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Introduction: We aim to compare the clinical and urodynamic profile of lower urinary tract symptoms (LUTS) in patients undergoing laparoscopic, open transabdominal, and laparoscopic transabdominal vesicovaginal fistulae (VVF) repair at 3 months of repair, that is, in early postoperative period. Materials and Methods: Fifty‐one consecutive patients with endoscopically confirmed VVF were enrolled in our study over 2 years. Malignant fistulae, radiation‐induced, and complex fistulae were excluded after cross‐sectional imaging. All patients underwent a postoperative assessment for the success of the repair. Then at 3 months, they completed the American Urological Association Symptom Score questionnaire and underwent a dual channel pressure‐flow urodynamic study. The results of transvaginal, laparoscopic, and open transabdominal repairs were compared. Results: All patients belonged to the Indian Caucasian race. The mean age was 35.43 ± 6.63 years. Thirty‐two patients had supratrigonal and 19 had trigonal fistulae. Laparoscopic transabdominal repair was done in 15 patients, open transabdominal repair in 22 patients, and transvaginal repair in 14 patients. Forty‐six patients reported some LUTS at a median follow‐up of 5.83 ± 2.37 months postoperatively. Only 18 (35.2%) of these patients had moderate to severe symptoms The postoperative bladder dysfunction rates in open transabdominal, transvaginal and laparoscopic transabdominal groups were 36.4%, 28.6%, and 20%, respectively. Twenty‐seven patients (52.9%) had some urodynamic abnormality, that is, small capacity (5), high voiding pressures (14), genuine stress incontinence (3), and poor compliance (3). Bladder capacity was a significant predictor of bladder dysfunction in our patients. Conclusions: In our study, all three surgical approaches were associated with bladder dysfunction, however, it was the least in the laparoscopic transabdominal approach. Postoperative bladder capacity is a significant predictor of bladder dysfunction. [ABSTRACT FROM AUTHOR]

Background and Aims: The aim of our study is to evaluate the possible urodynamic effect of prostatic urethral lift (PUL) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Methods: A consecutive series of patients undergoing PUL placement were consecutively enrolled in two centers. Inclusion criteria: ≥50 years of age, benign prostatic obstruction (BPO), international prostate symptom score (IPSS) ≥ 13, prostate volume ≤ 60 mL, and no middle prostate lobe. All patients were evaluated using a detailed clinical history, a validated questionnaire, flexible cystoscopy, and pressure flow studies (PFS) at baseline. PFS were performed at 6 months to evaluate the urodynamic effect of PUL. Results: Overall, 20 patients with a median age of 63 were enrolled. At six months, statistically significant improvements in terms of median Qmax (11.5 vs. 8.5; p < 0.05) and median IPSS (16 vs. 10.5; p < 0.05) were recorded, and sexual function was maintained. All urodynamic parameters improved at 6 months, and significance was reached for all values except for PdetQmax. Finally, Schäfer's class improved from a median of III to a median of II. More specifically, 16/20 presented an improvement in the Schäfer class, and 12/20 patients presented a BOOI < 20 at 6 months. Conclusions: PUL represents an effective treatment in patients with LUTS due to BPH and improves bladder outlet obstruction without any effect on sexual function. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effect of urethral catheterization on the accuracy of EMG uroflowmetry in children with non-neurogenic voiding disorders during pressure-flow (PF) studies compared to the non-invasive EMG uroflowmetry test. Methods: A retrospective study of children undergoing a urodynamic evaluation at our institution between 8/2018 and 7/2022 was employed. Urination curves and pelvic floor muscle activity were compared between PF studies and non-invasive EMG uroflowmetry test. The non-invasive test was selected as the standard benchmark. Results: 104 children were tested, with 34 children (33%) being able to urinate only in a non-invasive EMG uroflowmetry. The percentage of boys unable to urinate with a catheter was significantly higher than girls (54% vs. 13%, p-value < 0.001). In 70 children, a normal bell-shaped urination curve was found in 13 compared to 33 children in the PF studies and non-invasive uroflowmetry, respectively. PF studies demonstrated a specificity of 39% (95% CI 23–57) and a positive predictive value (PPV) of 61% (95% CI 53–67) in finding non-bell-shaped curves. Relaxation of pelvic muscles was found in 21 (30%) as opposed to 39 (55%) of children in invasive and non-invasive EMG uroflowmetry, respectively (p-value = 0.5). Conclusion: The accuracy of PF studies in children, primarily in boys, compared to the non-invasive uroflowmetry, was poor. This may pose potential errors in diagnosis and subsequent treatment. We recommend completing a non-invasive EMG uroflowmetry in cases where the child refused to urinate, or pathology was found, requiring a modification in treatment. [ABSTRACT FROM AUTHOR]

Background: During urodynamic testing (UT), patients may experience emotions such as embarrassment, discomfort, irritability, and tension, which can cause anxiety. Aromatherapy is a complementary and alternative treatment that may be employed in clinical settings to alleviate patients' anxiety before invasive procedures. Objectives: The aim of this study was to determine the effect of aromatherapy on patients' anxiety and cortisol levels during UT. Materials and Methods: The sample of this single‐center, prospective, two‐armed, randomized controlled clinical study consisted of 98 patients undergoing UT. Patients were randomly assigned to the intervention group (n = 49) and the control group (n = 49). The anxiety level was assessed using the state‐trait anxiety inventory (STAI), and measured with physiological responses to anxiety, such as changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), and cortisol levels, pre and post‐UT. Aromatherapy was applied to the intervention group starting 5 min before UT and continuing throughout the testing. The control group received routine treatment and care. Data were analyzed using Pearson's χ2, dependent samples t‐tests, and independent samples t‐tests. Results: In the study, post‐UT anxiety in the intervention group was significantly lower than in the control group (p < 0.001), while SpO2 was higher (p = 0.021). In the study group, post‐UT anxiety (p < 0.001), HR (p = 0.000), and cortisol levels (p = 0.005) decreased compared to pre‐UT, whereas in the control group, anxiety (p < 0.001) and HR (p = 0.000) decreased, and SBP (p = 0.010) and RR (p = 0.004) increased. Conclusions: Aromatherapy during UT positively influenced both the psychological and physiological responses to anxiety. [ABSTRACT FROM AUTHOR]

Abstract Objectives To evaluate the effect of urethral catheterization on the accuracy of EMG uroflowmetry in children with non-neurogenic voiding disorders during pressure-flow (PF) studies compared to the non-invasive EMG uroflowmetry test. Methods A retrospective study of children undergoing a urodynamic evaluation at our institution between 8/2018 and 7/2022 was employed. Urination curves and pelvic floor muscle activity were compared between PF studies and non-invasive EMG uroflowmetry test. The non-invasive test was selected as the standard benchmark. Results 104 children were tested, with 34 children (33%) being able to urinate only in a non-invasive EMG uroflowmetry. The percentage of boys unable to urinate with a catheter was significantly higher than girls (54% vs. 13%, p-value

Background and Aims: The aim of our study is to evaluate the possible urodynamic effect of prostatic urethral lift (PUL) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Methods: A consecutive series of patients undergoing PUL placement were consecutively enrolled in two centers. Inclusion criteria: ≥50 years of age, benign prostatic obstruction (BPO), international prostate symptom score (IPSS) ≥ 13, prostate volume ≤ 60 mL, and no middle prostate lobe. All patients were evaluated using a detailed clinical history, a validated questionnaire, flexible cystoscopy, and pressure flow studies (PFS) at baseline. PFS were performed at 6 months to evaluate the urodynamic effect of PUL. Results: Overall, 20 patients with a median age of 63 were enrolled. At six months, statistically significant improvements in terms of median Qmax (11.5 vs. 8.5; p < 0.05) and median IPSS (16 vs. 10.5; p < 0.05) were recorded, and sexual function was maintained. All urodynamic parameters improved at 6 months, and significance was reached for all values except for PdetQmax. Finally, Schäfer’s class improved from a median of III to a median of II. More specifically, 16/20 presented an improvement in the Schäfer class, and 12/20 patients presented a BOOI < 20 at 6 months. Conclusions: PUL represents an effective treatment in patients with LUTS due to BPH and improves bladder outlet obstruction without any effect on sexual function.

