Noninvasive external therapy of traditional Chinese medicine for preventing postpartum urinary retention in women with vaginal delivery: A network meta-analysis.

BACKGROUND: To compare the effect of different noninvasive external therapies of traditional Chinese medicine (TCM) on the prevention of postpartum urinary retention (PUR) using a network meta-analysis (NMA). METHODS: A search of the China National Knowledge Infrastructure, WanFangDate, VIP, China Biomedical Literature Database, PubMed, The Cochrane Library, Embase, and Web of Science databases were reviewed for related randomized controlled trials dated between database inception and December 31, 2022, on the prevention of PUR by noninvasive TCM. Two researchers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies; then, a NMA was performed using Revman5.3 software, State13.1 software, and frequency methodology. RESULTS: In total, 16 studies involving 3637 cases of parturients and 9 types of noninvasive TCM external treatments were incorporated into the NMA. The NMA results show that based on routine nursing, in terms of reducing the incidence of urinary retention, acupoint compressing combined with auricular acupressure is ranked first, followed by acupoint hot compress, acupoint massage combined with auricular acupressure, Yin-Yang therapy, acupoint massage, auricular acupressure, acupoint compressing, and routine nursing. In terms of urination time, acupoint compressing combined with auricular acupressure ranked first, followed by acupoint massage combined with auricular acupressure, acupoint electrical stimulation, acupoint compressing, TCM heating therapy, acupoint massage, auricular acupressure, and routine nursing. In terms of reducing residual urine volume after the first urination, acupoint compressing combined with auricular acupressure was ranked first, followed by auricular acupressure, acupoint compressing, acupoint massage, TCM heating therapy, and routine nursing. CONCLUSION: Current evidence shows that acupoint compressing combined with auricular acupressure may be the best noninvasive TCM treatment for preventing PUR based on routine nursing; however, further high-quality clinical randomized controlled trials are needed for validation and support.

Nursing interventions reduce postoperative urinary retention in fast-track total hip arthroplasty: A pilot study.

BACKGROUND: Postoperative urinary retention (POUR) is a common complication of spinal anesthesia that occurs in 10-80% of patients after total hip replacement (THR). Bladder catheterization carries risks for urinary tract infections, mechanical urethral trauma, urethral inflammation and subsequent strictures, pain, discomfort, an increased length of hospital stay, and a loss of patient dignity. OBJECTIVES: We investigated whether simple postoperative nurse-driven intervention protocols, including the sound of running tap water, followed by caffeinated hot beverages (tea or coffee) and pouring warm saline on the perineal area, could reduce POUR and the need for bladder catheterization. MATERIAL AND METHODS: This pilot study included 60 patients undergoing elective fast-track THR with spinal anesthesia and early patient ambulation. Patients with postoperative voiding difficulties received nursing interventions, including hearing running tap water, ingesting caffeinated beverages (tea and coffee), and warm saline poured over the perineal area. If voiding difficulties continued, bladder distention was examined by ultrasound. Catheterization was performed if the volume exceeded 500 mL or if distension caused discomfort or pain. RESULTS: Seven patients (11%) were excluded from the study due to prophylactic preoperative catheterization. Among the 53 included patients, 27 (51%) experienced spontaneous voiding difficulties and received nursing interventions, which induced voiding in 24 patients (45%, p = 0.0027), while 3 (6%) required catheterization. CONCLUSION: Simple nursing interventions reduced the need for bladder catheterization after fast-track THR.

Auricular bean embedding improves urination in epidural labor analgesia: A single center randomized controlled study.

