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Objective: To evaluate the effects of Prostate artery embolization (PAE) and open simple prostatectomy (OP) on lower urinary tract symptoms and urodynamic parameters in subjects with prostate size >80cc³., Methods: PoPAE study (OP or PAE) was a randomized, open-label controlled trial performed between January 2020 and May 2022. Subjects with large prostates (>80cc³), urodynamic parameters meeting obstruction criteria (Bladder Outlet Obstruction Index-BOOI>40), and good detrusor function (Bladder contractility index>100) were included. The primary and co-primary endpoints were the variation in peak flow rate on uroflowmetry (Qmax) and BOOI. The secondary endpoints were the IPSS and ultrasonographic changes., Results: Twenty three and 25 subjects underwent PAE and OP were evaluated, respectively. At baseline, the 2 groups have shown similar clinical, radiological, laboratory, and urodynamic parameters. After 6 months, Qmax improved 8,3 ± 4.17 mL/sec in PAE and 15.1 ± 8.04 mL/sec in OP (mean difference 6.78 in favor of PE; P = .012 [CI -9.00 to -3.00]). After treatment, 88% of those men underwent OP were classified as unobstructed or equivocal (BOOi<40). On the other hand, 70% of subjects underwent PAE remained obstructed (BOOI>40) and none of them shifted to unobstructed status (BOOI<20). It was observed a similar reduction in IPSS and PVR in both groups., Conclusion: PAE was inferior to conventional surgery for releasing BOO and improving peak urinary flow in large prostates. Nevertheless, PAE was able to improve symptoms and PVR, and might be an alternative method in selected patients., Competing Interests: Declaration of Competing Interest The authors declare to provide transparency on re-use of material and mention any unpublished material included in the manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To evaluate the urodynamics (UDS) of patients with postural tachycardia syndrome (PoTS)., Methods: Patients with a confirmed diagnosis of PoTS referred by the department of neuro-cardiology to the neuro-urology were identified and their UDS were retrospectively reviewed., Results: In total, 50 patients (47 = 94.0% female) with confirmed PoTS and available UDS were identified. Mean age of females and males was 32.4 and 28.2 years, P = .15. Intermittent self-catheterisation was being used by 15/47 (31.9%) females at assessment. Detrusor overactivity was observed in 6 females (12.8%) (all at end fill and associated with urgency). In total, 14 (29.8%) females had no sensation of filling. No patients had an "unsafe" bladder. In total, 15/47 (31.9%) of women were unable to void with UDS catheters. Straining was reported in 22/35 (68.8%) of females. The female bladder outflow obstruction index = P Det Q max - 2.2(Q max ) was over 5 in 10/28 (35.7%) and over 18 in 5 (17.9%). The bladder contractility index = P Det Q max  + 5Q max was under 100 in 18/28 (28.6%) women., Conclusion: The UDS of patients with "PoTS bladder" often demonstrate a poorly sensate but stable and safe bladder with functional obstruction and impaired bladder contractility that may necessitate straining or intermittent self-catheterisation., (Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the long-term impacts of bladder neck incision (BNI) on continence and ejaculatory function of adults who underwent concurrent posterior urethral valve (PUV) ablation and BNI during childhood., Materials and Methods: A retrospective chart review was performed to find all adult patients with relevant history. All patients had undergone BNI at 6 o'clock proximal to the verumontanum with caution to leave the adventitia and verumontanum untouched. Charts were reviewed and attempts were made to contact those ≥18 years old for follow-up. Patients were specifically evaluated for lower urinary tract symptoms and ejaculatory condition., Results: Among patients treated for PUV between 1998 and 2015 in our center, 21 were ≥18 years old at the time of assessment. Until February 2016, we were able to contact 18 patients, all of whom agreed to participate. Mean age was 21.1 ± 2.9 years with a mean follow-up of 12.5 ± 4.8 years. None of those contacted had incontinence or dry ejaculations. All considered their ejaculations normal and only one complained of weak ejaculations. Four of 5 patients who consented to perform a semen analysis had normal tests and 1 had low sperm count with abnormal motility., Conclusion: BNI is not associated with additional risk of incontinence and dry ejaculation in early adulthood and preserves antegrade ejaculation. Concomitant valve ablation with BNI may provide additional benefits in care of PUV children, especially those with prominent bladder neck and poor bladder function at presentation., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To investigate the clinical and urodynamic features of patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) according to their prostate size., Materials and Methods: We analyzed 2039 LUTS/BPH patients who underwent urodynamic study between October 2004 and August 2013. We divided the patients into three groups according to their prostate size: small (≤30 mL), moderately enlarged (31-80 mL), and large prostate (≥81 mL) groups. We compared the groups regarding age, International Prostatic Symptom Score, maximal flow rate (Qmax), postvoided residual (PVR), serum prostate-specific antigen, prostate volume measured by ultrasonography, and urodynamic findings., Results: Patients with a small prostate had better urodynamic outcomes than those with larger prostates in overall population. Although the total prostate volume significantly correlated with the bladder outlet obstruction (BOO) index (r  =  0.51), BOO patients with a small prostate had similar Qmax, higher PVR, and lower voiding efficiency, compared to those with larger prostates. Moreover, urodynamic parameters indicating bladder abnormalities, including low compliance and involuntary detrusor contraction positivity, were similar among the groups in BOO patients. A higher proportion of detrusor underactivity was also observed in the small prostate group in BOO patients. Finally, when adjusting for potential confounding variables, we identified serum prostate-specific antigen levels (odds ratio, 1.34) and Qmax (odds ratio, 0.77) as significant predictors for BOO in LUTS/BPH patients with a small prostate., Conclusion: BOO patients with a small prostate showed higher PVR and poor voiding efficiency, as well as similar urodynamic bladder abnormalities, compared to those with moderately enlarged and large prostates., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To investigate factors predicting that combination therapy would be insufficient in terms of efficacy, necessitating conversion to surgical intervention, in patients with lower urinary tract symptoms and/or benign prostatic enlargement., Materials and Methods: In total, 218 patients given combination therapy for 6 months or more were enrolled in our study. Candidate factors for surgical intervention before dutasteride administration were statistically analyzed. We also examined the proportion of stromal components in resected specimens of the intravesical prostatic protrusion (IPP) portion using the point-counting technique according to IPP grades., Results: Combination therapy was effective and was thus continued in 172 patients, whereas 46 required surgical intervention. The comparison between these two groups, by multivariate analysis, revealed significant differences in IPP and total International Prostate Symptom Score (IPSS). IPP (odds ratio 1.133, P <.001) was the strongest independent factor predicting conversion to surgical intervention. Receiver operating characteristic analysis identified the optimal cutoff value of IPP to be 8 mm (area under the curve: 0.9). This value yielded a sensitivity of 91% and a specificity of 72%. In addition, the mean proportion of stromal components in resected specimens of IPP according to IPP grades was grade I: 96.7%, grade II: 57.8%, and grade III: 21.4% (P <.001 for all), respectively., Conclusion: Our results suggest that in lower urinary tract symptoms and/or benign prostatic enlargement associated with severe IPP, combination therapy might have insufficient efficacy due to a low proportion of stromal components, necessitating conversion to surgical intervention., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To investigate the relationship between bladder wall thickness (BWT) and uroflowmetric parameters and the International Prostate Symptoms Score (IPSS) in patients with lower urinary tract symptoms (LUTS)., Patients and Methods: A total of 236 male patients who had LUTS-related benign prostatic enlargement with serum prostate-specific antigen level ≤4 ng/mL were included in this study. Age and duration of LUTS and IPSS were recorded. BWT was measured using 7.5 mHz suprapubic ultrasonography before uroflowmetry and postvoid residual (PVR) was calculated thereafter. The relationship between BWT and poor indicators for bladder outlet obstruction (BOO) (IPSS >19, Qmax <15 mL/min, PVR >100 cm(3)) was investigated., Results: The mean age was 62.5 ± 8.1 (39-77) years and the mean BWT was 3.8 ± 1.5 (1.4-8.7) mm. The mean IPSS, Qmax, PVR, and duration of LUTS were 17.7, 13.7 mL/min, 89.9, and 46.5 months, respectively. A positive correlation was found between BWT and IPSS, PVR and duration of LUTS, whereas a negative correlation was found between BWT and Qmax (P <.001). BWT increased when number of BOO parameters increased. BWT was 2.9 in patients without BOO parameters whereas BWT was 3.5, 4.1, and 4.5 mm in patients with any one, any two, and all parameters of BOO, respectively., Conclusion: BWT increased when number of BOO parameters increased. We believe that measurement of BWT is an easy, quick, and repeatable test to predict BOO severity., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To investigate the effect of detrusor overactivity (DO) on functional outcomes after holmium laser enucleation of the prostate (HoLEP)., Materials and Methods: One hundred ten men with benign prostatic obstruction were evaluated retrospectively. International Prostate Symptom Score, International Continence Society male questionnaire short form, 3-day voiding diary, and uroflowmetry with postvoid residual were evaluated preoperatively and at 3 and 6 months postoperatively. The patients underwent urodynamic study preoperatively and were divided into the DO group (58 of 110, 52.7%) and the non-DO group (52 of 100, 47.3%)., Results: Patients in the DO group were older than those in the non-DO group (71.4 vs 66.4 years), although prostate volume and degree of obstruction were not significantly different between the 2 groups. All International Prostate Symptom Score and uroflowmetry parameters improved significantly at the 3- and 6-month follow-ups. Storage symptoms in both groups were comparable preoperatively (9.7 vs 8.6); these improved similarly in both groups during follow-up (5.0 vs 4.0, 6-month follow-up). The number of patients taking anticholinergics increased significantly after HoLEP, from a baseline of 17 patients to 49 patients at the 3-month follow-up and 39 at the 6-month follow-up. More patients in the DO group were taking anticholinergics at the end of the follow-up period (48.3% vs 21.2%)., Conclusion: Although the storage symptoms improved significantly in both groups, a significant number of patients with DO group took anticholinergics after HoLEP. We recommend that surgeons should counsel the possibility of taking anticholinergics in the early postoperative period to the patients with DO at baseline., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To investigate whether bladder dysfunction after bladder outlet obstruction (BOO) could be altered by treatment with cilostazol, a phosphodiesterase 3 inhibitor (PDE3i)., Methods: Twelve-week-old female Sprague-Dawley rats were divided into 5 groups: groups 1 and 2, sham-operated rats and groups 3-5, BOO rats. Group 1 and 3 rats were given normal diet, group 2 and 5 rats were given high-dose PDE3i diet, and group 4 rats were given low-dose PDE3i diet. PDE3i was given within diet from the day of surgery. Four weeks after BOO, the bladder was excised and dissected into 4 longitudinal strips for isometric organ-bath assay. Contractile responses of bladder strips to electrical field stimulation (EFS), carbachol, and potassium chloride (KCl) were determined for each group., Results: BOO induced a significant increase in bladder weight in groups 3-5 compared with groups 1 and 2. PDE3i treatment did not affect bladder weight in sham or BOO rats. Contractile forces in response to EFS, carbachol, and KCl in group 3 were about 20%-40% of those in group 1. Contractile responses to EFS or KCl in PDE3i-treated BOO rats were not significantly different from those in group 3. Only high dose of PDE3i treatment in BOO rats caused a statistically significant increase in the response to carbachol compared with group 3., Conclusion: PDE3i has a small but significant protective effect on the contractile dysfunction induced by a 4-week BOO in rats, although the increase in bladder mass was not altered. PDE3i could be a useful protection against contractile dysfunction of the obstructed bladder., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To investigate the accuracy of micturitional urethral pressure profilometry (MUPP) for diagnosis, grading, and localization of bladder outlet obstruction (BOO) in men with obstructive lower urinary tract symptoms., Methods: This prospective study included adult men with voiding symptoms qualifying for urodynamics (UDS). Patients with urethral stricture, urinary-tract infection, and inflammatory diseases of the bladder were excluded. Patients were subjected to UDS followed by VCUG the same day. UDS was performed using Solar Silver (MMS International, Enschede, the Netherlands) and included uroflowmetry, resting cystometry with UPP, pressure-flow study with MUPP, and perineal surface-electromyography. The study was performed in accordance with International Continence Society Good Urodynamic-practice Guidelines (2002). VCUG was considered the gold standard for presence and localization of BOO., Results: A total of 64 male patients with mean age 53.3 ± 17.8 years and International Prostate Symptom Score 17.2 ± 6.8 completed the study. Uroflowmetry revealed maximum urine flow 10.1 ± 7.1 mL/s, voided-volume 218.9 ± 161.6 mL, and postvoid residue 129.8 ± 126.5 mL. For diagnosis of BOO, Abrams-Griffith number, Schaefer obstruction-grades, and obstruction-coefficient had weak agreement with VCUG (Cohen's kappa k <0.20), whereas urethral closure-pressure (Pclo) had strong agreement (k = 0.78). For grading, Pclomax had a significant positive linear correlation with Abram-Griffiths number (R(2) = 0.562; P = .0001). MUPP was able to localize the site of obstruction correctly in 55 of 57 obstructed patients., Conclusion: MUPP is highly accurate in diagnosis, grading, and localization of BOO in men with voiding dysfunction. It might be a useful supplement to VCUG/UDS., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To develop a urodynamic study (UDS) pattern system for aged male patients who complained of non-neurogenic lower urinary tract symptoms (LUTS) to create a reference guideline for their diagnosis and treatment by a retrospective analysis., Methods: A retrospective analysis of UDS data was carried out in 1984 male patients neurologically intact with symptoms suggestive of bladder outlet obstruction (BOO) aged older than 45 years (2002-2013). On the basis of their UDS characteristic findings, the patients were classified into 1 of 7 subgroups: equivocal or mild BOO with sphincter synergia with or without idiopathic detrusor overactivity (pattern A); equivocal or mild BOO with idiopathic sphincter overactivity (B); classic BOO with sphincter synergia (C) or overactivity (D); BOO with only detrusor low compliance (E); BOO with both detrusor underactivity and low compliance (F); and equivocal BOO with detrusor underactivity (G). The follow-up data were reviewed and analyzed thereafter., Results: The feasibility and rationality of this system were confirmed. The distribution of 7 patterns (pattern, case number, %) was A 158, 8%; B 59, 3%; C 1059, 53.3%; D 277, 14%; E 120, 6%; F 93, 4.7%; and G 218, 11%. A-G numbers in pattern C, D, and E were 103.1-141.4, higher than other patterns (P <.001), and functional pressure lengths of pattern C and D were 7.0-7.2 cm, longer than other patterns (P <.001)., Conclusion: A practical UDS pattern system for aged male patients with lower urinary tract symptoms suggestive of BOO was constructed, which can be used to optimize the diagnosis and treatment of these patients., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To determine the effect of tamsulosin hydrochloride on blood flow in the submucosal capillaries of the bladder (SCB) in a rat model of bladder outlet obstruction (BOO) using a pencil lens charge-coupled device microscopy system., Materials and Methods: BOO was established in rats by partial ligature of the proximal urethra and was maintained for 2 weeks. Tamsulosin or saline (control) was subcutaneously administered using an osmotic pump for 2 weeks immediately after surgery. The pencil lens charge-coupled device microscopy system was used to visualize the bladder microcirculation and quantitatively assess the blood flow in the SCB by measuring the velocity of the blood flow at the base and dome of the bladder. The blood flow in the SCB of the sham-operated rats, control BOO rats, and tamsulosin-treated BOO rats was compared., Results: The blood flow in the SCB was significantly greater at the base than at the dome of the bladder. The reduction in blood flow through the SCB at the base and dome of the bladder was more significant in the BOO rats than in the sham-operated rats. However, after pretreatment with tamsulosin, the BOO rats showed a significant increase in blood flow through the SCB at the base and dome of the bladder compared with that of the control rats. The pencil lens charge-coupled device microscopy system image showed that the BOO rats had chronic ischemic capillary injury, which was ameliorated by tamsulosin., Conclusion: The results of the present study suggest that tamsulosin hydrochloride protects the SCB from ischemic injury after BOO., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To investigate the effects of prolyl 4-hydroxylase (P4H) inhibitor on the bladder in rats with partial bladder outlet obstruction., Methods: Forty-five female Sprague-Dawley rats were divided into 3 groups; partial bladder outlet obstruction with P4H inhibitor 20 mg/kg (groups A1, A2, and A4, each n = 5), partial bladder outlet obstruction with normal saline (groups B1, B2, and B4, each n = 5), and normal control (groups C1, C2, and C4, each n = 5). After partial bladder outlet obstruction for 1, 2, and 4 weeks in the groups A and B, respectively, the inhibitor or normal saline were administered orally at the indicated dosage once a day for 2 weeks. After either 3, 4, or 6 weeks, the bladders were removed after cystometry., Results: The pressure and volume parameters from the cystometry and the muscle thickness from the Masson trichrome staining of groups A and B increased significantly compared to those in group C (P < .05), and those in group A were significantly lower than those of group B (P < .05). Based on immunohistochemical staining and reverse transcription-polymerase chain reaction, P4H expression in groups A and B was increased compared with that in group C. Furthermore, P4H expression showed a larger decrease in group A compared to that in group B. Collagens I and III protein expressions increased with partial bladder outlet obstruction in comparison with that of group C, and expression in group A was marginally decreased compared with expression in group B., Conclusion: Our data suggest that the P4H inhibitor may improve bladder function and reduce the bladder fibrosis caused by partial bladder outlet obstruction., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To analyze the timing of nocturia during sleep and its effect on sleep quality using the polysomnography (PSG) findings from patients with benign prostatic obstruction., Methods: From August 2009 to August 2010, 20 patients diagnosed with benign prostatic obstruction were enrolled in the present study. The sleep evaluation was performed by PSG. The Epworth index was used to evaluate the sleepiness of the patients. The effect of nocturia on sleep quality is evaluated by sleep efficacy, total sleep time, and rapid eye movement sleep duration, calculated from the hypnograms derived from the polysomnograms., Results: The mean age, total International Prostate Symptom Score, nocturia frequency on International Prostate Symptom Score, and frequency of nocturia recorded during PSG was 60.4 ± 8.5 years (range 44-74), 19.3 ± 4.9 (range 10-28), 3.5 ± 1.05 (range 2-5), and 1.35 ± 1.2 (range 0-4), respectively. In 6 patients (30%), the Epworth sleepiness score was pathologic (score >8). Nocturia correlated positively with increased daytime sleepiness, however it did not correlate with sleep efficacy or total sleep time. These parameters were affected by the apnea-hypopnea index, the major determinant of obstructive sleep apnea. Of the 20 patients, 14 (70%) experienced nocturia during PSG, and in these patients, we recorded 23 nocturia episodes that mostly occurred in the superficial sleep stage (16 [70%] of 23). Only 7 nocturia episodes (30%) occurred in the deep sleep stage. The sleep quality of patients with deep sleep nocturia did not differ from that of patients with superficial sleep nocturia., Conclusion: The results of our study have shown that nocturia predominantly occurs during the superficial sleep or rapid eye movement stage and is related to increased daytime sleepiness in patients with benign prostatic obstruction. The timing and frequency of nocturia had no significant affect on sleep quality; however, the presence of obstructive sleep apnea negatively interfered with these parameters., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To investigate the efficacy of near infrared spectroscopy (NIRS) and an algorithm on the diagnosis of bladder outlet obstruction in men with lower urinary tract symptoms (LUTS)., Methods: Male patients with LUTS were recruited and underwent uroflowmetry and urodynamic pressure flow study (PFS) with simultaneous transcutaneous NIRS monitoring. Next, the postvoid residual urine volume was measured using ultrasonography. Data analysis first classified each subject as obstructed or unobstructed using the standard pressure flow data and nomogram and compared these results with the NIRS algorithm, which analyzed the pattern of change of the NIRS data plus the measurements of the postvoid residual urine volume and peak flow rate on uroflowmetry., Results: A total of 65 patients were enrolled in the present study. Of these patients, 10 with equivocal PFS findings and 2 with concurrent urinary tract infection were excluded. Of the 53 patients, 29 and 24 were classified as obstructed and unobstructed according to the PFS outcomes, respectively. The International Prostate Symptom Score and uroflowmetry peak flow rate demonstrated significant differences between the obstructed and unobstructed patients. The NIRS algorithm correctly identified 25 patients diagnosed as obstructed (86.2%) and 21 diagnosed as unobstructed (87.5%) according to the PFS findings., Conclusion: The NIRS algorithm could be a noninvasive option for the diagnosis of bladder outlet obstruction in men with LUTS, with 86.2% and 87.5% sensitivity and specificity, respectively., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To determine the clinical and urodynamic differences in the presentation and the value of simultaneous fluoroscopy in dysfunctional voiding (DV) and primary bladder neck obstruction (PBNO); the 2 most common causes of non-neurogenic "functional" bladder outlet obstruction in women., Methods: A review of our urodynamic study database (March 2003 to August 2009) was conducted. DV was diagnosed when increased external sphincter activity was found during voluntary voiding on electromyography (EMG) or fluoroscopy. PBNO was diagnosed when a failure of bladder neck opening was noted on fluoroscopy during voiding. The demographics, symptoms, and urodynamic study parameters were collected. Comparisons were done using chi-square and 2-tailed t-tests., Results: DV was diagnosed in 34 women and PBNO in 16. The patients with DV were younger than those with PBNO (40.9 vs 59.2 years, P < .001). Women with DV showed a clinical trend toward having more storage symptoms than those with PBNO and fewer voiding symptoms. Patients with DV had a greater mean maximal flow rate (12 vs 7 mL/s, P = .027) and lower mean postvoid residual urine volume (125 vs 400 mL, P = .012). No significant differences were found in maximal detrusor pressure, detrusor pressure at maximal flow rate, or detrusor overactivity. EMG showed increased activity during voiding in 79.4% of those with DV and 14.3% of those with PBNO (P < .001)., Conclusion: Clinically, women with DV and PBNO had similar presentations, although those with PBNO had poorer emptying. The flow rates and patterns seemed to differ between those with DV and PBNO, although the voiding pressures were similar. EMG alone would have given the wrong diagnosis in 20.6% of those with DV (false negative) and 14.3% of those with PBNO (false positive). When fluoroscopy is used to define these entities, the accuracy of EMG to differentiate them is questionable., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To investigate the effects of botulinum toxin A (BoNT/A) on the expression of nerve growth factor (NGF) and transient receptor potential vanilloid 1 (TRPV1) in the urothelium and detrusor muscle of rats with partial bladder outlet obstruction (BOO)-induced detrusor overactivity., Methods: Male Sprague-Dawley rats were allocated to a control group, a BOO group, or a BoNT/A-treated BOO group. BoNT/A (1 U) was injected into the detrusor muscle simultaneously with the induction of BOO. The rats were assessed by cystometrography 3 weeks later. The bladder was then removed. Immunofluorescence staining and Western blotting was performed to localize and quantify the expression of NGF and TRPV1 in the urothelium and detrusor muscle., Results: Cystometrography revealed induction of an unstable bladder in the BOO group and recovery of bladder stability after BoNT/A treatment. Expression of the NGF and TRPV1 proteins in the urothelium was significantly greater in the BOO group than in the control group and had decreased significantly with BoNT/A treatment in BOO-induced rat. The expression of NGF in detrusor muscle was significantly greater in the BOO group than in the control group and subsequently decreased significantly with BoNT/A treatment in the BOO-induced rat. In contrast, TRPV1 expression in the detrusor muscle did not differ significantly among the 3 groups., Conclusion: Our experiments showed that detrusor wall injection of BoNT/A can modulate the expression of NGF and TRPV1, particularly in the urothelium, in accordance with recovery of bladder function., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the efficacy of alfuzosin treatment on voiding and storage in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) with respect to bladder outlet obstruction and contractility., Methods: A 12-month, multicenter, observational, prospective study was conducted at four university hospitals in Korea. Patients were divided into four groups: group 1 (bladder outlet obstruction index (BOOI) ≥20, bladder contractility index (BCI) ≥100), group 2 (BOOI ≥20, BCI <100), group 3 (BOOI <20, BCI ≥100), and group 4 (BOOI <20, BCI <100), with respect to BOOI and BCI evaluated by pressure-flow study. Treatment efficacy was analyzed by validated symptom scores., Results: Two-hundred thirty-two men with LUTS/BPH were enrolled, and 165 (41, 50, 30, and 44 in groups 1-4, respectively) were followed to the end of the study. After 12 months of alfuzosin treatment, all International Prostate Symptom Score (IPSS) parameters improved in all four groups. Mean improvement in IPSS subscore for voiding was 4.0 points in group 1, 5.5 points in group 2, 5.5 points in group 3, and 3.0 points in group 4. Change in IPSS subscore for storage was 2.5 points in group 1, 3.6 points in group 2, 2.9 points in group 3, and 1.8 points in group 4. There was no difference among four groups in improvements seen in storage or voiding IPSS subscore. International Continence Society male questionnaire scores significantly improved in all four groups with no between-group differences., Conclusions: Alfuzosin treatment in men with LUTS indicative of BPH effectively improved voiding and storage symptoms regardless of BOOI or BCI., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: To investigate the relationship between nitric oxide synthase (NOS) and oxidative stress and pathologic remodeling in the partial obstructed bladder of a rat model., Methods: We surgically established partial bladder outlet obstruction (PBOO) in 2 groups of rats and allowed it to persist for 3-6 weeks. Normal and sham-operated rats served as the controls. Each group contained 6 rats for a total of 24 rats. Cystometry was used to evaluate the bladder function. The bladders were removed, and histopathologic measurements were performed to evaluate bladder hypertrophy and fibrosis and NOS immunolocalization. Biochemical measurements were used to evaluated NOS mRNA and activity and the oxidative stress level., Results: The obstructed rats experienced significant increases in bladder weight, muscle hypertrophy, and deposits of collagen fibers compared with the normal and sham-operated groups. PBOO debilitated bladder contractibility, increased the residual urine volume and voiding interval, decreased the voiding volume, and caused poor bladder emptying, with an increased residual urine volume and decompensated bladder in the PBOO rats at 6 weeks. The elevation in malondialdehyde and reduction in superoxide dismutase activity in the PBOO rats suggested that oxidative stress injury occurred in the obstructed bladder. Lower inducible NOS and endothelial NOS (eNOS) mRNA expression was demonstrated through quantitative polymerase chain reaction. In particular, eNOS was significantly downregulated in the PBOO rats compared with the normal and sham-operated rats. The normal and PBOO bladder tissues did not express detectable levels of neuronal NOS mRNA or exhibit neuronal NOS immunoreactivity. The total NOS activity had decreased progressively in the PBOO groups in conjunction with the significantly decreased eNOS activity compared with that in the normal and sham-operated groups., Conclusions: These findings suggest that decreases in NOS activity and expression (mainly of eNOS) concomitant with increases in reactive oxygen species generation represent the underlying pathogenic mechanism of obstructed bladder remodeling and dysfunction., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the association between diabetic cystopathy (DC) and neuropathy (autonomic and peripheral) in patients with diabetes mellitus (DM) presenting with lower urinary tract symptoms (LUTS)., Methods: Men with DM who presented with bothersome LUTS were enrolled from January 2008 to June 2009. Their demographic and clinical profiles were noted. Multichannel urodynamic studies were performed using the Solar Silver digital urodynamic apparatus. Hand and foot sympathetic skin responses, and motor and sensory nerve-conduction velocity studies were performed using the Meditronic electromyographic/evoked potentials system., Results: A total of 52 men (mean age 61.3 ± 12.1 years, DM duration 11.0 ± 7.5 years) completed the study protocol. Of these 52 men, abnormal sympathetic skin responses, motor and sensory nerve-conduction velocity studies, and combined neuropathy (all 3 tests abnormal) were noted in 80.7% 57.7%, 57.7%, and 51.9%, respectively. Urodynamic studies showed impaired first sensation (>250 mL), increased capacity (>600 mL), detrusor underactivity, detrusor overactivity, high postvoid residual urine volume (more than one third of capacity), and bladder outlet obstruction (Abrams-Griffiths number >40) in 23.1%, 25.0%, 78.8%, 38.5%, 65.4%, and 28.8% of the men, respectively. Both sensory and motor DC correlated with abnormal motor and sensory nerve-conduction velocity studies (P = .015 and P = .005, respectively). Only motor DC correlated with abnormal sympathetic skin responses (P = .015). The correlations were stronger in the presence of combined neuropathy (sensory DC, P = .005; motor DC, P = .0001)., Conclusions: Men with DM and LUTS can present with varied urodynamic findings, apart from the classic sensory or motor cystopathy. A large proportion of these patients will have electrophysiologic evidence of neuropathy, and electrophysiologic evidence of neuropathy can moderately predict the presence of cystopathy., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To assess the factors associated with the presence of idiopathic detrusor overactivity (IDO) in male patients with clinical benign prostatic hyperplasia (BPH)., Materials and Methods: We prospectively evaluated 193 men who presented with lower urinary tract symptoms. Each patient underwent urodynamic evaluation, International Prostate Symptom Score (IPSS), uroflowmetry, residual volume check, and transrectal ultrasound for estimation of prostate volume. IDO was defined according to the new International Continence Society classification (2002) as involuntary detrusor contractions during cystometry, which may be spontaneous or provoked, regardless of amplitude. Patients were divided into groups according to the presence of detrusor overactivity and bladder outlet obstruction index (BOOI) greater than 40. Variables associated with the presence of IDO were analyzed using Student's t-test, chi-square test, linear-by-linear association test, and logistic regression analysis., Results: Of 193 patients, IDO was present in 49 (25.4%). BOOI and prostate volume showed significant but weak correlation. On univariate analysis, patients with IDO were older and showed smaller maximal bladder capacity (MBC), higher BOOI, higher maximal detrusor pressure at maximal flow rate, and higher irritative IPSS subscores. On logistic regression analysis, MBC and BOOI were the factors affecting the presence of IDO, with odds ratios of 0.981 and 1.046, respectively. Positive linear association was noted between BOOI and prevalence of DO by linear association test with prevalence of DO rising continuously with increasing BOOI., Conclusion: BOO is responsible for IDO and because the prevalence of IDO is inversely associated with the degree of obstruction, the treatment of BOO is potentially able to reverse the DO., (Copyright © 2011. Published by Elsevier Inc.)

