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Objective: To identify the prognostic factors causing persistent storage symptoms following transurethral resection of the prostate in patients with benign prostatic enlargement (BPE)., Methods: A total of 116 men with symptomatic BPE requiring surgery were enrolled in the study between January 2011 and December 2012. The patients underwent basic clinical evaluations including transrectal ultrasound, International Prostate Symptom Score and urodynamic study. After 6 months, International Prostate Symptom Score and uroflowmetry were rechecked. The definition of persistent storage symptoms was patients with storage scores >7 points. Logistic regression analysis and receiver operating characteristic analysis were conducted., Results: The 116 patients were divided into a persistent storage symptom-positive group (n = 33) and a storage symptom-negative group (n = 83). Multivariate analysis showed that the degrees of worse initial storage symptoms (odds ratio [OR] = 8.32), small bladder capacity (OR = 4.31), impaired detrusor contractility (OR = 2.96) and age (OR = 1.05) were consistently associated with persistent storage symptoms., Conclusions: This short-term study confirms the positive and consistent correlations between the baseline degree of worse initial storage symptoms, bladder capacity, detrusor contractility and age and the improvement in storage symptoms.

Purpose: To demonstrate the change in the expression of angiotensin II type 1 receptor (AT1) in the rat bladder with partial bladder outlet obstruction (P-BOO)., Materials and Methods: Bladder specimens were obtained from 12-week-old Wistar female rats that were divided into two groups, a P-BOO group and a control group. The rats of the P-BOO group were divided into six groups: a sham-operated control group, 1 day postoperatively, 2 days postoperatively, 4 days postoperatively, 7 days postoperatively and 14 days postoperatively. The cystometric findings and immunohistochemical staining of the detrusor muscle with the AT1 antibody were compared in each group., Results: AT1 localized on the cell membrane of the detrusor smooth muscle and in cytoplasm of suburothelial myofibroblasts in the control rats. The expression of AT1 disappeared in the detrusor muscle and suburothelial myofibroblasts in P-BOO, but AT1 was highly expressed in urothelial cells 1 day after surgery. The expression of AT1 in urothelial cells gradually decreased with time after surgery. AT1 completely disappeared in urothelial cells 14 days after surgery., Conclusions: The present study demonstrated that the site of AT1 expression changes in response to the mechanical stress caused by P-BOO, and finally there was no expression of AT1 in rat bladder tissue following P-BOO. These data suggest the change in AT1 expression may play a role in bladder function., (Copyright © 2012 S. Karger AG, Basel.)

Objectives: To assess the safety and clinical efficacy of Tm:YAG laser vaporesection of the prostate (ThuVaRP) at intermediate-term follow-up., Patients and Methods: We identified the first 60 consecutive patients who underwent ThuVaRP at our institute. Operative outcomes assessed were resection time, resection weight, drop in haemoglobin, transfusion rate, catheter time and complication rate. The International Prostate Symptom Score (IPSS) was documented at a mean follow-up period of 19 months postoperatively., Results: 45/60 patients underwent treatment due to lower urinary tract symptoms secondary to benign prostatic obstruction, 11/60 patients had a long-term catheter in situ for refractory urinary retention secondary to benign prostatic obstruction, and 4/60 patients had bladder outflow obstruction secondary to adenocarcinoma of the prostate. 1/60 patients developed urosepsis, 1/60 patients developed a urinary tract infection and 1/60 patients required 3-way catheterization and irrigation due to haematuria. No patients required a blood transfusion. The mean IPSS at a mean follow-up interval of 19 months (range 15-28 months) was 5.1 (range 1-23). Postoperative maximum flow rate improved from 7.9 to 17.1 ml/s, and post-micturition residual volume decreased from 254 to 86 ml., Conclusion: ThuVaRP is safe and appears to have durable efficacy at intermediate follow-up., (Copyright © 2011 S. Karger AG, Basel.)

