Ultrasound assessment of intravesical prostatic protrusion and detrusor wall thickness--new standards for noninvasive bladder outlet obstruction diagnosis?

PURPOSE: We evaluated the accuracy of detrusor wall thickness and intravesical prostatic protrusion, and the association of each test to diagnose bladder prostatic obstruction in patients with lower urinary tract symptoms. MATERIALS AND METHODS: We enrolled in the study 100 consecutive patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Baseline parameters were International Prostate Symptom Score, prostate volume, urinary flow rate, intravesical prostatic protrusion, detrusor wall thickness, Schaefer obstruction class, minimal urethral opening pressure and the urethral resistance algorithm bladder outlet obstruction index. A ROC curve was produced to calculate AUC and evaluate the diagnostic performance of intravesical prostatic protrusion, detrusor wall thickness and prostate volume for bladder prostatic obstruction. RESULTS: We noted a highly significant correlation between intravesical prostatic protrusion and the bladder outlet obstruction index (Spearman's rho = 0.49, p = 0.001), and Schaefer obstruction class (Spearman's rho = 0.51, p = 0.001). A highly significant correlation was also observed for detrusor wall thickness and the bladder outlet obstruction index (Spearman's rho = 0.57, p = 0.001), detrusor wall thickness and Schaefer obstruction class (Spearman's rho = 0.432, p = 0.02). On multivariate analysis intravesical prostatic protrusion and detrusor wall thickness were the only parameters associated with bladder prostatic obstruction (p = 0.015). The AUC for intravesical prostatic protrusion was 0.835 (95% CI 0.756-0.915) and for detrusor wall thickness it was 0.845 (95% CI 0.78-0.91). The association of intravesical prostatic protrusion and detrusor wall thickness produced the best diagnostic accuracy (87%) when the 2 tests were done consecutively. CONCLUSIONS: Suprapubic ultrasound of detrusor wall thickness and intravesical prostatic protrusion is a simple, noninvasive, accurate system to assess bladder prostatic obstruction in patients with lower urinary tract symptoms due to benign prostatic hyperplasia.

Effect of once-daily alfuzosin on urinary symptoms and flow rate in benign prostatic hyperplasia : a 24-hour home-uroflowmetry evaluation.

OBJECTIVE: To analyse the clinical and 24-hour urinary flow efficacy of alfuzosin 10mg once daily (OD), by means of the International Prostate Symptom Score (I-PSS) and home-based uroflowmetry (P-Flow) measurement, in patients with lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia. MATERIALS AND METHODS: In this open-label trial, 12 male patients (median age 67 years) with an I-PSS >15 (median 16) and maximum urinary flow (Q(max)) <15 mL/sec were evaluated. Patients underwent two days of P-Flow evaluation, and then received alfuzosin 10mg OD from day 3 to day 9. On days 7 and 8 they underwent further P-Flow evaluation. A second post-baseline evaluation I-PSS was recorded on day 9. RESULTS: Overall, 328 urinary flows were recorded and evaluated, an average of 27 flows per patient. A statistically significant improvement in mean maximum flow: (Q(max)) [10.8 +/- 2.8 vs 12.4 +/- 3 mL/sec; p = 0.02] and urinary voiding volume (219 +/- 70 vs 233 +/- 55mL; p = 0.04) were observed after treatment compared with baseline. No differences in the number of urinary flows were observed between baseline and after treatment (13 +/- 2.9 vs 14 +/- 1.8 flows; p = 0.199). A statistically significant difference between the two evaluations was noted for I-PSS (15.7 +/- 0.8 and 9.5 +/- 2; p = 0.02). Mean Q(max) recorded during treatment was always higher than baseline at different daytime evaluations. CONCLUSION: The alfuzosin 10mg OD formulation showed a significant improvement in I-PSS as well as a significant improvement in urinary flow parameters (Q(max)and urinary voiding volume) lasting for 24 hours in patients with LUTS.

Genetic instability in superficial bladder cancer and adjacent mucosa: an interphase cytogenetic study.

A systematic analysis of both tumors and the surrounding urothelium to help identify what lies behind the mechanism of multifocal tumor development has not yet been performed. In this study we investigated chromosome 1, 7, 9, and 17 aneusomy in 25 superficial papillary carcinomas and in 51 tissue samples taken from sites of macroscopically uninvolved urothelium surrounding the tumors, using the fluorescence in situ hybridization method. Our data demonstrated a close genetic relationship between all examined tumors and normal-appearing mucosa. Numeric aberrations of chromosomes 1, 7, 9, and 17 were found to exhibit similar patterns in all analyzed specimens, although with different frequencies.

