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Hannchorng Kuo - One of the best experts on this subject based on the ideXlab platform.
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therapeutic effects of botulinum toxin a via urethral sphincter injection on Voiding Dysfunction due to different bladder and urethral sphincter Dysfunctions
Toxins, 2019Co-Authors: Yukhun Lee, Hannchorng KuoAbstract:Botulinum toxin A (BoNT-A) urethral sphincter injections have been applied in treating Voiding Dysfunction but the treatment outcome is not consistent. This study analyzed treatment outcomes between patients with different bladder and urethral sphincter Dysfunctions. Patients with refractory Voiding Dysfunction due to neurogenic or non-neurogenic etiology were treated with urethral sphincter 100 U BoNT-A injections. The treatment outcomes were assessed by a global response assessment one month after treatment. The bladder neck opening and urodynamic parameters in preoperative videourodynamic study were compared between successful and failed treatment groups. A total of 80 non-neurogenic and 75 neurogenic patients were included. A successful outcome was noted in 92 (59.4%) patients and a failed outcome in 63 (40.6%). The treatment outcome was not affected by the gender, Voiding Dysfunction subtype, bladder Dysfunction, or sphincter Dysfunction subtypes. Except an open bladder neck and higher maximum flow rate, no significant difference was noted in the other variables between groups. Non-neurogenic patients with successful outcomes had a significantly higher detrusor pressure, and patients with neurogenic Voiding Dysfunction with successful results had higher maximum flow rates and smaller post-void residuals than those who failed the treatment. However, increased urinary incontinence was reported in 12 (13%) patients. BoNT-A urethral sphincter injection is effective in about 60% of either neurogenic or non-neurogenic patients with Voiding Dysfunction. An open bladder neck during Voiding and a higher maximum flow rate indicate a successful treatment outcome.
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urodynamic characteristics of detrusor underactivity in women with Voiding Dysfunction
PLOS ONE, 2018Co-Authors: Tsaihwa Yang, Feichi Chuang, Hannchorng KuoAbstract:INTRODUCTION AND HYPOTHESIS Voiding Dysfunction has gained interest due to its high prevalence in the elderly. This study characterized bladder Dysfunction in women with Voiding Dysfunction using video urodynamic studies (VUDS) focused on detrusor underactivity (DU). METHODS We studied 1914 women in which first-line medical treatment failed. Age, comorbidities, and urodynamic parameters were analyzed to determine the association between bladder sensation and contractility. RESULTS VUDS were normal in 2.9% (n = 56) of patients and showed DU in 23.1% (n = 443), detrusor hyperactivity and impaired contractility (DHIC) in 12.0% (n = 231), hypersensitive bladder in 17.0% (n = 325), detrusor overactivity (DO) in 2.6% (n = 49) and bladder outlet obstruction in 42.3% (n = 810). The mean age of patients in the DU and DHIC groups was significantly older than in women with normal VUDS and those with hypersensitive bladders (p<0.01). Decreased bladder sensation and larger cystometric bladder capacity were noted in the DU group compared to the DHIC, HSB, and DO groups. Bladder sensation was negatively associated with the bladder contractility. Bladder contractility index and Voiding efficiency were lower in the DU and DHIC groups compared to the normal group. CONCLUSIONS The bladder conditions of women with Voiding Dysfunction included DU, DHIC, HSB and DO. Bladder contractility index and Voiding efficiency were significantly lowest in DU and DHIC groups and lower in HSB and DO groups than normal tracing group. Reduced bladder sensation was noted in DU and negatively associated with detrusor contractility.