Objectives: To investigate the mechanism underlying the ameliorating effect of tamsulosin, an alpha(1)-adrenoceptor antagonist, on storage symptoms associated with benign prostatic hyperplasia, the effects of tamsulosin on bladder blood flow (BBF) and bladder function was evaluated in rats with bladder outlet obstruction (BOO)., Methods: BOO was produced by partial ligature of the proximal urethra, which was maintained for 2 weeks. Tamsulosin was subcutaneously administered via an osmotic pump for 2 weeks immediately after the BOO surgery. The BBF in the sham-operated rats, the control BOO rats, and the tamsulosin-treated BOO rats was measured using the fluoromicrosphere method. Each rat was kept in a metabolic cage for observation of micturition behavior. Expression of the alpha(1)-adrenoceptor subtype mRNA in the vesical artery was measured by reverse transcriptase-polymerase chain reaction., Results: BBF was significantly reduced in BOO rats compared with sham-operated rats, and tamsulosin significantly increased the BBF in BOO rats. Tamsulosin ameliorated the decrease in mean voided volume in BOO rats with bladder masses < 500 mg. Expression of the alpha(1)-adrenoceptor subtype in the vesical artery was alpha(1a)- > alpha(1d)-adrenoceptors; almost no expression was observed of alpha(1b)-adrenoceptors in either sham-operated or BOO rats., Conclusions: Tamsulosin increased BBF in BOO rats via an antagonistic effect, presumably on the alpha(1A)- and/or alpha(1D)-adrenoceptor in the vesical artery mainly, and improved the decrease in mean voided volume. Therefore, the results of this study suggest that tamsulosin improves bladder overactivity via improvement of BBF., (2010 Elsevier Inc. All rights reserved.)

