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Lec PM, Nitti VW. Bladder outlet obstruction in women: Advanced evaluation. Neurourol Urodyn 2024. [PMID: 38289332 DOI: 10.1002/nau.25298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/21/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Herein, we provide a review of the indications, practical considerations, and interpretation of urodynamics (UDS) with or without fluoroscopy, as well as cystourethroscopy, for women with suspected bladder outlet obstruction (BOO). METHODS AND RESULTS A narrative review was performed focusing on the current primary literature and society guidelines around advanced diagnostic modalities for female BOO patients. UDS studies help diagnose BOO by identifying high-pressure low-flow voiding patterns and/or the characteristic radiographic appearance of the bladder neck and urethra during micturition. Cystourethroscopy aids in evaluating structural aberrations of the bladder outlet, and in surgical planning. CONCLUSIONS UDS studies and cystourethroscopy are useful adjuncts in carefully-selected female patients with suspected BOO.
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Affiliation(s)
- Patrick M Lec
- Departments of Urology and Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Victor W Nitti
- Departments of Urology and Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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2
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Gleich LD, Goldman HB. Urethrolysis. Neurourol Urodyn 2024. [PMID: 38289318 DOI: 10.1002/nau.25387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Lauren D Gleich
- Cleveland Clinic, Lerner College of Medicine, Glickman Urologic and Kidney Institute, Cleveland, Ohio, USA
| | - Howard B Goldman
- Cleveland Clinic, Lerner College of Medicine, Glickman Urologic and Kidney Institute, Cleveland, Ohio, USA
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Valdevenito JP, Averbeck MA, Sinha S, Finazzi-Agro E, Gammie A. Re: Karl H. Pang, Riccardo Campi, Salvador Arlandis, et al. Diagnostic Tests for Female Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel. Eur Urol Focus 2022;8:1015-30. Eur Urol Focus 2023:S2405-4569(23)00030-5. [PMID: 36725445 DOI: 10.1016/j.euf.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/04/2023] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | - Enrico Finazzi-Agro
- Urology Unit, Department of Surgical Sciences. University of Rome Tor Vergata, Rome, Italy
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4
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Defining Bladder Outlet Obstruction in Women. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00654-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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5
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Arlandis S, Bø K, Cobussen-Boekhorst H, Costantini E, de Heide M, Farag F, Groen J, Karavitakis M, Lapitan MC, Manso M, Arteaga SM, Nambiar AK, Riogh ANA, O'Connor E, Omar MI, Peyronnet B, Phé V, Sakalis VI, Sihra N, Tzelves L, van Poelgeest-Pomfret ML, van den Bos TWL, van der Vaart H, Harding CK. European Association of Urology Guidelines on the Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 2: Underactive Bladder, Bladder Outlet Obstruction, and Nocturia. Eur Urol 2022; 82:60-70. [PMID: 35181193 DOI: 10.1016/j.eururo.2022.01.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/26/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Female lower urinary tract symptoms (LUTS) are a common presentation in urological practice. Thus far, only a limited number of female LUTS conditions have been included in the European Association of Urology (EAU) guidelines compendium. The new non-neurogenic female LUTS guidelines expand the remit to include these symptoms and conditions. OBJECTIVE To summarise the management of underactive bladder (UAB), bladder outlet obstruction (BOO), and nocturia in females. EVIDENCE ACQUISITION The literature search was updated in September 2021 and evidence synthesis was conducted using modified GRADE approach as outlined for all EAU guidelines. A new systematic review on BOO was carried out by the panel for purposes of this guideline. EVIDENCE SYNTHESIS The important considerations for informing guideline recommendations are presented, along with a summary of all the guideline recommendations. CONCLUSIONS Non-neurogenic female LUTS are an important presentation of urological dysfunction. Initial evaluation, diagnosis, and management should be carried out in a structured and logical fashion on the basis of the best available evidence. This guideline serves to present this evidence to practising urologists and other health care providers in an easily accessible and digestible format. PATIENT SUMMARY This report summarises the main recommendations from the European Association of Urology guideline on symptoms and diseases of the female lower urinary tract (bladder and urethra) not associated with neurological disease. We cover recommendations related to the treatment of underactive bladder, obstruction of the bladder outlet, and nighttime urination.
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Affiliation(s)
- Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | | | | | - Fawzy Farag
- Department of Urology, Sohag University Hospital, Sohag, Egypt; Department of Urology, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Marie Carmela Lapitan
- College of Medicine, Philippine General Hospital, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Margarida Manso
- Department of Urology, Centro Hospitalar Universitário São João, Porto, Portugal
| | | | - Arjun K Nambiar
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | | | | | | | - Benoit Peyronnet
- European Association of Urology, Arnhem, The Netherlands; Department of Urology, University of Rennes, Rennes, France
| | - Veronique Phé
- Department of Urology, AP-HP, Pitié-Salpêtrière Academic Hospital, Sorbonne University, Paris, France
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Néha Sihra
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Lazaros Tzelves
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | | | | | - Huub van der Vaart
- Department of Obstetrics and Gynecology, University Medical Center, Utrecht, The Netherlands
| | - Christopher K Harding
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
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6
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Mai HC, Wu RC, Lin VC, Kuo WWT, Wu CH. External validation of Solomon-Greenwell nomogram for female bladder outlet obstruction. Neurourol Urodyn 2021; 41:626-632. [PMID: 34962312 DOI: 10.1002/nau.24863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/30/2021] [Accepted: 12/14/2021] [Indexed: 11/12/2022]
Abstract
AIM There is no unified diagnostic standard for female bladder outlet obstruction (BOO) to date. The Solomon-Greenwell (S-G) nomogram was developed to indicate the probability of female BOO by performing a pressure-flow study, and the equation of the BOO Index in females (BOOIf) is PdetQmax - 2.2 × Qmax. We aimed to validate the diagnostic value of the S-G nomogram in female BOO. MATERIALS AND METHODS We retrospectively reviewed a videourodynamic study (VUDS) cohort in our institution. Between 2015 and 2020, 192 female patients underwent VUDS for lower urinary tract dysfunction (LUTD). We excluded patients with neurogenic LUTD (n = 30) and patients with no detrusor contraction and/or no void during VUDS (n = 51). The diagnosis of female BOO was based on the Nitti criteria (radiological evidence of urethral narrowing in the presence of a sustained detrusor pressure). BOOIf was calculated for each enrolled patient. The cutoff values of BOOIf were set at <0, >5, and >18 as the original S-G nomogram proposed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each threshold to diagnose female BOO were calculated. RESULTS Out of the 111 enrolled patients, 43 (38.7%) were diagnosed as having female BOO by VUDS. The most common etiology of female BOO was dysfunctional voiding (19/43, 44.2%), followed by primary bladder neck obstruction (PBNO, 15/43, 34.9%). When the cutoff value was <0 (low probability of obstruction), the sensitivity, specificity, PPV, and NPV were 90%, 91%, 92%, and 87%, respectively; when >5 (likely obstructed), the values were 79%, 96%, 92%, and 88%, respectively; and when >18 (obstruction almost certain), the values were 47%, 100%, 100%, and 75%, respectively. Fourteen of 15 PBNO patients would be classified as non-BOO if the cutoff value was >18. Six PBNO patients would not be diagnosed as female BOO if the threshold was >5. CONCLUSION A BOOIf <0 showed good diagnostic value for excluding female BOO. A BOOIf >18 had perfect specificity and PPV for diagnosing female BOO. However, the sensitivity of the S-G nomogram for detecting female BOO was unsatisfactory, especially for patients with PBNO. VUDS remains the examination of choice for patients with suspected female BOO.
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Affiliation(s)
- Hsing-Chia Mai
- Department of Urology, E-Da Cancer Hospital, Kaohsiung, Taiwan.,Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - Richard C Wu
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan.,Department of Urology, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Victor C Lin
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Wade W-T Kuo
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Hsien Wu
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan.,Department of Urology, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
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7
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Mozafarpour S, Chen A, Paredes Mogica JA, Nwaoha N, Farhad K, Morrison SM, De EJB. Urodynamic autonomic bladder dysfunction in women with complex chronic pelvic pain is associated with small fiber polyneuropathy. Neurourol Urodyn 2021; 41:482-489. [PMID: 34936711 DOI: 10.1002/nau.24858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/08/2021] [Accepted: 11/26/2021] [Indexed: 12/17/2022]
Abstract
AIMS Small fiber neuropathy/polyneuropathy (SFN) has been found to be present in 64% of complex (refractory or multisystem) chronic pelvic pain (CPP) patients. The small fiber dysfunction seen in SFN can negatively impact autonomic control of micturition in addition to pain. This study investigated the clinical association of autonomic dysfunction (detrusor underactivity and primary bladder neck obstruction [BNO]) on video urodynamics (VUDS) with SFN in patients with CPP. METHODS This was a retrospective observational study, querying data from patients with complex CPP. Inclusion criteria were: the presence of complex (refractory or multisystem) CPP, and completion of both (1) subspecialty autonomic neurology evaluation for SFN and (2) high-quality VUDS performed according to ICS standards. Autonomic bladder dysfunction (BNO or detrusor underactivity) on VUDS was compared to the presence of SFN. RESULTS Thirty-two female patients with complex CPP met criteria. Of the 32, 23 (72%) were found to have SFN. Patient with autonomic bladder dysfunction (BNO or detrusor underactivity) were more likely to have SFN (OR = 9.5 [95% CI: 1.641, 55.00], p = 0.007). Post-void residual volume was higher in the SFN group (p = 0.011 [95% CI: 13.12, 94.0]) and symptoms of urge urinary incontinence were more likely to be present (p = 0.000 [95% CI: -3.4, -1.25]). CONCLUSIONS Patients with complex CPP with autonomic bladder dysfunction are more likely to have SFN. This suggests patients with complex CPP should be considered for diagnosis and treatment of SFN, particularly if BNO or detrusor underactivity is noted on VUDS evaluation.
