Cluster analysis of men undergoing surgery for BPH/LUTS reveals prominent roles of both bladder outlet obstruction and diminished bladder contractility

Lower urinary tract symptoms (LUTS) in aging men are commonly attributed to bladder outlet obstruction from benign prostatic hyperplasia (BPH) but BPH/LUTS often reflects a confluence of many factors. We performed a hierarchical cluster analysis using four objective patient characteristics (age, HTN, DM, and BMI), and five pre-operative urodynamic variables (volume at first uninhibited detrusor contraction, number of uninhibited contractions, Bladder Outlet Obstruction Index (BOOI), Bladder Contractility Index (BCI) and Bladder Power at Qmax) to identify meaningful subgroups within a cohort of 94 men undergoing surgery for BPH/LUTS. Two meaningful subgroups (clusters) were identified. Significant differences between the two clusters included Prostate Volume (95 vs 53 cc; p-value = 0.001), BOOI (mean 70 vs 49; p-value = 0.001), BCI (mean 129 vs 83; p-value <0.001), Power (689 vs 236; p-value <0.001), Qmax (8.3 vs 4.9 cc/sec; p-value <0.001) and post-void residual (106 vs 250 cc; p-value = 0.001). One cluster is distinguished by larger prostate volume, greater outlet resistance and better bladder contractility. The other is distinguished by smaller prostate volume, lower outlet resistance and worse bladder contractility. Remarkably, the second cluster exhibited greater impairment of urine flow and bladder emptying. Surgery improved flow and emptying for patients in both clusters. These findings reveal important roles for both outlet obstruction and diminished detrusor function in development of diminished urine flow and impaired bladder emptying in patients with BPH/LUTS.

Download Full-text

Role of Uttarabasti in the management of Functional Bladder Outlet Obstruction: A Case Study

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v2i3.8243 ◽

2017 ◽

Vol 2 (3) ◽

Author(s):

Jaimin R. Patel

Keyword(s):

Bladder Outlet Obstruction ◽

Outlet Obstruction ◽

Urine Flow ◽

Complete Relief ◽

Urinary Flow ◽

Detrusor Sphincter Dyssynergia ◽

Symptom Appraisal ◽

Prostatic Enlargement ◽

Normal Urine ◽

Outflow Channel

Bladder outlet obstruction (BOO) produces compression or resistance upon the bladder outflow channel at any location from the bladder neck to urethral meatus. It may be induced by specific functional and anatomic causes. Functional obstruction may be caused by detrusor-sphincter dyssynergia (DSD) and anatomic obstruction most commonly from benign prostatic enlargement (BPH) or urethral stricture. Obstructive symptoms include hesitancy, sensation of incomplete bladder emptying, diminished urinary stream. The combination of PVR, urinary flow measures, and symptom appraisal has been generally accepted as the initial screening and evaluation paradigm for BOO. In, Ayurveda, BOO is similar to Mutraghata means obstruction in the urine flow. Uttarbasti is the prime treatment of Mutraghata. Present case is diagnosed as a functional bladder outlet obstruction (BOO) on the basis of symptoms, normal reports of USG and ascending urethrogram and diminished flow of urine in Uroflowmetry. Total 7 Uttarbasti with 50ml Sahcharadi Tailam was given along with Rasayana and Mutraghatahara medicine. Patient has complete relief in his obstructive urine complains and has normal urine flow without taking Tab. AFDURA after 7 years. And also improvement appear in Uroflowmetry.

Download Full-text

Correlation of intravesical prostatic protrusion with severity of lower urinary symptoms among patients with benign prostatic hyperplasia

African Journal of Urology ◽

10.1186/s12301-020-00102-0 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Babatunde K. Hamza ◽

Muhammed Ahmed ◽

Ahmad Bello ◽

Musliu Adetola Tolani ◽

Mudi Awaisu ◽

...

Keyword(s):

Flow Rate ◽

Bladder Outlet Obstruction ◽

Peak Flow ◽

Prostate Volume ◽

Outlet Obstruction ◽

Peak Flow Rate ◽

The Mean ◽

Benign Prostate ◽

Intravesical Prostatic Protrusion ◽

Lower Urinary

Abstract Background Benign prostate hyperplasia (BPH) is characterized by an increase in the number of epithelial and stromal cells in the periurethral area of the prostate. Lower urinary tract symptoms (LUTS) often develop as a manifestation of bladder outlet obstruction (BOO) due to benign prostate enlargement. When the prostate enlarges, protrusion into the bladder often occurs as a result of morphological changes of the gland. Prostatic protrusion into the bladder can be measured with ultrasound as intravesical prostatic protrusion (IPP). There are studies that have shown IPP as a reliable predictor of bladder obstruction index (BOOI) as measured by pressure flow studies. IPP is thereby reliable in assessing the severity of BOO in patients with BPH. The severity of symptoms in patients with BPH can be assessed through several scoring systems. The most widely used symptoms scoring system is the International Prostate Symptoms Score (IPSS). The aim of this study is to determine the correlation of IPP with IPSS in men with BPH at our facility. Methods The study was a cross-sectional observational study that was conducted at the Division of Urology, Department of Surgery, in our facility. The study was conducted on patients greater than 50 years LUTS and an enlarged prostate on digital rectal examination and/or ultrasound. All consenting patients were assessed with the International Prostate Symptoms Score (IPSS) questionnaire, following which an abdominal ultrasound was done to measure the intravesical prostatic protrusion (IPP), prostate volume (PV) and post-void residual (PVR) urine. All the patients had uroflowmetry, and the peak flow rate was determined. The data obtained were entered into a proforma. The results were analyzed using Statistical Package for Social Sciences (SPSS) software package version 20. Results A total of 167 patients were seen during the study period. The mean age was 63.7 ± 8.9 years, with a range of 45–90 years. The mean IPSS was 18.24 ± 6.93, with a range of 5–35. There were severe symptoms in 49.1%, while 43.1% had moderate symptoms and 7.8% had mild symptoms. The overall mean IPP was 10.3 ± 8 mm. Sixty-two patients (37.1%) had grade I IPP, 21 patients (12.6%) had grade II IPP and 84 patients (50.3%) had grade III IPP. The mean prostate volume and peak flow rate were 64 g ± 34.7 and 11.6 ml/s ± 5.4, respectively. The median PVR was 45 ml with a range of 0–400 ml. There was a significant positive correlation between the IPP and IPSS (P = 0.001). IPP also had a significant positive correlation with prostate volume and post-void residual and a significant negative correlation with the peak flow rate (P < 0.01). Conclusion Intravesical prostatic protrusion is a reliable predictor of severity of LUTS as measured by IPSS, and it also shows good correlation with other surrogates of bladder outlet obstruction.

