Research progress of noninvasive diagnosis of male bladder outlet obstruction / 中国综合临床

Currently, invasive urodynamic testing is the " gold standard" for the diagnosis of bladder outlet obstruction (BOO). However, this test is invasive, easy to cause hematuria, urinary tract infection and other complications, the application conditions are limited.In order to solve this problem, various non-invasive methods to diagnose or predict BOO have been studied.The use of existing inspection indicators such as ultrasound measurement, penile cuff test, near infrared spectroscopy and other new non-invasive methods provide a new research direction for the non-invasive diagnosis of bladder outlet obstruction.

Uso de la uroflujometría en el estudio de síntomas del tracto urinario bajo en pacientes masculinos. Hospital Central Universitario Dr. Antonio María Pineda / Use of uroflowmetry in the study of lower urinary tract symptoms in male patients. Central University Hospital Dr. Antonio María Pineda

La uroflujometría es un estudio no invasivo del tracto urinario inferior que entrega información objetiva del flujo urinario y es ampliamente recomendado por las guías europeas en el estudio de pacientes con sintomatología urinaria baja. Se realizó un estudio descriptivo transversal cuyo propósito fue describir el uso de la uroflujometría en el estudio de síntomas del tracto urinario bajo en pacientes masculinos que acudieron a la consulta de Servicio de Urología del Hospital Central Universitario Dr. Antonio María Pineda de la ciudad de Barquisimeto, estado Lara durante el lapso 2018- 2019. La muestra estuvo conformada por 150 pacientes. Los resultados indican que el 62% de la muestra corresponde a pacientes entre 60 y 70 años de edad de los cuales 52% manifestaron síntomas urinarios leves. La uroflujometría evidenció que 56% de los pacientes tienen un flujo máximo entre 10 y 20 ml/seg lo cual sugiere una probable obstrucción al flujo de salida; 78% de los pacientes presentan un flujo promedio entre 0 a 10 ml/seg. El 53% de los pacientes mostró un volumen de vaciado < 300 ml y 49% un tiempo de flujo máximo entre 30 y 50 segundos. En conclusión, la uroflujometría es un examen simple y rápido que proporciona información útil sobre la salud de las vías urinarias inferiores(AU)

Uroflowmetry is a non-invasive study of the lower urinary tract that provides objective information on urinary flow and is widely recommended by European guidelines for the study of patients with lower urinary tract symptoms. We performed a cross-sectional descriptive study to describe the use of uroflowmetry for the study of lower urinary tract symptoms in males who attended the Servicio de Urología of the Hospital Central Universitario Dr. Antonio María Pineda (Barquisimeto, Lara state) during the 2018- 2019 period. The sample was made up of 150 males. The results show that 62% of the sample included males between 60 and 70 years old and 52% complained of mild urinary symptoms. Uroflowmetry results showed that 56% of patients had a maximum flow between 10 and 20 ml/sec suggestive of urinary tract obstruction; 78% had an average flow between 0 and 10 ml/sec while 53% had a micturition volume < 300 ml and 49% had a maximum flow time between 30 and 50 seconds. Uroflowmetry is a simple and fast test which provides useful information about the health of lower urinary tract(AU)

Correlation of international prostate symptom score and uroflowmetry in evaluation of benign prostatic hyperplasia

