Significant Bladder Outlet Obstruction Research Articles

Application of Urethral Contrast Computed Tomography Three-Dimensional Imaging in the Postoperative Assessment of Prostate Hyperplasia.

This study assesses the morphological effectiveness of benign prostatic hyperplasia (BPH) surgery using multislice spiral computed tomography three-dimensional imaging (CT3D) with urethral contrast. Twenty-five male patients with BPH and bladder outlet obstruction (BOO) who underwent bipolar transurethral resection of the prostate were selected. Preoperative and postoperative CT3D indicators of retrograde and voiding cystourethrography, including bladder neck diameter, length of the posterior urethra, and degree of prostate protrusion into the bladder and upper and lower diameter of the prostate were used to assess bladder neck and posterior urethra morphology and BOO severity. In addition, preoperative and postoperative International Prostate Symptom Scores and maximum urine flow rates were compared. Postoperative CT3D was used to evaluate changes following obstruction relief postsurgery. Preoperative CT3D indicated significant BOO, whereas postoperative imaging showed improved patency but with irregular posterior urethral lumens and varying degrees of residual glandular tissue. Comparative analysis of preoperative and postoperative bladder outlet metrics revealed significant changes (p < .05). Urethral contrast CT3D effectively visualizes the prostate, bladder neck, and prostatic urethra. It quantifies changes in the urethral lumen postsurgery, correlating the extent of posterior urethral lumen spaciousness with urinary flow rates.

Surgical Outcomes and Predictive Factors in Patients With Detrusor Underactivity Undergoing Bladder Outlet Obstruction Surgery.

This study was conducted to evaluate the efficacy of bladder outlet surgery in patients with detrusor underactivity (DU) and to identify factors associated with successful outcomes. We conducted a retrospective review of men diagnosed with DU in urodynamic studies who underwent bladder outlet surgery for lower urinary tract symptoms between May 2018 and April 2023. The International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry (UFM), and multichannel urodynamic studies were administered. Successful treatment outcomes were defined as either an IPSS improvement of at least 50% or the regaining of spontaneous voiding in patients urethral catheterization prior to surgery. The study included 93 male patients. Men diagnosed with significant or equivocal bladder outlet obstruction (BOO) experienced significant postoperative improvements in IPSS (from 20.6 to 6.0 and from 17.4 to 6.5, respectively), maximum urine flow rate (from 5.0 mL/sec to 14.4 mL/sec and from 8.8 mL/sec to 12.2 mL/sec, respectively) and voiding efficiency (from 48.8% to 86.0% and from 61.2% to 85.1%, respectively). However, in the group without obstruction, the improvements in IPSS and UFM results were not significant. The presence of detrusor overactivity (odds ratio [OR], 3.152; P=0.025) and preoperative urinary catheterization (OR, 2.756; P=0.040) were associated with favorable treatment outcomes. Conversely, an unobstructed bladder outlet was identified as a negative prognostic factor. In men with DU accompanied by equivocal or significant BOO, surgical intervention to alleviate the obstruction may enhance the IPSS, quality of life, and UFM results. However, those with DU and an unobstructed bladder outlet face a comparatively high risk of treatment failure. Preoperative detrusor overactivity and urinary catheterization are associated with more favorable surgical outcomes. Consequently, active deobstructive surgery should be considered for patients with DU who are experiencing urinary retention.

Toxicity and outcomes after external beam irradiation for prostate cancer in patients with prior holmium laser enucleation of the prostate: Early experience.