BACKGROUND: Acupoint buried beans on the auricle is a feasible method to prevent and treat postpartum urinary retention. OBJECTIVE: This study investigated the effect of auricular acupoint buried beans on postpartum urination and maternal and fetal outcomes following epidural analgesia for labor. METHODS: Two hundred forty primiparas underwent vaginal trial labor analgesia from May 2020 to January 2021 and were randomly placed into the intervention and control groups. Both groups received epidural labor analgesia. Maternal urination during labor, 2 h postpartum, and the time for first postpartum urination were recorded as primary outcomes, with maternal and infant outcomes documented as secondary results. Statistical analysis was performed using the independent sample t-test, non-parametric rank-sum, or chi-square test using the SPSS Statistics 25.0 software. RESULTS: Two hundred eight study participants were subsequently included in the results, i.e., 105 patients in the intervention group and 103 in the control group. The intervention group comprised a significantly lower number of patients with excessive residual urine volume at cervical dilatation of 5-6 cm (P< 0.05). The total postpartum score of the intervention group was lower than in the control group (P< 0.01), and the time to first urination was shorter compared with the control group (P< 0.05). In the intervention group, the time of labor analgesia, the duration of the first stage of labor, and the total labor time were shorter compared with the control group (P< 0.01). CONCLUSION: Auricular acupoint embedded beans can improve the urination status at cervical dilatation of 5-6 cm and 2 h postpartum, as well as significantly shorten the duration of labor.

Changes in Anesthesia Can Reduce Periprocedural Urinary Retention After EVAR.

BACKGROUND: Enhanced recovery after surgery (ERAS) programs provide a streamlined approach for expedient postoperative care of high-volume procedures. Endovascular aortic repair (EVAR) has become standard treatment for abdominal aortic aneurysms and implementation of an early recovery program is warranted. Postoperative urinary retention (POUR) remains a problem lending to longer hospital stays and patient discomfort. We aim to demonstrate the utility of monitored anesthetic care (MAC) plus local anesthesia as a modality to minimize urinary retention following EVAR. METHODS: Single-center retrospective review from January 2017 to March 2020 of all patients undergoing standard elective EVAR under general anesthesia or MAC anesthesia. Local anesthetic at vessel access sites was used in all patients under MAC. Ruptured pathology and female sex were excluded from analysis. Patient characteristics, operative details, prostate measurements, and outcomes were abstracted from the electronic medical record. Urinary retention was defined as any requirement of straight catheterization, urinary catheter replacement, or discharge with urinary catheter. Chi square tests and logistic regression were used to determine predictors associated with POUR and increased hospital length of stay. RESULTS: Among 138 patients who underwent EVAR, eight (5.8%) were excluded due to ruptured pathology. Of the cohort, 113 (86.9%) were male with mean age of 73 years. Excluding female patients, 63 (55.8%) male patients underwent general anesthesia and 50 (44.3%) underwent MAC. Male patients under general anesthesia were more likely to have intra-operative urinary catheter placement when compared to MAC (82.5% vs. 36%, respectively; P < 0.001). POUR was identified in 17 patients (13.1%) of the entire study population with 15 events (88.2%) occurring in males. Excluding patients who were admitted to the ICU, twenty-two (19.5%) male patients stayed past postoperative day (POD) one, of which those who developed POUR were more likely to experience compared to those without POUR (45.6% vs. 9.7%, respectively; P = 0.001). On multivariable analysis, male patients who received MAC had a lower risk of developing POUR (OR 0.09, 95% CI 0.02-0.50). POUR was not associated with elective urinary catheter placement nor with pre-existing conditions such as diabetes, urinary retention, benign prostatic hypertrophy (BPH), or use of BPH medications. Additionally, neither prostate size nor volume was associated with developing POUR among male patients. CONCLUSION: MAC plus local anesthesia is associated with decreased rates of POUR after elective EVAR in male patients. ERAS pathways during elective EVAR interventions should implement MAC plus local anesthesia as an acceptable anesthetic option, where appropriate, in order to reduce urinary retention rates and subsequently decrease hospital length of stay in this patient cohort.

Can bipolar transurethral enucleation of the prostate be a better alternative to the bipolar transurethral resection of the prostate?: A prospective comparative study.