Aim: To assess the effects of ginseng saponin on relaxation of the bladder and prostatic urethra and to determine its mechanism of action., Materials and Methods: For the in vitro study, prostatic urethra muscle strips were harvested from 18 male New Zealand rabbits. The strips were mounted in organ baths and connected to force displacement transducers. After stabilization, maximal tissue contractions were obtained by the application of phenylepinephrine to the urethra strips, and a dose-response curve for ginseng saponin was constructed (10(-6)-10(-2)M). After pretreatment of urethra strips with N-nitro-L-arginine methyl ester (L-NAME), another dose-response curve for ginseng saponin was constructed. For the in vivo study, we used adult male Sprague-Dawley rats divided into three groups [control, partial bladder outlet obstruction (PBOO) and saponin-fed groups], and we monitored the vesical pressure (P(ves)) and urethral perfusion pressure (UPP)., Results: The ginseng saponin induced a significant dose-dependent relaxant effect on the prostatic urethra strips. A significant relaxant effect of ginseng saponin was observed from 10(-3)M, and ginseng saponin significantly relaxed urethra strips by 50.2 ± 20.26% at 10(-2)M. The relaxant effect was partially inhibited with L-NAME pretreatment. In the in vivo study, the change in UPP between baseline and relaxation was significantly higher in the saponin group than in the control or PBOO group (p < 0.001). The saponin group showed a significantly lower baseline P(ves) than the PBOO group., Conclusions: We observed a significant relaxation effect of ginseng saponin on the bladder and prostatic urethra in both in vitro and in vivo studies. The mechanism by which ginseng saponin induces relaxation appears to involve the nitric oxide/nitric oxide synthase pathway., (Copyright © 2012 S. Karger AG, Basel.)

Introduction: We estimated the diagnostic accuracy of Abrams-Griffiths number (AG), urethral resistance factor (URA) and detrusor-adjusted mean passive urethral resistance relation factor (DAMPF) for bladder outlet obstruction (BOO) in benign prostate hyperplasia (BPH) patients., Materials and Methods: AG, URA and DAMPF were obtained by pressure-flow studies from BPH patients. Receiver operating characteristic (ROC) curves were used to analyze the diagnostic accuracy of the AG, URA and DAMPF in the diagnosis of BOO., Results: Among the 172 cases there were 154 classified as obstructed (89.5%) and 18 as unobstructed (10.5%). There were statistically significant differences in AG, URA and DAMPF between the obstructed and the unobstructed cases. The ROC curve demonstrated a similar diagnostic accuracy in the diagnosis of BOO for AG and URA values, and the least was seen for the DAMPF value. An AG cutoff of >33 provided a sensitivity of 89.61% and a specificity of 100%. A URA cutoff of >28 provided a sensitivity of 91.56% and a specificity of 100%. A sensitivity of 93.51% and the weakest specificity of 77.78% were recorded for DAMPF values of >52. AG and URA had a similar accuracy, while the efficacy of DAMPF is significantly lower in the diagnosis of BOO., Conclusions: AG or URA appeared to be the best discriminating parameters of BOO in BPH patients. The DAMPF could be used to aid the BOO diagnosis. Lower cutoff values were suggested for these BOO parameters., (Copyright © 2010 S. Karger AG, Basel.)

Introduction: The prevalence of bladder outlet obstruction in men has been overestimated leading to improper clinical results after transurethral resection of the prostate., Patients and Methods: 3,830 consecutive male cases submitted for urodynamic evaluation were prospectively analyzed using a Schaefer nomogram. The prevalence of detrusor overactivity and the occurrence of obstruction were prospectively studied using standardized urodynamic practice., Results: Infravesical obstruction was diagnosed in 44.8% of the studied population: 0.7% of the obstructed cases were obstructed at the sphincter zone and 7.9% showed obstruction as a high-pressure, high-flow-rate pattern. Detrusor overactivity was demonstrated in 73.9% of the obstructed cases and in 22% of the unobstructed. Older patients (>60 years) seemed more likely (odds ratio: 2.8) to present detrusor overactivity, but at the same time showed less frequent obstruction. The oldest subjects (>80 years) showed a lower prevalence of obstruction, although overactive bladder was a common finding., Conclusion: Infravesical obstruction is less frequent than previously stated. The common assumption that obstruction is the cause of lower urinary tract symptoms in older men is wrong. Older men are more likely to suffer from detrusor overactivity resulting from lower urinary tract symptoms rather than infravesical obstruction. Urodynamic studies seem to be crucial for a proper diagnosis in men considered candidates for surgical treatment., (Copyright 2009 S. Karger AG, Basel.)

