1
|
Spirito L, Capra M, Sciorio C, Romano L, Morelli M, Valtorta A, Arcaniolo D, Mirto BF, Manfredi C, Sicignano E, Capone F, Giampaglia G, Iaconis S, Napolitano L, Machiella F, Quattrone C, Imperatore V, Crocetto F. Long-term functional outcomes and predictors of efficacy in thulium laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH): a retrospective observational study. J Basic Clin Physiol Pharmacol 2024; 0:jbcpp-2024-0036. [PMID: 38915209 DOI: 10.1515/jbcpp-2024-0036] [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: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 06/26/2024]
Abstract
OBJECTIVES Benign prostatic hyperplasia (BPH) is a common urological condition affecting aging men worldwide. Among the treatment options available for BPH, transurethral resection of the prostate (TURP) is the gold-standard invasive intervention. To reduce the TURP-related non-negligible morbidity, loss-of-ejaculation rate, hospitalization, blood loss and catheterization time several laser techniques have been developed, such as the Thulium Laser Enucleation of the Prostate (ThuLEP). To investigate the efficacy outcomes of the ThuLEP as a treatment option for benign prostatic hyperplasia (BPH) we performed a retrospective observational study at Moriggia Pelascini Hospital (Como, Italy) between January 2015 and September 2018. METHODS We included 265 patients who underwent ThuLEP at a specific hospital between defined dates. Data on various parameters, including post-void residue volume, peak urinary flow rate (Qmax), International Prostate Symptom Score (IPSS) for urinary symptoms, IPSS Quality of Life (QoL) score, and International Index of Erectile Function (IIEF) score for erectile dysfunction, were collected at baseline and follow-up. RESULTS The analysis revealed significant improvements in voiding efficiency, urinary flow, urinary symptoms, quality of life, and erectile function following ThuLEP. Furthermore, certain baseline characteristics, such as post-void residue, peak urinary flow rate, age, prostate volume, and aspirin usage, were found to influence treatment outcomes. CONCLUSIONS Despite the study's limitations, these findings contribute to understanding ThuLEP's effectiveness in managing BPH and can aid in making informed clinical decisions for patient care. Prospective studies with longer follow-up periods are recommended to validate and extend these results.
Collapse
Affiliation(s)
- Lorenzo Spirito
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Massimo Capra
- Urology Unit, 9337 Alessandro Manzoni Hospital , Lecco, Italy
| | - Carmine Sciorio
- Urology Unit, 9337 Alessandro Manzoni Hospital , Lecco, Italy
| | - Lorenzo Romano
- Urology Unit, 9337 Alessandro Manzoni Hospital , Lecco, Italy
| | - Michele Morelli
- Urology Unit, 9337 Alessandro Manzoni Hospital , Lecco, Italy
| | - Adelio Valtorta
- Urology Unit, 89497 Moriggia Pelascini Hospital , Como, Italy
| | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Benito Fabio Mirto
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Enrico Sicignano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Federico Capone
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Gaetano Giampaglia
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Salvatore Iaconis
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Fabio Machiella
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Carmelo Quattrone
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli" Naples, Italy
| | | | - Felice Crocetto
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli" Naples, Italy
| |
Collapse
|
2
|
Burton CS, Dobberfuhl AD, Comiter CV. Outcomes of Aquablation in Men With Acute and Chronic Urinary Retention. Urology 2023; 180:214-218. [PMID: 37442297 DOI: 10.1016/j.urology.2023.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/25/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To compare outcomes of Aquablation in men with acute and chronic urinary retention. METHODS We conducted a retrospective review of all men undergoing Aquablation resection of the prostate between May 2021 and August 2022. Men were classified as having acute urinary retention if they required either intermittent or indwelling catheter and chronic urinary retention if they had a postvoid residual >300 mL prior to surgery. We compared success rates and time to passage of trial without catheter as well as complication rates to those with no retention. RESULTS A total of 113 men underwent Aquablation including 28 with acute retention and 16 with chronic retention. Failure of initial void trial was significantly higher in patients with preoperative urinary retention (40%) and chronic retention with postvoid residual >300 mL (12.5%) compared to those with no retention (7.2%, P < .001). Among men with acute and chronic retention 98% were voiding spontaneously at a mean 5months follow-up. There was no difference in utilization of postoperative prostate medications, complications, International Prostate Symptom Score or uroflowmetry among men with acute, chronic, or no retention. CONCLUSION Aquablation is an effective method for treatment of men with urinary retention, with 98% achieving spontaneous voiding regardless of preoperative urodynamic findings. Men in acute retention prior to surgery were more likely to fail their initial void trial, which may support the recommendation for a delayed trial without catheter.
Collapse
Affiliation(s)
- Claire S Burton
- Stanford University School of Medicine, Department of Urology, Palo Alto, CA.
| | - Amy D Dobberfuhl
- Stanford University School of Medicine, Department of Urology, Palo Alto, CA
| | - Craig V Comiter
- Stanford University School of Medicine, Department of Urology, Palo Alto, CA
| |
Collapse
|
3
|
Yuk HD, Oh SJ. Effect of urinary retention on the surgical outcome of holmium laser enucleation of the benign prostatic hyperplasia. Investig Clin Urol 2023; 64:31-40. [PMID: 36629063 PMCID: PMC9834565 DOI: 10.4111/icu.20220232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate the effect of urinary retention (UR) on holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms. MATERIALS AND METHODS A retrospective analysis of a prospective cohort of patients who underwent HoLEP between January 2010 and December 2016 was performed. The perioperative factors, including the International Prostate Symptom Score, Overactive Bladder Symptom Score, prostate-specific antigen, urodynamic study results, uroflowmetry results, transrectal ultrasound prostate volume, operative time, morcellation time, enucleation weight, and complications, were evaluated. Postoperative evaluation was performed at 2, 3, and 6 months. RESULTS Overall, 903 patients were identified. The mean age and follow-up were 68.3 years and 6 months, respectively. Among the patients, 135 (15.0%) patients had a history of acute UR (AUR), and 36 patients (4.0%) had chronic UR (CUR). The mean detrusor pressures at maximum flow were 64.4, 74.3, and 77.7 cmH2O (p<0.001). The mean maximum flow rates (Qmax) were 7.6, 6.6, and 4.8 mL/s (p<0.001). Additionally, the mean bladder outlet obstruction indices were 49.5, 61.1, and 69.4 (p<0.001). The postoperative Qmax improved in all three groups. The mean postvoid residual volumes (PVRs) were 55, 75, and 333 mL preoperatively; 20, 29, and 66 mL at 2 weeks; 16, 23, and 45 mL at 3 months; and 15, 22, and 52 mL at 6 months (p<0.001). CONCLUSIONS Voiding symptoms, PVR, and Qmax of BPH patients with preoperative AUR and CUR significantly improved after Ho-LEP, similar to those without preoperative UR.
Collapse
Affiliation(s)
- Hyeong Dong Yuk
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Baboudjian M, Peyronnet B, Boissier R, Robert G, Cornu JN, Misrai V, Pradere B. Best nonsurgical managements of acute urinary retention: what's new? Curr Opin Urol 2022; 32:124-130. [PMID: 34954701 DOI: 10.1097/mou.0000000000000969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To provide a comprehensive review of the nonsurgical management of acute urinary retention (AUR). RECENT FINDINGS A recent meta-analysis confirmed that α-blockers are associated with higher rates of successful trial without catheter (TWOC) compared with placebo, while combination therapies do not significantly reduce the rate of recatheterization. Compared with standard TWOC, bladder perfusion with physiological serum prior to catheter removal is a simple and cost-effective method to increase TWOC success rates (odds ratio 2.41, 95% confidence interval 1.53-3.8), and to reduce time-to-discharge (-89.68 min, 95% confidence interval -160.55, -18.88). Clean intermittent catheterization (CIC) is increasingly used for urinary retention in patients with benign prostatic hyperplasia as existing data suggest that it may decrease the risk of urinary tract infections, accelerate spontaneous voiding recovery and might be more cost-effective compared with indwelling urethral catheterization. Ongoing trials are examining whether office-placed prostate stent may be a promising solution in patients with AUR. SUMMARY The recent development of alternative approaches to traditional TWOC may lead to new therapies for treating patients with AUR. Further studies are needed as the level of evidence from published studies remains low.
Collapse
Affiliation(s)
- Michael Baboudjian
- Department of Urology, La Conception Hospital
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille
| | | | | | - Grégoire Robert
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux
| | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
5
|
Chapple CR, Osman NI. Underactive Bladder Versus Bladder Outlet Obstruction: Don’t Get Tricked! Eur Urol Focus 2022; 8:388-390. [DOI: 10.1016/j.euf.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 11/04/2022]
|
6
|
Chen JW, Lin WJ, Lin CY, Hung CL, Hou CP, Tang CY. An Automatic Bleeding-Rank System for Transurethral Resection of the Prostate Surgery Videos Using Machine Learning. Diagnostics (Basel) 2021; 11:diagnostics11101767. [PMID: 34679465 PMCID: PMC8535166 DOI: 10.3390/diagnostics11101767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in aging males. Transurethral resection of the prostate (TURP) surgery is performed by a cystoscope passing through the urethra and scraping off the prostrate piece by piece through a cutting loop. Although TURP is a minimally invasive procedure, bleeding is still the most common complication. Therefore, the evaluation, monitoring, and prevention of interop bleeding during TURP are very important issues. The main idea of this study is to rank bleeding levels during TURP surgery from videos. Generally, to judge bleeding level by human eyes from surgery videos is a difficult task, which requires sufficient experienced urologists. In this study, machine learning-based ranking algorithms are proposed to efficiently evaluate the ranking of blood levels. Based on the visual clarity of the surgical field, the four ranking of blood levels, including score 0: excellent; score 1: acceptable; score 2: slightly bad; and 3: bad, were identified by urologists who have sufficient experience in TURP surgery. The results of extensive experiments show that the revised accuracy can achieve 90, 89, 90, and 91%, respectively. Particularly, the results reveal that the proposed methods were capable of classifying the ranking of bleeding level accurately and efficiently reducing the burden of urologists.
