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Purpose: The current study aimed to investigate the clinical comorbidities and urodynamic characteristics of a large cohort of women with dysfunctional voiding (DV) validated on a videourodynamic study (VUDS). Methods: Women who presented with VUDS-confirmed DV from 1998 to 2022 were retrospectively analyzed. Data on clinical symptoms, VUDS findings, and medical comorbidities including medical illness and previous surgical history were recorded and examined. Patients with DV were subgrouped according to age, presence of medical comorbidity, and different urodynamic parameters. The urodynamic parameters and treatment outcomes among the different subgroups were examined. Results: In total, 216 women were retrospectively analyzed. Among them, 188 (88.3%) presented with storage symptoms and 130 (61.0%) with voiding symptoms. Regarding outcomes, 48 (22.2%) patients had successful treatment outcomes; 76 (35.2%), improved outcomes; and 92 (42.6%), failed outcomes. Then, 150 (69.0%) patients presented with urodynamic DO. Patients with terminal DO experienced a significantly higher incidence of hypertension (56.8%), diabetes mellitus (37.9%), and latent central nervous system diseases (38.9%) than those with non-DO or phasic DO. Patients with phasic DO had a significantly higher detrusor pressure (Pdet) and bladder outlet obstruction index than those with non-DO and terminal DO. Patients with hypertension or those with a Pdet ≥ 35 cmH2O had high rates of successful treatment outcomes. Conclusions: DV is significantly associated with older age and a higher incidence of central nervous system diseases, hypertension, and diabetes mellitus in women. Patients with phasic DO had a high Pdet and BOO, and patients with hypertension or those with Pdet ≥35 cm H2O who received urethral sphincter treatment had a better treatment outcome. [ABSTRACT FROM AUTHOR]

The closure of the urethra in females under condition of stress is the result of a reflex contraction of the urethral rhabdosphincter and pelvic floor muscles. This is likely induced by activity of the abdominal muscles due to a sudden increase in abdominal pressure. This reflex contraction with increase of urethral pressure occurs a few milliseconds before an increase in intra-abdominal pressure. The urethral pressure increase during stress is only possible with fixation of the urethra by the pubourethral ligaments (PUL), facilitating urethral kinking. The highest and most important increase in pressure and resistance, occurs in the distal urethra due to this kinking of the urethra. [ABSTRACT FROM AUTHOR]

Purpose Nonneurogenic chronic urinary retention is an uncommon problem in young female individuals, and a well characterised causes is Fowler syndrome (primary disorder of urethral sphincter relaxation). Intermittent catheterisation is often challenging, and gold standard treatment sacral neuromodulation is not widely available. Urethral sphincter botulinum toxin injection has been shown to be effective cross-sectionally, however little is known about long-term outcomes. Methods Female individuals presenting with urinary retention due to Fowler syndrome were reviewed retrospectively from a single tertiary referral centre over an 11-year period (2010–2021). One hundred units of onabotulinum toxin A (BoTX-A) was injected into the striated urethral sphincter in a divided dose by the periurethral approach. Efficacy and side effects were assessed 4 weeks after injection. Results Thirty-three female individuals with a mean age of 40.1±14.1 years received 165 unique urethral sphincter BoTX-A injections over 11 years. Nineteen individuals (57.6%) presented in acute urinary retention, and 28 (84.8%) were reliant on catheterisation. Twenty-one individuals (64%) responded to BoTX-A injections and had a significantly raised baseline maximum urethral closure pressure (MUCP), compared to nonresponders (114.6 cm H2O, P=0.012). Side effects were reported following 19 injections (11.5%) however, were mild and transient. Fifteen individuals received more than 1 botulinum toxin injection (median, 3 injections), with a median interval of 112 days (interquartile range) and efficacy persisted following repeat injections and no safety concerns were seen. Conclusions Sphincter botulinum toxin through the periurethral approach is safe and effective following repeat injections, and offers a low-cost, minimally invasive alternative to managing female chronic urinary retention due to Fowler syndrome, particularly when there was a high baseline MUCP.

