Imaging urodynamic characteristics of lower urinary tract dysfunction in young male / 现代泌尿外科杂志

【Objective】 To analyze the results, characteristics and clinical value of video urodynamic study (VUD) of lower urinary tract symptoms (LUTS) in young male. 【Methods】 A total of 106 young male LUTS patients (18-45 years old) who received VUD in our hospital during Jan.2016 and Sep.2021 were collected to analyze the clinical and imaging urodynamic characteristics. 【Results】 Of the 106 patients, 55 (52.44%) had neurogenic lower urinary tract dysfunction (NLUTD)with clear neurological etiology, and 51 (48%) had non-neurogenic lower urinary tract dysfunction (NNLUTD). In NLUTD patients, dysuria was the most common symptom (76.74%); lumbosacral lesions were the main cause (76.36%); imaging urodynamics indicated weakening of detrusor muscle in different degrees. In NNLUTD patients,the main symptoms were frequent urination (48.72%) and dysuria (48.72%); about 58.97% of patients had two or more LUTS, and the main diagnosis was detrusor underactivity (DU)(35.90%). 【Conclusion】 NLUTD in young male is characterized by varying degrees of detrusor muscle weakness, detrusor sphincter dyscoordination, and decreased bladder compliance. NNLUTD is mostly caused by detrusor overactivity (DO) and DU.

Lower urinary tract symptoms in Parkinson's disease and multiple system atrophy / 中华老年医学杂志

Parkinson's disease(PD)and multiple system atrophy(MSA)are two common Parkinsonian syndromes with overlapping clinical manifestations, and clinical differential diagnosis is difficult.Lower urinary tract symptoms are one of the common non-motor symptoms of the two diseases.The incidence of lower urinary tract symptoms in MSA is higher, the onset is earlier, and the micturition period is more prominent.The urinary dysfunction in patients with PD is mainly caused by the central mechanism, leading to overactive bladder.MSA has more extensive lesions with both central and peripheral involvement, leading to overactive bladder and severe voiding dysfunction.Urodynamics can be used to evaluate bladder and urethral function.MSA has more prominent weak detrusor activity, residual urine volume, and early changes of urethral sphincter.The treatment of lower urinary tract symptoms in patients with PD is mainly based on anticholinergic drugs to improve overactive bladder, while in MSA patients with increased residual urine volume, intermittent catheterization is the main method to improve lower urinary tract symptoms.This article reviewed the epidemiology, pathological mechanism, urodynamics and treatment of lower urinary tract symptoms of the two diseases, so as to assist in their differential diagnosis and treatment.

Urodynamic assessment of voiding dysfunction associated with anorectal malformation / 中华实用儿科临床杂志

Anorectal malformation (ARM) accounts for the first place of digestive tract malformations in children, with the incidence of 1/5 000-1/1 500 in newborns.ARM is typically manifested as anal stenosis or anal atresia with or without fistulas and persistent cloaca.Genitourinary malformation is the most common malformation associated with ARM, with the incidence ranging 26%-55%.There were 35%-50% of ARM children develop spinal cord peripheral abnormalities or neurogenic lower urinary tract dysfunction, which usually causes voiding dysfunction associated with ARM.Urodynamic study is the best method to analyze the changes of lower urinary tract function, which can provide an objective classification for bladder and urethral function and guide the formulation of precision treatment plan and therapeutic efficacy during the follow-up period.This study aims to review the cause of voiding dysfunction asso-ciated with ARM and its urodynamic changes.

Efficacy and urodynamic analysis of robot assisted laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse / 中华泌尿外科杂志

Objective:To explore the efficacy and safety of robot assisted laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse.Methods:The data of 16 patients who underwent robot assisted laparoscopic sacrocolpopexy in Beijing Hospital from September 2019 to May 2022 were collected. The average age was (73.5±9.3) years, the preoperative course was 4-240 months, the body mass index was (24.2±1.7) kg/m 2, the number of births was (1.7±0.8), and the quantitative index of pelvic organ prolapse (POP-Q) was grade Ⅲ -Ⅳ. The maximum urine flow rate before operation was (9.6±3.4) ml/s, the maximum detrusor pressure during urination was 26 (20, 32) cmH 2O, the first sense urine volume of the bladder was (119.1±39.4) ml, the first sense urine urgency volume of the bladder was (253.6±75.7) ml, the maximum bladder pressure capacity was (406.0±79.8) ml, and the residual urine volume was 10 (10, 28) ml. The preoperative PFDI-20 score was 100 (70, 122) and the PFIQ-7 score was 107 (90, 160). During the robot assisted laparoscopic sacrocolpopexy, the right area of the sacral promontory was exposed, the anterior and posterior walls of the uterus were separated, and the 2 cm small hole was separated from the right broad ligament of the uterus. The mesh was cut into a "Y" shape and passed through the small hole. The anterior and posterior leaves of the Y-shaped mesh were sutured to fix the cervix, and the other end was fixed to the anterior longitudinal ligament of the sacrum. The operation time and intraoperative bleeding were observed. The effect of surgery was evaluated by preoperative and postoperative urodynamic imaging, POP-Q stage, PFDI-20 score and PFIQ -7 score. Results:All the 16 operations were successfully completed. No injury of urethra, bladder, rectum, important blood vessels and nerves occurred during the operation. The average operation time was (255.6±56.0) min, and the average amount of bleeding was (28.8±18.2) ml. There was no inhibitory contraction wave in 7 patients (44%) before operation, suggesting that there was detrusor overactivity. After operation, the detrusor overactivity disappeared or significantly decreased in 7 patients. The postoperative follow-up period was 3-36 months. During the follow-up period, one patient had recurrence, and the rest had no prolapse and urination problems. The POP-Q stage was reduced to grade 0-Ⅰ after the operation. The subjective satisfaction rate of patients was 94%. The PFDI-20 score [13(8, 24)] and PFIQ -7 score [11(6, 15)] after operation were significantly reduced ( P<0.001), the initial urgent volume of bladder (272.5±88.5) ml was significantly increased compared with that before operation ( P=0.038), and the maximum volume of bladder (427.2±79.2) ml was significantly increased compared with that before operation ( P=0.006). Image urodynamics showed that the patient basically recovered the pelvic floor anatomy and achieved functional reduction. Conclusions:Robot assisted laparoscopic sacrocolpopexy has good subjective and objective effects in POP, low recurrence rate and less complications. It needs a larger sample size study for confirming the improvement of bladder function.

