The aim of this study is to describe the prevalence and type of female voiding dysfunction (FVD) in patients with overactive bladder (OAB) who were studied by urodynamics and its relationship with voiding symptoms.Methods: This is a cross-sectional study of female adult patients with OAB syndrome who underwent UDS in a University Hospital in Chile between January 2015 and April 2020. FVD was defined either as bladder outlet obstruction (BOO) or detrusor underactivity (DU). BOO was established if the Solomon-Greenwell BOO index was higher than 18. DU was diagnosed when the invasive maximum flow rate (Qmax) was ≤15 ml/sec, detrusor pressure at Qmax (Pdet@Qmax) was ≤20 cmH 2 O and postvoid residual (PVR) was greater than 10%. Urodynamic data and clinical features were compared between groups.Results: Two hundred and ninety-nine UDS were selected and analyzed.Bladder outlet obstruction was diagnosed in 59 patients (19.7%), whereas DU was found in 10 patients (3.3%). In the multivariate analysis, the logistic regression to predict BOO demonstrated that night-time frequency, the presence of detrusor overactivity and a higher PVR were independent predictors of BOO. Instead, for DU, the only independent predictor was a smaller voided volume in the pressure-flow study. Conclusion: Female voiding dysfunction was found in 23% of patients with overactive bladder. BOO is more frequent than DU, and should be suspected in patients with higher night-time frequency, presence of detrusor overactivity and a high PVR. Instead, DU should be suspected in patients with a smaller voided volume.

Purpose: We sought to determine whether clinical risk factors and morphometric features on preoperative imaging can be utilized to identify those patients with cT1 tumors who are at higher risk of upstaging (pT3a). Materials and Methods: We performed a retrospective international case-control study of consecutive patients treated surgically with radical or partial nephrectomy for nonmetastatic renal cell carcinoma (cT1 N0) conducted between January 2010 and December 2018. Multivariable logistic regression models were used to study associations of preoperative risk factors on pT3a pathological upstaging among all patients, as well as subsets with those with preoperative tumors 4 cm, renal nephrometry scores, tumors 4 cm with nephrometry scores, and clear cell histology. We also examined association with pT3a subsets (renal vein, sinus fat, perinephric fat). Results: Among the 4,092 partial nephrectomy and 2,056 radical nephrectomy patients, pathological upstaging occurred in 4.9% and 23.3%, respectively. Among each group independent factors associated with pT3a upstaging were increasing preoperative tumor size, increasing age, and the presence of diabetes. Specifically, among partial nephrectomy subjects diabetes (OR[1.65; 95% CI 1.17, 2.29), male sex (OR[1.62; 95% CI 1.14, 2.33), and increasing BMI (OR[1.03; 95% CI 1.00, 1.05 per 1 unit BMI) were statistically associated with upstaging. Subset analyses identified hilar tumors as more likely to be upstaged (partial nephrectomy OR[1.91; 95% CI 1.12, 3.16; radical nephrectomy OR[2.16; 95% CI 1.44, 3.25).

Introduction Patients upstaged to pT3 after partial nephrectomy (PN) may be at an increased risk of disease progression compared to those patients submitted to radical nephrectomy (RN). We sought to identify preoperative factors predicting pT3 upstaging in localized renal cell carcinoma. Material and methods Patients submitted to nephrectomy for clinically localized (cT1–cT2) renal cell carcinoma between 2011 and 2016 were identified from a prospective registry, those presenting with locally advanced or metastatic disease were excluded. Clinical factors, laboratory, and imaging using RENAL score, were analyzed. A multivariate analysis was performed looking for stage pT3a predictors. Results Two hundred and nine patients were included, 66% were men, with a mean age of 57 years. Mean tumor size was 49 ±31 mm. 19% were staged as pT3a. Of this group, 10% underwent a PN. Age, hypertension, presence of hematuria, creatinine levels, size and RENAL score were statistically associated with locally advanced stage. The variables of the RENAL score that were associated to pT3a stage were size, nearness to renal sinus/collector system and contact with main renal vessels. On the multivariate analysis, only age, size, and contact with renal vessels were found to predict upstaging. A model was developed which was able to predict stage pT3a with an area under the curve (AUC) of 0.864 in the ROC curve. Conclusions Upstaging to pT3a is fairly common in clinically localized tumors. A formula that includes tumor size, age and contact with the main vessels on imaging, can help predict it. This should be considered when deciding if the patient is a candidate for nephron sparing surgery.

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Introduction: Both detrusor underactivity (DU) and bladder outlet obstruction (BOO) can coexist in patients with overactive bladder. Definitions of both DU and BOO are based on pressure-flow study (PFS) data. However, invasive urodynamics study can differ from a natural micturition, in fact, discrepancies between free uroflowmetry (UFM) and PFS have been largely described. Our goal is to assess the correlation of free-flowmetry and PFS among patients with OAB and to evaluate how different definitions of DU/BOO are able to discriminate patients with different free UFMs. Methods: A retrospective review of urodynamics performed at a single institution was conducted. Females with OAB who voided more than 150 mL in both UFM and PFS were included. Parameters from both voiding episodes were compared with nonparametric test. Two definitions of DU were applied; PIP1: Pdet@Qmax+Qmax < 30 and Gammie: Pdet@Qmax < 20 cmH 2 O, Qmax < 15 mL/s, and BVE < 90% (Bladder voiding efficiency). Also, two definitions of obstruction were chosen; Defretias: Pdet@Qmax ≥25 cmH 2 O and Qmax ≤ 12 mL/s and Solomon-Greenwell female BOO index ≥ 18.Patients who matched with each definition were compared to those who did not, to assess if any definitions were able to discriminate different noninvasive uroflowmetries.Results: A total of 195 patients were included. Overall, mean age was 55 ± 12 years, 90.8% had mixed urinary incontinence, and 39% complained of at least one voiding symptom. Globally, Qmax and BVE correlated poorly between UFM and PFS, showing that most of the variation corresponded to a systematic error. Twenty-two individuals were found to have DU, they had a difference of 13 mL/s on both maximum flows. Fifty-four patients showed BOO, with a difference between their Qmax of 19 mL/s. Among the four definitions analyzed, only PIP1 and Defreitas were able to discriminate patients with actually a lower Qmax on the free UFM.