The effect of a 6 Fr catheter on flow rate in men

Background:

The pressure-flow study (PFS) is considered the gold standard for the detection of bladder outlet obstruction (BOO) in men. However, several studies have raised the possibility that transurethral catheterization might have an obstructive effect on PFS while others did not.

Objectives:

To evaluate the effect of a 6 Fr transurethral catheter on the pressure-flow study and to evaluate its clinical implication in men.

Materials and Methods:

A retrospective chart review study of 515 men referred for an evaluation of lower urinary tract symptoms and who underwent an urodynamic study (UDS). Of those, 133 met our inclusion/exclusion criteria. Non invasive free-flow studies (NIFFS) were performed before every UDS. Cystometrogram and PFS were performed through a 6 Fr transurethral catheter.

Results:

The maximal flow rate (Q_max) was significantly higher (P < 0.001) in the NIFFS (15.0 mL/s (range 9.0-23.0)) than in the PFS (11.0 mL/s (range 7.0-18.5)). This difference became greater (18.5 mL/s (range 10.0-30.3) vs. 13.0 mL/s (range 6.0-25.0), in favor of the NIFFS) when we analyzed only the patients (n = 34) who voided a similar volume. According to the International Continence Society (ICS) nomogram, the use of the PFS alone would have resulted in the upstaging of 14% of cases (10/71) in the overall population and 24% (4/17) in the sub-analyzed group.

Conclusion:

A 6 Fr transurethral catheter significantly lowers the maximal flow rate by 4 mL/s. Its presence resulted in an upstaging on the ICS nomogram. However, further studies will be necessary to confirm this upstaging.

Uroflowmetry nomograms for healthy children 5 to 15 years old

PURPOSE

We determined flow rates and generated flow rate-voided volume nomograms based on healthy children 5 to 15 years old voiding spontaneously in their natural environment.

MATERIALS AND METHODS

A total of 824 healthy school children of both genders were enrolled. A single uroflow record from each child was evaluated. A total of 103 children with a voided volume of less than 50 ml and/or a staccato/interrupted uroflow pattern were excluded, and 721 records were analyzed. Data were evaluated using several mathematical formulas and goodness of fit was determined. Linear regression analysis was used to generate nomograms.

RESULTS

Flow rates and voided volumes increased with increasing age, with the effect being more pronounced in girls. No significant difference was noted in uroflow rates from 5 to 10 years, but significant differences (p <0.001) started appearing at 11 to 15 years. Also no significant difference was noted in uroflow rates among children 11 to 15 years. Therefore, 2 age groups were designated, with group 1 consisting of patients 5 to 10 years old and group 2 consisting of patients 11 to 15 years old. There were 222 boys and 122 girls in group 1 and 240 boys and 137 girls in group 2. In group 1 the maximum and average ± SD flow rates were 15.26 ± 4.54 ml per second and 7.68 ± 3.26 ml per second, respectively, for boys and 17.98 ± 6.06 ml per second and 9.19 ± 4.23 ml per second, respectively, for girls. In group 2 these rates were 22.50 ± 7.24 ml per second and 10.78 ± 4.03 ml per second, respectively, for boys and 27.16 ± 9.37 ml per second and 13.48 ± 5.21 ml per second, respectively, for girls.

CONCLUSIONS

This large study, which expands the scant existing literature on uroflow parameters in healthy children, will hopefully promote wider application of uroflowmetry testing in the pediatric population.

Salvage surgery after failed treatment of synthetic mesh sling complications

PURPOSE

We report our experience with the diagnosis and treatment of refractory synthetic sling complications in women.

MATERIALS AND METHODS

This is a retrospective study of consecutive women with failed treatments for mesh sling complications. Before and after surgery the patients completed validated questionnaires and voiding diaries, and underwent uroflow with post-void residuals, pad test, cystourethroscopy and videourodynamic studies. Treatment was individualized, and results were subdivided into the 2 groups of conditions and symptoms. Outcomes were assessed with the Patient Global Impression of Improvement with success classified as a score of 1, improvement as 2 to 3 and failure as 4 to 7.

RESULTS

A total of 47 women 35 to 83 years old (mean 60) had undergone at least 1 prior operation (range 1 to 4) to correct sling complications. Original sling composition was type 1 mesh in 36 patients and types 2 and 3 in 11. Surgical procedures included sling incision, sling excision, urethrolysis, urethral reconstruction, ureteroneocystotomy, cystectomy and urinary diversion, and enterocystoplasty. Median followup was 2 years (range 0.25 to 12, mean 3). Overall a successful outcome was achieved in 34 of 47 patients (72%) after the first salvage surgery. Reasons for failure were multiple for each patient. Of the 13 patients with treatment failure 9 subsequently underwent 14 operations. Success/improvement was achieved in 5 women (56%) after continent urinary diversion (1), continent urinary diversion and cystectomy (1), partial cystectomy and augmentation cystoplasty (1), biological sling and sinus tract excision (1), and vaginal mesh excision (1).

CONCLUSIONS

Success after the initial failure of mesh sling complications repair is possible but multiple surgeries may be required. Each symptom should be addressed separately.