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Bodmer NS, Wirth C, Birkhäuser V, Sartori AM, Leitner L, Averbeck MA, de Wachter S, Finazzi Agro E, Gammie A, Goldman HB, Kirschner-Hermanns R, F.W.M. Rosier P, Serati M, Solomon E, van Koeveringe G, Bachmann LM, Kessler TM. Randomised Controlled Trials Assessing the Clinical Value of Urodynamic Studies: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2022; 44:131-141. [PMID: 36110903 PMCID: PMC9469658 DOI: 10.1016/j.euros.2022.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/18/2022] Open
Abstract
Context The role of urodynamic studies (UDSs) in the diagnosis of lower urinary tract symptoms (LUTS) is crucial. Although expert statements and guidelines underline their value for clinical decision-making in various clinical settings, the academic debate as to their impact on patient outcomes continues. Objective To summarise the evidence from all randomised controlled trials assessing the clinical usefulness of UDS in the management of LUTS. Evidence acquisition For this systematic review, searches were performed without language restrictions in three electronic databases until November 18, 2020. The inclusion criteria were randomised controlled study design and allocation to receive UDS or not prior to any clinical management. Quality assessment was performed by two reviewers independently, using the Cochrane Collaboration’s tool for assessing the risk of bias. A random-effect meta-analysis was performed on the uniformly reported outcome parameters. Evidence synthesis Eight trials were included, and all but two focused on women with pure or predominant stress urinary incontinence (SUI). A meta-analysis of six studies including 942 female patients was possible for treatment success, as defined by the authors (relative risk 1.00, 95% confidence interval: 0.93–1.07), indicating no difference in efficacy when managing women with UDS. Conclusions Although UDSs are not replaceable in diagnostics, since there is no other equivalent method to find out exactly what the lower urinary tract problem is, there are little data supporting its impact on outcomes. Randomised controlled trials have focussed on a small group of women with uncomplicated SUI and showed no added value, but these findings cannot be extrapolated to the overall patient population with LUTS, warranting further well-designed trials. Patient summary Despite urodynamics being the gold standard to assess lower urinary tract symptoms (LUTS), as it is the only method that can specify lower urinary tract dysfunction, more studies assessing the clinical usefulness of urodynamic studies (UDSs) in the management of LUTS are needed. UDS investigation is not increasing the probability of success in the treatment of stress urinary incontinence.
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El Helou E, Naba J, Youssef K, Mjaess G, Sleilaty G, Helou S. Mobile sonouroflowmetry using voiding sound and volume. Sci Rep 2021; 11:11250. [PMID: 34045577 PMCID: PMC8159949 DOI: 10.1038/s41598-021-90659-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
Uroflowmetry (UF) is a common clinic-based non-invasive test to diagnose Lower Urinary Tract Dysfunction (LUTD). Accurate home-based uroflowmetry methods are needed to conveniently conduct repeated uroflowmetries when patients are physiologically ready to urinate. To this end, we propose and evaluate a novel mobile sonouroflowmetry (SUF) method that estimates the urinary flow rate from a sound signal recorded using a mobile phone. By linearly mapping the total sound energy to the total voided volume, the sound energy curve is transformed to a flow rate curve allowing the estimation of the flow rate over time. An evaluation using data from 44 healthy young men showed high similarity between the UF and SUF flow rates with a mixed-effects model correlation coefficient of 0.993 and a mean root mean square error of 2.37 ml/s. Maximum flow rates were estimated with an average absolute error of 2.41 ml/s. Future work on mobile uroflowmetry can use these results as an initial benchmark for flow rate estimation accuracy.
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Affiliation(s)
- Elie El Helou
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - Joy Naba
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Karim Youssef
- College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait
| | - Georges Mjaess
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | | | - Samar Helou
- Global Center for Medical Engineering and Informatics, Osaka University, Osaka, Japan.
