ABSTRACT
Objective To analyze the urodynamic data of the patients with benign prostatic hyperplasia(BPH)and provide evidence for the therapy.Methods 452 patients with BPH were selected.The mean age was(65.6 ±5.65)years(51 to 89 years).All patients had intact history documents which included the results of cystoscopy,urodynamics,doppler,DRE and PSA.Results 15 cases were not diagnosed with BOO.430 cases were diagnosed with BOO,among them,65 cases of bladder detrusor muscle weakness,bladder detrusor instability(detrusor,DI,instability)in 365 cases,3 cases were normal,and the other 4 cases had detrusor atony.In 445 patients the mean maximum urinary flow rate(8.32±3.15)ml/s,the average residual urine volume(87.68±79.46)ml,the average maximum flow rate when the detrusor pressure(62.32±7.54)cm H2O,maximum urethral closure pressure was(86.43±18.35)cmH2O,among which 19 cases were not suitable for surgery.At the end of the 426 patients underwent surgical treatment,postoperative follow-up of 3 to 18 months,the International Prostate Symptom Score(IPSS)from 0 to 5,the quality of life index(QOL)score of 0 to 1,Qmax 11 to 21 ml /s,residual urine(45.6±36.2)ml.There were significant differences between the preoperative and postoperative indexes(P<0.05).Conclusion Urodynamic tests can avoid the blindness in the surgery treatment of BPH.
ABSTRACT
<p><b>Objective</b>To compare and analyze the effects of transurethral resection of the prostate (TURP) and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with bladder detrusor overactivity.</p><p><b>METHODS</b>his study included 51 cases of BPH with bladder detrusor overactivity treated by TURP and another 58 treated by HoLEP. We evaluated the urination of the two groups of patients during the recovery period and at 3 and 6 months postoperatively.</p><p><b>RESULTS</b>There were no statistically significant differences in such baseline data as the blood PSA level, prostate volume, International Prostate Symptom Score (IPSS), and quality of life (QOL) between the two groups of patients, except in effective bladder capacity, which was higher in the TURP than in the HoLEP group (［315±59］ vs ［287±76］ ml, P<0.05). Urine storage symptoms were obviously improved in both of the groups postoperatively, with the storage symptoms score significantly decreased from 12.6±4.9 preoperatively to 7.5±3.9 at 3 months and 6.1±4.2 at 6 months after surgery in the TURP group (P<0.01) and from 13.7±5.7 to 7.9±4.2 and 7.0±5.1 in the HoLEP group (P<0.01). HoLEP manifested significant advantages over TURP in the postoperative urethral catheterization time (［2.7±0.8］ vs ［5.1±1.2］ d, P<0.05), postoperative bladder contracture time (［4.1±1.9］ vs ［5.8±2.4］ d, P<0.05), postoperative hospital stay (［4.4±1.8］ vs ［5.9±2.5］ d, P<0.05), and improvement of the maximum urinary flow rate, which was increased from (7.9±3.7) ml/s preoperatively to (16.8±4.3) ml/s at 3 months after surgery in the HoLEP group and from (8.6±3.2) ml/s to (14.6±4.3) ml/s in the TURP group (P<0.05).</p><p><b>CONCLUSIONS</b>Both TURP and HoLEP can improve bladder function and detrusor overactivity in BPH patients, with similar effects in improving urination at 3 to 6 months after surgery. However, HoLEP has more advantages over TURP during the period of postoperative recovery.</p>
Subject(s)
Humans , Male , Lasers, Solid-State , Therapeutic Uses , Length of Stay , Prostate , General Surgery , Prostatic Hyperplasia , General Surgery , Quality of Life , Transurethral Resection of Prostate , Methods , Treatment Outcome , Urinary Bladder Neck Obstruction , General Surgery , Urinary Bladder, Overactive , General Surgery , Urinary Catheterization , Urination , PhysiologyABSTRACT
Objective To explore the cause of acute urinary retention (AUR) ,the functional change of bladder detrusor. Methods The clinical data in 178 patients with AUR combined with urodynamic study were retrospectively analyzed. Results In male patients,the main cause of AUR was bladder oudet obstruction(BOO) ,the percent was 60.63%(77/127) ,in age more than 50 years old patients, while, in age less than 50 years old patients,the main cause was detrusor arcflexia (DUA), the percent was 72.55% (37/51), because of trauma of Iumbosacral vertebrae. In the female patients, the main cause of AUR was DUA. Between male and female patients with age more than 50 years old, there was significant difference in the cases of low compliance and DUA (P < 0.01) ,unstable bladder and BOO (P < 0.05). Conclusions The main cause of AUR in elderly male patients is BOO, which induces low eompliance and unstable bladder. While the main cause of AUR in female patients and young-middle age male is DUA .The function of detrusor changes differently with various causes.
