The evaluation of the prevalence of DOA concomitant to BPH: May the characteristic parameters of clinical DOA have any relationships with the presence of concomitant DOA?

Abstract

Objective: To investigate the prevalence of detrusor overactivity DOA concomitant to clinical benign prostate hyperplasia BPH and the relationship between some of the characteristic parameters of BPH and the presence of concomitant DOA.Materials and methods: This is a prospective analysis of 100 patients with a previous diagnosis of clinical BPH and no previous diagnosis of DOA. All patients were urodynamically evaluated and divided in two groups Group 1: Pure BPH, Group 2: BPH with DOA . Some characteristic parameters of BPH were statistically compared between two groups.Results: Filling cystometry results showed that 52 men %52 had detrusor overactivity. In pressure-flow studies, obstructive voiding findings were determined in all patients. In univariate analysis, patients with DOA were significantly older, had lower Q max, higher creatinine, higher IPSS and OAB V-8 scores. On the other hand, multivariate analysis revealed that only age, IPSS, and OAB V-8 scores were independently associated with the presence of DOA.Conclusion: In BPH patients, the presence of concomitant DOA is independently associated with only age, IPSS, and OABV8 scores. It will be very logical to consider concomitant DOA and especially to routinely use OAB questionnaire in the management of patients with previous diagnosis of clinical BPH and ongoing LUTS despite receiving prolonged medical treatment

Keywords

• Benign prostate hyperplasia,detrusor overactivity,lower urinary tract symptoms,urodynamic testing

BPH ile eşzamanlı detrüsör aşırı aktivitesi DAA sıklığının değerlendirilmesi: Karakteristik klinik BPH parametrelerinin eşzamanlı DAA mevcudiyeti ile ilişkisi var mı?

Abstract

Amaç: Benign prostat hiperplazisine BPH eşlik eden detrüsör aşırı aktivitesinin DAA prevalansını araştırmak ve karakteristik BPH parametreleri ile eşzamanlı DAA varlığı arasındaki olası ilişkiyi değerlendirmek.Gereç ve yöntem: Bu çalışmada DOA olduğu bilinmeyen klinik BPH’lı 100 hasta prospektif olarak değerlendirildi. Tüm hastalar operasyon öncesi dönemde ürodinami ile değerlendirildi. Hastalar ürodinami sonuçlarına göre iki gruba ayrıldı Grup 1: Pür BPH, Grup 2: BPH+DAA . İki grup arasında bazı klinik BPH parametreleri istatistiksel olarak karşılaştırıldı.Bulgular: Dolum sistometri sonuçları 52 %52 hastada DAA varlığını gösterdi. Basınç akım çalışmasında tüm hastalarda obstruktif işeme bulguları belirlendi. Tek değişkenli analizde, DAA’ lı hastalar daha yaşlı idi ve anlamlı biçimde daha düşük Q max, daha yüksek kreatinin düzeyi, daha yüksek IPSS ve AAM V-8 skoruna sahipti. Diğer yandan çok değişkenli analizde sadece yaş, IPSS ve AAM V-8 skorları bağımsız olarak eşzamanlı DAA varlığı ile ilişkili bulundu.Sonuç: Klinik BPH hastalarında eşzamanlı DAA varlığı bağımsız olarak sadece yaş, IPSS ve AAM V-8 skorları ile ilişkilidir. Daha önceden koyulmuş klinik BPH tanısı olan ve uzun süredir buna yönelik tedavi almasına karşın LUTS semptomları devam eden hastalarda eşzamanlı DAA aktivitesini her zaman dikkate almak ve bu tür hastalara yaklaşımda AAM V-8 sorgulamasını rutin olarak kullanmak oldukça mantıklı ve isabetli bir yaklaşım olacaktır

Keywords

• Benign prostat hiperplazisi,detrüsör aşırı aktivitesi,alt üriner sistem semptomları,ürodinamik inceleme

References

1. Lenderking WR, Nackley JF,Anderson RB, Testa MA . A review of the quality of life aspects of urinary urge inconti- nence. Pharmacoeconomics; 1: 11-23, 1996.
2. Mirone V, Imbimbo C, Longo N, Fusco F. The Detrusor Muscle: An Innocent Victim of Bladder Outlet Obstruc- tion. European urology; 51: 57– 66, 2007.
3. Chatelain C, Denis L, Foo KT, Khoury S, McConnell J. Be- nign Prostatic Hyperplasia. 5th International Consultation on Benign Prostatic Hyperplasia. Paris, France; 64:1255– 60, 2000.
4. Milson I, Abrams P, Cardozo L. How widespread are the symptoms of an overactive bladder and how are they man- aged? A population based prevalence study. BJU Int; 87: 760– 766, 2001.
5. Greenland JE, Brading AF. The effect of bladder outflow obstruction on detrusor blood flow changes during the voiding cycle in conscious pigs. J Urol; 165: 245–8, 2001.
6. Harrison SC, Hunnam GR, Farman P, Ferguson DR, Doyle PT. Bladder instability and denervation in patients with bladder outflow obstruction. Br J Urol; 60: 519– 22, 1987.
7. Kaplan SA. New Data on Tolterodine: Do Recent Findings Dipsel Questions About Treating Overactive Bladder in Men? European urology supplements; 6: 10–16, 2007.
8. Kuo HC. Videourodynamic Analysis of Pathophysiology of Men with Both Storage and Voiding Lower Urinary Tract Symptoms. Urology; 70: 272– 276, 2007.

