Urodynamics in benign prostatic hyperplasia

Current Opinion in Urology

Volumn 6, Issue 4, 1996, Pages 184-188

  Höfner, Klaus ^a   Jonas, Udo ^a  

^a HANNOVER MEDICAL SCHOOL   (Germany)

Author keywords

[No Author keywords available]

Indexed keywords

BLADDER NECK STENOSIS; HUMAN; MALE; MICTURITION; PRACTICE GUIDELINE; PRIORITY JOURNAL; PROSTATE HYPERTROPHY; RESIDUAL URINE; REVIEW; TREATMENT PLANNING; URODYNAMICS;

EID: 0029744384     PISSN: 09630643     EISSN: None     Source Type: Journal    
DOI: 10.1097/00042307-199607000-00004     Document Type: Review

References (31)

1. McConnell JD, Barry MJ, Bruskewitz RC, Bueschen AJ, Denton SE, Holtgrewe HL, Lange JL, McClennan BL, Mebust WK, Reilly NJ et al.: Benign prostatic hyperplasia: diagnosis and treatment Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services; 1994.
2. Cockett AT, Aso Y, Denis L, Murphy G, Khoury S, Abrams P, Barry M, Carlton GE, Fitzpatrick J, Gibbons R et al.: Recommendations of the International Consensus Committee concerning: 1. Prostate Symptom Score (I-PSS) and quality of life assessment, 2. Diagnostic work-up of patients presenting with symptoms suggestive of prostatism, 3. Standardization of the evaluation of treatment modalities, 4. BPH treatment recommendations. In The 2nd International Consultation on Benign Prostatic Hyperplasia (BPH), Paris, June 27-30, 1993, Proceedings. Edited by Cockett ATK, Khoury S, Aso Y, Chatelain C, Denis L, Griffiths K, Murphy G. Jersey, Channel Islands: Scientific Communication International Ltd; 1993: 553-564.
3. Chancellor MB, Rivas DA: American Urological Association Symptom Index for women with voiding symptoms: lack of index specificity for benign prostate hyperplasla. J Urol 1993, 150:1706-1706.
4. Chancellor MB, Rivas DA, Keeley FX, Lotfi MA, Gomella LG: Similarity of the American Urological Association Symptom Index among men with benign prostate hyperplasia (BPH), urethral obstruction not due to BPH and detrusor hyperreflexia without outlet obstruction. Br J Urol 1994, 74:200-203.
5. Reynard JM, Abrams P: Bladder-outlet obstruction - assessment of • symptoms. World J Urol 1995, 13:3-8. Using current concepts of urethral pressure-flow relationships, the relationship between the 'obstructive' symptoms of BPH, objective evidence of abnormal voiding and BOO was studied. Only the symptoms of hesitancy and poor flow were found to be related to BOO significantly. The symptoms of straining to void, intermittency, terminal dribbling and feeling of incomplete bladder emptying were not specific for BOO.
6. Nitti VW, Kim Y, Combs AJ: Correlation of the AUA Symptom Index with urodynamics in patients with suspected benign prostatic hyperplasia. Neurourol Urodyn 1994, 13:521-527.
7. Yalla SV, Sullivan MP, Lecamwasam HS, DuBeau CE, Vickers MA, • Cravalho EG: Correlation of American Urological Association Symptom Index with obstructive and nonobstructlve prostatism. J Urol 1995, 153:674-679. To establish the relationship between the AUA Symptom Score Index and prostatic obstruction, 125 men with voiding dysfunction presumably related to BPH were analyzed and video urodynamic studies were done, including micturitional urethral pressure profilometry for specifically diagnosing outlet obstruction. The mean AUA Symptom Index in the patients with obstruction was not statistically different from that in the non-obstructed group. Of the severely symptomatic patients, 22% did not have obstruction, whereas all mildly symptomatic patients did. No significant correlations were found between the severity of obstruction and the AUA Symptom Index in either group.
8. van Venrooij GE, Boon TA, de Gier RP: International prostate • symptom score and quality of life assessment versus urodynamic parameters in men with benign prostatic hyperplasia symptoms. J Urol 1995, 153:1516-1519. In 207 men with symptomatic BPH, the IPSS and score on quality of life were collected and pressure-flow studies were performed. No correlation was found between obstruction grade and any symptom score or quality of life score, while symptom score and quality of life correlated well.
9. 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, 154:396-398. One hundred and twenty-one consecutive, symptomatic patients older than 55 years were investigated with the AUA Symptom Score and multichannel pressure-flow urodynamic studies using the Schäfer nomogram for assessment of outflow obstruction. There were no significant correlations between uroflowmetry and BOO, uroflowmetry and AUA Symptom Scores and AUA Symptom Scores and BOO. The authors conclude that the parameters are independent variables and should not be linked in the evaluation and treatment decision of the patient with prostatism.
