Is there a correlation between the outcome of transurethral resection of prostate and preoperative degree of bladder outlet obstruction？

To compare the impact of transurethral resection of prostate （TURP） on symptom scores and maximal flow rates （Qmax） in patients with equivocal bladder outlet obstruction （BOO） and definite BOO and to assess the relationship between the surgical outcomes and degree of preoperative BOO, we prospectively evaluated men with lower urinary tract symptoms and bladder outlet obstruction index （BOO1） greater than 20, who were refractory to conventional medical treatment and underwent TURP. Urodynamic evaluation, International Prostate Symptom Score （IPSS）, uroflowmetry, post-void residual volume （PVR） check and transrectal ultrasound were performed. 20〈B001〈40 was defined as equivocal BOO and BOO1 〉~40 as definite BOO. Changes of IPSS, Qmax, PVR and correlation analysis was performed between the degree of improvement of Qmax, subdomains of I PSS and BOO1. Fifty-four patients showed equivocal BOO and 80 patients showed definite BOO. Preoperatively equivocal BOO group and definite BOO group showed significant differences in maximal bladder capacity and prevalence of detrusor overactivity, whereas no difference was noted in prostate volume. Postoperatively both groups showed improvements in Qmax, obstructive （IPSSO） and irritative （IPSSI） subdomain of IPSS, but the degree of improvement in Qmax and IPSSI subdomain was statistically significantly greater in definite BOO group. The degree of improvement of Qmax and IPSSI showed weak correlation with preoperative BOO1. As a weak correlation was identified between preoperative degree of BOO and outcome of TURP, other factors other than BOO1 such as severity of patients＇ symptoms should be considered in deciding treatment modality.

Comparison of Combination Treatments of Distigmine and either Mirabegron or Solifenacin for Rats with Partial Bladder Outlet Obstruction

Objective: Detrusor hyperactivity with impaired contractility (DHIC) is not an uncommon bladder disorder, and is often difficult to treat. Therefore, using a rat model featuring both urinary frequency and residual urine, we investigated whether an anticholinergic agent (solifenacin) or a β3-agonist (mirabegron) is more suitable to combine with distigmine to treat DHIC. Methods: The partial bladder outlet obstruction (BOO) rat model was used. Rats were treated for 2 weeks: BOO/Solifenacin group was treated with 0.1 mg/kg solifenacin (n = 8), BOO/Mirabegron group was treated with 1 mg/kg mirabegron (n = 8), BOO/- group was not drug-treated but was given distilled water (n = 8), and the control group was also given distilled water (n = 8). Then the urethral ligature was removed under urethane anesthesia, and continuous cystometry was performed to evaluate bladder function. Baseline measurements were taken, then distigmine was administered to all groups, and cystometry was performed again to measure changes in bladder function. Results: Residual volumes increased in the BOO/- group, and the detrusor contractions were more frequent than that of the control group. Solifenacin treatment did not influence changes, except for threshold pressure, to any cystometric measurements. However, mirabegron treatment decreased the residual volume and residual volume rate;it also decreased detrusor contraction frequency similar to measurements obtained from the control group. Distigmine treatment enhanced detrusor contractions, which resulted in less residual volume, and decreased detrusor contraction frequency in the BOO model. Conclusions: The combination of distigmine and mirabegron was determined to be a better treatment than the combination of distigmine and solifenacin for DHIC.

Primary Presentation of Ovarian Cancer with Bladder Outlet Obstruction/Chronic Urinary Retention in a 12-Year Old Female

Urinary retention in women is rare and is more frequently described as case reports or small case series. The female/male ratio is 1:13 with about 3 cases per 100,000 women every year We report a case of a 12-year old female student. She presented with progressive weight loss, worsening lower urinary tract symptoms with distended lower abdomen of 10 weeks duration. Physical examination revealed a mobile tender firm pelvic mass, 18 centimeters (cm) × 16 cm in size. Laboratory and imaging studies showed obstructive nephropathy and uropathy respectively. She was worked up and had uneventful exploratory laparotomy with right salpingo-oophorectomy, urinary bladder diverticulectomy and pelvic lymphadenectomy. Histopathology of the pelvic mass showed ovarian dysgerminoma with lymph node metastasis. She responded very well to chemotherapy and resumed her school activities. Bladder outlet obstruction is relatively rare in females and in the index patient, ovarian dysgerminoma is the cause leading to obstructive nephropathy and uropathy.