OBJECTIVE: To probe into the improvement effects of Buzhong Yiqi decoction combined with biofeedback electrical stimulation on mild to moderate stress urinary incontinence in middle-aged and elderly women. METHODS: A total of 132 middle-aged and elderly women with mild to moderate stress urinary incontinence admitted into the hospital from May 2021 to Mar. 2023 were divided into control group and combination group via random number table method, with 66 cases in each group. The control group was treated with mild to moderate stress urinary incontinence, the combination group was given Buzhong Yiqi decoction based on the control group. After 8 weeks of continuous treatment, the clinical efficacy, the scores of incontinence questionnaire short form ( ICI-Q-SF) and incontinence quality of life scale ( I-QOL ), results of 1h urine pad test, urodynamic indicators and surface myoelectricity of pelvic floor muscle before and after treatment were compared between two groups, and the incidences of adverse drug reactions were recorded. RESULTS: The total effective rate of the combination group was 95. 45% (63 / 66), higher than 80. 30% (53 / 66) of the control group, with statistically significant difference ( P < 0. 05). After treatment, the ICI-Q-SF scores, volumes and frequencies of urine leakage with 1 h, residual urine volumes, muscle voltages in pre-resting stage and post-resting stage of both groups were lower than those before treatment; the I-QOL score, bladder compliance, maximum urinary flow rate and maximum urethral closure pressure, muscle voltages in fast muscle (type Ⅱ muscle fibers) stage and slow muscle (type Ⅰ muscle fibers) stage of both groups were higher than those before treatment, with statistically significant differences (P<0. 05). After treatment, the ICI-Q-SF score, 1 h volumes and frequencies of urine leakage, residual urine volumes, muscle voltages in pre-resting stage and post-resting stage of the combination group were lower than those of the control group; the I-QOL score, bladder compliance, maximum urinary flow rate and maximum urethral closure pressure, muscle voltages in fast muscle (type Ⅱ muscle fibers) stage and slow muscle (type Ⅰ muscle fibers) stage of the combination group were higher than those of the control group, with statistically significant differences (P<0. 05). No adverse drug reactions occurred in either group during treatment. CONCLUSIONS: For middle-aged and elderly female patients with mild to moderate stress urinary incontinence, the treatment effects of Buzhong Yiqi decoction combined with biofeedback electrical stimulation is significant, which can improve patients’ incontinence status, quality of life, urodynamic parameters and pelvic floor muscle function, with good safety. [ABSTRACT FROM AUTHOR]

Introduction To investigate the role of trans-labial ultrasound study in detection of female urethral stenosis (FUS) compared to former cysto-urethroscopy as the currently available definitive diagnostic modality. Material and methods In this cross-sectional study, 60 consecutive patients with bladder outlet obstruction diagnosed by clinical symptoms and urodynamic study, were included from 2019 to 2022. For additional assessment, all these patients underwent gel-Infused trans-labial ultrasound (GITLUS) and cystourethroscopy. Trans-labial real-time ultrasonography was performed following the insertion of 20 ml steady stream viscous jelly into the urethral meatus to assess the length of the urethra and exact location and length of the probable narrowing, as well as the presence of peri-urethral fibrosis (PUF). Results In GITLUS evaluation, urethral stricture was found in 27 patients. Mean urethral length and stricture length were 35.63 ±4.78 and 17.04 ±10.59, respectively. All these stenosis were confirmed via cysto-urethroscopy. PUF was found in 20 of 27 patients. In cysto-urethroscopy, urethral stricture was confirmed in 40 patients: 13 in urethral meatus and 27 in other parts or pan-urethra. GITLUS could not reveal urethral stricture in 13 patients with meatal stenosis, confirmed with cystoscopy. GITLUS detected FUS less accurately when it involves pure distal urethra compared to other parts of urethra or pan-urethral stenosis (p value = 0.002). Conclusions GITLUS is a safe, non-invasive, and valuable technique for detecting FUS. The location and the length of the stricture and probable peri-urethral fibrosis can be identified by this method. However, in meatal or pure short-length distal urethral strictures, this method should be used with caution. [ABSTRACT FROM AUTHOR]

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Objective: To analyze the static and dynamic urodynamic parameters of reservoirs and continent conduits in continent cutaneous urinary diversion with catheterizable stoma. Materials and methods: 76 patients had augmented ileocystoplasty or continent urinary diversion with catheterizable urinary stoma based on Mitrofanoff principle and Yang-Monti procedure using subserous tunnel as continence mechanism. They were followed up for at least 6 months post-operatively for continence through stoma and divided into two groups (continents vs non-continent) according to stomal continence. Both groups had urodynamic assessment performed via the stoma to assess reservoir capacity, pressure and contractions, efferent limb functional length, reservoir overactivity, static and dynamic maximal closure pressures and leak point pressure. Results: Continence rate was 87%. Continent group included 66 patients and incontinent group included 10 patients. In both groups at rest, the reservoir pressure after filling did not exceed 25 cm H2O. During peristaltic contraction, the pressure did not exceed 30 cm H2O and the duct remained continent. After Valsalva maneuver, the reservoir pressure increased up to 34 (+ 7.4) cm H2O and leakage occur in 10 patients (13%). Reservoir (wall) overactivity was recorded in 54 patients, with insignificant rise in intraluminal pressure during the contractions. In both groups, the efferent tract closing pressure was always higher than the reservoir pressure. The mean of maximal closing pressure at Valsalva was 82.5 (+ 4.18) cm H2O in the continent group and 61.66 (+ 8.16) cm H2O in the incontinent group. The mean functional length of the conduit was 4.95 + 1.62 in the continent group and 2.80 + 1.50 cm in the incontinent group. Conclusions: Urodynamic evaluation of continent catheterizable cutaneous stoma after Yang-Monti procedure has a practical significance. Functional length of the conduit seems to be the most influential factor for continence reflecting static & dynamic maximal closure pressure. Higher conduit closing pressure is associated with better continence. Contractions of the pouch and peristaltic contraction of the conduit has no effect on continence mechanism.