Purpose: Dysfunctional voiding (DV) is not uncommon in women with non-neurogenic voiding dysfunction. Because of its unknown pathophysiology, effective and durable treatment is lacking. This study aimed to analyze the results of treatment and predictive factors for a successful outcome of botulinum toxin A (BoNT-A) treatment in female patients with DV. Methods: In total, 66 women with DV confirmed by a videourodynamic study (VUDS) were treated with a BoNT-A injection into the urethral sphincter once (n = 33) or several times (n = 33). VUDS was performed before (baseline) and after the BoNT-A treatment. Patients with a global response assessment of the voiding condition of 2 or 3 and a voiding efficiency (VE) of >20% than baseline were considered to have a successful outcome. The baseline demographics, VUDS parameters, and VUDS DV subtypes were compared between the successful and failed groups. Predictive factors for a successful outcome were investigated by logistic regression analyses. Results: Successful and failed outcomes were achieved in 27 (40.9%) and 39 (59.1%) women, respectively. After BoNT-A injections, the maximum flow rate (Qmax), voided volume, and VE all significantly increased, and the postvoid residual (PVR) was slightly improved. No significant difference in the number of injections and medical comorbidity was found between the groups. However, the successful group had a higher incidence of previous pelvic surgery. No significant difference in the treatment outcome was found among patients with different urethral obstruction sites. Significant improvements in Qmax, voided volume, PVR, VE, and the bladder outlet obstruction (BOO) index were noted in the successful group. A lower VE at baseline and a history of surgery were identified as predictive factors for a successful outcome of BoNT-A injections for treating DV. Conclusion: BoNT-A injections into the urethral sphincter can effectively improve VE in 40.9% of women with DV. Women with higher BOO grades and previous pelvic surgery are predicted to have a successful treatment outcome. [ABSTRACT FROM AUTHOR]

The closure of the urethra under the condition of stress is the result of a reflex contraction of the urethral rhabdosphincter and pelvic floor muscles. This is likely induced by activity of the abdominal muscles due to a sudden increase in abdominal pressure. This reflex contraction with an increase of urethral pressure occurs a few milliseconds before an increase in intraabdominal pressure. The urethral pressure increase during stress is only possible with fixation of the urethra by the pubourethral ligaments (PUL), facilitating urethral kinking. The highest and most important increase in pressure and resistance occurs in the distal urethra due to this kinking of the urethra. [ABSTRACT FROM AUTHOR]

Purpose: Nonneurogenic chronic urinary retention is an uncommon problem in young female individuals, and a well characterised causes is Fowler syndrome (primary disorder of urethral sphincter relaxation). Intermittent catheterisation is often challenging, and gold standard treatment sacral neuromodulation is not widely available. Urethral sphincter botulinum toxin injection has been shown to be effective cross-sectionally, however little is known about long-term outcomes. Methods: Female individuals presenting with urinary retention due to Fowler syndrome were reviewed retrospectively from a single tertiary referral centre over an 11-year period (2010–2021). One hundred units of onabotulinum toxin A (BoTX-A) was injected into the striated urethral sphincter in a divided dose by the periurethral approach. Efficacy and side effects were assessed 4 weeks after injection. Results: Thirty-three female individuals with a mean age of 40.1±14.1 years received 165 unique urethral sphincter BoTX-A injections over 11 years. Nineteen individuals (57.6%) presented in acute urinary retention, and 28 (84.8%) were reliant on catheterisation. Twenty-one individuals (64%) responded to BoTX-A injections and had a significantly raised baseline maximum urethral closure pressure (MUCP), compared to nonresponders (114.6 cm H2O, P=0.012). Side effects were reported following 19 injections (11.5%) however, were mild and transient. Fifteen individuals received more than 1 botulinum toxin injection (median, 3 injections), with a median interval of 112 days (interquartile range) and efficacy persisted following repeat injections and no safety concerns were seen. Conclusions: Sphincter botulinum toxin through the periurethral approach is safe and effective following repeat injections, and offers a low-cost, minimally invasive alternative to managing female chronic urinary retention due to Fowler syndrome, particularly when there was a high baseline MUCP. [ABSTRACT FROM AUTHOR]

Vaidyanathan Subramanian, Bakulesh Madhusudan Soni Northwest Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Southport, UKCorrespondence: Vaidyanathan Subramanian, Email subramanian.vaidyanathan@merseywestlancs.nhs.ukMethods: We used a Urethrotech catheterisation device in 57 male patients with spinal cord injury, in whom urethral catheterisation was unsuccessful or previous catheterisation was difficult.Results: Urethrotech catheter could be inserted in 51 patients. No patient developed urinary tract infection. In one patient, the guidewire could not be introduced into the bladder, and a coude Foley catheter was inserted. In two patients, the guidewire was inserted into the bladder, but a 16 CH catheter could not be advanced over the guidewire. Emergency suprapubic cystostomy was performed in one case; in the other, urethral stricture was dilated; a size 12 CH catheter was inserted. In three patients, the guidewire curled back into the urethra because of severe spasm of the urethral sphincter. Catheterisation with a Tiemann catheter was successful after administration of diazepam and/or stretching of the anal sphincter by another health professional, which caused reflex relaxation of the urethral sphincter. Complications of Urethrotech catheterisation included urethral bleeding, haematuria, pain, doubling back of the guidewire due to spasm of the urethral sphincter or from an empty bladder. We adopted variations in technique, eg filling the bladder with saline prior to catheterisation when feasible, insertion of the guidewire by the side of the old catheter, use of Tiemann tip catheters, administration of antibiotics, diazepam to control spasms, nifedipine to control autonomic dysreflexia, analgesics, stretching of the anal sphincter to induce reflex relaxation of the urethral sphincter, urgent imaging studies to confirm correct positioning of the catheter, omitting anticoagulants and monitoring patients, who developed bleeding.Conclusion: Use of Urethrotech in spinal injury patients warranted adaptations to the technique, which required expertise, experience, and backup facilities. To ensure patient safety, Urethrotech catheter should be used in a hospital setting, and by medical personnel with experience in the management of spinal cord injury patients.Keywords: urethral catheterisation, male, patient, urinary bladder, urethral sphincter, paraplegia, patient safety

