摘要 Objective: Despite high-grade intravesical prostatic protrusion (IPP) being closely related to bladder outlet obstruction (BOO), up to 21% of patients with low IPP remain obstructed. This study evaluates the characteristics and urodynamic findings of men with small prostates and low IPP. Methods: One hundred and fourteen men aged >50 years old with lower urinary tract symptoms (LUTS) were assessed with symptoms, uroflowmetry, serum prostate-specific antigen (PSA), transabdominal ultrasound measurement of prostate volume (PV), IPP and post-void residual urine (PVRU). All patients underwent pressure flow studies. Patients with PV < 30 mL and IPP ≤ 10 mm were examined for parameters correlating with BOO or impaired detrusor contractility. Results: Thirty-six patients had PV < 30 mL and IPP < 10 mm. Nine patients (25.0%) had urodynamic BOO, all with normal bladder contractility. Fourteen patients (38.9%) had poor detrusor contractility and all had no BOO. PV, PVRU and IPP were significantly associated with BOO, with IPP showing greatest positive correlation. Both Qmax and IPP were significantly associated with detrusor contractility. At 5-year follow-up, most patients responded to medical therapy. Only three out of nine patients (33.3%) with BOO eventually underwent surgery, and all had a high bladder neck seen on the resectoscope. Only one patient (7.1%) with poor detrusor contractility eventually required surgery after repeat pressure flow study revealed BOO. Conclusion: In men with small prostates and low IPP, the presence of BOO is associated with higher PV, PVRU and IPP, and most respond well to medical management. BOO can possibly be explained by elevation of the bladder neck by a small subcervical adenoma.
Abstract: Objective: Despite high-grade intravesical prostatic protrusion (IPP) being closely related to bladder outlet obstruction (BOO), up to 21% of patients with low IPP remain obstructed. This study evaluates the characteristics and urodynamic findings of men with small prostates and low IPP. Methods: One hundred and fourteen men aged >50 years old with lower urinary tract symptoms (LUTS) were assessed with symptoms, uroflowmetry, serum prostate-specific antigen (PSA), transabdominal ultrasound measurement of prostate volume (PV), IPP and post-void residual urine (PVRU). All patients underwent pressure flow studies. Patients with PV < 30 mL and IPP ≤ 10 mm were examined for parameters correlating with BOO or impaired detrusor contractility. Results: Thirty-six patients had PV < 30 mL and IPP < 10 mm. Nine patients (25.0%) had urodynamic BOO, all with normal bladder contractility. Fourteen patients (38.9%) had poor detrusor contractility and all had no BOO. PV, PVRU and IPP were significantly associated with BOO, with IPP showing greatest positive correlation. Both Qmax and IPP were significantly associated with detrusor contractility. At 5-year follow-up, most patients responded to medical therapy. Only three out of nine patients (33.3%) with BOO eventually underwent surgery, and all had a high bladder neck seen on the resectoscope. Only one patient (7.1%) with poor detrusor contractility eventually required surgery after repeat pressure flow study revealed BOO. Conclusion: In men with small prostates and low IPP, the presence of BOO is associated with higher PV, PVRU and IPP, and most respond well to medical management. BOO can possibly be explained by elevation of the bladder neck by a small subcervical adenoma.
通讯作者:
Keong Tatt Foo,E-mail address:foo.keong.tatt@sgh.com.sg
E-mail: foo.keong.tatt@sgh.com.sg
引用本文:
Han Jie Lee, Alvin Lee, Hong Hong Huang, Palaniappan Sundaram, Keong Tatt Foo. Patients with small prostates and low-grade intravesical prostatic protrusion——A urodynamic evaluation[J]. Asian Journal of Urology, 2017, 4(4): 247-252.
Han Jie Lee, Alvin Lee, Hong Hong Huang, Palaniappan Sundaram, Keong Tatt Foo. Patients with small prostates and low-grade intravesical prostatic protrusion——A urodynamic evaluation. Asian Journal of Urology, 2017, 4(4): 247-252.
[1] Eckhardt M, van Venrooji G, Boon T. Symptoms, prostate volume, and urodynamic findings in elderly male volunteers without and with LUTS and in patients with LUTS suggestive of benign prostatic hyperplasia. Urology 2001;58:966-71.
[2] Madersbacher S, Klingler HC, Djavan B, Stulnig T, Schatzl G, Schmidbauer CP, et al. Is obstruction predictable by clinical evaluation in patients with lower urinary tract symptoms? Br J Urol 1997;80:72-7.
[3] Chancellor MB, Rivas DA. American Urological Association Symptom Index for women with voiding symptoms:lack of index specificity for benign prostate hyperplasia. J Urol 1993; 150:1706-9.
