September 29, 2011

Quantifying the effect of urodynamic catheters on urine flow rate measurement.

Quantifying the effect of urodynamic catheters on urine flow rate measurement.:

Quantifying the effect of urodynamic catheters on urine flow rate measurement.

Neurourol Urodyn. 2011 Sep 26;

Authors: Harding C, Horsburgh B, Dorkin TJ, Thorpe AC

Abstract

INTRODUCTION: The effect of urodynamic catheters on urine flow rate (Q(max) ) is well documented but under-researched. Several studies show reduced Q(max) but methodologies and patient demographics differ. The aims of this study were to further quantify the effect of urodynamic catheters on Q(max) and to explore if this was consistent across different urodynamic diagnoses. METHODS: Four groups of 50 consecutive men attending for urodynamic studies (UDS) were retrospectively analyzed: Group 1 comprised 50 men with normal UDS, Group 2 was 50 men with BOO, and Group 3 contained 50 men with detrusor underactivity. Groups 1-3 had UDS performed using both 10 Fr filling and 4 Fr measuring catheters in situ. Group 4 comprised 50 men who had UDS performed with a smaller catheter assembly (8 Fr dual-lumen). Values of Q(max) with and without catheters present were compared using paired Student's t-tests. Differences between groups were compared using ANOVA. RESULTS: Q(max) measured during UDS in men from Groups 1-3 showed a mean reduction of 38% compared to Q(max) from "free" uroflowmetry. ANOVA indicated this reduction was significantly greater among men with normal UDS. Interestingly the group who underwent UDS with a smaller catheter assembly showed no significant reduction in Q(max) measured with catheters in situ. CONCLUSION: Our findings are in line with previous work suggesting that smaller calibre urethral catheters do not cause a significant obstructive effect during voiding. In addition it would appear that the reduction in Q(max) with larger urethral catheters in situ is greatest in those with normal urodynamics. Neurourol. Urodynam. © 2011 Wiley-Liss, Inc.


PMID: 21953734 [PubMed - as supplied by publisher]

September 25, 2011

Natural history of detrusor contractility--minimum ten-year urodynamic follow-up in men with bladder outlet obstruction and those with detrusor.

Natural history of detrusor contractility--minimum ten-year urodynamic follow-up in men with bladder outlet obstruction and those with detrusor.:
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Natural history of detrusor contractility--minimum ten-year urodynamic follow-up in men with bladder outlet obstruction and those with detrusor.

Scand J Urol Nephrol Suppl. 2004;(215):101-8

Authors: Al-Hayek S, Thomas A, Abrams P

OBJECTIVE: To check the long-term effect, in male patients, of treated and untreated bladder outlet obstruction (BOO) on detrusor contractility and to explore the relationship between ageing and detrusor underactivity (DUA). MATERIAL AND METHODS: Men investigated at the urodynamic department of Southmead Hospital in Bristol between 1972 and 1986 were traced and three groups were invited for repeat pressure-flow urodynamic studies (PFS). The first two groups included patients over 40 years old, with untreated or surgically treated BOO, and the third group had patients with DUA from all age groups. RESULTS: 196 patients (with a minimum 10 year gap from the first assessment) agreed to have repeat PFS. There was no statistically significant change in bladder contractility index (BCI) in patients with BOO treated by transurethral resection of the prostate (TURP) (mean difference in BCI was 0.01, 95% confidence interval -0.07 to 0.09, n=114). There was also no significant difference in BCI in untreated patients with BOO (p=0.10, n=53). The follow-up BCI was higher in untreated patients than in the surgically treated group. The BCI in patients with DUA did not change significantly after a minimum of 10 years' follow-up. CONCLUSIONS: There is no evidence to suggest that detrusor contractility declines with long-term BOO. Relieving the obstruction surgically does not improve the contractility. This is important when considering and counselling for TURP. Underactive detrusors remain underactive, but do not get worse with time, which could indicate that this is not an ageing process per se and may even have a congenital basis.

PMID: 15545204 [PubMed - indexed for MEDLINE]

September 16, 2011

Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score.

Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score.:

Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score.