Purpose: The current study aimed to investigate the clinical comorbidities and urodynamic characteristics of a large cohort of women with dysfunctional voiding (DV) validated on a videourodynamic study (VUDS). Methods: Women who presented with VUDS-confirmed DV from 1998 to 2022 were retrospectively analyzed. Data on clinical symptoms, VUDS findings, and medical comorbidities including medical illness and previous surgical history were recorded and examined. Patients with DV were subgrouped according to age, presence of medical comorbidity, and different urodynamic parameters. The urodynamic parameters and treatment outcomes among the different subgroups were examined. Results: In total, 216 women were retrospectively analyzed. Among them, 188 (88.3%) presented with storage symptoms and 130 (61.0%) with voiding symptoms. Regarding outcomes, 48 (22.2%) patients had successful treatment outcomes; 76 (35.2%), improved outcomes; and 92 (42.6%), failed outcomes. Then, 150 (69.0%) patients presented with urodynamic DO. Patients with terminal DO experienced a significantly higher incidence of hypertension (56.8%), diabetes mellitus (37.9%), and latent central nervous system diseases (38.9%) than those with non-DO or phasic DO. Patients with phasic DO had a significantly higher detrusor pressure (Pdet) and bladder outlet obstruction index than those with non-DO and terminal DO. Patients with hypertension or those with a Pdet ≥ 35 cmH2O had high rates of successful treatment outcomes. Conclusions: DV is significantly associated with older age and a higher incidence of central nervous system diseases, hypertension, and diabetes mellitus in women. Patients with phasic DO had a high Pdet and BOO, and patients with hypertension or those with Pdet ≥35 cm H2O who received urethral sphincter treatment had a better treatment outcome.

Background: Adjustable sling ATOMS-SSP results in ventral compression of the urethra with favorable results in the treatment of men with mild to moderate stress incontinence. However, with transobturator tunneling and mesh fixation, the surgeon has a range of options, which leads to different results and sometimes unfavorable positioning of the silicone cushion. Using retrograde urethrography (RUG), we identified ATOMS patients with considerable misplacement. We then modified the implantation technique when we performed the revision, and now present here our first experiences with this new surgical technique. Methods: Patients after ATOMS-SSP implantation at our clinic were systematically subjected to a RUG if incontinence persisted after adjustments. In case of unfavorable positioning, a revision was performed with the aim of achieving an idealized urethroproximal position of the silicone pad. During follow-up, a repeat RUG was performed, and both subjective and objective outcome parameters were recorded. Results: Four men met the above criteria and underwent revision with reimplantation using our new technique. All patients postoperatively experienced significantly improved continence. RUGs demonstrated an ideal ATOMS position immediately below the proximal bulbar urethra. Conclusions: Our proximal implantation technique, presented here for the first time, allows optimal positioning of the ATOMS SSP, which is reflected in the objective parameters and RUG. Its use in primary implantation should also be considered and an expansion to the indication of severe stress incontinence seems possible, but this should only be done in studies. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the incidence of central nervous system (CNS) diseases in adult patients with voiding dysfunction and videourodynamics (VUDS) proven urethral sphincter dysfunction. Methods: This retrospective analysis reviewed the medical charts of patients aged > 60 years who underwent VUDS for non-prostatic voiding dysfunction from 2006 to 2021. A chart review was performed to search for the occurrence and treatment of CNS diseases after the VUDS examination up to 2022. The diagnosis of CNS disease, such as cerebrovascular accidents (CVA), Parkinson's disease (PD), and dementia, by neurologists was also retrieved from the charts. Based on the VUDS findings, patients were divided into the following subgroups: dysfunctional voiding (DV), poor relaxation of the external sphincter (PRES), and hypersensitive bladder (HSB) and coordinated sphincter subgroups. The incidence of CVA, PD, and dementia in each subgroup was recorded and compared among them using one-way analysis of variance (ANOVA). Results: A total of 306 patients were included. VUDS examinations revealed DV in 87 patients, PRES in 108, and HSB in 111. Among them, 36 (11.8%) patients had CNS disease, including CVA in 23 (7.5%), PD in 4 (1.3%), and dementia in 9 (2.9%). Among the three subgroups, the DV group had the highest incidence rate of CNS disease (n = 16, 18.4%), followed by PRES (n = 12, 11.1%) and HSB (n = 8, 7.2%). However, no significant difference was noted in the incidence of CNS disease across the three subgroups. Nevertheless, the incidence of CNS disease was higher in patients with DV and PRES than that in the general population. Conclusions: The incidence of CNS diseases was high in patients aged > 60 years with voiding dysfunction due to urethral sphincter dysfunction. Patients with VUDS-confirmed DV had the highest incidence of CNS disease among the three subgroups. [ABSTRACT FROM AUTHOR]

