Humans ; Male ; Prostatic Hyperplasia ; complications ; Quality of Life ; Urinary Bladder, Overactive ; complications

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

OBJECTIVETo investigate the urodynamic features in patients of benign prostatic hyperplasia (BPH) with coexisting overactive bladder (OAB).

METHODSClinical data of 235 patients with symptomatic BPH who underwent urodynamic examination during January 2009 to May 2010 were retrospectively analyzed. Patients were divided into group of pure BPH, BPH with detrusor overactivity (DO), BPH with coexisting OAB without DO and BPH with coexisting OAB with DO. The difference of age, International Prostate Symptom Score (IPSS), transrectal ultrasound (TRUS)-volume, maximum flow rate, residual urine volume, bladder volume of first sensation, bladder volume of strong sensation, bladder outlet obstruction index (BOOI) and the prevalence of decreased detrusor contractility were compared between these groups. The urodynamic characteristics of DO between group of BPH with DO and group of BPH coexisting OAB and DO were analyzed.

RESULTSA total of 219 cases were included in the final analysis, with mean age of (66 ± 8) years, mean TRUS-volume was (35 ± 24) ml, mean maximum flow rate was (11 ± 6) ml/s. Of the 219 patients, 93 patients (42.5%) had pure BPH, 11 patients (5.0%) had BPH with DO, 52 patients (23.7%) had BPH coexisting OAB without DO, 63 patients (28.8%) had BPH coexisting OAB and DO. Comparing to group of BPH (n = 104), patients with BPH and OAB (n = 115) were older, had higher IPSS, bigger TRUS-volume, less bladder volume of first sensation and strong sensation, higher BOOI and higher prevalence of decreased detrusor contractility. Comparing to group of BPH with coexisting OAB without DO patients, patients of BPH with coexisting OAB and DO had higher IPSS score (19 ± 12 vs 17 ± 10), bigger TRUS-volume [(51 ± 33) ml vs (43 ± 27) ml], higher BOOI (49 ± 18 vs 37 ± 14). Comparing to patients pure BPH, patients of BPH with DO had less bladder volume of first sensation and bladder volume of strong sensation [(82 ± 41) ml vs (118 ± 35) ml;(335 ± 67) ml vs (419 ± 53) ml]. Comparing to group of BPH with DO, patients of BPH with coexisting OAB and DO had higher maximum DO pressure [(45 ± 36) cmH2O vs (39 ± 30) cmH2O (1 cmH2O = 0.098 kPa)] and longer DO time [(7 ± 4) s vs (6 ± 4) s].

CONCLUSIONSThe urodynamic features in patients with BPH differ greatly and these information should be helpful in making choice of treatment and in predicting treatment outcomes.

Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; complications ; physiopathology ; Retrospective Studies ; Urinary Bladder, Overactive ; complications ; physiopathology ; Urodynamics

PURPOSE: We compared bladder and urethral functions following radical prostatectomy (RP) between men with and without urinary incontinence (UI), using a large-scale database from SNU-experts-of-urodynamics-leading (SEOUL) Study Group. MATERIALS AND METHODS: Since July 2004, we have prospectively collected data on urodynamics from 303 patients with lower urinary tract symptoms (LUTS) following RP at three affiliated hospitals of SEOUL Study Group. After excluding 35 patients with neurogenic abnormality, pelvic irradiation after surgery, or a history of surgery on the lower urinary tract, 268 men were evaluated. We compared the urodynamic findings between men who had LUTS with UI (postprostatectomy incontinence [PPI] group) and those who had LUTS without UI (non-PPI group). RESULTS: The mean age at an urodynamic study was 68.2 years. Overall, a reduced bladder compliance (< or =20 mL/cmH2O) was shown in 27.2% of patients; and 31.3% patients had idiopathic detrusor overactivity. The patients in the PPI group were older (p=0.001) at an urodynamic study and had a lower maximum urethral closure pressure (MUCP) (p<0.001), as compared with those in the non-PPI group. Bladder capacity and detrusor pressure during voiding were also significantly lower in the PPI group. In the logistic regression, only MUCP and maximum cystometric capacity were identified as the related factor with the presence of PPI. CONCLUSIONS: In our study, significant number of patients with LUTS following RP showed a reduced bladder compliance and detrusor overactivity. PPI is associated with both impairment of the urethral closuring mechanism and bladder storage dysfunction.
Aged ; Humans ; Male ; Middle Aged ; Prospective Studies ; Prostatectomy/*adverse effects/methods ; Urethra/*physiopathology ; Urinary Bladder/*physiopathology ; Urinary Bladder, Overactive/complications ; Urinary Incontinence/*etiology/physiopathology ; 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

OBJECTIVETo measure the levels of urinary prostaglandins E2 (PGE2) in benign prostatic hyperplasia (BPH) patients with or without overactive bladder (OAB) symptoms and determine whether urinary PGE2 can serve as a biomarker for BPH-related OAB.

