ABSTRACT
Objective To analyze the impact of detrusor underactivity (DU) on the outcomes of transurethral resection of prostate (TURP) in patients with benign prostatic obstruction (BPO).Methods A retrospective study was conducted in 157 BPO patients who underwent TURP from January 2013 to December 2016.Their ages ranged from 48 to 86 years with a mean age of 70 years.All patients underwent urodynamic study before surgery,bladder contraction index(BCI) ranged from 49.3 to 208.6,with a mean of 120.1.The patients were divided into two groups according to BCI.DU group (BCI ＜ 100) consisted of 47 patients,non-DU group (BCI ≥ 100) 110patients.Before surgery,there were no significant differences in International Prostate Symptom Score (IPSS),storage and voiding symptom scores of IPSS (IPSS-S,IPSS-V),quality of life (QOL),maximum free flow rate (fQmax),post-voided residual urine volume (PVR) between the two groups[(21.5 ±7.0)vs.(21.5 ±6.2),(9.5 ±3.6)vs.(9.8 ±3.5),(12.0 ± 4.9)vs.(11.8±4.2),(5.1 ±0.8)vs.(5.3 ±0.7),(6.5±3.5)ml/s vs.(7.6±5.0)ml/s,(137.4± 146.2)ml vs.(105.2 ± 135.9)ml] (P ＞ 0.05 for each).The outcomes of TURP were assessed by the above mentioned parameters at 3 months postoperatively;IPSS、IPSS-S、IPSS-V were regarded as successful if they improved more than 50％,QOL was successful if it was improved more than 3,fQmax successful if it was improved 5ml/s.The change and successful improvement rates of the above mentioned parameters were compared between DU and non-DU group.Through receiver operating characteristic curve(ROC) analysis,patients were categorized into mild DU and severe DU group and compared the successful improvement rates between the two groups.Results Both DU group and non-DU group improved significantly in IPSS,IPSS-S,IPSS-V,QOL,fQmax,PVR at 3 months postoperatively (P ＜ 0.05)and the two groups differed significantly in those parameters [(8.6 ± 7.3) vs.(4.4 ±4.5),(5.0 ± 3.5) vs.(3.6 ±2.8),(3.6 ±5.1)vs.(0.9 ± 2.3),(2.3 ±1.5) vs.(1.5 ± 1.0),(11.5 ±6.9) ml/s vs.(16.3 ± 6.9) ml/s,(48.4 ± 65.6) ml vs.(23.6 ± 25.6) ml] (P ＜ 0.05 for each).In regard to the successful improvement rates of IPSS,IPSS-S,IPSS-V,QOL,fQ DU group was less successful than non-DU group [70.2％ (33/47)vs.90.9％ (100/110),51.1％ (24/47)vs.73.6％ (81/110),74.5％ (35/47)vs.93.6％ (103/110),59.6％ (28/47)vs.83.6％ (92/110),42.6％ (20/47)vs.81.8％ (90/110),P ＜0.05 for each].Youden index was maximum when BCI equaled to 82.There were significant differences in the successful improvement rates of IPSS and IPSS-V between mild DU (82 ≤ BCI ＜ 100) and severe DU (BCI ＜ 82) group [82.8％ (24/29) vs.50.0％ (9/18),86.2％ (25/29) vs.55.6％ (10/18),P ＜ 0.05 for each),no significant differences in IPSS-S and fQmax [58.6％ (17/29) vs.38.9％ (7/18),48.3％ (14/29) vs.33.3％ (6/18),P ＞ 0.05 for each].Conclusions Benign prostatic obstruction patients with DU can achieve improvement in both subjective and objective parameters after TURP,but patients without DU can get more improvement.BPO patients with severe DU patients show a worse improvement of the voiding symptom.Surgeons should have adequate communication with the patients and inform them of appropriate expectations.