10. McConnell JD: Editorial: Benign prostatic hyperplasia. J Urol 1995, •• 154:402-403. The author discusses the relationship between symptoms and pressure-flow studies and the value of pressure-flow studies as a baseline investigation.
11. 3, no urodynamic evidence of BOO was found. There was no correlation between symptom scores and the grade of BOO or prostate size.
12. Bosch JL, Kranse R, van Mastrigt R, Schroder FH: Reasons for the • weak correlation between prostate volume and urethral resistance parameters in patients with prostatism. J Urol 1995, 153:689-693. In this study, parameters that selectively quantify the compression type of obstruction correlated weakly to moderately with prostate volume, whereas parameters that mainly quantify constriction do not correlate at all with prostate volume. The variation in prostate volume was found to determine the variation in urethral resistance by 15% or less depending on the parameter used, which implies that the different pathophysiological mechanisms that can increase urethral resistance in the complex process of clinical BPH are mainly determined by factors other than the volume of the prostate.
13. Girman CJ, Jacobsen SJ, Guess HA, Oesterling JE, Chute CG, Panser • LA, Lieber MM: Natural history of prostatism: relationship among symptoms, prostate volume and peak urinary flow rate. J Urol 1995, 153:1510-1515. Relationships are described among symptoms, prostate volume and peak urinary flow rate in an age-stratified, community-based random sample of white men 40-79 years of age with no prior prostate surgery, prostate cancer or other conditions known to interfere with voiding. The results, based on randomly selected White men, suggest a somewhat stronger, albeit modest, relationship among symptoms, prostate size and urinary flow rate than previously reported in clinic-based studies.
14. Bissada NK, Finkbeiner AE, Redman JF: Accuracy of preoperative estimation of resection weight in transurethral prostatectomy. J Urol 1976, 116:201-202.
15. Jensen KM, Bruskewitz RC, Iversen P, Madsen PO: Significance of prostatic weight in prostatism. Urol Int 1983, 38:173-178.
16. Kaplan SA, Te AE, Pressler LB, Olsson CA: Transition zone index as a • method of assessing benign prostatic hyperplasia: correlation with symptoms, urine flow and detrusor pressure. J Urol 1995, 154:1764-1769. Sixty-one men with symptomatic BPH were evaluated prospectively according to symptoms, peak urine flow, pressure-flow analysis, transrectal ultrasound volume of the prostate and the transition zone, and calculation of a TZI. There was a stronger correlation between transition zone and symptoms and peak urine flow and a significant correlation between TZI and symptoms, peak urine flow and detrusor pressure at peak urine flow. A TZI of greater than 0.5 was a useful cut-off point and significant for delineating patients with more severe abnormalities of symptoms, peak urine flow, and detrusor pressure at peak urine flow.
17. Watanabe H: Diagnosis of benign prostatic hypertrophy by ultrasound and outcome from surgery. Aktuel Urol 1993, 24(suppl):127-130.
18. Krah H, Höfner K, Tan HK, Schäfer J, Hoffmann J, Jonas U: The shape •• of the prostate in transrectal ultrasound is no parameter to quantify mechanical obstruction. Aktuel Urol 1995, 26(suppl):119-120. This paper deals with the clinical value of the presumed circle area ratio derived from transrectal ultrasound of the prostate from which a correlation with BOO was assumed by Watanabe [17]. A correlation with the parameters of computerized pressure-flow analysis could not be confirmed.
19. Jensen KM-E: Uroflowmetry in elderly men. World J Urol 1995, • 13:21-23. In this article, a comprehensive review about the clinical value of uroflowmetry is given. The author draws the reader's attention to several pitfalls, such as artefacts, circadian changes, observer variations, volume threshold, relevant variables, reference values and clinical applicability.
20. Jensen KM, Jorgensen JB, Mogensen P: Urodynamics in prostatism. I. Prognostic value of uroflowmetry. Scand J Urol Nephrol 1988, 22:109-117.
21. max less than 10 ml/s, who showed statistically the same grade of mechanical obstruction as patients with a maximum flow rate more than 15 ml/s.