Collapse
Affiliation(s)
- Jian-Wen Chen
- Department of Computer Science, National Tsing Hua University, Hsinchu 30013, Taiwan; (J.-W.C.); (C.-Y.T.)
| | - Wan-Ju Lin
- Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan;
| | - Chun-Yuan Lin
- Department of Computer Science and Information Engineering, Asia University, Taichung 41354, Taiwan;
| | - Che-Lun Hung
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Computer Science and Communication Engineering, Providence University, Taichung 43301, Taiwan
- Correspondence: (C.-L.H.); (C.-P.H.)
| | - Chen-Pang Hou
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: (C.-L.H.); (C.-P.H.)
| | - Chuan-Yi Tang
- Department of Computer Science, National Tsing Hua University, Hsinchu 30013, Taiwan; (J.-W.C.); (C.-Y.T.)
- Department of Computer Science and Information Engineering, Providence University, Taichung 43301, Taiwan
| |
Collapse
|
7
|
Long Depaquit T, Baboudjian M, Gaillet S, Faures M, Karsenty G, Boissier R. [Learning of self-catheterization: For whom? Why? How?]. Prog Urol 2021; 31:911-916. [PMID: 34456139 DOI: 10.1016/j.purol.2021.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
Since the 1970s, self-catheterization is the preferred method of urine drainage in case of urinary retention of neurological etiology (paraplegia, multiple sclerosis…) and non-neurological cause (benign prostatic hypertrophy, acontractile bladder of the elderly subject…). The main objective is to allow the physiological alternation of filling and complete emptying phases, in order to preserve the renal function and prevent urinary infections. The learning of self-catheterization is simple but requires a therapeutic education session with trained personnel, at home or in a specialized center. Cognitive disorders, poor vision, lack of dexterity or lack of knowledge of urogenital anatomy are the main limitations to their implementation. Their success depends on the frequency of catheterization (every 4h), which is performed in a clean but non-sterile manner. The benefit/risk ratio is largely in favor of using them to replace the indwelling probe whenever possible.
Collapse
Affiliation(s)
- T Long Depaquit
- Service d'urologie et de transplantation rénale, Aix-Marseille Université, CHU La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - M Baboudjian
- Service d'urologie et de transplantation rénale, Aix-Marseille Université, CHU La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - S Gaillet
- Service d'urologie et de transplantation rénale, Aix-Marseille Université, CHU La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - M Faures
- Service d'urologie et de transplantation rénale, Aix-Marseille Université, CHU La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - G Karsenty
- Service d'urologie et de transplantation rénale, Aix-Marseille Université, CHU La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - R Boissier
- Service d'urologie et de transplantation rénale, Aix-Marseille Université, CHU La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France.
| |
Collapse
|
8
|
Baboudjian M, Savoie PH, Long JA, Boissier R. [Acute urine retention: Epidemiology, optimization of the care pathway and alternative to permanent bladder drainage]. Prog Urol 2021; 31:967-977. [PMID: 34420877 DOI: 10.1016/j.purol.2021.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this narrative review was to report the most relevant data on the contemporary management of Acute Urine Retention (AUR). METHODS A narrative synthesis of the articles in French and English available on the Pubmed database was carried out in June 2021. We explored the registry of Surveillance sanitaire des urgences et des décès (SurSaUD®, Santé Publique France) to rise original data regarding the epidemiology of AUR in France. RESULTS AUR is a therapeutic emergency that requires a rapid bladder drainage. The average age is 71 years, 87 % are men and the stay in the emergency department is >4hours. In France, the hospitalization rate for UAR is steadily decreasing from 42% in 2014 to 32% in 2019. The introduction of an α-blocker increases the chances to get rid of the urinary catheter of 47% to 77% versus placebo. A post-emergency AUR pathway allows lowering the number of people lost with follow-up and shortening the duration of bladder drainage. The first try for catheter removal should be organized within 48-72hours of the AUR. In case of unsuccessful catheter removal, it is recommended to teach self-catheterization to the patient. The placement of a temporary prostatic stent is a promising alternative that is under evaluation. Immediate surgery is associated with increased morbidity/mortality and is not recommended. CONCLUSION AUR is a common disease. The management has been optimized in recent years to improve the prognosis and the quality of life of patients.
Collapse
Affiliation(s)
- Michael Baboudjian
- Service d'urologie et de transplantation Rénale, CHU La Conception, AP-HM, Marseille, France
| | - Pierre Henri Savoie
- Service d'urologie, hôpital d'instruction des Armées Sainte Anne, Toulon, France
| | - Jean-Alexandre Long
- Service d'urologie et de la transplantation rénale, CHU Grenoble, France; TIMC-IMAG CNRS 5525, Grenoble, France
| | - Romain Boissier
- Service d'urologie et de transplantation Rénale, CHU La Conception, AP-HM, Marseille, France.
| |
Collapse
|
9
|
Aho T, Finch W, Jefferson P, Suraparaju L, Georgiades F. HoLEP for acute and non-neurogenic chronic urinary retention: how effective is it? World J Urol 2021; 39:2355-2361. [PMID: 33763730 DOI: 10.1007/s00345-021-03657-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/06/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine catheter status within 3 months of holmium laser enucleation of the prostate (HoLEP) for acute and non-neurogenic chronic urinary retention (AUR and NNCUR), to compare short-term outcomes of HoLEP for urinary retention (UR) versus lower urinary tract symptoms (LUTS), and to report long-term serum creatinine (SC) after HoLEP for high-pressure chronic urinary retention (HPCUR). METHODS A prospectively maintained database of the first 500 consecutive HoLEP cases performed under the care of a single surgeon was analysed retrospectively. Urodynamic studies (UDS) did not play a role in the decision making process for those with UR. NNCUR was defined as painless, with post-void residual volume (PVR) greater than 300 ml in men able to void and initial catheter drainage > 1000 ml in men unable to void. RESULTS 280/500 (56%) were in UR: AUR (195), and NNCUR (85) including 22 with HPCUR. The UR cohort were older with higher enucleated tissue weight [median (IQR); 72 years (66-79 year) and 56 g (29.8-86.3 g)], than the LUTS cohort [70 years (64-75 year) and 38 g (18-67 g)] (p < 0.001). 98.9% with AUR and 98.8% with NNCUR were catheter-free 3 months after HoLEP. There were no significant differences in transfusion rates, hospital stay, or time to first trial without catheter (TWOC) between the LUTS and UR cohorts, nor in international prostate symptom score and quality of life scores, maximum urinary flow rate, post void residual volume or urinary incontinence at 3 months. Patients with NNCUR were less likely to pass their first TWOC (58.8%) than those with AUR (84.6%) or LUTS (87.7%), p < 0.001. None with HPCUR had a clinically significant deterioration in SC at a median of 60 months (IQR 36-82 months). CONCLUSION HoLEP has 3-month catheter-free rates in excess of 98.5% for AUR and NNCUR in patients not pre-selected by UDS. First TWOC is significantly more likely to fail after HoLEP for NNCUR than AUR or LUTS. HoLEP is a durable treatment for HPCUR and there is no need to monitor renal function to detect recurrence.
Collapse
Affiliation(s)
- Tevita Aho
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - William Finch
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | |
Collapse
|
10
|
Sagen E, Nelzén O, Peeker R. Transurethral resection of the prostate: fate of the non-responders. Scand J Urol 2020; 54:443-448. [PMID: 32885703 DOI: 10.1080/21681805.2020.1812712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) has been the standard method of surgical management of benign prostatic enlargement for decades. Some patients experience significant voiding dysfunction and discomfort postoperatively, without any apparent clinical complications from the procedure. Furthermore, a significant proportion of men still require postoperative catheterisation. This study analysed patients defined as non-responders after TURP with the principal aim to reveal their fate. METHODS A prospectively recruited cohort of 355 men, who underwent TURP during 2010-2012, was investigated. Non-responders were identified as still requiring catheterisation postoperatively and/or exhibiting all of the following voiding outcomes based on the de Wildt criteria: IPSS > 7, bother score > 2, Qmax < 15 mL/s and PVR > 100 mL. The non-responders were followed for a maximum period of three years using retrospective chart reviews. RESULTS Thirty-five men were defined as non-responders. Of these, 26 men were operated on due to urinary retention and nine men due to bothersome symptoms. The non-responders were followed for a mean time of 72 months. Seven men underwent a redo-TURP and two men a bladder neck incision. Eleven of the 35 men were finally judged as having satisfactory voiding parameters. Sixteen men used CISC. Eleven men reduced the frequency of CISC to a minimum. Seven men had to use an indwelling catheter indefinitely. CONCLUSION Men with preoperative urinary retention constituted the vast majority of non-responders. The use of postoperative urodynamic studies was remarkably low. Almost one in three non-responders finally had a satisfactory outcome with or without re-intervention.
