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Malde S, Belal M, Mohamed-Ahmed R, Gibson W, Padilla-Fernandez B, Rantell A, Selai C, Solomon E, Abrams P. Can we define the optimal postvoid residual volume at which intermittent catheterization should be recommended, and are there other measures that could guide an intermittent catheterization protocol: ICI-RS 2023. Neurourol Urodyn 2024; 43:1353-1362. [PMID: 37905437 DOI: 10.1002/nau.25324] [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: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023]
Abstract
AIMS The postvoid residual (PVR) volume of urine in the bladder is widely used in clinical practice as a guide to initiate treatment, including clean-intermittent self-catheterization (CISC). It is often believed that an elevated PVR causes complications such as recurrent urinary tract infections (UTI) and renal failure. However, evidence for this is limited and identifying alternative measures to guide treatment decisions may optimize patient care. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2023 a Think Tank addressed the question of whether we can define the optimal PVR at which CISC should be recommended, and whether there are other measures that could guide a CISC protocol. METHODS The Think Tank conducted a literature review and expert consensus meeting focusing on current limitations in defining and measuring PVR, and highlighting other measures that may optimize selection for, and persistence with, CISC. RESULTS There is no consensus on the threshold value of PVR that is considered "elevated" or "significant." There is a lack of standardization on terminology, and the normal range of PVR in different populations of different ages remains to be well-studied. The measurement of PVR is influenced by several factors, including intraindividual variation, timing and method of measurement. Furthermore, the evidence linking an elevated PVR with complications such as UTI and renal failure is mixed. Other measures, such as bladder voiding efficiency or urodynamic parameters, may be better at predicting such complications, and therefore may be more relevant at guiding a CISC protocol. CONCLUSIONS There is a lack of high quality evidence to support PVR as a predictor for complications of UTI or renal failure. Threshold values for normal PVR in different populations are unknow, and so threshold values for "elevated" or "significant" PVR cannot be determined. Other factors, such as urodynamic findings, may be better at predicting complications and therefore guiding management decisions, and this remains to be studied. Areas for further research are proposed.
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Affiliation(s)
- Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mo Belal
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Barbara Padilla-Fernandez
- Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Angela Rantell
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Caroline Selai
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Eskinder Solomon
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Nitti VW, Kohan A, McCammon K, Jenkins B, Ifantides KB, Yushmanova I, Chapple C. Efficacy and safety of onabotulinumtoxinA for the treatment of overactive bladder in men and women: A pooled analysis. Neurourol Urodyn 2024. [PMID: 38973548 DOI: 10.1002/nau.25538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/31/2024] [Accepted: 06/21/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND This pooled analysis of randomized controlled studies investigated the safety and efficacy of onabotulinumtoxinA in male and female patients with overactive bladder (OAB). METHODS Data were pooled from four similarly designed trials in North America and Europe. Adults with idiopathic OAB for ≥6 months inadequately managed by at least one anticholinergic were randomized 1:1 or 2:1 to receive onabotulinumtoxinA 100 U or matched placebo in Cycle 1 and could request open-label retreatment with onabotulinumtoxinA 100 U at ≥12 weeks. Efficacy outcomes at Week 12 included the primary endpoint of mean urinary incontinence (UI) episodes per day and other variables, such as the proportion of patients with ≥50% reduction in daily UI episodes. Safety was assessed by monitoring treatment-emergent adverse events (TEAEs). Analyses by sex were descriptive. Males were further analyzed by benign prostatic hyperplasia (BPH) diagnosis status. RESULTS In the pooled population (N = 1564), there were 194 males (12.4%) and 1370 females (87.6%). Mean number of baseline UI episodes per day was 4.9 in males and 5.5 in females. At Week 12, numerically greater mean reductions from baseline in number of daily UI episodes were observed with the onabotulinumtoxinA 100 U group (females: -3.0; males: -2.2) versus placebo (females: -1.1; males: -1.3). Achievement of ≥50% reduction in daily UI episodes was numerically greater with onabotulinumtoxinA 100 U (females: 64.8%; males: 61.2%) versus placebo (females: 30.6%; males: 44.8%), and numerically higher in males without BPH (onabotulinumtoxinA: 65.1%; placebo: 50.9%) versus with BPH (onabotulinumtoxinA: 54.3%; placebo: 36.6%). A total of 34.7% of males and 39.4% of females experienced at least one TEAE in the first 12 weeks during treatment Cycle 1. Urinary tract infection rate was 13.1% in females and 4.2% in males; incidence of hematuria was 6.8% in males and 1.1% in females. Incidence of urinary retention (defined as incomplete emptying, requiring catheterization) was 2.7% in females and 4.7% in males. CONCLUSION OnabotulinumtoxinA 100 U was efficacious and well tolerated in men and women with OAB, including in males with and without BPH. No new safety findings were identified when data were analyzed by sex.
