A prospective randomized trial comparing transurethral prostatic resection and clean intermittent self-catheterization in men with chronic urinary retention

OBJECTIVE: To determine whether a preliminary period of clean intermittent self-catheterization (CISC) before transurethral resection of the prostate (TURP) improves bladder contractility and surgical outcome in men with chronic urinary retention (CUR), and whether pressure-flow studies (PFS) before TURP predict the outcome. PATIENTS AND METHODS: The study was a two-centre, pragmatic and randomized trial. Included were 41 men scheduled for TURP with lower urinary tract symptoms (LUTS), an International Prostate Symptom Score (IPSS) of > 7, benign prostatic enlargement and a persistent postvoid residual urine volume (PVR) of > 300 mL. They had conventional PFS using unphysiological filling. The patients then gave consent and were randomized into two treatment groups; the first had TURP after stabilizing renal function by indwelling catheterization if indicated, and the second was taught CISC. Men in both groups were reviewed at 3 and 6 months after surgery or the start of CISC, by the IPSS, urine culture and assay of plasma creatinine, and upper tract imaging and repeat PFS at 6 months. The primary outcome variables were IPSS, maximum urinary flow rate, voiding and end-filling pressures, and mean PVR; secondary variables included treatment failure, complications and other urodynamic measures. RESULTS: Of the 41 patients, 17 (mean age 67 years, range 52-84) were randomized to immediate TURP and 24 (mean age 69 years, range 55-85) to CISC. There was a significant improvement in IPSS and quality of life at 6 months in both groups (P < 0.001). In the CISC group there was a significant improvement in voiding and end-filling pressures, indicating recovery of bladder function (P < 0.001 for each). Of the 41 men, nine (22%) with voiding pressures of < or = 45 cmH2O had no significant improvement in symptoms or urodynamic variables. Detrusor overactivity was found in 17 (41%) patients, of whom six had upper tract dilatation which resolved after treatment. CONCLUSION: The present results emphasize the usefulness of CISC in ensuring the recovery of bladder function in men with CUR. Measuring the voiding pressure before TURP can predict the surgical outcome. Both CISC and immediate TURP are effective for relieving LUTS and result in a better quality of life. A preliminary period of CISC before TURP for men with CUR and low voiding pressure may be valuable. The presence of upper tract dilatation is associated with high end-void and end-fill bladder pressures, and such men have a good outcome from surgery.     

The optimal form of urinary drainage after acute retention of urine.

OBJECTIVE: To assess the outcome of different forms of urinary drainage, particularly for urinary tract infection (UTI), operative findings and patient preference, in patients treated for acute urinary retention (AUR). PATIENTS AND METHODS: A feasibility trial was conducted of men presenting with AUR; after a short period of indwelling catheterization (IDC) patients were taught how to use clean intermittent self-catheterization (CISC). Patients who failed this were re-catheterized and taught to manage a valve, or failing this a leg bag, and then discharged home. The patients were followed to assess the occurrence of spontaneous voiding, UTI, findings at prostatectomy and patient satisfaction. RESULTS: The CISC group (34 men) had a higher rate of spontaneous voiding than the IDC group (16 men; 56% vs 25%). The incidence of UTI was 32% in the CISC and 75% in the IDC group. At TURP, 20% in the CISC group had a UTI, compared with 69% in the IDC group. Patients using CISC preferred it and had fewer complications than the IDC group. The CISC group had a similar ability to manage and similar acceptance of their method of drainage as the IDC group. CONCLUSION: CISC is managed and accepted well by patients who can use the technique and results in fewer UTIs. It should be considered in patients who present with AUR, and it may delay surgery.     

Voiding diary for the evaluation of urinary incontinence and lower urinary tract symptoms: prospective assessment of patient compliance and burden

