Benign prostate obstruction(BPO) means bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH), which concerns BPH, and lower urinary tract symptoms(LUTS). To treat the BPO is the main purpose of therapy on BPH in clinic. This review includes recent advances in study of changes on urodynamics(UDS), morphology, prostatic composition, which occur in BPO.
Humans ; Male ; Prostatic Hyperplasia ; complications ; Urinary Bladder Neck Obstruction ; etiology ; physiopathology ; therapy ; Urodynamics

OBJECTIVETo study the neurophysiologic of detrusor overactivity (DO) due to partial bladder outflow obstruction (PBOO).

METHODSTwenty four female Wistar rats with DO caused by PBOO were studied simultaneously with ten sham-operated rats. An electrophysiological multi-channel simultaneous recording system was used to record pelvic afferent fiber potentials as well as the pudendal nerve motor branch potentials, external urethral sphincter electromyogram (EUS EMG) and abdominal muscle EMG during filling cystometry. To test the effect of the unstable contraction in DO rats after the decentralization of the central nervous system, DO rats were studied the changes of the unstable contraction after transection of the spinal cord (T(8) level), pelvic nerve, the sympathetic trunk, and the pudendal nerve.

RESULTSThe incidence of DO was 62.5% in filling cystometry. During filling cystometry, there are two type of DO contraction according to the changes of pelvic afferent fiber signals, the relevant nerves and muscles responses: the small pressure of the unstable contraction (S-DO) and the big pressure of the unstable contraction (B-DO). For the B-DO, there were significant changes in the recordings of pelvic afferent fiber, the motor branch of the pudendal nerve, EUS EMG, and abdominal muscle EMG. While all these differences have not been recorded during S-DO. Both the filling-voiding cycle and the unstable contraction of B-DO were eliminated and the base line of bladder pressure increased after T(8) spinal cord transection. While the S-DO was not affected by such transection. When bladder relevant nerves were transected by the sequence of the pelvic nerve, the sympathetic trunk, and the pudendal nerve, the filling-voiding cycle was eliminated. The base line of bladder pressure increased significantly. No B-DO was recorded, but the S-DO still existed.

CONCLUSIONThere are some bladder-genic factors take part in the DO contractions induced by PBOO.

Animals ; Disease Models, Animal ; Female ; Pelvic Floor ; innervation ; Rats ; Rats, Wistar ; Urinary Bladder ; innervation ; Urinary Bladder Neck Obstruction ; complications ; physiopathology ; Urinary Bladder, Overactive ; etiology ; physiopathology

This study aimed to investigate the relationship between bladder trabeculation, urinary function, and the stage of pelvic organ prolapse (POP). The medical records of 104 patients with POP who underwent cystoscopies and urodynamic studies were reviewed retrospectively. Age, incidence of detrusor instability, stage and site of POP, and the parameters of urodynamic studies of patients with and without bladder trabeculation were compared. The difference in the incidence of bladder trabeculation was estimated between patients with and without a suspected bladder outlet obstruction. There were significant differences in the patients' age, stage of POP, and maximal voiding velocity. Patients with a suspected bladder outlet obstruction had a significantly higher incidence of bladder trabeculation. In addition, patients with advanced stages of POP were also found to have a higher incidence of bladder trabeculation.
Uterine Prolapse/complications ; Urodynamics/*physiology ; Urinary Bladder Neck Obstruction/complications ; Urinary Bladder Diseases/*physiopathology ; Retrospective Studies ; Rectal Prolapse/complications ; Prolapse ; Pelvic Floor/physiopathology ; Middle Aged ; Humans ; Female ; Aged

In order to study the pathogenesis, clinical and pathological characteristics of proliferative lesions of the bladder, 50 cases of proliferative lesions of the bladder from 150 patients with complaints of frequency, urgency, hematuria and dysuria were subjected to cystoscopic biopsy of the suspicious foci in the bladder. In combination with the symptoms, urine and urodynamics, the relationship of proliferative lesions of the bladder to the inflammation and obstruction of the lower urinary tract was analyzed. Of the 50 cases of proliferative bladder lesions, 44 cases (88%) had lower urinary tract infection and 29 (58%) lower urinary tract obstruction. The patients with lower urinary tract obstruction were all complicated with infection. Three cases were associated with transitional cell carcinoma. Malignant cells were detected in 1 case by urinary cytologic examination. Proliferative lesions of the bladder, especially those without other obvious mucosa changes under cystoscopy, are common histological variants of urothelium in the patients with chronic inflammation and obstruction of the lower urinary tract. Chronic inflammation and obstruction of the lower urinary tract might be the causes for proliferative lesions of the bladder. It is suggested that different treatments should be applied according to the scope and histological type of the proliferative lesions.
Cystitis/*complications ; Hyperplasia ; Mucous Membrane/pathology ; Precancerous Conditions/*pathology ; Urinary Bladder/*pathology ; Urinary Bladder Diseases/*etiology ; Urinary Bladder Diseases/pathology ; Urinary Bladder Neck Obstruction/*complications ; Urination Disorders/complications ; Urodynamics/physiology