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Affiliation(s)
- Victor W Nitti
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Alfred Kohan
- Advanced Urology Center of New York, New York, New York, USA
| | - Kurt McCammon
- Eastern Virginia Medical School, Norfolk, Virginia, USA
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Gravas S, Gacci M, Gratzke C, Herrmann TRW, Karavitakis M, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Sakalis VI, Schouten N, Speakman MJ, Tikkinen KAO, Cornu JN. Summary Paper on the 2023 European Association of Urology Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms. Eur Urol 2023; 84:207-222. [PMID: 37202311 DOI: 10.1016/j.eururo.2023.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 05/20/2023]
Abstract
CONTEXT Lower urinary tract symptoms (LUTS) are common, often bothersome, and have multifactorial aetiology. OBJECTIVE To present a summary of the 2023 version of the European Association of Urology guidelines on the management of male LUTS. EVIDENCE ACQUISITION A structured literature search from 1966 to 2021 selected the articles with the highest certainty evidence. The Delphi technique consensus approach was used to develop the recommendations. EVIDENCE SYNTHESIS The assessment of men with LUTS should be practical. A careful medical history and physical examination are essential. Validated symptom scores, urine test, uroflowmetry, and postvoid urine residual, as well as frequency-volume charts for patients with nocturia or predominately storage symptoms should be used. Prostate-specific antigen should be ordered if a diagnosis of prostate cancer changes the treatment plan. Urodynamics should be performed for selected patients. Men with mild symptoms are candidates for watchful waiting. Behavioural modification should be offered to men with LUTS prior to, or concurrent with, treatment. The choice of medical treatment depends on the assessment findings, predominant type of symptoms, ability of the treatment to change the findings, and the expectations to be met in terms of the speed of onset, efficacy, side effects, and disease progression. Surgery is reserved for men with absolute indications, and for patients who fail or prefer not to receive medical therapy. Surgical management has been divided into five sections: resection, enucleation, vaporisation, and alternative ablative and nonablative techniques. The choice of surgical technique depends on patient's characteristics, expectations, and preferences; surgeon's expertise; and availability of modalities. CONCLUSIONS The guidelines provide an evidence-based approach for the management of male LUTS. PATIENT SUMMARY A clinical assessment should identify the cause(s) of symptoms and define the clinical profile and patient's expectations. The treatment should aim to ameliorate symptoms and reduce the risk of complications.
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Affiliation(s)
- Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Mauro Gacci
- 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
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Vasileios I Sakalis
- Department of Urology, Hippokrateion General Hospital, Thessaloniki, Greece.
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
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Post-voided residual urine ratio as a predictor of bladder outlet obstruction in men with lower urinary tract symptoms: development of a clinical nomogram. World J Urol 2023; 41:521-527. [PMID: 36527471 DOI: 10.1007/s00345-022-04259-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To confirm the correlation between post-void residual urine ratio (PVR-R) and BOO diagnosed by pressure-flow studies (PFS) in males with lower urinary tract symptoms (LUTS) and to develop a clinical nomogram. METHODS A consecutive series of patients aged 45 years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment for BOO including International Prostatic Symptoms Score, uroflowmetry, urodynamic studies, suprapubic ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BTW). PVR-R was defined as follows: PVR-R = (PVR/total Bladder Volume [BV]) × 100). Logistic regression analysis was used to investigate predictors of pathological bladder emptying (BOO) defined as Schafer > II. A nomogram to predict BOO based on the multivariable logistic regression model was then developed. RESULTS Overall 335 patients were enrolled. Overall, 131/335 (40%) presented BOO on PFS. In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 2.21 per mm; 95% confidence interval [CI], 1.57-3.09; p = 0.001), PVR-R (OR: 1.02 per %; 95% CI, 1.01-1.03; p = 0.034) and prostate volume (OR: 0.97 per mL; 95% CI, 0.95-0.98; p = 0.001) were significant predictors for BOO. The model presented an accuracy of 0.82 and a clinical net benefit in the range of 10-90%. CONCLUSIONS The present study confirms the important role of PVR-ratio in the prediction of BOO. For the first time, we present a clinical nomogram including PVR-ratio for the prediction of BOO.
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Abstract
Purpose of review In this article, we will review current dilemmas regarding evaluation and management of the geriatric bladder incorporating concepts of normal changes of aging as well as common lower urinary tract dysfunction. Recent findings Increasing age leads to functional changes in essentially all organ systems including the genitourinary system. Understanding the natural changes with age of the bladder as well as the signs and symptoms of pathologic conditions is paramount to diagnosis and treatment of urologic conditions in the geriatric population. Summary There are several conundrums in the diagnosis and evaluation of the geriatric bladder including the ability of the bladder to store, empty, as well as sensitivity disturbances. Diagnostic testing and goals of treatment should be individualized for each patient and personalized to consider patient comorbidities, limitations, and expectations.
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Peterson AC, Smith AR, Fraser MO, Yang CC, DeLancey JOL, Gillespie BW, Gore JL, Talaty P, Andreev VP, Kreder KJ, Mueller MG, Lai HH, Erickson BA, Kirkali Z. The Distribution of Post-Void Residual Volumes in People Seeking Care in the Symptoms of Lower Urinary Tract Dysfunction Network Observational Cohort Study With Comparison to Asymptomatic Populations. Urology 2019; 130:22-28. [PMID: 31018115 PMCID: PMC6660395 DOI: 10.1016/j.urology.2019.01.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/16/2019] [Accepted: 01/30/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the distribution of post-void residual (PVR) volumes across patients with and without lower urinary tract symptoms (LUTS) and examine relationships between self-reported voiding symptoms, storage symptoms, and PVR. METHODS PVR and demographic data were obtained from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) observational cohort study. Self-reported symptoms were collected using the American Urological Association Symptom Index and the LUTS Tool. PVR values were obtained from 2 other cohorts: living kidney donors with unknown LUTS from the Renal and Lung Living Donors Evaluation Study (RELIVE), and continent women in the Establishing the Prevalence of Incontinence (EPI) study, a population-based study of racial differences in urinary incontinence prevalence. RESULTS Across the 3 studies, median PVRs were similar: 26 mL in LURN (n = 880, range 0-932 mL), 20 mL in EPI (n = 166, range 0-400 mL), and 14 mL in RELIVE (n = 191, range 0-352 mL). In LURN, males had 3.6 times higher odds of having PVR > 200 mL (95% CI = 1.72-7.48). In RELIVE, median PVR was significantly higher for males (20 mL vs 0 mL, P= .004). Among women, only the intermittency severity rating was associated with a probability of an elevated PVR. Among men, incomplete emptying and burning severity rating were associated with a higher odds of elevated PVR, but urgency severity ratings were associated with lower odds of elevated PVR. CONCLUSION Care-seeking patients have PVRs similar to those in people with unknown history of LUTS (RELIVE) and without self-reported LUTS (EPI). Although PVR was correlated with voiding symptoms, the mean differences only explain ∼2% of the variance.
