Does urodynamics predict voiding after benign prostatic hyperplasia surgery in patients with detrusor underactivity?

Objective:We sought to determine if urodynamic study(UDS)predicted voiding outcomes in men with detrusor underactivity(DU)and benign prostatic enlargement(BPE)who underwent photovaporization of the prostate(PVP).Methods:Between September 2010 and July 2015,106 male patients with BPE and DU were identified.All patients underwent PVP.Urinary retention was noted by the preoperative necessity for an indwelling or intermittent catheter.Data collection included comorbidities,quality of life(QoL)scores,prostate volume,prostate-specific antigen(PSA),UDS and perioperative outcomes.UDS parameters included volume at first desire to void,volume at first urge to void,volume of severe urge,volume at capacity,compliance,detrusor contractions,maximum urinary flow rate(Qmax),and postvoid residual(PVR).Results:A total of 106 men were included in this analysis,who had urinary retention with a Foley catheter or clean intermittent catheterization(CIC)at the time of surgery.At baseline we found patients who voided had a detrusor pressure at Qmax(Pdet@Qmax)of 10.05±6.45 cmH2O compared to 16.78±12.17 cmH2O in those who did not void(p=0.071).Postoperatively,96(90.6%,mean age 76.9±26.2 years)of patients voided successfully while 10(9.4%,mean age 80.52±9.61 years)of patients remained in urinary retention.Mean baseline Qmax was 4.895±5.452 mL/s and 2.900±3.356 mL/s(p=0.087)in those who voided and did not respectively.PVR was 319.23±330.62 mL in those who voided and 276.88
263.27 mL(p=0.344)in those who did not void.No UDS parameter predicted who would void postoperatively or improvements in QoL.Conclusions:The patients with DU and BPE might be able to successfully void after undergoing PVP regardless of UDS findings.All men who voided had improved international prostate symptom score and QoL scores compared to baseline and these parameters were durable up to 12 months.

Ambulatory urodynamic monitoring of external urethral sphincter behavior in chronic prostatitis patients

Aim: To study the behavior of external urethral sphincter in chronic prostatitis (CP) patient under natural filling.Methods: Twenty-one CP patients and 17 normal volunteers were involved in the study. Both the patients andvolunteers underwent ambulatory urodynamic monitoring (AM) and conventional medium filling cystometry (CMG).Urodec 500 was used for AM and Menuet for CMG. AM findings from CP patients were compared with those fromnormal volunteers, and the results from AM were compared with those from CMG. Results: In AM, the restingand voiding external urethral sphincter (EUS) pressures and maximum urethral closure pressures (MUCP) weresignificantly higher in CP patients [ ( 121.5 ±10.3) and (85.6±3.5) cm water, respectively ] than in normalvolunteers [ (77.6±11.4) and (10.3±1.6) cm water, respectively)]. Conclusion: The behavioral changes ofEUS in CP patients included spasm and instability of EUS, which were demonstrated using AM under natural filling;the findings were also in accord with the results of CMG. (Asian J Androl 1999 Dec; 1: 215 -217)

Patients with small prostates and low-grade intravesical prostatic protrusion e A urodynamic evaluation

Abstract Objective:Despite high-grade intravesical prostatic protrusion(IPP)being closely related to bladder outlet obstruction(BOO),up to 21%of patients with low IPP remain obstructed.This study evaluates the characteristics and urodynamic findings of men with small prostates and low IPP.Methods:One hundred and fourteen men aged>50 years old with lower urinary tract symptoms(LUTS)were assessed with symptoms,uroflowmetry,serum prostate-specific antigen(PSA),transabdominal ultrasound measurement of prostate volume(PV),IPP and post-void residual urine(PVRU).All patients underwent pressure flow studies.Patients with PV<30 mL and IPP
10 mm were examined for parameters correlating with BOO or impaired detrusor contractility.Results:Thirty-six patients had PV<30 mL and IPP<10 mm.Nine patients(25.0%)had urodynamic BOO,all with normal bladder contractility.Fourteen patients(38.9%)had poor detrusor contractility and all had no BOO.PV,PVRU and IPP were significantly associated with BOO,with IPP showing greatest positive correlation.Both Qmax and IPP were significantly associated with detrusor contractility.At 5-year follow-up,most patients responded to medical therapy.Only three out of nine patients(33.3%)with BOO eventually underwent surgery,and all had a high bladder neck seen on the resectoscope.Only one patient(7.1%)with poor detrusor contractility eventually required surgery after repeat pressure flow study revealed BOO.Conclusion:In men with small prostates and low IPP,the presence of BOO is associated with higher PV,PVRU and IPP,and most respond well to medical management.BOO can possibly be explained by elevation of the bladder neck by a small subcervical adenoma.

