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Okeke CJ, Jeje EA, Obi AO, Ojewola RW, Ogunjimi MA, Tijani KH. Correlation between bladder wall thickness and uroflowmetry in West African patients with benign prostatic enlargement. Niger J Clin Pract 2023; 26:986-991. [PMID: 37635584 DOI: 10.4103/njcp.njcp_850_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background Pressure flow urodynamic study remains the gold standard for the diagnosis of bladder outlet obstruction; however, their use is limited by their relative unavailability in our environment, cost, and invasiveness. Measurement of bladder wall thickness (BWT) by transabdominal ultrasonography is a promising tool that can be used to diagnose bladder outlet obstruction in our environment where pressure-flow urodynamic study is not readily available. Objective The study aimed to correlate BWT with uroflowmetry and to establish a BWT cut-off in patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. Materials and Methods This was a prospective one-year study of patients with LUTS due to benign prostatic enlargement. The patients were divided into obstructed and non-obstructed groups with Q- max of 10 ml/s serving as the cut-off value. Receiver Operator Curve (ROC) was used to evaluate the performance of BWT in diagnosing BOO. Statistical significance was set at P < 0.05. Results The mean BWT and Q-max were 4.53 ± 2.70 mm and 15.06 ± 9.43 ml/s. There was a negative correlation between BWT and Q-max (r = -0.452, P = 0.000), Q-average (r = -0.336, P = 0.000), and voided volume (r = -0.228, P = 0.046). A BWT cut-off of 5.85 mm was found to be the best threshold to differentiate obstructed from non-obstructed patients with a sensitivity and specificity of 70 and 88.2 percent respectively. Conclusion Bladder wall thickness showed an inverse relationship with maximum flow rate with high sensitivity and specificity. This non-invasive test can be used as a screening tool for BOO in our setting, where the pressure flow urodynamic study is not readily available.
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Affiliation(s)
- C J Okeke
- Department of Urology, Epsom and St Helier University Hospitals NHS Trust, Surrey, London, United Kingdom
| | - E A Jeje
- Department of Surgery/College of Medicine, University of Lagos, Idi-Araba Surulere, Lagos, Nigeria
| | - A O Obi
- Alex-Ekwueme Federal University Teaching Hospital/Department of Surgery, Ebonyi State University Abakaliki Ebonyi State, Nigeria
| | - R W Ojewola
- Department of Surgery/College of Medicine, University of Lagos, Idi-Araba Surulere, Lagos, Nigeria
| | - M A Ogunjimi
- Department of Surgery/College of Medicine, University of Lagos, Idi-Araba Surulere, Lagos, Nigeria
| | - K H Tijani
- Department of Surgery/College of Medicine, University of Lagos, Idi-Araba Surulere, Lagos, Nigeria
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Bodmer NS, Wirth C, Birkhäuser V, Sartori AM, Leitner L, Averbeck MA, de Wachter S, Finazzi Agro E, Gammie A, Goldman HB, Kirschner-Hermanns R, F.W.M. Rosier P, Serati M, Solomon E, van Koeveringe G, Bachmann LM, Kessler TM. Randomised Controlled Trials Assessing the Clinical Value of Urodynamic Studies: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2022; 44:131-141. [PMID: 36110903 PMCID: PMC9469658 DOI: 10.1016/j.euros.2022.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/18/2022] Open
Abstract
Context The role of urodynamic studies (UDSs) in the diagnosis of lower urinary tract symptoms (LUTS) is crucial. Although expert statements and guidelines underline their value for clinical decision-making in various clinical settings, the academic debate as to their impact on patient outcomes continues. Objective To summarise the evidence from all randomised controlled trials assessing the clinical usefulness of UDS in the management of LUTS. Evidence acquisition For this systematic review, searches were performed without language restrictions in three electronic databases until November 18, 2020. The inclusion criteria were randomised controlled study design and allocation to receive UDS or not prior to any clinical management. Quality assessment was performed by two reviewers independently, using the Cochrane Collaboration’s tool for assessing the risk of bias. A random-effect meta-analysis was performed on the uniformly reported outcome parameters. Evidence synthesis Eight trials were included, and all but two focused on women with pure or predominant stress urinary incontinence (SUI). A meta-analysis of six studies including 942 female patients was possible for treatment success, as defined by the authors (relative risk 1.00, 95% confidence interval: 0.93–1.07), indicating no difference in efficacy when managing women with UDS. Conclusions Although UDSs are not replaceable in diagnostics, since there is no other equivalent method to find out exactly what the lower urinary tract problem is, there are little data supporting its impact on outcomes. Randomised controlled trials have focussed on a small group of women with uncomplicated SUI and showed no added value, but these findings cannot be extrapolated to the overall patient population with LUTS, warranting further well-designed trials. Patient summary Despite urodynamics being the gold standard to assess lower urinary tract symptoms (LUTS), as it is the only method that can specify lower urinary tract dysfunction, more studies assessing the clinical usefulness of urodynamic studies (UDSs) in the management of LUTS are needed. UDS investigation is not increasing the probability of success in the treatment of stress urinary incontinence.
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Cheng Y, Li T, Wu X, Ling Q, Rao K, Yuan X, Chen Z, Du G, Xu S. The diagnostic value of non-invasive methods for diagnosing bladder outlet obstruction in men with lower urinary tract symptoms: A meta-analysis. Front Surg 2022; 9:986679. [PMID: 36338622 PMCID: PMC9632994 DOI: 10.3389/fsurg.2022.986679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose We conducted the first meta-analysis to determine the diagnostic value of non-invasive methods for diagnosing bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS). Methods We searched a range of databases for relevant publications up to June 2022, including PubMed, Embase, Web of Science, and the Cochrane Library. Retrieved studies were then reviewed for eligibility and data were extracted. The risk of bias (RoB) was assessed using the QUADAS-2 tool. We then performed a formal meta-analysis to evaluate the accuracy of various non-invasive methods for diagnosing BOO in men. Results We identified 51 eligible studies including 7,897 patients for meta-analysis. The majority of the studies had a low overall RoB. Detrusor wall thickness (DWT) (pooled sensitivity (SSY): 71%; specificity (SPY): 88%; diagnostic odds ratio (DOR): 17.15; area under curve (AUC) 0.87) and the penile cuff test (PCT) (pooled SSY: 87%; SPY: 78%; DOR: 23.54; AUC: 0.88) showed high accuracy for diagnosing BOO. Furthermore, data suggested that DWT had the highest pooled SPY (0.89), DOR (32.58), and AUC (0.90), when using 2 mm as the cut-off. Conclusion Of the non-invasive tests tested, DWT and PCT had the highest levels of diagnostic accuracy for diagnosing BOO in men with LUTS. DWT, with a 2 mm cut-off, had the highest level of accuracy. These two methods represent good options as non-invasive tools for evaluating BOO in males.
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Boulma R, Charfi M, Trigui M, Daoud MF, Sahnoun M, Bouhaouala MH, Chouchen A. [Correlation between detrusor thickness, intravesical prostatic protrusion and maximum urinary flow in the monitoring of benign prostatic hyperplasia]. Prog Urol 2021; 32:291-297. [PMID: 34801388 DOI: 10.1016/j.purol.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/08/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Detrusor thickness (DT) and intravesical prostatic protrusion (IPP) are closely related to bladder outlet obstruction. The aim of our study was to look for correlation between DT, IPP and maximum urinary flow (Qmax). METHODS It is a prospective, observational study including men over fifty managed for benign prostatic hyperplasia. Low urinary tract symptoms were assessed with the International Prostatic Symptom Score (IPSS). Pelvic ultrasound was performed for all patients measuring prostatic volume, bladder volume, post- void residual, DT and IPP. Uroflowmetry was performed for all patients, Qmax was noted. Qmax equal or less than 15ml/s was considered pathologic. RESULTS Sixty patients were included for our study. Strong negative correlation was noted between DT, IPP and Qmax (r=-0.59, r=-0.61 respectively). Patients with pathologic Qmax had higher DT and IPP than those with normal Qmax, the difference was significant (P<0.01). Threshold values predicting pathologic Qmax were 3mm for DT and 7mm for IPP. ROC analysis reveals for DT an AUC of 0.84 (95% CI 0.76-0.92) and for IPP an AUC of 0.88 (95% CI 0.80-0.97). CONCLUSION Detrusor thickness and intravesical prostatic protrusion have strong negative correlation with Qmax. These parameters could be an alternative to Qmax measurement if uroflowmetry is unavailable. LEVEL OF EVIDENCE Grade B.
