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ABSTRACTS
Year : 2020  |  Volume : 12  |  Issue : 5  |  Page : 21-24  

Abstract - SUA202 (VOIDING Dysfunction)


Date of Web Publication9-Jun-2020

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DOI: 10.4103/0974-7796.278708

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How to cite this article:
. Abstract - SUA202 (VOIDING Dysfunction) . Urol Ann 2020;12, Suppl S1:21-4

How to cite this URL:
. Abstract - SUA202 (VOIDING Dysfunction) . Urol Ann [serial online] 2020 [cited 2021 Sep 21];12, Suppl S1:21-4. Available from: https://www.urologyannals.com/text.asp?2020/12/5/21/278708


   Long-term outcome of childhood bladder dysfunction Top


Ahmed Yamani, Sherif Eldesouqi1, Mai Banakhar, Khalid Kashougji2, Jamela Kari1

Departments of Urology,1Pediatric Nephrology and2Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia

E-mail: [email protected]

Background: Bladder dysfunction is an important cause of chronic kidney disease (CKD). It could be due to spinal lesion (SL), Hinman syndrome or non-neurogenic neurogenic bladder (NNNB) and following posterior urethral valve ablation named valve bladder syndrome (VBS).

Study Design: A retrospective study of all children with neurogenic bladder (NB) over 12 years duration from single center. Results: 199 children (134, boy, 67.3%), were included and divided into three groups; group1 (75 NNNB), group2 (64 SL) and group 3 (60 VBS).Their mean (SD) age at presentation was 43.96(49.66) month. The mean (SD) duration of follow up 71.79(45.46) month. Urodynamic study was done in 85 children before any surgical intervention , it revealed impaired bladder capacity in 49 children (57.6%), atonic bladder in one child (1.1%) while normal bladder compliance in 35 children (41.1%). 113 children (56.8%) were performing clean intermittent catheterization (CIC). Surgical interventions were required in 86 (43.2%). A significant improvement in the mean eGFR and the CKD stages was observed among the three studied groups but the NNNB group showed the least improvement. Children diagnosed and started management during their first year of life had better outcome. Performing CIC without the need for surgical intervention were associated with more improvement of renal function. Pyelonephritis and hydronephrosis have significant negative impact on kidney function. Renal scars was positive in 62%, but did not have negative effect on eGFR at the last follow up.

Forty children (20%) progressed to end stage kidney disease (ESKD), mainly from the VBS group. Renal replacement therapy was performed in23 children (11.5%); 11 hemodialysis, 11 peritoneal dialysis and one child received renal transplantation. Mortality was 7.5% (15 children) , caused by ESKD complications in 10 children, while the remaining died from non-renal causes.

Conclusion: Diagnosis and management of NB in early infancy is associated with better outcome. Successful CIC is more beneficial than vesicostomy and NB caused by spinal lesion is the best regarding preservation of kidney function, while VBS group is the worst.




   Posterior tibial nerve neurostimulation versus solifenacin oral therapy in the treatment of overactive bladder syndrome in women Top


Ahmed Kadry, Ammar Ghabeish, Ahmed Elnashar, Mokhtar Motawea, Isak Sameir, Samy Shaaban

Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

E-mail: [email protected]

Purpose: To compare the effectiveness of Posterior Tibial Nerve Neurostimulation versus oral solifenacin succinate in improvement of care of patients with overactive bladder (OAB) syndrome.

Material and Methods: A total of 50 female patients with overactive bladder presented to the urology clinic in Suez Canal University Hospital were randomly divided into two groups each 25 patients. 1st group was treated by posterior tibial nerve stimulation (PTNS) and the other group treated by oral solifenacin 10 mg. All patients were evaluated to history taking, Clinical examinations (vital signs, abdominal, gynecological and neurological examination), laboratory investigations, overactive bladder symptom score, Indevus urgency severity score, incontinence impact questionnaire and filling cystometry before and after treatment.