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Affiliation(s)
| | - Annie Chen
- Stony Brook University Hospital, Stony Brook, New York, USA
| | | | - Ngozi Nwaoha
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Khosro Farhad
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Elise J B De
- Massachusetts General Hospital, Boston, Massachusetts, USA
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8
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Pang KH, Campi R, Arlandis S, Bo K, Chapple CR, Costantini E, Farag F, Groen J, Karavitakis M, Lapitan MC, Manso M, Monagas Arteaga S, Nambiar AK, Nic An Ríogh AU, O'Connor EM, Osman NI, Peyronnet B, Phé V, Sakalis VI, Sihra N, Tzelves L, van der Vaart H, Yuan Y, Omar MI, Harding CK. Diagnostic Tests for Female Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel. Eur Urol Focus 2021; 8:1015-1030. [PMID: 34538750 DOI: 10.1016/j.euf.2021.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/09/2021] [Accepted: 09/07/2021] [Indexed: 02/01/2023]
Abstract
CONTEXT Female bladder outlet obstruction (fBOO) is a relatively uncommon condition compared with its male counterpart. Several criteria have been proposed to define fBOO, but the comparative diagnostic accuracy of these remains uncertain. OBJECTIVE To identify and compare different tests to diagnose fBOO through a systematic review process. EVIDENCE ACQUISITION A systematic review of the literature was performed according to the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. The EMBASE/MEDLINE/Cochrane databases were searched up to August 4, 2020. Studies on women ≥18 yr of age with suspected bladder outlet obstruction (BOO) involving diagnostic tests were included. Pressure-flow studies or fluoroscopy was used as the reference standard where possible. Two reviewers independently screened all articles, searched reference lists of retrieved articles, and performed data extraction. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). EVIDENCE SYNTHESIS Overall, 28 nonrandomised studies involving 10 248 patients were included in the qualitative analysis. There was significant heterogeneity regarding the characteristics of women included in BOO cohorts (ie, mixed cohorts including both anatomical and functional BOO). Pressure-flow studies ± fluoroscopy was evaluated in 25 studies. Transperineal Doppler ultrasound was used to evaluate bladder neck dynamics in two studies. One study tested the efficacy of transvaginal ultrasound. The urodynamic definition of fBOO also varied amongst studies with different parameters and thresholds used, which precluded a meta-analysis. Three studies derived nomograms using the maximum flow rate (Qmax) and voiding detrusor pressure at Qmax. The sensitivity, specificity, and overall accuracy ranges were 54.6-92.5%, 64.6-93.9%, and 64.1-92.2%, respectively. CONCLUSIONS The available evidence on diagnostic tests for fBOO is limited and heterogeneous. Pressure-flow studies ± fluoroscopy remains the current standard for diagnosing fBOO. PATIENT SUMMARY Evidence on tests used to diagnose female bladder outlet obstruction was reviewed. The most common test used was pressure-flow studies ± fluoroscopy, which remains the current standard for diagnosing bladder outlet obstruction in women. TAKE HOME MESSAGE: The available evidence on diagnostic tests for female bladder outlet obstruction is limited and heterogeneous. The most common test used was video-urodynamics, which remains the current standard for diagnosing bladder outlet obstruction in women.
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Affiliation(s)
- Karl H Pang
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Christopher R Chapple
- Section of Functional and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | | | - Fawzy Farag
- Department of Urology, Sohag University Hospital, Sohag, Egypt; Department of Urology, East Suffolk and North Essex NHS Foundation Trust, UK
| | - Jan Groen
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Marie Carmela Lapitan
- College of Medicine/Philippine General Hospital/National institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Margarida Manso
- Department of Urology, São João University Hospital Center, Porto, Portugal; Faculty of Medicine of Porto, Porto, Portugal
| | | | - Arjun K Nambiar
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | | | | | - Nadir I Osman
- Section of Functional and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | | | - Véronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne University, Paris, France
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Néha Sihra
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lazaros Tzelves
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | - Huub van der Vaart
- Division Woman & Baby, University Medical Center Utrecht, Utrecht, The Netherlands; Bergman Clinics Women's Health, The Netherlands
| | - Yuhong Yuan
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Muhammad Imran Omar
- University of Aberdeen, Aberdeen, UK; European Association of Urology, Arnhem, The Netherlands.
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Wei S, Ma M, Wu C, Yu B, Jiang L, Wen X, Fu F, Shi M. Using Search Trends to Analyze Web-Based Interest in Lower Urinary Tract Symptoms-Related Inquiries, Diagnoses, and Treatments in Mainland China: Infodemiology Study of Baidu Index Data. J Med Internet Res 2021; 23:e27029. [PMID: 34255683 PMCID: PMC8292938 DOI: 10.2196/27029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/10/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023] Open
Abstract
Background Lower urinary tract symptoms (LUTS) are one of the most commonly described urination disorders worldwide. Previous investigations have focused predominantly on the prospective identification of cases that meet the researchers’ criteria; thus, the genuine demands regarding LUTS from patients and related issues may be neglected. Objective We aimed to examine web-based search trends and behaviors related to LUTS on a national and regional scale by using the dominant, major search engine in mainland China. Methods Baidu Index was queried by using LUTS-related terms for the period of January 2011 to September 2020. The search volume for each term was recorded to analyze search trends and demographic distributions. For user interest, user demand graph data and trend data were collected and analyzed. Results Of the 13 LUTS domains, 11 domains are available in the Baidu Index database. The Baidu search index for each LUTS domain varied from 37.78% to 1.47%. The search trends for urinary frequency (2011-2018: annual percent change APC=7.82%; P<.001), incomplete emptying (2011-2014: APC=17.74%; P<.001), nocturia (2011-2018: APC=11.54%; P<.001), dysuria (2017-2020: APC=20.77%; P<.001), and incontinence (2011-2016: APC=13.39%; P<.001) exhibited fluctuations over time. The search index trends for weak stream (2011-2017: APC=−4.68%; P<.001; 2017-2020: APC=9.32%; P=.23), split stream (2011-2013: APC=9.50%; P=.44; 2013-2020: APC=2.05%; P=.71), urgency (2011-2018: APC=−2.63%; P=.03; 2018-2020: APC=8.58%; P=.19), and nocturnal enuresis (2011-2018: APC=−3.20%; P=.001; 2018-2020: APC=−4.21%; P=.04) remained relatively stable and consistent. The age distribution of the population for all LUTS-related inquiries showed that individuals aged 20 to 40 years made 73.86% (49,218,123/66,635,247) of the total search inquiries. Further, individuals aged 40 to 49 years made 12.29% (8,193,922/66,635,247) of the total search inquiries for all LUTS-related terms. People from the east part of China made 67.79% (45,172,031/66,635,247) of the total search queries. Additionally, most of the searches for LUTS-related terms were related to those for urinary diseases to varying degrees. Conclusions Web-based interest in LUTS-related terms fluctuated wildly and was reflected timely by Baidu Index in mainland China. The web-based search popularity of each LUTS-related term varied significantly and differed based on personal interests, the population’s concerns, regional variations, and gender. These data can be used by care providers to track the prevalence of LUTS and the population’s interests, guide the establishment of disease-specific health care policies, and optimize physician-patient health care sessions.