22. Bosch JLHR: Postvoid residual urine in the evaluation of men with • benign prostatic hyperplasia. World J Urol 1995, 13:17-20. This article reviews current opinions about the cause of postvoid residual urine, methods and accuracy of measurement, correlations between postvoid residual urine and symptoms as well as physiological measures of BPH and the role of postvoid residual urine determination in the evaluation of BPH patients. Community based data obtained on postvoid residual urine in men aged between 55 and 74 years in the city of Rotterdam are reported.
23. Nielsen KK, Nordling J, Hald T: Critical review of the diagnosis of prostatic obstruction. Neurourol Urodyn 1994, 13:201-217.
24. McConnell JD: Benign prostatic hyperplasia: treatment guidelines • and patient classification. Br J Urol 1995, 76(suppl 1):29-46. The author, chairman of the US BPH Guideline Panel, introduces in this fundamental review the history, background, contents, aims and conclusions of two current recommendations on the diagnosis and treatment of BPH (USA Government's AHCPR BPH Guideline Panel and the International Guidelines from the second International Consultation on BPH).
25. Lim CS, Abrams P: The Abrams-Griffiths nomogram. World J Urol • 1995, 13:34-39. The Abrams/Griffiths nomogram is presented as an easy method to distinguish between the presence or absence of obstruction. Using the values for the maximal flow and the corresponding voiding detrusor pressure a point can be plotted on the nomogram that determines whether the bladder outlet is obstructed, unobstructed, or equivocally obstructed. The Abrams/ Griffiths nomogram can be modified by assigning an Abrams/Griffiths number to each set of pressure-flow data.
26. van Mastrigt R, Kranse M: Analysis of pressure-flow data in terms of • computer-derived urethral resistance parameters. World J Urol 1995, 13:40-46. In this paper some aspects of the fundamental differences between pressure-flow analysis methods are discussed and illustrated. Subsequently, the properties and clinical performance of two computer-based methods for deriving continuous urethral resistance parameters are discussed.
27. Schäfer W: Analysis of bladder-outlet function with the linearized • passive urethral resistance relation, linPURR, and a disease-specific approach for grading obstruction: from complex to simple. World J Urol 1995, 13:47-58. Based on the concept of PURR a simple linearized format of the linear PURR is presented. Adding the actual linear PURR to an author's specific pressure-flow diagram an individual assessment is possible. The detrusor-adjusted mean PURR factor is an alternative format of reducing the PURR to a single number.
28. Höfner K, Kramer AE, Tan HK, Krah H, Jonas U: CHESS classification • of bladder-outflow obstruction: a consequence in the discussion of current concepts. World J Urol 1995, 13:59-64. One hundred and eighteen BPH patients were selected for computerized pressure-flow data analysis according to quadratic PURR function. After the documentation of a missing significant correlation of the PURR parameter footpoint and curvature/slope, the CHESS classification was developed as a two-dimensional 4 × 4 plane. The PURR footpoint was classified with the letters A, B, C and D, the PURR curvature/slope with the numbers 1, 2, 3, and 4.
29. Spangberg A: Estimation of urethral resistance by curve fitting in the •• pressure-flow plot Theory and experience in normal men and men with benign prostatic hypertrophy. World J Urol 1995, 13:65-69. The curvature of the urethral resistance relation was estimated in 21 normal men, in 32 prostatism patients, in 60 men with a diagnosis of BPH and obstruction, and in 55 men after treatment of BPH. Fifty-eight per cent of the normal men and prostatism patients had a urethral resistance relation with the convexity directed upward, demonstrating a low-compliant type of distensibility. After transurethral prostatectomy, significantly more men had the convexity of the urethral resistance relation directed downward, showing that the distensibility was more of a constrictive type. The use of several curvatures is recommended.
30. Schäfer W: Urethral resistance? Urodynamic concepts of physiological and pathological bladder outlet function during voiding. Neurourol Urodyn 1985, 4:161-201.
31. McConnell JD: Why pressure-flow studies should be optional and not mandatory studies for evaluating men with benign prostatic hyperplasia [Editorial]. Urology 1994, 44:156-158.