Association Between Urinary Flow Rate and Cognition in the Elderly: A Cross-Sectional Study

Background Age-related lower urinary tract symptoms (LUTS) is a common disease in the elderly. The reduction of urinary flow rate (UFR) as an assessment of LUTS is associated with cognitive impairment. The association between UFR and cognitive performance has not been studied to date. Methods We used data from the 2011 to 2014 U.S. National Health and Nutrition Examination Survey (NHANES). Finally, 2,724 participants aged 65-80 with available data on UFR and cognitive assessments were included. The cognitive function assessment used the digit symbol substitution test (DSST), Animal Fluency Test (AFT) and the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) immediate recall test. Multivariate logistic regressions were used to assess the association between UFR (exposure) and cognitive performance (outcome). Additionally, to ensure the reliability of data analysis, we converted UFR into categorical variables through tertile and then calculated the P for trend. Results Among 2,724 participants, the mean (SD) age was 69.26 (6.65) years, and 54.56% were women. After adjusting for covariates, UFR showed a positive correlation with DSST score (β = 2.00, [95%Cl:1.20-2.80], P<0.0001), AFT score (β = 0.57,[95%Cl:0.28-0.87], P=0.0001), CERAD immediate score(β = 0.24, [95%Cl:0.01-0.47], P=0.0435). In addition, we found a similar linear trend when UFR was regarded as a categorical variable (tertile) (P for trend <0.0001(both in AFT and DSST); P for trend =0.0403 in CERAD immediate test). Conclusions The decrease of UFR is related to cognitive decline in the elderly, which may suggest that UFR may be a clinical marker of predicting cognitive decline.

Evaluation of the short-term outcome of unilateral urethral mobilization for the management of bulbar urethral stricture

Background: In modern urology, successful male urethral reconstruction poses a continuing challenge.Methods: It was a quasi-experimental study conducted in the department of urology, Dhaka medical college hospital, Dhaka, Bangladesh between January 2010 to December 2011. 35 patients having bulbar urethral strictures admitted in the department were study participants. All the participants underwent unilateral urethral mobilization, for buccal mucosa graft urethroplasty and followed up at least six months. RGU and MCU was done when peak flow was <15 ml /sec in uroflowmetry. Urethroscopy was done at 3rd and 6th month. The statistics used to analyze the data were descriptive statistics, and the tests done were student’s t-test, chi-square test, ANOVA, and Fisher exact test.Results: The length of strictures was observed ≤3 cm among 31% (n=11) and >3 cm among 69% (n=24) patients. As the immediate postoperative outcome among the participants, we found the mean peak urinary flow rate (Qmax), 15.3±1.2 and voided urine volume (ml), 328.8±50. Finally, as the postoperative outcome after 6 months among the participants, we found the mean peak urinary flow rate (Qmax), 24.2±2.9; voided urine volume (ml), 330.8±50.1 and PVR (ml), 11.6±3.3. In this study, some potential complications were bleeding and wound infection which were found among 11.43% and 17.14% patients respectively. Conclusions: Considering the satisfactory outcomes and lower complications unilateral urethral mobilization procedure can be considered as an effective treatment method for the management of bulbar urethral stricture.

Variability of Urinary Creatinine in Healthy Individuals

Many urinary biomarkers are adjusted for dilution using creatinine or specific gravity. The aim was to evaluate the variability of creatinine excretion, in 24 h and spot samples, and to describe an openly available variability biobank. Urine and blood samples were collected from 60 healthy non-smoking adults, 29 men and 31 women. All urine was collected at six time points during two 24 h periods. Blood samples were also collected twice and stored frozen. Analyses of creatinine in urine was performed in fresh urine using an enzymatic method. For creatinine in urine, the intra-class correlation (ICC) was calculated for 24 h urine and spot samples. Diurnal variability was examined, as well as association with urinary flow rate. The creatinine excretion rate was lowest in overnight samples and relatively constant in the other five samples. The creatinine excretion rate in each individual was positively correlated with urinary flow rate. The creatinine concentration was highest in the overnight sample and at 09:30. For 24 h samples the ICC was 0.64, for overnight samples it was 0.5, and for all spot samples, it was much lower. The ICC for urinary creatinine depends on the time of day of sampling. Frozen samples from this variability biobank are open for researchers examining normal variability of their favorite biomarker(s).

