This article presents the current evidence and expert opinions on the patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) for patients with chronic spinal cord injury (SCI) in Taiwan. This review article focuses on the pathophysiology, treatment strategies, and priorities of bladder management in patients with chronic SCI. The main problems of SCI-NLUTD are storage failure, voiding failure, and combined retention and voiding failure. The priorities in the management of SCI-NLUTD are as follows in order of importance: (1) preserving renal function, (2) preventing urinary tract infection, (3) achieving efficient bladder emptying, (4) avoiding indwelling catheter use, (5) obtaining patient agreement with management, and (6) avoiding medication after proper management. Management of NLUTD in SCI patients should be based on urodynamic study findings rather than inferences from neurologic evaluations. Conservative treatment and bladder management by clean intermittent catheterization should be the first-line option. When surgical intervention is necessary, less invasive types of surgery and reversible procedures should be considered first and any unnecessary surgery in the lower urinary tract should be avoided.

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Purpose: To evaluate the use of the Holmium: Yttrium-aluminum-garnet (YAG) laser versus the conventional dorsal-slit procedure for adult male circumcision. Materials and Methods: From January 2020 to December 2020, 60 adult men diagnosed with as having phimosis and received circumcision were enrolled. Patients received either Holmium: YAG laser circumcision or conventional circumcision. In this study, we assessed the difference between the groups. Results: Although the operative time and blood loss decreased more in the Holmium: YAG laser circumcision group than in the conventional circumcision group (P < 0.001), a longer short-term delay in wound healing was observed in the laser circumcision group than in the conventional circumcision during the follow-up course (20.0% vs. 3.3%, P = 0.04). Our results also demonstrated no significant difference between the two groups in pain control, postoperative prepuce edema, prepuce redundancy, infection, or hematoma occurrence (P > 0.05). Microscopy findings of the resected prepuce in the Holmium: YAG laser circumcision group demonstrated a high percentage of coagulated small capillaries near the cutting edge. Conclusion: The holmium laser seems to be a concrete and feasible option for circumcision. Although patients undergoing holmium laser circumcision benefit from less blood loss and a rapid surgery compared to the conventional procedure, there is a higher risk of poor wound healing in short-term follow-up.

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Purpose: Postprostate surgeries urinary incontinence (UI) is one of the common bothersome complications of prostate surgery. Pelvic floor muscle exercises (PFME) have been reported to have benefits in shortening postoperative recovery time of UI. The aim of our study is to evaluate the efficacy of intensive schedule of PFME and pelvic muscle electrical stimulation in improving the recovery of postoperative UI. Materials and Methods: We prospectively enrolled 72 patients (63 Benign prostate hyperplasia [BPH] and 9 prostate cancer [PC]) who received transurethral resection of the prostate (TURP), anatomical endoscopic enucleation of the prostate (AEEP), Radical prostatectomy (RP) from January 2019 to December 2020. Twenty-seven patients who are unable to remove Foley catheter before discharge or loss follow-up were excluded. Finally, we enrolled 44 patients (35 BPH and 9 PC). All patients were assessed using the pad test, International Prostate Symptom Score, and Overactive Bladder Symptom Score. Abdominal ultrasonography or transrectal ultrasound of prostate was used to measure prostate volume and the postvoid residual urine volume. Results: The rate of UI was 60% and 88.9% immediately after removing the Foley catheter in TURP/AEEP and RP groups respectively. The incontinence rates in TURP/AEEP were 34.2%, 20%, and 3% after 2 weeks, 1 month, and 3 months' postoperation. In the RP group, the incontinence rate was 55.6%, 44.4% after 2 weeks, and 1 month postoperation. The pad amount was 63.11 ± 52.9 g, 37.89 ± 52.99 g, and 13.22 ± 18.48 g after 2 weeks, 1 month, and 3 months' postoperation. Conclusion: We demonstrated early intensive PFME program can shorten the recovery time of UI after prostate surgery.

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Bladder management of chronic spinal cord injured (SCI) patients usually starts with conservative treatment or minimally invasive procedures. This article reports the current evidence and expert opinions on the patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among patients with chronic SCI in Taiwan. We evaluated the role of clean intermittent catheterization (CIC), cystostomy, medical treatment, and minimally invasive therapy for treating urinary incontinence and voiding dysfunction in patients with chronic SCI. The bladder management for chronic SCI patients should be individualized. A balance between upper urinary tract protection and life quality improvement should be considered. Hand dexterity, abdominal muscle power, bladder sensation, and degree of urethral sphincter dyssynergia might affect the improvement of voiding efficiency and NLUTD. Intradetrusor Botulinum Toxin Type A (BoNT-A) injection has been proven to effectively treat neurogenic detrusor overactivity in SCI patients. However, CIC is still required in some patients after treatment. The urethral sphincter BoNT-ABoNT-A injection can effectively relax the dyssynergic sphincter; however, exacerbation of urinary incontinence usually limits its application in SCI patients. Repeat BoNT-ABoNT-A injection is necessary to maintain the therapeutic efficacy; therefore, some SCI patients might discontinue the treatment and convert to a permanent bladder management by surgical intervention. Identification of high-risk SCI patients is important to prevent renal functional deterioration in those with chronic SCI-NLUTD. Avoiding renal function deterioration and improving the quality of life of SCI patients with NLUTD are the most important aspects of treatment. Annual active surveillance of bladder and renal function is necessary.