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Azevedo C, Moura CDC, Corrêa HP, Assis BBD, Mata LRFD, Chianca TCM. Auriculotherapy in adults and elderly people with lower urinary tract symptoms: an integrative review. Rev Esc Enferm USP 2021; 55:e03707. [PMID: 33978143 DOI: 10.1590/s1980-220x2020000503707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 09/03/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the evidence available in the literature on the use of auriculotherapy in adults and elderly people with lower urinary tract symptoms. METHOD An integrative literature review. Primary study search was carried out in nine relevant health databases. The characterization of studies regarding the method of application of auriculotherapy was based on the Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture recommendations. RESULTS 296 studies were found, 17 pre-selected and eight included in the review. Favorable results from auriculotherapy were evidenced in specific populations, such as elderly men with prostatic disorders and individuals undergoing surgical procedures. The main urinary symptoms addressed were frequency, urgency, nocturia, incomplete voiding, intermittency, weak flow, effort to start urination, incontinence, and urinary retention. CONCLUSION Despite the limited number of studies and weaknesses with regard to sample size and different intervention protocols, it is suggested that auriculotherapy, associated or not with other complementary therapies, may contribute to lower urinary tract symptom control in adults and elderly people.
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Affiliation(s)
- Cissa Azevedo
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil
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Birkhäuser V, Sartori AM, Bodmer NS, Conlon T, Thiel J, Kessler TM, Bachmann LM. Metaepidemiological Inventory of Diagnostic Studies on Urodynamics. Eur Urol Focus 2020; 6:880-908. [PMID: 31866095 DOI: 10.1016/j.euf.2019.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/20/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Urodynamic investigations have a pivotal role in the diagnosis of lower urinary tract symptoms. Despite expert statements and guidelines supporting their usefulness for clinical decision making in various clinical domains, the academic debate remains controversial. OBJECTIVE To provide a metaepidemiological inventory of studies assessing the diagnostic properties of urodynamic investigations. DESIGN, SETTING, AND PARTICIPANTS Systematic searches without language restrictions were performed in (Pre-)Medline, EMBASE, and the Cochrane Library from inception until August 31, 2018. Checking of reference lists of included studies and reviews complemented searches. Records were compiled and screened for possible inclusion by reading title and abstracts by two teams of two research fellows. Inclusion criteria were as follows: prospective data collection and urodynamic investigations performed either as a diagnostic test or using a therapy monitoring instrument. No a priori selection on clinical domain was done. Double reading was performed on records marked "included." Extraction into a developed and piloted matrix was performed in duplicate and checked by a third research fellow. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Of each included article, study specifics, objective, study design, type of data collection, clinical domain, type and description of test used, and type of outcome were extracted and attributed to a framework. RESULTS AND LIMITATIONS Electronic searches retrieved 20 841 records. After screening, 299 abstracts were considered relevant. The main reasons for exclusion were as follows: animal studies, no primary data, editorial/opinion based on published data or reviews, primary objective of the study being not the assessment of urodynamic investigations, and post hoc (opportunistic) correlation studies. CONCLUSIONS To our knowledge, this is the first comprehensive collection of studies assessing the clinical usefulness of urodynamic investigations. The collection is the starting point for a series of systematic reviews assessing the diagnostic properties of urodynamic investigations. PATIENT SUMMARY The usefulness of urodynamic investigations for clinical decision making is under debate. We established an inventory of diagnostic studies on urodynamics to assess the value of urodynamics in various clinical applications.
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Affiliation(s)
- Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Institute for Regenerative Medicine, University of Zürich, Zürich, Switzerland
| | | | - Tara Conlon
- Medignition Inc., Research Consultants, Zürich, Switzerland
| | - Julien Thiel
- Medignition Inc., Research Consultants, Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Chen Z, Liu Y, Zhao M, Zu S, Li Y, Shi B, Wang S, Zhang X. Urinary ATP may be a biomarker for bladder outlet obstruction and its severity in patients with benign prostatic hyperplasia. Transl Androl Urol 2020; 9:284-294. [PMID: 32420134 PMCID: PMC7215044 DOI: 10.21037/tau.2020.02.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Urothelial cells release ATP into the urine in response to bladder stretch. Urinary ATP concentration in benign prostatic hyperplasia (BPH) patients was higher compared with asymptomatic controls. In this study, we aimed to explore the possibility that the urinary ATP level could be a non-invasive biomarker for bladder outlet obstruction (BOO) and its severity in BPH patients. Methods We included 117 BPH patients who underwent urodynamic studies and 109 asymptomatic controls. Urine samples at normal desire (from patients and controls), instilled fluids at maximum cystometric capacity (capacity fluid), and voided fluids during a pressure-flow study (only from patients) were collected. The ATP concentration in collected samples was measured using a luciferin-luciferase bioluminescence assay and normalized to urine creatinine (ATP/Cr). The degree of BOO was quantified using the BOO index (BOOI). Correlation between urodynamic parameters and urinary ATP concentration was analyzed in BPH patients. Results Urinary ATP concentration of BPH patients was significantly higher compared with controls (P<0.001). For BPH patients, a significant positive correlation was found between urinary ATP concentration and BOOI (P<0.0001). Although BPH patients with detrusor overactivity or a history of acute urinary retention had increased urinary ATP, a significant positive correlation between ATP and BOOI was also observed in these patients. When BOOI >40 was set as a cutoff point to differentiate BOO from non-BOO patients, the area under the receiver operating characteristic (ROC) curve was 0.77 (P<0.001). Conclusions BPH patients with BOO released higher amounts of ATP into the urine. Urinary ATP can be used as a non-invasive biomarker of BOO, and its level may also have a predictive value for the degree of obstruction.
