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GOAL The goal was to evaluate the results of sacral neuromodulation (SNM) in non-neurological vesical emptying disorders. PATIENTS AND METHODS From February 2010 to October 2017, 28 patients presenting voiding symptoms or a non-obstructive chronic urine retention without neurological cause have been operated for an SNM (test phase). The test was positive in case of decreased number of proper intermittent self-catheterization (SC) or post-voiding residual urine (PVR) of at least 50 %. A 100 % positive result meant the return to a spontaneous voiding without SC with a non-significative PVR (

Background: The ‘gold standard’ surgical treatment of clinically obstructive BPH is TURP, but life-threatening complications such as transurethral resection syndrome are occasionally observed. This has traditionally been provided as monopolar TURP, but morbidity associated with MTURP has led to the introduction of other surgical techniques. Objectives: To compare the effects of bipolar and monopolar TURP. Methods: In this prospective comparative study, 50 patients of each group undergo transurethral resection of prostate were enrolled and randomized to surgery by M‑TURP or B-TURP. International Prostate Symptom Score (IPSS), uroflowmetry, ultrasonography, prevoid, postvoid and international prostate symptom score (IPSS), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed. Results:No significant differences found in baseline characteristics or operative data, No differences found in IPSS, Qmax or PVRU volume. Conclusions:Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and Bipolar -TURP for the treatment of BPH. Accordingly, M-TURP continues to be a valid option for the treatment of BPE. Keywords: Transurethral resection of prostate, Monopolar, Bipolar.

OBJECTIVES The aim of this study was to critically evaluate distal extension of the midline urethral plate incision, extended tubularized incised plate (e-TIP) technique, with the standard TIP and investigating predictors of functional and cosmetic success. METHODS In a prospective study, consecutive patients with primary distal hypospadias presented for repair were randomized to undergo either extended TIP (e-TIP) or standard TIP (s-TIP) technique. Cosmetic outcome was evaluated postoperatively using Hypospadias-Objective-Penile-Evaluation (HOPE) score and measurement of ventral-glans-closure-length (VGCL) and meatal length (ML). Functional outcome was evaluated by maximal flow rate (Qmax), average flow rate (Qave), and postvoid residual urine (PVR). The effect of preoperative parameters on the outcome was assessed with regression analysis. RESULTS In all 94 cases, out of 110 randomized, were available for analysis. Forty-six in e-TIP group and 48 cases in s-TIP group with comparable preoperative demographics. Median (inter-quartile range) of postoperative total HOPE-score was 57(45-60) vs. 55(44-60) for e-TIP and s-TIP (p

Background Female urethral stricture (FUS) is an uncommon cause of lower urinary tract symptoms (LUTS) in women. Reconstructive techniques are being increasingly used for strictures resistant to the more conservative form of management. Most forms of reconstruction require cutting open of urethral meatus, thereby resulting in some loss of the meatus function. We hereby describe the technique of urethral meatus sparing ventral onlay mucosal graft augmentation urethroplasty with our initial experience. Methods We performed this procedure in 10 cases of FUS with normal meatus and prospectively studied the outcomes over a period of 6 months follow-up. Results There was 90 percent success rate with one recurrence. The mean Qmax increased from 7.2 to 19.5 ml/s, mean post-void residual urine (PVRU) decreased from 96.5 to 22.7 ml and the mean IPSS decreased from 26.1 to 5.7. There were no major complications noted and the patients demonstrated significant subjective and objective improvement of symptoms in the follow-up period. Conclusion The technique of meatus sparing ventral onlay augmentation graft urethroplasty is a promising approach with good outcomes, is reproducible and has minimal complication rate.

