Role of Phenylethanolamine-N-methyltransferase on Nicotine-Induced Vasodilation in Rat Cerebral Arteries.

OBJECTIVE: The sympathetic-parasympathetic (or axo-axonal) interaction mechanism mediated that neurogenic relaxation, which was dependent on norepinephrine (NE) releases from sympathetic nerve terminal and acts on ß2-adrenoceptor of parasympathetic nerve terminal, has been reported. As NE is a weak ß2-adrenoceptor agonist, there is a possibility that synaptic NE is converted to epinephrine by phenylethanolamine-N-methyltransferase (PNMT) and then acts on the ß2-adrenoceptors to induce neurogenic vasodilation. METHODS: Blood vessel myography technique was used to measure relaxation and contraction responses of isolated basilar arterial rings of rats. RESULTS: Nicotine-induced relaxation was sensitive to propranolol, guanethidine (an adrenergic neuronal blocker), and Nω-nitro-l-arginine. Nicotine- and exogenous NE-induced vasorelaxation was partially inhibited by LY-78335 (a PNMT inhibitor), and transmural nerve stimulation depolarized the nitrergic nerve terminal directly and was not inhibited by LY-78335; it then induced the release of nitric oxide (NO). Epinephrine-induced vasorelaxation was not affected by LY-78335. However, these vasorelaxations were completely inhibited by atenolol (a ß1-adrenoceptor antagonist) combined with ICI-118,551 (a ß2-adrenoceptor antagonist). CONCLUSIONS: These results suggest that NE may be methylated by PNMT to form epinephrine and cause the release of NO and vasodilation. These results provide further evidence supporting the physiological significance of the axo-axonal interaction mechanism in regulating brainstem vascular tone.

Methyl Palmitate Modulated NMDA-Induced Cerebral Hyperemia in Hypertensive Rats.

N-methyl-D-aspartate (NMDA) receptors were found to be dysfunctional in hypertensive rats. Methyl palmitate (MP) has been shown to diminish the nicotine-induced increase in blood flow in the brainstem. The aim of this study was to determine how MP modulated NMDA-induced increased regional cerebral blood flow (rCBF) in normotensive (WKY), spontaneously hypertensive (SHR), and renovascular hypertensive (RHR) rats. The increase in rCBF after the topical application of experimental drugs was measured using laser Doppler flowmetry. Topical NMDA application induced an MK-801-sensitive increase in rCBF in anesthetized WKY rats, which was inhibited by MP pretreatments. This inhibition was prevented by pretreatment with chelerythrine (a PKC inhibitor). The NMDA-induced increase in rCBF was also inhibited by the PKC activator in a concentration-dependent manner. Neither MP nor MK-801 affected the increase in rCBF induced by the topical application of acetylcholine or sodium nitroprusside. Topical application of MP to the parietal cortex of SHRs, on the other hand, increased basal rCBF slightly but significantly. MP enhanced the NMDA-induced increase in rCBF in SHRs and RHRs. These results suggested that MP had a dual effect on the modulation of rCBF. MP appears to play a significant physiological role in CBF regulation.

Relationship between sexual and bladder dysfunction in women consuming ketamine.

BACKGROUND: Although ketamine has become the second most popular recreational drug in Taiwan, there have been very few reported studies that investigated female sexual dysfunction (FSD) in ketamine abusers (KAs). AIMS: We sought to compare the difference between street and hospital KAs and explored the risk factors for FSD and lower urinary tract symptoms (LUTS) in KAs. METHODS: In this cross-sectional study, female KAs aged 18 years or older were invited to complete anonymous questionnaires during an educational course provided by the departments of substance control and prevention of the local government or under the instruction of medical providers at a urology clinic. Data were reported as median (IQR) and OR and analyzed with commercial statistical software. OUTCOMES: Key outcome measurements were illicit drug use history, FSD symptoms, and LUTS severity. RESULTS: We included 139 women (104 street and 35 hospital KAs) with a median age of 27.08 years. FSD was reported in 76% of all the participants (street vs hospital KAs, 68% vs 97%, P < 0.001). LUTS (Interstitial Cystitis Symptom Index [ICSI] + Interstitial Cystitis Problem Index [ICPI] ≥12) was found to be a significant risk factor for FSD in KAs. More hospital KAs (71%) reported experiencing LUTS (ICSI + ICPI ≥12) than street KAs (8%, P < 0.001). Longer duration of ketamine use (≥36 months) and mild to severe psychological symptoms (5-item Brief Symptom Rating Scale [BSRS-5] ≥6) were significant risk factors for LUTS. CLINICAL IMPLICATIONS: Sexual problems among KAs should not be overlooked since more severe sexual dysfunction was observed in patients reporting LUTS. STRENGTHS AND LIMITATIONS: To our knowledge, the present study is the largest study using validated and reliable questionnaires to examine FSD in KAs and also the first study to include street KAs. The main limitation of this study is using self-report questionnaires as they are subjective and susceptible to human errors and recall biases. CONCLUSIONS: Women who abused ketamine and reported experiencing LUTS were found to be more likely to have FSD.

