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Benign Prostat Hiperplazisi ve Antimuskarinik Tedavi. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2016. [DOI: 10.21673/anadoluklin.180743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sun F, Crisóstomo V, Báez-Díaz C, Sánchez FM. Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 1, Pathological Background and Clinical Implications. Cardiovasc Intervent Radiol 2015; 39:1-7. [PMID: 26581418 DOI: 10.1007/s00270-015-1233-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Abstract
Pathological features of benign prostatic hyperplasia (BPH) dictate various responses to prostatic artery embolization (PAE). Typically, BPH originates in the transition zone and periurethral region, where should be considered the primary target area in PAE procedures. Given that histological heterogeneity of components in hyperplasia nodules, epithelial or stromal, identifying the more responsive nodules to PAE will have clinical implications. Since some lower urinary tract symptoms (LUTS) in patients with BPH are usually related to bladder outlet obstruction-induced changes in bladder function rather than to outflow obstruction directly, proper selection of candidate patients prior to PAE is of great clinical importance. BPH is a typical chronic progressive condition, suggesting PAE could aim not only to relieve LUTS but also to delay or prevent the clinical progression. Awareness of the pathological background of BPH is essential for interventional radiologists to improve clinical outcomes and develop new treatment strategies in clinical practice of PAE.
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Affiliation(s)
- Fei Sun
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
| | - Verónica Crisóstomo
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
| | - Claudia Báez-Díaz
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
| | - Francisco M Sánchez
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
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Miyazato M, Tana T, Higa A, Oshiro T, Namitome R, Nezu U, Ueda S, Saito S. Prevalence and Risk Factors for Nocturia in an Outpatient Clinic. Low Urin Tract Symptoms 2013; 6:167-71. [PMID: 26663599 DOI: 10.1111/luts.12039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/12/2013] [Accepted: 08/25/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We evaluated the prevalence of and risk factors in patients with nocturia at a general medical clinic in Naha, Japan. METHODS We enrolled patients who had been regularly followed-up at a general medical clinic in Naha. Patients were asked to complete a self-reported questionnaire regarding medical history and the frequency of nocturnal voids in the last month with anonymity. Univariate and multivariate logistic regression tests were used to evaluate the risk factors for clinically significant nocturia. RESULTS In total, 357 patients (men, 192; women, 165; mean age, 60 years) were eligible for analysis. The prevalence rate of clinically significant nocturia in patients was 33.8%. Univariate, as well as multivariate, analysis revealed that age, gender, and hypertension were significant risk factors for nocturia. CONCLUSION Clinically significant nocturia is common among patients seen at a general medical clinic. Age and gender are the most definitive risk factors for nocturia. Hypertension may also be related to nocturia. Thus, it is important to evaluate not only urological problems but other medical problems in patients with nocturia.
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Affiliation(s)
- Minoru Miyazato
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | | | - Akira Higa
- Shuri Jokamachi Clinic Daiichi, Okinawa, Japan
| | - Takuma Oshiro
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Ryo Namitome
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Uru Nezu
- Department of Clinical Pharmacology and Therapeutics, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shinichiro Ueda
- Department of Clinical Pharmacology and Therapeutics, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Seiichi Saito
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Urodynamic characterization of lower urinary tract symptoms in men less than 40 years of age. World J Urol 2013; 32:469-73. [PMID: 23884373 DOI: 10.1007/s00345-013-1134-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 07/16/2013] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Lower urinary tract symptoms (LUTS) in young men are becoming a more recognized urologic issue that can arise from many causes, each with their own management strategy. The purpose of this study was to determine the rates and types of voiding dysfunction causing LUTS in men under 40 years. METHODS Videourodynamic studies (VUDS) of 87 men 40 years of age or less with LUTS for greater than 6 months, performed between July 2004 and June 2012 at Weill Cornell Medical College, were retrospectively analyzed. Patients with culture-proven bacterial prostatitis, symptoms for less than 6 months, a history of neurologic disease, or previous urological surgery affecting voiding function were excluded from the analysis. RESULTS The mean age of the patients was 31.84 ± 5.78. There were 37 patients that presented with more than one urinary symptom (42.5 %). The most frequent complaints included: urinary frequency (N = 42, 48.28 %), difficulty with urination (N = 41, 47.13 %), and urinary urgency (N = 21, 24.14 %). The most common urodynamic abnormality was bladder outlet obstruction (BOO) (N = 37, 42.53 %), dysfunctional voiding (N = 25, 28.74 %), detrusor underactivity (N = 10, 11.49 %), and detrusor overactivity (N = 7, 8.05 %). There were no differences seen in AUA symptom and quality of life scores across diagnosis groups. CONCLUSIONS Lower urinary tract symptoms can present in younger men with a variety of types of voiding dysfunction. This study uses VUDS to show that the most common types of voiding dysfunction in this population with chronic LUTS are BOO followed by dysfunctional voiding.