ABSTRACT: To analyze the efficacy and safety between bipolar transurethral enucleation of the prostate (BipoLEP) and bipolar transurethral resection of the prostate (B-TURP).One hundred twenty eight patients with benign prostatic hyperplasia were recruited and divided into group 1 (BipoLEP group, n = 72) and group 2 (B-TURP group, n = 56). The study period was from October 2016 to February 2019. All data parameters were prospectively collected and analyzed.In these 2 groups, there were no significant differences of the mean ages (71.88 ±â€Š6.54 years vs 73.05 ±â€Š7.05 years, P = .407), prostate volumes (99.14 ±â€Š9.5 mL vs 95.08 ±â€Š10.93 mL, P = .302) and the mean operation times (93.7 ±â€Š27.5 minutes vs 89.8 ±â€Š22.4 minutes, P = .065). In BipoLEP group, it had more prostate tissue resected (64.2 ±â€Š22.1 g vs 52.7 ±â€Š28.6 g, P = .018), less duration of continuous bladder irrigation (20.7 ±â€Š6.5 hours vs 29.6 ±â€Š8.3 hours, P = .044), shorter catheterization time (4.3 ±â€Š1.5 days vs 5.6 ±â€Š2.1 days, P = .032), shorter hospitalization stay (5.2 ±â€Š1.4 days vs 6.5 ±â€Š1.9 days, P = .031) and less complications (3 cases vs 9 cases, P = .021). There were significant improvements in 3-month postoperative parameters, including: post void residual urine, maximum flow rate, International Prostatic Symptoms Scale, and quality of life in each group (p < 0.01). However, there were no significant differences of preoperative and 3-month postoperative parameters, including: post void residual urine, maximum flow rate, International Prostatic Symptoms Scale, and quality of life between these 2 groups (P > .05).BipoLEP can produce a more radical prostatic resection with better safety profile and faster postoperative recovery. It may become a more favorable surgical alternative to the B-TURP, especially for the prostate larger than 80 g.

Auriculotherapy in the prevention of postoperative urinary retention in patients with thoracotomy and thoracic epidural analgesia: A randomized, double-blinded trial.

BACKGROUND: Thoracic epidural analgesia is associated with a high rate of postoperative urine retention (POUR). Auriculotherapy can reduce visceral dysfunction and can be helpful in anesthesiology and pain control. The aim of this study was to test the efficacy of preoperative auriculotherapy to decrease the occurrence of POUR. METHODS: This single-center, double-blinded, 2-arm randomized study was performed between January 2015 and May 2016 in a tertiary care university hospital. Male patients scheduled for an elective lung surgical procedure under combined general anesthesia and thoracic epidural analgesia were included. Auriculotherapy (A group) was performed once the patient was under general anesthesia with 5 semi-permanent needles inserted in both ears at the "Shen Men" "bladder", "pelvic parasympathetic", "anterior hypothalamus", and "frontal lobe" points. Five small round patches of adhesive pads were positioned bilaterally at the same points in the control group (C group). The main outcome measure was the requirement for bladder catheterization during the day and the first night following surgery. RESULTS: Fifty-three patients were randomized and 25 analyzed in each group. Requirement for bladder catheterization was different between groups: 24 C group patients (96%) and 18 A group patients (72%) (P = .049, Fisher exact test; Odds Ratio = 0.11 [0.01-0.95]. The number of patients needed to treat with auriculotherapy to avoid 1 case of bladder catheterization was 4. No adverse effect was observed due to auriculotherapy. CONCLUSION: This study demonstrates that auriculotherapy is a safe and useful technique reducing POUR in thoracotomy patients benefiting from thoracic epidural analgesia. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02290054 (November 13, 2014).

5-alpha-reductase inhibitor therapy postpones urine retention and prostate surgery in patients with prostate enlargement and a maximum uroflow rate of less than 15 ml/sec.

