RESUMO
This study assesses the morphological effectiveness of benign prostatic hyperplasia (BPH) surgery using multislice spiral computed tomography three-dimensional imaging (CT3D) with urethral contrast. Twenty-five male patients with BPH and bladder outlet obstruction (BOO) who underwent bipolar transurethral resection of the prostate were selected. Preoperative and postoperative CT3D indicators of retrograde and voiding cystourethrography, including bladder neck diameter, length of the posterior urethra, and degree of prostate protrusion into the bladder and upper and lower diameter of the prostate were used to assess bladder neck and posterior urethra morphology and BOO severity. In addition, preoperative and postoperative International Prostate Symptom Scores and maximum urine flow rates were compared. Postoperative CT3D was used to evaluate changes following obstruction relief postsurgery. Preoperative CT3D indicated significant BOO, whereas postoperative imaging showed improved patency but with irregular posterior urethral lumens and varying degrees of residual glandular tissue. Comparative analysis of preoperative and postoperative bladder outlet metrics revealed significant changes (p < .05). Urethral contrast CT3D effectively visualizes the prostate, bladder neck, and prostatic urethra. It quantifies changes in the urethral lumen postsurgery, correlating the extent of posterior urethral lumen spaciousness with urinary flow rates.
Assuntos
Imageamento Tridimensional , Hiperplasia Prostática , Obstrução do Colo da Bexiga Urinária , Humanos , Masculino , Hiperplasia Prostática/cirurgia , Hiperplasia Prostática/diagnóstico por imagem , Idoso , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/cirurgia , Obstrução do Colo da Bexiga Urinária/etiologia , Uretra/diagnóstico por imagem , Uretra/cirurgia , Pessoa de Meia-Idade , Ressecção Transuretral da Próstata , Meios de Contraste , Idoso de 80 Anos ou maisRESUMO
AIM: This study aimed to investigate the clinical significance of neutrophil-to-lymphocyte ratio and ultrasonic parameters in diagnosing bladder outlet obstruction in patients with benign prostatic hyperplasia. MATERIAL: Between September 2022 and January 2024, a total of 106 patients with benign prostatic hyperplasia were collected from Hongqi Hospital affiliated to Mudanjiang Medical University followed by urodynamic testing. The patients were categorized into three groups based on the International Prostate Symptom Score: mild (45 cases), moderate (36 cases), and severe (25 cases). Thirty-five healthy men were recruited at the hospital as a control group. All patients had blood tests and ultrasound scans. RESULTS: Neutrophil-to-lymphocyte ratio, detrusor wall thickness, detrusor muscle elastic modulus, internal gland elastic modulus, intravesical prostatic protrusion, and post-voiding residual volume were significantly correlated with the bladder outlet obstruction stage and showed good diagnostic efficiency (all P<0.05. There was no statistically significant difference observed in the external gland elastic modulus between the experimental group and the control group (P>0.05). CONCLUSIONS: The neutrophil-to-lymphocyte ratio, detrusor wall thickness, elastic modulus of the detrusor and glandular gland may hold clinical significance for diagnosing bladder outlet obstruction resulting from benign prostatic hyperplasia.
