Long term clinical follow up of four patients with Wolfram syndrome and urodynamic abnormalities

OBJECTIVES

Wolfram syndrome is characterised by insulin-dependent diabetes (IDDM), diabetes insipidus (DI), optic atrophy, sensorineural deafness and neurocognitive disorders. The DIDMOAD acronym has been recently modified to DIDMOAUD suggesting the rising awareness of the prevalence of urinary tract dysfunction (UD). End stage renal disease is the commonest cause of mortality in Wolfram syndrome. We present a case series with main objective of long term follow up in four children having Wolfram syndrome with evaluation of their urodynamic profile.

METHODS

A prospective follow up of four genetically proven children with Wolfram syndrome presenting to a tertiary care pediatric diabetes clinic in Pune, India was conducted. Their clinical, and urodynamic parameters were reviewed.

RESULTS

IDDM, in the first decade, was the initial presentation in all the four children (three male and one female). Three children had persistent polyuria and polydipsia despite having optimum glycemic control; hence were diagnosed to have DI and treated with desmopressin. All four patients entered spontaneous puberty. All patients had homozygous mutation in WFS1 gene; three with exon 8 and one with exon 6 novel mutations. These children with symptoms of lower urinary tract malfunction were further evaluated with urodynamic studies; two of them had hypocontractile detrusor and another had sphincter-detrusor dyssynergia. Patients with hypocontractile bladder were taught clean intermittent catheterization and the use of overnight drain.

CONCLUSIONS

We report a novel homozygous deletion in exon 6 of WFS-1 gene. The importance of evaluation of lower urinary tract malfunction is highlighted by our case series. The final bladder outcome in our cases was a poorly contractile bladder in three patients.

Does ejaculation have an effect on urinary flow rates?

INTRODUCTION

The primary objective of this investigation is to explore the impact of ejaculation on urinary flow rates in men experiencing lower urinary tract symptoms.

MATERIALS AND METHODS

This study involved the enrollment of 55 male patients who presented with lower urinary tract symptoms. An assessment encompassed components, including medical history, questionnaires related to sexual activity and lower urinary tract symptoms, bladder diary, physical examination, urinalysis, urine culture, ultrasound examination and measurements of serum prostate-specific antigen, free flow uroflowmetry, and post-void residual urine volume. All participants were instructed to abstain from ejaculation for 3 days before undergoing uroflowmetry (UF1). Subsequently, they were required to ejaculate. Subsequent uroflowmetry assessments were conducted at 2 to 4 h (UF2) and 48 to 50 h (UF3) after ejaculation. No further ejaculations were permitted during this timeframe.

RESULTS

The patients had a mean age of 50.97 ± 1.47 years. Statistically significant differences were observed in the mean values of Qmax and corrected Qmax (cQmax) between UF1 and UF2 measurements (p < 0.05). These differences were only in patients with benign prostatic enlargement (BPE) (p < 0.05). Furthermore, the number of patients with Qmax <15 mL/s showed a statistically significant difference between UF1 and UF2 measurements, specifically in the BPE group (p = 0.016).

CONCLUSIONS

In this study, we have observed a significant and temporary increase in the Qmax following ejaculation, particularly among patients with BPE. This indicates that ejaculation can potentially complicate the interpretation of uroflowmetry results. Therefore, further research is necessary to gain a more comprehensive understanding of this phenomenon.

Comparative study of mobile acoustic uroflowmetry and conventional uroflowmetry: A systematic review and meta analysis

INTRODUCTION

Uroflowmetry is a noninvasive measurement of the volume of urine excreted over time. Conventional uroflowmetry has become the main modality of urine flow measurement within time. However, this method requires the patient to be present in the hospital or healthcare setting, thus sometimes making the patients feel uncomfortable to undergo the examination. This led to multiple measurements which are inconvenient for the patients. Mobile acoustic uroflowmetry (sono-uroflowmetry) has been proposed as an alternative method of urine flow measurement due to its portability. This study aimed to evaluate the accuracy and reliability of sono-uroflowmetry as compared to conventional uroflowmetry.

METHODS

Electronic databases searching were done using prespecified search strategy to retrieve articles related with uroflowmetry. In addition, hand-search strategy was used to identify additional articles. Studies with participants who had undergone sono-uroflowmetry were included. Voided volume, voiding duration, maximum flow rate, and average flow rate were identified and used to determine the outcomes of measurement. The quality of included articles was conducted using checklist for Diagnostic Test Accuracy Studies by JBI.

RESULTS

Initial search yielded 335 articles with four additional papers identified through hand-searching process. Six papers were retrieved and further used in the narrative synthesis. Five studies enrolled male participants, while only one of the papers enrolled female participants as additional subgroup analysis. Therefore, the meta-analysis was performed by using only male participants. Based on the meta-analysis results, there were strong to very strong positive correlation in voided volume, voiding time, average flow, average flow rate, and maximum flow rate between sono and conventional uroflowmetry.

CONCLUSION

Sonouroflowmetry showed significant positive correlations to conventional uroflowmetry, signifying its use as an alternative of conventional uroflowmetry.

Familial congenital lower urinary tract obstruction (LUTO) suggested by screening for lower urinary tract dysfunction in parents of patients: A descriptive study

Background

Congenital lower urinary tract obstruction (LUTO) describes a heterogeneous group of congenital malformations. Posterior urethral valves (PUV) represent the most common entity. Familial occurrence has been described, suggestive of underlying genetic factors. LUTO can occur in various degrees of severity. In severe forms, oligohydramnios, pulmonary hypoplasia, and renal damage can occur resulting in high pre- and postnatal mortality. On the contrary, mild forms may become apparent through recurrent urinary tract infections. Such high phenotypic variability has been described even within the same family. Here, we systematically screened parents of affected children for symptoms of LUTO.

Methods

The study population consisted of parents of LUTO patients. Fathers over 50 years of age were excluded, to avoid inclusion of male phenocopies due to early prostatic hypertrophy. Uroflowmetry, ultrasonography for residual urine and hydronephrosis, and laboratory examination of standard renal retention parameters were assessed, and a detailed patient history was taken, including the assessment of the International Prostate Symptom Score.

Results

Twenty-nine of 42 LUTO families enrolled were found eligible for the present study. Of these, we identified five families in which the father had already been diagnosed with infravesical obstruction (17%). Of the remaining families, nine agreed to participate in our study. Of these nine families, eight families had a child affected with PUV and one family had a child with urethral stenosis. Here, we found two fathers and one mother with symptoms of LUTO suggestive of mild LUTO and one family, in which the unborn male fetal brother of the affected index patient was also diagnosed prenatally with LUTO.

Conclusion

Our observations suggest that LUTOs have a higher heritability than previously thought and that first-degree relatives of the affected should be clinically assessed for symptoms of LUTO.

Novel clinical diagnostic criteria based on noninvasive examination findings to predict the presence of urodynamic detrusor underactivity in men

AIMS

To investigate the usefulness of novel clinical diagnostic criteria based on noninvasive examination findings to diagnose urodynamic detrusor underactivity (DU) in men.

METHODS

We developed clinical diagnostic criteria to predict the presence of urodynamic DU in men as follows: (a) bladder voiding efficiency <70% on uroflowmetry, (b) existence of "sawtooth and interrupted waveforms" on uroflowmetry, and (c) ultrasonography-documented intravesical prostatic protrusion <10 mm. We analyzed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these clinical criteria for diagnosing urodynamic DU in men aged 50 years or above with lower urinary tract symptoms who underwent urodynamic studies.

RESULTS

Of the 314 men analyzed (mean age, 72.4 years; mean detrusor contraction index [DCI], 98.8; and mean bladder outlet obstruction index [BOOI], 43.9), 89 men met this clinical DU diagnostic criteria. Of these, 79 men (88.8%) had urodynamic DU (DCI < 100 and BOOI < 40), nine (10.1%) had DU + BOO (DCI < 100 and BOOI ≥ 40), and one (1.1%) had normal voiding functions. None of the men with urodynamic BOO (DCI ≥ 100 and BOOI ≥ 40) met the clinical DU diagnostic criteria. The sensitivity, specificity, PPV, and NPV of these clinical diagnostic criteria for urodynamic DU were 69.3%, 95.0%, 88.8%, and 84.4%, respectively.

CONCLUSION

The proposed clinical DU diagnostic criteria showed a high PPV (88.8%) for diagnosing urodynamic DU. None of the patients with BOO met the clinical diagnostic criteria for DU. These clinical DU diagnostic criteria may be useful in identifying men with urodynamic DU in clinical practice.

A novel predictive model for noninvasively diagnosing bladder outlet obstruction in female patients based on clinical features and uroflowmetry parameters

OBJECTIVE

To develop and validate a simple prediction model to diagnose female bladder outlet obstruction (fBOO) because of the invasive nature of standard urodynamic studies (UDS) for diagnosing fBOO.

METHODS

We retrospectively analyzed the data of 728 women who underwent UDS at Tongji Hospital between 2011 and 2021. The definition of fBOO was Pdet.Qmax  - 2.2 × Qmax  > 5 (BOOIf > 5). Independent predictive factors of fBOO were determined by multivariable logistic regression analysis. These predictive factors were incorporated into a predictive model to assess the risk of fBOO.

RESULTS

Of the 728 patients, 249 (34.2%) were identified as having fBOO and these women were randomly assigned to two groups, a model development group and a model validation group. Multivariate logistic regression demonstrated that age, Qmax , flow time, and voiding efficiency were independent risk factors for fBOO. The predictive model of fBOO showed a satisfactory performance, with area under the curve being 0.811 (95% confidence interval [CI] 0.771-0.850, P < 0.001), which was confirmed to be 0.820 (95% CI 0.759-0.882, P < 0.001) with external validation. The calibration curve indicated that the predicted probability had an excellent correspondence to observed frequency. Decision curve analysis demonstrated a greater clinical net benefit compared with the strategies of treat all or treat none when the predicted risk was in a range of 3% and 75%.

