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

Evaluating bladder function is important in prostatic hyperplasia surgery / 现代泌尿外科杂志

Benign prostatic hyperplasia (BPH) may lead to benign prostatic obstruction (BPO), which may result in bladder dysfunction. Based on the urodynamic analysis of bladder function of 793 BPO patients, bladder function could be classified into 3 stages and 6 types. Detrusor overactivity with impaired contractility (DHIC) is the transitional period of bladder function from compensation to decompensation. The indications of surgical therapy of bladder outlet obstruction (BOO) in different guidelines do not consider the bladder function. This paper emphasizes the importance of bladder function in the surgical choices for BOO, in order to select targeted and individualized surgical methods, and discusses the choice of surgical treatment for BPO from the perspective of bladder function.

The advances in the research of noninvasive diagnostic methods for bladder outlet obstruction / 中华泌尿外科杂志

This article reviewed the recent advances in the research of noninvasive diagnostic methods for bladder outlet obstruction. Penile cuff test, detrusor wall thickness, ultrasound-estimated bladder weight and near-spectroscopy showed a promising diagnostic results. However, more rigorous and higher level clinical trials with larger sample size are needed to validate the diagnostic value of these tests.

Inhibition of LIM kinase reduces contraction and proliferation in bladder smooth muscle

Overactive bladder (OAB) is the most bothersome symptom in lower urinary tract symptoms (LUTS). Current pharmacologic treatment aims to inhibit detrusor contraction; however, shows unsatisfied efficacy and high discontinuation rate. LIM kinases (LIMKs) promote smooth muscle contraction in the prostate; however, their function in the bladder smooth muscle remains unclear. Here, we studied effects of the LIMK inhibitors on bladder smooth muscle contraction and proliferation both

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.

Correlation Between Age, Ipss, Prostate Size With Histopathological Findings And Management Of Patients Of Prostatism

Introduction:Benign prostatic obstruction/enlargement (BPO/BPE) is one of the important aetiology for Bladder outlet obstruction (BOO) in men. Study has been planned to measure various parameters of bladder dysfunction by using Cystometry in patients of Prostatism and to find out correlation between various parameters like age, prostate size, IPSS, management of patients with Prostatism, choice of operative procedure performed and various histopatho-logical findings. Methods: This was observational study. Total 75 patients with age> 50 year and IPSS > 19 having symptoms of Prostatism were included in the study. Patient detailed history was taken and demographic parameters with IPSS, histopathological findings, management plan, Ultrasonography findings were recorded in structured profor-ma. Results: It is seen that the maximum i.e. 39 (52%) cases of prostatism are observed in the age group of 60 to 70 years. The average age was 67.29 years. Maximum i.e. 31 (41.33%) cases of prostatism had prostate size in 50-70 gms.36 patients were managed by catheterisation while surgery was performed in remaining 39 patients. Transurethral resection of prostate (TURP) was performed in 36 of 39 patients. IPSS was decreased significantly from average of 26 to average of 22 after 2 weeks of operation/catheterisation. Conclusion: Prevalence of BPE increases with age as there found to be positive correlation between age and Prostate size. TURP was preferred procedure in our tertiary centre for the treatment of BPE. Significant decrease in IPPS suggests improvement in symptoms of BPE after operation/catheterisation.

A Clinical Study on Correlation of Non-Invasive Diagnostic Tests in Evaluation and Management of Patients with Symptomatic Benign Prostatic Hyperplasia

Introduction: The gold standard for diagnosing bladderoutlet obstruction is pressure flow study but it is associatedwith side effects of high cost, invasiveness, infection, limitedavailability. So non invasive diagnostic tests becomes a goodoption. The diagnostic accuracy of these non invasive tests,however, remains uncertain. So this study was conductedto know the role of non invasive diagnostic tests likeInternational prostate symptom score (IPSS), Uroflowmetry(UFR), prostate volume, bladder wall thickness, post voidresidual urine in symptomatic patients with BPH in theirevaluation and in the planning of management.Material and methods: The present study included 108 malepatients above 50 years suffering from symptomatic BPH whoattended urology OPD at SVIMS, Tirupati. IPSS, Urinaryflow rates, bladder wall thickness, prostate volume, post voidresidual urine and urodynamic study have been recorded inthese patients at the time of enrollment into study.Results: One hundred and eight men between 50 – 79 years ofage with mean age of 62.4 years participated in this study. Allthe patients were divided into two groups as either obstructedor un obstructed based on Abraham – Griffith numbercalculated from the urodynamic study. Bladder wall thickness,Q max, Post void residual urine and prostate volume allhad statistically significant values between obstructed andun obstructed patients. However, there was no statisticalsignificant differences between age, IPSS in both the groupsConclusion: This study shows that in a subset of patientswith BPH with predefined inclusion and exclusion criteria,it should be possible to define obstruction with simple noninvasive parameters, without using invasive pressure flowstudy

