Uroflowmetric analysis and derivation of nomograms for normal paediatric Indian population between 5 to 15 years of age

Objective:We aimed to established normal uroflowmetric values and subsequently derived nomograms of _(max)imum flow rate(Q_(max))and average flow rate(Q_(avg))against voided volume(VV)in children aged 5-15 years at our institute.Methods:A total of 440 children underwent uroflowmetric evaluation with no history of urological,renal,psychiatric,or neurological disorder between 5 and 15 years of age.Each subject data regarding Q_(max),Q_(avg),VV,time to Q_(max),and flow time,as well as age,sex,height,and weight were recorded.Of the 440 children,around 300(68.18%)children could produce a normal flow rate at VV of more than 50 mL.Of the remaining 140(31.82%)children,50.00%voided less than 50 mL,and remaining 50.00%had abnormal voiding pattern,staccato or interrupted(21.43%each)and plateau or tower shaped(3.57%each).Cases were divided into two age groups(5-9 years and 10-15 years),and uroflowmetric analysis was done between boys and girls in both age groups to derive nomograms of Q_(avg) and Q_(max).Results:Q_(max) and Q_(avg) flow nomograms were plotted for boys and girls.Mean Q_(max) for boys was 16.68 mL/s and for girls 20.69 mL/s.The mean Q_(avg) values were 11.04 mL/s and 8.60 mL/s for girls and boys,respectively.The Q_(max) and Q_(avg) values were higher in girls.There were significant increases in flow rates with increasing age,body surface area,and VV in both sexes.Conclusions:Nomograms for Q_(max) and Q_(avg) may be a useful tool in evaluation of lower urinary tract disturbances in children.

Implication of ultrasound bladder parameters on treatment response in patients with benign prostatic hyperplasia under medical management

Objective:The prevalence of benign prostatic hyperplasia(BPH)rapidly increases after the 4th decade of life.The combination of tamsulosin and dutasteride is a well established therapy for BPH of
40 g.Non-invasive urodynamic parameters can predict the outcome of medical therapy in patients with BPH.We aimed to correlate these parameters with treatment responses in BPH patients under medical management.Methods:A prospective study was conducted in the Department of Urology in our hospital from May 2014 to April 2015.A total of 100 patients with BPH
40 g who fulfilled our inclusion criteria were included.Treatment responses were determined by the International Prostate Symptom Score(IPSS)and uroflowmetry.Transabdominal ultrasonography with Doppler was performed to measure prostate volume,intravesical prostatic protrusion(IPP),detrusor wall thickness(DWT),the prostatic capsular artery resistive index(RI)and prostatic urethral angle(PUA)before and 3 months after combination therapy of tamsulosin and dutasteride.Treatment responses were correlated with non-invasive urodynamic parameters.Results:The IPSS,uroflow,age,prostate volume,RI,IPP,DWT and PUA were correlated before and after treatment.Of the 100 patients,70(70%)showed significant improvement and 30(30%)showed no improvement with therapy.Conclusion:Ultrasound bladder parameters are useful tools for measuring the treatment response in BPH patients.Our study shows that RI and DWT significantly correlate with the treatment response in BPH patients.More importantly,pretreatment values of increased IPP and PUA determines the non-improvement of symptoms in BPH patients.Our study suggests the importance of transabdominal ultrasonography(KUBeP)with Doppler for evaluating treatment responses to medical management.

Bladder Neck Morphologic Changes and Clinical Correlation of Smokers Submitted to Radical Prostatectomy

Introduction: Smoking is an important risky factor to many diseases, affecting arterial system, skin and urogenital system, including bladder neck stenosis. Its effect on bladder neck has not been described. Objective: Evaluate possible morphological changes caused by nicotine in the bladder neck. Material and Method: Fragments of bladder neck of 16 patients were submitted to stereological analysis, and those patients are divided into two groups, one of smokers and the other of non-smokers with 7 and 9 patients, respectively. After 90 days of surgery, they were submitted to free uroflowmetry and data analyzed by T test, having statistical significance with P 0.05. Results: An increase of 63.26% in the amount of fibers in the elastic system of the smokers group was observed, a reduction of 35.96% in the thickness of arteries, as well as an increase of IPSS and decrease of maximum flow in uroflowmetry, all with statistical significance. Discussion: Laboratorial changes are similar to those found in other studies with different tissues, such as skin, in which those findings are related to premature ageing. Clinical results, though statistically significant, do not have clinical consistence because the study was meant to morphological analysis. Conclusion: Smoking increases the amount of fibers in the elastic system and decreases the thickness of bladder neck arteries.

Pelvic floor electrical stimulation and muscles training: a combined rehabilitative approach for management of non-neuropathic urinary incontinence in children

PURPOSE To assess the efficacy of combined transcutaneous interferential (IF) electrical stimulation and pelvic floor muscle training through biofeedback on non-neuropathic urinary incontinence in children. METHODS This prospective study comprised of 46 anatomically and neurologically normal children (9 boys, 37 girls;mean age of 8.4±2.2 years old) with non-neuropathic urinary incontinence. All children were evaluated by kidney and bladder ultrasounds, uroflowmetry with electromyography (EMG), a complete voiding diary and a dysfunctional voiding scoring questionnaire at the baseline. Children were randomly allocated into two treatment groups including group A (n=23) who underwent biofeedback therapy in addition to IF electrical stimulation and group B (n=23) who received only biofeedback therapy. Re-evaluation was performed 6 months and one year after completion of the treatment sessions.