Reversible Change of Bladder Hypertrophy Due to Benign Prostatic Hyperplasia After Surgical Relief of Obstruction

Kojima, Munekado; Inui, Emi; Ochiai, Atsushi; Naya, Yoshio; Kamoi, Kazumi; Ukimura, Osamu; Watanabe, Hiroki

doi:10.1097/00005392-199707000-00024

Cited by 68 publications

(37 citation statements)

References 17 publications

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“…Even after relief of obstruction, the changed bladder may not return to its original state before obstruction, and this might result in remaining symptoms (35). For example, Kojima et al (17) showed that their patients with a high ultrasoundestimated bladder weight above the fixed level of 80 g were characterized by irreversible pathological changes in the detrusor.…”

Section: Discussionmentioning

confidence: 99%

Persistent detrusor overactivity in rats after relief of partial urethral obstruction

Jin¹,

Andersson

Han³

et al. 2011

American Journal of Physiology-Regulatory, Integrative and Comp

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Detrusor overactivity (DO) persists after prostatectomy in 20% to 25% of patients with benign disease. Assuming that nonvoiding contractions (NVCs) can be used as a surrogate for DO in humans, the rat model of obstruction/ deobstruction may allow us to study the pathophysiology of persistent DO after deobstruction. We investigated bladder function, with a special focus on NVCs, in rats by use of a new, modified method of obstruction and deobstruction and compared these results with those obtained by use of the conventional method. Seventy female SpragueDawley rats underwent 1) sham operation (n ϭ 10), 2) obstruction by a modified method (Modif-Obs; n ϭ 12), 3) obstruction/deobstruction by the conventional method (Conv-Obs/Deobs; n ϭ 13), or 4) obstruction/deobstruction by the modified method (Modif-Obs/ Deobs; n ϭ 35). The Modif-Obs/Deobs animals were divided into subgroups with (DOϩ) and without (DOϪ) NVCs. Two weeks after partial urethral obstruction, the animals were deobstructed, and 1 wk later cystometry was performed with recording of intravesical and intra-abdominal pressures. NVCs were shown in all groups: ModifObs (80%), Conv-Obs/Deobs (100%), and Modif-Obs/Deobs (40%). In the Modif-Obs/Deobs group, bladder weight and the muscle-tocollagen ratio were higher in DOϩ than in DOϪ rats. The ModifObs/Deobs group showed no mortality compared with 25% mortality in the Conv-Obs/Deobs group. The modified method may be more adequate for studying persistent DO after deobstruction, because it resulted in pressure/volume-and DO-related parameters similar to those found in the clinical situation. The persistence of DO after deobstruction may partly be due to irreversible changes in the bladder caused during the period of obstruction. urinary bladder; cystometry BENIGN PROSTATIC HYPERPLASIA occurs as part of the aging process in men and affects Ͼ 50% of the male population over 60 yr of age (11). The clinical symptoms of benign prostatic hyperplasia are caused not only by the mass-related increase in urethral resistance but also by pathologic processes in the bladder wall secondary to the bladder outlet obstruction (BOO) (18,26,35,40). In many studies on patients with BOO undergoing surgery for benign prostatic hyperplasia, a significant percentage of patients report persistence of storage (irritative) symptoms, associated with detrusor overactivity (DO) on urodynamic investigation, even if the obstruction was successfully relieved. In fact, DO has been shown to persist after prostatectomy in 20% to 25% of patients treated for benign disease (2,19,29,33).Rats subjected to BOO will develop hyperactive voiding, characterized by increased frequency and nonvoiding contractions (NVCs), which persists after deobstruction in a proportion of the animals (6,20,23,24,27,30). The relations between symptoms, BOO, and bladder function can, for obvious reasons, not be studied in animal models. However, assuming that NVCs can be used as a surrogate parameter for DO in humans, the rat model of obstruction/deobstruction may offer an op...

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Section: Discussionmentioning

confidence: 99%

Persistent detrusor overactivity in rats after relief of partial urethral obstruction

Jin¹,

Andersson

Han³

et al. 2011

American Journal of Physiology-Regulatory, Integrative and Comp

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“…UEBW significantly decreased from 52.9±22.6 g to 31.6±15.8 g (р<0.0001) in approximately 33 patients 12-weeks post-prostatectomy. [18] However, the assumption that the bladder has a spherical configuration appears to be unrealistic.…”