Results: Posterior tibial nerve stimulation was effective in improving symptoms of OAB and improving cystometric parameters. Solifenacin 10 mg is effective in improving patient symptoms and also cystometric parameters. By comparing PTNS and Solifenacin they are equally effective in relieving OAB symptoms and improving questionnaires and cystometric parameters.

Conclusion: PTNS is a safe, non-invasive technique and effective in treating cases with OAB as comparable to solifenacin succinate.

Keywords: Overactive bladder, posterior tibial nerve stimulation, solifenacin

Overactive bladder (OAB), Posterior tibial nerve stimulation (PTNS), solifenacin


   Comparing the uroflow data in diabetic men versus nondiabetics: A prospective controlled study Top


Mohamad Habous, Simone Giona1, Saleh Binsaleh2, Osama Abdelwahab, Osama Laban,3 Anthony Mundy4

Jedda, Saudi Arabia,1Frimley, United Kingdom,2Riyadh, Saudi Arabia,3Tabouk, Saudi Arabia,4London, United Kingdom

E-mail: [email protected]

Introduction and Objective: Diabetes mellitus(DM) can cause a variety of lower urinary tract symptoms(LUTS), leading to diabetic cystopathy with broadly varied estimates of the prevalence rates.The pathophysiology of diabetic cystopathy is multifactorial, including disturbances of the detrusor, neuron, urothelium, and urethra.We wanted to compare the outcome data of uroflowmetry test in diabetic men and those without DM as a control group.

Methods: All men over 18 came to our urology clinic, complaining of LUTS for at least 3 months were prospectively included in this study, in 2 years period. Complete medical history including international prostate symptom score(IPSS) questionnaire, physical examination including body mass index(BMI)and comorbidity profile were collected .Standard uroflowmetry test was done, and prostate size was calculated through transrectal ultrasound.Patients with middle lobe ,urethral stricture and previous lower urinary tract surgery were excluded from the study.Database was done with Microsoft Excel and statistical analysis was done by SPSS software.

Results: 802 men were included in this analysis.332 were diabetic(type 2) and 470 were not(control group). Non diabetic Patients were generally Younger than diabetic (52.5y vs 61.3y,p=0.000).Those who are not diabetic had a Lower BMI than those affected (29.1 vs 30.2,p=0.035).Both groups were matched in prostate volume(39.2 ml for non-diabetics versus 12.2 for diabetics, p=0.135).Also there was no significant difference in IPSS between diabetics and non-diabetics(12.2 versus 11.8.p=0.345).When comparing uroflow data, non diabetics had longer Average flow time than those who are not (15.4s vs 9.9s,p=0.002).Also non diabetics had smaller post voiding residual(PVR) than those who are diabetics(64.8ml vs 94.29ml,p=0.000).There was no difference for max flow rate, voided volume, voiding time and average flow time between diabetics and non-diabetics [Table 1].

Conclusions: DM has an impact on voiding function mostly impairing bladder emptying with resultant increased post-void residual volume.




   Would Botulinum toxin A detrusor injections decrease the incidence of symptomatic urinary tract infections in patients with neurogenic detrusor overactivity? Top


Ahmed Yamani, Mai Banakhar

Department of Urology, King Abdulaziz University Hospital, Jeddah, KSA

E-mail: [email protected]

Objective: To study the effect of detrusor muscle Botulimum toxin A injection on the incidence of symptomatic urinary tract infection in neurogenic detrusor overactivity patients.

Methods: We conducted our retrospective chart review for all patients who received 200 or 300 U Botox (Allergan Inc., Irvine, CA, USA) into the detrusor injection in King Abdulaziz University hospital from April 2014 till August 2019. Inclusion criteria included: neurogenic bladder with detrusor overactivity, recurrent UTI (2 or more in 6 months documented by urine culture). Exclusion criteria: idiopathic Overactive bladder, Prostatic injections, no urodynamic test pre or post injection ,files with significant missing data. All patients received culture specific antibiotic and underwent Botox injection while on antibiotic with negative culture on treatment. Patients files were reviewed for Diagnosis, presence of reflux, hydronephrosis ,Urodynamic finding, dose of Botox used and incidence of symptomatic UTI post injection.

