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PubMed1995

Is there a correlation between prostate size and bladder-outlet obstruction?

This retrospective study was conducted in 521 men with micturition complaints to determine the relationship between prostate size and bladder-outlet obstruction. Analysis showed a statistically significant correlation between bladder-outlet obstruction and prostate size. Urodynamic bladder-outlet obstruction was confirmed in 90% of the patients with a prostate size of more than 80 cm3. In 32% of the patients with a prostate smaller than 40 cm3, no urodynamic evidence of bladder-outlet obstruction was found. There was no correlation between symptom scores (Madsen and I-PSS) and the grade of bladder-outlet obstruction or prostate size. We conclude that precise determination of the prostate size and urodynamics investigations are important (complementary) parameters in the assessment of elderly men with micturition complaints.

Aged↗
PubMed1993

Structural basis of geriatric voiding dysfunction. IV. Bladder outlet obstruction.

Several aspects of the pathogenesis of voiding dysfunction in bladder outlet obstruction remain unresolved. The structural basis of obstructive versus nonobstructive dysfunction was investigated in a prospective ultrastructural/urodynamic study of 35 elderly subjects of comparable age. Detrusor structure was examined by electron microscopy, with blinded clinical and urodynamic information. Seven detrusor specimens were segregated by a distinctive myohypertrophy, structural pattern, which matched with 6 male and 1 female subjects 72 to 96 years old (mean age 83) who had urodynamically proved outlet obstruction. This pattern was characterized by widely separated muscle cells with reduction of intermediate cell junctions, collagenosis, that is abundant collagen plus some elastic fibers, in the markedly widened spaces between individual muscle cells and abundant profiles characteristic of enlarged, hypertrophic muscle cells. Superimposed degeneration of muscle cells and axons in 6 specimens matched those of 5 men and 1 woman who had impaired detrusor contractility. In 3 specimens there were also abundant protrusion junctions and ultra-close abutments; these matched those of 2 men and 1 woman with obstruction plus detrusor overactivity. Observations on the degree of bladder trabeculation in the entire population of 35 subjects are presented. It is concluded that bladder outlet obstruction is associated with changes in detrusor structure that can account for the resultant voiding dysfunction. Features of the myohypertrophy pattern, with or without superimposed degeneration, can explain overall weakness of the obstructed detrusor despite hypertrophy of its cells. Protrusion junctions and abutments probably mediate electrical coupling of muscle cells leading to involuntary contractions in the overactive (unstable) obstructed detrusor. Excessive deposits of elastic fibers (hyperelastosis) between widely separated muscle cells and in interstitium are suggested as the probable structural basis for increased bladder distensibility and chronic retention.

Age Factors↗
PubMed2006

The effect of terazosin on functional bladder outlet obstruction in women: a pilot study.

PURPOSE: We assessed the effect of terazosin (Hytrin(R)) on functional bladder outlet obstruction in women. MATERIALS AND METHODS: Functional bladder outlet obstruction was defined as a maximum flow rate of less than 12 ml per second combined with a detrusor pressure at maximum flow rate of more than 20 cm H2O in pressure flow studies in the absence of neurological disorders or mechanical causes. In a prospective pilot study 15 women with functional bladder outlet obstruction were treated with terazosin. Terazosin was initiated at 1 mg daily and gradually increased to the maintenance dose of 5 mg daily during 2 weeks. Symptoms and urodynamic parameters were assessed before and 3 to 4 weeks after the initiation of alpha-blocker therapy. RESULTS: While on terazosin, voiding symptoms subjectively improved greater than 50% in 10 of the 15 women (p = 0.002). Median maximum urethral closure pressure at rest decreased significantly from 98 to 70 cm H2O (p = 0.001), median maximum detrusor pressure decreased from 45 to 35 cm H2O (p = 0.008), median detrusor pressure at maximum flow decreased from 34 to 27 ml per second and median post-void residual urine decreased from 120 to 40 ml (p = 0.006 and 0.002, respectively). There was a significant increase in the median maximum flow rate from 9 to 20 ml per second and in median voided volume from 300 to 340 ml (p = 0.0005 and 0.021, respectively). Storage symptoms, functional urethral length and maximum cystometric capacity did not change significantly with alpha-blocker therapy (p > 0.05). Overall terazosin resulted in a significant improvement in symptoms and urodynamic parameters in 10 of the 15 women (67%). CONCLUSIONS: Terazosin had a significant symptomatic and urodynamic effect in two-thirds of our patients. These results suggest that terazosin may be an effective treatment option in women with voiding dysfunction due to functional bladder outlet obstruction.