Objectives: To investigate the alterations of urine transforming growth factor-beta1 (TGF-beta1) and basic fibroblast growth factor (bFGF) following bladder outlet obstruction (BOO) in rats and to determine their correlation with the impaired detrusor contractibility., Methods: Wistar rats were divided into control, 2-week BOO 6-week and BOO groups. Impaired detrusor contractibility was quantified by measuring detrusor contraction force (DCF) of detrusor strip stimulated by carbachol. The enzyme-linked immunosorbent assay method was used to determine the urine levels of the 2 factors. Correlation analysis was conducted between DCF and urine levels of the 2 factors to see if there was an association between them after BOO., Results: DCF was found to be significantly lower in the 6-week BOO group than in the 2-week BOO and control groups. There is no significant difference regarding urine TGF-beta1 between the 2-week BOO and control groups (p > 0.05). Urine TGF-beta1 level in the 6-week BOO group was significantly higher than in the 2-week BOO (p < 0.05) and control groups (p < 0.05). There existed a negative correlation between DCF and urine TGF-beta1 (p < 0.05)., Conclusions: In an animal model, our results have suggested the potential role of urine TGF-beta1 as a noninvasive biomarker to predict detrusor contractibility after BOO., ((c) 2009 S. Karger AG, Basel.)

Objectives: To study the results and complications of the potassium-titanyl-phosphate (KTP, green) laser during transurethral incision of the bladder neck in the treatment of female voiding dysfunction due to bladder neck obstruction., Methods: A total of 40 women (43-79 years of age) with obstruction were identified. Patients with neurogenic, traumatic, or iatrogenic causes of obstruction were excluded. Preoperative investigations included a full urodynamic examination and urethrocystoscopy. Transurethral bladder neck incision with KTP was performed in all patients. Urodynamic results, clinical improvements in voiding symptoms, and volume of bleeding were assessed., Results: Of the 40 patients, 12 had chronic urinary retention and 28 had difficult micturition. The most common findings on urodynamic study were a high voiding pressure plus low flow rate and high urethral pressure. After treatment, the lower urinary tract symptoms were resolved or improved in all patients. Urodynamic study revealed decreased voiding pressure, post-void residual urine volume, and increased maximal flow rate., Conclusions: Transurethral incision of the bladder neck is effective in relieving voiding difficulties owing to anatomic or functional bladder neck obstruction in women. KTP has great efficacy in the treatment of female voiding dysfunction due to bladder neck obstruction., ((c) 2009 S. Karger AG, Basel.)

Introduction: In this study, we aimed to evaluate changes in contractile responses under in vitro conditions in detrusor overactivity (DO) in patients with bladder outflow obstruction (BOO)., Materials and Methods: Detrusor strips obtained during open prostatectomy procedure from 16 patients with BOO related to benign prostate hyperplasia were evaluated under in vitro conditions. Patients were assigned to two groups as patients with (DO) and without (no DO) DO. Four detrusor strips were prepared from each bladder in dimensions of 2 x 10 mm, and were suspended in organ bath. Responses to carbachol (10(-8) to 10(-3)M), electrical field stimulation (EFS) (0.5-32 Hz), single-dose adenosine 5'-triphosphate (ATP) (10(-3)M) and KCl (120 mM) were recorded to evaluate the contractile responses. EFS responses were repeated in the presence of NG-nitro-L-arginine methyl ester (L-NAME; 10 muM) and L-NAME + indomethacin. All responses were expressed as mg tension developed per mg of bladder tissue. Data obtained were compared using independent t test and one-way ANOVA test. Values of p < 0.05 were accepted as statistically significant., Results: Of the 16 patients on whom open prostatectomy was performed because of BOO, 8 of the patients were determined as no DO and 8 as DO. There were no differences between groups regarding age and residual urine. We found statistically significant differences between groups regarding dimensions of prostate, maximum bladder capacity and maximum bladder pressure. In the comparison of cumulative dose of carbachol, it was seen that responses were higher in the DO group, but the differences were not statistically significant. In EFS application, contractile responses were found to increase significantly in the DO group. No changes were observed between groups for ATP and KCl. EFS responses were found to be significantly higher in presence of L-NAME + indomethacin in the no DO group; however, no difference was seen in the DO group., Conclusions: Detrusor contractile responses to EFS increased in patients with BOO in presence of overactivity. These changes in contractile responses are observed possibly as a result of deterioration in neuromodulation, rather than as a result of changes in purinergic or cholinergic receptor sensation or level. We suggest that a noncholinergic-nonpurinergic mechanism can have some effect on these changes.