Effect of the Extracts of Pumpkin Seeds on the Urodynamics of Rabbits：An Experimental Study

Pumpkin seeds were prepared into oil n-butyle alcohol and ether extracts.The effects of the three extracts on the urodynamics of rabbits were observed.It was concluded that the oil preparation could remarkably reduce the bladder pressure ,increase the bladder compliance, reduce the urethral pressure. Other two kinds of preparations had no effect in this experimental. The mechanisms of the effect of oil preparation on the urodynamics and the prospect of clinical use was discussed.

Comprehensive urodynamics: Being devoted to clinical urologic practice

As a combined electrophysiological system for evaluating the lower urinary tract(LUT), comprehensive urodynamics(UDS) aims at duplicating patient's micturition process, either normal or abnormal, and further seeking for possible causative origin, either neurogenic or non-neurogenic, in order to guide treatment. Through thorough analysis, some so-called cutoff values, for example, bladder outlet obstruction(BOO) degree or dyssynergic degree between the detrusor and sphincter, could be gained; however, in most cases, their qualitative description, such as stress urinary incontinence, idiopathic detrusor underactivity(DUA), detrusor overactivity(IDO), low compliance, and idiopathic sphincter overactivity(ISO), is more preferable and important. In aged neurologically intact male patients with symptoms of the LUT(LUTS) including benign prostatic hyperplasia, a combined UDS system, which coupled BOO with compliance, was constructed. The patients may be categorized into one of the seven subgroups, including equivocal or mild BOO with sphincter synergia with or without IDO(pattern A), equivocal or mild BOO with ISO(B), classic BOO with sphincter synergia(C) or ISO(D), BOO with only low compliance(E), BOO with both DUA and low compliance(F), and potential BOO with DUA(G). This new system can be used to optimize diagnosis and treatment according to a derived guideline diagram.

Urodynamic analysis in 245 patients with benign prostatic hypertrophy

To study the mechanism of voiding disorder and promote thediagnosic accuracy of bladder outlet obstruction (BOO), a full setof urodynamic examination were employed with self-made semi-supine bed and Manneu Danec Urodynamic device in 245 patients.The results showed definite BOO in 161 cases, doubtful BOO in 50cases, detrusor muscle dysfunction in 65 cases, depressed bladdercompliance in 70 cases, urethral sphincter dyssynergia in 114 cas-es , and unstable bladder in 59 cases. There is a close relationshipbetween the functional urethral length and the prostatic urethrallength as determined by B ultrasound. It suggests that both the dy-namic and mechanical factors are attributed to voiding disorder inpatients with BPH. The urodynamic examination plays an importantrole in the diagnosis of BOO. (Chin J Androl 2000; 4: 234 - 236)

Urodynamic Characteristics of Awake Rats under Retrained versusFreely Moving Condition：Using a Novel Model