CONCLUSION

A novel predictive model of fBOO was developed and validated based on clinical features and noninvasive test parameters in female patients with lower urinary tract symptoms. The model is a quick and easy-to-use tool to assess the risk of fBOO for urologists in their routine practice without an invasive UDS.

Development and construction of an open-platform, open-source low-cost portable uroflowmeter: The OpenFlow device

BACKGROUND

Uroflowmetry is useful to screen for and manage many voiding disorders. Home-based uroflowmetry might better represent the patient's true voiding pattern and be more widely adopted if an accurate low-cost portable device was available.

OBJECTIVE

Development and initial evaluation of an open-platform, open-source low-cost portable uroflowmeter.

MATERIALS AND METHODS

We designed and built an uroflowmeter comprising of a load cell and digital memory card unit connected to a programmable microcontroller board mounted upon a 3D printed frame. It generated date-stamped tables which were processed and plotted. Twenty urologists were recruited to assess the device. Each participant received the equipment that was returned, along with a bladder diary, after at least 24 consecutive hours of homemade uroflowmetry recording. Additionally, were assessed with the International Prostatic Symptom Score (I-PSS) and Peeling diagram, whereas the device's ease of use, robustness, and portability were evaluated with a Likert-type questionnaire. Two experienced urodynamicists independently evaluated the tracings' quality rated with a 3° ordinal scale: (1) Interpretable without artifacts; (2) Interpretable with artifacts; (3) Uninterpretable.

RESULTS

Participants' median age was 36.6 years old, none having an I-PSS > 5 or Peeling > 2. Overall 138 voidings were recorded (77 daytime, 61 nightly episodes). The device's ease of use, robustness, and portability obtained maximum score in 80% of evaluations. Most (98%) of the tracings were considered interpretable. Limitations included its small study population and short monitoring times.

CONCLUSION

The construction of a cheap (<50 USD), accurate user-friendly portable uroflowmeter proved feasible, which could facilitate access to portable uroflowmetry.

Uroflowmetry parameters in healthy children between 5 and 15 years old

OBJECTIVES

Uroflowmetry (UFM) is the first-line noninvasive screening test employed in the diagnosis of lower urinary tract dysfunction (LUTD). The purpose of this study was to determine normal UFM values in healthy Turkish children among our local population.

METHODS

A total of 100 healthy girls and 62 healthy boys aged 5-15 years, who applied to İnönü University Turgut Özal Medical Center Pediatrics Polyclinic between February 2021 and January 2022, were included in the present study. The UFM parameters, including maximum flow rate (Qmax), average flow rate (Qavg), voided volume (VV), time to maximum flow, and voiding time, were measured using the Inoflow Smart System UFM Device and the resulting urine flow curve was recorded. The children were compared in terms of the UFM parameters based on their gender and age groups (5-10 years and 11-15 years).

RESULTS

The mean Qmax value in healthy female children aged 5-15 years (21.8 ± 8.6 mL/s) was significantly higher than in male children (17.98 ± 6.1 mL/s) (p = .003). VV, Qmax, and Qavg values of the children in the 11-15 age group were significantly higher than those in the age group of 5-10 years (p > .05 for each). VV, Qmax, and Qavg values were directly proportional to age (p = .0001, for each).

CONCLUSIONS

We believe that this study adds to the limited knowledge base regarding normal flow patterns in healthy children.

Chengai Nomogram: A Comprehensive Study of Uroflow Parameters and Characteristics in Healthy Adult Males From South India

Introduction Uroflowmetry is a widely accepted non-invasive diagnostic modality used in the evaluation of lower urinary tract dysfunction. While various nomograms have been established for different populations and races, there has been a lack of studies that focus on the South Indian populations. Consequently, the objective of the study was to investigate the urinary flow parameters in a healthy adult male South Indian population using uroflowmetry and identify the variations in flow rates. Additionally, the study sought to assess the influence of age and voided volume (VV) on flow rates and create a representative nomogram. Methods A total of 500 uroflowmetry tests were prospectively performed on healthy adult males. The gravimetric method was utilized for uroflowmetry. Flow charts and parameters were analyzed for correlation and linear regression models, and statistical calculations were employed to generate uroflow nomograms. Results The mean age of the participants was 37.77±9.91 years. The mean values for maximum flow rate (Qmax), average flow rate (Qavg), and VV were 23.42±6.64 mL/s, 11.71±3.77 mL/s, and 229.90±59 mL, respectively. A significant correlation was observed between flow rates (Qmax and Qavg) and VV, which indicated that increased VV leads to higher flow rates. Additionally, a significant negative correlation between the flow rates and age was noted. Conclusion The findings provide insight into the uroflow parameters of the South Indian adult male population and contribute to the development of nomograms, establishing normal reference ranges for flow rates across varying VVs. As a tribute to the hospital and the study participants, the nomogram was named the "Chengai Nomogram."

Characteristics of uroflowmetry patterns in men with detrusor underactivity revealed by artificial intelligence

OBJECTIVES

To elucidate the characteristics of uroflowmetry (UFM) observed in men with detrusor underactivity (DU) using our developed artificial intelligence (AI) diagnostic algorithm to distinguish between DU and bladder outlet obstruction (BOO).

METHODS

Subjective and objective parameters, including four UFM parameters (first peak flow rate, time to first peak, gradient to first peak, and the ratio of first peak flow rate to maximum flow rate [Qmax ]) selected by analyzing the judgment basis of the AI diagnostic system, were compared in 266 treatment-naive men with lower urinary tract symptoms (LUTS). Patients were divided into the DU (70; 26.32%) and non-DU (196; 73.68%) groups, and the UFM parameters for predicting the presence of DU were determined by multivariate analysis and receiver operating characteristic (ROC) curve analysis. Detrusor underactivity was defined as a bladder contractility index <100 and a BOO index <40.

RESULTS

Most parameters on the first peak flow of UFM were significantly lower in the DU group. On multivariate analysis, lower first peak flow rate and lower ratio of first peak flow rate to Qmax were significant parameters to predict DU. In the ROC analysis, the ratio of the first peak flow rate to Qmax showed the highest area under the curve (0.848) and yielded sensitivities of 76% and specificities of 83% for DU diagnosis, with cutoff values of 0.8.

CONCLUSIONS

Parameters on the first peak flow of UFM, especially the ratio of the first peak flow rate to Qmax , can diagnose DU with high accuracy in men with LUTS.

Correlation between bladder wall thickness and uroflowmetry in West African patients with benign prostatic enlargement

Background

Pressure flow urodynamic study remains the gold standard for the diagnosis of bladder outlet obstruction; however, their use is limited by their relative unavailability in our environment, cost, and invasiveness. Measurement of bladder wall thickness (BWT) by transabdominal ultrasonography is a promising tool that can be used to diagnose bladder outlet obstruction in our environment where pressure-flow urodynamic study is not readily available.

Objective

The study aimed to correlate BWT with uroflowmetry and to establish a BWT cut-off in patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement.

Materials and Methods

This was a prospective one-year study of patients with LUTS due to benign prostatic enlargement. The patients were divided into obstructed and non-obstructed groups with Q- max of 10 ml/s serving as the cut-off value. Receiver Operator Curve (ROC) was used to evaluate the performance of BWT in diagnosing BOO. Statistical significance was set at P < 0.05.

Results

The mean BWT and Q-max were 4.53 ± 2.70 mm and 15.06 ± 9.43 ml/s. There was a negative correlation between BWT and Q-max (r = -0.452, P = 0.000), Q-average (r = -0.336, P = 0.000), and voided volume (r = -0.228, P = 0.046). A BWT cut-off of 5.85 mm was found to be the best threshold to differentiate obstructed from non-obstructed patients with a sensitivity and specificity of 70 and 88.2 percent respectively.

Conclusion

Bladder wall thickness showed an inverse relationship with maximum flow rate with high sensitivity and specificity. This non-invasive test can be used as a screening tool for BOO in our setting, where the pressure flow urodynamic study is not readily available.

Study of correlation between Visual Prostate Symptom Score and International Prostate Symptom Score in men with lower urinary tract symptoms with reference to Uroflowmetry parameters in Indian population

PURPOSE

International prostate symptom score (IPSS) is a complex questionnaire method for objective assessment of Lower urinary tract symptoms. So, there is a need to develop a simple and easy scoring system that could be easily used for illiterates and older aged patients.

MATERIALS AND METHODS

It was a prospective observational study with 202 participants, conducted at the department of urology of a tertiary care hospital in eastern India. The patients more than 50 years of age, attending urology OPD with Lower urinary tract symptoms were included in the study. Printed IPSS and VPSS questionnaires were given to the patient to answer.

RESULTS

Eighty-two percent (82%) of the higher education group and 97% of the lower education group needed assistance to answer IPSS questionnaires while 18% of the higher education group and 44% of the lower education group needed assistance to answer VPSS questionnaires. Sixty-four (64%) of patients in our study belong to the high education level while 36% of patients belong to the low education group. The mean age was 60.1 years. The mean IPSS and VPSS were 19 and 11 respectively. The mean PSA was 1.5 ng/ml. The time taken to fill VPSS questionnaire was much less than IPSS questionnaires. All the patients felt that VPSS was easier. Statistically significant (p-value < 0.05) correlation was found between total IPSS and total VPSS, Q2 IPSS and Q1 VPSS, Q7 IPSS and Q2 VPSS, Q5 IPSS and Q3 VPSS, and IPSS Qol and VPSS Qol. A negative correlation was found between Q3 VPSS and Qmax, and Q5 IPSS and Qmax.

CONCLUSIONS

VPSS can be used as an alternative tool to IPSS to assess LUTS, which uses pictograms instead of questionnaires, even in patients with limited education.

Defining bladder outlet obstruction and detrusor underactivity in females with overactive bladder: Are we forgetting about the free uroflowmetry?

