Postphalloplasty urinary function test:an observational study of novel outcome instrument to capture urinary dysfunction and quality of life after phalloplasty

Due to growing social acceptance,there has been an increasing number of gender-affirmation surgeries performed in North America.Most research in this patient population focuses on surgical outcomes and advancing techniques.However,little work has been done to study functional outcomes.To better evaluate urinary dysfunction in the postphalloplasty trans men patient population,our group developed a novel patient-reported outcome instrument-the postphalloplasty urinary function test(PP UFT)and protocol to measure postvoid urethral volume(PVUR),and we present our preliminary results.We conducted a cross-sectional pilot study in a cohort of 15 adult trans men who had undergone phalloplasty with urethral lengthening surgery between 2018 and 2021.Patients had stable urinary function via the neophallus at the time of survey.Patients filled out the PP UFT and were asked to record their PVUR as per our protocol.The average PP UFT score was 8.9 out of 40 and the average quality-of-life(QOL)score was 2.6.Postvoid dribbling constituted the major complaint and on average comprised 63.2%of the reported PP UFT score.The average PVUR was 2.2 ml(range:0.5-5.6 ml).There was a positive correlation between higher PP UFT and worse-reported quality of life(P<0.01;R?=0.4).Current questionnaires accepted in cis-male urology have limitations for accurately capturing urinary dysfunction in this specific patient group.The combination of PP UFT and PVUR measurement offers potential for quantifying urinary function and quality of life in patients who undergo phalloplasty.Future studies will validate these instruments.

Tanshinone ⅡA improves functional recovery in spinal cord injury-induced lower urinary tract dysfunction

Tanshinone ⅡA, extracted from Salvia miltiorrhiza Bunge, exerts neuroprotective effects through its anti-inflammatory, anti-oxidative and anti-apoptotic properties. This study intravenously injected tanshinone ⅡA 20 mg/kg into rat models of spinal cord injury for 7 consecutive days. Results showed that tanshinone ⅡA could reduce the inflammation, edema as well as compensatory thickening of the bladder tissue, improve urodynamic parameters, attenuate secondary injury, and promote spinal cord regeneration. The number of hypertrophic and apoptotic dorsal root ganglion（L6–S1） cells was less after treatment with tanshinone ⅡA. The effects of tanshinone ⅡA were similar to intravenous injection of 30 mg/kg methylprednisolone. These findings suggested that tanshinone ⅡA improved functional recovery after spinal cord injury-induced lower urinary tract dysfunction by remodeling the spinal pathway involved in lower urinary tract control.

Effects of rectal cancer resection on male sexual function and urinary function

Objective： To investigate the changes in sexual function and urinary function following rectal cancer resection in male patients. Methods： 48 male patients with rectal cancer under 65 years old were included in the study and postoperative sexual function and urinary function were investigated through questionnaires and telephone interviews following resection of rectal cancer and the results were analyzed retrospectively. Results： The overall sexual dysfunction rate was 58.33%. The overall urinary dysfunction rate was 56.25%. No statistically significant differences in the incidences of sexual dysfunction and urinary dysfunction were found in the comparison between participants under 50 and above 50 years old, between those who received Mile＇s operation and Dixon＇s operation, and among those at different tumor stages respectively. Conclusion： The incidences of sexual dysfunction and urinary dysfunction in male patients following resection of rectal cancer are high. The age, ways of surgical management and stages of tumor are not apparently contributed to these complications.

Survey of spinal cord injury-induced neurogenic bladder studies using the Web of Science

