Cause Of Bladder Outflow Obstruction Research Articles

To Determine the Association of Transabdominal Sonographic Findings of Prostatic Volume and Post Void Residual Urine with the Severity of Symptoms as per International Prostate Symptom Score, in Cases of Benign Prostate Hypertrophy

Abstract Introduction: Benign prostatic hyperplasia is a common condition in elderly men and is a major cause of bladder outflow obstruction. Various parameters are used in clinical practice, to be able to assess the severity of the enlarged prostate and its direct effect on the quality of life of the patient in terms of evaluation of lower urinary tract symptoms (LUTSs). These are the International Prostate Symptom Score (IPSS); urodynamic studies such as uroflowmetry, measurement of postvoid residual urine (PVRU), prostatic volume (PV), intravesical prostatic protrusion, and digital rectal examination. Out of these, sonographic measurement of prostate volume and postvoid residual urine is the most widely used and readily available noninvasive methods. The present hospital-based study aims to establish an association between the PV, PVRU, and clinical symptom scores derived as per IPSS. Methods: This prospective, hospital-based study was done over a sample group of 748 symptomatic males with LUTS, referred from outpatient departments over a period of 2 years, for the assessment of PV and postvoid residual urine. The ordinal data sets were compared using the Chi-square test and a P < 0.05 was taken as statistically significant. Results: The Chi-square statistics for the association of prostate volume with IPSS were 13.1678. P value was = 0.01. The Chi-square statistics for the association between PVRU and IPSS scores were 1.613. P value was = 0.80645. Conclusion: The results derived from the data establish that the statistical association between prostate volume and IPSS scores is weakly significant and association between PVRU and IPSS scores is not statistically significant at all.

Outcome of boys with posterior urethral valves from a single tertiary hospital in Singapore.

Posterior urethral valve (PUV) is the most common congenital cause of bladder outflow obstruction in male infants. Despite timely treatment, renal damage can still occur in the long-term leading to chronic kidney disease (CKD). A retrospective review of all PUV patients in a single tertiary institution between April 1998 and July 2019 was conducted to analyze their presentations, management and outcomes. Long-term renal function, radiologic scans and somatic growth were evaluated. A total of 16 patients were included in this study. Two patients who defaulted all follow-ups were excluded. Seven patients (43.7%) presented in the antenatal period; four patients (25%) presented in the neonatal period and five patients (31.3%) presented in the post-neonatal period. Primary transurethral fulguration of valves was done in 13 patients, while three had vesicostomies as the primary procedure. Three patients had associated anterior urethral valves (AUV), which were treated endoscopically. Nine boys had additional procedures for diversion and undiversion, VUR, non-functioning kidney and clean intermittent catheterization. Ten patients had urodynamic studies performed, of which eight patients received anticholinergic therapy. Eleven patients had DMSA scans, of which three patients had a normal study and eight patients showed unilateral reduced function. Four patients were diagnosed with CKD on long-term follow-up duration over 5 years. All patients were shown to have good somatic growth. Patients with PUV can suffer from complications despite primary treatment. In our small cohort, a quarter of our patients developed CKD on follow-up. Thus, patients need long-term follow-up to optimize bladder and renal function.

Aetiology of Urinary Outflow Obstruction at a tertiary Care Hospital in Bangladesh

Background: There are several etiologies of urinary tract obstructions.Objective: The purpose of the present study was to find out the etiology of urinary tract obstructions. Methodology: This cross-sectional study was conducted in the Department of Surgery at Rajshahi Medical College, Rajshahi, Bangladesh from September 1994 to December 1995 for a period of one year and three months. All the patients who were presented with bladder outflow obstruction and were admitted in the general surgical unit of the hospital were taken as study population.Result: A total number of 50 patients were recruited for this study. The most frequent cause of bladder outflow obstruction was benign enlargement of prostate (26.0%), next common cause was impacted urethra stone (22.0%) and stricture urethra (22.0%). Rupture urethra was found in 7(14.0%) cases and carcinoma of prostate was found in 3(6.0%) cases.Conclusion: In conclusion the most frequent cause of bladder outflow obstruction is benign enlargement of prostate, impacted urethra stone and stricture urethra.Journal of Current and Advance Medical Research 2018;5(1):3-6

