An evaluation of the effect of bortezomib on radiation-induced urinary bladder dysfunction.

PURPOSE: The urinary bladder is one major organ at risk in radiotherapy of pelvic malignancies. The radiation response manifests in early and chronic changes in bladder function. These are based on inflammatory effects and changes in urothelial cell function and proliferation. This study evaluates the effect of bortezomib as an anti-proliferative and anti-inflammatory compound in an established mouse bladder model. The early radiation-induced bladder dysfunction in the mouse occurs in two phases during the first month after irradiation (phase I: day 0-15, phase II: days 16-30). MATERIALS AND METHODS: Daily bortezomib injections (0.02 mg/ml, subcutaneously) were administered between days 0-15 or 15-30 in separate groups. Single graded radiation doses were administered in five dose groups. Cystometry was carried out before (individual control) and during the first month after irradiation. When bladder capacity was decreased by ≥50%, mice were considered as responders. Statistical analysis was performed by the SPSS software version 24. RESULTS: Daily bortezomib injections between days 0-15 resulted in a significant decrease in responders for phase I. There was no significant effect with daily bortezomib injections between days 16-30. CONCLUSION: Two separate waves of acute radiation-induced urinary bladder dysfunction have distinct mechanisms that need further biological studies.

Effect of non-ablative laser treatment on overactive bladder symptoms, urinary incontinence and sexual function in women with urodynamic stress incontinence.

OBJECTIVE: To investigate the effects of non-ablative laser treatment on overactive bladder (OAB) syndromes, stress urinary incontinence and sexual function in women with urodynamic stress incontinence (USI). MATERIALS AND METHODS: Between April 2015 and June 2015, consecutive patients with USI with OAB syndromes underwent two sessions of Erbium:YAG laser treatment in a tertiary hospital. Patients received validated urological questionnaires, urodynamic studies, 1-h pad test and measurement of vaginal pressure before, one and three months after laser treatment. Questionnaires at 12 months were completed by telephone interview. Adverse effects and patients' satisfaction were also assessed. RESULTS: We included 30 patients with a mean age of 52.6 ± 8.8 years. Three months after therapy, mean 1-h pad test significantly decreased (P = 0.039). Significant improvement in OAB symptoms in four questionnaires were noted at three months post treatment, but not sustained for 12 months in two of them. Three months after therapy, mean vaginal pressure significantly improved (P = 0.009). Of 24 (82.7%) sexually active patients, 62.5% (15/24) and 54.2% (13/24) of their sexual partners reported improved sexual gratification three months later. No major adverse effects were noticed. CONCLUSIONS: Erbium:YAG laser treatment can resolve USI and coexistent OAB symptoms three months after therapy. Sexual experience is also improved. However, repeated laser therapy may be necessary after six months.

Does combination therapy with tamsulosin and trospium chloride improve lower urinary tract symptoms after SEEDS brachytherapy for prostate cancer compared with tamsulosin alone? : A prospective, randomized, controlled trial.

OBJECTIVE: To compare the efficacy of combination therapy with an alpha-blocker and an anticholinergic to monotherapy with an alpha blocker on lower urinary tract symptoms (LUTS) following brachytherapy in prostate cancer patients. MATERIAL AND METHODS: A total of 124 patients that had been clinically diagnosed with localized prostate cancer and underwent prostate brachytherapy were enrolled in the present study. Patients were randomized and allocated to two groups, including 60 to the combination group (tamsulosin 0.2 mg/day and trospium chloride 20 mg twice daily) and 64 to the monotherapy group (tamsulosin 0.2 mg/day). Treatment began 1 day after brachytherapy and continued for 6 months. LUTS were compared between the two groups using the total International Prostate Symptom Score (IPSS), storage and voiding IPSS subscores, quality of life (QoL) scores, maximum flow rate (Qmax), and postvoid residual (PVR) urine volume at 1, 3, 6, and 12 months after implantation. RESULTS: In all, 111 patients were ultimately analyzed in the study. Compared with pretreatment scores, a significant increase in total IPSS was found at 1, 3, and 6 months in both groups, but no statistically significant differences were observed between the two groups. The combination therapy group showed a greater decrease in the IPSS storage score compared with the monotherapy group at 1, 3, and 6 months (p = 0.031, 0.030 and 0.042, respectively). Patients receiving tamsulosin plus trospium chloride also showed significant improvements in QoL at 1 and 3 months compared with tamsulosin alone (P = 0.039, P = 0.047). Between the two groups, there was no significant difference in IPSS voiding score, Qmax, and PVR from baseline to each point of the study period. CONCLUSIONS: Combination therapy with tamsulosin and trospium chloride helped to improve IPSS storage symptoms and Qol scores in prostate brachytherapy patients with LUTS compared with tamsulosin monotherapy.