Adrenergic alpha-Antagonists↗
PubMed2004

Effects of alpha 1-adrenergic receptor subtype selective antagonists on lower urinary tract function in rats with bladder outlet obstruction.

PURPOSE: Antagonists of alpha 1-adrenergic receptors (alpha 1ARs) relieve obstructive and irritative symptoms in patients with bladder outlet obstruction. However, to our knowledge mechanisms underlying the relief of irritative symptoms remain unknown. Because bladder alpha 1dARs are up-regulated in some rats with bladder outlet obstruction, we investigated the effect of the alpha 1aAR antagonist 5-methyl urapidil (5MU) vs the alpha 1a/alpha 1dAR antagonist tamsulosin on urinary frequency in obstructed rats. MATERIALS AND METHODS: Baseline frequency was measured using a chronic micturition recording system and then obstruction (40 rats) or sham obstruction surgery (11 rats) was performed. After 6 weeks frequency was reassessed, followed by subcutaneous implantation of osmotic pumps to deliver 5MU, tamsulosin or vehicle for 1 week. Upon the completion of drug treatment urinary frequency was again measured and the pressor response to the alpha 1AR agonist phenylephrine was documented. RESULTS: Obstructed bladder mass was an average of 4.9 times greater than bladder mass in sham operated rats (p <0.001). Urinary frequency was elevated in obstructed rats with a bladder mass of greater than 500 mg vs all rats with a bladder mass of under 255 mg (p = 0.01). Of rats with a bladder mass of greater than 500 mg frequency was decreased in those treated with tamsulosin (p = 0.03) but not in those treated with 5MU. Tamsulosin and 5MU inhibited the pressor response to phenylephrine. CONCLUSIONS: Urinary frequency is increased in rats with a bladder mass of greater than 500 mg. The combined alpha 1a/alpha 1dAR antagonist tamsulosin decreases urinary frequency more than the alpha 1aAR selective antagonist 5MU. This finding supports the hypothesis that the alpha 1dAR is important for mediating irritative symptoms.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1999

Evaluation of patients with bladder outlet obstruction and mild international prostate symptom score followed up by watchful waiting.

OBJECTIVES: To examine the variability of bladder outlet obstruction and mild lower urinary tract symptoms in patients with benign prostatic hyperplasia (BPH) followed up by watchful waiting. METHODS: The International Prostate Symptom Score (IPSS) has four questions related to voiding symptoms and three related to filling symptoms. Scores of 0 to 7, 8 to 19, and 20 to 35 represent mild, moderate, and severe symptoms, respectively. Over a period of 36 months the IPSS questionnaire was administered to 479 patients 50 to 81 years old (mean age 63) with BPH. A pressure-flow study was used to determine the presence of bladder outlet obstruction. On the basis of their scores, the patients were classified into 50 with mild, 227 with moderate, and 202 with severe symptoms. In the present study only patients with a mild score were analyzed. RESULTS: Of 50 patients with mild symptoms, 16 (32%) had bladder outlet obstruction. After a period of 9 to 22 months (mean 17) of watchful waiting, these 16 patients were reviewed. Twelve (75%) of the 16 had bladder outlet obstruction reconfirmed by pressure-flow studies, and 3 (18.8%) of 16 had increased symptoms (moderate symptomatic) and underwent treatment (1 began pharmacologic treatment, and 2 chose transurethral resection). A total of 4 (25%) of 16 patients still had mild voiding disturbances and refused the second urodynamic evaluation. The remaining 34 patients with no obstruction had annual routine follow-up and had persistent mild symptom scores and normal uroflowmetric results. These patients did not undergo another pressure-flow evaluation. CONCLUSIONS: A pressure-flow study is routinely avoided in patients with a mild IPSS. From symptoms alone it was not possible to diagnose bladder outlet obstruction in these patients. Pressure-flow studies and symptom profiles measure different aspects of the clinical condition. After a mean follow-up of 17 months of watchful waiting, 13 (81.2%) of 1 6 patients were clinically stable. Because the need for therapy is dictated by quality of life, it is difficult to propose treatment for patients with minimal symptoms, even in the presence of bladder outlet obstruction.

