Ketamine cystitis is an emerging medical condition that requires a multi-disciplinary approach to manage the patients. Simple surgical management of the physical component of the contracted bladder may produce only suboptimal results, and could even cause further problems in some patients. The importance of compliance with post-operative care and abstinence from drug use should be stressed to the patients before surgery. In view of the high complication rate, the option of a simple ileal conduit should also be discussed prior to surgical intervention.

Selective dorsal rhizotomy significantly improved urgency, frequency, incontinence, and urodynamic bladder capacity at first incontinence in a significant proportion of spastic cerebral palsy children.

What ' s known on the subject? and What does the study add? Electronic urofl owmetry reasonably predicts the likelihood of bladder outlet obstruction (BOO) and risk of AUR. This low-cost device, Ufl owmeter TM , allows men to perform urofl owmetry at home with ease and the results are compatible with that of electronic urofl owmentry. It can also estimates risk of AUR and the need for TURP to relieve LUTS. OBJECTIVE• To show the clinical value of a simple fl owmeter, which has been devised to measure urofl ow on an ordinal scale ( < 10, 10 -15, 15 -19 and > 19 mL/s) at home, for the management of male lower urinary tract symptoms (LUTS). PATIENTS AND METHODS• A total of 186 men with LUTS were enrolled in the study.• The mean (range) follow-up was 220 (68 -431) days. The men ' s mean (range) age was 65.5 (46 -83) years, mean (range) maximum urinary fl ow rate (Qmax) 12.8 (4.3 -39.5) mL/s, mean (range) voided volume 294.8 (151 -686) mL; mean (range) postvoid residual urine volume (PVR) 50 (0 -303) mL and mean (range) International Prostate Symptom Score (IPSS) 13.5 (1 -31).• The men underwent electronic urofl owmetry ( ' clinic urofl owmetry ' ) and completed an IPSS questionnaire in the clinic. They then conducted 10 measurements with the device at home ( ' home urofl owetry ' ). The urofl owmetry and IPSS questionnaire were repeated 2 weeks later.• Quadratically weighted Kappa analysis ( κ ) of the home urofl owmetry vs. clinic urofl owmetry, and of the sensitivity and specifi city of the home urofl owmetry values to correspond to the mean Qmax of clinic urofl owmetry ( < 10, 10 -15, 15 -19 and > 19 mL/s) was performed. Similar analyses were performed for the IPSS.• Kaplan -Meier analysis was performed to evaluate whether home urofl owmetry was able to prognosticate acute urinary retention (AUR) or the need for transurethral resection of the prostate (TURP). RESULTS• The home urofl owmetry values ( κ = 0.84, 95% confi dence interval [ CI ] : 0.78 -0.90) were superior to the IPSS ( κ = 0.083; 95% CI: 0 -0.173) in correlating with the mean Qmax of clinic urofl owmetry.• Home urofl owmetry was most sensitive in identifying a mean Qmax of > 19 mL/s (sensitivity: 0.99; 95% CI:0.97 -1.00) and most specifi c in identifying a mean Qmax of < 10 mL/s (specifi city: 0.90; 95% CI:0.83 -0.94).• The home urofl owmetry works best in ruling out a mean Qmax of < 19 mL/s (diagnostic odds ratio [ DOR ] = 349.3; 95% CI:40.24 -3037.7), followed by a mean Qmax of < 15 mL/s (DOR = 91.02; 95% CI:31.23 -265.23) and a mean Qmax of < 10 mL/s (DOR = 32.04; 95% CI:14.0 -73.19).• Men with a home urofl owmetry value ≤ 10 mL/s were more likely ( n = 6; 8.8%) than those with a home urofl owmetry value > 10 mL/s ( n = 2; 1.7%) to develop AUR or require TURP (log-rank test: P = 0.017; hazard ratio:5.61(95% CI:1.10 -28.64)). The IPSS failed to display the same discriminative capability. CONCLUSION• Home urofl owmetry using this simple device is a satisfactory estimation of clinic urofl owmetry using an electronic fl owmeter and can predict the sig...