Holmium laser enucleation of the prostate (HoLEP) is commonly performed in patients with significant bladder outlet obstruction. However, there are few reports on the toxicity of external beam irradiation (RT) for prostate cancer in patients after prior HoLEP. In this study, we evaluate the side effects and treatment outcomes of RT after HoLEP. Eighteen patients who had HoLEP and subsequently received RT for prostate cancer were included. Data collected included patient and disease characteristics, urinary function, and radiation dose. Acute and late urinary (GU) and gastrointestinal (GI) side effects were evaluated. Disease control and survival rates were calculated using Kaplan-Meier method. Median follow-up was 18 months (range: 4-46 months). Median prostate volume was 107 ml before HoLEP and 24 ml after HoLEP. Median International Prostate Symptom Score (IPSS) was 17 (range: 5-32) before HoLEP. Median decline in IPSS score after HoLEP was 7 (range: -2-21). On uroflow study, peak flow rate, and post-void residual were significantly improved after HoLEP. After radiation, peak flow rate and average flow rate showed a decline but remained significantly improved compared to pre-HoLEP measurements. Maximum acute Common Terminology Criteria for Adverse Events (CTCAE) adverse events were 12 grade 1 and 3 grade 2 for GU, and 3 grade 1 for GI, respectively. Maximum late adverse events were 13 grade 1 and 2 grade 2 for GU, and all grade 0 for GI, respectively. At last follow-up, there were 8 grade 1 and 1 grade 2 late GU, and 3 grade 1 late GI adverse events, respectively. There was no significant increase in urinary incontinence after RT compared to before RT. The 18-month biochemical control, local control, distant control rates were 78%, 94%, and 80%, respectively. Patients who received RT as definitive treatment for prostate cancer after prior HoLEP had low risk of serious acute and late side effects. HoLEP can be safely performed and should be considered in patients with significant bladder outlet obstruction and large prostate volume before RT.

Muscarinic-3-receptor positive allosteric modulator ASP8302 in patients with underactive bladder. A randomized controlled trial.

The aim of this study is to evaluate safety and efficacy of ASP8302, a novel positive allosteric modulator for the muscarinic M3 receptor (M3-PAM), in patients with underactive bladder (UAB). A randomized, double-blind, placebo-controlled multicenter study was performed in adult male/female subjects with UAB, defined as incomplete bladder emptying (postvoid residual volume [PVR] > 100 ml) without significant bladder outlet obstruction and/or overactive bladder. Subjects were randomized (1:1) to receive 4-week oral once-daily administration of 100 mg ASP8302 or matching placebo. Primary endpoint was a change from baseline in PVR measured by catheterization after standardized bladder filling (PVRC2 ). Other endpoints included PVR and bladder voiding efficiency (BVE) measured in various ways, uroflowmetry, bladder diary, and questionnaires. Pressure-flow studies were performed in a subgroup. One hundred and thirty-five patients were randomized (ASP8302 group: 65 patients, placebo group: 70 patients). The median change in PVRC2 was -40.0 ml (ASP8302) versus -35.0 ml (placebo) and the difference between groups was -5.0 ml (p = 0.960). In males, functional and symptomatic outcomes improved, for example, maximum urine flow rate (Qmax ) and detrusor pressure at Qmax (Pdet.Qmax ) increased (mean difference in change ASP8302 vs. placebo: 3.8 ml/s, p = 0.031 and 12.7 cm H2 O, p = 0.034, respectively). Urinary incontinence episodes/24 h decreased in males with preexisting incontinence (mean difference: -0.35; p = 0.028). The incidence of adverse events was similar between study groups (ASP8302: 33.3%, placebo: 31.4%). In the included subjects, both baseline urine flow and bladder voiding pressure was low. Compared with PVR, simultaneous BVE measurements were more consistent between various methods (spontaneous vs. standardized bladder filling, catheterization vs. ultrasound [US]). ASP8302 was safe and well tolerated in patients with UAB identified by nonurodynamic clinical criteria, but it did not show efficacy in the primary endpoint. However, in males it showed improvement of symptoms and functional parameters. BVE (using US) is a more optimal outcome measure than PVR in UAB.

Non-invasive evaluation of bladder outlet obstruction in benign prostatic hyperplasia: a clinical correlation study

ABSTRACTObjectives: To determine the utility of ultrasonography (US)-derived parameters (e.g. prostate volume [PV], bladder wall thickness [BWT], post-void residual urine volume [PVR], and intravesical prostatic protrusion [IPP]) and uroflowmetry for identifying bladder outlet obstruction (BOO) by correlating them with the results of pressure–flow urodynamic studies (UDS).Patients and methods: In all, 164 patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH), from May 2016 to December 2018, were included in this study. All had International Prostate Symptoms Score (IPSS), Quality-of-Life (QOL) index, uroflowmetry (including maximum urinary flow rate [Qmax]) and PVR measured by transabdominal US. Pressure–flow UDS were performed on all men and BOO was defined by a BOO Index (BOOI) >40. Men with a Qmax of ≥12.0 mL/s were considered to have ‘good’ flow.Results: Amongst the 164 men, the mean (SD) age, PV, BWT and Qmax were 66.72 (9.88) years, 51.91 (13.24) mm, 5.07 (0.91) mm, and 8.46 (3.59) mL/s, respectively. In all, 91 (55.49%) patients had BOO with a BOOI >40 and nine (5.49%) had equivocal BOO with a BOOI of 20–40. The IPP was a statistically significant predictor (P < 0.001) of BOO compared with other variables in the initial evaluation. In patients with BOO confirmed by the pressure–flow UDS, IPP Grade III was associated with a higher BOOI than was Grade I and II (P < 0.001).Conclusion: BWT, PV and PVR in conjunction with IPP are good predictors of clinically significant BOO due to BPH.Abbreviations: AUC: area under the curve; BOOI: BOO Index; BPO, benign prostatic obstruction; BWT, bladder wall thickness; IPP: intravesical prostatic protrusion; Pdet: detrusor pressure; PV: prostate volume; PVR: post-void residual urine volume; Qmax: maximum urinary flow rate; QOL: quality of life; ROC: receiver operating characteristic; (TA)US: (transabdominal) ultrasonography; UDS: urodynamic studies