Development and validation of a clinical nomogram predicting bladder outlet obstruction via routine clinical parameters in men with refractory nonneurogenic lower urinary tract symptoms / 亚洲男科学杂志(英文版)

We aimed to develop and validate a clinical nomogram predicting bladder outlet obstruction (BOO) solely using routine clinical parameters in men with refractory nonneurogenic lower urinary tract symptoms (LUTS). A total of 750 eligible patients =50 years of age who had previously not responded (International Prostate Symptom Score [IPSS] improvement 4 points) to at least three different kinds of LUTS medications (including a-blocker) for the last 6 months were evaluated as subcohorts for nomogram development (n = 570) and for split-sample validation (n = 180). BOO was defined as Abrams-Griffiths number =40, or 20-39.9 with a slope of linear passive urethral resistance ratio 2 cmH2O ml-1 s-1. A stepwise multivariable logistic regression analysis was conducted to determine the predictors of BOO, and b-coefficients of the final model were selected to create a clinical nomogram. The final multivariable logistic regression model showed that age, IPSS, maximum urinary flow rate, postvoid residual volume, total prostate volume, and transitional zone index were significant for predicting BOO; these candidates were used to develop the final nomogram. The discrimination performance of the nomogram was 88.3% (95% CI: 82.7%-93.0%, P 0.001), and the nomogram was reasonably well-fitted to the ideal line of the calibration plot. Independent split-sample validation revealed 80.9% (95% CI: 75.5%-84.4%, P 0.001) accuracy. The proposed BOO nomogram based solely on routine clinical parameters was accurate and validated properly. This nomogram may be useful in determining further treatment, primarily focused on prostatic surgery for BOO, without impeding the detection of possible BOO in men with LUTS that is refractory to empirical medications.

Laparoscopic modified Y-V plasty for recurrent bladder outlet obstruction induced by operation of benign prostatic hyperplasia / 中华泌尿外科杂志

Objective To investigate the clinical effect of laparoscopic modified bladder neck Y-V plasty in the treatment of recurrent bladder outlet obstruction after surgery for prostatic hyperplasia.Methods Seventeen patients with recurrent bladder outlet obstruction after prostatic hyperplasia operation from May 2017 to January 2019 was treated by laparoscopic bladder neck Y-V plasty,with the median age of 71 years old (65-81 years).All had a history of repeated urination obstruction and urinary tract infection,and experienced at least 2 times transurethral stenosis incision,resection or repeated urethral dilatation,with 12 cases of bladder neck stenosis (type Ⅰ) and 5 cases of middle prostate stenosis (type Ⅱ).Three-port laparoscopy surgery was performed with outer-peritoneal route into the Retzius Gap.After revealing the bladder and prostate junction,the "Y" incision of the bladder and stenosis of the prostate urethra was firstly performed,and inverted symmetrical "V" shape suture was performed with two 3-0 Stratifix suture for two layers,including the 1th layer suture of mucosal and inner muscle layer,and the 2nd layer suture of the outer muscle and the serous layer.F22 silicone catheter was indwelled for 2 weeks postoperatively.Urinary flow rate and bladder urethral examination were perfrmed to evaluate the effect of surgery 2 weeks and 3 months after the operation respectively.Results Seventeen operations were completed successfully,with the median operation time of 100 minutes (30-100 minutes),the median operation blood loss of 50 ml (20-100 ml),and the median hospital stay of 5 days (1-7 days).The patient had unobstructed voiding after removing the urinary catheter 2 weeks postoperatively,and had no urinary incontinence.Postoperative median follow-up was 7 months (3-17 months) and no stenosis of the urethra was detected.Conclusions Laparoscopic modified bladder neck Y-V Plasty has the advantages of high success rate,low recurrence rate and minimally invasiveness in the treatment of recurrent bladder outlet obstruction after prostatic hyperplasia surgery,which is worthy of clinical application.