Urodynamic assessment of short-term effects of pelvic radiotherapy on bladder function in patients with gynecologic cancers.

OBJECTIVES: To determine the short-term effects of adjuvant or primary curative radiotherapy (RT) on the urinary system in women with gynecologic cancer. MATERIAL AND METHODS: This is a prospective, concurrent cohort study including 55 patients with gynecologic cancer who were divided into three groups. Group 1 included 10 patients who were administered adjuvant RT following a radical hysterectomy (RH); Group 2 included 36 patients who were administered adjuvant RT following a type 1 hysterectomy and Group 3 included 9 patients who were administered primary curative RT. Urogynecologic assessments were carried out on patients before and six months after the treatment. RESULTS: Compared to pretreatment, no significant differences were observed in any of the three groups after treatment in terms of incontinence, first urge to urinate, normal urge to urinate, severe urge to urinate and changes in residual urine volumes. There was a significant decrease in maximal vesical pressure after treatment in Group 1 and Group 3. The maxi-mum detrusor pressure decreased significantly in Group 1. The post-treatment decline in bladder capacity in Group 1 and Group 2 was also significant. CONCLUSIONS: RH and pelvic RT cause lower urinary system dysfunction. Especially patients who receive primary curative RT and patients who are administered RT after RH, where more pelvic denervation occurs, are at higher risk due to high doses of RT.

Predictive model of the prostate motion in the context of radiotherapy: A biomechanical approach relying on urodynamic data and mechanical testing.

In this paper, a biomechanical approach relying on urodynamic data and mechanical tests is proposed for an accurate prediction of the motion of the pelvic organs in the context of the prostate radiotherapy. As a first step, an experimental protocol is elaborated to characterize the mechanical properties of the bladder and rectum wall tissues; uniaxial tensile tests are performed on porcine substrates. In a second step, the parameters of Ogden-type hyperelastic constitutive models are identified; their relevance in the context of the implementation of a human biomechanical model is verified by means of preliminary Finite Elements (FE) simulations against human urodynamic data. In a third step, the identified constitutive equations are employed for the simulations of the motion and interactions of the pelvic organs due to concomitant changes of the distension volumes of the urinary bladder and rectum. The effectiveness of the developed biomechanical model is demonstrated in investigating the motion of the bladder, rectum and prostate organs; the results in terms of displacements are shown to be in good agreement with measurements inherent to a deceased person, with a relative error close to 6%.

The effects of simple and radical hysterectomy and radiotherapy on lower urinary tract symptoms and urodynamics.

PURPOSE: To evaluate effects of simple/radical hysterectomy, radiotherapy, and their combination on lower urinary tract symptoms (LUTS) and urodynamics. MATERIALS AND METHODS: Four groups were formed as simple hysterectomy; Group 1 (n = 20), Type-II hysterectomy; Group 2 (n = 11), Type-II hysterectomy + radiotherapy; Group 3 (n = 16), radiotherapy; Group 4 (n = 20). LUTS, bladder diary, pad test, Q-tip test, stress-test, urodynamics, bladder-wall-thickness measurement, King's Health Questionnaire (KHQ) performed prior and at six and 18 months after treatment. RESULTS: Pre-treatment prevalence of LUTS was higher in Group 1 and decreased at six and 18 months. LUTS increased in Groups 2, 3, and 4 at six months; some of the symptoms decreased to pre-treatment levels at 18 months. Quality of life improved in Group 1 and worsened in the others. Maximum bladder capacity increased in Group 1 and decreased in Groups 2 and 3. Bladder-wall-thickness, maximum detrusor pressures increased, urine sensation decreased in Groups 2 and 4. Maximum vesical pressure increased and compliance decreased in Groups 2 and 3. CONCLUSION: LUTS may decrease after simple hysterectomy. Radical hysterectomy and radiotherapy result in voiding dysfunction; however some of the symptoms may decrease to pre-treatment levels during follow-up.