AIMS: Voiding diary duration may be related to patient compliance and burden. To test this hypothesis, we evaluated patient compliance and burden. METHODS: Between January and July 2002, we prospectively evaluated 162 patients (57 males and 105 females, mean age 53.0, range 20-81 years) with stress urinary incontinence or lower urinary tract symptoms. At the initial visit, all patients underwent a detailed clinical evaluation including an International Prostate Symptom Score (I-PSS) assessment and were randomly requested to complete 2-day, 3-day, or 7-day voiding diaries (the three study groups). At the second visit, a simple self-administered questionnaire was completed by all patients. The questionnaire included 11 items on subject demographics and voiding diary-keeping. RESULTS: No significant differences were found in either the accuracy of diary-keeping or the daily average number of omissions when the three groups were compared. However, as the diary duration increased, the mean burden scores increased (P = 0.005), and the mean preferred duration of the diary in the 7-day group was significantly higher than that of the 2-day or 3-day groups (P < 0.001). After categorizing patients into two groups according to the degree of patient burden, members of the group with a greater perceived burden were found to have a significantly higher I-PSS quality of life score (P = 0.045) and to have kept a diary for a longer time (P = 0.038). CONCLUSIONS: Our results suggest that keeping a diary for 7 days may increase patient burden and thus, we recommend that the 7-day diary should be reduced to cover fewer days.     

Prophylactic antibiotics to prevent urinary tract infection during clean intermittent self-catheterization (CISC) for management of voiding dysfunction after prolapse and incontinence surgery: a decision analysis

Introduction and hypothesis  The objective of this study is to estimate efficacy of prophylactic antibiotics in UTI prevention during CISC for postoperative voiding dysfunction after prolapse/incontinence surgery. Methods  We constructed a decision tree model to evaluate risks and benefits of prophylactic antibiotics during CISC for voiding dysfunction after prolapse/incontinence surgery. The model randomized women requiring CISC to prophylactic antibiotics or no prophylaxis. Probabilities for UTI after CISC with or without prophylactic antibiotics, sequelae from antibiotic use or UTI, and utility values were obtained from published literature and practice quality assurance reviews. Main outcome was probability of experiencing no UTI or adverse event. Results  Under baseline assumptions, prophylactic antibiotics were favored in both models. In the true UTI model, prophylactic antibiotics had an 83.1% probability of no UTI or adverse events; 16.1% better than no prophylactic antibiotics. Conclusions  Using decision analysis methods, prophylactic antibiotics are favored for prevention of UTI during CISC to manage voiding dysfunction after prolapse/incontinence surgery.     

Efficacy of combined anticholinergic treatment and behavioral modification as a first line treatment for nonneurogenic and nonanatomical voiding dysfunction in children: a randomized controlled trial

PURPOSE: This randomized blinded clinical study was designed to compare the efficacy of tolterodine treatment combined with behavioral modification, behavioral modification alone and behavioral modification plus placebo in children with nonneurogenic, nonanatomical voiding dysfunction. MATERIALS AND METHODS: A total of 72 children meeting inclusion criteria were randomly allocated to 1 of 3 groups. One group received tolterodine (1 mg twice daily) along with behavioral modification, 1 received behavioral modification only and 1 received placebo with behavioral modification. A dysfunctional voiding scoring system questionnaire was completed for all patients at the beginning of the study, and at 1 and 3 months of treatment. RESULTS: A total of 71 patients were evaluated. The groups did not differ with respect to age, gender and symptom score before study enrollment (p >0.05). Repeated calculations of symptom scores at 1 month of the treatment revealed a significant decrease in symptoms in all 3 groups, with a significant decrease in patients receiving tolterodine. In addition, at month 3 the symptom score of the tolterodine group was significantly lower compared to month 1, while scores remained steady in the behavioral modification and behavioral modification plus placebo groups. CONCLUSIONS: Tolterodine combined with behavioral modification for voiding dysfunction in children without neurological or anatomical abnormality can be recommended as a first line treatment before invasive evaluation.     

A randomized controlled study comparing clinical effects of naftopidil and tamsulosin on benign prostatic hyperplasia

A prospective randomized controlled study was performed to compare the clinical effects of naftopidil and tamsulosin. Men complaining of lower urinary tract symptoms due to benign prostatic hyperplasia were randomized into two groups : one receiving 50mg naftopidil once daily (Naf group, n=36 patients), and the other receiving 0.2 mg tamsulosin once daily (Tam group, n=32 patients). In the Naf group at 12 weeks, 7 items of the International Prostate Symptom Score (IPSS), storage and voiding symptoms, total IPSS, quality of life (QOL) index (QOLI) and Qmax were improved significantly. In the Tam group at 12 weeks, 6 items of IPSS except urgency, storage and voiding symptoms, total IPSS, QOLI and Qmax were improved significantly. Improvement of residual urine volume (PVR) was insignificant in both groups. In intergroup comparison between the Naf and the Tam groups, variations of 7 items of IPSS, storage and voiding symptoms, total IPSS, QOLI, Qmax and PVR at 4 and 12 weeks after treatment were not statistically significant. There was almost no difference in clinical efficacy between Naf and Tam.     

