High prevalence of lower urinary tract dysfunction in patients with Prader-Willi syndrome

AIMS

To report the first noninvasive urodynamic screening of lower urinary tract dysfunction (LUTD) in children, adolescents, and young adults with Prader-Willi Syndrome (PWS).

METHODS

We recruited 37 PWS patients with/without lower urinary tract symptoms (LUTS) from our hospital. Uroflowmetry was performed in 36 patients. In addition, 20 patients underwent postvoid residual urine (PVR) measurement by transabdominal ultrasound. LUTD is defined as abnormal uroflow patterns, low peak flow rate (Q_max ), or elevated PVR by age. Videourodynamic study (VUDS) was performed in selected cases.

RESULTS

Mean and median age of the patients were 17.7 ± 7.8 years and 16 years. Male to female ratio was 15/22. Two patients were excluded from the following analysis because of voided volume less than or equal to 50 ml. Of the remaining 34 uroflowmetry examination, normal voiding pattern (bell shape) was observed in 22 (64.7%) patients. Abnormal uroflowmetry pattern were obstructive in 6 (17.6%), staccato in 3 (8.8%), intermittent in 2 (5.8%), tower in 1 (2.9%), and plateau in 0 patients. Ten (29.4%) patients had a Q_max less than 15 ml/s. Of 20 patients undergoing PVR tests 10 (50%) had elevated PVR by age ( > 6% of estimated bladder volume). In all, 17/34 (50.0%) PWS patients had at least one abnormality of the noninvasive tests. Of the three cases undergoing VUDS all showed detrusor sphincter dyssynergia.

CONCLUSIONS

Half of PWS patients with/without LUTS had LUTD. Noninvasive study such as uroflowmetry and postvoid residual urine by ultrasound is recommended to all patients with PWS.

Are Middle-Aged Men with Chronic Kidney Disease at Higher Risk of Having Nocturia than Age-Matched Controls

OBJECTIVE

We compared the lower urinary tract symptoms between middle-aged men with and without chronic kidney disease (CKD) under 50 years of age.

METHODS

Between October 2010 and July 2013, patients with CKD aged below 50 who received regular follow-ups at the nephrology outpatient clinics were enrolled. We also enrolled men aged below 50 years with estimated glomerular filtration rates (eGFR) higher than 60 mL/min per 1.73 m(2) and without history of kidney diseases from the health examination department as the control group. Clinical parameters and laboratory parameters were collected for analysis and comparison. The lower urinary tract symptoms were evaluated using the International Prostate Symptom Score (IPSS). Metabolic syndromes were defined according to the ATP III guidelines.

RESULTS

Overall, 50 men with CKD and 187 age-matched men without CKD were enrolled in the study (age: 44.9 ± 6.9 vs. 43.7.0 ± 4.3, P = 0.11). When compared with the age-matched control group, the occurrences of lower urinary tract symptoms were fewer in CKD patients, though not statistically significant. CKD Patients had significantly higher scores of nocturia (1.3 vs. 0.8, P = 0.02) but had significantly less urinary frequency and relatively fewer urgency score. Nocturia was significantly associated with eGFR. Multivariate analysis showed that lower eGFR and overweight were the only two independent risk factors for nocturia (P < 0.01), but was not the case for metabolic syndromes.

CONCLUSION

Middle-aged men with CKD had significantly more nocturia episodes than the age-matched control group, but had lower urinary frequency scores. Lower eGFR and overweight are independent risk factors for nocturia in middle-aged men.

Diagnosis and Management of Bladder Outlet Obstruction in Women

Bladder outlet obstruction (BOO) should be considered when a woman complains of voiding difficulty, abdominal straining to void, or refractory storage symptoms. Diagnosis of female BOO is not straightforward and usually requires invasive (video)urodyanmic study. A diagnostic algorithm is recommended for making optimal diagnosis. Female BOO can be classified as having anatomical and functional origins, and each contains several sub-classifications. Literatures published between 1988 and 2013 were reviewed and summarized for the diagnosis and therapy in each subtype of female BOO.