Aproximación urodinámica al tratamiento refractario de la incontinencia urinaria femenina con anticolinérgicos / Urodynamic approach to female urinary incontinence refractory to treatment with anticholinergics

OBJETIVO: Está muy difundida la aplicación del tratamiento anticolinérgico empírico en la incontinencia urinaria femenina con diferentes resultados. En nuestro trabajo se ha investigado la eficacia de los anticolinérgicos en el tratamiento de la incontinencia urinaria femenina, así como determinar urodinámicamente las posibles causas que expliquen la resistencia al mismo e intentar obtener predictores urodinámicos de éxito o fracaso. MÉTODOS: Se han evaluado 182 casos de mujeres mayores de 14 años con incontinencia urinaria, que habían sido tratadas con anticolinérgicos previamente durante al menos tres meses, a las que se les realizó historia clínica completa con anamnesis, exploración física, estudio urodinámico y videorradiológico del tracto urinario inferior. El análisis estadístico de los datos se realizó con el programa SPSS 17.0 para Windows. RESULTADOS: Se demostró eficacia terapéutica clínica en el 39,6% de los casos. La capacidad vesical cistomanométrica estaba disminuida en el 89,2% de las pacientes que no mejoraron clínicamente con los anticolinérgicos (p=0,01). La hiperactividad del detrusor fue demostrada urodinámicamente en el 51% de los casos (p=0,05) entre las pacientes sin mejoría clínica con el tratamiento anticolinérgico. Esta hiperactividad se demostró precozmente en el llenado vesical (<100ml). Se demostró urodinámicamente IUE en el 26,5% de las pacientes sin mejoría clínica postratamiento (p=0,04). Se demostró urodinámicamente obstrucción del TUI en el 20,6% de los casos sin mejoría clínica (p=0,05). Los datos videourodinámicos no demostraron una relación entre la hiperactividad del detrusor, el cistocele de alto grado (37,4% del total) y la morfología vesical irregular (11,5% del total)(AU)

CONCLUSIONES: Es importante la realización de un estudio urodinámico previo al tratamiento anticolinérgico de la incontinencia urinaria femenina para identificar los datos de mal pronóstico terapéutico como son la incontinencia urinaria de esfuerzo y la obstrucción del tracto urinario inferior, optimizando así la eficacia terapéutica de los anticolinérgicos(AU)

OBJECTIVES: The administration of empirical anticholinergic treatment is widespread in women with urinary incontinence and has produced varied results. The objective of our paper is to determine the effectiveness of anticholinergics for the treatment of female urinary incontinence and to determine by urodynamicsthe possible causes that may explain the resistance to anticholinergics to obtain urodynamic predictors of success or failure. METHODS: We evaluated 182 women over 14 years of age with urinary incontinence that had previously been treated with anticholinergics for at least three months. The patients underwent a complete medical history including clinical history, physical examination, and urodynamic and lower urinary tract video-radiologic studies. Statistical analysis was performed using SPSS 17.0 for Windows. RESULTS: Clinical therapeutic efficacy was demonstrated in 39.6% of cases. Cystometric bladder capacity was decreased in 89.2% of patients that did not improve clinically with anticholinergics (p=0.01). Detrusor overactivity was urodynamically demonstrated in 51% of cases (p = 0.05) among patients without clinical improvement with anticholinergic treatment. This hyperactivity was demonstrated during early bladder filling (<100ml). Urodynamic stress urinary incontinence (SUI) was demonstrated in 26.5% of patients without clinical improvement after treatment (p=0.04). Lower urinary tract obstruction was urodynamicallydemonstrated in 20.6% of patients with no clinical improvement (p=0.05). Urodynamic data did not demonstrate a relationship between detrusor overactivity, a high-grade cystocele (37.4% of total), and irregular bladder morphology (11.5% of total). CONCLUSIONS: It is important to conduct urodynamic study before starting anticholinergic treatment of females with urinary incontinence to identify therapeutic data of poor prognosis, such as SUI and lower urinary tract obstruction, thus optimizing the therapeutic efficacy of anticholinergics(AU)

Radiation exposure during pediatric videourodynamics.

