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Aims: The aim of this study is to investigate whether ketamine could relieve the social stress (SS)-related bladder dysfunction in mice., Materials and Methods: The FVB mice were randomly assigned to either undergo SS exposure for 60 minutes per day on seven consecutive days for 4 weeks (SS1) or control without SS (SS0). The SS0 were then allocated to single or no injection of ketamine (SS0K1 and SS0K0). In the group of SS1, the SS1 mice were allocated to receive single injection of saline (SS1K0), single dose (SS1K1) or five daily dose of (SS1K5) ketamine injection (25 mg/kg/day/ip) since day 22. In vivo cystometry and tissue bath wire myography were performed on day 29. Serum and urine level of brain-derived neurotrophic factor (BDNF) were measured with enzyme-linked immunosorbent assay., Results: In mice without social stress exposure, ketamine administration did not significantly affect voiding frequency (P > .05). SS 1 K 0 , SS 1 K 1, and SS 1 K 5 had significantly lower voiding frequency than that of control (SS 1 K 0 ) (each n = 15, P < .05). Ketamine administration reversed the trend of decreased voiding frequency in SS 1 mice. Stressed mice had significant higher serum level of BDNF that reduced by short-term ketamine. Stressed mice had detrusor overactivity and impaired detrusor contractility which were not reversed by short-term ketamine., Conclusions: Social stress leads to elevated serum BDNF, infrequent voiding, detrusor overactivity, and impaired contractility. Short-term administration of ketamine may improve SS-related infrequent voiding and elevated serum BDNF level. However, ketamine did not improve SS-related bladder dysfunction on urodynamic and myography studies., (© 2020 Wiley Periodicals, Inc.)

Purpose: To establish the first age- and gender-specific nomograms for single and two consecutive tests for post-void residual urine (PVR)., Material and Methods: Healthy children aged 4-12 years were enrolled for two sets of uroflowmetry and PVR. The first PVR and the lower value of the two consecutive PVRs of each child with a voided volume ≥50 ml were included for construction of Single- and Dual-PVR nomograms. Children with possible urinary tract infection or lower urinary tract dysfunctions were excluded., Results and Limitations: Totally, 1,128 children (583 boys and 545 girls) with a mean age of 7.7 ± 2.2 years were eligible for analysis. The 95th percentile of Single-PVR for all children was 27.2 ml, or 19.2% of bladder capacity (BC), while that for Dual-PVR were 11.2 ml or 6.0% of BC, respectively. Multivariate studies showed that PVR was positively associated with BC, negatively associated with age, higher in boys than girls, and higher in abnormal uroflow patterns. For children aged ≤6 years, a single PVR >30 ml or >21% BC, or repetitive PVR >20 ml or >10% BC can be regarded as elevated. For children aged ≥7 years, a single PVR >20 ml or 15% BC, or repetitive PVR >10 ml or 6% BC can be redefined as elevated., Conclusions: Age, gender, and BC should be taken into considerations at interpretation of PVR tests in children. Repeating PVR test is recommended when a single PVR is higher than the 95th percentile of age- and gender-specific PVR. Neurourol. Urodynam. 32: 1014-1018, 2013. © 2013 Wiley Periodicals, Inc., (Copyright © 2013 Wiley Periodicals, Inc.)