Collapse
Affiliation(s)
- Erik Sagen
- Research and Development Centre, NU Hospital Group, Uddevalla, Sweden.,Research and Development Centre, Hospital of Skaraborg, Skövde, Sweden.,Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Olle Nelzén
- Research and Development Centre, Hospital of Skaraborg, Skövde, Sweden
| | - Ralph Peeker
- Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy, Gothenburg, Sweden
| |
Collapse
|
11
|
Automated Classification of Blood Loss from Transurethral Resection of the Prostate Surgery Videos Using Deep Learning Technique. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10144908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transurethral resection of the prostate (TURP) is a surgical removal of obstructing prostate tissue. The total bleeding area is used to determine the performance of the TURP surgery. Although the traditional method for the detection of bleeding areas provides accurate results, it cannot detect them in time for surgery diagnosis. Moreover, it is easily disturbed to judge bleeding areas for experienced physicians because a red light pattern arising from the surgical cutting loop often appears on the images. Recently, the automatic computer-aided technique and artificial intelligence deep learning are broadly used in medical image recognition, which can effectively extract the desired features to reduce the burden of physicians and increase the accuracy of diagnosis. In this study, we integrated two state-of-the-art deep learning techniques for recognizing and extracting the red light areas arising from the cutting loop in the TURP surgery. First, the ResNet-50 model was used to recognize the red light pattern appearing in the chipped frames of the surgery videos. Then, the proposed Res-Unet model was used to segment the areas with the red light pattern and remove these areas. Finally, the hue, saturation, and value color space were used to classify the four levels of the blood loss under the circumstances of non-red light pattern images. The experiments have shown that the proposed Res-Unet model achieves higher accuracy than other segmentation algorithms in classifying the images with the red and non-red lights, and is able to extract the red light patterns and effectively remove them in the TURP surgery images. The proposed approaches presented here are capable of obtaining the level classifications of blood loss, which are helpful for physicians in diagnosis.
Collapse
|
12
|
Méndez-Rubio S, López-Pérez E, Laso-Martín S, Vírseda-Chamorro M, Salinas-Casado J, Esteban-Fuertes M, Moreno-Sierra J. The role of clean intermittent catheterization in the treatment for detrusor underactivity. Actas Urol Esp 2020; 44:233-238. [PMID: 32151472 DOI: 10.1016/j.acuro.2019.11.002] [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: 08/05/2019] [Revised: 11/04/2019] [Accepted: 11/19/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To study the influence of clean intermittent catheterization (CIC) on the lower urinary tract function in patients with urinary retention (UR) due to detrusor underactivity (DU). MATERIAL AND METHODS A longitudinal study was carried out on 49 patients (28 men, 21 women) of mean age 55years, who underwent CIC for UR secondary to DU. The mean CIC frequency was 3.15 times/day. Patients' clinical data were collected, and they underwent urodynamic study before and after CIC, with a mean interval of 4years. Fisher's exact test was used for the analysis of categorical variables and Student's t test for parametric variables. The level of significance was set at 0.05 for a two-tailed test. RESULTS The second urodynamic study showed a significantly increased bladder compliance, the Bladder Outlet Obstruction Index (BOOI) and the Bladder Contractility Index (BCI) also increased but without reaching statistical significance. There was a significantly higher percentage of benign prostatic hyperplasia (BPH) and acontractile detrusor cases among the group of patients whose BCI improved after CIC, with significantly lower CIC time. CONCLUSIONS CIC improved bladder compliance in the patients of our series. The BCI improved in BPH patients and in patients with acontractile detrusor.
Collapse
|
13
|
Gamé X, Phé V, Castel-Lacanal E, Forin V, de Sèze M, Lam O, Chartier-Kastler E, Keppenne V, Corcos J, Denys P, Caremel R, Loche CM, Scheiber-Nogueira MC, Karsenty G, Even A. Intermittent catheterization: Clinical practice guidelines from Association Française d'Urologie (AFU), Groupe de Neuro-urologie de Langue Française (GENULF), Société Française de Médecine Physique et de Réadaptation (SOFMER) and Société Interdisciplinaire Francophone d'UroDynamique et de Pelvi-Périnéologie (SIFUD-PP). Prog Urol 2020; 30:232-251. [PMID: 32220571 DOI: 10.1016/j.purol.2020.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/02/2020] [Accepted: 02/13/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Our objective was to provide guidelines covering all aspects of intermittent catheterisation (intermittent self-catheterisation and third-party intermittent catheterisation). MATERIALS AND METHODS A systematic review of the literature based on Pubmed, Embase, Google scholar was initiated in December 2014 and updated in April 2019. Given the lack of robust data and the numerous unresolved controversial issues, guidelines were established based on the formal consensus of experts from steering, scoring and review panels. RESULTS This allowed the formulation of 78 guidelines, extending from guidelines on indications for intermittent catheterisation, modalities for training and implementation, choice of equipment, management of bacteriuria and urinary tract infections, to the implementation of intermittent catheterisation in paediatric, geriatric populations, benign prostatic hyperplasia patients and continent urinary diversion patients with a cutaneous reservoir as well as other complications. These guidelines are pertinent to both intermittent self-catheterisation and third-party intermittent catheterisation. CONCLUSION These are the first comprehensive guidelines specifically aimed at intermittent catheterisation and extend to all aspects of intermittent catheterisation. They assist in the clinical decision-making process, specifically in relation to indications and modalities of intermittent catheterisation options. These guidelines are intended for urologists, gynaecologists, geriatricians, paediatricians, neurologists, physical and rehabilitation physicians, general practitioners and other health professionals including nurses, carers….
Collapse
Affiliation(s)
- X Gamé
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Université Paul Sabatier, Toulouse, France.
| | - V Phé
- Sorbonne Université, Service d'Urologie, AP-HP, hôpital Pitié-Salpetrière, Paris, France
| | - E Castel-Lacanal
- CHU Toulouse, service de Médecine Physique et de réadaptation et ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - V Forin
- Médecine Physique et de Réadaptation pédiatrique, Hôpital Armand Trousseau AP-HP, Sorbonne Université, Paris, France
| | - M de Sèze
- Cabinet de neuroUrologie et Pelviperinéologie, Clinique Saint Augustin, Bordeaux, France
| | - O Lam
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - E Chartier-Kastler
- Sorbonne Université, Service d'Urologie, AP-HP, hôpital Pitié-Salpetrière, Paris, France
| | - V Keppenne
- Service d'urologie, CHU Liège, Liège, Belgium
| | - J Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - P Denys
- Université de Versailles Saint Quentin. Service de Neuro Urologie, AP-HP, Hopital Raymond Poincaré, Garches, France
| | - R Caremel
- Clinique du Cèdre, Bois-Guillaume, France
| | - C-M Loche
- Service de Rééducation Neurolocomotrice, AP-HP, HU Henri Mondor, Créteil, France
| | | | - G Karsenty
- Aix-Marseille Université, Urologie et Transplantation Rénale, Hôpital La Conception, APHM, Marseille, France
| | - A Even
- Service de Neuro Urologie, AP-HP, Hôpital Raymond Poincaré, Garches, France
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Affiliation(s)
- Jenny Martin
- Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | | | - Mark Speakman
- Taunton and Somerset NHS Foundation Trust, Taunton, UK
| |
Collapse
|
16
|
Karavitakis M, Kyriazis I, Omar MI, Gravas S, Cornu JN, Drake MJ, Gacci M, Gratzke C, Herrmann TRW, Madersbacher S, Rieken M, Speakman MJ, Tikkinen KAO, Yuan Y, Mamoulakis C. Management of Urinary Retention in Patients with Benign Prostatic Obstruction: A Systematic Review and Meta-analysis. Eur Urol 2019; 75:788-798. [PMID: 30773327 DOI: 10.1016/j.eururo.2019.01.046] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/29/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT Practice patterns for the management of urinary retention (UR) secondary to benign prostatic obstruction (BPO; UR/BPO) vary widely and remain unstandardized. OBJECTIVE To review the evidence for managing patients with UR/BPO with pharmacological and nonpharmacological treatments included in the European Association of Urology guidelines on non-neurogenic male lower urinary tract symptoms. EVIDENCE ACQUISITION Search was conducted up to April 22, 2018, using CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. This systematic review included randomized controlled trials (RCTs) and prospective comparative studies. Methods as detailed in the Cochrane handbook were followed. Certainty of evidence (CoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. EVIDENCE SYNTHESIS Literature search identified 2074 citations. Twenty-one studies were included (qualitative synthesis). The evidence for managing patients with UR/BPO with pharmacological or nonpharmacological treatments is limited. CoE for most outcomes was low/very low. Only α1-blockers (alfuzosin and tamsulosin) have been evaluated in more than one RCT. Pooled results indicated that α1-blockers provided significantly higher rates of successful trial without catheter compared with placebo [alfuzosin: 322/540 (60%) vs 156/400 (39%) (odds ratio {OR} 2.28, 95% confidence interval {CI} 1.55 to 3.36; participants=940; studies=7; I2=41%; low CoE); tamsulosin: 75/158 (47%) vs 40/139 (29%) (OR 2.40, 95% CI 1.29 to 4.45; participants=297; studies=3; I2=30%; low CoE)] with rare adverse events. Similar rates were achieved with tamsulosin or alfuzosin [51/87 (59%) vs 45/84 (54%) (OR 1.28, 95% CI 0.68 to 2.41; participants=171; studies=2; I2=0%; very low CoE)]. Nonpharmacological treatments have been evaluated in RCTs/prospective comparative studies only sporadically. CONCLUSIONS There is some evidence that usage of α1-blockers (alfuzosin and tamsulosin) may improve resolution of UR/BPO. As most nonpharmacological treatments have not been evaluated in patients with UR/BPO, the evidence is inconclusive about their benefits and harms. PATIENT SUMMARY There is some evidence that alfuzosin and tamsulosin may increase the rates of successful trial without catheter, but little or no evidence on various nonpharmacological treatment options for managing patients with urinary retention secondary to benign prostatic obstruction.
