Patients with renal transplant and moderate-to-severe LUTS benefit from urodynamic evaluation and early transurethral resection of the prostate.

PURPOSE: To assess long-term renal function and micturition pattern of males submitted to transurethral resection of the prostate (TURP) for moderate-to-severe lower urinary tract symptoms (LUTS) after renal transplantation (RT). To investigate the role of clinical and urodynamic (UD) parameters for bladder outlet obstruction (BOO) diagnosis in these patients. METHODS: Retrospective data analysis of ≥ 50 years old patients who underwent RT between 01/2005 and 12/2016. Patients with moderate-to-severe LUTS after RT who underwent a urologic evaluation and a UD study were included. TURP was performed in case of BOO diagnosis. Kidney function and micturition patterns were evaluated before, 3, 12, 24, 36, and 48 months after TURP. Predictors of BOO were assessed at univariable and multivariable logistic regression models. Statistical analysis was performed with STATA16. RESULTS: 233 male patients ≥ 50 years underwent RT. 71/233 (30%) patients developed voiding LUTS. 52/71 (73%) patients with moderate-to-severe LUTS underwent UD. TURP was performed in 36/52 (69%) patients, with BOO diagnosis. Median (interquartile range) follow-up was 108 (75-136) months. Maximum flow at flowmetry (Qmax), International Prostate Symptom Score and post-voided residual volume improved significantly after surgery. Serum creatinine decreased and glomerular filtration rate improved significantly at follow-up, especially when TURP was performed ≤ 6 months from RT. At the multivariable model, bladder capacity ≥ 300 mL (OR = 1.74, CI 95% 1.03-3.15, p = 0.043) and detrusor pressure at Qmax (OR = 2.05, CI 95% 1.48-3.02, p = 0.035) were the independent predictors of BOO. CONCLUSION: RT patients with moderate-to-severe LUTS at risk for BOO and graft failure are better identified by UD than clinical parameters. Bladder capacity and voiding pressure are key for the early diagnosis of BOO.

Perioperative Outcomes of Transurethral Resection, Open Prostatectomy, and Laser Therapy in the Surgical Treatment of Benign Prostatic Obstruction: A "Real-World" Data Analysis from the URO-Cert Prostate Centers.

INTRODUCTION: The aim of the study is to compare length of hospital stay, transfusion rates, and re-intervention rates during hospitalization for transurethral resection of the prostate (TUR-P), open prostatectomy (OP), and laser therapy (LT) for surgical treatment of benign prostatic obstruction (BPO). METHODS: URO-Cert is an organization, in which clinical data of prostatic diseases from 2 university, 19 public, and 3 private hospitals and 270 office-based urologists are collected in order to document treatment quality. Data on diagnostics, therapy, and course of disease are recorded web based. The analysis includes datasets from 2005 to 2017. RESULTS: Of 10,420 patients, 8,389 were treated with TUR-P, 1,334 with OP, and 697 with LT. Median length of hospital stay was 6 days (IQR: 4-7) for TUR-P, 9 days (IQR: 7-11) for OP, and 5 days (IQR: 4-6) for LT (p < 0.001). Risk for a hospital stay ≥7 days was higher for OP versus TUR-P (OR: 7.25; 95% CI = 6.27-8.36; p < 0.001) and LT (OR: 17.89; 95% CI = 14.12-22.65; p < 0.001) and higher for TUR-P versus LT (OR: 2.47; 95% CI = 2.03-3.01; p < 0.001). OP had a significantly higher risk for transfusions than TUR-P (OR: 2.44; 95% CI = 1.74-3.41; p < 0.001) and LT (OR: 3.32; 95% CI = 1.56-7.01; p < 0.001). Transfusion rates were not significantly different between TUR-P and LT (OR: 1.36; 95% CI = 0.66-2.79; p = 0.51). Risk of re-intervention was not different between all 3 approaches. CONCLUSION: OP was associated with higher transfusion rates and longer hospital stay than TUR-P and LT. Risk of transfusion was not different between TUR-P and LT, but TUR-P was inferior to LT concerning length of hospital stay. Re-intervention rates during hospitalization did not differ between the groups.

Therapeutic efficacy of biofeedback pelvic floor muscle exercise in women with dysfunctional voiding.

