Quantifying bladder outflow obstruction in men:A comparison of four approximation methods exploiting large data samples

Introduction: A pressure flow study (PFS), part of the International Continence Society standard urodynamic test, is regarded gold standard for the classification and quantification of the urethral resistance (UR), expressed in the bladder outflow obstruction (BOO). For men with benign prostatic hyperplasia, the minimum urethral opening pressure (pmuo), found at the end of the passive urethral resistance relation is considered the relevant parameter describing BOO. However, in clinical practice, direct measurements of pmuo are easily confounded by terminal dribbling. For that reason, alternative methods were developed to derive pmuo, and thereby assess BOO using the maximum urine flow rate (Qmax) and the corresponding pressure (pdetQmax) instead. These methods were never directly compared against a large data set. With the increasing variety of treatments becoming available more precise grading of UR may become of relevance. The current study compares four well-known methods to approximate pmuo and examines the relation between pmuo and pdetQmax. Methods: In total, 1717 high-quality PFS of men referred with lower urinary tract symptoms between 2003 and 2020 without earlier lower urinary tract surgery were included. From these recordings, pmuo was calculated according to three one-parameter methods. In addition, a three-parameter method (3PM) was used, based on a fit through the lowest pressure flank of the pressure-flow plot. The estimated pmuo's were compared with a precisely assessed pmuo. A difference of &lt;10 cmH2O between an estimate and the actual pmuo was considered accurate. A comparison between the four approximation methods and the actual pmuo was visualized using a Bland–Altman plot. The differences between the actual and the estimated slope were assessed and dependency on pmuo was analyzed. Results: A total of 1717 studies were analyzed. In 55 (3.2%) PFS, 3PM analysis was impossible because all pressures after Qmax were higher than pdetQmax. The 3PM model was superior in predicting pmuo, with 75.9% of the approximations within a range of +10 or −10 cmH2O of the actual pmuo. Moreover, pmuo according to urethral resistance A (URA) and linearized passive urethral resistance relation (linPURR) appear equally reliable. Bladder outflow obstruction index (BOOI) was significantly less accurate when compared to all others. Bland–Altman analysis showed a tendency of BOOI to overestimate pmuo in men with higher grades of UR, while URA tended to underestimate pmuo in those cases. The slope between pmuo and pdetQmax-Qmax increased with larger pmuo, as opposed to the constant relation proposed within BOOI. Although significant differences were found, the clinical relevance of those differences is not known. Conclusion: Of the four methods to estimate pmuo and quantify BOO, 3PM was found the most accurate and BOOI the least accurate. As 3PM is not generally available and performance in lower quality PFS is unknown, linPURR is (for now) the most physiologically accurate.</p

Use of medical consumables in urology practice:is there a more sustainable way?

The Dutch Green Deal Healthcare 3.0 presents us with the challenge of reducing raw material usage by 50% by 2030. This study offers a first insight into material usage variations among Dutch urology clinics during various outpatient and clinical interventions. This national survey highlights a wide range in the utilization of single-use items, such as personal protective equipment and draping. Notably, only 60% of respondents use sterile gloves during a diagnostic cystoscopy, and draping is used in less than half the cases. Whilst performing a vasectomy or circumcision, a quarter of surgeons wear a surgical gown in addition to sterile gloves. Finding a balance between safe health care and a minimum of used materials is an important job for health care professionals. Sharing knowledge about best practices remains of paramount importance.</p

Use of medical consumables in urology practice:is there a more sustainable way?

The Dutch Green Deal Healthcare 3.0 presents us with the challenge of reducing raw material usage by 50% by 2030. This study offers a first insight into material usage variations among Dutch urology clinics during various outpatient and clinical interventions. This national survey highlights a wide range in the utilization of single-use items, such as personal protective equipment and draping. Notably, only 60% of respondents use sterile gloves during a diagnostic cystoscopy, and draping is used in less than half the cases. Whilst performing a vasectomy or circumcision, a quarter of surgeons wear a surgical gown in addition to sterile gloves. Finding a balance between safe health care and a minimum of used materials is an important job for health care professionals. Sharing knowledge about best practices remains of paramount importance.</p

Use of medical consumables in urology practice:is there a more sustainable way?