Assuntos
Linfócitos , Neutrófilos , Hiperplasia Prostática , Ultrassonografia , Obstrução do Colo da Bexiga Urinária , Humanos , Masculino , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/patologia , Obstrução do Colo da Bexiga Urinária/etiologia , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/patologia , Hiperplasia Prostática/sangue , Hiperplasia Prostática/complicações , Neutrófilos/patologia , Ultrassonografia/métodos , Pessoa de Meia-Idade , Idoso , Linfócitos/patologia , Contagem de Leucócitos , Estudos de Casos e Controles , Contagem de LinfócitosRESUMO
Background: Pressure flow urodynamic study remains the gold standard for the diagnosis of bladder outlet obstruction; however, their use is limited by their relative unavailability in our environment, cost, and invasiveness. Measurement of bladder wall thickness (BWT) by transabdominal ultrasonography is a promising tool that can be used to diagnose bladder outlet obstruction in our environment where pressure-flow urodynamic study is not readily available. Objective: The study aimed to correlate BWT with uroflowmetry and to establish a BWT cut-off in patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. Materials and Methods: This was a prospective one-year study of patients with LUTS due to benign prostatic enlargement. The patients were divided into obstructed and non-obstructed groups with Q- max of 10 ml/s serving as the cut-off value. Receiver Operator Curve (ROC) was used to evaluate the performance of BWT in diagnosing BOO. Statistical significance was set at P < 0.05. Results: The mean BWT and Q-max were 4.53 ± 2.70 mm and 15.06 ± 9.43 ml/s. There was a negative correlation between BWT and Q-max (r = -0.452, P = 0.000), Q-average (r = -0.336, P = 0.000), and voided volume (r = -0.228, P = 0.046). A BWT cut-off of 5.85 mm was found to be the best threshold to differentiate obstructed from non-obstructed patients with a sensitivity and specificity of 70 and 88.2 percent respectively. Conclusion: Bladder wall thickness showed an inverse relationship with maximum flow rate with high sensitivity and specificity. This non-invasive test can be used as a screening tool for BOO in our setting, where the pressure flow urodynamic study is not readily available.
Assuntos
Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Obstrução do Colo da Bexiga Urinária , Humanos , Masculino , Bexiga Urinária/diagnóstico por imagem , Estudos Prospectivos , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/etiologia , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/etiologia , Pacientes , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagemRESUMO
The role of the prostatic middle lobe in the presentation and management of benign prostatic hyperplasia (BPH) is under-appreciated. Middle lobe enlargement is associated with intravesical prostatic protrusion (IPP), which causes a unique type of bladder outlet obstruction (BOO) via a 'ball-valve' mechanism. IPP is a reliable predictor of BOO and the strongest independent factor for failure of medical therapy necessitating conversion to surgical intervention. Men with middle lobe enlargement tend to exhibit mixed symptoms of both the storage and the voiding types, but symptomatology will vary depending on the degree of IPP present. Initial assessments such as uroflowmetry and post-void residual volumes are inadequate to detect IPP and could confound the clinical picture. Radiological evaluation of prostate morphology is key to assessment as it provides important prognostic information and can help with operative planning. Treatment strategies employed for BPH should consider the shape and morphology of prostate adenomata, specifically the presence of middle lobe enlargement and the degree of associated IPP.
Assuntos
Hiperplasia Prostática , Obstrução do Colo da Bexiga Urinária , Masculino , Humanos , Próstata/diagnóstico por imagem , Próstata/cirurgia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/diagnóstico por imagem , Relevância Clínica , Ultrassonografia/efeitos adversos , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/etiologia , HipertrofiaAssuntos
Hiperplasia Prostática , Obstrução do Colo da Bexiga Urinária , Masculino , Humanos , Hiperplasia Prostática/complicações , Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/etiologia , Próstata/diagnóstico por imagem , UrodinâmicaRESUMO
Risk calculator (RC) combining PSA with other clinical information can help to better select patients at risk of prostate cancer (PCa) for prostate biopsy. The present study aimed to develop a new Pca RC, including MRI and bladder outlet obstruction parameters (BOOP). The ability of these parameters in predicting PCa and clinically significant PCa (csPCa: ISUP GG ≥ 2) was assessed by binary logistic regression. A total of 728 patients were included from two institutions. Of these, 395 (54.3%) had negative biopsies and 161 (22.11%) and 172 (23.6%) had a diagnosis of ISUP GG1 PCa and csPCa. The two RC ultimately included age, PSA, DRE, prostate volume (pVol), post-voided residual urinary volume (PVR), and PIRADS score. Regarding BOOP, higher prostate volumes (csPCa: OR 0.98, CI 0.97,0.99) and PVR ≥ 50 mL (csPCa: OR 0.27, CI 0.15, 0.47) were protective factors for the diagnosis of any PCa and csPCa. AUCs after internal validation were 0.78 (0.75, 0.82) and 0.82 (0.79, 0.86), respectively. Finally, decision curves analysis demonstrated higher benefit compared to the first-generation calculator and MRI alone. These novel RC based on MRI and BOOP may help to better select patient for prostate biopsy after prostate MRI.