Dysfunctional voiding (DV), a voiding dysfunction due to hyperactivity of the external urethral sphincter or pelvic floor muscles leading involuntary intermittent contractions during voiding, is not uncommon in neurologically normal women with lower urinary tract symptoms (LUTS). We aimed to investigate the therapeutic efficacy of biofeedback pelvic floor muscle training (PFMT) in female patients with DV and to identify the therapeutic efficacy. Thirty-one patients diagnosed with DV. All participates completed the 3-month biofeedback PFMT program, which was conducted by one experienced physiotherapist. At 3 months after treatment, the assessment of treatment outcomes included global response assessment (GRA), and the changes of clinical symptoms, quality of life index, and uroflowmetry parameters. 25 (80.6%) patients had successful outcomes (GRA ≥ 2), and clinical symptoms and quality of life index significantly improved after PFMT. Additionally, uroflowmetry parameters including maximum flow rate, voided volume, voiding efficiency, total bladder capacity, voiding time, and time to maximum flow rate significantly improved after PFMT treatment. Patients with the history of recurrent urinary tract infection in recent 1 year were found to have unsatisfied therapeutic outcomes. In conclusion, biofeedback PFMT is effective in female patients with DV with significant improvements in clinical symptoms, quality of life, and uroflowmetry parameters. The history of urinary tract infection in recent 1 year is a negative predictor of successful outcome.

The short-term efficacy of electrical pudendal nerve stimulation versus intravesical instillation for the urethral pain syndrome: a randomized clinical trial.

PURPOSE: Urethral pain syndrome is a chronic condition characterized by disturbing feeling or server pain sensed at the urethra without specific treatment. This double-center, two-arm controlled trial aimed to explore the efficacy of electrical pudendal nerve stimulation (EPNS) versus intravesical instillation (II) of heparin and alkalinized lidocaine for urethral pain syndrome (UPS). METHODS: Eighty eligible patients took three sessions of EPNS, or 1 session of II per week, for 6 consecutive weeks. The primary end point was the change of pelvic pain and urgency/frequency symptom (PUF) score from baseline to week 6. Secondary outcome measures included changes of visual analogue scale (VAS) score and three sub-score extracted from PUF score. RESULTS: The enrolled participants were all included in the intention-to-treat analyses, and baseline characteristics between the two groups were well balanced. The post-treatment PUF score decreased by 10.0 (7.00, 16.50) in the EPNS group, and by 7.0 (3.00, 10.00) in the II group. At the closure of treatment, the medians of changes in symptom score, bother score, pain-related score and VAS score were 6.50 (4.25, 10.00), 4.00 (2.00, 6.00), 6.00 (5.00, 8.00),4.50 (2.25, 6.00), respectively, in the EPNS group, and 4.00 (2.00, 7.00), 3.00 (1.00, 3.00), 3.00 (2.00, 6.00), 2.00 (1.00, 4.00), respectively, in the II group. All the between-group differences were statistically significant. CONCLUSION: Compared with the II, the EPNS results in superior pain control and better relief of lower urinary tract symptoms, and deserves further attention. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03671993).

Detrusor overactivity and underactivity: implication for lower urinary tract symptoms related to benign prostate hyperplasia diagnosis and treatment.

INTRODUCTION: Detrusor underactivity (DUA) and detrusor overactivity (DO) have potential impact on the outcomes of surgery for lower urinary tract symptoms related to benign prostate hyperplasia (LUTS/BPH). EVIDENCE ACQUISITION: We performed a literature search including studies on humans enrolling patients with preoperative urodynamic evidence of DO and/or DUA undergoing LUTS/BPH surgery. Factors that may influence the outcomes of surgery in these patients were evaluated. EVIDENCE SYNTHESIS: In patients with DUA mean bladder contractility index improved from +4 to +44.6, mean total International Prostate Symptom Score (IPSS) improved from -3 to -19.5 points, mean maximum urinary flow (Qmax) improved from +1.4 to +11.7 mL/s, and mean postvoid residual volume (PVR) improved from -16.5 to -736 mL. Older age, lack of obstruction, concomitant DO, lower detrusor contractility and use of transurethral resection of the prostate (TURP) or photovaporization (PV) instead of Holmium laser enucleation of the prostate (HoLEP) were associated with worse outcomes. In patients with DO, the percentage of DO resolution ranged from 57.1% to 83.3%. Mean total IPSS, Qmax, and PVR variations ranged from +0.9 to -15.7 points, from -0.2 mL/s to +14 mL/s, and from -19.6 to -202.5 mL, respectively. Older age, lack of obstruction, terminal DO, low maximum cystometric capacity, early and high amplitude DO, and use of transurethral prostate incision instead of TURP or open adenomectomy were associated with worse outcomes. CONCLUSIONS: In patients with DUA or DO, surgery for LUTS/BPH provides overall good results. However, a number of factors can affect these outcomes.

