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

Humans ; Magnetic Resonance Imaging ; Male ; Prostatectomy/methods* ; Urinary Bladder Neck Obstruction/etiology*

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

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

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

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 study the relationship between the degree of bladder outlet obstruction (BOO), detrusor contractility and residual urine in patients suffering from benign prostatic hyperplasia (BPH).

METHODSIn 181 patients with BPH, degree of BOO, detrusor contractility, residual urine caculated from cathetering combined with the difference between the filling and the voiding were recorded and analysized statistically using urodynamic technique.

RESULTSResidual urine increased when the detusor contractility was weakened (F = 12.134, P = 0.001). In patients wih severe BOO, there was no significant difference in residual urine (F = 2.386, P = 0.071).

CONCLUSIONSIncreased residual urine is mainly resulted from decreased detrusor contractility. BOO has no significant influence on residual urine. Some patients with normal or weakened detrusor contractility may have more residual urine.

Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Muscle Contraction ; physiology ; Muscle Hypertonia ; physiopathology ; Prostatic Hyperplasia ; complications ; physiopathology ; Urinary Bladder ; physiopathology ; Urinary Bladder Neck Obstruction ; etiology ; physiopathology ; Urination Disorders ; etiology ; physiopathology ; Urodynamics ; physiology

OBJECTIVESTo explore the parameters of prostate volume measured by TRUS in diagnosing bladder outlet obstruction (BOO) from BPH.

METHODSProstate volume(PV), transition zone volume(TZV) and transition zone index (TZI) were measured with TRUS in 116 cases of BPH aged from 59-75. Urodynamics were conducted, including Qmax, Pdet. Qmax and AG value. The correlation analysis was performed among them.

RESULTSPV, TZV and TZI were (69.7 +/- 45.9) ml, (43.5 +/- 25.6) ml and 0.57 +/- 0.14, respectively. Qmax, Pdet. Qmax and AG were (8.31 +/- 5.12) ml/s, (82.34 +/- 33.47) cm H2O and 66.72 +/- 30.46, respectively. IPSS and PSA were 25.3 +/- 4.7 and (4.12 +/- 3.64) ng/ml, respectively. The correlation analysis showed TZI (r = 0.742, P = 0.017) and TZV (r = 0.674, P = 0.031) were positively correlated with AG value. IPSS was positively correlated with TZV and TZI. There was also a positive correlation between PSA and PV, TZV and TZI.

CONCLUSIONSAs urodynamics, the parameters of prostate volume measured by TRUS are reliable to diagnose BOO due to BPH.

Aged ; Humans ; Male ; Middle Aged ; Prostate ; diagnostic imaging ; Prostate-Specific Antigen ; analysis ; Prostatic Hyperplasia ; complications ; diagnostic imaging ; Ultrasonography ; Urinary Bladder Neck Obstruction ; diagnostic imaging ; etiology ; Urodynamics

OBJECTIVESTo study residual fraction (RF) in the bladder outlet obstruction (BOO) resulting from benign prostatic hyperplasia (BPH).

METHODSFifty adult outpatients with BPH were evaluated. With ultrasound and uroflowmetry, prevoid volume (PV) and postvoid residual volume (PRV) and peak flow rate (Qmax) were determined. Linear dependence analysis of RF and Qmax, PRV and Qmax were conducted.

RESULTSThe coefficient between RF and Qmax showed extremely negative correlation(r = -0.3859, P < 0.01). Also, PRV and Qmax showed significant negative correlation (r = -0.2831, P < 0.05).

CONCLUSIONSThe greater the RF, the more serious the BOO, the poorer potency of bladder. It is recommended that RF be used as a good supplement to PVR in the routine non-invasive evaluation of BOO caused by BPH.

Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prostatic Hyperplasia ; complications ; physiopathology ; Ultrasonography ; Urinary Bladder Neck Obstruction ; diagnostic imaging ; etiology ; physiopathology ; Urodynamics