INTRODUCTION

Both detrusor underactivity (DU) and bladder outlet obstruction (BOO) can coexist in patients with overactive bladder. Definitions of both DU and BOO are based on pressure-flow study (PFS) data. However, invasive urodynamics study can differ from a natural micturition, in fact, discrepancies between free uroflowmetry (UFM) and PFS have been largely described. Our goal is to assess the correlation of free-flowmetry and PFS among patients with OAB and to evaluate how different definitions of DU/BOO are able to discriminate patients with different free UFMs.

METHODS

A retrospective review of urodynamics performed at a single institution was conducted. Females with OAB who voided more than 150 mL in both UFM and PFS were included. Parameters from both voiding episodes were compared with nonparametric test. Two definitions of DU were applied; PIP1: Pdet@Qmax+Qmax < 30 and Gammie: Pdet@Qmax < 20 cmH₂ O, Qmax < 15 mL/s, and BVE < 90% (Bladder voiding efficiency). Also, two definitions of obstruction were chosen; Defretias: Pdet@Qmax ≥25 cmH₂ O and Qmax ≤ 12 mL/s and Solomon-Greenwell female BOO index ≥ 18. Patients who matched with each definition were compared to those who did not, to assess if any definitions were able to discriminate different noninvasive uroflowmetries.

RESULTS

A total of 195 patients were included. Overall, mean age was 55 ± 12 years, 90.8% had mixed urinary incontinence, and 39% complained of at least one voiding symptom. Globally, Qmax and BVE correlated poorly between UFM and PFS, showing that most of the variation corresponded to a systematic error. Twenty-two individuals were found to have DU, they had a difference of 13 mL/s on both maximum flows. Fifty-four patients showed BOO, with a difference between their Qmax of 19 mL/s. Among the four definitions analyzed, only PIP1 and Defreitas were able to discriminate patients with actually a lower Qmax on the free UFM.

CONCLUSIONS

Patients with overactive bladder seem to have a systematic discordance between the urine flow of the free and invasive studies. Current definitions of DU and BOO, which are based on the PFS parameters, are not consistently able to discriminate patients who actually void deficiently on the free UFM.

Comparative effect of intraurethral clobetasol and tacrolimus in lichen sclerosus-associated urethral stricture disease

Background

Management of urethral stricture related to lichen sclerosus (LS) is now gradually changing from surgical to nonsurgical due to availability of anti-inflammatory agents such as corticosteroids and calcineurin inhibitors. We determined the clinical impact of these agents in such patients on outpatient department basis in terms of improvement in symptoms on International Prostate Symptom Score (IPSS), external skin appearance, and maximum urinary flow rate (Qmax).

Materials and Methods

Eighty patients of meatal stenosis and penile urethral stricture with histopathologically proven LS were divided into two groups, and clinical and predetermined parameters such as Qmax, IPSS, and changes in external appearance were compared between these groups after 3 months of topical and intraurethral application of clobetasol and tacrolimus with self-calibration.

Results

A significant intragroup difference was noted in IPSS (P < 0.001) as well as Qmax (P < 0.001); postintervention intergroup difference in IPSS was not significant (P = 0.94) and however postintervention intergroup difference in Qmax was significant in favor of clobetasol (P = 0.007). A significantly increased number of additional procedures were done in the group receiving intraurethral tacrolimus (P = 0.0473) with significantly less number of skin complication in the group with topically applied clobetasol (P = 0.003).

Conclusion

Though both clobetasol and tacrolimus, improved symptom score, Qmax and local external appearance yet topical and intra-urethral clobetasol application via urethral self calibration seems to be better option for lichen sclerosus related urethral stricture in terms cost and local complications.

Urinary flow rates in anterior hypospadias: Before and after repair and its clinical implication

Context

Hypospadias is a common urological anomaly which could be surgically corrected with good cosmetic results.

Aims

We aimed to detect changes in urinary flow parameters both before and after tubularised incised plate urethroplasty (TIPU) using uroflowmetry.

Settings and Design

Data collected were clinically implemented hypothesising the probability of urethrocutaneous fistula following stricture with Qmax variation.

Materials and Methods

This study is a prospective analysis done from December 2017 to October 2019. A total of 104 cases of anterior hypospadias were included in the study. A single surgical unit did TIPU. Pre-operative and post-operative uroflowmetry was done, and Qmax was recorded at 3 months, 6 months and 1 year after surgery. Mean Qmax was calculated for all intervals. A significant decrease in Qmax of a child (<2 standard deviation) was ascertained. Urethral calibration was done in those cases with a significant decrease of Qmax and analysed statistically.

Results

The mean age was 6.97 ± 2.41 years. Out of 104 children, 73 (70.2%) and 31 (29.8%) had distal and mid-shaft hypospadias, respectively. The pre-operative mean Qmax of the population was 6.20 ± 0.42 ml/s. Arithmetic mean Qmax at 3 months, 6 months and 1 year was 8.53 ± 0.42, 11.18 ± 0.47 and 13.71 ± 0.44 ml/s, respectively. On comparing the pre-operative with post-operative mean Qmax, a significant increase was found postoperatively (P < 0.0001). Twenty-four patients had significantly decreased Qmax value after 6 months. In these patients, follow-up urethral dilation was done with significant improvement.

Conclusion

The changes in maximum flow rate (Qmax) are suitable for use in routine follow-up. A significant decrease in Qmax over time indicates the onset of urethral stricture. These cases are to be intervened before venturing to redo urethroplasty.

A High-Efficiency Consultation Improves Urological Diagnosis in Patients with Complex LUTS-A Pilot Study

(1) Background: The diagnosis of moderate-severe lower urinary tract symptoms (LUTS) is not easy due to the complexity of the micturition act. Sequential diagnostic tests can be time consuming due to waiting lists. Thus, we developed a diagnostic model combining all the tests in a single one-stop consultation. (2) Methods: In a prospective pilot study in patients with complex LUTS, they received all diagnostic tests (ultrasound, uroflowmetry, cystoscopy, pressure-flow study) in a single consultation and by the same doctor. Patients' results were compared with those from a 2021 paired cohort that underwent the classical sequential diagnostic pathway. (3) Results: Per patient, the high-efficiency consultation saved: 175 days of waiting, 60 min doctor time and 120 nursing assistant time and over 300 euros on average. The intervention also saved 120 patient journeys to the hospital, lowering the total carbon footprint by 145.86 kg CO₂. In one-third of the patients, performing all the tests within the same consultation contributed to reaching a more appropriate diagnosis and thus more effective treatment. Patients' satisfaction was high, with good tolerability. (4) Conclusions: The high-efficiency urology consultation improves waiting times, therapeutic decisions and the degree of patient satisfaction while optimizing the use of resources and generating savings for the health system.

Consistency of uroflowmetry analysis in children among observers

AIM

The aim of the study is to compare the intra- and inter-observer interpretations of the same uroflowmetry study at two different times.

MATERIALS AND METHODS

Two-hundred children with a voided volume of 50% above the expected bladder capacity were included. All traces were asked to be evaluated by 11 observers two times in a time span of 1 month. These observers consist of pediatric urologists (n = 2), pediatric urology fellows (n = 2), urology residents (n = 5), and certified urodynamics nurses (n = 2). Each uroflowmetry was asked to be assessed for three domains: voided volume (VV), detrusor sphincter dyssynergia (DSD), and flow curve pattern (FCP).

RESULTS

Of the 200 patients with a median age of 10 (4-18) years, 128 (64%) were girls and 72 (36%) boys. The maximum flow rate and the median voided volume were found to be 20 (4-61) mL/s and 232 (116-781) mL. The Fleiss' kappa coefficient of VV, DSD, and FCP in the first assessment was 0.510, 0.501, and 0.346. In the second assessment, κ values were 0.530, 0.422, and 0.373. The best-agreed findings were similar at both times. These were found to be low VV (0.602 and 0.626) and intermittent pattern (0.500 and 0.553). Interpreters were found to have a statistically significant difference in agreement with their own interpretation at different times.

CONCLUSION

Both inter- and intra-observer reliability of the agreement point out the problem in the standardization of uroflowmetry. Inter- and intra-observer reliability of uroflowmetry interpretation can be increased by defining precise numbers and numerical algorithms.

Urine flow acceleration in healthy children: A retrospective cohort study

AIMS

To establish normal reference values of urine flow acceleration (Q_acc ) in healthy children, as there is a lack of nomograms for normative reference values of Q_acc by voided volumes in the pediatric population so far. Q_acc might be an early indicator of autonomic neuropathy in children and adolescents.

METHODS

Data were retrospectively collected from healthy children who underwent uroflowmetry between 1990 and 1992. Exclusion criteria were voided volume less than 20 ml, and postvoid residual more than 15%. Baseline characteristics and uroflowmetry parameters were collected from girls and boys aged between 6 and 18 years. Voided volume, voiding time, time to maximum flow rate, and maximum and average flow rates of urine were measured, and Q_acc was calculated. Postvoid bladder diameter was measured by ultrasonography and converted to volume.

RESULTS

Uroflowmetry parameters of 208 children (≤18 years old, 45.2% girls, mean age 9.68 ± 3.09 years) who performed 404 micturition were analyzed. Median voided volume, voiding time, time to Q_max , Q_ave , Q_max , Q_acc , and postvoid residual volume were 130 [20-460] ml, 10 [3-56] s, 3 [1-14] s, 11.7 [2.5-36.6] ml/s, 20.5 [5-50] ml/s, 6 [0.81-25] ml/s² , and 1.83 [0-38.62] ml, respectively. Q_acc nomograms were given in centile forms for girls and boys separately, which show an inversely proportional correlation between voided volumes.

CONCLUSIONS

These are the first nomograms for normative reference values of Q_acc in the pediatric population (girls and boys separately) by voided volumes in centile forms. These may be useful to interpret abnormal Q_acc values and diagnose lower urinary tract diseases over a wide range of voided volumes.

