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PURPOSE: To describe clinical outcomes among patients with benign prostatic hyperplasia (BPH) 24 months following prostatic artery embolization (PAE). MATERIALS AND METHODS: This was an international, multicenter, prospective trial of males with BPH with lower urinary tract symptoms (LUTS) or acute urinary retention (AUR) treated with PAE. The primary outcome was the 12 month change in the International Prostate Symptom Score (IPSS) for patients referred for bothersome LUTS, or urinary catheter independence for patients treated for AUR. Secondary outcome measures included changes in IPSS at 3 and 24 months, changes in quality of life (QoL), changes in the Sexual Health Inventory for Men (SHIM) questionnaire, technical success rate, and adverse events (AEs). Data were summarized using descriptive statistics. RESULTS: Four hundred seventy-eight consecutive patients underwent PAE (bothersome LUTS: N = 405; AUR: N = 73), mean age was 70 years. For patients treated for bothersome LUTS, mean total IPSS at baseline was 21.8 and decreased to 9.3, 10.6, and 11.2 at 3, 12, and 24 months following PAE, respectively (all p

Background: Lupus cystitis, a severe complication of systemic lupus erythematosus (SLE), presents considerable treatment challenges. Purpose: This case report describes the use of telitacicept in treating severe SLE with lupus cystitis. Research Design: A single patient with lupus cystitis. Study Sample: A patient with symptoms including frequent urination, urgency, and acute urinary retention. Data Collection and Analysis: Initial treatments included corticosteroid pulse therapy, immunoglobulin, and cyclophosphamide, which improved laboratory indicators but failed to alleviate symptoms of urinary retention. The patient was then treated with telitacicept. Results: Significant alleviation of urinary retention was observed shortly after incorporating telitacicept into the treatment regimen. The patient's condition remained stable with no relapse during the subsequent 10 months of follow-up. Conclusions: This case highlights the therapeutic potential of telitacicept for SLE patients who are unresponsive to conventional therapies, particularly those with severe manifestations such as lupus cystitis. [ABSTRACT FROM AUTHOR]

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Objective: Unusual clinical course Background: Acute urinary retention (AUR) is relatively rare in non-pregnant women and is usually associated with lower urinary tract dysfunction, neurological issues, or pelvic organ compression. Adenomyosis is a common gynecologic condition characterized by the invasion of endometrial glands and stroma into the myometrium, often accompanied by symptoms such as dysmenorrhea and heavy menstrual periods. Although adenomyosis is common, its involvement in causing urinary retention is rare but deserves clinical attention. Case Report: We report the case of a patient with recurrent urinary retention due to adenomyosis, who had a 20-year history of dysmenorrhea and menorrhagia. Imaging revealed significant thickening of the posterior uterine wall and a globular increase in size. Due to the ineffectiveness of conservative treatment, the patient ultimately underwent a total hysterectomy via laparoscopy. After the operation, the patient's urinary retention symptoms completely disappeared, her urinary function quickly returned to normal, and her postoperative follow-up showed no recurrence of urinary retention or other urinary-related symptoms. Conclusions: Although adenomyosis is common in women, acute urinary retention remains rare. This case report suggests that clinicians should consider adenomyosis as a potential cause alongside other common causes of recurrent or unexplained urinary retention in female patients, particularly in those presenting with classic symptoms such as prolonged dysmenorrhea and menorrhagia. The successful treatment of this case further highlights the importance of an individualized treatment plan, as total hysterectomy can effectively relieve symptoms and improve the patient's quality of life. [ABSTRACT FROM AUTHOR]

Background: Urinary retention (UR) is a clinical condition where patients cannot fully empty their bladder. Although numerous drugs are associated with UR, comprehensive and reliable studies identifying drugs that induce UR are scarce. Methods: This study leveraged data from the FDA Adverse Event Reporting System (FAERS) and the Canadian Vigilance Adverse Reaction (CVAR) database to explore adverse events (AEs) related to UR from 2004 to Q1 2024. The top 50 drugs were analyzed for annual reporting trends using linear regression. Disproportionality analysis using the reporting odds ratio (ROR) method, with P -values adjusted via Bonferroni correction, identified significant signals, which were then validated against drug labels and re-evaluated using the CVAR database. Time-to-onset analysis was also performed. Results: From 2004 to Q1 2024, FAERS recorded 17,785,793 AEs, with 16,183 (0.09%) identified as UR cases. The median age among these cases was 65 years, with males comprising 53.4%. There were significant annual increases in UR reports associated with antineoplastic agents (0.19% per year) and antidiabetic drugs (0.09% per year), while reports linked to bronchodilators decreased (−0.53% per year). Disproportionality analysis revealed significant signals for 34 drugs (68%), with the highest RORs observed in Fesoterodine, Mirabegron, and Solifenacin. Initial signal detection identified potential new UR signals for Abiraterone, Valacyclovir, Fluoxetine, Empagliflozin, Clopidogrel, and Amlodipine, with CVAR confirming signals for Abiraterone, Fluoxetine, and Empagliflozin. The median time to onset of UR was 29 days, with over half of the cases occurring within 30 days of initiating medication. Conclusion: The study identifies a rising trend in drug-related UR reports over the past 2 decades. The validation of new signals for Abiraterone, Fluoxetine, and Empagliflozin underscores the critical need for continuous drug safety monitoring and targeted research to better understand the mechanisms behind drug-induced UR. [ABSTRACT FROM AUTHOR]