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Affiliation(s)
| | | | | | | | | | | | | | - Pooja Talaty
- NorthShore University Health System, Glenview, IL
| | | | | | | | - H Henry Lai
- Washington University School of Medicine, St. Louis, MO
| | | | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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Özlülerden Y, Toktaş C, Zümrütbaş AE, Gülten MC, Başer A, Yapıcı O, Aybek Z. Can feeling of incomplete bladder emptying reflect significant postvoid residual urine? Is it reliable as a symptom solely? Investig Clin Urol 2018; 59:38-43. [PMID: 29333513 PMCID: PMC5754581 DOI: 10.4111/icu.2018.59.1.38] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/30/2017] [Indexed: 11/20/2022] Open
Abstract
Purpose The main objective of this study was to reveal the relationship between lower urinary tract symptoms (LUTS) and post-void residual (PVR) urine volume. Materials and Methods Between October 2014 and February 2015, older than 40 years patients were included in this study. Volunteers filled out a questionnaire consisted of demographic characteristics, comorbidities, medications, history of surgery and LUTS. Volunteers were undergone PVR measurement with transabdominal ultrasonography. The relationship between symptoms, demographic characteristics and PVR were analyzed. Results A total of 939 patients (756 men and 183 women) were enrolled in this study. There was a positive correlation between the sensation of incomplete bladder emptying and PVR volume in all age groups of women (p=0.0001). However such a relationship was found only over the age of 60 in the subgroup analysis of men (p=0.001). PVR volume increased in men by age (0.65 mL per year of age, p=0.011). In men, voiding symptoms and urgency were associated with a high PVR volume. In women, storage and voiding symptoms (except slow stream and terminal dribble) did not correlate with PVR volume. Conclusions Our study showed that all men over the age of 60 years and all women with the complaint of feeling of incomplete emptying should undergone PVR measurement. Women with the complaint of poor stream and men mainly with voiding symptoms are other candidates in whom PVR measurement would be considered as an important tool in the clinical management and follow-up.
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Affiliation(s)
| | - Cihan Toktaş
- Urology Clinic, Özel Sağlık Hospital, Denizli, Turkey
| | - Ali Ersin Zümrütbaş
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Mehmet Caner Gülten
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Aykut Başer
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Onur Yapıcı
- Urology Clinic, Acıpayam State Hospital, Denizli, Turkey
| | - Zafer Aybek
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
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Averbeck MA, De Lima NG, Motta GA, Beltrao LF, Abboud Filho NJ, Rigotti CP, Dos Santos WN, Dos Santos SKJ, Da Silva LFB, Rhoden EL. Collagen content in the bladder of men with LUTS undergoing open prostatectomy: A pilot study. Neurourol Urodyn 2017; 37:1088-1094. [PMID: 28945275 DOI: 10.1002/nau.23418] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/04/2017] [Indexed: 12/13/2022]
Abstract
AIMS To evaluate the collagen content in the bladder wall of men undergoing open prostate surgery. METHODS From July 2014 to August 2016, men aged ≥ 50 years, presenting LUTS and undergoing open prostate surgery due to benign prostatic enlargement (BPE) or prostate cancer were prospectively enrolled. Preoperative assessment included validated questionnaires (IPSS and OAB-V8), lower urinary tract ultrasound, and urodynamics. Bladder biopsies were obtained during open prostatectomy for determination of collagen content (sirius red-picric acid stain; polarized light analysis). Collagen to smooth muscle ratio (C/M) in the detrusor was measured and its relationship with preoperative parameters was investigated. The level of significance was P < 0.05. RESULTS Thirty-eight consecutive patients were included in this pilot study. Mean age was 66.36 ± 6.44 years and mean IPSS was 11.05 ± 8.72 points. Men diagnosed with diabetes mellitus (DM2) were found to have higher collagen content in the bladder wall when compared to non-diabetic patients (17.71 ± 6.82% vs 12.46 ± 5.2%, respectively; P = 0.024). Reduced bladder compliance was also marker for higher collagen content (P = 0.042). Bladder outlet obstruction (BOO) was not a predictor of increased collagen deposition in the bladder wall (P = 0.75). Patients with PVR ≥ 200 mL showed a higher collagen to smooth muscle ratio in the bladder wall (P = 0.036). CONCLUSIONS DM2 and urodynamic parameters, such as increased PVR and reduced bladder compliance, were associated with higher collagen content in the bladder wall of men with LUTS.
