High Prevalence of Psychological Comorbidities and Functional Neurological Symptoms in Women With Urinary Retention.

PURPOSE: Chronic idiopathic urinary retention (CIUR) in young women is poorly understood and a probable etiology is established only in around 40%, most commonly a primary disorder of external urethral sphincter relaxation, sometimes referred to as Fowler's syndrome. A high prevalence of psychological and functional comorbidities is reported, however these have been poorly characterized. MATERIALS AND METHODS: Women consecutively referred for the assessment and management of CIUR were evaluated cross-sectionally for 13 psychological/behavioral domains using a structured clinical interview: depression, anxiety, post-traumatic stress disorder (PTSD), other psychiatric history, functional neurological disorder, other functional syndromes, childhood and adult trauma, personality disorder, and self-harm (ever/current). RESULTS: A total of 91 women (mean age [SD]: 34 [11] years) were evaluated. Women with Fowler's syndrome (n = 69) were younger (mean age [SD]: 32 [9] vs 40 [13] years) than women without Fowler's syndrome and reported shorter mean duration of urinary symptoms (mean [SD]: 5 [6] vs 10 [9]). A high prevalence of psychiatric and psychological comorbidities was reported (97%) including current depression (77%), current anxiety (78%), and PTSD (32%). A high prevalence of functional neurological disorder (56%) and other functional symptoms (65%) was also reported. Self-harm was reported in (14%) and personality disorder in 16%. Childhood trauma was reported in 35% of women. CONCLUSIONS: Young women with CIUR report a high burden of psychiatric disorders, affective symptoms, trauma, PTSD, self-harm, and functional neurological disorder, particularly in those with Fowler's syndrome. These factors can undermine the engagement with health care professionals and affect management and should therefore be addressed during the urological assessment.

The Association of Previous Prostate Biopsy Related Complications and the Type of Complication with Patient Compliance with Rebiopsy Scheme.

PURPOSE: Prostate biopsy complications have important consequences that may affect patient compliance with rebiopsy schemes. However, to our knowledge this has not been studied in earnest. Thus, we evaluated whether previous prostate biopsy related complications and the type of complication were associated with repeat prostate biopsy compliance in a clinical trial with study mandated systematic biopsies. MATERIALS AND METHODS: We retrospectively analyzed the records of 4,939 men 50 to 75 years old who underwent 2-year prostate biopsy and were recommended to undergo 4-year prostate rebiopsy in the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) study. The analyzed biopsy complications were hematuria, urinary tract infection, acute urinary retention and hemospermia. RESULTS: A total of 260 men (5.3%) had a 2-year prostate biopsy related complication, including hematuria in 180 (3.6%), urinary tract infection in 36 (0.7%), acute urinary retention in 26 (0.5%) and hemospermia in 102 (2.1%). A total of 474 men (9.6%) were noncompliant with 4-year rebiopsy. On univariable analysis any previous complication (OR 1.56, 95% CI 1.08-2.24, p = 0.018), urinary tract infection (OR 2.72, 95% CI 1.23-6.00, p = 0.013), acute urinary retention (OR 4.24, 95% CI 1.83-9.81, p = 0.016) and hemospermia (OR 1.78, 95% CI 1.03-3.06, p = 0.037) were associated with rebiopsy noncompliance. Hematuria was not associated with rebiopsy noncompliance (OR 1.19, 95% CI 0.74-1.91, p = 0.483). Results were unchanged on multivariable analysis, including for any complication (OR 1.65, 95% CI 1.08-2.26, p = 0.018), for urinary tract infection (OR 2.62, 95% CI 1.07-3.21, p = 0.029), for acute urinary retention (OR 4.51, 95% CI 1.93-10.54, p = 0.001), for hemospermia (OR 1.85, 95% CI 1.07-3.21, p = 0.029) and for hematuria (OR 1.19, 95% CI 0.74-1.93, p = 0.472). CONCLUSIONS: In men who undergo repeat prostate biopsy a previous biopsy related complication and the type of complication were associated with lower compliance with rebiopsy schemes. Patients who experience biopsy related complications are ideal candidates to receive intervention regarding the importance of prostate rebiopsy to prevent noncompliance.