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Huang T, Qi J, Yu Y, Xu D, Jiao Y, Kang J, Zhu Y, Chen Y. Transitional zone index and intravesical prostatic protrusion in benign prostatic hyperplasia patients: correlations according to treatment received and other clinical data. Korean J Urol 2012; 53:253-7. [PMID: 22536468 PMCID: PMC3332136 DOI: 10.4111/kju.2012.53.4.253] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 12/13/2011] [Indexed: 11/26/2022] Open
Abstract
Purpose The aim of this research was to assess the value of the transitional zone index (TZI) and intravesical prostatic protrusion (IPP) from transrectal ultrasonography in evaluating the severity and progression of disease by analyzing the relationship between the 2 parameters and symptoms, clinical history, and urodynamics in benign prostatic hyperplasia (BPH) patients undergoing different treatment. Materials and Methods A total of 203 patients receiving medication and 162 patients who underwent transurethral resection of the prostate because of BPH were enrolled in this retrospective analysis. The clinical history and subjective and objective examination results of all patients were recorded and compared after being classified by TZI and IPP level. Linear regression was used to find correlations between IPP, TZI, and urodynamics. Results The 2 parameters were found to differ significantly between patients receiving medication and patients undergoing surgical therapy (p<0.05). PSA, maximum flow rate (Qmax), detrusor pressure at Qmax (PdetQmax), and the bladder outlet obstruction index (BOOI) differed according to various TZI levels (p<0.05). In addition, the voiding symptom score, Qmax, and BOOI of subgroups with various IPP levels were also significantly different (p<0.05). Both TZI and IPP had significant effects on Qmax, BOOI, and PdetQmax (p<0.05) and the incidence of acute urinary retention (p=0.000). Conclusions The results demonstrated that both TZI and IPP had favorable value for assessing severity and progression in patients with BPH. Further studies are needed to confirm whether the two parameters have predictive value in the efficacy of BPH treatment and could be considered as factors in the selection of therapy.