Összefoglaló. Bevezetés: A prosztatarák kezelésében jelentős szerepet kapnak a különböző sugárterápiás eljárások. Ennek ellenére a vizelési képességre gyakorolt, rövid és hosszú távú mellékhatásaikat objektív vizsgálómódszerrel igen kevés tanulmányban vizsgálták. Célkitűzés: Arra a kérdésre kerestük a választ, hogy hogyan változik a korai vizelési képesség a különböző sugárterápiás eljárások során. Módszerek: A vizsgálatunkban meghatározott protokoll szerint a kezelés előtt minden bevont beteggel IPSS-t (nemzetközi prosztatatünet-értékelő lap) töltettünk ki, illetve uroflow (vizeletáramlási) vizsgálatot végeztünk, suprapubicus ultrahanggal meghatározott mictiós residuum méréssel kiegészítve. A sugárkezelés befejezésétől számított 4–6 héten belül ismételten elvégeztük ezeket a vizsgálatokat, melyekbe összesen 26 beteget vontunk be. A kezelési modalitások szerint 6, kis dózisteljesítményű (low-dose rate; LDR) brachytherapiában, 5, nagy dózisteljesítményű (high-dose rate; HDR) brachytherapiában, 12, Cyberknife (CK) készüléken extrém hipofrakcionált sugárkezelésben és 3, lineáris gyorsítón (LINAC) mérsékelten hipofrakcionált sugárkezelésben részesített prosztatarákos beteget választottunk be. A kezelések hasonlósága miatt az LDR- és a HDR-csoportot együttesen brachytherapiás csoportként (BTCS), a CK- és a LINAC-csoportot teleterápiás csoportként (TTCS) vizsgáltuk. Eredmények: A BTCS betegeinél az IPSS- és az uroflow paraméterek korai romlása (IPSS irritatív panaszok: p = 0,003, IPSS obstruktív panaszok: p = 0,011, maximális áramlás: p = 0,003, átlagos áramlás: p = 0,006) szignifikánsnak bizonyult, a TTCS-ban mindösszesen az IPSS irritatív tünetekben volt kimutatható eltérés (p = 0,011). Következtetés: A sugárterápiás modalitás kiválasztása előtt javasolható az uroflow és az IPSS-vizsgálat elvégzése. Eredményeink alapján azoknál a betegeknél, akiknél a kezelés előtt középsúlyos vagy súlyos dysuriás vizelési panaszok állnak fenn, a brachytherapia helyett teleterápiás módszerek alkalmazását javasoljuk, amelyek kevésbé rontják a betegek korai vizeletürítési képességét. Orv Hetil. 2021; 162(33): 1328–1334. Summary. Introduction: Various radiotherapy procedures are applied in the treatment of prostate cancer. Nevertheless, their early and late side effects measured by uroflow and residual volume measurements have not been studied extensively. Objective: We investigated by objective methods the early changes of urination ability after different radiotherapy procedures. Methods: According to the protocol defined in our study, all patients had their IPSS (international prostate symptom score) determined, as well as their uroflow examinations and measurements of their residual urine via suprapubic ultrasound, carried out before treatment. These tests were then repeated at 4–6 weeks after the end of their radiotherapy. A total of 26 patients were included in the study. 6 patients were treated with low-dose rate (LDR) brachytherapy and 5 patients with high-dose rate (HDR) brachytherapy, 12 patients with Cyberknife (CK) using extreme hypofractionation and 3 patients with moderately hypofractionated radiotherapy with a linear accelerator (LINAC). Due to the similarity of the treatments, the LDR and HDR groups together were also studied as brachytherapy group and the CK and LINAC patients as teletherapy group. Results: We found that the early deterioration of IPSS and uroflow parameters after brachytherapy were significant (IPSS irritative symptoms: p = 0.003, IPSS obstructive symptoms: p = 0.011, maximum flow: p = 0.003, mean flow: p = 0.006), while in teletherapy only the IPSS irritative symptoms worsened significantly (p = 0.011). Conclusion: Based on our results, we suggest to perform uroflow examination and IPSS test before selecting therapeutic modality for patients with prostate cancer. In patients with moderate or severe urinary complaints before the treatment, we recommend to use teletherapy rather than brachytherapy. Orv Hetil. 2021; 162(33): 1328–1334.