Comparison of Outcome of Transurethral Resection of Prostate Between Patients With Preoperative Low or Normal and High Voiding Pressure

Objective: T0 compare the outcome of Transurethral Resecton of Prostate between Patients with Preoperative Low or Normal and High Voiding Pressure. Methods: This hospital based prospective observational study was conducted in the Department of Urology of Dhaka Medical college Hospital from July 2008 to June 2010 on male patients aging >59 years having Lower urinary tract symptoms (LUTS) attending to urology OPD& IPD were evaluated by history, physical examination including DRE and necessary investigations like USG of KUB and prostate with MCC & PVR, Q max, IPSS score to identify the potential candidates for TURP. Potential participants were counseled for urodynamic study. Who fulfilled the selection criteria included in this study in outpatient basis or admitted in the urology ward and numbered chronologically and performed urodynamic study and then patients underwent TURP, after 12 weeks of completion of TURP again a follow-up urodynamic study performed in all patients to compare the outcome between two groups. Sample size was 65, high pressure voiding group were 36 in number and Normal or low pressure voiding group were 29 in number. Data were collected on variables of interest using a structural data collection format. Data were processed and analyzed using SPSS (Statistical package for social science) software program. The test of significant employed to analyze the data was descriptive statistics and Student’s t-test, Paired and unpaired t- test, Fisher exact test. Probability value (P value < 0.05) was considered significant. Results: In this study the age ranges were 59 and 88 years and mean age was 70.7 ± 6.7 years. the maximum urinary flow rate, residual urine volume and maximum intravesical pressure 3 months after transurethral prostatic resection were significantly better in patients with high detrusor pressure compared to those with normal/low normal/low detrusor pressure (15.9±0.7 vs. 21.3±2.2ml/sec, p<0.001, 18.1±11.8 vs. 2.9±0.7 ml, p<0.001 and 48.3±6.2 vs. 71.9±15.2 cmH2O, p<0.001 respectively).The maximum urinary flow rate ( Q max ), residual urine volume, maximum intravesical pressure and detrusor pressure at peak urinary flow rate and also IPSS score were significantly improved 3 months after operation in both groups, more improvement was observed in preoperative high voiding pressure group. Post-voiding residual urine is a clear indication of poor outcome, and also the maximum urinary flow rate, maximum intravesical pressure and detrusor pressure at peak urinary flow rate all factors may precipitate decompensation of bladder and in low voiding pressure group decompensation of bladder occurs more than the high voiding pressure group as the preoperative and postoperative residual urine develops more in low voiding pressure group. Conclusion: The high voiding pressures (detrusor pressure) may influence in good postoperative outcome and helps in resolution of a significant outflow obstruction, there are good urodynamic reasons for avoiding unwanted TURP rather it could be justified by using urodynamic study which may predict outcome of TURP. So, we may assess properly the patient for prostatectomy by urodynamic study. As if we do this type of evaluation before TURP it may reduce the unwanted operation. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p 111-119

Evaluation of the Short Term Outcome of Unilateral Urethral Mobilization Compared to Circumferential Urethral Mobilization for the Management of Bulbar Urethral Stricture

Objective: To evaluate and compare the outcome of buccal mucosal graft urethroplasty of unilateral and circumferential urethral mobilization for the management of bulbar urethral stricture. Methods: Seventy patients having bulbar urethral strictures admitted in the Department of Urology, Dhaka Medical College Hospital, Dhaka between January 2010 to December 2011. Patients were divided into two groups. Group-I, underwent unilateral urethral mobilization, and Group-II, underwent circumferential urethral mobilization for buccal mucosa graft urethroplasty. All patients were followed up at least six months. The statistics used to analyze the data were descriptive statistics, and p value <0.05 was considered as significant. Results: Mean±SD of age in Group-II and Group-I were 41.1±9.2 and 37.4±8.2 years respectively. All the baseline findings were identically distributed between the groups. Comparison of outcome at month 3 showed that peak urinary flow rate increased from their baseline figures, but the increase was significantly more in the unilateral group than that in the circumferential group (21.2±1.2 vs. 18.9±2.0 Qmax, p =< 0.001). After 6 months, evaluation showed that the peak urinary flow rate significantly higher in Group-I, than that in Group-II, (24.2±2.9 vs. 21.9 ± 3.3, p < 0.001). The voided urine volume was also significantly higher in Group-I, than that in Group-II (330.8±50.1 vs. 294.5±46.1 ml, p = 0.004). Consequently, PVR was lower in the former group than that in the latter group (11.6±3.3 vs. 14.1±2.9 ml, p = 0.002). Complications in unilateral urethral mobilization had a significantly lower (20%) than that of circumferential urethral mobilization(45.71%) (p=0.024). Conclusion: Buccal mucosa grafting is a versatile and effective treatment for the anterior urethral stricture, and the outcome is excellent following unilateral urethral mobilization in experienced hands. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.32-37