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Affiliation(s)
- Rami Boulma
- Service d'urologie, hôpital FSI La Marsa, Tunis, Tunisie.
| | - Mehdi Charfi
- Service de radiologie, hôpital FSI La Marsa, Tunis, Tunisie.
| | - Mohamed Trigui
- Service d'urologie, hôpital FSI La Marsa, Tunis, Tunisie.
| | | | - Moez Sahnoun
- Service de chirurgie générale, hôpital FSI La Marsa, Tunis, Tunisie.
| | | | - Adnen Chouchen
- Service de chirurgie générale, hôpital FSI La Marsa, Tunis, Tunisie.
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Birkhäuser V, Sartori AM, Bodmer NS, Conlon T, Thiel J, Kessler TM, Bachmann LM. Metaepidemiological Inventory of Diagnostic Studies on Urodynamics. Eur Urol Focus 2020; 6:880-908. [PMID: 31866095 DOI: 10.1016/j.euf.2019.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/20/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Urodynamic investigations have a pivotal role in the diagnosis of lower urinary tract symptoms. Despite expert statements and guidelines supporting their usefulness for clinical decision making in various clinical domains, the academic debate remains controversial. OBJECTIVE To provide a metaepidemiological inventory of studies assessing the diagnostic properties of urodynamic investigations. DESIGN, SETTING, AND PARTICIPANTS Systematic searches without language restrictions were performed in (Pre-)Medline, EMBASE, and the Cochrane Library from inception until August 31, 2018. Checking of reference lists of included studies and reviews complemented searches. Records were compiled and screened for possible inclusion by reading title and abstracts by two teams of two research fellows. Inclusion criteria were as follows: prospective data collection and urodynamic investigations performed either as a diagnostic test or using a therapy monitoring instrument. No a priori selection on clinical domain was done. Double reading was performed on records marked "included." Extraction into a developed and piloted matrix was performed in duplicate and checked by a third research fellow. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Of each included article, study specifics, objective, study design, type of data collection, clinical domain, type and description of test used, and type of outcome were extracted and attributed to a framework. RESULTS AND LIMITATIONS Electronic searches retrieved 20 841 records. After screening, 299 abstracts were considered relevant. The main reasons for exclusion were as follows: animal studies, no primary data, editorial/opinion based on published data or reviews, primary objective of the study being not the assessment of urodynamic investigations, and post hoc (opportunistic) correlation studies. CONCLUSIONS To our knowledge, this is the first comprehensive collection of studies assessing the clinical usefulness of urodynamic investigations. The collection is the starting point for a series of systematic reviews assessing the diagnostic properties of urodynamic investigations. PATIENT SUMMARY The usefulness of urodynamic investigations for clinical decision making is under debate. We established an inventory of diagnostic studies on urodynamics to assess the value of urodynamics in various clinical applications.
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Affiliation(s)
- Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Institute for Regenerative Medicine, University of Zürich, Zürich, Switzerland
| | | | - Tara Conlon
- Medignition Inc., Research Consultants, Zürich, Switzerland
| | - Julien Thiel
- Medignition Inc., Research Consultants, Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Ahuizechukwu O, Ekwunife NM, Kinsley O, Obiora M. Correlation between prostate volume measured by ultrasound and detrusor wall thickness in men with benign prostatic hypertrophy. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:1-5. [PMID: 35814966 PMCID: PMC9267038 DOI: 10.4103/jwas.jwas_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
Abstract
Background: Benign prostatic hypertrophy (BPH) causes subvesical urinary obstruction in the elderly. It leads to changes in the bladder and upper urinary tract. This may be progressive with subsequent morbidities and mortalities. This study aims at determining the relationship between ultrasound-measured prostate volume and detrusor wall thickness (DWT) in men with BPH. Materials and Methods: One hundred and ten patients who met the inclusion criteria and were diagnosed with clinical BPH were enrolled. They had no other identifiable cause of bladder outlet obstruction. The International Prostate Symptoms Score (IPSS), Quality of Life (QOL) score, prostate volume, and DWT were measured. Correlation between prostate volume and DWT was done using SPSS version 20.0 (IBM, SPSS, Chicago, IL, USA). A P-value less than 0.05 was considered significant. Results: The mean age of patients was 68.3 ± 10.2 years, with a range of 40–100 years. The mean prostate volume and DWT were 94.2 ± 68.4 cm3 and 5.9 ± 3.0 mm, respectively. Mean QOL was 4.77 ± 1.35. The highest IPSS was 35 and lowest was 2. Nocturia was the major IPSS subscore. There was a positive correlation between prostate volume and DWT in men with BPH (r = 0.37; P = 0.007). This is statistically significant. Conclusion: Ultrasound-measured prostate volume correlates positively with DWT in men with BPH. This is statistically significant and is able to determine progression of the disease. Coexisting large prostate volume and thickened detrusor wall are an indicator of disease progression and eventual need for surgical intervention. This prevents renal damage.
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Reddy SVK, Shaik AB. Non-invasive evaluation of bladder outlet obstruction in benign prostatic hyperplasia: a clinical correlation study. Arab J Urol 2019; 17:259-264. [PMID: 31723442 PMCID: PMC6830236 DOI: 10.1080/2090598x.2019.1660071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/03/2019] [Indexed: 11/20/2022] Open
Abstract
Objectives: To determine the utility of ultrasonography (US)-derived parameters (e.g. prostate volume [PV], bladder wall thickness [BWT], post-void residual urine volume [PVR], and intravesical prostatic protrusion [IPP]) and uroflowmetry for identifying bladder outlet obstruction (BOO) by correlating them with the results of pressure–flow urodynamic studies (UDS). Patients and methods: In all, 164 patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH), from May 2016 to December 2018, were included in this study. All had International Prostate Symptoms Score (IPSS), Quality-of-Life (QOL) index, uroflowmetry (including maximum urinary flow rate [Qmax]) and PVR measured by transabdominal US. Pressure–flow UDS were performed on all men and BOO was defined by a BOO Index (BOOI) >40. Men with a Qmax of ≥12.0 mL/s were considered to have ‘good’ flow. Results: Amongst the 164 men, the mean (SD) age, PV, BWT and Qmax were 66.72 (9.88) years, 51.91 (13.24) mm, 5.07 (0.91) mm, and 8.46 (3.59) mL/s, respectively. In all, 91 (55.49%) patients had BOO with a BOOI >40 and nine (5.49%) had equivocal BOO with a BOOI of 20–40. The IPP was a statistically significant predictor (P < 0.001) of BOO compared with other variables in the initial evaluation. In patients with BOO confirmed by the pressure–flow UDS, IPP Grade III was associated with a higher BOOI than was Grade I and II (P < 0.001). Conclusion: BWT, PV and PVR in conjunction with IPP are good predictors of clinically significant BOO due to BPH. Abbreviations: AUC: area under the curve; BOOI: BOO Index; BPO, benign prostatic obstruction; BWT, bladder wall thickness; IPP: intravesical prostatic protrusion; Pdet: detrusor pressure; PV: prostate volume; PVR: post-void residual urine volume; Qmax: maximum urinary flow rate; QOL: quality of life; ROC: receiver operating characteristic; (TA)US: (transabdominal) ultrasonography; UDS: urodynamic studies
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Braga A, Serati M, Illiano E, Manassero F, Milanesi M, Natale F, Torella M, Pistolesi D, De Nunzio C, Soligo M, Finazzi Agrò E. When should we use urodynamic testing? Recommendations of the Italian Society of Urodynamics (SIUD). Part 2 - Male and neurogical population. MINERVA UROL NEFROL 2019; 72:187-199. [PMID: 31166102 DOI: 10.23736/s0393-2249.19.03447-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent studies in literature, have raised some doubts on the routine use of urodynamic testing. Many physicians and articles recommend a selective use of this tool, considering carefully risks and benefits. These recommendations are intended to guide clinicians in the right selection of the male and neurological patients to submit to a urodynamic evaluation. This is the second part of a previous article regarding the urodynamic recommendations in the female population. We reviewed the literature, regarding the use of UDS in male and neurological population with lower urinary tract symptoms (LUTS). Specifically, we analyzed and compared the guidelines and recommendations of the most important urology and urogynecology international scientific societies. These publications were used to create the evidence basis for characterizing the recommendations to perform urodynamic testing. A panel of 10 experts was composed and Delphi process was followed to obtain the panelist consensus. The final recommendations were approved by the unanimous consensus of the panel and compared with the best practice recommendations available in the literature. The recommendations are provided for diagnosis and management of common LUTS in male and neurological population. This review provides a summary of the most effective utilization of urodynamic studies for the global evaluation of patients with LUTS, and how to use them when really needed, avoiding unnecessary costs and patient inconveniences.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland -
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Ester Illiano
- Division of Urology and Andrology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Francesca Manassero
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Martina Milanesi
- Department of Urology, AOU Careggi Hospital, University of Florence, Florence, Italy
| | - Franca Natale
- Department of Urogynecology, San Carlo of Nancy Hospital, Rome, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Donatella Pistolesi
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Soligo
- Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
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Garg G, Sankhwar SN, Goel A, Pandey S, Sharma D, Parihar A. Evaluation of resistive index of the prostate and bladder sonomorphologic parameters as replacements for urodynamics to predict bladder outlet obstruction in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Low Urin Tract Symptoms 2019; 11:163-168. [PMID: 30793849 DOI: 10.1111/luts.12256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/07/2019] [Accepted: 01/16/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study investigated whether the resistive index (RI) of prostate and bladder sonomorphologic parameters (total prostate volume [TPV], detrusor wall thickness [DWT], intraprostatic protrusion [IPP]) can be used instead of urodynamic studies (UDS) to predict bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). METHODS Men aged ≥50 years with clinical BPH/LUTS were prospectively enrolled included. Basic evaluations, measurement of sonomorphologic parameters, and UDS were performed in accordance with the International Continence Society's Good Urodynamics Practices protocol. RESULTS Data of 240 patients were divided into two groups based on the BOO index(BOOI). Group 1 consisted of patients negative for BOO (BOOI <40), whereas Group 2 consisted of patients positive for BOO (BOOI > 40). Patient age, International Prostate Symptom Score (IPSS), quality of life score and post-void residual volume were comparable between the two groups, whereas significant differences were evident in peak flow rate, TPV, DWT, RI, and IPP (P < 0.01 for all). Pearson correlation analysis revealed a significant correlation between BOOI and DWT (r = 0.198, P = 0.002), IPP (r = 0.450, P = 0.000), and RI (r = 0.334, P = 0.000). Multiple regression analysis revealed a significant correlation between BOOI and IPP (β = 0.382, P = 0.000) and RI (β = 0.226, P = 0.000). Receiver operating characteristic analysis showed that the area under curve was 0.785 for RI (95% confidence interval [CI] 0.703-0.867, P < 0.001) and 0.905 for IPP (95% CI 0.850-0.961, P < 0.001). At a cut-off value of 7.5 mm for IPP, the sensitivity was 86.9%, specificity was 83.3% and positive predictive value was 92.41%. CONCLUSION IPP and RI may be the best non-invasive predictors for BOO in selected patients with LUTS/BPH.
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Affiliation(s)
- Gaurav Garg
- Department of Urology, King George's Medical University, Lucknow, India
| | | | - Apul Goel
- Department of Urology, King George's Medical University, Lucknow, India
| | - Siddharth Pandey
- Department of Urology, King George's Medical University, Lucknow, India
| | - Deepanshu Sharma
- Department of Urology, King George's Medical University, Lucknow, India
| | - Anit Parihar
- Department of Radiodiagnosis, King George's Medical University, Lucknow, India
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Systematic Review of the Performance of Noninvasive Tests in Diagnosing Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms. Eur Urol 2016; 71:391-402. [PMID: 27687821 DOI: 10.1016/j.eururo.2016.09.026] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/12/2016] [Indexed: 11/23/2022]
Abstract
CONTEXT Several noninvasive tests have been developed for diagnosing bladder outlet obstruction (BOO) in men to avoid the burden and morbidity associated with invasive urodynamics. The diagnostic accuracy of these tests, however, remains uncertain. OBJECTIVE To systematically review available evidence regarding the diagnostic accuracy of noninvasive tests in diagnosing BOO in men with lower urinary tract symptoms (LUTS) using a pressure-flow study as the reference standard. EVIDENCE ACQUISITION The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central, Google Scholar, and WHO International Clinical Trials Registry Platform Search Portal databases were searched up to May 18, 2016. All studies reporting diagnostic accuracy for noninvasive tests for BOO or detrusor underactivity in men with LUTS compared to pressure-flow studies were included. Two reviewers independently screened all articles, searched the reference lists of retrieved articles, and performed the data extraction. The quality of evidence and risk of bias were assessed using the QUADAS-2 tool. EVIDENCE SYNTHESIS The search yielded 2774 potentially relevant reports. After screening titles and abstracts, 53 reports were retrieved for full-text screening, of which 42 (recruiting a total of 4444 patients) were eligible. Overall, the results were predominantly based on findings from nonrandomised experimental studies and, within the limits of such study designs, the quality of evidence was typically moderate across the literature. Differences in noninvasive test threshold values and variations in the urodynamic definition of BOO between studies limited the comparability of the data. Detrusor wall thickness (median sensitivity 82%, specificity 92%), near-infrared spectroscopy (median sensitivity 85%, specificity 87%), and the penile cuff test (median sensitivity 88%, specificity 75%) were all found to have high sensitivity and specificity in diagnosing BOO. Uroflowmetry with a maximum flow rate of <10ml/s was reported to have lower median sensitivity and specificity of 68% and 70%, respectively. Intravesical prostatic protrusion of >10mm was reported to have similar diagnostic accuracy, with median sensitivity of 68% and specificity of 75%. CONCLUSIONS According to the literature, a number of noninvasive tests have high sensitivity and specificity in diagnosing BOO in men. However, although the majority of studies have a low overall risk of bias, the available evidence is limited by heterogeneity. While several tests have shown promising results regarding noninvasive assessment of BOO, invasive urodynamics remain the gold standard. PATIENT SUMMARY Urodynamics is an accurate but potentially uncomfortable test for patients in diagnosing bladder problems such as obstruction. We performed a thorough and comprehensive review of the literature to determine if there were less uncomfortable but equally effective alternatives to urodynamics for diagnosing bladder problems. We found that some simple tests appear to be promising, although they are not as accurate. Further research is needed before these tests are routinely used in place of urodynamics.
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Rademakers KLJ, van Koeveringe GA, Oelke M. Ultrasound detrusor wall thickness measurement in combination with bladder capacity can safely detect detrusor underactivity in adult men. World J Urol 2016; 35:153-159. [PMID: 27447991 DOI: 10.1007/s00345-016-1902-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/18/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Detrusor underactivity (DU) has lately gained increasing interest because this bladder condition is an important cause of post-void residual urine and lower urinary tract symptoms (LUTS) in adult men. Until now, DU can only be diagnosed by pressure-flow measurement. Therefore, the aim of this study was to search for noninvasive tests which can safely predict DU in adult men. METHODS Unselected, treatment-naïve male patients aged ≥40 years with uncomplicated, non-neurogenic LUTS were prospectively evaluated. All men received-after standard assessment of male LUTS-ultrasound detrusor wall thickness (DWT) measurements at a bladder filling ≥250 ml and computer urodynamic investigation. DU was defined as incomplete bladder emptying (>30 ml) in the absence of bladder outlet obstruction or dysfunctional voiding. Classification and regression tree (CART) analysis was used to determine parameters and threshold values for DU. RESULTS The study population consisted of 143 consecutive men with medians of 62 years, IPSS 16, and prostate volume 35 ml. In total, 33 patients (23.1 %) had DU. CART analysis showed that all men with DWT ≤ 1.23 mm plus bladder capacity >445 ml had DU. This multivariate model has a sensitivity of 42 %, specificity of 100 %, positive predictive value of 100 %, and negative predictive value of 85 %. CONCLUSIONS This study showed that all men with ultrasound DWT ≤ 1.23 mm + bladder capacity >445 ml have DU. Combination of these two tests could help physicians to diagnose DU noninvasively in clinical practice. A prospective independent study should confirm these results.