Introduction Urine collection from incontinent individuals can be challenging. Various methods have been devised to collect the sample without catheterization. Recently the PureWick external catheter was developed to draw the sample gently away from external female genitalia. While the primary purpose of the device is to prevent moisture and maintain skin integrity, the urine that is collected may be sent for laboratory analysis. We sought to validate the use of this collection method for common urine chemistry assays and urinalysis. Methods Twenty pools of residual urine samples were separated into “control” and “PureWick” treated samples. The control samples were maintained at room temperature while 15 mL of urine was added to the PureWick device which was connected to a vacuum line through a collection canister. The urine collected in the canister and the controls samples were all subject to urine chemistry strip, microscopic, and automated urine chemistry analysis. Results were compared between pairs of treated and control samples. Results No clear affect was noted on urine strip semi-quantitative or automated chemistry analysis from the PureWick collection. There was a statistically significant decrease in microscopic measurements of white blood cells and crystals in the PureWick urine samples. Discussion This study supports the use of the PureWick external catheter for collection of samples for most urinalysis and urine chemistry tests.

Background This study aimed to explore the application of CO2 lattice laser in the treatment of mild and moderate urinary incontinence in female patients. Methods We analyzed the clinical data of 33 female patients with mild to moderate urinary incontinence from a prospective cohort study, who were treated with FemiLift CO2 lattice laser instrument (Alma Laser Ltd, Caesarea, Israel) at our hospital from January 2018 to December 2018. All the female patients were married and fertile, with a mean age of (43.15±6.49) years old (35-62 years old). There were 18 participants with mild urinary incontinence and 15 with moderate urinary incontinence. All participants received laser treatment 3 times, with an interval of 30 days. The International Consultation of Incontinence Questionnaire- Short Form (ICIQ-SF) survey was conducted before the treatment, 3 months after, and 6 months after the treatment. A 1-hour urine pad test was used to quantify the leakage of urine. Residual urine and urine routine examination were performed to exclude other combined diseases. Results After 3 times of treatment with FemiLift CO2 laser, 13 cases were cured in 3 months, and 16 cases were cured in 6 months. 10 cases and 15 cases were significantly improved in 3 or 6 months, respectively. 2 patients had no significant changes, and no adverse reactions were recorded. The pad test showed that the symptom of all 33 patients were significantly improved, and the average scores of ICIQ-SF were significantly decreased (P

Introduction Mid-urethral sling (MUS) surgeries have revolutionized the management of stress urinary incontinence (SUI). However, MUS is a delicate balance of tension on the mid urethral segment with a 12 % risk of failure to achieve complete continence; and up-to 20 % chance of post-operative voiding dysfunction. We propose a simple technical modification in which the long ends of the tape at suprapubic or groin area are not cut immediately and are covered with a sterile dressing. After 48−72 h post-surgery the patient is checked for continence and voiding difficulties. Following this an ultrasonographic assessment of post-void residual urine is performed. Keeping in mind these 3 criteria the tape is adjusted. After complete subjective as well as objective satisfaction the long ends of tape are cut. Material and methods This is a retrospective analysis of women who underwent MUS surgery for the management of SUI, with our simple technical modification of tape adjustment in the postoperative period. A total of 17 patients operated by single surgeon in one year were included. Results Our results show that 58.8 % of our patients who underwent MUS procedures required post-operative tape adjustment. The number was significantly higher in the MUS – Retropubic group (85.7 %) as compared to the MUS – Obturator group (40 %). Three patients in the MUS – Retropubic group required a second time tape adjustment. Following tape adjustment all patients had complete continence (subjective and objective), with no voiding dysfunction. Conclusion The incidence of postoperative voiding dysfunction is significant following MUS surgery for SUI. A simple technical modification of delaying the cutting of the tape for two to three days gives the opportunity for perfect tension adjustment.