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Purpose: Urinary incontinence (UI) is a common complication of radical prostatectomy (RP) affecting patient's quality of life (QoL). In the present study, we aimed to investigate the effects of single-session preoperative pelvic floor muscle training (PFMT) with biofeedback (BFB) on short- and mid-term postoperative UI and QoL. Materials and Methods: This study was performed between 2018 and 2020. The patients were randomized into two groups: the case group received a training session with BFB, supervised oral and written instructions on pelvic floor muscle exercises in a 1-h-long training session 1 month before the surgery. Patients were asked to regularly perform exercises immediately after the session until surgery. The controls received no instructions. We used the International Consultation on Incontinence Questionnaire-UI (ICIQ-UI) short-form and ICIQ-Lower Urinary Tract Symptoms QoL Module (ICIQ-LUTSqol) at 1, 3, and 6 months after removing the urinary catheter. Results: A total of 80 patients with a mean age of 63.83 ± 3.61 years were analyzed. Patient characteristics were similar between the groups. The mean ICIQ-UI score was significantly lower in the intervention group at 1 and 3 months after catheter removal (P = 0.01 and P = 0.029, respectively) but similar at 6 months (P = 0.058). The mean ICIQ-LUTSqol score was significantly lower in the intervention group at 1, 3, and 6 months after catheter removal (P < 0.001, P = 0.005, and P = 0.011, respectively). Conclusion: A single session of preoperative PFMT with BFB has significant short-term effects on UI after RP but not at 6 months. However, this intervention can improve LUTS-related QoL even at 6 months after catheter removal.

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Purpose: To determine the agreement between two erectile dysfunction (ED) diagnostic methods, International Index of Erectile Function-15 (IIEF-15) questionnaire and “Androscan MIT” night penile tumescence recorder. Materials and Methods: An assessment of ED in 40 patients (age, 25–60 years) was performed using the “Androscan MIT” device and IIEF-15 questionnaire (erectile domain). Cohen's kappa coefficient and receiver operating characteristic (ROC) analyses were used to examine the difference between “Androscan MIT” and IIEF-15 questionnaire results. During ROC-analyses “Androscan MIT” results were considered the gold standard for ED diagnosis. Results: “Androscan MIT” results had a significant but weak positive correlation with IIEF-15 questionnaire (kappa value = 0.333, P < 0.01). Based on the ROC-analyses, it was found that the sensitivity and specificity of the IIEF-15 questionnaire for severe ED according to “Androscan MIT” were 100% and 55.9%, respectively. The sensitivity and specificity of the IIEF-15 questionnaire for moderate ED according to “Androscan MIT” were 63.2% and 57.1%, and for mild ED, 23.1% and 33.3% respectively. The lowest accuracy of the IIEF-15 questionnaire was for patients with normal erectile function (sensitivity and specificity were 0% and 44.7%, respectively). Conclusion: The agreement between the objective and subjective diagnosis of ED remains low. At the same time, the lower severity of ED according to “Androscan MIT” is associated with less diagnostic value of IIEF-15.

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Purpose: Coronavirus disease 2019 (COVID-19) is a disease that can affect many of our organs, and its effects on the human body are still unknown. In this study, we aimed to find the answer to the question of whether erectile dysfunction (ED) develops in patients who had COVID-19. Materials and Methods: This is a prospective study of 459 patients. Married male patients aged between 25 and 70 years and who were hospitalized and treated for COVID-19 were included in the study. The patients were divided into three groups as mild, moderate, and severe cases, according to the extent of the disease. Each patient was asked to complete the International Index of Erectile Function (IIEF) upon admission and 45^th and 90^th days after discharge. Admission, 45^th and 90^th values of IIEF were compared within itself. Results: Statistically significant differences were observed in the IIEF evaluations on admission and 45^th and 90^th days of the patients in the three groups. IIEF values of three patient groups displayed a decrease on the 45^th day with respect to admission, while the 90^th day values were higher in comparison to 45^th day, although still remained lower than the values of admission. Evaluation of the erectile function values of the patients revealed that IIEF values on admission decreased on 45^th and 90^th day values. Conclusions: We determined that COVID-19 affected IIEF values in male patients, which might cause ED by reducing erectile function values.

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Purpose: This study aimed to analyze the association between bladder conditions and Neurogenic lower urinary tract dysfunction (NLUTD) characteristics in patients with spinal cord injury (SCI) with different injury levels using a videourodynamic study (VUDS). Materials and Methods: A single-center, retrospective review of the VUDS database on patients with NLUTD and chronic SCI from 1997 to 2020. A total of 507 patients were enrolled. All patients had a comprehensive chart review, including the injury level, period from diagnosis to VUDS, and VUDS characteristics. Results: The mean age and duration from SCI diagnosis to VUDS were 44.2 ± 15.7 years and 81.8 ± 89.0 months. Detrusor overactivity (DO) was observed in 67.7% of patients and detrusor underactivity (DU) in 26.0%. Bladder outlet obstruction was noted in 78.3% of patients, including detrusor sphincter dyssynergia (DSD) in 53.3% and bladder neck dysfunction in 25.0%. DO and DSD were more commonly observed in patients with suprasacral lesions (P = 0.000 and P = 0.000, respectively), whereas DU had a higher prevalence in patients with lumbar or sacral lesions (P = 0.000). No statistically significant difference was observed in the prevalence of vesicoureteral reflux among different SCI levels. Bladder sensation parameters were more preserved in patients with cervical SCI than in those with lumbar SCI; however, no significant difference in bladder compliance was observed among patients with different SCI levels. Conclusion: The VUDS in patients with SCI revealed a high prevalence of DO, DU, and DSD, which varied among different injury levels. A precise VUDS is necessary for deciding bladder management for patients with SCI and voiding dysfunction.

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