BJU Int. 2011 Aug 26;

Authors: Fujimura T, Kume H, Nishimatsu H, Sugihara T, Nomiya A, Tsurumaki Y, Miyazaki H, Suzuki M, Fukuhara H, Enomoto Y, Homma Y

Abstract

Study Type - Therapy (symptom prevalence) Level of Evidence 2a What's known on the subject? and What does the study add? The International Prostate Symptom Score (IPSS) has been most commonly used for the symptom assessment of men with lower urinary tract symptoms (LUTS). However, LUTS in men are so variable that they may not be fully captured by the IPSS questionnaire alone. This study has demonstrated that the Care Lower Urinary Tract Symptom Score (CLSS) questionnaire, which addresses 10 important symptoms, is an appropriate initial assessment tool for LUTS in men with various diseases/conditions. OBJECTIVE: • International Prostate Symptom Score (IPSS) has been commonly used to assess lower urinary tract symptoms (LUTS). We have recently developed Core Lower Urinary Tract Symptom Score (CLSS). The aim of this study is to compare IPSS and CLSS for assessing LUTS in men. PATIENTS AND METHODS: • Consecutive 515 men fulfilled IPSS and CLSS questionnaires. • IPSS QOL Index was used as the QOL surrogate. • The clinical diagnoses were BPH (n = 116), BPH with OAB wet (n = 80), prostate cancer (n = 128), prostatitis (n = 68), underactive bladder (n = 8), others (n = 72), and controls (e.g., occult blood) (n = 42). • Simple statistics and predictability of poor QOL (QOL Index 4 or greater) were examined. RESULTS: • All symptom scores were significantly increased in symptomatic men compared with controls. Scores of corresponding symptoms of two questionnaires were significantly correlated (r = 0.58-0.85, all P < 0.0001). • A multivariate regression model to predict poor QOL indicated nine symptoms (daytime frequency, nocturia, urgency, urgency incontinence, slow stream, straining, incomplete emptying, bladder pain and urethral pain) as independent factors. • The hazard ratios for bladder pain (2.2) and urgency incontinence (2.0) were among the highest. • All the nine symptoms are addressed in CLSS, while three symptoms (urgency incontinence, bladder, and urethral pain) are dismissed in IPSS. CONCLUSION: • CLSS questionnaire is more comprehensive than IPSS questionnaire for symptom assessment of men with various diseases/conditions, although both questionnaires can capture LUTS with possible negative impact on QOL.


PMID: 21883834 [PubMed - as supplied by publisher]

September 13, 2011

Detrusor contraction duration and strength in the patients with benign prostatic enlargement.

Detrusor contraction duration and strength in the patients with benign prostatic enlargement.: "
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Detrusor contraction duration and strength in the patients with benign prostatic enlargement.

Bosn J Basic Med Sci. 2004 Feb;4(1):29-33

Authors: Aganović D, Prcić A

OBJECTIVE: examine detrusor contraction duration (DCD) in relation with obstruction grade and strength of detrusor contractility; analyze individual correlations of this parameter with urodynamic, physiological and symptoms variables in patients with benign prostatic enlargement (BPE). SAMPLE AND METHODOLOGY: 102 patients with proved BPE, underwent complete urodynamic measurements (UDM), namely uroflowmetry, cystometry and pressure/flow studies. Postvoid residual urine (PVR) was measured and the International Prostate Symptom Score (I-PSS) was fulfilled by each patient. Methodology of measurement and definitions of UDM are based on definitions and terminology defined by the International Continence Society. RESULTS: After grouping the patients (average age 64,7+/-8,5) related to obstruction grades according to the Schafer nomogram, ANOVA has shown a group extension of the detrusor contraction duration related to higher levels of obstruction (LinPURR 0-VI; p<0,01), which is also followed by stronger detrusor contractility (Pdetmax; p<0,001). Dichotomizing of the patients with DCD cut off point 90 sec. has shown that 67% patients with underactive detrusor have DCD>90 sec, while extension of DCD and increase of the obstruction level are directly related to preserved detrusor contractility only in 20,5% cases. There is neither statistically significant difference of DCD in the patients that are not in obstruction allocated in two groups depending on detrusor contraction strength, (t=1.2, p>0.05); nor in the patients who are in obstruction range, divided on the same way (t=0.568, p>0.05). There is also no difference of the same patients groups regarding PVR (t=1.38 and t=1.17, p>0.05). Individual correlation of DCD with I-PSS has not been shown (r=0.16, p>0.05), although there is a statistically significant correlation with its obstructive subset (r=0.20, p<0.05), as well as, with LinPUR and URA nomograms (r=0.33, r=0.29; respectively, p<0.005) and with Pdetmax (r=0.26, p<0.01), PdetQmax (r=0.24, p<0.05), Qmax and Qaver (r=0.31, p<0.005). DCD does not have individual correlations with patients' age, prostate volume and with cystometric capacity. CONCLUSION: DCD is rather independent urodynamical variable, which does not correlate with I-PSS. Generally, DCD is prolonged during obstruction, while extension of DCD only partially depends on detrusor contraction strength. Practically, individual correlations of DCD with the urodynamic factors, which characterize obstructions, are modest.

PMID: 15628977 [PubMed - indexed for MEDLINE]
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