Assuntos
Neoplasias da Próstata , Obstrução do Colo da Bexiga Urinária , Masculino , Humanos , Antígeno Prostático Específico , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/etiologia , Biópsia , Neoplasias da Próstata/patologia , Imageamento por Ressonância MagnéticaRESUMO
PURPOSE: To evaluate whether bladder wall thickness (BWT) measured by CT can be used to predict bladder outlet obstruction in men with low urinary tract symptoms (LUTS). METHODS: From 2015 to 2018, a total of 120 men with lower urinary tract symptoms who underwent both urodynamic studies and CT tests of the lower abdomen or pelvis were involved. Bladder wall thickness values were measured by CT scanning. RESULTS: Based on the urodynamic studies, 120 men were categorized into two groups, including 70/120 men (58.3%) in the bladder outlet obstruction (BOO) group and 50/120 men (41.7%) in the non-BOO group. The mean BWT was thicker in the BOO group than in the non-BOO group (3.87 vs. 2.75 mm, p < 0.001). The mean maximum bladder capacity (MBC) was lower in the BOO group than in the non-BOO group (263.42 vs. 308.96 ml, p < 0.001). The mean detrusor pressure at maximum urinary flow rate (PdetQmax) was higher in the patients in the BOO group than in those in the non-BOO group (102.28 vs. 49.25 cmH2O, p < 0.001). The ROC curve showed that BWT was a good predictor with an AUC of 0.855 (95% CI 0.785-0.924, p < 0.001). At the cutoff value of 3.20 mm, the predictive sensitivity of BWT for BOO was 72.9%, and the specificity was 90%. CONCLUSION: Increased bladder wall thickness was correlated with bladder outlet obstruction in men with LUTS. Bladder wall thickness measured by CT scans may be a noninvasive parameter to predict bladder outlet obstruction in men with LUTS.
Assuntos
Obstrução do Colo da Bexiga Urinária , Bexiga Urinária , Masculino , Humanos , Bexiga Urinária/diagnóstico por imagem , Estudos Retrospectivos , Obstrução do Colo da Bexiga Urinária/complicações , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Urodinâmica , Curva ROCRESUMO
BACKGROUND: The etiology of lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH) remains uncertain. OBJECTIVE: The purpose of our study was to quantitatively analyze anatomic characteristics on magnetic resonance imaging (MRI) to assess novel independent factors for symptoms. METHODS: This retrospective single-institution study evaluated treatment-naïve men who underwent prostate MRI within 3 months of international prostate symptom score (IPSS) scoring from June 2021 to February 2022. Factors measured on MRI included: size of the detrusor muscular ring (DMR) surrounding the bladder outlet, central gland (CG) mean apparent diffusion coefficient (ADC), levator hiatus (LH) volume, intrapelvic volume, intravesicular prostate protrusion (IPP) volume, CG volume, peripheral zone (PZ) volume, prostate urethra angle (PUA), and PZ background ordinal score. Multivariable logistic regression and receiver operating characteristic analysis were used to analyze factors for moderate/severe (IPSS ≥ 8) and severe LUTS/BPH (IPSS ≥ 20). RESULTS: A total of 303 men (mean age: 66.1 [SD: 8.1]) were included: 154 demonstrated moderate or severe symptoms with 28 severe and 149 with asymptomatic/mild symptoms. Increasing age [p = 0.02; odds ratio (OR): 1.05 (1.01-1.08)], PUA [p = 0.02; OR: 1.05 (1.01-1.09)], LH volume [p = 0.04; OR: 1.02 (1.00-1.05)], and DMR size measured as diameter [p < 0.001; OR: 5.0 (3.01-8.38)] or area [p < 0.001; OR: 1.92 (1.47-2.49)] were significantly independently associated with moderate/severe symptoms, with BMI [p = 0.02; OR: 0.93 (0.88-0.99)] inversely related. For every one cm increase in DMR diameter, patients had approximately five times the odds for moderate/severe symptoms. Increasing DMR size [diameter p < 0.001; OR: 2.74 (1.76-4.27) or area p < 0.001; OR: 1.37 (1.18-1.58)] was independently associated with severe symptoms. Optimal criterion cutoff of DMR diameter for moderate/severe symptoms was 1.2 cm [sensitivity: 77.3; specificity: 71.8; AUC: 0.80 (0.75-0.84)]. Inter-reader reliability was excellent for DMR diameter [ICC = 0.92 (0.90-0.94)]. CONCLUSION: Expansion of the DMR surrounding the bladder outlet is a novel anatomic factor independently associated with moderate and severe LUTS/BPH, taking into account prostate volumes, including quantified IPP volume, which were unrelated. Detrusor ring diameter, easily and reliably measured on routine prostate MRI, may relate to detrusor dysfunction from chronic stretching of this histologically distinct smooth muscle around the bladder neck.