Efficacy of an Alpha-Blocker for the Treatment of Nonneurogenic Voiding Dysfunction in Women: An 8-Week, Randomized, Double-Blind, Placebo-Controlled Trial / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the efficacy of an alpha-1 adrenergic receptor (α1-AR) blocker for the treatment of female voiding dysfunction (FVD) through a pressure-flow study. METHODS: This was a randomized, double-blind, placebo-controlled trial. Women aged ≥18 years with voiding symptoms, as defined by an American Urological Association symptom score (AUA-SS) ≥15 and a maximum flow rate (Qmax) 100 mL and/or a postvoid residual (PVR) volume >150 mL, were randomly allocated to either the alfuzosin or placebo group. After 8 weeks of treatment, changes in the AUA-SS, Bristol female lower urinary tract symptoms (BFLUTS) questionnaire, Qmax/PVR, and voiding diary were compared between groups. Patients’ satisfaction with the treatment was compared. Patients were categorized into 3 groups according to the Blaivas-Groutz bladder outlet obstruction (BOO) nomogram: none, mild, and moderate to severe. Subgroup comparisons were also made. RESULTS: Of a total of 187 women, 154 (79 alfuzosin, 75 placebo) were included in the analysis. After 8 weeks of treatment, the AUA-SS decreased by 7.0 in the alfuzosin group and by 8.0 in the placebo group. Changes in AUA-SS subscores, BFLUTS (except the I-sum), the voiding diary, and Qmax/PVR were not significantly different between groups. Approximately 54% of the alfuzosin group and 62% of the placebo group were satisfied with the treatment. No significant difference was observed between groups according to the presence or grade of BOO. CONCLUSIONS: Alfuzosin might not be more effective than placebo for treating FVD. The presence or the grade of BOO did not affect the results. A further study with sufficient power is needed to determine the efficacy of α1-AR blockers for the treatment of FVD.

The role of TRPV1 receptor in detrusor overactivity induced by partial bladder outlet obstrucion in rats / 中华泌尿外科杂志

Objective To investigate the role of transient receptor potential vanilloid tpye 1 (TRPV1) in the pathological process of detrusor overactivity (DO) induced by partial bladder outlet obstruction (BOO).Methods Between June 2014 and December 2014,40 female Wistar rats received partial urethral ligation and urodynamic analysis 6 weeks after.Urinary bladder and dorsal root ganglion (DRG) were removed and RT-PCR,Western Blot and IHC were performed to investigate the expression and location of TRPV1 in control and DO rats.Effect of different concentrations of TRPV1 agonist,as well as TRPV1 antagonist,was also evaluated with isolated detrusor strips.Results 40 female Wistar rats received BOO surgery and 26 of them developed DO.Immunohistochemistry observed linear TRPV1-reactive staining mainly in sub-urothelial and muscular layer.Expression of TRPV1 mRNA and protein in urinary bladder [(0.18±0.02) vs.(0.36 ±0.03),P＜0.05] and dorsal root ganglia (DRG) [(0.41 ±0.05) vs.(0.66 ±0.04),P ＜ 0.05] significantly increased in BOO induced OAB rats.In isolated detrusor strips studies,the amplitude [(0.26 ±0.05)g vs.(0.69 ±0.11)g,P ＜0.05] and frequency [(5.91 ±0.59) Hz vs.(8.75 ± 0.54) Hz,P ＜ 0.05] of contractions of DO tissues were significantly higher than that of control ones.Capsaicin significantly increased the amplitude but not frequency of detrusor intrinsic contractility and this effect was enhanced in OAB conditions.All changes induced by capsaicin were blocked by capsazepine pre-incubated.Conclusions In BOO induced DO rats,over-expressed TRPV1 was involved in DO pathological process by directly sensitizing bladder afferent fibers or indirectly enhancing detrusor intrinsic properties.