Background: Uroflowmetry is a simple non-invasive technique in evaluating patients presenting with Lower urinary tract symptoms (LUTS), to assess voiding patterns, maximum urinary flow (Qmax), average urinary flow (Qave) and voided urine volume. Uroflowmetry is considered mandatory prior to surgical intervention in diagnosis and assessment of men with LUTS. Correlating the International prostrate symptom score (IPSS) with that of uroflowmetry results will allow a better diagnosis and help in determining more appropriate modality of treatment. Therefore, the purpose of our study is to correlate IPSS and the findings of uroflowmetry in evaluation of Benign prostrate hypertrophy (BPH).Methods: This was a prospective study of 50 patients presenting with LUTS diagnosed with BPH. Patient’s symptoms were initially evaluated by administering a pre-treatment IPSS/Quality of Life Score (QoL) and uroflowmetry. All patients underwent Transurethral resection of the prostate (TURP). A post TURP IPSS/QoL score assessment and uroflowmetry was done. Pre-operative IPSS and uroflowmetry results were correlated using spearman’s correlation coefficient. Outcome of IPSS and uroflowmetry following TURP was assessed in terms of percentage improvement.Results: Statistically significant correlation (p<0.05) was seen between IPSS and uroflowmetry results. No correlation was found between prostate volume and IPSS. Significant improvement in symptom severity (IPSS score) and uroflowmetry results was observed in post TURP patients.Conclusion: IPSS is a valuable tool in the evaluation and grading of LUTS. Correlating both IPSS and uroflowmetry results will help in better diagnosis and management of patients. It can also be concluded that IPSS and uroflowmetry can be used for evaluation and monitoring patients following prostate surgery.

Management of Stricture Urethra: Our Experience at a Tertiary Care Centre

Introduction: Surgical correction is the fundamental strategyfor severe rheumatic mitral regurgitation as (MR) as medicalmanagement for MR can not prevent the hemodynamicconsequences of severe MR in the asymptomatic andminimally symptomatic subjects. The purpose of this study isto assess the impact of duration of progressive rheumatic MRon LVEF, PH, LV and right ventricular dysfunction and decideabout the selection of optimal timing for surgical interventionin our patient population.Material and methods: This study involves the data of 30patients of MVR divided over 2 groups, from 1st January 2015to 31st December, 2018 and follow up of the survivors. Therewere (a) 12 cases of isolated severe MR described as MR and(b) 18 cases of severe MR associated with mild MS describedas MS +MR. Changes in echocardiographic parameters inboth the groups after MVR, LVEF, LVESD, LV end diastolicdiameter (LVEDD), PASP and NYHA functional class wereassessed, analyzed and compared at 30 and 180 days.Results: In the postoperative period after 30 days,improvement of NYHA status were observed to be higher in13 survivors with MS +MR from III to I while it was 6 in MRgroup. This improvement noted more in younger group below40 years. NYHA changes from III to II was observed in 4 ineach in both groups more in older group above 40 years. At180 days, 1 each from NYHA II improved to I in youngergroup. Out of the 2 post operative mortality, there was 1 in MRgroup who had post operative RV dysfunction and died afterdischarge on 29th day and 1 in MS+MR group and who diedof respiratory failure after 7 days though the cardiac indicesimproved and both were in older group.Conclusion: MVR can reversely remodel hearts and restoreLV function with relatively preserved LV.

Primary development of visual uroflow scale / 北京大学学报(医学版)

OBJECTIVE@#To develop the visual uroflow scale (VUS), analyze the relationship of VUS score and index of free uroflowmetry, assess urination function preliminarily and improve the work efficiency in the clinic.@*METHODS@#Male lower urinary tract symptoms (LUTS) patients, who attended the Department of Urology in Peking University People's Hospital from March 2016 to March 2017, were assessed for their urination function according to the Visual Uroflow Scale without help from clinicians before undertaking a free uroflowmetry test. And afterwards, a free uroflowmetry was undertaken, and variables including maximal flow rate (Qmax), the average flow rate (Qave) and voiding volume (VV) was obtained. During the study, 124 cases were collected and 53 cases met the inclusion and exclusion criteria and were included in the study cohort. The Spearman correlation analysis was used for analyzing the correlation of VUS scores with free uroflowmetry variables and age. The validity of VUS was evaluated.@*RESULTS@#Most of the patients could choose the very figure matched with self-condition by first instinct without any help from the clinician. The data were analyzed by Spearman correlation analysis. In the present study, voiding time was positively correlated with the VUS score (correlation coefficient, 0.62, P < 0.05). In the present cohort, the patients chose the third and fourth figures to take longer time to urinate, implying worse LUTS situation. Flow time and VUS scores were positively correlated (correlation coefficient, 0.61, P < 0.05). The patients with higher VUS scores would spend more time on urinate, no matter how long urinary hesitation was. Both Qmax and Qave were negatively correlated with the VUS score (correlation coefficient －0.54, －0.62, P < 0.05). The study illustrated that the VUS score suggested that the Qmax basically and further reflected the urination function. And its relationship to age revealed the decreased urination function of aging male, which had reached a consensus.@*CONCLUSION@#Development of VUS has helped the clinician assess the urination function preliminarily at the first time. Patients are assessed for a VUS score before getting surgery or receiving the drug for treatment, and can be re-assessed after. The VUS score can provide an objective quantitative basis to evaluate the treatment efficacy. In addition, considering that it is convenient, timesaving and easy to understand, the VUS is available for follow-up.