Collapse
Affiliation(s)
- Markos Karavitakis
- Center of Minimal Invasive Urology Athens Medical Center, Athens, Greece
| | - Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | | | - Stavros Gravas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Jean-Nicolas Cornu
- Department of Urology, Charles-Nicolle University Hospital, Rouen Cedex, France
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol and Bristol Urological Institute, Bristol, UK
| | - Mauro Gacci
- Minimally Invasive and Robotic Surgery, and Kidney Transplantation, University of Florence AOUC-Careggi Hospital, Florence, Italy
| | | | - Thomas R W Herrmann
- Urology Clinic, Spital Thurgau AG, Frauenfeld, Switzerland; Department of Urology and Urological Oncology, Hanover Medical School, Hanover, Germany
| | | | - Malte Rieken
- alta uro AG, Basel, Switzerland, University Basel,Basel, Switzerland
| | | | - Kari A O Tikkinen
- Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Yuhong Yuan
- Division of Gastroenterology & Cochrane UGPD Group, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Canada
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece.
| |
Collapse
|
17
|
Gürbüz C, Drake MJ. Where can urodynamic testing help assess male lower urinary tract symptoms? Turk J Urol 2019; 45:157-163. [PMID: 30817272 DOI: 10.5152/tud.2019.82783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/05/2018] [Indexed: 01/23/2023]
Abstract
Urodynamic studies assess the function of the bladder and bladder outlet. They are often useful in the assessment and diagnosis of patients presenting with lower urinary tract symptoms (LUTS). The evidence regarding the value and risks of invasive urodynamics remains insufficient. However, men with LUTS who are assessed by invasive urodynamics are more likely to have their management changed and less likely to undergo surgery. This review discusses the role of urodynamic diagnosis and application in the diagnosis and treatment of male LUTS.
Collapse
Affiliation(s)
- Cenk Gürbüz
- Department of Urology Medistate Hospital, Beykoz University, İstanbul, Turkey
| | - Marcus J Drake
- Bristol Urological Institute and Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK
| |
Collapse
|
18
|
Abello A, DeWolf WC, Das AK. Expectant long-term follow-up of patients with chronic urinary retention. Neurourol Urodyn 2018; 38:305-309. [PMID: 30407653 DOI: 10.1002/nau.23853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/10/2018] [Indexed: 11/07/2022]
Abstract
AIMS To describe urologic complications in patients with chronically elevated post-void residual (PVR) volumes and to evaluate other related risk factors during a long-term follow-up in patients managed conservatively. METHODS Non-neurogenic patients who refused surgical intervention of the prostate and had PVR volumes >300 mL on two or more separate occasions at least 6 months apart were included. We followed this cohort over time, recorded complications and evaluated risk factors for complications. RESULTS Twenty-eight men with a mean age of 74 were followed for a median of 56 months (IQR: 26-101 months); 26 had benign prostatic hyperplasia with a median prostate size of 55 cc. Baseline median PVR was 468 cc (IQR: 395-828) and follow-up median PVR was 508 cc (IQR: 322-714). During follow-up, 13 patients (46%) had at least one complication with acute urinary retention being the most common occurring in 10 patients (36%) with 15 episodes. Other complications presented in less than 15%, and no patients developed permanent renal insufficiency. Patients with prostate size ≥ 100 cc had significantly higher total number of acute retention episodes (P-value: 0.01). CONCLUSIONS Although the presence of CUR could commonly predispose to episodes of acute retention, severe complications are infrequent although present. Additionally, prostate size may play a role in increasing some adverse outcomes. With proper counseling about different complications, patients with retention who denied surgical treatment can be safely followed for at least 5 years without renal deterioration.
Collapse
Affiliation(s)
- Alejandro Abello
- Urology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - William C DeWolf
- Urology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Anurag K Das
- Urology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
19
|
Drake MJ. Is Urodynamics Necessary when Assessing a Patient with Male Lower Urinary Tract Symptoms? Eur Urol Focus 2018; 4:54-56. [PMID: 29705282 DOI: 10.1016/j.euf.2018.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/31/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
Urodynamics can distinguish bladder outlet obstruction from detrusor underactivity. Clear identification of the mechanism of a man's voiding symptoms can help give the best chance of good outcome from surgery. Publication of results from the UPSTREAM study will help in establishing the exact place for urodynamic testing in male lower urinary tract symptoms.
Collapse
Affiliation(s)
- Marcus J Drake
- Bristol Urological Institute, University of Bristol, Southmead Hospital, Bristol, UK.
| |
Collapse
|
20
|
Welk B, McGarry P, Baverstock R, Carlson K, Hickling D. Do Urodynamic Findings Other Than Outlet Obstruction Influence the Decision to Perform a Transurethral Resection of Prostate? Urology 2018; 117:120-125. [PMID: 29704587 DOI: 10.1016/j.urology.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 03/27/2018] [Accepted: 04/10/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if urodynamic findings other than high-pressure voiding influence the decision to perform a transurethral resection of prostate (TURP). METHODS Four clinical scenarios were created featuring a healthy 65-year-old man. An electronic survey was distributed to members of the International Continence Society and the Society for Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. RESULTS Eighty-six urologists responded (median age was 45-54 years, 62% described their practice as academic). Scenario 1: an incidental residual urine >1 L with detrusor underactivity. The majority (76%) would offer a TURP; however, the estimated chance that the residual volume would improve was only 57%. Scenario 2: retention with detrusor overactivity but no voluntary voiding contraction. The majority (72%) would offer a TURP; however, the average chance quoted that he would void was only 48%. Scenario 3: catheter-dependent retention and an underactive detrusor. The majority (89%) would offer a TURP; however, the average chance quoted that he would void was only 53%. Scenario 4: a man with only frequency and urgency, but urodynamic bladder outlet obstruction. The majority (90%) would offer him a TURP; however, the average chance that his frequency and urgency would improve was only 64%, and the average estimated postoperative risk of urgency incontinence was 33%. Willingness to offer TURP did not correlate with physician characteristics. CONCLUSION Urodynamic findings other than bladder outlet obstruction were associated with modest perceived outcomes after TURP; however, despite this, urologists are still willing to offer this intervention.
Collapse
Affiliation(s)
- Blayne Welk
- Department of Surgery, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
| | - Patrick McGarry
- Department of Surgery, Western University, London, Ontario, Canada
| | - Richard Baverstock
- Department of Surgery, Division of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Carlson
- Department of Surgery, Division of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Duane Hickling
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
21
|
Review of underactive bladder. J Formos Med Assoc 2018; 117:178-184. [DOI: 10.1016/j.jfma.2017.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/29/2017] [Accepted: 09/07/2017] [Indexed: 12/13/2022] Open
|
22
|
Lin YH, Hou CP, Chen TH, Juang HH, Chang PL, Yang PS, Chen CL, Tsui KH. Transurethral resection of the prostate provides more favorable clinical outcomes compared with conservative medical treatment in patients with urinary retention caused by benign prostatic obstruction. BMC Geriatr 2018; 18:15. [PMID: 29338688 PMCID: PMC5771192 DOI: 10.1186/s12877-018-0709-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/03/2018] [Indexed: 11/28/2022] Open
Abstract
Background To evaluate the long-term surgical outcomes of patients with urinary retention (UR) caused by a benign prostatic obstruction (BPO) who underwent transurethral resection of the prostate (TURP), and compare their outcomes with those of patients who received medication without surgical intervention. Methods This retrospective cohort study analyzed claims data collected during the period of 1997–2012 from Taiwan’s National Health Insurance Research Database. We examined geriatric adverse events among patients who had received a diagnosis of symptomatic benign prostatic hyperplasia and whom experienced UR, and compared those who received TURP and medication only. Primary outcomes included urinary tract infection (UTI), UR, inguinal hernia, hemorrhoids, stroke, acute myocardial infarction, and bony fracture. We excluded patients who had concomitant prostate cancer, bladder cancer, or a long-term urinary catheter indwelling, as well as those who did not receive α-blocker medication regularly. Those aged <50 or >90 years were also excluded. The enrolled patients were categorized into TURP (n = 1218) and medication only (n = 795) groups. After 1:1 propensity score matching, we recorded and compared patients’ characteristics, postoperative clinical outcomes, and geriatric adverse events. Results The TURP cohort had a lower incidence of UTI and UR during the postoperative follow-up period from 2 months to 3 years than did the medication only group (20.7% vs. 28.9% and 12.5% vs. 27.6%, respectively, p < 0.001). The life-long bone fracture incidence was also lower in the TURP cohort (7.9% vs. 9.2%, p = 0.048). The incidence of other outcomes during the postoperative follow-up period did not differ between the two groups. Conclusions Compared with conservative treatment, TURP provides more favorable clinical outcomes in patients with UR caused by BPO. Patients who underwent TURP had a lower risk of UTI, repeat UR episodes, and emergent bony fracture. Thus, early surgical intervention should be considered for such patients.
