Ultrasonographic study of comparison of prostate volume and post void residual urine with age in north Indian population

Background: As men’s life expectancy increases, benign prostatic hyperplasia (BPH) is the significant cause of morbidity. BPH generally involves the central region of the prostate which gradually enlarges. Due to the central hypertrophic change of prostate the urethra is compressed and urinary outflow obstruction develops. Predictive risk factors associated with chance of developing urinary retention includes age, symptoms, urinary flow rate and prostate size. Estimation of accurate intravesical, residual urine has significant importance and serves as an index of adequacy of bladder emptying. Aims and Objectives: The study aimed to measure the post void residual urine volume with age in Prostate outflow obstruction and compare the prostate volume and post void residual urine with age by ultrasonography. Materials and Methods: The present study was performed in 100 patients. Transrectal ultrasonography was performed using 7.5 MHZ transrectal probe. Prostate volume was calculated with the help of inbuilt software, by measuring 3 dimensions of prostate in transverse and longitudinal sections. Transabdominal suprapubic ultrasound was done to measure post void residual urine. Results: It was seen that in the lower age groups, the prostate size was smaller, while in the higher age group it was higher (p>0.001). Minimum post void residual urine was seen in age group of 40-49 years (3.42 -+2.23ml). while maximum mean value was seen in the 70-79 years of age. Statistically a significant difference in mean was seen among different age groups (p<0.001). Conclusion: There is a significant correlation between age and post void residual urine volume and prostatic volume. The present study showed that PVRUV is a novel accurate non-invasive test for predicting prostate biopsyoutcome that can easily be used by clinicians, alone or in combination with Prostate Volume in the decision-making for treatment.

Asymptomatic bacteriuria and pyelonephritis during pregnancy

The most common extragenital pathology during pregnancy is urinary tract infection (UTI) of various localization. In some cases, untreated UTI can contribute to the development of obstetric, urological, and perinatal pathologies. Factors predisposing to the UTI manifestation may include increased progesterone, delayed peristalsis, urine retention in the ureters, uterine growth, bladder displacement, and increased residual urine volume. Asymptomatic bacteriuria (ASB) during pregnancy can increase the risk of pyelonephritis and subsequent maternal and fetal complications. Pregnant women should be screened for ASB at least once at the beginning of pregnancy (aft er 14 weeks). E.coli is the dominant uropathogen in 70 – 95% of UTI cases in pregnant women. The main treatment for ABT and pyelonephritis in pregnancy (PiP) is antibiotic therapy (ABT), which is prescribed empirically in most cases. There is currently no consensus on the choice of ABT and the duration of treatment for UTI in pregnant women. In the case of ineff ective drug therapy of PiP, it is necessary to raise the issue of the upper urinary tract drainage promptly.

Long-Term Effect of Early Post-operative Transcutaneous Electrical Stimulation on Voiding Function After Radical Hysterectomy: A Multicenter, Randomized, Controlled Trial

Introduction: Post-radical-hysterectomy (RH) patients suffer from a series of problems resulting from neurovascular injury, such as bladder dysfunction, which reduce their quality of life. We have designed this study to evaluate the efficacy of transcutaneous electrical stimulation (TENS) on patient rehabilitation after RH for early cervical cancer.Materials and methods: A total of 97 patients were enrolled in a randomized-controlled trial (from January 2015 to December 2019) involving 7 medical centers nationwide. Patients were assigned to either the intervention group (n = 46), or the control group (n = 51). TENS was given to patients in the intervention group from the 7th day after surgery for a total of 14–21 days. The control group received no TENS. Primary outcomes were measured for residual urine volume and recovery of urination function. Secondary outcomes were measures for urodynamics (UDS), pelvic floor electromyography function examination (PFEmF), and quality of life (QoL).Results: Residual urine volume and improvement in the rate of urination were found to show no significant differences on the 14th, 21st, and 28th days after surgery. The maximum flow rate (Qmax) in the intervention group was significantly higher than that in the control group on the 28th day, but there were no significant differences in average flow rate, voiding time, time to Qmax, muscle fiber strength, muscle fiber fatigue, and the abnormal rate of A3 reflection on the 28th day and the 3rd mo., as well as in the QoL at 3rd mo., 6th mo., and 12th mo. after surgery.Conclusion: Our study showed no sufficient evidence to prove that TENS under the trialed parameters could improve the subject's voiding function, PFEmF, and QOL after RH. This has provided valuable data for rehabilitation after RH.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02492542.