Outcome of augmentation sigmoidocystoplasty in children with neurogenic bladder

PURPOSE: The role of augmentation cystoplasty in the neuropathic bladder has been well determined since clean intermittent self-catheterization (CISC) has been accepted as a treatment modality in voiding dysfunction. We present our clinical experience with sigmoid augmentation cystoplasty in children with neurogenic bladder disorder. MATERIAL AND METHODS: From 1991 to 1997 sigmoid augmentation cystoplasty with modified clam technique was performed in 18 cases with neuropathic bladder pathologies. In 4 cases, ureteroneocystostomy was performed, 2 of whom were bilateral. Age range of these patients was 5-17 years (mean 10.3 years) and follow-up period was from 16 to 70 months (mean 41 months). RESULTS: Pyuria was detected in 10 cases and 2 of them were symptomatic. Clinical acidosis was detected in only 1 case. Fifteen cases (83%) were continent by using CISC with 4-6 hourly and detrusor pressure lower than 30 cm water at maximal bladder capacity. CONCLUSION: In children with neurogenic bladder pathologies refractory to conservative management, augmentation cystoplasty with CISC is an effective treatment modality in protecting the upper urinary tract and preventing incontinence.     

Posterior tibial nerve stimulation in the treatment of voiding dysfunction: urodynamic data

OBJECTIVES: To determine urodynamic changes and predictive factors in patients with voiding dysfunction who underwent 12 percutaneous tibial nerve stimulations. METHODS: Thirty nine patients with chronic voiding dysfunction were enrolled in a prospective multicenter trial in the Netherlands (n = 19) and in Italy (n = 20). A 50% reduction in total catheterised volume per 24 hr was taken as a primary objective outcome measure. Patients' request for continuation of treatment was regarded as subjective success. Objective urodynamic parameters and bladder indices were determined. Odds ratios and their 95% confidence interval were computed as a measure for predictive power in order to reveal predictive factors (Pdet at Qmax, Qmax, BVE, and BCI). RESULTS: Primary outcome measure was obtained in 41%, an additional 26% reduced their 24 hr residuals with more than 25%. Fifty nine percent of patients chose to continue treatment. Detrusor pressure at maximal flow, cystometric residuals, and bladder indices improved significantly for all patients (P < 0.05). Patients with minor voiding dysfunction were more prone to notice success (Odds ratio: 0.73; 95% CI: 0.51-0.94). CONCLUSIONS: PTNS is a young treatment modality, minimally invasive, and easily accessible. It might be an attractive first line option for patients with (minor) voiding dysfunction.     

Extracorporeal pelvic floor magnetic stimulation in children with voiding dysfunction

OBJECTIVE: To determine the effect of extracorporeal pelvic floor magnetic stimulation in children with an overactive bladder, as although such stimulation is an effective treatment for voiding dysfunction such as urge incontinence (UI) and urgency-frequency syndrome, experience in children is scarce. PATIENTS AND METHODS: This prospective study included 42 children diagnosed with an overactive bladder, based on urodynamic or video-urodynamic study; a complete follow-up was available in 34. The children were grouped into those with UI only, not monosymptomatic nocturnal enuresis (nMNE), or MNE, according to their symptoms. Clinical variables were assessed by recording a voiding and nocturnal enuresis diary before and after magnetic stimulation, the latter being administered twice a week for 4 weeks using a size-adjusted magnetic chair (each session took 20 min). RESULTS: The UI only and nMNE group had a significant decrease in voiding frequency and frequency of UI (P < 0.05); the MNE group also had a significant decrease in voiding frequency (P < 0.05). There was a significant increase in functional bladder capacity in all groups (P < 0.05) but no significant decrease in the mean volume and frequency of NE in the nMNE and MNE groups (P > 0.05). CONCLUSIONS: Extracorporeal pelvic floor magnetic stimulation has an acute effect on voiding dysfunction such as urge syndrome in children. However, controlled studies with a sham-stimulation group and various durations of stimulation are necessary for its application as a primary treatment for voiding dysfunction in children.     