Prostatic Artery Embolization for the Treatment of Recurrent Lower Urinary Tract Symptoms following Transurethral Resection of the Prostate.

PURPOSE: To evaluate the safety and efficacy of prostatic artery embolization (PAE) in patients with recurrent lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) who underwent a previous transurethral resection of the prostate (TURP). MATERIALS AND METHODS: This retrospective study analyzed 15 of 19 patients who underwent PAE for recurrent LUTS after TURP between February 2014 and April 2019. The technical and clinical success rates and complications related to the procedure were recorded. International Prostate Symptom Score (IPSS), quality of life (QoL), and prostatic volume (PV) were evaluated at baseline and 3- and 12-mo follow-up. RESULTS: The intervals from TURP to recurrent symptoms and from TURP to PAE were 4.3 y ± 3.2 and 5.6 y ± 3.8, respectively. Technical success was achieved in all patients. The clinical success rate for LUTS relief at 12 mo was 93.3% (14 of 15). IPSS significantly reduced from 22.5 ± 4.1 at baseline to 9.9 ± 4.9 at 12-mo follow-up, and QoL score improved from 4.7 ± 1.0 to 2.1 ± 1.1 (P < .05 for both). There was a significant mean reduction of 26.6% in PV at 12 mo, improving from 100.7 cm3 ± 38.5 to 73.9 cm3 ± 29.4 (P < .05). No severe complications were encountered. CONCLUSIONS: PAE may be a safe and effective treatment option for the management of recurrent LUTS secondary to BPH in patients who have previously undergone TURP.

An inhibitory effect of Berberine from herbal Coptis chinensis Franch on rat detrusor contraction in benign prostatic hyperplasia associated with lower urinary tract symptoms.

ETHNOPHARMACOLOGICAL RELEVANCE: Coptis chinensis Franch (CCF), also known as Huang Lian in China, is a traditional Chinese medicine that commonly used for more than 2000 years. Clinically, CCF often used as anti-inflammatory, immune regulation and other effects. It has been reported that the decoction containing CCF can be used for the treatment of benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS). AIM OF THE STUDY: This research aims to investigate the effect of CCF on inhibition of BPH development in vivo and in vitro, and further identify the active compound (s) and the possible mechanism involved in BPH-related bladder dysfunction. MATERIALS AND METHODS: Oestrodial/testosterone-induced BPH rat model was established as the in vivo model. The prostate index (PI) was calculated, the pathogenesis was analyzed and the micturition parameters were determined in the shamed-operated, BPH model and BPH + CCF groups after 4-week administration. The tension in detrusor strips was then assessed upon KCl or ACh stimulation with or without incubation of CCF or active compounds. To further investigate the signaling involved, rat detrusor cells were cultured as the in vitro models, the instantaneous calcium influx was measured and the ROCK-1 expression was detected. RESULTS: Increased PI value and the aggravated prostatic pathology were observed with voiding dysfunction in BPH rats, which were significantly blocked by oral CCF taken. ACh or KCl-induced contractile responses in detrusor strips were significantly inhibited and the micturition parameters were improved when incubation with CCF or its active compounds such as berberine. Both CCF and berberine suppressed the cellular calcium influx and ROCK-1 expression upon ACh stimulation, demonstrating that berberine was one of the active compounds that contributed to CCF-improved micturition symptoms and function. CONCLUSIONS: Taken together, our findings give evidence that CCF and its active compound berberine inhibited BPH and bladder dysfunction via Ca2+ and ROCK signaling, supporting their clinical use for BPH and BPH-related LUTS treatment.

Outcomes of transurethral resection of the prostate in unobstructed patients with concomitant detrusor underactivity.