Urodynamic investigation in conscious rats is widely employed to explore functional bladder disorders of various etiologies and pathogeneses. Rats can be placed in restraining cages or wide cabinets where they are allowed to move freely during cystometry. However, the requirements of special devices hampered the application of urodynamic test in freely moving rats, and whether the restraint has any effects on urodynamic parameters in conscious rats remains obscure. In the present study, we described a novel approach for urodynamic investigation in both restrained and freely moving conscious rats. In addition, we for the first time systematically compared the urodynamic parameters of rats in the two conditions. With the current method, we successfully recorded stable and repeatable intravesical pressure traces and collected expected reliable data, which supported the idea that the restraint does not affect the activity of the micturition reflex in rats, provided sufficient and appropriate measures could be applied during cystometry. Fewer technique problems were encountered during urodynamic examination in restrained rats than in freely moving ones. Taken together, conscious cystometry in rats placed in restraining cages with proper managements is a reliable and practical approach for evaluating the detrusor activity and bladder function.

Relationship between urodynamic patterns and lower urinary tract symptoms in Chinese women with a non-neurogenic bladder

Objective:To investigate the urodynamic study(UDS)patterns,obstruction status,continence status,and their correlations among neurologically intact women with lower urinary tract symptoms(LUTS)through an epidemiological and logistic regression analyses.Methods:We retrospectively analyzed the UDS data of 3265 neurologically intact women with LUTS(2002e2014).Five UDS patterns were identified:normo-active detrusor/sphincter(NA,or DSI,detrusor/sphincter intact),idiopathic detrusor overactivity(IDO),idiopathic sphincter overactivity(ISO),IDO+ISO,and detrusor underactivity(DUA).Analyses of UDS pattern distribution and stratification were performed(based on a modification of the European Urological Association-Madersbacher classification system),and their correlations with bladder outlet obstruction(BOO)and stress urinary incontinence(SUI)status were evaluated via logistic regression analysis.Results:NA,IDO,IDO+ISO,ISO,and DUA were noted in 927(28.4%),678(20.8%),320(9.8%),689(21.1%),and 651(19.9%)cases,respectively.Moreover,storage,storage+voiding,and voiding symptoms were noted in 62.4%,21.1%,and 16.5% cases,respectively,whereas BOO and SUI were observed in 12.1%and 29.0%cases,respectively.The risk factors for BOO included NA,IDO,ISO,and IDO+ISO,whereas the protective factors against BOO included storage symptoms,SUI,storage+voiding symptoms,and complaint duration within 1e12 months.NA was the only risk factor for SUI,whereas BOO,storage+voiding symptoms,IDO,and storage symptoms were protective factors for SUI.Conclusion:Five UDS patterns were identified among neurologically intact women with LUTS.Functional abnormalities of the detrusor and/or sphincter were the main causes of LUTS,and were correlated with the BOO or SUI status.Thus,the UDS pattern can provide additional information regarding the risk factors for BOO or SUI status,as compared to symptomatic typing.

The Aging Bladder in Females Evaluated by Urodynamics

Aim: To determine whether bladder functions deteriorate with age. Methods: Data contained in electronic medical record (INFOMED?) were used in this institutional retrospective review. Analysis was done on the urodynamic studies in women over 18 years old conducted between May 2011 and November 2015. Patients with previous history of pelvic surgery or radiotherapy, neurological disease, vaginal prolapse greater than grade I, congenital urogenital malformations, urinary obstructive disease, diabetes, or the use of any medication that could interfere with bladder function were excluded from the analysis. The urodynamic parameters analyzed were the Maximum Cystometric Capacity (MCC), Voiding Volume (VV), Maximum Flow (Qmax), Bladder Compliance (BC), Detrusor Pressure at Maximum Flow (PdetQmax), Bladder Contractility Index (BCI), Bladder Voiding Efficiency (BVE) and Post-Void Residual Urine Volume (PVR). Patients were further stratified in five groups according to age (A—18 to 40;B—41 to 50;C—51 to 60;D—61 to 70;E—over 70 years old). Results: Out of 3103 urodynamic studies analyzed, 719 were eligible for the study. The average age of patients was 49.3 (+13.2) years old and in all evaluated parameters, statistically significant correlation between age and decline of bladder function was obtained (p Conclusions: This study showed a decline in bladder storage function (reduction in MCC and BC) and in bladder emptying function (reduction in Qmax, PdetQmax, VV, BCI and BVE with an increase in PVR) with age.

