Management Of Bladder Outflow Obstruction Research Articles

Oncological and urinary outcomes following low-dose-rate brachytherapy with a median follow-up of 11.8 years.

To examine the long-term oncological outcomes and urological morbidity of low-dose-rate prostate brachytherapy (LDRBT) monotherapy using live intraoperative dosimetry planning and an automated needle navigation delivery system for the treatment of men with low and intermediate-risk prostate cancer. A prospective database of 400 consecutive patients who underwent LDRBT between July 2003 and June 2015 was retrospectively reviewed to assess urinary side-effects and biochemical progression, based on the Phoenix definition and also a definition of a prostate-specific antigen (PSA) level of ≥0.2 μg/L. Minimum patient follow-up was 5.5 years. The median follow-up of the entire cohort was 11.8 years. The median (range) PSA level was 6.1 (0.9-17) μg/L and the median Gleason score was 3 + 4. The biochemical relapse-free survival (RFS; freedom from biochemical recurrence) based on the Phoenix definition was 85.8% (343/400). The RFS using a 'surgical' definition of a PSA level of <0.2 μg/L was 71% (284/400). Of the 297 men followed for ≥10 years, prostate cancer-specific survival (PCSS) was 98% (291/297). Post-LDRBT urethral stricture developed in 11 men (2.8%, 11/400). For men with ≥10 years of follow-up, 22 men (7.4%, 22/297) required a pad for either stress or urge urinary incontinence (UI). UI was identified in only 2.2% (one of 46) of men who had a bladder neck incision (BNI) before LDRBT. LDRBT is associated with excellent PCSS, with a median follow-up of 11.8 years. The risk of post-implantation urethral stricture and UI is low and a pre-implantation BNI for management of bladder outflow obstruction does not increase the risk of UI or urethral stricture.

Bipolar Transurethral Resection of Prostate: Current Status in the Management of Bladder Outflow Obstruction

Monopolar transurethral resection of prostate has been the preferred surgical treatment of benign prostatic hyperplasia. Even in modern series there are significant risks such as haemorrhage requiring transfusion and TUR syndrome, although their incidence is lower than previously. Over the last decade or so newer technologies have emerged that have proven to be at least equivalent to monopolar TURP. Bipolar transurethral resection of the prostate in normal saline is a potentially safer option to monopolar resection but with equivalent efficacy in the medium term. This is supported by 2 recent meta-analyses. This review describes the technology, efficacy and safety profile of bipolar transurethral resection of the prostate.

POD-04.08 Management Algorithm for Bladder Outlet Obstruction in Women

To formulate a simple algorithm for management of bladder outflow obstruction (BOO) in Indian women.

The management of female voiding dysfunction: Fowler's syndrome -- a contemporary update.

Several aspects of voiding dysfunction in women remain under investigation, including standardization of the diagnosis and management of bladder outflow obstruction. This article describes a specific cause of urinary retention in young women, associated with a failure of urethral sphincter relaxation, and a treatment option that can restore voiding in this group of patients - sacral nerve electrical stimulation therapy. Recently there have been advances in the stimulator implantation technique, as well as in our appreciation of its mechanism of action. Advances include the use of ancillary investigations such as urethral function tests as well as better understanding of the clinical profile of these patients. Improvements in the surgical technique include better methods of lead fixation and a less invasive surgical approach. Research suggests the action of neuromodulation is on the afferent pathway, though it remains to be shown whether this is at a spinal or supraspinal level. It is likely that sacral nerve stimulation has an indirect modulatory effect on detrusor contractility rather than a direct effect on the sphincter. Experience of sacral nerve stimulation has increased over the past few years, and its application is expanding to other clinical domains. This knowledge has helped improve the therapy, which is particularly effective in the treatment of women with urinary retention. Although how it works is still not fully understood, this is something that is being addressed by ongoing research.

Intra‐prostatic vasculature studies: Can they predict the outcome of transurethral microwave thermotherapy for the management of bladder outflow obstruction?

Intra‐prostatic vasculature studies: Can they predict the outcome of transurethral microwave thermotherapy for the management of bladder outflow obstruction?

HOLMIUM LASER VERSUS TRANSURETHRAL RESECTION OF THE PROSTATE: A RANDOMIZED PROSPECTIVE TRIAL WITH 1-YEAR FOLLOWUP

The high-powered holmium:YAG laser can be used for incision, ablation and resection of the prostate. The technique of holmium laser resection of the prostate is compared to transurethral prostatic resection for surgical management of benign prostatic hyperplasia in this prospective randomized study. A total of 120 urodynamically obstructed cases were randomized to holmium laser or transurethral prostatic resection. All eligible patients were assessed preoperatively and at 3 weeks, and 3, 6 and 12 months postoperatively with an American Urological Association symptom score, peak urinary flow rate, and questionnaires concerning sexual function and continence. Preoperative pressure flow study, ultrasound prostate volume assessment and post-void residual volume measurement were repeated at the 6-month visit. All complications were noted. Holmium laser and transurethral resections resulted in significant improvements in symptom score, quality of life score, peak urinary flow rate and post-void residual urine measurements. Operating time was significantly longer in the holmium group but nursing contact time, catheter time and hospital stay were significantly less compared to the transurethral prostatic resection group. Urodynamic results were equivalent at 6 months. There were fewer side effects in the holmium group. Effects on continence, potency and symptoms were similar with 1-year followup. Holmium and transurethral resections of the prostate appear to be equivalent in surgical management of bladder outflow obstruction due to benign prostate hyperplasia. Perioperative morbidity was less in the holmium group.