PURPOSE: Videourodynamics is useful for evaluating and treating neurological disorders in children. Traditional urodynamic parameters can be obtained while simultaneous visualization of the urinary system can reveal anatomical anomalies. This additional information comes at the cost of radiation exposure to the child. We characterized radiation exposure from videourodynamics. MATERIALS AND METHODS: We reviewed all recent videourodynamic studies and recorded patient demographics, urological diagnoses, physical attributes, total fluoroscopy time, total radiation exposure in mGy, bladder capacity and the number of filling cycles performed. Multivariate linear regression was used to identify patient factors that independently influenced total radiation exposure. RESULTS: A total of 64 videourodynamic studies were performed in 34 female and 28 male patients with a mean age of 8.6 years (95% CI 7.2-10.0). The most common diagnosis was neurogenic bladder in 40 patients, although 49 had multiple diagnoses. Mean total fluoroscopy time was 1.8 minutes (95% CI 1.4-2.1) and mean total radiation exposure was 10 mGy (95% CI 7.5-13.3). On multivariate linear regression patient weight and bladder capacity were the only independent predictors of total radiation exposure. CONCLUSIONS: Videourodynamics entail significant radiation exposure. Patient weight and bladder capacity were independent predictors of total radiation exposure. Physician awareness of radiation exposure may result in the judicious use of fluoroscopy and aid in counseling parents on the risk of videourodynamics. Further research is needed to quantify organ specific doses of radiation due to medical imaging in children and the associated cancer risks.

Variability in bladder volumes of full bladders in definitive radiotherapy for cases of localized prostate cancer.

BACKGROUND AND PURPOSE: To evaluate variation in bladder volume of full bladders in definitive radiotherapy for localized prostate cancer and to investigate potential predictors of increased bladder volume variations. PATIENTS AND METHODS: In 40 patients, the bladder volume was measured with megavoltage computed tomography (MVCT) imaging performed just before irradiation during the administration of the 1st fraction (#1), the 10th fraction (#10), the 20th fraction (#20), and the 30th fraction (#30). Patients were instructed to avoid urinating for 60-90 minutes before the planning CT (pln-CT) scan and before daily irradiation. Patients were also encouraged to drink an unspecified volume of liquid that would result in a clear but tolerable urge to urinate. RESULTS: The population-mean bladder volume (±1SD) was 219 ml (±83 ml) at the planning CT scan (pln-CT), 186 ml (±96 ml) at #1, 149 ml (±73 ml) at #10, 137 ml (±59 ml) at #20, and 136 ml (±60 ml) at #30. The mean intrapatient variation in bladder volume (1 SD relative to the mean bladder volume of each patient) was 38% (range: 10-84%). The bladder volume at the pln-CT was correlated with the intrapatient variance in bladder volume with a correlation coefficient of 0.54 and p <0.001. CONCLUSION: We observed a significant decline in bladder volumes during the course of radiotherapy. The bladder volume at the pln-CT was a significant predictor of increased bladder volume variations.

Actualización videourodinámica de la clasificación del reflujo vesicoureteral en el niño / Video urodynamic update of the vesicoureteral reflux classifiation in children

Objetivo: La actualización de la clasificación del reflujo vesicoureteral en el niño. Métodos: Videourodinámica. Resultados: Se tipifican los distintos tipos de reflujo vesicoureteral en el niño. Conclusiones: Se sigue demostrando la utilidad de dicha clasificación con la introducción de algunas modificaciones, necesarias para su continua actualización (AU)

Objectives: To update the classification of vesicoureteral reflux in children. Methods: Videourodynamics. Results: We categorize the different types of vesicoureteral reflux in children. Conclusions: The usefulness of the classification is demonstrated, with the introduction of some modifications necessary for its continuous updating (AU)

[Influence of the chronic exposure to network frequency electromagnetic field on rats under interrupted and continuous action of EMF].

The aim of the study was the investigation of chronic exposure to network frequency electromagnetic field in the rats under interrupted or continuous action of electric magnetic field. We were studying their behavior by the method of "open field". Comparison of behavior of rats in the "open field" has shown that the significant difference in the emotional activity of rats was stated. The number of boluses and urination in rats of B group is 4,5 times more than in the individuals of C group (p<0,001), but the significant difference between the rats of control A and B groups has not been stated. Although, the number of boluses in the rats of B group was a little raised, this raise was not statistically significant (p<0,5). The rats of control A and C groups significantly distinguished from one another. The number of boluses and urination in the animals of C group was significantly lower (p<0,001). In that way, the rats which were under the discontinuous action of electromagnetic field were distinguished by high emotionality, which occur by increase of boluses and urination, the high number grooming behavior and increase of the number of translocation, that influences the functioning of hypothalamohypophysial system.