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Affiliation(s)
- Marcio A Averbeck
- Postgraduate in Health Sciences at Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Santa Casa Hospital Complex, Porto Alegre, Brazil.,Moinhos de Vento Hospital, Porto Alegre, Brazil
| | | | - Gabriela A Motta
- Postgraduate in Health Sciences at Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Lauro F Beltrao
- Urology Residency at Santa Casa Hospital Complex, Porto Alegre, Brazil
| | | | - Clarice P Rigotti
- Urology Residency at Santa Casa Hospital Complex, Porto Alegre, Brazil
| | | | | | - Luis F B Da Silva
- Urology Residency at Santa Casa Hospital Complex, Porto Alegre, Brazil
| | - Ernani L Rhoden
- Santa Casa Hospital Complex, Porto Alegre, Brazil.,Moinhos de Vento Hospital, Porto Alegre, Brazil.,Department of Urology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
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9
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Noguchi N, Chan L, Cumming RG, Blyth FM, Handelsman DJ, Waite LM, Le Couteur DG, Naganathan V. Natural history of post-void residual urine volume over 5 years in community-dwelling older men: The Concord Health and Ageing in Men Project. Neurourol Urodyn 2017; 37:1068-1073. [PMID: 28940729 DOI: 10.1002/nau.23415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 08/24/2017] [Indexed: 11/09/2022]
Abstract
AIMS To describe the natural history of post-void residual urine volume (PVR) in community-dwelling older men. METHODS The Concord Health and Ageing in Men Project involves a representative sample of community-dwelling men aged 70 and older in a defined geographic area of Sydney, Australia. PVR were measured at baseline and 2-year and 5-year follow-up. The measurements were considered valid when the voided volumes were 150 mL and over. Three-hundred twenty-nine men without conditions that are likely to alter PVR (neurological disorders, prostate cancer, and a history of urological treatment) were included in the analyses. RESULTS Baseline PVR were 0-49 mL in 183 men, 50-99 mL in 59 men, 100-199 mL in 72 men, 200-399 mL in 11 men, and 400 mL and over in 4 men. Thirteen out of 314 (4%) men with a baseline PVR of 0-199 mL and 2 out of 11 (18%) men with a baseline PVR of 200-399 mL had surgery for benign prostate enlargement (BPE) or indwelling catheterization over 5 years compared to three out of four men (75%) with a PVR of 400 mL and over. In all 101 men with a baseline PVR of less than 400 mL who did not receive urological treatment during follow-up and had valid PVR data for both 2-year and 5-year follow-up, PVR did not exceed 400 mL at either follow-up time point. CONCLUSION Conservative management may be appropriate for most older men with incidentally found elevated PVR of up to 400 mL.
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Affiliation(s)
- Naomi Noguchi
- Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute, Concord Hospital, University of Sydney, New South Wales, Australia.,Department of Urology, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Lewis Chan
- School of Public Health, University of Sydney, New South Wales, Australia
| | - Robert G Cumming
- Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute, Concord Hospital, University of Sydney, New South Wales, Australia.,Department of Urology, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute, Concord Hospital, University of Sydney, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute, Concord Hospital, University of Sydney, New South Wales, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute, Concord Hospital, University of Sydney, New South Wales, Australia.,ANZAC Research Institute, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute, Concord Hospital, University of Sydney, New South Wales, Australia
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10
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Okçelik S, Soydan H, Ateş F, Yilmaz Ö, Malkoç E, Şenkul T, Karademir K. Correlation Between Residual Volume of Male Patients After Uroflowmetry and Random Residual Volume. Low Urin Tract Symptoms 2017. [PMID: 28643427 DOI: 10.1111/luts.12162] [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: 11/29/2022]
Abstract
OBJECTIVES Our aim was to examine correlation between Post-void residual urine (PVR) after uroflowmetry and random PVR. METHODS Male patients reporting to the Urology outpatient clinic with LUTS were selected. Patients' age, prostate volume, bladder capacity, voided volume, maximum flow rate, average flow rate, random PVR and PVR after uroflowmetry were recorded. We evaluated the correlations between these parameters. Also we assessed if there was a difference between random PVR and PVR after uroflowmetry. We divided PVR after uroflowmetry and random PVR into three groups: Group 1: 0-50 mL, Group 2: 51-100 mL and Group 3: >100 mL. Also we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL. We compared these groups to determine whether a significant difference. RESULTS Seventy-seven patients applying to the urology outpatient clinic were assessed between 2013 and 2014. PVR after uroflowmetry was significantly higher than random PVR (P < 0.001). When we divided PVR after uroflowmetry and random PVR into three groups there was a significant difference between the groups (P = 0.02). When we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL, PVR after uroflowmetry was different, but random PVR was similar (P < 0.001, P = 0.72). CONCLUSIONS PVR after uroflowmetry seems to be incorrectly high in patients whose bladder capacity is above 400 mL.
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Affiliation(s)
- Sezgin Okçelik
- Department of Urology, Van Teaching and Research Hospital, Van, Turkey
| | - Hasan Soydan
- Department of Urology, Haydarpasa Sultan Abdulhamid Teaching and Research Hospital, Istanbul, Turkey
| | - Ferhat Ateş
- Department of Urology, Haydarpasa Sultan Abdulhamid Teaching and Research Hospital, Istanbul, Turkey
| | - Ömer Yilmaz
- Department of Urology, Haydarpasa Sultan Abdulhamid Teaching and Research Hospital, Istanbul, Turkey
| | - Ercan Malkoç
- Department of Urology, Haydarpasa Sultan Abdulhamid Teaching and Research Hospital, Istanbul, Turkey
| | - Temuçin Şenkul
- Department of Urology, Haydarpasa Sultan Abdulhamid Teaching and Research Hospital, Istanbul, Turkey
| | - Kenan Karademir
- Department of Urology, Haydarpasa Sultan Abdulhamid Teaching and Research Hospital, Istanbul, Turkey
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11
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GreenLight laser photoselective vaporization of the prostate for treatment of benign prostate hyperplasia/lower urinary tract symptoms in patients with different post-void residual urine. Lasers Med Sci 2017; 32:895-901. [PMID: 28293871 DOI: 10.1007/s10103-017-2190-1] [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] [Received: 12/30/2016] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
Abstract
The purpose of this study is to assess the safety and efficacy of GreenLight laser photoselective vaporization of the prostate (PVP) for the treatment of benign prostate hyperplasia/lower urinary tract symptoms (BPH/LUTS) in patients with different post-void residual urine (PVR). BPH/LUTS patients treated with PVP from January 2014 to January 2016 were enrolled in the present study. All patients were divided into PVR > 50, 50 ≤ PVR < 400, and PVR ≥ 400 ml groups, and standard general and urological methods for BPH/LUTS were carried out. PVP surgery was performed, and the follow-up outcome was investigated 6 months after surgery. A total of 429 patients were included, and there were no significant differences in comorbid diseases or habits among the three groups. The maximum urinary flow rate (Qmax) differed significantly among the groups (P < 0.001), while patients in the PVR < 50 ml group had higher maximum detrusor pressure (Pdet.max) level than the other two groups (P < 0.001). Patients in 50 ≤ PVR < 400 (P < 0.001) and PVR ≥ 400 (P < 0.001) ml groups were more likely to develop detrusor underactivity than those in the PVR < 50 ml group. All patients were treated with PVP, and there were no severe complications requiring rehospitalization or reoperation except nine designed re-treatments. Follow-up data of 387 patients were available. Significant improvement in outcome parameters (International Prostate Symptom Score [IPSS], Qmax, and PVR) was observed in comparison with baseline measurements for the three groups. PVP significantly improved the IPSS, Qmax, and PVR in patients with different PVR; PVP is a safe and effective procedure for BPH/LUTS patients.