Affective symptoms and quality of life in patients with voiding or storage dysfunction: Results before and after sacral neuromodulation: A prospective follow-up study.

AIMS: Sacral neuromodulation (SNM) is an effective treatment for patients with overactive bladder syndrome (OAB) or non-obstructive urinary retention (NOR). These lower urinary tract symptoms (LUTS) are the result of a functional urological cause but often coincide with psychological and/or psychiatric factors. It has been stated that there is an association between LUTS, depression and anxiety disorders. With this study we will investigate whether affective symptoms and quality of life (QoL) improve after successful SNM. METHODS: All patients eligible for SNM between March 2013 and March 2016, filled out the HADS (Hospital Anxiety and Depression Scale), SF-36 (Short Form-36) and either the International Consultation on Incontinence Modular Questionnaire (ICIQ) on Male/Female Lower Urinary Tract Symptoms (M/F-LUTS), or the OAB-q questionnaire, before and after the test procedure. Symptom improvement of ≥50% was considered as success. Results were analyzed by paired T-tests and the Wilcoxon signed-rank test. RESULTS: In total 95 patients were included. Mean age was 52.1 (SD 13.9). Fifty-six patients (59%) were implanted. Successful OAB patients reported a significant improvement in all domains of OAB-q, health change and affective symptoms. Successful NOR patients showed a significant improvement in voiding symptoms (P = 0.04) and health change (P = 0.03). However, they did not report significant improvement in affective symptoms. CONCLUSION: QoL and affective symptoms can significantly improve in LUTS patients who are successfully treated with SNM. When divided per indication, a significant improvement in affective symptoms together with QoL was only reported in successful OAB patients and not in successfully treated NOR patients.

Cognitive Behavioural Therapy for Paruresis or "Shy Bladder Syndrome": A Case Study.

BACKGROUND: Paruresis, or "shy bladder syndrome", is a relatively common anxiety disorder, yet little is known about the causes of, and effective treatments for this disabling condition. AIM: This report describes a case study in which a man (Peter) presenting with paruresis was treated using formulation-driven CBT, which aimed to address the idiosyncratic processes that were maintaining his anxiety and avoidance of urinating in public. METHOD: Peter attended 12 sessions of CBT including one follow-up session a month after treatment had ended. Treatment involved collaboratively developing an idiosyncratic case conceptualization (identifying longitudinal and cross-sectional factors involved in the development and maintenance of his difficulties), followed by a number of standard cognitive and behavioural interventions commonly used in evidence-based CBT protocols for other anxiety disorders. Peter completed sessional outcome measures of paruresis symptomatology, anxiety, depression, social anxiety and functional impairment. RESULTS: Peter subjectively found the intervention helpful and his scores on all of the outcome measures reduced over the course of his therapy, and were maintained at one month follow-up. CONCLUSIONS: This report adds to the scarce literature regarding effective treatments for individuals suffering with paruresis. Limitations of the design are acknowledged and ideas for further research in this area are discussed.

Screening for depression and anxiety in patients with storage or voiding dysfunction: A retrospective cohort study predicting outcome of sacral neuromodulation.

