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benign prostatic hyperplasia, bladder outflow obstruction, urodynamics
In order to reliably diagnose bladder outflow obstruction (BOO) in benign prostatic hyperplasia (BPH), we conducted a comparative study in 76 patients with clinically diagnosed BPH, 52 of whom had BOO and 24 who did not. Urodynamic assessment revealed that urethral opening pressure, minimal urethral opening pressure, detrusor pressure at maximal urine flow, and detrusor pressure were significantly higher in patients with BOO than in patients who did not have BOO or whose assessments1 were normal (P < 0.01); no significant difference between patients without BOO and those who were normal were found. Among the 27 patients who underwent prostatectomy, maximal flow rate rate was significantly higher in 23 patients with BOO than in 4 patients without BOO after surgery (P < 0.01). Patients with and without BOO had similar I-PSS (International Prostate Symptom Score) and PS (prostatic size) These results suggest that I-PSS, PS, free Qm (maximal flow rate) and RUV (residual urine volume) are not specific markers for BOO diagnosis in BPH patients. Besides, bladder neck pressure, bladder neck length, prostatic urethral pressure, and prostatic urethral length of static urethral pressure profile (SUPP) were significantly higher in BPH patients, compared to normal. However, there was no significant difference in SUPP between patients with and without BOO. We concluded that P/F (prostate and urine flow) study and SUPP together could provide better guide therapy options and prognosis of BPH.
2. Platz EA, Smit E, Curhan GC, Nyberg LM, Giovannucci E: Prevalence of and racial/ethnic variation in lower urinary tract symptoms and noncancer prostate surgery in U.S. men. Urology 2002, 59(6):877-883.
3. Rosen RC, Giuliano F, Carson CC: Sexual dysfunction and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). European urology 2005, 47(6):824-837.
4. Fourcade RO, Lacoin F, Roupret M, Slama A, Le Fur C, Michel E, Sitbon A, Cotte FE: Outcomes and general health-related quality of life among patients medically treated in general daily practice for lower urinary tract symptoms due to benign prostatic hyperplasia. World journal of urology, 30(3):419-426.
5. Ziada A, Rosenblum M, Crawford ED: Benign prostatic hyperplasia: an overview. Urology 1999, 53(3 Suppl 3a):1-6.
6. Homma Y, Gotoh M, Yokoyama O, Masumori N, Kawauchi A, Yamanishi T, Ishizuka O, Seki N, Kamoto T, Nagai A et al: Outline of JUA clinical guidelines for benign prostatic hyperplasia. Int J Urol, 18(11):741-756.
7. Masumori N, Furuya R, Tanaka Y, Furuya S, Ogura H, Tsukamoto T: The 12-year symptomatic outcome of transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction compared to the urodynamic findings before surgery. BJU international, 105(10):1429-1433.
8. Hakenberg OW, Pinnock CB, Marshall VR: The follow-up of patients with unfavourable early results of transurethral prostatectomy. BJU international 1999, 84(7):799-804.
9. Belal M, Abrams P: Noninvasive methods of diagnosing bladder outlet obstruction in men. Part 1: Nonurodynamic approach. The Journal of urology 2006, 176(1):22-28.
10. Chapple C: Antimuscarinics in men with lower urinary tract symptoms suggestive of bladder outlet obstruction due to benign prostatic hyperplasia. Current opinion in urology, 20(1):43-48.
11. Abrams P: Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU international 1999, 84(1):14-15.
12. Mirone V, Imbimbo C, Longo N, Fusco F: The detrusor muscle: an innocent victim of bladder outlet obstruction. European urology 2007, 51(1):57-66.
13. Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJ: EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). European urology 2004, 46(5):547-554.
14. Santos Dias J: Benign prostatic hyperplasia: clinical manifestations and evaluation. Techniques in vascular and interventional radiology, 15(4):265-269.
15. Stothers L, Guevara R, Macnab A: Classification of male lower urinary tract symptoms using mathematical modelling and a regression tree algorithm of noninvasive near-infrared spectroscopy parameters. European urology, 57(2):327-332.
16. Elterman DS, Chughtai B, Lee R, Te AE, Kaplan SA: Noninvasive methods to evaluate bladder obstruction in men. Int Braz J Urol, 39(1):4-9.
17. Rodrigues P, Lucon AM, Freire GC, Arap S: Urodynamic pressure flow studies can predict the clinical outcome after transurethral prostatic resection. The Journal of urology 2001, 165(2):499-502.
18. Loeb S, Han M, Roehl KA, Antenor JA, Catalona WJ: Accuracy of prostate weight estimation by digital rectal examination versus transrectal ultrasonography. The Journal of urology 2005, 173(1):63-65.
19. Oelke M, Hofner K, Jonas U, de la Rosette JJ, Ubbink DT, Wijkstra H: Diagnostic accuracy of noninvasive tests to evaluate bladder outlet obstruction in men: detrusor wall thickness, uroflowmetry, postvoid residual urine, and prostate volume. European urology 2007, 52(3):827-834.
20. Kang MY, Ku JH, Oh SJ: Non-invasive parameters predicting bladder outlet obstruction in Korean men with lower urinary tract symptoms. Journal of Korean medical science, 25(2):272-275.
21. Mochtar CA, Kiemeney LA, van Riemsdijk MM, Laguna MP, Debruyne FM, de la Rosette JJ: Post-void residual urine volume is not a good predictor of the need for invasive therapy among patients with benign prostatic hyperplasia. The Journal of urology 2006, 175(1):213-216.