Development of a clinical nomogram for predicting bladder outlet obstruction in male LUTS/BPH / 实用医学杂志

Objective To develop a clinical nomogram for predicting the probability of bladder outlet obstruction (BOO) in male LUTS/BPH using the most common and noninvasive parameters in clinical practice , with the hope of detecting BOO individually and precisely. Methods Retrospectively analyze the outpatients and inpatients of male LUTS/BPH from November 2003 to November 2015 in Guangzhou First People′s Hospital. Collect the Pressure-flow study parameters and other clinical parameters including Qmax , PV, TZV, TZI, PSA, and PVR. Find out the best independent predictors on the diagnosis of BOO and develop the nomogram for pre-dicting BOO. Results The data from 1 599 patients were analyzed. The areas under the ROC curve (AUCs)of PV, TZV, TZI, PSA, Qmax, and PVR were 0.803, 0.807, 0.698, 0.775, 0.742, and 0.641, respectively. Qmax, PV, and PSA were selected as the best clinical parameters to predict BOO. The Logistic regression equa-tion is Log(p)=0.332 4 - 0.201 8*Qmax + 0.026 6*PV + 1.135 1*PSA. Finally, a nomogram model was developed by R statistical software. This nomogram showed a concordance index of 0.854 according to the inter-nal validation of the model. Conclusions The clinical nomogram presented a high accuracy (85.4%) in de-tecting BOO, which would help predicting BOO in male LUTS/BPH noninvasively, individually, accurately, and providing valuable reference and guidance in clinical decision.

APPLICATION OF NONINVASIVE SONOGRAPHY IN THE DETERMINATION OF DETRU-SOR MUSCLULAR THICKNESS OF BLADDER OUTLET OBSTRUCTION / 现代医院

Objective To explore the clinical application of non - invasive sonography in the determination of detrusor thickness in bladder outlet obstruction. Methods Admitted from January 2012 to January 2014, 116 pa?tients with bladder outlet obstruction were selected as observed group, while another 88 patients without bladder outlet obstruction at the same period were selected as control group. The detrusor thickness determined by sonography in the two groups was comparatively analyzed. Results There were significant differences between the two groups in DWT, residual urine volume, urine output, Qmax, PdetQmax and Pdetmax and other indicators (p <0.05). Conclusion Ultrasonic determination of anterior bladder detrusor thickness is reliable to diagnose bladder outlet obstruction, with a high clinical promotional and diagnosis value.

Estimated Glomerular Filtration Rate in Patients with Lower Urinary Tract Symptoms/Benign Prostatic Obstruction in an Emerging Tertiary Centre.

Background: The association of benign prostatic hypertrophy (BPH) and chronic kidney disease (CKD) has been a subject of controversies. Combinations of recurrent urinary tract infections, chronic retention with large residual urine volumes and decreased bladder compliance have been reported to be associated with chronic renal failure in patients with benign prostatic obstruction. Aims: To determine the estimated glomerular filtration rate (eGFR) and find out its relationship with the International Prostate Symptom Score (IPSS). Methodology: This is a cross-sectional study involving 129 new patients with benign prostatic hypertrophy. The severity and the degree of bother associated with patient’s lower urinary tract symptoms (LUTS) were assessed using the IPSS while the eGFR was determine using the modified Modification of Diets in Renal Disease. Results: Majority (38.8%) were in stage 2 CKD with eGFR of 60-89 ml/min/1.73 m2 and only 6(4.7%) patients were in stage 5 CKD with eGFR <15 ml/min/1.73 m2. Overall 55(42.7%) were found to have CKD at presentation. There was no statistically significant difference between the severity of lower urinary tract symptoms (LUTS) and eGFR. The most observed symptom was urinary frequency followed by urgency which were present in 95 (73.6%) and 82 (63.6%) respectively. There was a significant difference in the quality of life among patient with eGFR less than or greater than 60 ml/min/1.73m2 p = .005. Conclusion: This study demonstrated an association between BPH and CKD in men whose symptoms were bothersome (those with poor QoL). The degree of bothersomeness (QoL) could be used as the determinant for requesting serum creatinine to assess the renal status of patient with BPH. Estimation of GFR among these patients with BPH will offer a rapid method of renal function assessment at presentation and thus facilitate the application of clinical practice guidelines and clinical performance measures to improve the outlook of possible renal complication.