Aged↗
PubMed2006

Partial bladder outlet obstruction selectively abolishes protein kinase C induced contraction of rabbit detrusor smooth muscle.

PURPOSE: Despite the acute onset, partial bladder outlet obstruction in the rabbit induces detrusor remodeling similar to that in men with benign prostatic hyperplasia in terms of its impact on structural and functional alterations in smooth muscle. We determined if partial bladder outlet obstruction induced remodeling alters the protein kinase C signaling pathway that leads to contraction. MATERIALS AND METHODS: Smooth muscle from control animals and those subjected to 2 weeks of partial bladder outlet obstruction were mounted for isometric force recording, measurement of myosin light chain phosphorylation and levels of adducin phosphorylation. Bladder muscle strips were stimulated by phorbol dibutyrate or carbachol in the presence and absence of bisindolylmaleimide-1. RESULTS: Smooth muscle strips from animals subjected to partial bladder outlet obstruction showed little to no increase in stress in response to phorbol dibutyrate and no increase in myosin light chain phosphorylation levels. Muscle strips from control animals produced a robust contraction with concomitant increases in myosin light chain phosphorylation. Inhibition of protein kinase C by bisindolylmaleimide-1 significantly depressed carbachol induced contractions of muscle strips from control animals but it had no effect on carbachol induced contractions of muscle strips from outlet obstructed animals. Phorbol dibutyrate increased phospho-adducin levels in muscle strips from the 2 animal sources, suggesting that protein kinase C could be activated. CONCLUSIONS: We propose that partial bladder outlet obstruction does not alter protein kinase C activation, but rather abolishes or uncouples the pathway(s) downstream of protein kinase C, leading to contraction. Loss of this pathway may contribute to the loss of normal voiding behavior and the resultant decompensated state.

Animals↗
PubMed2004

Routine bladder biopsies in men with bladder outlet obstruction?

OBJECTIVES: To establish whether routine evaluation of light microscopic changes in bladder biopsies in men with graded bladder outlet obstruction correlates with urodynamic parameters and to evaluate the performance of two pathologists in bladder biopsy interpretation. METHODS: In 63 consecutive patients presenting with lower urinary tract symptoms suggestive of bladder outlet obstruction, the workup included bladder biopsies, which were semiquantitatively and independently evaluated by two pathologists for fibrosis, elastosis, muscle cell degeneration, inflammation, and additional remarkable findings. Furthermore, as determined by their general impression, the pathologists gave a diagnosis of normal or graded abnormality. The pathologists' performance was compared and the clinical and urodynamic data were correlated to the consensus histologic diagnoses. RESULTS: Fifty-four of 63 cases could be evaluated. The intraobserver and interobserver reproducibility were reasonable, with a kappa of 0.35 and 0.50, respectively. The consensus diagnosis of abnormal bladder biopsy correlated with impaired bladder compliance and capacity. However, no correlation was found between the presence and severity of histologic abnormalities and Schäfer class, urethral resistance factor, instability, postvoid residual urine volume, symptom score, and prostate volume. CONCLUSIONS: Although abnormal bladder biopsies correlated significantly with impaired bladder capacity and compliance, routine evaluation of bladder biopsies is not indicated in the evaluation of bladder outlet obstruction.