Conventional Urodynamics and Ambulatory Monitoring in the Definition and Management of Bladder Outflow Obstruction

Purpose We determined whether ambulatory urodynamics and new objective methods of defining bladder outflow obstruction might improve the classification of bladder outflow obstruction over conventional urodynamics (cystometrography), and whether such measures might improve prediction of the outcome of prostatectomy. Materials and Methods A prospective study was performed of 122 men undergoing prostatectomy for symptoms and low flow rates. Cystometrography and ambulatory urodynamics were performed before and 6 months after prostatectomy but did not influence selection for operation. Methods of classifying obstruction included the Abrams-Griffiths nomogram, Schafer linear passive urethral resistance relation and Griffiths urethral resistance factor. Results The proportion of cases defined as obstructed did not differ on ambulatory urodynamics or cystometrography or when the Abrams-Griffiths nomogram was compared to the linear passive urethral resistance relation or urethral resistance factor. Significant improvements after prostatectomy were noted in flow rates (p less than 0.001), residual urine (p less than 0.001), voiding pressure (p less than 0.001) and symptom scores (p less than 0.001). Ambulatory urodynamics were more sensitive than cystometrography in detection of detrusor instability but detrusor instability did not correlate with outcome. Voiding pressures were greater during ambulatory urodynamics (p less than 0.02). The outcome of obstructed cases (on Abrams-Griffiths nomogram during ambulatory urodynamics) was better (79 percent good outcome) than that of nonobstructed or equivocally obstructed cases (55 percent good symptomatic outcome, p less than 0.05). Conclusions Men proved to have obstruction on the basis of pressure and flow measurements applied to a nomogram have better outcomes after transurethral resection of the prostate but sophisticated or computer derived methods of classification of obstruction did not improve prediction.

Conventional Urodynamics and Ambulatory Monitoring in the Definition and Management of Bladder Outflow Obstruction

Conventional Urodynamics and Ambulatory Monitoring in the Definition and Management of Bladder Outflow Obstruction

Use of the ASI Titanium Stent in the Management of Bladder Outflow Obstruction Due to Benign Prostatic Hyperplasia

An expandable titanium intraprostatic stent was inserted into 30 patients with intravesical obstruction due to benign prostatic hyperplasia (BPH). All of the men were considered unsuitable for transurethral resection of the prostate as a result of comorbid conditions. In 25 patients effective micturition was reestablished with this technique. In 21 of these men, who have been followed for longer than 1 year, the mean maximum flow rate at 1 year was 10.8 ml. per second and the mean residual urine was 56 ml. Although urinary tract infections occurred subsequent to stent insertion in 10 individuals, these resolved after appropriate antibiotic treatment and no stents have had to be removed for this reason. Followup cystoscopy or examination by electron microscopy of those stents that have been removed has shown partial epithelialization of the stent surface in a proportion of patients, and a minor degree of incrustation occurred in 1 case. We conclude that an expandable intraprostatic titanium stent is an acceptable alternative to transurethral resection of the prostate or long-term catheterization in this particular group of high risk patients.

Indoramin in the Treatment of Prostatic Bladder Outflow Obstruction

A series of 40 patients took part in a double-blind, placebo-controlled trial of indoramin in prostatic bladder outflow obstruction. Patients were assessed clinically and urodynamically before and after 4 weeks' treatment. Significant improvement was seen in nocturia, volume voided, flow rates and residual urine. The drug was well tolerated, although 7 patients on treatment and 7 on placebo noted side effects. These results suggest that indoramin may be a useful agent in the symptomatic management of bladder outflow obstruction.

The “Plain Film” Bladder Shadow in Outflow Obstruction: as Accurate a Discriminant of Residual Urine as Ultrasound

The height, width and area of the bladder shadow on post-micturition plain abdominal radiography was compared with the residual urine obtained at endoscopy from 58 men presenting with pure bladder outflow obstruction. Each parameter of the bladder shadow correlated significantly with the residual urine in patients in whom this shadow was visible. Post-micturition plain abdominal radiography is considerably cheaper than ultrasound and appears to be equally effective in the determination of residual urine. Its use as the sole imaging technique in the routine management of bladder outflow obstruction is recommended.

Indoramin—an Effective New Drug in the Management of Bladder Outflow Obstruction

There is a need for symptomatic relief in some patients with bladder outflow obstruction. The alpha blocker indoramin was tested in a prospective, double-blind, placebo-controlled trial. Thirty men were given indoramin or placebo. Flow rates and cystometrograms were performed before inclusion and at the end of 8 weeks' treatment. Indoramin gave significant relief of symptoms and dramatically improved peak flow rates. There were three withdrawals because of adverse effects and two withdrawals in the placebo group because of retention. Other side effects were either minor or transient.