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videourodynamic studies of women with Voiding Dysfunction
Scientific Reports, 2017Co-Authors: Shengmou Hsiao, Hohsiung Lin, Hannchorng KuoAbstract:This retrospective study is aimed to present videourodynamic findings of women with symptoms of Voiding Dysfunction in a medical center. Of 1914 women, the diagnoses included bladder outlet obstruction (BOO, n = 810, 42.3%), bladder Dysfunction (n = 1,048, 54.8%) and normal tracings (n = 56, 2.9%). Anatomic BOO (n = 49) included cystocele (n = 19) and urethral stricture (n = 30). Common functional BOOs included Dysfunctional Voiding (n = 325, 17.0%) and poor relaxation of the external sphincter (n = 336, 17.6%). Common bladder Dysfunction subtypes included detrusor underactivity (n = 337, 17.6%), detrusor hyperactivity with impaired contractility (n = 231, 12.1%), and bladder oversensitivity (n = 325, 17.0%). Receiver operating characteristic (ROC) analysis were performed, and the following optimum cutoff values were determined: (1) Voiding detrusor pressure at a maximum flow rate (Pdet.Qmax) = 30 cmH2O for differentiating BOO from bladder Dysfunction and normal tracings, with an ROC area of 0.78; (2) the Abrams-Griffiths number = 30 for differentiating anatomic from functional BOO, with an ROC area of 0.66; (3) post-void residual = 200 mL for differentiating bladder neck Dysfunction from the other BOOs, with an ROC area of 0.69; (4) Pdet.Qmax = 30 cmH2O for differentiating Dysfunctional Voiding from poor relaxation of the external sphincter with an ROC area of 0.93. The above findings can be used as initial guide for management of female BOO.
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effect of botulinum a toxin in the treatment of Voiding Dysfunction due to detrusor underactivity
Urology, 2003Co-Authors: Hannchorng KuoAbstract:Objectives To investigate the effects of botulinum A toxin in treating patients with Voiding Dysfunction due to detrusor underactivity. Methods Twenty patients with chronic urinary retention (n = 13) or severe dysuria (n = 7) received 50 U of botulinum A toxin by urethral injection. The clinical effects, obstructive symptom score, quality-of-life index, and urodynamics were compared at baseline and after treatment. Results Of the 4 males and 16 females (age range 14 to 86 years) with Voiding Dysfunction (cauda equina lesion in 5, Dysfunctional Voiding in 5, peripheral neuropathy in 6, and detrusor failure of unknown origin in 4), 18 (90%) were treated satisfactorily. Among these patients, the mean quality-of-life score decreased significantly from 5.68 +/- 0.67 to 1.16 +/- 1.61. The median Voiding pressure (56.5 +/- 41.2 versus 39.0 +/- 38.4 cm H(2)O) decreased significantly, as did the maximal urethral closure pressure (65.5 +/- 38.1 versus 50 +/- 32.1 cm H(2)O) and residual urine volume (300 +/- 189.1 versus 50 +/- 153.6 mL) at 2 weeks after treatment and remained stationary for 3 months. The subjective maximal effect was achieved within 1 to 2 weeks. In 7 patients, the indwelling catheters were removed, and in 4 patients who performed clean intermittent self-catheterization, the frequency decreased or it was discontinued. The other 7 patients with difficult urination had significant improvement in the obstructive symptom score (18 +/- 3.3 versus 7 +/- 4.5, P = 0.000). Conclusions Botulinum A toxin at a dose of 50 U was effective in reducing urethral sphincter resistance among our patients with detrusor underactivity and difficult urination.
Bart L.h. Bemelmans - One of the best experts on this subject based on the ideXlab platform.
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posterior tibial nerve stimulation in the treatment of Voiding Dysfunction urodynamic data
Neurourology and Urodynamics, 2004Co-Authors: Vera Vandoninck, Michael R. Van Balken, John Heesakkers, Lambertus A. Kiemeney, Frans M.j. Debruyne, Enrico Finazzi Agro, Bart L.h. BemelmansAbstract:OBJECTIVES: To determine urodynamic changes and predictive factors in patients with Voiding Dysfunction who underwent 12 percutaneous tibial nerve stimulations. METHODS: Thirty nine patients with chronic Voiding Dysfunction were enrolled in a prospective multicenter trial in the Netherlands (n = 19) and in Italy (n = 20). A 50% reduction in total catheterised volume per 24 hr was taken as a primary objective outcome measure. Patients' request for continuation of treatment was regarded as subjective success. Objective urodynamic parameters and bladder indices were determined. Odds ratios and their 95% confidence interval were computed as a measure for predictive power in order to reveal predictive factors (Pdet at Qmax, Qmax, BVE, and BCI). RESULTS: Primary outcome measure was obtained in 41%, an additional 26% reduced their 24 hr residuals with more than 25%. Fifty nine percent of patients chose to continue treatment. Detrusor pressure at maximal flow, cystometric residuals, and bladder indices improved significantly for all patients (P < 0.05). Patients with minor Voiding Dysfunction were more prone to notice success (Odds ratio: 0.73; 95% CI: 0.51-0.94). CONCLUSIONS: PTNS is a young treatment modality, minimally invasive, and easily accessible. It might be an attractive first line option for patients with (minor) Voiding Dysfunction.