Assuntos
Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Obstrução do Colo da Bexiga Urinária , Masculino , Humanos , Idoso , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/patologia , Bexiga Urinária/patologia , Estudos Retrospectivos , Reprodutibilidade dos Testes , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/etiologia , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/etiologia , Imageamento por Ressonância MagnéticaRESUMO
Background: Benign prostatic hypertrophy (BPH) is a common urological condition in men older than 50 years. It is important in the aetiologies of life-threatening obstructive uropathies. Ultrasound measurement of prostate volume is non-invasive, easily available, and a cost-effective method, useful in assessing bladder outlet obstruction (BOO). The International Prostate Symptoms Score (IPSS) on the other hand objectively assesses symptoms severity in BOO patients. Aim: This study was aimed at determining the correlation between ultrasound-measured prostate volume and IPSS in men with BPH. Patients and Methods: Following ethical approval from the Nnamdi Azikiwe University Teaching Hospital Ethical Committee, 100 patients who met the inclusion criteria and were diagnosed with clinical BPH were enrolled into the study. They had no other identifiable cause of BOO except BPH after clinical evaluation. The IPSS, Quality of life score (QOL), and prostate volumes were measured. Correlation between prostate volume, IPSS, and QOL were done using SPSS version 20. P value <0.05 was considered significant. Results: The mean age of patients was 69.3 ± 10.6 years with a range of 48-100 years. The mean prostate volume, IPSS, and QOL were 96.0 ± 70.5 cm3, 15.63 ± 8.6, and 4.8 ± 1.3, respectively. The highest recorded IPSS was 35 and the lowest was 4, whereas the smallest and largest recorded prostate volumes were 19 cm3 and 350 cm3, respectively. Nocturia was the major IPSS subscore. There was a weak positive correlation between prostate volume and IPSS in men with BPH (r = +0.109; P = 0.28) and between prostate volume and QOL (r = +0.072; P = 0.45). There was also a weak positive correlation between patients with only severe symptoms and corresponding prostate volumes (r = +0.122; P = 0.125). The correlation between patients with severe symptoms and their corresponding QOL was strong (r = +0.537; P = 0.135, respectively). These findings were, however, not statistically significant. Conclusion: There is a weak positive correlation between prostate volume measured by ultrasound and symptoms severity scores in patients with BPH, although not statistically significant. This may be as a result of the small sample size. A larger sample size may be able to achieve statistical significance.
Assuntos
Hiperplasia Prostática , Obstrução do Colo da Bexiga Urinária , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Próstata/diagnóstico por imagem , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Qualidade de Vida , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/etiologiaRESUMO
OBJECTIVE: To explore brain activation patterns on functional MRI (fMRI) in men with BPH and BOO before and after outlet obstruction procedures. METHODS: Men age ≥45 who failed conservative BPH therapy planning to undergo BOO procedures were recruited. Eligible men underwent a concurrent fMRI/urodynamics testing before and 6 months after BOO procedure. fMRI images were obtained via 3 Tesla MRI. Significant blood-oxygen-level-dependent (BOLD) signal activated voxels (P <.05) were identified at strong desire to void and (attempt at) voiding initiation pre- and post-BOO procedure. RESULTS: Eleven men were enrolled, of which 7 men completed the baseline scan, and 4 men completed the 6-month follow-up scan. Baseline decreased BOLD activity was observed in right inferior frontal gyrus (IFG), bilateral insula, inferior frontal gyrus (IFG) and thalamus. Significant changes in BOLD signal activity following BOO procedures were observed in the insula, IFG, and cingulate cortices. CONCLUSIONS: This represents a pilot study evaluating cortical activity in men with BPH and BOO. Despite limitations we found important changes in supraspinal activity in men with BPH and BOO during filling and emptying phases at baseline and following BOO procedure, with the potential to improve our understanding of neuroplasticity secondary to BPH and BOO. This preliminary data may serve as the foundation for larger future trials.