AIMS: The aim of the study was to evaluate the transurethral resection of the prostate (TURP) outcomes of unobstructed patients with detrusor underactivity (DUA), comparing the surgical results between obstructed and unobstructed males with concomitant DUA, at midterm follow-up. METHODS: This was an observational, prospective, comparative, nonrandomized study. Candidates to TURP underwent preoperative urodynamics (UD), with a diagnosis of DUA, were divided in two cohorts: Group A unobstructed men, group B males with bladder outlet obstruction (BOO). Males were evaluated yearly with uroflowmetry (UF), post-void residual (PVR), and bladder voiding efficiency (BVE), International Prostate Symptom Score (IPSS) questionnaire, visual analogic scale (VAS) for subjective assessment of the quality of life. The degree of the variation of maximum flow rate (Qmax), PVR, BVE, IPSS, VAS between baseline and follow-up (Δ) was evaluated. RESULTS: Patients in group A were 28 and in group B 23. Overall patient's mean ± SD age was 63.37 ± 12.41 years. Preoperative urodynamics characteristics: mean bladder contractility index (BCI) of 61.15 and 76.25 in group A and B, respectively; mean bladder outlet obstruction index (BOOI) of 17.25 and 50.15 in group A and group B, respectively. After surgery, overall patient group, group A, and group B showed a statistical improvement in IPSS score (P < .0001), Qmax (P < .0001), PVR (P < .0008), BVE (P < .03) and VAS (P < .0001). CONCLUSIONS: BOO had an important impact on the degree of improvement of Qmax and PVR/BVE, while had a poor influence on lower urinary tract symptoms amelioration. The most relevant outcomes were found when BOO was associated with DUA, which was not a contraindication to surgery.

Neurostimulation in neurogenic patients.

PURPOSE OF REVIEW: To provide an overview of available electrical stimulation devices in neurogenic patients with lower urinary tract disease. RECENT FINDINGS: It is advocated to do more studies in neurogenic patients as results seem promising and useful but most studies did not include neurogenic patients or neurogenic patients were not analyzed or reported separately. Most studies included a small heterogenous neurogenic group with multiple pathophysiologic origin focusing on effect of a treatment instead of results of a treatment in a specific neurogenic group. Neuromodulation or stimulation has the advantage that it acts on different organs, like bladder and bowel, so can treat neurogenic patients, who mostly suffer from multiple organ failure. SUMMARY: Brindley procedure, sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS) are available for a while already. The Brindley procedure (including sacral anterior root stimulation in combination with a rhizotomy of posterior sacral roots) is developed for selected spinal cord injury patient with a complete spinal injury, and has shown results for many years in neurogenic patients. An alternative to the rhizotomy is not established yet. SNM and PTNS are other modalities that are used in nonneurogenic patients, but are not yet indicated and much studied in neurogenic patients.

[Course of neurogenic bladder dysfunction in patients with spinal cord injury under homeopathic treatment]. / Verlauf der neurogenen Blasenfunktionsstörung bei Patienten mit Rückenmarkschädigung unter klassisch homöopathischer Therapie.

BACKGROUND: Nearly all patients with spinal cord injury (SCI) suffer from neurogenic lower urinary tract dysfunction (NLUTD). Untreated NLUTD is a risk factor for renal damage and can significantly affect quality of life (QoL). Patients with SCI frequently use complementary medicine to alleviate symptoms, namely for urologic problems. OBJECTIVES: We evaluated whether homeopathic treatment influences objective urodynamic parameters. MATERIALS AND METHODS: In a retrospective study, urodynamic data of patients with NLUTD due to SCI who received constitutional homeopathic treatment by the consultants of our hospital were evaluated before initiation of homeopathic treatment and at the most recent follow-up. Modifications in urologic treatment were taken into account. RESULTS: Urodynamic results from 35 patients who underwent homeopathic treatment (14 women, 21 men, median age 46 years, tetraplegia: n = 14; paraplegia: n = 21) were available at both time points and could therefore be evaluated. In all, 20 patients used intermittent catheterization, 6 persons had an indwelling catheter, and 9 persons emptied their bladders without a catheter. There were no significant differences in the urodynamic parameters before and during treatment. Changes in urologic therapy correlated with significant improvement in urodynamic findings. CONCLUSIONS: As all patients were under urologic surveillance, and immediate urologic treatment was established if necessary, a retrospective study design proved not to be suitable to detect possible influences of homeopathic treatment on urodynamic parameters in patients with SCI. Thus, a prospective randomized study is essential.

