups as daytime urinary incontinence (DUI), enuresis and both DUI and enuresis. The Pediatric Quality of Life InventoryTM (PedsQLTM) was administered to patients and mothers. Results: A total of 100 patients with voiding dysfunction admitted with urinary incontinence aged from 5 years to 18 years (mean age: 8.8±2.6) were included in the study. The mean dysfunctional voiding symptom score was 15.5±6.6 in all groups and significantly higher in the group who experienced both DUI and NE (p<0.001). No significant difference was observed in terms of mean PedsQL scores of the children and their mothers between groups with urinary incontinence (65.5±16 and 58.4±13.5, respectively), but a strong positive correlation was detected between them (p<0.001). The mean PedsQL score for the children aged from 8 years to 12 years was significantly lower than the scores for the children aged from 5 to 7 years (p<0.05). The mean PedsQL score for the children aged between 13, and 18 years was not different from the other age groups. Conclusion: The early diagnosis and treatment of patients aged from 8 to 12 years who had the lowest PedsQL score is important. Additionally, the success in the improvement of the quality of life of children with voiding dysfunction requires cooperation with parents. [ABSTRACT FROM AUTHOR]

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

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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]

Introduction and hypothesis: The purpose of the study was to evaluate the rate of postoperative voiding dysfunction after the insertion of an adjustable transobturator sling for the treatment of primary stress urinary incontinence (SUI). The secondary aim was to assess the objective and subjective cure rates and the impact of the surgery on quality of life.Methods: This prospective study included 171 patients with primary SUI who underwent insertion of an adjustable transobturator tape. A postoperative tension adjustment algorithm that included a cough stress test (CST), uroflowmetry and postvoid residual volume (PVR) measurement was applied in all patients the day after surgery. The baseline and control postoperative evaluations included vaginal examination, CST, Q-tip test, uroflowmetry and PVR measurement, 1-h pad test and administration questionnaires (UDI-6, IIQ-7, PISQ-12, ICIQ-SF).Results: The day after surgery 65 patients (38.0%) required tape tension adjustment: an increase in tension in 53 patients (31.0%) and a decrease in 12 (7.0%). Continence was achieved in all patients. No patients showed voiding dysfunction after adjustment. Follow-up data for 12 months were available in 157 patients (91.8%). The objective and subjective cure rates were 96.2% and 97.5%, respectively. There was no statistically significant decrease in Qmax (p = 0.899) or increase in PVR (p = 0.187). According to the questionnaires scores, quality of life was improved in all patients.Conclusion: The adjustable transobturator sling minimizes the risk of postoperative voiding dysfunction and allows high objective and subjective cure rates to be achieved in patients with primary SUI. The technique also improves the patient’s quality of life. [ABSTRACT FROM AUTHOR]

Urodynamics in female urology are often indicated when empiric or conservative treatment does not improve lower urinary tract symptoms. Based on the expected underlying lower urinary tract dysfunction, the urodynamic evaluation is designed by the clinician to reproduce a patient's symptoms and to identify underlying pathophysiological mechanisms, as well as to analyse other functions of the lower urinary tract which may be relevant for planning further (invasive) treatment. In this review, we describe the available urodynamic tests, the normal findings, and the evidence for the role of urodynamics, and on the specific measurements and parameters used to evaluate female lower urinary tract symptoms. In women with a suspected storage dysfunction, filling cystometry allows identification of detrusor overactivity or reduced bladder compliance as possible underlying causation of overactive bladder. Most women with stress incontinence have other storage and/or voiding symptoms and urodynamics should always be performed prior to invasive treatment. In the minority with pure stress urinary incontinence , urodynamic observations can guide the type of surgery chosen, but this has not yet been shown to change treatment outcome. Voiding dysfunction in women has recently received more research attention and various urodynamic parameters are being evaluated on their ability to distinguish detrusor underactivity from bladder outlet obstruction in pressure-flow studies. Video-urodynamics can provide a useful addition when anatomical information is needed in complex patients (eg, prior surgery or neurogenic patients). Finally, ambulatory urodynamics can be used when symptoms cannot be reproduced or explained by conventional urodynamics. [ABSTRACT FROM AUTHOR]

