PURPOSE: The aim of this study was to compare the penile cuff test (PCT) and standard pressure-flow study (PFS) in patients with bladder outlet obstruction. MATERIALS AND METHODS: A total of 58 male patients with moderate to severe lower urinary tract symptoms (LUTS) were selected. Seven patients were excluded; thus, 51 patients were finally enrolled. Each of the patients underwent a PCT and a subsequent PFS. The sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio were calculated. Chi-square and Fisher exact test were used to evaluate relationships between PCT results and maximal urine flow (Qmax); a p<0.05 was considered statistically significant. RESULTS: The mean (±standard deviation) age of the study group was 65.5±10.4 years. Overall, by use of the PCT, 24 patients were diagnosed as being obstructed and 27 patients as unobstructed. At the subsequent PFS, 16 of the 24 patients diagnosed as obstructed by the PCT were confirmed to be obstructed, 4 were diagnosed as unobstructed, and the remaining 4 patients appeared equivocal. Of the 27 patients shown to be unobstructed by the PCT, 25 were confirmed to not be obstructed by PFS, with 13 equivocal and 12 unobstructed. Two patients were diagnosed as being obstructed. For detecting obstruction, the PCT showed an SE of 88.9% and an SP of 75.7%. The PPV was 66.7% and the NPV was 93%. CONCLUSIONS: The PCT is a beneficial test for evaluating patients with LUTS. In particular, this instrument has an acceptable ability to reject obstruction caused by benign prostatic hyperplasia.
Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Nomograms ; Penis/physiopathology ; Predictive Value of Tests ; Pressure ; Sensitivity and Specificity ; Urinary Bladder Neck Obstruction/*diagnosis/physiopathology ; Urination/physiology ; Urodynamics

We performed a retrospective, case-control study to evaluate whether the urine flow acceleration (UFA, mL/s(2)) is superior to maximum uroflow (Qmax, mL/s) in diagnosing bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH). In this study, a total of 50 men with BPH (age: 58±12.5 years) and 50 controls (age: 59±13.0 years) were included. A pressure-flow study was used to determine the presence of BOO according to the recommendations of Incontinence Control Society (ICS). The results showed that the UFA and Qmax in BPH group were much lower than those in the control group [(2.05±0.85) vs. (4.60±1.25) mL/s(2) and (8.50±1.05) vs. (13.00±3.35) mL/s] (P<0.001). According to the criteria (UFA<2.05 mL/s(2), Qmax<10 mL/s), the sensitivity and specificity of UFA vs. Qmax in diagnosing BOO were 88%, 75% vs. 81%, 63%. UFA vs. Omax, when compared with the results of P-Q chart (the kappa values in corresponding analysis), was 0.55 vs. 0.35. The prostate volume, post void residual and detrusor pressure at Qmax between the two groups were 28.6±9.8 vs. 24.2±7.6 mL, 60.4±1.4 vs. 21.3±2.5 mL and 56.6±8.3 vs. 21.7±6.1 cmH2O, respectively (P<0.05). It was concluded that the UFA is a useful urodynamic parameter, and is superior to Qmax in diagnosing BOO in patients with BPH.
Case-Control Studies ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; physiopathology ; Retrospective Studies ; Urinary Bladder Neck Obstruction ; diagnosis ; physiopathology ; Urine ; physiology

The goal of this study was to evaluate the clinical and urodynamic features in Korean men with lower urinary tract symptoms (LUTS) and to determine non-invasive parameters for predicting bladder outlet obstruction (BOO). Four hundred twenty nine Korean men with LUTS over 50 yr of age underwent clinical evaluations for LUTS including urodynamic study. The patients were divided into two groups according to the presence of BOO. These two groups were compared with regard to age, the results of the uroflowmetry, serum prostate-specific antigen (PSA) level, prostate volume, International Prostate Symptom Score (I-PSS), and the results of the urodynamic study. Patients with BOO had a lower maximal flow rate (Q(max)), lower voided volume, higher serum PSA level and larger prostate volume (P<0.05). BOO group had a significantly higher rate of involuntary detrusor contraction and poor compliance compared to the patients without BOO (P<0.05). The multivariate analysis showed that Q(max) and poor compliance were significant factors for predicting BOO. Our results show that Q(max) plays a significant role in predicting BOO in Korean men with LUTS. In addition, BOO is significantly associated with detrusor dysfunction, therefore, secondary bladder dysfunction must be emphasized in the management of male patients with LUTS.
Aged ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prostate-Specific Antigen/blood ; Republic of Korea ; Severity of Illness Index ; Urinary Bladder Neck Obstruction/complications/*diagnosis/physiopathology ; Urination Disorders/complications/*diagnosis ; *Urodynamics

Seeing that the invasive measuring technique has many disadvantages, we have designed a noninvasive technical system for measuring isovolumetric bladder pressure by controlled inflation of a penile cuff. This system is easy-to-use and the measuring result provides quantitative information on isovolumetric bladder pressure during voiding. The doctor can discriminate obstruction from non-obstruction according to the data of measurement and flow rate.
Humans ; Male ; Middle Aged ; Penis ; physiology ; Pressure ; Signal Processing, Computer-Assisted ; Urinary Bladder ; physiopathology ; Urinary Bladder Neck Obstruction ; diagnosis ; physiopathology ; Urodynamics ; Urology ; instrumentation

OBJECTIVETo evaluate the measurement of intravesical prostatic protrusion (IPP) by transabdominal ultrasonography (TAUS) in the diagnosis of benign prostatic obstruction (BPO).