Adipose-derived stem cell-derived microvesicles prevent progression to bladder underactivity secondary to long-termed bilateral partial iliac arterial occlusion-induced bladder ischemia

Background The therapeutic effects of adipose-derived stem cells (ADSCs) and ADSC-derived microvesicles (MVs) were investigated in a rat model of bladder ischemia involving long-term (4 weeks) bilateral partial iliac arterial occlusion (BPAO). Methods The study included four groups: sham, BPAO, BPAO + ADSCs, and BPAO + ADSC-derived MVs. ADSCs or ADSC-derived MVs were injected through the femoral artery. Real-time laser speckle contrast imaging evaluated bladder microcirculation following BPAO. A 24-h behavior study and transcystometrogram were conducted after 4 weeks. Bladder histology, immunostaining, and lipid peroxidation assays were performed. The expression of P2X2, P2X3, M2, and M3 receptors, nerve growth factor (NGF), and collagen-1 was evaluated. Results BPAO for 4 weeks significantly reduced bladder microcirculation, prolonged the intercontraction interval, decreased voiding volume, increased residual urine volume, lengthened phase 1 contraction, shortened phase 2 contraction, increased neutrophil infiltration, increased malondialdehyde levels, and altered levels of P2X3 receptors. ADSC-derived MVs significantly ameliorated these effects, increased NGF expression, and decreased collagen-1 expression. ADSCs only improved voiding volume and increased residual urine volume. Conclusions ADSC-derived MVs prevented adverse consequences of long-term BPAO, including detrusor underactivity, bladder ischemia, and oxidative stress. Amelioration of inflammation, altered purinergic signaling, neuronal regeneration, and decreased fibrosis might be involved in the therapeutic mechanism.

Treatment of overactive bladder symptoms in women with Diunorm®: preliminary results report

Introduction. Overactive bladder (OAB) with or without urgent incontinence tends to progress with age and occurs in both men and women. However, the frequency of occurrence in the female population averages about 25%.Purpose of the study. To assess the effectiveness and safety of the drug Diunorm® (in caps.) in the prevention and treatment of OAB in women.Materials and methods. The statistical analysis includes the results of a survey of 28 women with symptoms of OAB, whose average age was 35.3 years. The drug Diunorm® was used for treatment in dosage 400 mg QD for 90 days. Patients completed the Overactive Bladder Awareness Tool and a urination diary. Additionally, urinalysis, bacteriological examination of urine, uroflowmetry, bladder ultrasound and cystoscopy were performed.Results. All women throughout the study had negative urine cultures and no pyuria in urinalysis, which excluded an infectious etiology of urinary dysfunction. During therapy, a statistically significant decrease in irritative symptoms was recorded according to the Overactive Bladder Awareness Tool questionnaire. The sum of points after 1 and 3 mo decreased by 3.0 and 4.3 points, respectively (p < 0.05). Positive dynamics in terms of the points' sum was noted in 75%, in relation to nocturia in 82% of patients (p < 0.01). The average urination rate increased from 13.3 ± 0.7 ml/s to 15.1 ± 0.7 ml/s and 15.4 ± 0.5 ml/s after 1.5 and 3 months, respectively (p < 0,0001). A similar trend was observed for maximum urine flow and residual urine volume. The maximum urine flow when taking Diunorm® increased from 15.9 ± 0.6 ml/s to 17.4 ± 0.5 ml/s and 18.1 ± 0.4 ml/s (p < 0.001). Residual urine volume decreased throughout the study. When included in the study, after 1,5 and 3 mo, this indicator was 19.9 ± 1.4; 12.2 ± 1.6 and 6.4 ± 1.1 ml, respectively (p < 0.001).Conclusion. Diunorm® can become a worthy alternative to traditional first-line OAB therapy. Comparative studies are required to obtain a high-level evidence base.