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Affiliation(s)
- Shanzun Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Ma
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Changjing Wu
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Botao Yu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Lisha Jiang
- Day Surgery Center, West China Hospital, Sichuan University, China, China
| | - Xi Wen
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Fudong Fu
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Shi
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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10
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Defining Voiding Dysfunction in Women: Bladder Outflow Obstruction versus Detrusor Underactivity. Int Neurourol J 2021; 25:244-251. [PMID: 33957716 PMCID: PMC8497729 DOI: 10.5213/inj.2040342.171] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/03/2020] [Indexed: 11/08/2022] Open
Abstract
Purpose We aimed to develop urodynamic criteria for more accurate diagnosis of bladder outlet obstruction (BOO) and detrusor underactivity (DU) in women with lower urinary tract symptoms (LUTS). Methods Initially, in a group of 68 consecutive women with LUTS and increased post-void residual who had undergone urodynamic investigation we examined the level of agreement between operating physician's diagnosis of BOO or DU and diagnosis according to urodynamic nomograms/indices, including the Blaivas-Groutz (B-G) nomogram, Urethral Resistance Association (URA), Bladder Outlet Obstruction Index (BOOI) and Bladder Contractility Index (BCI). Based on the initial results, we categorized 160 women into four groups using B-G nomogram and URA (Group 1: severe-moderate BOO, Group 2: mild BOO and URA≥20, Group 3: mild BOO and URA<20 and Group 4: non-obstructed) and compared urodynamic parameters. Finally, we redefined women as obstructed (group 1+2) and non-obstructed (group 3+4) for sub-analysis. Results The agreement between B-G nomogram and physician's diagnosis was poor in the mild obstruction zone (kappa=0.308, p=0.01). Adding URA (cutoff value 20), an excellent level of agreement was reached (kappa=0.856, p<0.001). Statistically significant differences were found between the four groups (ANOVA) in maximum flow (Qmax) (p<0.0001), voided volume (VV) (p=0.042), post void residual (PVR) (p=0.032), BOOI (p<0.0001) and BCI (p<0.0001) with a positive linear trend for Qmax and VV and negative linear trend for PVR and BOOI from group 1 to 4. In the subanalysis all parameters were statistically different between obstructed and nonobstructive women except BCI (Qmax: p=0.0001, VV: p=0.0091, PVR: p=0.0005, BOOI: p=0.0001). Conclusions The combination of B-G nomogram with the URA parameter increases the accuracy of diagnosing BOO among women with LUTS. Based on this combination, most women in the mild obstruction zone of the B-G nomogram would be considered underactive rather than obstructed.
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11
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Verhovsky G, Rappaport YH, Baberashvili I, Neheman A, Zisman A, Stav K. Bladder outlet obstruction is associated with bladder oversensitivity in women. Int Urogynecol J 2020; 32:2771-2776. [PMID: 33084961 DOI: 10.1007/s00192-020-04561-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Bladder outlet obstruction (BOO) in women might be associated with significant lower urinary tract storage symptoms such as increased frequency, urgency, and incontinence. This prospective study was designed to assess whether there is an objective association between BOO and abnormal parameters during filling cystometry in women. METHODS A total of 169 consecutive women (mean age 56 ± 14 years) who were referred for urodynamic investigation were prospectively recruited. Comprehensive medical, obstetric, and gynecological histories were recorded. All patients underwent physical examination, renal and bladder ultrasound, and filled out the International Prostate Symptoms Score (IPSS) questionnaire. The cohort was divided into obstructed and un-obstructed groups based on pressure flow results (Obstruction: Qmax <12 ml/s and Pdet @ Qmax >25 cmH2O). RESULT There was no significant difference in the frequency of detrusor overactivity between the obstructed and non-obstructed group (37% vs 32%, p = 0.71). All bladder sensation volumes were significantly lower in obstructed women than non-obstructed women in univariate and multivariate logistic regression analyses. Of the sensation parameters, first desire to void (FDV) had the highest area under the curve (AUC = 0.75, 95% CI = 0.672-0.837, p < 0.001) for predicting BOO. FDV < 105 ml showed a strong association with BOO with OR = 9.84 (95% CI 4.122-23.508, p < 0.0001). On univariate and multivariate analyses adjusted to 50 cc reduction in sensation volume, all sensation parameters, were associated with bladder outlet obstruction. CONCLUSION Our results suggest that there might be a strong association between bladder oversensitivity and BOO in women. This may shed light on the pathophysiological connection between obstruction and enhanced afferent signaling from the bladder.
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Affiliation(s)
- Guy Verhovsky
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel.
| | - Yishai Hode Rappaport
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel
| | - Ilia Baberashvili
- Department of Nephrology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Neheman
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel
| | - Kobi Stav
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel
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12
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Urodynamics for the “Failed” Midurethral Sling. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00589-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Panwar P, Bansal D, Lekha Raveendran R, Kumar A. Primary Bladder Neck Obstruction in a Young Woman: A Novel Technique of Bladder Neck Incision Using Holmium Laser. J Endourol Case Rep 2020; 6:153-155. [DOI: 10.1089/cren.2019.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pankaj Panwar
- Department of Urology, Uro-Oncology, Robotics and Renal Transplant, Max Group of Hospitals, Delhi, India
| | - Devanshu Bansal
- Department of Urology, Uro-Oncology, Robotics and Renal Transplant, Max Group of Hospitals, Delhi, India
| | - Rakhul Lekha Raveendran
- Department of Urology, Uro-Oncology, Robotics and Renal Transplant, Max Group of Hospitals, Delhi, India
| | - Anant Kumar
- Department of Urology, Uro-Oncology, Robotics and Renal Transplant, Max Group of Hospitals, Delhi, India
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Lindsay J, Solomon E, Nadeem M, Pakzad M, Hamid R, Ockrim J, Greenwell T. Treatment validation of the Solomon-Greenwell nomogram for female bladder outlet obstruction. Neurourol Urodyn 2020; 39:1371-1377. [PMID: 32249980 DOI: 10.1002/nau.24347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/17/2020] [Indexed: 11/07/2022]
Abstract
AIM Bladder outflow in women (bladder outlet obstruction [BOO]) has no well-accepted defining diagnostic criteria. Various nomograms exist based on flow rates, pressure-flow data, and fluoroscopy. We have prospectively evaluated the Solomon-Greenwell bladder outflow obstruction nomogram (SG BOO nomogram) as a measurement of BOO resolution following targeted surgical intervention. METHODS The routine posttreatment urodynamics of 21 unselected women with an original urodynamic diagnosis of BOO on fluoroscopy and the SG BOO nomogram (BOO boundary defined as Qmax > 2.2 Pdet.Qmax + 5) were reviewed. All women had symptomatic BOO secondary to anterior pelvic organ prolapse (aPOP), urethrovaginal fistula (UVF), previous stress urinary incontinence (SUI) surgery, urethral stricture (US), or urethral diverticulum (U Div). Following treatment, all presenting symptoms resolved and simple urodynamics were performed as part of routine follow-up. RESULTS The urodynamic findings preoperatively and postoperatively showed statistically significant changes posttreatment in mean flow rate which increased from 9.38 to 14.71 mL/s, mean Pdet.Qmax which decreased from 38 to 18.38 cmH2 O, and mean SG BOO nomogram probability (PBOO) which reduced from PBOO = 0.68 to 0.08. Mean SG BOO nomogram PBOO was significantly reduced posttreatment in all individual categories except UVF where a nonsignificant reduction from PBOO = 0.55 to 0.05 occurred. CONCLUSIONS All urodynamic parameters significantly improve in women who become asymptomatic following surgical treatment of BOO. This improvement is best demonstrated by the change in probability of BOO according to the Solomon-Greenwell nomogram. These findings underline the validity of the Solomon-Greenwell female BOO nomogram for diagnosing and monitoring BOO in women.
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Affiliation(s)
- Jamie Lindsay
- Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eskinder Solomon
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mehwash Nadeem
- Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mahreen Pakzad
- Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rizwan Hamid
- Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jeremy Ockrim
- Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tamsin Greenwell
- Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK
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15
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Rubilotta E, Balzarro M, D'Amico A, Cerruto MA, Bassi S, Bovo C, Iacovelli V, Bianchi D, Artibani W, Finazzi Agrò E. Pure stress urinary incontinence: analysis of prevalence, estimation of costs, and financial impact. BMC Urol 2019; 19:44. [PMID: 31164133 PMCID: PMC6549321 DOI: 10.1186/s12894-019-0468-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 04/26/2019] [Indexed: 12/02/2022] Open
Abstract
Background The prevalence of pure stress urinary incontinence (P-SUI) and the role of urodynamic investigation (UDI) prior to surgery for stress urinary incontinence (SUI) is debated. Since the exact prevalence of P-SUI is not clear, its clinical and economic impact is not well defined. The aims of this study were to evaluate the prevalence of P-SUI in a population of women who underwent UDI for urinary incontinence (UI), also assessing: 1) the correspondence between clinical diagnosis of P-SUI and urodynamic findings; 2) the analysis of costs in terms of UDI and eventually post-UDI avoided surgical procedures. Methods A single cohort of women who underwent UDI for UI between January 2012 and July 2016 was prospectively collected and retrospectively analyzed. Clinical P-SUI was defined by the strict criteria of the International Continence Society. For each patient, history, physical examination and UDI were collected. The correspondence between clinical and urodynamic findings of P-SUI was analyzed. The rate of clinical P-SUI changed after performing UDI and the number of unnecessary intervention after UDI were reported. A wide cost analysis of UDIs, and the amount of surgical procedures that were believed unnecessary after UDI was reported. Results Stress urinary incontinence was present in 323/544 (59.4%) patients. The prevalence of clinical P-SUI was 20.7% (67/323), while the prevalence of complicated SUI (C-SUI) was 79.3% (256/323). After UDI, diagnosis of P-SUI decreased to 18.3% (59/232). In 10.2% of cases (6/59) the scheduled middle urethral sling (MUS) was suppressed after the UDI results because 3/6 cases had detrusor overactivity and urge incontinence, in 2/6 cases SUI was treated with a conservative management, in 1/6 case an important voiding dysfunction was detected. Considering the national reimbursement in our country, the cost of each UDI was 296.5 euros and the total amount was 17,493.5 euros. So far the surgery-related savings covered 61.7–105.0% of the costs of total number of UDIs performed in the uncomplicated patients. Conclusions The prevalence of clinical P-SUI is relevant, involving about 20% of women with clinical SUI. Although the correspondence between clinical and urodynamic diagnosis was high, we demonstrated that UDI may help in some cases to avoid an inappropriate surgical treatment. Therefore, UDI prior to SUI surgery should be considered to achieve a correct diagnosis and a proper therapeutic strategy.
