The impact of pontine disease on lower urinary tract symptoms in patients with multiple sclerosis.

AIMS: To investigate the relationship between pontine lesion characteristics on MRI and lower urinary tract symptoms (LUTS) in patients with multiple sclerosis (MS). METHODS: We performed a prospective cohort study of patients with MS and LUTS who were undergoing brain/spine MRI. Patients were administered the American Urological Association Symptom Score (AUA-SS), Medical, Epidemiologic, and Social Aspects of Aging questionnaire (MESA), and Urogenital Distress Inventory questionnaire (UDI-6), underwent Kurtzke Expanded Disability Status Scale (EDSS) scoring by a neurologist, and had their MRIs reviewed by a neuroradiologist. The relationships between symptom scores and lesion number, size, and location were analyzed. RESULTS: There were 42 patients that completed the study and 20 (48%) had one or more pontine lesions. Total AUA-SS and UDI-6 were related to multiple Short Form Health Survey (SF-36) scales and not EDSS scoring. Weak urinary stream measured on the AUA-SS (P = 0.028), and urgency incontinence measured on the MESA questionnaire (P = 0.034) were related to pontine lesion diameter. There was no difference in urinary symptoms according to the presence or absence of a pontine lesion, or according to lesion location within the pons. CONCLUSIONS: Pontine lesion size appears to be related to lower urinary tract symptoms (weak stream and urgency incontinence) in patients with MS. Therefore, CNS lesion characteristics may be able to phenotype voiding symptoms in patients with MS. Neurourol. Urodynam. 36:453-456, 2017. © 2016 Wiley Periodicals, Inc.

Accuracy of a Portable Bladder Scanner to Measure Post-Void Residual Urine Volume in Women with Pelvic Organ Prolapse.

INTRODUCTION: Lower urinary tract evaluation in women with pelvic organ prolapse commonly includes measurement of the post-void residual urine volume. Portable bladder scanners may not accurately measure post-void residual urine volume in women with pelvic organ prolapse as the bladder is no longer in its normal anatomical position. In this study we investigated the accuracy of the BladderScan® BVI 9400 to measure post-void residual urine volume in women with prolapse. METHODS: We conducted a prospective observational study of 31 women with pelvic organ prolapse being evaluated in the outpatient setting. Women underwent 3 post-void residual urine volume measurements, including 1) portable bladder scan with prolapse not reduced, 2) portable bladder scan with prolapse reduced and 3) straight catheterization. Student's t-test, Pearson's correlation and Bland-Altman analysis were used to compare the 3 measurements. RESULTS: There were no differences in absolute errors among the 3 methods of measurement (all p >0.05). All 3 measurements were strongly correlated (all r >0.85 and all p <0.001). The bladder scan measurements obtained during prolapse reduction did not appear to agree more with the catheterized volume than the bladder scan measurements obtained when prolapse was not reduced. Bladder scan error was not related to obesity (p=0.46) or prior hysterectomy (p=0.81). CONCLUSIONS: Pelvic organ prolapse did not affect post-void residual urine volume measurement error using a portable bladder scanner. Thus, it may be unnecessary to reduce stage 2-3 pelvic organ prolapse before obtaining a post-void residual urine volume measurement.

The presence of high-grade prostatic intraepithelial neoplasia or atypia on prostate biopsy does not adversely affect prostatectomy outcomes for patients otherwise eligible for active surveillance.

OBJECTIVE: To investigate if the presence of concomitant high-grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) on biopsy increases the risk of occult adverse pathology in patients otherwise suitable for active surveillance (AS). METHODS: Patients with D'Amico low-risk prostate cancer on ≥ 10-core biopsy who underwent radical prostatectomy at our academic center were evaluated for eligibility for AS by either Epstein criteria or Memorial Sloan Kettering Cancer Center (MSKCC) criteria. Prostatectomy specimens of patients eligible for AS were compared to determine if the presence of clinical HGPIN or ASAP affected the primary outcomes of pathologic upstaging and Gleason score upgrading. RESULTS: Of 553 patients with low-risk prostate cancer, 400 patients (72.3%) met the MSKCC criteria, whereas only 170 patients (30.7%) met the Epstein criteria. HGPIN was present in approximately 32%, and ASAP in approximately 12%, of each AS cohort. On univariate and multivariate analyses, HGPIN and ASAP had no impact on the rate of upgrading and upstaging in either Epstein or MSKCC AS-eligible patients. Furthermore, the presence of HGPIN and ASAP had no impact on the 5-year biochemical recurrence-free survival. CONCLUSION: The presence of HGPIN or ASAP does not increase the risk of upgrading, upstaging, or adverse pathology at the time of prostatectomy for patients who meet the AS criteria. If otherwise suitable, HGPIN and ASAP should not impact the decision to choose AS. However, analysis of prospective AS trials is required to determine if HGPIN or ASAP impacts tumor progression once on AS.