We conducted the present study to assess the correlation of the prostatic anatomical parameters, especially the ratio of peripheral zone thickness and transitional zone thickness, with clinical and uroflowmetry characteristics suggestive of benign prostate hyperplasia (BPH). A total of 468 consecutive patients with a detailed medical history were identified. All patients were evaluated by scoring subjective symptoms with the International Prostate Symptom Score (IPSS) and quality of life (QoL). The prostatic anatomical parameters were measured using transrectal ultrasonography, and postvoid residual urine and maximum flow rate (Qmax) values were also determined. Pearson's correlation analysis revealed that both total prostate volume (TPV; r = 0.160, P < 0.001) and transitional zone volume (TZV; r = 0.104, P = 0.016) increased with patients' age; however, no correlations were observed of TPV, TZV, transitional zone index (TZI), and transitional zone thickness (TZT) with IPSS or QoL (all P > 0.05). Peripheral to transitional zone index (PTI) was found negatively correlated with total IPSS (r = −0.113, P = 0.024), storage IPSS (r = −0.103, P = 0.041), and voiding IPSS (r = −0.123, P = 0.014). As regards the uroflowmetry characteristics, PTI (r = 0.157, P = 0.007) was indicated to be positively correlated with Qmax and negatively correlated with TZI (r = −0.119, P = 0.042) and TZT (r = −0.118, P = 0.045), but not correlated with TPV, TZV, or peripheral zone thickness (PZT) (all P > 0.05). Postvoid residual urine (PVR) had not correlated with all the prostatic anatomical variables (all P > 0.05). This is the first study that formally proposed the concept of PTI, which is an easy-to-measure prostate anatomical parameter which significantly correlates with total IPSS, storage IPSS, voiding IPSS, and Qmax, suggesting that PTI would be useful in evaluating and managing men with lower urinary tract symptoms (LUTS)/BPH. However, well-designed studies are mandatory to verify the clinical utility of PTI.

OBJECTIVE: To analyze the association between patient history profile, conventional urodynamic variables, and specific types of urinary incontinence (UI) in order to establish the role of urodynamic in differentiating various types of UI in women. MATERIAL AND METHODS: This cross-sectional study enrolled 547 women with UI. All patients were divided into three groups according to the UI type based on questionnaires: stress UI (SUI), mixed UI (MixUI), and urgent UI (UUI). Patient history taking, physical examination, and conventional urodynamics were performed. The association between patient profile characteristics, urodynamic data, and type of UI were assessed using one-way analysis of variance and chi-square tests. RESULTS: Significant correlations were observed between the age, body mass index (BMI), cystocele, menopausal status, and most urodynamic data in at least one UI group (p

Supplemental Digital Content is available in the text., Purpose: The purpose of this retrospective study was to compare the surgical, urinary, and survival outcomes between nerve-sparing radical hysterectomy (NSRH) and traditional radical hysterectomy (TRH) for stage IB cervical cancer, in which all the primary procedures were performed by a single physician. Methods: Patients with cervical cancer of International Federation of Gynecology and Obstetrics (FIGO) stage IB were included if they received radical hysterectomy of class III or type C in 1 center between February 2001 and November 2015. The epidemiological, clinicopathologic, surgical, and urinary data were collected and compared between the NSRH and TRH groups. The follow-up period ended in December 2016. Results: A total of 406 patients were identified, including 111 (27.3%) in the TRH group and 295 (72.7%) in the NSRH group. Most epidemiological and clinicopathologic characteristics were balanced between the 2 groups. The NSRH and TRH groups had similar mean operating times and comparable short-term postoperative complications, but NSRH had less mean estimated blood loss and a shorter mean postoperative stay (all P

A 44-year-old woman visited a hospital with microscopic hematuria in June 2009. Computed tomography showed a large bladder diverticulum at right lateral wall and urachal remnant. Cystoscopic examination showed a large diverticulum at the right lateral wall that closes to the dome. She was followed up closely without therapeutic intervention; however, the residual urine increased gradually and frequent bladder diverticulitis developed. She underwent laparoscopic bladder diverticulectomy and excision of the urachal remnant simultaneously without any complications in August 2017. Laparoscopic approach for a large bladder diverticulum and urachal remnant is useful with safe, effective, and minimally invasive.

Background/aims Sacral neuromodulation (SNM) is a well-established treatment in several urinary and bowel dysfunctions, nevertheless its role on sexual dysfunction remains unclear. We evaluate the impact of SNM on sexual function and its association with age at SNM, functional diagnosis and post-void residual urine (PVR) before SNM. Methods Patients who had SNM were retrospectively analyzed. Sexual function was assessed before and after treatment with the International Index of Erectile Function (IIEF-5) for men and the Female Sexual Function Index (FSFI) for women. IIEF-5 and FSFI were also associated with age at SNM, functional diagnosis, and PVR. Results Fifteen females and 9 males, with a median age of 41 years (26-72 years), median follow-up 20.7 months (2-53 months) were enrolled. IIEF-5 improved in 4 patients (p = 0.06), and FSFI total score in 5 (p = 0.2). There was significant association between functional diagnosis and FSFI total score (p = 0.05), and FSFI specific domains of arousal (p = 0.03), lubrication (p = 0.04), and satisfaction (p = 0.03), with significant improvement showed in patients with detrusor overactivity with impaired contractility. Conclusion Although gains observed in IIEF-5 and FSFI were modest, our preliminary results show that SNM may have favorable impact on sexual function.