Purpose of Review: Functional complications after orthotopic neobladder urinary diversion (ONB), including urinary incontinence and urinary retention, present unique challenges. The purpose of this review is to outline contemporary treatment options for voiding dysfunction after ONB in females. Recent Findings: Meticulous surgical technique in the form of urethral nerve-sparing has been shown to play an important role in maintaining continence, as has sparing the uterus when possible. Data supporting the effectiveness of lifestyle measures, urethral bulking, pubovaginal slings, and transobturator slings in the treatment of urinary incontinence are widely variable and limited to case reports. Urinary retention is still most effectively managed with self-catheterization. Summary: Voiding dysfunction after ONB can be devastating. Recent advances focus on improving surgical techniques to decrease the risk of incontinence and retention, as post-operative management options are limited. [ABSTRACT FROM AUTHOR]

Although evidence shows that urodynamic study may not improve outcomes, it can be used to evaluate men with lower urinary tract symptoms (LUTSs) which have not been adequately delineated and treated. In young men with LUTS not responding to treatment based on clinical examination, or elderly men with LUTS and incontinence, a complete urodynamic evaluation is mandatory to understand the pathophysiology underlying LUTS, such as bladder outlet obstruction (BOO), detrusor overactivity, and detrusor underactivity. Preoperative urodynamic study-proven BOO is a predictor of a successful surgical outcome. An urodynamic study should be performed when patients with LUTS are planning to undergo surgical treatment for benign prostatic obstruction. [ABSTRACT FROM AUTHOR]

Copyright of Der Gynäkologe 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.)

This review assessed the epidemiology of voiding dysfunctions in South Korea. Comprehensive understanding of this epidemiology is crucial because the senior population and the social burden are increasing because of voiding dysfunctions is growing. We searched the medical records using several terms related to voiding dysfunction: benign prostatic hyperplasia, urinary incontinence, lower urinary tract symptoms, overactive bladder, and nocturia. We then estimated the prevalence of voiding dysfunctions in South Korea; our data were comparable with those from other countries, with slight differences. The ranges of incidences varied widely between studies, mostly because investigators defined disorders differently. Voiding dysfunction greatly affects healthcare costs and individual quality of life; therefore, more proper and valuable epidemiologic data are needed. In addition, efforts to unify the definitions of various voiding dysfunctions and progress in investigational methodologies using multimedia are warranted. [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]

The article presents the findings of a narrative review of the literature published during 2013 about the developments in female urology. The authors also discuss the advances in the management of pelvic and lower urinary tract disorders such as recurrent urinary tract infections (UTIs), overactive bladder (OAB) and pelvic organ prolapse (POP). A table that depicts the summary of the literature is also presented.

Objective.The aim of this study was to explore the relationship between voided volume (VV) and urge to void among patients with lower urinary tract symptoms. Material and methods. Consecutive adult patients (aged 23-90 years) were enrolled, and completed a 24 h bladder diary and the Urgency Perception Scale (UPS). Patients were categorized as urgency or non-urgency based on the Overactive Bladder Symptom Score. The relationship between UPS and VV (based on the bladder diary) was analyzed by Spearman's rho and proportional odds model. Results. In total, 1265 micturitions were evaluated in 117 individuals (41 men, 76 women; 56 individuals in the urgency and 61 in the non-urgency group). The mean (± SD) VV and UPS were 192 ± 127 ml and 2.4 ± 1.2 ml in the urgency group and 173 ± 124 ml and 1.7 ± 1.1 ml in the non-urgency group, respectively. Spearman's rho (between UPS and VV) was 0.21 [95% confidence interval (CI) 0.13-029, p < 0.001] for the urgency group, 0.32 (95% CI 0.25-0.39, p < 0.001) for the non-urgency group, and 0.28 (95% CI 0.23-0.33, p < 0.001) for the total cohort. Urgency patients had higher UPS [odds ratio (OR) 3.1, 95% CI 2.5-3.8]. Overall, each additional 50 ml VV increased the odds of having a higher UPS with OR 1.2 (95% CI 1.2-1.3). The relationship between VV and UPS score was similar in both groups ( p = 0.548 for interaction). Conclusion. Although urgency patients void with a higher UPS score, among both urgency and non-urgency patients there is only a weak correlation between VV and the urge to void. This suggests that there are factors other than VV that cause the urge to void. [ABSTRACT FROM AUTHOR]