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

METHODSTwo hundred and eighty-seven consecutive patients with clinical BPH were retrospectively evaluated in this study. Each patient underwent urodynamic evaluation and completed the International Prostate Symptom Score (IPSS) and Quality of Life (QoL) questionnaire. Patients with neurological symptoms or other diseases likely to affect detrusor functions were strictly excluded. The 184 BPH patients included in the study were divided into groups according to the presence of DO as shown in urodynamic tests. Univariate analysis of factors associated with the presence of DO were performed using Student's t-test and the Mann-Whitney test; multivariate analysis used stepwise Logistic regressions. The relationship between degree of bladder outlet obstruction (BOO) and DO was also investigated using a linear-by-linear association test.

RESULTSOf 184 BPH patients, DO was present in 76 (41.3%). On univariate analysis, patients with DO were older (P = 0.000), and showed smaller maximal bladder capacity (MBC, P = 0.000) and voided volume (P = 0.000), higher maximal detrusor pressure (P = 0.000) and projected isovolumetric pressure (PIP) (P = 0.005), higher Abrams-Griffiths number (P = 0.000) and degree of bladder outlet obstruction (P = 0.000), higher IPSS (P = 0.000) and irritative IPSS subscores (P = 0.000). Stepwise Logistic regression analysis showed that PIP (OR = 1.012, 95% CI 1.002 - 1.023, P = 0.019), age (OR = 1.030, 95%CI 1.005 - 1.067, P = 0.059), and MBC (OR = 0.993, 95%CI 0.990 - 0.996, P = 0.000) were independent risk factors for DO in BPH patients. Linear-by-linear association tests indicated a positive linear association between DO and severity of BOO, with incidence of DO increasing with BOO grade (P = 0.000).

CONCLUSIONSIn Chinese BPH patients, PIP, MBC, and age were independent factors affecting the presence of DO. DO incidence continuously increases with the degree of BOO.

Adult ; Aged ; Aged, 80 and over ; Humans ; Logistic Models ; Male ; Middle Aged ; Prostatic Hyperplasia ; complications ; physiopathology ; Urinary Bladder Neck Obstruction ; complications ; Urinary Bladder, Overactive ; etiology

In order to study the pathogenesis, clinical and pathological characteristics of proliferative lesions of the bladder, 50 cases of proliferative lesions of the bladder from 150 patients with complaints of frequency, urgency, hematuria and dysuria were subjected to cystoscopic biopsy of the suspicious foci in the bladder. In combination with the symptoms, urine and urodynamics, the relationship of proliferative lesions of the bladder to the inflammation and obstruction of the lower urinary tract was analyzed. Of the 50 cases of proliferative bladder lesions, 44 cases (88%) had lower urinary tract infection and 29 (58%) lower urinary tract obstruction. The patients with lower urinary tract obstruction were all complicated with infection. Three cases were associated with transitional cell carcinoma. Malignant cells were detected in 1 case by urinary cytologic examination. Proliferative lesions of the bladder, especially those without other obvious mucosa changes under cystoscopy, are common histological variants of urothelium in the patients with chronic inflammation and obstruction of the lower urinary tract. Chronic inflammation and obstruction of the lower urinary tract might be the causes for proliferative lesions of the bladder. It is suggested that different treatments should be applied according to the scope and histological type of the proliferative lesions.
Adult ; Aged ; Cystitis ; complications ; Female ; Humans ; Hyperplasia ; Male ; Middle Aged ; Mucous Membrane ; pathology ; Precancerous Conditions ; pathology ; Urinary Bladder ; pathology ; Urinary Bladder Diseases ; etiology ; pathology ; Urinary Bladder Neck Obstruction ; complications ; Urination Disorders ; complications ; Urodynamics ; physiology

OBJECTIVETo analyze the correlation of the length and volume of intravesical prostatic protrusion (IPP) with bladder outflow obstruction (BOO) in patients with BPH and to find a simple method for the diagnosis of the disease.

