Sonographic correlations between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic hyperplasia in Ibadan, Nigeria

Evaluating bladder outlet obstruction (BOO) in patients with prostatic enlargement may reflect the severity of the disease and aid in predicting the treatment outcome. Objectives: To determine the sonological correlation between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic enlargement. Methods: This prospective study was conducted over one year at the Department of Radiology, University College Hospital, Ibadan. A transabdominal ultrasound scan of the urinary bladder and prostate gland was carried out on patients with prostatic enlargement and BOO. The intravesical prostatic protrusion, pre-and post-void urine volumes, prostate volume and bladder wall thickness were measured. Results: A total of 132 men aged 43 to 90 years (mean age: 63.8±8.64 years) were studied. The median size of the intravesical prostatic protrusion (IPP) was 7.25 mm (IQR: 0.00 mm; 14.9 mm). The mean prostate volume was 63.3ml±36.0ml. Most subjects (55; 41.7%) had a prostate volume above 60ml, and most patients (101, 77.2%) had bladder wall thickness less than 5mm. The mean bladder wall thickness was 4.26mm±1.54mm. There was a statistically significant correlation between IPP and pre-void urine volume and prostate volume (p = 0.002 and <0.001, respectively). Patients over 70 years had increasing IPP and post-void urine, which lacked statistical significance (p =0.15). Conclusion: The severity of bladder outlet obstruction was reflected in the pre-void urine volume, which correlated with the size of IPP

Cystourethrography in Posterior Urethral Valves: Review of 20 Cases

Background: Posterior urethral valves (PUV) is a common cause of bladder outlet obstruction in the male infant; child or adolescent. Early diagnosis is important in order to prevent renal damage. Aim: To highlight delays in early diagnosis as a result of changing dressing habits-use of diapers in children.Methods: A retrospective review of 20 patients with posterior urethral valves seen by the author over a period of five years (1999-2003) at a private radiological diagnostic centre in Port Harcourt. Results: In the period under review; 208 patients had cystourethrography in the centre. Of these; 35(16) were paediatric patients. Twenty(57) of the paediatric patients had posterior urethral valves and all the patients were males. Majority of the patients (85) were seen in the first two years of life. All the patients presented with abdominal distension. Five of the patients whose mothers were primips were not able to describe the pattern of urine flow from the children as they always had diapers on. Diverticulum was seen in five patients (25) and these were aged one year and above.Conclusion: Posterior urethral valves is a common cause of bladder outlet obstruction in male children. Diverticulum; a complication of bladder outlet obstruction was common. Use of diapers and poor education may contribute to delays in diagnosis. Early diagnosis is important to prevent end-stage renal failure

Prostatic Fossa Gauze-Packing in the Prevention of Blood Clot Obstruction of the Bladder after Transvesical Prostatectomy

BACKGROUND: Clot obstruction often complicates transvesical prostatectomy. Any measure that prevents this will be a great relief to both surgeon and patient. OBJECTIVE: To demonstrate that packing the prostatic fossa with roller gauze bandage after transvesical prostatectomy can prevent post-operative clot blockage of bladder drainage. METHODS: Charts of all patients who had transvesical prostatectomy at Jasman Hospital Udo by me from 1988 to 1997 were sorted into two groups ; Group A; not packed and Group B; packed. Information sought included patient's age; type of prostatectomy performed; whether the prostatic fossa was packed or not ; average duration of catheter drainage; and complications. RESULTS: There were 68 patients who had no fossa packing and 72 in Group B with fossa packing. The age range of the two groups A and B were respective 45-85year-old and 50-83 years. In both groups the highest number of patients was in the 60 t0 79 age bracket (48 in group A ; 70; and 56 in group B (78). Bladder blockage occurred in 32(47) patients without packing and none (0) in group B with packing. Average duration of bladder drainage was 14 days in each group. There was no persisting vesico-cutaneous fistula. Temporary urinary incontinence occurred in three (3) patients who had no packing and in five (7) with packing. CONCLUSION: Gauze-packing of the prostatic fossa during transvesical prostatectomy can prevent bladder obstruction from clot retention without undue complications

Bladder neck resection with preservation an antegrate ejaculation

Objective: To evaluate a new method of bladder neck resection and to determine; whether or not antegrade ejaculation can be preserved. Patients and Methods Twenty patients with bladder neck obstruction were treated by bladder neck resection with preservation of more than 1 cm proximal to the verumontanum. The patients were evaluated before and after resection by semen volume; sperm count symptom improvement and urodynamic evaluation. Results With this technique preserving 1 cm of the supramontanal part; we could preserve antegrade ejaculation in 17 out of 20 patients (85); while in two patients only a small amount of semen was ejaculated and in one patient; complete retrograde ejaculation was reported. Conclusion The complication of retrograde ejaculation in young patients who are in need of fertililty may be avoided by preservation of 1 cm of the supramontanal part during bladder neck resection