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Affiliation(s)
- Kevin L J Rademakers
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Matthias Oelke
- Department of Urology, OE 6240, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Warren GJ, Erickson BA. The role of noninvasive testing and questionnaires in urethroplasty follow-up. Transl Androl Urol 2016; 3:221-6. [PMID: 26816769 PMCID: PMC4708166 DOI: 10.3978/j.issn.2223-4683.2014.04.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Urethroplasty is the preferred surgical approach for the management of urethral stricture disease. To date, no standard has been established to evaluate stricture recurrence after urethral reconstruction, though both invasive and non-invasive methods are used widely. In this article we review the role of noninvasive testing and questionnaires in urethral monitoring after urethroplasty.
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Affiliation(s)
- Gareth J Warren
- Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Bradley A Erickson
- Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
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Intravesical Prostatic Protrusion: A Potential Marker of Alpha-blocker Treatment Success in Patients With Benign Prostatic Enlargement. Urology 2015; 88:161-5. [PMID: 26680245 DOI: 10.1016/j.urology.2015.11.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the value of anatomic and blood-flow measurements of the prostate via ultrasound in identifying medical treatment response of patients with lower urinary tract symptoms due to benign prostatic enlargement. A secondary objective of the study was to compare transabdominal-transrectal measurements. MATERIALS AND METHODS Male patients (age range 50-80) with lower urinary tract symptoms who applied to our outpatient clinic to be diagnosed with benign prostatic enlargement that were eligible for medical management were included in the prospective study. Patients (n = 49) were administered with tamsulosin for management. At baseline evaluation, all patients underwent International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), transabdominal and transrectal ultrasound [prostate volume (PV), post-void rezidu and intravesical prostatic protrusion (IPP)], and prostate subcapsular resistive index value measurement. Follow-ups were carried out 1 and 3 months after treatment. At these time-points, patients were assessed with IPSS and uroflowmetry. RESULTS IPP were identified to be negatively correlated with baseline Qmax values (P = .001, R = -0.485) and positively correlated with PSA (P = .013, R = 0.353) and PV (P = .003, R = 0.420). PV was related with resistive index (P = .026, R = 0.318) and PSA (P = .001, R = 0.619). Subsequent to medical treatment on the follow-ups, an overall improvement in the IPSS and Qmax was identified (P = .001). However, a negative correlation was identified in the change that occurred between IPSS and IPP (P = .004, R = -0.410). Other parameters were not correlated (P > .05) with the change in IPSS and Qmax. Transabdominal and transrectal measures were similar (P = .001). CONCLUSION This study has shown that increased IPP values are associated with lower response to alpha-receptor specific management. Transabdominal measurements are sufficient for the evaluation compared with transrectal measurement.
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De Nunzio C, Autorino R, Bachmann A, Briganti A, Carter S, Chun F, Novara G, Sosnowski R, Thiruchelvam N, Tubaro A, Ahyai S. The diagnosis of benign prostatic obstruction: Development of a clinical nomogram. Neurourol Urodyn 2014; 35:235-40. [PMID: 25524269 DOI: 10.1002/nau.22705] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 10/22/2014] [Indexed: 11/08/2022]
Abstract
AIMS To develop a nomogram predicting benign prostatic obstruction (BPO). METHODS We included in this study 600 men with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE) who underwent standardized pressure flow studies (PFS) between 1996 and 2000. Complete clinical and urodynamic data were available for all patients. Variables assessed in univariate and multivariate logistic regression models consisted of IPSS, PSA, prostate size, maximal urinary flow rate (Qmax) at free flow, residual urine (RU), and bladder wall thickness (BWT). These were used to predict significant BPO (defined as a Schäfer grade ≥ 3 in PFS). RESULTS A preliminary multivariate model, including IPSS, Qmax at free flow and RU, suggested that only Qmax at free flow was a statistically significant predictor of BPO (P = 0.00) with a predictive accuracy (PA) of 82%. Further development of the multivariate model showed how the inclusion of BWT did not increase PA. Only transitional zone volume (TZV) proved to be an additional statistically significant predictor for BPO (P = 0.00). The combination of Qmax at free flow and TZV demonstrated a PA of 83.2% and were included in the final nomogram format. CONCLUSIONS We developed a clinical nomogram, which is both accurate and well calibrated, which can be helpful in the management of patients with LUTS and BPE. External validation is warranted to confirm our findings.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Sant' Andrea Hospital "La Sapienza,", Rome, Italy
| | - Riccardo Autorino
- Department of Urology, Urology Clinic, Second University of Naples, Naples, Italy
| | - Alexander Bachmann
- Department of Urology, Urologische Klinik, Universitätsspital Basel, Basel, Switzerland
| | - Alberto Briganti
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
| | - Simon Carter
- Department of Urology, London Clinic, London, United Kingdom
| | - Felix Chun
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Giacomo Novara
- Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy
| | - Roman Sosnowski
- Department of Urology, M. Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland
| | | | - Andrea Tubaro
- Department of Urology, Sant' Andrea Hospital "La Sapienza,", Rome, Italy
| | - Sascha Ahyai
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Benign prostatic hyperplasia (BPH) is a highly prevalent and costly condition that affects older men worldwide. Many affected men develop lower urinary tract symptoms, which can have a negative impact on their quality of life. In the past, transurethral resection of the prostate (TURP) was the mainstay of treatment. However, several efficacious drug treatments have been developed, which have transformed BPH from an acute surgical entity to a chronic medical condition. Specifically, multiple clinical trials have shown that α adrenoceptor antagonists can significantly ameliorate lower urinary tract symptoms. Moreover, 5α reductase inhibitors, alone or combined with an α adrenoceptor antagonist, can reverse the natural course of BPH, reducing the risk of urinary retention and the need for surgical intervention. Newer medical regimens including the use of antimuscarinic agents or phosphodiesterase type 5 inhibitors, have shown promise in men with predominantly storage symptoms and concomitant erectile dysfunction, respectively. For men who do not adequately respond to conservative measures or pharmacotherapy, minimally invasive surgical techniques (such as transurethral needle ablation, microwave thermotherapy, and prostatic urethral lift) may be of benefit, although they lack the durability of TURP. A variety of laser procedures have also been introduced, whose improved hemostatic properties abrogate many of the complications associated with traditional surgery.
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Affiliation(s)
- John M Hollingsworth
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA Center for Healthcare Outcomes and Policy, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Timothy J Wilt
- Minneapolis VA Center for Chronic Diseases Outcomes Research, Minneapolis, MN 55417, USA University of Minnesota School of Medicine, Minneapolis, MN, USA
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Rosier PF, Giarenis I, Valentini FA, Wein A, Cardozo L. Do patients with symptoms and signs of lower urinary tract dysfunction need a urodynamic diagnosis? ICI-RS 2013. Neurourol Urodyn 2014; 33:581-6. [DOI: 10.1002/nau.22580] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/05/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Peter F.W.M. Rosier
- Department of Urology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Ilias Giarenis
- Department of Urogynaecology; King's College Hospital NHS Foundation Trust; London United Kingdom
| | | | - Alan Wein
- University of Pennsylvania Health System Perelman Center for Advanced Medicine; Los Angeles Philadelphia
| | - Linda Cardozo
- Department of Urogynaecology; King's College Hospital NHS Foundation Trust; London United Kingdom
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Yang X, Wang K, Zhao J, Yu W, Li L. The value of respective urodynamic parameters for evaluating the occurrence of complications linked to benign prostatic enlargement. Int Urol Nephrol 2014; 46:1761-8. [PMID: 24811567 DOI: 10.1007/s11255-014-0722-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 04/21/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the correlation between urodynamic parameters and urinary tract complications linked to benign prostatic enlargement (BPE), as well to assess the possible value of these parameters for predicting complications. METHODS We retrospectively analyzed the relationship between the complications and correlative urodynamic data of 486 BPH patients. Multivariate stepwise logistic regression was used to identify major independent predictors and establish regression models. Receiver operating characteristic (ROC) curves were constructed to evaluate the models' predictive values. RESULTS All of the individual parameters examined significantly correlated with most of the complications linked to BPE, except bladder calculus. According to ROC analysis, all of the areas under ROC curves (AUC), comparison of the individual parameters and the combined effects from the logistical regression models reached statistical significance (p < 0.05), and combining the parameters revealed a higher AUC compared to the individual parameters; however, all of the AUCs were below 0.9. CONCLUSIONS Urodynamic parameters are significantly correlated with most of the complications linked to BPE, and these parameters have predictive value for the occurrence of these complications with limited values.
