1
|
Comparison of Penile Cuff Test and Conventional Urodynamic Study Prior to Photoselective Vaporization of Prostate for Benign Prostate Hyperplasia Using a 120 W GreenLight High Performance System Laser. J Clin Med 2020; 9:jcm9041189. [PMID: 32326373 PMCID: PMC7231057 DOI: 10.3390/jcm9041189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background: We compared the utility of the penile cuff test (PCT) and the conventional urodynamic study (UDS) for the preoperative assessment of patients undergoing scheduled photoselective vaporization of the prostate (PVP) for benign prostate hyperplasia (BPH). Methods: Fifty-nine patients with voiding lower urinary tract symptoms (LUTS) underwent a simultaneous PCT and conventional UDS before PVP. The modified International Continence Society (ICS) nomogram was used to confirm bladder outlet obstruction after measuring maximum urinary flow rate and highest pressure at flow interruption. The PCT and UDS results, in terms of modified ICS nomogram predictions, were compared. Their sensitivities, specificities, and positive and negative predictive values were calculated. Results: Thirty-six patients were diagnosed as obstructed and 23 as non-obstructed/equivocal using the modified ICS nomogram during the PCT. All 36 of the first group were confirmed as obstructed by UDS. Of the 23 diagnosed as non-obstructed/equivocal by the PCT, 14 were confirmed to be non-obstructed by UDS, with nine diagnosed as obstructed. The PCT showed a sensitivity of 80% and a specificity of 100%. The positive and negative predictive values were 100% and 60.9%, respectively. Conclusions: In conclusion, despite our small number of patients, the PCT’s high sensitivity and specificity suggest that it may provide diagnostic information about bladder outlet obstruction before PVP for patients with voiding LUTS. Evidently, the PCT has the potential to be used for some patients as a screening alternative to invasive UDS.
Collapse
|
2
|
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]
|
3
|
de Lima ML, Netto NR. Urodynamic studies in the surgical treatment of benign prostatic hyperplasia. Int Braz J Urol 2003; 29:418-22. [PMID: 15745586 DOI: 10.1590/s1677-55382003000500005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2003] [Accepted: 06/09/2003] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE We compared the clinical and urodynamic outcome of men with lower urinary tract symptoms with and without previous urodynamic evaluation submitted to transurethral resection of the prostate. MATERIALS AND METHODS A prospective and randomized study was performed in 315 patients who underwent transurethral resection of the prostate. In 151 patients (group A) with a mean age of 63 years, transurethral resection of the prostate was performed without a prior urodynamic study, and group B, 164 patients with a mean age of 61 years, underwent a urodynamic study prior to surgical procedure. In group B, only obstructed patients were selected for surgery. All patients had I-PSS higher than 15 and underwent at least 2 uroflowmetry and flow was lower than 10 ml/sec. At 6-month follow up, patients in both groups underwent the I-PSS questionnaire and pressure / flow study. RESULTS The symptomatology and uroflowmetry did not display different behavior between the groups. The mean postoperative score for group A was 8.87 + 3.27 and for group B was 9.32 + 3.14 (p = 0.22). The mean postoperative uroflow for group A was 17.0 + 2.1 mL/s and for group B was 16.6 + 2.2 mL/s (p = 0.15).Postoperative, in group A, 27 patients (17.8%) were obstructed and in group B, 16 patients (9.75%) were obstructed (p = 0.03). CONCLUSION The study suggests that the previous urodynamic study is not the only factor related to the success of surgical outcome; and therefore, the symptomatology and uroflowmetry associated would be enough during the preoperative routine studies for BPH patients.
Collapse
Affiliation(s)
- Marcelo L de Lima
- Division of Urology, University of Campinas Medical Center, Unicamp, Campinas, São Paulo, Brazil.