METHODSWe studied the clinical data of 109 BPH patients referred for lower urinary tract symptoms (LUTS) from April 2005 to December 2006. IPP was measured by TAUS, urodynamic parameters such as Qmax and PdetQmax obtained by urodynamic studies and AG values calculated. The patients were divided into an obstruction and a non-obstruction group according to their AG values.

RESULTSIPP was found statistically different between the obstruction and non-obstruction groups (P<0.001) and positively correlated with the AG value (r=0.729, P=0.001). With the cutoff at IPP > or = 10 mm for the diagnosis of BPO, the sensitivity, specificity and accuracy of the diagnosis were 89.9%, 97.5% and 92.7%, respectively.

CONCLUSIONThe measurement of IPP by TAUS offers a valuable help for the diagnosis of BPO.

Aged ; Aged, 80 and over ; Endosonography ; methods ; Humans ; Male ; Middle Aged ; Prostate ; diagnostic imaging ; Prostatic Hyperplasia ; diagnostic imaging ; physiopathology ; Reproducibility of Results ; Sensitivity and Specificity ; Urinary Bladder ; diagnostic imaging ; physiopathology ; Urinary Bladder Neck Obstruction ; diagnosis ; physiopathology ; Urodynamics

OBJECTIVETo investigate the changes and its clinical significance of ultrasound evaluated bladder wall weight (UEBW) pre and after surgery in patients with benign prostatic hyperplasia (BPH).

METHODSThe clinical data of 63 patients of benign prostatic hyperplasia and 30 of contrast control were studied. The bladder wall weight was calculated by subtracting the volume of sphere represented by the urine volume inside the bladder from the volume of the sphere representing the whole bladder (sphere with a radius = internal radius + bladder wall thickness). Bladder outlet obstruction (BOO) and bladder function was evaluated by urodynamic studies. Of the 63 patients with BPH, UEBW was (97 +/- 54) g, while the control group was only (41 +/- 14) g. UEBW was found to be significantly correlated with LinPURR grade (R = 0.47, P < 0.01) and positive residual urine volume (R = 0.48, P < 0.01), and it was negatively correlated with Qmax (R = -0.52, P < 0.01) and detrusor contraction strength (presented as WF, R = -0.4, P < 0.05).

RESULTSA significant difference was found between the UEBW pre and after surgery [(99 +/- 50) g vs. (56 +/- 21) g, t = 5.05, P < 0.01)]. UEBW decreased 43.68%, and IPSS score decreased 16.81 point, while Qmax increased 8.38 ml/s.

CONCLUSIONAs an non-invasive methods, measurement of bladder wall weight appears to be a useful marker in evaluating status before operation and in monitoring the effect of surgery for patients with BPH.

Humans ; Male ; Middle Aged ; Organ Size ; Prostatic Hyperplasia ; complications ; pathology ; surgery ; Time Factors ; Transurethral Resection of Prostate ; Treatment Outcome ; Urinary Bladder ; pathology ; physiopathology ; Urinary Bladder Neck Obstruction ; diagnosis ; etiology ; Urodynamics

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

AIMTo compare the use of the suprapubic puncture method versus the transurethral method in pressure-flow studies in patients with benign prostatic hyperplasia.

METHODSTwenty-three men with benign prostatic hyperplasia underwent both suprapubic and transurethral pressure-flow studies during a single session. Standard pressure-flow variables were recorded in all patients with both methods, enabling calculation of obstruction using commonly used grading systems, such as the urethral resistance algorithm, the Abrams-Griffith (AG) number and the Schaer linear nomogram.

RESULTSThere were statistically significant differences between the methods in the mean values of maximum flow rate (P < 0.05), detrusor pressure at the maximum flow (P < 0.01), urethral resistance algorithm (P < 0.01), AG number (P < 0.01) and maximum cystic capacity (P < 0.01). Of the men in the study, 10 (43.5%) remained in the same Schaer class with both methods and 18 (78.3%) in the same AG number area. Using the transurethral method, 12 (52.2%) men increased their Schaer class by one and 1 (4.3%) by two. There were also differences between the suprapubic and transurethral methods using the AG number: 4 (17.4%) men moved from a classification of equivocal to obstructed and 1 (4.3%) from unobstructed to equivocal.

CONCLUSIONThe differences between the techniques for measuring intravesical pressure alter the grading of obstruction determined by several of the commonly used classifications. An 8 F transurethral catheter significantly increases the likelihood of a diagnosis of bladder outlet obstruction when compared with the suprapubic method.

Aged ; Humans ; Male ; Middle Aged ; Pressure ; Prostatic Hyperplasia ; physiopathology ; Punctures ; Urinary Bladder Neck Obstruction ; diagnosis ; Urinary Catheterization ; Urination ; physiology ; Urodynamics