Study of neurological deficits in patients with tuberculous meningitis and its association with urodynamic study

Background: Tuberculous meningitis (TBM) is the main form of tuberculosis that affects the central nervous system and is associated with high rates of death and disability. The objective of this study was to study neurological symptoms in TBM patients using clinical diagnosis and MRI of spine and comparing with urodynamic study.Methods: Fifty one patients diagnosed with TBM were studied in Neurology Department of KGM Medical University, Lucknow. Uroflowmetry and urodynamic study were done to divide the patients into normal and abnormal. A detailed history taking, general physical and neurological examination using MRI spinal cord was done and recorded on a predesigned proforma.Results: Visual impairment, hemiparesis, paraparesis, abnormal tone and reflexes in lower limbs showed significant association with abnormality in urodynamic study. MRI spine showed significant relationship of spinal meningeal enhancement, lumbosacral arachnoiditis, with abnormal urodynamic study.Conclusions: We found a significant association between neurological symptoms and abnormal urodynamic

A Study of Normal Female Uroflowmetry for Development of Flow Volume Nomogram in an Indian Population

Introduction: Uroflowmetry is a common urological toolto diagnose bladder outlet obstruction in males but it is notappropriate to use the same for females as female uroflowmetrynomograms are not universally acceptable. By conducting thisstudy we aim to create a nomogram for our population andcompare our findings with other investigators. Study aimed toestablish maximum flowrate and average flowrate in womenand develop its NomogramMaterial and Methods: A total of 445 patients meetinginclusion criteria were enrolled and uroflowmetry performed.Peak flow rate (Qmax), average flow rate (Qave),time topeak flow rate (TQmax),voided volume(VV), post voidresidue(PVR) and total voiding time (TVV) were recorded.Corrected Qmax, Corrected Qave and Body Mass Index (BMIwere calculated. statistical analysis was done.Result: Both peak flow rate and average flow rate correlatespositively with voided volume while they correlates negativelywith age and BMI. Both corrected Qmax and corrected Qavewere not having significant negative correlation with age andBMI. Multivariate regression analysis revealed only voidedvolume to significantly affect PFR independently. Univariatelinear regression analysis revealed that only voided volumeaffects the Average flow rate.Conclusion: This study gives a reference value of peak andaverage flow rates of normal women in the form of confidencelimit to help clinicians diagnose poor flow rates taking intoaccount voided volumes (flow–volume nomograms) as wellas age (corrected flow–age nomogram).

Value of the visual prostate symptom score in evaluation of symptomatic benign prostatic enlargement: prospective study in a Nigerian population