Role of 99mTc-bombesin scan in diagnosis and staging of prostate cancer.

Aim of this work was to asses whether a novel 99mTc labeled Bombesin (BN) can play a clinical role in diagnosis and staging of prostate cancer. 14 patients were studied with trans-rectal ultrasonography-guided biopsy, CT and MRI and with 99mTc BN Scintigraphy. Five patients were also imaged by 111In Octreotide (O) scan. All the patients but one were submitted to surgery and final diagnosis was reached by pathology, taken as the gold standard method. Two patients showed benign adenoma and 12 patients showed cancer at biopsy. 99mTc BN SPECT was positive in all 12 patients with cancer. Four of these patients also showed pelvic focal uptake, referred to inguinal lymph-nodal involvement. MRI and CT provided similar findings in only three cases. Pathologic evaluation after operation confirmed the invasion of nodes in all four subjects. Both 99mTc BN and 111In O scans provided normal findings in the two subjects affected by benign adenoma, while 111In O was positive in only two of three patients with cancer and was always unable to detect nodal invasion. These preliminary data suggest that 99mTc BN SPECT scan could be useful to detect primary prostate cancer and to reveal loco-regional node involvement.

Patients with bladder outlet obstruction who refuse treatment show no clinical and urodynamic change after long-term follow-up.

OBJECTIVE: To evaluate in patients with mild bladder outlet obstruction (BOO) who refused the proposed treatment and were on watchful waiting (WW), the symptomatic and urodynamic changes after 1-5 years of follow-up. METHODS: 102 patients with lower urinary tract symptoms (LUTS) and BOO (Schafer class: 2-6, median 3) were clinically and urodinamically re-evaluated after 1-5 years of follow-up. Of these, 82 were submitted to medical (alfuzosin or finasteride) or surgical treatment (prostatectomy or TUIP) and 20, who refused the proposed treatment, were on WW. A retrospective study was made on these 20 patients who underwent a second International Prostatic Symptom Score and pressure-flow evaluation after 1-5 years (median: 22 months) of watchful waiting. Wilcoxon matched-pairs signed-ranks test and Kruskal Wallis as appropriate were used for statistical analysis. RESULTS: In the group of patients who refused the proposed treatment, no statistically significant differences between the two evaluations were observed for any of the parameters investigated: International Prostatic Symptom Score (15.1 +/- 6.8; 14.7 +/- 7.5); maximum flow (11.5 +/- 4.2; 12.1 +/- 4.3); residual urine (90.2 +/- 154.5; 113.3 +/- 158.4); Schäfer class (2.9 +/- 0.9; 2.8 +/- 1.2); Urethral Resistance Algorithm (37.1 +/- 14.4; 37.3 +/- 16.3); Projected Isometric Pressure (113.7 +/- 26.5; 112.7 +/- 21.8). CONCLUSIONS: Patients with mild BOO may remain clinically and urodynamically stable for a long time.

Bipolar transurethral resection of prostate: clinical and urodynamic evaluation.

OBJECTIVES: To report our experience with the clinical effectiveness of endoscopic resection of the prostate using the bipolar Gyrus PlasmaKinetic System. METHODS: A total of 120 patients with lower urinary tract symptoms were observed from 2002 to 2005. Of these 120 patients, 90 developed benign prostatic hyperplasia and were considered to have obstruction, and 51 of these 90 were scheduled for prostate surgery. The patients were randomized 1:1, using envelopes, into two groups: bipolar transurethral resection of the prostate (TURP) using the Gyrus PlasmaKinetic System (PK group) and monopolar TURP (standard TURP group). All patients were evaluated at baseline and follow-up (12 months after treatment) by medical history, International Prostate Symptom Score, inclusive of the question on quality of life, and physical examination, including digital rectal examination, transrectal ultrasonography, and pressure flow study. Statistical analysis was applied on the change in International Prostate Symptom Score and urodynamic parameters comparing the endpoints with baseline and comparing the baseline and follow-up characteristics between the two groups. RESULTS: The mean resection time was 39.1 minutes and 31.7 minutes for the PK and standard TURP groups, respectively (P = 0.437). The mean postoperative hemoglobin reduction at 24 hours of follow-up was 1.25 g/dL, with a 2.1% hematocrit reduction, in the PK group and 1.81 g/dL, with a 3.2% hematocrit reduction, in the standard TURP group (P = 0.716). Improvements in flow rate, International Prostate Symptom Score, quality-of-life score, and bladder outlet obstruction grade were comparable between the two groups. CONCLUSIONS: Bipolar TURP using the bipolar Gyrus PlasmaKinetic System seems to be a safe and effective procedure that is potentially associated with fewer side effects and could result in this procedure being more attractive for high-risk patients or, as recently proposed, for training purposes.