BACKGROUND: This study investigated the risk of transurethral resection of prostate (TURP) and acute urine retention (AUR) in relation to 5-alpha-reductase inhibitor (5ARI) therapy. METHODS: We identified 22,687 patients who were newly diagnosed with PE and low urinary tract symptoms (LUTS) between January 1, 2002 and December 31, 2011. We further classified study subjects who had moderate to severe LUTS and a maximum uroflow rate of less than 15ml/sec into three groups by their defined daily dose (DDD) of 5ARI used. The control group consisted of 7-28 cumulative DDD (cDDD) 5ARI users, while the short-term treatment group was 29-179cDDD 5ARI users, and the long-term treatment group was users of more than 180cDDD 5ARI. Each patient was monitored to identify those who subsequently developed TURP and AUR. RESULTS: TURP and AUR are detected in 5.6% of control group, 7.6% of short-term treatment group and 5.5% of long-term treatment group during 10-year follow up. Compared with the control group, there was no difference in the risk of TURP and AUR in the short-term and long-term treatment groups (HR = 1.41, 95% CI 0.76 to 2.62 and HR = 0.81, 95% CI 0.42 to 1.56, respectively). CONCLUSION: 5ARI therapy did not change the risk of TURP and AUR events in patients with PE, moderate to severe LUTS and a maximum uroflow rate of less than 15 ml/sec in 10 years of follow-up. But long-term 5ARI used can postpone AUR and TURP for 8.16 months.

[INCIDENCE OF ACUTE URINARY RETENTION IN PATIENTS WITH PROSTATIC ADENOMA AND 8-YEAR LONG TAMSULOSIN THERAPY].

This report introduces results of an 8-year study estimating the risk of acute urinary retention in patients with stage I prostatic adenoma. Patients were randomly assigned into two groups. The first group consisted of 331 men was regularly taking Omnic (tamsulosin) 0.4 mg 1 time daily for 8 years as a means of medical therapy. The second group consisted of 334 patients treated with herbal preparations (Gentos, Tadenan or Speman). In the case of acute urinary retention patients were taken to the urological department to release urine from the urinary bladder by catheterization or by the surgical procedure. The incidence of acute urinary retention in group 1 ranged from 0.3 to 1.2% per year and, for a total of 8 years of follow-up was 6.45%. In the second group, it ranged from 1.8 to 7.3% per year, making a total of 36.2%. Therefore, the risk of acute urinary retention in patients receiving Omnic (tamsulosin) was reduced by 5.6 times in comparison with the group of patients treated with herbal medications. Thus, the need for surgery decreased from 27.8 to 6.3%. According to the results of an 8-year long tamsulosin was found as a safe and highly effective means to reduce the risk of acute urinary retention.

Complications of transrectal ultrasound-guided prostate biopsy: impact of prebiopsy enema.

PURPOSE: Transrectal ultrasound (TRUS)-guided biopsy of the prostate is usually safe. However, some patients are hospitalized owing to complications from TRUS biopsy. We identified the risk factors for complications and effective preventive measures for treating complications after TRUS biopsy. MATERIALS AND METHODS: Medical records and radiological images of 1,083 patients who underwent TRUS biopsy of the prostate over 10 years in Gyeongsang National University Hospital were examined retrospectively to investigate the correlation between complications after TRUS biopsy and preventive antibiotics, prebiopsy enema, number of biopsy cores, and pathological findings. RESULTS: Complications occurred in 69 patients (6.4%). The complication rates of the 1,008 patients who received antibiotics and the 75 patients who did not were 6.3% and 8.0%, respectively (p=0.469). Complication rates of the pre-biopsy enema group (n=658) and the group without prebiopsy enema (n=425) were 4.7% and 8.9%, respectively (p=0.007). Complication rates of the 6-core biopsy group (n=41) and the 12-core biopsy group (n=955) were 7.3% and 6.3%, respectively (p=0.891). Complication rates of the prostate cancer group (n=306) and the no prostate cancer group (n=713) were 6.2% and 6.6%, respectively (p=0.740). CONCLUSIONS: A prebiopsy enema was associated with a reduced risk of complications after TRUS biopsy. Preventive antibiotics, number of biopsy cores, and pathological findings did not significantly influence the complication rate.

Dutasteride plus tamsulosin fixed-dose combination first-line therapy versus tamsulosin monotherapy in the treatment of benign prostatic hyperplasia: a budget impact analysis in the Greek healthcare setting.