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

Adult spina bifida patients are an underserved population in terms of healthcare in general and urologic care in particular. These patients have unique urologic issues arising from the underlying disease process as well as prior treatments. Multidisciplinary clinics deliver coordinated care in a limited number of locations and many patients receive care in their local community. In an effort to improve patient care, this article will empower the general adult urologist to care for the urologic needs of adult spina bifida patients and educate the reader about the fundamentals of transitional urologic care. [ABSTRACT FROM AUTHOR]

The M(3) receptor (M(3)-mAChR) is the major muscarinic subtype in the animal bladder responsible for detrusor contraction. The alterations in its protein quantity and biosynthesis during diabetic cystopathy were investigated. Three-month-old male Wistar rats were divided into two groups: (1) 2-week diabetic rats and (2) normoglycemic control rats. Diabetes was induced by a single intravenous injection of 60 mg/kg streptozotocin. The amount of M(3) receptor protein in the rat bladder body tissue was measured by Western immunoblotting using monoclonal antibodies. For determination of M(3) muscarinic receptor mRNA in the bladder tissue, the method of Northern blotting was employed. The results of the Western immunoblotting showed that the amount of M(3)-mAChR protein in the diabetic bladder was significantly increased by about 70.2 +/− 8.5 % when compared to the control bladder (p < 0.05, n = 8). Northern blotting demonstrated a 54.7 +/− 6.0 % increase of M(3)-mAChR mRNA in the diabetic bladder (p < 0.05, n = 8). The findings of the present study demonstrated an upregulation of M(3)-mAChR biosynthesis in the diabetic urinary bladder. This phenomenon offers an explanation of the increased contractility after muscarinic stimulation of the detrusor muscle of diabetic animals in human diabetic cystopathy as clasically described consists of triad of decreased bladder sensation, increased capacity and impaired detrusor contractility; however it is now clear that significant number of patients will have overactive bladder. High clinical suspicion and referal for urodynamics will allow improved diagnosis and treatment of bladder dysfunction. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify the incidence and potential risk factors affecting postoperative transient urinary retention (TR) with transobturator tape (TOT) mid-urethral sling surgery for female patients with stress urinary incontinence (SUI). Study design: We reviewed the medical records of 305 patients with SUI who underwent the TOT procedure. Postoperative TR was defined as follows: (1) patients had still voiding difficulty after removing the Foley catheter postoperatively and (2) straining pattern of postoperative voiding with the post-void residual urine volume (PVR) larger than 100mL during 1st or 2nd trial of self-voiding and (3) these voiding problems are resolved within 48h without any special treatment. The Foley catheter was removed routinely on the first postoperative day. Age, previous pelvic surgery history, co-existence of cystocele, number of vaginal deliveries and all urodynamic parameters were analyzed and compared between the TR group and control group. Results: The incidence of TR was 9.5%. Comparative analysis revealed concomitant prolapse surgery including anterior and posterior repair, Valsalva leak point pressure and preoperative PVR. In multivariate analysis, preoperative PVR proved to be a potential risk factor for TR. Conclusion: TR was not a rare postoperative complication after TOT procedures. Potential risk factors for transient retention include preoperative PVR. [Copyright &y& Elsevier]

