Incidence Of Bladder Outlet Obstruction Research Articles

Outcomes of bladder outlet obstruction following extensive vaginal pelvic reconstruction surgery on patient with advanced pelvic organ prolapse.

To evaluate the impact of extensive vaginal pelvic reconstruction surgery (PRS) on advanced pelvic organ prolapse (POP) patients with bladder outlet obstruction (BOO). We conducted a single-center, retrospective analysis of women who received extensive vaginal pelvic reconstruction surgery for advanced POP (POP-Q ≥3) with BOO from January 2006 to January 2016. Data regarding preoperative evaluation, surgical procedure, and postoperative management were abstracted from medical records. Patients were considered to have BOO when detrusor pressure at maximum flow (Dmax) was ≥20 cm H2O and peak flow rate (Qmax) was ≤15 mL/s. Patients with postoperative value of Dmax lower than 20 cm H2O or Qmax higher than 15 mL/s were regarded as objectively cured. A total of 1894 patients with POP stages III or IV were assessed. The incidence of BOO was 22.8% (431/1894) within this patient population of advanced POP. One year after the vaginal PRS, the objective cure rate of BOO was 98.1%. Urodynamic parameters showed a significant increase in Qmax (P < 0.001), while Dmax (P < 0.001) and postvoid residual urine (PVR) (P < 0.001) were significantly decreased. Previous POP surgery, native tissue repair (NTR), PVR ≥200 mL, and maximal cystometric capacity (MCC) ≥500 mL increase the likelihood of persistent BOO in patients. Vaginal PRS demonstrated effectiveness in treating BOO in patients with advanced POP. Irrespective of the types of transvaginal mesh (TVM), using TVM achieved better outcome than did NTR. Previous POP surgery, preoperative PVR ≥200 mL, and MCC ≥500 mL were the risk factors predicting the failure of PRS in improving BOO.

Clinical study and management of bladder outlet obstruction

Background: The incidence of bladder outlet obstruction is different and varied in both age and gender. Hence this study was conducted to assess the incidence, etiology and management of bladder outlet obstruction in patients above 18 years of age in both sexes.Methods: This was a tertiary care hospital based longitudinal study. A total of 100 cases were recruited during the period between 01st June 2014 to 31st May 2016 with objective evidence of bladder outlet obstruction. The subject's demographic data, incidence, etiological factors and clinical presentations of bladder outlet obstruction were recorded on data sheet and analyzed.Results: Male preponderance was observed in the study. Maximum incidence of bladder outlet obstruction was observed in the age group of 60-69 years. The most common cause for bladder outlet obstruction in males was benign prostate hyperplasia (BPH), where as in females the major etiological factor was bladder neck stenosis. Out of 94 cases causing bladder outlet obstruction in males, 37 underwent TURP, 11 cases were treated with alpha blockers like Tamsulosin (medical management), 9 underwent cystolithotripsy, 8 underwent b/l orchidectomy, 7 underwent radical cystectomy and ileal conduit, 7 underwent VIU, 7 underwent urethroplasty, 5 underwent open prostatectomy, 3 underwent cystolithotomy whereas in female’s bladder neck stenosis treated by bladder neck incision.Conclusions: Men were the most affected with BPH, being the leading cause. Among women, bladder neck stenosis was the main cause. Initial and definitive management were varied between causes, gender and age.

Incidence and Aetiology of Bladder Outlet Obstruction in Mangalore, Karnataka

Background and objective: Bladder outlet obstruction (BOO) is a blockage at the base of the bladder. BOO is a common cause of lower urinary tract symptoms in men and women. The condition is common in older men. Due to increased life expectancy there is an increased incidence of BOO. Thereby, we carried out a study to know the incidence of bladder outlet obstruction (BOO) in patients above 18 years attended in our institution along with the causative factors in them. Methods: A cross-sectional study was carried out among 100 adults. Ultrasound scan was the initial modality to diagnose BOO. X-ray KUB was used for bladder stones. Serum prostate specific antigen (PSA) and prostatic biopsy were done in cases of suspected carcinoma prostate. Cystoscopy was done in cases of suspected bladder cancer and bladder neck stenosis. Biopsy was taken in cases of bladder cancer. Results: Out of total of 100 cases in the age range 18–80 years, 53% had benign prostatic enlargement, 8% had carcinoma prostate, 14% had urethral tear, 7% had bladder cancer, 12% vesical calculus, 6% with bladder neck stenosis. In all, 94% cases were males and 6% females. Only the cases of bladder neck stenosis were females. Conclusion: This study highlights that BOO, a potentially curable illness commonly found in older men, benign prostatic hyperplasia (BPH) being the common cause. The key to successful treatment is in early diagnosis and treatment.

