Thirty-two patients with voiding dysfunction attributable to symptomatic benign prostatic hyperplasia were treated with naftopidil, an alpha 1-blocker, at doses of 25-75 mg/day for 4-6 weeks. The efficacy of the drug was assessed from the changes in urinary symptoms and urodynamic data. Total symptom scores were significantly reduced after treatment (P < 0.001). Average flow rate and maximum flow rate were significantly increased (P < 0.001 and P < 0.001, respectively), and residual urine volume, residual urine rate (ratio of residual urine volume/sum of voided volume and residual urine volume), and maximum urethral closure pressure were significantly (P < 0.05, P < 0.01, and P < 0.05, respectively) reduced, and at bladder capacity, the first desire to void was significantly (P < 0.05) increased. The pressure/flow study demonstrated no changes in intravesical pressure at maximum flow, but a significant (P < 0.05) reduction in minimum urethral resistance. A mild side effect (dizziness) was noted in one patient (3.3%), which soon disappeared after the dose was decreased. The efficacy was good or excellent in 21 of 30 patients (70.0%). The drug was evaluated to be promising in the treatment of bladder outlet obstruction due to benign prostatic hyperplasia.
A pressure-flow study was performed with a 5-micro-tip transducer catheter in 6 normal male volunteers (bladder neck diameters 0.80 cm. or larger) and 13 male subjects suspected of having bladder neck contracture. Intraurethral pressure was measured at various sites in the urethra at maximum flow to calculate hydraulic energy at these sites using the Bernoulli equation. When the subjects were divided into 2 groups (1 group with a bladder neck diameter of 0.73 cm. or larger and 1 with a bladder neck diameter of 0.60 cm. or smaller), the relative value of energy (ratios to the initial energy generated in the bladder) at the external urethral sphincter was significantly (p < 0.01) greater in the former than in the latter group. Therefore, the "flow rate controlling zone" lies at the external urethral sphincter in the former group and at the bladder neck in the latter group.
A 7 3-year-old man presented with pain in the right flank and fever. A ureteroduodenal fistula was demonstrated by intravenous pyelography and excised with nephroureterectomy. This seems to be the 8th case of such a lesion.
External urethral function was urodynamically examined in 13 patients with benign prostatic hypertrophy (BPH) associated with chronic urinary retention and in 5 volunteers. Prevoiding drop in external urethral sphincter pressure was noted in all the volunteers, whereas it was not found in 6 of the 13 cases of BPH. Bladder neck opening pressure was higher in these 6 cases (p < 0.05). After administration of phentolamine, prevoiding drop was noted in 5 of these 6 cases and bladder neck opening pressure decreased so much that there was no significant intergroup difference. The above results mean that the increase in α-adrenergic receptors makes the prostate, which has been already hypertrophied, less elastic, inhibiting external urinary sphincter function.
Thirty-one patients with intervertebral disc prolapse (IDP) underwent urodynamic study before surgical operation. The lesion was located between C4 and T10 in 14, T11 and L2 in 2 and L2 and S1 in 15 patients. Preoperative urinary symptoms were obstructive in 11 (36%), irritative in 5 (16%) and both obstructive and irritative in 5 (16%) patients, and the remaining 19 patients (32%) had no symptoms. Preoperative urodynamic abnormalities were noted in 23 cases (74%): abnormal urinary uroflow in 6 of 14 cases (43%), residual urine of more than 30 ml in 9 of 31 cases (29%), abnormal cystometrogram and/or external sphincter EMG in 16 of 31 cases (52%). These urodynamic abnormalities were closely correlated with perineal hyposensitivity. Voiding function was re-examined in 22 patients after operation: improved in 14 (64%), unchanged in 1 (4%), worsened in 2 (9%) and normal in 5 (23%) before and after operation. Therefore the above results could indicate that the presence of perineal hyposensitivity should be suspected to have voiding dysfunction in patients with IDP. Orthopedic surgery may improve voiding dysfunction in the majority of patients.
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