Traumatic spinal cord injury (SCI) results in the time-dependent development of urinary impairment due to neurogenic detrusor overactivity (NDO) and detrusor-sphincter-dyssynergia (DSD). This is known to be accompanied by massive changes in the bladder wall. It is presently less clear if the urethra wall also undergoes remodelling. To investigate this issue, female rats were submitted to complete spinal transection at the T8/T9 level and left to recover for 1 week and 4 weeks. To confirm the presence of SCI-induced NDO, bladder function was assessed by cystometry under urethane anesthesia before euthanasia. Spinal intact animals were used as controls. Urethras were collected and processed for further analysis. Following thoracic SCI, time-dependent changes in the urethra wall were observed. Histological assessment revealed marked urethral epithelium reorganization in response to SCI, as evidenced by an increase in epithelial thickness. At the muscular layer, SCI resulted in strong atrophy of the smooth muscle present in the urethral sphincter. Innervation was also affected, as evidenced by a pronounced decrease in the expression of markers of general innervation, particularly those present in sensory and sympathetic nerve fibres. The present data show an evident impact of SCI on the urethra, with significant histological rearrangement, accompanied by sensory and sympathetic denervation. It is likely that these changes will affect urethral function and contribute to SCI-induced urinary dysfunction, and they deserve further investigation. [ABSTRACT FROM AUTHOR]

Les symptômes de la phase de vidange peuvent être secondaires à un obstacle fonctionnel sphinctérien, dynamique, par défaut de relaxation, voire contraction paradoxale du sphincter strié pendant la miction, parfois appelé « hypertonie urétrale » – terme imprécis et non adapté, devant probablement être abandonné. Plusieurs entités chez le sujet non neurologique ont été décrites : le syndrome de Fowler, le syndrome de Hinman, la dyssynergie fonctionnelle par défaut de relâchement des muscles du plancher pelvien, avec des taux de complications différents selon l'étiologie. Le diagnostic se fait généralement sur un faisceau d'arguments obtenus par les études pression-débit, les imageries permictionnelles, voire l'électromyogramme du sphincter strié urétral. La prise en charge comprend, en premier lieu, des mesures comportementales et une prise en charge rééducative avec biofeedback. En cas d'échec, le recours à la neuromodulation sacrée ou aux autosondages est possible. Voiding difficulties can be related to a functional and dynamic urethral obstruction, due to delayed or incomplete relaxation, or paradoxical urethral sphincter contractions during voiding, sometimes called "urethral hypertonia" – an imprecise and poorly defined term which should probably not be used anymore. Different dysfunctions have been described in patients without neurological disorder: Fowler's syndrome, Hinman's syndrome or dysfunctional voiding, with various complications rates function of the etiology of the symptoms. The diagnosis will generally be made on the basis of a set of arguments obtained by pressure-flow studies, imaging during micturition, and sometimes urethral sphincter electromyography. Primary management includes behavioral measures and pelvic floor muscles physiotherapy with biofeedback. Second line treatment include sacral neuromodulation or intermittent catheterization. [ABSTRACT FROM AUTHOR]