1698 FEMALE VOIDING NONOGRAM OVERESTIMATES THE INCIDENCE OF OUTLET OBSTRUCTION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology1 Apr 20111698 FEMALE VOIDING NONOGRAM OVERESTIMATES THE INCIDENCE OF OUTLET OBSTRUCTION Peter Rosier Peter RosierPeter Rosier Utrecht, Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1889AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Both a nomogram (the GautzBlaivas; GBN) as well as standard pressure flow graph (P/Q) analysis can be used to analyze female voiding however no comparative studies exist and standards are lacking. We have tested GBN versus P/Q analysis with effectivity of voiding as comparator. Furthermore we have compared the incidence of bladder outlet obstruction (BOO) as diagnosed with both methods. METHODS Standard urodynamic testing was performed for non neurologic lower urinary tract dysfunction and symptoms (LUT(D)S) in 289 succesive adult female patients. Predominant LUT(D)S were: stress incont 19%; OAB 30%; mixed (incont) sypmtoms 11%; recurrent UTI 18% Other 20%.) Patients were alowed to void in -normal- sitting position when, at the end of (transuretrhal F8; medium fill; 20° saline filling) cystometry, strong but not uncomfortable desire to void occured. Very unrepresentative (patient reporting) voids are not included in this analysis. Postvoid residual (PVR) was measured before cystometry as well as after P/Q via the F8 catheter. RESULTS Average (P/Q) voided volume was 375mL (sd 155mL) Qmax 26mL/s (sd 14mL/s) and PVR 47mL (sd 107mL). 18% of the patients had ineffective voiding (emptied% ≤80%) On the basis of BGN 28,5% of these patients has BOO and on the basis of standard P/Q analysis 4%. BGN does not classify detrusor (voiding) underactivity but P/Q analysis classifies 39% of these patients as 'weak contraction'. 20% of the patients diagnosed as BOO with either method had ineffective emptying Ineffective emptying is however 4.3 times more likely with a diagnosis 'P/Q analysis BOO' as compared with 1.1 times, associated with 'BGN-BOO'. Bladder contraction analysis diagnosis of detrusor underactivity is 6.5 times more likely to be associated with ineffective voiding and therefore superior. CONCLUSIONS The diagnosis of 'bladder outlet obstruction' had an incidence of almost 30% on the basis of BGN and (only) 4% when standard P/Q limits were aplied in a series of nearly 300 consecutive women. Ineffective female emptying was associated with underactive detrusor which cannot be diagnosed with BGN. We conclude on the basis of the superior association of voiding efficiency with standard P/Q analysis that the BGN is overestimating (the number of female patients) with BOO. We reccomend that standard P/Q analysis and not BGN, is preferable in female patients with LUT(D)S. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e683 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Rosier Utrecht, Netherlands More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Predictive Factors for Female Bladder Outlet Obstruction Defined by Pressure-Flow Study

Purpose: We investigated pre-urodynamic study parameters of bladder outlet obstruction (BOO) defined by pressure-flow study (PFS) in female patients without anatomical obstruction. Materials and Methods: The cohort of this study consisted of 320 women who did not have anatomical BOO in whom urodynamic study was conducted for lower urinary tract symptoms (LUTS). BOO was defined when the PFS maximal flow rate (Qmax) was ≤12 ml/sec and Pdet Qmax was ≥25 cmH2O. The main outcomes were the incidence of BOO and its predictive factors in our cohort. Results: Of the total patients, 39 (12.2%) were diagnosed with BOO in the PFS. Free Qmax and maximal voided volume (MVV) were significant predictors of BOO (p 15 ml/sec or MVV is >350 ml, PFS may be not essential. On the contrary, if free Qmax and MVV are below these levels, PFS may be indicated to evaluate the presence of BOO. (Korean J Urol 2009;50: 848-853) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Clinical Significance of Urodynamic Analysis in Patients with Benign Prostatic Enlargement Complicated with Diabetes Mellitus

Aim: To compare the bladder dysfunction associated with benign prostatic enlargement (BPE) in patients with and without diabetes mellitus (DM) by urodynamic study. Materials and Methods: The records of 166 first-visit BPE patients were reviewed. Patients were divided into two groups: concomitant group (CG) – 74 patients with BPE complicated with DM, and single group (SG) – 92 isolated BPE patients. Urodynamic findings of the two groups were analyzed. Results: In the clinical data, increased postvoiding residual urine volume (PVR) appeared more often in CG (p < 0.05). In the urodynamic findings, significantly higher maximum cystometric capacity (MCC), incidence of impaired bladder sensation, bladder compliance and detrusor overactivity existed in CG (p < 0.05). In addition, the maximum detrusor pressure during voiding (Pdet_max) and the incidence of bladder outlet obstruction (BOO) were significantly higher in SG (p < 0.05). Conclusions: Impaired bladder function is more severe in patients with BPE complicated with DM than those isolated BPE patients. Urodynamic study can provide objective data on diagnosis of voiding dysfunction in BPE patients with and without DM, and it is helpful for doctors to choose better clinical intervention.