| | | |
Collapse
|
4
|
Brierly RD, Hindley RG, McLarty E, Harding DM, Thomas PJ. A prospective controlled quantitative study of ultrastructural changes in the underactive detrusor. J Urol 2003; 169:1374-8. [PMID: 12629365 DOI: 10.1097/01.ju.0000055781.07630.aa] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We quantify and compare ultrastructural changes seen at high power on electron microscopic examination of detrusor biopsies from underactive and control bladders. MATERIALS AND METHODS The detrusor underactivity group consisted of 14 patients (mean age 64.0 years) with post-micturition residuals greater than 300 ml., impaired contractility and no obstruction on urodynamics. A total of 17 patients who voided normally voiders with residual volume less than 50 ml. served as the control group. Bladder biopsies were obtained endoscopically using cold cup technique and processed using standard methods. All specimens were randomized and studied at high power (x12,000 to x24,000) by an examiner who was blinded to the groups. All complete cells within each random grid field were counted up to a total of 500. The number of disrupted cells per 500 cells was noted. RESULTS Disruptive cell profiles were found in all biopsies. Median cell count was 20 cells/500 in 14 controls and 96.5 cells/500 in the underactive detrusor group (p <0.001). The number of disruptive cell profiles did not correlate with age in the control group (r = 0.34, p = 0.18). CONCLUSIONS There were distinct morphological changes in the detrusor associated with bladder dysfunction with approximately 4 times more disruptive cells in patients with an underactive bladder. However, there was no correlation between age and number of disruptive cells, suggesting that this is not a process of aging per se. Ultrastructure studies may have a role as an adjunct to urodynamics in the diagnosis of bladder dysfunction.
Collapse
Affiliation(s)
- R D Brierly
- Department of Urology, Royal Sussex County Hospital, East Sussex, United Kingdom
| | | | | | | | | |
Collapse
|
5
|
Berges R, Dreikorn K, Höfner K, Jonas U, Laval KU, Madersbacher S, Michel MC, Muschter R, Oelke M, Pientka L, Tschuschke C, Tunn U, Schalkhäuser K, Göckel-Beining B, Heidenreich A, Rübben H, Schalkhäuser K, Thon W, Thüroff J, Weidner W. [Guidelines for German urologists on diagnosis of benign prostate syndrome]. Urologe A 2003; 42:584-90. [PMID: 12715130 DOI: 10.1007/s00120-003-0319-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
6
|
Brierly RD, Hindley RG, McLarty E, Harding DM, Thomas PJ. A prospective evaluation of detrusor ultrastructural changes in bladder outlet obstruction. BJU Int 2003; 91:360-4. [PMID: 12603415 DOI: 10.1046/j.1464-410x.2003.04092.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To characterize the ultrastructure of detrusor smooth muscle from the bladders of symptomatic men with bladder outlet obstruction (BOO) caused by benign prostatic enlargement (BPE) and compare this with a matched control group; to determine how detrusor morphology relates to urodynamic findings and to develop a better understanding of the natural development of bladder dysfunction related to BOO. PATIENTS AND METHODS Twelve men (mean age 66 years, range 52-77) with urodynamically confirmed BOO caused by BPE and 12 age-matched asymptomatic normally voiding controls (mean age 67.8 years, undergoing cystoscopy for other conditions) had detrusor biopsies taken endoscopically. The biopsies were processed for electron microscopy using standard methods. The specimens were randomized and examined at medium power (x 4000) by an examiner unaware of the urodynamic findings. Any ultrastructural patterns identified subjectively were noted. RESULTS In the BOO group eight of the 12 men had a myohypertrophic pattern, half of which were associated with a degenerative pattern of hypocontractility. Of the remaining four patients, two had the degenerative pattern alone and two were normal. The six men whose biopsies had a degenerative pattern had consistent postvoid residual volumes of > 150 mL; the remainder all had volumes of < 150 mL. There were no ultrastructural abnormalities in the control patients. CONCLUSIONS There are interesting qualitative ultrastructural changes in the obstructed detrusor, but they are not consistent enough to provide a reliable diagnostic tool. However, there may be an important relationship between the degenerative pattern and postvoid residual volume in BOO.
Collapse
Affiliation(s)
- R D Brierly
- Department of Urology, Royal Sussex County Hospital, Brighton, East Sussex, UK.
| | | | | | | | | |
Collapse
|
7
|
Machino R, Kakizaki H, Ameda K, Shibata T, Tanaka H, Matsuura S, Koyanagi T. Detrusor instability with equivocal obstruction: A predictor of unfavorable symptomatic outcomes after transurethral prostatectomy. Neurourol Urodyn 2003; 21:444-9. [PMID: 12232878 DOI: 10.1002/nau.10057] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS To elucidate whether preoperative urodynamic findings can predict outcomes of transurethral resection of the prostate (TUR-P). METHODS Sixty-two patients with symptomatic benign prostatic hyperplasia were categorized in three different ways based on findings of preoperative pressure-flow study (PFS) and cystometry: urodynamic obstruction (determined by the Abrams-Griffiths nomogram), detrusor instability (DI), and combination of both. Outcomes of TUR-P regarding symptom, function, and quality of life (QOL) were analyzed by changes in the International Prostate Symptom Score (I-PSS), maximum flow rate in uroflowmetry, and QOL index before and after TUR-P, respectively. Overall outcome was defined as success when all of the three categories showed successful improvement. RESULTS Neither urodynamic obstruction alone nor DI alone predicted outcomes of TUR-P. However, symptomatic and overall outcomes were significantly worse in patients who were not obstructed but had DI. Postoperative persistent DI was more frequently noted in patients without clear obstruction (60%) than in those with obstruction (27%). Patients with equivocal obstruction showed less satisfactory symptomatic outcomes of TUR-P when DI was accompanied. Persistent DI might be the principle cause of unfavorable outcomes. CONCLUSIONS Preoperative evaluation of DI is of benefit because it enhances predictive value of the PFS.