Comparing the outcomes and effectiveness of robotic-assisted sacrocolpopexy and laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: Abdominal sacrocolpopexy is regarded as the gold standard for management of pelvic organ prolapse (POP). Nowadays, minimally invasive surgeries are preferred, and sacrocolpopexy can be performed using either a laparoscopic or robotic-assisted approach. The aim of the current study was to compare the efficacy and safety of robotic-assisted sacrocolpopexy (RASC) and laparoscopic sacrocolpopexy (LSC) through an updated systematic review and meta-analysis. METHODS: We performed a systematic literature review of different databases and related references from their inception until July 2020 without language restrictions. All randomized control trials and comparative studies that compared RASC and LSC for the management of POP were included. RESULTS: A total of 13 studies including 2115 participants were included for the pooled analysis. The pooled results revealed that RASC was associated with a significantly longer operative time (weighted mean difference, 29.53 min; 95% confidence interval [CI], 12.88 to 46.18 min, P = 0.0005), significantly less estimated blood loss (weighted mean difference, -86.52 ml; 95% CI -130.26 to -42.79 ml, P = 0.0001), significantly fewer overall intraoperative complications (odds ratio [OR] 0.6; 95% CI 0.40 to 0.91; P = 0.01) and significantly lower conversion rate (OR 0.39; 95% CI 0.19 to 0.82; P = 0.01) compared with LSC. There were no significant differences between the length of hospital stays, overall postoperative complications, postoperative stress incontinence, mesh erosion and effectiveness between the two groups. CONCLUSION: The current study showed comparable efficacy between RASC and LSC. Though RASC was associated with less blood loss and a lower conversion rate, the differences were not clinically significant. The choice of surgical procedure with either RASC or LSC is according to surgeon discretion and patient preferences.

High prevalence of lower urinary tract dysfunction in patients with Prader-Willi syndrome.

AIMS: To report the first noninvasive urodynamic screening of lower urinary tract dysfunction (LUTD) in children, adolescents, and young adults with Prader-Willi Syndrome (PWS). METHODS: We recruited 37 PWS patients with/without lower urinary tract symptoms (LUTS) from our hospital. Uroflowmetry was performed in 36 patients. In addition, 20 patients underwent postvoid residual urine (PVR) measurement by transabdominal ultrasound. LUTD is defined as abnormal uroflow patterns, low peak flow rate (Qmax ), or elevated PVR by age. Videourodynamic study (VUDS) was performed in selected cases. RESULTS: Mean and median age of the patients were 17.7 ± 7.8 years and 16 years. Male to female ratio was 15/22. Two patients were excluded from the following analysis because of voided volume less than or equal to 50 ml. Of the remaining 34 uroflowmetry examination, normal voiding pattern (bell shape) was observed in 22 (64.7%) patients. Abnormal uroflowmetry pattern were obstructive in 6 (17.6%), staccato in 3 (8.8%), intermittent in 2 (5.8%), tower in 1 (2.9%), and plateau in 0 patients. Ten (29.4%) patients had a Qmax less than 15 ml/s. Of 20 patients undergoing PVR tests 10 (50%) had elevated PVR by age ( > 6% of estimated bladder volume). In all, 17/34 (50.0%) PWS patients had at least one abnormality of the noninvasive tests. Of the three cases undergoing VUDS all showed detrusor sphincter dyssynergia. CONCLUSIONS: Half of PWS patients with/without LUTS had LUTD. Noninvasive study such as uroflowmetry and postvoid residual urine by ultrasound is recommended to all patients with PWS.