Bladder Outlet Obstruction in the Female Overactive Bladder: Correct Diagnostic Criteria for Bladder Outlet Obstruction?

Puropose: We analyzed retrospectively the result of urodynamic studies of the female patients with overactive bladder to reveal the incidence of accompanying bladder outlet obstruction and compared the urodynamic charateristics according to the diagnostic criteria for bladder outlet obstruction to help make the appropriate diagnosis. Material and methods: A total of 230 women who underwent urodynamic studies for evaluation of overactive bladder were retrospectively reviewed. The patients were classified as having obstruction based on two criteria, including one pressure flow cutoff point criteria (free Qmax < 12ml/ sec and pdetQmax ≧ 20cmH2O) (group I) and moderate or severe obstruction by the Blaivas- Groutz nomogram (group II). Urodynamic characteristics of the patients in Group 1 and 2 were compared with those of 42 patients having only overactive bladder without any voiding symptom (OAB group). Results: Of the patients 31 (13.5%) were in group I, 42 (18.3%) in group II. Qmax of group I was the lowest among 3 groups. Detrusor pressure at maximum measurable flow and maximum detrusor pressure during voiding in group 1 and II were significantly higher than in OAB group. Detrusor overactivity was more observed in group I and II, and there was no signigicant difference in the presence of voiding symptoms between group I and II. Only 9 patients (4%) had obstruction by both of criteria. Conclusions: Considering the high incidence of bladder outlet obstruction in the patients of overactive bladder and non-specificity of the symptoms by bladder outlet obstruction, thorough urodynamic study may be helpful in detection and treatment of bladder outlet obstruction of the overactive bladder patients. The further study for the criteria of female bladder outlet obstruction should be necessary to make its accurate diagnosis. (J Korean Continence Soc 2008;12:145-9)

Predictors of Antimuscarinic Treatment Response for Female Patients with Overactive Bladder

Purpose: To analyze the predictors of the antimuscarinic treatment response for female patients with an overactive bladder (OAB). Materials and Methods: Eighty women diagnosed with an OAB, who had also undergone 3 months of treatment with propiverine hydrochloride (20mg/day), were enrolled. All patients were assessed by history taking, physical examination, urinalysis, frequency/volume charts and urodynamic study (UDS) prior to treatment; frequency/volume charts and a patients' satisfaction were analyzed 3 months after treatment. Patients were divided into satisfied, moderate and unsatisfied groups according to their subjective satisfaction. Results: Subgroups according to the patients' subjective satisfaction included 57, 14 and 9 patients for satisfied, moderate and unsatisfied group, respectively. In the UDS, detrusor overactivity was noted in 15 patients of the satisfied group, 2 of the moderate group, but none of the unsatisfied group. Maximum detrusor pressure and detrusor pressure at maximum flow were higher in the unsatisfied group. The incidence of bladder outlet obstruction (BOO) was higher in the moderate and unsatisfied groups. In pre-treatment frequency/volume chart, the frequency of urge symptom was significantly increased in the satisfied group. Comparing the preand post-treatment frequency/volume charts revealed that the satisfied and moderate groups showed decreased frequency and nocturia, and increased functional bladder capacity compared to unsatisfied group after treatment. Conclusions: The efficacy of antimuscarinic treatment in female OAB could be associated with the frequency of urge symptom, detrusor overactivity and BOO; an UDS may aid in predicting the efficacy of antimuscarinic treatment. (Korean J Urol 2007;48:66-71) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

PD-07.01: Incidence of bladder outlet obstruction after primary treatment for prostate cancer: data from CaPSURE

PD-07.01: Incidence of bladder outlet obstruction after primary treatment for prostate cancer: data from CaPSURE

Bladder calculi: Did the clinical picture change?

Objectives Recent improvements in socioeconomic conditions have changed the clinical picture of urinary stones, including bladder calculi. With the ongoing changes in these predisposing factors, it is possible that the clinical picture of bladder calculi will show additional changes. Nevertheless, few contemporary series of bladder calculi in published English reports have addressed these issues. Methods We retrospectively reviewed the records of 328 patients who underwent surgical therapy for bladder calculi at our institution from January 1995 to June 2005. Results Acute urinary retention was the most common presenting symptom (n = 221, 67%). Patients who presented with urinary retention were younger (37 versus 48 years, P <0.001), had a greater incidence of recent renal colic (40% versus 19%, P <0.01), and had a lower incidence of bladder outlet obstruction (14% versus 37%, P <0.001) compared with the nonretention group. However, previous stone passage did not influence the probability of presenting with urinary retention. Small bladder stones were associated with a greater likelihood of presenting with urinary retention. The retention group had greater incidence of stones less than 1 cm in diameter compared with the nonretention group (72% versus 39%, P <0.001). Finally, calcium oxalate was found in 78% of patients with bladder calculi. Conclusions Acute urinary retention was the main mode of presentation in patients with bladder calculi. Younger age, a history of recent renal colic, and smaller stones appeared to increase the likelihood for patients to present with urinary retention.

