Bladder outflow obstruction in women: Clinical and basic evaluation.

AIM: Female bladder outflow obstruction is an underdiagnosed and undermanaged condition. This review article aims to illustrate the basic and clinical evaluation of patients who might have this condition. REVIEW: Clinical evaluation includes clinical history, examination, and basic investigations, including uroflowmetry and postvoid residual, urinalysis and culture, renal function assessment, ultrasound of kidneys and bladder, voiding cystourethrography, and magnetic resonance imaging. Based on the initial evaluation, if the concern of obstruction is high, the clinician might undergo further advanced evaluation. CONCLUSION: Basic evaluation is the initial step in the diagnosis of female bladder outflow obstruction, the clinician need to have a high index of suspicion and often further advanced evaluation is needed to confirm the diagnosis.

Technical aspects and outcome review of continent catheterizable channels in the adult neurourologic population.

Multiple techniques for the creation of continent catheterizable channels have been reported. Several continence mechanisms have been used, including tunneled flap valves, nipple valves, and hydraulic valves. Moreover, several organs have been used, including the appendix, bowel, ureters, and bladders. In this review, we describe various techniques and their outcomes in the adult neuro-urological population. Compared to nipple valves, tunneled flap valves using the appendix and other organs are the most commonly performed procedures but have a higher number of reported complications when compared to nipple valves. Hydraulic valves have been largely abandoned due to disappointing long-term results.

Is Sacral Neuromodulation a Treatment Option for Primary Bladder Neck Obstruction?

Here, we present the first reported case that used sacral neuromodulation as a treatment option for bladder neck obstruction in a 48-year-old man who presented with a long-standing history of lower urinary tract symptoms such as storage and voiding symptoms unresponsive to conservative and medical treatments, including chemodenervation. The patient was diagnosed with primary bladder neck obstruction (PBNO) using a urodynamic study, voiding cystourethrography, and cystoscopy. Sacral neuromodulation was used because the patient refused bladder neck incision because of the risk of retrograde ejaculation. The patient reported significant improvement in symptoms with no obstructive pattern on follow-up uroflowmetry after six months. The use of alpha-blockers, bladder neck incision, and Botox injection into the bladder neck to treat PBNO has been reported. The successful use of sacral neuromodulation to treat PBNO has not been reported before.

Histopathological diagnoses and patterns in transrectal ultrasound-guided prostatic biopsy series from a large tertiary care center in Saudi Arabia.

AIM: The aim of the study was to report our transrectal ultrasound (TRUS)-guided prostatic biopsy histopathological diagnoses and clinical findings in our prostate cancer patients in a tertiary care center. METHODS: We have reviewed our TRUS biopsy series done in our department from January 2011 to December 2016. We reviewed our patient's prebiopsy prostate-specific antigen (PSA) findings and the histopathological diagnoses and determined the clinical and pathological features of prostate cancer patients in our series. RESULTS: A total of 398 patients underwent 12 core TRUS biopsies. Benign prostatatic hyperplasia was found in 48.5% of the patients and prostate cancer was found in 113 patients (28.4%). Among them, metastatic prostate cancer was found in 51.7% of them. High Gleason score (8-10) was found in 56.6% and a PSA of more than 20 was found in 63.3% of the patients. CONCLUSION: We recommend a mass public awareness program to encourage our patients to seek early prostate cancer screening and to alert the medical community to encourage more awareness of prostate cancer screening.

Is Early Surgical Treatment for Benign Prostatic Hyperplasia Preferable to Prolonged Medical Therapy: Pros and Cons.

Background and objectives: Treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) has shifted over the last decades, with medical therapy becoming the primary treatment modality while surgery is being reserved mostly to patients who are not responding to medical treatment or presenting with complications from BPH. Here, we aim to explore the evidence supporting or not early surgical treatment of BPH as opposed to prolonged medical therapy course. Materials and Methods: The debate was presented with a "pro and con" structure. The "pro" side supported the early surgical management of BPH. The "con" side successively refuted the "pro" side arguments. Results: The "pro" side highlighted the superior efficacy and cost-effectiveness of surgery over medical treatment for BPH, as well as the possibility of worse postoperative outcomes for delayed surgical treatment. The "con" side considered that medical therapy is efficient in well selected patients and can avoid the serious risks inherent to surgical treatment of BPH including important sexual side effects. Conclusions: Randomized clinical trials comparing the outcomes for prolonged medical therapy versus early surgical treatment could determine which approach is more beneficial in the long-term in context of the aging population. Until then, both approaches have their advantages and patients should be involve in the treatment decision.

