Search

The pathophysiology of OAB is complex, multifactorial and still largely unknown. Several pathophysiological mechanisms have been highlighted that may play a different role in different patient groups. There are now experimental evidences that support both the myogenic and neurogenic hypothesis, but in recent years the "integrative" hypothesis has been gaining more and more acceptance, where a disruption in the multiple interactions between different cell types (neurons, urothelium, interstitial cells, myocytes) and network functions represent a central element of lower urinary tract dysfunctions. Of utmost importance, a disorder in the urothelial sensory function and in the urothelial/suburothelial non-neural cholinergic system, favored by age and comorbidities, appears to be crucial for the development of the OAB. Neuroplastic and detrusor changes in OAB are broadly similar to those observed in bladders exposed to outlet obstruction, neuropathies, inflammation or aging, and may be driven by a common urothelial dysfunction. Several signaling substances and their receptors were found to be involved in central pathways of bidirectional communication between the different cell types in the bladder, and were shown to be modified in several animal models of OAB as well as in human models, indicating new potential therapeutic targets.

Although transurethral resection of the prostate (TURP) is the gold standard for treatment of BPH, a new, minimally invasive technique, called Interstitial Laser Coagulation (ILC), introduced by Muschter and Hofstetter, has been developed to treat BPH. ILC is base on the coagulation of prostatic tissue by means of diffused laser light using a diode laser system with a temperature feed-back (Indigo Medical 830e TM). We report our results in treating 20 patients with BPH and Bladder Outlet Obstruction (BOO), after a mean follow-up of 7 months. To define the indication for treatment and to monitor the success, urinary flow-rate (Omax), I-PSS symptoms score, residual urinary volume and prostate volume determined by ultrasound were recorded before treatment and after 3, 6, 12 months. Transurethrally, under spinal or regional anaesthesia, 2 or 3 insertions of the laser fibre in each prostatic lobe were performed beginning at the apex directly proximal to the bladder neck, made at 1 cm intervals, using a modified model Olympus cystoscope. After 6 months, Qmax increased from 6, 7 ml/sec to 11, 3 ml/sec; I-PSS score decreased from 18 to 8; residual urinary volume from 130 ml to 40 ml, prostate volume decreased from 60 to 48 ml. In selected cases, urodynamic evaluation was performed before and after treatment. Urodynamic findings were classified according Shafer diagram to grade B.O.O.: the score was 4 before treatment and 2 after 6 months. We observed UTI in 3 cases, retrograde ejaculation and acute urinary retention in 1 case, transitory irritative and obstructive syndrome in 8 cases after treatment. ILC is a simple, safe and effective treatment for BPH with significant improvements in both objective and subjective parameters. It is cheaper than others mini-invasive therapies and is able to treat any prostate volume, saving urethra and sexual function.

The authors describe the ultrasonic images they obtained in the follow up of three groups of patients who were divided according to basic pathology and treated with Nd: Yag Laser with contact (CLAP) and side firing (VLAP) fibers. Next the great differences noted between the results achieved with ultrasonic investigation and those obtained with flowmeter controls and IPSS are presented. The authors discuss the possible causes of these dissonances and hypothesize a new way to evaluate cervico-urethral de-obstruction: no longer an anatomical technique but a functional one.

Alfuzosina has a specific antagonist effect on the alfa-1-adrenergic post-junctional receptor posed at urethral laeve musculature, prostatic capsule and vesical trgonum. It's and ideal drug the symptoms of the difficult urinary flow typical of the benign prostatic hypertrophia (IPB) and of some patologies of vesical collum to attenuate. With this work we want to demonstrate the anatomic alterations of vesical collum and prostatic urethra by means of dynamic recording mictional phase with transrectal scan carried out before and after treatment. In this study, 30 patients were divided into three groups of 10 in relation to the pathology: overtone of vesical collum, little benign prostatic ipertrophia and great benign prostatic ipertrophia have included. The patients of each group have also been divided in undergroups of five (selected with the method of double-blind) of which the first treated with alfuzosina 7.5 mg/die for 30 days and the second with placebo. Considering the limits of this study, the analysis of the results have permitted to conclude that the drug has determined a subjective improvement in all patients except those with great IPB, while the objective valuation, reached comparing scan dynamic pictures before and after treatment, has made it possible to visualize an improvement on the opening of the vesical collum and the prostatic urethra after therapy with great variations of the size of che mictional funnel and same prostatic urethra. The alfuzosina is efficacious, in the cases under examination, except the third group were the compression on the urethra was of an elevated degree.

62 men with prostatic hypertrophy and bladder obstruction and 31 age matched women without lower urinary tract obstruction, underwent urodynamic testing which included uroflowmetry, gas cystometry, urethral pressure measurement: electromyography and pressure flow study was only performed to the patients with prostatic hypertrophy. No patient with neurological disease, diabetes mellitus, pelvic operation, neoplasm or stone of the bladder was admitted to the study. Involuntary detrusor contractions (unstable detrusor) were found in 74.2% of male patients and in 25.8% of female patients. In male patients aged over 72 the percentage was 81.8% while in the female patients of the same age was 60%. All the 62 male patients underwent prostatectomy. Two months after surgery, acystometry was done. Unstable detrusor was found in 63.1% of cases. Patients over 80 had a percentage of 100%. These data suggest obstructive prostatic hypertrophy as an important factor in development of involuntary bladder contractions, but the primary pathophysiological factor appears to be age of patients.

Primary bladder neck obstruction in women is quite rare and its symptoms--dysuria, frequency, and urgency--are equivocal. Routine radiological investigations alone do not allow a diagnosis to be made, due to the lack of simultaneous measurements of detrusor pressure and urine flow. A precise diagnosis is thus to be obtained by synchronous video urodynamic studies which allow the depiction of nonfunneling or tight bladder neck during the entire phase of detrusor contraction, of bladder trabeculae and diverticula, vesico-ureteral reflux, long micturition time and incomplete voiding. When these radiological signs are associated with a rise in detrusor voiding pressure over 60 cm of water and with peak urine flow lower than 15 ml/s, the diagnosis of bladder neck obstruction is unquestionable, and the appropriate pharmacologic/endoscopic treatment can be administered.