Collapse
Affiliation(s)
- Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan, Republic of China.,School of Medicine, Chang Gung University, 259 Wen-Hwa 1 st Road, Kweishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan, Republic of China.,School of Medicine, Chang Gung University, 259 Wen-Hwa 1 st Road, Kweishan, Taoyuan, Taiwan, Republic of China
| | - Tien-Hsing Chen
- School of Medicine, Chang Gung University, 259 Wen-Hwa 1 st Road, Kweishan, Taoyuan, Taiwan, Republic of China.,Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, Taiwan, Republic of China
| | - Horng-Heng Juang
- Department of Anatomy, School of Medicine, Chang Gung University, Kwei-shan, Tao-Yuan, Taiwan, Republic of China
| | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan, Republic of China.,School of Medicine, Chang Gung University, 259 Wen-Hwa 1 st Road, Kweishan, Taoyuan, Taiwan, Republic of China
| | - Pei-Shan Yang
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan, Republic of China.,School of Medicine, Chang Gung University, 259 Wen-Hwa 1 st Road, Kweishan, Taoyuan, Taiwan, Republic of China
| | - Chien-Lun Chen
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan, Republic of China.,School of Medicine, Chang Gung University, 259 Wen-Hwa 1 st Road, Kweishan, Taoyuan, Taiwan, Republic of China
| | - Ke-Hung Tsui
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan, Republic of China. .,School of Medicine, Chang Gung University, 259 Wen-Hwa 1 st Road, Kweishan, Taoyuan, Taiwan, Republic of China.
| |
Collapse
|
23
|
Abstract
The underactive bladder (UAB)/detrusor underactivity (DU) is a relatively common condition. It is difficult to diagnose and can be difficult to manage. The aim of this review is to provide a review of the diagnosis and different surgical treatment options for UAB/DU. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, UAB, DU, TURP, reduction cystoplasty, bladder diverticulectomy and sacral neuromodulation (SNM). Search results were assessed for their overall relevance to this review. Definitions, general overview and management options were extracted from the relevant medical literature. DU affects up to 45% of men and women >70 years of age. The symptoms of DU overlap significantly with overactive bladder (OAB) and bladder outlet obstruction (BOO). Urodynamic findings include low voiding pressure combined with slow intermittent flow and incomplete bladder emptying. Non-operative management for DU is acceptable; only 1 in 6 male patients may need a TURP and acute urinary retention (AUR) is rare. TURP for DU is feasible and is associated with good short and medium term outcomes, but over time, there is a return to baseline symptoms. Bladder diverticulectomy can also improve DU, but there is a paucity of guidelines on patient selection. SNM provides excellent outcomes for DU, but patient selection is important.
Collapse
Affiliation(s)
- Johan Gani
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Urology, Western Health, Footscray, Victoria, Australia
| | - Derek Hennessey
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| |
Collapse
|
24
|
Stoffel JT, Peterson AC, Sandhu JS, Suskind AM, Wei JT, Lightner DJ. AUA White Paper on Nonneurogenic Chronic Urinary Retention: Consensus Definition, Treatment Algorithm, and Outcome End Points. J Urol 2017; 198:153-160. [PMID: 28163030 DOI: 10.1016/j.juro.2017.01.075] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The AUA (American Urological Association) QIPS (Quality Improvement and Patient Safety) committee created a white paper on the diagnosis and management of nonneurogenic chronic urinary retention. MATERIALS AND METHODS Recommendations for the white paper were based on a review of the literature and consensus expert opinion from the workgroup. RESULTS The workgroup defined nonneurogenic chronic urinary retention as an elevated post-void residual of greater than 300 mL that persisted for at least 6 months and documented on 2 or more separate occasions. It is proposed that chronic urinary retention should be categorized by risk (high vs low) and symptomatology (symptomatic versus asymptomatic). High risk chronic urinary retention was defined as hydronephrosis on imaging, stage 3 chronic kidney disease or recurrent culture proven urinary tract infection or urosepsis. Symptomatic chronic urinary retention was defined as subjectively moderate to severe urinary symptoms impacting quality of life and/or a recent history of catheterization. A treatment algorithm was developed predicated on stratifying patients with chronic urinary retention first by risk and then by symptoms. The proposed 4 primary outcomes that should be assessed to determine effectiveness of retention treatment are 1) symptom improvement, 2) risk reduction, 3) successful trial of voiding without catheterization, and 4) stability of symptoms and risk over time. CONCLUSIONS Defining and categorizing nonneurogenic chronic urinary retention, creating a treatment algorithm and proposing treatment end points will hopefully spur comparative research that will ultimately lead to a better understanding of this challenging condition.
Collapse
Affiliation(s)
| | | | | | - Anne M Suskind
- University of Calfornia, San Francisco, San Francisco, California
| | - John T Wei
- University of Michigan, Ann Arbor, Michigan
| | | |
Collapse
|
25
|
Sokhal AK, Sinha RJ, Purkait B, Singh V. Transurethral resection of prostate in benign prostatic enlargement with underactive bladder: A retrospective outcome analysis. Urol Ann 2017; 9:131-135. [PMID: 28479762 PMCID: PMC5405654 DOI: 10.4103/ua.ua_115_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate the clinical outcome and efficacy of transurethral resection of the prostate in patients of benign prostatic enlargement (BPE) with underactive bladder. Materials and Methods: Retrospective study of 174 patients, who underwent transurethral resection of prostate (TURP) between 2008 and 2015, for lower urinary tract symptoms with BPE with bladder underactivity. Clinical history, physical examination, renal function test, urinalysis, cystourethroscopy, transabdominal or transrectal ultrasonography, and urodynamic study were recorded. Patients having a history of neurologic conditions, spinal trauma or surgery, pelvic trauma or surgery, diabetes mellitus with end organ damage, urethral pathology or surgery, and prostatic cancer were excluded from the study. Results: The mean follow-up period was 22.4 ± 6.2 months. Mean prostate volume was 42.8 ± 6.4 ml and mean serum prostate-specific antigen was 2.3 ± 1.8 ng/ml. The International Prostate Symptom Score changed from 24.6 ± 4.2 preoperatively to 10.8 ± 5.8 postoperatively which was found statistically significant. Quality of life (QOL) score changed from 4.8 ± 1.2 to 2.6 ± 0.4. Twenty-two patients out of 174 remained on a per-urethral catheter or clean intermittent catheterization due to voiding failure after TURP beyond 1 month. Conclusions: TURP should be considered a viable treatment option in men with enlarged prostate with underactive detrusor who had poor response to medical treatment. Preoperative counseling and postoperative follow-up are crucial in the management of such patients.
Collapse
Affiliation(s)
- Ashok Kumar Sokhal
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rahul Janak Sinha
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bimalesh Purkait
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vishwajeet Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
26
|
[S2e guideline of the German urologists: Instrumental treatment of benign prostatic hyperplasia]. Urologe A 2016; 55:195-207. [PMID: 26518304 DOI: 10.1007/s00120-015-3983-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.
Collapse
|
27
|
Bekarma H, Rooney H, Khan R, Miller G, Dunn I. Teaching of intermittent self-catheterisation through dedicated nurse-led TOV clinic for patients with uncomplicated acute urinary retention: How useful is it in practice? JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415815603602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Acute urinary retention (AUR) is a common urological emergency. Our institution has established an outpatient pathway for managing patients with uncomplicated AUR on discharge from A&E: with catheter education and alpha-blocker therapy. They are followed up in a nurse-led clinic where intermittent self-catheterisation (ISC) can be taught if required. The aim of this study is to investigate the outcomes of our nurse-led trial of void (TOV) clinic and specifically the merit of teaching ISC. Methods: Data was prospectively collected and analysed for all patients with AUR who were followed up in the nurse-led TOV clinic between October 2012 and December 2014. Results: Over 26 months, 120 men with AUR attended the TOV clinic with an average age of 71 years (range 28–94 years). Forty-nine of 120 (41%) patients had an identifiable cause for AUR (UTI=13, constipation=13, alcohol=11, anti-cholinergics=7, post-operative=4 and post-brachytherapy=1). Sixty-four men passed and 50 failed TOV. Six were excluded from this analysis as they did not proceed to TOV in clinic (three requested LTC and three were not appropriate for outpatient clinic). All 50 patients who failed TOV were offered ISC. Thirty-two of 50 patients (64%) learnt ISC. Ten declined and eight were unable to perform ISC. Only seven of 50 patients (14%) went on to have a TURP, four of whom had declined to learn ISC. Of the remaining 43 patients, 24 (56%) had return of spontaneous voiding. Conclusion: In our experience, a pathway for reviewing AUR patients in a nurse-led TOV clinic where expertise for ISC tuition is available is extremely useful. In our series, only 14% of patients who failed TOV required TURP. Bladder function often returns to normal over time but ISC offers patients an autonomous management option if satisfactory to themselves whilst avoiding the complications of LTC.