Objectives: To determine whether the anatomic configuration of the prostate, including the intravesical prostatic protrusion (IPP), as assessed by noninvasive ultrasonography, can predict the voiding parameters in men aged > or = 50 years who present with lower urinary tract symptoms., Methods: We assessed 157 consecutive men aged > or = 50 years who presented with lower urinary tract symptoms at their first visit. The initial evaluations included medical history, International Prostate Symptom Score and quality-of-life assessments, digital rectal examination, urinalysis, total serum prostate-specific antigen measurement, and free uroflowmetry and postvoid residual urine volume assessments. Transabdominal ultrasonography was used to assess the IPP and prostate contour, and transrectal ultrasonography was used to obtain a classification of benign prostatic hyperplasia., Results: A total of 9 patients, 4 (5.0%) with a type 1 and 5 (16.7%) with a type 3 prostate contour presented with acute urinary retention. All patients with acute urinary retention were classified as having IPP grade 3. The storage International Prostate Symptom Score differed significantly between patients with IPP grade 1 and those with IPP grade 2 or 3. The peak urinary flow rate was significantly reduced in patients with type 2 and 3 and those with IPP grade 3. The stratification of the patients into 3 groups according to prostate volume (< 30, 30-40, and > 40 cm(3)) showed that those with type 2 and 3 had a significantly lower peak urinary flow rate., Conclusions: The results of our study have shown that, in addition to IPP, patients with a type 2 or 3 prostate contour are more likely to have a decreased peak urinary flow rate and to present with acute urinary retention. However, larger scale studies are needed to confirm these results.