2112 DIODE LASER ENUCLEATION OF PROSTATE: A NOVEL ALTERNATIVE TO TRANSURETHRAL RESECTION OF PROSTATE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology1 Apr 20112112 DIODE LASER ENUCLEATION OF PROSTATE: A NOVEL ALTERNATIVE TO TRANSURETHRAL RESECTION OF PROSTATE Stephen Shei-Dei Yang and Shang-Jen Chang Stephen Shei-Dei YangStephen Shei-Dei Yang Taipei, Taiwan More articles by this author and Shang-Jen ChangShang-Jen Chang Taipei, Taiwan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2308AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laser enucleation of prostate with Ho:YAG (HoLEP) is a promising alternative to transurethral resection of prostate (TURP). Instead of Ho:YAG, we used end-firing diode laser at 80Watt, continuous wave to enucleate the prostate (DoLEP). Surgical outcomes of DoLEP and TURP are compared. METHODS Ninety-nine patients with significant bladder outlet obstruction and total prostate volume of more than 40ml were enrolled for DoLEP or TURP, which was chosen by the surgeon¡¦s preference. The 34 TURPs were done by two surgeons, and all the 65 DoLEPs were done by a single surgeon (YSS). The surgical technique of DoLEP is a modification of HoLEP, except the use of end-firing diode laser. The enucleated prostatic tissues were cut into small pieces by electroresection and then removed. The first 35 patients undergoing DoLEP were grouped as DoLEP-T1, and the late 30 cases as DoLEP-T2. RESULTS Demographic data, perioperative parameters were comparable between groups (table 1), except that the difference of hemoglobin was statistically lower in the group DoLEP-T2 than group TURP (1.69 vs. 0.74, p=0.01). Of cases undergoing DoLEP, total prostate volume ranged from 40–190ml. Improvements in both subjective (IPSS, Figure 1A) and objective voiding parameters (peak flow rate, Figure 1B and post-void residual urine, Figure 1C)were comparable between groups and sustained up to one year follow-up. overall TURP (I) DoLEP-T1 (II) DoLEP-T2 (III) p-value No 99 34 35 30 Age (years) 71.3±8.5 72.5±9.1 69.6±8.2 71.9±7.9 0.32 Follow-up (months) 6.7±5.1 5.9±5 9.6±5.3 4.2±2.9 III,III Total prostate vol. (ml) 70.7±27.3 72.7±24.7 65.6±21.5 74.3±35.1 0.38 Adenoma vol. (ml). 39.8±21.3 40.7±20.9 37.5±19.6 41.3±24.0 0.75 Pre-op Hb (g/dL) 13.9±1.5 13.7±1.5 14.2±1.7 13.9±1.2 0.41 Post-op Hb difference 1.17±1.13 1.69±1.13 1.19±0.96 0.74±1.16 IIII Resected prostate (gm) 27.6±18.9 30.7±21.0 25.5±16.5 26.2±19.1 0.47 Op. time (mins) 92.8±41.2 94.0±37.4 95.1±49.8 87.8±37.7 0.76 Catheterization time (hours) 50.6±30.5 68.0±37.4 37.2±20.3 45.9±21.2 III,III Post-op stay (days) 3.2±1.2 3.63±1.09 3.20±1.26 2.77±1.25 IIII CONCLUSIONS DoLEP provided better hemostasis than TURP, and resulted in less blood loss. The risk of deep tissue penetration by diode laser was prevented by enucleation rather than vaporization after incising the prostatic mucosa. Improvements in voiding function were comparable between DoLEP and TURP. The real role of DoLEP requires further investigations. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e844-e845 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Shei-Dei Yang Taipei, Taiwan More articles by this author Shang-Jen Chang Taipei, Taiwan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1614 THE ROLE OF NON-INVASIVE PRESSURE FLOW STUDY IN HIGHLY SIMPTOMATIC/BOTHERED MEN WITH BLADDER OUTLET OBSTRUCION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamic Testing1 Apr 20101614 THE ROLE OF NON-INVASIVE PRESSURE FLOW STUDY IN HIGHLY SIMPTOMATIC/BOTHERED MEN WITH BLADDER OUTLET OBSTRUCION Nelson Batezini, Marcia Eli Girotti, Fernando Almeida, João Paulo Zambon, Eduardo Pinto, and Milton Skaff Nelson BateziniNelson Batezini More articles by this author , Marcia Eli GirottiMarcia Eli Girotti More articles by this author , Fernando AlmeidaFernando Almeida More articles by this author , João Paulo ZambonJoão Paulo Zambon More articles by this author , Eduardo PintoEduardo Pinto More articles by this author , and Milton SkaffMilton Skaff More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1394AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The gold standard to evaluate BOO is the invasive pressure-flow study. The aim of this study is to evaluate non-invasive pressure flow test to predict BOO before surgery. METHODS Between January 2008 and february 2009, we prospectively evaluated men with lower urinary tract symptoms (IPSS>18 and QoL 3) scheduled for complete urodynamic study (UDS). Patients with urinary infection, neurological problems, bladder stones and indwelling catheters were excluded. Patients were underwent non-invasive pressure flow test (Medplus CT 3000–Dynamed–Sao Paulo-Brazil), just before initiate the UDS. Non-invasive pressure-flow test (NIPF) was performed with a cuff around penile body that allowed registering the pressure necessary to stop urinary flow (MCCP - maximum closure cuff pressure). The MCCP and maximum flow rate were plotted in the NewCastle′s Nomogram and classified as: 1) bladder outlet obstruction (BOO) or 2) non obstructed. The UDS was performed following the International Continence Society good urodynamic practice. The pressure-flow study was performed with a 4 F catheter in stand position. The pressure-flow results were plotted in Schafer′s Nomogram and patients were classified from I – VI. Patients were considered as having BOO when classified as Schafer > III. RESULTS We evaluated 50 men with mean age of 65 +/- 8 years, IPSS ranging from 24 to 35 and Quality of life score was higher than 4 in all patients. Table 1 shows the results form NIPF and invasive pressure-flow study. Out of the 17 patients classified as non-obstructed by the non invasive study, 7 patients presented detrusor underactivity, 1 patient had BOO and 9 were non-obstructed with normal pressure-flow study by UDS. In the evaluation of BOO, the non-invasive pressure-flow demonstrated a sensitivity of 87.8 % and a specificity of 80,9% Table 1. Comparison of Invasive and non-invasive pressure flow study on diagnosis of BOO. Bladder Outlet Obstruction Non Obstructed Invasive pressure flow study 29 21 Noninvasive pressure flow 33 17 CONCLUSIONS The non-invasive pressure flow study demonstrated a sensitivity of 87.8 % and a specificity of 80,9% in diagnosis of significant BOO. It should be considered as an important tool in the diagnosis, treatment and follow up of men with voiding symptoms. São Paulo, Brazil© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e623-e624 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nelson Batezini More articles by this author Marcia Eli Girotti More articles by this author Fernando Almeida More articles by this author João Paulo Zambon More articles by this author Eduardo Pinto More articles by this author Milton Skaff More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia

