PURPOSE: Benign prostatic hyperplasia (BPH) frequently combines other geriatric diseases, which affect voiding in complicated manner. However, differential diagnosis of BPH attributable to voiding dysfunction in such complicated cases has been difficult. Videourodynamic study, allowing the better correlation of structure and function, have had an important position in the diagnosis of various kind of voiding dysfunction. We compared diagnostic values between traditional pressure-flow study and videourodynamic study in the evaluation of the BPH. MATERIAL AND METHODS: Forty-seven men were subjected to this study, who showed lower urinary tract symptoms (LUTS) secondary to BPH combined with other underlying diseases (cerebrovascular disease, spinal cord injury, diabetes mellitus, Parkinson's disease) which could affect the voiding pattern. Included was patients older than 50 years, with a total International Prostate Symptom Score (IPSS) of 8 points or more. All patients were evaluated with detailed history, physical examination including digital rectal examination, prostate specific antigen (PSA), transrectal ultrasonography (TRUS), and videourodynamic study. Pressure-flow study was additionally performed in 27 patients who had been diagnosed as equivocal or obstructed or unobstructed on videourodynamic findings. RESULTS: The sensitivity of videourodynamic study and pressure-flow procedures was 87% and 55%, respectively, as complete pressure-flow data are not available in 12 patients due to difficult urination by catheterization. The specificity of videourodynamic study and pressure-flow study was 76% and 100%, respectively. Videourodynamic study additionally showed uninhibited bladder contraction and/or detrusor sphincter dyssynergia (internal or external) in 65.1% of the patients, which are not available from pressure-flow study. CONCLUSIONS: To diagnose voiding dysfunction from BPH in complicated case, videourodynamic study showed advantages over pressure-flow study in terms of diagnostic sensitivity, both functional and anatomical informations on lower urinary tract. It is likely that the videourodynamic study is the method of choice for the assessment of voiding dysfunction in BPH combined with other diseases.
Ataxia ; Catheterization ; Catheters ; Diabetes Mellitus ; Diagnosis* ; Diagnosis, Differential ; Digital Rectal Examination ; Humans ; Lower Urinary Tract Symptoms ; Male ; Physical Examination ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; Sensitivity and Specificity ; Spinal Diseases ; Ultrasonography ; Urinary Bladder ; Urinary Tract ; Urination

Purpose: Access block due to the lack of hospital beds causes crowding of emergency departments (ED). We initiated the “boarding restriction protocol” that limits the time of stay in the ED for patients awaiting hospitalization to 24 hours from arrival. The purpose of this study was to determine the effect of the boarding restriction protocol on ED crowding. Materials and Methods: The primary outcome was ED occupancy rate, which was calculated as the ratio of the number of occupying patients to the total number of ED beds. Time factors, such as length of stay (LOS), treatment time, and boarding time, were investigated. Results: The mean of the ED occupancy rate decreased from 1.532±0.432 prior to implementation of the protocol to 1.273±0.353 after (p<0.001). According to time series analysis, the absolute effect caused by the protocol was -0.189 (-0.277 to -0.110) (p=0.001). The proportion of patients with LOS exceeding 24 hours decreased from 7.6% to 4.0% (p<0.001). Among admitted patients, ED LOS decreased from 770.7 (421.4–1587.1) minutes to 630.2 (398.0–1156.8) minutes (p<0.001); treatment time increased from 319.6 (198.5–482.8) minutes to 344.7 (213.4–519.5) minutes (p<0.001); and boarding time decreased from 298.9 (109.5–1149.0) minutes to 204.1 (98.7–545.7) minutes (p<0.001). In pre-protocol period, boarding patients accumulated in the ED during the weekdays and resolved on Friday, but this pattern was alleviated in post-period. Conclusion The boarding restriction protocol was effective in alleviating ED crowding by reducing the accumulation of boarding patients in the ED during the weekdays