PDF
ePub
Citation
Print
Abstract
Purpose
Lower urinary tract symptoms (LUTS) can be caused by abnormal detrusor activity, bladder outlet obstruction (BOO), or numerous other factors. These factors must be evaluated with scrutiny, especially when prostate volume is small and the patient is about to have invasive treatment. We evaluated the urodynamic findings of patients with LUTS and small prostate volumes.
Materials and Methods
From January 2006 to December 2008, a total of 140 men with LUTS underwent urodynamic study. Of these 140 men, 51 patients with prostate volume ≤30 ml and an International Prostate Symptom Score (IPSS) ≥8 were evaluated.
Results
The average age of the patients was 65.5±7.4 years (range 46∼86), mean prostate volume was 24.5±5.1 (range 13.0∼30.0), mean IPSS was 15.5±7.7 (range 8∼34), and quality of life (QOL) score was 3.4±1.5 (range 3∼6). BOO was the most common finding, affecting 21 (41.2%) patients. The patients with BOO were significantly older than the unobstructed patients (70.1±5.9 and 62.4±6.7 years, respectively; p＜0.001) and had larger prostates (27.5±3.1 and 22.4±5.1, respectively; p＜0.001). Furthermore, they had higher IPSS, but the difference was not significant (p=0.074). Eighteen (35.5%) patients had normal findings, while detrusor underactivity (DU) was found in 15 (29.4%) and detrusor overactivity (DO) in 3 (5.9%) patients. There was no significant difference in age, prostate volume, or IPSS between men with and without DU.
Conclusions
The most common finding of LUTS with small prostate volume is BOO, even though it accounts for less than half of the patients. However, patients with normal finding or DU on urodynamic study account for majority of cases, emphasizing the value of urodynamic study before invasive treatments.
REFERENCES
1). Chute CG, Panser LA, Girman CJ, Oesterling JE, Guess HA, Jacobsen SJ, et al. The prevalence of prostatism: a population-based survey of urinary symptoms. J Urol. 1993; 150:85–9.
2). Abrams PH, Feneley RC. The significance of the symptoms associated with bladder outflow obstruction. Urol Int. 1978; 33:171–4.
3). Kuo HC. Pathophysiology of lower urinary tract symptoms in aged men without bladder outlet obstruction. Urol Int. 2000; 64:86–92.
4). Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002; 21:167–78.
5). Van Mastrigt R, Rollema HJ. The prognostic value of bladder contractility in transurethral resection of the prostate. J Urol. 1992; 148:1856–60.
6). Krogh J, Beuke HP, Christensen AB, Spars⊘ BH. Longterm results of bladder neck incision in men. Urol Int. 1991; 46:55–7.
7). Andersen JT, Nordling J, Meyhoff HH, Jacobsen O, Hald T. Functional bladder neck obstruction. Late results after endoscopic bladder neck incision. Scand J Urol Nephrol. 1980; 14:17–22.
9). Crowe R, Noble J, Robson T, Soediono P, Milroy EJ, Burnstock G. An increase of neuropeptide Y but not nitric oxide synthase-immunoreactive nerves in the bladder neck from male patients with bladder neck dyssynergia. J Urol. 1995; 154:1231–6.
10). Chai TC, Belville WD, McGuire EJ, Nyquist L. Specificity of the American Urological Association voiding symptom index: comparison of unselected and selected samples of both sexes. J Urol. 1993; 150:1710–3.
11). Lepor H, Machi G. Comparison of AUA symptom index in unselected males and females between fifty-five and seventy-nine years of age. Urology. 1993; 42:36–40.
12). Jolleys JV, Jolleys JC, Willson J, Donovan J, Nanchamel K, Abrams P. Does sexual quality to urinary symptoms? Neurourol Urodyn. 1993; 12:391–2.
13). Ko DS, Fenster HN, Chambers K, Sullivan LD, Jens M, Goldenberg SL. The correlation of multichannel urodynamic pressure-flow studies and American Urological Association symptom index in the evaluation of benign prostatic hyperplasia. J Urol. 1995; 154:396–8.
14). Kaplan SA, Bowers DL, Te AE, Olsson CA. Differential diagnosis of prostatism: a 12-year retrospective analysis of symptoms, urodynamics and satisfaction with therapy. J Urol. 1996; 155:1305–8.
15). Kim HJ, Kim SS, Park HS, Lee JG. Urodynamic analysis of men with lower urinary tract symptoms without benign prostatic hyperplasia. Korean J Urol. 2002; 43:231–6.
16). Lee JG, Shim KS, Koh SK. Incidence of detrusor underactivity in men with prostatism older than 50 years. Korean J Urol. 1999; 40:347–52.
17). Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up. BJU Int. 2004; 93:745–50.
18). Jensen KM. Clinical evaluation of routine urodynamic investi- gations in prostatism. Neurourol Urodyn. 1989; 8:645–78.
19). Rollema HJ, Van Mastrigt R. Improved indication and followup in transurethral resection of the prostate using the computer program CLIM: a prospective study. J Urol. 1992; 148:111–5.
20). Shäfer W, Nopponey R, Rubben H, Lutzeyer W. The value of free flow rate and pressure flow studies in the routine investigation of BPH patients. Neurourol Urodyn. 1988; 7:219–21.
Table 1.
Final urodynamic diagnoses in patients with prostates ≤30 ml
| Diagnosis | N | % |
|---|---|---|
| Normal | 18 | 35.3 |
| BOO | 15 | 29.4 |
| DU | 11 | 21.6 |
| BOO+DU | 4 | 7.9 |
| DO | 1 | 1.9 |
| BOO+DO | 2 | 3.9 |
| Total | 51 | 100.0 |
Table 2.
Comparison of patients with and without BOO
Table 3.
Comparison of patients with and without DU
XML Download