Objectives: Nitric oxide is a neurotransmitter that is related to overactive bladder. This study was undertaken to evaluate the expression of nitric oxide synthases (NOS) in relation to bladder function after the removal of the bladder outlet obstruction in rats., Materials and Methods: 50 rats were divided into a control group (n = 10) and an experimental group (n = 40). The bladders in the experimental group were partially obstructed for 3 weeks. 3 weeks after removal, cystometrograms (CMG) were performed. On the basis of CMG results, the experimental group was subdivided into 'normalized' and 'overactive' groups. Expression of neuronal, inducible, and endothelial NOS mRNA in bladders of each group was analyzed by reverse transcriptase polymerase chain reaction (RT-PCR)., Results: On the CMG, the contraction interval of the overactive group was markedly decreased. RT-PCR results showed significantly decreased expression of nNOS and iNOS mRNA in the normalized group compared to the control group, and increased nNOS levels in the overactive group, compared to the normalized group (p < 0.05). A marked increase in eNOS mRNA expression was evident in the normalized and overactive groups compared to the control group (p < 0.05)., Conclusions: Our results clearly show increases in nNOS and eNOS expression according to bladder function, which may be related to a persistently overactive bladder or irritative symptoms, following the removal of a bladder outlet obstruction., ((c) 2008 S. Karger AG, Basel.)

Background: Evidence indicates that decreased blood flow to the bladder plays a major role in obstructive bladder dysfunction in the rabbit model of partial bladder outlet obstruction (PBOO), and that nitric oxide (NO) regulation of blood flow may be important in modulating the degree of obstructive bladder dysfunction. The specific aim of our study is to determine the effect of feeding rabbits a diet high in L-arginine on the response to PBOO., Materials and Methods: Sixteen male NZ White rabbits were separated into 4 groups of 4 each. The rabbits in groups 1 and 3 underwent PBOO. The rabbits in groups 2 and 4 were sham-operated. For 1 week prior to surgery, and 2 weeks postoperatively, each rabbit in groups 1 and 2 was put on a diet containing 7% arginine. Rabbits in groups 3 and 4 were on a normal diet (0.76% arginine)., Results: PBOO resulted in a greater increase in bladder weight in the control group than the arginine group. PBOO resulted in a greater decrease in compliance in the control group than the arginine group. The contractile responses to all agents in the arginine control group were greater than in the control normal diet group. PBOO resulted in a greater decrease in the response to field stimulation in the control group than in the arginine group., Conclusions: These studies clearly demonstrate that feeding rabbits a diet high in L-arginine was beneficial for the control rabbits, and reduced the level of dysfunctions following PBOO.