Collapse
Affiliation(s)
- H Bekarma
- Department of Urology, Monklands General Hospital, UK
| | - H Rooney
- Department of Urology, Monklands General Hospital, UK
| | - R Khan
- Department of Urology, Monklands General Hospital, UK
| | - G Miller
- Department of Urology, Monklands General Hospital, UK
| | - I Dunn
- Department of Urology, Monklands General Hospital, UK
| |
Collapse
|
28
|
Wang J, Zhai Y, Wu J, Zhao S, Zhou J, Liu Z. Acupuncture for Chronic Urinary Retention due to Spinal Cord Injury: A Systematic Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:9245186. [PMID: 27190542 PMCID: PMC4846757 DOI: 10.1155/2016/9245186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/20/2016] [Accepted: 03/22/2016] [Indexed: 11/17/2022]
Abstract
No systematic review has been published on the use of acupuncture for the treatment of chronic urinary retention (CUR) due to spinal cord injury (SCI). The aim of this review was to assess the effectiveness and safety of acupuncture for CUR due to SCI. Three randomized controlled trials (RCTs) including 334 patients with CUR due to SCI were included. Meta-analysis showed that acupuncture plus rehabilitation training was much better than rehabilitation training alone in decreasing postvoid residual (PVR) urine volume (MD -109.44, 95% CI -156.53 to -62.35). Likewise, a combination of acupuncture and aseptic intermittent catheterization was better than aseptic intermittent catheterization alone in improving response rates (RR 1.23, 95% CI 1.10 to 1.38). No severe adverse events were reported. In conclusion, acupuncture as a complementary therapy may have a potential effect in CUR due to SCI in decreasing PVR and improving bladder voiding. Additionally, acupuncture may be safe in treating CUR caused by SCI. However, due to the lack of high quality RCTs, we could not draw any definitive conclusions. More well-designed RCTs are needed to provide strong evidence.
Collapse
Affiliation(s)
- Jia Wang
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange Street, Xicheng District, Beijing 100053, China
| | - Yanbing Zhai
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange Street, Xicheng District, Beijing 100053, China
- Beijing University of Chinese Medicine, No. 11 North Third Ring Road, Chaoyang District, Beijing 100029, China
| | - Jiani Wu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange Street, Xicheng District, Beijing 100053, China
| | - Shitong Zhao
- Beijing University of Chinese Medicine, No. 11 North Third Ring Road, Chaoyang District, Beijing 100029, China
| | - Jing Zhou
- Beijing University of Chinese Medicine, No. 11 North Third Ring Road, Chaoyang District, Beijing 100029, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange Street, Xicheng District, Beijing 100053, China
| |
Collapse
|
29
|
Kidd EA, Stewart F, Kassis NC, Hom E, Omar MI. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev 2015; 2015:CD004203. [PMID: 26661940 PMCID: PMC8612698 DOI: 10.1002/14651858.cd004203.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Indwelling urethral catheters are often used for bladder drainage in hospital. Urinary tract infection is the most common hospital-acquired infection, and a common complication of urinary catheterisation. Pain, ease of use and quality of life are important to consider, as well as formal economic analysis. Suprapubic catheterisation can also result in bowel perforation and death. OBJECTIVES To determine the advantages and disadvantages of alternative routes of short-term bladder catheterisation in adults in terms of infection, adverse events, replacement, duration of use, participant satisfaction and cost effectiveness. For the purpose of this review, we define 'short-term' as intended duration of catheterisation for 14 days or less. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 26 February 2015), CINAHL (searched 27 January 2015) and the reference lists of relevant articles. SELECTION CRITERIA We included all randomised and quasi-randomised trials comparing different routes of catheterisation for short-term use in hospitalised adults. DATA COLLECTION AND ANALYSIS At least two review authors extracted data and performed 'Risk of bias' assessment of the included trials. We sought clarification from the trialists if further information was required. MAIN RESULTS In this systematic review, we included 42 trials.Twenty-five trials compared indwelling urethral and suprapubic catheterisation. There was insufficient evidence for symptomatic urinary tract infection (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.61 to 1.69; 5 trials, 575 participants; very low-quality evidence). Participants with indwelling catheters had more cases of asymptomatic bacteriuria (RR 2.25, 95% CI 1.63 to 3.10; 19 trials, 1894 participants; very low quality evidence) and more participants reported pain (RR 5.62, 95% CI 3.31 to 9.55; 4 trials, 535 participants; low-quality evidence). Duration of catheterisation was shorter in the indwelling urethral catheter group (MD -1.73, 95% CI -2.42 to -1.05; 2 trials, 274 participants).Fourteen trials compared indwelling urethral catheterisation with intermittent catheterisation. Two trials had data for symptomatic UTI which were suitable for meta-analysis. Due to evidence of significant clinical and statistical heterogeneity, we did not pool the results, which were inconclusive and the quality of evidence was very low. The main source of heterogeneity was the reason for hospitalisation as Hakvoort and colleagues recruited participants undergoing urogenital surgery; whereas in the trial conducted by Tang and colleagues elderly women in geriatric rehabilitation ward were recruited. The evidence was also inconclusive for asymptomatic bacteriuria (RR 1.04; 95% CI 0.85 to 1.28; 13 trials, 1333 participants; very low quality evidence). Almost three times as many people developed acute urinary retention with the intermittent catheter (16% with urethral versus 45% with intermittent); RR 0.45, 95% CI 0.22 to 0.91; 4 trials, 384 participants.Three trials compared intermittent catheterisation with suprapubic catheterisation, with only female participants. The evidence was inconclusive for symptomatic urinary tract infection, asymptomatic bacteriuria, pain or cost.None of the trials reported the following critical outcomes: quality of life; ease of use, and cost utility analysis. AUTHORS' CONCLUSIONS Suprapubic catheters reduced the number of participants with asymptomatic bacteriuria, recatheterisation and pain compared with indwelling urethral. The evidence for symptomatic urinary tract infection was inconclusive.For indwelling versus intermittent urethral catheterisation, the evidence was inconclusive for symptomatic urinary tract infection and asymptomatic bacteriuria. No trials reported pain.The evidence was inconclusive for suprapubic versus intermittent urethral catheterisation. Trials should use a standardised definition for symptomatic urinary tract infection. Further adequately-powered trials comparing all catheters are required, particularly suprapubic and intermittent urethral catheterisation.
Collapse
Affiliation(s)
- Emily A Kidd
- University of AberdeenCochrane Incontinence GroupHealth Sciences Building (second floor)AberdeenUKAB25 2ZD
| | - Fiona Stewart
- University of AberdeenAcademic Urology UnitForesterhillAberdeenScotlandUKAB25 2ZD
| | - Nadine C Kassis
- Toledo Clinic Urogynecology3425 Executive ParkwaySuite 108ToledoUSAOH 43606
| | - Emily Hom
- Baylor Scott and White Health2401 South 31st StreetMS‐01‐E316ATempleTXUSA76508
| | - Muhammad Imran Omar
- University of AberdeenAcademic Urology UnitForesterhillAberdeenScotlandUKAB25 2ZD
| | | |
Collapse
|
30
|
Yenli E, Aboah K, Gyasi-Sarpong C, Azorliade R, Arhin A. Acute and chronic urine retention among adults at the urology section of the Accident and Emergency Unit of Komfo Anokye Teaching Hospital, Kumasi, Ghana. AFRICAN JOURNAL OF UROLOGY 2015. [DOI: 10.1016/j.afju.2014.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
31
|
Wilson M. Clean intermittent self-catheterisation: working with patients. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:76, 78, 80 passim. [PMID: 25615991 DOI: 10.12968/bjon.2015.24.2.76] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clean intermittent self-catheterisation is carried out when the bladder cannot be emptied adequately by voiding. Because learning how to self-catheterise can be daunting, it is essential that the nurse has the time, knowledge and skills necessary support the patient during the learning phase, so that he or she can develop confidence and master the technique. Causes for urinary retention are considered and step-by-step instructions are given for both female and male patients, including problems that may be encountered and how these can be overcome. Examples of catheters and other aids available are suggested, with reference to particular features they may have, to overcome difficulties or to assist patients with particular needs. Issues including infection, frequency of catheterisation and fluid intake are also discussed.
Collapse
Affiliation(s)
- Mary Wilson
- retired Nurse Practitioner for Bladder and Bowel Health, Humber NHS Foundation Trust
| |
Collapse
|
32
|
Raison N, Challacombe B. Opening the flood gates: holmium laser enucleation is superior to photoselective vaporization of the prostate for the treatment of chronic urinary retention. BJU Int 2015; 115:178-9. [PMID: 25604716 DOI: 10.1111/bju.12740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nicholas Raison
- Urology Department, Guy's and St Thomas' NHS Trust, Guy's Hospital, Great Maze Pond, London, UK.
| | | |
Collapse
|
33
|
Jaeger CD, Mitchell CR, Mynderse LA, Krambeck AE. Holmium laser enucleation (HoLEP) and photoselective vaporisation of the prostate (PVP) for patients with benign prostatic hyperplasia (BPH) and chronic urinary retention. BJU Int 2015; 115:295-9. [DOI: 10.1111/bju.12674] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Lance A. Mynderse
- Department of Urology; Mayo Clinic School of Medicine; Rochester MN USA
| | - Amy E. Krambeck
- Department of Urology; Mayo Clinic School of Medicine; Rochester MN USA
| |
Collapse
|
34
|
Shimoni Z, Fruger E, Froom P. Measurement of post-void residual bladder volumes in hospitalized older adults. Am J Med 2015; 128:77-81. [PMID: 25193275 DOI: 10.1016/j.amjmed.2014.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/05/2014] [Accepted: 08/14/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is commonly recommended to catheterize or closely follow up patients with post-void residual volumes of 150 mL or more, but the frequency of such findings in geriatric hospitalized patients and the need for intervention are unclear. METHODS Post-void residual volumes were measured by ultrasound examination within 14 hours of admission in 464 patients aged 70 years or more who were hospitalized in a regional hospital general internal medicine department. Outcome variables included the need for an indwelling catheter and complications of urinary retention during the hospitalization. RESULTS Post-void residual volumes of ≥150 mL were common (23.9%; 111/464) and had the following distribution: 150 to 299 mL, 13.1% (61/464); 300 to 499 mL, 6.4% (30/464); and 500 mL or more, 6% (28/464). The rate of indwelling catheters was 3.2% (15/464). Results of post-void residual volumes did not predict the need for indwelling catheters in those without other criteria, although those with indications for indwelling catheters had a significantly higher frequency of post-void residual volumes ≥500 mL (P < .001) compared with those without such indications. CONCLUSIONS We conclude that urinary retention in hospitalized geriatric patients is common, but measurements of post-void residual volumes did not have definite clinical utility. However, the study had limited power to determine the benefits or potential harms of urinary catheterization for elevated post-void residual volumes.