Introduction and hypothesis: The aim of this study is to report a novel understanding of the urodynamic parameters used to diagnose iatrogenic female obstruction. There is no consensual definition of infravesical obstruction in women. Numerous criteria were designed with arbitrary cutoff values with poor clinical correlation. In order to determine the urodynamic profile of infravesical female obstruction we restricted our analysis to women who acquired voiding disturbances after being submitted to stress urinary incontinence (SUI) surgery. Methods: A total of 302 women developed obstructive symptoms or voiding difficulties after SUI operations: 176 cases had had Kelly-Kennedy operations (58.2 %), 50 had had Burch operations (16.5 %), 37 (12.2 %) had had anterior colporrhaphy + abdominal (Burch) operations, 33 (10.9 %) had had sling operations, and 8 (2.6 %) had had Marshall-Marchetti operations. Obstructive urinary symptoms started in 1-120 days after the operation and urodynamic evaluations were done after various periods of time (median 18.4 months). Clinical presentations varied widely with irritative symptoms predominating the picture. Results: Five patterns of pressure-flow relationships could be identified: (1) elevated pressure and poor flow (7.2 %), (2) normal pressure and poor flow (41.5 %), (3) normal pressure and flow associated with prolonged flow time (24.2 %), (4) poor detrusor contraction and elevated residual volume (12.9 %), and (5) elevated pressure and high flow (14.5 %). No relationship was established amongst the group and the Urinary Distress Inventory questionnaire. Conclusions: Infravesical obstruction in women does not fit a single model. As suggested, obstruction in women must be based on broad clinical pictures and urinary complaints. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Some lower urinary tract dysfunction (LUTD) subtypes may have similar symptoms. This study aimed to investigate the feasibility of using the International Prostate Symptom Score (IPSS) to evaluate lower urinary tract symptoms (LUTS) in women. Methods: All consecutive women with non-stress urinary incontinence LUTS who visited the urologic clinics for treatment were prospectively enrolled. LUTS include urinary storage, voiding, and post-micturition symptoms. All enrolled patients were requested to complete the Overactive Bladder Symptom Score (OABSS) and the modified Indevus Urgency Severity Scale (IUSS) questionnaires as well undergo uroflowmetry and post-void residual testing. A videourodynamic study was also performed, if indicated, for LUTD. Results: A total of 222 women were enrolled, including 60 with overactive bladder (OAB) dry, 42 with OAB wet, 78 with bladder oversensitivity, and 42 with voiding dysfunction. A significantly higher IPSS voiding to storage subscore ratio (IPSS-V/S) and IPSS voiding score were found in the voiding dysfunction group. IPSS-V/S was found to have the highest area under the receiver-operating characteristic curve for predicting voiding LUTD than other noninvasive methods, and an IPSS-V/S of ≥1.33 had the best predictive value for female voiding LUTD with a high negative predictive value (97.4 %). In addition, significantly higher IPSS storage subscore (IPSS-S) values were found in the OAB wet subgroup, and the IPSS-S was well correlated with the OABSS and IUSS. Conclusions: The IPSS can be used to evaluate female LUTD. IPSS-V/S may provide an initial guide for the treatment of voiding dysfunction in women. In addition, IPSS-S may be used for evaluating storage LUTD in women. [ABSTRACT FROM AUTHOR]

Cerebrovascular accident or stroke is a devastating neurologic event that can have both short and long term urologic complications. The purpose of this article is to provide an up-to-date review of the incidence and causes of voiding dysfunction after stroke, the evaluation of voiding dysfunction in patients after stroke, and the recommendations on the management of voiding dysfunction following stroke. The reported incidence of urinary incontinence varies from 28-79 % and the causes of urinary incontinence following stroke are multifactorial. Detrusor overactivity is predominant and detrusor underactivity is somewhat less prevalent. Urodynamic findings in patients with stroke vary depending upon timing of the study and associated comorbidities. Currently there are no large longitudinal studies linking urodynamic findings with location or degree of infarct. Based on current studies, we conclude that patients with detrusor underactivity should be managed with clean intermittent catheterization or indwelling Foley catheter, while timed voiding with or without anticholinergic therapy may be an effective treatment for patients with detrusor overactivity after stroke. [ABSTRACT FROM AUTHOR]