Application of modified upper urinary tract video urodynamics in evaluating the surgical effect and guiding the treatment after ureteral reconstruction / 中华泌尿外科杂志

Objective:To explore the clinical value of modified upper urinary tract video urodynamics in evaluating the surgical effect and guiding the follow-up treatment after ureteral reconstruction.Methods:From December 2018 to November 2020, sixty-nine patients underwent upper urinary tract reconstruction and received modified video urodynamics at the time of nephrostomy removal 3 months after the surgery in the RECUTTER database (29 cases in Peking University First Hospital, 22 cases in Emergency General Hospital, and 18 cases in Beijing Jiangong Hospital). There were 39 males and 30 females, with an average age of (40.4±12.7)years. The stricture was located in left in 34 patients, right side in 27 patients, and bilateral sides in 8 patients. The upper, middle, and lower thirds of the ureter were affected in 26, 10, and 33 cases, respectively. The preoperative creatinine was (92.3±26.9)μmol/L, and the estimated glomerular filtration rate (eGFR) was (85.1±23.2)ml/(min·1.73m 2). The upper urinary tract reconstruction included ileal replacement of ureter in 25 cases (36.2%), pyeloplasty in 8 cases (11.6%), ureteroneocystostomy in 9 cases (13.0%), boari flap in 6 cases (8.7%), lingual mucosal graft ureteroplasty in 9 cases (13.0%), appendiceal onlay ureteroplasty in 3 cases (4.3%), ureteroureterostomy in 3 cases (4.3%), and balloon dilation in 6 cases (8.7%). Based on the pressure and imaging, the results could be divided into three types, type Ⅰ, the pressure difference remained stable near baseline, and the renal pelvis pressure was below 22 cmH 2O(1 cmH 2O=0.098 kPa), and the reconstructed ureter is well visualized during the whole perfusion process; type Ⅱ, the pressure difference increases with the perfusion, but it can decrease to a normal level with the ureteral peristalsis; type Ⅲ, the pressure difference exceeds 15 cmH 2O, and the ureteral peristalsis is weak or disappears at the same time. The management strategies and treatment effects of different subtypes were analyzed. Successful treatment was defined as no further treatment required, the absence of hydronephrosis-related symptoms, and the improved or stabilized degree of hydronephrosis. Results:All 69 patients successfully completed upper urinary tract video urodynamics. The pressure difference was higher than 15 cmH 2O in 8 patients, and the median pressure difference was 37(19-54)cmH 2O. The renal pelvis pressure exceeded 22 cmH 2O in 10 patients, and the median pressure was 63.5 (24-155) cmH 2O. Video urodynamic results of upper urinary tract were classified as type Ⅰ in 60 cases, type Ⅱ in 5 cases, and type Ⅲ in 4 cases. Patients in type Ⅰ do not require other treatment after nephrostomy tube removal. Patients in type Ⅱ should avoid holding urine after the removal of nephrostomy and D-J tubes. All patients in type Ⅲ received further treatment, of which 2 patients replaced D-J tube regularly, 1 patient underwent long-term metal ureteral stent replacement, and 1 patient underwent ureteroscopic balloon dilation. The median follow-up time was 24 (18-42) months. All patients in type Ⅰ met the criteria for surgical success, The pre-and postoperative creatinine in type Ⅰ patients were (88.71±23.09)μmol/L and (88.75±23.64)μmol/L ( P=0.984), and eGFR were (88.06±22.66)ml/(min· 1.73m 2)and (87.97±23.01)ml/(min·1.73m 2), respectively( P=0.969). For type Ⅱ patients, ultrasound showed that the degree of hydronephrosis improved in 3 cases and remained stable in 2 cases. The pre-and postoperative creatinine were (105.97±7.75)μmol/L and (97.63±7.56)μmol/L ( P=0.216), and eGFR were (69.08±14.74)ml/(min·1.73m 2)and (75.95±14.02)ml/(min·1.73m 2)( P=0.243), respectively. For type Ⅲ patients, ultrasound showed that the degree of hydronephrosis remained stable. The pre-and postoperative creatinine were (105.14±44.34)μmol/L and (101.49±57.02)μmol/L ( P=0.684), and eGFR were (65.32±19.85)ml/(min·1.73m 2) and (73.42±27.88) ml/(min·1.73m 2), respectively( P=0.316). Conclusions:The pressure and imaging results of modified upper urinary tract video urodynamics can assist in evaluating the surgical effect of ureteral reconstruction, and the classification has certain guiding significance for further treatment.

