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PubMed1978

Transurethral bladder neck operation in neurogenic bladder.

86 adults with bladder outlet obstruction and neurogenic bladder underwent bladder neck resection or incision to establish effective vesical emptying or damping of detrusor reflex activity. Follow-up examinations revealed a good effect on flow, reflux and hydronephrosis, infection rate and symptoms such as frequency, dysuria, nocturia and urgency. Since 1974, bladder neck incision is preferred; resection remains for selected cases only.

Adolescent↗
PubMed1976

Patterns of urinary flow in benign prostatic hypertrophy.

Multiple urinary flow recordings were carried out on 51 men and without bladder outlet obstruction due to benign prostatic hypertrophy. All patients were over 50 years of age. Six urinary flow patterns (types 0-5) were defined. Types 0-3 were found in patients without obstruction, while all six patients were observed in those with clinical obstruction. Following prostatic surgery, only types 1, 2 and 3 were found. Only type 5 flow pattern can be determined by flow rate alone because it is by definition on the curve obtained when peak flow rate is below 4 ml per second. In this study, no type of flow pattern was characteristic of bladder outlet obstruction due to benign prostatic hypertrophy. The supposedly characteristic type of flow pattern in this clinical condition reported by earlier workers is mainly a result of a difference in the age distribution between their control and test groups.

Aged↗
PubMed1979

Prostatism. I. The correlation between symptoms, cystometric and urodynamic findings.

One hundred and seven consecutive patients referred with symptoms of bladder outlet obstruction were studied using cystometry and combined pressure-flow-electromyographic investigation. The symptoms of infravesical obstruction were not statistically significantly correlated to the hydrodynamic documentation of increased bladder outlet resistance as judged by maximum flow rate and the calculated urethral resistance. Irritative symptoms such as frequency, nocturia, urgency and urgeincontinence were statistically significantly correlated to the presence of detrusor hyperreflexia. The functional disorder bladder neck dyssynergia was encounterd in 5% of the patients (95% confidence limits 1-10%). This diagnosis cannot be made by conventional urological investigations. It is concluded that objective demonstration of infravesical obstruction is mandatory in the selection of patients with symptoms of lower urinary tract dysfunction for surgery on the prostate or the bladder neck.

Adult↗
PubMed1977

Posterior urethral valves in adults: a report of 2 cases.

Herein we review 2 cases of posterior urethral valves in adults. Significant secondary bladder neck obstruction occurred in both cases and required transurethral incision before the bladder outlet obstruction was relieved. The management is described of the secondary upper tract changes that occurred.

Adult↗
PubMed1977

The adynamic terminal ureteral segment.

Recently, we observed hydroureteronephrosis owing to an adynamic transmural distal ureteral segment associated with a thickened bladder, consequent to bladder outlet obstruction. Histological examination disclosed a loss of intrinsic musculature of the terminal ureteral segment with fibrosis. The importance of this entity is in the fact that upper tract dilatation and deterioration may progress, despite apparently successful correction of the bladder outlet uropathy.

Child↗
PubMed1978

Imperforate anus and colon calcification in association with the prune belly syndrome.

Two patients with the prune belly syndrome demonstrated colon calcifications and anorectal malformations. Bladder outlet obstruction was present in both cases. Calcifications were also found in the renal collecting system and bladder of one patient. No fistula was demonstrated between the genitourinary tract and bowel in either infant at autopsy. The calcification in the colon and urinary tract is probably secondary to stasis.

Abdominal Muscles↗
PubMed1977

Manometric and electromyographic assessment of urethral resistances in children.

In an attempt to define urethral resistances in children, 84 cystometries were performed, combined with an anal EMG in 54 cases. The urethral pressure profile was measured in each patient. The following parameters were studied: bladder tone, activity and contractility; micturition EMG; maximal urethral pressure; aspects of the urine stream; and residual urine. It was found that each parameter considered alone is insufficient for assessment of bladder outlet obstruction. Only the complete investigation proved to be highly reliable as a complement to radiological findings, and allowed a dynamic assessment of bladder and sphincter functions.

Adolescent↗
PubMed1977

Blow out of a colocystoplasty loop owing to bladder neck obstruction.

A case of blowout of the colonic segment of a colocystoplasty at its free end owing to late development of bladder neck obstruction is described. Prostatitis and secondary bladder neck contracture provided further hindrance to the already inefficient voiding mechanism and predisposed to the rupture of the decompensated bowel loop. This is an extreme example of proof that the colonic loop, except as an improved substitute for an ileal segment, cannot withstand high intraluminal pressures generated in the presence of bladder outlet obstruction.