Evaluation of bladder outlet obstruction in benign prostatic hyperplasia patients using shear wave sonoelastography: a prospective study / 中华泌尿外科杂志

Objective To evaluate the correlation between the elastic modulus of prostate and the degree of bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH) patients in order to build a new non-invasive diagnostic indicator for BOO.Methods From november 2011 to November 2012,a total of 34 BPH patients were enrolled in this prospective study.Clinical information of the patients including age,international prostate symptom score (IPSS) and quality of life (QOL) were collected.The morphological features of prostate including total prostate volume,transitaion zone volume and transition zone index were detected by transrectal ultrasound (US),and prostate elastic modulus was detected using shear wave sonoelastograhy.After US examination,urodynamic study was performed by the urologist and pressure-flow curves were used to determine the diagnosis and the degree of bladder outlet obstruction.The correlation of prostate elastic modulus and other features including clinical information,morphological features and urodynamic features with the degree of bladder outlet obstruction were evaluated.ROC curves were evaluated.The feature with the best diagnostic performance was obtained,the diagnostic values of which were calculated.Results 9 patients had no BOO,with the average prostate elastic modulus of (27.3±5.0) kPa; 12 patients had mild to moderate BOO,with the average prostate elastic modulus of (30.7±2.8) kPa; 13 patients had severe BOO,with the average prostate elastic modulus of (34.7±2.4) kPa.The prostate elastic modulus had higher correlation coefficient with the degree of bladder outlet obstruction than the other features (r =0.754,P=0.000).It also had the highest AUC of 0.853 (95％CI 0.720-0.986).At a cutoffof 31.65 kPa,the sensitivity,specificity and accuracy of the prostate elastic modulus for the diagnosis of BOO were 72％,90％and 81％ respectively.Conclusion The prostate elastic modulus is highly correlated with the degree of bladder outlet obstruction,which might serve as a novel,promising indicator to evaluate BOO in BPH patients.

Effect of low-dose paclitaxel on morphology of bladder in rats with infra-vesical obstruction / 中国病理生理杂志

AIM: To investigate the effects of low-dose paclitaxel on the morphology of bladder after partial bladder outlet obstruction ( BOO) in rats.METHODS:Healthy female Sprague-Dawley rats ( n=30) were randomly di-vided into sham operation group, BOO group and low-dose paclitaxel group.The rats in BOO group and low-dose paclitaxel group received operation to establish an obstruction model, while the rats in sham group underwent sham operation.After operation, the rats in low-dose paclitaxel group received intraperitoneal injection of paclitaxel at a dose of 0.3 mg/kg twice a week for 4 weeks.At the same time, the animals in sham group and BOO group received the same volume of saline by in-traperitoneal injection.Four weeks after operation, each rat was sedated and the bladder was weighted.Histological chan-ges of the bladder were observed by HE staining.Collagen deposition in the bladder tissue was observed by Masson stai-ning, and the fibrosis area was measured.The ultrastructure of the detrusor was studied by transmission electron microsco-py.RESULTS:Compared with sham operation group, a significant increase in bladder weight (0.376 g ±0.052 g vs 0.112 g ±0.014 g, P<0.05), the muscle hypertrophy, and a decrease in the percentage of collagen area [collagen/(col-lagen+muscle), 29.66%±2.69%vs 38.94%±3.67%, P<0.05] was observed in BOO group.Under electron micro-scope, intracellular connection had more gap junction and desmosomes than intermediate junction.The cell gap widened with a large amount of collagen fiber.Compared with BOO group, low-dose paclitaxel group decreased bladder weight (0.215 g ±0.025 g vs 0.376 g ±0.052 g, P<0.05) and improved the muscle hypertrophy.The percentage of the colla-gen area was also decreased (19.94%±1.90% vs 29.66%±2.69%, P<0.05).The detrusor microstructure showed that the intermediate junction was characterized by a predominance among the intracellular connections, and the intercellu-lar space contained less collagen fibers in low-dose paclitaxel group.CONCLUSION:Low-dose paclitaxel may ameliorate the morphological damage of the bladder and recover bladder function in the rats with BOO by slowing down the process of bladder fibrosis.

