bladder was filled slowly (50 mL/min) with 0.2 M KCl, which resembles the osmolarity of concentrated urine, and evaluated by cystometry. In parallel, TRCDUS and measurement of the CPD of the LUT were performed. The patients with LUTS were then treated with daily α -blocker (0.4 mg tamsulosin) for 5 weeks and urodynamic variables as well as perfusion were evaluated again. RESULTSIn the healthy men, perfusion of the LUT increased considerably (157%) during filling of the bladder to a mean ( SD ) maximum cystometric capacity (C max ) of 481 (28.9) mL. All the patients with LUTS had a reduced mean C max during filling with KCl at 322.4 (58.5) mL. The mean CPD in the urinary bladder and the prostate were only increased by 58.4% during filling with KCl. After α -blocker therapy the mean C max during filling with KCl rose to 382.5 (42.9) mL; furthermore, perfusion of the LUT measured by CPD was significantly increased (132.8%). CONCLUSIONSThe present data strongly suggest that LUTS are associated with chronic ischaemia of the prostate and urinary bladder. α -blockers increase perfusion in the LUT and C max . These results might explain the therapeutic effects of α -blockers on LUTS. KEYWORDSlower urinary tract symptoms, perfusion of bladder and prostate, α -blocker, tamsulosin, ischaemia Study Type -Aetiology (individual case control) Level of Evidence 3b OBJECTIVETo investigate whether a mechanism of action of α -blockers on lower urinary tract symptoms (LUTS) involves improved perfusion of the LUT.

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Laparoscopic ureteropyelostomy and subtotal ureterectomy provide effective treatment for this rare condition. The minimally invasive technique may also have clinical applications in the pediatric population.