Objectives: We evaluated the effect of transurethral resection of the prostate (TUR-P) in men with weak bladder contractility who were unresponsive to medical treatment., Methods: Among the patients who underwent TUR-P for lower urinary tract symptoms at our institution, we reviewed the records of consecutive 71 patients who had preoperative urodynamic evaluations. According to the bladder outlet obstruction index and the bladder contractility index, the patients were divided into 2 groups: group A (25 patients) with unobstructed and weak bladder contractility, and group B (46 patients) with obstructed and/or normal bladder contractility. We investigated the differences of International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Q(max)), postvoid residuals (PVR), and the patient subjective satisfaction between the 2 groups after the TUR-P., Results: Mean follow-up period after TUR-P was 19 months (range 12 to 55 months). After the TUR-P, the IPSS/QoL, and PVR were significantly improved in group A and all parameters in group B. Patients in group B showed a more significant improvement with regard to the IPSS and they were more satisfied after the TUR-P than group A., Conclusions: There were significant improvements in IPSS/QoL and PVR after TUR-P in patients with weak bladder contractility and more than 60% were satisfied with the results of the surgery. TUR-P is considered an optional procedure for the treatment of men with weak bladder contractility who are unresponsive to medical treatment.

Objectives: Urodynamic studies are considered the reference standard to diagnose bladder outlet obstruction. However, the procedure is invasive, expensive, and time-consuming. The purpose of this study was to evaluate a new minimally invasive urodynamic assessment model and compare the results with those of conventional urodynamic evaluation., Methods: The study included 50 male patients who presented with lower urinary tract symptoms. Their mean age was 62 years (range 34 to 82). After undergoing a conventional urodynamic study, they underwent the minimally invasive evaluation. The urethral device is a conical apparatus that adapts to the urethral meatus and fossa navicularis. The isometric bladder pressure and interrupted flow were recorded. The results of the conventional assessment were classified according to the Abrams-Griffiths number and a logistic regression fit was applied to the minimally invasive method., Results: Only two variables demonstrated the predictive capacity: the isometric pressure and interrupted flow. In addition to selecting the relevant variables, logistic regression analysis is a more adequate model that provides a binary result of obstructed and unobstructed, used to predict the normal and equivocal categories of the Abrams-Griffiths classification, and taken as the reference standard. The sensitivity and specificity of the new method was 67% and 79%, respectively., Conclusions: The urethral device proved to be simple and easy to use. The minimally invasive method was able to detect most patients with bladder outlet obstruction; thus, the conventional urodynamic assessment could be avoided. We consider this method to have a place as a first-line noninvasive examination.