The use of vaginal lasers in the treatment of urinary incontinence and overactive bladder, systematic review.

OBJECTIVES: To evaluate the available literature to assess the safety, efficacy, and outcomes of lasers in the treatment of female stress urinary incontinence (SUI) and overactive bladder (OAB). METHODS: Pubmed search was conducted up to May 2020, including observational and investigational human studies that documented the effects on laser treatment in SUI and OAB. RESULTS: A total of 27 studies, recording subjective or objective measures in SUI or OAB were included. Lasers used included Er:YAG and Fractional CO2 lasers. The overall quality of studies was poor, and 23/27 studies were case series (LOE:4). Er:YAG laser showed a modest reduction in mild SUI cases, with benefits lasting a maximum of 13-16 months. Er:YAG laser for OAB showed conflicting results, with a trend to improve OAB symptoms for up to 12 months. Fractional CO2 laser showed an improvement of mild SUI in few studies; however, no long-term data are available. For OAB symptoms, studies showed minimal improvement that was evaluated in short term studies. When reported, adverse events were insignificant, however, they were not reported systematically. Several limitations have been noticed in the current literature of vaginal lasers, including large variation in laser settings and protocols, short term follow up, lack of urodynamic evaluation, and appropriate objective measures. CONCLUSION: Based on the available literature, lasers cannot be recommended as a treatment option at this time. Future better-quality studies are needed to document the exact mechanism of action, longevity, safety and its eventual place into the current treatment algorithms of SUI and OAB.

Relationship between urinary incontinence symptoms and urodynamic findings using a validated Arabic questionnaire.

BACKGROUND: Urinary incontinence is common, particularly in women. Urodynamic studies (UDS) can accurately assess the condition. Less invasive objective measuring tools correlate with urodynamic findings, but the Arabic version of the Urogenital Distress Inventory-6 (UDI-6) questionnaire has not been previously correlated with UDS in Arabian patients. OBJECTIVE: To correlate the Arabic version of the UDI-6 with urodynamic findings in Arabian women with urinary incontinence. DESIGN: Prospective. SETTING: Tertiary referral urology clinic. PATIENTS AND METHODS: All female patients presenting with urinary incontinence between July 2013 to March 2014. Patients answered the Arabic UDI-6 questionnaire and underwent a history and clinical examination, urine culture and UDS. MAIN OUTCOME MEASURES: Correlation between Arabic UDI-6 questionnaire score and urodynamic diagnosis. RESULTS: Eighty-seven women with a mean age of 57 (range, 22-72) years completed the UDI-6 and underwent UDS. The questionnaire revealed that 20 (23%) patients had urge incontinence, 28 (32%) had stress incontinence and 39 (45%) had mixed incontinence. As diagnosed by UDS, 26 (30%) had urge incontinence, 37 (42%) had stress incontinence, 16 (18%) had mixed incontinence and 8 (9%) had no abnormality. Eighty-six percent of patients (24/28) with pure stress urinary incontinence (SUI) symptoms had a positive UDS, and 55% (11/20) of patients with pure urge incontinence symptoms had a positive UDS. Of all patients with positiveresponse to the question for SUI, 53/67, 79% had positive UDS diagnosis with a correlation coefficient of 0.65 (P < .01). Of all patients with positive responses for urge incontinence, 27/59, 45.8% had positive UDS diagnosis with a moderate correlation coefficient of 0.38 (P < .01). CONCLUSIONS: The validated Arabic UDI-6 correlates significantly with UDS findings in Arabian women, particularly in women with SUI. LIMITATIONS: The sample size was relatively small, which prevented sub-analyses. Patient comorbidities were not evaluated.

Priapism associated with pregabalin.

Priapism is a well-known cause of erectile dysfunction. There are a wide variety of causes, including hemoglobinopathy, neurological diseases, and drugs. We present a case report of an Asian man who presented with priapism that was continuous for 3 days after taking three doses of pregabalin for chronic back pain. Cavernous aspiration, phenylephrine injection, and a winter shunt all failed to achieve detumescence. The patient then presented to our institution on the 5(th) day of his initial presentation, and an El-Ghorab shunt was performed, after which detumescence and pain relief were achieved. We suggest that pregabalin might induce tumescence through acting on the α2δ1 subunit of voltage-gated calcium channels in the penile smooth muscle or by presynaptic inhibition of noradrenaline release. Further studies are warranted regarding the action of pregabalin and its effect on penile physiology.