Collapse
Affiliation(s)
- Zvi Shimoni
- Internal Medicine B, Laniado Hospital, Netanya, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Ela Fruger
- Internal Medicine B, Laniado Hospital, Netanya, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Paul Froom
- School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
35
|
Asimakopoulos AD, De Nunzio C, Kocjancic E, Tubaro A, Rosier PF, Finazzi-Agrò E. Measurement of post-void residual urine. Neurourol Urodyn 2014; 35:55-7. [DOI: 10.1002/nau.22671] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 08/01/2014] [Indexed: 11/08/2022]
Affiliation(s)
| | - Cosimo De Nunzio
- Department of Urology; Sant'Andrea Hospital; Faculty of Health Sciences “La Sapienza” University of Rome; Rome Italy
| | - Ervin Kocjancic
- Director division of Pelvic Health and Reconstructive Urology; Department of Urology; University of Illinois at Chicago; Chicago Illinois
| | - Andrea Tubaro
- Department of Urology; Sant'Andrea Hospital; Faculty of Health Sciences “La Sapienza” University of Rome; Rome Italy
| | - Peter F. Rosier
- University Medical Centre Utrecht; Department of Urology; Utrecht The Netherlands
| | - Enrico Finazzi-Agrò
- Unit for Functional Urology; Policlinico Tor Vergata; Department of Experimental Medicine and Surgery; Tor Vergata University of Rome; Rome Italy
| |
Collapse
|
36
|
Factors associated with continuing medical therapy after transurethral resection of prostate. Urology 2014; 84:675-80. [PMID: 25059592 DOI: 10.1016/j.urology.2014.04.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 04/10/2014] [Accepted: 04/15/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To report the clinical characteristics of patients who have persistent lower urinary tract symptoms (LUTS) after surgery for benign prostatic hyperplasia (BPH) and continue their medical therapy postoperatively. MATERIALS AND METHODS We retrospectively studied 372 patients who underwent transurethral resection of prostate for LUTS/BPH in 8 institutions to determine the differences between patients who continued LUTS/BPH medications for >3 months after surgery and those who did not. Preoperative, intraoperative, and postoperative clinical parameters were assessed. The Student t test and chi square test were used to compare each parameter between patient groups. Multivariate logistic regression analysis was performed to identify risk factors for persistent LUTS and continuing medical therapy after surgery. RESULTS There were 205 patients (55.1%) who continued their LUTS/BPH medications for >3 months postoperatively. They reported poorer International Prostate Symptom Scores and uroflowmetry results after surgery. Multivariate analysis showed that age >70 years (odds ratio [OR], 2.474; P = .001), history of diabetes (OR, 1.949; P = .040), history of cerebrovascular accident (OR, 5.932; P = .001), any previous LUTS/BPH medication use (OR, 5.384; P = <0.001), and previous antimuscarinic drug use (OR, 2.962; P = .016) were significantly associated with symptom persistency and continuing medical therapy. CONCLUSION Many patients have persistent voiding dysfunction after surgical treatment for LUTS/BPH. Older age, history of diabetes, history of cerebrovascular accidents, and preoperative antimuscarinic drug uses are possible risk factors.
Collapse
|
37
|
Factors determining the amount of residual urine in men with bladder outlet obstruction: Could it be a predictor for bladder contractility? Arab J Urol 2014; 12:214-8. [PMID: 26019952 PMCID: PMC4435510 DOI: 10.1016/j.aju.2014.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/20/2014] [Accepted: 03/26/2014] [Indexed: 11/24/2022] Open
Abstract
Objective To determine from urodynamic data what causes an increased postvoid residual urine volume (PVR) in men with bladder outlet obstruction (BOO), urethral resistance or bladder failure, and to determine how to predict bladder contractility from the PVR. Patients and methods We analysed retrospectively the pressure-flow studies (PFS) of 90 men with BOO. Nine patients could not void and the remaining 81 were divided into three groups, i.e. A (30 men, PVR < 100 mL), B (30 men, PVR 100–450 mL) and C (21 men, PVR > 450 mL). The division was made according to a receiver operating characteristic curve, showing that using a threshold PVR of 450 mL had the best sensitivity and specificity for detecting the start of bladder failure. Results The filling phase showed an increase in bladder capacity with the increase in PVR and a significantly lower incidence of detrusor overactivity in group C. The voiding phase showed a significant decrease in voided volume and maximum urinary flow rate (Qmax) as the PVR increased, while the urethral resistance factor (URF) increased from group A to B to C. The detrusor pressure at Qmax (PdetQmax) and opening pressure were significantly higher in group B, which had the highest bladder contractility index (BCI) and longest duration of contraction. Group C had the lowest BCI and the lowest PdetQmax. Conclusions In men with BOO, PVR results from increasing outlet resistance at the start and up to a PVR of 450 mL, where the bladder reaches its maximum compensation. At volumes of >450 mL, both the outlet resistance and bladder failure are working together, leading to detrusor decompensation.
Collapse
|
38
|
Abstract
Most men will develop histological BPH if they live long enough. Approximately, half will develop benign prostatic enlargement (BPE) and about half of these will get BOO with high bladder pressures and low flow, this in turn leads to detrusor wall hypertrophy. Many of these men will only have lower urinary tract symptoms (LUTS) but a significant number will also suffer the other complications of BPH. These include urinary retention (acute and chronic), haematuria, urinary tract infection, bladder stones, bladder wall damage, renal dysfunction, incontinence and erectile dysfunction. Recognition of the complications of BPH/BOO early allows more effective management of these complications. This is particularly important for the more serious urinary infections and also for high-pressure chronic retention (HPCR). Complications of LUTS/BPH are very rare in clinical trials because of their strict inclusion and exclusion criteria but are more common in real life practice.
Collapse
Affiliation(s)
- Mark J Speakman
- Department of Urology, Musgrove Park Hospital, Taunton, Somerset TA1 5DA UK
| | - Xi Cheng
- Department of Urology, Musgrove Park Hospital, Taunton, Somerset TA1 5DA UK
| |
Collapse
|
39
|
Parihar JS, Ha YS, Kim IY. Bladder neck contracture-incidence and management following contemporary robot assisted radical prostatectomy technique. Prostate Int 2014; 2:12-8. [PMID: 24693529 PMCID: PMC3970984 DOI: 10.12954/pi.13034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/03/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose: Bladder neck contracture (BNC) is a well-recognized complication following robot-assisted radical prostatectomy (RARP) for treatment of localized prostate cancer with a reported incidence of up to 1.4%. In this series, we report our institutional experience and management results. Methods: A prospectively collected database of patients who underwent RARP by a single surgeon from 2006 to 2012 was reviewed. Watertight bladder neck to urethral anastomosis was performed over 18-French foley catheter. BNC was diagnosed by flexible cystoscopy in patients who developed symptoms of bladder outlet obstruction. Subsequently, these patients underwent cold knife bladder neck incisions. Patients then followed a strict self regimen of clean intermittent catheterization (CIC). We identify the patient demographics, incidence of BNC, associated risk factors and success of subsequent management. Results: Total of 930 patients who underwent RARP for localized prostate cancer was identified. BNC was identified in 15 patients, 1.6% incidence. Mean patient age and preoperative prostate-specific antigen was 58.8 years old and 7.83 ng/mL (range, 2.5–14.55 ng/mL) respectively. Mean estimated blood loss was 361±193 mL (range, 50–650 mL). Follow-up was mean of 23.4 months. Average time to BNC diagnosis was 5.5 months. In three patients, a foreign body was identified at bladder neck. On multivariate analysis, estimated blood loss was significantly associated with development of BNC. All patients underwent cystoscopy and bladder neck incision with a 3-month CIC regimen. Out of 15 index patients, none had a BNC recurrence over the follow-up period. Conclusions: BNC was identified in 1.6% of patients in our series following RARP. Intraoperative blood loss was a significant risk factor for BNC. In 20% of BNC patients a migrated foreign body was noted at vesicourethral anastomosis. Primary management of patients with BNC following RARP should be bladder neck incision and self CIC regimen.
Collapse
Affiliation(s)
- Jaspreet Singh Parihar
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Yun-Sok Ha
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA ; Department of Urology, Kyungpook National University Medical Center, Daegu, Korea
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| |
Collapse
|
40
|
Nnabugwu II, Udeh EI, Enivwenae OA, Ugwumba FO, Ozoemena OF. Reducing the burden of regular indwelling urinary catheter changes in the catheter clinics: the opinion of patients and relatives on the practice of self-catheterization. Patient Prefer Adherence 2014; 8:1179-83. [PMID: 25214771 PMCID: PMC4159498 DOI: 10.2147/ppa.s66520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Clean intermittent self-catheterization is accepted worldwide as a standard of care for patients with long-standing need for urinary bladder decompression. Evidence of its routine practice in our low-resource setting is lacking, leading to increasing number of patients with a long-standing indwelling urinary catheter. OBJECTIVE To seek the opinion of patients already using indwelling catheters regarding the practice of self-catheterization. PATIENTS AND METHODS Over a 4-month period, the opinion of every patient and patient's relative that attended the regular urinary catheter clinic was sought using an intern-administered questionnaire. The data was analyzed using SPSS version 20. RESULTS A total of 108 patients completed the questionnaire. Age range was 16-100 years with a mean of 62.2±15.5 years. Only 30.5% of the patients had formal education beyond the primary level. The median cost for change of the indwelling catheter was 1,325 naira ($8.28 US) with a range of 500-4,000 naira ($3.13-$25 USD). Analysis showed that: 70.8% of patients aged under 60 years/60.6% of those with formal education beyond primary level/61.9% of those wearing catheters for <3 months would give consent for training in self-catheterization. Higher cost of catheter change did not influence the decision to consider self-catheterization. Of the 59 patient relatives who completed the questionnaire, 63% of those younger than 50 years old and 69.2% of those with tertiary education would be willing to undertake training to administer self-catheterization. CONCLUSION A select group of patients and accompanying relatives in our low-resource setting are willing to learn and practice self-catheterization.