Objectives: Recent evidence indicates that ischemia and reperfusion (free radical generation) are major etiologic factors in the rabbit bladder subjected to partial outlet obstruction. The current investigation was designed to determine the time course of damage caused by reactive oxygen species (ROS) and reactive nitrogen species (RNS) by measuring the carbonyl and nitrotyrosine content of the bladder., Methods: Male rabbits underwent surgical partial bladder outlet obstruction for durations of 1, 2, 4, and 8 weeks. Sham-operated rabbits served as controls. The contractile responses to field stimulation (32 Hz) and carbachol (20 micromol/L) were determined. The nerve density was determined by using immunohistochemical methods. The carbonyl and nitrotyrosine contents within the bladder body wall and mucosa were analyzed by Western blotting., Results: Nerve density showed marked decrease in obstructed bladders. The responses to field stimulation and carbachol showed remarkable decrease in bladders after 8 weeks' obstruction. The protein carbonylation increased significantly in obstructed bladders when compared with controls, both in mucosa and muscles and reached the highest level in 4 weeks' obstruction. There was a 2-fold increase for nitrotyrosine in mucosa after 8 weeks of obstruction. The increased expression of nitrotyrosine in muscle was maximized at 4 weeks of obstruction., Conclusions: The free radicals mediated protein carbonylation and tyrosine nitration occurs to a significant degree in the partially obstructed rabbit bladder. This may be related with sensory and contractile dysfunction and can be used as markers for free radical damage and reperfusion injury.

Objectives: To investigate the contribution of urodynamically proven presence or absence (International Continence Society classification) of bladder outlet obstruction (BOO) to treatment recommendations for lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia, and to investigate the impact of the replacement of the invasively estimated BOO classification with the noninvasively assessed BOO probability on treatment recommendations., Methods: Mandatory tests, recommended tests, and pressure-flow studies (with BOO classification) were performed in 150 consecutive men with LUTS suggestive of BPH. Three experienced urologists proposed, independently of each other, the treatment for each patient: watchful waiting, pharmacologic treatment, or surgery. After repeat randomization of the patients and replacement of the BOO classification with the BOO probability, the procedure was repeated 1 month later. A third treatment proposal was done after repeat randomization and after replacement of the BOO probability with the BOO classification., Results: The symptom score and quality-of-life score were the most decisive in the treatment recommendations, followed by the BOO probability and BOO classification. The medical history, physical status, and duration of the complaints did not significantly affect the treatment recommendations. The intraindividual agreement between the judgments that included the BOO classification and the judgments that included the BOO probability was comparable to the agreement between both judgments that included BOO classification. The interindividual agreement between the judgments that included the BOO classification was not significantly different from that of the judgments that included the BOO probability., Conclusions: The symptom score and quality-of-life score were the most decisive in the medical treatment recommendations, followed by the BOO probability and BOO classification. The noninvasively assessed BOO probability was as valuable as the invasively estimated BOO classification in the medical treatment recommendations.

Objectives: An artificial neural network model previously described by us that was based on lower urinary tract symptoms yielded a modest prediction of bladder outlet obstruction. The aim of this study was to establish another model, using more objective parameters, that could better predict for bladder outlet obstruction., Methods: The records of 457 patients were used in the construction of the model. Of the 457 records, 300 were allocated to the training phase and 157 to the testing phase. All patients had the average flow rate, maximal flow rate, postvoid residual urine volume (PVR), and total prostate volume recorded. The results of the pressure flow study of those patients were considered the reference standard against which the artificial neural network was tested., Results: Three models were tested. Models 1 and 2 were based on a three-output design (ie, nonobstructed, equivocal, and obstructed). The only difference was the number of iterations. The accuracy of the first model was 60.5% compared with 46.5% for the second. For a third model, in which the equivocal pressure flow study results were added to the nonobstructed group, the accuracy rose to 72%. Deletion of equivocal cases (around 19% of the total) was associated with an accuracy of 76% in the prediction of obstruction., Conclusions: An artificial neural network based on objective and noninvasive parameters could replace the pressure flow study in only 72% of cases. An accuracy of 76% in the detection of bladder outlet obstruction is rather impractical, because an equivocal zone has always been available on pressure flow study nomograms.

Objectives: To compare urodynamic findings after holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia-related bladder outlet obstruction., Methods: From January to October 2002, 100 consecutive patients with benign prostatic hyperplasia with obstructive lower urinary tract symptoms were randomized to surgical treatment with either HoLEP (group 1, n = 52) or TURP (group 2, n = 48). All patients were preoperatively assessed using the International Prostate Symptom Score and quality-of-life question, total serum prostate-specific antigen measurement, transrectal ultrasonography, and complete urodynamic study. The operative time, catheterization time, and overall hospital stay were also recorded for both groups. All patients were assessed at 1, 6, and 12 months postoperatively using a complete urodynamic evaluation., Results: All patients were obstructed preoperatively (Schäfer grade greater than 2). Both groups were comparable in terms of age, total serum prostate-specific antigen level, International Prostate Symptom Score, and urodynamic results. At 1, 6, and 12 months of follow-up, no statistically significant differences were recorded in terms of detrussor pressure at maximal urinary flow rate, Schäfer grade (linear passive urethral resistance relation), maximal urinary flow rate, International Prostate Symptom Score, and quality-of-life score. In the HoLEP group, the catheterization time and hospital stay were significantly shorter. Transitory lower urinary tract symptoms after 3 months of follow-up and dysuria were more frequent in the HoLEP group than in the TURP group, although at 12 months of follow-up, the results were comparable., Conclusions: Both HoLEP and TURP were equally effective in relieving bladder outlet obstruction. Although associated with greater early self-resolving irritative symptoms, HoLEP can guarantee a shorter catheterization time and hospital stay with longer operative times, proposing itself as an attractive alternative to standard TURP.

Objectives: To analyze the lower urinary tract symptoms (LUTS) and videourodynamic characteristics of female bladder outlet obstruction (BOO)., Methods: Videourodynamic studies were performed in 207 women with signs and symptoms of BOO. Bladder outlet obstruction was defined as the radiologic evidence of bladder outlet narrowing plus a voiding pressure greater than 35 cm H2O and a maximum flow rate less than 15 mL/s or a voiding pressure greater than 40 cm H2O. Women with BOO were categorized into five groups on the basis of the videourodynamic findings. The LUTS and urodynamic parameters were analyzed according to these classifications., Results: Videourodynamic study revealed bladder neck obstruction in 18 patients (8.7%), urethral sphincter obstruction in 56 (27.1%), pelvic floor muscle obstruction in 106 (51.2%), high-grade pelvic organ prolapse and BOO in 13 (6.3%), and urethral stricture in 14 (6.8%). Urgency frequency was reported by 94% and difficult urination by 57% of the total patients. Among the 17 patients with urinary retention, obstruction was noted at the urethral sphincter in 10, pelvic floor muscle in 5, bladder neck in 1, and urethral stricture in 1. Detrusor overactivity was found in 52.7% of total patients and was most frequent in those with urethral sphincter obstruction (78.6%). Patients with bladder neck obstruction had the highest voiding pressure and lowest maximum flow rate., Conclusions: Differences in videourodynamic characteristics of women with BOO might be associated with the underlying pathophysiology of the bladder, urethral, and pelvic floor muscle dysfunction.

Objectives: Partial outlet obstruction mediates decreased contractile responses and increased collagen synthesis; however, it is not known to what extent the increased collagen contributes to contractile dysfunction., Methods: Sixteen WNZ rabbits were divided into three groups: control, 2-week obstructed, and 2-week sham. Each rabbit was anesthetized, and the bladder was excised and cut into equal width strips of 0.5, 1.0, and 2.0-cm lengths. The contractile responses to field stimulation, carbachol, potassium chloride, and adenosine triphosphate were determined. At the end of the experiment, each strip was fixed in formalin and immunostained for collagen., Results: The contractile responses for the control and sham strips were similar for all strip lengths. In obstructed tissue, the shorter strip lengths generated significantly more tension per cross-sectional area than did the longer strips. The collagen density and distribution were similar for the control and sham bladders. The obstructed bladders had significantly increased collagen deposits between and within the smooth muscle bundles and cells., Conclusions: Because the relationship between strip size and contraction were similar for field stimulation, carbachol, and potassium chloride, it is the increased density of connective tissue within and between the muscle bundles and fibers that interferes with contraction (ie, the greater the strip length, the greater the interference and the greater the contractile dysfunction). Therefore, both functional and structural alterations in the obstructed bladder participate in contractile dysfunction.

Objectives: To investigate alterations in gap junctional protein, connexin-43 (Cx-43), in the rat detrusor muscle with partial bladder outlet obstruction (P-BOO). Muscle cell actions, such as detrusor contractions, are thought to be synchronized by way of gap junctional intercellular communication. Gap junctions may play an important role in voiding, and P-BOO is a common medical problem., Methods: A total of 33 female Wistar rats (12 weeks old) were divided into a P-BOO group and a sham-operated control group and were killed at 2, 4, and 8 weeks after surgery. Cystometric investigation, the alteration of gap junction, and Cx-43 protein expression, which compose the gap junction, were examined., Results: The number of gap junctions was decreased in the P-BOO rat bladder. Furthermore, decreased cellular membrane expression of Cx-43 proteins was detected in rat detrusor muscle cells more than 4 weeks after surgery. The gap junctions of the detrusor muscle cell membranes were significantly fewer in number in the P-BOO rats with no detrusor contractions., Conclusions: These data suggest that the normal signals that contribute to voiding function could be transported directly through the gap junctions. Voiding dysfunction may be caused by the disruption of gap junctional intercellular communication.