Collapse
Affiliation(s)
- Rintaro Machino
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | | | | | | | | | | | | |
Collapse
|
8
|
Kakizaki H, Machino R, Koyanagi T. Clinical experience in lower urinary tract symptoms. BJU Int 2001; 88 Suppl 2:23-6; discussion 49-50. [PMID: 11589666 DOI: 10.1111/j.1464-410x.2001.00115.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- H Kakizaki
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | | | | |
Collapse
|
9
|
VIDEOURODYNAMIC STUDIES IN MEN WITH LOWER URINARY TRACT SYMPTOMS:. J Urol 2001. [DOI: 10.1097/00005392-200109000-00024] [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]
|
10
|
VIDEOURODYNAMIC STUDIES IN MEN WITH LOWER URINARY TRACT SYMPTOMS: A COMPARISON OF COMMUNITY BASED VERSUS REFERRAL UROLOGICAL PRACTICES. J Urol 2001. [DOI: 10.1016/s0022-5347(05)65862-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
11
|
Affiliation(s)
- Y Homma
- Department of Urology, Tokyo University Branch Hospital, Tokyo, Japan.
| |
Collapse
|
12
|
Arnold EP. Tamsulosin in men with confirmed bladder outlet obstruction: a clinical and urodynamic analysis from a single centre in New Zealand. BJU Int 2001; 87:24-30. [PMID: 11121988 DOI: 10.1046/j.1464-410x.2001.00983.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the clinical and pressure-flow effects of tamsulosin 0.4 mg once daily in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic obstruction (BPO), as documented by pressure-flow studies performed according to a standardized protocol in one centre. PATIENTS AND METHODS A single-centre study was conducted with an open-label design comprising a 2-week, single-blind, placebo run-in period and a 12-week active treatment period with tamsulosin 0.4 mg once daily. Eligible patients were men (aged > or = 45 years) with LUTS (total International Prostate Symptom Score, IPSS, > or = 13) with a free-flow maximum urinary flow rate (Qmax) of > or = 4 mL/s for a voided volume of > or = 120 mL. After the 2-week placebo run-in period, only patients with BPO (i.e. in the obstructed zone of the Abrams-Griffiths, AG, nomogram) received active treatment with tamsulosin. The two primary efficacy variables were the change in detrusor pressure at maximum flow (PdetQmax) and the total IPSS, from baseline to endpoint. A standardized protocol was used for all pressure-flow studies. RESULTS In all, 42 patients were enrolled into the 2-week placebo run-in period, after which 30 received active treatment with tamsulosin 0.4 mg once daily. All 12 patients (29%) who discontinued during the placebo run-in period failed to fulfil the pressure-flow entry criterion of confirmed obstruction. The 30 patients who received tamsulosin had a high mean PdetQmax (82.1 cm H2O) and high mean AG number (68.1) at baseline, as would be expected in obstructed patients. Tamsulosin produced a significant reduction in mean PdetQmax (-10.6 cm H2O or -13%; P = 0.005 vs baseline). The mean AG number decreased accordingly (-15.5 points or -23%; P < 0.001 vs baseline). The pressure-flow mean Qmax was increased by 2.5 mL/s (36%) from 7.0 mL/s at baseline (P = 0.002 vs baseline). Urodynamic improvements were accompanied by a good symptomatic response; the mean total IPSS was reduced by 6.7 points from a baseline value of 18.1 (-37%, P < 0.001 vs baseline). At the endpoint, 67% of patients had a clinically significant symptomatic response (defined as a decrease in total IPSS of > or = 25% from baseline). Twenty-six patients (87%) were either slightly improved (13) or were much improved (13) in the opinion of the investigator. Twelve patients with LUTS who were unobstructed after the 2-week placebo run-in (PdetQmax 44.1 cm H2O) received tamsulosin treatment outside of the study protocol. Although these patients had no decrease in mean PdetQmax, the magnitude of the symptomatic response (decrease in total IPSS -6.4 or -34%, P = 0.001) was comparable with that in unobstructed patients; the free-flow Qmax was also significantly improved. Possibly or probably drug-related adverse events were reported in nine patients; one discontinued tamsulosin treatment because of a serious adverse event. CONCLUSION Tamsulosin 0.4 mg once daily can produce a significant decrease in detrusor pressure, increase in flow rate and a symptomatic improvement in patients with LUTS and confirmed obstruction. Patients with LUTS who are unobstructed and have a low initial detrusor pressure appear to have no improvement in detrusor pressure, but have similar clinical responses to those in obstructed patients. Pressure-flow studies can be reserved for those patients with LUTS who fail to respond to these agents and in whom further diagnosis and management is warranted.