OBJECTIVE：To identify global trends in research on spinal cord injury-induced neurogenic bladder, through a bibliometric analysis using the Web of Science. DATA RETRIEVAL：We performed a bibliometric analysis of studies on spinal cord injury-induced neurogenic bladder using the Web of Science.Data retrieval was performed using key words＂spinal cord injury＂,＂spinal injury＂,＂neurogenic bladder＂,＂neuropathic bladder＂,＂neurogenic lower urinary tract dysfunction＂,＂neurogenic voiding dysfunction＂,＂neurogenic urination disorder＂and ＂neurogenic vesicourethral dysfunction＂. SELECTION CRITERIA：Inclusion criteria：（a）published peer-reviewed articles on spinal cord injury-induced neurogenic bladder indexed in the Web of Science;（b）type of articles：original research articles and reviews;（c）year of publication：no limitation.Exclusion criteria：（a）articles that required manual searching or telephone access;（b）Corrected papers and book chapters. MAIN OUTCOME MEASURES：（1）Annual publication output;（2）distribution according to journals; （3）distribution according to subject areas;（4）distribution according to country;（5）distribution according to institution;and（6）top cited publications. RESULTS：There were 646 research articles addressing spinal cord injury-induced neurogenic bladder in the Web of Science.Research on spinal cord injury-induced neurogenic bladder was found in the Science Citation Index-Expanded as of 1946.The United States,Ireland and Switzerland were the three major countries contributing to studies in spinal cord injury-induced neurogenic bladder in the 1970s.However,in the 1990s,the United States,the United Kingdom,the Netherlands,Germany and Japan published more papers on spinal cord injury-induced neurogenic bladder than Switzerland,and Ireland fell off the top ten countries list.In this century,the United States ranks first in spinal cord injury-induced neurogenic bladder studies,followed by France,the United Kingdom,Germany,Switzerland and Japan.Subject categories including urology, nephrology and clinical neurology,as well as rehabilitation,are represented in spinal cord injury-induced neurogenic bladder studies. CONCLUSION：From our analysis of the literature and research trends,we conclude that spinal cord injury-induced neurogenic bladder is a hot topic that will continue to generate considerable research interest in the future.

Clinical Characteristics and Urodynamic Analysis of Urinary Dysfunction in Multiple Sclerosis

Background： Both lower urinary tract dysfunction and urinary symptoms are prevalent in patients with multiple sclerosis （MS）. Although the significance of identifying and treating urinary symptoms in MS is currently well-known, there is no information about the real prevalence and therapeutic effect of urinary symptoms in patients with MS. The purpose of this study was to analyze the major symptoms and urodynamic abnormalities, and observe the therapeutic effect in different MS characteristics. Methods： We enrolled 126 patients with urological dysfunction who were recruited between July 2008 and January 2015 in Beijing Tian Tan Hospital, Capital Medical University and conducted overactive bladder system score （OABSS）, urodynamic investigation, and expanded disability status scale （EDSS）. Changes of urinary symptoms and urodynamic parameters were investigated. Results： Urgency was the predominant urinary symptom, and detrusor overactivity was the major bladder dysfunction. There was a positive correlation between EDSS and OABSS. Clinically isolated syndrome （CIS） had lowest EDSS and OABSS. CIS exhibited significant improvements in OABSS, maximum urinary flow rate （Qmax）, and bladder volume at the first desire to voiding and maximum bladder volume after the treatment （P 〈 0.05）. Relapsing-remitting MS showed significant improvements in the OABSS, Qmax, and bladder volume at the first desire to voiding, maximum bladder volume and bladder compliance after the treatment （P 〈 0.05）. Progressive MS exhibited significant increase in the bladder volume at the first desire to voiding, the detrusor pressure at maximum flow rate （PdetQmax）, and bladder compliance after the treatment （P 〈 0.05）. Conclusions： Urodynamic parameters examined are important in providing an accurate diagnosis, guiding management decisions of MS. Early and effective treatment may improve the bladder function and the quality of life at the early stages of MS.

Pelvic autonomic nerve preservation in radical rectal cancer surgery:changes in the past 3 decades

The advent of total mesorectal excision(TME)together with minimally invasive techniques such as laparoscopic colorectal surgery and robotic surgery has improved surgical results.However,the incidence of bladder and sexual dysfunction remains high.This may be particularly distressing for the patient and troublesome to manage for the surgeon when it does occur.The increased use of neoadjuvant and adjuvant radiotherapy is also associated with poorer functional outcomes.In this review,we evaluate current understanding of the anatomy of pelvic nerves which are divided into the areas of the inferior mesenteric artery pedicle,the lateral pelvic wall and dissection around the urogenital organs.Surgical techniques in these areas are discussed.We also discuss the results in functional outcomes of the various techniques including open,laparoscopic and robotic over the last 30 years.

Evaluation, treatment, and surveillance of neurogenic detrusor overactivity in spinal cord injury patients

Neurogenic detrusor overactivity is a common urodynamic finding in patients with supra-sacral spinal cord injury. Early evaluation, stepped management, and close follow-up reduce the risk of upper urinary tract deterioration, renal failure and incontinence. In this article, we aim to outline the modern pathway of the management of this complex disease. Evaluation of patients with history, physical examination, renal function assessment, cystoscopy, and urodynamic study are essential. Management of neurogenic detrusor overactivity with adequate bladder drainage, medical therapy, intradetrusor botulinum injections, and surgery can be offered in a stepwise manner. Follow-up after specific interventions should be done in a timely fashion to detect treatment response and to avoid complications of poorly managed neurogenic detrusor overactivity.