BACKGROUND: Preliminary clinical observations found that Jiawei Chunze Decoction is an effective formula for clinical treatment of urinary retention after spinal cord injury. Animal experiments have found that the phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathway is closely related to the degree of bladder dysfunction. OBJECTIVE: To further investigate the effects of Jiawei Chunze Decoction on bladder function and PI3K/Akt signaling pathway in rats with urinary retention. METHODS: Sixty female Sprague-Dawley rats were randomly divided into sham operation group, model group, Jiawei Chunze Decoction low-dose group, Jiawei Chunze Decoction high-dose group and agonist group. In the sham operation group, the spinal cord was exposed but not transected. In the other groups, the modified Hassan Shaker spinal cord transection method was used to prepare the model of sacral medullary injury. At 24 hours after modeling, the sham operation group and model group were intragastrically given equal volume of normal saline, Jiawei Chunze Decoction low-dose and high-dose groups were given Jiawei Chunze Decoction granules containing 14.4 and 28.8 g/kg, respectively, via intragastric administration for 4 weeks, and the agonist group was treated with an intraperitoneal injection of PI3K/Akt signaling pathway agonist 740Y-P at a dose of 0.02 mg/kg. After 4 weeks of treatment, the maximum bladder capacity, leakage point pressure and bladder compliance of rats in each group were detected by urine flow dynamics. The minimum bladder contraction tension and frequency of rats in each group were detected by detrusor pull test. The pathological changes of the rat bladder in each group were observed by hematoxylin-eosin staining. The concentrations of GRP78, CHOP and Caspase-12 in serum were detected by ELISA, and the mRNA and protein expressions of PI3K, Akt, GRP78, CHOP and Caspase-12 in bladder tissues were detected by RT-PCR and western blot, respectively. RESULTS AND CONCLUSION: Compared with the sham operation group, the maximum bladder volume, bladder compliance and minimum systolic tension of rats in the model group were increased (P < 0.05), and the leakage point pressure and bladder contraction frequency were decreased (P < 0.05); serum GRP78, CHOP, and Caspase-12 levels were also increased (P < 0.05). The arrangement of bladder epithelial cells in the model group was disordered, and there was monocyte infiltration between cells, tissue edema, and detrusor tract atrophy. The mRNA and protein expressions of PI3K and Akt in bladder tissues were significantly decreased in the model group compared with the sham operation group, while those of GRP78, CHOP and Caspase-12 were increased (P < 0.05). Compared with the model group, the maximum bladder volume, bladder compliance and minimum systolic tension of rats were decreased in the Jiawei Chunze Decoction low-dose, high-dose and agonist groups after 4 weeks of intervention (P < 0.05), while the leakage point pressure and bladder contraction frequency were increased (P < 0.05); serum GRP78, CHOP, Caspase-12 levels were decreased (P < 0.05). The bladder epithelial cells in the three intervention groups were distributed evenly, arranged neatly, with less inflammatory cell infiltration and fuller detrusor muscle bundle. Compared with the model group, the mRNA and protein expressions of PI3K and Akt were increased in the three intervention groups, while those of GRP78, CHOP and Caspase-12 were decreased (P < 0.05). The Jiawei Chunze Decoction high-dose group was better than the Jiawei Chunze Decoction low-dose group and shared the similar results with the agonist group. To conclude, Jiawei Chunze Decoction can improve the bladder function of rats with urinary retention after spinal cord injury, and the mechanism may be related to reducing the occurrence of endoplasmic reticulum stress in bladder tissue through the PI3K/Akt signaling pathway, and then alleviating apoptosis. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the safety and efficacy of HoLEP in patients aged > 85 years with indwelling catheter (IDC). Methods: We retrospectively analyzed our bicentric HoLEP database to identify consecutive patients with IDC and trial without catheter (TWOC) failure who underwent surgery between June 2012 and April 2020. Our primary focus was on the population over 85 years of age; Patients under 70 years of age were used as controls. We evaluated the rate of postoperative spontaneous micturition, adverse events and mortality, as well as catheterization duration, hospital stay, and rate of urinary incontinence. Results: In total, 144 patients were included, with 71 (49.3%) and 73 (50.8%) in the ≥ 85 and control group, respectively. The median [IQR] prostatic volume and Charlson score was 90 [70–130] vs. 90 [65–120] mL and 6 [5–7] vs. 3 [2–4] in the ≥ 85 and control groups, respectively. Postoperatively, the rates of major complications (2% vs. 3%) and transfusion (11% vs. 9%) were not significantly different. The median length of stay (2 [1–3] vs. 1 [1–2]; p = 0.03) and rate of TWOC failure during hospitalization (24% vs. 5%, p < 0.001) were significantly higher in the ≥ 85 group. At 3 months and one year follow-up visits, 0 and 10 patients (14.1%) in the ≥ 85 group and 0 and 2 patients (3%) in the control group died, respectively. One year after surgery, 69 (97%) and 73 (100%) (p = 0.2) patients in the ≥ 85 and control groups, respectively, could void spontaneously. Conclusion: HoLEP is a safe and effective procedure for elderly patients with indwelling catheters. At one year, 97% of patients achieved spontaneous voiding, while the urinary incontinence rate was 11%. The 1-year mortality rate was 14%, comparable to that of the general male population of the same age. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Given the intricacy involved in diagnosing prostatic abscess and the associated risk of severe complications, we present a case involving a 72-year-old male patient initially suspected of urinary retention due to benign prostatic enlargement, only to reveal multiple prostatic abscesses during surgical intervention. The objective is to raise awareness among clinicians regarding the potential presence of latent prostatic abscess and to prevent the occurrence of serious complications. Timely implementation of aggressive antimicrobial therapy and surgical drainage has been shown to significantly enhance patient prognosis and mitigate the risk of serious complications. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: We aimed to evaluate the clean intermittent catheterization (CIC) rate in women undergoing their first OnabotulinumtoxinA (BTX-A) treatment and to investigate factors predictive of initiating CIC. Methods: This was a retrospective cohort of women, who had their first BTX-A treatment for symptoms of overactive bladder (OAB) syndrome, with a pretreatment urodynamic study (UDS). We reviewed demographic, medical and gynecological history, UDS, pretreatment bladder diaries, objective examinations, BTX-A treatment details, and post-void residual (PVR) reports in the electronic medical record. Botox® Allergan 100 International Units were injected into the detrusor at 10–20 sites. Statistical analyses included univariate and multivariate logistic regression analyses. Results: We included 397 women. Median age was 68 (Q1–Q3: 54–76) years. CIC rate was 8.6% (n = 34) following the first BTX-A treatment. Urgency urinary incontinence (UUI) reduced the risk of undergoing CIC (OR 0.30, 95% CI 0.09–0.97). A bladder capacity of 500 ml or greater in the bladder diary increased the risk of CIC (OR 2.46, 95% CI 1.06–5.70), whereas reported leakages were associated with a decreased risk of CIC (OR 0.24, 95% CI 0.10–0.57). Multivariate logistic regression analysis showed that anterior colporrhaphy (OR 3.71, 95% CI 1.52–9.06) and 10-ml increments in median maximum cystometric capacity (OR 1.03, 95% CI 1.00–1.06) predicted CIC, whereas UUI was a protective factor for CIC (OR 0.23, 95% CI 0.07–0.79). Conclusions: A history of anterior colporrhaphy, large bladder capacity, and absence of incontinence episodes in bladder diary or UDS were risk factors for CIC after the first BTX-A treatment. [ABSTRACT FROM AUTHOR]