Background: To evaluate the correlation of Visual Prostate Symptom Score (VPSS) with International Prostate Symptom Score (IPSS) and Maximum Urinary Flow (Qmax). To investigate the effect of educational level on the ability to independently complete the VPSS versus the IPSS and time taken to do so.Methods: Bio data was taken from men with lower urinary tract symptoms (LUTS) due to Benign Prostatic Enlargement (BPE) who presented at the Urology clinic of Jos University Teaching Hospital. They were administered the IPSS questionnaire and VPSS pictogram, which they completed with or without physician assistance and the time taken to do so was noted. They subsequently had uroflowmetry done on same visit and the data was recorded in a structured proforma. Statistical analysis was done using SPSS(R) version 20. Correlation test was done for VPSS, IPSS and Qmax while the paired t-test was used for the average time spent in completing both questionnaires. A p-value <0.05 was considered as significant.Results: Eighty-five men (aged 42 to 94 years) were enrolled in the study. The VPSS correlated significantly with the IPSS in terms of total score (r = +0.684, p<0.001) and QoL (r = +0.570, p<0.001), as well as with the Qmax (r = -0.222, p = 0.041). A greater proportion (21.2%) of men with limited education could complete the VPSS without physician assistance as compared to the IPSS (6.0%) and the average time taken to complete the VPSS (170.51 seconds) was significantly shorter than the time taken to complete the IPSS (406.42 seconds).Conclusions: The VPSS correlates significantly with the IPSS and Qmax. It can be completed without physician assistance by a greater proportion of men with limited education within a shorter time period.

Male lower urinary tract symptoms in correlation with age, quality of life scores, parameters of uroflowmetry and prostate size, a single institution study

OBJECTIVE@#To correlate male lower urinary tract symptoms between age, quality of life scores,parameters of uroflowmetry and prostate size.@*PATIENTS AND METHODS@#Two hundred eight males were included in this study. Uroflowmetry parameters,age, International Prostate Symptom Score (IPSS), Quality of Life (QoL) scores and prostate sizewere gathered. For correlation, distribution of age, uroflowmetry parameters and prostate size werefirst compared to IPSS. Analysis of variance was used to compare age of patients, while Kruskall-wallis test was used to compare the QoL, uroflowmetry parameters, and prostate size on each IPSSgroups. Ordinal logistic regression analysis was used to correlate IPSS to age, quality of life,uroflowmetry parameters, and prostate size both for multivariate and univariate analysis.@*RESULTS@#There was no significant correlation between age and IPSS. However, on profile distribution,the age distribution between symptom scores were statistically similar. Qol scores were directlyproportional to IPSS. Thus, patients with a worse QoL score were more likely to have higher IPSS.Qmax scores decreased as symptom severity increased. Patients with higher Qmax scores are lesslikely to have higher IPSS scores. Voided volume was observed to decrease as IPSS severity increased,but this was not statistically significant. Patients with higher post void residual scores were morelikely to have higher IPSS. There was also no significant correlation between prostate size and IPSS.@*CONCLUSION@#There were no significant correlation between IPSS and age, voided volume and prostatesize. On the other hand, patients with a worse QoL score and a high post void residual had higherIPSS. Patients with a high Qmax, are less likely to have an elevated IPSS.

Clinical Study on Heat-sensitive Moxibustion for Poisonous Snakebites-induced Bladder Dysfunction of Different Degrees / 上海针灸杂志

Objective To observe the safety and severity of heat-sensitive moxibustion in treating poisonous snakebites-induced bladder dysfunction of different degrees.Method Twenty-six patients diagnosed with bladder dysfunction due to poisonous snakebites were examined by type-B ultrasonic scanning for residual urine volume and uroflowmetry. The patients were treated with heat-sensitive moxibustion. The residual urine volume and uroflowmetry parameters were compared between different severity degrees of bladder dysfunction before and after treatment.Result The residual urine volumes were changed significantly in the mild group and moderate group after treatment (P0.05). The maximum urine flow rate (Qmax) was significantly changed in the mild group after the treatment (P0.05).Conclusion Heat-sensitive moxibustion is significantly effective in treating mild-moderate bladder dysfunction due to poisonous snakebites, and it’s safe and reliable.

Uroflowmetry of specific bladder capacity in the detection of early diabetic cystopathy / 中国医师进修杂志

Objective To evaluate the diagnostic value of uroflowmetry of specific bladder capacity in the detection of early diabetic cystopathy (DCP). Methods One hundred and nine patients with type 2 diabetes mellitus (DM) and 48 normal control subjects (control group) were completed the uroflowmetry in bladder capacity about 300 ml. The patients with DM were divided into DM course≥10 years group and DM course0.05). There were no statistical differences in volume leading to first bladder sensation (P>0.05). Conclusions MFR decrease detected with the technology of uroflowmetry specific bladder capacity may be widely used in screening early DCP.