Initial experience with holmium laser enucleation of the prostate in a urology specialist hospital in Nigeria

Background Holmium laser enucleation of the prostate (HoLEP) is a more recent procedure for the management of Benign Prostatic Hyperplasia compared to open prostatectomy or Transurethral Resection of the Prostate. HoLEP is not commonly done in Nigeria. The objective of the study was to determine whether our initial experience with HoLEP in Abuja, favourably compared to those of other centres across the world. Methods A retrospective study was done on 40 patients who had HoLEP between October 2018 and December 2019. Pre- and post-operative International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), prostate sizes, maximum flow rate (Qmax) and post-void residual urine volume (PVR) were collated. The duration of irrigation, catheterization and length of hospital stay were also recorded and analysed. Complications were documented. Results There were improvements in IPSS from 19.67 to 5.41, PSA from 8.07 to 2.03 ng/ml,Qmax from 11.27 to 29.67 ml/min, PVR from 88.99 to 32.8 ml, while average prostate sizes reduced from 116.54 to 30.3 g after surgery. Following HoLEP, the duration of irrigation was 18.00 h, catheterization was 26.76 h and length of hospital stay was 1.82 days. Two (5.0%) patients were recatheterized, 4 (10.0%) developed post-operative bladder neck stenosis. Conclusions The outcome of HoLEP in our experience compared favourably with those from other centres. With adequate training and requisite equipment in resource-poor environments, technical procedures like HoLEP can be embarked on with favourable results.

Intrapartum pudendal nerve block analgesia and risk of postpartum urinary retention: a cohort study

Introduction and hypothesis Pudendal nerve block analgesia (PNB) is used as pain relief in the final stage of childbirth. We hypothesized that PNB is associated with higher rates of postpartum urinary retention. Methods We performed a cohort study among primiparous women with a singleton, cephalic vaginal birth at Oslo University Hospital, Norway. Women receiving PNB were included in the exposed group, while the subsequent woman giving birth without PNB was included in the unexposed group. We compared the likelihood of postpartum urinary retention, defined as catheterization within 3 h after birth. Logistic regression analysis stratified by mode of delivery was performed adjusting for epidural analgesia, episiotomy and birth unit. Results Of the 1007 included women, 499 were exposed to PNB and 508 were unexposed. In adjusted analyses, women exposed to PNB did not differ in likelihood of postpartum urinary retention compared to women unexposed to PNB in either spontaneous (odds ratio[OR]: 0.82, 95% confidence interval [CI] 0.55–1.22) or instrumental (OR 1.45, 95% CI 0.89–2.39) births. Furthermore, no differences between the groups were observed with excessive residual urine volume or catheterization after > 3 h. Conclusions PBD was associated with neither risk of postpartum urinary retention nor excessive residual urine volume and is therefore unlikely to hamper future bladder function.

Safety and efficacy of prostatic artery embolization for large benign prostatic hyperplasia in elderly patients

Objective To assess the safety and efficacy of prostatic arterial embolization (PAE) for elderly patients with lower urinary tract symptoms secondary to large benign prostatic hyperplasia. Methods Twenty-eight patients (>80 years of age) with prostate volume >80 mL were enrolled from October 2016 to October 2019. PAE was performed using microspheres and functional results were evaluated at 1, 3, 6, and 12 months postoperatively. The following data were recorded: International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urine flow rate (Qmax), post-void residual urine volume, prostate volume and total prostate-specific antigen level. Results Selective prostatic arterial catheterization and embolization were achieved in 27 of 28 patients. Follow-up data were available for those 27 patients until 12 months postoperatively. Significant improvements were found at all postoperative time points in terms of the mean IPSS, mean QoL score, mean Qmax, mean post-void residual urine volume, mean total prostate-specific antigen level, and mean prostate volume. The overall complication rate was 46.4%. Conclusions PAE is an efficacious and safe treatment for elderly patients with large prostate volume; it may offer an effective approach for patients who are not candidates for open or endoscopic surgical procedures because of comorbidities.