Association between voiding lower urinary tract symptoms and findings on dynamic magnetic resonance imaging with regard to pelvic organs and their supportive structures.

OBJECTIVES: Pelvic organ prolapse (POP) causes voiding lower urinary tract symptoms (vLUTS). In the present study, we investigated the association between vLUTS and pelvic organ mobility (POM), including relevant supportive structures, on dynamic magnetic resonance imaging (dMRI). METHODS: We included 118 patients who had POP of stage II or less before straining and stage III or more when straining during dMRI. The presence of vLUTS and overactive bladder (OAB) was determined by a voiding subscore of the International Prostate Symptom Score (vIPSS) ≥5 and the OAB symptom score, respectively. POM was measured by dMRI before and during straining, and patients with and without vLUTS as well as patients with and without vLUTS and/or OAB were compared. p < .05 was considered to be statistically significant. RESULTS: According to vIPSS, 42 patients (35.6%) had vLUTS. On dMRI, patients with vLUTS showed a significantly more ventral position and/or movement of the bladder and cervix. Moreover, patients with vLUTS and OAB had significantly more ventral movement of the uterine cervix and a larger strain on imaginary uterosacral and cardinal ligaments than those without these symptoms. In addition, patients with vLUTS and OAB had significantly higher vIPSS than those with vLUTS alone. CONCLUSIONS: vLUTS may be associated with the proximity of the bladder and cervix to the pubic bone and consequent compression of the urethra by the prolapsed organs. vLUTS with OAB might indicate more advanced lower urinary tract dysfunction than vLUTS alone.

Association between overactive bladder and pelvic organ mobility as evaluated by dynamic magnetic resonance imaging.

Overactive bladder (OAB) is a prevalent condition, which negatively impacts patients' quality of life. Pelvic organ prolapse (POP), also prevalent in women, has been recognized as an important etiology of female OAB, although the pathophysiological mechanisms remain controversial. In this study, we reviewed findings of dynamic magnetic resonance imaging (dMRI) in 118 patients with POP and investigated the association between dMRI findings, including positions and mobilities of pelvic organs as well as parameters of pelvic organ support and bladder outlet obstruction (urethral kinking), and OAB in order to elucidate the pathophysiology of OAB in patients with POP. Our results showed that compared with non-OAB patients, OAB patients had a significantly higher body mass index, more severe pelvic floor muscle impairment, and more profound supportive defects in the uterine cervix (apical compartment). On the other hand, dMRI parameters showed hardly any significant difference between patients with mild and moderate to severe OAB. These findings may imply that levator ani impairment and defective supports of the apical compartment could be associated with the presence of OAB and that the severity of OAB could be affected by factors other than those related to pelvic organ mobility and support or urethral kinking.

[Complications and Proposed Preventive Measure of Holumium Laser Enucleation of the Prostate during the Initial Phase at Our Hospital].

Clinical charts of 95 patients who underwent holmium laser enucleation of the prostate (HoLEP) between May 2012 and January 2016 were reviewed for complications and their causative factors, as well as treatment outcomes. Of 23 intraoperative complications and 3 cases of prolonged post prostatectomy incontinence, 23 incidents (89%) occurred within the initial 20 cases performed by each surgeon. The details of the intraoperative complications were : bladder injury, 6 (6.3%) ; perforation at 6 o'clock beneath the bladder neck, 2 (2.1%) ; capsular perforation, 4 (4.2%) ; and equipment failure, 9 (9.5%). Bladder injury and capsular perforation resulted frompoor hemostasis, while perforation beneath the bladder neck resulted fromforceful retrograde dissection under disorientation. Excessive tension in the external sphincter during retrograde dissection, but not antegrade, could lead to prolonged incontinence. HoLEP improved bladder outlet obstruction subjectively and objectively. During the initial phase of HoLEP, adequate hemostasis and meticulous plane dissection at the bladder neck and antegrade dissection at the apical portions are of paramount importance to prevent significant surgical complications.

[Association between Proposed Cancer Foci from the Results of Systematic 12-Core Transrectal Needle Biopsies and Actual Cancer Foci from Radical Prostatectomy Specimens].

We investigated the diagnostic yield for systematic 12-core transrectal prostate needle biopsies. Subjects were 56 prostatic cancer patients who were diagnosed with transrectal ultrasound-guided 12 core prostate needle biopsies and who underwent open retropubic radical prostatectomy. Pathological findings were compared between needle biopsy specimens and total prostatectomy specimens in terms of the presence or absence of cancer foci. For the comparison, the prostate was divided into 5 regions : the apical, middle, basal, far lateral and transitional regions. Then, based on the pathological findings of the biopsies, the sensitivity, specificity, positive predictive value and negative predictive value were calculated for each region. As a result, the sensitivity and the specificity in the transitional region tended to be lower than in other regions, and six of ten false positive lesions were located in the transitional region on the biopsy specimens. Also, the negative predictive value tended to be lower in the apical and far lateral regions. In conclusion, thorough punctures in the apical, transitional, and far lateral regions of the prostate at the systematic transrectal biopsy were paramount important for improving the detection of cancer foci in these regions.