Objective. To study the relationship between clinical and radiation variants of myelopathy and types of the neurogenic dysfunction of the lower urinary tract in patients with infectious spondylitis. Material and Methods. A single-center cohort observational study was conducted with the analysis of medical records and a prospective examination of 20 patients with infectious spondylitis complicated by neurogenic dysfunction of the lower urinary tract. Results. Infectious spondylitis can be complicated by the development of various urodynamic disorders, including neurogenic detrusor hyperactivity (30 %), its combination with detrusor-sphincter dissinergia (30 %) and a decrease in detrusor contractility (40 %). In 50 % of patients, an urodynamic examination revealed an increase in detrusor pressure of more than 40 cm water. There was no connection between the development of any type of lower urinary tract dysfunction and MRI types of myelopathy according to Vendatam, as well as between the level of spinal cord compression and the severity of neurological disorders according to AIS. Conclusion. The results of the study do not confirm the existence of a relationship between the various characteristics of myelopathy in infectious spondylitis and the results of urodynamic examination. The limitation of the reliability of the results is the small number of observations. Studies with a larger sample are required to assess the relationship between the clinical and radiation characteristics of myelopathy and variants of neurogenic dysfunction of the lower urinary tract in patients with infectious spondylitis.

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

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

Abstract Background Multiple sclerosis (MS) is the most frequent autoimmune neurological disease in the young population. Vesico-sphincter disorders are frequent in the course of the disease; it has been reported that 90% of MS patients will develop a lower urinary tract disorder within 18 years of the diagnosis. Methods The aim of this study is to identify the frequency, severity, diagnosis, and treatment of overactive bladder (OAB) in MS patients at the Mohammed VI hospital university in Oujda-Morocco. It is a cross-sectional study. The population was collected in neurology department of Mohammed VI hospital university in Oujda-Morocco. The population cohort consisted of patients diagnosed with multiple sclerosis, which were invited to the urology department where they underwent urinary screening and completed a form of questions regarding the frequency and severity of OAB and its influence on quality of life. Result In our study, the mean age of the patients was 43 years, and our sample was composed of 48% males and 52% females, and the most frequent lower urinary tract symptom was urgency (57%), followed by urinary frequency (29%) and urge incontinence (14%). The recurrent-remittent form was the most frequent (62%), followed by the primary progressive form (24%) and the secondary progressive recurrent form (14%). Among the patients, 33% presented a mild symptomatology, 48% moderate, and 19% severe. In this study, it was found that the intensity of urinary symptoms and the MS disability score were positively correlated with quality of life and disease duration. Conclusion The urgency was the major symptom of the lower urinary tract, and the MS disability score and the severity of OAB were associated with the quality of life of the patients. The urological evaluation of patients with multiple sclerosis should be performed routinely to identify OAB and to treat this condition appropriately.

Objective: Several single-incision mini-slings (SIMSs) have been developed to minimize the potential complications associated with retropubic or transobturator mid-urethral slings. However, few studies compared the efficacy of different types of SIMS. This study compared the outcomes of an adjustable SIMS (Ajust) with a nonadjustable SIMS (Solyx) in the treatment of urodynamic stress incontinence (USI) over postoperative follow-up of 12 months. Materials and methods: In this study, the surgical outcomes of the first 30 patients receiving Ajust and the first 30 patients undergoing Solyx at a university hospital were reviewed retrospectively, all of whom were diagnosed with USI without coexistent pelvic organ prolapse. Preoperative and postoperative examinations included structured urogynecological questionnaires, 1-hour pad tests, and complete urodynamic testing. Patient demographics, urodynamic parameters, and 12-months surgical outcomes were compared between the Ajust and Solyx groups. Results: There were no significant differences between the Ajust and Solyx groups in terms of subjective cure rate (93.3% vs 90.0%), objective cure rate (89.3% vs 89.3%), and de novo urgency or urge urinary incontinence (13.3% vs 16.7%) 12 months after surgery. Postoperatively, both Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7 scores were significantly improved in the Ajust and Solyx groups. In comparison with preoperative data, postoperative urodynamic results revealed a significant decrease in maximal urethral closure pressure in the Ajust group (n = 28) and a significant increase in residual urine in the Solyx group (n = 28). However, significant differences were not observed in the postoperative pad test and urodynamic data between the Ajust and Solyx groups, and no major complications occurred in either group. Conclusions: In this paper describing the preliminary experience of 30 patients, both adjustable and nonadjustable SIMS performed by an experienced surgeon were safe and effective in correcting USI at 12-month postoperative follow-up.

Purpose: Neurogenic bladder associated with spina bifida disease remains a major cause for mortality or morbidity due to kidney damages. However, we currently do not know which urodynamic findings are associated with an higher risk of upper tract damages in spina bifida patients. The objective of the present study was to evaluate urodynamic findings associated with functional kidney failure and/or with morphological kidney damages. Methods: A large single-center restrospective study was conducted in our national referral center for spina bifida patients using our patients' files. All urodynamics curves were assessed by the same examinator. Functional and/or morphological evaluation of the upper urinary tract were done at the same moment as the urodynamic exam (between 1 week before and 1 month after). Kidney function was assessed using creatinine serum levels or 24 h urinary creatinine levels (creatinine clearance) for walking patients, or with the 24 h urinary creatinine level for wheelchair‐users. Results: We included 262 spina bifida patients in this study. Fifty-five patients had a poor bladder compliance (21.4%) and 88 of them had detrusor overactivity (33.6%). Twenty patients had a stage 2 kidney failure (eGFR < 60 ml/min) and 81 patients out of 254 (30.9%) had an abnormal morphological examination. There were three urodynamic findings significantly associated with UUTD: bladder compliance (OR = 0.18; p = 0.007), Pdetmax (OR = 14.7; p = 0.003) and detrusor overactivity (OR = 1.84; p = 0.03). Conclusion: In this large series of spina bifida patients, maximum detrusor pressure and bladder compliance are the main urodynamic findings determinants of UUTD risk. [ABSTRACT FROM AUTHOR]

Straining to void is the need to make a muscular effort in order to initiate, maintain or improve the urinary stream, through an increase in abdominal pressure. This pattern of bladder emptying is frequently observed in women with pelvic organ prolapse causing urinary obstruction, to overcome the increased resistance to urine flow. However, frequent increases in abdominal pressure are a risk factor for developing pelvic organ prolapse, and might play a role in its recurrence after surgery. The aim of this study was to investigate the role of straining identified at urodynamic study in prolapse recurrence after surgical repair. This was a retrospective study on women submitted to prolapse repair by vaginal hysterectomy with modified McCall culdoplasty and anterior colporraphy. All patients underwent a preoperative urodynamic evaluation including a pressure-flow study performed after prolapse reduction by means of a vaginal pessary; straining was defined by a simultaneous and similar increase in intravesical and abdominal pressures of at least 10 cmH 2 O over the baseline during bladder emptying, corresponding to intermittent peaks of urine flow. Patients were divided into two groups according to the presence or absence of straining, and they were compared for surgical results at 12 months and for the rate of anterior or central recurrence over time. Women with straining (n = 16), compared to women with normal voiding (n = 43), showed a higher risk of anterior recurrence over time at Kaplan-Meier curves, for both stage II (p = 0.02) and stage III prolapse (p = 0.02). No difference was seen for central recurrence during the follow up period. POP-Q staging at 12 months was similar for the two groups, except for the location of the Aa point which was significantly better for women without straining (−1.6 ± 0.1 cm vs −0.8 ± 0.3 cm, p = 0.03). Straining to void identified in preoperative urodynamic study seems to increase the risk of anterior recurrence after surgical repair of pelvic organ prolapse. [ABSTRACT FROM AUTHOR]

