Urodynamic profile of lower urinary tract symptoms in young men: A testimony of the truth?

Aim: To evaluate the impact of urodynamic study (UDS) in the management of young men presenting with lower urinary tract symptoms (LUTSs). Materials and Methods: This is a retrospective, observational study of urodynamic findings of 128 patients presented with LUTS at the Department of Urology, Institute of Nephrourology, Bangalore, over a period of 5 years (August 2014 to July 2019). Pre- and post-UDS diagnoses as well as treatment modalities were compared to evaluate the usefulness of UDS. Results: A total of 110 patients (86%) had abnormal UDS findings. Before UDS, 55 (43%) patients were clinically diagnosed for overactive bladder; after UDS, bladder outlet obstruction (BOO) was seen in 32 (25%) patients and detrusor overactivity in 18 (14.1%). Clinically, BOO was diagnosed in 36 (28.1%) patients; however, urodynamic findings of BOO were seen only in 23 (18%) patients. Pre-UDS, bladder underactivity was suspected in 23 (18%); however, underactive detrusor was noted in 20 (15.6%) patients, and 3 (2.4%) patients were normal on UDS. Post-UDS, antibiotics were not prescribed to anyone. 18 (14%) patients underwent surgery after UDS confirmation of BOO. 67 patients (52.3%) had their clinical diagnosis changed following UDS. Concomitant changes in the management were required for 59 patients (46%). Conclusion: Etiologies of LUTSs in young men are more varied. Clinical diagnosis and treatment are often empirical and inaccurate. UDS is useful to achieve accurate diagnosis and to guide appropriate treatment. Video urodyanamics should be used to evaluate LUTS in young men.

Urodynamic profile in posterior urethral valve patients following fulguration: Does age at fulguration matter?

INTRODUCTION: Children with posterior urethral valve (PUV) may develop urinary bladder (UB) dysfunction even after valve fulguration (VF). Using Urodynamics (UDS), we sought to identify whether age at VF and time elapsed since VF contributed to UB dysfunction. MATERIALS AND METHODS: Between January 2009 and July 2016, 39 PUV patients referred to a tertiary care center for UDS were classified into Groups A and B (based on age if <2 or ≥2 years at VF) and subclassified into Group A1/A2 and B1/B2 depending on time duration after VF (TVU). A1 and B1 constituted TVU ≤4 years and A2 and B2 constituted TVU >4 years, respectively. RESULTS: Median (range) ages at VF and UDS were 18 (1-108) months and 9 (1-19) years. Median (range) time between VF and UDS was 60 (6-164) months. Reduced compliance was seen in 67%, detrusor overactivity in 38.5%, and leak in 15.4% boys, respectively. Median (range) Qmax was 8 (0-28) ml/s and 25% boys had hypocontractile detrusor at voiding. Statistically significant reduction was found in compliance when comparing Group B versus Group A (P = 0.037) and in bladder capacity (P = 0.002) and compliance (P = 0.043) in Group A2 versus A1. CONCLUSIONS: Boys with VF at <2 years had better urodynamic profiles than those with fulguration over 2 years of age. As the time period since fulguration increased, there was a higher incidence of bladder dysfunction in both the groups.

Nasogastric tube as abdominal pressure sensor in urodynamics-Proof of concept of a novel approach.

AIMS: The standard sensor for abdominal pressure (Pabd) measurement in urodynamics (UD) is a rectal sensor. In patients where the rectum is not available due to prior surgery or when external anal sphincter (EAS) tone is poor, rectal sensor may slip, making Pabd recording unreliable. Vaginal Pabd measurement and wireless vaginal sensors have been tried. We present our preliminary series of a novel nasogastric tube (NG) sensor for Pabd measurement. METHODS: We identified patients undergoing UD with a NG Pabd sensor from a prospectively maintained UD database of a tertiary care urological center between July 2013 and December 2016. RESULTS: Out of 1325 urodynamic procedures done, 46 (3.5%) were performed using NG Pabd sensor. The median (IQR) age was 44 (12) years. Indications for UD in these patients were neurogenic bladder in 22 (47.8%), urinary retention in 17 (37%), post-meningomyelocele repair in four (8.7%), traumatic paraplegia in two (4.3%), and cervical myelopathy in one (2.2%). The indications for NG Pabd sensor were lax EAS tone (40; 86.9%), post-abdominoperineal resection (2; 4.3%), and painful thrombosed hemorrhoids (4; 8.7%). It was possible to make definitive urodynamic diagnosis in all patients using NG Pabd sensor. Initial calibration and NG Pabd excursions throughout the study were similar to that of rectal Pabd sensor. There were no problems with NG tube tolerance. CONCLUSION: Use of nasogastric sensor is feasible, accurate, cost-effective, and viable alternative for Pabd measurement in patients with poor anal tone or absent rectum due to postoperative status.

A quantitative comparison between free uroflow variables and urodynamic data, and the effect of the size of urodynamic catheters on its interpretation.

OBJECTIVE: To assess the effect of the urodynamic catheter on the urinary flow rate and residual volume in various urodynamic diagnoses, and compare the outcome when using a smaller catheter, as the effect of this catheter on free uroflow variables is mostly studied in patients with bladder outlet obstruction (BOO) and little is known about its effect in other urodynamic diagnoses. PATIENTS AND METHODS: In all, 319 men undergoing a pressure-flow study (PFS) with a 5 F filling and 5 F measuring bladder catheter were subdivided into three groups based on a urodynamic diagnosis, i.e. normal PFS (group 1), BOO (group 2) and detrusor underactivity (DU, group 3). Another group (4) comprised 61 patients who had a PFS with the filling catheter removed before the voiding phase. The effect of the catheters on the maximum urinary flow rate (Qmax) and the postvoid residual volume (PVR) was analysed statistically and compared among the groups. We also compared the free-flow variables with the clinical and urodynamic variables. RESULTS: Groups 1-3 (with two catheters) had a significantly lower Qmax and higher PVR than those voiding with one catheter (group 4). The reduction in Qmax was highest in group 3 (41.9%) and least in group 2 (21%). Group 4 showed no significant change in Qmax in cases with BOO and a normal PFS but a significant decline in those with DU (19.6%). The PVR was positively associated with the bladder capacity and negatively with detrusor contractility, but no association with a urodynamic diagnosis of BOO or any specific symptom. CONCLUSION: Detrusor contractility was the strongest predictor of the obstructive effect caused by the catheter. This study justifies the use of a single 5 F catheter at the time of voiding, although that can also cause a reduction in flow in patients with DU.