Download Full-text

Alterations in purinergic and cholinergic components of contractile responses of isolated detrusor contraction in a rat model of partial bladder outlet obstruction

BJU International ◽

10.1111/j.1464-410x.2006.06010.x ◽

2006 ◽

Vol 97 (2) ◽

pp. 372-378 ◽

Cited By ~ 19

Author(s):

FREDERICK C.L. BANKS ◽

GILLIAN E. KNIGHT ◽

ROBERT C. CALVERT ◽

ROBERT J. MORGAN ◽

GEOFFREY BURNSTOCK

Keyword(s):

Rat Model ◽

Bladder Outlet Obstruction ◽

Outlet Obstruction ◽

Detrusor Contraction ◽

Contractile Responses ◽

Partial Bladder Outlet Obstruction

Download Full-text

DETRUSOR CONTRACTION DURATION AS A URODYNAMIC PARAMETER OF BLADDER OUTLET OBSTRUCTION FOR EVALUATING MEN WITH LOWER URINARY TRACT SYMPTOMS

The Journal of Urology ◽

10.1097/00005392-199808000-00052 ◽

1998 ◽

pp. 482-486 ◽

Cited By ~ 1

Author(s):

KANAME AMEDA ◽

GRAEME S. STEELE ◽

MARYROSE P. SULLIVAN ◽

DORON STEMBER ◽

SUBBARAO V. YALLA

Keyword(s):

Urinary Tract ◽

Lower Urinary Tract Symptoms ◽

Bladder Outlet Obstruction ◽

Lower Urinary Tract ◽

Outlet Obstruction ◽

Detrusor Contraction ◽

Contraction Duration ◽

Urinary Tract Symptoms ◽

Urodynamic Parameter ◽

Lower Urinary

Download Full-text

MRI texture features may predict differentiation and nodal stage of cervical cancer: a pilot study

Acta Radiologica Open ◽

10.1177/2058460117729574 ◽

2017 ◽

Vol 6 (10) ◽

pp. 205846011772957 ◽

Cited By ~ 16

Author(s):

Anton S Becker ◽

Soleen Ghafoor ◽

Magda Marcon ◽

Jose A Perucho ◽

Moritz C Wurnig ◽

...

Keyword(s):

Cervical Cancer ◽

Cluster Analysis ◽

Texture Analysis ◽

Texture Features ◽

Hierarchical Cluster ◽

Nodal Status ◽

P Value ◽

Tumor Differentiation ◽

Pelvic Mri ◽

Poorly Differentiated

Background Texture analysis in oncological magnetic resonance imaging (MRI) may yield surrogate markers for tumor differentiation and staging, both of which are important factors in the treatment planning for cervical cancer. Purpose To identify texture features which may predict tumor differentiation and nodal status in diffusion-weighted imaging (DWI) of cervical carcinoma Material and Methods Twenty-three patients were enrolled in this prospective, institutional review board (IRB)-approved study. Pelvic MRI was performed at 3-T including a DWI echo-planar sequence with b-values 40, 300, and 800 s/mm2. Apparent diffusion coefficient (ADC) maps were used for region of interest (ROI)-based texture analysis (32 texture features) of tumor, muscle, and fat based on histogram and gray-level matrices (GLM). All features confounded by the ROI size (linear model) were excluded. The remaining features were examined for correlations with histological differentiation (Spearman) and nodal status (Kruskal–Wallis). Hierarchical cluster analysis was used to identify correlations between features. A P value < 0.05 was considered statistically significant. Results Mean age was 55 years (range = 37–78 years). Biopsy revealed two well-differentiated, eight moderately differentiated, two moderately to poorly differentiated tumors, and five poorly differentiated tumors. Six tumors could not be graded. Lymph nodes were involved in 11 patients. Three GLM features correlated with the differentiation: LRHGE (ϱ = 0.53, P = 0.03), ZP (ϱ = –0.49, P < 0.05), and SZE (ϱ = –0.51, P = 0.04). Two histogram features, skewness (0.65 vs. 1.08, P = 0.04) and kurtosis (0.53 vs. 1.67, P = 0.02), were higher in patients with positive nodal status. Cluster analysis revealed several co-correlations. Conclusion We identified potentially predictive GLM features for histological tumor differentiation and histogram features for nodal cancer stage.

Download Full-text