Biopsy↗
PubMed1998

Development of noninvasive velocity flow video urodynamics using Doppler sonography. Part II: clinical application in bladder outlet obstruction.

OBJECTIVES: We have developed a totally noninvasive urodynamic technique based on the concept of Doppler sonography, which was tested in men with and without bladder outlet obstruction. MATERIALS AND METHODS: An ultrasonic image directed Doppler system with a 3.75 MHz. micro-convex electro-probe was operated transperineally using a specially devised remote control robotic holder. Uroflow rates from the urethral meatus were also measured with a flowmeter. The color Doppler ultrasound image and digital flow velocity data were processed by a personal computer. Color scale data were analyzed by customized software. Multiple rectangle sample volumes could be set in any size in any position, and the resulting color encoded data were averaged. Calculation was performed every 0.5 second and a flow velocity curve in the region of interest was obtained. A total of 12 men, 6 without (controls) and 6 with bladder outlet obstruction, were evaluated by conventional pressure flow study and the new Doppler ultrasound urodynamic system. Bladder outlet obstruction was determined using the nomogram of Abrams and Griffiths. The sample volume for a flow velocity curve was set only in the prostatic urethra and, thus, maximum flow velocity in and functional cross-sectional area of the prostatic urethra were determined. RESULTS: Urinary stream in the male urethra was clearly detected and flow velocity in the prostatic urethra could be measured in all cases. Maximum flow rate measured by a flowmeter was significantly lower in the bladder outlet obstruction group. Maximum flow velocity by Doppler study was almost the same in the obstructed and control groups. Functional cross-sectional area, which was calculated by dividing maximum flow rate by maximum flow velocity, was lower in the bladder outlet obstruction (mean plus or minus standard deviation 0.31+/-0.16 cm.2) than control group (0.78+/-0.23 cm.2) (p = 0.006). Velocity flow plots were possible in both groups. CONCLUSIONS: The concept of noninvasive pressure flow-like urodynamic evaluation based on Doppler ultrasound is feasible. Parameters of flow velocity as well as functional cross-sectional area can be used in the diagnosis of bladder outlet obstruction and to localize the site of obstruction.

Humans↗
PubMed2000

Early diagnosis of fetal bladder outlet obstruction.

Prenatal ultrasonography has facilitated early diagnosis of in utero bladder outlet obstruction. This represents one of the earliest diagnoses of prune-belly syndrome and sheds light on the natural history of the bladder outlet obstruction in the fetus.

Adult↗
PubMed2004

[Experimental study of the expression of the bladder wall proteins in bladder outlet obstruction in the rabbit].

OBJECTIVES: To determine the relationship of the bladder wall levels of the contractile proteins: whole actin, beta-actin, alpha-sarcomeric-actina caldesmon and of the Heat Stress Protein HSP-70, with the partial bladder outlet obstruction. MATERIAL AND METHODS: It was carried out an experimental study on 43 New-Zealand rabbits. These animals were divided into a control group and six experimental groups with partial bladder outlet obstruction induced by an incomplete tie around the urethra. The experimental groups were defined according the day when the animals were sacrified: at 24 hours, 7 days, 15 days, 1 month, 3 months and 6 months of the obstruction. It was determined in all animals the muscular bladder wall concentration of whole actin, beta-actin, alpha-sarcomeric-actin, caldesmon and HSP-70 protein, according to Western Blotting technique. The results were analyzed by means of ANOVA, using the Scheffe post hoc method. RESULTS: The bladder weight of the obstructed animals increased significantly in two stages: until the day 15 and between the day 15 and the end of the study, corresponding to theoretical phases of initial hypertrophy and compensation. The level of whole actin showed a significant decrease at the beginning of compensation phase, while the beta-actin level increased in the phase of initial hypertrophy and the alpha-sarcomeric-actin level increased at the end of the compensation phase, while the caldesmon and the HSP-70 made it at the end of the initial hypertrophy phase. CONCLUSIONS: Analysing our data we conclued that the determination of the caldesmon levels is the marker that better adjusts to the changes associated with partial bladder outlet obstruction in the rabbit.