AIMS: It has been reported that somatic treatment in patients with affective symptoms has a higher risk of failure. The aim was to investigate whether affective symptoms could predict the outcome of sacral neuromodulation (SNM) for lower urinary tract symptoms (LUTS). METHODS: All patients that underwent a SNM evaluation between 2006 and 2013 and filled out a Hospital Anxiety and Depression Score (HADS) before treatment, were included. Chi-square analysis and bivariate logistic regression were used to assess associations and predictive value. RESULTS: Eighty-six patients were included, 65 females and 21 males. Most patients, 66, had overactive bladder syndrome (OAB). The remaining 20 patients suffered from non-obstructive urinary retention (NOR). Thirty-nine OAB patients and 17 NOR patients, had a normal total HADS score before treatment. Significantly more patients showed abnormal HADS-D (P = 0.047) and HADS-A (P = 0.015) scores in the OAB group compared to the NOR group. Success of SNM could not be predicted by the HADS score P = 0.464 (after 1 year P = 0.446). Subsequent analysis revealed that an abnormal HADS score was not related to the occurrence of SNM adverse events. CONCLUSIONS: The present study did not reveal a significant relationship between an abnormal HADS score and failure of the SNM test period in a mixed group of OAB and NOR patients. However, differences between OAB and NOR patients concerning affective symptoms were present. It is known that psychological factors play a role in the severity of LUTS, but they may not predict SNM outcome. Neurourol. Urodynam. 35:1011-1016, 2016. © 2015 Wiley Periodicals, Inc.

Health-related quality of life and psychological well-being in patients with benign prostatic hyperplasia.

AIMS AND OBJECTIVES: To examine the health-related quality of life and psychological well-being of patients with benign prostatic hyperplasia and identify the predictive factors of health-related quality of life. BACKGROUND: Benign prostatic hyperplasia is highly prevalent in ageing men and causes bothersome lower urinary tract symptoms, which has a negative impact on their health-related quality of life. The current practice of managing benign prostatic hyperplasia focuses on relieving physical symptoms. However, the impact of benign prostatic hyperplasia on the patients' health-related quality of life and psychological well-being remains understudied, especially in the Asian population. DESIGN: A descriptive correlational survey study. METHODS: A convenience sample of 97 patients with benign prostatic hyperplasia was recruited at an outpatient urology clinic of a tertiary hospital in Singapore. The health-related quality of life, lower urinary tract symptoms and psychological well-being of the participants were assessed using the 12-item Short-Form Health Survey, International Prostate Symptom Score and the Hospital Anxiety and Depression Scale, respectively. RESULTS: The health-related quality of life scores were low with physical and mental health component scores of 47·0 and 48·9, respectively, as assessed by the 12-item Short-Form Health Survey. There was a high prevalence of anxiety (10·3%) and depression (21·6%). Correlation analysis revealed significantly negative relationships between lower urinary tract symptoms, anxiety, depression and physical and mental health dimensions of the 12-item Short-Form Health Survey. Multiple linear regression analysis further identified that postvoid residual urine and lower urinary tract symptoms were predictive factors of the physical health dimension, whereas anxiety and depression were predictive factors of the mental health dimension of the 12-item Short-Form Health Survey. CONCLUSIONS: The health-related quality of life of patients with benign prostatic hyperplasia was poor, and their psychological well-being was severely affected. Postvoid residual urine, lower urinary tract symptoms, anxiety and depression were identified to be significant predictive factors of the health-related quality of life of patients with benign prostatic hyperplasia. RELEVANCE TO CLINICAL PRACTICE: Findings from this study provide useful evidence-based information for healthcare professionals in the development and implementation of effective and culturally sensitive interventions to improve the health-related quality of life and psychological well-being of patients with benign prostatic hyperplasia.

Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia.

PURPOSE: To show that prostatic artery embolization (PAE) improves quality of life (QoL) and lower urinary tract symptoms in patients with acute urinary retention caused by benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: This was a single-center prospective study of PAE in 11 patients with BPH managed with indwelling urinary catheters. International Prostate Symptom Score (IPSS), ultrasound, magnetic resonance (MR) imaging, QoL, and urodynamic tests were used to assess outcomes. Prostate size ranged from 30 to 90 g, and embolizations were performed with 300-500-µm Embosphere microspheres. RESULTS: The rate of technical success (ie, bilateral PAE) was 75%, and the rate of clinical success (ie, catheter removal and symptom improvement) was 91% (10 of 11 patients). Postembolization syndrome manifested as mild pain in the perineum, retropubic area, and/or urethra. Ten of 11 patients urinated spontaneously after Foley catheter removal 4-25 days after PAE (mean, 12.1 d). No major complications were observed. Follow-up ranged from 19 to 48 months. In an asymptomatic patient, a discrete area of hypoperfusion suggesting small ischemia of the bladder was observed on 30-day MR imaging follow-up, but the bladder was normal on 90-day MR imaging. After 1 year, mean prostate volume reduction was greater than 30%, symptoms were mild (mean IPSS, 2.8 ± 2.1; P = .04), no erectile dysfunction was observed, and QoL improved significantly (mean, 0.4 ± 0.5; P = .001) using the paired t test. CONCLUSIONS: Patients with severe symptoms and acute urinary retention caused by BPH can be treated safely by PAE, which improves clinical symptoms and QoL.