9. Schafer W, Abrams P, Liao LM. Good urodynamic prac- tices: uroflowmetry, filling cystometry, and pressureflow studies. Neurourol Urodyn; 21: 261– 74, 2002.
10. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulm- sten U, van Kerrebroeck P, Victor A, Wein A. The standar- disation of terminology of lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Neurourol. Urodyn; 21: 167- 178, 2002.
11. Chapple CR, Roehrborn CG. A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol; 49: 651– 9, 2006.
12. Lepor H. Nonoperative management of benign prostatic hyperplasia. J Urol; 141: 1283– 9, 1989.
13. Madsen FA, Bruskewitz RC. Clinical manifestations of be- nign prostatic hyperplasia. Urol Clin North Am; 22: 291– 8, 1995.
14. Knutson T, Edlund C, Fall M, Dahlstrand C. BPH with coexisting overactive bladder dysfunction—an everyday urological dilemma. Neurourol Urodyn; 20: 237– 47, 2001.
15. Fusco F, Groutz A, Blaivas JG, Chaikin DC, Weiss JP. Vid- eourodynamic studies in men with lower urinary tract symptoms: a comparison of community based versus re- ferral urological practices. J Urol; 166: 910– 3, 2001.
16. Lee JY, Kim HW, Koh JS, Suh HJ, Chancellor MB . Com- parison of doxazosin with or without tolterodine in men with symptomatic bladder outlet obstruction and an over- active bladder. BJU Int; 94: 817– 20, 2004.
17. Hyman MJ, Groutz A, Blaivas JG. Detrusor instability in men: correlation of lower urinary tract symptoms with urodynamic findings. J Urol; 166: 550– 2, 2001.
18. Oelke M, Baard J, Wijkstra H, de la Rosette J.J., Jonas U, Höfner K. Age and Bladder Outlet Obstruction Are In- dependently Associated with Detrusor Overactivity in Patients with Benign Prostatic Hyperplasia. Eur Urol; 54: 419- 26, 2008.
19. Liu H T, Kuo H. Videourodynamic analysis of pathophysi- ology of men with both storage and voiding lower urinary tract symptoms. Urology; 70(2): 272- 75, 2007.
20. de Nunzio C, Franco G, Rocchegiani A. The evolution of detrusor overactivity after watchful waiting, medical thera- py and surgery in patients with bladder outlet obstruction. J Urol; 169: 535– 9, 2003.
21. Machino R, Kakizaki H, Ameda K. Detrusor instability with equivocal obstruction: a predictor of unfavourable symptomatic outcomes after transurethral prostatectomy. Neurourol Urodyn; 21: 444– 9, 2002.
22. Witjes WP, Aarnink RG, Ezz-el-Din K, Wijkstra H, De- bruyne EM, de la Rosette JJ. The correlation between pros- tate volume, transition zone volume, transition zone index and clinical and urodynamic investigation in patients with lower urinary tract symptoms. Br J Urol; 180: 84–90, 1997.
23. Tubaro A, La Vecchia C, for Uroscreening Study Group. The relation of lower urinary tract symptoms with lifestyle factors and objective measures of benign prostatic enlarge- ment and obstruction: an Italian survey. Eur Urol; 45: 767– 72, 2004.
24. Chancellor MB, Blaivas JG, Kaplan SA, Axelrod S. Bladder outlet obstruction versus impaired detrusor contractility. The role of uroflow. J Urol; 145: 810, 1991.
25. Yang Q, Peters TJ, Donovan JL, Wilt TJ, Abrams P. Trans- urethral incision compared with transurethral resection of the prostate for bladder outlet obstruction: a systematic review and meta-analysis of randomised controlled trials. J Urol; 165: 1526– 32, 2001.
26. Madersbacher S, Marberger M. Is transurethral resection of the prostate still justified? Br J Urol; 83: 227– 37, 1999.
27. Mirone V, Imbimbo C, Longo N, Fusco F: The detrusor muscle: an innocent victim of bladder outlet obstruction. Eur Urol; 51: 57– 66, 2007.
28. Ameda K, Koyanagi T, Nantani M. The relevance of preop- erative cystometrography in patients with benign prostatic hyperplasia: correlating the findings with clinical features and outcome after prostatectomy. J Urol; 152: 443– 7, 1994.
29. Steers W. Pathophysiology of overactive bladder and urge urinary incontinence. Rev Urol; 4: 7– 18, 2002.
30. Sibley GN. The physiological response of the detrusor muscle to experimental bladder outflow obstruction in the pig. Br J Urol; 60: 332– 6, 1987.