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Affiliation(s)
- Tao Huang
- Department of Urology, Xin Hua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Long-term alpha-blockers and anticholinergic combination treatment for men with lower urinary tract symptoms in real-life practice. Int Urol Nephrol 2012; 44:1077-84. [DOI: 10.1007/s11255-012-0173-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 03/31/2012] [Indexed: 11/27/2022]
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MacDiarmid SA. Combination antimuscarinics and α-blockers for benign prostatic hyperplasia. Curr Urol Rep 2008; 9:265-71. [DOI: 10.1007/s11934-008-0047-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lee JM, Chung H, Kim TW, Kim HS, Wang JH, Yang SK. The Correlation of Intravesical Prostatic Protrusion with Storage Symptoms, as Measured by Transrectal Ultrasound. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.2.145] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jun Min Lee
- Department of Urology, Chungju Hospital, College of Medicine, Konkuk University, Chungju, Korea
| | - Hong Chung
- Department of Urology, Chungju Hospital, College of Medicine, Konkuk University, Chungju, Korea
| | - Tong-Wook Kim
- Department of Urology, Chungju Hospital, College of Medicine, Konkuk University, Chungju, Korea
| | - Hong Sup Kim
- Department of Urology, Chungju Hospital, College of Medicine, Konkuk University, Chungju, Korea
| | - Joon Ho Wang
- Department of Internal Medicine, Chungju Hospital, College of Medicine, Konkuk University, Chungju, Korea
| | - Sang-Kuk Yang
- Department of Urology, Chungju Hospital, College of Medicine, Konkuk University, Chungju, Korea
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Kaplan SA. [The role of muscarinic receptor antagonists in the treatment of men with lower urinary tract symptoms secondary to BPH]. Actas Urol Esp 2007; 31:86-91. [PMID: 17645086 DOI: 10.1016/s0210-4806(07)73604-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Use of antimuscarinic agents in male patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and with symptoms of overactive bladder (OAB) has become increasingly relevant over the last few years. Prescription of these drugs is in conflict with a long-established concept learnt in Medical School: antimuscarinics are contraindicated in patients with BPH. Several factors, however, have placed this issue under constant review. The description of OAB syndrome and the scientific research carried out over recent years have provided epidemiological and pathophysiological data worthwhile reviewing, most importantly in order to understand why a review of such a solidly established concept has been raised. This paper reviews the prevalence of OAB in men with BPH, the role of urodynamics to evaluate men with OAB and the existing evidence on the effect antimuscarinics have in terms of efficacy and safety on male patients with detrusor obstruction and overactivity.
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Affiliation(s)
- Steven A Kaplan
- Departament of Urology, Institute of Bladder and Prostate Health, Weill Cornell Medical College, New York, NY 10021, USA.
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Abstract
Millions of men suffer from overactive bladder and lower urinary tract symptoms. The adverse effects on quality of life and costs associated with the condition have been well described. In men, the pathophysiology of lower urinary tract symptoms may be from a number of causes including bladder outlet obstruction, detrusor overactivity, or both. Increasing data and clinical experience support the efficacy and safety of anticholinergics in men; the rate of urinary retention has been equal to that of placebo in short-term studies. Urodynamics play a vital role in defining the bladder and/or outlet dysfunction and help direct one's therapy.
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Affiliation(s)
- Scott MacDiarmid
- Alliance Urology Specialists, Bladder Control and Pelvic Pain Center, 509 N. Elam, Greensboro, NC 27403, USA.
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Monoski MA, Gonzalez RR, Sandhu JS, Reddy B, Te AE. Urodynamic predictors of outcomes with photoselective laser vaporization prostatectomy in patients with benign prostatic hyperplasia and preoperative retention. Urology 2006; 68:312-7. [PMID: 16904443 DOI: 10.1016/j.urology.2006.02.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Revised: 12/23/2005] [Accepted: 02/13/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To determine whether preoperative urodynamic parameters can predict the outcome in men in urinary retention and aid in counseling these men. METHODS Forty men in urinary retention due to benign prostatic hyperplasia underwent photoselective laser vaporization prostatectomy (PVP). Preoperative urodynamic studies were used to identify the men with detrusor overactivity (DO) and impaired detrusor contractility (IDC). The International Prostate Symptom Score (IPSS), maximal flow rate, and postvoid residual urine volume were collected at 1, 3, 6, and 12 months after PVP. RESULTS Of the 40 men, 8 (20%) had IDC and 30 had DO (75%) preoperatively. The men without preoperative DO had a significantly lower IPSS than those with preoperative DO at 1 month of follow-up. Men without preoperative IDC had a significantly lower IPSS and postvoid residual urine volume at the same point compared with men with preoperative IDC. The flow rate in men with preoperative IDC 1 and 6 months postoperatively was significantly lower than in men without preoperative IDC. CONCLUSIONS Preoperative urodynamic parameters predict for outcome in men in urinary retention undergoing PVP. Men in urinary retention benefit from PVP with an improvement in both subjective and objective voiding function, regardless of the presence of DO or IDC. Postoperatively, patients with DO have more voiding symptoms than those without DO, and are almost twice as likely to require anticholinergics. Men without IDC have better IPSS, flow rates, and postvoid residual urine volumes compared with men with IDC. Of the 8 men with IDC, 3 required reoperation within the first year.