Assuntos
Hiperplasia Prostática , Obstrução do Colo da Bexiga Urinária , Masculino , Humanos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/cirurgia , Bexiga Urinária , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Projetos Piloto , Urodinâmica , Imageamento por Ressonância MagnéticaAssuntos
Embolização Terapêutica , Terapia a Laser , Hiperplasia Prostática , Obstrução do Colo da Bexiga Urinária , Artérias , Embolização Terapêutica/efeitos adversos , Humanos , Terapia a Laser/efeitos adversos , Lasers , Masculino , Próstata/diagnóstico por imagem , Próstata/cirurgia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/cirurgia , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgiaRESUMO
PURPOSE: Evaluation of male with primary bladder neck obstruction (PBNO) using MRI and MR voiding cystourethrography (MR-VCU) to study both anatomical aspects of bladder neck and urethral lumen. METHODS: In this retrospective study 21 male patients (mean age 33 ± 14) with urodynamic diagnosis of PBNO and 5 healthy volunteers ((mean age 28 ± 2) as control group were enrolled. Both patients and control group underwent 1.5 T MRI. Sagittal and oblique coronal Turbo-Spin-Echo T2-weighted scans were performed. Only patients underwent MR voiding cystourethrography (MR-VCU) performed with T1-weighted spoiled 3D gradient-echo sagittal acquisitions. Bladder lumen was filled with contrast-material-enhanced urine. Blinded test by two radiologists was performed to evaluate causes of bladder outlet obstruction evaluating MR-VCU. Anatomical MRI features of both control group and patients were compared in consensus by senior radiologist and urologist using the analysis of variance (ANOVA) test. RESULTS: MRI allowed evaluation of the bladder neck muscular structures. We found 4 groups of PBNO patients: 52% hypertrophy of posterior lip of bladder sphincter; 20% asymmetry of lateral portion of bladder sphincter; 14% bladder neck cyst; 14% showed normal aspect of bladder neck. Comparison between the control group and first and second PBNO groups was considered statistically significant (p < 0.05) with diagnostic accuracy of 87%. Only 13 patients (61%) were able to perform MR-VCU and radiologists always made the diagnosis of PBNO. CONCLUSION: MRI together with MR-VCU provides useful anatomical and functional information in the study of bladder neck and urethral lumen. These preliminary results suggest that MRI could substitute for standard cystourethrogram in patients with PBNO.
Assuntos
Obstrução do Colo da Bexiga Urinária , Adulto , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Urodinâmica , Adulto JovemRESUMO
INTRODUCTION: Detrusor thickness (DT) and intravesical prostatic protrusion (IPP) are closely related to bladder outlet obstruction. The aim of our study was to look for correlation between DT, IPP and maximum urinary flow (Qmax). METHODS: It is a prospective, observational study including men over fifty managed for benign prostatic hyperplasia. Low urinary tract symptoms were assessed with the International Prostatic Symptom Score (IPSS). Pelvic ultrasound was performed for all patients measuring prostatic volume, bladder volume, post- void residual, DT and IPP. Uroflowmetry was performed for all patients, Qmax was noted. Qmax equal or less than 15ml/s was considered pathologic. RESULTS: Sixty patients were included for our study. Strong negative correlation was noted between DT, IPP and Qmax (r=-0.59, r=-0.61 respectively). Patients with pathologic Qmax had higher DT and IPP than those with normal Qmax, the difference was significant (P<0.01). Threshold values predicting pathologic Qmax were 3mm for DT and 7mm for IPP. ROC analysis reveals for DT an AUC of 0.84 (95% CI 0.76-0.92) and for IPP an AUC of 0.88 (95% CI 0.80-0.97). CONCLUSION: Detrusor thickness and intravesical prostatic protrusion have strong negative correlation with Qmax. These parameters could be an alternative to Qmax measurement if uroflowmetry is unavailable. LEVEL OF EVIDENCE: Grade B.
