Storage Detrusor Pressure in Bilateral Hydroureteronephrosis

Ghobish, Ammar

doi:10.1159/000052505

Cited by 13 publications

(14 citation statements)

References 8 publications

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“…8 A small study of 27 patients suggested that a storage pressure threshold of 15 cm H 2 0 for the development of HN. 16 Our study shows (Figure 1) that the groups with the highest probability of hydronephrosis all had storage abnormality (all four groups to the right). The most important predictor of hydronephrosis appears to be the presence of storage abnormality with the highest risk in those who also had normal detrusor contractility.…”

Section: Discussionmentioning

confidence: 63%

“…Though suspected, this issue has not been well examined in non‐neurogenic adult men 8 . A small study of 27 patients suggested that a storage pressure threshold of 15 cm H 2 0 for the development of HN 16 . Our study shows (Figure 1) that the groups with the highest probability of hydronephrosis all had storage abnormality (all four groups to the right).…”

Section: Discussionmentioning

confidence: 64%

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Is isolated bladder outlet obstruction associated with hydronephrosis? A database analysis

Sinha

Matai

2020

Neurourology and Urodynamics

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Aims: To examine whether isolated bladder outlet obstruction in the absence of associated lower urinary tract abnormality results in hydronephrosis. Isolated obstruction causes a brief rise in bladder pressure that might not trigger hydronephrosis. Methods: Data included adult men who underwent urodynamics for refractory non-neurogenic lower tract symptoms between 2011 and 2020. International Continence Society indices for obstruction (bladder outlet obstruction index [BOOI] ≥ 40) and underactivity (bladder contractility index [BCI] < 100) were calculated. Storage abnormality was defined as detrusor overactivity (DO) or poor compliance (<20 ml/cm H 2 0). Isolated obstruction was defined as BOOI ≥ 40, BCI ≥ 100 and no storage abnormality. Nonparametric tests using R program (3.5.0) applied (p < .05 significant). Logistic regression analyses were performed to study the relationships of hydronephrosis with lower urinary tract function. Results: A total 1596 men (range, 18-91 years; median, 51.0 years; Q3, 64.0 years; Q1, 34.0 years) were eligible. Hydronephrosis was noted in 274 (17.2%). A total of 45.4% were obstructed, 52.3% were underactive and 41.7% had storage abnormality. Storage abnormality (odds ratios [OR], 2.05; 95% confidence interval [CI]: 1.56, 2.69; p < .001) and bladder contractility (OR, 1.68; 95% CI, 1.25-2.26; p < .001) but not obstruction (OR, 1.07; 95% CI, 0.80-1.44; p = .634) was associated with hydronephrosis. Of eight possible combinations, men with BOO ≥ 40, BCI ≥ 100 and storage abnormality had highest probability of hydronephrosis (OR, 0.29; 95% CI, 0.24-0.33). Subanalysis showed that poor compliance (OR, 3.39; 95% CI, 2.49-4.60; p < .001) but not DO was associated with hydronephrosis. Younger age and higher postvoid residual urine were also associated with hydronephrosis. Conclusions: In adult men with refractory non-neurogenic lower urinary tract symptoms, isolated bladder outlet obstruction is not associated with hydronephrosis.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 64%

Is isolated bladder outlet obstruction associated with hydronephrosis? A database analysis

Sinha

Matai

2020

Neurourology and Urodynamics

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“…Out of 43 patients with hypocompliance, Hackler et al [31] reported 23 patients with Pdet <40 cmH 2 O at maximum bladder capacity. Ghobish [32] assessed the portion of the storage phase in which there was high Pdet in 27 patients with bilateral hydroureteronephrosis. High Pdet >15 cmH 2 O was sustained at 25, 50 and 75% of bladder capacity in 11, 44 and 88% of patients during the storage phase.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