Psychological and psychiatric factors as predictors for success in sacral neuromodulation treatment.

UNLABELLED: What's known on the subject? and What does the study add? Sacral neuromodulation (SNM) is a well-established treatment for patients with chronic LUTS. The selection of eligible candidates could be improved by identifying factors that can predict a successful response. In the present study, we evaluated the role of various psychological and psychiatric factors in relation to SNM treatment. OBJECTIVE: • To evaluate if psychological and psychiatric factors can predict the outcome of test stimulation or permanent treatment with sacral neuromodulation (SNM). PATIENTS AND METHODS: • Between 2006 and 2009, patients with overactive bladder syndrome or non-obstructive urinary retention who were eligible for test stimulation were included. • All patients completed the Amsterdam Biographic Questionnaire (ABQ), which measures the personality traits of the patient, and the Symptom Check-List-90-Revised (SCL-90-R), which is a screening instrument for neuroticism, and for current level of complaints. • The results of the questionnaires were compared with the outcomes of test stimulation and permanent treatment. • In addition to the questionnaires, we also included the psychiatric history as a potential predictive factor. RESULTS: • On univariate analysis there was no relationship between the psychological characteristics and the outcome of test stimulation or the occurrence of adverse events (AEs) with permanent treatment. • A history of psychiatric disease was not related to the outcome of test stimulation, but was shown to be a positive predictor for the occurrence of AEs with permanent SNM treatment. CONCLUSIONS: • In the present study there was no evidence that psychological screening with the ABQ or SCL-90-R can predict the outcome of SNM treatment. • Patients with a medical history of psychiatric disease appear to be more likely to encounter AEs with permanent SNM treatment.

[Devastated bladder outlet-suprapubic catheter vs. reconstruction]. / Der zerstörte Blasenauslass ("devastated bladder outlet") ­ suprapubischer Katheter vs. Rekonstruktion.

The combination of a severe urethral sphincter defect with simultaneous development of recurrent bladder outlet obstruction characterizes a "devastated bladder outlet", which often is not surgically reconstructable. Clinically, quality of life is considerably compromised in affected patients with a wide variance of symptoms, mostly complete incontinence, but also urinary retention. This condition is usually preceded by multiple endoscopic interventions or even open surgical procedures, occasionally also in combination with radiotherapy of the pelvic region as part of multimodal oncological therapy. Treatment of these cases is complex and limited to few promising procedures. A potential therapy should primarily include the decision about the possibility of preserving the urinary bladder. In individual cases, this can result in simple therapy options while at the same time maintaining an acceptable quality of life for those affected. If there is no possibility of a refunctionalization of the original bladder, supravesical urinary diversion is indicated as a last-resort therapy. This paper provides a review as well as the limits and possibilities of conservative and surgical treatment options for a devastated bladder outlet.

Social stress in mice induces voiding dysfunction and bladder wall remodeling.