Urodynamic Abnormalities in Patients with Relapsing Remitting Multiple Sclerosis

Background: Multiple sclerosis (MS) is a disease with wide variability in clinical presentation. Bladder dysfunctions are very common in MS patients. Early detection of bladder abnormalities is important to improve the outcome in MS patients. Objectives: The aim of this study is to evaluate the urodynamic detected bladder dysfunctions in relapsing remitting MS patients with mild or without lower urinary tract symptoms. Methods: This is a prospective study for 32 patients with relapsing remitting Multiple Sclerosis from January 2017 to June 2018. We included patients with mild or without lower urinary tract symptoms (LUTS) who had mild to moderate disability. Urodynamic studies were performed for all patients. Results: Urodynamic abnormalities were detected in 22 patients (68.75%). Detrusor overactivity (DO) was present alone in 8 patients (25%);DO combined with detrusor external sphincter dyssynergia in 8 patients (25%);DO with low compliant bladder and impaired contractility in another 4 patients (13%) while DO with low complaint bladder in 2 patients (6%). Bladder dysfunction was correlated to high disability score;longer duration of illness;frequent relapses and the presence of LUTS. Conclusion: Urodynamic abnormalities were found in 68.75% of our patients. This highlights the importance of urodynamic studies in the early evaluation of relapsing remitting Multiple Sclerosis.

Clinical Study on Evaluation of Autonomic Nervous Dysfunction Based on Imaging Urodynamic Examination with Slow Filling and Synchronous Blood Pressure Monitoring in the Patients with Cervicothoracic Spinal Cord Injury

Objective: Explore the rule of autonomic nervous dysfunction in the patients with urination disorder after high level spinal cord injury, and seek a safe, objective and accurate method to evaluate autonomic nervous function. Patients and Method: 48 patients with dysuria after cervicothoracic SCI were selected. Before, during and after imaging urodynamic examination with slow filling in supine position, blood pressure and ECG were monitored simultaneously. The symptoms of sweating, shivering, headache, flushing and chills were observed and recorded. The study of the relationship among the changes of blood pressure, heart rate and urodynamic indexes and the above symptoms was analyzed. Results: They were divided into three groups: group A (no obvious abnormality), group B (hyperactivity) and group C (hypoactivity) according to their BP, HR and existing the symptoms or not. Conclusion: The incidence of autonomic dysfunction in the high level SCI patients with dysuria was very high (79.17%), most of them were hyperactivity, and a few were low function. The changes of SBP and DBP in the hypoactivity group all appeared an increasing and then declining trend, while the change of HR in the low function one was lower than normal and decreased continuously. The main inducements of AD are neurogenic detrusor overactivity, detrusor sphincter dyssynergia, elevated abdominal pressure and abnormal bladder sensitivity. The asymptomatic patients had a higher occurrence rate (43.75%). Only by imaging urodynamic examination with slow filling and synchronous blood pressure monitoring, can autonomic nervous function of the patients be evaluated safely, objectively, early and accurately.

Urodynamic Findings in Young Women of Less Than Forty Years Old with Lower Urinary Tract Symptoms

Purpose: The aim of the study was to determine urodynamic findings in young women (<40 years old) with bothersome lower urinary tract symptoms. Materials and Methods: The records of 315 women were reviewed during 2002 to 2010. Those with neurological disease, history of urogenital malignancies, urethral stricture or trauma, acute UTI, unsterile urine analysis, congenital urological disease, pelvic organ prolapse, diabetes mellitus or a primary complaint of stress incontinence were excluded. All completed the American Urological Association Symptom Index (AUASI) and underwent urodynamic studies. Results: Bladder dysfunction was diagnosed in 78.4% of the patients with urge incontinence. Bladder and voiding phase dysfunction were found in 134 (42.5%) and 110 (34.9%) of patients, respectively. Occult neurological disease was later diagnosed in 10 women (3.17%) with urge incontinence and bladder dysfunction. Discussion: Urge incontinence and voiding symptoms are frequently associated with urodynamical abnormalities. Urge incontinence and bladder dysfunction may be a sign of occult neurological disease in this population. The presenting symptoms are useful in determining the advantage of urodynamic study in this population.