A performance comparison of the fully automated urine particle analyzer UF-5000 with UF-1000i and Gram staining in predicting bacterial growth patterns in women with uncomplicated urinary tract infections.

BACKGROUND: The aim of this study was to compare the performance of the new flow cytometer UF-5000 with the UF-1000i and Gram staining for determining bacterial patterns in urine samples. METHODS: Women who attended our clinic with symptoms suggestive of urinary tract infection were enrolled in the study. Mid-stream urine samples were collected for gram staining, urine analysis and urine cultures. Bacterial patterns were classified using the UF-1000i (none, cocci bacteria or rods/mixed growth), the UF-5000 (none, cocci, rods or mixed growth) and Gram staining. RESULTS: Among the 102 included samples, there were 10 g-positive cocci, 2 g-positive bacilli, 66 g-negative rods, and 24 mixed growth. The sensitivity/specificity of the UF-1000i was 81.8/91.1% for gram-negative rods and 23.5/96.9% for cocci/mixed. The sensitivity/specificity of the UF-5000 was 80.0/88.2% for gram negative rods and 70.0/86.5% for gram-positive cocci. CONCLUSIONS: The UF-5000 demonstrated good sensitivity and specificity for Gram-negative bacilli and demonstrated an improved sensitivity for detecting Gram-positive cocci compared with the UF-1000i.

Perivascular Adipose Tissue Modulation of Neurogenic Vasorelaxation of Rat Mesenteric Arteries.

Perivascular sympathetic-sensory interactions have been shown to regulate calcitonin gene-related peptide (CGRP)-mediated vasodilation in rats. We investigated whether perivascular adipose tissue (PVAT) modulates the neurogenic vasorelaxation of isolated rat mesenteric arteries. Mesenteric arterial rings were prepared with or without PVAT (PVAT+ or PVAT-) and with either an intact or denuded endothelium (EC+ or EC-). The results of myography analysis revealed that vasocontraction to phenylephrine was highest in EC-PVAT-, lowest in EC+PVAT+, and intermediate in EC-PVAT+ and EC+PVAT-. Transmural nerve stimulation (TNS) induced the tetrodotoxin-sensitive relaxation of the phenylephrine-precontracted mesenteric arteries. However, nicotine induced minor relaxation in EC-PVAT+, whereas vasorelaxation was significantly enhanced in EC-PVAT-. Nicotine-induced vasorelaxation was insensitive to propranolol and also significantly lower in sympathetically-denervated and guanethidine-treated EC-PVAT-, whereas TNS-induced vasorelaxation persisted. In EC-PVAT- depleted of CGRP via capsaicin, nicotine- and TNS-induced vasorelaxation was almost absent. Lowering the pH of Krebs' solution using HCl led to pH-dependent vasorelaxation that was sensitive to CGRP8-37. Furthermore, nicotine-induced relaxation of EC-PVAT-, which was not affected by leptin, was blocked by methyl palmitate. Methyl palmitate did not affect TNS- or HCl-induced vasorelaxation. These results suggest that PVAT plays a modulatory role in regulating sympathetic-sensory interaction-mediated CGRPergic vasorelaxation via the release of methyl palmitate.

Hydrogen Protons Modulate Perivascular Axo-axonal Interactions in the Middle Cerebral Artery of Rats.