Several studies have anecdotally reported the occurrence of altered urinary voiding patterns in rodents exposed to social stress. A recent study characterized the urodynamic and central changes in a rat model of social defeat. Here, we describe a similar voiding phenotype induced in mice by social stress and in addition we describe potential molecular mechanisms underlying the resulting bladder wall remodeling. The mechanism leading to the altered voiding habits and underlying bladder phenotype may be relevant to the human syndrome of dysfunctional voiding which is thought to have a psychological component. To better characterize and investigate social stress-induced bladder wall hypertrophy, FVB mice (6 wk old) were randomized to either social stress or control manipulation. The stress involved repeated cycles of a 1-h direct exposure to a larger aggressive C57Bl6 breeder mouse followed by a 23-h period of barrier separation over 4 wk. Social stress resulted in altered urinary voiding patterns suggestive of urinary retention and increased bladder mass. In vivo cystometry revealed an increased volume at micturition with no change in the voiding pressure. Examination of these bladders revealed increased nuclear expression of the transcription factors MEF-2 and NFAT, as well as increased expression of the myosin heavy chain B isoform mRNA. BrdU uptake was increased within the urothelium and lamina propria layers in the social stress group. We conclude that social stress induces urinary retention that ultimately leads to shifts in transcription factors, alterations in myosin heavy chain isoform expression, and increases in DNA synthesis that mediate bladder wall remodeling. Social stress-induced bladder dysfunction in rodents may provide insight into the underlying mechanisms and potential treatment of dysfunctional voiding in humans.

Impact of urodynamic based incontinence diagnosis on quality of life in women.

AIMS: To characterize the effect of urodynamic diagnosis on degree of incontinence related bother and health related quality of life in a large, multi-ethnic population of women. METHODS: Effects of multichannel urodynamic diagnosis, urethral competency, and other patient characteristics on abbreviated Urogenital Distress Inventory (UDI6) and Incontinence Impact Questionnaire (IIQ7) composite scores were analyzed retrospectively. RESULTS: Six hundred eleven patients were included. Mean UDI6 and IIQ7 scores were significantly higher among patients with mixed incontinence, detrusor overactivity, urinary stress incontinence with overactive bladder, and negative studies compared to those with stress incontinence without OAB. The relative composite UDI6 and IIQ7 mean scores did not significantly differ between the mixed incontinence, detrusor overactivity, stress incontinence with OAB and negative study groups. UDI6 and IIQ7 scores were significantly higher among stress incontinent patients with intrinsic sphincter deficiency, but similar among mixed incontinent patients with intrinsic sphincter deficiency. CONCLUSION: Urodynamic diagnoses of detrusor overactivity, mixed incontinence, and stress incontinence with overactive bladder are associated with significantly worse incontinence related bother and health related quality of life when compared to those with stress incontinence without OAB. These conditions appear to have similar degree of impact on incontinence related bother and quality of life. Patients presenting with symptoms of incontinence can suffer a similar compromise in quality of life despite a negative MCUD study.

The psychometric validation of a US English satisfaction measure for patients with benign prostatic hyperplasia and lower urinary tract symptoms.

BACKGROUND: The purpose of the current study was to validate the US English Patient Perception of Study Medication (PPSM) questionnaire, which measures patient satisfaction with Benign Prostatic Hyperplasia (BPH) treatment and was administered to men with BPH lower urinary tract symptoms (LUTS) enrolled in a multi-national clinical trial. METHODS: Patients with moderate to severe BPH symptoms completed three disease-specific measures: The International Prostate Symptom Score (IPSS), the BPH Impact Index (BII) and the PPSM, at baseline (after completion of the placebo run-in period) and at every 13-week clinic visit thereafter for the duration of the study treatment period. The PPSM was analysed to assess its variability, reliability and validity. RESULTS: There were 879 patients included in the analyses, with a mean age of 66.7 years. The PPSM was found to comprise two factors - PPSM-Global and PPSM-Pain, with a Total Score ranging from 7 to 49. It demonstrated good internal consistency (Cronbach's alpha ranged from .95 to .97) and also demonstrated convergent validity through significant correlations with the IPSS (.48 to .58), IPSS Quality of Life (QoL) item (.41 to .63) and BII (.31 to .45) and known-groups validity against the IPSS, IPSS QoL item and BII. CONCLUSION: Results support the use of the PPSM as a measure of satisfaction in BPH patient groups.

Paruresis or shy bladder syndrome: an unknown urologic malady?