Introduction: Bladder outflow obstruction may cause obstructive or irritative symptoms. The diagnosis of female functional bladder neck obstruction requires a pressure/flow study and electromyography performed by videourodynamics. The treatment includes self-catheterization or bladder neck incision. We administered tamsulosin, an alpha1A/alpha1D-selective adrenergic antagonist, in women with functional bladder neck obstruction to evaluate its potential therapeutic effects., Patients and Methods: A group of 18 women affected by functional bladder neck obstruction was selected. The diagnosis was made by means of a pressure/flow study combined with electromyography and a fluoroscopic test. The diagnostic criteria were: high detrusor pressure with reduced maximum flow, silent electromyography activity, and bladder neck nonfunnelling during the fluoroscopic test. Tamsulosin 0.4 mg once daily was administered for at least 30 days. Patients with a postvoid residual urine volume > or = 100 ml performed intermittent self-catheterization. Patients with a postvoid residual urine volume < 100 ml performed self-catheterization every 7 days. After 30 days of therapy, all patients underwent a new pressure/flow study and a micturition fluoroscopic test., Results: 10 (56%) out of 18 treated patients showed a statistically significant improvement in symptoms, maximum flow, and postvoid residual urine volume (p < 0.01)., Conclusion: The use of alpha1-blockers may be an initial treatment option for female functional bladder neck obstruction, as this therapeutic option proved to be effective in more than 50% of our patients suffering from this voiding dysfunction., (Copyright 2005 S. Karger AG, Basel.)

Introduction: We previously developed a noninvasive video urodynamic study using color Doppler ultrasonography. We sought the best flow velocity-related parameter which would allow prediction of an improvement in lower urinary tract symptoms (LUTS) after alpha 1-blocker treatment., Methods: Twenty-two men with benign prostatic hyperplasia who were treated with a nonselective alpha 1-blocker (urapidil) were included. Subjective symptoms were evaluated using the International Prostate Symptom Score (IPSS) before and after alpha 1-blocker treatment. We measured the flow velocities using a transperineal ultrasound technique in the distal prostatic urethra just proximal to the external urethral sphincter (V1) and in the sphincteric urethra (V2), and used them to obtain the velocity ratio (VR=V1/V2). The corresponding functional cross-sectional areas of the urethra at these two sites (A1 and A2) were calculated as Q(max)/V. All these parameters obtained by the velocity-flow urodynamics were compared before treatment and after 4 weeks., Results: After treatment, V1 and VR were decreased, and A1 was increased. V2 correlated best with the change in IPSS before and after alpha 1-blocker therapy, with Spearman's rho of 0.584. All men with V2 exceeding 50 cm/s did not show an improvement in the LUTS., Conclusions: The maximum flow velocity at the sphincteric urethra (V2) can predict the subjective outcome of alpha 1-blocker treatment. The velocity-flow parameters changed after alpha 1-blocker treatment. We confirmed that the transperineal ultrasound urodynamic study is not only noninvasive but also informative., (copyright 2004 S. Karger AG, Basel)

Introduction: Bladder outlet obstruction (BOO) is often overlooked in the diagnosis of women with lower urinary tract symptoms. Although the incidence of BOO is not high in the female population with lower urinary tract symptoms, a correct diagnosis for BOO is important. This study was designed to compare the urodynamic parameters in women with bladder outlet obstruction (BOO), stress urinary incontinence (SUI) and asymptomatic volunteers., Materials and Methods: Videourodynamic study was performed in 76 patients who were clinically diagnosed as BOO, 265 with stress urinary incontinence (SUI). In addition, 30 asymptomatic female volunteers were recruited and served as controls. Voiding pressure (P(det.Qmax)), maximum flow rate (Qmax), and urodynamic parameters were compared among the BOO, SUI and control groups and the criteria values for BOO in women were estimated., Results: BOO was identified in 30 women with bladder outlet stricture, 40 women with dysfunctional voiding, and 6 women with high-grade cystocele. The mean P(det.Qmax) was significantly higher and the mean Qmax was significantly lower in the obstructed groups. When a P(det.Qmax) > or =35 cm H(2)O was set as the criteria for BOO, the sensitivity was 96.1% and specificity was 89.0%, whereas a P(det.Qmax) of > or =30 cm H(2)O had a sensitivity of 100% but the specificity was only 65.5%. If the criteria of BOO was set as P(det.Qmax) > or =35 cm H(2)O combined with Qmax < or =15 ml/s, the sensitivity for BOO was 81.6% and specificity was 93.9%., Conclusions: Our results demonstrate a P(det.Qmax) of > or =30 cm H(2)O is a good index value for screening of female BOO. When a P(det.Qmax) of > or =35 cm H(2)O combined with a Qmax < or =15 ml/s was found, a high suspicion of BOO should be raised, for which a specificity of 93.9% and sensitivity of 81.6% for BOO was obtained., (Copyright 2004 S. Karger AG, Basel)