The Dutch Green Deal Healthcare 3.0 presents us with the challenge of reducing raw material usage by 50% by 2030. This study offers a first insight into material usage variations among Dutch urology clinics during various outpatient and clinical interventions. This national survey highlights a wide range in the utilization of single-use items, such as personal protective equipment and draping. Notably, only 60% of respondents use sterile gloves during a diagnostic cystoscopy, and draping is used in less than half the cases. Whilst performing a vasectomy or circumcision, a quarter of surgeons wear a surgical gown in addition to sterile gloves. Finding a balance between safe health care and a minimum of used materials is an important job for health care professionals. Sharing knowledge about best practices remains of paramount importance.</p

Arterio-ureteral fistula:a nationwide cross-sectional questionnaire analysis

PURPOSE: Arterio-ureteral fistula (AUF) is an uncommon diagnosis, but potentially lethal. Although the number of reports has increased over the past two decades, the true incidence and contemporary urologists’ experience and approach in clinical practice remains unknown. This research is conducted to provide insight in the incidence of AUF in The Netherlands, and the applied diagnostic tests and therapeutic approaches in modern practice. METHODS: A nationwide cross-sectional questionnaire analysis was performed by sending a survey to all registered Dutch urologists. Data collection included information on experience with patients with AUF; and their medical history, diagnostics, treatment, and follow-up, and were captured in a standardized template by two independent reviewers. Descriptive statistics were used. RESULTS: Response rate was 62% and 56 AUFs in 53 patients were reported between 2003 and 2018. The estimated incidence of AUF in The Netherlands in this time period is 3.5 AUFs per year. Hematuria was observed in all patients; 9% intermittent microhematuria, and 91% presenting with, or building up to massive hematuria. For the final diagnosis, angiography was the most efficient modality, confirming diagnosis in 58%. Treatment comprised predominantly endovascular intervention. CONCLUSION: The diagnosis AUF should be considered in patients with persistent intermittent or massive hematuria. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00345-021-03910-3

Langetermijn follow-up van katheteriseerbare vesicostoma’s bij kinderen, een vergelijking van verschillende technieken

The objective of this study was to compare long-term results of the different techniques used to create continent catheterizable channels (CCC’s) in a single institution. Primary outcomes were revision free survival, stenosis and incontinence. A total of 117 CCC’s were included with median follow-up of 85 months. Surgical revision was required in 52% and laparotomy in 27% of cases. Stenosis requiring revision was seen in 33%. Complete revision was required in eight (7%) cases. A fausse route was formed in 9% of cases. A CCC is an elegant solution for children who experience problems with urethral catheterization. We found no significant differences in outcome between CCC’s from appendix or bladder flap, leading us to conclude that a bladder flap CCC is a good alternative solution if the appendix is not available and bladder volume is sufficient

A systematic review on cell-seeded tissue engineering of penile corpora

Tissue engineering of corporal tissue is a new development in otherwise untreatable erectile dysfunction and in urethral reconstructions to treat hypospadias or severe urethral stricture disease. Multiple complications can arise with the current treatments, whereas engineered tissue, if well vascularized and existing of autologous cells, may lead to better results. The aim of this review was to provide an overview of literature on cell-seeded-based tissue engineering of corporal penile tissue. A literature search was performed following the PRISMA guidelines. Papers describing cell-seeded tissue engineering of corporal tissue were included. Studies using different techniques, such as intracavernous injection were excluded. Fifteen articles were included in the review. Twelve of these studies described engineering of the corpus cavernosum in animal models. Two articles were found on engineering of animal corpus spongiosum and one article on engineering of the human glans. Both synthetic scaffolds and biological scaffolds were used. The advantage of a biological, acellular scaffold was that the native, complex architecture of corporal tissue was maintained. Most studies used endothelial and smooth muscle cells from corporal origin, but stem cells were also investigated. Furthermore, dynamic culturing achieved an improved cell content and functionality. This review has summarized the developments in tissue engineering of corpus cavernosum and spongiosum tissue. Functional tissue has been developed in animal studies with the use of seeded cells on scaffolds. This knowledge will form a basis for the development of tissue engineering of corporal tissue for clinical applications

