In women with incontinence, the need for pressure-flow study before surgery and abnormalities in the voiding phase. An up-to-date comment on the available problem accompanied by literature

Objective: To investigate the differences between urodynamic findings and history in women with urinary incontinence before surgery and clarify the need for preoperative pressure-flow studies. Materials and methods: The medical records of 1018 women who underwent urodynamic examination for urinary incontinence between 2010 and 2015 were evaluated retrospectively. Stress (n = 442), urge (n = 334) and mixed (n = 242) were classified as type urinary incontinence according to urodynamics. The voiding phase findings of the patients were examined. Results: The mean age of the patients was 47.85 ± 0.27 years. 18.4% of patients (n = 187) had voiding phase problems. Furthermore, this condition was seen in the most urge incontinence type urinary incontinence (35%). There was a statistically significant difference between the groups' voiding phase findings (p < 0.0001). The relationship between the patient's history and international consultation on incontinence questionnaire form scoring (ICIQ) and the urodynamics results showed no excellent correlation. Conclusions: Voiding phase abnormalities are not uncommon in patients with urinary incontinence. They should be considered in the evaluation of patients. Voiding phase findings may show significant differences between urodynamic data and history. Besides, the data obtained with the questionnaire forms were significantly different from the findings obtained by urodynamics. Consequently, urodynamics may change pre-operative clinical decision.

Modified bladder outlet obstruction index for powerful efficacy prediction of transurethral resection of prostate with benign prostatic hyperplasia

Background The correlation between modified bladder outlet obstruction index (MBOOI) and surgical efficacy still remains unknown. The purpose of the study was to investigate the clinical value of the MBOOI and its use in predicting surgical efficacy in men receiving transurethral resection of the prostate (TURP). Methods A total of 403 patients with benign prostate hyperplasia (BPH) were included in this study. The International Prostate Symptom Score (IPSS), quality of life (QoL) index, transrectal ultrasonography, and pressure flow study were conducted for all patients. The bladder outlet obstruction index (BOOI) (PdetQmax–2Qmax) and MBOOI (Pves–2Qmax) were calculated. All patients underwent TURP, and surgical efficacy was accessed by the improvements in IPSS, QoL, and Qmax 6 months after surgery. The association between surgical efficacy and baseline factors was statistically analyzed. Results A comparison of effective and ineffective groups based on the overall efficacy showed that significant differences were observed in PSA, Pves, PdetQmax, Pabd, BOOI, MBOOI, TZV, TZI, IPSS-t, IPSS-v, IPSS-s, Qmax, and PVR at baseline (p < 0.05). Binary logistic regression analysis suggested that MBOOI was the only baseline parameter correlated with the improvements in IPSS, QoL, Qmax, and the overall efficacy. Additionally, the ROC analysis further verified that MBOOI was more optimal than BOOI, TZV and TZI in predicting the surgical efficacy. Conclusion Although both MBOOI and BOOI can predict the clinical symptoms and surgical efficacy of BPH patients to a certain extent, however, compared to BOOI, MBOOI may be a more useful factor that can be used to predict the surgical efficacy of TURP. Trial registration retrospectively registered.

Modified Bladder Outlet Obstruction Index for Powerful Efficacy Prediction of Transurethral Resection of Prostate with Benign Prostatic Hyperplasia

Background：The correlation between modified bladder outlet obstruction index (MBOOI) and surgical efficacy still remains unknown. The purpose of the study was to investigate the clinical value of the MBOOI and its use in predicting surgical efficacy in men receiving transurethral resection of the prostate (TURP).Methods ：A total of 403 patients with benign prostate hyperplasia (BPH) were included in this study. The International Prostate Symptom Score (IPSS), quality of life (QoL) index, transrectal ultrasonography, and pressure flow study (PFS) were conducted for all patients. The bladder outlet obstruction index (BOOI) (PdetQmax -2Qmax) and MBOOI (Pves-2Qmax) were calculated. All patients underwent TURP, and surgical efficacy was accessed by the improvements in IPSS, QoL, and Qmax 6 months after surgery. The association between surgical efficacy and baseline factors was statistically analyzed.Results：A comparison of effective and ineffective groups based on the overall efficacy showed that significant differences were observed in PSA, Pves, PdetQmax, Pabd, BOOI, MBOOI, TZV, TZI, IPSS-t, IPSS-v, IPSS-s, Qmax, and PVR at baseline (P<0.05). Compared with BOOI, the results of Pearson’s correlation analysis showed that there was a more optimal correlation of MBOOI with preoperative variables, as well as with the changes postoperative(P<0.05). Binary logistic regression analysis suggested that MBOOI was the only baseline parameter correlated with the improvements in IPSS, QoL, Qmax, and the overall efficacy. Additionally, the ROC analysis further verified that MBOOI was more optimal than BOOI, TZV and TZI in predicting the surgical efficacy.Conclusion：Compared to BOOI, MBOOI may be a more useful factor that can be used to predict the surgical efficacy of TURP.Trial registration: retrospectively registered.