Adult↗
PubMed1975

Inverted urinary papilloma: report of five cases and review of the literature.

Five new cases of inverted urinary papilloma are described and 13 previously reported cased are reviewed. All 18 examples were seen in adult males, with ages ranging from 26 to 79 years (average 57 years). Ten patients presented with symptoms of bladder outlet obstruction and 8 with haematuria. With one probable exception all of the tumours were solitary. Sixteen were found in the region of the bladder neck and prostatic urethra, and only 2 occurred on other sites. The papillomas were pedunculated or sessile and ranged in size from a few mms to 3 cms in greatest diameter. Most had smooth surfaces in contrast to the usual exophytic papillary urothelial neoplasms. Microscopically they showed a striking resemblance to the inverted papillomas of the nasal cavity and paranasal sinuses. In those examples where the stalk or base of the papilloma was included in the sections, there was no evidence of invasion of the underlying smooth muscle. Fourteen of the patients have been followed for periods ranging from 7 months to 11 years (average 2.5 years) and no recurrences have been documented. Simple local resection, by the transurethral route where possible, appears to be adequate treatment for these distinctive papillomas.

Aged↗
PubMed1977

[Neurogenic urethra. Urethrogram and pathophysiological aspects].

In the analysis of neurogenic urinary voiding disturbances, too much attention has been paid to the bladder, too little to the muscular tubing of the posterior urethra and to the pelvic floor. Contrast radiography of the urethra in injection and micturition, combined with urodynamic investigations, seemed suitable for comprehension of neurogenic functional disturbances of the posterior urethra and the pelvic floor. A cross section of 143 predominantly traumatic patients and 69 patients with myelomeningocele were investigated radiologically. In addition, in a number of patients urinary flow was determined by uroflowmetry and micturition studies with simultaneous recording of intravesical and intrarectal pressure, of the EMG-activity of the pelvic floor and urinary flow were performed by a special method. The radiologic section shows that the urinary picture of various neurogenic bladder types are characterized by specific changes in form of the posterior urethra. With the help of systematic investigations of a number of cases it was demonstrated that in automatic bladder the roentgen contour of the urethra changes with duration of illness and that primarily secondary, morphologic changes--recognizable at the same time from the increasing number of radiologically demonstrable changes of the prostate and the seminal vesicles--are responsible. Simultaneously a typical deformation of the posterior urethra in passive urinary voiding is described, and attention directed to the fact that the urinary pictures of children with neurogenic impaired urethra sometimes cannot be distinguished from those with urethral values. Urinary flow measurements show that the flow rates from a cross section of patients with lesions of the upper and lower neurons are significantly lower in comparison to normals. With the help of combined urodynamic investigations it was demonstrated that a functional obstruction was present in the neurogenic bladder at the level of spastic and of paretic pelvic floors. It was proved that the roentgenologically visible deformation of the posterior urethra plays a quite decisive role in neurogenically disturbed urinary voiding. It is the main reason why, despite sufficient bladder pressure values, urinary voiding remains unsatisfactory and urinary performance low. Hence the therapeutic consequence follows: an improvement in urinary performance in neurogenic bladder is generally only possible through a decrease in the expulsion resistance. Various operative procedures for the release of bladder outlet obstruction and their uses are discussed.

Female↗
PubMed1976

Observations on vesical diverticulum in childhood.

An operation was required in 78 children with vesical diverticula in the absence of bladder outlet obstruction. Virtually all diverticula were located in juxtaposition to the ureteral orifice and were associated with vesicoureteral reflux in all but 6 of 89 diverticulum-ureteral units. Upper tract changes were seen on excretory urography in 78 per cent of the refluxing units. The surgical procedure of choice was diverticulectomy and ureteroneocystostomy, which yielded a high degree of success. Diverticulectomy alone and vesical neck revision were rarely indicated.

Adolescent↗
PubMed2026

Aquablation/AquaBeam Waterjet Therapy for Benign Prostatic Hyperplasia: Three-Year Functional and Ejaculatory Outcomes in a Multicenter Real-World Italian Cohort.