Previous studies have demonstrated that nicotine can induce relaxation of the middle cerebral artery (MCA). However, whether this relaxation is associated with the activity of sensory calcitonin gene-related peptide (CGRP) nerves and whether this is modulated by hydrogen protons (H), facilitating the release of CGRP from sensory CGRPergic nerve terminals in the MCA, remains unclear. In this study, we examined the role of H in the modulation of neurogenic vasomotor responses in the rat-isolated endothelium-denuded MCA. Wire myography was used to measure vasoreactivity and indicated that nicotine-induced relaxation was sensitive to tetrodotoxin and lidocaine and drastically reduced levels of guanethidine (an adrenergic neuronal blocker), N-nitro-L-arginine (L-NNA), CGRP8-37, vasoactive intestinal polypeptide (VIP)6-28, capsaicin, capsazepine (a transient receptor potential vanilloid-1 inhibitor), and tetraethylammonium. However, this nicotine-induced relaxation was not sensitive to propranolol. Lowering the pH of the buffer solution with HCl caused pH-dependent vasorelaxation and deceased intracellular pH in the MCA rings, which was sensitive to L-NNA, CGRP8-37, VIP6-28, capsazepine, 4-aminopyridine (a voltage-gated potassium channel antagonist), and paxilline (a large conductance Ca-activated K channel antagonist). However, HCl-induced relaxation was not inhibited by glibenclamide (an ATP-sensitive K channel blocker). These results suggested that electrical and chemical activation of cerebral perivascular adrenergic nerves led to the release of H, which then facilitated the release of NO, VIP, and CGRP, resulting in vasorelaxation. Lowering the pH of the buffer solution caused potassium channels of vascular smooth muscle cells and perivascular nerves to open. In conclusion, our results demonstrated that H may act as a modulator on MCA perivascular nerves and/or smooth muscles.

Does ketamine ameliorate the social stress-related bladder dysfunction in mice?

AIMS: The aim of this study is to investigate whether ketamine could relieve the social stress (SS)-related bladder dysfunction in mice. MATERIALS AND METHODS: The FVB mice were randomly assigned to either undergo SS exposure for 60 minutes per day on seven consecutive days for 4 weeks (SS1) or control without SS (SS0). The SS0 were then allocated to single or no injection of ketamine (SS0K1 and SS0K0). In the group of SS1, the SS1 mice were allocated to receive single injection of saline (SS1K0), single dose (SS1K1) or five daily dose of (SS1K5) ketamine injection (25 mg/kg/day/ip) since day 22. In vivo cystometry and tissue bath wire myography were performed on day 29. Serum and urine level of brain-derived neurotrophic factor (BDNF) were measured with enzyme-linked immunosorbent assay. RESULTS: In mice without social stress exposure, ketamine administration did not significantly affect voiding frequency (P > .05). SS1 K0 , SS1 K1, and SS1 K5 had significantly lower voiding frequency than that of control (SS1 K0 ) (each n = 15, P < .05). Ketamine administration reversed the trend of decreased voiding frequency in SS1 mice. Stressed mice had significant higher serum level of BDNF that reduced by short-term ketamine. Stressed mice had detrusor overactivity and impaired detrusor contractility which were not reversed by short-term ketamine. CONCLUSIONS: Social stress leads to elevated serum BDNF, infrequent voiding, detrusor overactivity, and impaired contractility. Short-term administration of ketamine may improve SS-related infrequent voiding and elevated serum BDNF level. However, ketamine did not improve SS-related bladder dysfunction on urodynamic and myography studies.

Surgical niche for the treatment of erectile dysfunction.

Penile erection implicates arterial inflow, sinusoidal relaxation and corporoveno-occlusive function. By far the most widely recognized vascular etiologies responsible for organic erectile dysfunction can be divided into arterial insufficiency, corporoveno-occlusive dysfunction or mixed type, with corporoveno-occlusive dysfunction representing the most common finding. In arteriogenic erectile dysfunction, corpora cavernosa show lower oxygen tension, leading to a diminished volume of cavernosal smooth muscle and consequential corporoveno-occlusive dysfunction. Current studies support the contention that corporoveno-occlusive dysfunction is an effect rather than the cause of erectile dysfunction. Surgical interventions have consisted primarily of penile revascularization surgery for arterial insufficiency and penile venous surgery for corporoveno-occlusive dysfunction, whatever the mechanism. However, the surgical effectiveness remained debatable and unproven, mostly owing to the lack of consistent hemodynamic assessment, standardized select patient and validated outcome measures, as well as various surgical procedures. Penile vascular surgery has been disclaimed to be the treatment of choice based on the currently available guidelines. However, reports on penile revascularization surgery support its utility in treating arterial insufficiency in otherwise healthy patients aged <55 years with erectile dysfunction of late attributable to arterial occlusive disease. Furthermore, it is noteworthy that penile venous surgery might be beneficial for selected patients with corporoveno-occlusive dysfunction, especially with a better understanding of the innovated venous anatomy of the penis. Penile vascular surgery might remain a viable alternative for the treatment of erectile dysfunction, and could have found its niche in the possibility of obtaining spontaneous, unaided and natural erection.

