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ABSTRACT Due to growing social acceptance, there has been an increasing number of gender-affirmation surgeries performed in North America. Most research in this patient population focuses on surgical outcomes and advancing techniques. However, little work has been done to study functional outcomes. To better evaluate urinary dysfunction in the postphalloplasty trans men patient population, our group developed a novel patient-reported outcome instrument - the postphalloplasty urinary function test (PP UFT) and protocol to measure postvoid urethral volume (PVUR), and we present our preliminary results. We conducted a cross-sectional pilot study in a cohort of 15 adult trans men who had undergone phalloplasty with urethral lengthening surgery between 2018 and 2021. Patients had stable urinary function via the neophallus at the time of survey. Patients filled out the PP UFT and were asked to record their PVUR as per our protocol. The average PP UFT score was 8.9 out of 40 and the average quality-of-life (QOL) score was 2.6. Postvoid dribbling constituted the major complaint and on average comprised 63.2% of the reported PP UFT score. The average PVUR was 2.2 ml (range: 0.5-5.6 ml). There was a positive correlation between higher PP UFT and worse-reported quality of life (P < 0.01; R2 = 0.4). Current questionnaires accepted in cis-male urology have limitations for accurately capturing urinary dysfunction in this specific patient group. The combination of PP UFT and PVUR measurement offers potential for quantifying urinary function and quality of life in patients who undergo phalloplasty. Future studies will validate these instruments.

Void spot assay (VSA) noninvasively evaluates urination. This study optimizes VSA by comparing post‐assay paper visualization techniques: bright field light (BF), ultraviolet light (UV), and ninhydrin spray (N). Male rats were placed in filter paper lined cages for 4 h. After the assay, all papers were dried. BF images were photographed (digital camera). UV images were captured using a Darkroom ultraviolet imaging cabinet. Papers were sprayed with ninhydrin and photographed (digital camera). All images were converted to binary for analysis with Void Whizzard. UV versus BF significantly differed in area. All three groups significantly differed in overall spot count and spots 0–0.1 cm2. UV versus N and UV versus BF significantly differed in 0.1–0.25 cm2 spots, UV versus N in 0.25–0.5 cm2, and N versus BF in spots 0.5–1 cm2. Overall BF visualization proved difficult. N provided an ideal way to highlight urine and image with a digital camera. Human fingerprints from pre‐assay handling of paper interfered with the analysis of the smallest sized spots; however, there were no differences in the detection of larger spots, spot distribution, or overall spot area. This study contributes to the development of a standardized VSA protocol for assessing bladder function in rodent models.

PurposeIntermittent catheterization (IC) is a proven effective long-term bladder management strategy for individuals who have lower urinary tract dysfunction. This study provides clinical evidence about multiple-reuse versus single-use catheterization techniques and if catheter choice can have an impact on health-related quality of life (HRQoL). MethodA prospective, multi-center, clinical trial studied patients who currently practiced catheter reuse, and who agreed to prospectively evaluate single-use hydrophilic-coated (HC) (i.e. LoFric) catheters for 4 weeks. A validated Intermittent Self-Catheterization Questionnaire (ISC-Q) was used to obtain HRQoL. Reused catheters were collected and studied with regard to microbial and debris contamination. ResultsThe study included 39 patients who had practiced IC for a mean of 10 years, 6 times daily. At inclusion, all patients reused catheters for a mean of 21 days (SD = 48) per catheter. 36 patients completed the prospective test period and the mean ISC-Q score increased from 58.0 (SD = 22.6) to 67.2 (SD = 17.7) when patients switched to the single-use HC catheters (p = 0.0101). At the end of the study, 83% (95% CI [67–94%]) preferred to continue using single-use HC catheters. All collected reused catheters (100%) were contaminated by debris and 74% (95% CI [58–87%]) were contaminated by microorganisms, some with biofilm.ConclusionSingle-use HC catheters improved HRQoL and were preferred over catheter reuse among people practicing IC. Catheter multiple-reuse may pose a potential safety concern due to colonization by microorganisms as well as having reduced acceptance compared to single use.Trial registry numberClinicalTrials.gov NCT02129738.