Effect of preoperative urodynamic study on urinary outcomes after transobturator sling / Efeito do estudo urodinâmico pré-operatório nos resultados pós-operatórios do sling transobturador

Abstract Objective To evaluate whether performing preoperative urodynamic study influences postoperative urinary symptoms of women with stress urinary incontinence that underwent transobturator sling. Methods Retrospective analysis of patients treated for stress urinary incontinence by transobturator sling from August 2011 to October 2018. Predictor variables included preoperative urodynamic study, age, incontinence severity, body mass index, preoperative storage symptoms and previous anti-urinary incontinence procedure. Outcome variables were postoperative subjective continence status, storage symptoms and complications. Logistic regression after propensity score was employed to compare outcomes between patients who underwent or not pre-operative urodynamic study. Results The present study included 88 patients with an average follow-up of 269 days. Most patients (n = 52; 59.1%) described storage symptoms other than stress urinary incontinence, and 38 patients (43.2%) underwent preoperative urodynamic studies. Logistic regression after propensity score did not reveal an association between urinary continence outcomes and performance of preoperative urodynamic study (odds ratio 0.57; confidence interval [CI]: 0.11-2.49). Among women that did not undergo urodynamic study, there was a subjective improvement in urinary incontinence in 92% of the cases versus 87% in those that underwent urodynamic study (p = 0.461). Furthermore, postoperative storage symptoms were similar between women who did not undergo urodynamic study and those who underwent urodynamic study, 13.2% versus 18.4%, respectively (p = 0.753). Conclusion Preoperative urodynamic study had no impact on urinary incontinence cure outcomes as well as on urinary storage symptoms after the transobturator sling in women with stress urinary incontinence.

Resumo Objetivo Avaliar a influência do estudo urodinâmico pré-operatório nos resultados miccionais pós-operatórios em mulheres com incontinência urinária de esforço submetidas a sling transobturador. Métodos Análise retrospectiva de mulheres com incontinência urinária de esforço submetidas a sling transobturador entre agosto de 2011 e outubro de 2018. As variáveis preditoras pré-operatórias, entre outras, foram a realização do estudo urodinâmico, gravidade da incontinência e sintomas urinários de armazenamento. As variáveis de desfecho pós-operatórias foram o status subjetivo da continência, sintomas de armazenamento urinário e complicações cirúrgicas. A regressão logística após o escore de propensão foi empregada para comparar os resultados entre os pacientes que foram submetidos ou não ao estudo urodinâmico pré-operatório. Resultados Foram incluídas no presente estudo 88 pacientes com um seguimento médio de 269 dias. A maioria das pacientes apresentava sintomas miccionais de armazenamento (n = 52; 59,1%) concomitantes à incontinência urinária de esforço. Um pouco menos da metade das pacientes (n = 38; 43,2%) foram submetidas a estudo urodinâmico pré-operatório. A regressão logística após o escore de propensão não revelou associação entre os resultados de continência urinária e a realização de estudo urodinâmico pré-operatório (odds ratio 0,57; intervalo de confiança [IC]: 0,11-2,49). Além disso, os sintomas de armazenamento urinário pós-operatórios foram similares entre as pacientes que não realizaram e aquelas que realizaram o estudo urodinâmico, 13,2% e 18,4% respectivamente (p = 0,753). Conclusão O estudo urodinâmico pré-operatório não teve impacto nos resultados de continência urinária, bem como nos sintomas de armazenamento urinário após o sling transobturatório.

Comparative study on real-world data of water filled and air charged manometry in urodynamic examinations / 中华泌尿外科杂志