Assuntos
Hiperplasia Prostática , Obstrução do Colo da Bexiga Urinária , Humanos , Masculino , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Ultrassonografia , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/etiologiaAssuntos
Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/terapia , Parto Obstétrico , Diagnóstico Diferencial , Feminino , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/genética , Doenças Fetais/terapia , Fetoscopia , Humanos , Gravidez , Prognóstico , Ultrassonografia Pré-Natal , Obstrução do Colo da Bexiga Urinária/congênito , Obstrução do Colo da Bexiga Urinária/genéticaRESUMO
Giant colonic diverticulum, defined as a single diverticulum ≤ 4 cm, is rarely encountered. Due to the high incidence of complications related to the disease, obtaining the correct diagnosis early in the disease course is essential. Diagnosis is usually reached by conventional and cross-sectional abdominal radiography. Treatment decisions should be ideally made by a multidisciplinary discussion among surgeons, interventional radiologists, and the patient. The treatment of choice is the surgical management by open or laparoscopic approach.
Assuntos
Divertículo do Colo/complicações , Divertículo do Colo/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/etiologia , Idoso , Divertículo do Colo/cirurgia , Feminino , Humanos , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Obstrução do Colo da Bexiga Urinária/cirurgiaRESUMO
INTRODUCTION: Detrusor dysfunction is known to persist in several patients of Posterior Urethral Valve (PUV) after successful fulguration leading to progressive deterioration of renal function. Persistent bladder outlet obstruction (BOO) in the form of bladder neck hypertrophy, residual valves or strictures may contribute to progressive detrusor dysfunction. These are assessed radiologically or cystoscopically and are managed variedly by anticholinergics, alpha-adrenergic blockers or even bladder neck incision. Unfortunately, currently we do not have any objective measures to evaluate the degree of BOO in children or follow treatment outcome of any such measures. OBJECTIVE: To assess the feasibility of pressure flow studies in children and proposition of an age independent index to quantify outflow parameters. STUDY DESIGN: We retrospectively studied the urodynamic data of the follow up cases of PUV who had been referred to us for urodynamic evaluation. Free flow uroflowmetries and filling and voiding cystometrogram were performed as per recommended protocol. Parameters like Adjusted Bladder Capacity (ABC = Voided volume + post void residue; expressed as percentage of expected bladder capacity {EBC}), overactivity, compliance, Qmax and P det at Qmax were taken into consideration. Indices like Bladder Outlet Obstruction Index (BOOI) and Bladder Contractility Index (BCI) were calculated. Multivariate analysis was run to assess correlation of ABC with other parameters. Receiver Operating Characteristics (ROC) curve analysis was performed to assess predictive values of BOOI for ABC. RESULTS: We did not find the ABC to change with age as has been classically described. Qmax and BCI were found to correlate with age. Values obtained for P det at Qmax and BOOI were not dependent on age and were in similar range as observed in adults. On multivariate analysis, small bladder was found to positively correlate with presence of overactivity, high BOOI and low BCI. ROC curve analysis showed a BOOI >29 could predict ABC to be <100% EBC with moderate sensitivity and specificity. DISCUSSION: Pressure flow studies are the only objective means of quantifying outlet resistance, hitherto they have been considered to be unrepresentative in children. Documentation and correction of high outflow pressures may arrest the cycle of detrusor hypertrophy and dysfunction. CONCLUSION: Quality pressure flow studies are feasible in children. Values of P det at Qmax and BOOI in children are age independent and similar to those observed in adults. BOOI can be potentially used in children to assess degree of BOO.