Usefulness of a Sonographic Bladder Scan for Uroflowmetry and the Evaluation of the Anxiety Level Associated with Uroflowmetry / 대한비뇨기과학회지

PURPOSE: Uroflowmetry (UFM) requires at least 125ml to 150ml of urine volume for an adequate interpretation. It is common to repeat UFM in clinical settings because of an insufficient voided volume, which may be induced by increased anxiety. To reduce performing repeated UFMs, we evaluate the usefulness of performing a prevoiding sonographic bladder scan and we determined the anxiety level before performing UFM. MATERIALS AND METHODS: We enrolled one hundred two patients (mean age: 62.6+/-15.0 years) who visited our clinic due to voiding dysfunction. The bladder volume prior to UFM was measured by an automated bladder scan (Biocon-500(TM), Mcube Technology) when the patients felt a strong fullness sensation. All the patients kept a voiding diary for 3 days, and they underwent the State-Trait Anxiety Inventory questionnaire, the fullness scale and UFM. RESULTS: The mean prevoiding volume was 307+/-124ml and the mean voided volume was 271+/-129ml. There was a correlation between the prevoiding scan volume and the voided volume: voided volume=17.502+(0.724xprevoiding volume) (r=0.851, p<0.001). Among the 333 patients without a bladder scan and who had UFM performed, 25.8% showed insufficient voided volumes of less than 125ml, and 32.4% showed voided volumes of less than 150ml. However, among the 102 patients who underwent a bladder scan, 9.8% showed insufficient voided volumes of less than 125ml and 12.7% showed voided volumes of less than 150ml (p<0.001). The patients who had a higher state of anxiety than trait anxiety before their UFM revealed a relatively decreased functional bladder capacity (p=0.013). CONCLUSIONS: Although UFM is simple, the patient may feel embarrassed before test. Anxiety can cause a decreased functional bladder capacity. A prevoiding sonographic bladder scan can reduce the incidence of insufficiently voided UFM.

The Influence of Labor and Cesarean Section in Uroflowmetry / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study is to evaluate the uroflow parameters of the pregnant women before delivery and immediate postpartum period. METHODS: Forty four patients delivered by spontaneous vaginal delivery (NVD group) and 46 patients by Cesarean section (C/SEC group) and 28 non-pregnant young women (Control group) were included in this study. Uroflow were checked 1 day before and 2 days after delivery by Jupiter 8000 (FM Wiest(R)) uroflowmetry. Mean value of the uroflow parameters in each group was compared using ANOVA t-test. For continuous data, linear associations with each of the uroflow parameters were assessed using a Pearson correlation coefficient. RESULTS: Maximal (18.48+/-5.21 mL/sec) and mean flow rate (9.45+/-3.73 mL/sec) of pregnant women were lower than control group (22.75+/-5.14 mL/sec), and were not changed after delivery (18.79+/-6.03 mL/ sec). Total flow time of pregnant woman (14.06+/-6.09 sec) was longer than control group (8.05+/-5.32 sec) before delivery, and increased after delivery especially after cesarean delivery. Time to peak flow of pregnant women (8.44+/-9.48 sec) was shorter than control group (16.33+/-6.11 sec) before delivery, and was similar to control group after delivery. Total voided volume (121.39+/-50.17 mL) was less than control group before delivery, and was increased after delivery (246.77+/-127.42 mL). Total voided volume after delivery was not different with control group statistically. CONCLUSION: There was no statistically differences before and after delivery in maximal flow rate, but was lower than non-pregnant women. Total flow time was much prolonged after delivery, especially after cesarean delivery. Time to peak flow and voided volume were restored to levels of non-pregnant women after delivery.