Platelet-rich plasma (PRP) is used for tissue repair and regeneration. Herein, we investigated the therapeutic efficacy and mid-term durability of injections of PRP into the urethral sphincter for the management of postprostatectomy incontinence (PPI). Thirty-nine patients with PPI that were refractory to conservative treatments were prospectively enrolled. They received repeated PRP urethral sphincter injections monthly for a total of four months. The primary endpoint was the Global Response Assessment (GRA) score after treatment. The secondary endpoints included changes in the stress urinary incontinence (SUI) visual analog scale (VAS) from baseline to the end of follow-up and urodynamic parameters from baseline to 3 months. The mean follow-up period after the entire treatment course was 21.0 ± 11.3 (range: 1.6–36.3) months. After PRP injections, the median GRA score with quartiles was 2.0 (1.0, 2.0). The SUI VAS and abdominal leak point pressure significantly improved from 6.9 ± 1.8 to 4.4 ± 2.3, p < 0.001, and from 74.8 ± 37.0 to 115.5 ± 57.9 cmH2O, p = 0.004, respectively, after the fourth PRP urethral sphincter injection. Following PRP urethral sphincter injections, the severity of SUI significantly reduced, indicating efficacy and mid-term durability as a novel treatment for PPI. [ABSTRACT FROM AUTHOR]

AimObesity has been an independent risk factor for female stress urinary incontinence (SUI), the mechanism of this association remains unknown. The aim of this study is to validate the hypothesis that urethral dysfunction is a possible contributor to SUI in obese women.MethodsTen Zucker Fatty (ZF) (ZUC-Leprfa 185) and 10 Zucker Lean (ZL) (ZUC-Leprfa 186) female rats at 12-week-old were used in this experiment. The urethral sphincter rings were harvested from the bladder neck through to the most proximal 2/3 regions. In the organ bath study, single pulses of electrical field stimulation (EFS) were applied. For the fatiguing stimulation, repeated multi-pulse EFS with 70 mA were applied at frequency of 5 Hz for 5 min. Caffeine-containing Krebs' solution was administrated to contract the urethra until the contraction began to reach a plateau for 10 min. We performed immunofluorescence staining of the urethra after the experiment was finished.ResultsCompared to ZL controls, ZF rats had significantly impaired muscle contractile activity (MCA) (P

The aim of this article is to review the utility of elastography in the day-to-day clinical practice of the urologist. An electronic database search was performed on PubMed and Cochrane Library with a date range between January 2000 and December 2021. The search yielded 94 articles that passed the inclusion and exclusion criteria. The articles were reviewed and discussed by organ, pathology and according to the physical principle underlying the elastographic method. Elastography was used in the study of normal organs, tumoral masses, chronic upper and lower urinary tract obstructive diseases, dysfunctions of the lower urinary tract and the male reproductive system, and as a pre- and post-treatment monitoring tool. Elastography has numerous applications in urology, but due to a lack of standardization in the methodology and equipment, further studies are required. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The study aims to compare the urethral sphincter size and bladder neck position and mobility in women with different parities. Methods: Women referred to the urodynamics clinic for lower urinary tract and prolapse symptoms were included in the study. A detailed history was taken, and transperineal two- and three-dimensional ultrasound was performed on all the women. The women were divided into four groups according to the vaginal parity. Group 1 had no vaginal childbirths. Group 2 had one, group 3 had two and group 4 had three or more vaginal childbirths. The data was analysed and compared among the groups. Results: One hundred fifty women were included in the study. There were 34, 22, 48 and 46 women in groups 1 to 4 respectively. The distribution of different urodynamic diagnoses was similar in all four groups. The urethral sphincter measurements were significantly larger in the vaginally nulliparous group than in all other groups. The measurements were not smaller in multiparous women than in primiparous women. The bladder neck was at a lower position at rest in parous women than nulliparous women. The bladder neck movement was not more in groups 2 to 4 than in group 1. Conclusion: The urethral sphincter was smaller and the bladder neck position was lower in parous women than nulliparous women. These differences were not progressive with increasing parity. Request for elective caesarean section during the second pregnancy to protect the urethra is not supported by this study. [ABSTRACT FROM AUTHOR]

AimsThere are competing hypotheses about the etiology of post prostatectomy incontinence (PPI). The purpose of this study was to determine the anatomical and functional differences between men with and without PPI.MethodsCase-control study of continent and incontinent men after radical prostatectomy who underwent functional and anatomic studies with urodynamics and 3.0 Tesla MRI. All men were at least 12 months post prostatectomy and none had a history of pelvic radiation or any prior surgery for incontinence.ResultsBaseline demographics, surgical approach, and pathology were similar between incontinent (cases) (n = 14) and continent (controls) (n = 12) men. Among the cases, the average 24 hr pad weight was 400.0 ± 176.9 g with a mean of 2.4 ± 0.7 pads per day. Urethral pressure profiles at rest did not significantly differ between groups; however, with a Kegel maneuver the rise in urethral pressure was 2.6 fold higher in controls. On MRI, the urethral length was 31-35% shorter and the bladder neck was 28.9° more funneled in cases. There were no differences in levator ani muscle size between groups. There was distortion of the sphincter area in 85.7% of cases and in 16.7% of controls (P = 0.001).ConclusionsMen with PPI were not able to increase urethral pressure with a Kegel maneuver despite similar resting urethral pressure profiles. Additionally, incontinent men had shorter urethras and were more likely to have distortion of the sphincter area. All suggesting that the sphincter in men with PPI is both diminutive and poorly functional.