Purpose:  The urodynamic study is an invasive test, and causes pain and stress in the patient. We have investigated the effect of rectal midazolam sedation on the pain, stress, and cooperation of women performing urodynamic study.  Materials and Methods: At the present randomized clinical trial (RCT) from January to July of 2021 a total of 84 women were prospectively randomized to undergo urodynamic study with or without sedation. The primary outcome of interest was experienced pain during urodynamic study. In the intervention group, after monitoring baseline vital signs (heart rate, blood pressure, O2 saturation), sedation was done with rectal midazolam at a dose of 0.3 mg/kg (maximum 15 mg). Completing the procedure, after recovery from sedation patients were asked to fill a self-assessed visual analog pain scale (VAS, 0-10), 5-point visual stress scale (1-5) and, patient collaboration level during urodynamic study was evaluated by nurse with a researcher-made tool (0-3). In the control group test was performed in routine practice with no sedation. Baseline vital signs measured pre and intra-procedural time, as well as their experienced pain, stress, and cooperation levels were recorded.  Results: 84 female cases were evaluated. In terms of comparison of changes in pre and intra-test physiologic parameters, results showed that there were no significant differences between the two groups for all physiologic parameters: SBP, DBP, PR, SpO2. Analysis of the pain score showed that it was lower in the intervention group, and there was a significant difference in pain score between the two groups (P =.024). While the stress and corporation scores were not reported statistically significant (P=.388 and P=.955, respectively).Conclusion:   Sedation with rectal midazolam in adult women before UDS is safe and effective in reducing pain but is not effective in reducing stress and increasing cooperation. The amount of pain based on the visual analog pain scale is mild and although this method is safe, its use routinely is not recommended. [ABSTRACT FROM AUTHOR]

Objective: To report the current clinical features, treatment patterns and outcomes of female patients who were seen at a tertiary referral centre with a primary diagnosis of nocturia, and to assess the predictive factors of therapeutic management failure. Patients and methods: A retrospective chart review of all new female patients seen in a single-centre functional urology practice with the diagnosis of nocturia was performed. Up to three visits within a 12-month period from the time of presenting were reviewed. The primary endpoint was patient-reported improvement assessed at each follow-up visit and the change in the number of nocturia episodes. Results: In all, 239 female patients were included for analysis. The prevalence of nocturnal polyuria, reduced bladder capacity, and global polyuria were 75%, 40.2%, and 18.1%, respectively. Within the first two visits, 72.7% of patients had started a treatment beyond behavioural therapies. Anticholinergics were the most commonly initiated treatment (47.2% of patients). At the latest considered visit, 80 patients reported improvement in nocturia (45.5%) and there was a mean - 0.8 decrease in the number of nocturia episodes from 4 to 3.2, which was statistically significant (P

Background: Detrusor underactivity (DU) is a frequent clinical issue that is poorly understood. Both the diagnosis and the course of treatment are challenging and unpredictable. In men, DU and bladder outlet obstruction (BOO) frequently coexist. Prostatic surgery may enhance voiding efficiency (VE). Aim: To improve the outcome of transurethral resection of the prostate (TURP) by selecting Benign Prostatic Hyperplasia (BPH) patient with significant post-voiding residual urine who could benefit from surgery and could void normally after TURP. Patients and Methods: This is a clinical trial - single arm study included 24 male patients above 50 years old with BPH and significant postvoiding residual urine who underwent TURP. Urodynamic predictors were assessed. Results: There was significant difference between patients with good and poor outcomes regarding IPSS pre-operatively, Qmax, postvoid residual (PVR), Voiding Efficiency and BCI Conclusion: The success rate of prostatectomy was 83.3% and about 16.7% had poor outcomes. Patients with higher BCI had good prognosis. [ABSTRACT FROM AUTHOR]

Purpose To present the outcomes of revascularized pyeloureterocystoplasty with ureterocele unroofing in end stage bladder patients with duplex system and ureterocele. Methods Thirteen patients with obstruction of intrauterine outlet from an ectopic obstructive ureterocele were included. Fourteen units of duplex systems underwent upper pole partial nephrectomy in conjunction with augmentation revascularized pyeloureterocystoplaty and ureterocele unroofing. The anterior and lateral walls of the ureterocele were excised before cystoplasty, and the resultant edges of the posterior wall were sutured to the bladder epithelium. Anastomosis of the upper pole vein and artery to the inferior iliac artery and the common iliac vein was performed. Detubularization of the whole ureter was performed with exception of the intramural ureteric part that kept tubularized for ‘jet/turbulent’ occurrence. Five patients (control group) underwent pyeloureterocystoplasty without revascularization. Patients underwent several evaluations in long-term follow-up. Results Patients were all dry by day and night in our long-term follow-up. Urinary incontinence improved in patients with no need for re-augmentation technique. Vesicoureteral reflux subsided in all patients postoperatively except one, who was asymptomatic. After five years, median bladder capacity rose from 128.5 ml to 395 ml and bladder compliance showed significant improvement from 15 ml/cm H2O to 29 ml/cm H2O, in experimental group and remained stable for 24–36 months. Median bladder capacity did not rise significantly in control group. Conclusion Pyeloureterocystoplasty is an efficient choice in this type of patients, which may prevent the recurrence of hypocompliant bladders and prevent ischemia and subsequent fibrosis.

Posterior Urethral Valves (PUV) are the most common cause of lower urinary tract obstruction. More severe forms are detected early in pregnancy (mainly type I), while other forms are usually discovered later in childhood when investigating lower urinary tract symptoms. Bladder dysfunction is common and is associated with urinary incontinence in about 55% (0%–72%). Despite the removal of the obstruction by urethral valve ablation, pathological changes of the urinary tract can occur with progressive bladder dysfunction, which can cause deterioration of the upper urinary tract as well. For this reason, all children with PUV require long-term follow-up, always until puberty, and in many cases life-long. Therefore, management of PUV is not only limited to obstruction relief, but prevention and treatment of bladder dysfunction, based on urodynamic observations, is paramount. During time, urodynamic patterns may change from detrusor overactivity to decreased compliance/small capacity bladder, to myogenic failure (valve bladder). In the past, an aggressive surgical approach was performed in all patients, and valve resection was considered an emergency procedure. With the development of fetal surgery, vesico-amniotic shunting has been performed as well. Due to improvements of prenatal ultrasound, the presence of PUV is usually already suspected during pregnancy, and subsequent treatment should be performed in high-volume centers, with a multidisciplinary, more conservative approach. This is considered to be more effective and safer. Primary valve ablation is performed after clinical stability and is no longer considered an emergency procedure after birth. During childhood, a multidisciplinary approach (pediatric urologist, nephrologist, urotherapist) is recommended as well in all patients, to improve toilet training, using an advanced urotherapy program with medical treatments and urodynamic evaluations. The aim of this paper is to present our single center experience over 30 years.