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posterior tibial nerve stimulation in the treatment of Voiding Dysfunction urodynamic data
Neurourology and Urodynamics, 2004Co-Authors: Vera Vandoninck, Michael R. Van Balken, John Heesakkers, Lambertus A. Kiemeney, Frans M.j. Debruyne, Enrico Finazzi Agro, Bart L.h. BemelmansAbstract:Objectives To determine urodynamic changes and predictive factors in patients with Voiding Dysfunction who underwent 12 percutaneous tibial nerve stimulations. Methods Thirty nine patients with chronic Voiding Dysfunction were enrolled in a prospective multicenter trial in the Netherlands (n = 19) and in Italy (n = 20). A 50% reduction in total catheterised volume per 24 hr was taken as a primary objective outcome measure. Patients' request for continuation of treatment was regarded as subjective success. Objective urodynamic parameters and bladder indices were determined. Odds ratios and their 95% confidence interval were computed as a measure for predictive power in order to reveal predictive factors (Pdet at Qmax, Qmax, BVE, and BCI). Results Primary outcome measure was obtained in 41%, an additional 26% reduced their 24 hr residuals with more than 25%. Fifty nine percent of patients chose to continue treatment. Detrusor pressure at maximal flow, cystometric residuals, and bladder indices improved significantly for all patients (P < 0.05). Patients with minor Voiding Dysfunction were more prone to notice success (Odds ratio: 0.73; 95% CI: 0.51–0.94). Conclusions PTNS is a young treatment modality, minimally invasive, and easily accessible. It might be an attractive first line option for patients with (minor) Voiding Dysfunction. Neurourol. Urodynam. 23:246–251, 2004. © 2004 Wiley-Liss, Inc.
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Posterior tibial nerve stimulation in the treatment of idiopathic nonobstructive Voiding Dysfunction.
Urology, 2003Co-Authors: Vera Vandoninck, Michael R. Van Balken, Filomena Petta, John Heesakkers, Lambertus A. Kiemeney, Frans M.j. Debruyne, Enrico Finazzi Agr, Francesco Micali, Bart L.h. BemelmansAbstract:Abstract Objectives To evaluate the effect of stimulation of the posterior tibial nerve in the treatment of Voiding Dysfunction. Methods Thirty-nine patients with chronic Voiding Dysfunction necessitating clean intermittent catheterization were enrolled in a prospective multicenter trial in the Netherlands (n = 19) and Italy (n = 20). They underwent 12 weekly sessions of posterior tibial nerve stimulation. Frequency/volume charts, an incontinence quality-of-life instrument, and the MOS 36-item Short-Form Health Survey were completed at 0 and 12 weeks. Subjective success was defined by the patient’s positive response resulting in a request to continue treatment. Efficacy was based on analysis of the frequency/volume charts comparing the baseline values with the data at 12 weeks. A reduction of 50% or more in total catheterized volume was considered as an objective success (primary outcome measurement). Results Of the 39 patients, 23 (59%) chose to continue treatment. The frequency/volume charts showed a 50% decrease in total catheterized volume in 16 (41%) of 39 patients. Additionally, 10 patients (26%) noted a reduction of 25% to 50% in their total catheterized volume. For all patients, the total catheterized volume decreased by a mean of −228 mL (range −49 to −528). The incontinence quality-of-life instrument and Short-Form Health Survey parameters improved significantly. Conclusions Percutaneous stimulation of the posterior tibial nerve seems to be an effective, minimally invasive option worth trying in patients with idiopathic Voiding Dysfunction. Improvement was seen in objective micturition parameters, as well as in subjective quality-of-life data.
Karin Glavind - One of the best experts on this subject based on the ideXlab platform.
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incidence and treatment of postoperative Voiding Dysfunction after the tension free vaginal tape procedure
International Urogynecology Journal, 2015Co-Authors: Karin Glavind, Susy ShimAbstract:Introduction and hypothesis One of the most commonly experienced postoperative complications of the tension-free vaginal tape procedure (TVT) is Voiding Dysfunction (VD). The aim of this retrospective study was to evaluate our incidence of postoperative VD, our results after tape mobilisation, and whether demographic data could predict VD.