Objective: To report the relationship between the ages initiating toilet training for urinary continence (TTU) and bladder function in healthy kindergarteners., Patients and Methods: In 3 years, we evaluated urinary continence status and bladder function in 318 healthy kindergarteners. Children with congenital anomaly, neurological disorder, or developmental disability were excluded. A parent completed the questionnaire including the age at initiation and the duration of TTU, the current status of daytime and nighttime continence, the age of attaining daytime and nighttime continence, frequency of defecation and Bristol Stool Scale. All children underwent uroflowmetry and post-void residual urine (PVR) examinations., Results: Finally, 235 respondents (106 boys/129 girls, mean age = 4.8 ± 0.9 years) were eligible for analysis. The mean age initiating TTU was 24.4 ± 8.4 months (range: 1-52 months). Girls started TTU earlier than boys (23.3 months vs. 25.7 months, P = 0.03). Children started daytime TTU earlier (≤ 18, 19-24, and >24 months, N = 66, 71, and 98, respectively) was associated with earlier attainment of both daytime and nighttime continence (correlation coefficient = 0.60 and 0.31, respectively, P < 0.01). Children started nighttime TTU earlier (<30 months vs. ≥ 30 months) was associated with early attainment of nighttime continence and lower rate of enuresis (14.3% vs. 33.3%, P < 0.01). The prevalence rate of repeat abnormal uroflow patterns and repeat elevated PVR (>20 ml) was not different between early and late TTU., Conclusion: Early toilet training for urine was associated with early attainment of both daytime and nighttime urinary continence, and does not appear to be associated with bladder dysfunction., (Copyright © 2011 Wiley-Liss, Inc.)

Aim: To report the cut-off value for large voided volume (LVV) suggestive of abnormal uroflow pattern or elevated post-void residual urine (PVR) in healthy kindergarteners., Methods: From 2003 through 2008, we enrolled 417 healthy kindergarten children for evaluation of uroflowmetry tests and PVR. The uroflowmetry curves were interpreted if voided volumes (VV) were >50 ml, and categorized as bell-shaped, staccato, plateau, and interrupted. Only bell-shaped curves were categorized as normal. After 2006, PVR was assessed within 5 min after each voiding with a VV >50 ml. A PVR >20 ml is regarded as elevated. Receiver operative characteristic (ROC) curves were constructed to evaluate the cut-off value of VV/expected bladder capacity (EBC) with regard to nonbell-shaped uroflowmetry curves, and/or elevated PVR., Results: Of 385 children (mean age: 4.85 ± 0.96 years), 699 uroflowmetry, and 556 PVR data were eligible for analysis. There were 502 (71.8%) bell-shaped, 76 (10.9%) plateau, 102 (14.6%) staccato, and 19 (2.7%) interrupted curves. Mean and median PVR were 12.4 ± 21.2 and 5.5 ml, respectively. Of 556 PVRs, 96 (17.3%) were >20 ml. Based on the ROC curve for the nonbell-shaped curves and/or elevated PVR, VV >100% EBC was best defined as LVV. There were statistically more elevated PVR, and more nonbell-shaped curves in the voidings with than without LVV. There is a trend that peak flow rate decreased when VV was >150% EBC., Conclusions: VV of more than 100% EBC can be defined as LVV which was associated with higher rates of abnormal uroflow pattern and/or elevated PVR., (Copyright © 2010 Wiley-Liss, Inc.)

Purpose: We report intra-individual variability, related factors and the normal reference value of post-void residual urine in children., Materials and Methods: Healthy kindergarteners were enrolled for the evaluation of post-void residual urine, which was assessed by ultrasound within 5 minutes after voiding when voided volume was greater than 50 ml. Bladder over distention was arbitrarily defined as a bladder capacity (voided volume plus post-void residual urine) of 115% or greater of expected bladder capacity. The Pearson correlation method was used to evaluate the correlation between post-void residual urine and related factors., Results: More than 1 post-void residual urine value was recorded in 219 children with a mean +/- SD age of 4.9 +/- 0.9 years. Mean post-void residual urine was 12.2 +/- 20.3 ml (median 5.5). The correlation for consecutive post-void residual urine was low in all children and negligible in the 129 without bladder over distention (r = 0.34 and 0.13, respectively). Repeat post-void residual urine greater than 20 ml and greater than 10% bladder capacity was observed in 2.3% and 7.8% of children, respectively, without bladder over distention. Post-void residual urine increased as bladder capacity increased (r = 0.38, p <0.01). Excluding those with bladder over distention, post-void residual urine decreased as the age of the child increased. Children who drank more fluids before voiding had a higher rate of bladder over distention for each micturition than those who drank regularly (13.8% vs 4.9%, p = 0.04)., Conclusions: Because of the significant intra-individual variability of post-void residual urine, a single post-void residual urine test is not reliable for assessing pediatric voiding function. Two post-void residual urine tests are recommended. Post-void residual urine is affected by bladder over distention, age of the child and possibly extra hydration before assessment. Abnormal post-void residual urine could be defined as post-void residual urine greater than 20 ml, rather than as greater than 10% bladder capacity, on repeat micturitions without bladder over distention.