Assuntos
Obstrução do Colo da Bexiga Urinária , Urodinâmica , Adulto , Criança , Humanos , Curva ROC , Estudos Retrospectivos , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/etiologiaRESUMO
Fetal lower urinary tract obstruction (LUTO) is classically based on prenatal ultrasound identification of a dilated/ thick-walled bladder, bilateral hydronephrosis, dilated ureters and a dilated posterior urethra (also known as the "keyhole sign") in a male fetus. Although the most common underlying diagnosis is posterior urethral valves, the prenatal appearance may be similar with urethral atresia or stenosis, the Prune-Belly Syndrome, or even a cloacal anomaly in a female. These conditions form part of the Congenital Anomalies of Kidney and Urinary Tract (CAKUT) spectrum, which is the commonest cause of end-stage renal disease in children. Although it is difficult to predict postnatal renal function from the prenatal appearance, studies have recently identified predictive features (based on ultrasound findings and fetal biochemistry), and established staging systems to assist with counselling, and, where indicated, patient selection for in-utero intervention. Current in-utero therapy includes amnio-infusion, vesico-amniotic shunting, and fetal cystoscopy with valve ablation or urethral stenting. Postnatal survival and renal functional outcomes, complications and management uncertainties are described, highlighting areas of future development.
Assuntos
Ultrassonografia Pré-Natal/métodos , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Anormalidades Urogenitais/diagnóstico por imagem , Refluxo Vesicoureteral/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Gravidez , Prognóstico , Ultrassonografia Pré-Natal/normas , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/terapia , Anormalidades Urogenitais/diagnóstico , Anormalidades Urogenitais/terapia , Refluxo Vesicoureteral/diagnóstico , Refluxo Vesicoureteral/terapiaRESUMO
INTRODUCTION: We investigated which benign prostatic hyperplasia-related lower urinary parameters are related to upper urinary tract obstruction and whether transurethral prostatectomy could improve upper urinary tract obstruction. MATERIALS AND METHODS: Patients with prostate size over 30 g and urodynamically proven bladder outlet obstruction were enrolled in this prospective observational study. Bladder wall thickness and prostate size were measured by ultrasonography. A urodynamic study with laboratory tests including serum creatinine, prostate-specific antigen, and urinalysis was performed. Finally, a diuretic scintigraphy using mercaptoacetyltriglycine was performed. Tests except the urodynamic evaluation were repeated after transurethral prostatectomy. RESULTS: In total, 24 patients were enrolled, and 19 patients completed the present study. The mean values of age (yrs), prostate size (mL), bladder thickness (mm), bladder compliance (ΔmL/Δpr), and the bladder outlet obstruction index were 68.42 ± 8.25, 72.29 ± 32.78, 4.42 ± 1.14, 50.17 ± 32.15, and 82.11 ± 34.68, respectively. The mean T1/2 (min) was 17.51 ± 16.34 on the left side and 15.30 ± 11.96 on the right side. Statistical analysis showed that bladder compliance and bladder thickness were preoperatively related to upper urinary tract obstruction (p = 0.001 and p = 0.007, respectively). Diuretic mercaptoacetyltriglycine scan in 19 patients showed improvement 6 months after prostate surgery. Clinically significant proteinuria was associated with upper urinary tract obstruction, and proteinuria was also improved after prostate surgery. CONCLUSION: Storage-phase bladder dysfunction could be a reliable urodynamic factor for the indication of upper urinary tract obstruction in patients with benign prostatic hyperplasia, and upper urinary tract obstruction with subsequent kidney damage could be improved by surgical decompression of benign prostatic obstruction.