Background: Multiple sclerosis (MS) is a recurrent, autoimmune, and inflammatory demyelinating chronic disease that typically manifests in young adulthood and exerts adverse effects on sexual functions., Aim: The study evaluated the prevalence of sexual dysfunctions (SDs) and the relationship with neurological disability, depression, and lower urinary tract symptoms (LUTS) in a cohort of MS female patients, comparing these results with those of healthy women., Methods: From January 2023 to January 2024, consecutive premenopausal female patients with MS, were recruited and the examination included urinalysis, ultrasonography and a urodynamic test according to the International Continence Society standard., Outcomes: Descriptive statistics were reported as mean and standard deviation for continuous variables (analyzed by independent samples Mann-Whitney U test and independent samples Kruskal-Wallis test) while categorical variables were reported as frequency and percentage (analyzed by chi-square test with Fisher's exact test)., Results: Female Sexual Function Index (FSFI) total score and all FSFI subscales scores were significantly lower in patients with MS vs healthy control subjects ( P < .001); FSFI total scores and all FSFI subscale scores were statistically significantly lower in patients with MS with an International Prostate Symptom Score ≥20 ( P < .001) and considering a cutoff for Beck Depression Inventory-II score ≥17, depression was present in 61% (n = 47 of 77) of patients with MS and completely absent in the control group., Clinical Translation: The knowledge that SDs are a common problem in MS and in other chronic illnesses can alleviate the feeling of stigma and talking openly of sexual problems can be helpful for the patients and so the doctor-patient relationship can be reinforced., Strengths and Limitations: The sample was drawn from a single center, and larger multicenter studies that include both genders are needed to obtain strong results., Conclusion: Our findings confirm the idea of a polygenic and multifactorial etiology of female SDs in MS. Therefore, women with MS should be evaluated in terms of SDs during follow-ups., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society for Sexual Medicine.)

Background: To evaluate the pre-operative factors affecting clinical response to prostate surgery in men with benign prostatic hyperplasia (BPH). Materials and methods: In this prospective cohort study, 172 patients who underwent surgical intervention for BPH (either as open prostatectomy (n = 78) or monopolar-trans-urethral resection of prostate (n = 94) from February 2017 to October 2019 were consecutively enrolled. Pre-operative conventional three-lumen urodynamic study and transabdominal sonography were performed for all patients to determine peak flow rate (Qmax), detrusor pressure at the peak flow rate (PdetQmax), post-void residual volume (PVR), presence of detrusor overactivity (DO), prostate volume and median lobe size, and bladder wall thickness with empty and full bladder. Uroflowmetry and cystoscopy were performed during follow-up, whenever indicated. Successful surgical outcome was defined as subjective satisfaction of the patient and a Qmax of more than 15 ml/s on post-operative uroflowmetry. Results: At 1-year follow-up, complete resolution of lower urinary tract syndrome (LUTS) was detected in 138 (80.2%) patients; however, 21 (12.2%) still had pure obstructive LUTS, 9 (5.2%) had pure storage LUTS, and 4 (2.3%) were still suffering from both storage and obstructive LUTS. After performing multivariable analysis, shorter duration of pre-operative medical treatment and higher pre-operative bladder contractility index (BCI) were found to be independent predictors of successful surgery (p = 0.012 and p < 0.001, respectively). Results of the ROC curve analysis showed that a preoperative BCI level more than 90.95 and pre-surgical medical treatment duration less than 14.45 months have the most specificity and sensitivity to predict the success of surgical outcome. We also observed that the probability of recovery decreased considerably over time following surgery. Conclusion: Shorter duration of pre-operative medical treatment and increased pre-operative BCI can independently predict favorable outcome of BPH surgery. These factors could be used for better patient management and appropriate planning and consultation before BPH surgery. [ABSTRACT FROM AUTHOR]

Objective: To compare urodynamic changes before and after hysterectomy (laparoscopic vs. vaginal approach) for benign gynecological diseases. Patients and Methods: A total of 90 women with a mean age of 56.36-years were enrolled in this study between August 2019 and April 2021. They were divided into two equal groups (45 patients each). Group, I had a vaginal hysterectomy, and Group II had a laparoscopic hysterectomy. All patients were assessed clinically using ICIQ-FLUTS questionnaire and a urodynamic study before and six months after surgery. Results: Both vaginal and laparoscopic hysterectomy did not significantly change the maximum flow rate, voiding time, and average flow rate. The increase in residual urine volume in group I was not significant (p = 0.129), as was in Group II (p = 0.217). All the modifications, however, were within permissible limits. According to the cystometry result, volume at initial sensation rose in both groups after surgery, with no statistically significant difference (p = 0.364). After both forms of hysterectomy, maximum bladder capacity did not vary considerably. Preoperatively, all study participants exhibited no overactivity of the detrusor muscle; nevertheless, following surgery, overactivity was noted in 9 patients after vaginal hysterectomy compared to three patients after laparoscopic hysterectomy, and all the alterations were within a clinically acceptable range. In addition, the ICIQ-FLUTS score was not significantly different between the study groups. Conclusions: According to the urodynamic study, hysterectomy for benign uterine conditions, whether vaginal or laparoscopic, did not adversely affect urinary bladder function. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: To analyze the immunochemical and urodynamic outcomes after partial versus complete excision of transvaginal polypropylene mesh (PPM) from pelvic walls of rats. Methods: Forty-eight female Sprague-Dawley (SD) rats were randomly distributed into seven groups: control, mesh total removal 60 days (M-T 60D), mesh total removal 180 days (M-T 180D), mesh partial removal 60 days (M-H 60D), mesh partial removal 180 days (M-H 180D), sham 60 days (Sham 60D), and sham 180 days (Sham 180D). In the mesh groups, PPM was inserted and partially (0.3 × 0.3 cm) or completely removed 30 days later. In the Sham group, the space between the vagina and bladder was dissected without placing or removing the synthetic mesh at day 1 and day 30 later. Urodynamic studies, immunochemical analysis, and Western blot were done at days 60 and 180. Results: The M-T 60D voiding pressure was significantly decreased compared to the Sham 60D and M-H 60D. The voiding interval of M-T 60D was significantly shorter than that of M-H 60D. In the M-T 60D and M-T 180D groups, the leak point pressure was significantly less than in their corresponding sham groups. IL-1 and TNF-α were significantly more intense in M-T 60D compared to M-H 60D and Sham 60D. NGF was significantly greater in M-T 60D compared to Sham 60D. There were no significant differences in MMP-2 and CD-31s throughout the group. Conclusion: Total mesh excision incites a host inflammatory response and transitory lower urinary tract dysfunction. Despite the good outcomes after total excision, the invasiveness and surgical risk associated with repeated procedures should not be underestimateded. [ABSTRACT FROM AUTHOR]

Introduction: To assess the long-term effect of bladder augmentation surgery in patients with spina bifida and to identify risk factors for severe bladder dysfunction requiring bladder augmentation. Methods: A retrospective analysis was performed on 178 patients with spina bifida, 23 of them underwent bladder augmentation. Surgery outcome was evaluated according to urodynamic assessments at three follow-up time points per patient up to 120 months postoperatively. The results were compared to the preoperative situation and to the non-operated control group. Bladder function was evaluated using the modified Hostility score. To identify risk factors for bladder dysfunction requiring bladder augmentation, characteristics such as type of spina bifida, lesion level and therapy of bladder dysfunction were analyzed. Results: A high spinal lesion level is a risk factor for requiring bladder augmentation. In the BA group, significantly more thoracic lesions were found than NBA group, BA: 26.1%, NBA: 8.4% (p = 0.021). With bladder augmentation surgery, the modified Hostility score decreased from a preoperative median value of 4.3 ± 1.4 to 1.6 ± 1.0 at the third postoperative follow-up (FU3 = 61–120 months after surgery). In the reference group, the score of the last urological assessment was 2.0 ± 1.5. The age at which clean intermittent catheterization or anticholinergic medication started had no significant influence on the decision to perform bladder augmentation. Discussion/conclusion: Spina bifida patients with bladder augmentation had a significant improvement of the bladder function even at long-term follow-up. A high level of spinal lesion was a predisposing factor for requiring a bladder augmentation. [ABSTRACT FROM AUTHOR]