[Benign prostatic hyperplasia : New and treatment-relevant aspects from the DGU guidelines]. / Benignes Prostatasyndrom : Neues und Praxisrelevantes aus den DGU-Leitlinien.

The diagnosis and treatment of lower urinary tract symptoms (LUTS) due to benign prostatic enlargement plays an important role in daily urological practice. Therefore, a targeted and resource-saving approach is essential. A rational base-line work-up of our patients provides the necessary information for obtaining the diagnosis and only needs to be expanded in individual cases. In addition to drug therapy, the modification of lifestyle and the possibility of watchful waiting must not be underestimated. Simple measures such as a timed fluid intake, double micturition in the case of residual urine development, but also bladder reconditioning can significantly improve the quality of life of our patients. Regarding surgical treatment, laser procedures have found their way into many departments and have established themselves in daily routine as a reference procedure in addition to transurethral resection of the prostate (TUR-P) and simple open prostatectomy. New, minimally invasive procedures-such as prostatic artery embolization (PAE), the Rezum™- (NxThera Inc., Maple-Grove, MN, USA) or the Aquabeam® (Procept, Redwood City, CA, USA) procedure, but also nonablative procedures such as iTind© (TIND, Medi-Tate, Or Akiva, Israel) or Urolift® (Neotract Inc., Pleasanton, CA, USA)-offer new treatment options to those affected, with the potential to maintain patient's sexual function. As a result, individual risk assessment and advice on the advantages and disadvantages of all available treatment options-even more than today-will be an important part of LUTS treatment. An individual approach, similar to that used in the treatment of oncological disease, will become standard also in the treatment of benign prostatic syndrome.

Urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux who have undergone sacral neuromodulation.

AIMS: To assess the urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux (VUR) who underwent sacral neuromodulation (SNM). METHODS: We retrospectively reviewed the records of 19 patients with neurogenic lower urinary tract dysfunction (NLUTD) who underwent SNM at our center from July 2018 to July 2019. Clinical data and video-urodynamic parameters were collected. VUR grading systems were used to evaluate upper urinary tract function. RESULTS: The mean test duration was 24 ± 8.2 days. The urodynamic evaluation showed a significant increase in the mean maximum cystometric capacity (136.3 ± 118.2 vs 216.5 ± 137.8 mL; P = .0071) and compliance (8.7 ± 8.52 vs18.3 + 16.47 mL/H2 O; P = .016), as well as a decrease in maximum intravesical pressure (57 ± 39.23 vs 36.58 ± 31.16 H2 O; P = .0064). In the voiding phase, none of the patients had automatic urination at the baseline and testing phases. In 8 of 19 patients who had detrusor overactivity (DO), the DO disappeared (four patients) or was delayed (four patients). The VUR in 3 of 12 ureter units disappeared. The grade of VUR or the volume before VUR improved in 8 ureter units, and the remaining 1 did not change significantly. An implant was performed in 16 cases. After permanent implantation, all patients needed intermittent catheterization to empty the bladder. CONCLUSIONS: This retrospective study indicates that SNM can improve the urinary storage function of the bladder in appropriate patients with NLUTD. For patients with VUR, SNM can cure or reduce VUR by improving DO and bladder compliance.

Randomized Comparison of Prostatic Artery Embolization versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Hyperplasia.

PURPOSE: To compare clinical and functional outcomes of prostatic artery embolization (PAE) with those of transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Noninferiority randomized trial was conducted involving men over 60 years of age with LUTS secondary to BPH. From November 2014 to January 2017, 45 patients were randomized to PAE (n = 23) or to TURP (n = 22). PAE was performed with 300- to 500-µm microspheres with the patient under local anesthesia, whereas bipolar TURP was performed with the patients under spinal or general anesthesia. Primary outcomes were changes in peak urinary flow (Qmax) and international prostate symptoms score (IPSS) from baseline to 12 months. Quality of life (QoL), and prostate volume (PV) changes from baseline to 12 month were secondary outcomes. Adverse events were compared using the Clavien classification. RESULTS: Mean Qmax increased from 6.1 mL/s in the PAE group and from 9.6 mL/s in the TURP patients (P = .862 for noninferiority), and mean IPSS reduction was 21.0 points for PAE and 18.2 points for TURP subjects (P = .080) at 12 months. A greater QoL improvement was reported in the PAE group (3.78 points for PAE and 3.09 points for TURP; P = .002). Mean PV reduction was 20.5 cm³ (34.2%) for PAE subjects and 44.7 cm³ (71.2%) for TURP subjects (P < .001). There were fewer adverse events reported in the PAE group than in the TURP group (n = 15 vs n = 47; P < .001). CONCLUSIONS: Reduction of LUTS in the PAE group was similar to that in the TURP group at 12 months, with fewer complications secondary to PAE. Long-term follow-up is needed to compare the durability of the symptomatic improvement from each procedure.