Little data exist about the impact of dissection methods on bladder function during nerve-sparing radical hysterectomy (NSRH). This randomized controlled trial compared the urodynamic and survival outcomes of different methods dissecting the inferior hypogastric plexus (IHP) during laparoscopic NSRH. Eligible patients presenting with stage IB cervical cancer from 9 May 2013 to 27 October 2015 were randomized at a ratio of 1:1 and subjected to waterjet (study group) or traditional blunt (control group) dissection of the IHP for laparoscopic type C radical hysterectomy. Participants were subjected to urodynamic evaluations before and after NSRH. The primary measurement was the proportion of patients with residual urine (RU) ≤ 100 ml, while secondary measurements included urodynamic parameters, disease-free survival (DFS), and overall survival (OS). In total, 191 women met the inclusion criteria, and 160 patients were included in the final analysis, with 80 randomized to each group. At 14 days after NSRH, the study group had more patients with RU ≤ 100 ml than the control group (82.5% vs. 62.5%, p = 0.005). The study group had similar urodynamic outcomes of preoperative and postoperative tests. Comparison with the study group and preoperative tests revealed the control group had significant bladder function impairment at 4 months after NSRH. After a median follow-up of 33 months, the dissection methods had no significant impact on DFS or OS. Waterjet dissection of the IHP in laparoscopic NSRH resulted in a more rapid return of normal urodynamics without compromising survival outcome. ClinicalTrials.gov Identifiers NCT03015376 (PUMCH-OBGYN-2013), NCT03291236 (SOCM-1).

Case Urethral prolapse (UP) is a rare condition with unknown etiology. We reported on an 86-year-old woman with a normal BMI and cystocele, presented with acute urinary retention and perineal pain. A residual urine of 950 mL was measured and released by an indwelling catheter. The physical examination revealed 2 × 3 cm severely sore and purple polyp around the urethral meatus with signs of necrosis. A diagnosis of a strangulated urethral prolapse was stated. Outcome The patient was admitted to the Department of Urology, and treated with surgical excision using the four-quadrant excisional technique. The histopathological examination revealed a non-keratinized, inflammatory squamous epithelium. At a follow-up visit, the patient remained asymptomatic and a complete anatomical resolution was achieved. Conclusion UP is an uncommon, sometimes misdiagnosed condition. The management is controversial and to date no consensus exists. This clinical picture is sufficient for diagnosis and surgical excision of the prolapsed urethral mucosa is reasonable if there are signs of strangulation.

Clinical assessment and urodynamic studies (UDS) remain the gold standard for the diagnosis of lower urinary tract dysfunction (LUTD) but it is important to recognize the potential and emerging role of noninvasive diagnostic, prognostic, and predictive biomarkers in this field. In particular, imaging provides direct information about the morphological and functional anatomy of the lower urinary tract (LUT), allowing a better understanding of the pathophysiology of LUTD. Ultrasound (US) is the first-choice imaging modality in the diagnostic workup of men and women with lower urinary tract symptoms due to its cost-effectiveness, lack of radiation exposure, noninvasiveness, and wide availability. Different ultrasound approaches are available such as transabdominal (TAUS), transperineal (TPUS), transvaginal (TVUS), and transrectal (TRUS) ultrasound. Due to the differences in the anatomy of LUT in males and females, resulting in different pathological disorders and clinical presentations, and to the different ultrasound approaches available in the two genders, the diagnostic US assessment of LUTD in men and women will be discussed separately. TAUS represents the first-line approach in both sexes and it provides a primary assessment of post-void residual urine (PVR) and bladder wall thickness (BWT). TPUS is the recommended approach in women for an optimal evaluation of urethral status (mobility and funneling) and pelvic organ prolapse. In men, TAUS and TRUS are used to assess prostate size and morphology and biomarkers that evaluate both these parameters are preferred, such as presumed circle area ratio (PCAR), intravesical prostatic protrusion (IPP) and prostatic urethral angle (PUA). The aim of this chapter is to provide practical information on the use of imaging, primarily US, in the diagnosis of LUTD.