Decrease of urinary bladder contractility in patients with benign prostate hyperplasia

Aim of the study.Estimation of the decrease of urinary bladder contractility in patients with benign prostate hyperplasia (BPH). Patients and methods.In 146 BPH patients (mean age 62,1 0,8) urodynamic investigation including uroflowmetry and pressure-flow study was performed. The results of miction cystometry were evaluated using Shafer nomogram, the emptying idex was calculated as relation of voiding volume to maximal cystometric capacity. Results.56,2% BPH patients showed the decreased detrusor contractility. The results of urinary bladder contractility estimation by Shafer nomogram are dependent on the degree of infravesical obstruction (IVO). The emptying index is not related to the presence and degree of IVO and characterizes the degree of urinary bladder emptying as well as contraction duration. Concomitant lumbar osteochondrosis and diabetes detoriates urinary bladder emptying. Reliable contractility estimation may only be performed based on urodynamic study since basic BPH patients examination is not sufficient. Conclusion.In has to be considered during treatment strategy planning that in many BPH patients low urinary truct disfunction is determined by the decrease of urinary bladder contractility and not by IVO.

Urodynamic Studies for the Diagnosis of Lower Urinary Tract Symptoms: Experience in BSMMU

Objectives: The aim of urodynamic testing is to obtain objective information regarding urinary bladder storage and voiding function. This investigation provides information of the underlying causes depending on the individual situation and findings. Materials and Methods: This Retrospective study of the UDS was conducted at Urology department of Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2012 to April 2017. A total of 403 cases of urodynamic studies done. Patient age range was 10-85 years. Female Patient was only 41 and post operative cases was only six. Bladder dairy, Ultrasonography of Kidney, ureter, bladder with maximum cystometric capacity (MCC)and post void residue (PVR), Urine culture were done for most of the patient. Patient with indwelling catheter was remove and clean intermittent catheterization was demonstrated. There was no patient with pace maker or valve replacement. We didn’t use routine prophylactic antibiotics, Patients was advice to contact to UDS room physically or over telephone if they feel fever, retention, and other complications. Urodynamic tests include uroflowmetry, postvoid residual measurement, cystometric test, leak point pressure measurement, pressure flow study, and few cases with electromyography. Results: Among them most cases are equivocal and obstructive cases are ranked second about 68 cases (16.87 These were Benign Prostatic Hyperplasia (BPH), stricture urethra, atonic bladder, and dysfunctional voiding. Only five patients had urinary tract infections (1.2%) with rise of temperature but only two had cultural positive and treated with sensitive antibiotics. Organism were streptococcus aureus and pseudomonus. One female and one male patient develop retention and relived by continuous catheterisation and after 7 days removed catheter. Conclusions: Urodynamics could help most diagnosis of LUTSs in most of the cases. We are not yet in using video urodynamics instead urethrocystoscopy may help in assessing the urethra and bladder neck. Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p.8-13

Urodynamic Pressure-Flow Study (Pfs) for the Prediction of Surgical Outcome in Bph With Urinary Retention

Introduction: Urinary retention can be either chronic or acute in onset. Urinary retention can result from impaired detrusor contractility or obstruction of bladder outlet. Twenty five to 30% of men with decreased flow are not obstructed 1. Either uroflowmetry or post-void residue (PVR) can not differentiate obstruction from impaired detrusor contractility. In this study, an effort has been paid to know the usefulness of pressure-flow study in urinary retention due to suspected benign prostatic hyperplasia(BPH) cases for predicting the outcome of surgery. Methods: This is a before after clinical study, conducted in Bangabandhu Sheikh Mujib Medical University, Dhaka. Total 32 patients were selected for the study. Patients age ranges from 49-78 years.Patients with chronic and refractory urinary retention due to BPH were enrolled for the study. They were divided into group A (pre-operative) and group B (Post-operative). TURP was done in all 32 patients by single surgeon. Study variables were detrusor pressure at maximum flow (Pdet@Qmax), bladder outlet obstruction index(BOOI), bladder contractility index( BCI) and post void residue (PVR). Result: Total number of patients was 32. Age ranges from 49-78 years. Twenty one (65.6%) had BPH with chronic retention and 11 (34.4%) had BPH with refractory retention.Pdet@Qmax between Group A and Group B was highly significant (p=0.001). But difference is not significant in Pdet@Qmax d” 40 subgroup of patients (p=0.673). Bladder outlet obstruction index between Group A and Group B is highly significantly (p=0.001), but, that does not observed in BOOI <20 subgroup(p=0.600). Bladder contractility index in both Normal (BCI 100-150) and strong ( BCI >150 ) subgroups are significant ( p=0.001 and 0.001 respectively ). But it is not significant in BCI<100 sub group (p=0.021). Post void residue between Group A and Group B is highly significant (p=0.001). But in PVR >300m subgroup, difference is insignificant (p=0.120). Conclusion: In this study, overall favorable outcome observed in all patients after TURP but Pdet@Qmax <40 cm of water, BOOI <20, BCI <100 and PVR >300 ml groups of patients are at high risk of unfavorable clinical outcome after TURP. With the help of presence flow study (PFS) prior knowledge of these factors, it is possible to predict postoperative outcome. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.74-77