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Affiliation(s)
- Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI), Piazzale Aristide Stefani, 1, 37126, Verona, Italy.
| | - Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI), Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Antonio D'Amico
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI), Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Maria Angela Cerruto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI), Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Silvia Bassi
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI), Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Chiara Bovo
- Healthcare Department Administrator, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Valerio Iacovelli
- Department of Experimental Medicine and Surgery, Urology Unit, Tor Vergata University, Rome, Italy
| | - Daniele Bianchi
- Department of Experimental Medicine and Surgery, Urology Unit, Tor Vergata University, Rome, Italy
| | - Walter Artibani
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI), Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Enrico Finazzi Agrò
- Department of Experimental Medicine and Surgery, Urology Unit, Tor Vergata University, Rome, Italy
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Valentini FA, Nelson PP. Mathematical Modeling and Uroflow-Based Nomograms in Voiding Dysfunction Evaluation: Ready for Prime Time? CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Kuo YC, Kuo HC. Videourodynamic characteristics of interstitial cystitis/bladder pain syndrome-The role of bladder outlet dysfunction in the pathophysiology. Neurourol Urodyn 2018; 37:1971-1977. [PMID: 29504632 DOI: 10.1002/nau.23542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/07/2018] [Indexed: 11/09/2022]
Abstract
AIMS To investigate the characteristics of videourodynamic study (VUDS) in females with interstitial cystitis/bladder pain syndrome (IC/BPS) focusing on the etiologies of bladder outlet dysfunction (BOD) and their associations with clinical and urodynamic parameters. METHODS IC/BPS females with complete data on symptom assessment, VUDS, the potassium sensitivity test, and cystoscopic hydrodistention were reviewed retrospectively. Diagnoses of bladder dysfunction (hypersensitive bladder, HSB) and BOD including dysfunctional voiding (DV), poor relaxation of the external urethral sphincter (PRES), and bladder neck dysfunction (BND) were made by VUDS. The clinical and urodynamic parameters between patients with normal and abnormal VUDS diagnoses were analyzed. RESULTS A total of 348 IC/BPS female patients (mean age 48.8 ± 13.5) were enrolled. HSB was found in 307 (88.2%) patients and BOD in 209 (60.1%). The causes of BOD included DV in 40 (11.5%), PRES in 168 (48.3%), and BND in 1 (0.3%). Patients with DV and BND had higher, and those with PRES had lower detrusor pressures at maximum flow rate (Qmax ) than those with normal tracings. For all BOD patients, univariate logistic regression revealed a significant positive correlation of disease duration and negative correlations of urodynamic volume parameters with BOD in IC/BPS patients. Multivariate logistic regression found a cut-off value of Qmax ≦ 11 mL/s predicted BOD in IC/BPS with a receiver operating characteristic area of 0.81 (sensitivity = 82.0%, specificity = 68.5%). CONCLUSIONS HSB and BOD are common findings on VUDS in IC/BPS females. BOD is associated with duration and hypersensitive bladder. A Qmax ≦ 11 mL/s predicts BOD in IC/BPS.
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Affiliation(s)
- Yuh-Chen Kuo
- Department of Urology, Yangming Branch of Taipei City Hospital, Taipei, Taiwan.,Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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18
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Solomon E, Yasmin H, Duffy M, Rashid T, Akinluyi E, Greenwell TJ. Developing and validating a new nomogram for diagnosing bladder outlet obstruction in women. Neurourol Urodyn 2018; 37:368-378. [PMID: 28666055 DOI: 10.1002/nau.23307] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/31/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To develop and validate a nomogram for assessing bladder outlet obstruction (BOO) in women derived from concurrent Pdet.Qmax and Qmax based on radiographic evidence of increased urethral resistance. PATIENTS AND METHODS Retrospective analysis of prospectively acquired video-urodynamics and clinical data of 185 women (development cohort) was performed. The Pdet.Qmax were plotted against Qmax and cluster analysis was performed to determine an axis that best divided the definitively obstructed and unobstructed. Using data from a further 350 women (validation cohort), the sensitivity and specificity of the derived criterion was calculated. Finally, the data from both groups was pooled together and using binary logistic regression analysis, a nomogram was produced. RESULTS Of the 535 patients in the two cohorts, (122 [22.8%]) demonstrated radiographic evidence of BOO. Cluster analysis identified the axis that best separates the radiographically obstructed and unobstructed as Pdet.Qmax = 2*Qmax . Using the data from the validation cohort, the sensitivity and specificity for this was calculated as 0.94 and 0.93, respectively. A nomogram, representing the probability of BOO for concurrent Pdet.Qmax and Qmax measurements was derived by pooling data from both cohorts. Alternatively, a female BOO index (BOOIf) may be calculated mathematically using the formula BOOIf = Pdet.Qmax - 2.2*Qmax, that is, BOOIf < 0, <10% probability of obstruction, BOOIf > 5 likely obstructed (50%) and If BOOIf > 18, obstruction almost certain (>90%). CONCLUSION A female BOO nomogram (the SG nomogram) with high sensitivity and specificity is proposed. The nomogram can be used to stratify the degree of BOO or assess response to treatment.
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Affiliation(s)
| | - Habiba Yasmin
- University College London Hospitals NHS Trust, London, UK
| | - Megan Duffy
- University College London Hospitals NHS Trust, London, UK
| | - Tanwir Rashid
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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New frontiers in molecular and imaging research on evaluation and diagnosis of bladder outlet obstruction in women. CURRENT BLADDER DYSFUNCTION REPORTS 2017; 12:291-297. [PMID: 29225720 DOI: 10.1007/s11884-017-0429-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose Diagnosis of bladder outlet obstruction (BOO) often presents a challenge in female patients. Traditional diagnostic elements such as symptom history and urodynamic data are rarely clear cut in women. Therefore, we sought to review the current literature on diagnosis of female BOO, focusing on new frontiers in the realm of molecular markers and imaging modalities. Recent Findings In addition to fluoroscopy in the setting of videourodynamics, ultrasound and MRI can augment the diagnosis and aid in therapeutic planning in certain etiologies of female BOO. Furthermore, multiple potential biomarkers (i.e. nerve growth factor, prostaglandins, ATP) that have been studied in correlation to BOO in animal models as well as human subjects hold promise for diagnostic applications. Summary These novel techniques may augment standard clinical and urodynamic evaluation of BOO in females. Future directions include further studies of each of these biomarkers in female patients with BOO compared to normal controls to test their feasibility as potential screening tools.
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20
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Malde S, Solomon E, Spilotros M, Mukhtar B, Pakzad M, Hamid R, Ockrim J, Greenwell T. Female bladder outlet obstruction: Common symptoms masking an uncommon cause. Low Urin Tract Symptoms 2017; 11:72-77. [DOI: 10.1111/luts.12196] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sachin Malde
- Department of Urology; University College London Hospital; London UK
| | - Eskinder Solomon
- Department of Urology; University College London Hospital; London UK
| | - Marco Spilotros
- Department of Urology; University College London Hospital; London UK
| | - Bashir Mukhtar
- Department of Urology; University College London Hospital; London UK
| | - Mahreen Pakzad
- Department of Urology; University College London Hospital; London UK
| | - Rizwan Hamid
- Department of Urology; University College London Hospital; London UK
| | - Jeremy Ockrim
- Department of Urology; University College London Hospital; London UK
| | - Tamsin Greenwell
- Department of Urology; University College London Hospital; London UK
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Abstract
This retrospective study is aimed to present videourodynamic findings of women with symptoms of voiding dysfunction in a medical center. Of 1914 women, the diagnoses included bladder outlet obstruction (BOO, n = 810, 42.3%), bladder dysfunction (n = 1,048, 54.8%) and normal tracings (n = 56, 2.9%). Anatomic BOO (n = 49) included cystocele (n = 19) and urethral stricture (n = 30). Common functional BOOs included dysfunctional voiding (n = 325, 17.0%) and poor relaxation of the external sphincter (n = 336, 17.6%). Common bladder dysfunction subtypes included detrusor underactivity (n = 337, 17.6%), detrusor hyperactivity with impaired contractility (n = 231, 12.1%), and bladder oversensitivity (n = 325, 17.0%). Receiver operating characteristic (ROC) analysis were performed, and the following optimum cutoff values were determined: (1) voiding detrusor pressure at a maximum flow rate (Pdet.Qmax) = 30 cmH2O for differentiating BOO from bladder dysfunction and normal tracings, with an ROC area of 0.78; (2) the Abrams-Griffiths number = 30 for differentiating anatomic from functional BOO, with an ROC area of 0.66; (3) post-void residual = 200 mL for differentiating bladder neck dysfunction from the other BOOs, with an ROC area of 0.69; (4) Pdet.Qmax = 30 cmH2O for differentiating dysfunctional voiding from poor relaxation of the external sphincter with an ROC area of 0.93. The above findings can be used as initial guide for management of female BOO.