Urodynamic test and female urinary stress incontinence:An open debate

In this editorial we discussed the pros and cons of urodynamics in the assessment of female stress urinary incontinence.

The Additional Value of Cystoscopy with Urodynamic Study in the Assessment of Patients with Urinary Incontinence

Background: Urinary incontinence (UI) is generally defined as the involuntary loss of urine from the bladder through the urethral meatus. Filling cystometry is the method by which the pressure/ volume relationship of the bladder is measured during bladder filling. Purpose: To determine the value of diagnostic cystoscopy in addition to Urodynamic study (UDS) in patients with primary urinary incontinence. Material and Methods: 200 patients with primary incontinence studied prospectively from January 2013 to June 2014. Their age ranges from (14 - 93 years), 86.5% were female, and 13.5% of them were male. In addition to physical, neurological examination and bio-chemical investigations, urine analysis and urine culture with Ultra-sound and Post void residual volume (PVRV), all patients underwent diagnosticflexible cystoscopy under local anesthesia, and urodynamic study. Result: 43.5% of patients age were between (34 - 53 years), (39%) between (54 - 73 years), (9%) between (14 - 33 years) and (8.5%) were between (74 - 93 years). Atonic bladder on UDS were (40.5%), Detrusor over activity (29%), patients with normal UDS were (22%) and patients that had DSD (Detrusor Sphincter Dyssynergia) were (8.5%). Eighty-four cases (42%) were found to have normal cystoscopy, those with grade-I-II bladder wall trabeculations were (49%) and patients with grade-III were (8.5%). Sixty-one patients (30.5%) with normal diagnostic cystoscopy have abnormal UDS (Atonic bladder, over-active bladder and DSD) while twenty-one (10.5%) patients with normal UDS had bladder wall trabeculations (grade-I-III) on diagnostic cystoscopy. Conclusion: Diagnostic cystoscopy in addition to urodynamic study will put in further knowledge in the assessment of patients with urinary incontinence. To some extent, it can predict the diagnosis.

Autonomic Dysreflexia Severity between Urodynamics and Cystoscopy in Patients with Spinal Cord Injury above T6

Objective: The objective is to evaluate autonomic dysreflexia (AD) severity between urodynamics and cystoscopy in patients with spinal cord injury (SCI) above thoracic 6 (T6). Design: It is a cross-sectional survey. Subject and methods: The study was carried out in 22 patients with SCI above T6 who underwent both procedures of urodynamics and cystoscopy;all patients developed episodes of AD. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured and recorded at the beginning and during the various stages of the two examinations. AD was defined as a rise in SBP above 20 mm Hg. Results: There was no significant difference in SBP and DBP at baseline before urodynamics and cystoscopy. Both urodynamics and cystoscopy triggered episodes of AD. The volume of water instilled during cystoscopy was typically standard and smaller (150 mL) in comparison with urodynamics, where volume varied depending on cystometric bladder capacity (the mean bladder volume in our study was 234.86 ± 139.06 mL). The SBP was significantly different between cystoscopy and urodynamics (49.23 ± 23.07 mm Hg and 35.14 ± 15.75 mm Hg, respectively;P = 0.023). Conclusions: Although bladder distension during cystoscopy was less than that in urodynamics, the severity of AD was more pronounced during cystoscopy. It is recommended that monitoring of cardiovascular parameters during these procedures should be routinely performed.