METHODThe length and volume IPP were measured by transrectal ultrasound for 87 patients with BPH, the diagnosis of BOO was made by urodynamic tests and the correlation of the length and volume of IPP with BOO was analyzed, and reanalyzed 3 months after oral medication of a-blocker. The length and volume of IPP were measured again during the operation in 54 of the cases to confirm the ultrasound findings.

RESULTSBOO was diagnosed in 51 of the patients. The coefficient of correlation between the length of IPP and BOO and that between the volume of IPP and BOO were 0.53 and 0.47 (P < 0.01). Not considering the dynamic factors, they were 0.69 and 0.62 (P < 0.01), respectively. BOO was confirmed in patients with the length of IPP > 1.0 cm or the volume > 1.5 ml. There was no significant difference between the results of transrectal ultrasound and the findings during the operation concerning the length and volume of IPP (P > 0.05).

CONCLUSIONThere is a close correlation between the length and volume of IPP and BOO, which can be conveniently applied to the diagnosis of BOO in BPH patients.

Aged ; Humans ; Male ; Middle Aged ; Prostate ; diagnostic imaging ; Prostatic Hyperplasia ; complications ; diagnostic imaging ; Ultrasonography ; Urinary Bladder ; diagnostic imaging ; Urinary Bladder Neck Obstruction ; diagnosis ; etiology ; physiopathology ; Urodynamics

PURPOSES: Transurethral resection of the prostate (TURP) for symptomatic benign prostate hyperplasia (BPH) remains a gold standard for surgical treatment, but significant morbidities are associated with the procedure. Transurethral electro-vaporization of prostate (TVP) using a grooved ball electrode, a modification of standard TURP, was tried on bladder outlet obstruction in an attempt to reduce the morbidity rate of TURP. We compared between the TVP and standard TURP to estimate the efficacy and safety. MATERIALS AND METHODS: A comparative trial of 44 patients with symptomatic BPH from May 1995 to December 1995 was performed. Of the patients 20 were received operation with TVP (Group I) and 24 were received with standard TURP (Group II). Patients were assessed at baseline for both safety and efficacy and in follow-up at 1 and 3 months. Efficacy parameters evaluated included American Urological Association (AUA) symptom score, peak urine flow (Qmax) and postvoid residual urine (ml). Safety parameters evaluated included incidence of side effects, operative time (in minutes), postoperative catheterization time, change in hematocrit and serum sodium. RESULTS: The mean age of each group was 63.7+-6.4 years (Group I) and 68.8+-7.6 years (Group II), the prostate size was 32.4+-3.4g and 34.5+-6.5g. The mean operation time was shorter in Group I (56+-11min) than Group II (85+-34min), (P<0.05). The change of Hematocrit(ml/dl) was lower in group I (from 41.1+-5.0 to 39.5+-4.2) than group II (from 39.6+-4.4 to 35.2+-5.5), (P<0.05). The mean catheterization time was 3.3+-1.3 days and 4.8+-1.7 days, (P<0.05). change of maximal flow rate, post-void residual volume and AUA symptom score was not significantly different between each group. The incidence of postoperative complications were not significantly different between each group. CONCLUSIONS: Although the TURP is the gold standard for the treatment of symptomatic BPH with high success rate, but significant morbidities rate are associated with this procedure. So, TVP is new and potentially useful modification of TURP. In this preliminary study, there has been significant clinical improvement maintained with minimal morbidity. This early clinical experience highlights several potential advantages of TVP, including rapid convalescence time, short hospital day, and minimal blood loss. So, TVP is one of the various therapeutic alternatives for BPH lowering the morbidity rate of standard TURP.
Catheterization ; Catheters ; Convalescence ; Electrodes ; Follow-Up Studies ; Hematocrit ; Humans ; Hyperplasia ; Incidence ; Operative Time ; Postoperative Complications ; Prostate* ; Residual Volume ; Sodium ; Transurethral Resection of Prostate ; Urinary Bladder Neck Obstruction

OBJECTIVETo analyze the value of the diagnostic criteria for bladder outlet obstruction in benign prostatic hyperplasia (BPH).

