Urodynamic studies in the evaluation of young men presenting with lower urinary tract symptoms

AIM: To evaluate the usefulness of urodynamic study in young men with lower urinary tract symptoms (LUTS). METHODS: We reviewed the charts of 50 men with LUTS aged 50 years and below. Those with neurological diseases, urethral trauma or strictures were excluded. All underwent multichannel urodynamic studies (UDS). The pre- and post-UDS diagnoses and treatment modalities were compared. RESULTS: Mean age was 38.1 years (17-49). The main pre-UDS diagnoses included prostatitis in seven (14%), overactive bladder in seventeen (34%) and benign prostatic hyperplasia in nine (18%). Pre-UDS management ranged from anticholingeric agents for thirteen (26%), alpha-adrenergic antagonists for nine (18%), antibiotics for six (12%). Abnormal UDS were noted in 36 (72%), including detrusor overactivity in 9 (18%), detrusor underactivity/acontractility in 5 (10%) and bladder outlet obstruction in 21 (42%). Fourteen (28%) had primary bladder neck dysfunction and five (10%) had benign prostatic hyperplasia. Post-UDS management included anticholingeric agents for ten (26%), alpha-adrenergic antagonists for seventeen (34%), catheterization for four (10%), behavioral therapy for three (6%), surgery for three (6%). None were prescribed antibiotics. Following UDS, the diagnosis had to be updated in 40 (80%) and concomitant change in management was required in 34 (68%). CONCLUSION: Young men presenting with LUTS have different underlying etiologies. Clinical diagnosis and treatment are often empiric and inaccurate. Urodynamic study is useful in the evaluation of this group of patients as it aids in arriving at an accurate diagnosis and guides treatment therapy.     

良性前列腺增生中医证型与尿动力学参数相关性研究

目的:探讨良性前列腺增生(BPH)中医证型与尿动力学参数的相关性。方法:152例BPH患者,中医辨证分为肾阴不足、肾阳虚弱、瘀阻水道、脾气虚弱、肺热气郁、湿热下注、痰浊郁结七型,均进行尿动力学检查。结果:152例BPH患者中,肾阳虚弱型71例(46.71%),瘀阻水道型40例(26.31%),肾阴不足型14例(9.21%)。膀胱出口梗阻为III～VI度肾阳虚弱型有58例,瘀阻水道型有38例,其中严重梗阻(V～VI)26例。膀胱逼尿肌收缩功能极弱中(n=12),肾阳虚弱型4例,占33.33%(4/12),瘀阻水道型7例,占58.33%(7/12);膀胱逼尿肌收缩功能弱者中(n=48),肾阳虚弱型为27例,占56.25%(27/48),瘀阻水道型17例,占35.42%(17/48)。结论:BPH中医各辨证分型与膀胱出口梗阻和膀胱逼尿肌收缩力有一定的相关性,从而为中医证型的量化和客观化提供相应的证据。     

手术治疗伴逼尿肌乏力的前列腺增生症

目的探讨BPH并有逼尿肌乏力(ACD)的病人是否手术等问题,为BPH并有逼尿肌乏力的病人治疗方法的选择提供依据.方法对尿动力学检查确认有ACD的15例BPH进行手术治疗.手术后复查尿流率.对所得数据进行自身配对t检验.结果术前和术后最大尿流率分别为(3.3±3.1)ml/s和(14.88±6.08)ml/s(P＜0.05).结论在前列腺摘除后,BPH伴有逼尿肌乏力的病人也能够产生有效排尿.故对确有膀胱出口梗阻(BOO)存在的BPH病人,即使有逼尿肌收缩乏力,也应积极手术.     

尿动力学在前列腺增生诊疗中的策略及其理论支撑

BPH患者的梗阻性和刺激性下尿路症状多种多样，缺乏特异性。尿动力学检鹰对BPH患者确定膀胱出口梗阻部位及程度、评估逼尿肌功能状态、预测手术疗效和并发症、术后评价疗效及分析并发症的原因均有重要的应用价值，对于合理选择BPH治疗策略的参考作用不可替代。     

D-004 ameliorates phenylephrine-induced urodynamic changes and increased prostate and bladder oxidative stress in rats

Background

Lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) mainly depend on alpha1-adrenoreceptors (α₁-ADR) stimulation, but a link with oxidative stress (OS) is also involved. D-004, a lipid extract of Roystonea regia fruits, antagonizes ADR-induced responses and produces antioxidant effects. The objective of this study was to investigate whether D-004 produce antioxidant effects in rats with phenylephrine (PHE)-induced urodynamic changes.

Methods

Rats were randomized into eight groups (ten rats/group): a negative vehicle control and seven groups injected with PHE: a positive control, three treated with D-004 (200, 400 and 800 mg/kg) and three others with tamsulosin (0.4 mg/kg), grape seed extract (GSE) (250 mg/kg) and vitamin E (VE) (250 mg/kg), respectively.

Results

Effects on urinary total volume (UTV), volume voided per micturition (VM), malondialdehyde (MDA) and carbonyl groups (CG) concentrations in prostate and bladder homogenates were study outcomes. While VM and UTV lowered significantly in the positive control as compared to the negative control group, the opposite occurred with prostate and bladder MDA and CG values. D-004 (200-800 mg/kg) increased significantly both VM and UTV, lowered significantly MDA in prostate and bladder homogenates, and reduced GC levels only in the prostate. Tamsulosin increased significantly VM and UTV, but unchanged oxidative variables. GSE and VE unchanged the UTV, whereas VE, not GSE, modestly but significantly attenuated the PHE-induced decrease of VM.

Conclusions

Single oral administration of D-004 (200-800 mg/kg) was the only treatment that ameliorated the urodynamic changes and reduced increased oxidative variables in the prostate of rats with PHE-induced prostate hyperplasia.