METHODSThis study included 86 BPH patients and 34 male control subjects without lower urinary tract symptoms. Based on the OAB symptom scores (OABSS), the BPH cases were classified as BPH/OAB (n =49) and BPH/non-OAB (n = 37) to be treated orally with tamsulosin alone and tamsulosin + tolterodine-tartrate, respectively, for 12 weeks. We measured the urinary PGE2 levels of all the subjects by ELISA before and after medication, the total PGE2 level normalized to the concentration of the urinary creatinine (PGE2/Cr). We also obtained the residual urine volume, Qmax, prostate volume, PSA level, IPSS and OABSS of the BPH patients, and compared them among different groups.

RESULTSThe baseline PGE2/Cr level was significantly lower in the control than in the BPH/OAB and BPH/non-OAB groups (both P <0.05), and higher in the BPH/OAB than in the BPH/non-OAB patients (P <0.05). After 12 weeks'treatment, the urinary PGE2/Cr level was remarkably decreased with relief of the OAB symptoms in the BPH/OAB patients (P <0.05) , but not in the BPH/non-OAB group (P >0.05). The concentration of PGE2 was not correlated with the IPSS storage score and OABSS of the BPH/OAB patients (P >0.05).

CONCLUSIONPatients with BPH/OAB have significantly higher urinary PGE2/Cr levels than those with BPH/non-OAB and normal controls, which tend to decrease with the alleviation of OAB symptoms. Our findings suggest that urinary PGE2 can be a potential biomarker for BPH/OAB.

Aged ; Biomarkers ; urine ; Case-Control Studies ; Dinoprostone ; urine ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; complications ; urine ; Urinary Bladder, Overactive ; complications ; urine

OBJECTIVETo assess the effectiveness and safety of the alphala/d blocker naftopidil in the treatment of benign prostatic hyperplasia (BPH) patients with overactive bladder (OAB) symptoms.

METHODSFifty BPH patients with OAB symptoms were treated with naftopidil at the dose of 25 mg/d for 6 weeks. A self-controlled clinical trial was conducted. The effectiveness and safety of the drug were observed by comparing the International Prostate Symptom Scores (IPSS), quality of life indexes (QOL), maximum urinary flow rates (Qmax) , average urinary flow rates (Qave), voiding volumes (VV), blood pressures (BP) and heart rates (HR) obtained before and after the treatment.

RESULTSAfter 6 weeks' medication, the 46 assessable cases showed an average decrease of 9.75 in IPSS (P < 0.01), 3.97 in voiding symptom score (P < 0.01), 5.78 in urinary storage symptom score (P < 0.01) and 1.95 in QOL (P < 0.01), and a mean increase of 4.29 ml/s in Qmax (P < 0.01), 3.75 ml/s in Qave (P < 0.01) and 55.12 ml/s in VV (P < 0.05). But no significant changes were observed in BP and HR. Only 1 patient (4.35%) experienced the adverse event of dizziness.

CONCLUSIONThe alphalA/D blocker naftopidil is both effective and safe in the treatment of BPH patients with OAB symptoms.

Adrenergic alpha-Antagonists ; therapeutic use ; Aged ; Humans ; Male ; Middle Aged ; Naphthalenes ; therapeutic use ; Piperazines ; therapeutic use ; Prostatic Hyperplasia ; complications ; drug therapy ; Urinary Bladder, Overactive ; complications ; drug therapy

OBJECTIVETo evaluate the effectiveness of the monotherapy of Cardura and the combination therapy of Cardura and Tolterodine L-Tartrate Tablets for II° ? benign prostate hyperplasia (BPH) with overactive bladder (OAB).

METHODSThis study included 87 cases of BPH with OAB, with a disease course > or = 3 months, daily urination > or = 8 times, nocturnal urination > or = 2 times, urine volume < 200 ml per time, International Prostate Symptom Score (IPSS) > or = 8, OAB symptom score (OABS) > or = 3, quality of life score (QOL) > or = 3, post-void residual (PVR) < or = 100 ml, maximum urinary flow (Qmax) > or = 5 ml/s, prostate weight 25-50 g, and PSA < 4 microg/L. We randomized the patients to a monotherapy group (n = 44) and combination group (n = 43), the former treated with Cardura 4 mg qd, and the latter with Cardura 4 mg + Tolterodine L-Tartrate Tablets 4 mg qd, both for 8 weeks. Then we recorded the IPSS, OABS, Qmax, PVR, PSA, and adverse events.

