Surgical management of a large iatrogenic urethral diverticulum in a male patient: A case report.

Acquired urethral diverticula in male patients are a rare finding. We report a case of a 70-year male with a past medical history of type 2 diabetes who presented with post micturition dribbling and a scrotal mass which was identified as a urethral diverticulum. We also outline the surgical management in this patient and review similar cases reported in the literature.

Ambulatory urodynamics in clinical practice: A single centre experience.

OBJECTIVES: To assess the additional value of ambulatory urodynamics (AUDS) monitoring in the management of patients with unexplained lower urinary tract symptoms. METHODS: A retrospective review of the urodynamic data at a tertiary referral center between January 2006 and December 2018. During this period 12,123 urodynamic studies were conducted; 430 patients were arranged to have AUDS monitoring because their symptoms were not reproduced with either standard or video urodynamics (UDS). RESULTS: A total of 391 patients were included, (360 females, 31 males). Symptoms were reproduced in 74% of cases. The most common AUDS finding was detrusor overactivity with or without incontinence, followed by urodynamic stress incontinence. In 75.7% of the patients, the additional information from AUDS resulted in a change to patient management. CONCLUSIONS: Additional UDS findings were made in the majority of patients who underwent AUDS. This helped in setting a new treatment plan for the bothersome urinary findings. AUDS monitoring is a useful additional diagnostic tool and can help to guide patient management where symptoms are not explained by standard or video UDS.

Use of an occlusive penile clamp during filling cystometry in men with symptoms of stress urinary incontinence.

OBJECTIVE: In severe post-prostatectomy stress urinary incontinence (SUI), urodynamics may not identify crucial parameters because of inadequate bladder filling. This study evaluated cystometry and pressure flow studies (PFS) in men in whom severe SUI during attempted filling necessitated application of a penile clamp to allow filling to reach cystometric capacity. Men who had undergone prior radical prostatectomy were identified from a database of patients attending for video urodynamic testing between 2012 and 2017. Symptom scores, bladder diary and free flow rate tests were retrieved. Measurements of the subgroup of men for whom a Thomson-Walker compression clamp was used to enable full urodynamic evaluation were evaluated. 166 patients were identified. In 30 patients (18%), severe SUI led to incomplete filling cystometry. Following application of the penile compression clamp, further filling was achieved in each case. Applying the clamp did not alter vesical filling or impede pressure recording. These men had a lower maximum urethral closure pressure (31.6 vs. 46.5 cm H2 O; P < 0.001), volume at strong desire to void (132 vs. 242 mL; P = 0.003) and cystometric capacity (226 mL with clamp applied vs. 310 mL; P < 0.001) than the overall post-prostatectomy incontinence population. Flow rates during PFS were comparable, but detrusor pressure at maximum flow was lower in the clamp group (11 vs. 22 cm H2 O; P = 0.009). A penile clamp applied at the time when leakage becomes excessive during filling cystometry avoids premature test termination in men with severe incontinence.

Profile of mirabegron in the treatment of overactive bladder: place in therapy.

Mirabegron is a relatively new drug introduced to treat overactive bladder syndrome. It can be used either on its own or as part of a combination. This drug has been extensively studied, with a good number of Phase II and Phase III trials showing promising outcomes. These studies show that mirabegron is an effective, well-tolerated drug, which could have some adverse effects of concern. In this review, we look at the trials on mirabegron, as well as its pharmacokinetics, mechanism of action, and side effects as documented in the literature.