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22
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Rademakers K, Apostolidis A, Constantinou C, Fry C, Kirschner-Hermanns R, Oelke M, Parsons B, Nelson P, Valentini F, Gammie A. Recommendations for future development of contractility and obstruction nomograms for women. ICI-RS 2014. Neurourol Urodyn 2016; 35:307-11. [PMID: 26872573 DOI: 10.1002/nau.22776] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/04/2015] [Indexed: 12/20/2022]
Abstract
AIMS At present, existing bladder outlet obstruction (BOO) nomograms for women are still not universally accepted. Moreover, only limited information is available regarding bladder contractility in women. The aim is to present the discussions and recommendations from the think tank session "Can we construct and validate contractility and obstruction nomograms for women?" held at the 2014 International Consultation on Incontinence-Research Society (ICI-RS) meeting in Bristol, UK. METHODS An overview of clinical significance, bladder mechanics and modelling, lack of existing nomograms for women, and development of new nomograms were presented and discussed in a multidisciplinary think tank session. This think tank session was based on a collaboration between physicians, engineers, and researchers and consensus was achieved on future research initiatives. RESULTS AND CONCLUSIONS Based on the think tank discussion, the ICI-RS panel put forward the following recommendations: the need to acquire normative age-matched data in women to define "normal" and "pathological" values of urodynamic parameters; the inclusion of additional clinical data in new nomograms and the use of this extra dimension to develop clinically applicable nomograms for female BOO and contractility; and finally, the need to take into account the variability of BOO in women when developing female bladder contractility nomograms.
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Affiliation(s)
- Kevin Rademakers
- Department of Urology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | | | - Christopher Fry
- School of Physiology and Pharmacology, University of Bristol, United Kingdom
| | - Ruth Kirschner-Hermanns
- University Clinic, Clinic of Urology/Neuro-Urology Bonn, Rheinisch Friedrich-Wilhelms University, Germany
| | - Matthias Oelke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Brian Parsons
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Pierre Nelson
- ER6-Université Pierre et Marie Curie (Paris 06), Paris, France
| | | | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
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23
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Abstract
The non-specific symptoms the patients express upon the presentation of female bladder outlet obstruction make it a challenge to diagnose. There are subtle differences between the obstructed patient and those whose bladders are underactive and/or fail to mount a detrusor contraction. These disparities can be extracted through a thorough history and examination. At times, the clinician may utilize nomograms, non-invasive uroflow, and urodynamics with the addition of fluoroscopy to establish the diagnosis of obstruction. Management of the obstruction depends on the nature of the condition, whether functional or anatomical. The increase in the number of sling procedures performed to treat stress urinary incontinence has resulted in a rise in the number of iatrogenic obstructions. The temporal relationship between surgery and obstruction is the key to identifying the problem.
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Shen W, Ji H, Yang C, Zhang H, Xiong T, Wu X, Zhang J, Zhou Z. Controlled transurethral resection and incision of the bladder neck to treat female primary bladder neck obstruction: Description of a novel surgical procedure. Int J Urol 2016; 23:491-5. [PMID: 27037830 DOI: 10.1111/iju.13085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/21/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the efficacy and complications of controlled transurethral resection and incision of the bladder neck to treat female primary bladder neck obstruction. METHODS A total of 59 patients who were diagnosed with female primary bladder neck obstruction by urodynamic examination underwent surgical procedures at Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China, between March 2010 and March 2014. For all patients, neurogenic, anatomical and dysfunctional voiding causes of bladder outlet obstruction had been excluded. Perioperative and follow-up data, including operative time, maximum urine flow rate, residual urine volume, International Prostate Symptom Score and Quality of Life Score, were prospectively investigated. RESULTS All of the operations were completed uneventful. The median operative time was 15 ± 8 min (range 10-22 min). No massive hemorrhage or infection was reported. Follow-up data were available for 59, 59, and 57 of the patients at 1, 6 and 12 months postoperatively, respectively. The mean maximum urine flow rate increased from 7.2 ± 3.9 mL/s preoperatively to 26.1 ± 5.2 mL/s postoperatively. The mean residual urine volume decreased from 162 ± 75 to 20 ± 7 mL. The mean International Prostate Symptom Score decreased from 24.5 ± 7.2 to 5.5 ± 3.6. The mean Quality of Life Score decreased from 5.4 ± 1.7 to 1.9 ± 1.1. All of the differences between the preoperative and postoperative values were significant (P < 0.001). CONCLUSIONS The novel technique described here shortens the length of the urethra to 2.5 cm, which both released the obstruction and maintained continence. The results of the present preliminary study show that this method represents a safe and effective treatment for female primary bladder neck obstruction.
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Affiliation(s)
- Wenhao Shen
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Huixiang Ji
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Chao Yang
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Heng Zhang
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Tailing Xiong
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Xiaojun Wu
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Jiahua Zhang
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Zhansong Zhou
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
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Özveren B, Keskin S. Presentation and prognosis of female acute urinary retention: Analysis of an unusual clinical condition in outpatients. Urol Ann 2016; 8:444-448. [PMID: 28057989 PMCID: PMC5100150 DOI: 10.4103/0974-7796.192111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Acute urinary retention (AUR) in females is a poorly defined condition with undetermined epidemiology. This study aimed to evaluate female AUR in an outpatient population. PATIENTS AND METHODS One hundred and thirty-eight adult female outpatients who presented to the emergency room with symptoms of urinary retention were retrospectively analyzed. The women who were ultimately diagnosed with true, complete AUR were systematically reviewed for clinical characteristics and management. RESULTS In this outpatient cohort with urinary retention complaints, only 23% of the patients were diagnosed with objective AUR. Detailed medical and urological history in addition to urogenital, neurological, and pelvic examinations was essential; urine analysis and pelvic ultrasonography were necessary as baseline investigations. Further radiological and urodynamic tests were required in a minority. Specific etiology was established in 77% of the patients, whereas there was more than one probable cause in 16% of the patients, and no specific cause was found in 6.5% of the patients. Bladder decompression and correction of the underlying cause helped 92.6% of the reviewed patients to eventually achieve spontaneous micturition. CONCLUSIONS The proportion of true, complete AUR among female outpatients presenting to the emergency department was 23% following urological evaluation. Acute condition was resolved by urgent catheterization in all, and the majority of women had eventually resumed spontaneous voiding.
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Affiliation(s)
- Bora Özveren
- Department of Urology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Selçuk Keskin
- Department of Urology, Acibadem University School of Medicine, Istanbul, Turkey
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Takahashi S, Takei M, Nishizawa O, Yamaguchi O, Kato K, Gotoh M, Yoshimura Y, Takeyama M, Ozawa H, Shimada M, Yamanishi T, Yoshida M, Tomoe H, Yokoyama O, Koyama M. Clinical Guideline for Female Lower Urinary Tract Symptoms. Low Urin Tract Symptoms 2015; 8:5-29. [PMID: 26789539 DOI: 10.1111/luts.12111] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 06/28/2015] [Indexed: 12/16/2022]
Abstract
The "Japanese Clinical Guideline for Female Lower Urinary Tract Symptoms," published in Japan in November 2013, contains two algorithms (a primary and a specialized treatment algorithm) that are novel worldwide as they cover female lower urinary tract symptoms other than urinary incontinence. For primary treatment, necessary types of evaluation include querying the patient regarding symptoms and medical history, examining physical findings, and performing urinalysis. The types of evaluations that should be performed for select cases include evaluation with symptom/quality of life (QOL) questionnaires, urination records, residual urine measurement, urine cytology, urine culture, serum creatinine measurement, and ultrasonography. If the main symptoms are voiding/post-voiding, specialized treatment should be considered because multiple conditions may be involved. When storage difficulties are the main symptoms, the patient should be assessed using the primary algorithm. When conditions such as overactive bladder or stress incontinence are diagnosed and treatment is administered, but sufficient improvement is not achieved, the specialized algorithm should be considered. In case of specialized treatment, physiological re-evaluation, urinary tract/pelvic imaging evaluation, and urodynamic testing are conducted for conditions such as refractory overactive bladder and stress incontinence. There are two causes of voiding/post-voiding symptoms: lower urinary tract obstruction and detrusor underactivity. Lower urinary tract obstruction caused by pelvic organ prolapse may be improved by surgery.