Uroflowmetry as a Screening Test for Neurogenic Bladder in Children with Cerebral Palsy / 대한비뇨기과학회지

PURPOSE: It is well known that a high proportion of patients with cerebral palsy have neurogenic bladder. However, cystometry performed to determine the presence and type of neurogenic bladder is an invasive procedure. We evaluated the validity of uroflowmetry and postvoid residual urine volume as a screening tool for neurogenic bladder in children with cerebral palsy. MATERIALS AND METHODS: 34 children with cerebral palsy (range 6-13 years) were randomly selected for this study. Uroflowmetry and residual urine volume were deter mined at least twice in 22 children. Uroflow curve pattern was classified into normal, tower, plateau and staccato type. All patients underwent cystometry with sphincter elec tromyography. We analyzed relationship between the results of uroflowmetry and cystometry. RESULTS: Of the 34 patients, 23 (67.6%) children displayed upper motor neuron lesion of bladder. 11 (32.4%) had uninhibited contraction, 9 (26.5%) small capacity and con comitant detrusor-external sphincter dyssnergia was found in 3 (8.8%). Of 22 children who performed uroflowmetry, 13 showed abnormality. Staccato, tower, and plateau type of pattern was seen 11 (84.6%), 1 (7.7%), and 1 (7.7%) patient, respectively. The re maining 9 (40.9%) children were normal. Eleven of the 13 children with abnormal uroflow curve on uroflowmetry showed upper motor neuron lesion of bladder. Among 13 children with abnormal cystometric results, 11 reveal abnormal uroflow curves. 2 children (22.2%) displayed upper motor neuron lesion of bladder among the 9 children with normal uroflow curve. So, uroflowmetry reveal sensitivity 84.6%, specificity 77.8% for neurogenic bladder in cerebral palsied children. CONCLUSIONS: These results show a high rate of neurogenic bladder in children with cerebral palsy as in previous reports. Abnormalities on uroflow curve correlated well with abnormal cystometry findings. We believe that uroflowmetry is a viable noninvasive screening tool for the detection of neurogenic bladder in children with cerebral palsy.

The Significance of Uroflowmetry after Repair of Hypospadias / 대한비뇨기과학회지

PURPOSE: To determine the role of uroflowmetry in the evaluation of the functional results of hypospadias repair we reviewed the asymptomatic patients who underwent hypospadias repair. MATERIALS AND METHODS: A total of the 34 patients was available for this study. Age of patient were ranged from 3 to 14 years(mean; 8.8+/-4.67 years) at the time of uroflowmetry and followup ranged from 7 months to 3.5 years(mean; 2.4+/-0.88 years) after repair of hypospadias. The peak uroflow were compared to age dependent nomograms that indicate the normal range of peak flows according to the voided volumes. Flow rates were defined as low if they decreased below 90 percentile of the expected normal range. RESULTS: The peak urine flow in hypospadias repair patients(12.1 +/-8.74m1/sec) was not significantly different from normal control(12.9+/-5.10 ml/sec). Five of the 34 patients had peak flow below the normal ranges. One of the 17 patients with chordee and one of the 11 without chordee showed low peak urine flow. One of the 14 patients with anterior hypospadias, one of the 8 with posterior hypospadias and none with mid hypospadias showed low peak urine flow. According to the methods of repair one of the 12 patients with onlay island flap, one of the 5 with pyramidal procedure and three of the 6 who had undergone previous attempts at hypospadias in other hospital showed low peak urine flow Two of the 5 patients who revealed low peak uroflow rate were managed with periodic meatal dilatation and the 3 were managed with internal urethrotomy for proximal urethral stricture. CONCLUSIONS: The uroflowmetry is an easy and noninvasive method to detect asymptomatic urethral stricture In hypospadias repair patients.