The efficacy of pentosan polysulfate monotherapy for preventing recurrent urinary tract infections in women: A multicenter open-label randomized controlled trial.

BACKGROUND/PURPOSE: Pentosan polysulfate sodium (PPS), a semi-synthetic polysaccharide that adheres to bladder mucosa, is effective in treating interstitial cystitis. We evaluated the clinical benefit of PPS for the prevention of recurrent urinary tract infection (UTI) in women. METHODS: We conducted a multicenter, open-label, prospective, phase II, randomized controlled trial enrolling women with recurrent UTI ≥ 2 times in the past 6 months or ≥ 3 times in the past 12 months. Patients received oral PPS monotherapy for 16 weeks in treatment group. All patients were followed every 28 days until UTI recurrence or up to 112 days. The primary endpoint was the UTI recurrence-free survival. Adverse events were recorded as secondary endpoint. RESULTS: A total of 26 women were eligible for analysis. In the PPS group, none (0%) of the 12 patients had UTI recurrence during the study period. However, 9 (64%) of 14 patients had UTI recurrence in the control group. The UTI recurrence-free survival was significantly higher in the PPS group than in the control group (log-rank test p = 0.0004). One adverse event which led to discontinuation of the trial regimen was regarded as irrelevance of PPS treatment. The limitation was the small number of cases. CONCLUSION: Among women with recurrent UTI, 16-week PPS monotherapy significantly reduced UTI recurrence when compared with the control group.

Do uroflowmetry and post - void residual urine tests necessary in children with primary nocturnal enuresis?

OBJECTIVES: To examine the benefits of repetitive uroflowmetry and post void residual urine (PVR) tests in children with primary nocturnal enuresis (PNE). MATERIAL AND METHODS: Children aged ≥6 years with PNE who visited our clinics for management of enuresis were included for study. Patients were requested to complete a questionnaire including baseline characteristics and Dysfunctional Voiding Symptom Score (DVSS), 2-day bladder diary, and Rome III criteria for constipation. Two uroflowmetry and PVR tests were requested. Children with congenital or neurogenic genitourinary tract disorders were excluded. All children underwent urotherapy and desmopressin combined with anticholinergics or laxatives if indicated. The definition of abnormal flow patterns (≥1 abnormal), elevated PVR (≥1 abnormal), small maximal voided volume (MVV), nocturnal polyuria (NP) and response to treatment complied with the ICCS standardization document. Kaplan-Meier survival analysis and Cox proportional-hazards regression tests were used to evaluate the predictors of response. RESULTS: In total, 100 children aged 8.5±2.3 years were enrolled for study (M: F=66:34) with 7.3±7.4 months of follow-up. Poor correlation was observed between DVSS/small MVV and PVR (p>0.05). Univariate analysis revealed that elevated PVR is associated with significantly less hazard of complete response to medical treatment (HR: 0.52, p=0.03), while not significantly associated with abnormal flow patterns, NP, constipation or small MVV. Multivariate analysis revealed that only elevated PVR (HR 0.30, 95% CI 0.12-0.80) and NP (HR 2.8, 95% CI 1.10-7.28) were significant predictors for complete response. CONCLUSIONS: In managing pediatric enuresis, elevated PVR is a significant predictor for lower chance of complete response to treatment whether they had high DVSS or not.

The efficacy of acupuncture in managing patients with chronic prostatitis/chronic pelvic pain syndrome: A systemic review and meta-analysis.