Objectives: The aim of our study was to evaluate the symptomatic and urodynamic changes after 1-5 years of treatment with alfuzosin in patients with benign prostatic hyperplasia., Methods: Out of 255 patients with lower urinary tract symptoms observed from 1992 to 1997, who completed the International Prostatic Symptom Score (I-PSS) and underwent full urodynamic investigation, 161 were found to be obstructed (Schäfer classes 2-6). One hundred and two subsequently consented to a second clinical and urodynamic evaluation. Out of these, 46 underwent surgical treatment, 20 were elected for watchful waiting (WW) and 36 received a medical treatment. Twenty out of these, with a mean age of 65 years, a mean prostatic volume of 44 ml (20-70) a median Schäfer's obstruction class of 3 (range 2-5) were treated with slow release alfuzosin 5 mg twice a day. We re-evaluated these 20 patients with a second I-PSS and pressure-flow study after 1-5 years (mean: 2 years) of treatment. The patients in the WW group with comparable baseline characteristics were considered as controls. The Wilcoxon matched-pairs signed rank test and the Kruskal-Wallis test were used for statistical analysis., Results: In the group treated with alfuzosin, no differences were noted for I-PSS (14.9 +/- 6,8; 13.3 +/- 5); maximum flow (124 +/- 6; 14 +/- 6) and projected isometric pressure (105 +/- 36; 105 +/- 26). Statistically significant differences were noted for residual urine (103 +/- 100; 33 +/- 38, p = 0.02); detrusor pressure at maximum flow (64.4 +/- 23; 53 +/- 12, p = 0.04), minimum urethral opening pressure (36.5 +/- 9; 31 +/- 9, p = 0.02), Schäfer class (2.7 +/- 0.7; 2 +/- 0.8, p = 0.04); urethral resistance algorithm (34.7 +/- 11; 27 +/- 7, p = 0.02). Statistically significant differences between baseline and follow-up were noted for none of the clinical and urodynamic parameters in the WW group., Conclusions: Patients with bladder outlet obstruction seem to remain clinically stable and to improve urodynamically when treated with alfuzosin for a long period of time., (Copyright 2003 S. Karger AG, Basel)

Objectives: To analyze the pathophysiology of persistent lower urinary tract symptoms (LUTS) in patients after transurethral prostatectomy (TURP)., Methods: A total of 185 patients who had persistent LUTS after TURP were enrolled into this study. All of these patients underwent multichannel videourodynamic studies and were classified into 6 groups according to the urodynamic results. Preoperative prostate volume, resected adenoma weight, and preoperative Q(max) were determined in each of the groups and the symptomatology and urodynamic findings were compared., Results: A normal videourodynamic tracing was found in 17 patients (9.1%), pure detrusor instability in 18 (9.6%), low detrusor contractility in 35 (18.7%), detrusor instability and inadequate detrusor contractility (DHIC) in 27 (14.4%), poor relaxation of the urethral sphincter in 36 (19.3%), and bladder outlet obstruction (BOO) in 52 (27.8%). Incontinence was noted in 74 patients (40%), and 18 of them had BOO (24.3%). In urodynamic findings, Q(max) and residual urine showed no significant difference among patients with low contractility, poor relaxation of sphincter, DHIC and BOO. Concerning the preoperative prostatic volume, patients with low contractility, poor relaxation of urethral sphincter, and DHIC had a nonsignificantly smaller prostate volume and resected prostate weight than other groups. Preoperative Q(max) showed no significant difference among all groups., Conclusions: Symptoms alone are unreliable in predicting urodynamic findings with respect to obstruction and detrusor instability after TURP. Over half of the patients with persistent LUTS had a small prostate volume and small resected adenoma weight, indicating that some of these patients may not have had BOO. Videourodynamic study is helpful in making an accurate diagnosis for refractory LUTS after TURP., (Copyright 2002 S. Karger AG, Basel)