BACKGROUND: The purpose of this study was to explore the budget impact of dutasteride plus tamsulosin fixed-dose combination (DUT + TAM FDC) versus tamsulosin monotherapy, in the treatment of patients with benign prostatic hyperplasia (BPH) from the perspective of the Greek healthcare insurance system. METHODS: A Microsoft Excel-based model was developed to estimate the financial consequences of adopting DUT + TAM FDC within the Greek healthcare setting. The model, compared six mutually exclusive health states in two alternative treatment options: current standard of care and the introduction of DUT + TAM FDC in the market. The model used clinical inputs from the CombAT study; data on resource use associated with the management of BPH in Greece were derived from expert panel, and unit cost data were derived from official reimbursement tariffs. A payer perspective was taken into account. As patient distribution data between public and private sectors are not available in Greece two scenarios were investigated, considering the whole eligible population in each scenario. A 4 year time horizon was taken into account and included treatment costs, number of transurethral resections of the prostate (TURPs) and acute urinary retention (AUR) episodes avoided. RESULTS: The clinical benefit from the market adoption of DUT + TAM FDC in Greece was 1,758 TURPs and 972 episodes of AUR avoided cumulatively in a four year period. The increase in total costs from the gradual introduction of DUT + TAM FDC to the Greek healthcare system ranges from €1.3 million in the first year to €5.8 million in the fourth year, for the public sector, and €1.2 million to €4.0 million, for the private sector. This represents an increase of 1.91% to 7.94% for the public sector and 1.10% 3.29% in the private sector, during the 4-year time horizon. CONCLUSIONS: Budget impact analysis (BIA) results indicated that the gradual introduction of DUT + TAM FDC, would increase the overall budget of the disease, however providing better clinical outcomes. DUT + TAM FDC drug acquisition cost is partly offset by the reduction in the costs associated with the treatment of the disease.

Factors affecting de novo urinary retention after Holmium laser enucleation of the prostate.

OBJECTIVE: Patients can experience urinary retention (UR) after Holmium laser enucleation of the prostate (HoLEP) that requires bladder distension during the procedure. The aim of this retrospective study is to identify factors affecting the UR after HoLEP. MATERIALS AND METHODS: 336 patients, which underwent HoLEP for a symptomatic benign prostatic hyperplasia between July 2008 and March 2012, were included in this study. Urethral catheters were routinely removed one or two days after surgery. UR was defined as the need for an indwelling catheter placement following a failure to void after catheter removal. Demographic and clinical parameters were compared between the UR (n = 37) and the non-urinary retention (non-UR; n = 299) groups. RESULTS: The mean age of patients was 68.3 (±6.5) years and the mean operative time was 75.3 (±37.4) min. Thirty seven patients (11.0%) experienced a postoperative UR. UR patients voided catheter free an average of 1.9 (±1.7) days after UR. With regard to the causes of UR, 24 (7.1%) and 13 (3.9%) patients experienced a blood clot-related UR and a non-clot related UR respectively. Using multivariate analysis (p<0.05), we found significant differences between the UR and the non-UR groups with regard to a morcellation efficiency (OR 0.701, 95% CI 0.498-0.988) and a bleeding-related complication, such as, a reoperation for bleeding (OR 0.039, 95% CI 0.004-0.383) or a transfusion (OR 0.144, 95% CI 0.027-0.877). Age, history of diabetes, prostate volume, pre-operative post-void residual, bladder contractility index, learning curve, and operative time were not significantly associated with the UR (p>0.05). CONCLUSIONS: De novo UR after HoLEP was found to be self-limited and it was not related to learning curve, patient age, diabetes, or operative time. Efficient morcellation and careful control of bleeding, which reduces clot formation, decrease the risk of UR after HoLEP.

Prospective non-randomized comparison of open versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair under different anesthetic methods.