Objectives: To investigate whether detrusor overactivity (DO) and the response to the ice water test (IWT) influence nighttime urinary frequency in patients with lower urinary tract symptoms., Methods: A total of 114 patients with lower urinary tract symptoms, who were older than 50 years, with an International Prostate Symptom Score 8 or more points and a quality of life index of 2 or greater, were evaluated by a 48-hour frequency-volume chart, free flowmetry, pressure flow study, and IWT., Results: The DO-positive IWT responders had a significantly greater bladder outlet obstruction index than did the DO-positive IWT nonresponders and the DO-negative IWT nonresponders. The DO-positive IWT responders had significantly more frequent nocturia and smaller nighttime maximal and minimal voided volumes than did the DO-negative IWT nonresponders without any difference in the nocturnal voided volume. The patients with nocturia two or more times had a significantly larger nocturnal voided volume and smaller nighttime minimal voided volume than the patients with nocturia less than two times. The incidence of DO-positive IWT responders was significantly greater among the patients with nocturia three or more times than that among those with nocturia less than three times. In the multivariate logistic model, the nocturnal voided volume and nighttime minimal voided volume were independently associated with nocturia two or more times and the DO-positive IWT responders were independently associated with nocturia three or more times., Conclusions: Once high-grade bladder outlet obstruction induces C-fiber-related DO, it is strongly suggested that this process, together with nocturnal polyuria, plays an important role in the consequent clinical manifestations of nocturia in patients with lower urinary tract symptoms.

Objectives: To determine the functional changes in the bladder and the expression of adhesion molecules in bladder tissue during chronic partial urethral obstruction and after release of partial obstruction in rats., Methods: Twenty-one male Sprague-Dawley rats were separated into three groups, each containing 7 rats. A sham operation was performed in group 1 and cystometry was done 6 weeks later. In groups 2 and 3, hypertrophied unstable bladders were developed by partial infravesical outflow obstruction during a 6-week period. After this period, cystometry was performed in all group 2 rats. In group 3, the ligature was removed, the rats were followed up for 6 weeks, and then cystometry was performed. After cystometric evaluation, the bladders in all the rats were removed, weighed, and studied immunohistopathologically., Results: After release of infravesical outflow obstruction, the bladder weight, residual volume, bladder capacity, maximal voiding pressure, voiding amplitude, and bladder contraction time decreased and bladder compliance increased in group 3 compared with group 2. CD44 and E-cadherin expression in the interstitial space and uroepithelial bladder tissue in group 2 rats stained intensely compared with those of groups 1 and 3., Conclusions: After release of 6 weeks of infravesical outflow obstruction, the cystometric parameters were significantly improved. Expression of CD44 and E-cadherin in the obstructed bladder tissue may be a pathologic sign of inflammation.

Objectives: To determine the risk of clinical progressions in men with mild lower urinary tract symptoms of bladder outlet obstruction and identify the predictors for progression in this group of men., Methods: A total of 397 men who presented to the urology clinics with mild symptoms of bladder outlet obstruction (International Prostate Symptom Score less than 8) were analyzed in this longitudinal study conducted during a 4-year period. They began with the watchful waiting protocol and were followed up every 3 months for 48 months. Age, International Prostate Symptom Score (IPSS), divided into obstructive symptom score and irritative symptom score, serum prostate-specific antigen level, total prostate volume, transitional zone volume, urinary flow rates, and postvoid residual urine volume were documented., Results: The cumulative incidence of clinical progression, defined as worsening of the IPSS with migration to the moderate symptom group (IPSS 8 to 18) or severe symptom group (IPSS 19 to 35) and an increase in IPSS of more than 2 points, was 6%, 13%, 15%, 24%, 28%, and 31% at 6, 12, 18, 24, 36, and 48 months, respectively. Nineteen patients (4.9%) developed acute urinary retention within the 48-month follow-up period. Of these 19 patients, only 2 (0.6%) required transurethral resection of the prostate. The variables of importance for disease progression in the artificial neural network analysis were, in order of statistical significance, prostate-specific antigen level, obstructive symptom score, and transitional zone volume., Conclusions: The risk for men with mild symptoms of bladder outlet obstruction to progress clinically and develop complications such as acute retention of urine is moderate. Prostate-specific antigen, obstructive symptom score, and transitional zone volume were identified as important risk factors.

Objectives: To improve the definition of pressure-flow study cutoff values for anatomic female bladder outlet obstruction (BOO) by comparing these parameters in women with clinical obstruction with those of normal controls., Methods: In the past 3 years, 82 consecutive women with clinical anatomic BOO were investigated according to an institutional review board-approved protocol that included imaging and urodynamic studies. The data from these women were then added to those of our previously published cohort of 87 patients. The controls were 20 female volunteers without any urologic complaints and without a history of bladder or urethral surgery who had undergone a urodynamic study. Three groups of women with BOO were identified in the most recent cohort: 20 with Stage III-IV cystocele, 23 who had undergone previous anti-incontinence surgery, and 39 with distal periurethral fibrosis or stricture. The optimal combination of the maximal flow rate (Qmax) and detrusor pressure at maximal flow rate (PdetQmax) for determining BOO was calculated using nonparametric receiver operating characteristic curves for the entire cohort of 169 women with obstruction., Results: Age, Qmax, and PdetQmax were similar among the three BOO groups. The area under the receiver operating characteristic curve for BOO was 0.762 for Qmax (95% confidence interval 0.661 to 0.864, P <0.001) and 0.721 for PdetQmax (95% confidence interval 0.617 to 0.824, P <0.001). After adjusting for the effect of age, PdetQmax (P <0.001) and Qmax (P <0.011) were independently associated with BOO., Conclusions: After adjusting for age and using normal controls rather than an incontinent control population, we present pressure-flow study cutoff values to aid in the urodynamic study diagnosis of women with anatomic BOO.

Objectives: To determine whether results similar to a previous study, in which sucrose-induced diuresis started before creating partial outlet obstruction resulted in protection of bladder contractile function in obstructed animals, would be obtained if diuresis were begun after creation of partial outlet obstruction., Methods: Thirty-six rats were separated into six groups of 6 rats each: group 1, control; group 2, diuresis; group 3, obstructed; group 4, obstructed immediately after diuresis; group 5, obstructed with diuresis beginning 10 days after obstruction; and group 6, obstructed before diuresis. Diuresis was induced by feeding 5% sucrose instead of water. After 3 weeks of obstruction, all bladders were excised, cut into longitudinal strips, and mounted in isolated muscle baths for physiologic study., Results: Sucrose-induced diuresis resulted in a statistically significant increase in bladder mass and a mild increase in smooth muscle contractility compared with the control water-fed group. Obstruction resulted in a fourfold increase in bladder weight and substantial decreases in the responses to all forms of stimulation. The bladder weights of the obstruction plus diuresed groups were all similar to the diuresis-alone group and significantly lower than those of the obstructed group. All diuresed groups showed protection of the contractile responses compared with the obstruction-alone group. Unexpectedly, the group that began diuresis 1 day after obstruction showed the strongest protection., Conclusions: Diuresis significantly reduced the increase in bladder mass induced by obstruction and also reduced the level of contractile dysfunction. Diuresis begun 1 day after obstruction resulted in the greatest level of protection.

Objectives: To develop a noninvasive method to measure urinary flow rate in the mouse. This could be useful for the study of bladder outlet obstruction, as well as processes affecting detrusor function in the awake animal. Genetically engineered mice can improve our understanding of a variety of human bladder diseases., Methods: A metabolic cage without a fecal separation screen was placed above a precision balance that reported the mass of the excreta pan every 100 ms. A computational algorithm identified voids suitable for assessment of uroflow from other excretory events. These algorithms were verified by comparison with a series of images obtained automatically before and during the excretory events. Intraurethral acetic acid was used to induce urethritis and to verify the sensitivity of the measurement technique., Results: Automatic categorization and characterization of uroflow was successful. Brief exposures of the urethra of the female C57BL6/J mouse to 2% acetic acid decreased uroflow and increased the void duration without a change in the voided volume., Conclusions: This method will enable studies of urologic function in mice of differing age, sex, strain, and genetic constitution. Murine urethritis can be differentiated from cystitis, known to be associated with a decrease in voided volume. The observed changes were consistent with urethral obstruction induced by local swelling and inflammation.

Objectives: To examine whether the severity of lower urinary tract symptoms (LUTS), when controlled for other factors, is related to erectile dysfunction (ED) in the male veteran population. Early evidence suggests that LUTS may be associated with ED in men., Methods: A total of 181 male veterans were prospectively entered into the study. They completed the Sexual Health Inventory for Men (SHIM) and International Prostate Symptom Score (IPSS) questionnaires. Of the 181 men, 144 also underwent uroflowmetry, including determination of the postvoid residual urine volume. Demographic and medical history data were recorded. Pearson correlation coefficients and multiple linear regression analysis were used to examine the relationship between LUTS and ED, as well as the effects of age and comorbidities., Results: The correlation coefficient (r) for the SHIM score with the total IPSS was -0.17 (P = 0.023); with the obstructive IPSS, it was -0.20 (P = 0.006); and with the irritative IPSS, -0.05 (P = 0.492). Age was the only other factor with a statistically significant correlation with the SHIM score (r = -0.23, P = 0.002). Multiple linear regression modeling showed obstructive IPSS (P = 0.001) and depression (P = 0.017) to be the only statistically significant predictors of the SHIM score. A consistent negative correlation was found between obstructive IPSS and the SHIM score across age groups, with the strongest effect for men aged 60 to 70 years (r = -0.412, P = 0.003)., Conclusions: Obstructive LUTS correlated with, and were predictive of, ED, even after controlling for age and comorbidities. Although age correlated with ED, it did not add to the power of the multiple linear regression model composed of obstructive IPSS and depression.