Abstract Background The aim of this retrospective study was to evaluate the clinical efficacy and safety of botulinum toxin type A (BTX-A) injection into the urethral sphincter to treat patients with underactive bladder (UAB). Methods From September 2012 to December 2018, 35 patients with UAB who presented with dysuria were treated with BTX-A (Prosigne®, Lanzhou Biological Products, Lanzhou, China). All patients were evaluated using the International Continence Society standard for video-urodynamic examination before and 1 month after treatment. The index includes maximum urinary flow rate, detrusor leak point pressure, and maximum urethral pressure. Post-voiding residual urine volume was measured using ultrasound before, one and 3 months post injection. Results After 1 month of treatment, the maximum flow rate increased from 2.5 ± 1.1 ml/s to 6.6 ± 1.7 ml/s (P

Platelet-rich plasma (PRP) is used for tissue repair and regeneration. Herein, we investigated the therapeutic efficacy and mid-term durability of injections of PRP into the urethral sphincter for the management of postprostatectomy incontinence (PPI). Thirty-nine patients with PPI that were refractory to conservative treatments were prospectively enrolled. They received repeated PRP urethral sphincter injections monthly for a total of four months. The primary endpoint was the Global Response Assessment (GRA) score after treatment. The secondary endpoints included changes in the stress urinary incontinence (SUI) visual analog scale (VAS) from baseline to the end of follow-up and urodynamic parameters from baseline to 3 months. The mean follow-up period after the entire treatment course was 21.0 ± 11.3 (range: 1.6–36.3) months. After PRP injections, the median GRA score with quartiles was 2.0 (1.0, 2.0). The SUI VAS and abdominal leak point pressure significantly improved from 6.9 ± 1.8 to 4.4 ± 2.3, p < 0.001, and from 74.8 ± 37.0 to 115.5 ± 57.9 cmH2O, p = 0.004, respectively, after the fourth PRP urethral sphincter injection. Following PRP urethral sphincter injections, the severity of SUI significantly reduced, indicating efficacy and mid-term durability as a novel treatment for PPI.

A new surgical procedure for the treatment of primary bladder neck obstruction with maintenance of anterograde ejaculation is proposed. In place of monolateral or bilateral bladder neck incision, associated with a loss of ejaculation rate of up to 30%, the new surgical procedure consists of laser drilling the bladder neck with a number of holes and without muscle fiber disruption. The effect of this novel procedure has been studied numerically, with a simplified two-dimensional numerical model of the internal urethral sphincter, varying the position and the number of holes in the fibrotic region of the urethral tissue. Results show an improvement of the urethral sphincter opening by increasing the number of holes, ranging from about 6% to 16% of recovery. Moreover, a non-aligned position of holes positively influences the opening recovery. The concentrations of maximum principal strain and stress have been registered in the proximity of the interface between the physiologic and diseased sphincter, and in those regions where the radial thickness is significantly thinner. The effects on the first five patients have been included in the study, showing improvement in micturition, lower urinary tract symptoms, sustained ejaculatory function, and quality of life. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objective was to determine age-related changes in measurements of urethral sphincter complex components in asymptomatic nulliparous women. Methods: Eighty nulliparous women ≥18 years underwent 3D ultrasound of the anterior pelvic compartment in a cross-sectional study. Measurements of the urethral sphincter components (smooth muscle sphincter [SMS] and striated urinary sphincter [SUS]) and urethra including area, length, width, and distance of the SUS and SMS from the urethrovesical junction were obtained. The women were grouped into four age groups: < 30 years (group A), 30 to < 45 (group B), 45 to < 60 (group C), and ≥ 60 years (group D). Age-related differences in the measurements were determined. Inter-rater and intra-rater agreement were performed for 20 nulliparous women. Results: There were 24, 18, 26, and 12 women in groups A, B, C, and D respectively. None of the urethral sphincter complex measurements was significantly associated with age (p > 0.05). No differences were found between the groups for any measurements using one-way ANOVA and multiple comparison pairwise comparison (p > 0.05) other than width of SMS (C > A), urethral length (C > A), and distance of SUS from urethrovesical junction (C > D). Inter-rater and intra-rater agreement were moderate for area, length, and width of SUS (intraclass correlation 0.6) and good (intraclass correlation above 0.8) for the remaining measurements. Conclusion: Other than width of SMS, urethral length, and distance of SUS from urethrovesical junction, the dimensions of urethral sphincter complex components, as visualized by 3D endovaginal ultrasound, do not vary with age. [ABSTRACT FROM AUTHOR]

