Bassem S. Wadie

THE RELATIONSHIP OF THE INTERNATIONAL PROSTATE SYMPTOM SCORE AND OBJECTIVE PARAMETERS FOR DIAGNOSING BLADDER OUTLET OBSTRUCTION. PART I: WHEN STATISTICS FAIL

PURPOSE We evaluated the International Prostate Symptom Score and correlated it with objective means of determining bladder outlet obstruction. MATERIALS AND METHODS Beginning in May 1996, 460 men 41 to 88 years old (mean age plus or minus standard deviation 60.4 +/- 9.4) were prospectively included in this study. Symptoms were evaluated using the International Prostate Symptom Score, and digital rectal examination, outpatient cystoscopy, prostate specific antigen determination and transrectal ultrasound were done. Urodynamic evaluation included uroflowmetry, filling cystometry and pressure flow study. RESULTS Linear regression was done to correlate scores with measurable parameters. We noted no correlation of the total, obstructive symptoms or irritative symptoms score with objective parameters, including the average and maximum flow rate, post-void residual urine, prostate size and Schäfer grade. CONCLUSIONS Prostatic symptom scores are qualitative. Using them to quantify the degree of obstruction or evaluate therapy is questionable.

The Relationship of Detrusor Instability and Symptoms With Objective Parameters Used for Diagnosing Bladder Outlet Obstruction: A Prospective Study

PURPOSE Detrusor instability is a common urodynamic finding in patients with prostatic obstruction. In prospective fashion we evaluated detrusor instability in patients with lower urinary tract symptoms attributable to benign prostatic hyperplasia and determined its possible association with the degree of obstruction. MATERIALS AND METHODS A total of 459 men with a mean age plus or minus standard deviation of 60.4 +/- 9.4 years who were investigated for lower urinary tract symptoms at our facility answered an Arabic standardized version of International Prostate Symptom Score and underwent simple uroflowmetry, outpatient cystoscopy and transrectal ultrasound. Invasive urodynamics, including filling and voiding cystometry, was done with pressure flow analysis according to the Schäfer nomogram. Statistical significance was tested by the Mann-Whitney U and Wilcoxon rank sum tests. RESULTS Of the 459 patients 108 (23.5%) had detrusor instability. Instability significantly affected patient symptom score and conception of quality of life. Moreover, instability significantly affected the degree of obstruction, as measured by the maximum flow rate, post-void residual urine, prostate volume and Schäfer grade of obstruction. CONCLUSIONS Detrusor instability affects patient symptoms and quality of life. It also signifies a more severe degree of obstruction in male patients with lower urinary tract symptoms and bladder outlet obstruction due to benign prostatic hyperplasia.

Bladder erosion of tension-free vaginal tape presented as vesical stone; management and review of literature

The vesical stone formation due to intravesical mesh erosion of tension-free vaginal tape (TVT) is rare. In this report, a case of 48-year-old patient who underwent (TVT) elsewhere is discussed. The patient was presented with vesical stone and persistent stress urinary incontinence. Intravesical stone was detected by non-contrast computed tomography and cystourethroscopy. Stone fragmentation was done by pneumatic lithotripsy and transurethral resection of the mesh was performed. The postoperative control cystoscopy demonstrated complete healing of bladder mucosa.

High-energy transurethral microwave thermotherapy: symptomatic vs urodynamic success

To evaluate the subjective and objective treatment results of high‐energy transurethral microwave thermotherapy (TUMT) for symptomatic benign prostatic hyperplasia (BPH), and investigate the possible variables for predicting symptomatic and/or urodynamic success.

Severe stress urinary incontinence: Objective analysis of risk factors

OBJECTIVE To assess differences between patients suffering from severe degree of stress urinary incontinence versus those with mild degree and to detect the risk factors of severity. MATERIALS AND METHODS 118 patients suffered from pure SUI were enrolled in a prospective study. According to VLPP, patients were categorized into 2 groups: mild (VLPP>60) and severe (VLPP<60). Risk factors included age, parity, gravidity, menopausal status, co-morbidities and surgical history were investigated. RESULTS 35 patients had severe SUI; their mean VLPP±SD was 47±8cm H2O, while in 83 patients with mild SUI, mean VLPP was 90±20cm H2O. No significant difference was detected between both groups concerning clinical parameters except for the presence of bronchial asthma in which the difference was approaching statistical significance (P=0.07). Patients with multiple deliveries have triple risk to develop severe SUI. Obese patients with BMI>30 and those with bronchial asthma are more prone to develop severe type (OR: 1.9, 95%CI: .07-5 and OR: 9.4, 95% CI: 0.7-25 respectively). CONCLUSIONS Bronchial asthma, obesity and multiple parities might be associated with low VLPP. Severe SUI is a resultant of multi-factors rather than one risk factor.