Background: The value and application of urodynamic evaluation (UDS) have been a controversial topic in recent years. Gaining robust data on the patient viewpoint in this area is important since, even when UDS findings do not change the management plan, the objective diagnostic information gained from UDS may be valued by patients. Moreover, insights from UDS may empower treating physicians to counsel patients more effectively and manage their expectations regarding treatment outcomes. Objective: This expert narrative review aims to analyze the findings of published studies in this area, looking at two topics in turn: (a) the tolerability and acceptability of the UDS procedure itself from the patient perspective and (b) patient perceptions of the clinical value of insights provided by UDS. Design, Setting, Participants, and Outcome Measurements: An evidence assessment was conducted using selected articles from the literature reporting data on patients' perspectives on the tolerability, acceptability, utility, and value of the urodynamic investigation. Results and Limitations: Although pain, discomfort, and infection risks are frequently used as a rationale to skip UDS when initial management fails, there is good evidence that, from the patients' perspective, the procedure is very well tolerated in most cases. There are only a few articles available that assess patient perceptions of the usefulness of UDS, but those that do exist appear to demonstrate that the insights gained from UDS are widely welcomed by patients in the interest of receiving a more tailored and personalized treatment approach. Conclusion: From the patient perspective, UDS appears to be a well‐accepted and well‐tolerated diagnostic tool in patients with lower urinary tract symptoms, particularly when an appropriate explanation is provided before the examination. Our review also highlights that patients value the objective information provided by UDS and that this outweighs the temporary invasiveness of the test. This information is particularly relevant in light of the relative lack of evidence in the literature about patient expectations of specialist care in functional urology, which may have hindered progress with quality of care. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine if the method of rebooking intravesical Botulinum neurotoxin A injections for treatment of detrusor overactivity causes treatment delays. The records of patients diagnosed with urodynamically proven detrusor overactivity treated with Botox® between March 2005 and October 2018 were included in a retrospective multicentre case series. Rebooking method was categorised into: (i) patient-initiated rebooking methods, (ii) doctor-initiated rebooking methods and (iii) automatic rebooking. Primary outcome was the proportion of patients with delay in reinjection >1 month after cessation of effect. A total of 336 patients were included in this study and results showed that 180/336 underwent a second and 122/180 a third cycle of Botulinum neurotoxin A. Patient- reported efficacy ranged from 73--84%, urinary tract infection rate was 8--11% per cycle and de novo urinary retention rate was 8.2--16.1% per cycle. The method of rebooking was patient-initiated in 45% (n=68) of cases and doctor-initiated in 55% (n=83) for the second injection. The rate of delay to retreatment was not clinically significant between the two groups at 33% and 37%, respectively. For those who progressed to a third cycle, the method of rebooking was automated in 11% (n=12) of patients and doctor- or patient-initiated rebooking in 89% (n=97). Automatic rebooking method resulted in a significantly lower rate of delay to injection (8% vs 44%, p=0.026). Significant delays occur in the reinjection of intravesical Botulinum neurotoxin A for detrusor overactivity. These delays can be reduced by utilising an automatic rebooking method once dose and duration of effect are established. [ABSTRACT FROM AUTHOR]

Abstract Objective To evaluate whether performing preoperative urodynamic study influences postoperative urinary symptoms of women with stress urinary incontinence that underwent transobturator sling. Methods Retrospective analysis of patients treated for stress urinary incontinence by transobturator sling from August 2011 to October 2018. Predictor variables included preoperative urodynamic study, age, incontinence severity, body mass index, preoperative storage symptoms and previous anti-urinary incontinence procedure. Outcome variables were postoperative subjective continence status, storage symptoms and complications. Logistic regression after propensity score was employed to compare outcomes between patients who underwent or not pre-operative urodynamic study. Results The present study included 88 patients with an average follow-up of 269 days. Most patients (n = 52; 59.1%) described storage symptoms other than stress urinary incontinence, and 38 patients (43.2%) underwent preoperative urodynamic studies. Logistic regression after propensity score did not reveal an association between urinary continence outcomes and performance of preoperative urodynamic study (odds ratio 0.57; confidence interval [CI]: 0.11-2.49). Among women that did not undergo urodynamic study, there was a subjective improvement in urinary incontinence in 92% of the cases versus 87% in those that underwent urodynamic study (p = 0.461). Furthermore, postoperative storage symptoms were similar between women who did not undergo urodynamic study and those who underwent urodynamic study, 13.2% versus 18.4%, respectively (p = 0.753). Conclusion Preoperative urodynamic study had no impact on urinary incontinence cure outcomes as well as on urinary storage symptoms after the transobturator sling in women with stress urinary incontinence.

This study aimed to investigate the ultrastructural characteristics of the bladder of patients with detrusor underactivity (DU) of various etiologies. Twenty-five patients with DU and control subjects underwent urodynamic testing and transmission electron microscopic examination of bladder specimens. The epithelium, lamina propria, and muscle layers were analyzed separately. The DU bladders exhibited total epithelial denudation (52%). In the bladders with remaining epithelium, apical cell uroplakins (44.4%) and tight junction complexes (77.8%) were also noted. The lamina propria was characterized by loose extracellular connective tissue (48%) and a lack of nerve terminals (76%). Smooth muscle shrinkage and a loss of their regular spindle shape (91.6%) were also noted in the detrusor layer. Patients with DU with intact epithelial cell layers had significantly larger void volumes and maximal flow rates than those with mild or severe epithelial denudation. Patients with remaining nerve terminals in lamina propria had a stronger first sensation of filling and smaller residual urine volume than those without nerve terminals. The proportion of ultrastructural defects of the bladder was not significantly different among patients with DU of various etiologies and treatment outcomes. DU bladders were characterized by ultrastructural defects in the entire bladder, and the defects were correlated to clinical parameters. [ABSTRACT FROM AUTHOR]

To present the outcomes of revascularized pyeloureterocystoplasty with ureterocele unroofing in end stage bladder patients with duplex system and ureterocele. Thirteen patients with obstruction of intrauterine outlet from an ectopic obstructive ureterocele were included. Fourteen units of duplex systems underwent upper pole partial nephrectomy in conjunction with augmentation revascularized pyeloureterocystoplaty and ureterocele unroofing. The anterior and lateral walls of the ureterocele were excised before cystoplasty, and the resultant edges of the posterior wall were sutured to the bladder epithelium. Anastomosis of the upper pole vein and artery to the inferior iliac artery and the common iliac vein was performed. Detubularization of the whole ureter was performed with exception of the intramural ureteric part that kept tubularized for 'jet/turbulent' occurrence. Five patients (control group) underwent pyeloureterocystoplasty without revascularization. Patients underwent several evaluations in long-term follow-up. Patients were all dry by day and night in our long-term follow-up. Urinary incontinence improved in patients with no need for re-augmentation technique. Vesicoureteral reflux subsided in all patients postoperatively except one, who was asymptomatic. After five years, median bladder capacity rose from 128.5 ml to 395 ml and bladder compliance showed significant improvement from 15 ml/cm H2O to 29 ml/cm H2O, in experimental group and remained stable for 24–36 months. Median bladder capacity did not rise significantly in control group. Pyeloureterocystoplasty is an efficient choice in this type of patients, which may prevent the recurrence of hypocompliant bladders and prevent ischemia and subsequent fibrosis. [ABSTRACT FROM AUTHOR]