Aims: Traditionally, the urethra has been considered a mere conduit to guide urine from the bladder to the external side of the body. Building evidence indicates that the urethra may directly influence bladder function via mechanisms restricted to the lower urinary tract (LUT). Methods: Here, we discuss the tissue arrangement of the urethra and addressed the contribution of new paraneuronal cells to LUT function. We also briefly reviewed two frequent LUT pathologies associated with urethral dysfunction. Results: Continence depends on an intact and functional urethral sphincter, composed of smooth, and striated muscle fibers and regulated by somatic and autonomic fibers. Recent studies suggest the existence of an urethro‐vesical reflex that also contributes to normal LUT function. Indeed, the urethral lumen is lined by a specialized epithelium, the urothelium, in the proximal urethra. In this region, recent evidence demonstrates the presence of specific paraneuronal cells, expressing the neurotransmitters acetylcholine and serotonin. These cells are in close proximity of nerve fibers coursing in the lamina propria and are able to release neurotransmitters and rapidly induce detrusor contractions, supporting the existence of an urethro‐vesical crosstalk. Conclusion: The mechanism underlying the fast communication between the urethra and thebladder are beginning to be understood and should involve the interaction between specificepithelial cells and fibres innervating the urethral wall. It is likely that this reflex should bealtered in pathological conditions, becoming an attractive therapeutic target. [ABSTRACT FROM AUTHOR]

Introduction. Today there is many highly effective surgical approaches in the treatment of benign prostatic hyperplasia (BPH). New technologies in the treatment of BPH continue to be implemented. Despite this in some patients the results of surgical treatment for short-term and long-term monitoring is unsatisfactory.Purpose of research. Тo improve the results of treatment of patients with benign prostatic hyperplasiaMaterials and methods. The functional state of the urethral sphincter was studied in 123 patients with symptomatic BPH. According to the treatment method, all patients were separated into groups. Group 1 - patients with established standard indications for surgical treatment. After surgery, patients with persistent obstructive urination received therapy with a central muscle relaxant for three months. Group 2 - patients with uncomplicated BPH, having hypertonic urethral sphincter and receiving drug therapy according to the established urodynamic patterns.Results. Our analysis of the efficacy of surgical treatment of patients with BPH demonstrates a significant correlation between negative outcomes of surgery for BPH with increased tone of the external urethral sphincter. So, in 70.1% of cases, symptomatic obstructive Low Urinary Tract Symptoms (LUTS) in BPH were accompanied by increased tone of the urethral sphincter from standard parameters. We believe that these changes were related to the anatomical characteristics of nodular hyperplasia.Conclusions. Exactly this fact, that these patients had urethral sphincter dysfunction in 14.5% of cases made for poor effect of surgical treatment of BPH. Use of muscle relaxants centrally acting drug therapy in these cases, significantly improves the urodynamics of lower urinary tract, which is accompanied by regression of LUTS.

Objectives: The anatomic integrity of the female mid urethra is an important factor for urinary continence. However, the associations between the urethral volume and potential affecting factors still remain uncertain. The aim of this study was to investigate the impact of potential factors, including age, height, weight, body mass index (BMI), parity number, delivery mode, and menopause, on the midurethral volume to assist in more‐accurate evaluations of urethral anatomy and urinary continence mechanisms in clinical practice. Methods: A total of 244 women were included in this study. All patients had no incontinence symptoms and underwent transvaginal ultrasound examinations. Detailed histories and demographic data were collected. Urethral volumes were acquired, and volume parameters were measured offline, including the urethral sphincter volume (USV), midurethral complex volume (CV), and inner core volume (ICV). Correlations were analyzed by the Spearman test. For categorical variables, an analysis of variance, Mann‐Whitney tests, or Kruskal‐Wallis tests were used to estimate associations of potential affecting factors and volumes. Results: The mean age, height, weight, and BMI ± SD of the patients were 35.42 ± 9.88 years, 161.50 ± 4.96 cm, 60.72 ± 11.42 kg, and 23.29 ± 4.20 kg/m2, respectively. Among potential affecting factors, age had a weak correlation with the USV, CV, and ICV (P =.031,.003, and.004; r = 0.140, 0.193, and 0.187), whereas parity numbers significantly affected the USV, CV, and ICV (P =.014,.021, and.026). The urethral volume became larger with increasing parity. Height (P =.391,.637, and.647), weight (P =.077,.130, and.245), BMI (P =.583,.592, and.643), delivery mode (P =.483,.171, and.104), and menopausal status (P =.611,.717, and.830) had no significant impact on the midurethral volume data (USV, CV, and ICV). Conclusions: The midurethral volume tended to increase with age and parity in continent women. [ABSTRACT FROM AUTHOR]