Objective:Evaluate the influence of different pressure transmission media of urodynamic water filled catheter(WFC) and air charged catheter(ACC) on the pressure measurement results to determine whether they can be used interchangeably.Methods:The results of 2 147 patients who underwent urodynamic examination in our hospital from January 2014 to December 2020 were retrospectively analyzed. A total of 2 538 times of bladder manometry data were obtained, including 1 299 times in WFC group, 856 times in male and 443 times in female, aged 37(24, 50)years, course of disease 1.2(0.4, 5.0) years, 1 130 times in neurogenic bladder(NB)and 169 times in non-neurogenic bladder(N-NB); In ACC group, there were 1 239 times, 773 times for male and 466 times for female, with age of 37(24, 55)years, course of disease of 1.5(0.5, 6.0)years, 1 040 times for Nb and 199 times for N-NB. There was no significant difference in baseline data of general clinical data between the two groups. The intravesical pressure(Pves), intra-abdominal pressure(Pabd)and detrusor pressure(Pdet) of WFC and ACC patients during filling and urination were analyzed. For traumatic spinal cord injury(SCI) and idiopathic patients, the two sets of pressure measurement data were analyzed separately. Nonparametric test and Chi-square test were used to compare the Pves, Pabd, and Pdet recorded by the two manometry catheters before, at the end and after urination, the maximum detrusor pressure at DO(Pdet.max-DO), and the maximum detrusor pressure during spontaneous urination (Pdet. max) and the detrusor pressure (Pdet.Qmax) corresponding to the maximum urine flow rate, the maximum urethral pressure (MUP) and the maximum urethral closure pressure (MUCP) during resting urethral pressure profile, and the initial cough Pdet signal pattern (typeⅠ, typeⅡand typeⅢ).Results:Regardless of the cause, the Pabd values measured by ACC were significantly higher than WFC before filling, end filling and after voiding[18(10, 26)cmH 2O vs.15(11, 21)cmH 2O; 23(16, 31)cmH 2O vs. 20(14, 26)cmH 2O; 23(15, 31)cmH 2O vs.18(12, 24)cmH 2O], and Pdet were significantly lower than WFC[0(0, 0) cmH 2O vs. 0(0, 1)cmH 2O; 5(1, 13)cmH 2O vs. 9(4, 17)cmH 2O; 6(1, 12)cmH 2O vs. 7(3, 14)cmH 2O]. In the initial cough state, Pves and Pabd increase value were also significantly lower than that of WFC [22(12, 36)cmH 2O vs. 23(14, 38)cmH 2O; 20(10, 33)cmH 2O vs. 21(12, 36)cmH 2O]. The Pves measured by ACC was also significantly higher than WFC before filling and after voiding[18(10, 27)cmH 2O vs. 16(11, 21)cmH 2O; 30(22, 39)cmH 2O vs. 26(20, 36)cmH 2O]. Maximum urethral pressure (MUP) and maximum urethral closure pressure (MUCP) measured by ACC were significantly higher than WFC [91(69, 118)cmH 2O vs.81(64, 106)cmH 2O; 77(55, 103)cmH 2O vs. 68(48, 91)cmH 2O], and there were no significant differences in Pdet.max-DO、Pdet.max和Pdet.Qmax. For patients with traumatic SCI, the Pves measured by ACC was significantly higher than WFC before filling[15(10, 24)cmH 2O vs. 14(10, 20)cmH 2O], and only MUP was significantly higher than WFC in the measurement of urethral pressure[95(71, 119)cmH 2O vs. 85(65, 112)cmH 2O], and there were no significant differences in Pdet.max-DO, Pdet.max, Pdet.Qmax and MUCP. For idiopathic patients, Pves measured by ACC before filling and after urination were significantly higher than WFC[25(20, 29)cmH 2O vs. 18(11, 23)cmH 2O; 35(29, 44)cmH 2O vs. 28(20, 38)cmH 2O], while Pdet.max-DO, Pdet.max, Pdet.Q max, MUP and MUCP were not significantly different in different pressure measurement systems. For the comparison of the initial cough Pdet signal pattern, ACC is easier to detect type Ⅰ, and WFC is easier to detect type Ⅱ and type Ⅲ. Conclusions:Compared with WFC, ACC measured higher Pves and Pabd and lower Pdet in resting state, and lower Pves and Pabd in initial cough state. The pressure values and signal pattern measured by WFC and ACC are not completely consistent, so they cannot be used interchangeably.

Functional connectivity within prefrontal cortex in patients with overactive bladder based on rs-fNIRS measurement synchronous urodynamic monitoring / 中华泌尿外科杂志

Objective:To detect the abnormalities within the functional connectivity (FC) of the prefrontal cortex (PFC) in patients with overactive bladder (OAB) and to explore its central pathogenesis.Methods:Seven OAB patients (OAB group, 6 females, mean age 47.6±16.0 years) and 13 healthy controls [HC] (HC group, 10 females, mean age 49.9±9.2 years) were prospectively enrolled from August to December 2020. All subjects underwent rs-fNIRS scanning synchronized with urodynamic monitoring, and two rs-fNIRS scans were performed when the bladder was empty and when the desire to void was strong/urodynamic monitoring indicated detrusor hyperactivity (DO). The Pearson's correlation coefficients (r value, i. e., FC value) between time series of the 22 channels were calculated, and a 22×22 FC matrix for each subject was obtained. A paired-sample t-test ( P<0.05, FDR corrected) was used to compare the difference in FC values between the HC group and the OAB group when the bladder was empty and the desire to void was strong. A two-sample t-test ( P<0.05, FDR corrected) was used to compare the group differences in FC values between OAB and HC groups. Results:In this study, 7 patients were included in the OAB group, including 1 male and 6 female. The mean age was (47.6±16.0) years old. In HC group, 13 healthy subjects were included, including 3 males and 10 females. The mean age was (49.9±9.2) years. There was no significant difference in baseline data between the two groups, including age, sex composition, years of education, handedness and urgency score at the second scan ( P>0.05). Residual urine volume in both groups was less than 10 ml. The OABSS score, 3-day urine diary parameters (frequency of urination/24 h, frequency of urinary incontinence/24 h, frequency of urgency/24 h) and maximum detrusor pressure during urine storage in OAB group were significantly higher than those in HC group, with statistical significance ( P<0.01). The average urination volume/time, bladder capacity at first sensation and maximum bladder capacity in OAB group were significantly lower than those in HC group, and the differences were statistically significant ( P<0.01). In the process of bladder filling to strong desire to void, the detrusor pressure in HC group was stable without DO, and 6 cases in OAB group had DO. Compared to empty bladder state, healthy subjects with strong desire to void showed significantly increased FC within PFC in 5 Brodmann area (BA9, BA10, BA44, BA45, BA46)and 13 edges, such as the BA9(left dorsolateral prefrontal cortex [DLPFC]: ch 4, 5, 7 and right DLPFC: ch 3), BA10(left frontopolar area: ch 12, 21 and right frontopolar area: ch 10, 18), BA44(left pars opercularis Broca's area: ch 15), BA45(left pars triangularis: ch 22), BA46(left DLPFC: ch 6, 14); significantly decreased FC in 3 brain regions (BA9, BA10 and BA46) and 2 edges, such as the BA9(left DLPFC: ch 7), BA10(left frontopolar area: ch21 and right frontopolar area: ch 17), BA46(right DLPFC: ch 9). There was no significant difference in FC within PFC between OAB and HC groups with empty bladder. However, during the strong desire to void state, the FC within PFC in OAB patients was significantly abnormal when compared with HC. OAB patients showed significantly increased FC within PFC in 4 brain regions (BA9, BA10, BA45 and BA46) and 4 edges, such as the BA9(right DLPFC: ch 1 and left DLPFC: ch 7), BA10(right frontopolar area: ch 17), BA45(left pars triangularis: ch 22), BA46(right DLPFC: ch 9, 16); significantly decreased FC in 3 brain regions (BA9, BA10 and BA46) and 4 edges, such as the BA9 (right DLPFC: ch 3 and left DLPFC: ch 4), BA10(left frontopolar area: ch 12, 21), BA46(left DLPFC: ch 14) Conclusion:Compared with HC group, the PFC in OAB group showed significant abnormalities, which may lead to "dyssynergia" of PFC internal functions, result in frontal lobe dysfunction, involving sensory integration, motivation drive, emotional control and decision whether to urinate or not, etc., leading to urinary control dysfunction, which manifested as typical clinical symptoms of OAB. Our findings contribute to the understanding of the central pathogenesis of OAB and may provide a theoretical basis for the emergence of targeted brain therapy in the future.