Results: Total of 93 patients were diagnosed as neurogenic detrusor overactivity and symptomatic UTI. Diagnosis included spina bifida in 53 patients, hinman's syndrome in 35, others included multiple sclerosis, transverse myelitis and spinal cord injury. Median Patients age was 22y ( 8y -55y). Dose used was 300IU in 58% of patients while 41% received 200IU. Hydronephrosis was present in 25% of cases, while vesicoureteric reflux in 11%. Most patients were already using anticholinergic medication 62% and doing CIC 79%. Their main complaint were symptomatic UTI in 26% while 74% presented with urine leak. After receiving Botox injection 75% of patient (70) had no more symptomatic UTI. Urodynamic test post injection showed decreased filling pressure in 65% and increased bladder capacity in 79% . Correlation analysis showed significant correlation between resolved UTI post Botox Injection and Pt diagnosis, presence of hydronephrosis and post injection filling pressure with P value of p=0.028, p=0.023,p=0.018 respectively.

Conclusion: Intradetrusor muscle Botox injections significantly decreased the incidence of symptomatic UTIs in neurogenic detrusor patients. This effects seemed to be related to decreasing intravesical filling pressure and maintaining low pressure reservoir.


   Investigating if glycated hemoglobin and duration of diabetes have an impact on uroflowmetry results in diabetic men Top


Mohamad Habous, Simone Giona1, Saleh Binsaleh2, Osama Abdelwahab, Osama Laban,3 Anthony Mundy4

Jedda, Saudi Arabia,1Frimley, United Kingdom,2Riyadh, Saudi Arabia,3Tabouk, Saudi Arabia,4London, United Kingdom

E-mail: [email protected]

Introduction and Objective: Diabetes mellitus(DM) contributes to the earlier onset and increased severity of lower urinary tract symptoms(LUTS).We aimed to investigate if uroflowmetry outcome is affected by both controlling blood sugar and duration of being diabetic.

Methods: All men with type 2 DM and non-diabetics(as a control group)who came to our urology clinic, complaining of LUTS for > 3 months were prospectively enrolled in this study.Complete medical history, physical examination and comorbidity profile were collected.Laboratory tests including glycated hemoglobin HA1c were done for all patients. Standard uroflowmetry test was done.All patients had prostate size was calculated through transrectal ultrasound.Patients with middle lobe,urethral stricture and previous lower urinary tract surgery were excluded from the study.

Results: 634 men were included in this analysis 332 of them diabetics. Mean age was 62,mean HA1c was 7.4%,and mean years of DM was12.7.When comparing the HA1c level of those with controlled DM (HbA1C< 8%) with those who are poorly controlled (HbA1C38%), we found no statistical significant difference in any of the uroflowmetry variables [Table 1]. A multivariate analysis was performed to investigate if a longer or shorter history of DM could impact on patients” flowmetry results. Our cohort of patients was stratified per year of diabetes for 4groups:DM for Up to 5y, from6 to10y,from 11 to 15y,and > 15y.The groups were then compared.Our multivariate analysis showed statistically significant increase in voided volume (p<0.01) and flow time (p <0.001)with increase duration of DM. A statistically significant increase in post void residual was also found, but only when the cohort of diabetic patients was compared to the non-diabetics. No statistically significant differences were found in maximum flow rate(p=0.242) and prostate volume(p=0.486) among the groups.

Conclusions: We failed to find statistically difference between controlled and poorly controlled diabetic men in outcome of uroflowmetry results. Longer periods of being diabetic were correlated only with increasing voided volume and time.






 

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