To date, shy bladder syndrome, or "paruresis," chiefly has been seen as a psychological problem; consequently, little attention has been focused on this debilitating condition. The best estimate is that 7% of the general population, or approximately 17 million people in the United States, suffer from paruresis. While much has been written about urologic topics, such as incontinence and the neurogenic bladder, urologic literature does not contain any articles that specifically refer to paruresis. Little is known about the underlying causes of paruresis, but research indicates that the condition may have a physiological basis in addition to the more obvious psychological factors. Paruresis is a complex medical condition of unknown origin. The lack of awareness among the medical, nursing, and therapeutic communities contributes to the significant unmet needs of patients suffering from paruresis and its related symptoms. Only with education and research, in addition to clarification and agreement of the terminology for this phenomenon, can progress be made in understanding and effectively treating paruresis.

Paruresis (psychogenic inhibition of micturition): cognitive behavioral formulation and treatment.

Paruresis is a condition characterized by difficulty or inability to urinate in situations where others are present, or may soon be present. Despite knowledge that paruresis can significantly impact on occupational functioning, social functioning, and quality of life, there exists a paucity of research into effective treatments. Although cognitive conceptualizations have been advanced for other anxiety disorders, there has not been a comprehensive cognitive behavioral model of paruresis. This article presents a revised cognitive and behavioral conceptualization of paruresis, drawing on empirical evidence from other anxiety disorders. Using this conceptualization, a cognitive-behavioral intervention strategy is outlined, with clear targets for cognitive and behavioral strategies.

Sacral neuromodulation for urinary retention.

Urinary retention without an identifiable urological cause presents a diagnostic and therapeutic challenge. Patients with nonobstructive chronic urinary retention usually have to rely on intermittent self-catheterization or indwelling suprapubic or transurethral catheters, which significantly affect quality of life. For some patients, however, sacral neuromodulation (SNM) offers an effective therapeutic alternative, and women with primary disorder of urethral sphincter relaxation (Fowler's syndrome) seem to respond particularly well to this treatment. Although the mechanism of action of SNM is not well understood and requires further investigation, it seems to involve afferent mediation of spinal cord reflexes and brain networks. The evolution of SNM devices and improvements in surgical and testing techniques, especially the introduction of the two-stage tined lead procedure, have considerably reduced the failure, adverse event and surgical revision rates associated with SNM, ensuring that this modality is an effective minimally invasive treatment for urinary retention.

Traditional Vietnamese health and healing.

Approximately 1.2 million Vietnamese live in the United States. Health care providers need to understand that this population differs greatly from other cultures depending on gender, religion, generation, reason for migration, enclave identity, educational level, and language preference. This article will explore the history, communication practices, biocultural ecology, and health care principles among this population.

Can feeling of incomplete bladder emptying reflect significant postvoid residual urine? Is it reliable as a symptom solely?

PURPOSE: The main objective of this study was to reveal the relationship between lower urinary tract symptoms (LUTS) and post-void residual (PVR) urine volume. MATERIALS AND METHODS: Between October 2014 and February 2015, older than 40 years patients were included in this study. Volunteers filled out a questionnaire consisted of demographic characteristics, comorbidities, medications, history of surgery and LUTS. Volunteers were undergone PVR measurement with transabdominal ultrasonography. The relationship between symptoms, demographic characteristics and PVR were analyzed. RESULTS: A total of 939 patients (756 men and 183 women) were enrolled in this study. There was a positive correlation between the sensation of incomplete bladder emptying and PVR volume in all age groups of women (p=0.0001). However such a relationship was found only over the age of 60 in the subgroup analysis of men (p=0.001). PVR volume increased in men by age (0.65 mL per year of age, p=0.011). In men, voiding symptoms and urgency were associated with a high PVR volume. In women, storage and voiding symptoms (except slow stream and terminal dribble) did not correlate with PVR volume. CONCLUSIONS: Our study showed that all men over the age of 60 years and all women with the complaint of feeling of incomplete emptying should undergone PVR measurement. Women with the complaint of poor stream and men mainly with voiding symptoms are other candidates in whom PVR measurement would be considered as an important tool in the clinical management and follow-up.