Assuntos
Glicina/análogos & derivados , Rim/efeitos dos fármacos , Hiperplasia Prostática/tratamento farmacológico , Obstrução do Colo da Bexiga Urinária/tratamento farmacológico , Idoso , Terapia Combinada , Diuréticos/administração & dosagem , Glicina/administração & dosagem , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Masculino , Pessoa de Meia-Idade , Próstata/efeitos dos fármacos , Próstata/patologia , Próstata/cirurgia , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/patologia , Hiperplasia Prostática/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/patologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Sistema Urinário/diagnóstico por imagem , Sistema Urinário/efeitos dos fármacos , Sistema Urinário/patologia , Sistema Urinário/cirurgiaRESUMO
INTRODUCTION: Few studies on prostate artery embolization (PAE) follow patients up after 12 months. We aimed to evaluate the symptomatic efficacy of PAE in our patient cohort at 3 years. METHOD: A total of 48 consecutive patients undergoing PAE from June 2012 to August 2014 were included in this retrospective study. All patients underwent formal urodynamics to confirm bladder outflow obstruction prior to PAE. International Prostate Symptom Score (IPSS) was performed at baseline, 3 months, 12 months and 3 years post-PAE. RESULTS: Mean patient age was 65.6 ± 7.4, prostate volume 99.1 ± 56.6 cm3, IPSS 23.5 ± 6.0, quality-of-life score 4.6 ± 0.9, Qmax 8.4 ± 2.8 ml/s, post-void residual volume 185.8 ± 55.6 ml. Technical success (bilateral embolization) was achieved in 43 out of 48 cases (89.6%). 11/39 bilateral PAE patients completing follow-up (2 died, 2 lost to follow-up) underwent surgery, indicating a 71.8% clinical success rate at 3 years. No significant change was demonstrated in IPSS or QOL between 1 and 3 years for patients free from surgical intervention (IPSS 8.3 vs 10.0, p = 0.09 and QOL 1.3 vs 1.5, p = 0.23). 3/11 patients undergoing surgery had a prominent 'ball-valve' median lobe, and 1/11 patients had a high bladder neck elevation contributing to symptoms. CONCLUSION: Clinical success post-PAE remains high with few patients opting for surgery or experiencing a worsening of symptoms after 12 months.
Assuntos
Embolização Terapêutica/métodos , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/terapia , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Angiografia por Tomografia Computadorizada/métodos , Seguimentos , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/irrigação sanguínea , Próstata/diagnóstico por imagem , Hiperplasia Prostática/complicações , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/etiologiaRESUMO
OBJECTIVES: Incompatibility between currently available fetoscopes and the anatomical constraints of the distended fetal bladder, with the resulting curvature around the bladder neck, account for most technical difficulties during fetal cystoscopy in lower urinary tract obstruction (LUTO). The aim of this anatomical study was to assess by magnetic resonance imaging (MRI) the variation in three bladder angles (bladder-neck angle (BNA), vesicourethral angle (VUA) and angle between bladder dome and posterior urethra (DUA)), according to gestational age (GA), bladder volume and the presence of LUTO. METHODS: From our fetal medicine database, we retrieved for review 46 MRI examinations of male fetuses between 2015 and 2019, including 17 with LUTO, examined at a mean GA of 28.1 (range, 17.3-35.0) weeks and 29 age-matched controls, examined at 29.9 (range, 21.9-35.0) weeks. We measured bladder volume, bladder-wall thickness and the three bladder angles, and used the Mann-Whitney U-test to compare values between groups. Variations according to GA and bladder volume were determined using analysis of variance (ANOVA). A reliability study was performed using the Bland-Altman method and Lin's correlation coefficient was calculated. RESULTS: Both bladder volume and bladder-wall thickness were significantly greater in the LUTO group (P < 0.01). BNA was significantly larger in LUTO compared with control fetuses: the mean (range) was 127.1° (101.6-161.6°) vs 111.2° (88.5-157.3°) (P < 0.01). DUA averaged 117° and showed no difference between the groups (P = 0.92). No statistical comparison was performed on VUA since this was not measurable in most control fetuses. ANOVA showed no variation of any angle with bladder volume in both LUTO fetuses and control fetuses. BNA in LUTO fetuses was the only angle to vary with GA, being larger after, compared with at or before, 25 weeks (P = 0.04). The reliability study showed an acceptable bias for both intra- and interobserver reproducibility for all three angles. CONCLUSION: The findings that BNA is increased by approximately 15° in fetuses with LUTO and DUA averages 117° could aid in development of a customized fetal cystoscope and help to overcome the current technical challenges of fetal cystoscopy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.