Actins↗
PubMed1989

Pulmonary development in the fetal lamb with severe bladder outlet obstruction and oligohydramnios: a morphometric study.

The lethal feature of male newborns with severe bladder outlet obstruction and oligohydramnios is pulmonary hypoplasia. We report a fetal lamb model of bladder outlet obstruction created in the early second trimester, and morphometric analysis of the profound pulmonary hypoplasia that resulted. At 55 to 65 days of gestation 8 consecutive male fetuses underwent surgical clipping of the urethra and urachus near the abdominal wall. A sham operation was performed in 1 female fetus. The lambs were delivered by cesarean section 10 weeks later. The right lungs were immediately fixed at a distending pressure of 25 cm. water. The results of the morphometric studies were compared to control animals from our earlier study of normal fetal lamb lung development; slides for both studies were scored in a blind, randomized fashion by 1 of us (S. G. D.). Although mean body weights for the groups were similar, mean right lung volume in the operated lambs was 63.8 cM.3 compared to 158 cM.3 in the control animals and 137 cM.3 in the sham operated fetus (p less than 0.0005). Relative volume of respiratory tissue was 87 per cent in the operated animals, and 92 per cent in the controls and the sham operated fetus (p less than 0.0005). Microscopic morphometry revealed an increased relative volume of inter-alveolar tissue in the experimental animals (35 compared to 23 per cent in the normal lambs, p less than 0.05), with a corresponding decrease in relative airspace volume. Alveolar numerical density and alveolar surface density were not statistically different between the groups, although total alveolar number and surface area were substantially decreased in the operated lambs due to the reduced mean lung volume. Mean alveolar wall thickness was increased at 3.6 microM. in the operated group versus 2.1 microM. in the normal group (p less than 0.0005) and 2.8 microM. in the sham operated fetus. Thus, the lung in the lamb with severe bladder outlet obstruction is hypoplastic and immature.

Amniotic Fluid↗
PubMed1999

Renal renin-angiotensin system dysregulation caused by partial bladder outlet obstruction in fetal sheep.

BACKGROUND: To determine whether fetal renal obstruction activates the renal renin-angiotensin system (RAS), an important mediator in normal kidney development and obstructive nephropathy, we used a model of fetal partial bladder outlet obstruction (PBOO). METHODS: Total RNA and protein was extracted from kidney of sheep fetuses with partial bladder outlet obstruction created at 95 days gestation, after 2 (N = 6) and 5 weeks of obstruction (term; N = 6), and from normal fetal sheep at various time points between 60 and 135 days of gestation (total N = 19). Relative levels of mRNA for renin, angiotensinogen, type 1 and 2 angiotensin II (Ang II) receptors (AT-1 and AT-2), and transforming growth factor-beta1 (TGF-beta1) were assessed by semiquantitative reverse transcription-polymerase chain reaction. Expression levels of AT-2 receptor protein were measured by Western blot analysis. RESULTS: Renin mRNA expression was increased (250%) after two weeks of obstruction. In normal fetuses, AT-1 expression was low at 60 to 75 days of gestation and increased toward the end of gestation, whereas AT-2 expression showed a reversed pattern. At 109 days, PBOO caused an increased expression of AT-2 mRNA compared with normals (400%). Correspondingly, AT-2 receptor protein was more abundant in obstructed kidneys. TGF-beta1 mRNA expression was significantly increased in obstructed kidneys at 109 days gestation. CONCLUSIONS: These observations confirm the reciprocal developmental regulation of AT-1 and AT-2 receptors' expression, suggesting their functional role in renal development. Partial bladder outlet obstruction produces specific alterations: increased renin expression and altered balance of receptor subtypes, which may induce altered functional and vascular regulation of the obstructed fetal kidney. TGF-beta1, a mediator of Ang II-induced fibrosis, may play a role in inducing and propagating interstitial fibrosis.