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Affiliation(s)
- Xingliang Yang
- Department of Urology, Second Affiliated Hospital, Third Military Medical University, Chongqing, 400037, China
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18
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Alali S, Aitken KJ, Schröder A, Gribble A, Bagli DJ, Vitkin IA. Assessment of local structural disorders of the bladder wall in partial bladder outlet obstruction using polarized light imaging. BIOMEDICAL OPTICS EXPRESS 2014; 5:621-9. [PMID: 24575354 PMCID: PMC3920890 DOI: 10.1364/boe.5.000621] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/09/2014] [Accepted: 01/13/2014] [Indexed: 05/03/2023]
Abstract
Partial bladder outlet obstruction causes prominent morphological changes in the bladder wall, which leads to bladder dysfunction. In this paper, we demonstrate that polarized light imaging can be used to identify the location of obstruction induced structural changes that other imaging modalities fail to detect. We induced 2-week and 6-week partial outlet obstruction in rats, harvested obstructed bladders, then measured their retardances while distended to high pressures and compared them to controls. Our results show that the retardance of the central part of the ventral side (above the ureters) closer to the urethra can be used as a potential metric of the distending bladder obstruction.
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Affiliation(s)
- Sanaz Alali
- University of Toronto, Division of Biophysics and Bioimaging, Ontario Cancer Institute/University Health Network and Department of Medical Biophysics, 610 University Avenue, Toronto, Ontario M5G 2M9 Canada
| | - Karen J. Aitken
- University of Toronto, Division of Urology, Developmental & Stem Cell Biology, Sick Kids Hospital, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
| | - Annette Schröder
- University of Toronto, Division of Urology, Developmental & Stem Cell Biology, Sick Kids Hospital, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
| | - Adam Gribble
- University of Toronto, Division of Biophysics and Bioimaging, Ontario Cancer Institute/University Health Network and Department of Medical Biophysics, 610 University Avenue, Toronto, Ontario M5G 2M9 Canada
| | - Darius J. Bagli
- University of Toronto, Division of Urology, Developmental & Stem Cell Biology, Sick Kids Hospital, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
| | - I. Alex Vitkin
- University of Toronto, Division of Biophysics and Bioimaging, Ontario Cancer Institute/University Health Network and Department of Medical Biophysics, 610 University Avenue, Toronto, Ontario M5G 2M9 Canada
- University of Toronto, Department of Radiation Oncology, 610 University Avenue, Toronto, Ontario M5G 2M9 Canada
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ElSaied W, Mosharafa A, ElFayoumy H, ElGhoniemy M, Ziada A, ElGhamrawy H, Ibrahim A, Abdel-Azim M. Detrusor wall thickness compared to other non-invasive methods in diagnosing men with bladder outlet obstruction: A prospective controlled study. AFRICAN JOURNAL OF UROLOGY 2013. [DOI: 10.1016/j.afju.2013.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Wen JG, Cui LG, Li YD, Shang XP, Zhu W, Zhang RL, Meng QJ, Zhang SJ. Urine flow acceleration is superior to Qmax in diagnosing BOO in patients with BPH. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2013; 33:563-566. [PMID: 23904378 DOI: 10.1007/s11596-013-1159-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/14/2012] [Indexed: 06/02/2023]
Abstract
We performed a retrospective, case-control study to evaluate whether the urine flow acceleration (UFA, mL/s(2)) 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/s(2) and (8.50±1.05) vs. (13.00±3.35) mL/s] (P<0.001). According to the criteria (UFA<2.05 mL/s(2), 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 prostate 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 cmH2O, 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.
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Affiliation(s)
- Jian-Guo Wen
- Urodynamic Center and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Lin-Gang Cui
- Urodynamic Center and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yi-Dong Li
- Urodynamic Center and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiao-Ping Shang
- Urodynamic Center and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Wen Zhu
- Urodynamic Center and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Rui-Li Zhang
- Urodynamic Center and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Qing-Jun Meng
- Urodynamic Center and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Sheng-Jun Zhang
- Henan Key-disciplines Laboratory of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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21
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Ko SY, Kim YJ, Park HS, Jeon HJ, Park HK, Paick SH, Kim HG, Lho YS, Jung SI. Sonographic findings of ectopic prostatic tissue in the bladder: a case report and review of the literature. Clin Imaging 2013; 37:778-9. [PMID: 23462732 DOI: 10.1016/j.clinimag.2013.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/28/2012] [Accepted: 01/01/2013] [Indexed: 12/22/2022]
Abstract
Ectopic prostatic tissue in the bladder has rarely been reported, and there is currently no report about the sonographic findings of this entity. In this study, we present the imaging findings of ectopic prostatic tissue in the bladder on transrectal ultrasonography.
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Affiliation(s)
- Su Yeon Ko
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
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Rachaneni S, Balogun M, Latthe P. Bladder-wall-thickness ultrasound scan in the investigation of LUTS in women: challenges and limitations. Int Urogynecol J 2013; 24:725-8. [PMID: 23376906 DOI: 10.1007/s00192-013-2048-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 01/10/2013] [Indexed: 11/28/2022]
Abstract
Bladder-wall-thickness (BWT) ultrasound assessment in lower urinary tract conditions has been studied extensively for the last 30 years. There is some evidence that it may have diagnostic utility in detrusor overactivity (DO). The cutoff value for BWT for diagnosing DO is still a matter of debate, with different studies using different values. Transvaginal scanning is the most accurate route of measuring BWT, with excellent interobserver variation and reproducibility. There is still ongoing evaluation of bladder ultrasound and its place in the investigation of overactive bladder symptoms.
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Affiliation(s)
- S Rachaneni
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, B15 2TT, UK.
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Reis RBD, Cologna AJ, Machado RD, Machado MT, Nogueira L, Reis LO, Carvalhal G, Rodrigues Jr AA, Kaplan SA, Faria EF. Lack of association between the ICIQ-SF questionnaire and the urodynamic diagnosis in men with post radical prostatectomy incontinence. Acta Cir Bras 2013; 28 Suppl 1:37-42. [PMID: 23381822 DOI: 10.1590/s0102-86502013001300008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To analyze the correlation between the "International Consultation on Incontinence Questionnaire-Short Form" (ICIQ-UISF) survey and the urodynamic findings in men with urinary incontinence (UI) following radical prostatectomy (RP). METHODS: 88 men who presented post-RP UI for a minimum of 1 year were enrolled prospectively. All answered the ICIQ-UISF survey and underwent urodynamic testing. Patients were divided in 3 Groups according to their urodynamic diagnosis: Group 1, patients with sphincteric incontinence (SI) alone; Group 2, patients with mixed UI (SI + Bladder Dysfunction (BD)); and Group 3, patients with BD alone. Data were analyzed using SPSS v16.0 software. RESULTS: There were 51 men in Group 1 (57.9%); 30 in Group 2 (34%); and 7 (7.9%) in Group 3. BD was found in 37/88 patients (42%), but it was the main cause of UI in only 14 patients (15.9%). There was no statistically significant difference among the mean ICIQ-UISFs values from groups 1, 2, or 3 (p>0.05). The symptoms of stress incontinence correlated with the urodynamic finding of SI (r = 0.59), and complaints of urinary urgency correlated with the presence of detrusor overactivity (DO) (r = 0.37), but these complaints did not predict the main cause of UI. CONCLUSION: The etiology of UI following RP cannot be predicted by the ICIQ-UISF survey. Symptoms of stress and urge incontinence predict the findings of SI and DO on urodynamic tests, but they cannot ascertain the main cause of UI. Urodynamic testing remains the gold standard to assess the etiology of post-RP UI.