Diagnosis and treatment for female patients with bladder outlet obstruction combining bladder pain syndrome / 中华泌尿外科杂志

Objective To explore the diagnosis and treatment of female bladder outlet obstruction (BOO) with bladder pain as major symptom.Methods From November 2008 to December 2012,21 female patients suffered from urinary frequency,urgency,pain in suprapubic area during bladder filling phase were enrolled in the study.Video-urodynamics (VUD) study combined with free urinary flow rate andresidual urine were performed in all patients in order to make the diagnosis of BOO clearly.The mean maximum urinary flow rate was (11.5±3.6) ml/s,and the mean maximal detrusor pressure was (39.1±17.8) cmH2O.Combining with the voiding radiography,19 patients were diagnosed as bladder neck obstruction,and the other 2 were diagnosed as urethral stricture.All patients were accepted the hydrodistension under the epidural anesthesia.The bladder biopsy was performed if the typical glomerulations were observed under the cystoscopy.Bladder neck incision and urethral dilatation were performed on these patients respectively.Symptom changes of bladder pain were recorded by using O'Leary-Sant scale,the pain,urgency,frequency symptom (PUF) scale and quality of Life (QOL) Scale.The data were collected within 48 months postoperation,respectively.Results The pathological findings of bladder mucosa biopsy showed acute or chronic inflammation in all patients.The mean follow-up was 6.7±5.9 months.We compared the corresponding data such as:voiding times per day,nocturnal frequency,O'Leary Sant scores,PUF and QOL between pre and post-treatment.Significant differences were observed during all corresponding data (P＜0.05).The voiding times per day changed from 24.3± 11.8 to 13.0±5.9.The nocturnal frequency decreased from 6.5±2.7 to 3.3± 1.6.O'Leary Sant scores changed from 24.6±7.3 to 14.7±7.4.The PUF scores changed from 22.9±6.2 to 12.0± 7.1.And the QOL scores changed from 5.0±0.8 to 2.9±1.5.Conclusions Free urinary flow rate and residual urine combined with VUD are very important in diagnosing female BOO with bladder pain as major symptom.Bladder pain symptoms will be significantly improved after the obstruction was relieved according to VUD results.

The clinical efficacy of the therapy scheme of green light photoselective vaporization combined testicular resection plus anti-androgen on advanced prostate cancer and bladder outlet obstruction / 中国综合临床

Objective To evaluate the clinical efficacy of green light photoselective vaporization(PVP)combined testicular resection plus anti-androgen treatment on advanced prostate cancer and bladder outlet obstruction.Methods Twenty cases with PVP of advanced prostate cancer and bladder outlet obstruction were selected as our subjects,who underwent PVP testicular resection plus anti-androgen treatment.The clinical information was recorded.Results All patients were succeed through surgery.Maximum urinary flow rate (MFR) at the pre-operation was (2.0 ± 1.0) ml/s,and increased to (14.0 ± 4.5) ml/s after operation.Serum prostate specific antigen (PSA) was decreased from the preoperative (176.5 ± 160.5) μg/L to (2.0 ± 1.0)μg/L International prostate symptom score (IPSS) was from (25.0 ± 5.0) down to (8.0 ± 1.0) points.The quality of life (QOL) score was (4.0 ± 2.0) at pre-operation,higher than after operation (1.0 ± 1.0)points.There were significant differences between preoperative and postoperative (t =9.502,7.371,5.328,8.350,P ＜0.05).Every patient was followed up from 3 to 18 months.The improvements regarding of clinical symptoms were seen including voiding,and all patients survived with tumor.Conclusion Advanced prostate cancer associate with bladder outlet obstruction.The therapy plan of PVP joint testicular resection plus antiandrogen is proved to improve symptoms of urethral obstruction and patient quality of life.