OBJECTIVES: This study aimed to systemically review published randomized control trials that compared the efficacy of acupuncture with sham acupuncture or standard medical treatment as management for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS: A systemic search of the PubMED®, Embase, Airiti Library, and China Journal Net was done for all randomized controlled trials that compared the efficacy of acupuncture with sham acupuncture, alpha-blockers, antibiotics, or anti-inflammatory drugs in patients with CP/CPPS. Two investigators conducted the literature search, quality assessment, and data extraction. The data were then analyzed using the Cochrane Collaboration Review Manager (RevMan®, version 5.3). The study endpoints were response rate, the National Institute of Health-Chronic Prostatitis Index (NIH-CPSI), and the International Prostate symptom score (IPSS) reduction. RESULTS: Three and four randomized controlled trials compared acupuncture with sham acupuncture (n = 101 vs. 103) and medical treatment (n = 156 vs. 138), respectively. The results revealed that acupuncture was superior to sham acupuncture as regards response rate (OR: 5.15, 95%CI: 2.72-9.75; P < 0.01), NIH-CPSI (WMD: -6.09, 95%CI: -7.85 to -4.33), and IPSS (WMD: -2.44, 95%CI: -4.86 to -0.03; P = 0.05) reductions, therefore, excluding the placebo effect. Compared to standard medical treatments, acupuncture had a significantly higher response rate (OR: 3.57, 95%CI: 1.78-7.15; P < 0.01). CONCLUSIONS: Acupuncture has promising efficacy for patients with CP/CPPS. Compared to standard medical treatment, it has better efficacy. Thus, it may also serve as a standard treatment option when available. Neurourol. Urodynam. 36:474-481, 2017. © 2016 Wiley Periodicals, Inc.

Treatment of daytime urinary incontinence: A standardization document from the International Children's Continence Society.

PURPOSE: This article is a standardization document of the International Children's Continence Society (ICCS); it represent a consensus of ICCS on the management of pediatric daytime urine incontinence (DUI). MATERIALS AND METHODS: This document was designed and written by a multi-disciplinary core group of authors appointed by the ICCS' board. RESULTS: Based on evidence of studies and the experience of experts, the treatment guideline of DUI is assembled in this standardization document. Guidelines and the algorithm of management include non-pharmacological treatment (urotherapy), as well as the pharmacological therapy and other modalities that are presented for DUI in general, as along with recommendations for individual conditions. CONCLUSION: The final document is not a systematic literature review. It includes relevant research when available as well as experts' opinion on the current understanding of daytime incontinence in children. This document illustrates that specific treatment of DUI based on an exact diagnosis is effective. The mainstay of treatment is urotherapy, but a combination of treatment modalities is often necessary. Neurourol. Urodynam. 36:43-50, 2017. © 2015 Wiley Periodicals, Inc.

Rapid differentiation of cocci/mixed bacteria from rods in voided urine culture of women with uncomplicated urinary tract infections.

OBJECTIVES: To evaluate the ability of laser flow cytometry to predict cocci/mixed growth in the pre-analytical phase of urine specimens. METHODS: We retrospectively reviewed urine samples from women with uncomplicated urinary tract infections from urologic clinics for study. Urine analyses were performed with laser flow cytometry (UF1000i, Sysmex, Kobe, Japan) and then diagrams were generated (forward scatter vs. fluorescent light scatter). Each specimen (bacteria count >357 BACT/µL) was classified as either cocci bacteria or rods/mixed growth according to the diagrams. Standard urine cultures were performed, and the agreement between cultures and the UF1000i interpretations was analyzed with kappa statistics. RESULTS: Finally, 491 specimens met the criteria for analysis. Among the 376 specimens with single bacteria growth, there were 26 gram-positive cocci (13 Streptococci spp., 7 Staphylococci spp., 6 Enterococci spp.), 1 gram-positive rods (Corynebacterium spp.), and 349 gram-negative rods (273 Escherichia coli, 33 Klebsiella spp., 29 Proteus spp., 6 Citrobacter spp., 4 Enterobacter spp., 3 Pseudomonas spp., and 1 Providencia spp.). There were 115 specimens with two bacteria species or more that were regarded as mixed growth. Agreement of rods or cocci/mixed growth between the laser flow cytometry and urine cultures yielded a kappa value of 0.58. The positive and negative predictive rate of the UF1000i for cocci/mixed growth in voided urine culture was 81.8% and 84.7%, respectively. CONCLUSIONS: Through laser flow cytometry, we can predict growth of cocci/mixed growth in the pre-analytical phase of urine culture, thus avoiding unnecessary urine culture and waiting time.