Brain activation patterns of female multiple sclerosis patients with voiding dysfunction.

AIMS: We compared brain activation patterns between female multiple sclerosis (MS) patients with voiding dysfunction (VD) and those without. We aim to expand current knowledge of supraspinal correlates of voiding initiation within a cohort of female MS patients with and without VD. MATERIALS AND METHODS: Twenty-eight ambulatory female MS patients with stable disease and lower urinary tract dysfunction were recruited for this study. Subjects were divided into group 1, without VD (n = 14), and group 2, with VD (n = 14), defined as postvoid residual urine of ≥40% of maximum cystometric capacity or need for self-catheterization. We recorded brain activity via functional magnetic resonance imaging (fMRI) with simultaneous urodynamic testing. Average fMRI activation maps (the Student t test) were created for both groups, and areas of significant activation were identified (P < .05). A priori regions of interest (ROIs), identified by prior meta-analysis to be involved in voiding, were selected. RESULTS: Group-averaged blood-oxygen level-dependent (BOLD) activation maps demonstrated significant differences between groups 1 and 2 during initiation of voiding with group 2 showing significantly lower levels of activation in all ROIs except for the left cerebellum and right cingulate gyrus. Interestingly, group 2 displayed negative BOLD signals, while group 1 displayed positive signals in the right and left pontine micturition center, right periaqueductal gray, left thalamus, and left cingulate gyrus. The activation map of group 1 was similar to healthy controls. CONCLUSIONS: Our results support the hypothesis that distinct supraspinal activation patterns exist between female MS patients with VD and those without.

Correlation between prostatic urethral angulation and symptomatic improvement after surgery in patients with lower urinary tract symptoms according to prostate size.

PURPOSE: To investigate the effect of prostate anatomical factors on the changes in lower urinary tract symptoms (LUTS) and uroflowmetric values after surgery. METHODS: The medical records of 448 patients who underwent transurethral resection of the prostate (TURP) from January 2006 to December 2018 were analyzed retrospectively. Changes in the International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual urine volume (PVR) at 3 months after TURP were evaluated. Prostate volume, intravesical prostatic protrusion (IPP), and prostatic urethral angulation (PUA) were measured using transrectal ultrasonography, and their effect on the changes in LUTS after TURP was analyzed using multivariable linear regression. RESULTS: Among patients with prostate volume < 50 mL, preoperative IPSS total score (IPSS-t), voiding symptom score (IPSS-vs), and storage symptom score (IPSS-ss) were significantly better in patients with a smaller PUA (< 51°) than in those with a larger PUA (≥ 51°) (p = 0.001, < 0.001, and 0.020, respectively). Changes in IPSS-t, IPSS-vs, IPSS-ss, and PVR at 3 months after TURP were significantly correlated with PUA (p ≤ 0.001, < 0.001, 0.048, and 0.012, respectively). Multivariable linear regression revealed PUA to be independently associated with changes in IPPS-t and IPSS-vs (p = 0.025 and < 0.001, respectively) only in patients with prostate volume < 50 mL. CONCLUSION: Prostatic urethral angulation was significantly associated with postoperative changes in LUTS only in patients with small prostate, and had no clinical significance in patients with large prostate. In patients with small prostate and large PUA, surgery should actively be considered.

Comparison of Short-Term Outcomes between Button-Type Bipolar Plasma Vaporization and Transurethral Resection for the Prostate: A Systematic Review and Meta-Analysis.