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treatment of prolonged Voiding Dysfunction after tension free vaginal tape procedure
Obstetrical & Gynecological Survey, 2007Co-Authors: Karin Glavind, Emilie GlavindAbstract:Since its introduction about a decade ago, the tension-free vaginal tape (TVT) operation has been the most widely used surgical procedure for treating women with stress urinary incontinence. Postoperative Voiding Dysfunction is reported in 1.5% to 14% of patients, and there is, as yet, no consensus on how best to manage those affected. The investigators reviewed 143 patients having a TVT procedure in the years 1998-2005. In all cases, it was the only surgery performed and was carried out as originally described by Ulmsten. No vaginal pack was used after the operation and, in the absence of bladder perforation, the catheter was removed at the end of surgery. If a bladder scan the next morning disclosed more than 100 mL of residual urine, the patient was asked to perform clean intermittent catheterization (CIC) at home. Prolonged Voiding Dysfunction was defined as a need for CIC for longer than 1-2 weeks postoperatively accompanied by a feeling of incomplete emptying. Three bladder perforations occurred, all of them within a year of introduction of the operation. Two of the 143 patients, 1.4% of the total, had stress incontinence 3 months postoperatively. Ten patients (7%) had prolonged Voiding Dysfunction despite a lack of intraoperative complications. Only one of them had a history of urogynecological surgery-an anterior repair. Urodynamic studies proved stress incontinence in all 10 patients. In five instances, the tape was pulled down by about 5 cm, and all these patients remained dry. Incontinence recurred in 2 patients when the tape was cut. Three patients performed CIC for periods ranging from 5 weeks to 9 months, but some degree of prolonged Voiding and/or urgency persisted in all of them. When Voiding Dysfunction is present following the TVT procedure, the tape should be pulled down after 1 to 3 weeks. Cutting the tape entails a risk that incontinence will recur. Prolonged CIC may result in slow urine flow and a need for double Voiding.
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Treatment of prolonged Voiding Dysfunction after tension-free vaginal tape procedure
Acta obstetricia et gynecologica Scandinavica, 2007Co-Authors: Karin Glavind, Emilie GlavindAbstract:Background. No consensus on the proper treatment of prolonged Voiding Dysfunction after incontinence operations exists. We, therefore, evaluated the treatment of this problem. Methods. We reviewed all 143 patients who underwent a tension-free vaginal tape procedure (TVT) between April 1998 and June 2005. Prolonged Voiding Dysfunction was defined as the need to perform intermittent catheterisation for more than 1–2 weeks, and a subjective feeling of incomplete emptying. Results. Ten patients (7%) with prolonged Voiding difficulties were encountered. In 5 patients (50%) the tape was pulled down. This was performed after 1 week (1 patient), 2 weeks (2 patients) and 3 weeks (2 patients). All these patients were cured of their Voiding Dysfunction and remained dry. In 2 patients, the tape was cut after 5 and 7 months. Both patients were cured of their Voiding difficulties, but had recurrent stress incontinence. Three patients performed clean intermittent catheterisation for a period of 5 weeks, 7 months and 9 m...
Subbarao V Yalla - One of the best experts on this subject based on the ideXlab platform.
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urodynamic characterization of nonobstructive Voiding Dysfunction in symptomatic elderly men
The Journal of Urology, 1999Co-Authors: Kaname Ameda, Maryrose P Sullivan, Robert J Bae, Subbarao V YallaAbstract:AbstractPurpose: The pathogenesis of lower urinary tract symptoms in men without bladder outlet obstruction has not been well characterized. Therefore, we defined the urodynamic abnormalities associated with symptomatic nonobstructive Voiding Dysfunction, and determined the relationship between age and type of Dysfunction.Materials and Methods: Video urodynamic studies of symptomatic men without outlet obstruction were examined. The criterion for a normal bladder outlet was a pressure gradient across the prostatic urethra of 5 cm. water or less in the absence of distal stricture. A maximum isometric contraction pressure less than 60 cm. water was regarded as impaired detrusor contractility. Detrusor instability was defined as involuntary detrusor contractions during filling or the inability to suppress a detrusor contraction after initiation of flow. Patients were categorized into 4 groups based on the urodynamic findings.Results: Of 193 men (mean age 69.6 +/- 10.5 years) 40.9% had detrusor instability (g...