Evaluation of bladder dysfunction in children and adolescents with type 1 diabetes mellitus by uroflowmetry

OBJECTIVES

Diabetic cystopathy is a condition characterized by decreased bladder sensitivity, increased bladder capacity, decreased bladder contractility and increased residual urine volume. It can also be considered as an early indicator of autonomic dysfunction. In this study, it was aimed to evaluate bladder functions by uroflowmetry in children and adolescents with the diagnosis of type 1 diabetes mellitus.

METHODS

Type 1 diabetes mellitus children and adolescents were applied uroflowmetry and post-void residual urine volumes were evaluated. The physical examination findings of the patients and the laboratory data of diabetes control were obtained from the clinic files.

RESULTS

A total of 51 cases aged 72-216 (155.6 ± 35.4) months were enrolled into the study. Diabetes age of the cases was 66.5 ± 46.2(13-180) months. The last one year average of HbA_1c of the patients was found to be 9.7 ± 1.9%. A total of 9.8% had good, 39.2% moderate and 51% poor metabolic control, respectively. While urodynamic evaluation was normal in 36 (70.6%) of 51 participants, voiding dysfunction was found in 15. There was no statistically significant difference between groups with and without voiding dysfunction in terms of age, gender, duration of diabetes, metabolic control and HbA_1c values.

CONCLUSIONS

It is very important to follow up patients with type 1 diabetes mellitus in terms of autonomic dysfunction. Diabetic bladder clinic, which can be observed independently of diabetes duration and metabolic control, is also included in this status. Urodynamic evaluation will be helpful both in demonstrating bladder dysfunction and in preventing possible complications.

Uroflowmetry is a viable surrogate for urethroscopy in evaluation of anatomical success following urethroplasty

OBJECTIVES

This study aimed to investigate the utility of uroflowmetry in predicting anatomical success following urethroplasty based on real-world clinical data.

METHODS

Data from 100 male patients who underwent urethroplasty for urethral strictures at our institute were analyzed. Postoperative anatomical success was determined as the passage of a 16.2 Fr flexible endoscope after approximately 4 months following the procedure. Sensitivity and specificity of the maximal flow rate (Q_max ), average flow rate (Q_ave ), and Q_max  - Q_ave for anatomical success were determined, along with receiver operating characteristic analysis. The optimal cutoff was set using Youden's index.

RESULTS

Anatomical success was observed in 67%. Voided volumes in the success and failure groups were equivalent: 252 ± 121 versus 242 ± 91 ml, respectively. In 18 cases, voided volumes were <150 ml. Parameters of uroflowmetry were all significantly higher in the anatomical success group when compared to those in the failure group: the mean value of Q_max was 26.1 versus 15.0 ml/s; Q_ave , 14.2 versus 9.1 ml/s; and Q_max  - Q_ave , 11.9 versus 5.9 ml/s, respectively (p < 0.0001 for each parameter). The area under the curve was 0.8082 for Q_max , 0.7727 for Q_ave , and 0.8186 for Q_max  - Q_ave . Optimal cutoff values for Q_max and Q_max  - Q_ave were 20 and 6 ml/s, which predicted anatomical success with 86% and 87% positive predictive value, respectively.

CONCLUSION

This analysis presents statistically valid cutoffs by which uroflowmetry can be used as a viable surrogate of anatomical success following urethroplasty in clinical practice.

Estimation of Urine Flow Velocity Using Millimeter-Wave FMCW Radar

This study investigated the feasibility of remotely estimating the urinary flow velocity of a human subject with high accuracy using millimeter-wave radar. Uroflowmetry is a measurement that involves the speed and volume of voided urine to diagnose benign prostatic hyperplasia or bladder abnormalities. Traditionally, the urine velocity during urination has been determined indirectly by analyzing the urine weight during urination. The maximum velocity and urination pattern were then used as a reference to determine the health condition of the prostate and bladder. The traditional uroflowmetry comprises an indirect measurement related to the flow path to the reservoir that causes time delay and water waves that impact the weight. We proposed radar-based uroflowmetry to directly measure the velocity of urine flow, which is more accurate. We exploited Frequency-Modulated Continuous-Wave (FMCW) radar that provides a range-Doppler diagram, allowing extraction of the velocity of a target at a certain range. To verify the proposed method, first, we measured water speed from a water hose using radar and compared it to a calculated value. Next, to emulate the urination scenario, we used a squeezable dummy bladder to create a streamlined water flow in front of the millimeter-wave FMCW radar. We validated the result by concurrently employing the traditional uroflowmetry that is based on a weight sensor to compare the results with the proposed radar-based method. The comparison of the two results confirmed that radar velocity estimation can yield results, confirmed by the traditional method, while demonstrating more detailed features of urination.

Acellular Tissue Engineered Pericardial Patch Urethroplasty: A New Horizon of Substitution Urethroplasty

OBJECTIVE

Buccal mucosal graft is the best autologous material for substitution urethroplasty. However, in cases where buccal mucosa is unavailable, a non-autologous tissue like acellular tissue-engineered pericar- dial patch can be very helpful. Our study is a small approach regarding the success and durability of acellular tissue-engineered pericardial patch as a substitution tissue in urethroplasty.

MATERIAL AND METHODS

A total of 22 patients underwent acellular tissue-engineered pericardial patch substi- tution urethroplasty using dorsolateral onlay technique for long segment urethral stricture, for a period of twoyears. Observations and comparison were made in terms of postoperative change in maximum urinary flowrate (Qmax), resolution of obstructive lower urinary tract symptoms, improvement in retrograde urethrogram and complications encountered, with buccal mucosal graft urethroplasty as a historical control.

RESULTS

Out of these 22 patients, 18 patients had successful outcomes considering maximum flow rate (Qmax)> 10 mL/s on uroflowmetry, resolved obstructive lower urinary tract symptoms, and normal postoperativeretrograde urethrogram, whereas four patients were considered a failure because of Qmax <10 mL/s, unre- solved obstructed lower urinary tract symptoms and recurrence of urethral stricture on retrograde urethro-gram and development of urethrocutaneous fistula.

CONCLUSION

Acellular tissue-engineered pericardial patch substitution urethroplasty can be a useful alternative to autologous tissue substitution, especially where the buccal mucosal graft is unavailable for urethroplasty.

Prevalence of lower urinary tract symptoms in children with early-treated infantile-onset Pompe disease: A single-centre cross-sectional study

AIM

To evaluate lower urinary tract symptoms (LUTS) in children with infantile-onset Pompe disease (IOPD) who received early treatment.

METHODS

Pompe disease (PD), or glycogen storage disease II is a rare autosomal recessive lysosomal storage disease that affects multiple organ systems. To our knowledge, only one study has focused on the relationship between LUTS and incontinence in children with PD. This cross-sectional study was conducted from August 2019 through March 2021 and children with IOPD, who had received early and regular enzyme replacement therapy, were enrolled. Participants or their parents completed the Dysfunctional Voiding Scoring System (DVSS) questionnaire. All children underwent uroflowmetry and postvoid residual urine measurements. Fourteen children (age, 4-9 years) with IOPD were enrolled.

RESULTS

Ten patients (71.4%) had abnormal uroflow curves. In addition, results of the DVSS revealed that approximately half (42.9%) of our IOPD patients had voiding dysfunction, with urinary incontinence as the most common symptom (64.3%, 9/14). No significant correlations were found between LUTS and uroflow curves in children with IOPD.

CONCLUSIONS

The frequency of LUTS and lower urinary tract dysfunction noted on uroflowmetry should encourage pediatricians to actively identify IOPD patients with LUTS, regardless of the timing and frequency of their treatments, and refer them to a urologist for further evaluation and appropriate treatment.

Through the zipper or pants down: Does it change uroflowmetry parameters in healthy males?

OBJECTIVE

To evaluate if voiding through the zipper or voiding pants down would make any difference with regard to uroflowmetry parameters and postvoiding residual urine (PVR) volumes in healthy males with no lower urinary tract symptoms (LUTS).

METHODS

Healthy males over 18 years of age with no LUTS were prospectively evaluated using a uroflowmetry test. Each individual was asked to void through the zipper (group 1) and pants down (group 2) at different times. The uroflowmetry test was repeated if the voided volume did not exceed 150 mL. Uroflowmetry results such as voided volume, maximum flow rate (Qmax), average flow rate (Qave), and duration of voiding were noted. PVR volume was assessed using ultrasonography. Electromyography was not used. Data are shown as mean ± standard deviation. For statistical analysis, a paired t test was used to analyze parametric parameters.

RESULTS

A total of 44 males were enrolled. The median age of the individuals was 24 (range 18-44 years). There were no statistically significant differences between the two measurements in terms of voided volume (307 ± 121 mL vs 325 ± 145 mL, P = .365) and duration of voiding (25 ± 11 s vs 23.8 ± 11.6 s, P = .526). However, there were statistically significant differences in Qmax (26.6 ± 6.7 mL/s vs 30.0 ± 8.2 mL/s, P = .001), Qave (14.4 ± 3.6 mL/s vs 16.2 ± 5.1 mL/s, P = .009), and PVR volumes (23.9 ± 19.4 mL vs 3.9 ± 9.6 mL, P = .0001).

CONCLUSION

Voiding pants down shows higher flow rates and lower PVR than voiding through the zipper in individuals with no LUTS. Future studies with a larger number of individuals (including those with LUTS) and a broader age range cohort are required for solid conclusions.

Noninvasive Evaluation of Bladder Bowel Dysfunction and its Extrapolation as Biofeedback Therapy to Train Pelvic Floor Muscles

Aims

This study aimed to evaluate the noninvasive methods to diagnose bladder bowel dysfunction (BBD) and its extrapolation on biofeedback therapy and pelvic floor exercises (PFE) to treat these children.

Settings and Design

A retrospective cohort study at a tertiary care center was conducted between January 2010 and December 2020, on 204 children, aged 4-18 years, arbitrarily divided into two groups-4-12 and 13-18 years.