Objectives: To investigate the urodynamic changes after detrusor injection of botulinum A toxin in patients with detrusor overactivity refractory to treatment with anticholinergic agents., Methods: Thirty patients with detrusor overactivity refractory to anticholinergic agents were treated with detrusor injection of botulinum A toxin (Botox) 200 U at 40 sites. Urodynamic parameters and symptom scores were assessed at baseline and 2 weeks and 3 months after the injections. Patients' responses were classified as excellent, improved, or failed., Results: The 12 female and 18 male patients were aged 7 to 83 years (mean 67 +/- 17). Of the 30 patients, 12 had neurogenic detrusor overactivity, 8 had idiopathic detrusor overactivity, and 10 had previous bladder outlet obstruction or had undergone previous transurethral prostatectomy. After detrusor botulinum A toxin injection, 8 patients regained urinary continence (26.7%), 14 patients had improvement in frequency, urgency, and incontinence (46.7%), and treatment failed 8 patients (26.7%). The total success rate was 73.3%. Four patients experienced transient urinary retention and six had difficulty urinating after treatment. The urodynamic results showed increased cystometric capacity, decreased voiding pressure, increased postvoid residual urinary volume, decreased voiding efficiency, and increased bladder neck opening time at 2 weeks. The voiding pressure remained low and bladder neck opening time remained increased at 3 months, although the postvoid residual volume and voiding efficiency had returned to baseline levels. The therapeutic effects lasted for 3 to 9 months (mean 5.3)., Conclusions: Detrusor injection of 200 U of botulinum A toxin is effective in the treatment of detrusor overactivity that is refractory to anticholinergic agents. Patients with detrusor overactivity and inadequate contractility should be carefully selected for this procedure because the postvoid residual urine volume may increase after treatment.

Objectives: To investigate what combination of easily available parameters allows the noninvasive prediction of infravesical obstruction in optimal agreement with urodynamic classification. Urodynamically, men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia are classified as nonobstructed or obstructed., Methods: Mandatory and recommended tests were performed in 160 consecutive men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. The classification of the International Continence Society, the group-specific urethral resistance factor, and Schäfer's obstruction grade were estimated from urodynamic studies. The frequency-volume charts were analyzed. A separate group of 173 consecutive men was used for validation., Results: The formula, prostate volume (in cubic centimeters) - 3 x maximal urinary free flow rate (in milliliters per second) - 0.2 x mean voided volume (in milliliters; as estimated from frequency-volume charts), was optimal in the classification compared with the urodynamic classification. Extension of this formula to more than three parameters did not result in better selection. As estimated from receiver operating characteristic curves, the accuracy of the formula appeared to be good. The method of quantifying urethral resistance minimally affected the classification that resulted from the combination. From the results, a diagram was created presenting the probability of an individual to have infravesical obstruction. The validation results were satisfactory., Conclusions: The prediction of the probability of a man with lower urinary tract symptoms suggestive of benign prostatic hyperplasia to have infravesical obstruction can be deduced from a diagram based on a formula composed of three readily available parameters: prostate volume, maximal urinary free flow rate, and mean voided volume.

Bladder hypertrophy and detrusor overactivity are well-known bladder responses to outlet obstruction. Mechanical stretch stress is considered the trigger inducing these responses in the urodynamically overloaded bladder. Several studies using an in vitro model of mechanical stress demonstrate that repetitive stretch stimulation of bladder smooth muscle cells results in increased expression of a variety of growth factors and other specific proteins. In the bladder smooth muscle cell, stretch-activated ion channels (SACs) and protein kinase C (PKC) sarcolemmal proteins may function as sensors for external mechanical forces. In particular, SACs couple mechanical stress to activation of c-jun NH2-terminal kinase, which leads to a rapid induction of nuclear transcription factors. PKC also may involve an indirect or direct regulation of nuclear events. In addition, mechanical stress may induce the release of angiotensin II in an autocrine fashion. These factors in turn stimulate expression of specific gene-encoding proteins, such as heparin-binding epidermal growth factor-like growth factor, nerve growth factor, and an isomer of cyclooxygenase-2, all of which have the potential to contribute to structural and functional alterations in the bladder after obstruction.

Objectives: To establish whether routine evaluation of light microscopic changes in bladder biopsies in men with graded bladder outlet obstruction correlates with urodynamic parameters and to evaluate the performance of two pathologists in bladder biopsy interpretation., Methods: In 63 consecutive patients presenting with lower urinary tract symptoms suggestive of bladder outlet obstruction, the workup included bladder biopsies, which were semiquantitatively and independently evaluated by two pathologists for fibrosis, elastosis, muscle cell degeneration, inflammation, and additional remarkable findings. Furthermore, as determined by their general impression, the pathologists gave a diagnosis of normal or graded abnormality. The pathologists' performance was compared and the clinical and urodynamic data were correlated to the consensus histologic diagnoses., Results: Fifty-four of 63 cases could be evaluated. The intraobserver and interobserver reproducibility were reasonable, with a kappa of 0.35 and 0.50, respectively. The consensus diagnosis of abnormal bladder biopsy correlated with impaired bladder compliance and capacity. However, no correlation was found between the presence and severity of histologic abnormalities and Schäfer class, urethral resistance factor, instability, postvoid residual urine volume, symptom score, and prostate volume., Conclusions: Although abnormal bladder biopsies correlated significantly with impaired bladder capacity and compliance, routine evaluation of bladder biopsies is not indicated in the evaluation of bladder outlet obstruction.

Objectives: To investigate the structural and morphologic effect of distension after partial outlet obstruction in rabbits., Methods: Thirty male New Zealand white rabbits were separated into two groups: control (sham) and partial outlet obstruction (3 weeks). Three rabbits from each group were distended to 5%, 25%, 50%, 100%, and 125% of capacity. Each bladder was fixed at the volume in buffered formalin for 6 to 8 hours. Sections of dorsal and ventral bladder were blocked, and cross sections were evaluated. Quantitative morphometry was performed, and CD31 immunohistochemistry was used to characterize the vascularity., Results: Partial outlet obstruction resulted in increased bladder weight and capacity and increased thickness of the mucosa, submucosa, detrusor, and serosa. In the control bladder, the greatest thinning was seen between 5% and 25% capacity, and in the obstructed group, the greatest thinning occurred between 25% and 50%. The level of vascular collapse was significantly greater for the control bladders than for the obstructed bladders at all levels of distension. Finally, the obstructed bladders showed a significantly greater level of vascularity in the submucosa than the control bladders., Conclusions: Normal bladder distension resulted in significant morphologic changes when the bladder was distended to 25% of capacity but changed relatively little between 25% and 125%. However, distension of the obstructed bladder resulted in significant morphologic changes when the bladder was distended from 25% to 50% of capacity but changed relatively little between 50% and 125%.

Objectives: To elucidate the clinical significance of detrusor overactivity (DO) that is probably due to C-fiber activation caused by bladder outlet obstruction (BOO), we examined the responses to the ice water test (IWT) in patients with benign prostatic hyperplasia (BPH) and assessed the results with reference to the clinical manifestations and urodynamic findings., Methods: A total of 127 patients without neurologic disease, who were older than 50 years of age, with an International Prostate Symptom Score of 8 points or greater and a quality of life index of 2 or more points, were enrolled in this study. We tested the response to ice water instillation by monitoring the intravesical pressure in all cases and assessed the results with reference to the findings of International Prostate Symptom Score and quality of life index questionnaires, BOO indexes, 48-hour frequency volume charts, prostate volume, and data from free-flowmetry and pressure flow studies for detecting DO. Twenty patients with neurogenic bladder dysfunction underwent IWT as a control group., Results: The responders to the IWT accounted for 14 (70%) of the 20 patients with neurogenic bladder dysfunction and 35 (27%) of the 127 patients without neurologic disease. All of these responders showed DO on the pressure flow studies. The patients without neurologic disease who responded to the IWT had higher BOO indexes than did the nonresponders and had a smaller volume at a maximal desire to void on the urodynamic studies. The largest single-voided volume recorded from the 48-hour frequency volume charts was also smaller for the responders than for the nonresponders., Conclusions: The patients with BPH clearly showed that DO was mainly due to active C-fibers stimulated by high-grade BOO and that DO was a cause of urgency and frequency-related symptoms with decreased bladder capacity. It will be necessary to assess the inhibitory effect of capsaicin on DO caused by activation of C-fibers and the reversibility of C-fiber activation after surgical treatment for BPH, so that the criteria for decision-making for the treatment of BPH may be clarified with the aid of the IWT.

