Increase in detrusor wall thickness indicates bladder outlet obstruction (BOO) in men

Oelke, Matthias; Höfner, K.; Wiese, Birgitt; Grünewald, V.; Jonas, Udo

doi:10.1007/s00345-001-0238-z

Cited by 155 publications

(139 citation statements)

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“…Uroflowmetry was assessed in 2580 patients across 16 studies. Thirteen studies used a cutoff value of 10 ml/s to diagnose BOO and reported median sensitivity of 68.3%, specificity of 70.5%, a PPV of 74.3% and NPV of 68% [7,12,13,15,16,18,20,21,26,30,33,34,38,40,41]. However, studies varied considerably in their choice of defining variable and cutoff values.…”

Section: Diagnostic Accuracy Resultsmentioning

confidence: 99%

“…DWT/BWT. DWT was studied in 848 patients across eight studies [6,8,16,17,24,31,33,34], five of which used a cutoff of 2 mm to define BOO, with high median sensitivity of 82.7%, specificity of 92.6%, a PPV of 90.5%, and NPV of 85%. Furthermore, a well-conducted exploratory study reported a cutoff value of 2.9 mm as having the best diagnostic value, with specificity of 100%.…”

Section: Diagnostic Accuracy Resultsmentioning

confidence: 99%

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Systematic Review of the Performance of Noninvasive Tests in Diagnosing Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms

et al. 2017

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Keywords:Bladder outlet obstruction (BOO) Men Lower urinary tract symptoms Diagnosis Urodynamics Noninvasive Systematic review Please visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. AbstractContext: Several noninvasive tests have been developed for diagnosing bladder outlet obstruction (BOO) in men to avoid the burden and morbidity associated with invasive urodynamics. The diagnostic accuracy of these tests, however, remains uncertain. Objective: To systematically review available evidence regarding the diagnostic accuracy of noninvasive tests in diagnosing BOO in men with lower urinary tract symptoms (LUTS) using a pressure-flow study as the reference standard. Evidence acquisition: The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central, Google Scholar, and WHO International Clinical Trials Registry Platform Search Portal databases were searched up to May 18, 2016. All studies reporting diagnostic accuracy for noninvasive tests for BOO or detrusor underactivity in men with LUTS compared to pressure-flow studies were included. Two reviewers independently screened all articles, searched the reference lists of retrieved articles, and performed the data extraction. The quality of evidence and risk of bias were assessed using the QUADAS-2 tool. Evidence synthesis: The search yielded 2774 potentially relevant reports. After screening titles and abstracts, 53 reports were retrieved for full-text screening, of which 42 (recruiting a total of 4444 patients) were eligible. Overall, the results were predominantly based on findings from nonrandomised experimental studies and, within the limits of such study designs, the quality of evidence was typically moderate across the literature. Differences in noninvasive test threshold values and variations in the urodynamic definition of BOO between studies limited the comparability of the data.

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Section: Diagnostic Accuracy Resultsmentioning

confidence: 99%

Section: Diagnostic Accuracy Resultsmentioning

confidence: 99%

Systematic Review of the Performance of Noninvasive Tests in Diagnosing Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms

et al. 2017

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“…LUTS were classified according to the IPSS as minimal (score 0-7), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) and severe ( > 20). The duration of LUTS was also recorded .…”

Section: Methodsmentioning

confidence: 99%

“…The bladder wall thickness (BWT) was also determined by abdominal US using a baseline bladder capacity of 60% (i.e. 150-200 mL) with values of > 2 mm being considered abnormal [12]. All patients had a detailed medical history taken, a physical examination and urine analysis, with laboratory blood tests.…”

Section: Methodsmentioning

confidence: 99%

Immunohistochemical estimation of hypoxia in human obstructed bladder and correlation with clinical variables