Association of Detrusor Muscular Activity With the Outcome of Transurethral Resection of Prostate in Patients With Severity of Bladder Outflow Obstruction

Objective: To evaluate the association of detrusor muscular activity with outcome of TURP in patients with severity of bladder outflow obstruction. Methods: This is a hospital based cross sectional study conducted in the Department of Urology of Dhaka Medical College Hospital, Dhaka.Elderly male patients having lower urinary tract symptoms (IPSS=20-35) with no retention (non-catheterized patient), who attended in Dhaka Medical College Hospital, were included in the study. A total of 73 patients meeting the enrollment criteria were included in the study. They were evaluated by history, physical examination including DRE and necessary investigations to identify the potential candidates for TURP. Then the potential participants were counseled for Urodynamic study. All patients underwent TURP by expert surgeon. Three months after TURP, repeat Urodynamic study was done and the results were compared to see the outcome. Afterward the data were plotted for the clarification of detrusor contractility at three levels: normal detrusor contractility (voiding pressure 40-60cm of water), detrusor over activity (voiding pressure >60cm of water) and detrusor under activity (voiding pressure <40 cm of water). According to the provisional ICS nomogram for the analysis of voiding, patients were divided into three classes. In BOO Index(PdetQmax-2Qmax),obstructed(BOOI > 40); equivocal(BOOI=20-40);Unobstructed(BOOId” 20) are taken into consideration. The test statistic used to analyze the data was descriptive statistics and ANOVA test. The level of significance was set at 0.05 and P<O.05 was considered significant. Results: Out of 73 patients 8 didn’t attend follow up session and hence excluded keeping 65 for final analysis. The mean age was 66.3 ± 9.7 years (50- 87 years) .Detrusor over activity was present in 13(20%), normal detrusor contractility was observed in 46(70.8%) and weak contractility in 6(9.2%). Peak urinary flow rate was almost similar among patients of different groups. However, voided volume and residual volume were lowest in overactive group and highest in underactive group, while normal group was in between two (p = 0.007 and p = 0.046 respectively). Maximum urinary flow rate and voided urine between patients of moderate and severe bladder outlet obstruction were almost comparable (p =0.120 and p = 0.270 respectively). However, residual urine volume was much higher in the patients of moderate BOO than that in severe BOO (p = 0.001).The patients of OAB experienced a significant improvement in percentage of reduction of residual urine volume compared to normal and underactive bladder (p = 0.002), However, there were no significant difference among the patients with overactive, normal and underactive bladder with respect to peak urinary flow rate and voided urine volume (p = 0.499 and p = 0.847 respectively). Conclusion: TURP is an effective surgical procedure for treatment of BPH, especially for patients with severe degree of BOO with normal or overactive detrusor contraction. Bangladesh Journal of Urology, Vol. 18, No. 2, July 2015 p.56-61

Success of Handmade Transobturator Slings Prepared From Conventional Polypropylene Mesh in the Treatment of Stress Urinary Incontinence in Women