ABSTRACT
Objective To evaluate the relationship between urodynamics and ultrastructure of bladder detrusor in patients with benign prostatic hyperplasia(BPH). Methods The ultrastructure of detrusor was studied by transmission electron microscopy in 43 cases of BPH(mean age 69.5±6.0 years)and 21 cases(mean age 65.4±7.2 years)of geriatric without bladder outlet obstruction(the controls).All the cases were performed urodynamic test. Results The IPSS(21.1±3.0 VS 7.6±1.4),maximum flow rate(7.7±1.3 ml/s VS 14.9±2.3 ml/s)and AG(44.8±9.9 VS 19.0±5.9)showed significant differences between the the BPH group and control group(P<0.01).Pdet-Qmax in the BPH group(60.1±11.0 cm H20)was higher than that in the control group(48.7±7.1 cm H2o) (P<0.05).The relative density of mitochondria in the BPH group(0.81±0.24)was lower than that in the control group(1.03±0.11)(P<0.05).The intercellular linkage in the BPH group(19.4±4.8 rim)was larger than the control group(14.1±2.0 nm)(P<0.05). Conclusions The swelling and reduction of the relative density of mitochondria could be seen in the bladder detrusor of BPH patients.The large intercellular linkage might be the reason of decrease the coordinate contractility of the blad-der detrusor.
ABSTRACT
Objective To investigate the P2X3 receptor expression in L6-S1 dorsal root ganglion (DRG)and bladder detrusor in a rat model of neurogenic bladder and urethra. Methods Eighty Sprague-Dawley rats wererecruited and randomly divided into a sacral injury group, a suprasacral injury group and a control group. Spinal tran-section was performed to establish the animal model of neurogenic bladder and urethra in rats of the sacral injurygroup and suprasacral injury group. Check the P2X3 receptor expression in DBG and bladder detrusor among thethree groups by Western blot test at 20 days after model establishment. Results P2X3 receptor expression in L6-S1DRG of sacral injury group was significantly less than that of the suprasacral injury group, which was in turn signifi-cantly higher than that of the control group. P2X3 receptor expression in bladder detrusor of sacral injury group wassignificantly lower than that of the suprasacral injury group, which was in turn significantly higher than that of thecontrol group. Conclusion There was close relationship between P2X3 receptor expression and dysfunction of blad-der and urethra.
ABSTRACT
@#ObjectiveTo investigate the effects of electroacupuncture in Guanyuan(Ren4) and Zhongji(Ren3) on the functions of neurogenic bladder in patients with spinal cord injury(SCI) with the standard urodynamic measure.Methods15 patients with neurogenic bladder after SCI were included into the study.During urodynamic measure,they accepted electroacupuncture in Guanyuan(Ren4) and Zhongji(Ren3).The changes of the bladder storage volume(VH2O),bladder pressure(Pves),detrusor pressure(Pdet) and bladder compliance(BC) before and after electroacupuncture were recorded.ResultsThe patients' VH2O increased from(124.00±77.37) ml to(144.47±85.87) ml(P<0.01),Pves decreased from(65.33±23.90) cmH2O to(55.27±17.52) cmH2O(P<0.05),Pdet decreased from(52.87±18.68) cmH2O to(44.93±15.82) cmH2O(P<0.05)and BC increased from(2.35±2.05) ml/cmH2O to(3.48±3.04) ml/cmH2O(P<0.01).ConclusionElectroacupuncture is effective on neurogenic bladder recovery in patients with SCI.
ABSTRACT
Considerable advances have been made in the understanding of the cellular processes that result in contraction and relaxation of detrusor smooth muscle recently,particularly in the role and modulation of calcium.Several changes in these cellular mechanisms that impair normal function have been observed in detrusor muscle from patients with unstable bladders.Whether these changes represent primary causes of bladder dysfunction or whether they are secondary to bladder dysfunction remains to be determined.Nevertheless,the identification of specific cellular lesions in bladder dysfunction presents a novel approach to identification of drug targets and potential treatment modalities.