There were 152 patients with prostatism investigated by inflow cystometry and pressure flow analysis of micturition before and after elective prostatectomy. Many symptoms attributed to obstruction were found to be owing to bladder instability, which was demonstrated in 60 per cent of the patients. The symptomatic improvement postoperatively was accompanied by a decrease in the incidence of instability to 25 per cent. The repeat urodynamic studies and symptom analysis demonstrated a surgical success rate of 88 per cent.
169 female patients with outlet obstruction have been studied urodynamically. The results of treatment of the outlet obstruction in 102 patients have been analysed and the reason for the failures discussed. Patients with stable detrusors and those with symptoms of recurrent urinary tract infection responded well to treatment, provided this relieved the obstruction adequately; symptomatic relief was less common in patients with unstable detrusors, despite adequate outflow readjustment.
The evaluation of urodynamic function by symptomatology, clinical examination, static radiography and endoscopy is considerably less reliable than is sometimes appreciated.Since the establishment of our Urodynamic Clinic we have reviewed more than 6,000 patients with dysfunctional voiding (Turner-Warwick and Whiteside, 1969) ; synchronous cine/pressure/ flow cystography has been used in the last 3,000 of these (Bates, Whiteside and Turner-Warwick, 1970). This communication is an attempt to summarise some aspects of our present thinking related to problems of bladder neck dysfunction and outflow impairment.In considering bladder outflow obstruction we must seriously question some commonly held precepts relating to the significance of various facets: symptomatology ; the absence of post-voiding residual urine; the endoscopic evaluation of the bladder neck ; trabeculation of the bladder; the actual size of the prostate; etc.
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