We retrospectively reviewed women who had voiding dysfunction and underwent TUI-BN at least once at our institution from March 2007 to April 2019. All patients underwent VUDS before TUI-BN and after this operation. Female patients with proven urinary tract infections, previous anti-incontinence surgery, or spinal cord injury were not enrolled in this study. This study had been approved by the Institutional Review Board and the Ethics Committee of Hualien Tzu Chi Hospital, Hualien, Taiwan (IRB: 100-06). Informed consent was waived due to the retrospective nature of the analysis.
VUDS was performed in accordance with the recommendations of the International Continence Society [10 (link)]. A multichannel urodynamic system (Life-Tech Inc., Stafford, TX, USA) and a C-arm fluoroscope (Toshiba, Tokyo, Japan) were used. VUDS was repeated at least twice to obtain a reproducible pressure flow trace. The first sensation of filling (FSF), full sensation (FS), cystometric bladder capacity (CBC), bladder compliance, maximum flow rate (Qmax), detrusor pressure at Qmax (Pdet.Qmax), post-void residual volume (PVR), sphincter electromyography activity (EMG), voided volume (Vol), bladder outlet obstruction index (BOOI, defined as Pdet.Qmax − [2 × Qmax]), bladder contractility index (BCI, defined as BCI = Pdet Qmax + 5 Qmax), voiding efficiency (VE, defined as voided Vol/bladder capacity × 100%), and corrected maximum flow rate (cQmax, defined as Qmax/Vol1/2) were documented. During VUDS, voiding cystourethrography was carried out using a C-arm fluoroscope positioned 45 degrees from the buttocks so that the urethra could be lengthened and the bladder neck, urethral sphincter, and distal urethra could be clearly seen.
Patients with severe difficulty in urination, straining while voiding, large PVR, and a narrow bladder neck observed during voiding in VUDS, were initially treated with alpha-blockers for at least three months. If LUTS were refractory to medication, TUI-BN was advised. The surgical procedure of TUI-BN has been reported in a previous study [8 (link)]. If patients still had dysuria, straining while voiding, large PVR, or VE less than 25% after the initial TUI-BN, post-operative VUDS was performed. Consecutive TUI-BN, transurethral external sphincter incision (TUI-ES), or urethral sphincter onabotulinumtoxin A (Botox) injection was advised according to the findings in the second VUDS. Patients with neurological deficit such as a history of cerebrovascular accident, Parkinsonism, myelomeningocele, poliomyelitis, radical hysterectomy, or spine surgery were categorized as with neurologic bladder. Patients without any neurological deficit were grouped into the with non-neurogenic bladder category. The current voiding status was recorded through direct interviews by the same research assistant. The surgical complications such as de novo incontinence and vesicovaginal fistula and additional surgical procedures for complications such as suburethral sling implantation and urethral platelet-rich plasma (PRP) injection were documented.
The descriptions and terminology for urodynamic parameters were in accordance with the recommendations of the International Continence Society [11 (link)]. The primary endpoint of this study was the success rate between TUI-BN alone and TUI-BN with an additional procedure. We defined an improvement in VE by ≥ 50% after treatment as a successful outcome. The parameters between the successful and failed groups were compared using the chi-square test for categorical variables and the Wilcoxon rank-sum test for continuous variables. The secondary endpoint of this study is the predictor factors for surgical success. The demographics and VUDS parameters were analyzed using univariate and multivariate logistic regression to clarify the predictive factors and the discriminatory capacity was investigated using an area under the curve (AUC) analysis. A p-value < 0.05 was considered statistically significant. Complications of the surgery are the third endpoint for this study.
VUDS was performed in accordance with the recommendations of the International Continence Society [10 (link)]. A multichannel urodynamic system (Life-Tech Inc., Stafford, TX, USA) and a C-arm fluoroscope (Toshiba, Tokyo, Japan) were used. VUDS was repeated at least twice to obtain a reproducible pressure flow trace. The first sensation of filling (FSF), full sensation (FS), cystometric bladder capacity (CBC), bladder compliance, maximum flow rate (Qmax), detrusor pressure at Qmax (Pdet.Qmax), post-void residual volume (PVR), sphincter electromyography activity (EMG), voided volume (Vol), bladder outlet obstruction index (BOOI, defined as Pdet.Qmax − [2 × Qmax]), bladder contractility index (BCI, defined as BCI = Pdet Qmax + 5 Qmax), voiding efficiency (VE, defined as voided Vol/bladder capacity × 100%), and corrected maximum flow rate (cQmax, defined as Qmax/Vol1/2) were documented. During VUDS, voiding cystourethrography was carried out using a C-arm fluoroscope positioned 45 degrees from the buttocks so that the urethra could be lengthened and the bladder neck, urethral sphincter, and distal urethra could be clearly seen.
Patients with severe difficulty in urination, straining while voiding, large PVR, and a narrow bladder neck observed during voiding in VUDS, were initially treated with alpha-blockers for at least three months. If LUTS were refractory to medication, TUI-BN was advised. The surgical procedure of TUI-BN has been reported in a previous study [8 (link)]. If patients still had dysuria, straining while voiding, large PVR, or VE less than 25% after the initial TUI-BN, post-operative VUDS was performed. Consecutive TUI-BN, transurethral external sphincter incision (TUI-ES), or urethral sphincter onabotulinumtoxin A (Botox) injection was advised according to the findings in the second VUDS. Patients with neurological deficit such as a history of cerebrovascular accident, Parkinsonism, myelomeningocele, poliomyelitis, radical hysterectomy, or spine surgery were categorized as with neurologic bladder. Patients without any neurological deficit were grouped into the with non-neurogenic bladder category. The current voiding status was recorded through direct interviews by the same research assistant. The surgical complications such as de novo incontinence and vesicovaginal fistula and additional surgical procedures for complications such as suburethral sling implantation and urethral platelet-rich plasma (PRP) injection were documented.
The descriptions and terminology for urodynamic parameters were in accordance with the recommendations of the International Continence Society [11 (link)]. The primary endpoint of this study was the success rate between TUI-BN alone and TUI-BN with an additional procedure. We defined an improvement in VE by ≥ 50% after treatment as a successful outcome. The parameters between the successful and failed groups were compared using the chi-square test for categorical variables and the Wilcoxon rank-sum test for continuous variables. The secondary endpoint of this study is the predictor factors for surgical success. The demographics and VUDS parameters were analyzed using univariate and multivariate logistic regression to clarify the predictive factors and the discriminatory capacity was investigated using an area under the curve (AUC) analysis. A p-value < 0.05 was considered statistically significant. Complications of the surgery are the third endpoint for this study.
Free full text: Click here