盆腔肿瘤放疗后排尿功能障碍患者的尿动力学评估

目的:评估盆腔肿瘤放疗后患者下尿路功能,分析排尿功能障碍类型.方法:对放疗组21例患者:子宫颈癌15例,骶髓肿瘤2例,直肠癌4例;正常对照组17例,采用常规方法行尿动力学测定,按照美国泌尿协会症状评分(AUA评分)标准进行评分,分析评分与放疗剂量关系,以及尿频尿急、排尿困难、尿失禁三类排尿功能障碍发生的原因.结果:膀胱容量、顺应性、逼尿肌收缩强度、残余尿与对照组比较有显著性差异(P<0.05);放疗组尿失禁患者6例(28.6%),排尿困难11例(52.3%),尿频尿急4例(14.0%).放疗后患者的排尿功能障碍严重程度与放疗剂量有一定相关性(r=0.43,P<0.05).结论:盆腔肿瘤放疗对膀胱尿道功能有明显影响,尿动力学检查有助于放疗后复杂排尿功能障碍的评估.     

The correlation between preoperative voiding mechanism and surgical outcome of the tension-free vaginal tape procedure,with reference to quality of life

OBJECTIVES: To determine whether the surgical outcome of the tension-free vaginal tape (TVT) procedure differs in patients with dysfunctional voiding (DV) or normal voiding. PATIENTS AND METHODS: The voiding mechanism and surgical efficacy of the TVT procedure were analysed retrospectively by reviewing the charts of 79 consecutive women treated over 2 years. Based on their initial voiding mechanism, the patients were divided into two groups, with or without DV. The King's Health Questionnaire was used to evaluate the women's quality of life both before and 1 year after surgery. RESULTS: The change in free maximum urinary flow rate (Qmax) after surgery differed significantly between the groups (P = 0.001). Moreover, both before and after surgery, the free Qmax was significantly lower (P = 0.019 and 0.001, respectively), and the detrusor pressure at Qmax (both P < 0.001) and urethral resistance (P = 0.036 and 0.027, respectively) significantly higher in the group with DV. The subjective outcome measure showed that the cure rates were not significantly different in the two groups (P = 0.173), but the objective outcome measure showed a significant difference (P = 0.025). Analysis of the total scores for all domains showed that significantly more women improved by> 25% in the group without than in those with DV (P = 0.016). CONCLUSIONS: The objective cure rate of the group without DV undergoing the TVT procedure was significantly higher than in those with DV. In addition, subjective measures assessed by the disease-specific quality-of-life questionnaire indicated that the group without DV had a better quality of life than those with DV.     

Effect of a preoperative self-catheterization video on anxiety: a randomized controlled trial

Introduction and hypothesis

The purpose of this study was to determine if a clean intermittent self-catheterization (CISC) instructional video could improve anxiety in women undergoing prolapse and/or incontinence surgery.

Methods

A total of 199 women were randomized to preoperative CISC video or routine counseling prior to prolapse/incontinence surgery. Patient anxiety, satisfaction, and concerns about CISC were evaluated using the State-Trait Anxiety Inventory-State (STAI-S) and study-specific visual analog scale (VAS) questions at four perioperative time points.

Results

STAI-S and VAS anxiety measures were similar at baseline between groups; no significant differences were seen by group at any time point. STAI-S scores varied considerably over time, with highest scores at voiding trial failure and lowest scores at postoperative visit. Women in the video group had improved STAI-S scores and reported less worry and more comfort with CISC immediately following video viewing. Women with anxiety/depression had higher STAI-S scores at voiding trial failure and discharge and reported less anxiety reduction following video viewing compared to non-anxious/non-depressed peers.

Conclusions

Women undergoing prolapse/incontinence surgery have significant perioperative anxiety, which is exacerbated by voiding trial failure. Preoperative CISC video viewing decreases anxiety scores immediately following viewing, but this effect is not sustained at voiding trial failure. Women with baseline anxiety/depression exhibit less anxiety score improvement after video viewing and have overall higher anxiety scores perioperatively.     