Retropubic Bulbourethral Sling for Post-Prostatectomy Male Incontinence: 2-Year Followup

PURPOSE Post-prostatectomy incontinence is usually due to sphincter damage as a complication of prostatectomy but may result from other causes. The intermediate term outcome of the retropubic bulbourethral sling is presented. MATERIALS AND METHODS Included in study were 40 men with post-prostatectomy incontinence who used 5 or greater pads daily for protection. All patients had undergone prostatectomy, including transurethral resection in 17, holmium laser enucleation in 3, and open retropubic and radical prostatectomy in 12 and 8, respectively. Preoperatively voiding cystourethrogram and urodynamics were done in all men as applicable. A bulbourethral sling was prepared from polypropylene mesh. Suspension was achieved using size zero nylon sutures to fix the mesh in front of the rectus sheath. Patients were followed at 1 week, 3 and 6 months, and semiannually thereafter. RESULTS Median incontinence duration was 3 years (range 0.5 to 14). Concomitant surgery was done in 11 men (27.5%), 34 (85%) were dry at 24-month followup and 10 (25%) underwent retightening at 3 to 6 months. Urodynamics showed no significant change in filling or voiding parameters. The increase in maximum urethral closure pressure and functional urethral length was not statistically significant. CONCLUSIONS The described retropubic bulbourethral sling is a viable option for severe male incontinence with a satisfactory cure rate at intermediate followup. It is adjustable and cost-effective.

THE RELATIONSHIP OF THE INTERNATIONAL PROSTATE SYMPTOM SCORE AND OBJECTIVE PARAMETERS FOR DIAGNOSING BLADDER OUTLET OBSTRUCTION. PART II: THE POTENTIAL USEFULNESS OF ARTIFICIAL NEURAL NETWORKS

PURPOSE The International Prostate Symptom Score (I-PSS) is used exclusively for evaluating patients with a prostate condition and following various treatment modalities. As previously demonstrated, there is poor or no correlation of bladder outlet obstruction diagnosed by pressure flow study with the symptoms projected by the I-PSS. Thus, we applied an artificial neural network model to assess patients with lower urinary tract symptoms. MATERIALS AND METHODS Data on 460 patients enrolled in part 1 of our study were entered into a multilayer feed forward, back propagation network. RESULTS In the training set of 305 patients the model predicted obstruction in 94% with 94% sensitivity and 68% specificity. In the test set of 155 patients it predicted obstruction in 87% with 87% sensitivity and 44% specificity. CONCLUSIONS The accuracy of the model for diagnosing obstruction based on the I-PSS is acceptable, considering that statistical models failed to demonstrate a correlation of symptoms with objective obstruction.

Placard‐shaped in situ vaginal wall sling for the treatment of stress urinary incontinence

Purpose:  To evaluate the efficacy of a simple and economic procedure using a placard‐shaped in situ anterior vaginal wall sling for the treatment of stress urinary incontinence, with or without cystocele repair.

Short-term results of rotoresection for benign prostatic hyperplasia: a prospective study of safety and efficacy.

To assess the safety and efficacy of rotoresection as a method for treating benign prostatic hyperplasia (BPH).

Management of refractory OAB in the non-neurogenic patient.

Overactive bladder (OAB) is one of the most common bothersome urological diseases. It also has a negative economic impact. Pathophysiology entails changes in neurogenic and myogenic factors, as well as urinary biomarkers such as nerve growth factor (NGF) and prostaglandins (PGs). With symptoms from OAB-Dry to OAB-Wet, the urodynamic pattern of OAB bladder is often characterized by idiopathic detrusor overactivity with lower threshold of sensation, diminished compliance and capacity. Treatment ranges from a combination of behavioral modifications (BM)/ pelvic floor muscle training (PFMT) to combinations of antimuscarinics, Botox injection, nerve stimulation and augmentation cystoplasty. Herein, a contemporary review on the different aspects of management of refractory OAB in patients without neuropathic disorders is presented.