Effect of doxazosin on rabbit bladder compliance after partial bladder outlet obstruction

Objective To explore the effect of doxazosin on rabbit bladder compliance after partial bladder outlet ob- struction. Methods A total of 40 male New Zealand white rabbits were randomized into 4 groups,with 10 rabbits in each group. Partial bladder outlet

Underactive bladder:Pathophysiology and clinical significance

Underactive bladder(UAB)is a voiding disorder which generates disabling lower urinary tract symptoms(LUTS)due to the inability to produce an effective voiding contraction sufficient to empty the bladder.The underlying abnormality,that is usually appreciated when performing urodynamic studies,has been defined by the International Continence Society(ICS)as detrusor underactivity(DUA).DUA is a common yet under-researched bladder dysfunction.The prevalence of DUA in different patient groups suggests that multiple aetiologies are implicated.Currently there is no effective therapeutic approach to treat this condition.An improved understanding of the underlying mechanisms is needed to facilitate the development of new advances in treatment.The purpose of this review is to discuss the epidemiology,pathophysiology,common causes and risk factors potentially leading to DUA;to aid in the appropriate diagnosis of DUA to potentially improve treatment outcomes.

Relationship between urodynamic patterns and lower urinary tract symptoms in Chinese women with a non-neurogenic bladder

Objective:To investigate the urodynamic study(UDS)patterns,obstruction status,continence status,and their correlations among neurologically intact women with lower urinary tract symptoms(LUTS)through an epidemiological and logistic regression analyses.Methods:We retrospectively analyzed the UDS data of 3265 neurologically intact women with LUTS(2002e2014).Five UDS patterns were identified:normo-active detrusor/sphincter(NA,or DSI,detrusor/sphincter intact),idiopathic detrusor overactivity(IDO),idiopathic sphincter overactivity(ISO),IDO+ISO,and detrusor underactivity(DUA).Analyses of UDS pattern distribution and stratification were performed(based on a modification of the European Urological Association-Madersbacher classification system),and their correlations with bladder outlet obstruction(BOO)and stress urinary incontinence(SUI)status were evaluated via logistic regression analysis.Results:NA,IDO,IDO+ISO,ISO,and DUA were noted in 927(28.4%),678(20.8%),320(9.8%),689(21.1%),and 651(19.9%)cases,respectively.Moreover,storage,storage+voiding,and voiding symptoms were noted in 62.4%,21.1%,and 16.5% cases,respectively,whereas BOO and SUI were observed in 12.1%and 29.0%cases,respectively.The risk factors for BOO included NA,IDO,ISO,and IDO+ISO,whereas the protective factors against BOO included storage symptoms,SUI,storage+voiding symptoms,and complaint duration within 1e12 months.NA was the only risk factor for SUI,whereas BOO,storage+voiding symptoms,IDO,and storage symptoms were protective factors for SUI.Conclusion:Five UDS patterns were identified among neurologically intact women with LUTS.Functional abnormalities of the detrusor and/or sphincter were the main causes of LUTS,and were correlated with the BOO or SUI status.Thus,the UDS pattern can provide additional information regarding the risk factors for BOO or SUI status,as compared to symptomatic typing.

Correlation between bladder compliance and the content of detrusor collagen fibers

Objective： To explore the possible correlation between bladder compliance （BC） and the changes in detrusor collagen fiber content after bladder outlet obstruction （BOO）. Methods： Ninety healthy female Sprague-Dawley （SD） rats were enrolled in this experiment and divided into an experimental group and a control group randomly, using the randomizing table method, with 70 rats in the experimental group and 20 rats in the control group. Six weeks after BOO modeling was established, BC was evaluated through bladder testing. Bladder tissues were then fixed and embedded in paraffin. The tissues were cut into thin slices, followed by Masson staining and observation under a microscope. Results： Compared with the control group, the BC of the experimental group rats increased, and the difference had statistical significance （P 〈 0.05）; the content of detrusor collagen fibers of the rats in the experimental group increased significantly compared to the control group. Conclusions： The content of detrusor collagen fibers increased significantly after BOO, and BC was higher.