Background： Both lower urinary tract dysfunction and urinary symptoms are prevalent in patients with multiple sclerosis （MS）. Although the significance of identifying and treating urinary symptoms in MS is currently well-known, there is no information about the real prevalence and therapeutic effect of urinary symptoms in patients with MS. The purpose of this study was to analyze the major symptoms and urodynamic abnormalities, and observe the therapeutic effect in different MS characteristics. Methods： We enrolled 126 patients with urological dysfunction who were recruited between July 2008 and January 2015 in Beijing Tian Tan Hospital, Capital Medical University and conducted overactive bladder system score （OABSS）, urodynamic investigation, and expanded disability status scale （EDSS）. Changes of urinary symptoms and urodynamic parameters were investigated. Results： Urgency was the predominant urinary symptom, and detrusor overactivity was the major bladder dysfunction. There was a positive correlation between EDSS and OABSS. Clinically isolated syndrome （CIS） had lowest EDSS and OABSS. CIS exhibited significant improvements in OABSS, maximum urinary flow rate （Qmax）, and bladder volume at the first desire to voiding and maximum bladder volume after the treatment （P 〈 0.05）. Relapsing-remitting MS showed significant improvements in the OABSS, Qmax, and bladder volume at the first desire to voiding, maximum bladder volume and bladder compliance after the treatment （P 〈 0.05）. Progressive MS exhibited significant increase in the bladder volume at the first desire to voiding, the detrusor pressure at maximum flow rate （PdetQmax）, and bladder compliance after the treatment （P 〈 0.05）. Conclusions： Urodynamic parameters examined are important in providing an accurate diagnosis, guiding management decisions of MS. Early and effective treatment may improve the bladder function and the quality of life at the early stages of MS.

Background To evaluate whether intermittent catheterization for bladder training can reduce urinary catheterization duration in patients undergoing mid-low rectal cancer surgery. Methods Stratified by gender, 330 patients were divided into a 5-day catheterization control group, and experimental groups A (3-day bladder training) and B (5-day bladder training), with 110 patients each. Results Two-way ANOVA found that gender affected recatheterization, Pdet@Qmax, Qmax, BOOI and three-day total urine volume. No difference between groups A and B. Patients in experimental group A had a shorter time to first void ( P  = 0.030) and lower three-day average residual urine volume ( P  = 0.011) than the control group, and patients in experimental group B had a larger urine volume ( P  = 0.043) and lower first residual urine volume ( P  = 0.001). Bladder training reduced recatheterization in males. The nomogram constructed based on the logistic regression model better predicted the risk of urinary tract infection (AUC = 0.669) and recatheterization (AUC = 0.731). These two models may help provide new tools for the postoperative care of patients with mid-low rectal cancer. Conclusions Three-day catheter removal after bladder training is non-inferior to five-day removal. Bladder training is effective in reducing the chances of recatheterization in patients with mid-low rectal cancer. Trial registration This study was registered with the China Clinical Trials Registry at 22th March, 2018 (No. ChiCTR1800015313, https://www.chictr.org.cn/showproj.html?proj=26123 ).

Background Intermittent urethral catheter clamping is widely used to reduce secondary catheterization in patients after proctectomy; however, its effectiveness is unclear. Materials and methods This study investigated the effects of intermittent catheter clamping combined with active urination training (ICCAUT) on postoperative urinary dysfunction in patients after proctectomy. This retrospective cohort study analyzed data on patients who underwent laparoscopic/robotic-assisted proctectomy at a single medical center in China between July 2023 and January 2024. Methods Patients received ICCAUT or free urinary drainage during the indwelling urethral catheter period after surgery. Data from the ICCAUT and free-drainage groups were compared. The primary outcome measure was urinary dysfunction. The secondary outcomes were urinary tract infections, time to first void after catheter removal, and urine volume during first voiding. Propensity-score matching (PSM), inverse probability-of-treatment weighting (IPTW), and multivariable logistic regression analyses were used to identify factors associated with urinary dysfunction. Results Among 360 eligible patients, 173 received a free-drainage strategy and 187 received ICCAUT. The incidence of urinary dysfunction was 52.5% overall and was significantly lower in the ICCAUT group than in the free-drainage group (45.1% vs. 59.4%; p  = 0.009). The lower incidence of urinary dysfunction in the ICCAUT group was confirmed in the PSM (44.7% vs. 59.3%; p  = 0.03) and IPTW (44.5% vs. 57.1%; p  = 0.028) analyses. Multivariable logistic regression analysis revealed that ICCAUT was independently associated with a lower risk of urinary dysfunction (OR, 0.55; 95% CI, 0.34–0.89; p  = 0.015). Subgroup analysis found that, compared with female patients, male patients are more likely to benefit from the ICCAUT strategy ( p for interaction = 0.029; adjusted OR, 0.33; 95% CI, 0.17–0.62; p  < 0.001). The ICCAUT strategy did not significantly increase the risk of urinary tract infection ( p  = 0.349). Conclusions The ICCAUT strategy may benefit the recovery of urinary function after proctectomy, especially for male patients. ICCAUT showed an independent association with a lower risk of urinary dysfunction and UTI, with urinary tract infection comparable to that of the free-drainage strategy.