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Affiliation(s)
- Mara A Monoski
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, New York 10021, USA
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Jaffe WI, Te AE. Overactive bladder in the male patient: Epidemiology, etiology, evaluation, and treatment. CURRENT BLADDER DYSFUNCTION REPORTS 2006. [DOI: 10.1007/s11884-006-0008-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee C, Seong B. Urodynamic Findings of Chronic Nonbacterial Prostatitis Patients with Urinary Symptoms. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.3.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Changug Lee
- Department of Urology, Hanil General Hospital, Seoul, Korea
| | - Bongmo Seong
- Department of Urology, Hanil General Hospital, Seoul, Korea
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Kim SH, Kim DY. Urodynamic Analysis of Taxi Drivers with Lower Urinary Tract Symptoms. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.2.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sung Hoon Kim
- Department of Urology, College of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Duk-Yoon Kim
- Department of Urology, College of Medicine, Catholic University of Daegu, Daegu, Korea
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Jaffe WI, Te AE. Overactive bladder in the male patient: epidemiology, etiology, evaluation, and treatment. Curr Urol Rep 2005; 6:410-8. [PMID: 16238913 DOI: 10.1007/s11934-005-0034-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The urologist's approach to the diagnosis and treatment of lower urinary tract symptoms (LUTS) in male patients has changed significantly over the past decade. Advances in the basic science arena combined with a wealth of clinical data have pointed to the importance of bladder pathophysiology in the development of urinary symptoms. Historically, men with LUTS were diagnosed with "prostatism," an all-encompassing term that includes both voiding and storage symptoms that may or may not be related to prostatic obstruction. Parallel to the scientific advances in the field, the urologic lexicon began to evolve and has allowed us to more specifically describe, and therefore investigate and treat, different aspects of male LUTS. It is now well recognized that many men suffer from storage symptoms that may be more related to bladder dysfunction than to prostatic obstruction. It will be critical to integrate our knowledge of prostatic growth and obstruction, the bladder response to outlet obstruction, environmental and lifestyle factors, and age-related changes to fully understand the complex pathophysiology of male LUTS, specifically overactive bladder syndrome.
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Affiliation(s)
- William I Jaffe
- Temple University School of Medicine, Broad and Ontario Streets, Suite 350 Parkinson Pavilion, Philadelphia, PA 19140, USA.
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Kanik EA, Erdem E, Abidinoglu D, Acar D, Akbay E, Ulusoy E. Can the outcome of transurethral resection of the prostate be predicted preoperatively? Urology 2005; 64:302-5. [PMID: 15302483 DOI: 10.1016/j.urology.2004.03.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2004] [Accepted: 03/22/2004] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To establish a formula for predicting the outcome of transurethral resection of the prostate using noninvasive parameters of preoperative evaluation. METHODS The data of 54 men with a mean age of 57 years (range 43 to 78) were retrospectively analyzed. The International Prostate Symptom Score, quality-of-life score of the International Prostate Symptom Score questionnaire, maximal flow rate (Qmax) recorded during uroflowmetry, age, prostate volume calculated by transrectal ultrasonography, postvoid residual urine volume, and results of pressure-flow studies were evaluated to find a formula that would predict the outcome of transurethral resection of the prostate. The patients were evaluated by uroflowmetry, postvoid residual urine volume determination, and International Prostate Symptom Score questionnaire at 3 months postoperatively. Four different success criteria were investigated with the calculated equations. RESULTS According to the discriminant analysis, two new scores were calculated as S(1) = (0.169 x age) - (0.0075 x Qmax) and S2 = (0.168 x age) - (0.095 x Qmax) - (0.007 x detrusor pressure at Qmax). For the four success criteria, the optimal cutoff, obtained from the receiver operating characteristic curves of S(1) and S(2), was 8.83 and 9.21, respectively. A statistically significant difference was not found between S1 and S2. The S1 formula had a sensitivity between 71.8% and 85.2%, specificity between 71.4% and 86.7%, and positive predictive value between 72.2% and 92.9% for the four different criteria using two simple variables (Qmax of uroflowmetry and age). CONCLUSIONS Because urodynamic parameters did not add benefit to the formula consisting of age and Qmax of uroflowmetry with considerable sensitivity and specificity, performing urodynamic studies might not be useful for predicting the outcome of transurethral resection of the prostate.