Coping styles in patients with hypospadias

Objective: The objective of this study is to investigate the coping styles used by patients with hypospadias. Long-term hypospadias studies generally show satisfying outcomes, but some report a lower quality of life (QoL) or poorer psychosocial adjustment, particularly in patients with proximal hypospadias. A lower QoL or psychosocial adjustment was found to be associated with passive coping styles in other pediatric patient populations. Hypothetically, patients with hypospadias also develop different coping styles due to medical experiences in childhood, leading to the lower QoL outcomes on the long term. However, coping styles of patients with hypospadias have never been analyzed. Patients and methods: Adult men with hypospadias repair in childhood were recruited (n = 55; aged 19.9 [IQR 19.2–22.1]). Coping styles were determined with the Utrecht Coping List (UCL) and results compared with a reference group of male students (n = 55, age 20–30 years, no medical history). Sub analysis of coping styles of the hypospadias groups was done based on three items: severity of hypospadias, time of last hypospadias surgery and occurrence of postoperative complications. Results: Compared to the reference groups, patients with hypospadias had higher scores on Avoidance (P < 0.05), particularly patients who had ≥1 postoperative complication or proximal hypospadias. Patients with proximal hypospadias also had lower scores on Seeking Social Support compared to the reference group (P < 0.05). Within the hypospadias group, coping style scores did not differ based on severity of hypospadias, timing of surgery or postoperative complications. Conclusion: Patients with hypospadias, particularly those with proximal hypospadias or a postoperative complication, more often use an avoiding coping style compared to a reference population. Attention to coping styles during the follow-up of patients with hypospadias might help to improve the QoL in these patients

Coping styles in patients with hypospadias

Objective: The objective of this study is to investigate the coping styles used by patients with hypospadias. Long-term hypospadias studies generally show satisfying outcomes, but some report a lower quality of life (QoL) or poorer psychosocial adjustment, particularly in patients with proximal hypospadias. A lower QoL or psychosocial adjustment was found to be associated with passive coping styles in other pediatric patient populations. Hypothetically, patients with hypospadias also develop different coping styles due to medical experiences in childhood, leading to the lower QoL outcomes on the long term. However, coping styles of patients with hypospadias have never been analyzed. Patients and methods: Adult men with hypospadias repair in childhood were recruited (n = 55; aged 19.9 [IQR 19.2–22.1]). Coping styles were determined with the Utrecht Coping List (UCL) and results compared with a reference group of male students (n = 55, age 20–30 years, no medical history). Sub analysis of coping styles of the hypospadias groups was done based on three items: severity of hypospadias, time of last hypospadias surgery and occurrence of postoperative complications. Results: Compared to the reference groups, patients with hypospadias had higher scores on Avoidance (P < 0.05), particularly patients who had ≥1 postoperative complication or proximal hypospadias. Patients with proximal hypospadias also had lower scores on Seeking Social Support compared to the reference group (P < 0.05). Within the hypospadias group, coping style scores did not differ based on severity of hypospadias, timing of surgery or postoperative complications. Conclusion: Patients with hypospadias, particularly those with proximal hypospadias or a postoperative complication, more often use an avoiding coping style compared to a reference population. Attention to coping styles during the follow-up of patients with hypospadias might help to improve the QoL in these patients

Long-term effect of conservative treatment versus low threshold endoscopic desobstruction on urine incontinence and urgency in boys with persistent overactive bladder symptoms : A cohort study

Aims: To assess the long-term effects of two treatment strategies (low threshold endoscopic desobstruction vs. conservative treatment) on urinary incontinence (UI) and urgency-frequency in boys. Methods: Boys with persistent overactive bladder symptoms treated in two tertiary referral centers between 2006 and 2009 were included. Treatment strategy in center 1 was urethrocystoscopy (UCS) and in case of obstruction urethral desobstruction and in center 2 conservative. The primary outcome was time to being dry during daytime, secondary outcomes were being dry both day and night and presence of urgency-frequency, using the “provisional” International Consultation on Incontinence Questionnaires Children's Lower Urinary Tract Symptoms (LUTS) questionnaire. Results: Median age at start of treatment was 8.0 (IQR 6.4-9.4) years in center 1 and 8.4 (IQR 6.0-10.1) years in center 2. At baseline daytime incontinence was present in 100/104 children (96%, center 1) and 37/44 (84%, center 2). In center 1, UCS was performed in 98 (93%) boys, with desobstruction in 93 (88%), while in center 2 these numbers were 16 (36%), and 5 (11%). There were no differences between groups after a mean follow-up of 5 years concerning dryness at daytime (HR 0.86, 0.56-1.30), dryness day and night (HR 0.72, 0.51-1.14), and presence of urgency-frequency (HR 0.67, 0.38-1.25). Conclusions: The benefit of a strategy including low-threshold UCS and endoscopic desobstruction in boys with urge incontinence and suspected infravesical obstruction to prevent LUTS and incontinence on the longer term could not be confirmed