PURPOSE: To compare prospectively open vs. laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair performed under different anesthetic methods. METHODS: A total of 175 patients scheduled for unilateral inguinal hernia repair were assigned to one of the following groups: (i) open repair under local anesthesia, (ii) open repair under regional anesthesia, (iii) open repair under general anesthesia, and (iv) TAPP under regional anesthesia. Immediate postoperative pain was the main outcome measured. Short- and long-term complications and the degree of patient satisfaction were also assessed. RESULTS: Transabdominal preperitoneal repair under regional anesthesia yielded the lowest pain scores, whereas open repair under general anesthesia yielded the highest pain scores (P < 0.05). Open repair under local or general anesthesia had a lower urinary retention incidence than the spinal groups (P < 0.05). Chronic pain incidence was lower for the TAPP group (P 0.003). There were no differences in other short- and long-term complications. CONCLUSION: Transabdominal preperitoneal repair under spinal anesthesia proved superior to open repair performed under different types of anesthesia in terms of immediate (24-h) postoperative pain. The method of anesthesia might have contributed more to this favorable outcome than the surgical technique itself, but at the cost of a high urinary retention incidence. The incidence of chronic pain was lower after TAPP repair.

[Does the surgeon have an influence on clinical voiding parameters and postoperative sexual function after TURP?]. / Hat der Operateur einen Einfluss auf Harnflussparameter und die erektile Funktion nach TURP?

BACKGROUND: Benign prostate syndrome (BPS) is a common phenomenon in the aging male. Transurethral resection of the prostate (TURP) remains the international standard of care for -patients requiring surgical intervention for BPS. Although the voiding improvement following TURP is well-documented, controversy exists regarding its effect on post-operative sexual function. In this study we investigated the possible influence of individual surgeons on clinical voiding parameters and post-operative sexual function after TURP. PATIENTS/MATERIALS AND METHODS: We analyzed 123 patients with a mean age of 70 years (46-88 years) who had undergone TURP secondary to BPS. To evaluate the clinical parameters, patients completed the IPSS and IIEF-15 questionnaires preoperatively and 1 year postoperatively. Additional parameters including urinary flow and post voiding residual volume were also collected. RESULTS: A statistically significant improvement in voiding function was noted postoperatively. The mean IPSS improved from 19.35 to 6.49 (p<0.05). Objective flow parameters also improved; Qmax 10.43-19.46 mL/s (p<0.05) and residual volume 95-11 mL (p<0.05). The mean pre-operative prostate volume was 41.8 cm³. The mean resected tissue weight was 21.1 g. The pa-tients showed no significant change in the frequency of their sexual activity following TURP, however IIEF-15 sexual function and erectile function scores declined mildly. This was statistically significant with pre-op IIEF-15=30.52 and post-op 26.24 (p<0.05). Comparing individual surgeons, no statistically significant difference was noted in IPSS and IIEF-15 functional outcome scores. Although significant differences existed in the total amount of resected tissue, the percentage of resected adenoma in relation to total prostate volume was not statistically significant. CONCLUSION: Overall, IPSS scores improved significantly following TURP and sexual function scored declined mildly. We detected no influence between surgeons on clinical voiding parameters and postoperative sexual function after TURP using the IPSS and IIEF-15 questionnaires.

Effects of bipolar and monopolar transurethral resection of the prostate on urinary and erectile function: a prospective randomized comparative study.

OBJECTIVE: To evaluate the outcomes of bipolar vs conventional monopolar transurethral resection of the prostate (TURP) on urinary and erectile function. MATERIAL AND METHODS: A total of 286 patients with benign prostatic hyperplasia (BPH) were randomized to bipolar or monopolar conventional TURP treatment groups. Operative and early postoperative variables and complications were recorded and all patients were re-evaluated at 1, 3, 6 and 12 months after surgery using the International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual urine volume (PVR) and the erectile function domain of the International Index of Erectile Function (IIEF-ED). A comparative evaluation of erectile function was performed on 188 preoperatively non-catheterized patients with regular sexual partners. RESULTS: The operating time was shorter in the bipolar TURP group. Postoperative bleeding and blood transfusion requirements did not significantly differ between the two groups. Sodium levels were significantly lower in the monopolar group than in the bipolar group. Transuretheral resection syndrome developed in two (1.4%) patients in the monopolar group. Both groups had similar and significantly improved IPSS values, maximum urinary flow rate values and PVR measurement. ED worsened in 32 (17.0%) patients, improved in 53 (28.2%) patients, and was unchanged in 103 (54.8%) patients. Changes in the IIEF scores during the follow-up period were similar between the bipolar and monopolar groups. CONCLUSION: Bipolar TURP is a safe and effective procedure that is associated with a significantly shorter operating time, a smaller reduction in serum sodium levels and a similar efficacy compared with conventional monopolar TURP.