Background: Previous meta-analysis evaluated a limited number of parameters regarding the comparison of BTPV and TURP for BPH. Method: PubMed, Embase and Cochrane Library were searched for literature comparing BTPV with TURP. Data of efficacy (IPSS, Qmax, PVR and QoL) and safety were extracted and evaluated using either SMD or OR with 95% CI. All analyses were performed by RevMan 5.3. Results: Eleven trials with 1690 patients were selected. Compare to BTPV, TURP had better 6-month IPSS (SMD=0.36, 95% CI 0.08 to 0.63), better 1- (SMD=-0.38, 95% CI -0.63 to -0.12), 6- (SMD=-0.73, 95% CI -0.99 to -0.46) and 12-month Qmax (SMD=-0.47, 95% CI -0.85 to -0.10), better 6-month PVR (SMD=1.18, 95% CI 0.87 to 1.48), as well as better 3- (SMD=-0.24, 95% CI -0.48 to -0.01) and 6-month QoL (SMD=-0.62, 95% CI -0.91 to -0.33). However, BTPV had shorter catheterization time (SMD=-0.96, 95% CI -1.12 to -0.79) and hospital stay (SMD=-0.71, 95% CI -0.89 to -0.53), less hemoglobin decrease (SMD=-1.09, 95% CI -1.27 to -0.91) and virtually shorter operation time (SMD=-0.15, 95% CI -0.31 to 0.01). Moreover, BTPV had fewer occurrence of overall complications (OR=0.52, 95% CI 0.40 to 0.69), Clavien III-IV complications (OR=0.61, 95% CI 0.37 to 1.02), blood transfusion (OR=0.25, 95% CI 0.09 to 0.69), hematuria (OR=0.27, 95% CI 0.13 to 0.56) and capsular perforation (OR=0.19, 95% CI 0.08 to 0.48). Subgroup analysis indicated BTPV and bipolar TURP had similar total complications (OR 1.08, 95% CI 0.40-2.88, P=0.88) and Clavien III-IV complications (OR 1.42, 95% CI 0.36-5.57, P=0.61) and blood transfusion rate (OR 0.28, 95% CI 0.04-1.73, P=0.17). Conclusion: Both TURP and BTPV could significantly improve IPPS, Qmax, PVR and QoL. TURP had slightly better short-term efficacy, while BTPV had better safety. However, subgroup analysis found bipolar TURP and BTPV had similar safety.

The real-life management of overactive bladder: Turkish Continence Society multicenter prospective cohort study with short-term outcome.

INTRODUCTION: Turkish Continence Society aimed to analyze how overactive bladder (OAB) is being managed in routine practice by the urologists in Turkey. MATERIAL AND METHODS: Fourteen urology departments were randomly selected to represent the whole population in this multicenter study. An online data entry and storage software was created for patient recruitment and data assessment. A survey including demographic data, daily habits, lower urinary tract symptoms, and Turkish-validated OAB-V8 and ICIQ-SF questionnaires were completed by all patients. Second part of the survey, including the questions about clinical evaluation and management of the patient, was completed by the treating physician. RESULTS: A total of 507 patients (394 female and 113 male) were included. Behavioral therapy was recommended to 73.2% of female and 81.4% of male patients although bladder diary was requested for 59.5% and 52.7% of the female and male patients, respectively. In the first visit, 86.1% of the female and 89.3% of the male patients were given antimuscarinics (P = .431). Antimuscarinic-related side effects occurred in 94.9% and 88.9% of the female and male patients, respectively (P = .937). However, the rate of medical treatment change due to antimuscarinic-related side effects was only 1.7% in female and 4.8% in male patients at the end of 4 months. CONCLUSIONS: Behavioral therapy and antimuscarinics were the preferred initial treatment modalities of OAB in concordance with the guidelines. Despite guideline recommendations, bladder diaries were not utilized in half of the patients. Insufficient efficacy appeared to be the main reason for treatment modification.

Persistent storage symptoms after TURP can be predicted with a nomogram derived from the ice water test.