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structural basis of geriatric Voiding Dysfunction iii detrusor overactivity
The Journal of Urology, 1993Co-Authors: Ahmad Elbadawi, Subbarao V Yalla, Neil M ResnickAbstract:AbstractDetrusor overactivity in the absence of outlet obstruction is common in the elderly. The few available studies on structure of the overactive detrusor generally have dealt only with its innervation. We conducted a prospective study to examine the ultrastructure of muscle cells, interstitium and nerves of the detrusor in biopsies from 35 elderly subjects to identify structural correlates of various urodynamically defined forms of Voiding Dysfunction. A distinctive dysjunction structural pattern was identified blindly in 15 detrusor biopsies. These patterns matched 12 women and 3 men 66 to 96 years old (mean age 79 years) who were segregated independently as a detrusor overactivity group by prospective urodynamic evaluation. All but 1 patient had incontinence and/or other symptoms, and none had diabetes or a significant neurological deficit. The dysjunction pattern was characterized by moderately widened intercellular spaces, scarce intermediate muscle cell junctions, abundant distinctive protrusion...
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structural basis of geriatric Voiding Dysfunction iv bladder outlet obstruction
The Journal of Urology, 1993Co-Authors: Ahmad Elbadawi, Subbarao V Yalla, Neil M ResnickAbstract:AbstractSeveral aspects of the pathogenesis of Voiding Dysfunction in bladder outlet obstruction remain unresolved. The structural basis of obstructive versus nonobstructive Dysfunction was investigated in a prospective ultrastruetural/urodynamic study of 35 elderly subjects of comparable age. Detrusor structure was examined by electron microscopy, with blinded clinical and urodynamic information. Seven detrusor specimens were segregated by a distinctive myohypertrophy, structural pattern, which matched with 6 male and 1 female subjects 72 to 96 years old (mean age 83) who had urodynamically proved outlet obstruction. This pattern was characterized by widely separated muscle cells with reduction of intermediate cell junctions, collagenosis, that is abundant collagen plus some elastic fibers, in the markedly widened spaces between individual muscle cells and abundant profiles characteristic of enlarged, hypertrophic muscle cells. Superimposed degeneration of muscle cells and axons in 6 specimens matched th...
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structural basis of geriatric Voiding Dysfunction ii aging detrusor normal versus impaired contractility
The Journal of Urology, 1993Co-Authors: Ahmad Elbadawi, Subbarao V Yalla, Neil M ResnickAbstract:AbstractLittle information on the structural norm of the aging detrusor is currently available. To gain insight into the pathophysiology of geriatric Voiding Dysfunction, detrusor biopsies were examined by electron microscopy to identify structural correlates of specific, urodynamically defined abnormalities of vesical function in 35 elderly subjects. Prospective urodynamic grouping of the subjects and segregation of the detrusor specimens by ultrastructural features were done independently and blindly. One structural pattern so identified, the dense band pattern, matched the urodynamic group with neither detrusor overactivity nor bladder outlet obstruction. This neither group included 11 women and 2 men 65 to 91 years old (mean age 76 years). Except for 2 patients with minimal stress incontinence, all were symptom-free. None of the patients had diabetes or a neurological deficit. Urodynamically, 10 patients had impaired and 3 had normal detrusor contractility. The dense band structural pattern was charac...
Vera Vandoninck - One of the best experts on this subject based on the ideXlab platform.
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posterior tibial nerve stimulation in the treatment of Voiding Dysfunction urodynamic data
Neurourology and Urodynamics, 2004Co-Authors: Vera Vandoninck, Michael R. Van Balken, John Heesakkers, Lambertus A. Kiemeney, Frans M.j. Debruyne, Enrico Finazzi Agro, Bart L.h. BemelmansAbstract:OBJECTIVES: To determine urodynamic changes and predictive factors in patients with Voiding Dysfunction who underwent 12 percutaneous tibial nerve stimulations. METHODS: Thirty nine patients with chronic Voiding Dysfunction were enrolled in a prospective multicenter trial in the Netherlands (n = 19) and in Italy (n = 20). A 50% reduction in total catheterised volume per 24 hr was taken as a primary objective outcome measure. Patients' request for continuation of treatment was regarded as subjective success. Objective urodynamic parameters and bladder indices were determined. Odds ratios and their 95% confidence interval were computed as a measure for predictive power in order to reveal predictive factors (Pdet at Qmax, Qmax, BVE, and BCI). RESULTS: Primary outcome measure was obtained in 41%, an additional 26% reduced their 24 hr residuals with more than 25%. Fifty nine percent of patients chose to continue treatment. Detrusor pressure at maximal flow, cystometric residuals, and bladder indices improved significantly for all patients (P < 0.05). Patients with minor Voiding Dysfunction were more prone to notice success (Odds ratio: 0.73; 95% CI: 0.51-0.94). CONCLUSIONS: PTNS is a young treatment modality, minimally invasive, and easily accessible. It might be an attractive first line option for patients with (minor) Voiding Dysfunction.