Changes in Symptom Score and Uroflowmetry in 3 and 6 Months after Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia / 대한남성과학회지

PURPOSE: To evaluate the effectiveness of transurethral microwave thermotherapy (TUMT) using the Prostatron with Prostasoft 2.5 software in the patients with benign prostatic hyperplasia(BPH). PATIENTS AND METHODS: Patients with a Madsen symptom score (MSS) and International Prostate Symptom Score (IPSS) of 8 or more and a maximal uroflow rate of 15mL/sec or less were treated. Fifty-five patients (mean age 64.5 years, range 54~75 years) were followed up for 3 months and 23 patients (mean age 63.9 years, range 52~72 years) for 6 months. The MSS, IPSS, and uroflowmetry values (maximal flow rate, average flow rate, delay time, flow time, voiding time, time to maximal flow, and postvoiding residual volume), and quality of life were measured at baseline and 3 and 6 months after TUMT. RESULTS: The MSS (14.7 vs. 5.42, 14.2 vs. 3.90), IPSS (21.6 vs. 9.57, 20.0 vs. 6.73), and quality of life (4.37 vs. 2.53, 4.24 vs. 1.86) were significantly improved at 3 and 6 months after treatment (p<0.01). All uroflowmetry values except delay time were significantly improved at 3 months (p<0.01); at 6 months, the maximal flow rate (11.0 vs. 14.3 mL/sec), residual urine (70.3 vs. 22.6 mL) (p<0.01), and average flow rate (5.26 vs. 7.19 mL/sec) (p<0.05) were improved. CONCLUSIONS: High-energy TUMT could be an effective and safe method for the treatment of symptomatic BPH. Further studies on the long-term outcome of this procedure are necessary.

Usefulness of Voiding Symptom Score and Uroflowmetry as the Screening Methods for Patients with Prostatitis Syndrome / 대한비뇨기과학회지

PURPOSE: Recently, urine reflux into prostate during abnormal micturition has been proved and suggested to be an important pathogenetic factor that evoked the symptoms of prostatitis syndrome. The evaluation of voiding dysfunction in these patients may give the useful information to select the treatment methods or the next step of study. The objectives of this study was to evaluate the usefulness of voiding symptom score and uroflowmetry as the screening methods for patients with nonbacterial prostatitis syndrome. MATERIALS AND METHODS: For patients with prostatitis syndrome, evaluations of urine, prostatic secretion, voiding symptom scores(IPSS: international prostate symptoms score), and uroflowmetry were performed. Patients were divided into 3 groups according to the patterns of uroflow curve[type N; normal bell shape with Qmax(maximal flow rate) > 20ml/sec, type I; irregular shape, regardless of Qmax, type P; plateau shape with Qmaxf15ml/sec]. For patients with cutie patterns of type I and p, G-blockers were tried initially for 1-2 months and the effectiveness of o-blockers according to the changes of IPSS, Qmax and patterns of uroflow cutie was estimated. Patients with the pattern of type N and non-responders to o-blockers were further investigated to rule out any other cause. RESULTS: Among total 64 patients, 55 patients(86%) showed the abnormal uroflow cuties(Type I or P). 34(61.8%) of these 55 patients responded to alpha-blockers with changes of IPSS from 18.3 to 8.1(p<0.001) and of Qmax from 13.gm1/sec to 20.0ml/sec(p<0.001). The response to o-blockers was expected highly in group of type I with more than 10m1/sec of Qmax and less than 20points of IPSS(14.7folds). Of the 9 of type N patients, 6 were revealed to have idiopathic detrusor instability and 18 of 21 non-responders to alpha-blockers were diagnosed to have the bladder neck obstruction. CONCLUSIONS: The results that the effectiveness to o-blockers and the possibility of other disease could be characterized by IPSS and uroflowmetry suggest IPSS and uroflowmetry may be the useful screening methods for patients with prostatitis syndrome.