The analysis of urodynamic and clinical features of detrusor underactivity in elderly men / 中华老年医学杂志

Objective:To analyze the urodynamic and clinical features of detrusor underactivity(DU)in elderly men aged 60 years and over.Methods:Five hundred and seventy-three men aged 60 years and over underwent urodynamic measurements due to dysuria were retrospectively analyzed.According to the urodynamic parameters of bladder contractibility index(BCI)and bladder outlet obstruction index(BOOI), they were divided into the three groups: only detrusor underactivity(DU group)(BCI<100 and BOOI<20), only bladder outlet obstruction(BOO group)(BCI≥100 and BOOI≥40), and the combined non-DU and non-BOO group(NDB group)(BCI≥100 and BOOI<20). The urodynamic and clinical features were compared between the three groups.Results:The internalized 323 patients meeting inclusion and exclusion criteria were divided into 3 groups: 75 in the DU, 207 in the BOO and 41 in the NDB.The age was higher in DU and BOO groups than in NDB group( P<0.05). The DU group versus the NDB group showed the higher levels or values in the volume at first desire(FDV)[(279±80)ml vs.(238±72)ml], the proportions of incomplete bladder emptying(41% vs.17%), urine flow interruption(39% vs.15%)and retention(26% vs.7%), and the lower levels in the voiding efficiency(VE)[(61±32)% vs.(110±41)%], (all P<0.05). The DU group vs.the BOO group showed the increased levels or values in the FDV[(279±80)ml vs.(206±67)ml]and maximum cytometric capacity(MCC)(353±113 ml vs.281±94 ml)and the proportions of urine flow interruption(39% vs.22%), TURP(26% vs.6%), and retention(26% vs.14%), and the decreased levels or values in the VE[(61±32)% vs.(78±37%)], the proportions of DO(41% vs.77%), urgency(26% vs.43%)and nocturia(23% vs.39%)(all P<0.05). Conclusions:The main urodynamic and clinical features are manifested as the reduction of bladder sensation and bladder emptying rate, urine flow interruption, urinary retention and having a TURP history in elderly man with detrusor underactivity.The proportions of DU and BOO are increased along with aging.

Effect of meditation on physiological and psychological stress of patients underwent urodynamic examination / 中国实用护理杂志

Objective:To explore the effects of meditation on patients underwent urodynamic examination.Methods:Totally 90 patients with benign prostatic hyperplasia who underwent urodynamic examination in the Department of Urology at the hospital from September 2018 to December 2019 were enrolled in the present study. They were assigned to experimental group and control group, with 45 cases in each group. The control group received routine nursing, basis on this, the experimental group carried out meditation training. The examination time, examination success rate as well as the incidence of complications were recorded between two groups. The systolic blood pressure, diastolic blood pressure and heart rate was compared at 10 min before the start of examination, 10 min after the start of examination, 10 min after the end of examination, respectively. In addition, the psychological stress was assessed by Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) at 1 day before the start of examination, 1 hour before the start of examination and 10 min after the end of examination.Results:The examination time were (33.56±4.95) min and the incidence of hematuria were 4.4% (2/45) in the experimental group, significantly lower than (36.42±6.32) min and 17.8% (8/45) in the control group, the difference was statistically significant (t value was 2.460, χ 2 value was 4.050, P<0.05). At 10 min before the start of examination, 10 min after the start of examination, the systolic blood pressure and diastolic blood pressure were (129.18±10.99) mmHg (1 mmHg=0.133 kPa), (130.73±11.81) mmHg and (89.42±14.50) mmHg, (98.36±15.51) mmHg in the experimental group, significantly lower than (135.93±10.17) mmHg, (139.49±10.64) mmHg and (96.29±13.85) mmHg, (105.80±12.02) mmHg in the control group ( t values were 2.297-3.695, P<0.01 or 0.05); at 10 min before the start of examination, 10 min after the start of examination, 10 min after the end of examination, the heart rate were (85.53±11.82) times/min, (90.51±8.82) times/min, (74.09±8.20) times/min in the experimental group, significantly lower than (92.80±11.95) times/min, (95.84±10.02) times/min, (77.60±8.51) times/min in the control group, the difference was statistically significant ( t values were 2.900, 2.680, 1.992, P<0.01 or 0.05). At 1 hour before the start of examination, the SAS and SDS scores were (54.42±3.85) pionts and (54.11±4.65) points in the experimental group, significantly lower than (58.44±7.37) pionts and (56.11±4.48) pionts in the control group, the difference was statistically significant ( t values were 3.247, 2.079, P<0.01 or 0.05). Conclusion:The meditation can help to relieve the physiological and psychological stress of patients who underwent urodynamic examination, shorten the examination time as well as reduce complications.