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Affiliation(s)
- Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Mineo Takei
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Osamu Nishizawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Osamu Yamaguchi
- Division of Bioengineering and LUTD Research, School of Engineering, Nihon University, Koriyama, Japan
| | - Kumiko Kato
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Hideo Ozawa
- Department of Urology, Kawasaki Hospital, Kawasaki Medical School, Kurashiki, Japan
| | - Makoto Shimada
- Department of Urology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Obu City, Japan
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masayasu Koyama
- Women's Lifecare Medicine, Department of Obstetrics & Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Valentini FA, Nelson PP, Zimmern PE. VBN-based nomograms provide critical voiding parameters which can be used for invasive or non-invasive flow interpretation of women at risk of obstruction over time. Neurourol Urodyn 2015; 36:37-42. [PMID: 26436961 DOI: 10.1002/nau.22893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/07/2015] [Indexed: 11/10/2022]
Abstract
AIMS To design a simple office-based method to evaluate characteristic parameters from free uroflowmetries (FF) or pressure flow studies (PFs). This method can be applied by any physician to any recording, for instance in the follow-up of women at risk of developing outflow obstruction over time after surgical interventions. METHOD Using pressure-flow studies (PFs), a reliable evaluation of urethral obstruction (U) and detrusor contractility (k) parameters could be obtained from the maximum flow rate and detrusor pressure at maximum flow rate. Nomograms for these parameters were derived from theoretical computations using the VBN model. Then, to allow an evaluation of the real urethral obstruction, a protocol was designed incorporating FF data in the follow-up of women suspected of urethral obstruction. RESULTS Two nomograms were obtained: (1) A urethral obstruction nomogram allowing to define a Woman Obstruction Index (WOI = pdet.Qmax - 0.5*Qmax ) which has the same structure than the A-G number in men. (2) A detrusor contractility nomogram which was generalized to all initial bladder volumes. The curves were fitted by algebraic equations easily programmable on any handheld device. CONCLUSION Using a mathematical model of micturition and data extracted from PFs, two nomograms on urethral obstruction and detrusor contractility were designed. This tool offers a rapid and practical method for the clinician to follow women at risk of obstruction over time. Its applications will be the purpose of further studies. Neurourol. Urodynam. 36:37-42, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Françoise A Valentini
- Université Pierre et Marie CURIE (Paris 06) Paris and Hôpital Rothschild, Paris, France
| | - Pierre P Nelson
- Université Pierre et Marie CURIE (Paris 06) Paris and Hôpital Rothschild, Paris, France
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Aggarwal H, Lemack GE. Primary Bladder Neck Obstruction in Men and Women: an Update on Diagnosis and Management. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Huppertz ND, Kirschner-Hermanns R, Tolba RH, Grosse JO. Telemetric monitoring of bladder function in female Göttingen minipigs. BJU Int 2015; 116:823-32. [PMID: 25682883 DOI: 10.1111/bju.13089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To generate real-time radio-telemetric urodynamic reference data of maximum detrusor pressure (Pdet max ), maximum flow rate (Qmax) and estimated grade of infravesical obstruction, as well as duration of detrusor contraction (DOC), in female Göttingen minipigs and to describe translational aspects of the use of Göttingen minipigs for urological research. MATERIALS AND METHODS A telemetric transmitter was implanted into five female Göttingen minipigs, and 24 h measurements in metabolic cages were taken. Through operator-based analysis, synchronized real-time radio-telemetric cystometric data with flowmetric data and video sequences were used to determine voiding detrusor contractions (VCs) and non-voiding detrusor contractions (NVCs). Furthermore, data from telemetric natural-filling cystometry from free-moving and restricted maintenance conditions were compared for potential differences. RESULTS The median (range) Pdet max of VCs was 120.6 (21.0-370.0) cmH2 O and, therefore, significantly different from that of NVCs (64.60 [20.4-280.6 cmH2 O] cm H2 O). Intraindividual comparison of minipig data revealed great differences in voiding contractions. The effects of limited movement on VCs were analysed and showed significantly higher Pdet max and lower DOC than in free-moving conditions. CONCLUSION The presented data can be used for the development of telecystometric implanted minipig models, to investigate changes of detrusor function such as under- or overactivity, and might serve as model for bladder changes occurring with iatrogenic bladder outlet obstruction (BOO) or different therapeutic options for overactive bladder. Radio-telemetric real-time natural filling and voiding cystometries are feasible, reproducible in non-anaesthetized minipigs with free or limited movement and can give new insights into circadian behaviour and physiological and pathological bladder function.
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Affiliation(s)
- Nadine D Huppertz
- Department of Urology, University Hospital RWTH Aachen University, Aachen, Germany
| | - Ruth Kirschner-Hermanns
- Department of Neuro-Urology, University Clinic Friedrich-Wilhelms-University Bonn and Neurologic Rehabilitation Centre Godeshöhe, Bonn, Germany
| | - Rene H Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Joachim O Grosse
- Department of Urology, University Hospital RWTH Aachen University, Aachen, Germany
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The significance and factors related to bladder outlet obstruction in pelvic floor dysfunction in preoperative urodynamic studies: A retrospective cohort study. Obstet Gynecol Sci 2014; 57:59-65. [PMID: 24596819 PMCID: PMC3924746 DOI: 10.5468/ogs.2014.57.1.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 09/04/2013] [Accepted: 09/29/2013] [Indexed: 11/08/2022] Open
Abstract
Objective To demonstrate the significance of bladder outlet obstruction (BOO) in preoperative urodynamic studies (UDS) in women who have been diagnosed with pelvic floor dysfunction including pelvic organ prolapsed (POP) and stress urinary incontinence (SUI). Methods The medical records of 150 patients with pelvic floor dysfunction who underwent preoperative UDS at Yonsei University Health System from 2006 to 2012 were reviewed. Under the criteria of BOO, as a maximal flow rate in free-flow study (Qmax) less than 12 mL/sec and a detrusor pressure at Qmax in pressure-flow study (PdetQmax) higher than 20 cmH2O in UDS, they were divided into two groups: a group of 50 patients with BOO and a group of 100 patients without BOO. Comparisons were made between the patients with and without BOO in preoperative UDS. Results In the POP-with-SUI group, 25 patients with BOO had lower mean Qmax (10.0 vs. 25.4 mL/sec, P < 0.001), higher PdetQmax (49.6 vs. 21.5 cmH2O, P < 0.001), lower maximum cystometric capacity (422.7 vs. 454.0 mL, P = 0.007), and higher postvoidal residual volume (44.3 vs. 21.1 mL, P = 0.021) than the patients without BOO. In the SUI-only group, the mean Qmax was significantly lower in the 25 patients with BOO (9.4 vs. 25.4 mL/sec, P < 0.001). The mean PdetQmax was significantly higher with BOO (39.6 vs. 25.4 cmH2O, P = 0.004). In the univariate analyses, menopause, maximum cystometric capacity, and cystoscopic bladder trabeculation were associated with BOO. Conclusion In the univariate analysis, menopause, MCC and cystoscopic bladder trabeculation were associated with BOO. In the multivariate model, however, no significant association with BOO was found.
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Lee JY, Hah YS, Lee DH, Bang WJ, Ham WS, Lee SW, Cho KS. Clinical features of supervoiders who suffer from lower urinary tract symptoms: a propensity score-matching study. World J Urol 2013; 31:1463-8. [DOI: 10.1007/s00345-013-1081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022] Open
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Cetinel B, Tarcan T. Management of complications after tension-free midurethral slings. Korean J Urol 2013; 54:651-9. [PMID: 24175037 PMCID: PMC3806987 DOI: 10.4111/kju.2013.54.10.651] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 08/16/2013] [Indexed: 12/04/2022] Open
Abstract
Since their introduction in 1996, tension-free midurethral slings (MUS) have been proven to have long-term efficacy and safety. They are considered the gold standard treatment of female stress urinary incontinence, especially in cases that are associated with urethral hypermobility. However, they are not free of complications and, although rare, some of these complications can be challenging for both patients and physicians. Some complications occur intraoperatively, whereas others appear in the early or late postoperative period. There is less controversy in the diagnosis and treatment of complications such as vaginal extrusion or urinary system erosion, whereas de novo voiding problems are at best not completely understood. Voiding dysfunction after MUS placement may vary in a wide range from urinary frequency or urgency to retention and is usually attributed to the obstructive or irritative effect of the sling. However, present urodynamic criteria for the diagnosis of female infravesical obstruction are not satisfactory, and the best management policy for de novo voiding dysfunction remains controversial. In the majority of cases, the diagnosis of obstruction leading to a urethral release surgery depends on a combination of several clinical findings. The timing of urethral release surgery varies depending on the preferences of the surgeon, and the outcome of this surgery is not always predictable. The purpose of this review was to assess the diagnosis and management of the immediate, short-term, and long-term complications of MUS in light of the current literature in an attempt to determine the best management policy.