Objective: To investigate the ultrastructure of the trigonal muscle (= superficial trigone), relate it to normal function, and identify any changes it may undergo in voiding dysfunction., Materials and Methods: 20 men (median age 67 years) with low-stage prostatic carcinoma, 10 with and 10 without bladder outlet obstruction, were selected by urodynamic evaluation. Trigonal biopsy was performed at radical prostatectomy, and processed for electron-microscopic study by standard procedures. Biopsies were evaluated independently by 2 examiners without prior knowledge of urodynamic data., Results: Three obstructed and 1 unobstructed bladder had impaired detrusor contractility, and 1 obstructed bladder had detrusor overactivity. Compared to the previously investigated detrusor, the trigonal muscle had smaller compact bundles and fascicles with less collagen and more elastic tissue. Muscle cells had no or rare intermediate junctions that mediate mechanical coupling in normal detrusor, but predominant close cell appositions that mediate electrical coupling. Smooth muscle in most biopsies had widespread or focal features characteristic of the aged detrusor. None, however, had the features previously associated with obstructed detrusor, or detrusor with impaired contractility., Conclusions: The trigonal muscle does not undergo structural changes as previously described in the detrusor in association with voiding dysfunction. Its contraction depends on electrical coupling of its muscle cells, and has a supportive role in normal micturition, mooring the terminal ureters to the bladder base, to allow efflux and guard against reflux of urine. Activation of volume and tension sensory neuroterminals may contribute to some storage and voiding micturition reflexes, and may be related to normal and abnormal perception of urge., (Copyright 2001 S. Karger AG, Basel)

To investigate whether the differences in histological composition would be responsible for the grade of bladder outlet obstruction evaluated by pressure-flow (P-F) study and that increase in some histological components would result in increased degree of the obstruction, we evaluated relationships between morphometic data and results of P-F study. All prostate specimens with benign prostatic hyperplasia (BPH), obtained from 18 patients undergoing transurethral resection of the prostate, were analyzed by quantitative morphometry. Preoperatively each patient underwent P-F study. Stroma comprised the greater part of prostate (73%). Of all histological elements, fibrous tissue was the largest (48%). The relative and total volume of respective components showed no correlationships with parameters in P-F study. The differences in tissue composition did not affect the outcome of urodynamics. This result was the same even in a smooth muscle-rich subgroup. Also, in view of how small or large fibrous tissue and glandular elements were, no significant correlationships could be pointed out. The degree of infravesical obstruction and the outcome of P-F study cannot be explained by histological composition alone.

Detrusor dysfunction secondary to partial outflow obstruction is caused in part by decreased blood flow to the detrusor. We investigated changes in blood flow to the bladder and in bladder function after inducing partial outflow obstruction. The urethras of male Sprague-Dawley rats were constricted by sutures to degrees representing either mild and severe obstruction. Blood flow to the bladder was measured by a Doppler flowmeter prior to and 7 days after obstruction. In vivo and in vitro experiments were performed 7 days after surgery. After cystometry was used to determine bladder capacity, the pressure at which micturition was induced, and maximum voiding pressure, the bladder was removed and placed in an organ bath where increases in intravesical pressure in response to field stimulation were evaluated. Finally, volume-pressure studies were performed in order to determine passive detrusor compliance and response to field stimulation at each specific capacity in vitro. Although blood flow to the bladder was significantly decreased by severe obstruction, no differences in blood flow between control and mildly obstructed bladders was observed. While maximum voiding pressure decreased in severely obstructed bladders, both the pressure at which micturition was induced and bladder capacity were increased. The response to field stimulation was increased by mild obstruction but decreased by severe obstruction, although bladder compliance was increased by both. The peak response to filled stimulation was observed at a larger capacity in severely obstructed bladders than the others. In conclusion, when outflow obstruction was mild, blood flow to the bladder remained unchanged and detrusor contractility increased. On the other hand, severe obstruction decreased bladder blood flow and induced deterioration of detrusor function.