Alpha-blockers, the current common treatment for lower urinary tract symptoms (LUTS), are also used to treat bladder outlet obstruction (BOO), but the effect is not as clinically significant as in LUTS. All currently marketed phosphodiesterase type 5 (PDE5) inhibitors have recently been shown to significantly affect LUTS, although BOO-related efficacy has not been determined. Therefore, the extent of a causal relationship between LUTS and underlying benign prostatic enlargement (BPE) is questionable. LUTS may also be interpreted as symptoms related to detrusor overactivity, especially when no significant BOO is associated with BPE. Research is required to understand the efficacy of PDE5 inhibitors in LUTS but not in BOO. For vardenafil, nonclinical experiments and initial, preliminary clinical data suggest that the underlying effect may occur on the detrusor and not the prostate.

Funktionelle Ergebnisse nach Laservaporisation der Prostata mit dem KTP-Laser

Treatment for bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH) impairs the quality of life. The potassium tintanyl phosphate (KTP) vaporisation of the prostate offers promising modalities in treatment of BOO. We prospectively determined the impact of KTP-lasertherapy on voiding function, quality of life and sexual function. So far a total of n=123 patients complaining of symptomatic BPH were treated with an 80 watt Laser. N= 40 of them agreed to participate in the study and were evaluated prospectively. Preoperative pressure-flow-studies verified significant bladder outlet obstruction in all cases. Disease specific quality of life and sexual function were assessed using the International Prostate Symptom Score (IPSS) and International Inventory of Erectile Function (IIEF). Three months after treatment follow-up video-urodynamics were carried out to determine changements in pressure flow and bladder function. All patients showed significant improvement after a hospital stay of 4,9 days. The maximum flow rate increased from 9,1 ml/sec preoperatively to 20,2 ml/sec and the amount of residual urine decreased from 98 ml preoperatively to 17 ml immediately after removal of the catheter. Urodynamics after the follow up period showed that the maximum urinary flow improved from 9.7 ml/s preoperatively to 17,6 ml/s and the volume of residual urine decreased from a median of 127.5 ml preoperatively to 45 ml postoperatively. The IPSS and IIEF decreased from a median of 20,4 preoperatively to 8,16 and from a median of 14 preoperatively to 12,7 respectively. The pressure-flow study verified the desobstruction and showed a decline in detrusor pressure at maximum flow from 76,66 cm H2O to 33,79 cm H2O. The urethral opening pressure sank from 75.86 cm H2O preoperatively to 37,51 cm H2O postoperatively. The potassium tintanyl phosphate (KTP) vaporisation of the prostate is a promising new method in the treatment of benign prostatic hyperplasia as shown by the data. Beside its low perioperative and postoperative morbidity due to a high hemostatic property it offers a good tissue debulking effect.

THE MALE SLING FOR STRESS URINARY INCONTINENCE: URODYNAMIC AND SUBJECTIVE ASSESSMENT

We prospectively examined whether the fixed urethral resistance of the perineal male sling for the treatment of stress incontinence causes significant bladder outlet obstruction or de novo voiding dysfunction. A total of 22 patients (average age 67 years old) were evaluated before and after surgery with videourodynamics, the self-administered UCLA Prostate Cancer Index incontinence section and pad score. Mean followup was 25 months (range 6 to 42). All patients complained of a moderate to severe problem before surgery. After surgery 16 (73%) reported a very small problem/no problem, 3 (14%) a moderate problem and 3 (14%) reported a big problem. Average pad use +/- SD decreased from 4.6 +/- 2.5 to 0.74 +/- 1.0 pads (p <0.01). Median UCLA Prostate Cancer Index incontinence score increased from 82 to 313, p <0.001. Mean retrograde leak point pressure (RLPP) increased from 30.4 +/- 15.9 to 59.9 +/- 9.7 cm water. Bladder outlet obstruction did not develop in any patients after surgery. Average maximum flow rate did not change significantly (17.7 +/- 6.5 vs 19.2 +/- 9.7 ml per second, p = 0.6). Nor was there a significant change in detrusor pressure at maximum flow rate (40.3 +/- 9.2 vs 45.8 +/- 14.7 cm water, p = 0.3). While de novo urgency or urge incontinence did not develop in any patients, 2 of 5 patients with a moderate/big leakage problem demonstrated postoperative detrusor overactivity on cystometry. Both individuals requiring more than 3 pads daily had a postoperative RLPP of less than 50 cm water. Pad use, leak point pressure and urinary incontinence scores are significantly improved after sling surgery. Fixed resistance does not lead to bladder outlet obstruction. Postoperative RLPP less than 50 cm water and urodynamic detrusor overactivity are associated with increased pad use and bother.

Correlation of intravesical prostatic protrusion with bladder outlet obstruction.