Koritsiadis¹,

Stravodimos²,

Koutalellis³

et al. 2008

BJU International

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OBJECTIVETo investigate the tissue distribution of ischaemia in human detrusor in patients with bladder outlet obstruction (BOO) and to correlate the results with clinical variables, as clinical BOO is a common problem in ageing men and ischaemia might be important in detrusor dysfunction.PATIENTS AND METHODSFrom September 2004 to October 2006, 70 patients were recruited, comprising 60 scheduled for surgery to treat benign prostatic hyperplasia (the study group) and 10 as controls. Detrusor tissue was retrieved and stained for hypoxia‐inducible factor (HIF)‐1α, a cellular marker of hypoxia.RESULTSThe mean (sd) total number of cells immunoreactive to HIF‐1α in the study group was 93.3 (48.09), and in the specimens from the control group only few rare cells showed weak immunoreactivity to HIF‐1α (0–2). Positive cells were in different proportions between muscle bundles and submucosa, expressed mainly in stromal cells. The urothelium and detrusor muscle showed no immunoreactivity to HIF‐1α. There was strong immunoreactivity in patients with prolonged BOO (<10 years), declining thereafter, and in those patients with urinary retention.CONCLUSIONSThe urothelium and detrusor seem to be more resistant to hypoxic stress, while stromal cells perceive low oxygen tension. The bladder response to chronic hypoxia through HIF‐1α expression is limited in time and might depend on the functional status of the detrusor.

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“…Our data showed estrogen-induced urothelial cell proliferation both in vivo and in vitro. In contrast to the muscle cell hyperplasia frequently observed in BOO, 40,41 the detrusor in AROMϩ/6J mice undergoes atrophy at 10 months of age. Similarly to AROMϩ/N males, 29,35 the AROMϩ/6J males showed high serum E 2 and low testosterone levels, decreased androgen/estrogen ratio, and disrupted reproductive development and spermatogenesis, putatively due to estrogen susceptibility of the C57Bl/6J genetic background.…”

Section: Discussionmentioning

confidence: 61%

Molecular Mechanisms of Bladder Outlet Obstruction in Transgenic Male Mice Overexpressing Aromatase (Cyp19a1)

Lin

Rahman

Lin

et al. 2011

The American Journal of Pathology

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We investigated the etiology and molecular mechanisms of bladder outlet obstruction (BOO). Transgenic (Tg) male mice overexpressing aromatase (Cyp19a1) under the ubiquitin C promoter in the estrogen-susceptible C57Bl/6J genetic background (AROM؉/ 6J) developed inguinal hernia by 2 months and severe BOO by 9 to 10 months, with 100% penetrance. These mice gradually developed uremia, renal failure, renal retention, and finally died. The BOO bladders were threefold larger than in age-matched wild-type (WT) males and were filled with urine on necropsy. Hypotrophic smooth muscle cells formed the thin detrusor urinae muscle, and collagen III accumulation contributed to the reduced compliance of the bladder. p-AKT and ER␣ expression were up-regulated and Pten expression was down-regulated in the BOO bladder urothelium. Expression of only ER␣ in the intradetrusor fibroblasts suggests a specific role of this estrogen receptor form in urothelial proliferation. Inactivation of Pten, which in turn activated the p-AKT pathway, was strictly related to the activation of the ER␣ pathway in the BOO bladders. Human relevance for these findings was provided by increased expression of p-AKT, PCNA, and ER␣ and decreased expression of PTEN in severe human BOO samples, compared with subnormal to mild samples. These findings clarify the involvement of estrogen excess and/or imbalance of the androgen/estrogen ratio in the molecular pathogenetic mechanisms of BOO and provide a novel lead into potential treatment strategies for BOO. A close interrelationship between lower urinary tract (bladder and urethra) symptoms, bladder outlet obstruction (BOO), and benign prostatic hyperplasia has been shown in aging men. 1-4 These symptoms, which include increased voiding frequency and urgency, nocturia, incomplete bladder emptying, hesitancy, weak stream, and straining, occur in mild to severe form in 50% to 85% of men over 50 years of age. 5-8 BOO, which reduces or prevents the flow of urine into the urethra, and urinary tract infection, bladder cancer, and incontinence comprise the major causes of lower urinary tract symptoms. 9,10 Congenital or acquired BOO can result in a stiff-walled, fibrotic bladder with low capacity, high pressure, and noncompliance, which may ultimately damage the kidneys. 10 The incidence of lower urinary tract symp-

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Increase in detrusor wall thickness indicates bladder outlet obstruction (BOO) in men

Cited by 155 publications

References 0 publications

Systematic Review of the Performance of Noninvasive Tests in Diagnosing Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms

Systematic Review of the Performance of Noninvasive Tests in Diagnosing Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms

Immunohistochemical estimation of hypoxia in human obstructed bladder and correlation with clinical variables

Molecular Mechanisms of Bladder Outlet Obstruction in Transgenic Male Mice Overexpressing Aromatase (Cyp19a1)

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