Urodynamics of men with urinary retention

Guo, David; Comiter, Craig V.; Elliott, Christopher S.

doi:10.1111/iju.13395

Cited by 8 publications

(5 citation statements)

References 21 publications

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“…In this study, detrusor contractility appeared to degrade over time with bladder outlet obstruction, and PVR increased with contractility impairment. These results are consistent with those of Chen et al who showed a decrease in BCI and an increase in PVR over time 15 and Guo et al who demonstrated that more than 75% of patients with urinary retention had impaired contractility, 1 supporting the hypothesis of a progressive degradation of contractility related to bladder outlet obstruction.…”

Section: Discussionsupporting

confidence: 92%

“…These voiding disorders can be related to a bladder outlet obstruction, most frequently benign prostatic hyperplasia in men, and/or an impaired detrusor contractility. Bladder outlet obstruction may itself lead to a progressive detrusor contractility alteration, decreasing the ability of the detrusor to respond to high bladder filling with thus a risk of urinary retention 1 . A better understanding of the factors related to detrusor contractility is therefore essential for the diagnostic and therapeutic management of voiding disorders.…”

Section: Introductionmentioning

confidence: 99%

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Effect of bladder filling volume on detrusor contractility in men with bladder outlet obstruction

Hermieu

Chesnel

Teng

et al. 2022

Neurourology and Urodynamics

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Introduction: Bladder outlet obstruction alters detrusor contractility, reducing the bladder's ability to respond to large filling with a risk of urinary retention. The objective was to assess the effect of bladder filling volume on detrusor contractility in men with bladder outlet obstruction.Methods: A prospective multicenter study in two pelviperineology departments. Male patients eligible for urodynamics (IPSS score > 7) were included from January to July 2022. In case of absence of bladder outlet obstruction on pressure-flow studies, they were secondarily excluded. The primary endpoint was the maximum isometric detrusor pressure during a stop-test, corresponding to detrusor contractility, measured at 3 filling volumes (50%, 75%, and 100% of cystometric capacity).Results: Fifty-two patients performed urodynamics, of whom 12 were excluded because of lack of obstruction or inability to perform the stop-test. Detrusor contractility was significantly higher for a 75% bladder filling than 50% and for a 75% filling than 100%, with a mean difference of 19.5; confidence interval (CI) 95% [14.3; 24.8] and 12.2; CI 95% [6.9; 17.5] cmH 2 O respectively (p < 0,01). Conclusion:In case of bladder outlet obstruction in men, detrusor contractility depends on bladder filling volume, with reduced contractility when the bladder was underfilled or overfilled. This phenomenon could help to explain the mechanisms of urinary retention in men with bladder outlet obstruction.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Effect of bladder filling volume on detrusor contractility in men with bladder outlet obstruction

Hermieu

Chesnel

Teng

et al. 2022

Neurourology and Urodynamics

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“…For men with DU and BOO who underwent surgery, only 64% of patients reported that they were satisfied with the surgery [ 12 ]. Guo et al [ 43 ] found that a total of 60% men with urinary retention have BOO. This highlights that prostate surgery may not adequately control all urinary retention cases and also that not all urinary retention patients need receive prostate surgery.…”

Section: Diagnosis and Evaluation (Shown In Table 1 )mentioning

confidence: 99%

Detrusor Underactivity in Men with Bladder Outlet Obstruction

2022

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Detrusor underactivity (DU) and bladder outlet obstruction (BOO) are both common troublesome causes of lower urinary tract symptoms (LUTS) and often impact on quality of life simultaneously in men. This article aims to focus on DU with BOO in male patients. Methods: Original articles concerning DU with BOO were identified through literature research from PubMed and EMBASE database. We selected 38 articles in our review, including those concerning pathophysiology, evaluation, treatment and predictors for a successful BOO surgery for DU. Results: DU from BOO can result from several pathophysiological mechanisms. Although urodynamic study (UDS) is considered as a precise method to diagnose DU and BOO, there are some previous studies which proposed a non-invasive method to identify DU related to BOO. The treatment goal of DU is restoring bladder contractility using medication or surgery. Releasing outlet obstruction and resistance is the main strategy to restore bladder contractility when medication to directly increase bladder contractility has had limited efficacy. Conclusions: DU from BOO is poorly understood and is largely under-researched. The etiology and pathophysiology still need to be evaluated. Effective and safe medication to restore bladder contractility is also lacking. It remains valuable to perform further research to reveal the unknown aspects of DU.