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Affiliation(s)
- E Arzu Kanik
- Department of Biostatistics, Mersin University School of Medicine, Mersin, Turkey
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Abstract
Similar to bladder outlet obstruction (BOO), overactive bladder (OAB) symptoms are very common and increase in prevalence as men age. Whether or not OAB symptoms are thought to be secondary to BOO, the goal of treatment of symptoms should result in an improved quality of life and ultimately prevent clinical deterioration. A common dilemma when treating men with obstruction and OAB is the risk of acute urinary retention or morbidities related to increasing postvoid residuals. In this article, the relationship of OAB to BOO is examined and the role of urodynamics and data on the use of anticholinergics in men with OAB and obstruction are reviewed. An algorithm for managing men with OAB also is proposed. In men with OAB without evidence of obstruction (including OAB after treatment for BOO), first-line medical therapy with anticholinergics is indicated. However, in men with OAB and concomitant BOO, nomogram has been developed to assist in the management of patients at risk for urinary retention. Men with significant obstruction should be appropriately treated to decrease bladder outlet resistance before adding anticholinergics for the treatment of OAB.
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Affiliation(s)
- Ricardo R González
- Department of Urology, New York Presbyterian Hospital, Weill Medical College of Cornell University, 525 East 68th Street, Suite F918, New York, NY 10021, USA
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Clemens JQ. The role of urodynamics in the diagnosis and treatment of benign prostatic hyperplasia. Curr Urol Rep 2003; 4:269-75. [PMID: 12882717 DOI: 10.1007/s11934-003-0083-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J Quentin Clemens
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Tarry 11-715, Chicago, IL 60611, USA.
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Interactions Between Prostate Volume, Filling Cystometric Estimated Parameters, and Data From Pressure-Flow Studies in 565 Men With Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia. J Urol 2002. [DOI: 10.1097/00005392-200207000-00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kaplan SA. Interactions Between Prostate Volume, Filling Cystometric Estimated Parameters, and Data From Pressure-Flow Studies in 565 Men With Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia. J Urol 2002. [DOI: 10.1016/s0022-5347(05)64968-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rossi C, Kortmann BB, Sonke GS, Floratos DL, Kiemeney LA, Wijkstra H, de la ROSETTE JJ. alpha-Blockade improves symptoms suggestive of bladder outlet obstruction but fails to relieve it. J Urol 2001; 165:38-41. [PMID: 11125359 DOI: 10.1097/00005392-200101000-00010] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We investigated the effect of the alpha-blockers alfuzosin, terazosin and tamsulosin on urodynamic parameters after 6 months of therapy. MATERIALS AND METHODS Between February 1992 and June 1998, 163 patients with lower urinary tract symptoms suggestive of bladder outlet obstruction were treated with alfuzosin (60), terazosin (66) and tamsulosin (37). Patients were evaluated with urodynamic studies, including pressure flow analysis, before treatment and after 6 months of therapy. Initially, all patients were also assessed by the International Prostate Symptom Score questionnaire and measurement of urinary flow rate. RESULTS The majority of patients had no clear improvement in obstructive parameters, regardless of the alpha-blocker used, as urethral resistance factor and detrusor pressure maximum flow rate decreased by only 4 cm. H2O. There was a clear subjective and statistically significant decrease in International Prostate Symptom Score and quality of life scores of 6 and 2 points, respectively. No relevant statistical difference was noted among the effects of the 3 alpha-blockers on relieving symptoms or improving urodynamic parameters of obstruction. CONCLUSIONS The alpha-blockers are effective for treating symptoms suggestive of bladder outlet obstruction in patients presenting with lower urinary tract symptoms but not for treating the obstruction.