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Blatt AH, Brammah S, Tse V, Chan L. Transurethral prostate resection in patients with hypocontractile detrusor--what is the predictive value of ultrastructural detrusor changes? J Urol 2012; 188:2294-9. [PMID: 23083643 DOI: 10.1016/j.juro.2012.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Men with detrusor failure and chronic urinary retention have a lower voiding success rate and higher postoperative morbidity following transurethral prostatectomy than those with bladder outlet obstruction. Current investigations, including urodynamics, may be unable to predict the response to surgical treatment. We identified ultrastructural features on detrusor biopsy that correlated with the postoperative voiding outcome in patients with a hypocontractile detrusor undergoing transurethral prostatectomy. MATERIALS AND METHODS Detrusor biopsies were obtained from 17 patients with urodynamic evidence of bladder outlet obstruction or a hypocontractile detrusor undergoing transurethral prostatectomy and from 5 controls. Specimens were examined by transmission electron microscopy. Ten individual detrusor ultrastructural features were analyzed. Findings were compared with preoperative and postoperative clinical parameters. RESULTS Failure to void after transurethral prostatectomy was significantly associated with the ultrastructural features of variation in muscle cell size, muscle cell shape, collagenosis and abnormal fascicles. These 4 features were significantly associated with each other, defining a distinctive pattern of detrusor failure. For transurethral prostatectomy failure the sensitivity, specificity, and positive and negative predictive values of all 4 features together were 60%, 91%, 75% and 84%, respectively. Three or 4 features on detrusor biopsy predicted voiding failure. CONCLUSIONS Detrusor ultrastructural analysis is highly predictive of voiding outcome following transurethral prostatectomy in patients with detrusor failure. Patients with ultrastructural features previously described as part of the myohypertrophy pattern do not have a primary diagnosis of bladder outlet obstruction but rather detrusor failure secondary to bladder outlet obstruction.
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Affiliation(s)
- Alison H Blatt
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
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25
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Yurt M, Süer E, Gülpınar Ö, Telli O, Arıkan N. Diagnosis of Bladder Outlet Obstruction in Men With Lower Urinary Tract Symptoms: Comparison of Near Infrared Spectroscopy Algorithm and Pressure Flow Study in a Prospective Study. Urology 2012; 80:182-6. [DOI: 10.1016/j.urology.2012.03.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 03/15/2012] [Accepted: 03/20/2012] [Indexed: 12/01/2022]
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Aldaqadossi HA, Elgamal SA, Saad M. The value of measuring the prostatic resistive index vs. pressure-flow studies in the diagnosis of bladder outlet obstruction caused by benign prostatic hyperplasia. Arab J Urol 2012; 10:186-91. [PMID: 26558024 PMCID: PMC4442904 DOI: 10.1016/j.aju.2011.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 12/12/2011] [Accepted: 12/25/2011] [Indexed: 01/22/2023] Open
Abstract
Objective To compare the prostatic resistive index (RI) and measurements from pressure-flow studies (PFS) for the diagnosis and follow-up of bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH). Patients and methods In all, 338 men (aged 55–82 years) presenting with lower urinary tract symptoms were evaluated prospectively for BOO secondary to BPH. In all patients, the prostatic RI was measured by transrectal power Doppler ultrasonography. PFS were assessed in all patients and depending on the results the patients were divided into an obstructive and an unobstructive group. The receiver operating characteristic (ROC) curve was used to determine the prostatic RI threshold value for predicting BOO secondary to BPH. Patients who were confirmed to have BOO secondary to BPH received either medical or surgical treatment, and they were re-evaluated after 3 and 6 months with prostatic RI measurements. Results According to the PFS the obstructive group included 158 patients and the unobstructive group 180 patients. The mean (SD) prostatic RI was significantly higher in the obstructive group, at 0.73 (0.04), than in the unobstructive group, 0.65 (0.05) (P < 0.001). Using the ROC curve a prostatic RI of ⩾ 0.71 predicted BOO secondary to BPH, with 84.6% sensitivity, 78.4% specificity and 83.8% overall predictability. After management, the prostatic RI of the obstructive group, 0.69 (0.08), was significantly lower than before treatment, 0.73 (0.04) (P < 0.05). Conclusions The prostatic RI can predict BOO with high specificity and sensitivity. We believe that the prostatic RI could be a useful variable for the diagnosis and follow-up of patients with BPH.
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Affiliation(s)
| | | | - Mohammed Saad
- Department of Radiology, Fayoum Faculty of Medicine, Fayoum, Egypt
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27
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Does prostate configuration affect the efficacy and safety of GreenLight HPS™ laser photoselective vaporization prostatectomy (PVP)? Lasers Med Sci 2012; 28:473-8. [PMID: 22460737 DOI: 10.1007/s10103-012-1085-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 03/13/2012] [Indexed: 12/19/2022]
Abstract
We evaluate the efficacy and safety of GreenLight HPS™ laser photoselective vaporization prostatectomy (PVP) for the treatment of benign prostatic hyperplasia (BPH) with different prostate configuration. Patients were stratified into two groups: bilobe (group I) and trilobe (group II) BPH. Transurethral PVP was performed using a 120 W GreenLight HPS™ side-firing laser system. American Urological Association Symptom Score (AUASS), Quality of Life (QoL) score, maximum flow rate (Q max), and postvoid residual (PVR) were measured preoperatively and at 1 and 4 weeks and 3, 6, 12, 18, 24 and 36 months postoperatively. A number of 160 consecutive patients were identified (I: 86, II: 74). Among the preoperative parameters, there were significant differences (p < 0.05) in prostate volume (I: 46.0 ± 19.8; II: 87.5 ± 39.6 ml), Q max (I: 9.9 ± 3.9; II: 8.7 ± 3.5 ml/sec), PVR (I: 59.2 ± 124.6; II: 97.7 ± 119.1 ml) and PSA (I: 1.4 ± 1.4; II: 3.6 ± 2.6 ng/ml), while AUASS and QoL were similar (p > 0.05). Significant differences (p < 0.05) in laser utilization (I: 9.5 ± 6.6; II: 19.5 ± 11.6 min) and energy usage (I: 63.1 ± 43.9; II: 132.5 ± 81.1 kJ) were noted. Clinical outcomes (AUASS, QoL, Q max, and PVR) showed immediate and stable improvement from baseline (p < 0.05) within each group, but no significant differences between the two groups were observed during the follow-up period (p > 0.05). The incidences of adverse events were low and similar in both groups. Our experience suggests that BPH configuration has little effect on the efficacy and safety of GreenLight HPS™ laser PVP.
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Oelke M, Kirschner-Hermanns R, Thiruchelvam N, Heesakkers J. Can we identify men who will have complications from benign prostatic obstruction (BPO)?: ICI-RS 2011. Neurourol Urodyn 2012; 31:322-6. [DOI: 10.1002/nau.22222] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 01/12/2012] [Indexed: 11/07/2022]
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Kuhn A, Brandner S, Kuhn P, Robinson D, Raio L. Does bladder wall thickness decrease when obstruction is resolved? Int Urogynecol J 2012; 23:1239-44. [PMID: 22249277 DOI: 10.1007/s00192-011-1642-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Accepted: 12/24/2011] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the current study was to determine if sonographic bladder wall thickness diminishes after symptomatic obstruction is resolved in female patients after stress incontinence surgery. METHODS Between December 2008 and December 2010, 62 female patients with symptomatic bladder outlet obstruction, as defined by Blaivas, who had undergone prior surgery for urinary stress incontinence were included in the study. The patients' history was taken and symptoms were noted. Patients underwent gynaecological examination, and multichannel urodynamic assessment was performed. Vaginal sonographic assessment of the bladder wall thickness (BWT) was performed before and after urethrolysis. RESULTS 62 patients were included in this study, 55 of whom had undergone suburethral sling insertion and seven had Burch colposuspension. Postoperatively, BWT decreased significantly from 9.1 mm ± 2.1 to 7.6 mm ± 2.2 (p < 0.0001). In seven patients, obstruction was still unresolved postoperatively; of these, two had undergone a retropubic sling insertion and two had a Burch colposuspension. An ROC curve analysis showed a significant positive association between residual urine and persistent obstruction before surgery (AUC 0.76, 95%CI 0.58-0.94; p < 0.05). CONCLUSIONS If obstruction is resolved, bladder wall thickness decreases. Preoperatively elevated residual urine may increase the risk of persistent obstruction after urethrolysis.
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Affiliation(s)
- Annette Kuhn
- Urogynaecology, Department of Gynaecology, University Hospital and University of Bern, Effingerstrasse 102, CH 3010 Bern, Switzerland.