ObjectiveTo review the current definitions, terminology, epidemiology and aetiology of detrusor underactivity (DU), with specific attention to the diagnostic criteria in use. In addition, we address the relation and the overlap between DU and bladder outlet obstruction (BOO). In this mini-review, we hope to help identify DU patients and facilitate structured clinical evaluation and research.MethodsWe searched the English literature using ScienceDirect and PubMed for relevant articles. We used the following terms: 'detrusor underactivity', 'underactive bladder', 'post voiding residual', 'post micturition residual', 'acontractile bladder', 'detrusor failure', and 'detrusor areflexia'.ResultDU is one of the most common conditions causing lower urinary tract symptoms (LUTS). Unfortunately, it is also the most poorly understood bladder dysfunction with scant research. To our knowledge there is no clear definition and no non-invasive method to characterise this important clinical condition. DU may result from the normal ageing process; however, it has multiple aetiologies including neurogenic and myogenic dysfunction. In many cases the symptoms of DU are similar to those of BOO and it usually requires invasive urodynamic study (UDS) for diagnosis to differentiate the two diagnoses. A number of diagnostic tests may be used including: UDS testing, the Schafer pressure/flow nomogram, linear passive urethral resistance relation, Watts factor, and the bladder contractility index. Of these, UDS testing is the most practical as it determines both the maximum urinary flow rate and the pressure exerted by the detrusor muscle relative to the maximal flow of urine, allowing for precise characterisation of detrusor function.ConclusionCurrently, the diagnosis of DU is based on invasive urodynamic parameters as defined by the International Continence Society in 2002. There is no consensus for the definition of DU prior to 2002. As there is significant overlap between the symptoms of DU and BOO, it is difficult to diagnose DU clinically.

Aims: Primary objective is to investigate whether prostatic urethral lift (PUL) results in an improvement of urodynamic parameters that define bladder outlet obstruction (urethral resistance algorithm [urethral resistance factor (URA)], Schäfer grade, detrusor pressure at maximum flow [PdetQmax], and detrusor pressure at bladder opening [PdetOpen]). Materials and Methods: Twenty patients (main inclusion criteria: ≥50 years of age, benign prostatic obstruction (BPO), international prostate symptom score (IPSS) ≥13, prostate volume ≤60 mL, and no middle prostate lobe) were enrolled in the study and a PUL was performed. Patients underwent urodynamic investigation and filled out the IPSS and quality of life (QoL) before and after PUL. A paired t-test was used to analyze the results. Results: The mean age was 68 years (range 55–79), mean prostate volume (TRUS) was 45 mL (range 20–59), and mean prostate-specific antigen was 2.0 μg/L (0.2–4.4). IPSS of the 16 patients reduced significantly (from 22.20 to 14.47, p = 0.000). Qmax during pressure flow study improved significantly (from 4.5 to 7.2 mL/s, p = 0.001), no significant difference was found in Qmax during free uroflowmetry. There was no significant difference found in postvoiding residual. URA decreased significantly post-treatment (from 52 to 37 cmH2O, p = 0.000). The Schäfer obstruction plot decreased significantly (from 3.5 to 2.6, p = 0.022). Seven patients underwent Greenlight Laser Vaporization of the prostate after the PUL attributable to unsatisfactory results. Conclusions: PUL has desobstructive effects, but they seem clinically modest. The procedure improves urodynamic parameters as well as QoL in males with lower urinary tract symptoms based on BPO. However, the mechanism how PUL leads to a remarkable symptom relief remains unclear and cannot be explained by the desobstructive mechanisms we observed. [ABSTRACT FROM AUTHOR]

Objective: The relationship between histological changes and urodynamic findings emerging in neobladders (NBs) in a long term was not previously investigated. This study aimed to investigate the relationship between histological changes and urodynamic findings in the NB. Materials and Methods: Patients undergoing radical cystectomy and Studer NB were included in the study. Patients with follow-up times <48 months were assigned to group 1 (n = 5) and those with follow-up times >48 months in group 2 (n = 6). Metabolic, endoscopic, histologic, urodynamic, and continence parameters were evaluated after surgery. Results: No metabolic disorders or pathology was observed in the endoscopy of any patients. Histological evaluation revealed a decreased chronic inflammation and villus length severity over the years, with increased goblet cell numbers and fibrosis rates. Maximum reservoir capacity, compliance, and voiding pressure values for groups 1 and 2 were 418±42.1 and 401.33±67.8 mL, 15.65±2.7 and 18.54±4.98 mL/cm H2O, and 28.2±2.28 and 30.6±7.4 cm H2O, respectively. Maximum reservoir capacity was higher in group 1 than in group 2, whereas compliance and voiding pressure were lower, without significant differences (p = 0.84, p = 0.64, and p = 0.97; respectively). Conclusion: No effects were observed on urodynamıc parameters resulting from the development of long term histological changes in the NB. However, the NB appeared to adapt to its new function by gradually assuming a similar morphology to the urothelium, maintaining a sufficient capacity and compliance. Daytime continence was achieved at a rate of 90.9%, without metabolic pathology. [ABSTRACT FROM AUTHOR]

Neurogenic bladder (NGB) secondary to spinal cord injury (SCI) is accompanied with several complications such as urinary tract deterioration, urinary incontinence, and consequently lower quality of life (QoL), significant morbidities, and occasionally death. Current therapeutic methods have some side effects and there is no treatment for the upper urinary tract injuries. Stem cell therapy is a promising method for treating this condition. However, the best timing and the best route of its transplantation have not yet been determined. Animal models of SCI, especially in rats, are the most commonly used method for evaluating the efficacy of cell therapy in NGB improvement, and the most common assessment method is the urodynamic studies (UDS). However, there are variations in the range of UDS parameters among the published studies. The current review aimed to discuss the effect of stem cell transplantation on bladder dysfunction recovery based on urodynamic parameters after SCI in rats. For this purpose, the cell source, doses, the route of administration, and the complete UDS equipment and its parameters were summarized in SCI models in rats. In some urodynamic test results, to some extent, an improvement in the lower urinary system function was observed in each treatment group. However, this improvement was far from full functional recovery. The average cell dose was about 1 million cells in every injected site. In most studies, the stem cells (SCs) were transplanted 9 days after the injury using PE-50 and PE-60. Many researchers have recommended further experimental and clinical studies to confirm this treatment modality.

Introduction: Radical cystectomy with orthotopic urinary diversion is considered the gold standard for treatment of muscular invasive bladder cancer or high-risk nonmuscular invasive bladder cancer. The choice of orthotopic neobladder reconstruction depends on the clinical outcomes of it and should be planned with the patients, especially the risk of incontinence. Methods: this study included 52 Egyptian patients underwent radical cystectomy and orthotopic neobladder reconstruction with sigmoid (25 patients) and ileal (27 patients) segments. Postoperative clinical outcomes between the sigmoid and ileal neobladder groups were compared. Results: In the present study, 12 intraoperative complications (6 in each group) and 19 postoperative complications (17 in sigmoid and 15 in ileal group) occurred; however, there was no significant difference in the incidence of intraoperative and postoperative complications between both groups. There were no significant differences in the continence status and spontaneous voiding between both groups. There were no significant differences in maximal flow rate and voided volume between both groups. Night voiding frequency in the ileal neobladder patients was significantly smaller than sigmoid neobladder patients. Free flowery showed a significant difference of voiding time and volume in favor of sigmoid neobladder group. Maximum urethral pressure and urethral closing pressure were significantly higher in ileal neobladder group. Conclusions: Both types of neobladder reconstruction resulted in comparatively satisfactory outcomes; however, the voiding function in sigmoid neobladder group appeared to be more favorable than that in ileal neobladder group.