'Have you had a wee yet?' Postpartum urinary retention.

Physiological changes in the bladder that occur during pregnancy predispose women to develop symptomatic retention of urine during the first hours to days after birth (Saultz et al 1991, Lose et al 1992). A basic definition of postpartum urinary retention (PUR) is the lack of spontaneous micturition six hours after vaginal birth or after removing an indwelling catheter (Humburg 2008). PUR after vaginal birth is a relatively common event, with the reported incidence ranging from 1.7 per cent to 17.9 per cent (Carley et al 2002, Ching-Chung et al 2002, Glavind and Bjørk 2003, Yip et al 2004). When examining why PUR occurs following vaginal birth research often states that instrument-assisted birth and regional analgesia are both independently associated (MacLennan 2002, Groutz 2001,Teo et al 2007). Other common risk factors include primiparity, prolonged first and second stage, perineal damage and oxytocin use (MacLennan 2002, Glavind and Bjørk 2003, Humburg 2008, Groutz et al 2001, Teo et al 2007). Unrecognised urinary retention and mismanagement may lead to recurrent urinary tract infections, upper urinary tract damage and permanent voiding difficulties (Groutz et al 2001). Humburg (2008) suggests that, overall, the lack of guidelines is one of the major problems in treating women with PUR. Careful questioning and examination from the midwife should always be performed to avoid any complication.

Pretreatment nomogram to predict the risk of acute urinary retention after I-125 prostate brachytherapy.

PURPOSE: Acute urinary retention (AUR) after iodine-125 (I-125) prostate brachytherapy negatively influences long-term quality of life and therefore should be prevented. We aimed to develop a nomogram to preoperatively predict the risk of AUR. METHODS: Using the preoperative data of 714 consecutive patients who underwent I-125 prostate brachytherapy between 2005 and 2008 at our department, we modeled the probability of AUR. Multivariate logistic regression analysis was used to assess the predictive ability of a set of pretreatment predictors and the additional value of a new risk factor (the extent of prostate protrusion into the bladder). The performance of the final model was assessed with calibration and discrimination measures. RESULTS: Of the 714 patients, 57 patients (8.0%) developed AUR after implantation. Multivariate analysis showed that the combination of prostate volume, IPSS score, neoadjuvant hormonal treatment and the extent of prostate protrusion contribute to the prediction of AUR. The discriminative value (receiver operator characteristic area, ROC) of the basic model (including prostate volume, International Prostate Symptom Score, and neoadjuvant hormonal treatment) to predict the development of AUR was 0.70. The addition of prostate protrusion significantly increased the discriminative power of the model (ROC 0.82). Calibration of this final model was good. The nomogram showed that among patients with a low sum score (<18 points), the risk of AUR was only 0%-5%. However, in patients with a high sum score (>35 points), the risk of AUR was more than 20%. CONCLUSION: This nomogram is a useful tool for physicians to predict the risk of AUR after I-125 prostate brachytherapy. The nomogram can aid in individualized treatment decision-making and patient counseling.

[Results of three-year clinical study of prostamol uno efficacy and safety in patients with initial symptoms of prostatic adenoma and risk of its progression].

Prostamol Uno (PU) efficacy and safety were studied in a multicenter, open-population, randomized and comparative trial. PU was given in a single daily dose 320 mg for 36 months to 50 patients with initial symptoms of prostatic adenoma (PA) in comparison with 50 matched controls. The trial evaluated PU action on the symptoms progression and quality of life with application of questionnaires IPSS and QoL (BS). It was found that PU treatment relieved PA symptoms by IPSS, while these symptoms progressed in the controls. QoL improved in the study group and deteriorated in the control one. Administration of PU significantly increased urinary flow rate though in the controls urinary flow rate decreased, size of the prostate diminished and increased, respectively. Changes in the PSA were not seen and were insignificant, respectively. The results of the study say that prostamol Uno in a dose 320 mg/day can prevent PA progression without side effects.