Análise da expressão das metaloproteinases e seus inibidores teciduais no músculo detrusor de pacientes com obstrução infravesical por hiperplasia prostática benigna / Expression of metalloproteinases and their tissue inhibitors in the detrusor muscle of patients with bladder outlet obstruction due to benign prostatic hyperplasia

Introdução: A obstrução infravesical (OIV) de longo prazo secundária a hiperplasia prostática benigna (HPB) pode causar alterações funcionais e morfológicas na bexiga. Um dos principais eventos consiste no aumento da deposição de colágeno e perda de complacência vesical, levando a alteração de armazenamento e esvaziamento urinário. O aumento da deposição de colágeno na matriz extracelular (MEC) da musculatura detrusora é a principal razão para a diminuição da complacência vesical. Na bexiga, assim como em outros órgãos, este fenômeno depende da atividade equilibrada de enzimas proteolíticas, incluindo as metaloproteinases (MMP) e os seus inibidores endógenos (inibidores teciduais de metaloproteinases-TIMPs). Como estes fenômenos são desconhecidos na bexiga obstruída, o objetivo deste estudo foi avaliar a expressão gênica de colágeno, MMPs e seus inibidores na bexiga de pacientes com obstrução infravesical. Material e Métodos: Foi realizada uma análise prospectiva e controlada de 43 pacientes com OIV devido a HPB, que foram submetidos à ressecção transuretral da próstata (RTUP) entre 2011 e 2012. Como grupo controle foram selecionados espécimes de músculo detrusor de 10 pacientes que foram submetidos a prostatectomia radical retropúbica devido adenocarcinoma de próstata. Todos estes pacientes tinham idade menor que 60 anos, tamanho de próstata menor que 30 gramas ao ultra-som e escore internacional de sintomas prostáticos (IPSS) menor que 7. Todos os pacientes foram submetidos a estudo urodinâmico pré e pós operatório (após 6 meses). A biópsia de fragmento de músculo da bexiga foi realizada ao final da RTUP e colocada em solução estabilizadora de RNA para quantificação da expressão de colágenos I e III, metaloproteinases de matriz 1, 2 e 9, e inibidores de MMPs (TIMP1, TIMP2 e RECK) na bexiga de pacientes com HPB. Os genes descritos foram avaliados através da técnica de reação em cadeia da polimerase quantitativa em tempo real (qRT-PCR)....

Introduction: Long-term Bladder outlet obstruction (BOO) secondary to Benign prostatic Hyperplasia (BPH) can cause functional and morphological abnormalities in the bladder, such as increased collagen deposition and loss of compliance, leading to urinary storage and voiding symptoms. A decrease in bladder compliance is known to be correlated with deterioration of renal function. Increased deposition of collagen in the extracellular matrix (ECM) is the primary reason for a decreased compliance. In the bladder, as in other organs, this phenomenon is dependent on the balanced activity of proteolytic enzymes, including matrix metalloproteinases (MMPs) and their endogenous inhibitors, tissue inhibitors of metalloproteinases (TIMPs). The imbalance between MMPs and TIMPs is a key regulator in ECM turnover. Since these mechanisms are unknown in the obstructed bladder, the objective of this study was to evaluate gene expression of collagen, MMPs and their inhibitors in patients with bladder outlet obstruction due to BPH. Material and Methods: We performed a prospective and controlled analysis of 43 patients with BOO due to BPH who underwent transurethral resection of the prostate (TURP) from 2011 to 2012. The control group was comprised of 10 bladder specimens from patients with < 60 years who underwent radical prostatectomy with an International Prostatic Symptom Score (IPSS) < 8 and prostate volume < 30 grams. All patients underwent urodynamic analysis pre and post operatively after 6 months. A biopsy of the bladder muscle was performed at the end of TURP for analysis of collagen, metalloproteinases and TIMPs gene expressions. For this purpose we used the quantitative real time polymerase chain reaction method (qRT-PCR)...

Clinical significance of Qmax and residual urine in benign prostatic hyperplasia / 中华泌尿外科杂志

Objective To investigate the significance of Qmax and residual urine in evaluation of bladder function in the patients with benign prostatic hyperplasia (BPH).Methods The clinical data of 61 patients with BPH and 20 healthy persons in control group were evaluated.Bladder function,uroflowmetry and ultrasonic residual urine measurement were performed in the 2 groups.The correlation between Q max and residual urine in BPH group was investigated.Results There was significant difference in Qmax between the BPH group and control group (8 vs.21 ml/s,u=-6.090,P=0.007).There was significant difference in residual urine between the 2 groups (60 vs.9 ml,u =-6.718,P=0.005).And there was a negtive correlation between residual urine and Qmax in BPH group (r=-0.366,P=0.009).Conclusion It is useful to measure the Qmax and residual urine in evaluation of bladder function affected by bladder outlet obstruction caused by BPH.