OBJECTIVE: To ascertain the association of cystourethroscopic findings of bladder neck elevation with urodynamic bladder outlet obstruction (BOO) in patients with lower urinary tract symptoms and benign prostatic hyperplasia (LUTS-BPH).
MATERIALS AND METHODS: Study subjects were 646 consecutive men aged >40 years diagnosed with LUTS-BPH at Seoul National University Hospital from December 2005 through January 2012. We collected the International Prostatic Symptom Score, serum prostate-specific antigen levels, prostate volume measured by transrectal ultrasonography, uroflowmetry with postvoid residual volume, and urodynamics with a pressure flow study. We examined the degree of lateral lobe protrusion of prostate, bladder neck elevation degree (BNE-D), and bladder neck elevation angle (BNE-A) under a cystourethroscopic examination.
RESULTS: When we examined BNE by cystourethroscope, the mean BNE-A was 26.1°. Higher BNE-D was strongly positively correlated with BNE-A, but neither was associated with the degree of lateral lobe protrusion of prostate. Patients with higher BNE-A (≥35°) had higher BOO index and more obstructed voiding patterns than those with lower BNE-A (< 35°). BNE-A was positively correlated with BOO index (r = 0.186). However, we identified only total prostate volume (odds ratio [OR], 1.036), maximal flow rate (Qmax; OR, 0.843), and detrusor pressure at Qmax (PdetQmax; OR, 1.278) as significant predictors of BOO in the multivariate analysis.
CONCLUSION: In sum, patients with higher BNE-A (≥35°) by cystourethroscope had higher BOO index and more obstructed voiding patterns than those with lower BNE-A (< 35°). Moreover, both BNE-D and BNE-A were positively correlated with BOO index. Thus, cystourethroscopic findings of BNE status can be helpful to predict urodynamic BOO in the patients with LUTS-BPH.
Written by:
Kang M, Kim M, Choo MS, Bae J, Ku JH, Yoo C, Oh SJ. Are you the author?
Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Urology, Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea; Department of Urology, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea; Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL.
Reference: Urology. 2014 Dec;84(6):1461-6.
doi: 10.1016/j.urology.2014.08.037
PubMed Abstract
PMID: 25432841