Objective: Our study aimed to the efficacy of silodosin in patients with LUTS associated with BPH who were not-responder to previous ARs blocker therapy. Methods: Patients who did not benefit from alpha blockers treatment, but did not want surgical treatment are included in this study. At enrollment, 75 patients and 75 patients were assigned to group 1 and group 2, respectively. Group 1 received silodosin 8 mg, group 2 received their previous α blocker. Results: Although, in group 1 mean IPSS score at baseline was 20,81±0,97, and it significantly decreased to 17,12±1,25 at third months, in group 2 no significant changes were observed. On the other hand in group 1 a decrease was also observed for both IPSS sub score was significantly reduced at third months, when it is compared with baseline. At the end of the third month, a significant improvement in this parameter was observed after switching to silodosin, as compared with first value (p< 0,05). As to the residual urine, significant improvement was observed in the silodosin group but no significant improvement was observed in group 2. Conclusion: This study was conducted to investigate the effectiveness and safety of silodosin in patients with BPH who had not achieved satisfactory symptom control with other α blockers in routine clinical practice before surgical treatment. Thus, at least patients who have different comorbidities will be protected from morbidities of surgery.

OBJECTIVE: Surgical treatment for female urethral stricture is varied and lacks consensus. Dorsal and ventral approaches of urethroplasty have comparable success rate with debatable limitations. We describe modifications in dorsal onlay graft urethroplasty to mitigate the surgical limitations and improve functional outcomes. MATERIAL AND METHODS: We retrospectively analyzed 8 patients with strictures treated with dorsal onlay urethroplasty at our center. The inclusion criteria were American Urology Association (AUA) score >20, calibration 24 cmH(2)O, and urethroscopic visualization of the stricture. Surgical modifications included dorsal plane dissection away from the clitoris; limited lateral urethral dissection; omitting graft quilting onto the clitoris, and urethral slitting directly at the stricture site (for mid and proximal strictures), sparing the meatus and using canoe-shaped grafts for distal strictures. Success was defined as improvement in the AUA scores and Qmax >12 mL/s, without requiring any further intervention. RESULTS: The mean age was 50.5±10.6 years. Statistically significant improvements in mean AUA score [14.5±2.20 (p=0.012)], Qmax [23.63±2.44 (p=0.012)], post-void residual urine [107.88±40.37 (p=0.012)], and sexual function scores [6.833±2.23 (p=0.027)] were noted at a mean follow-up of 3 months. Distal strictures were more common. Mean urethral caliber was 9.62 Fr. No cases of de novo incontinence or sexual dissatisfaction were reported. CONCLUSION: In our experience, the dorsal onlay technique works well, but without a comparative evidence for ventral onlay, it is difficult to conclude that one is preferred over the other.

Introduction Bladder hernia is relatively rare in cases of inguinal hernia. In some instances, bladder hernia may be treated as inguinal hernia if bladder prolapse is not recognized. Because of the rarity of inguinal bladder hernias, there are no related detailed reports from studies performed at a single institution. In our hospital, patients with suspected inguinal hernia undergo CT in the prone position, enabling the diagnosis of bladder hernia preoperatively. This study aimed to clarify the clinical characteristics of inguinal bladder hernias and consider noteworthy points in their laparoscopic treatment. Methods This retrospective analysis included data from 32 consecutive patients with bladder hernia in 1126 patients with inguinal hernia. In each patient, the lengths of the hernial orifice and prolapsed bladder were measured on the CT images and intraoperatively. Totally extraperitoneal (TEP) repair was performed in all patients, who were then followed for 1 year postoperatively. Results Inguinal bladder hernia was detected on CT in 32 of 1126 patients (2.8%). Among them, only five (15.6%) had urological symptoms such as pollakiuria or the sensation of residual urine. The 32 patients were classified into three groups according to hernia subtype: intraperitoneal (n = 12, 37.5%), para-peritoneal (n = 15, 46.9%), and extraperitoneal (n = 5, 15.6%). The prolapsed bladder of the extraperitoneal type was significantly shorter than that of the other subtypes. The prolapsed bladders were directly identified in the extraperitoneal space and repaired safely with TEP. One recurrence (3.1%) occurred 2 months postoperatively. Conclusion Preoperative CT and TEP are useful for the definitive diagnosis and treatment of inguinal bladder hernia.