141: Incidence of Bladder Outlet Obstruction after Primary Treatment for Prostate Cancer

141: Incidence of Bladder Outlet Obstruction after Primary Treatment for Prostate Cancer

Urodynamic assessment of bladder-outlet obstruction in women

Bladder-outlet obstruction (BOO) in women has become an increasingly recognized entity over the past several years. This is partly because of the greater number of anti-incontinence surgeries being performed, which can infrequently result in iatrogenic obstruction; and partly because of improvements in the ability to diagnose and recognize BOO. In this review, the symptoms associated with BOO in women, and whether these symptoms can reliably predict the presence of BOO, will be discussed. The incidence of BOO following surgical anti-incontinence procedures and the urodynamic diagnosis of BOO in women, detailing the various criteria that have been proposed, are also reviewed.

Urodynamic Parameters for the Diagnosis of Bladder Outlet Obstruction in Women

Introduction: Bladder outlet obstruction (BOO) is often overlooked in the diagnosis of women with lower urinary tract symptoms. Although the incidence of BOO is not high in the female population with lower urinary tract symptoms, a correct diagnosis for BOO is important. This study was designed to compare the urodynamic parameters in women with bladder outlet obstruction (BOO), stress urinary incontinence (SUI) and asymptomatic volunteers. Materials and Methods: Videourodynamic study was performed in 76 patients who were clinically diagnosed as BOO, 265 with stress urinary incontinence (SUI). In addition, 30 asymptomatic female volunteers were recruited and served as controls. Voiding pressure (P_det.Qmax), maximum flow rate (Qmax), and urodynamic parameters were compared among the BOO, SUI and control groups and the criteria values for BOO in women were estimated. Results: BOO was identified in 30 women with bladder outlet stricture, 40 women with dysfunctional voiding, and 6 women with high-grade cystocele. The mean P_det.Qmax was significantly higher and the mean Qmax was significantly lower in the obstructed groups. When a P_det.Qmax ≧35 cm H₂O was set as the criteria for BOO, the sensitivity was 96.1% and specificity was 89.0%, whereas a P_det.Qmax of ≧30 cm H₂O had a sensitivity of 100% but the specificity was only 65.5%. If the criteria of BOO was set as P_det.Qmax ≧35 cm H₂O combined with Qmax ≤15 ml/s, the sensitivity for BOO was 81.6% and specificity was 93.9%. Conclusions: Our results demonstrate a P_det.Qmax of ≧30 cm H₂O is a good index value for screening of female BOO. When a P_det.Qmax of ≧35 cm H₂O combined with a Qmax ≤15 ml/s was found, a high suspicion of BOO should be raised, for which a specificity of 93.9% and sensitivity of 81.6% for BOO was obtained.

Questionnaire analysis on sex difference in lower urinary tract symptoms

Objectives. To examine the sex difference in the prevalence and severity of lower urinary tract symptoms in Japanese men and women. Methods. Of 970 individuals who attended the public lectures by urologists and a famous veterinarian that were organized as a public service of the 88th Annual Meeting of the Japanese Urological Association (June 2000, Sapporo, Japan), 677 (70%) completed the self-administered International Prostate Symptom Score (IPSS) questionnaire. The scores of 653 attendees aged 30 to 79 years (446 men, mean age 67.5 and 207 women, mean age 60.7) were the basis of this study. Results. A significant age-related increase in IPSS and quality-of-life score was observed in both men and women. The ratio of moderate (IPSS 8 to 19) to severe (IPSS 20 or greater) symptoms in the 50s, 60s, and 70s was 52%, 72%, and 80% in men and 27%, 36%, and 55% in women, respectively. Additional analysis in each decade showed that at age 50 years and older the total score and voiding symptom score of IPSS, as well as the quality-of-life score, were significantly greater in men than in women. Conclusions. The total IPSS and quality-of-life score correlated highly with age in both sexes. At the age of 50 years and older, men had severer voiding symptoms than did women. Although the age-related changes in bladder function predispose both men and women equally to lower urinary tract symptoms, the higher incidence of bladder outlet obstruction in men having a prostate may have a significant influence on the higher voiding symptom score in men.