Objective: To determine the improvement of the quality of life in patient of BPH after transurethral resection of prostate. Methods: A total of 102 of patients complaining lower urinary tract symtoms due to Benign prostatic hyperplasia (BPH). Each of the patient was followed up at 8 weeks (1st visit), 16 weeks (2nd visit) and 24 weeks (3rd visit) after transurethral resection of prostate (TURP). Before TURP for base line study of each patient was evaluated by history, physical examination, digital rectal examination (DRE), International Prostate Symptoms Score (IPSS), Quality of Life Score (QOL), Urinalysis, volume of the prostate and post voidal residual urine (PVR) were determined by ultrasonogram. Improvement of lower urinary tract symptoms and quality of life was determined using IPSS. Improvement was based on the changes from base line in symptoms,urinary flow rate, amount of post voidal residual urine and quality of life.Urine flow rate was measured by uroflowmetry as peak urinary flow rate (Qmax), voiding time and voided volume and was considered valid only if the voided volume was >200 ml. Symptoms were assessed using IPSS & consisting of seven symptoms (frequency, nocturia, urge in continence, urgency, hesitancy, terminal dribbling and sense of incomplete evacuation) that were graded from 0-5. An overall symptoms score was calculated. Result: 102 cases were evaluated by history, physical examination, digital rectal examination (DRE), international prostate symptom scoring (IPSS), quality of life (QOL) scoring, uroflowmetry, post voided residual urine (PVR) and volume of prostate by USG and serum prostate specific antigen (PSA). Cases were selected between 60-75 years. In group-A, among 42 cases (41.2%) <65 years and group-B, 60 cases (58.80%) > 65 years. Age of the patients of each group was compared with IPSS, PVR, Qmax and QOL. Before TURP, IPSS range 17-25 and mean 21.61+2.43, after TURP, range 0-7 and mean 4.27+1.71). There was significant correlation between the IPSS obstructive scores and Qmax at base line (P=<0.001), while correlations at the 1st, 2nd and 3rd follow up significant. There was also a significant correlation between IPSS obstructive score and PVR, and quality of life. After TURP, the IPSS Score showed significant improvements in urinary symptoms with the IPSS showing more significant change for obstructive symptoms. A significant improvement of IPSS was found from 2 months to 6 months follow up after TURP. The change was tested using “paired student ‘t’ test”. Mean quality of life was 5.01+0.64 at base line, which became 0.60+0.91 at end point and therefore change of mean QOL was -4.41+0.93 ml. A significant improvement QOL after transurethral resection of the prostate. The change was test using ‘Paired Student‘t’ test’. The change was found significant (P=<0.001). Conclusion: Transurethral resection of prostate resolves obstructive symptoms, rapid improvement of urinary flow rate and quality of life that is why it is considered as gold standard treatment for moderate to severe symptomatic BPH patients. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.3-8

Impact Of Transurethral Resection Of Prostate On International Prostate Symptom Score And Peak Urinary Flow Rate

Objectives: To evaluate urinary symptoms and quality of life in patient with BPH before and after TURP. To determine the impact of TURP on the urinary symptoms (IPSS) and peak urinary flow rate. Methods: This study is prospective study carried out between 2010 and 2011 in the department of Urology, National Institute of Kidney Diseases & Urology. Total 102 cases were selected purposively according to selection criteria. Each patient was observed and followed up at 8 weeks (1st visit), 16 weeks (2nd visit) 24 weeks (3rd visit) after transurethral resection of prostate (TURP). IPSS score, QOL score also recorded and uroflowmetry was done to see the peak urinary flow rate (Qmax) of urine and voiding time. USG was done to see post voidal residual urine volume and DRE also done in selected cases. Data was complied and statistical analysis were done using computer based software, Statistical Package for Social Science (SPSS), using paired ‘t’ test. A P value <0.05 was taken as significance. Results: Before TURP, IPSS range 17-25 and mean 21.61+2.43, after TURP, range 0-7 and mean 4.27+1.71). Hence a significant improvement of IPSS was found from 2 months to 6 months follow up after TURP. The change was tested using “paired student ‘t’ test”. Before TURP Qmax range 7-12.2 and mean was 9.96+1.69, which became range 18-25 and mean was 22.61+2.28 after TURP and therefore change of mean Qmax was 12.64+2.69. The change was tested using “paired student ‘t’ test”. The change was found significant (P<0.001). Conclusion: Transurethral resection of prostate resolves obstructive symptoms, rapid improvement of urinary flow rate Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2013 p.11-15