The majority of women with pelvic organ prolapse and stress urinary incontinence report more than one symptom that affects urinary, bowel, or sexual function. Most research studies on outcomes following surgery for pelvic organ prolapse and stress incontinence focus on anatomic outcomes and relief of symptoms specific to prolapse and/or stress incontinence. Pelvic symptoms related to voiding function such as de novo urgency or incontinence, bowel function, and sexual function are clinically important outcomes but are infrequently reported. Deterioration of pelvic symptoms postoperatively is associated with decreased patient satisfaction, which underscores the importance of effectively assessing functional and anatomic treatment outcomes. Future studies of reconstructive pelvic surgery should routinely include multiple domain functional outcomes specifically addressing voiding, defecatory, and sexual function. [ABSTRACT FROM AUTHOR]

Neurogenic bladder encompasses many conditions that affect the bladder in patients with neurologic disease. Although there is no standard definition for neurogenic bladder, for the intent and purpose of this review, it is defined as any pathologic process affecting the central and/or peripheral nervous systems that results in urine storage or emptying dysfunction. It often presents clinically as varying degrees of urinary incontinence and/or retention but can present with urinary tract infections, urinary tract stones, or upper urinary tract deterioration. It is up to the clinician to identify wherein the problem lies-is it an outlet problem, bladder problem, or both? What is affected: storage, emptying, or both? These factors should be considered together to identify patients who may benefit from surgical intervention. This review focuses on patient evaluation and surgical interventions for adult patients with neurogenic bladder. Surgical interventions for problems with emptying due to detrusor external sphincter dyssynergia include surgical external sphincterotomy, chemical external sphincterotomy, urethral stent, and sphincter dilation. For detrusor underactivity, detrusor myoplasty and neuromodulation are discussed. For neurogenic detrusor overactivity and impaired compliance and capacity, botulinum toxin injection, sacral neuromodulation, and patch enterocystoplasty are discussed. For decreased compliance/capacity, detrusorotomy is also discussed. For combined problems, urinary diversions are also discussed. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: This is a prospective randomized controlled trial of cough versus no cough test in the tension-free vaginal tape (TVT) procedure to determine its effect upon voiding dysfunction and 12-month efficacy. Methods: The trial was conducted in a single tertiary urogynecology unit. Women ≥21 years old with primary urodynamic stress incontinence without voiding dysfunction were considered eligible. Participants were randomized to undergo the TVT procedure using either an intraoperative cough test or using no intraoperative cough test. Our hypothesis was that postoperative voiding dysfunction would be more common in the 'no cough test' arm. The primary outcome was proportion of patients successfully completing a trial of void (TOV) within 24 h of catheter removal. Efficacy at 12 months comprised the secondary outcome. Participants were randomized using a computer-generated randomization sequence by an independent party who was not the operating surgeon. Due to the nature of the intervention to be tested, neither the patients nor the operating surgeons were blinded to the randomization process during the procedure. Results: This trial is reported according to the recommendations of the 2010 CONSORT statement. In total, 94 women were recruited over a 4-year study period. Of these, 92 women were randomized (47 in the 'cough' group and 45 in the 'no cough' group). In one case, the TVT procedure was abandoned intraoperatively, leaving 91 women who underwent analysis. There was no significant difference in the proportion of women with a successful TOV within 24 h between the two arms (79% in the 'cough' group versus 71% in the 'no cough' group; p = 0.47). Efficacy data at 12 months were not significantly different between groups. Conclusion: Our data suggest that the performance of the intraoperative cough test during the TVT procedure does not reduce the incidence of postoperative voiding dysfunction (as determined by successful TOV within 24 h) nor affect efficacy. The removal of the cough test from the standard TVT technique may be appropriate. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Iatrogenic female urethral obstruction resulting from sling operations may be related to surgical inexperience and must be better understood. Although there are no widely recognized parameters for this type of study, a single-surgeon consecutive series offers an opportunity to study the role of expertise in sling operations over time. Methods: This study consecutively examined 176 women who underwent an autologous fascial sling procedure. Postoperative urethral obstruction was identified by the occurrence of voiding dysfunctions. Clinically obstructed patients were invited to undergo a postoperative urodynamic evaluation after 3 months. To enable comparison, patients were placed into 6-month groups according to the time of surgery. Results: A total of 159 cases were evaluated with a mean follow-up time of 32.4 ± 13.4 months. Stress continence was cured in 97.5% of cases. Although 29 patients were identified as obstructed, only 20 underwent a postoperative urodynamic evaluation. Only five of the clinically obstructed cases showed a high P Q. All of the other cases met one or more of the non-classic parameters linked to obstruction. Overactive bladder was present in 14 (63.6%) of the obstructed cases. Iatrogenic urethral obstruction was more common among the early cases (30.4%) than among the later ones (5%) ( P < 0.001). Postoperative urodynamic evaluation showed a trend toward obstruction on pressure flow studies. Conclusions: Autologous fascial sling operations require expertise and involve a clear surgical learning curve. Iatrogenic obstruction in females does not fit a single model and may be difficult to recognize. Obstruction in females must be identified through clinical indicators and postoperative urinary complaints rather than the high detrusor pressure observed in men. Furthermore, iatrogenic female obstruction can probably be minimized but not eliminated. [ABSTRACT FROM AUTHOR]