METHODSA total of 358 patients with BPH were divided into 3 grades according to fibrous urethrocystoscopy information on the severity of obstructions, which were classified as Grade 1 (slight), Grade 2 (moderate), and Grade 3 (severe). By Schäfer's graph they were divided into 7 grades, represented by 0 to VI. We analyzed the volume of prostate, maximum flow rate (Qmax), residual urine volume, International Prostatic Symptom Score (IPSS) and detrusor instability. Statistical analysis ANOVA (analysis of variance) was made, spearman correlation evaluated and the coefficient of determination measured.

RESULTSOf all the patients, 27 were classified as Grade 1, 236 as Grade 2 and 95 as Grade 3. Eighty-four patients had detrusor instability. The volumes of the prostate ranged from 16 ml to 145 ml, averaging (47.04 +/- 15.61) ml. The mean maximum flow rate was (10.02 +/- 2.12) ml/min and the mean residual urine volume was (84.06 +/- 36.50) ml. With the increase of the severity of obstruction, the volume of the prostate increased (F = 4.216, P < 0.05), IPSS rose (F = 8.408, P < 0.001), the maximum flow rate decreased (F = 22.43, P < 0.001), the residual urine volume rose (F = 163.232, P < 0.001), the incidence of detrusor instability increased (F = 23.637, P < 0.001) and Schäfer's grades were elevated (F = 202.897, P < 0.001). The volume of the prostate, the maximum flow rate (Qmax), residual urine volume, IPSS detrusor instability and Schäfer's grades were all correlated significantly with the severity of the obstruction. The correlation index and coefficient of determination were r = 0.29, R2 = 0.08; r = 0.35, R2 = 0.12; r = -0.69, R2 = 0.47; r = 0.60, R2 = 0.36; r = 0.33, R2 = 0.11; r = 0.72, R2 = 0.52; respectively. The correlation between the urethrocystoscopy information and Schäfer's graph on the severity of the obstruction were the best criteria of all.

CONCLUSIONThe severity of the obstruction at urethrocystoscopy correlates well with that at urodynamic investigation. Such criteria could improve the sensitivity and specificity of the diagnosis of bladder outlet obstruction.

Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; complications ; diagnosis ; Retrospective Studies ; Urinary Bladder Neck Obstruction ; diagnosis ; etiology ; Urodynamics

OBJECTIVEApplying bladder outlet obstruction number (BOON) to predict bladder outlet obstruction (BOO) of benign prostatic hyperplasia (BPH).

METHODSSeventy-six male who were suspected to suffer from BOO due to BPH with lower urinary tract symptoms were evaluated. The data included prostate volume (by transrectal prostate ultrasound), maximum urine flow rate (Qmax) and mean voided volume to calculate the BOON by simple algorithm: prostate volume (cm(3))-3 x Qmax (ml/s)-0.2 x mean voided volume (ml). Pressure-flow study was also performed on each patient to get AG number and Schäfer obstruction grade. Correlation between traditional parameters, BOON and AG number was calculated to evaluate the price of using BOON to predict BOO.

RESULTSParameters such as age, prostate volume, maximum urine flow rate, residual urine and BOON were used as independent and AG was used as dependent to calculated the multiple linear regression. Data expressed the entire regression equation's R = 0.542 (P = 0.000), and result showed BOON had the strongest relationship with AG (P = 0.000). Eighteen patients' BOON number were greater than -10, by AG number and Schäfer obstruction grade proving, all these patients were suffered from BOO, the sensitivity and the specificity of judging BOO by BOON were 31% and 100% respectively. While take BOON as -20, the sensitivity and the specificity were 42.4% and 88.2%, when take BOON as -30, the sensitivity and the specificity were 66.1% and 82.4%, respectively. Fifty-two persons' BOON were greater than -40, 46 patients suffered from BOO, the sensitivity and the specificity were 77.9% and 64.7%, the specificity and the opportunity of having BOO decreased significantly. The data showed that: taking BOON = -30 as critical point can predict BOO with higher sensitivity and specificity, greater BOON means greater possibility of BOO.

CONCLUSIONSUsing BOON which is deduced from prostate volume, maximum urine flow rate and mean voided volume, the point -30 as critical point, can predict the probability of BOO with higher sensitivity and specificity.

Aged ; Aged, 80 and over ; Humans ; Linear Models ; Male ; Middle Aged ; Prostatic Hyperplasia ; complications ; Sensitivity and Specificity ; Urinary Bladder Neck Obstruction ; diagnosis ; etiology ; Urodynamics