Percutaneous tibial nerve stimulation versus sham efficacy in the treatment of refractory overactive bladder: outcomes following a shortened 6-week protocol, a prospective randomized controlled trial.

PURPOSE: It is a prospective randomized controlled trial comparing the efficacy of percutaneous tibial nerve stimulation versus sham for a shortened 6-week protocol of treatment in management of refractory OAB in non-neurogenic adult patients. METHODS: A total of 50 adults with refractory non-neurogenic overactive bladder symptoms were randomized 1:1 to 6 weeks of treatment with weekly percutaneous tibial nerve stimulation or sham therapy. Overactive bladder symptom score as well as 3-day voiding diaries were completed at baseline and at 7th week, 3rd and 6th month. RESULTS: The 7th week, 3rd and 6th month symptom score assessment for overall bladder symptoms demonstrated that percutaneous tibial nerve stimulation patients achieved statistically significant improvement in bladder symptoms with 52% reporting moderately improved responses compared to non-response of sham patients from baseline (P = 0.001). Voiding diary parameters after 6 weeks of therapy showed that PTNS patients had statistically significant improvements in frequency, voided volume and urgency urinary incontinence episodes compared to sham. No serious device-related adverse events or malfunctions were reported. CONCLUSION: A shortened 6-week treatment protocol with PTNS appears to be successful and more effective than sham in the treatment of refractory OAB. PTNS therapy is safe and effective in treating OAB symptoms with 52% success rate following a shortened 6-week protocol. The duration of treatment with PTNS can be halved compared to the conventional 12 weeks, which would make it more acceptable and cost effective for patients.

Short-term results of rotoresection for benign prostatic hyperplasia: a prospective study of safety and efficacy.

OBJECTIVE: To assess the safety and efficacy of rotoresection as a method for treating benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Thirty patients were prospectively enrolled between September 2000 and May 2001 (mean age 61 years, sd 6, range 52-78). All patients had a symptom score (AUA) of > 12, a maximum urinary flow rate (Qmax) of < 12 mL/s, a prostate of 20-80 mL and a prostate-specific antigen (PSA) level of 0-4 ng/mL. Patients with prostate or bladder cancer, a PSA level of > 10 ng/mL, previous prostate surgery, previous pelvic surgery, urethral stricture, active urinary tract infection (UTI), acute urine retention, neuropathic bladder and a serum creatinine of > 1.8 mg/mL were excluded. The adenoma was resected using the Rotoresect system (Karl Storz, Tuttlingen, Germany); the mean (sd) operative duration was 45.2 (9.9) min. The catheter was removed after 1.97 (0.3) days and patients assessed at 1, 3 and 6 months after surgery by an AUA score, Qmax, blood haemoglobin level, urine analysis and transrectal ultrasonography; all patients but two completed the follow-up. RESULTS: At 6 months the mean (sd) AUA score decreased from 20.5 (3.8) to 1.6 (1.3), the Qmax increased from 8.7 (2) to 25.3 (12.6) mL/s, and the total prostate volume decreased from 36.5 (13) to 20.5 (7.8) mL. The mean initial haemoglobin level was 138 (10) g/L and at 1 month was 135 (12) g/L. No patient required a blood transfusion or had signs of transurethral resection syndrome. Early complications included UTI and mild stress incontinence in 10 and 11 patients, respectively. At 6 months these patients had sterile urine and were continent. Two patients had a urethral stricture and posterior urethral stone at 6 months and were treated successfully. CONCLUSION: In the short-term, rotoresection is a safe and effective method for treating BPH; there was no significant blood loss or resection syndrome. The hospital stay was short, with excellent functional results.

Urodynamic evaluation of voiding function in females with stress urinary incontinence

Objective The evaluation of voiding function in females with lower urinary tract symptoms (LUTS) with a special emphasis on the evaluation of storage function and the state of continence. Patients and Methods 176 patients were investigated for urinary incontinence-related problems at the Unit for Neuro-Urology and Urodynamics of the Department of Urology; University Medical Center Nijmegen (The Netherlands). The patients were classified into two groups according to their symptoms and urodynamic studies. Group I consisted of 103 patients with stress urinary incontinence (SUI); while Group 2 included 73 patients with other forms of urinary incontinence or no urodynamic abnormalities at all. All patients were subjected to urodynamic investigations including uroflowmetry; static and dynamic urethral pressure profiles; filling cystometry and pressure-flow studies. Results It was noted that the bladder capacity as well as the average and maximum flow rates tended to be higher among patients with SUI. Some insignificant increase in outlet obstruction; as assessed by the Lin PURR nomogram was noticed. Detrusor contractility was only found to be significantly reduced in patients with SUI when the total Watts factor was compared in both groups. Conclusion When comparing both groups; significant differences were found in the filling cystometry as well as in the urethral pressure profile variables. Some differences were also detected with regard to pressure-flow studies and detrusor contractility during voiding

The relationship of the International Prostate Symptom Score and objective parameters for diagnosing bladder outlet obstruction. Part I: when statistics fail.

PURPOSE: We evaluated the International Prostate Symptom Score and correlated it with objective means of determining bladder outlet obstruction. MATERIALS AND METHODS: Beginning in May 1996, 460 men 41 to 88 years old (mean age plus or minus standard deviation 60.4 +/- 9.4) were prospectively included in this study. Symptoms were evaluated using the International Prostate Symptom Score, and digital rectal examination, outpatient cystoscopy, prostate specific antigen determination and transrectal ultrasound were done. Urodynamic evaluation included uroflowmetry, filling cystometry and pressure flow study. RESULTS: Linear regression was done to correlate scores with measurable parameters. We noted no correlation of the total, obstructive symptoms or irritative symptoms score with objective parameters, including the average and maximum flow rate, post-void residual urine, prostate size and Schäfer grade. CONCLUSIONS: Prostatic symptom scores are qualitative. Using them to quantify the degree of obstruction or evaluate therapy is questionable.

The relationship of the International Prostate Symptom Score and objective parameters for diagnosing bladder outlet obstruction. Part II: the potential usefulness of artificial neural networks.

PURPOSE: The International Prostate Symptom Score (I-PSS) is used exclusively for evaluating patients with a prostate condition and following various treatment modalities. As previously demonstrated, there is poor or no correlation of bladder outlet obstruction diagnosed by pressure flow study with the symptoms projected by the I-PSS. Thus, we applied an artificial neural network model to assess patients with lower urinary tract symptoms. MATERIALS AND METHODS: Data on 460 patients enrolled in part 1 of our study were entered into a multilayer feed forward, back propagation network. RESULTS: In the training set of 305 patients the model predicted obstruction in 94% with 94% sensitivity and 68% specificity. In the test set of 155 patients it predicted obstruction in 87% with 87% sensitivity and 44% specificity. CONCLUSIONS: The accuracy of the model for diagnosing obstruction based on the I-PSS is acceptable, considering that statistical models failed to demonstrate a correlation of symptoms with objective obstruction.