Inflammatory response, stress response and urodynamic changes after total pelvic floor reconstruction in patients with pelvic organ prolapse

Objective: To investigate the changes of inflammatory response, stress response and urodynamic changes after total pelvic floor reconstruction in patients with pelvic organ prolapse. Methods: According to random data table method, 80 cases of pelvic organ prolapse were randomly divided into the control group (n=40) and observation group (n=40), patients in the control group were given conventional vaginal hysterectomy plus vaginal wall repair sugery and the observation group received total pelvic floor reconstruction. The levels of the serum inflammatory factor,oxidative stress before and after surgery, and postoperative urodynamic changes were compared. Results: The levels of serum hs-CRP, IL-1β,TNF-α, NE, E and Ins in the two groups before treatment were not statistically significant. Compared with the group before treatment, the levels of hs-CRP, IL-1β, TNF-α, NE, E were significantly increased in both groups after treatment, and the observation group levels were significantly lower than those in the control group after treatment;in terms of urodynamics, the postoperative maximal bladder volume and Qmax were significantly higher in the observation group than in the control group, the postoperative levels of PdetQMax, PdetMax and PVR in the observation group were significantly lower than those in the control group. Conclusion: Compared with vaginal hysterectomy plus vaginal wall repair sugery, total pelvic floor reconstruction can light the patient's inflammation, stress response and improve the patient's urinary function, and the overall effect is better which has important clinical value.

Correlation of urodynamic characteristics with insulin resistance and serum damage media in diabetic patients with benign prostatic hyperplasia

Objective:To study the correlation of urodynamic characteristics with insulin resistance and serum damage media in patients with diabetes and benign prostatic hyperplasia (BPH). Methods:45 patients with type 2 diabetes mellitus and BPH treated in our hospital between May 2014 and August 2016 were selected as DM+BPH group, 58 patients with BPH alone were selected as BPH group, and 50 healthy volunteers were selected as control group. Urodynamic tester was used to measure the maximum flow rate (MFR), postvoid residual (PVR) and detrusor pressure at maximum flow rate (Pdet), and serum was collected to determine insulin resistance indexes and oxidative stress indexes. Results:MFR and Pdet of DM+BPH group were significantly lower than those of control group (P<0.05) while PVR was significantly higher than that of control group (P<0.05);MFR of BPH group was significantly lower than that of control group (P<0.05) while PVR and Pdet were significantly higher than those of control group (P<0.05);MFR and Pdet of DM+BPH group were significantly lower than those of BPH group (P<0.05) while PVR was significantly higher than that of BPH group (P<0.05);insulin secretion index (HOMA-β), insulin sensitive index (ISI) as well as serum manganese superoxide dismutase (MnSOD), copper-zinc superoxide dismutase (CuZnSOD) and glutathione peroxidase (GPx) levels of DM+BPH group and BPH group were significantly lower than those of control group (P<0.05) while insulin resistance index (HOMA-IR) as well as serum thioredoxin (Trx) and thioredoxin-interacting protein (TXNIP) levels was significantly higher than those of control group (P<0.05);HOMA-β, ISI as well as serum MnSOD, CuZnSOD and GPx levels of DM+BPH group were significantly lower than those of BPH group (P<0.05), positively correlated with MFR and Pdet, and negatively correlated with MFR, and HOMA-IR as well as serum Trx and TXNIP levels was significantly higher than those of BPH group (P<0.05), negatively correlated with MFR and Pdet, and positively correlated with MFR. Conclusions: Insulin resistance and oxidative stress injury are the mechanisms that cause the urodynamic changes in patients with diabetes and BPH.

Urodynamic study of enhanced continent mechanism using tapered ileum as continent urinary reservoir

