Correlation of tools for objective evaluation of infravesical obstruction of men with lower urinary tract symptoms

ABSTRACT Purpose To identify how the most frequently used parameters in daily clinical practice diagnosing bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH) correlate to each other. Materials and methods The study included 452 patients with lower urinary tract symptoms (LUTS) of the UNICAMP urology outpatient clinic of LUTS. Inclusion criteria: patients with BOO due to BPH who agreed to participate in the study. Exclusion criteria: patients with urinary tract infection, neurological diseases that compromised the lower urinary tract, prior prostatic surgery, radiotherapy or urethral stenosis. Patient assessment: history, international prostate symptoms score (IPSS), nocturnal quality of life score (NQoL) questionnaires, physical and digital rectal examination (DRE), PSA, transabdominal ultrasound with intravesical prostate protrusion (IPP), post-mictional residue and free uroflowmetry. Results There was no strong Spearman correlation among the studied variables. The only moderate correlations occurred between IPSS and NQoL (p <0001; c=0.56) and between IPP and prostate volume (p <0001; c=0.57). Weak correlations between IPP and post-mictional residue (p <0001; c=0.31) and free uroflowmetry (p <0001; c=-0.26); and between IPSS and free uroflowmetry (p <0001, c=-0.21) were observed. Conclusion In this study, we found moderate, weak, very weak and absent correlation among the various parameters used in the diagnosis and management of BOO due to BPH. As the value of these tools is variable, the creation of a logical and objective algorithm was not possible and the treatment is based on the interpretation of clinical symptoms.

Prevalence of urodynamic changes with risk for upper urinary tract damage in neuroschistosomiasis patients

Abstract INTRODUCTION: This study aimed to identify the prevalence of urodynamic changes with an associated risk of developing upper urinary tract damage in neuroschistosomiasis patients. METHODS: A prospective study was conducted, wherein68 patients were admitted for analysis of urodynamics, urea and creatinine levels, and uroculture. RESULTS: Blood test results did not indicate kidney failure. There were cases of asymptomatic bacteriuria. Common symptoms were frequent nocturia and detrusor overactivity. Results of low compliance and low cystometric capacity were both statistically significant (p = 0.001 and p = 0.002, respectively). CONCLUSIONS: A high prevalence of negative urodynamic changes were found in neuroschistosomiasis patients.

Evaluation of female overactive bladder using urodynamics: relationship with female voiding dysfunction

ABSTRACTPurpose:To investigate the role of urodynamic study (UDS) in female patients with overactive bladder (OAB) analyzing the relationship between OAB symptoms and female voiding dysfunction (FVD).Materials and Methods:We analyzed the clinical and urodynamic data of 163 women with OAB symptoms. OAB symptoms were categorized as dry and wet. FVD was described as detrusor underactivity (DUA), which was defined as a maximum flow rate (Qmax) of ≤15mL/s associated with a detrusor pressure at Qmax (PdetQmax) of ≤20cmH2O, along with bladder outlet obstruction (BOO), which was defined as a Qmax of ≤15mL/s with a PdetQmax of >20cmH2O. Clinical and urodynamic results were compared between patients with dry and wet symptoms and between those with and without FVD.Results:78 (47.9%) had dry, and 85 (52.1%) had wet symptoms. The entire group had a relatively low Qmax (15.1±6.6mL/s) and relatively high number of BOO (42.9%, 70/163) and DUA (8.6%, 14/163). A significantly higher number of patients with wet symptoms had detrusor overactivity compared to those with dry, as detected by the UDS (p<0.05). No significant differences were found in BOO and DUA number between dry and wet groups. Further, the international prostate symptom score did not different significantly between patients with and without FVD.Conclusion:A significant number of women with OAB had voiding dysfunction. However, the OAB symptoms themselves were not useful for predicting the presence of FVD. Therefore, UDS may be necessary for accurate diagnosis in women with OAB symptoms.