Video urodynamics using transrectal ultrasonography for lower urinary tract symptoms in women

AIMS: To understand the properties of lower urinary tract disorders in women, we evaluated 60 female patients with lower urinary tract disorders or symptoms of recurrent cystitis by free uroflowmetry and video urodynamics using transrectal ultrasonography (VU-TRUS). METHODS: Results of urodynamic studies or symptoms of stress incontinence were used to divide 60 women into 7 normal controls and 53 with voiding dysfunctions. RESULTS: In normal controls, VU-TRUS showed that the mean posterior urethrovesical angle and anteroposterior diameter of the proximal urethra at maximum flow was 151.4 degrees and 4.9 mm, respectively. In patients with voiding dysfunction, VU-TRUS during voiding revealed various urethral abnormalities, including 16 detrusor sphincter dyssynergia, 4 detrusor bladder neck dyssynergia, and 13 insufficient opening of the entire urethra. VU-TRUS also showed pelvic floor abnormalities, including 24 urethral hypermobilities (group 1) and 11 cystoceles (group 2). Eighteen patients had neither urethral hypermobility nor cystocele (group 3). Major pressure-flow abnormalities in the 53 patients with voiding dysfunctions were weak detrusor (72%) and/or bladder outlet obstruction (25%). There were no significant differences in the distribution of the pressure-flow abnormalities among the three groups. However, the mean values of abdominal pressure at maximum flow of group 1 (20.9 cm H(2)O) and group 2 (17.9 cm H(2)O) were significantly higher than that of group 3 (6.3 cm H(2)O; each P < 0.05). The mean values of residual urine volume of group 2 (60.8 mL) and group 3 (77.6 mL) were significantly higher than that of group 1 (23.5 mL; each P < 0.05). CONCLUSIONS: The symptoms of women with lower urinary tract disorders were frequently accompanied by urethral and/or pelvic floor abnormalities during voiding that were clearly detected by VU-TRUS. VU-TRUS is useful for objective evaluation of female lower urinary tract symptoms.     

Do female patients with predominant voiding symptoms really have objective voiding-phase dysfunction?

ObjectivesTo investigate whether female patients with predominant voiding symptom really have objective voiding phase dysfunction.MethodsFemale patients with lower urinary tract symptoms who underwent video-urodynamic study between January 2009 and December 2012 were recruited. All patients completed a 3-day frequency-volume chart. Symptom severity was evaluated using International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS) and Urogenital Distress Inventory (UDI-6) questionnaires. The patients with IPSS-voiding subscores greater than IPSS-storage subscores and their most bother symptom are one of voiding symptom of IPSS were defined as subjective voiding dysfunction group (SVD group). The demographics, IPSS scores, OABSS scores, frequency-volume charts and urodynamic variables were compared between SVD and non-SVD groups.ResultsOf the 842 enrolled patients, 142 (16.9%) were classified into SVD group. Total IPSS and IPSS-voiding subscores of SVD group were significantly higher than those of non-SVD group. Conversely, IPSS-storage subscores, OABSS and UDI-6 scores of SVD group were significantly lower than those of non-SVD group. The prevalence of urodynamic voiding phase dysfunction was 64.7% in SVD group, which was significantly higher than those of non-SVD group (37.8%, p < 0.01). SVD group showed more prevalent bladder outlet obstruction (50.0% vs. 27.0%, p < 0.01). There were no significant differences in the prevalence of impaired detrusor contractility between SVD and non-SVD group. Detrusor overactivity was more prevalent in non-SVD group (5.6% vs. 18.6%, p < 0.01).ConclusionsEven though the female patients complain of predominant voiding symptoms, only two thirds of them were identified having urodynamic voiding phase dysfunction. On the other hand, in female patients whose predominant complaint are not voiding symptom, around one third of them were found to have urodynamic voiding phase dysfunction. This study clearly indicates that in females subjective low urinary tract symptoms are not necessarily reliable.     