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Huang T, Qi J, Yu YJ, Xu D, Jiao Y, Kang J, Chen YQ, Zhu YK. Predictive value of resistive index, detrusor wall thickness and ultrasound estimated bladder weight regarding the outcome after transurethral prostatectomy for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. Int J Urol 2012; 19:343-50. [PMID: 22220830 DOI: 10.1111/j.1442-2042.2011.02942.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the value of three parameters from preoperative ultrasonography in predicting the outcome of transurethral prostatectomy in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. METHODS A total of 239 patients with lower urinary tract symptoms suggestive of benign prostatic obstruction entering our department for surgical therapy were prospectively recruited. All of them underwent both ultrasound and urodynamics before receiving standard transurethral prostatectomy by the same team of surgeons. For 202 patients, 6-month follow-up data were available after the surgery, including the International Prostate Symptom Score, the Quality of Life score and the maximum flow rate. Preoperative data stratified by different degree of recovery were compared and the influence of ultrasound parameters on the surgical outcome was analyzed by using logistic regression and receiver-operator characteristic curve analyses. RESULTS Baseline transitional zone index, intravesical prostatic protrusion, resistive index, detrusor wall thickness and ultrasonic estimation of bladder weight were significantly different between patients with an effective outcome and those with an ineffective outcome (P < 0.05). Resistive index, detrusor wall thickness and ultrasonic estimation of bladder weight were selected as independent factors correlated with the efficacy of transurethral prostatectomy by logistic regression (P < 0.05). All three factors had adequate area under receiver-operator characteristic curve with resistive index having the largest area (0.816, 95% CI 0.759-0.874). The combined positive predictive value in effective surgical outcome of resistive index, detrusor wall thickness and ultrasonic estimation was 96.3%. CONCLUSIONS Resistive index, detrusor wall thickness and ultrasonic estimation adequately predict the outcome of transurethral prostatectomy. Measuring these parameters by preoperative ultrasound might aid in determining the need for surgical intervention.
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Affiliation(s)
- Tao Huang
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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31
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Application of ultrasonography and the resistive index for evaluating bladder outlet obstruction in patients with benign prostatic hyperplasia. Curr Urol Rep 2011; 12:255-60. [PMID: 21475953 DOI: 10.1007/s11934-011-0189-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Benign prostatic hyperplasia (BPH) is an extremely common and chronic condition that can lead to bladder outlet obstruction (BOO) in elderly men. Although pressure-flow studies are considered the most reliable method for evaluating BOO, they are invasive and complicated. Transrectal ultrasonography (TRUS) is a promising alternative because of its minimal invasiveness. Recently, TRUS imaging has been shown capable of measuring the resistive index, a useful parameter for evaluating BOO and for determining proper medical intervention in patients suffering from BPH.
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Griffiths CJ, Pickard RS. Review of invasive urodynamics and progress towards non-invasive measurements in the assessment of bladder outlet obstruction. Indian J Urol 2011; 25:83-91. [PMID: 19468436 PMCID: PMC2684312 DOI: 10.4103/0970-1591.45544] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This article defines the need for objective measurements to help diagnose the cause of lower urinary tract symptoms (LUTS). It describes the conventional techniques available, mainly invasive, and then summarizes the emerging range of non-invasive measurement techniques. METHODS This is a narrative review derived form the clinical and scientific knowledge of the authors together with consideration of selected literature. RESULTS Consideration of measured bladder pressure urinary flow rate during voiding in an invasive pressure flow study is considered the gold standard for categorization of bladder outlet obstruction (BOO). The diagnosis is currently made by plotting the detrusor pressure at maximum flow (p(detQmax)) and maximum flow rate (Q(max)) on the nomogram approved by the International Continence Society. This plot will categorize the void as obstructed, equivocal or unobstructed. The invasive and relatively complex nature of this investigation has led to a number of inventive techniques to categorize BOO either by measuring bladder pressure non-invasively or by providing a proxy measure such as bladder weight. CONCLUSION Non-invasive methods of diagnosing BOO show great promise and a few have reached the stage of being commercially available. Further studies are however needed to validate the measurement technique and assess their worth in the assessment of men with LUTS.
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Affiliation(s)
- C J Griffiths
- Department of Medical Physics, Freeman Hospital, Newcastle University, Newcastle upon Tyne, UK
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Bosch JLHR, Cardozo L, Hashim H, Hilton P, Oelke M, Robinson D. Constructing trials to show whether urodynamic studies are necessary in lower urinary tract dysfunction. Neurourol Urodyn 2011; 30:735-40. [DOI: 10.1002/nau.21130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Song K, Choo MS, Lee KS, Han JY, Lee YS, Kim JC, Cho JS. The Long-term Effect of Alfuzosin in Patients With Lower Urinary Tract Symptoms Suggestive of Benign Prostate Hyperplasia: Evaluation of Voiding and Storage Function With Respect to Bladder Outlet Obstruction Grade and Contractility. Urology 2011; 77:1177-82. [DOI: 10.1016/j.urology.2010.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 09/24/2010] [Accepted: 10/13/2010] [Indexed: 11/17/2022]
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Han DH, Lee HW, Sung HH, Lee HN, Lee YS, Lee KS. The Diagnostic Efficacy of 3-Dimensional Ultrasound Estimated Bladder Weight Corrected for Body Surface Area as an Alternative Nonurodynamic Parameter of Bladder Outlet Obstruction. J Urol 2011; 185:964-9. [PMID: 21247605 DOI: 10.1016/j.juro.2010.10.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Won Lee
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, South Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ha Na Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Suk Lee
- Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Masan, South Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Shinbo H, Kurita Y, Takada S, Imanishi T, Otsuka A, Furuse H, Nakanishi T, Mugiya S, Ozono S. Resistive Index as Risk Factor for Acute Urinary Retention in Patients With Benign Prostatic Hyperplasia. Urology 2010; 76:1440-5. [PMID: 20646746 DOI: 10.1016/j.urology.2010.04.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Revised: 03/27/2010] [Accepted: 04/12/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Hitoshi Shinbo
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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37
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Concordance of Near Infrared Spectroscopy With Pressure Flow Studies in Men With Lower Urinary Tract Symptoms. J Urol 2010; 184:2434-9. [PMID: 20952031 DOI: 10.1016/j.juro.2010.08.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Indexed: 11/21/2022]
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Kuhn A, Genoud S, Robinson D, Herrmann G, Günthert A, Brandner S, Raio L. Sonographic transvaginal bladder wall thickness: does the measurement discriminate between urodynamic diagnoses? Neurourol Urodyn 2010; 30:325-8. [PMID: 20949598 DOI: 10.1002/nau.20997] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 07/21/2010] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Measurement of bladder wall thickness (BWT) using transvaginal ultrasound has previously been shown to discriminate between women with confirmed detrusor overactivity and those with urodynamic stress incontinence. Aim of the current study was to determine if vaginally measured BWT correlates with urodynamic diagnoses in a female population. PATIENTS AND METHODS Between December 2008 and February 2010, adult female consecutive patients undergoing urogynaecologic investigation for lower urinary symptoms were approached to participate in this study. Ethical consent for the current study was obtained. Patients underwent multichannel urodynamics and transvaginal ultrasound measuring the bladder in three location with an emptied bladder. RESULTS 123 patients were included in the study with a median age of 69 years (range 40-93), median parity of 2 (range 0-3) and a median body mass index of 29.5 kg/m(2) (range 23-38). Urodynamic stress incontinence was diagnosed in 59 patients, DO in 40 and obstruction in 24 cases. Bladder wall thickness was significantly higher in DO patients and in obstruction than in urodynamic stress incontinence. Detrusor pressure at maximum flow rate (pdet/Q(max) ) correlated significantly with BWT. CONCLUSION Bladder wall thickness shows a significantly positive correlation to pdet/Q(max) and to urodynamic diagnoses of stress incontinence, DO and obstruction.
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Affiliation(s)
- Annette Kuhn
- Urogynaecology, Department of Obstetrics and Gynaecology, University of Bern and University Hospital, Bern, Switzerland.