Zinner syndrome: an unusual cause of bladder outflow obstruction

Zinner syndrome is a rare condition comprising a triad of unilateral renal agenesis, ipsilateral seminal vesicle obstruction and ipsilateral ejaculatory duct obstruction. The mutual embryological origins of the seminal vesicle and the ureteral bud result in both anomalous genital and urinary tracts. We present the case of a 39-year-old patient where the initial presentation of this condition was bladder outflow obstruction. In this paper, we discuss the embryological origin of this condition, the range of imaging tools used to diagnose Zinner syndrome and the inherent benefits and shortcomings of each modality.

A Review of Laser Treatment for Symptomatic BPH (Benign Prostatic Hyperplasia).

Benign prostatic hyperplasia (BPH) is the predominant cause of bladder outflow obstruction and is associated with significant morbidity. Surgical removal of adenoma has been a key treatment principle for alleviation of obstruction. Lasers have been used as an alternative to transurethral resection of the prostate (TURP), due to the higher complications of the latter procedure, since the early 1990s. Early generations of lasers utilized coagulative and ablative techniques to dis-obstruct the bladder. Ablative techniques have remained popular with the resurgence of 532-nm vaporization (commonly known as GreenLight). Enucleation techniques especially with the holmium laser have shown durable efficacy in randomized controlled trials whilst new modalities such as thulium still require long-term data. This review examines the most common types of laser technology used in BPH surgery, with a focus on efficacy and side effect profile.

Timing of morphologic and apoptotic changes in the sheep fetal kidney in response to bladder outflow obstruction

Purpose Posterior urethral valves are the main cause of bladder outflow obstruction in human fetuses. Thirty per cent of boys with valves develop end-stage renal disease, despite intervention in the postnatal period. The timing and mechanisms of renal damage in bladder outflow obstruction are unknown. We investigated the timing of changes in morphology and apoptosis in the fetal sheep kidney in response to obstruction. Materials and methods Thirty-three fetal lambs at day 70 of gestation underwent surgical creation of bladder outflow obstruction. Twenty-nine fetal lambs had sham surgery. Fetal kidneys were collected 2, 5, 10, 20 and 30 days after surgery. Renal histology was examined. Real-time PCR was used to quantify the renal cortical expression of the pro-apoptotic gene Bax and anti-apoptotic gene Bcl-X. The TUNEL technique was used to assess regional renal apoptosis in response to obstruction. Results Changes in renal morphology were evident as early as 2 days after surgery in fetuses with bladder outflow obstruction, and progressed over 20–30 days to cystic renal dysplasia. Bladder outflow obstruction increased the renal cortical expression of Bax relative to Bcl-X. Tubular apoptosis peaked after 2 days of obstruction. Blastemal apoptosis peaked after 5 days of obstruction. Conclusions Changes in pro- and anti-apoptotic gene expression in the fetal renal cortex, and alterations in the number of apoptotic cells and renal morphology are evident soon after the onset of bladder outflow obstruction. These findings suggest that damage to the developing fetal kidney begins to occur at the onset of obstruction. Attempts to preserve renal function by antenatal interventions may best be achieved by early treatment.

The use of sacral reflex latencies in detrusor bladder neck dyssynergia.

Detrusor bladder neck dyssynergia (DBND) is a well recognised cause of bladder outflow obstruction, especially in the younger man. The cause is unknown, and the aim of this study was to determine if any neurological dysfunction is associated with this condition. Twenty-five males with proven DBND had sacral reflex latency studies performed. The conduction latencies indicate that the underlying cause is unrelated to any demonstrable neuropathy. Sacral reflex latencies are not helpful in the investigation of DBND.