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“…Guo DP. et al [10], при оцінюванні уродинамічного дослідження 67 чоловіків із затримкою сечі визначив, що середня Q max становила 3 мл/с, PdetQ max 54 см H 2 O. Обструкція вихідного отвору сечового міхура була діагностована у 60% хворих. За індексом скорочувальної здатності сечового міхура гіпоактивність детрузора була у 73 %; однак лише 29% були класифіковані як такі, що мають Рис.…”

Section: лікування захворювань що супроводжуються інфравезикальною об...unclassified

Treatment of Diseases Accompanied by Infravesical Obstruction in Young Men

Nikitin¹,

Reznikovov²

2022

Ukr. ž. med. bìol. sportu

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The purpose of the work was to study the possibilities of conservative and surgical treatment of infravesical obstruction in young patients with lower urinary tract symptoms. Materials and methods. Urodynamic diagnosis of infravesical obstruction due to increased resistance of the prostatic part of the urethra was established in 36 patients, whose age was 32.76 ± 1.13 years on average. The volume of the prostate gland according to transrectal ultrasound examination varied from 18 to 32 cm3 (on average 24.05 ± 1.28 cm3). Based on the results of a complex urodynamic study, 3 groups were identified: group 1 – 12 (33.3%) patients with infravesical obstruction with low-amplitude detrusor hyperactivity in the filling phase; group 2 – 13 (36.1%) patients with infravesical obstruction without an abdominal component during urination; group 3 – 11 (30.6%) men with infravesical obstruction in the presence of an abdominal component during urination. The control group included 16 men aged 21–48 years (on average 36.32 ± 2.34 years), who had no lower urinary tract symptoms. The effectiveness of drug therapy was assessed by comparing the initial indicators and quality of life indicators after 1 month, the IPSS index, the maximum volumetric rate of urination, and the residual urine volume. Results and discussion. To select the first line of therapy, the data of a complex urodynamic study and other examination methods (tamsulosin 0.4 mg, tamsulosin 0.4 mg + solifenacin 5 mg or tamsulosin 0.4 mg + mirabegron 25 mg) were taken into account. 16 patients who felt improvement after 1 month of drug treatment continued to experience it for 12–18 months. 17 (47.2%) persons out of 36 examined patients underwent surgical intervention due to symptoms of infravesical obstruction: 14 (70.0%) out of 20 – in whom drug therapy did not achieve the expected effect and 3 patients who refused conservative therapy despite its effectiveness. The patients underwent transurethral resection of the prostate gland. 12–18 months after observation, the patients determined a significant improvement in their condition, namely, in all parameters there was no significant difference from the control indicators. Conclusion. The effectiveness of conservative therapy in young men with infravesical obstruction reaches only 44.4%. But in case of improvement from treatment after 1 month, the stable positive effect of this type of treatment remains for 12–18 months. We believe that the main cause of infravesical obstruction in this contingent of patients may be benign prostatic hyperplasia, which debuted at earlier terms. Observation and treatment of this group of patients should be carried out according to the same principles as in patients with a similar pathology of an older age. If conservative therapy is ineffective within 1 month in this contingent of patients, transurethral resection of the prostate gland is indicated. After 12–18 months of observation, the operated patients determined a significant improvement in their condition, namely – in all parameters there was no significant difference from the control indicators. Thus, in case of absence of effectiveness of drug therapy in young male patients with infravesical obstruction, minimally invasive surgical intervention can significantly improve the quality of life, normalize urodynamic indicators, and reduce the IPSS score

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Urodynamics of men with urinary retention

Cited by 8 publications

References 21 publications

Effect of bladder filling volume on detrusor contractility in men with bladder outlet obstruction

Effect of bladder filling volume on detrusor contractility in men with bladder outlet obstruction

Detrusor Underactivity in Men with Bladder Outlet Obstruction

Treatment of Diseases Accompanied by Infravesical Obstruction in Young Men

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