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Abstract
PURPOSE OF REVIEW Voiding dysfunction in older men is an important health issue, with significant morbidity and biosocioeconomic burden. Treatment decisions are increasingly complex as many older men also suffer concurrent comorbidities and polypharmacy. A relatively sparse number of publications specifically examine this relevant topic. RECENT FINDINGS Common geriatric voiding syndromes include overactive bladder (OAB) and underactive bladder, with nocturia and incontinence often the most bothersome lower urinary tract symptoms, and may represent a falls risk together with OAB and incontinence. The combination of detrusor overactivity and impaired contractility may coexist in older patients and can be particularly difficult to diagnose and treat clinically. A small but not insignificant proportion of older men experience spontaneous remission of OAB symptoms without treatment, and 'watchful waiting' may be a reasonable option. OAB treatment with mirabegron may have a preferable side-effect profile compared with anticholinergics in older men. Intravesical onabotulinum toxin A is effective but risk of retention is greater in the older adults. Benign prostatic obstruction (BPO) and underactive bladder may lead to urinary retention, necessitating surgery or catheterization. BPO surgery is a reasonable option in older men, with realistic counselling of postoperative expectations. Combination BPO surgery and medical OAB treatment is suitable for detrusor overactivity and impaired contractility. Stress incontinence in older patients is usually iatrogenic and treatment can include continence applicances, urethral bulking agents, suburethral sling or artificial urinary sphincter. SUMMARY Management of voiding dysfunction in older patients need to take into account multiple factors including symptomatic and functional impairment, cognition, comorbidities and polypharmacy. Future research examining pathophysiology and treatment outcomes of voiding dysfunction in the older patient population is increasingly relevant.
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Chughtai B, Forde JC, Thomas DDM, Laor L, Hossack T, Woo HH, Te AE, Kaplan SA. Benign prostatic hyperplasia. Nat Rev Dis Primers 2016; 2:16031. [PMID: 27147135 DOI: 10.1038/nrdp.2016.31] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Benign prostatic hyperplasia (BPH), which causes lower urinary tract symptoms (LUTS), is a common diagnosis among the ageing male population with increasing prevalence. Many risks factors, both modifiable and non-modifiable, can increase the risk of development and progression of BPH and LUTS. The symptoms can be obstructive (resulting in urinary hesitancy, weak stream, straining or prolonged voiding) or irritative (resulting in increased urinary frequency and urgency, nocturia, urge incontinence and reduced voiding volumes), or can affect the patient after micturition (for example, postvoid dribble or incomplete emptying). BPH occurs when both stromal and epithelial cells of the prostate in the transitional zone proliferate by processes that are thought to be influenced by inflammation and sex hormones, causing prostate enlargement. Patients with LUTS undergo several key diagnostic investigations before being diagnosed with BPH. Treatment options for men with BPH start at watchful waiting and progress through medical to surgical interventions. For the majority of patients, the starting point on the treatment pathway will be dictated by their symptoms and degree of bother.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - James C Forde
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - Dominique Dana Marie Thomas
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - Leanna Laor
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - Tania Hossack
- Department of Urology, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Henry H Woo
- Department of Urology, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Alexis E Te
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, 625 Madison Avenue, New York, New York 10022, USA
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Warren GJ, Erickson BA. The role of noninvasive testing and questionnaires in urethroplasty follow-up. Transl Androl Urol 2016; 3:221-6. [PMID: 26816769 PMCID: PMC4708166 DOI: 10.3978/j.issn.2223-4683.2014.04.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Urethroplasty is the preferred surgical approach for the management of urethral stricture disease. To date, no standard has been established to evaluate stricture recurrence after urethral reconstruction, though both invasive and non-invasive methods are used widely. In this article we review the role of noninvasive testing and questionnaires in urethral monitoring after urethroplasty.