Efficacy, Safety, and Durability of 532 nm Laser Photovaporization of the Prostate with GreenLight 180 W XPS in Men with Acute Urinary Retention.

OBJECTIVE: We assessed the effectiveness and durability of 532 nm laser photovaporization with GreenLight XPS in men with and without preoperative urinary retention. MATERIALS AND METHODS: From 2010 to 2017 we prospectively studied men who underwent photovaporization of the prostate (PVP) for obstructive lower urinary tract symptoms (LUTS) secondary to BPH. The cohort was retrospectively divided into those with catheter dependent retention and those with elective PVP. Primary endpoints were catheter-free rate and improvement in quality of life (QoL) scores, international prostate symptom score (IPSS), maximum urinary flow rate (Qmax), and postvoid residual (PVR). The secondary endpoints of the study were complication outcomes as defined by the standardized Clavien-Dindo grading system. RESULTS: One hundred thirty-seven men with preoperative retention and 195 men without preoperative retention underwent PVP. Men with preoperative retention were older (70 years vs 66 years; p < 0.001), had a higher American Society of Anesthesiology (ASA) score, and had a higher prevalence of neurologic disease (8% vs 2.6%; p = 0.04). These men also had a larger prostate volume (76 cc vs 69 cc; p < 0.001) and higher prostate specific antigen (5 ng/mL vs 2.7 ng/mL; p < 0.001) than those without retention. Patients with preoperative retention also had higher preoperative baseline IPSS and QoL score. After PVP they improved to values similar to those without retention, with durability up to 24 months. After PVP, men in preoperative retention had similar rates to fail their first void trial (18.2% vs 10.3%, p = 0.053). There was a 96% catheter-free rate in the men with preoperative retention. The rate of complication was higher in the nonretention group, specifically at 90 days (35.4% vs 21.2%; p = 0.009), with almost all the complications being Clavien-Dindo grade 2. CONCLUSION: PVP is an effective, safe, and durable treatment for men in acute urinary retention (AUR) with a catheter-free rate of 96%. The improvement is similar to those who did not present in AUR.

Qualitative Exploration of the Patient Experience of Underactive Bladder.

BACKGROUND: Underactive bladder (UAB) is considered the symptom complex associated with the urodynamic diagnosis of detrusor underactivity. OBJECTIVE: The aim of this research was to investigate the patient reported experience of the symptoms, signs, and impact of UAB. This research is also part of the initial qualitative phase for the development of a new patient reported outcome measure for the assessment of UAB. DESIGN, SETTING, AND PARTICIPANTS: Qualitative methods were used to understand the experience of UAB from a patient perspective, in a purposive sample of male (n=29) and female (n=15) patients aged 27-88 yr (mean: 64 yr), diagnosed with a primary diagnosis of detrusor underactivity, with or without coexisting urological conditions. Semistructured interviews were conducted in Bristol, UK. RESULTS: Male and female patients reported a variety of lower urinary tract symptoms and associated impact on quality of life. Storage symptoms of nocturia, increased daytime frequency, and urgency, and the voiding symptoms of slow stream, hesitancy, and straining were reported by over half of the patients. A sensation of incomplete emptying and postmicturition dribble were also frequently described. Most had a post void residual >30ml (n=34, 77%, median: 199ml) with many reporting urinary tract infections, a history of self-catheterisation, and some experiencing occasional acute retention episodes. These symptoms and signs can have a broad impact on quality of life including having to plan their daily activities around the location of toilets, disruption to sleep, social life, and associated effect on family and friends. CONCLUSIONS: Knowledge of the lived experience of UAB obtained in the current study will be used for the development of a new patient reported outcome measure and help inform the current working definition of UAB. PATIENT SUMMARY: The symptoms, signs, and impact on quality of life of underactive bladder are described by patients with the condition.