OBJECTIVE: To evaluate the 3-year functional outcomes of Aquablation/AquaBeam waterjet therapy for bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH), with particular attention to urinary symptoms, quality of life, continence, ejaculatory function, and complications. METHODS: We performed a retrospective analysis of a prospectively maintained multicenter database including 218 consecutive men who underwent Aquablation/AquaBeam for symptomatic BPH between January 2019 and January 2022 at three referral centers. Functional outcomes assessed preoperatively and during follow-up included International Prostate Symptom Score (IPSS), IPSS quality-of-life item (IPSS-QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR), continence, and ejaculatory function. Median follow-up was 36 months. Ejaculatory preservation was evaluated only in patients with preserved antegrade ejaculation at baseline. RESULTS: Median age was 61 years (IQR 57-66), median prostate-specific antigen (PSA) was 2.52 ng/mL (IQR 0.40-21.60), and median prostate volume was 55 mL (IQR 40-73). Median operative time was 56 min, while median catheterization time and length of hospital stay were both 48 h. Functional improvements were evident from the 3-month follow-up and remained stable through 36 months. At 36 months, median IPSS improved to 5 and median Qmax to 18 mL/s. Median PSA changed modestly from 2.52 ng/mL at baseline to 2.75 ng/mL at 36 months. No cases of de novo urinary incontinence were observed throughout follow-up. Among patients with preserved antegrade ejaculation at baseline, 87% maintained antegrade ejaculation at 36 months. Most postoperative complications were minor (Clavien-Dindo grade I-II, 20.2%). One grade III rectal injury occurred (0.5%). Median hemoglobin decreased from 15.2 g/dL preoperatively to 14.0 g/dL before hospital discharge, and two patients required blood transfusion. During the 36-month follow-up, no surgical retreatment was required, whereas 11 patients (5.0%) received temporary medical retreatment. CONCLUSION: In this multicenter real-world cohort, Aquablation/AquaBeam was safe and effective over 3 years, providing durable improvement in lower urinary tract symptoms and quality of life while preserving continence and antegrade ejaculation in most patients. These findings support Aquablation/AquaBeam as a valuable minimally invasive surgical option for selected men with BPH, particularly those who prioritize preservation of ejaculatory function. Longer-term and comparative studies are warranted. TRIAL REGISTRATION: 48281.

Humans↗
PubMed1978

Urethral pressure profile in children: a comparison between perfused catheters and micro-transducers, and a study of the usefulness of urethral pressure profile measurements in children.

Urethral pressure profiles were done on 46 children by the classical open-end perfused catheter and by a micro-transducer mounted on the tip of a catheter. A comparative study of the results obtained using the 2 methods demonstrates clearly the superiority of the micro-transducer over the perfused catheter. There are so many limitations of precison with the perfused catheter method that its usefulness for clinical studies seems questionable. With both methods the urethral pressure profile alone was not sufficient for distinguishing betweeen obstructed and non-obstructed bladder outlets.

Child↗
PubMed1977

Reversible malignant hypertension and azotemia due to urethral stricture.

A previously normotensive 24-year-old black man developed malignant hypertension and azotemia. The patient was found to have bladder outlet obstruction due to urethral stricture. Transurethral dilation resulted in brisk improvement in renal function and rapid lowering of blood pressure in association with minimal diuresis. On follow-up one year later, while he was not receiving medications, the blood pressure was 120/70 mm Hg and the creatinine clearance was 150 ml/min. A kidney biopsy specimen showed minimal residual pathologic abnormalities in the renal arteries and arterioles. The renin-angiotensin system was probably involved in the maintenance of the hypertension, in view of the elevated peripheral plasma renin activity on admission. This represents a rare case of hypertension due to urethral stricture. Despite rapid progression to azotemic malignant hypertension, urethral dilation restored the blood pressure and renal function to normal.

Adult↗
PubMed1976

Unilateral renal agenesis presenting as anuria.

The most common cause of sudden and total cessation of urine output is obstructive uropathy, usually at the bladder outlet. Bilateral ureteral obstruction is a much less common cause of anuria. In additioh, unilateral obstruction in the presence of a solitary kidney must be considered in the differential diagnosis. Primary renal parenchymal disorders and pre-renal azotemia occasionally may be anuric but more commonly are oliguric. A case of unilateral renal agenesis presenting as anuria and obstruction of the solitary kidney is described.

Anuria↗
PubMed1977

Psychiatric aspects of recurrent cystitis in women.

Using both psychometric questionnaires and psychiatric interview it has been shown that women with recurrent cystitis have significantly more psychiatric symptoms (particularly those of anxiety) than the population as a whole. By comparison with the expected prevalence, the study group shows a 3-fold increase in psychiatric symptoms antedating micturition symptoms, and a 10-fold increase in psychiatric symptoms overall. Significant differences in psychometric profiles have been demonstrated between different clinical subgroups of patients (e.g. bladder instability, outlet obstruction and dyspareunia). A multifactorial approach (including an awareness of psychiatric factors) to patients complaining of recurrent cystitis can produce a treatment failure rate as low as 4.4%.

Adolescent↗