Section: Ultrasound Estimated Bladder Weightmentioning

confidence: 99%

Imaging assessments of lower urinary tract dysfunctions: Future steps

Farag¹,

Heesakkers²

2014

Turkish Journal of Urology

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Urodynamic tests are the standard diagnostic method for lower urinary tract dysfunctions (LUTD). However, these tests are invasive. The current review describes the noninvasive imaging techniques that have been used to monitor LUTD. The main imaging technologies that have been applied in diagnosing LUTD were 2D ultrasonography, Doppler ultrasonography, and near-infrared spectroscopy (NIRS). Ultrasonographic parameters, such as bladder wall thickness (BWT), detrusor wall thickness (DWT), and ultrasound-estimated bladder weight (UEBW), have been proposed as surrogates for bladder outlet obstruction (BOO) or detrusor overactivity (DO). Few studies have reported diagnostic cut-offs in diagnosing BOO or DO; thus, there is still a need to standardize the measurement method. NIRS can detect the hemodynamic changes related to DO and BOO in real-time, which could be advantageous in clinical practice , but the liability of NIRS to motion artefacts is a limitation. Bladder strain imaging in real-time using 2D ultrasound enables noninvasive estimation of the dynamic changes in the bladder wall during voiding. Many imaging techniques have been used to monitor the urinary bladder during the storage and voiding phases of the micturition cycle. These techniques were either static [i.e., measuring fixed parameters, such as BWT, DWT, UEBW, and intravesical prostatic protrusion (IVPP)] or dynamic (monitoring the structural and hemodynamic changes in the bladder wall in real-time). These techniques are currently being developed and standardized for potential use in diagnosing LUTD in clinical practice.

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“…19 Interestingly, there was no difference between the 3 time-groups in our study regarding the postoperative need of chronic clean intermittent catheterization -consistent with a report by Kojima and colleagues on the reversibility of detrusor muscle changes after relief of outflow obstruction. 20 Longer medical treatment for BPH has been associated with a decreased number of patients undergoing BPH surgery resulting in increased prostate volume with potentially more patients needing open surgery. 21 The question is whether changes in laser surgery over the past 16 years have been able to sustain surgical outcome despite significant changes in the target population.…”

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confidence: 99%

Changing patients’ profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-centre perspective

Elkoushy

Elshal

Elhilali

2015

CUAJ

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Introduction:We assessed the change of patients' profile presenting for symptomatic benign prostatic hyperplasia (BPH) over 16 years and its impact on surgical outcomes over this time. We reviewed demographic and preoperative data, including prostate volume; international prostate symptoms score (IPSS), quality of life (QoL), and peak flow rate (Qmax). We also recorded any perioperative and long-term complications. Results: A total of 1835 patients were included in our study, including 542 (29.5%) in Group 1, 614 (33.5%) in Group 2, and 679 (37%) in Group 3. Preoperative prostate volume was positively correlated with age at surgery (r = 0.62, p < 0.001), total energy used (r = 0.47, p < 0.001), and total operative time (r = 0.47, p < 0.001). Patients in Group 3 were significantly older (75.28 ± 8.47 in Group 3 vs. 71.11 ± 8.9 in Group 2 vs. 65.3 ± 9.04 years in Group 1, p <0.001), were more coagulopathic (18.7% Group 3 vs. 12.3% Group 2 vs. 5.9% Group 1, p < 0.001), and had significantly larger prostates (87.96 ± 49.80 in Group 3 vs. 78.44 ± 50.84 in Group 2 vs. 74.50 ± 46.53 Group 1, p < 0.001). Preoperative prostatic medications significantly increased over time (72.6% in Group 1 vs. 85.5% in Group 2, vs. 87.4% Group 3, p < 0.001). IPSS, QoL and Qmax were significantly abnormal in patients in Group 3 (p < 0.001). After a mean follow-up of 3 years, the number of patients who did not require reoperation progressively increased (94.1% Group 1 vs. 96.1% Group 2 vs. 98.3% Group 3). Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with postoperative urinary incontinence. Conclusions:Patients presenting for surgery due to symptomatic BPH over the last 16 years were significantly older, more morbid, and had larger prostates and more abnormal voiding parameters. Over time, patients used prostatic medications more frequently. Despite the changes in patient profiles, perioperative safety and complication rates between groups were comparable, likely due to advancements in laser technology and techniques. Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with reversible postoperative urinary incontinence.

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Reversible Change of Bladder Hypertrophy Due to Benign Prostatic Hyperplasia After Surgical Relief of Obstruction

Cited by 68 publications

References 17 publications

Persistent detrusor overactivity in rats after relief of partial urethral obstruction

Persistent detrusor overactivity in rats after relief of partial urethral obstruction

Imaging assessments of lower urinary tract dysfunctions: Future steps

Changing patients’ profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-centre perspective

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