External urethral sphincter (EUS) dysfunction is a common, bothersome female voiding dysfunction. This study aims to analyze the characteristics of different types of female EUS dysfunction, as well as to determine the outcome predictors of sphincteric botulinum toxin A (BoNT-A) injection. Women receiving sphincteric BoNT-A injections for refractory EUS dysfunction were retrospectively reviewed. A comparison of the baseline clinical, urodynamic parameters and the treatment responses were made for patients with different EUS dysfunctions. A total of 106 females were included. Significantly increased detrusor overactivity, detrusor contracting pressure and the bladder outlet obstruction index with decreased urge sensation were noted in patients diagnosed with dysfunctional voiding or detrusor sphincter dyssynergia comparing to those diagnosed with poor relaxation of the external urethral sphincter. The average subjective improvement rate was 67% for the injection. The therapeutic effect was not affected by the type of EUS dysfunction. The multivariate analysis revealed that bladder neck narrowing and catheterization history were predictive of negative outcomes. There is a distinct urodynamic presentation for each type of female EUS dysfunction. Sphincteric BoNT-A injection provides a good therapeutic outcome for refractory EUS dysfunction. A narrowing bladder neck and a history of catheterization suggest poor therapeutic outcomes.

Aims: We sought to determine whether somatic lumbar nerve transfer to the pelvic nerve's anterior vesical branch after sacral decentralization for detrusor muscle reinnervation also leads to aberrant innervation of the bladder outlet. Methods: Twenty‐six female mongrel hound dogs underwent transection of sacral dorsal and ventral spinal roots (ie, sacral decentralization). Immediately afterward, 12 received genitofemoral nerve transfer and 9 received femoral nerve branch transfer. Five were left sacrally decentralized. Controls included 3 sham‐operated and 6 unoperated. Eight months postsurgery, the bladder and urethra were injected with retrograde tracing dyes cystoscopically. After 3 weeks, detrusor and urethral pressures were assayed electrophysiologically immediately before euthanasia and characterization of neural reinnervation. Results: Electrical stimulation of spinal cords or roots did not lead to increased urethral sphincter pressure in nerve transfer animals, compared with decentralized animals, confirming a lack of functional reinnervation of the bladder outlet. In contrast, mean detrusor pressure increased after lumbar cord/root stimulation. In sham/unoperated animals, urethral and bladder dye injections resulted in labeled neurons in sacral level neural structures (dorsal root ganglia [DRG], sympathetic trunk ganglia [STG], and spinal cord ventral horns); labeling absent in decentralized animals. Urethral dye injections did not result in labeling in lumbar or sacral level neural structures in either nerve transfer group while bladder dye injections lead to increased labeled neurons in lumbar level DRG, STG, and ventral horns, compared to sacrally decentralized animals. Conclusion: Pelvic nerve transfer for bladder reinnervation does not impact urethral sphincter innervation. [ABSTRACT FROM AUTHOR]

Aims: Dysfunctional voiding (DV) remains a poorly understood and a poorly managed problem, both in children and adults. The Think Tank (TT) discussed how to improve the management of DV in these two different age groups and in transitional care. Methods: During the 2018 International Consultation on Incontinence Research Society held in Bristol, a multidisciplinary TT on DV was created. The presentations and subsequent discussion, leading to research recommendations intended to improve the management of DV in children and adults are summarized. Results: To improve the management of DV in children and adults, the TT panel proposed: (1) to conduct reliable prevalence studies of DV; (2) to perform longitudinal studies to prospectively test the sequence hypothesis by answering the following questions: (a) Which, if any children show a progression from overactive bladder or voiding postponement to DV?; (b) Which children develop each disorder without precursors?; and (c) Is there a continuation of DV from childhood to adulthood, or are adult cases new‐onset presentations?; (3) to obtain detailed information regarding psychopathology to understand which comorbid psychological disorders prevail and at which rate, in those suffering DV; (4) to develop and validate diagnostic tools specifically for DV; (5) to better establish urodynamic correlates of DV specific for different age groups; and (6) to generate prospective long‐term data regarding the efficacy of different treatment options and management strategies. Conclusions: The future research recommendations of this TT may improve our management of DV in children and adults. [ABSTRACT FROM AUTHOR]