Urodynamic analysis of 70 children with different lower urinary tract symptoms / 中华实用儿科临床杂志

Objective:To explore the characteristics of urodynamic parameters of children with different lower urinary tract symptoms (LUTS) but without neurogenic or organic diseases, thus providing references for the clinical diagnosis and treatment.Method:Clinical data of LUTS children without neurogenic or organic diseases who underwent urodynamic tests in the Department of Urology, Beijing Children′s Hospital of Capital Medical University from January 2017 to December 2019 were retrospectively analyzed.A total of 70 LUTS children aged 5-12 years were recruited, involving 46 males and 24 females with the median age of 9.0 (7.0, 10.0) years.According to the main symptoms of LUTS, patients were divided into 4 groups: urinary frequency and urgency group, urinary incontinence group, enuresis group and others.All children underwent urodynamic tests, including noninvasive uroflow rate/pelvic floor electromyography and urethral catheterization cystometry.Urodynamic parameters were recorded for analysis.The results of urodynamic study were compared among urinary frequency and urgency group, urinary incontinence group and enuresis group.Results:There were no significant differences in the noninvasive uroflow rate and post-voiding resi-dual volume among the three groups.Contractions of pelvic floor muscles during urination in children with abnormal urine flow curve were more often observed than those with normal urine flow curve ( 17/38 cases vs.2/32 cases, χ2=13.012, P<0.05). The contractions in children with staccato-shaped curve were more often observed than those with plateau-shaped curve (13/22 cases vs.3/14 cases, χ2=36.000, P<0.05). There were no significant differences in the main invasive urodynamic parameters of storage and emptying phase among the three groups.The bladder compliance of children with detrusor overactivity (DO) was lower than those without DO [12.64(9.00, 21.11) mL/cmH 2O vs.32.22(21.81, 97.75) mL/cmH 2O, 1 cmH 2O=0.098 kPa, Z=-26.333, P<0.001]. The maximum urethral static pressure of children with enuresis was higher than those with urinary frequency and urgency, and urinary incontinence [(120.00±20.69) cmH 2O vs.(81.17±28.09) cmH 2O vs.(69.59±22.19) cmH 2O, F=12.170, P<0.05]. The maximum urethral closed pressure of children with enuresis was higher than those with urinary frequency and urgency, and urinary incontinence [(109.86±41.94) cmH 2O vs.(62.41±26.71) cmH 2O vs.(58.09±20.49) cmH 2O, F=11.804, P<0.05]. Conclusions:Urodynamic abnormalities are common in LUTS children without neurogenic or organic diseases.Urodynamic tests can be applied to identify the types and distributions of potential urodynamic abnormalities, and to guide the treatment and reflect curative effect.DO and decreased bladder compliance are the most common urodynamic abnormalities, which should be monitored and treated in time.

Research progress of noninvasive diagnosis of male bladder outlet obstruction / 中国综合临床

Currently, invasive urodynamic testing is the " gold standard" for the diagnosis of bladder outlet obstruction (BOO). However, this test is invasive, easy to cause hematuria, urinary tract infection and other complications, the application conditions are limited.In order to solve this problem, various non-invasive methods to diagnose or predict BOO have been studied.The use of existing inspection indicators such as ultrasound measurement, penile cuff test, near infrared spectroscopy and other new non-invasive methods provide a new research direction for the non-invasive diagnosis of bladder outlet obstruction.

Role of urodynamics in evaluation of lower urinary tract dysfunction in women of pelvic organ prolapse

Background: Utero-vaginal prolapse is a common gynecological disorder, result from weakness of musculoskeletal structure that support the pelvic organ. Although it is not an emergency situation but severely affect the quality of life. Women with utero-vaginal prolapse may present with lower urinary tract dysfunction but association of urological changes with UV prolapse and beneficial effect of surgery on these changes is still debatable. Urodynamic study such as cystometry and uroflowmetry help in better understanding of lower urinary tract dysfunction and assist to plan appropriate surgical management thereby reduce chances of postoperative voiding dysfunction.Methods: A total of 30 women of pelvic organ prolapse with lower urinary tract dysfunction, over a period of one year, were subjected to urodynamic studies after thorough evaluation by history, examination and standardized questionnaire both pre and post operatively and data analysed.Results: In present study, urodynamic study identified urinary dysfunction in 93.34% of women recruited in study. Obstruction was present in 36.67% of women. Detrusor overactivity along with obstruction was seen in 20.00% of women. Urodynamic stress incontinence and urodynamic stress incontinence along with obstruction was identified in 13.33% of women each and detrusor overactivity was observed in 10.00% of women.Conclusions: In present study it was found that, if surgical management of pelvic organ prolapse is planned according to urodynamic study, it will improve urologic profile of patients. To conclude that urodynamic study should be an integral part of diagnostic work up of uterovaginal prolapse patients require larger sample size and at least 6 months follow-up duration after surgery.