Leiomyoma Of Urinary Bladder a Rare Entity:Series Of 3 Cases And Review Of Literature

Introduction:Leiomyoma of urinary bladder is a rare entity and comprises 0.43%of all bladder tumors.Here we present our series of 3 cases and the related review of literature.Methods:3 cases of bladder leiomyoma presented over a period of 16 months in Osmania Medical College and Hospital.Detailed history was taken,physical examination,routine blood,urine and radiological investigations were done.Patients were treated by Trensurethral Resection(TUR)of the mass and histopathological analysis with Immunohistochemistry was done for all cases.Results:All 3 cases were females with mean age of 31.6 years.All cases were endovesical type,mass near bladder neck and presented with obstructive symptoms.Two cases presented with acute retention of urine.Radiological investigations in all patients suggested a possibility of leiomyoma and all cases had reduced urinary flow rates.Histopathology confirmed the diagnosis in all cases.No recurrence was found at one year of follow up.Conclusion:Leiomyoma of urinary bladder is a rare disorder which frequently occurs in middle aged females.Symptoms are related to its size and location,diagnosis is confirmed by histopathological analysis.Treatment is by surgery(mainly TUR).Prognosis of the disease is excellent.

Work Capacity of the Bladder During Voiding： A Novel Method to Evaluate Bladder Contractile Function and Bladder Outlet Obstruction

Background： Work in voiding （WIV） of the bladder may be used to evaluate bladder status throughout urination rather than at a single time point. Few studies, however, have assessed WIV owing to the complexity of its calculations. We have developed a method of calculating work capacity of the bladder while voiding and analyzed the associations of bladder work parameters with bladder contractile function and bladder outlet obstruction （BOO）. Methods： The study retrospectively evaluated 160 men and 23 women, aged 〉40 years and with a detrusor pressure at maximal flow rate （PdetQmax） of ≥40 cmH2O in men, who underwent urodynamic testing. The bladder power integration method was used to calculate WIV; WIV per second （WIV/t） and WIV per liter of urine voided （WIV/v） were also calculated. In men, the relationships between these work capacity parameters and PdetQmax and Abrams-Griffiths （AG） number were determined using linear-by-linear association tests, and relationships between work capacity parameters and BOO grade were investigated using Spearman＇s association test. Results： The mean WIV was 1.15 ± 0.78 J and 1.30 ± 0.88 J, mean WIV/t was 22.95 ± 14,45 mW and 23.78 ± 17.02 mW, and mean WIV/v was 5.59 ± 2.32 J/L and 2.83 ± 1.87 J/L in men and women, respectively. In men, WIV/v showed significant positive associations with PdetQmax （r = 0.845, P = 0.000）, AG number （r = 0.814, P = 0.000）, and Schafer class （r = 0.726, P = 0.000）. Conversely, WIV and WIV/t showed no associations with PdetQmax or AG number. In patients with BOO （Schafer class 〉 II）, WIV/v correlated positively with increasing BOO grade. Conclusions： WIV can be calculated from simple urodynamic parameters using the bladder power integration method. WIV/v may be a marker of BOO grade, and the bladder contractile function can be evaluated by WIV and WIV/t.

Non-invasive evaluation of lower urinary tract symptoms(LUTS)in men

Lower urinary tract symptoms(LUTS)are common in males over the age of 40 years old and are likely to increase with an aging population.Currently urodynamic studies are the gold standard to determine the aetiology of voiding dysfunction and LUTS.However,due to its invasive nature,a great number of non-invasive ultrasound based investigations have been developed to assess patients with symptomatic LUTS.The clinical application of noninvasive tests could potentially stratify patients who would require more invasive investigations and allow more precise patient directed treatment.A PubMed literature review was performed and we will discuss the non-invasive investigations that have been developed thus far,focusing on bladder wall and detrusor wall thickness(BWT&DWT),ultrasound estimated bladder weight(UEBW)and intravesical prostatic protrusion(IPP).

Urine Flow Acceleration Is Superior to Qmax in Diagnosing BOO in Patients with BPH

Summary： We performed a retrospective, case-control study to evaluate whether the urine flow acceleration （UFA, mL/s2） is superior to maximum uroflow （Qmax, mL/s） in diagnosing bladder outlet obstruction （BOO） in patients with benign prostatic hyperplasia （BPH）. In this study, a total of 50 men with BPH （age： 58±12.5 years） and 50 controls （age： 59±13.0 years） were included. A pressure-flow study was used to determine the presence of BOO according to the recommendations of Incontinence Control Society （ICS）. The results showed that the UFA and Qmax in BPH group were much lower than those in the control group [（2.05±0.85） vs. （4.60±1.25） mL/s2 and （8.50±1.05） vs. （13.00±3.35） mL/s] （P〈0.001）. Accol;ding to the criteria （UFA〈2.05 mL/s2, Qmax〈10 mL/s）, the sensitivity and specificity of UFA vs. Qmax in diagnosing BOO were 88%, 75% vs. 81%, 63%. UFA vs. Omax, when compared with the results of P-Q chart （the kappa values in corresponding analysis）, was 0.55 vs. 0.35. The pros- tate volume, post void residual and detrusor pressure at Qmax between the two groups were 28.6±9.8 vs. 24.2±7.6 mL, 60.4±1.4 vs. 21.3±2.5 mL and 56.6±8.3 vs. 21.7±6.1 cmHzO, respectively （P〈0.05）. It was concluded that the UFA is a useful urodynamic parameter, and is superior to Qmax in diagnosing BOO in patients with BPH.