A quantitative approach to the interpretation of uroflowmetry in children.

PURPOSE: We hypothesized that by correcting for volume and creating a flow index (FI) we could develop a reproducible and reliable means to estimate flows in children without the use of a flow nomogram. Our second hypothesis was that this volume corrected FI could define objective parameters for the different flow curves that are described in the ICCS document. METHODS: Uroflowmetry curves of 1,268 healthy children were analyzed. Quadratic equations using nonlinear regression for both sexes were generated for each set of presumed normal voiders (learning data) (NV). The NV test data were used to verify the equations. Linear regression analysis was used to compare the variance between actual and estimated flow rates. A FI (Actual Qavg/Estimated Qavg) was created and ROC analysis for all flow types was performed. Sensitivity and specificity analysis was performed on all voids to validate the accuracy of the FI to predict flow pattern. RESULTS: Analysis of the FI from the first void to the second confirmed the accuracy and reproducibility in both males and females using various means of analysis. ROC analysis shows that there are very strong AUC's for Bell, plateau, and tower flow patterns. Sensitivity and specificity analysis reveals that defined FI parameters are able to predict the flow patterns. CONCLUSION: Our predictive formulas allow for direct comparison of one flow to the next in a single patient when the FI is used. Utilizing the FI, we can predict the type of flow pattern removing subjectivity from the analysis of uroflow patterns. Neurourol. Urodynam. 35:836-846, 2016. © 2015 Wiley Periodicals, Inc.

Comparing the efficacy and safety between robotic-assisted versus open pyeloplasty in children: a systemic review and meta-analysis.

OBJECTIVE: This manuscript is mainly to systemically review the published reports that compared the efficacy and safety of robotic-assisted (RP) versus open pyeloplasty (OP) in children with ureteropelvic junction obstruction (UPJO). METHODS: We did a systemic search in the PubMed(®) for all randomized controlled trials or comparative studies that compared the surgical results of robotic versus open pyeloplasty in children with UPJO. Two of the authors (Hsu and Chang) independently did the literature search, quality assessment, and data extraction. The obtained data were analyzed with Cochrane Collaboration Review Manager (RevMan(®), version 5.3). The end points of the analysis and review included age, operative time, hospital stay, costs, complications, and success rate. RESULTS: In total, seven comparative trials and three studies using national database met the criteria that comprised 20,691 (RP:OP = 1956:18,735) patients in the meta-analysis. Most studies reported median value of patient age, operative time, and hospital stay. Only a small proportion of studies could be included for meta-analysis. The enrolled trials revealed that RP was more frequently performed in older children, required longer operative time, and shorter hospital stay. The postoperative success rate was comparable (RR = 0.99, 95 CI 0.94-1.04). Comparing with OP, there was a significant higher complication rate (RR = 1.29, 95 CI 1.10-1.51) and higher costs in the RP group. CONCLUSION: Robotic-assisted pyeloplasty may be a promising alternative minimal invasive surgery for UPJO in children if the higher complication rates and higher costs in the RP can be overcome in the near future.

Obese children at higher risk for having overactive bladder symptoms: a community-based study.

AIMS: To investigate the association between obesity and lower urinary tract symptoms (LUTS) in healthy children. METHODS: Healthy community children (5-12 years) were enrolled to evaluate LUTS and voiding function, and classified by body mass index as being of normal weight, overweight, or obese. A questionnaire was completed by one parent of each child and included baseline characteristics, Dysfunctional Voiding Symptom Score, obstructive sleep apnea-related symptoms, stressful events, and nocturnal enuresis status in the past months. Overactive bladder (OAB) was defined by an urgency symptom score of ≥ 2. Monosymptomatic nocturnal enuresis (MNE) was defined as nocturnal enuresis without either OAB or daytime incontinence. RESULTS: A total of 838 children (mean age, 8.0 ± 2.0 years) were eligible for analysis. The prevalence of overweight and obesity was 14.0% and 10.7%, respectively, without gender disparity. Obese children had higher urgency symptom score than children of normal weight (0.87 ± 1.00 vs. 0.60 ± 0.87; P = 0.03). Multivariate analysis showed that significant risk factors for OAB were younger age (OR, 1.17; 95% CI, 1.06-1.29) and obesity (OR, 1.97; 95% CI, 1.14-3.40), while not gender, overweight, obstructive sleep apnea-related symptoms, and stressful events. Statistically significant risk factors for MNE were younger age and stressful events, while not obesity. CONCLUSIONS: Obese community children were at a higher risk of having OAB while not for MNE.