The opioid crisis has led many providers to inquire about the capabilities of urine drug testing (UDT) to detect contemporary compounds such as fentanyl and fentanyl analogs (FAs). However, current methods for clinical UDT, including immunoassays and targeted liquid chromatography tandem mass spectrometry, are not designed to broadly screen for the variety of FAs that may be encountered. In this proof-of-principle study, we developed a precursor ion scan (PIS) method to enable semi-targeted data acquisition for structurally related FAs. Based on the knowledge that many analogs fragment to m/z = 188 and m/z = 105, data were acquired on all precursor ions of 250–400 Da that fragmented to these product ions. Using a tandem mass spectrometer, we analyzed 102 residual urine specimens, in which we identified fentanyl, acetylfentanyl and acrylfentanyl. In 30 contrived urine samples, the PIS was also able to identify furanylfentanyl, butyrylfentanyl, 4-fluoroisobutyrylfentanyl and despropionylfentanyl with accuracy ranging from 83% to 100%.

Objective: To compare standard urotherapy with a combination of urotherapy and biofeedback sessions and to determine the changes that these therapies promote in children with dysfunctional voiding. Patients and Methods: The data of 45 patients who participated in the study from January 2010 to March 2013 were evaluated. All patients underwent urinary system ultrasonography to determine post-void residual urine volumes and urinary system anomalies. All patients were diagnosed using uroflowmetry - electromyography (EMG). The flow pattern, maximum flow rate, and urethral sphincter activity were evaluated in all patients using uroflowmetry - EMG. Each patient underwent standard urotherapy, and the results were recorded. Subsequently, biofeedback sessions were added for all patients, and the changes in the results were recorded and statistically compared. Results: A total of forty - five patients were included, of which 34 were female and 11 were male and the average age of the patients was 8.4 ± 2.44 years (range: 5 - 15 years). After the standard urotherapy plus biofeedback sessions, the post-void residual urine volumes, incontinence rates and infection rates of patients were significantly lower than those with the standard urotherapy (p < 0.05). A statistically significant improvement in voiding symptoms was observed after the addition of biofeedback sessions to the standard urotherapy compared with the standard urotherapy alone (p < 0.05). Conclusions: Our study showed that a combination of urotherapy and biofeedback was more effective in decreasing urinary incontinence rates, infection rates and post - void residual urine volumes in children with dysfunctional voiding than standard urotherapy alone, and it also showed that this combination therapy corrected voiding patterns significantly and objectively.

Purpose: Lower urinary tract symptoms (LUTS) are correlated with erectile dysfunction (ED), but research on whether post-micturition dribble (PMD) is related to ED is limited. We assessed the correlation between PMD and ED in middle-aged and older Korean men with LUTS. Materials and Methods: In our prospective, cross-sectional, observational, multicenter study, we enrolled 205 men (age >40 years) with LUTS. LUTS and ED were assessed using the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5), respectively. PMD was assessed using the Hallym PostMicturition Dribble Questionnaire, Question 1, and the PMD volume was calculated in a paper test. Age, prostate volume, serum prostate-specific antigen, maximum urinary flow rate, and postvoid residual urine were also evaluated. Results: There were significant differences in the total and voiding IPSS between men with and without ED (p=0.042 and 0.043, respectively). The Hallym PostMicturition Dribble Questionnaire 1 score was inversely well correlated with the IIEF-5 score (r=-0.388, p

Women who conceive while receiving peritoneal dialysis (PD) are at a high risk of encountering maternal and fetal complications. Although the occurrence of successful pregnancies in women with end-stage renal disease undergoing PD is becoming more common with advancing dialysis technology, women in this population must be monitored by a team of dedicated renal physicians and obstetric teams to ensure the best maternal and fetal outcomes are achieved. Given the haemodynamic advantages of PD over haemodialysis in pregnancy, PD therapy is the favoured renal replacement option in pregnant women with end-stage renal disease. This is particularly true when PD is initiated after conception or if pregnancy occurs within 1 year of starting PD. The management of anaemia, hypertension, dry weight adjustment, and dialysis regimen in a pregnant PD patient will undergo continuous adjustment to maintain haemodynamic and physiologic stability to meet the demands of the pregnancy-associated changes. In this article, the incidence and management of fetal and maternal complications and pregnancy outcomes in women receiving PD are reviewed based on the latest literature available.