Purpose: We report the effects of bladder over distention on pediatric voiding function., Materials and Methods: We enrolled healthy kindergarten children (mean age 4.5 +/- 1.0 years) for 2 observations of uroflowmetry and post-void residual urine. Additional observations were requested if the voided volume was less than 50% of expected bladder capacity. Post-void residual was assessed within 5 minutes after voiding. A post-void residual of more than 20 ml is regarded as increased. Bladder capacity is defined as voided volume plus post-void residual and shown as percentage of expected bladder capacity. The uroflowmetry curves were categorized as bell-shaped or nonbell-shaped., Results: Among 188 children 355 observations of uroflowmetry and post-void residual were eligible for evaluation. Nonbell-shaped uroflowmetry curves and increased post-void residual were noted in 75 (21.1%) and 78 (22%) of 355 voids, respectively. Based on the receiver operating characteristic curve for the nonbell-shaped curves and increased post-void residual, bladder capacity of 115% of expected bladder capacity or more is defined as bladder over distention. There were statistically more increased post-void residuals and more nonbell-shaped uroflowmetry curves in the voids with bladder over distention than in those without over distention (p <0.01). Of the 38 children displaying both types of curves the nonbell-shaped curves usually occurred at a higher bladder capacity than did the bell-shaped curves (133% +/- 46% expected bladder capacity vs 84% +/- 38% expected bladder capacity, p <0.01). Peak uroflow rate increased as bladder capacity increased but decreased at extreme bladder over distention., Conclusions: Optimal bladder capacity is important for assessing pediatric voiding function. Bladder over distention resulted in more nonbell-shaped uroflowmetry curves and more increased post-void residual. At extreme over distention peak flow rate decreased as well.

Objectives: To evaluate the voiding function, ejaculation status and sexual function after the novel modification of transurethral incision of the bladder neck (TIBN) treating young men with primary bladder neck obstruction (PBNO)., Methods: Using a videourodynamic study, PBNO was diagnosed in 33 young men 27-50 years of age who presented with chronic lower urinary tract symptoms and low urinary flow. TIBN was performed in all patients, with the modification of preserving a portion of the supramontanal tissue during the procedure. International Prostate Symptom Score (I-PSS), quality of life, uroflowmetry, postvoid residual urine, the status of ejaculation and sexual function using the 5-item version of the International Index of Erectile Function (IIEF-5) were assessed before, 3 and 24 months after treatment., Results: Follow-up data were available in 32 (97%) and 26 (79%) patients at 3 and 24 months postoperatively, respectively. During the 2-year follow-up, mean I-PSS decreased from 20.7 to 5.9 (p < 0.01). Mean quality of life decreased from 4.2 to 2.3 (p < 0.01). Mean maximum flow increased from 10.7 to 19.2 ml/s (p < 0.01). Mean postvoiding residual urine decreased from 107 to 48 ml (p < 0.01). All patients had antegrade ejaculation postoperatively. Mean IIEF scores did not change significantly (22.6 +/- 2.6 vs. 20.7 +/- 4.3, p = 0.08). Successful overall outcome was achieved in 22 (84.6%) of 26 patients., Conclusions: Applying this modified TIBN to treat the sexually active young men with PBNO had the advantage of improving voiding function and preserving both antegrade ejaculation and sexual function., ((c) 2008 S. Karger AG, Basel.)