[4] Foo KT, Lim KB, Ho H, Fook S. Co-relationship between the size of the prostate, the intravesical prostatic protrusion and benign prostatic obstruction. Eur Urol Suppl 2005;4:71.
[5] Chia SJ, Heng CT, Chan SP, Foo KT. Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU Int 2003;91:371-4.
[6] Kuo TLC, Teo JSM, Foo KT. The role of intravesical prostatic protrusion (IPP) in the evaluation and treatment of bladder outlet obstruction (BOO). Neurourol Urodyn 2016;35:535-7. http://dx.doi.org/10.1002/nau.22741.
[7] Abrams P. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency:three simple indices to define bladder voiding function. BJU Int 1999;84:14-5.
[8] Hirayama A, Samma S, Fujimoto K, Yamaguchi A, Akiyama T, Fukui Y. Comparison of parameters to determine the cause of urinary disturbance in men with prostate volume less than 20 milliliters. Int J Urol 2002;9:554-9.
[9] Gomes CM, Nunes RV, Araújo RM, Sacomani CR, TrigoRocha FE, Bruschini H, et al. Urodynamic evaluation of patients with lower urinary symptoms and small prostate volume. Urol Int 2008;81:129-34.
[10] Abrams PH, Farrar DJ, Turner WR, Whiteside CG, Feneley RC. The results of prostatectomy:a symptomatic and urodynamic analysis of 152 patients. J Urol 1979;121:640-2.
[11] Seki N, Takei M, Yamaguchi A, Naito S. Analysis of prognostic factors regarding the outcome after a transurethral resection for symptomatic benign prostatic enlargement. Neurourol Urodyn 2006;25:428-32.
[12] Rodrigues P, Lucon AM, Freire GC, Arap S. Urodynamic pressure flow studies can predict the clinical outcome after transurethral prostatic resection. J Urol 2001;165:499-502.
[13] Gravas S, Bach T, Bachmann A, Drake M, Gacci M, Gratzke C, et al. Guidelines on the management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO); European Association of Urology. 2015. Available at:https://uroweb.org/wp-content/uploads/EAUGuidelines-Non-Neurogenic-Male-LUTS-Guidelines-2015-v2.pdf[Accessed 28 June 2016].
[14] Groen J, Bosch JL. Bladder contraction strength parameters poorly predict the necessity of long-term catheterization after a pubovaginal rectus fascial sling procedure. J Urol 2004; 172:1006-9.
[15] Oelke M, Rademakers KLJ, van Koeveringe GA, on behalf of the FORCE Research Group, on behalf of the FORCE Research Group, Maastricht & Hannover. Unravelling detrusor underactivity:development of a bladder outlet resistancedbladder contractility nomogram for adult male patients with lower urinary tract symptoms. Neurourol Urodyn 2016;35:980-6. http://dx.doi.org/10.1002/nau. 22841.
[16] Griffiths D, van Mastrigt R, Bosch R. Quantification of urethral resistance and bladder function during voiding, with special reference to the effects of prostate size reduction on urethral obstruction due to benign prostatic hyperplasia. Neurourol Urodyn 1989;8:17-27.
[17] Turner-Warwick R. Clinical problems associated with urodynamic abnormalities. In:Lutzeyer W, Melchior H, editors. Urodynamics. Berlin:Springer Verlag; 1970. p. 237-63.
[18] Nitti VW. Primary bladder neck obstruction in men and women. Rev Urol 2005;7(Suppl. 8):S12-7.
[19] Kaplan SA, Te AE, Pressler LB, Olsson CA. Transition zone index as a method of assessing benign prostatic hyperplasia:correlation with symptoms, urine flow and detrusor pressure. J Urol 1995;154:1764-9.
[20] Lepor H, Nieder A, Feser J, O'Connell C, Dixon C. Total prostate and transition zone volumes, and transition zone index are poorly correlated with objective measures of clinical benign prostatic hyperplasia. J Urol 1997;158:85-8.
[21] Chancellor MB, Rivas DA, Keeley FX, Lotfi MA, Gomella LG. Similarity of the American Urological Association Symptom Index among men with benign prostate hyperplasia (BPH), urethral obstruction not due to BPH and detrusor hyperreflexia without outlet obstruction. Br J Urol 1994;74:200-3.
Christopher Hartman, Nikhil Gupta, David Leavitt, David Hoenig, Zeph Okeke, Arthur Smith. Advances in percutaneous stone surgery[J]. Asian Journal of Urology, 2015, 2(1): 26
-32
.
