Ten cases of small intestinal obstruction seen over a period of 6 years (1971-6) in young girls within the narrow age range of 13-18 years are described. The patients were all within 2 years of menarche. In all these cases the obstruction was due to a membrane encasing the small intestine in the manner of a cocoon. There was no previous history of abdominal operation, peritonitis or prolonged drug intake. The clinical features, operative findings and management of the cases are presented. Possible causes of the condition are discussed. In view of the similar clinical presentation in all these patients, their conditions can be grouped as a clinical entity--'the abdominal cocoon'.

variables were then correlated with the results from a pressure-flow study. RESULTSThe IPP was a statistically significant predictor ( P < 0.001) of bladder outlet obstruction (BOO) compared with other variables in the initial evaluation. In all, 125 patients had significant BOO, defined as a BOO index of >40. Of these men, 94 had grade III and 30 had grade I-II IPP. Seventy-five patients had a BOO index of <40; 69 had grade I-II and six grade III IPP. In patients with BOO confirmed on the pressure-flow study, grade III IPP was associated with a higher BOO index than was grade I-II ( P < 0.001). CONCLUSIONThe IPP assessed by transabdominal ultrasonography is a better and more reliable predictor of BOO than the other variables assessed. KEYWORDS intravesical protrusion, prostate, lower urinary tract symptoms, bladder outlet obstruction OBJECTIVESTo determine the effect of intravesical protrusion of the prostate (IPP, graded I to III) on lower urinary tract function, by correlating it with the results of a pressure-flow study. PATIENTS AND METHODSIn a prospective study men (aged >50 years) with lower urinary tract symptoms were initially evaluated as recommended by the International Consultation on Benign Prostatic Hyperplasia, together with the IPP and prostate volume, as measured by transabdominal ultrasonography. These

No abstract

Aim:The aims of this study were to define the relationship between intravesical prostatic protrusion (IPP), prostate-specific antigen (PSA) and prostate volume (PV) and to determine which one of them is the best predictor of bladder outlet obstruction (BOO) due to benign prostatic enlargement. Methods: A prospective study of 114 male patients older than 50 years examined between November 2001 and 2002 was performed. They were evaluated with digital rectal examination, International Prostate Symptoms Score, PSA, uroflowmetry, postvoid residual urine measurement, IPP and PV using transabdominal ultrasound scan. Statistical analysis included scatter plot with Spearman's correlation coefficients and nominal logistic regression Results: Prostate volume, IPP and PSA showed parallel correlation. Although all three indices had good correlation with BOO index, IPP was the best. The Spearman rho correlation coefficients were 0.314, 0.408 and 0.507 for PV, PSA and IPP, respectively. Using receiver-operator characteristic curves, the areas under the curve for PV, PSA and IPP were 0.637, 0.703 and 0.772, respectively. The positive predictive values of PV, PSA and IPP were 65%, 68% and 72%, respectively. Using a nominal regression model, IPP remained the most significant independent index to determine BOO. Conclusions: All three non-invasive indices correlate with one another. The study showed that IPP is a better predictor for BOO than PSA or PV.

IPP is a useful predictor for evaluating the success of a voiding trial following ARU. Patients with a grade 1 prostate may benefit from a trial without a catheter. However, patients with a grade 3 prostate are less likely to do so and would require a more definitive surgical procedure.