Elevated postvoid residual urine volume predicting recurrence of urinary tract infections in toilet-trained children.

BACKGROUND: The aim of this study was to examine whether toilet-trained children with a history of febrile urinary tract infection (fUTI) and elevated postvoid residual (PVR) urine volume according to a recently published PVR nomogram were at greater risk of UTI recurrence. MATERIALS AND METHODS: One month after recovery from febrile UTI, constipation was diagnosed according to the Rome III criteria, and lower urinary tract (LUT) function was evaluated with two sets of uroflowmetry and PVR by ultrasonography. For children aged ≦ 6 and ≧ 7 years, elevated PVR is defined as >20 and >10 ml, respectively. Cox proportion hazards regression was used to evaluate the risk factors for recurrence of UTI. RESULTS: Between 2005 and 2011, 60 children aged 6.5 ± 2.5 years (boy:girl ratio 27:33) were enrolled for analysis. Univariate analysis showed that recurrent febrile UTI was more commonly observed in children with elevated PVR [repetitive elevated PVR: hazard ratio (HR) 5.75, 95% confidence interval (CI) 1.41-23.4; one elevated PVR: HR 4.53, 95% CI 1.01-20.2] and high-grade vesicoureteral reflux (VUR; HR 4.53, 95% CI 1.46-14.07). Multivariate analysis showed that younger age (HR 1.37, 95% CI 1.03-1.82, p < 0.01) and elevated PVR (HR 2.88, 95% CI 1.44-5.73, p = 0.01) were significant, independent risk factors for recurrent febrile UTI--but not gender, presence of high-grade VUR and constipation. CONCLUSION: Elevated PVR defined by the new PVR nomogram predicted recurrent UTI in children with history of febrile UTI. Care should be taken to manage children with elevated PVR.

Reliability and Validity of a Chinese Version of Urinary Tract Infection Symptom Assessment Questionnaire.

OBJECTIVES: Our study evaluates the reliability and validity of a Chinese version of the Urinary Tract Infection Symptom Assessment questionnaire (UTISA). MATERIAL AND METHODS: Our study enrolled women who were diagnosed with uncomplicated urinary tract infection (uUTI) at clinics. The Chinese version of UTISA was completed upon first visit to the clinic for uUTI and at 1-week follow-up. We enrolled 124 age-matched women without uUTI from the community as the control group. The UTISA consists of 14 items (seven symptom items and seven related to quality of life), with each item scoring 0 to 3. The internal consistency was assessed with Chronbach's alpha test. Factor analysis was used to classify symptoms into latent factors. The predictive validity was analyzed by using logistic regression and Receiver Operating Characteristic (ROC) curve analysis. RESULTS: Mean total symptom scores of the UTISA in the 169 cases and 124 controls were 8.9 ± 4.6 and 1.4 ± 2.4, respectively (p < 0.01). The alpha coefficient was 0.77, showing a homogeneous composition of symptoms. At a cut-off value of greater than 3, the UTISA symptom score had good predictive value for uUTI (sensitivity of 87.0%, and specificity of 93.1%). Factor analysis revealed two latent variables: 1) lower urinary tract symptoms and 2) physical symptoms. Among the seven items, we found that urinary frequency (OR = 2.6), dysuria (OR = 5.0), sense of incomplete emptying (OR=2.0), and hematuria (OR=7.6) were significant predictors for uUTI. CONCLUSIONS: The Chinese version of UTISA is reliable to predict uncomplicated UTI in women with an optimal cut-off point at > 3.