Urodynamic studies and features of anaesthesia during intradetrusor botulinum therapy in the context of the COVID-19 pandemic (literature review)

The coronavirus pandemic has had a severe impact on the health care system. It is also changing the appointment and conduct of diagnostic procedures, emergency and routine medical care. According to the medical guidelines of the European Society of Urology (EAU) for the provision of urological care during the current epidemic situation, various levels of urgency have been proposed for diagnostic and therapeutic measures depending on the type of disease. Urodynamic studies refer to studies with a priority level from P2 (for neurogenic dysfunction of the urinary tract) to P4 (for lower urinary tract dysfunction without the risk of damage to the upper urinary tract). The question arises regarding the safety of these studies, both for patients and medical staff, and possible measures to reduce the risk of infection in a viral pandemic. Because of the increased workload of hospitals that have not been redesigned for the fight against coronavirus infection and provide routine and emergency urological care, an even greater need has arisen to find effective and safe methods of local anaesthesia for performing urodynamic studies and intradetrusive injections of botulinum toxin type A under local anesthesia in outpatient and outpatient settings (for example, in a short-term hospital). This article presents a literature review on the principles and features of performing urodynamic studies in the context of the Covid-19 pandemic and the effectiveness and safety of using various methods of local anaesthesia when performing intradetrusor injections of botulinum toxin with detrusor hyperactivity of a neurogenic and non-neurogenic nature. There were evaluated forms of local anaesthesia such as intradetrusor instillation of lidocaine, electrophoresis, and the use of alternative solutions for urinary bladder irrigation (for example, Ringer’s solution).

Anesthetic protocols for urodynamic studies of the lower urinary tract in small rodents—A systematic review

Urodynamic studies in rats and mice are broadly used to examine pathomechnisms of disease and identify and test therapeutic targets. This review aims to highlight the effects of the anesthetics on the lower urinary tract function and seeks to identify protocols that allow recovery from anesthesia and repeated measurements while preserving the function which is being studied. All studies published in English language, which compared the data obtained under various types of anesthesia and the urodynamics performed in awake animals were included. It appears that urethane, an anesthetic recommended extensively for the investigation of lower urinary tract function, is appropriate for acute urodynamic studies only. Major advantages of urethane are its stability and ability to preserve the micturition reflex. Due to its toxicity and carcinogenicity, urethane anesthesia should not be used for recovery procedures. This review evaluated available alternatives including propofol, isoflurane and combinations of urethane, ketamine/xylazine, ketamine/medetomidine, and/or fentanyl/fluanisone/midazolam. Different effects have been demonstrated among these drugs on the urinary bladder, the urethral sphincter, as well as on their neuroregulation. The lowest incidence of adverse effects was observed with the use of a combination of ketamine and xylazine. Although the variations in the reviewed study protocols represent a limitation, we believe that this summary will help in standardizing and optimizing future experiments.

Impact of radiotherapy for localized prostate cancer on bladder function as demonstrated on urodynamics study: A systematic review

Introduction: This study aimed to describe the effects of bladder function following radiotherapy for localized prostate cancer by performing a systematic review on studies reporting on urodynamic findings after radiotherapy. Methods: This systematic review was conducted in accordance with PRISMA guidelines. The review protocol was registered at PROSPERO (CRD42021229037). A systematic search was conducted using PubMed, Cochrane Library, Scopus, and OVID Embase. Studies were included if they involved men who underwent urodynamic studies following radiotherapy for localized prostate cancer. A total of 798 articles were screened and five articles included. A qualitative analysis was performed. Results: Bladder compliance appears to be impaired following radiotherapy, especially with longer followup. Impaired bladder compliance was reported in 18.8–62.5% of patients following radiotherapy. Bladder capacity was found to be statistically significantly lower following radiotherapy compared to pre-radiotherapy, and when compared with patients who did not undergo pelvic radiotherapy. Bladder outlet obstruction (BOO) persists post-radiotherapy in most patients at three and 18 months post-radiotherapy. De novo detrusor overactivity (DO) of 13.3% has been reported at 18 months post-radiotherapy. This review is limited by the absence of level I/II studies. Conclusions: Radiotherapy for localized prostate cancer results in decreased bladder compliance and capacity demonstrated on urodynamic studies. Resolution of BOO appears less likely in comparison to series on radical prostatectomy. De novo DO may develop following radiotherapy, especially with longer followup. With only low level of evidence studies available at present, further high-quality, prospective studies are important to elucidate the impact of radiotherapy on bladder and urethral function.