脊髓损伤患者下尿路功能障碍的尿动力学检查

目的提高对神经源性下尿路功能障碍患者的诊断水平,并为针对性选择康复手段提供可靠依据. 方法对220例不同损伤平面和程度的脊髓损伤患者进行尿动力学检查,其中100例患者常规测定膀胱压力容积和尿道压力图,另120例患者采用膀胱-外括约肌压同步连续测定法分别记录膀胱容量为100 ml时的逼尿肌压、反射排尿时的最大逼尿肌压、最大尿道压,并对所得结果进行统计学分析. 结果除圆锥马尾损伤组的最大尿道压(83±38)cm H2O(1 cm H2O=0.098 kPa)和动态逼尿肌压(12±10)cm H2O低于其他各组,其差异有显著意义(t＝2.096～2.656,P<0.05)外,不同损伤组患者膀胱顺应性降低的发生率相似(分别为51.2%,52.4%和50%);同组不同损伤程度患者间各项参数比较差异无显著意义(t＝1.023,P>0.05).120例患者根据膀胱-外括约肌压同步连续测定法记录尿道压曲线发现,其曲线形状大致可分为4型. 结论除圆锥马尾损伤组的最大尿道压和动态逼尿肌压低于其他各组外,其他参数与损伤平面和损伤程度无关.圆锥马尾损伤组多为不完全性损伤,故而逼尿肌括约肌协同失调的发生率较低.尿道压力曲线的表现与外括约肌和尿道周围横纹肌活动有关.     

Quality of life in patients having an ileal conduit, continent reservoir or orthotopic neobladder after cystectomy for bladder carcinoma

BACKGROUND: To compare the QOL in patients with ileal or colon conduits (IC), continent urinary reservoir (CR) and ileal neobladder (NB), a retrospective study was conducted using a questionnaire sent by mail. METHODS: Seventy-nine patients with a mean age of 60 years were included in this study. A total of 36, 22 and 21 underwent IC, CR and NB, respectively and were alive at the time of this study. A structured questionnaire consisting of 97 questions that covered general condition and physical condition, reconstruction-related symptoms, psychological status, sexual life, social status and satisfaction with the treatment was employed. RESULTS: The IC group frequently complained of changes in bathing habits and loss of using public baths in comparison with the CR and the NB groups. High scores for loss of sexual desire were obtained in the IC, the CR and the NB groups, in this order. Because of the nearly physiological voiding, the NB group desired a voiding condition like pre-operative status as compared with the IC and the CR groups. However, for most of the questionnaire items no difference was seen among the IC, CR and NB groups concerning general condition, reconstruction-related symptoms, psychological status, sexual life, social status, satisfaction with the treatment and global satisfaction with life and health. CONCLUSIONS: There was little difference in the QOL score of the questionnaire and satisfaction among the IC, CR and NB groups. It was suggested that almost every patient accepted and adapted to the present status of general quality of life in each group.     

The long-term voiding function and sexual function after pelvic nerve-sparing radical surgery for rectal cancer

BACKGROUND: The aim of the present study is to symptomatically analyze the extent to which pelvic nerve-sparing radical surgery for rectal cancer impacts on long-term voiding and male sexual function. METHODS: A self-administered questionnaire was mailed to 68 patients who underwent pelvic nerve-sparing radical surgery for invasive rectal cancer with 52 responses (28 men and 24 women; 27 complete and 25 incomplete preservation; response rate 76.5%). Each patient was asked to record if there had been any changes in lower urinary tract symptoms after surgery. Sexual function was also investigated in men. RESULTS: Of the 52 patients, 48 (92%) maintained voluntary voiding without catheterization in the long term. Clean intermittent self-catheterization was performed in only four patients with incomplete preservation because of persistent voiding dysfunction. Subjectively, approximately 60% of the patients remained unchanged in lower urinary tract symptoms after surgery. The satisfaction rate regarding the current voiding status was significantly higher in women than in men (83% versus 61%, P = 0.0294), but was not significantly different between those with complete (76%) and incomplete preservation (64%). Despite the acceptable urinary status, 88% of men had some deterioration in the erectile function, regardless of the types of surgical procedures. Overall, 64% of men were unsatisfied with the current sexual function. CONCLUSIONS: Pelvic nerve-sparing radical surgery for rectal cancer preserved the long-term voiding function in the majority of patients. In completely preserved patients and in women, symptomatic outcomes were more satisfactory. Postoperative erectile dysfunction was found to be a serious problem, even in complete nerve-sparing procedure.     