Urinary incontinence and other voiding dysfunctions are common sequelae post CVA (cerebrovascualar accident). Urinary incontinence declines over time; however, other voiding issues appear. Voiding dysfunctions not only have a significant impact on a person's quality of life and mortality, but also impact the person's caregiver. Urodynamic studies are important to help further understand, develop and direct bladder management. However, studies evaluating urodynamic findings in those with urinary incontinence shortly after CVA (within 3 months) are limited. While uninhibited contractions are the most common urodynamic finding in post-CVA incontinence, a number of men and women have other urodynamic findings causing incontinence. The type, onset, resolution and urodynamics of post-CVA symptoms other than urinary incontinence are rarely discussed. A literature review emphasizes that further research is needed not only in the evaluation of the most effective bladder management strategies for urinary incontinence, but also in the area of post stroke voiding dysfunction as a whole. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Urinary retention after radical laparoscopic surgery for severe endometriosis is a clinically relevant complication. We hypothesized a relationship between the amount of resected nerves and the occurrence of urinary retention. Methods: We evaluated, retrospectively, a cohort of 221 patients. The expression of nerves in the resected specimens was investigated in patients with urinary retention and matched controls using standardized immunohistochemistry techniques. Results: The prevalence of urinary retention was 4.6% ( n = 10). Importantly, there was no difference between cases and controls regarding the quantity of nerves in the resected specimens. The cumulative probability of 50% to overcome urinary retention was reached after 5.6 months. Age was the main risk factor for persistent retention (40.3 years with vs. 31.6 years without, p = 0.01). Conclusions: In older endometriosis patients, surgical radicality should be balanced against preservation of organ function. There is a fairly good chance to recover, even after 6 months, which is important for patient counseling. [ABSTRACT FROM AUTHOR]

With diabetes mellitus (DM) reaching epidemic proportions, the identification of voiding dysfunction as a common and burdensome complication of this disease is critical. Research into diabetic voiding dysfunction significantly lags behind other complications of DM, such as retinopathy and nephropathy. Recent studies have revealed that DM predisposes patients to a wide range of lower urinary tract dysfunction, from the classic diabetic cystopathy of incomplete emptying to urgency incontinence. In this review, we discuss the current concepts of diabetic voiding dysfunction with a critical analysis of the available evidence. [ABSTRACT FROM AUTHOR]

Voiding dysfunction in the female patient significantly affects the patient's quality of life. The condition is poorly understood, has varied etiology and clinical presentation, and lacks standard definitions with no consensus on diagnostic criteria. It consists of a constellation of symptoms involving both phases of the micturition cycle. Appropriate diagnosis and treatment of female lower urinary tract symptoms (LUTS) is of paramount importance. However, the differentiation of female LUTS into various syndromes is currently controversial. This article comprehensively reviews the commonly encountered female non-neurogenic LUTS (overactive bladder, interstitial cystitis, and painful bladder syndrome); discusses the contemporary management of these syndromes; and emphasizes a syndromic approach to the condition. [ABSTRACT FROM AUTHOR]