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Affiliation(s)
- Bülent Cetinel
- Department of Urology, Istanbul University Cerrahpaşa Medical School, Istanbul, Turkey
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Petrou SP, Ryan K, Metz-Kudashick D, Heckman MG, Thiel DD. Voiding chain cystourethography: assessing a historical test's role in selection for urethrolysis. Int Braz J Urol 2013; 39:498-505. [PMID: 24054397 DOI: 10.1590/s1677-5538.ibju.2013.04.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 06/14/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the benefit of voiding chain cystourethrography (VCC) [placing a radiographic opaque chain into the urethra and bladder and asking the patient to void under fluoroscopy] in the urodynamic evaluation of female bladder outlet obstruction (BOO). MATERIALS AND METHODS Females with post anti-incontinence operation voiding dysfunction who underwent urodynamic evaluation augmented with VCC and later had urethrolysis were identified. Six diagnostic criteria for obstruction were applied to each patient: (1) VCC ( obstructed: chain was angulated and could not be voiding out) (2) Video urodynamic study (VUDS) (detrusor contraction combined with radiographic obstruction) (3) maximum flow (Qmax) ≤ 15 cc/sec, detrusor pressure (pDet)@ Qmax ≥ 20 cm H20 (4) Qmax ≤ 11 cc/sec, pDet@ Qmax ≥ 25 cm H20 (5) Qmax ≤ 12 cc/sec, pDet@ Qmax ≥ 25 cm H20 (6) Blaivas-Groutz (B-G) nomogram. Urethrolysis results were reviewed. Agreement in assessment of BOO criteria was assessed by estimating the proportion of pair-wise agreements along with an exact binomial 95% confidence interval (CI) and by estimating kappa along with a 95 % CI. RESULTS Twenty-one patients were identified. Twenty of the 22 urethrolyses (91%) were clinically successful. Diagnosis of BOO was most common for VCC (86 %) and then B-G Nomogram (67 %). Agreement with the VCC was relatively poor for each of the five other methods (14% -62%) with the video urodynamic study (VUDS) being the best. Three patients with successful urethrolysis were diagnosed only by the VCC. All of kappa values regarding agreement with the VCC were low; the highest value of 0.15 was observed for VUDS. CONCLUSION VCC may augment selection criteria for urethrolysis.
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Affiliation(s)
- Steven P Petrou
- Department of Urology, Mayo Clinic, Jacksonville, Florida, USA
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Lakeman MME, Hakvoort RA, Van de Weijer EP, Emanuel MH, Roovers JPWR. Anterior colporrhaphy does not induce bladder outlet obstruction. Int Urogynecol J 2012; 23:723-8. [PMID: 22314892 PMCID: PMC3357473 DOI: 10.1007/s00192-012-1688-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 01/25/2012] [Indexed: 11/25/2022]
Abstract
Introduction and hypothesis We aimed to evaluate if anterior colporrhaphy causes incomplete voiding due to bladder outlet obstruction. Methods Women scheduled for anterior colporrhaphy were asked to undergo multichannel urodynamic investigation before surgery and the first postoperative day. Bladder outlet obstruction was assessed using the Blaivas–Groutz voiding nomogram. Maximum flow rate, detrusor pressure and residual volume were compared between pre- and postoperative measurements and between women with and without an abnormal post-void residual volume (PVR; volume exceeding 150 ml). Results Seventeen women participated. One woman who was unobstructed before surgery was obstructed after surgery. Overall, detrusor pressure and maximum flow rate before and after surgery did not differ. After surgery, six women had an abnormal PVR, one was unable to void, four were mildly obstructed and one moderately obstructed. Conclusion Urodynamic investigation the first day after anterior colporrhaphy did not show that anterior colporrhaphy induces bladder outlet obstruction. The explanation for postoperative urinary retention can therefore also lie in non-anatomical causes such as postoperative pain and psychological factors.
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Affiliation(s)
- M M E Lakeman
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Room H4-205, PO Box 22700, 1105 DE Amsterdam, The Netherlands.
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Jeon S, Yoo EH. Predictive value of obstructive voiding symptoms and objective bladder emptying tests for urinary retention. J OBSTET GYNAECOL 2012; 32:770-2. [DOI: 10.3109/01443615.2012.716105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Deffieux X, Thubert T, Amarenco G. Apport des explorations complémentaires au cours du bilan d’une dysurie de la femme. Prog Urol 2012; 22:628-35. [DOI: 10.1016/j.purol.2012.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 08/08/2012] [Indexed: 10/27/2022]
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Deirmentzoglou S, Giannitsas K, Perimenis P, Petsas T, Athanasopoulos A. Correlation of ultrasound-estimated bladder weight to urodynamic diagnoses in women with lower urinary tract symptoms. Urology 2012; 80:66-70. [PMID: 22748866 DOI: 10.1016/j.urology.2012.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 04/12/2012] [Accepted: 04/12/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test the hypothesis that the ultrasound-estimated bladder weight (UEBW) will correlate with the urodynamic diagnoses in women with lower urinary tract symptoms, in particular, detrusor underactivity and bladder outflow obstruction. Ultrasonography has been increasingly used in the assessment of lower urinary tract conditions. METHODS Adult women referred to the urodynamics suite for investigation of lower urinary tract symptoms were enrolled. After urodynamic evaluation, the portable BladderScan BVM 6500 device was used to calculate the bladder wall thickness and UEBW according to a standardized protocol. The patients were categorized according to the urodynamic findings. Women with normal findings, despite the symptoms for which they were referred, were used as the control group. The UEBW and bladder wall thickness measurements were compared between the groups and controls, using the Mann-Whitney and Kolmogorov-Smirnov tests. P <.05 was considered statistically significant. RESULTS A total of 187 women were enrolled. The UEBW was significantly lower in the patients with detrusor underactivity than in the controls (39.3 ± 3.0 g vs 45.7 ± 3.1 g, P <.001). Significant differences were also noted between the controls and patients with bladder outflow obstruction, with or without detrusor overactivity (45.7 ± 3.1 g vs 52.1 ± 3.9 g and 52.3 ± 6.2 g, respectively; P <.001 for both). The difference, in terms of the UEBW, between controls and patients with detrusor overactivity was not statistically significant (45.7 ± 3.1 g vs 45.3 ± 3.0, P > .05). CONCLUSION A significantly reduced UEBW in female patients with detrusor underactivity and a significantly increased UEBW in patients with bladder outflow obstruction were found. However, the finding of a significantly increased bladder weight in patients with detrusor overactivity was not confirmed in the present study.
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Hickling D, Aponte M, Nitti V. Evaluation and Management of Outlet Obstruction in Women Without Anatomical Abnormalities on Physical Exam or Cystoscopy. Curr Urol Rep 2012; 13:356-62. [DOI: 10.1007/s11934-012-0267-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rodrigues P, Hering F, Dias EC. Female obstruction after incontinence surgery may present different urodynamic patterns. Int Urogynecol J 2012; 24:331-6. [PMID: 22752015 DOI: 10.1007/s00192-012-1869-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 06/16/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study is to report a novel understanding of the urodynamic parameters used to diagnose iatrogenic female obstruction. There is no consensual definition of infravesical obstruction in women. Numerous criteria were designed with arbitrary cutoff values with poor clinical correlation. In order to determine the urodynamic profile of infravesical female obstruction we restricted our analysis to women who acquired voiding disturbances after being submitted to stress urinary incontinence (SUI) surgery. METHODS A total of 302 women developed obstructive symptoms or voiding difficulties after SUI operations: 176 cases had had Kelly-Kennedy operations (58.2 %), 50 had had Burch operations (16.5 %), 37 (12.2 %) had had anterior colporrhaphy + abdominal (Burch) operations, 33 (10.9 %) had had sling operations, and 8 (2.6 %) had had Marshall-Marchetti operations. Obstructive urinary symptoms started in 1-120 days after the operation and urodynamic evaluations were done after various periods of time (median 18.4 months). Clinical presentations varied widely with irritative symptoms predominating the picture. RESULTS Five patterns of pressure-flow relationships could be identified: (1) elevated pressure and poor flow (7.2 %), (2) normal pressure and poor flow (41.5 %), (3) normal pressure and flow associated with prolonged flow time (24.2 %), (4) poor detrusor contraction and elevated residual volume (12.9 %), and (5) elevated pressure and high flow (14.5 %). No relationship was established amongst the group and the Urinary Distress Inventory questionnaire. CONCLUSIONS Infravesical obstruction in women does not fit a single model. As suggested, obstruction in women must be based on broad clinical pictures and urinary complaints.
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Affiliation(s)
- Paulo Rodrigues
- Division of Neurourology and Voiding Disturbances, Beneficência Portuguesa Hospital of São Paulo, São Paulo, Brazil.
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Jeong SJ, Kim HJ, Lee YJ, Lee JK, Lee BK, Choo YM, Oh JJ, Lee SC, Jeong CW, Yoon CY, Hong SK, Byun SS, Lee SE. Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women. Korean J Urol 2012; 53:342-8. [PMID: 22670194 PMCID: PMC3364474 DOI: 10.4111/kju.2012.53.5.342] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 01/14/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To identify the prevalence and clinical features of detrusor underactivity (DU) in elderly men and women presenting with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS We reviewed 1,179 patients aged over 65 years who had undergone a urodynamic study for LUTS with no neurological or anatomical conditions. DU was defined as a bladder contractility index <100 and a maximal flow rate (Qmax) ≤12 ml/s combined with a detrusor pressure at Qmax ≤10 cmH(2)O for men and women, respectively. RESULTS Of the patients, 40.2% of men and 13.3% of women were classified as having DU (p<0.001). Types of clinical symptoms were not significantly different between patients with and without DU. In men, whereas the prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum, the prevalence of DU and detrusor overactivity (DO) increased with age, and 46.5% of men with DU also had DO or BOO. In women, the prevalence of DU also increased with age, and the trend was more remarkable in women aged over 70 years. DU was accompanied by DO or urodynamic stress urinary incontinence (USUI) in 72.6% of the women with DU. Women with DU were found to have lower cystometric capacity and exhibited a greater incidence of reduced compliance than did women without DU. CONCLUSIONS DU was a common mechanism underlying LUTS in the elderly population, especially in men. One half of the men and three quarters of the women with DU also had other pathologies such as DO, BOO, or USUI.