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posterior tibial nerve stimulation in the treatment of Voiding Dysfunction urodynamic data
Neurourology and Urodynamics, 2004Co-Authors: Vera Vandoninck, Michael R. Van Balken, John Heesakkers, Lambertus A. Kiemeney, Frans M.j. Debruyne, Enrico Finazzi Agro, Bart L.h. BemelmansAbstract:Objectives To determine urodynamic changes and predictive factors in patients with Voiding Dysfunction who underwent 12 percutaneous tibial nerve stimulations. Methods Thirty nine patients with chronic Voiding Dysfunction were enrolled in a prospective multicenter trial in the Netherlands (n = 19) and in Italy (n = 20). A 50% reduction in total catheterised volume per 24 hr was taken as a primary objective outcome measure. Patients' request for continuation of treatment was regarded as subjective success. Objective urodynamic parameters and bladder indices were determined. Odds ratios and their 95% confidence interval were computed as a measure for predictive power in order to reveal predictive factors (Pdet at Qmax, Qmax, BVE, and BCI). Results Primary outcome measure was obtained in 41%, an additional 26% reduced their 24 hr residuals with more than 25%. Fifty nine percent of patients chose to continue treatment. Detrusor pressure at maximal flow, cystometric residuals, and bladder indices improved significantly for all patients (P < 0.05). Patients with minor Voiding Dysfunction were more prone to notice success (Odds ratio: 0.73; 95% CI: 0.51–0.94). Conclusions PTNS is a young treatment modality, minimally invasive, and easily accessible. It might be an attractive first line option for patients with (minor) Voiding Dysfunction. Neurourol. Urodynam. 23:246–251, 2004. © 2004 Wiley-Liss, Inc.
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Posterior tibial nerve stimulation in the treatment of idiopathic nonobstructive Voiding Dysfunction.
Urology, 2003Co-Authors: Vera Vandoninck, Michael R. Van Balken, Filomena Petta, John Heesakkers, Lambertus A. Kiemeney, Frans M.j. Debruyne, Enrico Finazzi Agr, Francesco Micali, Bart L.h. BemelmansAbstract:Abstract Objectives To evaluate the effect of stimulation of the posterior tibial nerve in the treatment of Voiding Dysfunction. Methods Thirty-nine patients with chronic Voiding Dysfunction necessitating clean intermittent catheterization were enrolled in a prospective multicenter trial in the Netherlands (n = 19) and Italy (n = 20). They underwent 12 weekly sessions of posterior tibial nerve stimulation. Frequency/volume charts, an incontinence quality-of-life instrument, and the MOS 36-item Short-Form Health Survey were completed at 0 and 12 weeks. Subjective success was defined by the patient’s positive response resulting in a request to continue treatment. Efficacy was based on analysis of the frequency/volume charts comparing the baseline values with the data at 12 weeks. A reduction of 50% or more in total catheterized volume was considered as an objective success (primary outcome measurement). Results Of the 39 patients, 23 (59%) chose to continue treatment. The frequency/volume charts showed a 50% decrease in total catheterized volume in 16 (41%) of 39 patients. Additionally, 10 patients (26%) noted a reduction of 25% to 50% in their total catheterized volume. For all patients, the total catheterized volume decreased by a mean of −228 mL (range −49 to −528). The incontinence quality-of-life instrument and Short-Form Health Survey parameters improved significantly. Conclusions Percutaneous stimulation of the posterior tibial nerve seems to be an effective, minimally invasive option worth trying in patients with idiopathic Voiding Dysfunction. Improvement was seen in objective micturition parameters, as well as in subjective quality-of-life data.