Subjects and Methods

Details of lower urinary tract dysfunction were recorded as International Children's Continence Society nomenclature. Bowel habits were recorded and functional constipation was graded using ROME IV. The data recorded were urine analysis, a voiding diary, a dysfunctional voiding symptom score, and uroflowmetry with or without electromyography. Ultrasonography, voiding cystourethrogram, and magnetic resonance imaging were done in appropriate cases. Dysfunctional Voiding Severity Score was used to assist the evaluation and outcome. The treatment protocol included urotherapy, uroflow biofeedback, PFEs, prophylactic antibiotics, pharmacotherapy, and treatment of constipation.

Statistical Analysis Used

Statistical analysis was done using SPSS version 26 and paired t-test was used for comparison and calculating P value.

Results

There was a significant improvement in DVSS and uroflow parameters. However, the magnitude of change produced varied among the age groups. Patients who failed to show any clinical benefit were subjected to alternative therapies such as intrasphincteric Botulinum A toxin with or without neuromodulation.

Conclusions

Integrated uroflow biofeedback (IUB) and PFE expedites the recovery by supplementing the effect of urotherapy; hence, this should be offered to all children with BBD.

The usefulness of uroflowmetry and ultrasound bladder scanning as diagnostic tools in primary care for new male patients with lower urinary tract symptoms; a cluster randomized controlled trial

BACKGROUND

Uroflowmetry and ultrasound scanning of the post-void residual volume are diagnostic instruments in specialist urological care of men referred with lower urinary tract symptoms (LUTS). We hypothesized that implementing uroflowmetry and post-void ultrasound bladder scanning in primary care for men with LUTS will reduce the number of referrals to urologists.

OBJECTIVE

To assess the effect on referrals to urologists for new male patients over 50 years of age with LUTS when performing uroflowmetry and post-void ultrasound bladder scanning in primary care.

METHODS

A cluster randomized controlled trial was conducted among Dutch general practitioners (GPs). The GPs enrolled male patients with the first-time presentation of LUTS, these were randomized to primary-care treatment with or without uroflowmetry and post-void bladder scanning. Primary outcome: percentage of patients referred to urologists within 3 and 12 months. Secondary outcomes: changes in the International Prostate Symptom Score (IPSS) and the IPSS-Quality of Life, patient satisfaction and urologic medication usage after 12 months.

RESULTS

Four GPs were randomly assigned to the intervention group (132 patients) and seven to the control group (212 patients). The percentage of patients referred to urologists did not differ significantly between the intervention group vs the control group: within 3 months 19.7% versus 10.4% (OR 1.9, 95% CI 0.8 to 5.0), and within 12 months 28.8% versus 21.2% (OR 1.5, 95% CI 0.9 to 2.5).

CONCLUSIONS

Performing uroflowmetry and ultrasound bladder scanning in primary care as additional diagnostic tools do not reduce the number of referrals to urologists. We do not recommend using these diagnostic tools in general practice in the diagnostic work-up of these patients.

Evaluation of non-invasive tests as diagnostic tools in assessment of bladder outlet obstruction severity in men with anterior urethral stricture

Introduction

The aim of this article was to evaluate non-invasive tests, which were typically used in preoperative diagnosis of male patients with anterior urethral strictures in the assessment of the urethral resistance caused by urethral occlusion.

Material and methods

A total of 63 adult males with confirmed urethral stricture and aged below 55 years old were enrolled in the study. Data obtained from non-invasive tests such as uroflowmetry (UF), ultrasound examination (USG), and questionnaires such as from The International Prostatic Symptom Score (IPSS), and The Patient-Reported Outcome Measure for Urethral Stricture Surgery (USS-PROM) were analyzed.

Results

Among all analyzed non-invasive tests, bladder wall thickness (BWT) showed the highest correlation with the degree of urethral occlusion described as percentage of preserved urethral lumen (r = -0.70; p <0.0001). UF variables presented medium degree of correlation, with maximum flow rate (Qmax) as the best parameter (p = 0.45; p = 0.0005). Results from both questionnaires did not show any correlation with the severity of the urethral stricture. Multiple linear regression analysis showed that only BWT was an independent predictor in detection degree of urethral occlusion.

Conclusions

UF and USG seem to be useful additional diagnostic tools in assessment severity of urethral occlusion in men suffering from anterior urethral stricture. Among them, USG had the highest correlation with degree of urethral occlusion.

Uroflowmetry pattern in detrusor underactivity and bladder outlet obstruction in male patients with lower urinary tract symptoms

OBJECTIVES

To investigate if uroflowmetry (UFM) curve patterns could differentiate between detrusor underactivity (DU) and bladder outlet obstruction (BOO).

METHODS

A hundred consecutive data sets of male patients who were evaluated using UFM and invasive urodynamics (pressure flow study) were retrospectively collected. DU and BOO were diagnosed according to the bladder contractility index and BOO index. The UFM curve with two or more notches was defined as sawtooth pattern, and the interrupted pattern was defined if several curves with interruptions reducing to zero were noted. We also compared other UFM parameters including maximum and average flow rates (Qmax and Qave), voiding time, time to Qmax, the slope to first peak flow, the number of notches on the curve (sawtooth pattern), the number of curves (interrupted pattern), and the maximum drop on the sawtooth pattern.

RESULTS

Twenty-five and forty-nine patients were categorized in the BOO group and the DU group, respectively. The incidence of sawtooth pattern was significantly higher in the DU group (57%) than in the BOO group (32%), while the incidence of interrupted pattern was not different between the two groups (36% in the BOO group and 49% in the DU group). There were significant differences in age (area under the curve = 0.75), prostatic volume (0.67), the slope to first peak flow (0.58), the number of notches on the curve (0.61), and the maximum drop (0.76) between the two groups.

CONCLUSIONS

The sawtooth UFM pattern is more common in patients with DU than in those with BOO. New parameters on UFM curve patterns could be helpful to evaluate DU and BOO without invasive urodynamics.

[Effect of Tadalafil SZ on endothelial function in patients with erectile dysfunction]

The aim of the study was to assess the efficacy and safety of taking tadalafil at a dose of 5 mg per day or 20 mg "on demand" for the state of endothelial function, the severity of erectile dysfunction (ERD) and urodynamics in men with mild to moderate ERD.

MATERIALS AND METHODS

The study included 60 male patients with benign prostatic hyperplasia aged 44 to 60 years with erectile dysfunction and cardiovascular pathology (arterial hypertension, ischemic heart disease). All patients were divided into 3 groups of 20 people. Patients of the 1st group for the treatment of ERD were prescribed tadalafil (Tadalafil SZ, NAO Severnaya Zvezda) in a daily dose of 5 mg / day. Men of the 2nd group took tadalafil 20 mg "on demand", but at least 1 time per week. The third group, in which tadalafil was not prescribed, served as a control. The duration of the study was 4 weeks.

RESULTS

A significant effect of tadalafil on indicators of endothelial dysfunction (endothelin-1, nitric oxide, stiffness and reflection index, endothelial function indicator) was demonstrated. The use of tadalafil at a dose of 5 mg daily for four weeks has been shown to be advantageous compared to the use of 20 mg "on demand". Daily intake of tadalafil at a dose of 5 mg and 20 mg "on demand" was safe for patients with cardiovascular disease.

CONCLUSION

The data obtained make it possible to recommend this drug for the correction of endothelial dysfunction in patients with benign prostatic hyperplasia, including patients with concomitant cardiovascular diseases.

The Relationship between Vitamin D Level and Lower Urinary Tract Symptoms in Women

Objectives:

In the literature, the effects of vitamin D on lower urinary tract symptoms (LUTS) have been investigated. Conflicting results have been reported in these studies conducted. LUTS is more common in women. In this study, we aimed to evaluate the relationship between vitamin D and LUTS in female patients using the uroflowmetric method.

Methods:

This retrospective cohort study included 186 female patients who were admitted with LUTS. Demographic characteristics, medical history, calcium (Ca) and vitamin D, including laboratory studies and uroflowmetry results, as maximum urine flow rate (Qmax), average urine flow rate (Qav) and voided volume (V) were recorded. Patients were divided into two groups according to age (18-50 and ≥51) and vitamin D levels (<20 and ≥20). Laboratory parameters and uroflowmetry results were compared between groups.

Results:

Mean age was 56.85±12.95 years. Mean vitamin D level was 21.19±13.93 ng/mL (2.5-83.5). Mean Qmax value was 35.41±12.63, whereas the mean Qav was 19.13±9.89, and the mean V was 446.60±165.08 mL. Vitamin D levels differed according to age groups (p=0.044). No significant difference was observed between groups according to Qmax, Qav and V values (p>0.05). No significant correlation was detected between vitamin D level and Qmax, Qav and V values. However, a negative correlation was detected between serum Ca level and V values (p=0.042) in the low vitamin D group.

Conclusion:

There was no direct relationship between vitamin D levels and LUTS in respect to uroflowmetry. However, we determined that Ca levels affect the uroflowmetry parameter in patients with low vitamin D levels. There is a need for further studies emphasizing serum Ca levels in addition to vitamin D levels in patients with LUTS.

Comparison of Outcome and Success Rate of Onlay Island Flap and Dorsal Inlay Graft in Hypospadias Reconstruction: A Prospective Study

Background

Chordee correction, urethroplasty, and tissue reconstruction are performed to correct and retain standard functionality of the penis in hypospadias. Conventional reconstruction techniques, such as onlay island flap and the dorsal inlay graft, can be performed based on the classification of hypospadias. However, the outcomes and complication rates have not been widely studied. Thus, we aimed to provide preliminary evidence regarding the efficacy and safety of both approaches in hypospadias reconstruction.