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Affiliation(s)
- Gareth J Warren
- Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Bradley A Erickson
- Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
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Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, Oelke M, Tikkinen KAO, Gravas S. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol 2015; 67:1099-1109. [PMID: 25613154 DOI: 10.1016/j.eururo.2014.12.038] [Citation(s) in RCA: 599] [Impact Index Per Article: 66.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/26/2014] [Indexed: 11/25/2022]
Abstract
CONTEXT Lower urinary tract symptoms (LUTS) represent one of the most common clinical complaints in adult men and have multifactorial aetiology. OBJECTIVE To develop European Association of Urology (EAU) guidelines on the assessment of men with non-neurogenic LUTS. EVIDENCE ACQUISITION A structured literature search on the assessment of non-neurogenic male LUTS was conducted. Articles with the highest available level of evidence were selected. The Delphi technique consensus approach was used to develop the recommendations. EVIDENCE SYNTHESIS As a routine part of the initial assessment of male LUTS, a medical history must be taken, a validated symptom score questionnaire with quality-of-life question(s) should be completed, a physical examination including digital rectal examination should be performed, urinalysis must be ordered, post-void residual urine (PVR) should be measured, and uroflowmetry may be performed. Micturition frequency-volume charts or bladder diaries should be used to assess male LUTS with a prominent storage component or nocturia. Prostate-specific antigen (PSA) should be measured only if a diagnosis of prostate cancer will change the management or if PSA can assist in decision-making for patients at risk of symptom progression and complications. Renal function must be assessed if renal impairment is suspected from the history and clinical examination, if the patient has hydronephrosis, or when considering surgical treatment for male LUTS. Uroflowmetry should be performed before any treatment. Imaging of the upper urinary tract in men with LUTS should be performed in patients with large PVR, haematuria, or a history of urolithiasis. Imaging of the prostate should be performed if this assists in choosing the appropriate drug and when considering surgical treatment. Urethrocystoscopy should only be performed in men with LUTS to exclude suspected bladder or urethral pathology and/or before minimally invasive/surgical therapies if the findings may change treatment. Pressure-flow studies should be performed only in individual patients for specific indications before surgery or when evaluation of the pathophysiology underlying LUTS is warranted. CONCLUSIONS These guidelines provide evidence-based practical guidance for assessment of non-neurogenic male LUTS. An extended version is available online (www.uroweb.org/guidelines). PATIENT SUMMARY This article presents a short version of European Association of Urology guidelines for non-neurogenic male lower urinary tract symptoms (LUTS). The recommended tests should be able to distinguish between uncomplicated male LUTS and possible differential diagnoses and to evaluate baseline parameters for treatment. The guidelines also define the clinical profile of patients to provide the best evidence-based care. An algorithm was developed to guide physicians in using appropriate diagnostic tests.
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Affiliation(s)
- Christian Gratzke
- Department of Urology, Urologische Klinik und Poliklinik, Klinikum der Universität München-Grosshadern, Munich, Germany
| | | | - Aurelien Descazeaud
- Department of Urology, Dupuytren Hospital, University of Limoges, Limoges, France
| | - Marcus J Drake
- Bristol Urological Institute and School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Matthias Oelke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Kari A O Tikkinen
- Departments of Urology and Public Health, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Stavros Gravas
- Department of Urology, University of Thessaly, Larissa, Greece.
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Riyach O, Ahsaini M, Kharbach Y, Bounoual M, Tazi MF, El Ammari JE, Mellas S, Fassi MEJ, Khallouk A, Farih MH. Bilateral ureteral obstruction revealing a benign prostatic hypertrophy: a case report and review of the literature. J Med Case Rep 2014; 8:42. [PMID: 24513237 PMCID: PMC3930078 DOI: 10.1186/1752-1947-8-42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/12/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Prostatic hyperplasia is the most frequent tumor in men older than 50 years of age. Bilateral hydronephrosis secondary to benign prostatic hypertrophy is a rare condition most often due to vesicoureteral reflux. Herein we report a case of a patient with bilateral hydronephrosis with distal ureter obstruction caused by detrusor hypertrophy due to prostatic hyperplasia, our analysis of the clinical data and a review of the relevant published literature. CASE PRESENTATION We report a case of a 65-year-old Berber man with clinically significant storage, bladder-emptying symptoms and bilateral low back pain with renal biologic failure and bilateral ureterohydronephrosis, distal ureteral stenosis, detrusor hypertrophy and prostate hyperplasia without significant post-void residual urine volume visualized by abdominal sonography. The patient underwent bilateral JJ stent insertion with transurethral resection of the prostate. The patient was discharged 3 days after surgery without any obvious complications. At his 3-month follow-up examination, the JJ stent was removed and the patient had comfortable urination without renal failure. CONCLUSION This is an extremely rare condition that has important diagnostic considerations because of the possibility of comorbid severe obstructive uropathy and chronic renal failure.
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Affiliation(s)
- Omar Riyach
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Fez, BP: 1893 –Km 2.200 Route de Sidi Harazem, Fez, Morocco
| | - Mustapha Ahsaini
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
| | - Youssef Kharbach
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
| | - Mohammed Bounoual
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
| | - Mohammed Fadl Tazi
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
| | | | - Soufiane Mellas
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
| | | | - Abdelhak Khallouk
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
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Rule AD, Bailey KR, Lieske JC, Peyser PA, Turner ST. Estimating the glomerular filtration rate from serum creatinine is better than from cystatin C for evaluating risk factors associated with chronic kidney disease. Kidney Int 2013; 83:1169-76. [PMID: 23423253 PMCID: PMC3661736 DOI: 10.1038/ki.2013.7] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chronic kidney disease risk factors may associate with the estimated glomerular filtration rate (eGFR) differently than with the measured GFR. To examine this, we evaluated 1150 patients (mean age 65 years) in two community cohorts for risk factors, measured GFR by iothalamate clearance, and eGFR based on creatinine (Cr), cystatin C (CysC), or both. The interaction between each risk factor and eGFR (relative to measured GFR) identified risk factor associations with eGFR along non-GFR pathways. In a subset of 40 patients with two visits, the mean coefficient of variation was 8.2% for measured GFR, 6.4% for eGFRCr, 8.2% for eGFRCr-CysC, and 10.7% for eGFRCysC. The measured GFR was better correlated with eGFRCr-CysC (r, 0.74) than eGFRCr (r, 0.70) or eGFRCysC (r, 0.68). Lower measured GFR associated with lower 24-hour urine creatinine, albuminuria, hypertension, diabetes, higher triglycerides, and higher uric acid. Lower eGFRCr had these same associations except for an association with higher 24-hour urine creatinine along a non-GFR pathway. Lower eGFRCysC and eGFRCr-CysC also had these same associations but also associated with obesity, albuminuria, hypertension, diabetes, higher triglycerides, higher C-reactive protein, and higher uric acid along non-GFR pathways. Thus, cystatin C improves estimation of GFR over creatinine alone; however, the association between most of the risk factors and GFR was more accurate by eGFR based on creatinine alone. This is explained by the association of these risk factors with the non-GFR determinants of cystatin C.