[Urodynamic changes of the lower urinary tracts and their correction in combined and complex treatment of neoplasms in organs of the small pelvic].

The authors believe that systematization and standardization of prophylaxis and treatment of urinary complications after radiotherapy for cancer of the lesser pelvis organs are necessary. We studied urinary bladder function, applied a complex of diagnostic procedures including combined urodynamic investigation in the course of radiotherapy. This promoted more effective therapy and higher life quality in the studied patients.

Application of external microwave thermotherapy in urology: past, present, and future.

The excellent clinical results of transurethral microwave thermotherapy (TUMT) for the treatment of symptomatic benign prostatic hyperplasia (BPH) gave to TUMT the leading position among the microwave thermotherapy modalities available for the treatment of different urologic conditions. Research in TUMT has focused on operating software, temperature monitoring, intraprostatic heat distribution, cell-kill calculations, and correlations with clinical variables. Randomized comparisons of TUMT with other established therapies for BPH, including transurethral resection, have facilitated the evaluation of the clinical outcome, durability, morbidity, and costs of the treatment. The applications of microwave thermotherapy in other urologic diseases are also presented in this review.

(125)Iodine prostate brachytherapy: outcome from the first 100 consecutive patients and selection strategies incorporating urodynamics.

OBJECTIVE: To report the results from the first 100 consecutive patients treated with 125I transperineal interstitial prostate brachytherapy between March 1999 and June 2001, and to determine if the International Prostate Symptom Score (IPSS), prostate volume or urodynamic variables correlate with acute morbidity. PATIENTS AND METHODS: Patients were assessed prospectively by uroflowmetry, the IPSS, a physical examination and transrectal ultrasonography. Of the 100 patients, 57 had a full urodynamic assessment, 61 presented with lower urinary tract symptoms (LUTS), 25 were screen-detected and 14 presented with other problems. The IPSS was recorded at 1, 6 and 12 weeks, and then at 3-monthly intervals after treatment; significant events, e.g. acute urinary retention (AUR) and rectal symptoms, were recorded prospectively; the mean follow-up was 16 months. RESULTS: No patients were incontinent after treatment. There was a temporary deterioration in IPSS in 89% of patients. Peak symptoms occurred at 6 weeks and a statistically significant deterioration in IPSS persisted until 9 months, but continued to improve throughout the follow-up. AUR affected seven patients, with a further 20 using clean intermittent self-catheterization (CISC) for symptoms. In most patients the symptoms resolved spontaneously to the levels before treatment, with only two patients requiring surgery for bladder outlet obstruction. The IPSS before treatment did not predict urodynamic obstruction. Urodynamically unobstructed patients did not require catheterization. By 2 years after implantation the mean IPSS was better than before treatment. Five patients had mild, transient proctitis. CONCLUSION: Selecting patients with a low prostate volume and IPSS is likely to optimize the outcome of brachytherapy. Urodynamic studies may be helpful in predicting the risk of AUR and symptoms requiring CISC. Despite many patients presenting with LUTS, acute morbidity was no worse than that reported in large American series of predominantly screening-detected cancers. Prostate brachytherapy is well tolerated and may be safely delivered to patients with prostate cancer in the UK.

Urodynamic changes at 18 months post-therapy in patients treated with external beam radiotherapy for prostate carcinoma.

PURPOSE: To quantify the effect of radiotherapy (RT) on urodynamics at 18 months post-therapy, using urodynamic study, in prostate cancer patients undergoing definitive external beam RT. METHODS AND MATERIALS: A total of 17 patients with clinically localized prostate cancer were accrued into a single-arm prospective study. Fifteen of 17 patients completed scheduled multichannel video-urodynamic study at baseline as well as 3 and 18 months after RT. Baseline quantitative urodynamic parameters were compared with those at 18 months post-RT to assess the nature and extent of urodynamic change brought about by RT. These quantitative changes were further correlated to the change in self-assessed qualitative urinary function measured by International Prostate Symptom Score (IPSS), Quality of Life assessment index (QoL), and urinary functional inquiry. RESULTS: The statistically significant quantitative changes detected by the urodynamic study at 18 months post-RT were decrease in bladder capacity and bladder volume at first sensation in both the supine and upright position, and reduction in bladder volume at desire to void in the supine position. In our cohort, the mean reduction in bladder capacity was 100 mL in the supine position and 54 mL in the upright position. No statistically significant change was observed with regard to pressure, maximum flow rate, voided volume, or postvoid residual volume. Furthermore, there was no statistically significant change in bladder compliance, bladder instability, or bladder outlet obstruction. No statistically significant change in self-assessed qualitative urological function was observed between baseline and 18 months post-RT, measured by the 3 parameters (IPSS, QoL, and urinary frequency over 24 h). CONCLUSIONS: This is the first quantitative study that prospectively evaluated the effect of RT on urodynamics in prostate cancer patients receiving definitive RT. The statistically significant changes at 18 months post-RT were reduction in bladder capacity, reduction in bladder volume at first sensation, and decrease in bladder volume at desire to void. Despite the decrease in these parameters, there was no statistically significant adverse effect of RT on bladder compliance, bladder stability, or bladder outlet flow. This observation corresponded well with no significant change in IPSS, QoL, or urinary frequency over 24 h. Furthermore, these results confirm the notion that most prostate cancer patients generally tolerate RT very well.