Catheter induced hypospadias, urethral trauma and penile abscess in completely recoverable neurological afflictions: preventable entities

Background: Catheter associated complications are very common in the emergency departments of medicine, general surgery, orthopaedics and in community. They mostly occur in patients with neurological afflictions because of inexperience of the first handlers as they lack the insight of altered physiology and anatomy in the lower urinary tract because of neurological lesions and also because of an inadequate advice at the time of discharge regarding the catheter care. Objectives of this study were to find the prevalence of per-urethral catheter associated injuries in patients with neurological lesions in a tertiary care centre of south-eastern Punjab and their prevention in completely recoverable neurological afflictions.Methods: This is a cross-sectional observational study conducted in urology department from 1st August 2017-31st August 2018. The data was taken from medicine, general surgery and orthopedic emergency departments. A total of 82 patients were taken from 19-78 years and 49 patients had per-urethral catheter placement. Analysis was done using Statistical Program of Special Sciences, version 20.Results: It was observed that overall neurological lesions are more common in males (80.48%) as compared to females (19.51%) and distributed over an age range of 19-84 years in both sexes. Out of total patients, 59.75% required per urethral catheterization. The prevalence of per-urethral catheter associated complications was 20.40%.Conclusions: Insertion of per-urethral catheter is a simple procedure but an error of omission on the part of health professionals’ results in a serious complication in a neurological patient. Proper insertion technique and catheter care are to be followed to prevent avoidable complications in this subset of patients.

Factors associated with ultrasound diagnosed neurogenic bladder complications following spinal cord injury

@#secondary medical impairment following spinal cord injury(SCI). Ultrasound (US) of the kidneys, ureters and bladder(KUB) has been recommended as a useful, non-invasivesurveillance method with good diagnostic sensitivity. Thisstudy aims to understand US diagnosed NB complicationsand identify its associated factors.Methods: We enrolled all patients referred for SCIrehabilitation from 2012 to 2015 that fulfilled our studycriteria. Data that were retrospectively reviewed includeddemographic and clinical characteristic data; and US KUBsurveillance studies.Results: Out of 136 electronic medical records reviewed, 110fulfilled the study criteria. The prevalence of NB in our studypopulation was 80.9%. We found 22(20%) of the patientsshowed evidence of US diagnosed NB complications withthe mean detection of 9.61±7.91 months following initial SCI.The reported NB complications were specific morphologicalchanges in the bladder wall 8(36.4%); followed byunilateral/bilateral hydronephrosis 7(31.8%); bladder and/orrenal calculi 5(22.7%); and mixed complication 2(9.1%)respectively. Half of the patients with NB complications hadurodynamic diagnosis of neurogenic detrusor overactivitywith/without evidence of detrusor sphincter dyssynergia.We found co-existing neurogenic bowel, presence ofspasticity and mode of bladder management weresignificantly associated factors with US diagnosed NBcomplications (p<0.05), while spasticity was its predictorwith adjusted Odds Ratio value of 3.93 (1.14, 13.56).Conclusion: NB is a common secondary medical impairmentin our SCI population. A proportion of them had USdiagnosed NB complications. Co-existing neurogenic bowel,presence of spasticity and mode of bladder managementwere its associated factors; while spasticity was itspredictor.

A Clinical Study on Correlation of Non-Invasive Diagnostic Tests in Evaluation and Management of Patients with Symptomatic Benign Prostatic Hyperplasia

Introduction: The gold standard for diagnosing bladderoutlet obstruction is pressure flow study but it is associatedwith side effects of high cost, invasiveness, infection, limitedavailability. So non invasive diagnostic tests becomes a goodoption. The diagnostic accuracy of these non invasive tests,however, remains uncertain. So this study was conductedto know the role of non invasive diagnostic tests likeInternational prostate symptom score (IPSS), Uroflowmetry(UFR), prostate volume, bladder wall thickness, post voidresidual urine in symptomatic patients with BPH in theirevaluation and in the planning of management.Material and methods: The present study included 108 malepatients above 50 years suffering from symptomatic BPH whoattended urology OPD at SVIMS, Tirupati. IPSS, Urinaryflow rates, bladder wall thickness, prostate volume, post voidresidual urine and urodynamic study have been recorded inthese patients at the time of enrollment into study.Results: One hundred and eight men between 50 – 79 years ofage with mean age of 62.4 years participated in this study. Allthe patients were divided into two groups as either obstructedor un obstructed based on Abraham – Griffith numbercalculated from the urodynamic study. Bladder wall thickness,Q max, Post void residual urine and prostate volume allhad statistically significant values between obstructed andun obstructed patients. However, there was no statisticalsignificant differences between age, IPSS in both the groupsConclusion: This study shows that in a subset of patientswith BPH with predefined inclusion and exclusion criteria,it should be possible to define obstruction with simple noninvasive parameters, without using invasive pressure flowstudy

Effect of 's external treatment combined with long-snake moxibustion at governor vessel on urodynamic for neurogenic bladder after spinal cord injury / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of 's external treatment combined with long-snake moxibustion at the governor vessel for neurogenic bladder after spinal cord injury.@*METHODS@#A total of 64 patients with neurogenic bladder after spinal cord injury were randomly divided into an observation group and a control group, 32 cases in each group. The patients in the control group were treated with routine acupuncture and rehabilitation of bladder function; based on the treatment in the control group, the patients in the observation group were treated with 's external treatment combined with long-snake moxibustion at the governor vessel, twice a week for 8 weeks. Urodynamic test, including residual urine volume (RUV), maximum flow rate of urination (Qmax), bladder pressure at filling phase (Pves), maximum detrusor pressure (Pdet-max) and maximum urinary bladder volume (VMCC), was performed before and after 8-week treatment.@*RESULTS@#The urodynamic indexes in the two groups were improved compared with before treatment (0.05).@*CONCLUSION@#Based on routine acupuncture and rehabilitation of bladder function, 's external treatment combined with long-snake moxibustion at the governor vessel could effectively improve urodynamic indexes, reduce residual urine, reduce bladder pressure and increase the maximum capacity of bladder, thereby improving bladder compliance and bladder function.