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Affiliation(s)
- Zhenghao Chen
- Department of Urology, Second Hospital of Shandong University, Jinan 250000, China
| | - Yaxiao Liu
- Department of Urology, Qilu Hospital of Shandong University, Jinan 250000, China
| | - Mengmeng Zhao
- Department of Urology, Second Hospital of Shandong University, Jinan 250000, China
| | - Shulu Zu
- Department of Urology, Second Hospital of Shandong University, Jinan 250000, China
| | - Yan Li
- Department of Urology, Qilu Hospital of Shandong University, Jinan 250000, China
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan 250000, China
| | - Shaoyong Wang
- Department of Urology, Second Hospital of Shandong University, Jinan 250000, China
| | - Xiulin Zhang
- Department of Urology, Second Hospital of Shandong University, Jinan 250000, China
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Moreira AM, de Assis AM, Carnevale FC, Oliveira DS, Antunes AA. Improvements in Irritative Versus Obstructive Symptoms of the International Prostate Symptom Score After Prostatic Artery Embolization in 174 Patients, in a Single Center. Cardiovasc Intervent Radiol 2020; 43:613-619. [PMID: 31897620 DOI: 10.1007/s00270-019-02398-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/12/2019] [Indexed: 02/06/2023]
Abstract
AIM The aim of this study is to compare the improvements in irritative versus obstructive symptoms of the International Prostate Symptom Score (IPSS) after prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Between 2010 and 2018, 186 patients underwent PAE in a single center and 174 patients were retrospectively selected. The inclusion criteria were symptoms due to BPH, refractory to pharmacological treatment and IPSS ≥ 8. The mean age of the patients was 63.7 ± 7.2 years, the mean prostate volume 89.5 ± 42.5 cm3, and the mean IPSS 19.0 ± 6.2 points. Patient data were reviewed at baseline, 3, 12 and 24 months and compared using the ANOVA mixed models and the Tukey's multiple comparison test. RESULTS Obstructive subscores dropped more significantly than irritative subscores (p < 0.0001). The mean decrease in each IPSS item was frequency 2.4 (83%); urgency 0.8 (87%); nocturia 1.3 (49%); incomplete emptying 2.6 (83%); intermittency 2.3 (91%); weak stream 2.9 (82%); straining 1.6 (91%). The area under the curve for baseline obstructive scores was 0.7 (p = 0.006) and 0.59 (p = 0.182) for irritative scores. The most common BPH clinical manifestations include irritative and/or obstructive symptoms, the latter usually more prevalent. The IPSS drop observed after PAE suggests that it acts predominantly over obstructive symptoms (p < 0.0001). CONCLUSION Although a predominant improvement in obstructive symptoms may be observed after PAE, nocturia complaints may require special attention. The severity of baseline obstructive symptoms may significantly predict clinical outcomes.
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Affiliation(s)
- Airton Mota Moreira
- Interventional Radiology and Endovascular Surgery Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, 05403-000, São Paulo, SP, Brazil.
| | - André Moreira de Assis
- Interventional Radiology and Endovascular Surgery Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, 05403-000, São Paulo, SP, Brazil
| | - Francisco Cesar Carnevale
- Interventional Radiology and Endovascular Surgery Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, 05403-000, São Paulo, SP, Brazil
| | - Daniel Simões Oliveira
- Interventional Radiology and Endovascular Surgery Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, 05403-000, São Paulo, SP, Brazil
| | - Alberto Azoubel Antunes
- Urology Department, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, 05403-000, São Paulo, SP, Brazil
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