Conservative treatment of intraperitoneal bladder perforation during transurethral resection of bladder tumor.

A new technique for conservative treatment of intraperitoneal bladder perforation during transurethral resection of bladder tumor is presented. This technique consists in the percutaneous insertion of an intraperitoneal drainage tube, using as a guide the sheath of the resectoscope, which is advanced through the bladder perforation and peritoneum up to the abdominal wall.

The evolution of detrusor overactivity after watchful waiting, medical therapy and surgery in patients with bladder outlet obstruction.

PURPOSE: We analyzed the evolution of detrusor overactivity in patients with bladder outlet obstruction treated with either medical or surgical therapy or watchful waiting. MATERIALS AND METHODS: Of 255 patients with symptomatic benign prostatic enlargement who completed the International Prostate Symptom Score and underwent full urodynamic investigation 161 presented with bladder outlet obstruction. Of the 161 men 101 were reevaluated with a second clinical evaluation and urodynamics 1 to 5 years (mean 2) after watchful waiting in 20, medical treatment (alfuzosin 20 and finasteride 16) in 36 and surgery (transurethral incision of the prostate 13 and prostatectomy 32) in 45. For statistical analysis Wilcoxon matched paired data and Kruskal Wallis tests were used as appropriate. RESULTS: Overall detrusor overactivity was present in 53 patients (52%) at baseline and 41 (40%) at followup. Detrusor overactivity was present in 9 patients (45%) at baseline and 11 (55%) at followup in the watchful waiting group (p = 0.17); 7 (35%) at baseline and 6 (30%) at followup in the alfuzosin group (p = 0.37); 10 (62.5%) at baseline and 10 at followup in the finasteride group (p = 1); 6 (46%) at baseline and 4 (30%) at followup in the transurethral prostate incision group (p = 0.48); and 21 (68%) at baseline and 10 (31%) at followup in the prostatectomy group (p = 0.02). CONCLUSIONS: Detrusor overactivity is highly prevalent (52%) in patients with bladder outlet obstruction, and appears to persist for long periods when obstruction is left untreated or treated only with medical therapy. However, surgical treatment of bladder outlet obstruction, prostatectomy in particular, significantly reduces the incidence of detrusor overactivity and lessens the chance of its de novo appearance for up to 5 years.

99mTc-bombesin detects prostate cancer and invasion of pelvic lymph nodes.

Biopsy is the standard method for the diagnosis of prostate cancer; however, it is inadequate for the assessment of lymph node invasion. Radionuclide imaging might be useful for both diagnosis and N staging, but it requires high uptake of radiotracers in order to overcome difficulties arising from the anatomy of the region. The aim of this study was to assess whether or not technetium-99m labelled bombesin (99mTc-BN) scan is able to detect prostate cancer and invasion of pelvic lymph nodes. Ten patients were studied with 99mTc-BN, transrectal ultrasonography, biopsy, computed tomography and magnetic resonance imaging. All the patients with cancer were operated on. Planar dynamic scintigraphy and single-photon emission tomography (SPET) were performed after administration of 185 MBq 99mTc-BN. Two patients showed benign adenoma and eight showed cancer at biopsy. The average Gleason's score was 7.5+/-1.3. 99mTc-BN dynamic planar scan showed hot spots in the prostatic fossa in two of the eight patients with cancer, both of whom had a prostate-specific antigen level higher than 20 ng/ml. In these patients, high uptake inside the prostatic fossa was detected as early as 1 min after injection, before the arrival of radioactivity in the bladder. True positive SPET scans were obtained in all eight patients with cancer. Invasion of the obturator nodes was detected by SPET in three patients, and in all three was confirmed at surgery. Our preliminary data encourage further studies on the prostate with 99mTc-BN. If the high sensitivity of 99mTc-BN SPET is confirmed, this method may play an important role in diagnosing and staging prostate cancer.