Collapse
Affiliation(s)
- Ikenna I Nnabugwu
- Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
- Correspondence: Ikenna I Nnabugwu, Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, PMB 00129, 400001 Enugu State, Nigeria, Email
| | - Emeka I Udeh
- Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Oghenekaro A Enivwenae
- Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Fred O Ugwumba
- Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Oyiogu F Ozoemena
- Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| |
Collapse
|
41
|
Abstract
Urinary retention, defined as the inability to void, is a common medical problem. If unidentified and/or untreated, it may become a serious condition that can lead to kidney damage or urosepsis, compromising the patient's life.
Acute urinary retention (AUR) is usually easy to identify and to treat as patients usually complain of hypogastric pain and anuria. Proper bladder drainage with urethral or suprapubic catheter is the first line of treatment, with posterior studies to determine the cause of retention.
Chronic urinary retention (CUR) is often much more difficult to identify. It is invariably linked to increased post-void residual urine (PVR), but its asymptomatic nature makes it often a hidden condition.
There is a wide range of intrinsic and extrinsic, obstructive and non-obstructive causes affecting the lower urinary tract, which can lead to urinary retention. Due to the differences in urinary physiology and in order to simplify diagnosis and management, these are usually studied separately in men and in women. Management consists of a variety of options depending on the cause of retention, including conservative treatment, drug therapy and several forms of surgery.
In this review, we make an overview of the main causes of acute and chronic urinary retention in men and women, focusing on the main aspects of diagnosis and management.
Collapse
|
42
|
Lubahn JD, Zhao LC, Scott JF, Hudak SJ, Chee J, Terlecki R, Breyer B, Morey AF. Poor quality of life in patients with urethral stricture treated with intermittent self-dilation. J Urol 2013; 191:143-7. [PMID: 23820057 DOI: 10.1016/j.juro.2013.06.054] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE We assessed patient perceptions of regular intermittent self-dilation in men with urethral stricture. MATERIALS AND METHODS We constructed and distributed a visual analog questionnaire to evaluate intermittent self-dilation via catheterization by men referred for urethral stricture management at a total of 4 institutions. Items assessed included patient duration, frequency, difficulty and pain associated with intermittent self-dilation as well as interference of intermittent self-dilation with daily activity. The primary outcome was patient perceived quality of life. Multivariate analysis was performed to assess factors that affected this outcome. RESULTS Included in the study were 85 patients with a median age of 68 years, a median of 3.0 years on intermittent self-dilation and a median frequency of 1 dilation per day. On a 1 to 10 scale the median intermittent self-dilation difficulty was 5.0 ± 2.7, the median pain score was 3.0 ± 2.7 and median interference with daily life was 2.0 ± 1.3. Overall quality of life in patients with stricture was poor (median score 7.0 ± 2.6 with poor quality of life defined as 7 or greater). On univariate analysis younger age (p <0.01), interference (p = 0.03), pain (p <0.01) and difficulty performing intermittent self-dilation (p = 0.03) correlated with poor quality of life in a statistically significant manner. On multivariate analysis only difficulty catheterizing (p <0.01) and younger age (p = 0.05) were statistically significant predictors. Patients with stricture involving the posterior urethra had a statistically significant increase in difficulty and decrease in quality of life (each p = 0.04). CONCLUSIONS Most patients with urethral stricture who are on intermittent self-dilation rate difficulty and pain as moderate, and inconvenience as low but report poor quality of life.
Collapse
Affiliation(s)
- Jessica D Lubahn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lee C Zhao
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - J Francis Scott
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Steven J Hudak
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Justin Chee
- Department of Urology, Alfred Health, Melbourne, Victoria, Australia
| | - Ryan Terlecki
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Benjamin Breyer
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
43
|
Blatt AH, Brammah S, Tse V, Chan L. Transurethral prostate resection in patients with hypocontractile detrusor--what is the predictive value of ultrastructural detrusor changes? J Urol 2012; 188:2294-9. [PMID: 23083643 DOI: 10.1016/j.juro.2012.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Men with detrusor failure and chronic urinary retention have a lower voiding success rate and higher postoperative morbidity following transurethral prostatectomy than those with bladder outlet obstruction. Current investigations, including urodynamics, may be unable to predict the response to surgical treatment. We identified ultrastructural features on detrusor biopsy that correlated with the postoperative voiding outcome in patients with a hypocontractile detrusor undergoing transurethral prostatectomy. MATERIALS AND METHODS Detrusor biopsies were obtained from 17 patients with urodynamic evidence of bladder outlet obstruction or a hypocontractile detrusor undergoing transurethral prostatectomy and from 5 controls. Specimens were examined by transmission electron microscopy. Ten individual detrusor ultrastructural features were analyzed. Findings were compared with preoperative and postoperative clinical parameters. RESULTS Failure to void after transurethral prostatectomy was significantly associated with the ultrastructural features of variation in muscle cell size, muscle cell shape, collagenosis and abnormal fascicles. These 4 features were significantly associated with each other, defining a distinctive pattern of detrusor failure. For transurethral prostatectomy failure the sensitivity, specificity, and positive and negative predictive values of all 4 features together were 60%, 91%, 75% and 84%, respectively. Three or 4 features on detrusor biopsy predicted voiding failure. CONCLUSIONS Detrusor ultrastructural analysis is highly predictive of voiding outcome following transurethral prostatectomy in patients with detrusor failure. Patients with ultrastructural features previously described as part of the myohypertrophy pattern do not have a primary diagnosis of bladder outlet obstruction but rather detrusor failure secondary to bladder outlet obstruction.
Collapse
Affiliation(s)
- Alison H Blatt
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
| | | | | | | |
Collapse
|
44
|
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]
|
45
|
Lewis JM, Yalla SV, Stanitski KE, Sullivan MP. Spectrum of urodynamic abnormalities and renal function changes in adult men with non-neurogenic urinary retention. Neurourol Urodyn 2012; 31:544-8. [PMID: 22298049 DOI: 10.1002/nau.22196] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 12/06/2011] [Indexed: 11/06/2022]
|
46
|
Homma Y, Gotoh M, Yokoyama O, Masumori N, Kawauchi A, Yamanishi T, Ishizuka O, Seki N, Kamoto T, Nagai A, Ozono S. JUA clinical guidelines for benign prostatic hyperplasia. Int J Urol 2011. [DOI: 10.1111/j.1442-2042.2011.02861.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
47
|
Homma Y, Gotoh M, Yokoyama O, Masumori N, Kawauchi A, Yamanishi T, Ishizuka O, Seki N, Kamoto T, Nagai A, Ozono S. Outline of JUA clinical guidelines for benign prostatic hyperplasia. Int J Urol 2011; 18:741-56. [DOI: 10.1111/j.1442-2042.2011.02860.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
48
|
|
49
|
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
| |
Collapse
|
50
|
Shaw C, Logan K, Webber I, Broome L, Samuel S. Effect of clean intermittent self-catheterization on quality of life: a qualitative study. J Adv Nurs 2008; 61:641-50. [PMID: 18302605 DOI: 10.1111/j.1365-2648.2007.04556.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a study to describe the experience of people carrying out clean intermittent self-catheterization and the impact on their quality of life. BACKGROUND Clean intermittent self-catheterization is a recommended treatment for people experiencing urinary voiding difficulties. The majority of the literature to date has focused on biomedical issues such as complication rates and use of different catheters. METHOD A qualitative approach was used based on grounded theory. Fifteen users (eight men and seven women) of intermittent self-catheterization took part in semi-structured interviews during 2006. Ages ranged from 33 to 81 years (median 65 years). Reasons for self-catheterization included multiple sclerosis, urethral stricture and high residual volumes. Thematic analysis was used to develop hypotheses about the causes and consequences of the core category 'quality of life'. FINDINGS The core category consisted of two subcategories of positive and negative impacts. Positive impacts were related to improvement in lower urinary tract symptoms, whereas the negative impacts resulted from the practical difficulties encountered, and the psychological and cultural context of worry and stigma. The factors influencing variations in quality of life impacts were sex, lifestyle, frequency and duration of carrying out self-catheterization, technical difficulties, type of catheter, co-morbidities and individual predispositions. CONCLUSION The model has the potential to help professionals to identify the factors likely to influence response to clean intermittent self-catheterization, and could be used as a tool to help identify those who may have difficulty complying with the treatment or to aid advice-giving on situations that may cause difficulties.
Collapse
Affiliation(s)
- Chris Shaw
- Department of Health, Sports and Science, University of Glamorgan, Wales, UK.
| | | | | | | | | |
Collapse
|