ABSTRACT
Objective To explore the effect of doxazosin on rabbit bladder compliance after partial bladder outlet obstruction. Methods A total of 40 male New Zealand white rabbits were randomized into 4 groups, with 10 rabbits in each group. Partial bladder outlet obstruction was established in groups B and C, while groups A and D underwent the same operation but without partial bladder outlet obstruction. On the day after the operation, groups C and D received oral administration of doxazosin. After 14 weeks, urodynamic examinations were carried out in all groups, and the bladder was weighted after cystectomy. Results Bladder weight was (3.2±0.9) g in group A, (14.1±2.3) g in group B, (5.0±2.0) in group C,and (2.9±0.5) g in group D. The bladder weight in groups B and C increased significantly compared to groups A and D (P＜0.01), group B increased significantly over group C (P＜0.01), and there was no significant difference between groups A and D (P＞0.05).The detrusor leak point pressure was (10.2±2.5) cm H2O in group A, (18.8±6.1) cm H2O in group B, (13.5±4.7) cm H2O in group C,and (11.6±3.6) cm H2O in group D. The detrusor leak point pressure in group B was significantly higher than group A, group D (P＜0.01) and group C (P＜0.05). There was no significant difference between group A, group C and group D (P＞0.05). The bladder compliance was (2.86±0.56) ml/cm H2O in group A, (1.22±0.39) ml/cm H2O in group B, (4.25±2.19) ml/cm H2O in group C,and (2.90±0.53) ml/cm H2O in group D. The bladder compliance was significantly decreased in group B compared to groups A and D (P＜0.01). Bladder compliance in group C was significantly higher than in groups A and D (P＜0.05), and there was no significant difference between group A and group D (P＞0.05). Conclusion Early use of doxazosin can delay the occurrence of lower bladder compliance after partial bladder outlet obstruction, thus protecting the storage function of bladder.
ABSTRACT
Objective To investigate a minimal invasive surgical therapy for tumors in the an terior wall close to bladder neck. Methods A 5～10 mm incision was made in abdominal wall below the umbilicus and laparoscopic devices were introduced into the bladder.Tumors were excised and coa gulated under the monitoring of cystoscopy. Results Tumors at the anterior wall of bladder were easily exposed and removed.The recovery time was nearly the same as that of TURBT.No tumor recurrence was observed in 3～10 months period. Conclusions Tumors at the anterior wall of bladder could be easily removed by the combined use of cystoscopy and laparoscopy and open surgery might be avoided.
ABSTRACT
Objective To evaluate the diagnostic efficacy of MR urography(MRU) in the diagnosis of urinary diseases. Methods MR urography was performed in 58 patients with urologic diseases,inclu- ding :renal tuberculosis(6),various congenital anomalies of urinary tract(27),renal pelvis carcinoma(2), ureteral carcinoma (10),ureteral polyp(2),ureteral calculi(8) and iatrogenic ureteral stricture(3). Results MR urography provided high-resolution images of the kidneys and urinary tract in all patients.The characteristics of renal tuberculosis,urinary tract dilation and the various anatomic anomalies were depicted well.MR urography was successful in localizing the level of obstruction in all of the 58 patients(100%),although MR urography alone could not reliably determine the cause of obstruction in some cases. Conclusions In diagnosing urinary diseases,MR urography has its advantages and limitations.It should be used appropriately in diagnosing urinary diseases.
ABSTRACT
Objective To evaluate the diagnostic value of MR urography(MRU) in the diagnosis of renal tuberculosis. Methods MRU features of 18 cases of renal tuberculosis,nonvisualized or poorly visualized in IVU,were analyzed and compared with pathologic findings. Results MRU provided high-resolution images of the kidneys and upper urinary tract in all patients.MRU features of renal tuberculosis and corresponding pathologic changes were summarized. Conclusions MRU has a great value in diagnosing renal tuberculosis when the kidneys are nonvisualized or poorly visualized in IVU.It can provide diagnostic evidence and is helpful with choice of the therapeutic strategy.