RESULTSThe baseline parameters showed no significant differences between the two groups (P > 0.05). In comparison with the baseline, both the monotherapy group and the combination therapy group showed significant decreased in the IPSS (16.50 +/- 4.27 vs 13.68 +/- 3.69 and 15.51 +/- 3.80 vs 11.49 +/- 2.75), urine storage symptom score (10.48 +/- 2.75 vs 7.98 +/- 2.34 and 9.47 +/- 2.31 vs 5.74 +/- 1.66), OABS (8.55 +/- 2.69 vs 6.32 +/- 1.97 and 8.21 +/- 2.55 vs 4.44 +/- 1.62), urgent micturition score (4.25 +/- 1.06 vs 3.23 +/- 0.99 and 4.07 +/- 0.83 vs 2.26 +/- 1.05), QOL (5.36 +/- 0.72 vs 3.43 +/- 0.66 and 5.07 +/- 0.86 vs 2.37 +/- 0.76) and PVR ([44.55 +/- 22.39] vs [38.30 +/- 20.20] ml and [36.19 +/- 21.21] vs [24.98 +/- 17.60] ml) (P < 0.01). All the six parameters were significantly more improved in the combination therapy group than in the monotherapy group (P < 0.01), but there were no remarkable differences between the groups in Qmax and voiding symptom score (P > 0.05). Neither group exhibited significant changes in the PSA level and prostate weight after treatment as compared with the baseline (P > 0.05). No acute urinary retention and other severe adverse reactions were observed during the medication.

CONCLUSIONBoth Cardura monotherapy and the combination therapy of Cardura + Tolterodine L-Tartrate Tablets can improve II ? BPH with OAB, and the latter has an even better efficacy than the former.

Aged ; Benzhydryl Compounds ; therapeutic use ; Cresols ; therapeutic use ; Doxazosin ; therapeutic use ; Drug Therapy, Combination ; Humans ; Male ; Middle Aged ; Phenylpropanolamine ; therapeutic use ; Prostatic Hyperplasia ; complications ; drug therapy ; Tolterodine Tartrate ; Treatment Outcome ; Urinary Bladder, Overactive ; complications ; drug therapy

OBJECTIVETo evaluate the efficacy and safety of Tolterodine Tartrate combined with the alpha-receptor blocker in the treatment of benign prostatic hyperplasia with detrusor overactivity (BPH-DO).

METHODSA total of 113 patients with BPH-DO were randomly assigned to receive Tolterodine Tartrate combined with Cardura (Group A) and Cardura alone (Group B), both for 12 weeks. Then we recorded and compared their average 24 h urinary frequency, IPSS and QOL score, maximum urinary flow rate, residual urine volume and urinary retention times before and after the treatment.

RESULTSAfter the treatment, Group A showed significantly better improvement in the average 24 h urinary frequency and scores on IPSS and QOL than Group B. No significant differences were found between the two groups in the maximum urinary flow rate and residual urine volume. No acute urinary retention occurred in either group.

CONCLUSIONThe combined use of Tolterodine Tartrate and the alpha-receptor blocker can effectively relieve the symptoms of dysuria, urinary frequency and urinary urgency in patients with BPH-DO, with neither significant adverse effects on the maximum flow rate and residual urine volume nor increase in the incidence of acute urinary retention.

Adrenergic alpha-Antagonists ; therapeutic use ; Aged ; Benzhydryl Compounds ; therapeutic use ; Cresols ; therapeutic use ; Humans ; Male ; Muscarinic Antagonists ; therapeutic use ; Phenylpropanolamine ; therapeutic use ; Prostatic Hyperplasia ; complications ; drug therapy ; Tolterodine Tartrate ; Treatment Outcome ; Urinary Bladder, Overactive ; complications ; drug therapy

OBJECTIVETo evaluate clinical efficacy of holmium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia (BPH) and overactive bladder (OAB).

METHODSFrom May 2007 to May 2010, a total of 37 patients diagnosed BPH and OAB were treated by holmium laser enucleation of the prostate. After a mean follow-up of 4.9 months postoperatively, indices such as International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum flow rate (Qmax), residual urine volume and video urodynamics were monitored and statistically analyzed.

RESULTSThe mean preoperative IPSS and QOL score were 29.6 ± 5.2 and 4.3 ± 0.9, and decreased to 4.6 ± 1.2 and 1.2 ± 1.0 postoperative. The mean Qmax was (6 ± 3) ml/s preoperative and increased to (21 ± 5) ml/s postoperative. Preoperative average residual urine volume was (167 ± 11) ml, decreased to (41 ± 18) ml after operation. During follow-up, 86.5% patients' symptoms and quality of life improved continuously, however 13.5% patients existed residual postoperative OAB symptoms.

CONCLUSIONSWhen BPH with OAB patients exist bladder outlet obstruction, bladder outlet obstruction should be relieved first then OAB symptoms can be relieved in majority of patients, but some patients have residual symptoms.

Aged ; Aged, 80 and over ; Follow-Up Studies ; Humans ; Lasers, Solid-State ; therapeutic use ; Male ; Middle Aged ; Prostatic Hyperplasia ; complications ; surgery ; Transurethral Resection of Prostate ; methods ; Treatment Outcome ; Urinary Bladder, Overactive ; complications ; surgery