Objectives: To investigate the weak correlation between bladder outlet obstruction (BOO), as diagnosed using the provisional International Continence Society nomogram for the definition of BOO in men, and postvoid residual urine volume., Methods: The relationship between voiding to completion and several indexes for bladder outlet resistance and bladder contractility was studied in 131 pressure flow studies in male patients using multivariate logistic regression analysis., Results: The International Continence Society nomogram and the related BOO index weakly predict for postvoid residual urine volume (areas under the receiver operating characteristic curve 0.63 and 0.64, respectively). The BOO index primarily measures bladder outlet resistance. If the nomogram or BOO index is augmented with bladder contractility information, the postvoid residual urine volume can be predicted significantly better (eg, area under the receiver operating characteristic curve [0.89] for the combination of the BOO index and bladder contractility information)., Conclusions: The weak correlation between BOO and postvoid residual urine volume is related to the fact that emptying the bladder to completion depends on bladder contractility, as well as bladder outlet resistance. It is possible to estimate the probability to void to completion quite accurately on the basis of bladder outlet resistance and bladder contractility. We named this probability "relative bladder outlet resistance." A high probability of a postvoid residual urine volume may be assumed to indicate "relative BOO." By its very nature, the correlation between "relative BOO" and postvoid residual urine volume is good.

Objectives: To examine the urodynamic (UDS) attributes of detrusor overactivity (DO) in patients with Parkinson's disease in comparison to DO in men without neurologic disease, in whom DO is presumably outlet obstruction induced., Methods: The UDS database was reviewed for three groups of patients: group 1, men with lower urinary tract symptoms (LUTS) and no known neurologic condition with DO (n = 22); group 2, men with Parkinson's disease and LUTS (n = 39); and group 3, women with Parkinson's disease and LUTS (n = 18). Statistical analysis was used to compare the UDS parameters and diagnoses among the groups and to test for associations between Parkinson's disease duration, Hoehn and Yahr score, and UDS findings., Results: Patients with Parkinson's disease had a significantly lower median volume at first detrusor contraction than those with non-neurogenic DO. The percentage of group 1 patients with urge incontinence was significantly lower than that found in the other two groups (9.1% versus 53.8% and 55.6%, P <0.001 and 0.002, respectively). No statistically significant correlation between the duration or severity of Parkinson's disease and UDS parameters was found., Conclusions: Men with non-neurogenic LUTS are less likely to have urge incontinence on UDS than either men or women with Parkinson's disease. DO owing to Parkinson's disease occurs earlier during filling compared with non-neurogenic DO, especially in women. The duration and severity of Parkinson's disease are not predictive of the nature or severity of UDS abnormalities.

Objectives: To study the causes for the variation between measurements, which is considerable, in maximal flow rate (Qmax) and the associated detrusor pressure (PdetQmax). Because of the central role of Qmax and PdetQmax in the diagnosis of bladder outlet obstruction, this is reason for concern., Methods: Spectral analysis was carried out on two consecutive urodynamic measurements in 131 patients. The parameters for bladder outlet resistance and bladder contraction strength were determined, and difference plots were made to study the systematic variations. Logistic regression analysis was used to study whether the differences represent true changes of the function of the lower urinary tract., Results: Signal components in the detrusor pressure and the flow rate signal with frequencies of 1 Hz or greater may be considered noise. Filtering out these frequencies changes the estimates of Qmax and PdetQmax, but not the between-measurement difference in them. Bladder contractility and bladder outlet resistance were systematically lower in the second measurement. Both the systematic and nonsystematic between-measurement variations were statistically significant predictors for postvoid residual urine volume., Conclusions: The nonsystematic between-measurement variability in Qmax and PdetQmax apparently reflects true variability in the physiologic state of the bladder outlet. It therefore does not discredit the pressure-flow study as the preferred method in the diagnosis of bladder outlet obstruction. Rather, the pressure-flow study is the only currently available method to study and quantify the apparent within-patient variability in bladder outlet resistance and bladder contractility.

Objectives: To examine the effect of cross-sectional catheter diameter on urodynamic measurement of bladder outlet obstruction as predicted by the Abrams-Griffiths nomogram., Methods: Thirty-one patients with symptomatic benign prostatic hyperplasia underwent free flow measurements followed by pressure-flow urodynamic evaluation using 5F and 10F urethral catheters in randomly assigned order. The measurements of voided volume, maximal flow rate (Qmax), postvoid residual volume, and detrusor pressure at maximal flow (PdetQmax) were compared. Data points were then plotted on the Abrams-Griffiths nomogram, and categorization of bladder outlet obstruction was assigned for each catheter size., Results: The use of 10F catheters resulted in both a significant decrease in Qmax and increase in PdetQmax compared with the use of 5F catheters. Of 31 patients, 10 (32%) were incorrectly categorized as obstructed according to the Abrams-Griffiths nomogram when the larger sized catheter was used, and 17 (55%) experienced migration from a less obstructed to a more obstructed category., Conclusions: The use of 5F catheters allows for more accurate diagnosis of bladder outlet obstruction. In urodynamic evaluations, the larger size 10F catheters should be avoided, especially in patients with borderline symptoms.

Objectives: To determine whether young age at presentation is associated with poor renal function in patients with posterior urethral valves (PUVs). Previous studies have indicated that a young age at diagnosis is an adverse prognostic factor for patients with PUVs., Methods: Fifty-three children with PUVs were diagnosed between January 1998 and March 2000. The patients included 25 infants with a median age of 3 months (group 1) and 28 children with a median age of 3.5 years (group 2). No statistically significant difference was present between the two groups regarding presenting symptoms, incidence of hydronephrosis, bilateral vesicoureteral reflux, presence of popoff mechanisms, or number of positive urinary cultures at presentation. Primary valve ablation was carried out in all patients. The median follow-up period for groups 1 and 2 was 19 and 18.5 months, respectively (P <0.05)., Results: The percentage of serum creatinine deviation greater than the normal age-reference range was calculated for each patient at diagnosis and at the last follow-up visit. The median percentage of serum creatinine deviation at presentation was 190% for group 1 and 22% for group 2 (P >0.05). The median percentage of serum creatinine deviation at the last follow-up visit was nil for group 1 and 10% for group 2 (P <0.009). Persistently dilated upper tracts were noted in 48% and 86% of patients in groups 1 and 2, respectively (P <0.004)., Conclusions: In contrast to the findings of previous studies, we provide evidence of a less favorable outcome with delayed presentation of PUVs relative to those diagnosed in the first year after birth in respect to renal function and upper tract dilation.

Objectives: To examine whether bladder smooth muscle dysfunction after outlet obstruction could be altered by treatment with aspirin. Long-term outlet obstruction causes contractile and metabolic dysfunction of the bladder in vivo and in vitro. The evidence is growing that a decrease in bladder perfusion is an important cause of this phenomenon. The platelet aggregation inhibitor, acetylsalicylic acid (aspirin), has been used to improve perfusion of the heart for decades., Methods: Ten male New Zealand white rabbits were obstructed for 4 weeks. Five rabbits received no further treatment (Obs), and 5 rabbits received 2 mg/kg/day aspirin (Obs+aspirin), administered by an osmotic pump implanted subcutaneously 1 week before the surgical obstruction. The bleeding time was measured to confirm the effectiveness of the aspirin treatment. Three different control groups were created: sham-operated rabbits, unobstructed rabbits with pumps containing DMSO (vehicle), and unobstructed rabbits with pumps containing aspirin. The contractile responses of bladder strips to field stimulation, adenosine triphosphate, carbachol, and KCl were determined. A section of each detrusor tissue was fixed in formalin and used to determine the smooth muscle and collagen (connective tissue) volume fraction., Results: No differences were found in the bladder weights or responses to stimuli in the different control groups, which were therefore combined. Partial bladder outlet obstruction caused significant increases in the bladder weight of the obstructed animals (Obs+aspirin, 10.15 +/- 0.87 g; Obs, 10.17 +/- 0.88 g; and controls, 2.87 +/- 0.21 g). The aspirin treatment increased the bleeding time from 1.7 +/- 0.3 minutes to 3.3 +/- 0.1 minutes. The responses to field stimulation were significantly reduced in all of the obstructed rabbits. However, the responses of the bladder strips from the Obs rabbits to field stimulation were impaired to a significantly greater degree than were those from the Obs+aspirin rabbits. The response to 32-Hz stimulation was reduced by 86% in the Obs group but by only 64% in the Obs+aspirin group. The responses to carbachol were significantly reduced by 62% in the strips from the Obs rabbits, but the responses of the strips from the Obs+aspirin rabbits were similar to the responses of the strips from the controls. The responses to KCl and adenosine triphosphate were reduced, although they just failed to achieve statistical significance using Bonferroni's analysis. The ratio of smooth muscle and connective tissue shifted slightly toward smooth muscle after 4 weeks of obstruction, but no difference was found with or without aspirin treatment., Conclusions: Low-dose aspirin has a small but significant protective effect on the contractile dysfunction induced by bladder outlet obstruction in rabbits, although the increase in bladder mass was not altered. Bladders of the same weight showed improved responses to all forms of stimulation after pretreatment with aspirin. Already used by millions of patients with heart diseases, aspirin could be a useful protection against contractile dysfunction of the obstructed bladder.