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Affiliation(s)
- C Rossi
- Department of Urology, University Medical Centre Nijmegen, Nijmegen, The Netherlands
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Kuo HC. Clinical prostate score for diagnosis of bladder outlet obstruction by prostate measurements and uroflowmetry. Urology 1999; 54:90-6. [PMID: 10414733 DOI: 10.1016/s0090-4295(99)00092-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To establish a clinical prostate score based on the parameters of uroflowmetry and prostate measurements to provide a better prediction of benign prostatic obstruction (BPO) in men with lower urinary tract symptoms (LUTS) and small prostate volume. METHODS From October 1997 to September 1998, a prospective study of 324 consecutive men with LUTS was conducted in a community hospital in Taiwan. All patients were first evaluated by uroflowmetry and transrectal sonography of the prostate, and a videourodynamic study (VUDS) was performed before any medication was given. Patients were grouped as obstructed or unobstructed according to the results of the VUDS. Parameters from uroflowmetry and prostate measurements were evaluated for their sensitivity in predicting BPO. A clinical prostate score was established by summing scores on seven prostatic and uroflowmetric items: maximal flow rate (Qmax), flow pattern, voided volume, residual urine amount, total prostate volume (TPV), transition zone index (TZI), and prostatic configuration. Each of these items had a score representing the grade of sensitivity of BPO. RESULTS Among the 324 men examined, only 65.4% were found to have obstruction by VUDS. A value of Qmax 10 mL/s or less had a sensitivity of only 75.4% and specificity of only 63.7% for BPO. A constrictive flow pattern had 87.2% sensitivity, residual urine 100 mL or greater had 86.1%, TPV 40 mL or greater had 94.6%, TZI 0.5 or greater had 87.8%, and the presence of a median lobe had 87.1% sensitivity; the presence of any of these factors added 2 points to the score. The other parameters were scored as 1, 0, and -1, representing their sensitivity as slightly superior or inferior to that of LUTS. A prostate score of 3 or greater had a sensitivity of 87.2% and a specificity of 60.8% for BPO. On the basis of this prostate score, 148 patients (46%) would have been treated for BPO without the need for further investigation, of whom 19 (5.9%) would have been misdiagnosed. The remaining 176 patients (54%) would have undergone a VUDS and 93 of these patients (28.7%) were unobstructed. CONCLUSIONS By combining uroflowmetry and transrectal sonography of the prostate, patients with LUTS can be diagnosed with a good sensitivity and specificity. Using the parameters in the uroflow and prostate measurements, a prostate score could be established and used as an indicator of BPO for selecting patients with LUTS who require further treatment or invasive VUDS.
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Affiliation(s)
- H C Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Abstract
In the past decade, the symptom score has been considered the essential part of the evaluation of patients with lower urinary tract symptoms (LUTS). At the University of Wisconsin, the author's have stopped routine use of symptom scores because of their limited utility in dealing with the patient's concerns. Except from men electing invasive treatment, the authors do not serve the patients better with urodynamic testing either. Bothersomeness, not symptom score or objective measures is what drives the decision making process in benign prostatic hyperplasia (BPH) management. Generally, the authors now select patients for treatment according to the degree to which they are bothered by their LUTS.
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Affiliation(s)
- J V Jepsen
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, USA
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26
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Gerber GS. The role of urodynamic study in the evaluation and management of men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urology 1996; 48:668-75. [PMID: 8911507 DOI: 10.1016/s0090-4295(96)00249-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- G S Gerber
- Department of Surgery, University of Chicago Pritzker School of Medicine, Illinois, USA
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Kaplan SA, Reis RB. Significant Correlation of the American Urological Association Symptom Score and a Novel Urodynamic Parameter: Detrusor Contraction Duration. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65479-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Steven A. Kaplan
- Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Rodolfo B. Reis
- Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York
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