Patients and Methods

A prospective study with two time evaluations of 14 and 180 days post-operatively was performed at the Urology outpatient clinic from October 2014 to September 2019. A proportion comparison of success rate, time to the complication, operation time, catheterization duration, uroflowmetry parameter post-surgery, and mean scores comparison of PPPS were measured as the intended outcomes.

Results

In a total of 59 pediatric hypospadias, patients who had undergone reconstruction are included in this study. Higher subjects’ age and severe chordee severity were more common in the dorsal inlay graft group (age=7.50 [1–26] months; severe chordee 45.8%) compared to the onlay island flap group (age=4.0 [1–67] months; severe chordee 31.4%), both groups showed similar satisfaction regarding meatal shape and position (P=0.618), glands shape (P=0.324), penile skin shape (P=0.489), and general cosmetic appearance (P=0.526). Complication occurrence and time to complication duration of both groups were also not statistically significant (P=0.464 and P=0.413). There are no significant differences in Q_max, Q_mean, voided volume, and PVR of both groups (P=0.125, 0.136, 0.076, 0.260, respectively). Significant differences in operation times and catheterization duration are found in this study (P<0001).

Conclusion

Outcome evaluation regarding functional, complication and patient satisfaction comparing onlay flap and dorsal inlay graft for hypospadias patients is scarce. This study found that both procedures can be considered safe with comparable incidence of complications.

Urological Aspects in Patients with Alkaptonuria: A Case-Control Study

This study aimed to evaluate the urinary tract for dynamic function and stones and calcifications in patients with alkaptonuria. Thirty-eight patients were prospectively divided into two groups. Study group (A) involved 17 patients; the average age was 42 years. The control group (B) involved 21 patients; the average age was 37 years. All patients from the two groups underwent uroflowmetry assessment and ultrasonography for the kidneys and urinary bladder, and prostate in two phases (full bladder and empty bladder). Group A-Bladder volume ranged between 400 and 520 cc. The peak flow rate was between 7 and 23 mL/s, with an average of 18.6 mL/s. Flow rate curves shape were acceptable to the normal bell-shape curve in 11 patients. Seven patients (41%) had prostate calcification accounting for 5%-35% of prostate size. Group B-Bladder volume ranged between 290 and 510 cc. The peak flow rate was 8-27 ml/s, with an average of 20 mL/sec. Normal bell shape voiding curves were observed in 17 patients (80%). Four patients (19%) had prostate calcification accounting for 2%-12% of prostate size. Renal measurements on ultrasonography were the same in both groups. Patients with alkaptonuria developed prostate calcification at younger age; they have a slight but not statistically significant reduced peak urinary flow rate and post void residual urine.

Uroflowmetry in Non-Monosymptomatic Nocturnal Enuresis in Children of Coastal Region of Croatia

PURPOSE

The aim of the study was to describe clinical characteristics and bladder assessment in children with Non-Monosymptomatic Nocturnal Enuresis (NMNE) in coastal region of Croatia.

MATERIALS AND METHODS

Records on 85 patients with NMNE were retrospectively reviewed. Bladder assessments were performed in all children. In this research we: (i) compare clinical characteristics and features of bladder assessment: uroflowmetry, post void residuals (PVR) and bladder wall thickness between boys and girls with NMNE and we compare (ii) clinical characteristics and bladder assessment between children with primary and secondary NMNE.

RESULTS

There were 46 girls and 39 boys. The total of 59 children had primary NMNE and 26 children had secondary NMNE. Uroflow pattern was abnormal in 42% of all children with NMNE. Abnormal uroflow pattern in children with NMNE was more often in girls than in boys (P < 0.05) and in children with secondary than in children with primary NMNE (P < 0.05). Ultrasound evidence of bladder wall thickness was more frequent in boys than in girls. Girls were more likely to have dysfunctional voiding and larger residual urinary volume than boys.

CONCLUSIONS

Abnormal uroflow pattern in children with NMNE was more often in girls than boys and in children with secondary than in children with primary NMNE.

Evaluation of Voiding Position on Uroflowmetry Parameters and Post Void Residual Urine in Patients With Benign Prostatic Hyperplasia and Healthy Men

Uncertainty remains whether it is best for men to void in a sitting or standing position. The objective of this study is to evaluate the effect of standing and sitting voiding position on uroflowmetry parameters and post void residual urine (PVRU) in patients with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) and healthy men. A total of 116 participants with BPH (Group 1) and 78 healthy men (Group 2) were enrolled in the study. The uroflowmetry parameters were measured in both positions. The PVRU volume was measured using transabdominal ultrasound after each voiding. Uroflowmetry parameters and PVRU were measured and compared between the two different voiding positions using Wilcoxon signed rank test. In Group 1, there were significant statistical differences in uroflowmetry parameters between standing and sitting voiding position. The median of maximum flow rate in Group 1 in standing and sitting position was 14.7 ml/s (IQR; 11.7-17.5) and 11 ml/s (IQR; 8.9-13.3), respectively (p < .0001). The median voided volume at standing position was 340 ml (IQR; 276-455) while it was 267 ml (IQR; 194-390) at sitting position (p < .0001). Median average flow rate in standing position was 5.9 ml/s (IQR; 4.5-7.5) and 5 ml (IQR; 3.2-6.4) in sitting position. There was a statistically significant difference between the median of PVRU in standing and sitting position (p < .0001). In patients with BPH, voiding in standing position showed better uroflowmetry parameters and significant less PVRU volume.

A comparative study of alpha-1a blockers (tamsulosin) versus estrogens in the treatment of lower urinary tract symptoms in perimenopausal females

OBJECTIVE

Lower urinary tract symptoms (LUTS) in perimenopausal females are very common. It can be treated with alpha-blockers or application of topical oestrogen. The purpose of this study is to compare the efficacy of alpha-blockers versus topical estrogen in the treatment of LUTS in perimenopausal females.

MATERIALS AND METHODS

All perimenopausal females between the age group of 45 and 60 years who present with the symptom of voiding LUTS were divided into two groups. Acute urinary retention patients were excluded from the study. The first group was given alpha-blocker (tamsulosin) and other group was given topical estrogen application (0.5%-1%) in the periurethral region. Patients were followed up clinically by voiding components of the International Prostate Symptom Score and objectively by uroflowmetry and postvoid residual (PVR) urine estimation (ultrasonography).

RESULTS

Alpha-blocker group had 40 females and topical estrogen group had 40 females. During the 6-week period, 8 patients of the first group and 6 patients of the estrogen group discontinued the treatment. In the first group, pretreatment mean Qmax (maximum flow rate) of patients was 7.2 ml/s and posttreatment Qmax was 18.4. In the second group, the values were 7.4 ml/s and 10.2, respectively. This difference was statistically significant (P < 0.0001). In the first group, pretreatment PVR urine was significant, which became insignificant after the treatment, whereas in the second group, PVR was significant posttreatment also.

CONCLUSION

Alpha-1a blockers should be used as the first-line medical management in perimenopausal females with symptoms of LUTS, as they have a clear advantage over topical estrogens.

Quality control of uroflowmetry and urodynamic data from two large multicenter studies of male lower urinary tract symptoms

AIM

The International Continence Society (ICS) has standardized quality control and interpretation of uroflowmetry and urodynamics. We evaluated traces from two large studies of male lower urinary tract symptoms (UPSTREAM and UNBLOCS) against ICS standards of urodynamic equipment and practice.

METHODS

Ten percent of uroflowmetry and urodynamics traces were selected at random from hospital sites. A data capture template was designed from the ICS Fundamentals of Urodynamic Practice checklist. Two pretrained blinded assessors extracted the data, with a third assessor to arbitrate. Departmental records of calibration checks and equipment maintenance were scrutinized.

RESULTS

Seven out of twenty-five (28%) departments reported no calibration checks. Four sites (16%) could not provide annual service records. In 32 out of 296 (10.8%) uroflowmetry traces, findings were affected by artifact. One hundred ten urodynamic study traces were reviewed; in 11 records (10%), key pressure traces were incompletely displayed. In 30 (27.2%), reference zero was not set to atmospheric pressure. Resting pressures were outside the expected range for 36 (32.7%). Pressure drift was seen in 18 traces (16.4%). At pressure-flow study commencement, permission to void was omitted in 15 (13.6%). Cough testing after voiding was done in 71.2%, but the resulting cough spikes were significantly different in 16.5%. Erroneous diagnosis of bladder outlet obstruction (BOO) was identified in six cases (5.5%).

CONCLUSIONS

Erroneous diagnosis of BOO is a serious error of interpretation, as it could lead to unnecessary surgery. Other errors of standardization, testing, and interpretation were identified with lower risk of adverse implications. Inconsistent documentation of service records mean equipment accuracy is uncertain.

Flow resistive forces index (QRF): Development and clinical applicability assessment of a novel measure of bladder outlet resistance, aiming to enhance the diagnostic performance of uroflowmetry

BACKGROUND

Currently, the diagnostic ability of uroflowmetry, the most widely used urodynamic test available for initial assessment of patients with lower urinary tract symptoms (LUTS), is considered limited by its inability to accurately discriminate between the underlying mechanisms of this condition. To improve the diagnostic accuracy of uroflow, we developed a mathematical formula that calculates the flow resistive forces index (QRF), a novel measure of bladder outflow/urethral resistance, and assessed its clinical applicability compared to the maximum flow rate (Q_max ).

MATERIALS AND METHODS

A cross-sectional observational study was conducted in a cohort of 61 adult men presenting with voiding dysfunction symptoms, who all underwent free uroflowmetry followed by pressure flow study. The development of the mathematical formula which contains five key uroflowmetry variables (voided volume, flow time, Q_max , average flow rate, and peak flow time) was based on the assumption that urine volume momentum changes during voiding, the concept of diphasic uroflow pattern (acceleration/deceleration), and the urethral resistance factor (URA) equation. Study subjects were classified either as obstructed or nonobstructed according to established urodynamic criteria (linearized passive urethral resistance relation, LinPURR; Abrams-Griffiths number, AGN [also called bladder outlet obstruction index, BOOI]; and URA). Univariate linear correlations, binary logistic regression model, and receiver operating characteristic (ROC) curve statistical analysis were employed (SPSS-22, MedCalc, GraphPad [P < .05]).