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Affiliation(s)
- Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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Jeong SJ, Kim HJ, Lee BK, Rha W, Oh JJ, Jeong CW, Kim JH, Yoon CY, Hong SK, Byun SS, Lee SE. Women with pure stress urinary incontinence symptoms assessed by the initial standard evaluation including measurement of post-void residual volume and a stress test: Are urodynamic studies still needed? Neurourol Urodyn 2012; 31:508-12. [DOI: 10.1002/nau.21215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Accepted: 08/12/2011] [Indexed: 11/09/2022]
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Sekido N. Bladder contractility and urethral resistance relation: what does a pressure flow study tell us? Int J Urol 2012; 19:216-28. [PMID: 22233177 DOI: 10.1111/j.1442-2042.2011.02947.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hydrodynamic analysis of a pressure flow study is the only reliable method to determine the presence or absence of a bladder outlet obstruction, especially benign prostatic obstruction. To interpret the results of pressure flow study in benign prostatic obstruction, understanding the outlines of the basic theory about evaluation of the relationship between bladder contractility and urethral resistance relation is of paramount importance. In contrast, hydrodynamic analysis of pressure flow study in conditions other than benign prostatic obstruction is complicated by the limits of theories about the hydrodynamics of the lower urinary tract. In this review, the proposed hydrodynamic theories about the relationship between bladder contractility and urethral resistance relation are outlined. Then, problems encountered in the application of hydrodynamic analysis of pressure flow study to diseases other than benign prostatic obstruction are discussed.
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Affiliation(s)
- Noritoshi Sekido
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
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Abstract
Bladder outlet obstruction in females remains a poorly understood condition and is much rarer as compared to males. More difficult is the objective diagnosis of this condition. There is no general agreement on the Urodynamic parameters to define the condition with certainty. A number of conditions are involved particularly in urinary retention in females are not completely understood. Besides, external sphincter dysfunction and post surgical retentions add another group of conditions which are distinct from retentions seen in the males. This article takes a review of various aetiological factors of Bladder outlet obstruction in women. An attempt is made to standardise the Urodynamic parameters for use in females, based on our data and experimentation on the models of the bladder and urethra. This article also takes a review of uncommon conditions such as Fowler's syndrome which often complicate evaluation of this condition.
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Affiliation(s)
- Shirish Yande
- Centre for Advanced Urodynamics, Ratna Memorial Hospital, Pune, India
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Smith ARB, Artibani W, Drake MJ. Managing unsatisfactory outcome after mid-urethral tape insertion. Neurourol Urodyn 2011; 30:771-4. [PMID: 21661028 DOI: 10.1002/nau.21090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article reviews the literature on the assessment and management of women whose previous mid-urethral tape surgery to manage stress urinary incontinence symptoms has failed to produce a satisfactory outcome. In many areas the literature is deficient and the article includes consensus statements drawn from the International Continence Society Research Society meeting in Bristol in June 2010. The need for a structured approach to assessment and management is highlighted, so that further research into areas of uncertainty can be prioritized. The article concludes with a number of research recommendations.
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The effect of urethral calibration on female primary bladder outlet obstruction. Int Urogynecol J 2011; 23:217-21. [PMID: 21809157 DOI: 10.1007/s00192-011-1515-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS While primary bladder outlet obstruction (BOO) in women has become an increasingly recognized entity over the past few years, the optimal management for such condition is yet to be defined. We assessed the effect of urethral calibration in the treatment of female BOO. METHODS A retrospective review of female patients undergoing urethral calibration with urethral dilator for BOO from 2000 to 2009 was performed. BOO was defined as a maximum flow rate (Qmax) of less than 15 ml/s together with a detrusor pressure at maximum flow rate (PdetQmax) of more than 20 cmH(2)O in urodynamic studies in the absence of neurological disorders or mechanical causes. Pre-calibration and post-calibration urodynamic studies were compared. RESULTS Twenty women were diagnosed of BOO on urodynamic criteria (mean age 56 ± 14 years). Sixty percent of the patients had obstructive symptoms, while 50% of them had irritative symptoms. Reassessment urodynamic studies were performed 6 months after urethral calibration. Although there was no significant change in Qmax and post-void residual urine after urethral calibration (9.6 ± 2.8 vs 9.7 ± 4.0 ml/s, p = 0.869 and 246 ± 196 vs 263 ± 198 ml, p = 0.753, respectively), PdetQmax significantly improved (72.2 ± 39 vs 50.2 ± 30.5 cmH(2)O, p = 0.013). Only one patient developed urinary tract infection after the procedure. No complication of incontinence had been observed. Among the 20 patients, 13 patients (65%) had a second urethral calibration after the reassessment urodynamic study for persistent symptoms. CONCLUSIONS Female patients with bladder outlet obstruction showed improvement in the urodynamic parameters after urethral calibration. However, its durability is not certain yet. Future studies concerning clinical symptoms correlation with urodynamic parameters would help further delineate the role of urethral calibration in the management of bladder outlet obstruction in women.
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Abstract
Urinary retention (UR) can be defined as inability to achieve complete bladder emptying by voluntary micturition, and categorized as acute UR, chronic UR or incomplete bladder emptying. UR is common in elderly men but symptomatic UR is unusual in women. The epidemiology of female UR is not well documented. There are numerous causes now recognized in women, broadly categorized as infective, pharmacological, neurological, anatomical, myopathic and functional; labeling symptoms as having a “psychogenic basis” should be avoided. Detrusor failure is often an underlying factor that complicates interpretation. Initial management includes bladder drainage (intermittent or indwelling catheterization) if the woman is symptomatic or at risk of complications, and correcting likely causes. Investigations should be focused on identifying the underlying etiology and any reversible factor. A detailed history, general and pelvic examination are needed; urine dipstick analysis, routine microscopy and culture, and pelvic and renal ultrasound are suitable baseline investigations. Urodynamic tests are required in specific situations. Urethral dilatation has a limited role, but it should be considered if there is urethral stenosis. Definitive management requires correction of cause where possible and symptom management where no correctable cause is detected. Follow-up is needed for monitoring response to treatment, detection of complications and symptom control. Fowler’s syndrome is a specific group diagnosed on urethral sphincter electromyogram, representing a very challenging clinical scenario.
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Affiliation(s)
- Amit Mevcha
- Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB, UK
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Dancz CE, Ozel B. Is there a pelvic organ prolapse threshold that predicts bladder outflow obstruction? Int Urogynecol J 2011; 22:863-8. [PMID: 21340645 DOI: 10.1007/s00192-011-1373-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 01/28/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To determine if there is a cutpoint of anterior vaginal wall prolapse which predicts bladder outflow obstruction. METHODS Subjects with and without bladder outflow obstruction (BOO) were identified. Baseline characteristics, urodynamics, and exam findings were compared. RESULTS Forty-seven women with BOO were compared to 115 women without BOO. Those with obstruction were significantly older (53.9 vs. 50.0 years, p = 0.015) had higher parity (p = 0.03), significantly smaller maximum bladder capacity (359.0 vs. 426.0 ml, p < 0.0001), and were less likely to leak at smaller volumes (213.0 vs. 109.0 ml, p = 0.006) than those without obstruction. Those with obstruction also had higher measurements on Aa (p = 0.004) and Ba (p = 0.001), though receiver operator curve analysis did not reveal a clear point of anterior prolapse at which bladder outflow obstruction occurs. CONCLUSIONS Bladder outflow obstruction is associated with anterior vaginal wall prolapse, though there is no clear cutpoint of anterior prolapse which predicts obstruction.
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Affiliation(s)
- Christina E Dancz
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 1200 N State St IRD 518, Los Angeles, CA 90033, USA.
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The influence of preoperative bladder outlet obstruction on continence and satisfaction in patients with stress urinary incontinence after midurethral sling. Int Neurourol J 2010; 14:267-71. [PMID: 21253340 PMCID: PMC3021820 DOI: 10.5213/inj.2010.14.4.267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 12/23/2010] [Indexed: 11/08/2022] Open
Abstract
PURPOSE We studied the influence of preoperative bladder outlet obstruction (BOO) on postoperative continence rates and patient satisfaction after the midurethral sling procedure. METHODS A total of 159 women who underwent the midurethral sling procedure were evaluated. Using the Blaivas-Groutz nomogram, we assigned the patients were assigned to Group I (n=37, no obstruction), Group II (n=89, mild obstruction), or Group III (n=33, moderate to severe obstruction). Continence rates, patient satisfaction, urinary sensation scale and uroflowmetry were evaluated postoperatively. RESULTS There were no significant differences in continence rates, satisfaction, or postoperative maximal flow rate between the 3 groups. Postoperative urgency was improved after surgery in Groups I and II (P<0.05) but not in Group III. CONCLUSIONS BOO does not seem to be a risk factor for failure after the midurethral sling procedure. However, BOO may be considered as a potential factor for persistent storage symptoms after the midurethral sling.
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Whittam BM, Kaufman MR, Dmochowski RR. Current Status of Urodynamics for Evaluation of Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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