To determine the effect of intravesical protrusion of the prostate (IPP, graded I to III) on lower urinary tract function, by correlating it with the results of a pressure-flow study. In a prospective study men (aged> 50 years) with lower urinary tract symptoms were initially evaluated as recommended by the International Consultation on Benign Prostatic Hyperplasia, together with the IPP and prostate volume, as measured by transabdominal ultrasonography. These variables were then correlated with the results from a pressure-flow study. The IPP was a statistically significant predictor (P < 0.001) of bladder outlet obstruction (BOO) compared with other variables in the initial evaluation. In all, 125 patients had significant BOO, defined as a BOO index of> 40. Of these men, 94 had grade III and 30 had grade I-II IPP. Seventy-five patients had a BOO index of < 40; 69 had grade I-II and six grade III IPP. In patients with BOO confirmed on the pressure-flow study, grade III IPP was associated with a higher BOO index than was grade I-II (P < 0.001). The IPP assessed by transabdominal ultrasonography is a better and more reliable predictor of BOO than the other variables assessed.

Few patients with “chronic prostatitis” have significant bladder outlet obstruction

Objectives. A high prevalence of significant bladder outlet obstruction has been reported among men diagnosed as having “chronic prostatitis.” To evaluate the possibility that case selection may determine this high prevalence, we compared findings in patients referred directly to our Urodynamic Unit with that of patients evaluated in our Prostatitis Clinic. Methods. The videourodynamics records of 201 men aged 18 to 50 years who presented to the Urodynamic Unit with any lower tract symptoms (irritative and/or obstructive with or without pain) were compared with the findings in 123 Prostatitis Clinic patients. The latter were evaluated for obstruction with flow rates and, if abnormal, by retrograde urethrograms and videourodynamics. Results. Only 37 (18%) of 201 patients referred to the Urodynamic Unit had pain as a significant symptom and might have been diagnosed as having chronic prostatitis. Of these 37 patients, 4 (11%) had definite obstruction, 6 (16%) were equivocal, 6 (16%) were hypocontractile, 1 (3%) had pseudodyssynergia, and 7 (19%) had normal findings. The remainder had abnormalities of bladder filling (hypersensitivity in 11 [30%] and detrusor instability in 2 [5%]). Fewer of the 123 patients with prostatitis had obstruction (definite in 2 [1.6%] and equivocal in 1 [0.8%]) ( P = 0.03), 2 (1.6%) had hypocontractile detrusors, and 2 had urethral strictures. Conclusions. Patients referred to the Urodynamic Unit with lower urinary tract symptoms and pain rarely have bladder outlet obstruction. However, they are significantly more likely to have bladder outlet obstruction than patients referred to the Prostatitis Clinic who can be screened for obstruction by history, flow rate, postvoid residual, and retrograde urethrogram.

Morphometric quantitation of stromain human benign prostatic hyperplasia

Objectives. Human benign prostatic hyperplasia (BPH) consists of three major histologic components: stroma, epithelium, and luminal space. For the relief of bladder outlet obstruction caused by BPH, quantitation of the histologic composition of BPH may aid in selecting treatment. To investigate variation between patients in the stromal percentage of BPH, we performed quantitative morphometry on specimens from patients with clinically significant bladder outlet obstruction obtained by three procedures: open prostatectomy, transurethral resection of the prostate (TURP), and prostate needle biopsy (PNB) just prior to TURK Methods. Ten specimens obtained by each surgical procedure were analyzed. Specimenswere stained with antibody to muscle-specific actin to mark the stroma; quantitation of stroma was accomplished by computer image analysis. Results. The percentage of stroma in all BPH cases ranged from 49.9% to 76.7% (mean, 65.4%, SD = 7.4). No significant difference was observed when comparing samples obtained by the three procedures ( p = 0.70). Smooth muscle stromal composition was also quantified in PNB specimens. For these samples, a significant inverse relationship was found between the percentage stroma in the biopsy and the percentage of stroma composed of smooth muscle (r 2 = 0.49; p = 0.021). Conclusions. The data demonstrated that the largest component of BPH was stroma, which comprised approximately 50% to 75% of the total hyperplastic tissue. The mean and range of stromal percentage were similar whether investigating large tissue samples from open prostatectomies or small samples from needle biopsies. PNB data indicated that an increased percentage of stroma may be due to increased nonmuscular elements in the stroma.

Leiomyoma of bladder report of 2 cases and demonstration of ultrasonic appearance

Two cases of bladder leiomyoma are reported. Both are women who presented witha palpable mass on pelvic examination, one asymptomatic and the second with significant bladder outlet obstruction. Results of ultrasound examinations are presented. Complete local resection: was curative in both patients.