Purpose of ReviewIntravesical antibiotics (IVA) has been used for prophylaxis and treatment of recurrent urinary tract infections (rUTIs). However, there is a lack of comprehensive evidence and consensus on its use. We conducted a systematic review to collect all available data about the effectiveness of IVA in prevention and treatment of rUTIs and to give an overview on the outcomes to date.MethodsA systematic review was carried out for all English language articles from inception to August 2017, according to the Cochrane and PRISMA standards using MEDLINE, Scopus, Biomed Central, EMBASE, CINAHL, and Web of Science with references cross-checked and individual urology journals hand-searched.ResultsAfter an initial identification of 658 studies, we screened 37 abstracts and 18 full-text papers of which 11 were included in our final review. This included 285 patients with a mean age of 52 years and a female:male ratio of 129:117. The IVA used was gentamicin, neomycin/polymyxin, neomycin or colistin and IVA was used for rUTIs as prophylaxis in 5 studies (n = 168) and treatment in 6 studies (n = 117). Overall, a good reduction in symptomatic UTI was seen in 78%, with a short-term success rate and discontinuation rates of 71% (120/168) and 8% (14/168) in the prophylaxis group and 88% (103/117) and 5% (6/117) in the treatment groups respectively. There was a change in the sensitivity of organisms in 30% (50/168) and 23% (27/117) in the treatment and prophylaxis groups respectively. Twenty patients discontinued their IVA instillations which were higher for the non-gentamicin group (11%) compared to the gentamicin group (5%). The side effects were minor and included allergy, suprapubic discomfort, autonomic dysreflexia, urinary tract infections and diarrhoea.SummaryIntravesical antimicrobial instillation seems to be a relatively safe and effective method for the prophylaxis and treatment of recurrent UTIs, especially in the short term. It gives clinicians an alternative treatment modality in high-risk patients predisposed to UTIs where all other forms of systemic treatments have failed.

Purpose of ReviewUrinary dysfunction is a common entity in patients undergoing radical pelvic surgery for non-urologic malignancies. These dysfunctions may manifest as lower urinary tract symptoms (LUTS) or signs such as urinary retention or leakage. Review of current literature is performed to describe the differing urinary dysfunctions that manifest after colorectal resection, hysterectomy, and sacrectomy.Recent FindingsConventional radical surgery for pelvic malignancies often will result in debilitating functional problems. As advances in surgical techniques and management options become more available, patients can have better functional outcomes, specifically in the lower urinary tract. Nerve-sparing techniques as well as vascular preservation are becoming more important to preserve function as patient survival is improving. Additionally, newer methods are being explored, such as nerve stimulation for those who are unable to empty adequately. This article also addresses different management options for specific voiding dysfunction that may result from pelvic surgery.SummaryPreventative strategies such as nerve preservation during surgery are an important concept to prevent urinary dysfunction. The goal to good functional outcomes includes maintaining reservoir compliance and capacity as well as allowing proper outlet for voiding. We discuss different modalities to help achieve a functional lower urinary tract for patients with lower urinary tract dysfunction after pelvic surgery.

The aim of the present study is to describe the type and frequency of bladder dysfunction in a series of female patients with multiple sclerosis (MS) from Rio de Janeiro, and analyze the role of the urologist in the multidisciplinary team. A team of urologists and a neurologist from the Hospital da Lagoa, Rio de Janeiro, Brazil, interviewed female patients with MS about illness onset, urologic follow-up since diagnosis, current stage of the disease and current urological symptoms. The interview was followed by an urodynamic testing, ultrasound of the urinary tract and urinalysis. Data resulting from the interviews and exam results were gathered and submitted to statistical evaluation. Sixty one patients were evaluated, with average age of 41.4 years. Urinary symptoms such as urinary incontinence, urinary hesitancy, urinary retention, urinary urgency and incomplete bladder emptying were reported in 44% of patients as initial signs of MS disease. Mean disease duration was 8 years and all patients (100%) with the primary progressive form of the disease and 63.5% with the relapsing-remitting presentation had urological symptoms. Analysis of complementary exams showed that 37.7% of urinalysis, 8.2% of the urinary tract ultrasound exams and 66.7% of the urodynamic evaluations were abnormal and the most frequent abnormality were overactive neurogenic bladder. Only 4 patients (6.6%) had seen an urologist during the course of their disease and only 1.6% had performed an urodynamic evaluation. This study shows a high prevalence (68%) of urinary dysfunction in a female population with MS. Urologic care should be part of the multidisciplinary team since the beginning of the disease. An urodynamic evaluation and simple urinalysis should be included in the routine testing during disease follow-up due to the high incidence of neurogenic bladder and other urologic complications.

Purpose of ReviewTo present the available literature pertaining to the management of lower urinary tract symptoms (LUTS) after pelvic radiation (RT) in female patients treated for pelvic malignancy.Recent FindingsRecent publications have focused on isolating de novo RT-induced LUTS in women from other contributors to urinary symptoms such as pelvic surgery and chemotherapy. There is a paucity of literature on the treatment of RT-related changes to urinary function.SummaryThe treatment of pelvic malignancies in women alters voiding function. RT contributes to the deterioration of voiding function. More study is needed to evaluate the efficacy of available therapies.