Pressure-flow studies in patients with benign prostatic hyperplasia:a study comparing suprapubic and transurethral methods

Aim： To compare the use of the suprapubic puncture method versus the transurethral method in pressure-flow studies in patients with benign prostatic hyperplasia. Methods： Twenty-three men with benign prostatic hyperplasia underwent both suprapubic and transurethral pressure-flow studies during a single session. Standard pressure-flow variables were recorded in all patients with both methods, enabling calculation of obstruction using commonly used grading systems, such as the urethral resistance algorithm, the Abrams-Griffith （AG） number and the Schaefer linear nomogram. Results： There were statistically significant differences between the methods in the mean values of maximum flow rate （P 〈 0.05）, detrusor pressure at the maximum flow （P 〈 0.01）, urethral resistance algorithm （P 〈 0.01）, AG number （P 〈 0.01） and maximum cystic capacity （P 〈 0.01）. Of the men in the study, 10 （43.5%） remained in the same Schaefer class with both methods and 18 （78.3%） in the same AG number area. Using the transurethral method, 12 （52.2%） men increased their Schaefer class by one and 1 （4.3%） by two. There were also differences between the suprapubic and transurethral methods using the AG number： 4 （17.4%） men moved from a classification of equivocal to obstructed and 1 （4.3%） from unobstructed to equivocal. Conclusion： The differences between the techniques for measuring intravesical pressure alter the grading of obstruction determined by several of the commonly used classifications. An 8 F transurethral catheter significantly increases the likelihood of a diagnosis of bladder outlet obstruction when compared with the suprapubic method.

Botulinum toxin and benign prostatic hyperplasia

Benign prostatic hyperplasia(BPH)is a clinical condition where lower urinary tract symptoms are caused by both a physically obstructing prostate as well as tight smooth muscles around the bladder outlet.Treatment of this condition with botulinum toxin has been used since 2003,but this interest has somewhat died down after two large randomized controlled trials(RCTs)showing equivalence of results between their treatment and placebo arms.However,with review of animal studies and unexplained exaggerated effect of the placebo arms of the two RCTs,together with recent data of sustained benefits after 18 months of treatment,the place of botulinum toxin in the BPH field is probably still present.

Predictive Factors for a Successful Day Case Benign Prostatic Hyperplasia Surgery: A Review

Introduction: Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the lads greater than 70 affected. BPH is caused by unregulated proliferation within the prostate, which may cause physical obstruction of the prostatic urethra and result in anatomic bladder outlet obstruction (BOO). Transurethral resection of the prostate (TURP) has been the historical gold standard up till now to which all endoscopic procedures for benign prostatic hyperplasia (BPH) are compared with a mean hospital stay of three days. This surgery although efficacious has been related with increased morbidity and increased day case failure rates as compared to newer techniques. These shortcomings have prompted the utilization of newer methods like Transurethral enucleation and resection of the prostate (TUERP), Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP). This review will discuss the enucleation techniques, advantages and therefore the predictive factors for a successful day case prostate surgery. Materials and Methods: During this review, we discuss the newer techniques utilized in day case BPH surgery as well as the predictive factors for a successful BPH surgery, both enucleation, benefits and morcellation are covered also. Results: TUERP, ThuLEP and HoLEP have literature supporting the advantages of these techniques, which demonstrates its ability in day case BPH surgeries in specially selected cases with favorable factors and a 61% overall success rate. Conclusion: TUERP, ThuLEP and HoLEP Have proven to show favorable outcomes in day case BPH surgery with urologist’s experience, prostate size, duration of operation, age, use of anticoagulants, morning theatre list and ASA score being the key factors for a successful day case surgery.

Multiple factors related to detrusor overactivity in Chinese patients with benign prostate hyperplasia

Background Detrusor overactivity （DO） is a known cause of lower urinary tract symptoms and occurs in 50%-75% of benign prostate hyperplasia （BPH） patients. We sought to investigate the clinical and urodynamic factors that are associated with the presence of DO in Chinese BPH patients.