[Function of the lower urinary tract in patients after treatment of cervical cancer]. / Czynnosc dolnego odcinka ukladu moczowego u chorych po leczeniu raka szyjki macicy.

OBJECTIVES: Irritation of lower urinary tract--bladder and urethra--is seen as a common risk factor for radiotherapy treatment. Is it possible to reduce miction disorders and urinary incontinence? DESIGN: Functional assessment of the lower urinary tract in women treated with surgery and radiotherapy. MATERIALS AND METHODS: Authors evaluated 25 patients diagnosed with uterus neck cancer treated with surgery or radiotherapy during 1998-2001. Urodynamic assessment was based on uroflowmetry, residual urine volume measurement and cystometry results. RESULTS: Lower urinary tract ailments were present in all 25 patients, in 2 of them they were only temporary--during recovery after surgery. During miction symptoms were reported by 23 patients, 20 patients reported symptoms between mictions. During and after treatment all patients reported the increase in symptoms and changes of urodynamics parameters. CONCLUSIONS: Function of the lower urinary tract are disturbed whilst radiotherapy treatment of uterus neck cancer. Functional diagnostics is important in oncological treatment design and should be evaluated separately for each patients.

Transurethral holmium: YAG laser prostatectomy using a side-firing fiber for bladder outlet obstruction due to benign prostatic enlargement: urodynamic evaluation of surgical outcome.

OBJECTIVES: To prospectively assess the efficacy of transurethral holmium (Ho):YAG laser prostatectomy using a side-firing fiber in patients with bladder outlet obstruction due to benign prostatic enlargement (BPE) from the standpoint of urodynamics. METHODS: 32 male patients with BPE aged 53-83 (mean 69.4) years were operated on. All patients, excluding 3 with urinary retention, were evaluated with the International Prostatic Symptom Score (IPSS), Quality of Life (QOL) score and uroflowmetry up to 12 months postoperatively, and a pressure/flow study was performed before and 3 months after the operation. RESULTS: The total IPSS score, QOL score, average and maximum flow rates improved significantly (p<0.0001) at 12 months postoperatively. In the pressure/flow study, detrusor opening pressure, maximum detrusor pressure, detrusor pressure at maximum flow, minimum urethral opening pressure, and Abrams-Griffiths number decreased significantly (p<0.0001, p = 0.0001, p<0.0001, p = 0.0019 and p<0.0001, respectively) 3 months postoperatively. Detrusor instability disappeared in 12 of 17 patients and remained in 2. CONCLUSIONS: Transurethral Ho:YAG laser prostatectomy was found to be effective for the treatment of bladder outlet obstruction due to BPE.

Urodynamics and laser prostatectomy.

A total of 81 patients with symptomatic bladder-outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) underwent visual laser ablation of the prostate (VLAP) using a right-angled firing neodynium: YAG laser. The mean pre-operative prostatic volume was 48.5 ml. All patients were discharged on the 1st post-operative day with an indwelling catheter. Two patients underwent a transurethral prostatectomy (TURP) after failing a trial without catheter on two occasions. Of the remaining 79 patients, 75 were evaluated 6 months post-operatively. Mean symptom scores (I-PSS) decreased from 20.9 to 5.8, the mean maximal urinary flow rate increased from 7.9 to 16.4 ml/s and the mean residual volume decreased from 88.1 to 15.6 ml. Several different methods of evaluating BOO from pressure-flow measurements were used and all showed improvement. All the above-mentioned parameters showed a highly significant improvement (P < 0.01) at 6 months.