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Automated evaluation of urethral obstruction.

The measurement of detrusor pressure and flow rate during voiding is the only way to objectively measure or grade infravesical obstruction. The resulting data cannot be interpreted easily. Manual as well as automatic methods have been introduced to derive one or several factors or parameters to quantify urethral resistance. A number of these methods are described in this overview. Since automatic methods involving computers guarantee uniform, unbiased, and objective processing of data, besides enabling the use of (statistical) methods that take into account more than one or two of the measured pressure and flow rate values, emphasis is on these methods. Some clinical results obtained with such automatic methods are discussed to illustrate the clinical value and possible impact on diagnosis and evaluation of treatment of lower urinary tract disorders.

Diagnosis, Computer-Assisted↗

Congenital posterior urethral obstruction: the historical perspective

The currently accepted interpretation of urethral anatomy and pathology in boys is based on studies from the first half of this century, most notably from Hugh Hampton Young and his colleagues. The studies that led to Young's conclusions and the developments in the management allow for reinterpretation, particularly with the advent of prenatal diagnosis and video-endoscopic recording technology.

Journal Article↗

Urethral obstruction in a dog: an unusual presentation of T-cell lymphoma.

A six-year-old, neutered male golden retriever was presented for evaluation of stranguria. Upon physical examination, the dog was thin and actively was straining to urinate. A large, firm bladder was palpated. Urethral pressure profilometry was indicative of a focal, nondistensible lesion in the midurethra which was confirmed with a positive contrast urethrogram. Ultrasonographically, a well-marginated tubular mass was visualized midurethra, and a region of small bowel was noted to have an annular mural thickening with corrugations of the mucosal surface. The abnormal areas were aspirated percutaneously, and lymphoma was diagnosed upon cytological examination of the aspirated material. At necropsy, a diagnosis of diffuse T-cell lymphoma was confirmed.

Animals↗

The prenatal ultrasonic diagnosis of urethral obstruction and diverticulum of the urinary bladder.

In a 28 year old gravida 2 para 1 an ultrasonogram at 35 weeks of gestation revealed a huge cystic abdominal tumor in fetus. Postpartum ultrasound, excretory urography and micturating cystourethrography showed a trabeculated bladder with a large diverticulum and hydronephrosis due to a posterior urethral valve. The prenatal diagnosis of this anomaly and immediate surgical intervention prevented additional severe damage in the newborn.

Adult↗

Evaluation of cervico-urethral obstruction with ambulatory pressure/flow studies: an alternative to conventional pressure/flow studies?

Most of the urodynamic studies are conducted in the laboratory during a brief recording time and under nonphysiological conditions and, thus, may fail to unfold the nature of existing pathological conditions of the lower urinary tract; false positives and false negatives are possible. To overcome some of the difficulties associated with conventional P/F studies we have developed, with the cooperation of Medical Measurement System company, Entschede, The Netherlands, a portable system (UDS 2000) for ambulatory monitoring of intravesical pressure, abdominal pressure and EMG connectable with a weight transducer flowmeter that permits performing Holter P/F measurements. We compared the results obtained with conventional P/F studies and with the Holter P/F studies in 58 BPH patients. During the filling phase we observed a slightly increased number of stable detrusors with Holter P/F recording (46 vs 42); conversely, the number of patients suffering from urge incontinence was the same (7 pts). During the voiding phase, out of 45 patients considered obstructed at conventional P/F study, only 42 were really urodynamically obstructed (93.3%), while 3 other patients had borderline obstruction. Four patients with borderline obstruction at conventional P/F study were considered nonobstructed after Holter P/F.

Adult↗

Urethral obstruction in a male llama.

An 8-year-old sexually intact male llama was euthanatized because of obstruction of the penile portion of the urethra and rupture of the urinary bladder. Clinical signs of obstruction included anorexia, lethargy, teeth grinding, straining to defecate, inability to urinate, and tense abdomen. Laboratory findings included anemia, leukocytosis with left shift, high serum urea nitrogen, creatinine, and phosphorus concentrations, and low serum chloride concentration. Necropsy revealed ruptured urinary bladder and acute fibrinous peritonitis. A firm, gray, nonmineralized urethral plug occluded the penile portion of the urethra for a distance of 14 cm in the midpenile region, distal to the sigmoid flexure of the penis. The urinary bladder mucosa and the urethra had microscopic evidence of chronic inflammation. Escherichia coli, Klebsiella sp, and alpha-streptococci were isolated from the urethral plug.

Animals↗