Objective: To assess the satisfaction level of final year medical students with urinary catheterization workshop and the factors affecting it. Study Design: Cross-sectional study. Setting: Wah Medical College, Wah Cantonment. Period: October 15th, 2023 to January 15th, 2024. Methods: Satisfaction level and factors for its improvement were assessed by using a questionnaire after conducting a mandatory workshop on the skill of urinary catheterization. All the 90 final-year MBBS students present on the day of the workshop were included in the study using purposive sampling technique. The data was analyzed by using SPSS version 25. Fisher's exact test was applied to assess the association of gender with satisfaction level of students considering a p-value lesser than 0.05 as significant. For the open-ended questions, quantitative content analysis was performed. Results: The mean age of the students was 23.6+1.1 years. 82.2% of the participants had a very high satisfaction level with the workshop. Difference was observed when the satisfaction level of the students was assessed across gender (p-value=0.02). 45.6% of the students rated the workshop as good in all domains. The identified factors that can improve satisfaction with the workshop include the provision of refreshments, making smaller batches for teaching, providing feedback after skill performance and giving more time for practice. Conclusion: The majority of the students were highly satisfied with the workshop. Around half of the participants regarded the workshop as good in all domains but the students identified some factors for the improvement of satisfaction level with the workshop. [ABSTRACT FROM AUTHOR]