Animals↗
PubMed2005

[Combined use of TUVP and TURP for prostate cancer with bladder outlet obstruction].

OBJECTIVE: To investigate a new surgical method for the treatment of prostate cancer with bladder outlet obstruction. METHODS: Forty-seven patients with prostate cancer complicated with bladder outlet obstruction were treated by combined use of transurethral electrovaporization ablation of the prostate (TUVP) and transurethral resection of the prostate (TURP). RESULTS: The operations were successful, with satisfactory results and no serious complication. IPSS decreased from (26.5 +/- 4.8) pre-operatively to (8.5 +/- 2.2) post-operatively (P < 0.05); Qmax increased from (4.6 +/- 1.5) ml/s to (14.5 +/- 3.6) ml/s (P < 0.05); and PSA decreased from (58.1 +/- 7.2) microg/L to (3.6 +/- 1.8) microg/L (P < 0.01). CONCLUSION: The combined use of TUVP and TURP is a safe and ideal method for the treatment of prostate cancer with bladder outlet obstruction.

Aged↗
PubMed2002

Modulation of bladder alpha1-adrenergic receptor subtype expression by bladder outlet obstruction.

PURPOSE: alpha1-Adrenergic receptor (alpha1AR) antagonists are effective for relieving obstructive and irritative symptoms in patients with bladder outlet obstruction. While the alpha1aAR is responsible for prostate smooth muscle relaxation and outlet obstruction relief, to our knowledge the mechanisms underlying the relief of irritative symptoms remain to be determined. Therefore, we investigated mechanisms by which bladder alpha1AR subtypes may be involved in this process. MATERIALS AND METHODS: We studied 42 rats, including 6 unoperated controls, 17 sham operated controls and 19 obstructed animals. Animals were characterized for baseline voiding pattern, followed by surgical intervention or sham surgery to establish obstruction (1.09 mm. restricted opening). After 6 weeks to enable the development of detrusor hypertrophy, voiding behavior was reexamined, the animals were sacrificed and bladder tissue was immediately placed in liquid nitrogen. alpha1AR subtype messenger (m)RNA was quantitated using quantitative competitive reverse transcriptase-polymerase chain reaction and protein expression was determined using radioligand binding with the alpha1AR antagonist [125iodine]2-(-[4-hydroxyphenyl]-ethyl-aminomethyl)tetralone (saturation analysis for total alpha1AR density and competition analysis with BMY7378 and 5-methylurapidel to determine alpha1AR subtypes). RESULTS: In this model 6-week surgical obstruction produced a 6.3-fold increase in bladder weight versus sham operation (p <0.001), concurrent with increased voiding frequency versus before obstruction (p <0.004). Although bladder alpha1AR density did not increase overall with obstruction, striking changes in alpha1AR subtype expression occurred. In control animals 70% of alpha1AR mRNA was the alpha1a subtype, 5% were alpha1b and 25% were alpha1d, whereas in obstructed animals bladder alpha1AR expression changed to 23% alpha1a, 2% alpha1b and 75% alpha1d. Changes in alpha1AR mRNA expression were of similar magnitude throughout the bladder dome, mid body and base. Parallel changes were also evident at the protein level with 100% alpha1aAR expression in control animals changing to new onset alpha1dAR expression (mean plus or minus standard error of mean 36% +/- 7%) in animals with a 5-fold or greater increase in bladder weight. CONCLUSIONS: Our findings indicate a remarkable increase in bladder alpha1dAR mRNA and protein expression after 6 weeks of obstruction and resultant detrusor hypertrophy. This finding is potentially important since alpha1dARs have 10 to 100-fold higher affinity for the endogenous neurotransmitter norepinephrine than the alpha1a or alpha1bAR subtypes. These findings imply that targeting alpha1d may provide a new therapeutic approach for controlling bladder irritative symptoms and possibly detrusor overactivity associated with bladder outlet obstruction.