A retrospective cohort of 163 male patients having either uni- (UI) or bilateral incision (BI) of the bladder neck to relieve infravesical obstruction was reviewed. Short-term results were excellent with significant improvement of flow rates. 82% (UI) and 87% (BI) of the incised patients were satisfied. Long-term results were assessed by a life-table analysis. 17% (UI) and 12% (BI) of the patients needed a reoperation during the observation period of 6 years. It is concluded that bladder neck incision is a method with few complications and favourable long-term results.

The opening contraction energy (Eop), i.e. the energy expended by the detrusor in the opening phase of micturition, was measured in 70 males (mean age 63 +/- 9 years) with bladder outflow obstruction (compressive obstruction) due to benign prostatic hypertrophy. Significant correlations (p less than 0.001) were found between Eop and the maximum external voiding power developed by the detrusor, Wext max (rs = -0.57), between Wext max and the fraction of bladder volume voided, VV% (rs = 0.65), and between Eop and VV% (rs = -0.77) - which suggests that increasing values of Eop affect the energy which the detrusor can supply for completion and termination of voiding. It then seems the parameter Eop would be able to assess not only the opening phase of micturition, but the emptying phase as well - the greater Eop (i.e. the greater the work needed to unfold the urethral lumen and start urine flow), the lesser the muscle mechanical capability of the urinary bladder to completely void. Thus, we eventually believe that calculating the parameter Eop may prove to be a complete, though indirect, method of quantifying the degree of prostatic (compressive) obstruction of the vesical outlet by a single numerical index.

Combined uroflowmetry and external sphincter electromyography studies were done both preoperatively and postoperatively in patients with benign prostatic hyperplasia. In 56 patients preoperative electromyography during voiding showed silent or markedly suppressed activity in 41 patients (73.2%), while the remaining 15 patients (27.8%) revealed active electromyography. In the postoperative studies, 12 patients revealed active electromyography even after the release of obstruction. The urine flow rate following operation was not drastically improved in the active electromyography group compared to the silent electromyography group. We suppose that long-term urethral obstruction with prostatic adenoma could influence the function of relaxation of the external sphincter muscle in some patients with benign prostatic hyperplasia.

The functional obstruction of bladder neck in male patients is a well-known and long-known entity. Etiology, natural history and mechanism of this condition are not yet fully understood. The patients suffer from obstructive symptoms since childhood. The results of a full radiological, urological and urodynamics assessment of 10 patients with such symptoms are presented. Diathermic incision of bladder neck was the therapy of choice. Retrograde ejaculation of seminal fluid was not observed. The prognosis of this disease is good. Uroflowmetry, cystometry and micturating cysto-urethrography are mandatory for the correct diagnosis.

Symptoms of bladder neck dysfunction in the female are rarely encountered. In 5 females, i.e., 0.6% of the female patients referred for urodynamic investigation, we found parameters consistent with bladder neck dysfunction. Prolonged opening time, slow stream, but otherwise normal voiding reflexes were the main features.

Urodynamic investigations were performed in 9 males, suffering from dysfunction of the bladder neck (detrusor bladder neck dyssynergia). The parameters of micturition were compared with the values in normal males and in patients with prostatic obstruction. By introducing a new factor, the maximum opening time, we found a characteristic pattern in dysfunction of the bladder neck, making selection of patients for endoscopic incision of the bladder neck possible. The maximum and mean flow rates increased significantly in 5 patients treated with incision of the bladder neck. The diagnostic value of voiding cystourethrography and urodynamic investigation is discussed.

The shape of the urethral closure pressure profile of 281 male patients has been analysed. 'Prostatic' length, 'prostatic' peak, 'prostatic' plateau height and 'prostatic' plateau area have been measured. Thist study has shown that these parameters have a significant relation to the diagnosis of bladder outflow obstruction made after urodynamic studies.