OBJECTIVE: To investigate the effect of extramural support from the pouch and abdominal wall to enhance the continent mechanism of tapered ileum. METHODS: A total of 24 patients underwent a procedure in which an ileal segment was tapered into an efferent tube, of which a part was placed between the back surface of the rectus muscle and the ileal pouch wall. The internal orifice of the tapered ileum was anastomosed to the ileal pouch and its external orifice was anastomosed to the umbilicus. A urodynamic study of the efferent tubes and pouch was done 1.5 to 3 months and 6 to 24 months postoperatively. RESULTS: One patient died of heart disease 55 days postoperatively, while 22 of the remaining 23 were completely continent day and night. At 1.5 to 3 months, the urodynamic study of the efferent tubes demonstrated that the maximum closure pressure with a full pouch was 46 - 124 cmH(2)O (91.26 +/- 15.71 cmH(2)O) and with an empty pouch was 34 - 84 cmH(2)O (67 +/- 10.60 cmH(2)O). The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t = -11.78 and P = 0.00001). At 6 to 24 months, a second urodynamic study was performed on 18 cases, demonstrating a reservoir capacity of 420 to 750 ml (481.67 +/- 78.83 ml). Reservoir pressure was 6 to 9 cmH(2)O (7.17 +/- 1.17 cmH(2)O) when the pouch was filled to 50 ml, and 16 to 35 cmH(2)O (24.12 +/- 5.61 cmH(2)O) when it was filled to maximum capacity. There was no contractive wave during the filling in any patient. Maximum closure pressure in the efferent tube was 80 to 194 cm H(2)O (98.89 +/- 26.34 cmH(2)O) when the pouch was filled with saline, and 64 to 128 cmH(2)O (74.78 +/- 14.54 cmH(2)O) when the pouch was empty. The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t = -7.58 and P = 0.00003). CONCLUSIONS: This study indicates that the continent mechanism of tapered ileum may be greatly enhanced by extramural support from the abdominal and pouch walls.

Urodynamic analysis of non-improvement after prostatectomy

OBJECTIVE: To study the factors that affect the prognosis of the patients with benign prostatic hypertrophy (BPH) after prostatectomy. METHODS: Using urodynamic methods, we studied 50 BPH patients with embarrassing outcomes after prostatectomy. RESULTS: Detrusor instability (Dl) appeared in 20 (40%) patients. Twelve (24%) patients suffered from weak contractility of the detrusor and 18 (36%) patients had bladder outlet obstruction. CONCLUSIONS: Dl, weak contractility of the detrusor and bladder outlet obstruction are the most frequent causes affecting the prognosis of BPH patients after prostatectomy. Urodynamics may play a significant role in the identification of the causes of unsatisfied prognosis of BPH patients.

Urodynamic assessment of bladder storage function after radical hysterectomy for cervical cancer

Background:After radical hysterectomy for cervical cancer,the most common complication is lower urinary tract symptoms.Post-operatively,bladder capacity can alter bladder function for a prolonged period.This study aimed to identify factors affecting bladder storage function.Methods:A multicenter,retrospective cohort study was conducted.Information of patients with stages IA2 to IIB cervical cancer with urodynamic study results were retrospectively collected from nine hospitals between June 2013 and June 2018 according to the inclusion criteria.Demographic,surgical,and oncological data were collected.The univariate and multivariate logistic regression was used to identify clinical factors associated with bladder storage function.Results:Two hundred and three patients with cervical cancer had urodynamic testing post-operatively.Ninety-five(46.8%)patients were diagnosed with stress urinary incontinence(SUI).The incidence of low bladder compliance(LBC)was 23.2%.Twenty-seven(13.3%)patients showed detrusor overactivity(DO).Fifty-seven patients(28.1%)presented with a decreased maximum cystometric capacity(DMCC).The probability of composite bladder storage dysfunction was 68.0%.Multivariate analysis confirmed that laparoscopy represents a protective factor for SUI with an odds ratio of 0.498(P=0.034).Patients who underwent a nerve-sparing procedure were less odds to experience SUI(P=0.014).A significant positive correlation between LBC and DO was observed(P<0.001).A greater length of the resected vagina and chemoradiotherapy were common risk factors for LBC and DO,while radiotherapy exerted a stronger effect than chemotherapy.Additionally,patients who received chemoradiotherapy frequently developed a DMCC.The follow-up time was not correlated with bladder storage function.Conclusion:A nerve-sparing procedure without longer resected vagina is recommended for protecting the bladder storage function.