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Affiliation(s)
- Andrew D Rule
- Division of Nephrology and Hypertension, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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18
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Negro C, Muir G. Reply. BJU Int 2013; 111:E139-40. [DOI: 10.1111/j.1464-410x.2013.11397_6.x] [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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19
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Seitz M, Herlemann A, Magistro G, Stief CG. [Diagnostics of benign prostate syndrome]. Urologe A 2013; 52:193-6. [PMID: 23417045 DOI: 10.1007/s00120-012-3085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The diagnostic work-up of lower urinary tract symptoms (LUTS) in the German guidelines consists of obligatory and optional diagnostic parameters. Recommendations for assessing LUTS include patient history, symptom questionnaires (IPSS international prostate symptoms score), physical examination, urine analysis, prostate-specific antigen, uroflowmetry, ultrasound examination of the urinary bladder, including postvoid residual urine and ultrasound examination of the upper urinary tract. Optional tests are voiding diary, pressure-flow studies, ultrasound measurement of detrusor wall thickness, urethrocystography and urethrocystoscopy. Ultrasound measurement of detrusor wall thickness in particular has a 95 % positive predictive value in diagnosing bladder outlet obstruction. With all diagnostic parameters it is possible to treat LUTS in a risk-adapted manner.
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Affiliation(s)
- M Seitz
- UroClinic Bogenhausen, Richard-Strauss-Straße 82, Munich, Germany.
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20
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Negro CL, Muir GH. Chronic urinary retention in men: How we define it, and how does it affect treatment outcome. BJU Int 2012; 110:1590-4. [DOI: 10.1111/j.1464-410x.2012.11101.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Cambio AJ, Evans CP. Outcomes and quality of life issues in the pharmacological management of benign prostatic hyperplasia (BPH). Ther Clin Risk Manag 2011; 3:181-96. [PMID: 18360626 PMCID: PMC1936299 DOI: 10.2147/tcrm.2007.3.1.181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a common disease of the aging male population. BPH treatment includes a variety of pharmacological and surgical interventions. The goal of this paper is to review the natural history of BPH, outcomes of pharmacological management, effects on quality of life (QoL), future pharmacotherapies, and associated patient-focused perspectives. MATERIALS AND METHODS Medline searches for the keywords benign prostatic hyperplasia, BPH, alpha blockers, 5 alpha-reductase, and quality of life were performed. Relevant literature was reviewed and analyzed. RESULTS Alpha blockers, 5 alpha-reductase inhibitors, and phytotherapy are the three categories of pharmaceutical interventions currently available for BPH. Various clinical trials have shown that alpha blockers and 5 alpha-reductase inhibitors are safe, efficacious, and improve QoL in patients with BPH. The evidence for phytotherapeutics is not as convincing. The current armamentarium of pharmaceutical interventions are encompassed in these three classes of medications. New pharmacotherapies based on novel mechanisms are on the horizon. CONCLUSION There are a variety of safe and efficacious medical therapies available for the management of BPH and it is important for the practicing physician to have an understanding of these pharmacotherapies and their potential impact on the patient. There is not enough evidence to make a recommendation regarding phytotherapy use. New classes of drugs for BPH will likely find their way into routine use.
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Affiliation(s)
- Angelo J Cambio
- Department of Urology [A.J.C., C.P.E.], University of California Davis, Sacramento, CA, USA
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22
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The Natural History and Predictive Factors of Voided Volume in Older Men: The Krimpen Study. J Urol 2011; 185:213-8. [DOI: 10.1016/j.juro.2010.08.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Indexed: 01/22/2023]
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23
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Berges R, Dreikorn K, Höfner K, Madersbacher S, Michel MC, Muschter R, Oelke M, Reich O, Rulf W, Tschuschke C, Tunn U. [Diagnostic and differential diagnosis of benign prostate syndrome (BPS): guidelines of the German Urologists]. Urologe A 2010; 48:1356-60, 1362-4. [PMID: 19756468 DOI: 10.1007/s00120-009-2066-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Mehdizadeh JL, Leach GE. Role of Invasive Urodynamic Testing in Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms. Urol Clin North Am 2009; 36:431-41, v. [DOI: 10.1016/j.ucl.2009.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Meeks JJ, Erickson BA, Granieri MA, Gonzalez CM. Stricture recurrence after urethroplasty: a systematic review. J Urol 2009; 182:1266-70. [PMID: 19683309 DOI: 10.1016/j.juro.2009.06.027] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Indexed: 11/27/2022]
Abstract
PURPOSE Urethroplasty remains the gold standard for the management of urethral stricture disease with acceptable long-term success. However, the standard by which stricture recurrence is defined and evaluated after urethral reconstruction remains widely variable. We conducted a systematic review of the urological literature to determine how stricture recurrence is defined and evaluated. MATERIALS AND METHODS A systematic review was conducted on all contemporary urethroplasty articles published between 2000 and 2008. Using the term "urethroplasty" 302 articles were identified and evaluated. A total of 86 articles were included in the analysis. RESULTS The overall recurrence rate for all reconstructive procedures was 15.6%, which remained stable between 2000 and 2008. Stricture recurrence was determined by a mean of 3 (range 1 to 8) different diagnostic tests. The most common primary diagnostic tests for recurrence were uroflowmetry (56% of articles) and retrograde urethrography (51%). Cystourethroscopy was used as a primary screen to identify stricture recurrence in 25% of articles, and as a secondary procedure in another 21%. Recurrence was defined as the need for an additional surgical procedure or dilation in 75% and 52% of articles, respectively. CONCLUSIONS The methods used to determine stricture recurrence after urethroplasty remain widely variable. The use of a standardized surveillance protocol to define stricture recurrence after urethral reconstruction may allow more effective comparison of urethroplasty outcomes across institutions.