PURPOSE: To predict the persistence of storage symptoms after transurethral resection of the prostate (TURP) using a nomogram derived from the ice water test (IWT). METHODS: The IWTs of 73 men with lower urinary tract symptoms and prostatic bladder outlet obstruction were retrospectively analyzed. The strength of the detrusor contraction was approximated by using the detrusor gradient of Δpdet /Δt at maximum detrusor pressure and the area under the curve. The parameters were utilized in a nomogram, which facilitated a severity categorization from 1 to 10. Patients with a positive IWT in the categories 1 to 2 were assigned to group A, categories 3 to 4 to group B and categories 5 and higher to group C. After TURP, patients with persisting storage symptoms were offered a botulinum toxin injection. RESULTS: There were 32 patients (44%) with negative and 41 patients (56%) with positive IWTs. Patients with negative IWTs were classified in category 1. Regarding patients with positive IWTs, 14 (34%) were correlated to group A, 14 (34%) to group B, and 13 (32%) to group C. The necessity of a subsequent botulinum toxin injection correlated significantly with a higher nomogram category (P < .001) as well as higher severity categorization (P < .001). In multivariate analysis, the nomogram category was an independent predictor for botulinum toxin injection (P = .002, OR, 6.9, CI, 2.0-23.9). CONCLUSION: The quantification of the detrusor contraction during the IWT allowed stratification of patients in risk categories for persistent storage symptoms after TURP and the potential need for later botulinum toxin injections.

Impact of 5-Alpha-Reductase Inhibitors Use at the Time of Prostatic Artery Embolization for Treatment of Benign Prostatic Obstruction.

PURPOSE: To compare the 12-month post-prostatic artery embolization (PAE) clinical outcomes of patients who were and were not taking 5-alpha-reductase inhibitors (5ARIs) at the time of PAE. MATERIALS AND METHODS: A retrospective review was conducted of patients who underwent PAE from 2010 to 2017 due to lower urinary tract symptoms, secondary to benign prostatic hyperplasia (BPH). One hundred fifty-five patients were included and divided in 2 groups; these groups did not present statistically significant differences in their baseline characteristics-those taking 5ARIs (Y-5ARIs, n = 40) and those not taking 5ARIs (N-5ARIs, n = 115). International Prostate Symptom Score (IPSS), the sub-item Quality of Life (QoL), and the incidence of clinical failure were used as primary endpoints. Secondary endpoints included mean prostate volume reduction and mean peak flow rate (Qmax) improvement. Clinical failure or recurrence was defined as absence of symptomatic improvement (IPSS ≥ 8 or QoL ≥ 3) or the need for invasive BPH treatment (PAE or transurethral resection of the prostate) during the 12-month follow-up period. RESULTS: After 12-month follow-up, IPSS, QoL, and prostatic volume were significantly lower compared to baseline in both groups, and Qmax showed a significant increase. No statistically significant differences were observed in outcomes between N-5ARIs and Y-5ARIs, and the clinical failure rate for both groups was approximately 20%. CONCLUSIONS: The use of 5ARIs did not show a detrimental effect on clinical outcomes of PAE, in either subjective (IPSS, QoL, and clinical failure) or objective (prostatic volume and Qmax) parameters.

Pelvic floor biofeedback therapy in children: Assessment of symptom scores in responders and non-responders.

INTRODUCTION: Pelvic Floor Biofeedback Therapy (PFBT) can be an effective treatment for pediatric lower urinary tract symptoms (LUTS). Due to differing perceptions of efficacy and practice patterns, we sought to further evaluate PFBT in our practice. We hypothesized that PFBT results in quiescence of EMG activity during voiding and improves questionnaire scores in patients with LUTS. METHODS: We retrospectively reviewed all patients undergoing PFBT and refined the analysis to females ≥6 years old with ≥2 sessions with completed voiding questionnaires pre- and post-treatment, active EMG during voiding, with non-neurogenic urinary tract complaints refractory to standard urotherapy. Validated Bladder Bowel Dysfunction (BBD) questionnaires were collected at each visit. Quiescence of EMG activity and changes in BBD score were the primary outcomes. RESULTS: 229 patients underwent ≥1 PFBT session, of which 64 females ≥6 years of age with ≥2 PFBT sessions and completed pre and post PFBT voiding questionnaires were identified. In this group, mean age at PFBT start was 10.1 (6.2-17.0). Patients completed 3.1 sessions (2-6). No difference was seen in post-void residual (PVR) between first and last session (23.8 vs 22.6 mL, P = 0.55). Median questionnaire score decreased from 18 (4-42) before to 13 (2-28) following PFBT (P < 0.0001). Responders, characterized by silencing of the EMG after PFBT, occurred in 31% (20/64). Non-responders were younger (P = 0.007) with higher pre-PFBT questionnaire scores. CONCLUSION: The use of PFBT appears to result in a significant reduction in symptom scores, though quiescence of EMG was observed following therapy in less than 1/3 of patients.