Fluctuation of night time frequency in patients with symptomatic nocturia

BACKGROUND: We examined the fluctuation and causes of voiding frequency during the night in patients with symptomatic nocturia. MATERIALS AND METHODS: Actual night time frequency was recorded by 72 patients for a total of 769 nights (mean 10.7 nights per patient) and was compared with the 'nocturia score' of the International Prostate Symptom Scores (I-PSS). If a patient experienced nocturnal frequency higher or lower than usual, he or she checked the items on a questionnaire considered reasons for the changes. RESULTS: For 471 nights of 769 (61%), actual voiding frequency did not correspond with nocturia score. Patient-by-patient fluctuation in actual voiding frequency during the night was marked. The most prevalent patient-reported reason for fluctuation was amount of fluid intake, followed by duration of time in bed, feeling colder or warmer during time in bed and increased difficulty going to sleep. Fatigue, difficulty going to sleep and salt intake could affect night time frequency positively or negatively. When nocturia score and total score of the I-PSS were high, the differences between actual nocturnal frequency and nocturia score were significantly larger (3 or less, 0.71; 3-4 or more, 1.05, P<0.0001 and 13 or less, 0.78; 14 or more, 0.97; P=0.0030, respectively). Female patients tended to have nocturia scores differing from actual frequency of urination (1.03 versus male patients 0.84, P=0.0673). CONCLUSIONS: There is considerable discrepancy between the nocturia score of the I-PSS and actual voiding frequency, in addition to marked fluctuation of actual voiding frequency in symptomatic patients. Patient perception of fluctuation of night time frequency can provide clues to useful clinical education of patients regarding nocturia.     

Chronic prostatitis during puberty

OBJECTIVE: To investigate the features of chronic prostatitis (CP) during puberty and the effects of biofeedback on young males with this disease. PATIENTS AND METHODS: In all, 40 patients were divided into two groups; group 1 included 25 pubertal patients with CP (mean age 16.5 years, sd 1.1) and group 2 was a control group including 15 patients (mean age 16.2 years, sd 1.2) with a normal lower urinary tract. National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scores (three parts) were assessed individually in both groups. Expressed prostatic secretions and urine samples after prostate massage from group 1 were cultured to determine whether patients were infected with bacteria, and group 1 was categorized into various NIH types. Each patients in the two groups underwent urodynamics and group 1 were treated with biofeedback. RESULTS: In group 1, there were one, three and 21 patients with type II, IIIA and IIIB prostatitis. The incidence of staccato voiding and detrusor-sphincter dyssynergia (DSD), and the maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), maximum detrusor pressure (Pdetmax) and maximum urethral closure pressure (MUCP) between the groups were significantly different (P < 0.05). The total NIH-CPSI scores and all the subdomains between the groups before biofeedback were significantly different (P < 0.001). In group 1 the difference in NIH-CPSI scores and Qmax before and after biofeedback was significant (P < 0.05). CONCLUSIONS: The main type of CP during puberty is IIIB; the dominating symptom is a voiding disorder. The impact on life and psychological effects are substantial. Pubertal boys with CP have pelvic floor dysfunction and several abnormal urodynamic values, i.e. staccato voiding, DSD, decreasing Qmax, and increasing Pdetmax and MUCP. The effect of biofeedback strategies for treating pubertal CP is satisfactory.     

Reconstructive surgery in voiding dysfunction: experience with 69 patients

Objectives. To present our reconstructive surgery experience with voiding dysfunction due to both neurologic and non-neurologic etiology.Methods. From March 1993 to January 2000, 69 patients (43 men and 26 women) with voiding dysfunction underwent lower urinary tract reconstruction. Mean patient age at the time of surgery was 34.5 years (range 9 to 75). Voiding dysfunction had a neurologic etiology in 65.2% of the patients and a non-neurologic etiology in 34.8%. Urodynamic investigation revealed poor bladder compliance in 52%, detrusor hyperreflexia in 19%, and a combination of the two in 29% of the patients. Thirteen patients (19%) had coexistent intrinsic sphincteric deficiency. A total of 56.5% of the patients had upper urinary tract deterioration. Most patients (78%) had severe urinary incontinence. Augmentation cystoplasty was performed in 60 patients. Nine patients had augmentation cystoplasty with a continent stoma. Concomitant procedures were performed in 11 patients.Results. Mean follow-up was 36.6 months (range 8 to 108). Marked improvement of the upper tracts was documented in 79% of the patients in the neuropathic and 73% in the non-neuropathic group. High continence rates were achieved in both groups (82% and 94%, respectively). Intermittent catheterization rate was 88.6% in the neuropathic and 44% in the non-neuropathic groups and patient satisfaction rate was 84% and 94%, respectively. Three major complications in 2 patients required surgery.Conclusions. Surgical reconstruction to treat urinary incontinence and upper urinary tract deterioration gives satisfactory results in voiding dysfunction in the case of medical treatment failure.