Objective To determine if urodynamic findings other than high-pressure voiding influence the decision to perform a transurethral resection of prostate (TURP). Methods Four clinical scenarios were created featuring a healthy 65-year-old man. An electronic survey was distributed to members of the International Continence Society and the Society for Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. Results Eighty-six urologists responded (median age was 45-54 years, 62% described their practice as academic). Scenario 1: an incidental residual urine >1 L with detrusor underactivity. The majority (76%) would offer a TURP; however, the estimated chance that the residual volume would improve was only 57%. Scenario 2: retention with detrusor overactivity but no voluntary voiding contraction. The majority (72%) would offer a TURP; however, the average chance quoted that he would void was only 48%. Scenario 3: catheter-dependent retention and an underactive detrusor. The majority (89%) would offer a TURP; however, the average chance quoted that he would void was only 53%. Scenario 4: a man with only frequency and urgency, but urodynamic bladder outlet obstruction. The majority (90%) would offer him a TURP; however, the average chance that his frequency and urgency would improve was only 64%, and the average estimated postoperative risk of urgency incontinence was 33%. Willingness to offer TURP did not correlate with physician characteristics. Conclusion Urodynamic findings other than bladder outlet obstruction were associated with modest perceived outcomes after TURP; however, despite this, urologists are still willing to offer this intervention.

Introduction Lower urinary tract symptoms secondary to increased prostate volume are associated with aging and are becoming more prevalent due to increased life expectancy. We present our experience with transperitoneal laparoscopic adenomectomy for the management of bladder outlet obstruction caused by benign prostatic enlargement. Materials and methods We performed a retrospective review of patients who underwent laparoscopic adenomectomy between 2005 and 2015. We recorded age, maximum flow and postvoid residual urine (preoperative and postoperative), surgical time, operative bleeding, weight and pathology, complications and duration of catheterisation and hospitalization. Results We included 80 patients with a mean age of 70 years. The mean preoperative and postoperative Qmax was 8.21 mL/s and 22.52 mL/s, respectively. The mean preoperative and postoperative postvoid residual urine was 91.4 mL and 14.2 mL, respectively. The mean surgical time was 137.7 min. Conversion to open surgery was necessary in one case due to intestinal injury. The mean intraoperative bleeding was 227.6 mL. The mean hospital stay was 5.46 days, and the catheterisation time was 4.86 days. There were 13 complications, which were recorded according to the Clavien-Dindo system, 3 of which were severe. The mean weight of the surgical specimen was 80.02 g. Pathology showed benign hyperplasia in 75 cases and prostate cancer in the remaining 5. Conclusion Laparoscopic adenomectomy is a safe, reproducible technique with the same functional results as open surgery. Our series shows that this approach is useful and safe and has a low rate of complications.

Objective To investigate if the use of therapeutic agents for dysuria is a risk factor for the primary recurrence of non-muscle invasive bladder cancer (NMIBC). Methods First, patients with NMIBC were divided into two groups: the non-recurrence group and the recurrence group. Patient characteristics were compared between both groups. The risk factors of recurrence that were statistically different between the two groups were identified by multivariate analysis. Second, we divided the patients into risk and non-risk groups, and differences in the recurrence-free survival (RFS) between the two groups were analyzed before and after propensity score matching (PSM). Results A total of 162 patients were included, with 84 patients in the non-recurrence group and 78 patients in the recurrence group. In the multivariate analysis, the intake of dysuria agents and bacillus Calmette–Guérin (BCG) therapy were independent factors. The RFS results in terms of the intake of dysuria agents were statistically significant before and after PSM analysis, but no factors were significantly different between the BCG and non-BCG groups after PSM. Conclusions Therapeutic agents for dysuria might be at an independent risk factor for NMIBC recurrence. This trial is registered with the UMIN Clinical Trials Registry under the number UMIN000036097 ( https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno = R000041122 ).