Stress Urinary Incontinence: Treatment With Platelet-Rich-Plasma Injection and Placement of Polydioxanone Threads—A Pilot Study

Stress urinary incontinence is an important clinical problem that affects millions of women worldwide. The aim of this article was the evaluation of a minimally invasive procedure as an alternative treatment for mild urinary stress incontinence in women, using platelet-rich-plasma (PRP) injections and polydioxanone (PDO) threads. A total of 23 patients with mild urinary incontinence, mean age 46, were evaluated with detailed history, examination, urinary diary, complete laboratory tests, ultrasonography, urodynamic studies, and completion of International Consultation on Incontinence Questionaire–Urinary Incontinence Short Form (ICIQ-UI SF). Under local anesthesia, PRP was injected through the anterior vaginal wall, PDO threads placed in paraurethral, suburethral, and lateral urethrovaginal spaces, using instruments developed for safe and effective performance. Patients were analyzed at 1, 2, 4, 8 weeks and 6 months posttreatment. A total of 10 patients were biopsed preoperatively and 60 days after treatment. Symptoms and ICIQ-UI SF score were significantly improved. Postoperative urodynamic studies were normal in all cases. Biopsies after treatment showed a dense connective tissue tridimensional mesh. No complications or adverse effects were observed. All patients declared satisfaction with results, will have the procedure again, and will recommend it. The minimally invasive technique presented here results in strengthening of the paraurethral, suburethral, and lateral urethrovaginal spaces and the mucosa of the anterior vaginal wall. The combination of PRP injections and the placement of PDO threads creates a fibrotic and absorbable mesh-like structure, aimed to increase the urethral resistance, so that under effort the intravesical pressure does not overcome the urethral pressure. These results suggest that the procedure is safe and a cost-effective alternative in patients with mild urinary incontinence, reducing the need for invasive surgical procedures. Larger studies are needed to confirm the results of this study.

Prophylactic Antibiotics for Urinary Tract Infections after Urodynamic Studies: A Meta-Analysis

Aim. We aimed to perform a meta-analysis to determine whether antibiotic prophylaxis reduces the incidence of urinary tract infections (UTIs) after urodynamic studies (UDS). Methods. We conducted a systematic search of PubMed, Web of Science, Ovid, Elsevier, ClinicalKey, Embase, Cochrane Library, Medline, and Wiley Online Library. Randomized controlled trials (RCTs) comparing the effectiveness of prophylactic antibiotics with placebo or no treatment in preventing UTI after UDS were included. Two reviewers extracted data independently, and RevMan 5.3 software was used to analyze relative risk (RR) with 95% confidence intervals (CI). Heterogeneity was assessed by the Q test and I 2 test. Results. The final meta-analysis included 1829 patients in 13 RCTs. Compared with the placebo or no treatment group, prophylactic antibiotics could significantly reduce the risk of bacteriuria ( RR = 0.42 , 95% CI: 0.30-0.60) and the risk of symptomatic UTI ( RR = 0.65 , 95% CI: 0.48-0.88). In addition, there was no statistically significant difference in the risk of adverse events ( RR = 4.93 , 95% CI: 0.61-40.05). No significant heterogeneity or publication bias was found in this study. Conclusions. Current evidence showed that prophylactic antibiotics could reduce the risk of asymptomatic bacteriuria and symptomatic UTI after UDS without increasing the incidence of adverse events.