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Affiliation(s)
- Joshua J Meeks
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA
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26
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Rule AD, St Sauver JL, Jacobson DJ, McGree ME, Girman CJ, Lieber MM, Jacobsen SJ. Three-dimensional ultrasound bladder characteristics and their association with prostate size and lower urinary tract dysfunction among men in the community. Urology 2009; 74:908-13. [PMID: 19647300 DOI: 10.1016/j.urology.2009.04.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 04/13/2009] [Accepted: 04/14/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To characterize ultrasound bladder measures, and to determine whether these measures were associated with measures of lower urinary tract dysfunction. METHODS Three-dimensional ultrasounds were used to assess bladder surface area (SA), bladder wall thickness (BWT), and estimated bladder weight (EBW) in a random sample of the Olmsted County, Minnesota, male population. Uroflowometry was used to determine maximum urinary flow rates, and ultrasound was used to assess postvoid residual volume. Prostate volume was assessed with transrectal ultrasound and prostate-specific antigen (PSA) levels were assessed from serum samples. Correlation and linear regression analyses assessed relationships between bladder measures and prostate volume, PSA, maximum flow rate, and postvoid residual. RESULTS Among 259 men, median bladder SA was 228 cm(2) (25th, 75th percentiles: 180, 279), median BWT was 2.3 mm (25th, 75th percentiles: 1.8, 2.7), and median EBW was 48.5 g (25th, 75th percentiles: 43.7, 53.0). Decreased bladder SA was correlated with increased PSA level, increased prostate volume, higher American Urological Association Symptom Index (AUASI) scores (r(s) = -0.13 to -0.21; P = .03-.001), and decreased maximum flow rate (r(s) = 0.21, P = .001). Increased BWT was correlated with increased PSA level (r(s) = 0.22, P = .0003), increased prostate volume (r(s) = 0.17, P = .01), and decreased maximum flow rate (r(s) = -0.14, P = .03). Increased EBW was correlated with increased maximum flow rate (r(s) = 0.14, P = .03) and decreased AUASI score (r(s) = -0.13, P = .04). CONCLUSIONS Decreased SA and EBW were moderately associated with decreased maximum flow rate and increased AUASI scores, suggesting that such measures may provide insight into detrusor dysfunction.
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Affiliation(s)
- Andrew D Rule
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
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27
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Song HD, Cho SY, Lee KC, Cho IR. The Risk Factors for Increased Post-Voiding Residual Urine Volume after Long-Term Anticholinergic Therapy in Patients with Benign Prostatic Hyperplasia and Overactive Bladder. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.10.982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hyun Dong Song
- Department of Urology, College of Medicine, Inje University, Gimhae, Korea
| | - Sung Yong Cho
- Department of Urology, College of Medicine, Inje University, Gimhae, Korea
| | - Keon Cheol Lee
- Department of Urology, College of Medicine, Inje University, Gimhae, Korea
| | - In Rae Cho
- Department of Urology, College of Medicine, Inje University, Gimhae, Korea
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Kaplan SA, Wein AJ, Staskin DR, Roehrborn CG, Steers WD. Urinary Retention and Post-Void Residual Urine in Men: Separating Truth From Tradition. J Urol 2008; 180:47-54. [DOI: 10.1016/j.juro.2008.03.027] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Steven A. Kaplan
- Department of Urology, Weill Medical College, Cornell University, New York, New York
| | - Alan J. Wein
- Division of Urology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - David R. Staskin
- Section of Voiding Dysfunction, New York-Presbyterian Hospital, Weill Medical College, Cornell University, New York, New York
- Department of Urology, Weill Medical College, Cornell University, New York, New York
- Department of Obstetrics/Gynecology, Weill Medical College, Cornell University, New York, New York
| | - Claus G. Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - William D. Steers
- Department of Urology, University of Virginia Medical School, Charlottesville, Virginia
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29
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Liao LM, Schaefer W. Cross-sectional and longitudinal studies on interaction between bladder compliance and outflow obstruction in men with benign prostatic hyperplasia. Asian J Androl 2007; 9:51-6. [PMID: 16888684 DOI: 10.1111/j.1745-7262.2007.00221.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIM To explore the interaction between bladder compliance (BC) and bladder outflow obstruction (BOO) in men with benign prostatic hyperplasia (BPH) using cross-sectional and longitudinal studies. METHODS A total of 181 men with BPH were recruited, and 100 of them were followed for one year. Cystometry was performed in a standing or a sitting position with 30 mL/min infusion. BC was manually corrected and defined. Obstruction coefficient (OCO), linear passive urethral resistance relation and international continence society (ICS) nomogram were used to diagnose BOO. The obstructed parameters were compared between the reduced BC group and the non-reduced group. BC was compared between the first investigation at the beginning of study and the second investigation at the end of study during the one-year follow-up period. RESULTS The group with reduced BC had increased OCO and linear passive urethral resistance relation. BC was significantly lower in the obstructed group (55.7 mL/cm water) than that in unobstructed and equivocal one (74.9 mL/cm water, P <0.01). BC gradually reduced with the increased obstructed grade. There was a significantly weak negative correlation between BC and OCO (r = -0.132, P < 0.01). Over the one-year follow-up period in the longitudinal study, BC for all men changed from 54.4 to 48.8 mL/cm water (P >0.05), and BC for the group with BOO fell from 58.4 +/- 70.1 to 46.5 +/- 38.7 mL/cm water (P>0.05). CONCLUSION In men with BPH, a significant systematic decrease occurred in BC in the obstructed group and a significant systematic increase with urethral resistance occurred in the low BC group. A longitudinal study of the tendency of BC reduction in a group with BOO is necessary in the future.
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Affiliation(s)
- Li-Min Liao
- Department of Urology, China Rehabilitation Research Center, Rehabilitation College of Capital Medical University, Beijing 100068, China.
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Current World Literature. Curr Opin Urol 2007; 17:77-81. [PMID: 17143115 DOI: 10.1097/mou.0b013e328012cbca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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