Prostatodynia: Characteristics of Uroflowmetries / 대한비뇨기과학회지

PURPOSE: Prostatodynia (PD) is a kind of syndrome by many causes and many patients with PD Are refractory to treatments of prostatitis. Considering a large part of complaints of PD patients are involving voiding symptoms, screening for voiding difficulty in patients with PD using uroflowmetry can be useful for selecting the following diagnostic method and choice of treatment. But characteristics of uroflowmetries in PD patients are not clarified. In this study, we analyzed data and types of curves from uroflowmetries in patients with PD to clarify and evaluate the characteristics of their voiding patterns. MATERIALS AND METHODS: Patients (n=48) and 11 healthy men under age 40 were selected. All the patients and controls underwent uroflowmetries. According to 5 types of uroflow curves by Jphirgensen et at, all the uroflow curves were classified, and maximum flow rate (Qmax; ml/sec) and average flow rate (Qave; ml/sec) were compared. RESULTS: Qmax (15.9 ml/sec) and Qave (9.0 ml/sec) in PD patients were all lower than those (24.5 ml/sec, 15.5 ml/sec) in controls (p<0.001, <0.001). By the classification of uroflow curves, uroflow curves of controls were all type 1. In PD patients, 12 (25%) were type 1, 6 (12.5%) were type 2, 13 (27.1%) were type 3, 17 (35.4%) were type 5, and none of them was type 4. Comparing RESULTS of each type PD patients with those of controls shows that there was no statistically significant difference between type 1 PD patients and controls, while Qmax and Qave of type 2, type 3, and type 5 PD patients were all lower than those of controls (statistically significant). Qmax and Qave were the lowest in type 5 (12.0 ml/sec, 7.2 ml/sec). CONCLUSION: From the RESULTS of our investigations, we suggest that a large part of PD patients have voiding problems and the uroflowmetry deserves to be a screening test for them. We think further studies are necessary to clarify the exact causes involving voiding symptoms in patients with PD.

Nomogram in Asymptomatic Elderly Males / 대한비뇨기과학회지

Uroflowmetry is important and simple method in the evaluation of prostatism and lower urinary tract obstruction. But nomogram of old males was not made till now in Korea. And the aim of our study was to provide a control group of males without prostatism who were in relevant age group. So, we investigated 312 males, who were over 50 years and had no subjective voiding problem. And we select 173 males, whose symptom scores were less than 6 out of 27 possible points of Madsen & Iverson's score system and nomogram was made. The 173 males were divided in 5-year groups and we gained maximal flow rate(MFR) and average flow rate(AFR). It was found that the mean value of MFR and AFR decreased from 20.5 t 8.lm1/sec and 13.2+/-5.8ml/sec at the A group( 50-54 years) to 15.4+/-6.1ml/sec and 9.3+/-4.5ml/sec at the G group(over 80 years). The mean voided volume was 211mL. The MFR and AFR are very closely related to the voided volume(P<0.01) and the adjusted maximal flow rate has been tested clinically by comparing preoperative voidings and postoperative voidings of prostatectomy patients. We conclude that this nomogram is very useful in diagnosing and follow-up of patients with BPH or lower urinary tract obstruction.

Clinical observation of transurethral prostatectomy / 대한비뇨기과학회지

A clinical observation was made on the 204 consecutive patients who had underwent transurethral resection of the prostate(TURP) between Jan. 1987 and Dec. 1992 focusing on uroflowmetry and complications. The uroflowmetries using flow rate nomogram were performed on 75 patients preoperatively and postoperatively. The preoperative maximum flow rats was 9.6+/-4.9 ml/sec(-2.5 SD) and postoperative maximum flow rate was 18.1+/-8.7 ml/sec (-1.0 SD). Uroflowmetry was convenient and helpful to evaluate the results after TURP. Early complications were voiding difficulty(7.8%), delayed bleeding(4.4%), bleeding requiring transurethral fulguration(2.0%), TUR syndrome(2.0%) and epididymitis(1.0%). The early postoperative morbidity was 16.2% and risk factors for early morbidity were resection time longer than 90 minutes, age more than 80 years. associated neurogenic bladder and prostatic cancer on biopsy. Delayed complications were urethral stricture(3.5%), urinary incontinence(2.0%), and obstruction requiring re-TURP(1.5%). Delayed morbidity was 6.9% and the only risk factor for delayed morbidity was resection time longer than 90 minutes. Careful attention to risk factors and surgical details is needed to reduce the amountand significance of the postoperative morbidity.