Study Type – Therapy (case series)
Level of Evidence 4
What's known on the subject? and What does the study add?
Several sets of comprehensive treatment guidelines (national and international) exist for managing male lower urinary tract symptoms (LUTS), but these are not widely adopted in primary and secondary care, and are not consistently applied across Europe.
This paper will improve the consistency of treatment approaches for adult males with LUTS by providing a clear, concise summary of existing treatment guidelines that can be easily adopted by urologists and primary care specialists.
OBJECTIVE
To review current treatment guidelines (international and national) on managing male lower urinary tract symptoms (LUTS) and to summarize them for easy application in clinical practice.
METHODS
A group of European urology specialists from primary and secondary care reviewed current treatment guidelines for male LUTS.
RESULTS
The most appropriate recommendations for managing male LUTS were identified from existing international and national guidelines, and were summarized and simplified for use as a quick reference guide for healthcare professionals managing LUTS in adult males.
CONCLUSIONS
Current guidelines for managing male LUTS were developed by urologists and are too complex for easy application in routine practice.
This brief summary of current guidance should help to achieve consistent adoption of recommendations for best practice, improve working relationships between primary care specialists and urologists and clarify which patients' treatments should be managed entirely by urology specialists.
Acute urinary retention (AUR) in women is an uncommon occurrence described by the International Continence Society (ICS) as a painful, palpable, or perceptible bladder when the patient is unable to pass urine. Contrarily to men, AUR in women is not usually due to any obstructive process. Neurologic causes are the most common reason for AUR in reproductive-age women. A few case reports have been published concerning women suffering from gynecological pathology and AUR, and they propose extrinsic compression of the urinary tract. In the case we report, AUR pathophysiology was compression of the pelvic plexus by a giant uterine leiomyoma. An electromyogram displayed motor polyradiculopathy of S1 and S2 nerve roots, and the patient was unable to urinate due to an uncontractible bladder.
Aim
To validate an electronic 3‐day bladder diary (BD) as an easy‐to‐use app for smart‐phone (eDM3d).
Methods
Descriptive and cross‐sectional prospective study. One hundred and thirty‐six patients with overactive bladder syndrome (OABs) or nocturia who had a smart‐phone and attended the urology clinics of a tertiary hospital from June to November 2017 were included. Patients filled the eDM3d (test) and the Spanish validated paper BD (DM3d) and questionnaires ICIQ‐UISF and BASQ during the first week. Two weeks later, they repeated the eDM3d (retest). We assessed feasibility of the eDM3d (percentage of variables completed), test‐retest reliability (qualitative variables: McNemar test; quantitative variables: ICC), paper‐app correlation (qualitative variables: Kappa index; quantitative variables: ICC) and convergent validity (correlation between eDM3d and questionnaires, Spearman's rank test). Patients answered a question about satisfaction: “If you had to repeat a BD again, would you choose paper or the app version?”
Results
One hundred and twenty‐three (90.4%) participants completed all the variables of the first eDM3d. There were no significant differences in the proportion of patients classified as positive for each symptom between test and retest. ICC ranged from 0.73 to 0.94 for all variables (P < 0.001) in the test‐retest assessment. Paper‐app correlation was good to excellent for all variables (ICC 0.76‐0.95, P < 0.001; Kappa index 0.56‐0.84, P < 0.001). Correlation between the eDM3d and the questionnaires ranged from 0.23 to 0.6 (P < 0.01). 120 (88.2%) patients would choose the eDM3d if they had to repeat a BD.
Conclusion
The eDM3d presents suitable feasibility, reliability, and validity to assess patients with OABs or nocturia who have a smart‐phone.
Introduction. Transplantation surgery teams often have to face complex cases. In certain circumstances, such as occlusion of the iliac vessels or prior pelvic surgery, heterotopic kidney transplantation may not be feasible and orthotopic kidney transplantation (OKT) could be a good alternative. Kidney autotransplantation (KAT) has been described as a potential treatment for complex renovascular, ureteral, or neoplastic conditions. There are scarce data regarding the complications and outcomes of these procedures; therefore, we present our experience. Materials and Methods. We retrospectively analysed the medical records of both 21 patients who had received OKT and 19 patients who underwent KAT between 1993 and 2020. We collected demographic features and data regarding surgical technique, complications, and graft outcomes. Kidney graft survival was calculated using Kaplan–Meier survival analysis. Results. Regarding OKT, in 15 (71.43%) cases, it was the first kidney transplantation. The most common indication was the unsuitable iliac region due to vascular abnormalities (57.14%). The early postoperative complication rate was high (66.67%), with 23.81% of Clavien grade 3b complications. During the follow-up period (mean 5.76 -SD 6.15- years), we detected 9 (42.85%) graft losses. At 1 year, the survival rate was 84.9%. Concerning KAT, the most frequent indication was ureteral pathology (52.63%), followed by vascular lesions (42.11%). The overall early complication rate was 42.11%. During the follow-up period (mean of 4.47 years), 4 (15.79%) graft losses were reported. Conclusions. Although OKT and KAT have high complication rates, these techniques can be considered as two valuable approaches for complex cases, in the absence of other therapeutic options.
Ultrasounds in general, and transperineal or translabial ultrasound in particular, are in the process of becoming the standard diagnostic method in urogynecology. Their wide availability, the standardization of parameters, the possibility of evaluating not only the bladder but also the levator ani muscle or pelvic organ prolapses (POP) contribute to this fact. It allows to obtain data in a non invasive way before and after therapy.
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