et al. 2015

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ObjectivesTo compare outcomes of renal transplantation (RTx) in children with end-stage renal disease (ESRD) resulting from lower urinary tract dysfunction (LUTD) vs other causes. Patients and MethodsA database of children (<18 years old) who underwent RTx between May 2008 and April 2012 was reviewed. Patients were divided into those with LUTD (group A, n = 29) and those with other causes of ESRD (group B, n = 74). RTx was performed after achieving low intravesical pressure (<30 cmH 2 O) with adequate bladder capacity and drainage. The groups were compared using Student's t-test, MannWhitney, chi-squared or exact tests. Graft survival rates (GSRs) were evaluated using Kaplan-Meier curves and the log-rank test. ResultsThe mean AE SD (range) age of the study cohort was 5.05 AE 12.4 (2.2-18) years. Causes of LUTD were posterior urethral valve (PUV; 41.4%), vesico-ureteric reflux (VUR; 37.9%), neurogenic bladder (10.3%), prune belly syndrome (3.4%), obstructive megaureter (3.4%) and urethral stricture disease (3.4%). There was no significant difference in age, dialysis duration or donor type. In group A, 25 of the 29 patients (86.2%) underwent ≥1 surgery to optimize the urinary tract for allograft. Pretransplant nephrectomy was performed in 15 of the 29 patients (51.7%), PUV ablation in nine patients (31%) and ileocystoplasty in four patients (13.7%). The mean AE SD follow-up was 4.52 AE 1.55 and 4.07 AE 1.27 years in groups A and B, respectively. There was no significant difference in creatinine and eGFR between the groups at different points of follow-up. The GSRs at the end of the study were 93.1 and 91.1% in groups A and B, respectively (P = 1.00). According to Kaplan-Meier survival curves, there was no significant difference in the GSR between the groups using the log-rank test (P = 0.503). No graft was lost as a result of urological complications. In group B, one child died from septicaemia. The rate of urinary tract infections was 24 and 12% in groups A and B, respectively, but was not significant. No significant difference was found between the groups with regard to the incidence of post-transplantation hydronephrosis. Of the 22 patients who had hydronephrosis after transplantation, three were complicated by UTI. Injection of bulking agents was required in two patients for treatment of grade 3 VUR. In the third patient, augmentation cystoplasty was needed. ConclusionAcceptable graft function, survival and UTI rates can be achieved in children with ESRD attributable to LUTD. Thorough assessment and optimization of LUT, together with close follow-up, are key for successful RTx.

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“…Deterioration of renal function was found in the Olmsted community in symptomatic men (IPSS >7, odds ratio 2.91) with low maximum urinary flow rate (Q max <15 ml/sec, odds ratio 2.96) and PVR >100 ml (odds ratio 2.28) 38. As mentioned in the previous section, patients with renal insufficiency had higher intravesical pressures compared to men without renal insufficiency 37. Furthermore, men with decreased bladder compliance were likely to develop renal insufficiency (78%) compared to men with normal bladder compliance (36%),39 and low bladder compliance was directly related to BPO (compliance 23 ml/cmH 2 O in men with and 39 ml/cmH 2 O in men without BPO) 40.…”

Section: Resultsmentioning

confidence: 77%

“…However, there are multiple other possible causes for bilateral hydronephrosis,36 which all have not been rigorously studied. One trial in 27 patients with bilateral hydronephrosis found in 52% of patients bladder storage pressures (P det ) >40 cmH 2 O at maximum bladder capacity; however, increased storage pressures in patients with hydronephrosis were not necessarily sustained during the entire storage phase 37. Interestingly, higher and sustained storage pressures were related to renal insufficiency in patients with hydronephrosis indicating that vesical pressure during the filling phase may play an important role for upper urinary tract complications.…”

Section: Resultsmentioning

confidence: 99%

Can we identify men who will have complications from benign prostatic obstruction (BPO)?: ICI‐RS 2011

Oelke

Kirschner‐Hermanns

Thiruchelvam

et al. 2012

Neurourology and Urodynamics

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In contrast to the widespread belief of urologist, there is only rudimentary data available showing no convincing association between urinary tract complications and BPO. The ICI-RS proposes that prospective trials are conducted to demonstrate the association between complications and BPO by using cystometry, pressure-flow (P/F) studies, and other commonly used BPO parameters in men with complications and comparing those with a cohort of age-matched men without complications. Non-invasive proxy parameters of BPO, for example, ultrasonic measurement of detrusor wall thickness, can be used instead of P/F studies especially in longitudinal trials.

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Storage Detrusor Pressure in Bilateral Hydroureteronephrosis

Cited by 13 publications

References 8 publications

Is isolated bladder outlet obstruction associated with hydronephrosis? A database analysis

Is isolated bladder outlet obstruction associated with hydronephrosis? A database analysis

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

Can we identify men who will have complications from benign prostatic obstruction (BPO)?: ICI‐RS 2011

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