RESULTS

Outflow obstruction was diagnosed in 50.8% (1 in 2) patients. Univariate analysis, and bivariate linear correlation, binary logistic regression, and ROC curve analyses showed that the QRF was a strong independent predictor of bladder outlet/outflow obstruction (BOO), significantly outperforming Q_max .

CONCLUSIONS

QRF index accurately predicts BOO, significantly outperforming the currently widely used bladder outlet obstruction estimator Q_max . Despite potential study limitations (mainly small cohort size and lack of control group), we anticipate that with further study and proper clinical validation, QRF could become a valuable complement to uroflowmetry.

Normative noninvasive bladder function measurements in healthy women: A systematic review and meta-analysis

AIM

To conduct an evidence synthesis of normative reference values for bladder function parameters in women.

METHODS

We conducted a systematic review and meta-analysis of studies reporting bladder function parameters obtained from noninvasive tests in healthy women. Seven databases were searched for relevant studies from inception through December 2018, with manual searching of reference lists. We included English language articles that provided quantitative data on urination frequency, voided and postvoid residual volumes, and uroflowmetry results in women without lower urinary tract symptoms. Study selection, data extraction, and quality assessment were undertaken by at least two independent reviewers. Random-effects meta-analytic models were used to derive study-level pooled mean estimates and 95% confidence intervals.

RESULTS

A total of 24 studies (N = 3090 women, age range, 18-91 years) met eligibility criteria. Pooled mean estimates of bladder function parameters were: 6.6 daytime voids (95% confidence interval (95% CI), 6.2, 7.0), 0.4 nighttime voids (95% CI, 0.0, 0.8), 1577 mL for 24-hour voided volume (95% CI 1428,1725); 12 mL for postvoid residual volume (95% CI, 4, 20); and 28 mL/sec for maximum flow rate (95% CI, 27,30). Between-study heterogeneity was high for all outcomes (I²  = 61.1-99.6%), but insufficient data were available to explore reasons for this high heterogeneity (eg, differences by age).

CONCLUSION

Although summary mean estimates of bladder function parameters were calculated, the wide heterogeneity across studies precludes generalization of these estimates to all healthy women. Further research is needed to determine normative reference values within specific groups, such as those defined by age.

Chronological Changes In Uroflowmetry After Hypospadias Repair: An Observational Study

Aim

Urinary flow after urethroplasty is of paramount importance. The aim of this study is to evaluate the progression of uroflowmetry (UF) parameters after different distal and proximal hypospadias repair techniques.

Methods

In this cohort study, cases that underwent primary hypospadias repair at our institution between March 2010 and December 2018 were included when uncomplicated, asymptomatic and toilet-trained. UF findings and post void residual were described after each specific technique.

Results

In all, 88 patients were eligible. Time to last UF ranged from 35 to 138 months postoperatively. Significant increase started 36 months after distal tubularized incised plate urethroplasty (TIP) and afterwards than Mathieu technique. While was noticed 24 and 36 months after Onlay technique and proximal TIP, respectively; however, TIP showed steady significant increase atall time intervals. Duckett repair exhibited insignificant change in maximum flow rate (Qmax) values, buccal mucosal graft (BMG) and inner preputial graft (IPG), significant increase in the Qmax values after 6 and 24 months, respectively, then remained steady high. Transposed preputial flap (TPF) showed significant increase at 6-12 months only, then remained steady lower than the other two techniques. Obstructed flow was 37% after distal TIP, 30% after Mathieu, 25% after proximal TIP, 66.7% after Duckett repair, and 33.3% after TPF. There were no obstructed cases after BMG and IPG.

Discussion

Improvement by time varied between techniques. After repair most cases are below the 50th percentile, implying that the reconstructed urethra is not functioning as a normal urethra. Staged repair for proximal hypospadias is preferable to a heroic one-stage procedure.

Conclusion

Choice of the surgical technique for hypospadias repair had impact on the improvement of Qmax values. TIP improved 36 months postoperatively. However, for proximal cases staged graft repair had earlier improvement and higher Qmax values than proximal TIP and Onlay techniques.

Can Grafted Tubularized Incised Plate Urethroplasty be Used to Repair Narrow Urethral Plate Hypospadias? Its Functional Evaluation Using Uroflowmetry

Aim:

Using uroflowmetry, the aim of this study is to determine the functional results of the grafted tubularized incised plate (GTIP) urethroplasty used to repair poor urethral plate hypospadias.

Settings and Design:

Seventy-one patients (mean age: 5.7 years, follow-up: 1–5.5 years) were selected from those who underwent surgery using the GTIP technique from 2013 to 2015 at our institution.

Methods:

Patients included were able to void voluntarily and had no fistula. The flow pattern, maximum urinary flow rate (Q_max), voided volume (vv), average flow rate, and voiding time were measured. The results were expressed as percentiles and interpreted according to Siroky nomogram. The Q_max was considered normal if >25^th percentile, as equivocally obstructed when in the 5^th–25^th percentile, and obstructed if <5^th percentile.

Results:

Hypospadias was distal in 45, mid penile in 17 and proximal penile in 9. The uroflow curve was bell-shaped in 24 (30%), interrupted in 9 (14%), slightly flattened in 31 (46%), and a plateau in 7 (10%). Flow rate nomograms revealed that 49 (68%) were above the 25^th percentile, 9 (17%) were below the 5^th percentile, and 13 (15%) were between these ranges. Eleven patients showed improvement in the flow curve and maximum urinary flow rate (Q_max) in follow-up uroflowmetry.

Conclusion:

GTIP repair provides satisfactory functional results. A long-term follow-up is needed to confirm these results.

Chronic kidney disease and urological disorders: systematic use of uroflowmetry in nephropathic patients

Background

Chronic kidney disease (CKD) is a highly prevalent condition. Urologic disorders are known causes of CKD, but often remain undiagnosed and underestimated also for their insidious onset and slow progression. We aimed to evaluate the prevalence of urological unrecognized diseases in CKD patients by uroflowmetry.

Methods

We enrolled consecutive stable CKD outpatients. The patients carried out two questionnaires, the International Prostate Symptom Score and Incontinence Questionnaire-Short Form, and they also underwent uroflowmetry, evaluating max flow rate (Q_max), voiding time and voided volume values.

Results

A total of 83 patients (43 males, mean age of 59.8 ± 13.3 years) were enrolled. Our study showed 28 males and 10 females with a significant reduction of Q_max (P < 0.001) while 21 females reported a significant increase of Q_max (P < 0.001) with a prevalence of 49.5% of functional urological disease. Moreover, we showed a significant association between Q_max and creatinine (P = 0.013), estimated glomerular filtration rate (P = 0.029) and voiding volume (P = 0.05). We have not shown significant associations with age (P = 0.215), body mass index (P = 0.793), systolic blood pressure (P = 0.642) or diastolic blood pressure (P = 0.305). Moreover, Pearson’s chi-squared test showed a significant association between Q_max altered with CKD (χ²  = 1.885, P = 0.170) and recurrent infection (χ² = 8.886, P = 0.012), while we have not shown an association with proteinuria (χ² = 0.484, P = 0.785), diabetes (χ² = 0.334, P = 0.563) or hypertension (χ² = 1.885, P = 0.170).

Conclusions

We showed an elevated prevalence of urological diseases in nephropathic patients; therefore, we suggest to include uroflowmetry in CKD patient assessment, considering the non-invasiveness, repeatability and low cost of examination. Uroflowmetry could be used to identify previously unrecognized urological diseases, which may prevent the onset of CKD or progression to end-stage renal disease and reduce the costs of management.

Transrectal Doppler Sonography of Benign Prostatic Enlargement in Nigerian Men

Background:

Transrectal ultrasonography (TRUS) is the best route for examining the prostate gland because of transducer proximity, elaboration of zonal anatomical details, and Doppler assessment of prostatic arteries’ hemodynamics.

Materials and Methods:

This was a cross-sectional study of 300 men with benign prostatic enlargement (BPE) and 300 healthy age-matched controls. The resistive index (RI) of the left capsular, right capsular and urethral arteries were assessed by TRUS and correlated with these parameters: maximum urine flow rate (Q_max), total prostatic volume (TPV), transitional zone volume (TZV), transitional zone index (TZI), presumed circle area ratio, and the International Prostatic Symptoms Score (IPSS).

Results:

The RI of capsular and urethral arteries correlated significantly with Q_max, TPV, TZV, TZI, and IPSS. Of the three different RIs evaluated, the RI of UA showed the strongest correlation with Q_max (r =- 0.51; P < 0.0001). The RIs were significantly higher in obstructive BOO than the non-obstructive group (Q_max of <15 ml/sec and ≥15 ml/sec, respectively). The mean RI values were 0.73 ± 0.05 vs. 0.63 ± 0.04 for the RCA; 0.73 ± 0.05 vs. 0.62 ± 0.04 for the LCA; and 0.73 ± 0.06 vs. 0.62 ± 0.05 for the UA in the BPE and controls, respectively (P < 0.001). The TPV values were 52.36 ± 28.67 and 18.28 ± 4.26 in BPE and controls, respectively (P < 0.001).

Conclusion:

Prostatic artery RIs are elevated in BPE. Increase in RI correlated with increase in TPV, TZV and TZI, urinary symptoms’ severity, poor QOL, and the severity of BOO.

Comparative study of urethroplasties to reduce urethral strictures in patients with severe hypospadias

Objective

Transverse island pedicle flap (TIPF) plus transected urethral plate-preserving urethroplasty is increasingly used for treatment of severe hypospadias. We aimed to reduce the occurrence of urethral strictures in patients undergoing such procedures.