Neurological status predicts response to alpha-blockers in men with voiding dysfunction and Parkinson's disease

OBJECTIVES: To evaluate predictors of the response to doxazosin, a selective alpha-adrenoceptor antagonist, when used for the treatment of lower urinary tract symptoms in men with Parkinson's disease. METHODS: In a prospective study, 33 consecutive men (mean age 59.2±7.0 years) with Parkinson's disease and lower urinary tract symptoms were evaluated. Neurological dysfunction was assessed with the Unified Parkinson's Disease Rating Scale. Urological assessment was performed at baseline and after 12 weeks of treatment with 4 mg/day of extended-release doxazosin, including symptom evaluation with the International Continence Society male short-form questionnaire, an assessment of the impact of lower urinary tract symptoms on quality of life and urodynamics. Clinical and urodynamic predictors of response were specifically evaluated. RESULTS: Compared with the score at baseline, the total International Continence Society male short-form score was reduced after doxazosin administration, from 17.4±7.5 to 11.1±6.9 (p<0.001). The impact of lower urinary tract symptoms on quality of life was also significantly reduced, from 1.8±1.1 to 1.0±1.0 (p<0.001) and the maximum urinary flow varied from 9.3±4.4 to 11.2±4.6 ml/s (p = 0.025). The severity of neurological impairment ...

Obesity and smoking: Are they modulators of cough intravesical peak pressure in stress urinary incontinence?

PURPOSE: SUI (Stress Urinary Incontinence) results from sudden increases in intravesical peak pressures exceeding urethral resistance leading to involuntary urine loss. Obesity and smoking are well established reversible risk factors for SUI and may alter intravesical peak pressures. BMI, smoking status, and other clinical factors were studied to determine their relationship to CIPP (maximal Intravesical Peak Pressures generated by Cough) in SUI complaining women. MATERIALS AND METHODS: Three hundred nineteen women complaining of SUI were evaluated with medical history and urodynamics. Age, parity, comorbidities, previous surgery, BMI and history of smoking were obtained. The maximal intravesical peak pressures generated by cough (CIPP) and cough leak point pressure (CLPP) were acquired. Univariate and multivariate analysis were conducted. RESULTS: Current smokers and former smokers had similar CIPP (170cmH2O and 170cmH2O; p = 0.5, respectively); Those individuals who had never smoked had significantly lower CIPP (140cmH2O; p = 0.000 and p = 0.009 respectively). BMI was directly related to CIPP (r = 0.41; p = 0.000). Vaginal deliveries (r = -0.15, p = 0.08) and diabetes (r = 0.15, p = 0.016) were also directly related to CIPP on univariate analysis. Only smoking status (p = 0.000) and BMI (p = 0.000) were independently significantly related to CIPP on multivariate analysis. CONCLUSIONS: Obesity and smoking showed increased CIPP (maximal Intravesical Peak Pressures generated by Cough). While reduced BMI is related to lower CIPP, smoking cessation does not appear to diminish CIPP. These findings suggest that weight loss may reduce incontinence by CIPP modulation. However, the benefits of smoking cessation without additional lifestyle modification, may have no benefit to improve urinary incontinence.

Medical history value in female urinary incontinence / Valor propedêutico da anammenese em incontinência urinária feminina

Objetivo: Determinar a relação entre dados de história clínica e os diagnósticos obtidos em exame urodinâmico em pacientes do sexo feminino com incontinência urinária. Materiais e métodos: Foram estudadas 126 pacientes do sexo feminino, com história clínica de incontinência urinária, sem doença infecciosa ou neurológica associada. Resultados: Nas pacientes com história clínica de incontinência urinária exclusiva aos esforços obteve-se 87,5 porcento de concordância com o diagnóstico urodinâmico, e nas pacientes em que a incontinência ao esforço era associada à urgência miccional encontramos apenas 55 porcento de concordância no diagnóstico. Ao aplicarmos os testes estatísticos encontramos diferença significativa (p<0,0001), o que justificaria a indicação do estudo urodinâmico neste grupo de mulheres. Conclusão: A história clínica de perdas urinárias aos esforços exclusiva é de alta sensibilidade para o diagnóstico de incontinência urinária genuína de esforço. A presença do sintoma urgência miccional associado à incontinência urinária por esforço é indicação para realização do estudo urodinâmico.