Showing papers by "Peter F.W.M. Rosier published in 2015"

Postoperative bladder catheterization based on individual bladder capacity: a randomized trial

Abstract: Background: Untreated postoperative urinary retention can result in permanent lower urinary tract dysfunction and can be prevented by timely bladder catheterization. The author hypothesized that the incidence of postoperative bladder catheterization can be decreased by using the patient's own maximum bladder capacity (MBC) instead of a fixed bladder volume of 500 ml as a threshold for catheterization. Methods: Randomized parallel-arm and single-blinded comparative effectiveness trial conducted in 1,840 surgical patients, operated under general or spinal anesthesia without an indwelling urinary catheter. Patients were randomized to either use their individual MBC (index) or a fixed bladder volume of 500 ml (control) as a threshold for postoperative bladder catheterization. Preoperatively, the MBC was determined at home by voiding in a calibrated bowl. All other bladder volumes were measured by ultrasound. Postoperatively, bladder catheterization was performed when spontaneous voiding was impossible, and the ultrasound measurement exceeded the threshold for the group in which the patient was randomized (500 or MBC). The primary outcome was the incidence of bladder catheterization. Results: The average MBC in the control group was 582 ml (199 ml) and in the index group 611 ml (+/- 209 ml). The incidence of catheterization decreased from 11.8% (107 of 909 patients) in the control group to 8.6% (80 of 931) in the index group (relative risk 0.73, 95% CI 0.55 to 0.96, P = 0.025). There were no adverse events in either group. Conclusions: In patients undergoing surgery under general or spinal anesthesia using the MBC rather than a fixed 500 ml threshold for bladder catheterization is a safe approach that significantly reduces the incidence of postoperative bladder catheterizations.

Intra- prostatic protrusion shows a typical urodynamic pattern on pressure flow analysis.

Abstract: Hypothesis / aims of study Prostate enlargement may cause symptoms of lower urinary tract dysfunction in male patients. Intravesical protrusion of the prostate middle lobe (IPP) has been reported by various research groups as a specific type of prostate enlargement, relevant for management. Reports suggest that patients with IPP do respond to a lesser extent on alpha blocking therapy and recent single centre studies and expert opinions suggest that these patients could specifically benefit from surgery. The pathophysiology of the voiding dysfunction related to IPP is however poorly understood. A ‘ball valve’ obstruction type is suggested in some manuscripts, based on hypothesis or on cystoscopic appearance. IPP may be recognized on transrectal or transabdominal ultrasound, but the observation does not explain why IPP leads to failure of prostate (alphablocking) relaxing treatment. Pressure flow analysis can be applied for the diagnosis and grading of bladder outlet obstruction and the detrusor pressure at maximum flow (PdetatQmax) has shown relevance in clinical practice. The ICS obstruction number (ICS-OBS) is based on PdetatQmax. A pressure flow (P/Q) graph or -plot, showing the pressure and flow relation of the complete voiding however, provides additional information about the voiding process. The ‘laws’ of distensible collapsible tube hydrodynamics are helpful in clinical interpretation of pressure and flow dynamics during voiding. Minimum pressure required to ensure flow is a measure of collapsibility and (Pdetat)Qmax is a measure of distensibility or ‘flow controlling zone’. Usually bladder outlet distension is maximal at the moment of Qmax. After Qmax the pressure and flow (and detrusor and outlet) are normally in balance and collapse of the bladder outlet is seen at the termination of flow. Previous studies have shown that pressure and flow are however not perfectly balanced throughout the entire voiding in every patient. Some have demonstrated variety in slope and curvature, when compared to the ‘standard’ and ‘static’ passive urethral resistance relation. We present P/Q-graph observations in patients with IPP as a step towards better understanding of voiding dynamics in these patients and have the aim to elucidate pathophysiology IPP dynamics and explain the relative resistance to pharmacotherapy of these patients.

Clinical –not invasive urodynamics- indicators for Detrusor Underactivity; The UnderActive Bladder syndrome?

Abstract: Hypothesis / aims of study A recent review concluded that ‘...the term detrusor underactivity (DU) and its associated symptoms and signs remain surrounded by ambiguity and confusion’. Although the ICS definition of DU ‘...a –voluntary voidingcontraction of reduced strength and/or duration resulting in prolonged emptying and/or failure to achieve complete bladder emptying within a normal time span.‘ is understandable and appears face valid, it lacks quantifying statements. Though DU is –undisputeda urodynamic diagnosis, it is attractive to search for not invasive indicators for DU and a recent expert statement suggests that an underactive bladder symptom complex exists. We have explored a dataset of urodynamic measurements to evaluate clinical not invasive urodynamic indicators for DU.