Methods

Sixty-five patients with severe hypospadias were enrolled. Thirty-two patients underwent onlay-tube-onlay urethroplasty (Group A), and 33 patients underwent modified Duplay urethroplasty (Group B). Postoperative complications were recorded, including fistulas, urethral strictures, and diverticula.

Results

Three patients (9.4%) in Group A and 10 patients (30.3%) in group B had urethrocutaneous fistulas. Three patients (9.4%) in Group A and 0 patients (0%) in Group B had urethral strictures. No patient in the two groups had symptoms of diverticulum or penile chordee. The results of uroflowmetry were better in Group B than Group A, when comparing uroflow patterns.

Conclusions

TIPF plus transected urethral plate-preserving urethroplasty can lower the occurrence of stricture, which is a challenging complication. The occurrence of stricture was lower in patients who underwent modified Duplay urethroplasty, and neourethral function and quality were better in these patient. Thus, this modified procedure can be used for treatment of severe hypospadias.

Does inguinal hernia repair affect uroflowmetric parameters? A prospective controlled clinical trial

OBJECTIVE

The aim of this study was to determine the changes in uroflowmetric values of male patients following elective inguinal hernia repair.

METHODS

The study group comprised patients treated with open or laparoscopic inguinal hernia repair. Patients who underwent surgery due to various diseases such as cataract, multinodular goiter, choledocholithiasis, thyroid and breast cancer, hydrocele, or spermatocele were recruited to the control group. Perioperative characteristics, including pain assessed using the visual analog scale (VAS), uroflowmetric values, and post-void residual urine volumes (PVR), were recorded preoperatively and on Postoperative Days (POD) 1 and 30. Uroflowmetry, VAS, and PVR values were also recorded for the control group on Study Days 1, 3, and 30.

RESULTS

There were 103 subjects in this study (52 treated with elective inguinal hernia repair in the study group, 51 in the control group). Preoperative VAS, maximum and average flow rate, and PVR were similar in the 2 groups (P > .05 for all), whereas comparisons of these 3 factors on POD 1 revealed significant differences (P < .001 for all). Linear regression analysis demonstrated that preoperative maximum and POD 1 VAS values of patients who underwent elective inguinal hernia repair could significantly predict acute urinary retention or voiding dysfunction (P = .001 for all).

CONCLUSION

Postoperative pain affect parameters and cause urinary retention after open or laparoscopic inguinal hernia repair.

[Current concept of diagnosis of benign prostatic hyperplasia]

This literature review outlines the most common methods of diagnosis of benign prostatic hyperplasia. Promising diagnostic modalities include uroflowmetry, assessment of International Prostate Symptom Score (IPSS), transrectal ultrasound and prostate elastography. The authors address social implications and epidemiological features of the disease in Russia and developed countries.

[Outcomes of ER:YAG LASER treatment of stress urinary incontinence in women]

AIM

To evaluate the effectiveness of a new method of treatment for stress urinary incontinence in women using an ER: YAG laser in SMOOTH mode and investigate pathophysiological and pathomorphological changes induced by erbium laser.

MATERIALS AND METHODS

This study comprised 98 women aged 37-63 years, who between 2014 and 2016 were diagnosed with SUI (type 1 and 2a, 2b) and grade 0-2 vaginal prolapse. The treatment was performed with a 2940 nm Er:YAG laser (Fotona, Slovenia) using a SMOOTH mode. Clinical assessment included PFIQ-7 and PISQ-12 questionnaires, uroflowmetry, laser Doppler flowmetry and biopsy of the anterior vaginal wall. The examination was carried out at baseline and 1-2 months after the treatment.

RESULTS

The effectiveness of treatment was 73%. There was no deterioration after the procedure. Analysis of PFIQ-7 and PISQ-12 questionnaires showed that patients with mild incontinence had the greatest difference between pre- and posttreatment results. Uroflowmetry parameters improved in a majority of patients. Results of laser Doppler flowmetry demonstrated the improvement of blood flow in the microvascular bed. An important feature of the vaginal biopsy after laser exposure was an increase in neoangiogenesis.

DISCUSSION

The findings of questionnaires and clinical evaluation of patients with SUI and vaginal prolapse before and after treatment with Er: YAG laser showed high therapeutic effectiveness of this treatment modality.

CONCLUSION

Clinical effectiveness of ER: YAG laser in SMOOTH mode was 73%. Patients with type 1 and 2a SUI and mild or moderate incontinence have the best prognosis after treatment with this method.

How can we maximize the diagnostic utility of uroflow?: ICI-RS 2017

AIMS

To gauge the current level of diagnostic utility of uroflowmetry and to suggest areas needing research to improve this.

METHODS

A summary of the debate held at the 2017 meeting of the International Consultation on Incontinence Research Society, with subsequent analysis by the authors.

RESULTS

Limited diagnostic sensitivity and specificity exist for maximum flow rates, multiple uroflow measurements, and flow-volume nomograms. There is a lack of clarity in flow rate curve shape description and uroflow time measurement.

CONCLUSIONS

There is a need for research to combine uroflowmetry with other non-invasive indicators. Better standardizations of test technique, flow-volume nomograms, uroflow shape descriptions, and time measurements are required.

[The effectiveness of Uroprofit in women with chronic cystitis]

AIM

To evaluate the effectiveness of the biologically active dietary supplement Uroprofit in the comprehensive management of exacerbations of chronic recurrent cystitis in women.

MATERIALS AND METHODS

We examined 40 women with chronic cystitis aged 20-68 years. All patients were allocated to receive either monotherapy with fosfomycin (Monural) (control group, n=20) or combination therapy with fosfomycin and biologically active dietary supplement Uroprofit (study group, n=20). The results were evaluated at 1 and 2 months after treatment initiation. All patients before and after treatment underwent diagnostic work-up including standard laboratory tests, uroflowmetry, cystometry, cystoscopy, and laser Doppler flowmetry to assess microcirculation.

RESULTS

The patients of the study group showed faster improvement in clinical manifestations of the disease, laboratory indicators, the dynamics of the endoscopic pattern and had positive changes in the bladder mucosa microcirculation.

DISCUSSION

Uroprofit produces an antimicrobial and anti-inflammatory effect, helps normalize urodynamics of the lower urinary tract, improves microcirculation in the bladder wall and reduces the risk of repeated relapses of chronic cystitis.

CONCLUSION

Uroprofit could be recommended as a component of the comprehensive management of exacerbations of chronic recurrent cystitis in women and as the means of preventing relapses in disease-free periods.

Correlation Between Residual Volume of Male Patients After Uroflowmetry and Random Residual Volume

OBJECTIVES

Our aim was to examine correlation between Post-void residual urine (PVR) after uroflowmetry and random PVR.

METHODS

Male patients reporting to the Urology outpatient clinic with LUTS were selected. Patients' age, prostate volume, bladder capacity, voided volume, maximum flow rate, average flow rate, random PVR and PVR after uroflowmetry were recorded. We evaluated the correlations between these parameters. Also we assessed if there was a difference between random PVR and PVR after uroflowmetry. We divided PVR after uroflowmetry and random PVR into three groups: Group 1: 0-50 mL, Group 2: 51-100 mL and Group 3: >100 mL. Also we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL. We compared these groups to determine whether a significant difference.

RESULTS

Seventy-seven patients applying to the urology outpatient clinic were assessed between 2013 and 2014. PVR after uroflowmetry was significantly higher than random PVR (P < 0.001). When we divided PVR after uroflowmetry and random PVR into three groups there was a significant difference between the groups (P = 0.02). When we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL, PVR after uroflowmetry was different, but random PVR was similar (P < 0.001, P = 0.72).

CONCLUSIONS

PVR after uroflowmetry seems to be incorrectly high in patients whose bladder capacity is above 400 mL.

The effectiveness of biofeedback therapy in children with monosymptomatic enuresis resistant to desmopressin treatment

OBJECTIVE

To investigate the effect of biofeedback therapy on children with desmopressin- resistant primary monosymptomatic enuresis (MsE).

MATERIAL AND METHODS

The study comprised both retrospective and prospective sections. A total of 262 medical files of patients who were diagnosed as enuresis between November 2012 and January 2015 were retrospectively screened. Patients with neuropathic bladder, daytime voiding problems, anatomical pathology and enuresis-related diseases were excluded from the study. The demographic data and family characteristics of 29 children with desmopressin- resistantprimary MsE were recorded. After biofeedback treatment patients whose frequency of enuretic episodes decrease by more than 50% were included in the successful biofeedback treatment group (SBTG), while other patients were categorized in the unsuccessful biofeedback treatment group (USGBT). The outcomes of uroflowmetry, voided volume, postvoiding residue (PVR) and total bladder volume/age-adjusted normal bladder capacity (TBV/NBC) were recorded before and at the sixth month of the treatment.

RESULTS

The mean age of 29 patients included in the study was 9.14±3.07 (6-15) years. Of patients, 16 were male (55.2%) and 13 were female (44.8%). Before biofeedback treatment the frequency of enuresis was 25.1±5.76 days/month, while after treatment this was calculated as 8.52±10.07 days/month. After treatment 8 patients (28.6%) achieved complete dryness. Twenty patients (69%), benefited from biofeedback (SBTG), while there were 9 patients (31%) in the USBTG group. There was no significant difference between the SBTG and USBTG groups in terms of age, body mass index and sex. The average bladder capacity of the patients increased from 215 mL to 257 mL after biofeedback treatment (p<0.001). The TBV/NBC value before treatment was 0.66, while after treatment it was 0.77 (p<0.001). There was a statistically significant difference between the SBTG and USBTG groups in terms of presence of MsE in mother, and both parents (p=0.001, p=0.016, respectively).

CONCLUSION

Biofeedback therapy is a safe, simple, and minimally invasive treatment modality in children with MsE resistant to desmopressin treatment. This treatment, which was found to increase total bladder capacity, may be recommended for children with MsE when conventional desmopressin treatment fails.