Purpose: To establish the correlation between flow rate curve shape and video-urodynamic findings in women with lower urinary tract symptoms (LUTS). Methods: A retrospective review of consecutive women with LUTS who performed a free flow study immediately before undergoing video-urodynamic investigations over a 28-month period. Flow rate curve shape and video-urodynamic parameters were analysed. Free flow curves were defined into five categories: bell-shaped, prolonged, fluctuating, intermittent or plateau. Women who voided less than 150 ml on the free flow study were excluded from the analysis. Results: A total of 250 women with LUTS, with a mean age 48 years (range 18–83), were included. Bell-shaped tracings excluded obstruction in 89%. Prolonged flow rate curves diagnosed obstruction in 62% and detrusor underactivity in 8%. Fluctuating and intermittent flow rate curves were associated with urodynamic obstruction in 37 and 39%, respectively, and detrusor underactivity in 25 and 29%, respectively. A plateau flow rate curve was indicative of urodynamic obstruction in all three cases observed. Conclusion: Flow rate curve patterns can be suggestive of urodynamic diagnoses. Women without a prolonged void and bell-shaped traces had normal voiding urodynamics in 76% of cases, and the majority could be managed without invasive investigations. Patients with fluctuating and intermittent flow rate curves demonstrate a spectrum of urodynamic diagnoses with a third of cases having obstruction and a third of cases having detrusor underactivity. Plateau flow rate curve patterns are associated with urethral obstruction. [ABSTRACT FROM AUTHOR]

Purpose: To investigate pre-operative urodynamic parameters in male sling patients to ascertain whether this might better predict surgical outcomes and facilitate patient selection. Methods: We performed a retrospective, case notes and video-urodynamics, review of men who underwent AdVanceXP male sling in three London hospitals between 2012 and 2019. Urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was performed in one centre. Results: Successful outcome was seen in 99/130 (76%) of men who required one pad or less per day. The dry rate was 51%. Pad usage was linked to worse surgical outcomes, mean 2.6 (range 1–6.5) for success vs 3.6 (range 1–10) although the ranges were wide (p = 0.002). 24 h pad weight also reached statistical significance (p = 0.05), with a mean of 181 g for success group versus 475 g for the non-successful group. The incidence of DO in the non-successful group was significantly higher than in successful group (55% versus 29%, p = 0.0009). Bladder capacity less than 250 ml was also associated with worse outcomes (p = 0.003). Reduced compliance was not correlated with outcomes (31% for success groups vs 45% for non-successful group, p = 0.15). Preoperative RLPP was performed in 60/130 patients but did not independently reach statistical significance (p = 0.25). Conclusion: Urodynamic parameters related to bladder function—detrusor overactivity and reduced maximum cystometric capacity predict male sling outcomes and may help in patient selection for male sling (or sphincter) surgery; whereas urodynamic parameters of sphincter incompetency (RLPP) were not predictive. Further larger scale studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Overactive bladder (OAB) syndrome correlates with mental disorders, especially depressive disorders and anxiety disorders, and less frequently obsessive-compulsive symptoms, and occurs mostly in older people. Obsessive-compulsive disorder (OCD) is more frequent in OAB patients. Most OCD people are diagnosed at the age of about 19, typically with an earlier age of onset in boys than in girls, but the onset after age 35 does occur less frequently. Objectives: This study aimed to evaluate the relationship between OCD and OAB. Methods: In this case-control study, 1,160 cases who were over 18 years old who were referred to the urodynamic clinic of Shohadae-Tajrish center from June 2013 to February 2018 in Tehran, Iran, enrolled of whom 580 were considered the control group who were non-OAB patients, and 580 subjects were considered the case group who were OAB patients. The diagnosis of OAB was confirmed by a single urologist. All cases had detrusor overactivity (DO) in urodynamic study (UDS). The OAB-validated 8-questionnaire screen test (OAB-V8) was conducted, and the diagnosis of OCDwas confirmed by a single psychiatrist according to DSM-5 criteria. Moreover, the Yale-Brown questionnaire was completed for each patient to rate the severity of OCD symptoms. Results: About the Yale-Brown Obsessive-compulsive Scale (Y-BOCS) total score, there is a significant difference between patients with obsessive traits and the control group (P < 0.001). OCD scores were significantly higher in the OAB group compared to the control group (P < 0.001). Logistic regression analysis showed that the population of the studied patients with OAB was more probable to have OCD than non-OAB control subjects in aged classified groups (OR: 6.23; P < 0.001). Conclusions: The findings of this study showed that OAB patients reported higher obsessive-compulsive scores (Y-BOCS) compared to the controls. There is an independent correlation between OCD and OAB. However, the linkage between OCD and OAB justifies the need for more research. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the ultrastructural characteristics of the bladder of patients with detrusor underactivity (DU) of various etiologies. Twenty-five patients with DU and control subjects underwent urodynamic testing and transmission electron microscopic examination of bladder specimens. The epithelium, lamina propria, and muscle layers were analyzed separately. The DU bladders exhibited total epithelial denudation (52%). In the bladders with remaining epithelium, apical cell uroplakins (44.4%) and tight junction complexes (77.8%) were also noted. The lamina propria was characterized by loose extracellular connective tissue (48%) and a lack of nerve terminals (76%). Smooth muscle shrinkage and a loss of their regular spindle shape (91.6%) were also noted in the detrusor layer. Patients with DU with intact epithelial cell layers had significantly larger void volumes and maximal flow rates than those with mild or severe epithelial denudation. Patients with remaining nerve terminals in lamina propria had a stronger first sensation of filling and smaller residual urine volume than those without nerve terminals. The proportion of ultrastructural defects of the bladder was not significantly different among patients with DU of various etiologies and treatment outcomes. DU bladders were characterized by ultrastructural defects in the entire bladder, and the defects were correlated to clinical parameters.

To determine in patients with overactive bladder (OAB), urodynamic differences as well to compare the characteristics of patient's, with presence of detrusor overactivity on urodynamics with those with absence of detrusor overactivity. Taking into account the urodynamic findings, the patients with OAB symptoms were categorized into one of two groups: group 1 (with detrusor overactivity) or group 2 (without detrusor overactivity), and comparative analyses for both groups were performed (epidemiological data, patient history, urodynamic criteria, bladder diaries, IC-OAB, IC-OABqol – questionnaires). There was a significant difference in age as well in the disease duration between group 1 and group 2. Although the mean number of micturitions and nocturia episodes was comparable, the numbers of urgency episodes differed significantly. The number of 'wet' patients was significantly higher in the group 1 with the significantly higher number of incontinence episodes. Group 1 demonstrated higher OAB symptom scores and higher impact on the patients' quality of life. More than half of the patients complaining of urgency-frequency do not have detrusor overactivity upon urodynamic testing, and only half have detrusor overactivity that correlates with urge perception. The patients with no detrusor overactivity appear to be significantly younger and have fewer symptoms, with a less pronounced impact on quality of life. They also have significantly higher maximal bladder capacity. This data supports the hypothesis that both conditions are different phases (early and late) of the same pathological state, or may be two different subtypes of OAB. [ABSTRACT FROM AUTHOR]