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Erickson BA, Breyer BN, McAninch JW. The use of uroflowmetry to diagnose recurrent stricture after urethral reconstructive surgery. J Urol 2010; 184:1386-90. [PMID: 20727546 DOI: 10.1016/j.juro.2010.06.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The ability of uroflowmetry to diagnose recurrent stricture disease after urethroplasty has not been fully investigated. MATERIALS AND METHODS Our routine post-urethroplasty monitoring includes retrograde urethrogram and voiding cystourethrogram at 3 and 12 months, in addition to uroflowmetry at 3-month intervals for a year. All uroflowmetry data, including maximum flow rate, voided volume and voiding curve shape, as well as retrograde urethrogram/voiding cystourethrogram and voiding symptom data are stored in a prospectively maintained urethroplasty database that was analyzed for patients with postoperative retrograde urethrogram/voiding cystourethrogram and satisfactory uroflowmetry in the same period. Uroflowmetry data points and urinary symptoms were compared with corresponding findings on retrograde urethrogram/voiding cystourethrogram to determine the ability of uroflowmetry to predict recurrence. RESULTS A total of 278 men (68%) met study inclusion criteria, of whom 63 (23%) had recurrent stricture. Using a maximum flow rate of less than 10 ml per second resulted in only 54% test sensitivity to predict recurrence. The highest sensitivity and negative predictive value (each 99%) were achieved when all men with symptoms and/or obstructed flow curves were evaluated. Symptoms alone had a high specificity (87%), sensitivity (88%) and negative predictive value (95%). CONCLUSIONS Uroflowmetry is an adequate test to screen for postoperative stricture recurrence but only when the voiding curve and urinary symptoms are also evaluated. The flow rate alone does not appear to be a reliable tool to evaluate stricture recurrence.
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Affiliation(s)
- Bradley A Erickson
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
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40
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Ku JH, Ko DW, Cho JY, Oh SJ. Correlation Between Prostatic Urethral Angle and Bladder Outlet Obstruction Index in Patients With Lower Urinary Tract Symptoms. Urology 2010; 75:1467-71. [PMID: 19962734 DOI: 10.1016/j.urology.2009.08.049] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 06/15/2009] [Accepted: 08/20/2009] [Indexed: 10/20/2022]
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Franco G, De Nunzio C, Leonardo C, Tubaro A, Ciccariello M, De Dominicis C, Miano L, Laurenti C. Ultrasound Assessment of Intravesical Prostatic Protrusion and Detrusor Wall Thickness—New Standards for Noninvasive Bladder Outlet Obstruction Diagnosis? J Urol 2010; 183:2270-4. [DOI: 10.1016/j.juro.2010.02.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Giorgio Franco
- Department of Urology, “La Sapienza” University, Rome, Italy
| | | | | | - Andrea Tubaro
- Department of Urology, “La Sapienza” University, Rome, Italy
| | | | | | - Lucio Miano
- Department of Urology, “La Sapienza” University, Rome, Italy
| | - Cesare Laurenti
- Department of Urology, “La Sapienza” University, Rome, Italy
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Oelke M. International consultation on incontinence-research society (ICI-RS) report on non-invasive urodynamics: The need of standardization of ultrasound bladder and detrusor wall thickness measurements to quantify bladder wall hypertrophy. Neurourol Urodyn 2010; 29:634-9. [DOI: 10.1002/nau.20834] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Berges R, Dreikorn K, Höfner K, Madersbacher S, Michel MC, Muschter R, Oelke M, Reich O, Rulf W, Tschuschke C, Tunn U. [Diagnostic and differential diagnosis of benign prostate syndrome (BPS): guidelines of the German Urologists]. Urologe A 2010; 48:1356-60, 1362-4. [PMID: 19756468 DOI: 10.1007/s00120-009-2066-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Kang MY, Ku JH, Oh SJ. Non-invasive parameters predicting bladder outlet obstruction in Korean men with lower urinary tract symptoms. J Korean Med Sci 2010; 25:272-5. [PMID: 20119582 PMCID: PMC2811296 DOI: 10.3346/jkms.2010.25.2.272] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 04/23/2009] [Indexed: 12/04/2022] Open
Abstract
The goal of this study was to evaluate the clinical and urodynamic features in Korean men with lower urinary tract symptoms (LUTS) and to determine non-invasive parameters for predicting bladder outlet obstruction (BOO). Four hundred twenty nine Korean men with LUTS over 50 yr of age underwent clinical evaluations for LUTS including urodynamic study. The patients were divided into two groups according to the presence of BOO. These two groups were compared with regard to age, the results of the uroflowmetry, serum prostate-specific antigen (PSA) level, prostate volume, International Prostate Symptom Score (I-PSS), and the results of the urodynamic study. Patients with BOO had a lower maximal flow rate (Q(max)), lower voided volume, higher serum PSA level and larger prostate volume (P<0.05). BOO group had a significantly higher rate of involuntary detrusor contraction and poor compliance compared to the patients without BOO (P<0.05). The multivariate analysis showed that Q(max) and poor compliance were significant factors for predicting BOO. Our results show that Q(max) plays a significant role in predicting BOO in Korean men with LUTS. In addition, BOO is significantly associated with detrusor dysfunction, therefore, secondary bladder dysfunction must be emphasized in the management of male patients with LUTS.
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Affiliation(s)
- Min-Yong Kang
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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45
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Bladder weight and detrusor thickness as parameters of progression of benign prostatic hyperplasia. Curr Opin Urol 2010; 20:37-42. [DOI: 10.1097/mou.0b013e32833307e0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Parsons BA, Bright E, Shaban AM, Whitehouse A, Drake MJ. The role of invasive and non-invasive urodynamics in male voiding lower urinary tract symptoms. World J Urol 2009; 29:191-7. [PMID: 19916009 DOI: 10.1007/s00345-009-0488-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 10/23/2009] [Indexed: 10/20/2022] Open
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Caffarel J, Griffiths C, Pickard R, Robson W, Drinnan M. Modeling the clinical assessment of men with suspected obstructed voiding using Bayes' Theorem. Neurourol Urodyn 2009; 27:797-801. [PMID: 18508333 DOI: 10.1002/nau.20587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIMS Pressure-flow studies (PFS) are the only reliable way to diagnose bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS). However, in routine clinical practice, BOO is usually inferred by any of a number of tests (symptoms, flow rate, prostate size...). Bayes' Theorem provides a mathematical method, which may be similar to the process used by clinicians, for combining the results of multiple tests to reach a diagnosis. We have applied Bayes' Theorem to the results of several tests known weakly to predict BOO in men with LUTS to assess if they improve the diagnostic accuracy of a flow rate test which alone is known to predict obstruction moderately well. METHODS We applied Bayes' Theorem to data from 50 patients using Q(max) alone and with the inclusion of additional variables (IPSS, PSA, and residual urine), to establish individual probabilities of BOO. The chi-squared statistic (with trend) was used to compare the relative diagnostic values, against the BOO index calculated from the results of subsequent PFS. RESULTS The diagnostic value of Q(max) alone (chi-squared = 9.2, P = 0.002), was superior than that for the Bayesian model using the combination of tests available (chi-squared = 4.9, P = 0.026). CONCLUSIONS Although in our sample relevant additional tests do not improve the diagnostic power of Q(max) as a predictor of BOO, we believe the Bayesian approach is conceptually suited to modeling clinical decision making but may be better tested for a more clinically relevant outcome such as treatment response.
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Affiliation(s)
- Jennifer Caffarel
- Regional Medical Physics Department, Freeman Hospital, Newcastle Upon Tyne, UK.
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48
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Positioning invasive versus noninvasive urodynamics in the assessment of bladder outlet obstruction. Curr Opin Urol 2009; 19:55-62. [PMID: 19057217 DOI: 10.1097/mou.0b013e328317ca9b] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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49
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Reis LO, Barreiro GC, Baracat J, Prudente A, D'Ancona CA. Intravesical protrusion of the prostate as a predictive method of bladder outlet obstruction. Int Braz J Urol 2008; 34:627-33; discussion 634-7. [PMID: 18986567 DOI: 10.1590/s1677-55382008000500012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2008] [Indexed: 11/22/2022] Open
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50
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Gratzke C, Reich O. Editorial Comment on: Diagnostic Accuracy of Noninvasive Tests to Evaluate Bladder Outlet Obstruction in Men: Detrusor Wall Thickness, Uroflowmetry, Postvoid Residual Urine, and Prostate Volume. Eur Urol 2007; 52:835. [PMID: 17207917 DOI: 10.1016/j.eururo.2006.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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