Collapse
Affiliation(s)
- E P Arnold
- Department of Urology, Christchurch Hospital, Christchurch, New Zealand.
| |
Collapse
|
13
|
Pannek J, Berges RR, Haupt G, Senge T. Value of the Danish Prostate Symptom Score compared to the AUA symptom score and pressure/flow studies in the preoperative evaluation of men with symptomatic benign prostatic hyperplasia. Neurourol Urodyn 2000; 17:9-18. [PMID: 9453687 DOI: 10.1002/(sici)1520-6777(1998)17:1<9::aid-nau3>3.0.co;2-h] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Danish Prostate Symptom Score (DAN-PSS) is a new questionnaire for the assessment of lower tract urinary symptoms (LUTS), which claims to be able to predict bladder outlet obstruction. We evaluated the ability of the DAN-PSS to assess LUTS, to predict obstruction, and to predict treatment outcome in men with symptomatic uncomplicated BPH. Twenty-five consecutive men with symptomatic uncomplicated BPH filled in the AUA symptom score and the DAN-PSS and underwent uroflowmetry and pressure-flow studies prior to transurethral prostatic resection (TURP). Patients were reevaluated 4 days and 8 months after surgery. AUA score and DAN-PSS both assessed LUTS and were sensitive to symptom changes after therapy. Compared to pressure/flow studies, neither score correlated with bladder outlet obstruction. Peak urinary flow, however, correlated significantly with obstruction. None of the diagnostic tools used was able to improve patient selection for surgical treatment. The DAN-PSS is a valid and sensitive questionnaire for the assessment of LUTS. It is not able, however, to predict bladder outlet obstruction. In men with uncomplicated BPH, urodynamic evaluation of bladder outlet obstruction did not improve the subjective outcome of TURP.
Collapse
Affiliation(s)
- J Pannek
- Department of Urology, Ruhr-Universität Bochum, Herne, Germany
| | | | | | | |
Collapse
|
14
|
Kakizaki H, Koyanagi T. Current view and status of the treatment of lower urinary tract symptoms and neurogenic lower urinary tract dysfunction. BJU Int 2000; 85 Suppl 2:25-30. [PMID: 10781182 DOI: 10.1046/j.1464-410x.2000.00060.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- H Kakizaki
- Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan.
| | | |
Collapse
|
15
|
|
16
|
Homma Y, Gotoh M, Takei M, Kawabe K, Yamaguchi T. Predictability of conventional tests for the assessment of bladder outlet obstruction in benign prostatic hyperplasia. Int J Urol 1998; 5:61-6. [PMID: 9535603 DOI: 10.1111/j.1442-2042.1998.tb00238.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The degree of bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH) is most accurately quantified by pressure flow studies (PFS), although these studies are more invasive and complicated than conventional tests. We examined how precisely conventional tests predicted the PFS-assessed degree of BOO. METHODS The study population consisted of 232 BPH patients who had undergone routine conventional tests and PFS. Correlation of the conventional test results with the degree of BOO assessed by PFS was examined by Spearman's correlation coefficients. Regression and subgroup analyses were performed to predict the degree of BOO using the conventional test results as the explanatory variables. RESULTS The degree of BOO correlated with prostate volume, the degree of endoscopic obstruction, and to a lesser extent, with the maximum flow rate (Qmax) and age. The predictability of conventional tests alone, or in combination, for BOO, was approximately 60% to 70%, which is not acceptable for investigational use. However, almost all patients with a prostate volume larger than 30 mL, or with severe obstruction on urethroscopic findings, had an obstructed bladder outlet. CONCLUSION PFS is mandatory when the precise evaluation of the degree of BOO is required, and patients are highly likely to have an outlet obstruction when they have a prostate larger than 30 mL, or severely obstructed posterior urethra on endoscopy.
Collapse
Affiliation(s)
- Y Homma
- Department of Urology, The University of Tokyo, Japan
| | | | | | | | | |
Collapse
|