Abstract: Background: Wide variation exists in prevalence estimates of overactive bladder (OAB) syndrome. Objective: To determine how the frequency of urinary urgency or urgency urinary incontinence (UUI)—the cornerstone symptoms of OAB—affects symptom-related bother, health-related quality of life (HRQL), and ultimately clinically meaningful prevalence. Design, setting, and participants: Questionnaires were mailed to 6000 subjects (18–79 yr of age) randomly identified from the Finnish Population Register in 2003–2004. Measurements: The frequency (scale: never, rarely, often, always) and bother (scale: none, small, moderate, major) of urgency and UUI were assessed using the Danish Prostatic Symptom Score (DAN-PSS). HRQL was measured with the generic 15D instrument. For HRQL analyses, respondents were classified according to six symptom categories by frequency of urgency and UUI. Results and limitations: Of those subjects queried, 62.4% responded to the survey (53.7% female). Any urgency was reported by more than half of all respondents (54.2% [95% confidence interval (CI), 51.6–56.7] of men; 56.9% [95% CI, 52.9–61.0] of women), whereas any UUI was reported by one in nine men (10.7% [95% CI, 8.9–12.4]) and one in four women (25.7% [95% CI, 22.8–28.7]). However, only one in seven of all respondents with urgency and less than one in three with UUI reported at least moderate bother. With increasing OAB severity, statistically significant decreases were found in the total 15D score and on all 15D dimensions (p <0.001 for all). Reporting often urgency without UUI or rare urgency with rare UUI is associated with a clinically important decrease in HRQL. Although the response proportion was high, approximately one-third of those contacted did not participate. Conclusions: Increased severity of urgency and UUI is associated with a statistically significant and clinically important decrease in HRQL. Assessing bother associated with OAB drastically modifies the measured OAB prevalence and accounts for variation among studies. [Copyright &y& Elsevier]

Introduction and hypothesis: This study aims to test the hypothesis that a urethra-to-bladder inhibitory pathway exists through which periurethral neuromuscular electrical stimulation (NMES) inhibits overactive bladder contractions in rats. Methods: Bladder overactivity was induced in 22 female Sprague Dawley rats by injection of ketamine/xylazine/acepromizine (K/X/A). A bipolar electrode was placed surgically in the periurethral region to deliver NMES. Intravesical pressure, bladder inter-contraction interval (ICI) and voided volume (VV) were monitored while the bladder was continuously infused with saline. Results: K/X/A induced more frequent bladder contractions (ICI = 48.6 ± 20.1 s, before cutting the pubo-symphasis) compared to a 10-min ICI induced by urethane. NMES significantly increased ICI (63.1 ± 31.3 s before vs. 97.2 ± 42.9 s after NMES, p < 0.001) and VV (0.063 = 0.041 ml before vs. 0.088 = 0.044 ml after NMES, p < 0.02). Conclusions: Injection of K/X/A may potentially be used as a model of bladder overactivity. NMES inhibits bladder contractions in rats with bladder overactivity, which supports the existence of a urethra-to-bladder inhibitory pathway. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of this study was to determine the predictive value of urodynamics to reproduce clinical findings of urinary frequency (UF), urge urinary incontinence (UUI), and/or stress urinary incontinence (SUI). Methods: We retrospectively reviewed the data of patients diagnosed with UF, UUI, and/or SUI and subsequently underwent urodynamics. Urodynamic findings were correlated with clinical findings to determine the predictive value of urodynamics. Results: A total of 537 patients (366 females and 171 males) met study criteria. Two hundred seventy-eight patients had symptoms of UUI; 59% demonstrated detrusor overactivity on urodynamics. Three hundred eight patients had SUI on history and physical examination; 45% had urodynamic stress incontinence. A low maximum cystometric capacity (<200 ml) was not significantly associated with urinary frequency ( p = 0.4). Conclusions: Urodynamics has a low predictive value to reproduce clinical findings of UF, UUI, and/or SUI. Many patients with evidence of UF, UUI, and/or SUI on history and/or physical examination do not demonstrate supporting urodynamic evidence. [ABSTRACT FROM AUTHOR]