Objective: To establish a normal reference value of postvoid residual (PVR) urine volume in "healthy" adults. Methods: Adults were recruited to undergo uroflowmetry and PVR. Those with neurological disorders, malignancy, diabetes, known lower urinary tract dysfunction, and urinary tract infection within the previous 3 months, were excluded from the study. Constipation was defined as Rome IV ≥ 2. Results: Of the 883 adults enrolled in this study, 194 (22.3%) did not complete the questionnaires or perform the uroflowmetry, 103 (11.7%) met ≥1 exclusion criteria and thus were excluded. In addition, 30 and 38 uroflowmetry were excluded due to artifacts and low bladder volume (BV) (<100 mL), respectively. Finally, 515 uroflowmetry and PVR data from adults aged 36–89 (mean: 59.0 ± 9.5) were examined. There was a significant nonlinear relationship between BV and PVR (p < 0.05), with PVR significantly increased when BV was around 528 mL. Women had lower PVR than men (p < 0.05). PVR also increased as the International Prostatic Symptom Score (IPSS) increased. PVR was unaffected by age and functional constipation. A multivariate analysis revealed that BV (p < 0.05) and IPSS (p < 0.05) had significant influence on PVR, but age, gender, and Rome IV score did not. The 90th and 95th percentiles of PVR for men were 73.2 mL (25% of BV) and 102.6 mL (30% of BV), respectively, while for women they were 60.5 mL (21% of BV) and 93.8 mL (27% of BV), respectively. Conclusion: Women had lower PVR than men. The 90th percentile or 95th percentile of normal adults' PVR may serve as the upper limit of normal PVR, and readings above this level may necessitate additional evaluation and treatment. Further studies are required to substantiate these recommendations. [ABSTRACT FROM AUTHOR]

Elevated post void residual (PVR) is a significant risk factor for urinary tract infections (UTI). It is also a significant predictor of treatment outcomes in cases of vesicoureteral reflux, pediatric enuresis, and non-neurogenic LUT dysfunction. However, the absence of age-specific nomograms for adolescents may limit PVR's use in clinical practice. To establish age- and gender-specific normal PVR urine volume in adolescents. Healthy adolescents aged 12–18 years were recruited to undergo two uroflowmetry and PVR studies whenever they felt the urge to urinate. Adolescents with neurological disorders, known LUT dysfunction or UTI were excluded. A total of 1050 adolescents were invited, but only 651 consented. Fourteen participants were excluded due to low bladder volume (BV < 100 ml) in both assessments (n = 12), BV < 100 ml in one assessment (n = 1), or failure to provide relevant history (n = 1). From the 1084 uroflowmetry and PVR obtained from 637 adolescents, 190 results were further excluded due to artefacts (n = 152), BV < 100 ml (n = 27), PVR >100 ml (n = 5) and missing information (n = 6). Ultimately, 894 uroflowmetry and PVR from 605 adolescents (mean age 14.6 ± 1.5 years) were analyzed. PVRs were higher in adolescents aged 15–18 years than in those aged 12–14 years (P < 0.001). Moreover, they were higher in females than in males (P < 0.001). Multivariate analysis revealed that PVR was positively influenced by age (P = 0.001) and BV (P < 0.001). The age- and gender-specific percentiles of PVR in ml and percentage of BV were calculated. We recommend a repeat PVR and close monitoring if PVR is above the 90th percentile, i.e., PVR >20 ml (7% BV) for males of both the age groups, and PVR >25 ml (9% BV) and PVR >35 ml (>10% BV) for females aged 12–14 and 15–18 years, respectively. Further investigation may be warranted if the repeat PVR is above the 95th percentile, i.e., PVR >30 ml (8% BV) and >30 ml (11% BV) for males aged 12–14 and 15–18 years, respectively, and PVR >35 ml (11% BV) and >45 ml (13% BV) for females aged 12–14 and 15–18 years, respectively. PVR increases with age and varies by gender; thus, age-and gender-specific reference values should be used. Further data from other countries is required to determine whether the study's recommendations can be applied globally. [ABSTRACT FROM AUTHOR]