Urodynamic analysis of extraperitoneal Studer orthotropic ileal neobladder following radical cystectomy / 中华泌尿外科杂志

Objective To evaluate changes of the urodynamics of extraperitoneal Studer orthotropic ileal neobladder after radical cystectomy.Methods Between July 2013 and October 2017,Retrospective analysis was performed on 58 bladder cancer patients.58 patients who underwent retrograde extraperitoneal approach of radical cystectomy and Studer orthotopic ileal neobladder.The patients were comprised of 56 male and 2 female patients with average age of 62 years.There were 9 cases of T1,26 cases of T2,20 cases of T3,and 3 cases of T4.All operations were completed by open suprapubic extraperitoneal approach,then entered the abdominal cavity.An ileal segment 50-55 cm long was isolated which was 25 cm proximal to the ileocecum.The 35-40 cm ileal segment was detubularized along its antimesenteric border.The anterior wall was folded forward with U-shaped and the edges were sutured to formed a neobladder.The proximal 15cm was reserved for the double isoperistaltic afferent limb.The lowest part of the neobladder was anastomosed with urethral stump,the peritoneum was closed at the mesentery,and the neobladder was completely placed extraperitoneal.Upper urinary tract function was examined by renal function test,enhanced CT,IVU or cystography.Uroflowmetry,urodynamic evaluation,diurnal and nocturnal continence were performed at 3,6,12,24 months following the surgery.Results After removed of the catheter,all patients were able to urinate through the urethra.The 3,6,12,24 month follow-up data of urodynamic were compared.The maximum neobladder capacity was[(378 ±66) vs.(381 ± 102)vs.(438 ± 75)vs.(472 ±96)] ml,the maximum flow rate [(10.2 ± 2.8) vs.(14.9 ± 4.3) vs.(16.4 ± 3.6) vs.(17.6 ± 2.1)] ml/s,maximum bladder pressure during filling was [(23.0 ± 4.6) vs.(21.7 ± 7.1) vs.(20.6 ± 6.4) vs.(18.8 ±6.3)] cmH2 O,the PVR was[(68.0 ± 33.2) vs.(36.2 ± 10.1) vs.(30.6 ± 11.9) vs.(14.0 t 9.6)] ml.There were significant differences between the 6-month and 12-month.There were no significant differences in the maximum bladder pressure during flowing [(38.6 ± 7.4) vs.(49.2 ± 6.8) vs.(58.4 ± 10.5) vs.(56.8 ± 7.4)] cmH2O.53 cases were followed up 12 months after surgery.Excellent daytime and nighttime continence was 98％ (52/53)and 83 ％ (44/53)in the first year.Mild unilateral hydronephrosis occurred in 2 cases 1 month after surgery.Blood electrolytes and renal function were within the normal range.1 case presented bilateral mild hydronephrosis 12 months after surgery,without bladder and ureter regurgitation.The blood electrolyte and renal function of the other patients were in normal range with no signs of ureteral stricture and upper urinary tract hydronephrosis.Conclusions Extraperitoneal Studer orthotopic ileal neobladder reduced the interference of postoperative intraperitoneal intestinal tract on neobladder function.Postoperative patients have a smooth urination,a safe pressure during the storage period.The urination period,and the function of day and night urinary control is close to normal physiological characteristics.

Progress of urethral instability in children with overactive bladder syndrome / 中华实用儿科临床杂志

The pathogenesis of overactive bladder syndrome (OAB) is still unclear.Although OAB is defined as " overactive bladder" , the lesion is not confined to the bladder, studies have been showed that urethral instability (URI) can also induce symptom of OAB.The author has observed 146 children with OAB and found that URI is one of the causes of OAB, and also has a significant effect on the treatment of OAB.Recently, the role of URI played in OAB has gradually been emphasized, however, the research of URI is still controversial.At present, the first-line treatment of OAB is mainly anticholinergic drugs for the detrusor overactivity, and lack of diagnosis and related treatment mea-sures in urethral dysfunction.The updated progress of URI in children with OAB were summarized in this review.

Prowess of urethral instability in children with overactive bladder syndrome / 中华实用儿科临床杂志

The pathogenesis of overactive bladder syndrome (OAB) is still unclear.Although OAB is defined as "overactive bladder",the lesion is not confined to the bladder,studies have been showed that urethral instability (URI) can also induce symptom of OAB.The author has observed 146 children with OAB and found that URI is one of the causes of OAB,and also has a significant effect on the treatment of OAB.Recently,the role of URI played in OAB has gradually been emphasized,however,the research of URI is still controversial.At present,the first-line treatment of OAB is mainly anticholinergic drugs for the detrusor overactivity,and lack of diagnosis and related treatment measures in urethral dysfunction.The updated progress of URI in children with OAB were summarized in this review.