Animals↗
PubMed1986

Müllerian remnant causing bladder outlet obstruction.

Less than one-third of patients with persistent müllerian duct remnants develop bladder outlet obstructive symptoms. We report on two cases of bladder outlet obstruction caused by massive dilatation of persistent müllerian duct remnants. Such structures should be suspected when outlet obstructive symptoms occur in patients with hypospadias and/or undescended gonads. Care should be taken to identify possible urethral obstruction distal to the prostatic urethra as a cause of gross enlargement of persistent müllerian duct remnants.

Adolescent↗
PubMed1998

Prenatal bladder outlet obstruction secondary to ureterocele.

We present 2 cases of prenatal hydroureteronephrosis and bladder outlet obstruction due to an obstructing ureterocele. Both neonates were stabilized and managed with early endoscopic decompression. Neither infant demonstrated significant function in the kidney ipsilateral to the ureterocele either before or after ureterocele puncture. There have been few cases reported of prenatal bladder outlet obstruction due to a ureterocele. Our limited experience has been poor with regard to salvaging the affected upper tract. Future definitive management will be tailored as more of these cases are documented.

Female↗
PubMed1978

Detrusor pressure in bladder outlet obstruction.

Synchronous urinary flow and pressure studies were done on 51 male adults consiting of 12 normal subjects and 39 patients with varying degrees of bladder outlet obstruction due to benign prostatic hypertrophy. Mean maximum detrusor pressure levels of 50 mm. Hg and above were found to be indicative of bladder outlet obstruction. Elevated mean maximum detrusor pressure fell preoperatively within normal limits after prostatecomy. Chronic retention of urine was not associated with poor contraction of the detrusor muscle. Clinical findings of obstruction were shown to be inadequate for estimation of maximum detrusor pressure. Recording the detrusor pressure was found to be a better urodynamic test for bladder outlet obstruction than recording the urinary flow rate. Recording urinary flow is, however, a simple test and should remain a screening test for impaired drainage of the bladder outlet.

Aged↗
PubMed2002

Effect of catheter size on urodynamic assessment of bladder outlet obstruction.

OBJECTIVES: To examine the effect of cross-sectional catheter diameter on urodynamic measurement of bladder outlet obstruction as predicted by the Abrams-Griffiths nomogram. METHODS: Thirty-one patients with symptomatic benign prostatic hyperplasia underwent free flow measurements followed by pressure-flow urodynamic evaluation using 5F and 10F urethral catheters in randomly assigned order. The measurements of voided volume, maximal flow rate (Qmax), postvoid residual volume, and detrusor pressure at maximal flow (PdetQmax) were compared. Data points were then plotted on the Abrams-Griffiths nomogram, and categorization of bladder outlet obstruction was assigned for each catheter size. RESULTS: The use of 10F catheters resulted in both a significant decrease in Qmax and increase in PdetQmax compared with the use of 5F catheters. Of 31 patients, 10 (32%) were incorrectly categorized as obstructed according to the Abrams-Griffiths nomogram when the larger sized catheter was used, and 17 (55%) experienced migration from a less obstructed to a more obstructed category. CONCLUSIONS: The use of 5F catheters allows for more accurate diagnosis of bladder outlet obstruction. In urodynamic evaluations, the larger size 10F catheters should be avoided, especially in patients with borderline symptoms.

Aged↗