Benign prostat hiperplazili hastalarda mesane çıkım obstrüksiyonu üreteral orifisler arasındaki mesafeyi etkiler mi?

Yıl 2009, Cilt: 36 Sayı: 4, 248 - 251, 01.12.2009

Cüneyt Özden Cevdet Serkan Gökkaya Özer Güzel Tagmaç Deren Özdem Levent Özdal Ali Memis

Öz

Objectives: Many morphological changes occur in the bladder due to bladder outlet obstruction (BOO) in patients with benign prostate hyperplasia (BPH). In the present study we evaluated the relationship between interureteric distance (IUD) of the orifices and BOO in BPH patients. Materials and methods: Thirty-seven consecutive patients with lower urinary tract symptoms at the urology polyclinic included in the study. Patients divided into 2 groups according to maximal flow rate (Qmax). The first group constituted of 18 patients with Qmax < 15ml/s and the second group constituted of 19 patients Qmax > 15ml/s. The IUD measurement was performed with Doppler ultrasonography. Results: There was no significant difference between the groups regarding mean age and prostate volume. Mean IUD in the first group was 32.7&plusmn;5.4 mm and mean IUD in the second group was 31.5&plusmn;5.1 mm. There was no statistically significant difference between the groups regarding the IUD. Conclusions: Data obtained from the study revealed that measurement of IUD with Doppler ultrasonography not significantly related to BOO. Keywords: Benign prostate hyperplasia, bladder outlet obstruction, doppler ultrasonography

Anahtar Kelimeler

-

Benign prostat hiperplazili hastalarda mesane çıkım obstrüksiyonu üreteral orifisler arasındaki mesafeyi etkiler mi?

Öz

Amaç: Benign prostat hiperplazili (BPH) hastalarda mesane
çıkım obstrüksiyonuna (MÇO) bağlı olarak mesanede
birçok morfolojik değişiklikler ortaya çıkmaktadır.
Bu çalışmada BPH’lı hastalarda üreteral orifisler arasındaki
interüreterik mesafe (İÜM) ile MÇO arasındaki ilişki
değerlendirildi.
Gereç ve yöntem: Çalışmaya poliklinimize alt üriner sistem
şikayetleri ile başvuran 37 hasta dahil edildi. Hastalar
üroflowmetrik maksimal akım hızına (Qmax) göre 2
gruba ayrıldı. 1 grubu Qmax 15 ml/sn olan 19 hasta oluşturdu. Hastaların
İÜM ölçümleri Doppler ultrasonografi ile yapıldı.
Bulgular: Her iki grup arasında ortalama yaş ve prostat
volümleri bakımından anlamlı fark yoktu. 1. grubdaki
hastalarda ortalama İÜM 32.7±5.4 mm iken 2. grubdaki
hastalarda ortalama İÜM 31.5±5.1 mm olarak tespit edildi.
Her iki grup arasında İÜM bakımından istatistiksel
olarak anlamlı fark yoktu.
Sonuç: Elde ettiğimiz veriler BPH’li hastalarda Doppler
ultrasonografi ile ölçülen İÜM ve MÇO arasında anlamlı
bir ilişki olmadığını gösterdi

Anahtar Kelimeler

Benign prostat hiperplazisi, Doppler ultrasonografi, Mesane çıkım obstrüksiyonu

Kaynakça

• Christensen MM, Bruskewitz RC. Clinical manifestation of benign prostatic hyperplasia and indications for therapeu- tic intervention. Urol Clin North Am 1990; 17: 509-516.
• Emberton M, Cornel EB, Bassi PF, Fourcade RO, Gomez JM, Castro R. Benign prostatic hyperplasia as a progres- sive disease: a guide to the risk factors and options for medical management. Int J Clin Pract 2008; 62: 1076- 1086.
• Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Em- berton M, de la Rosette JJ. EAU 2004 guidelines on as- sessment, therapy and follow-up of men with lower uri- nary tract symptoms suggestive of benign prostatic ob- struction (BPH guidelines). Eur Urol 2004 46: 547-554.
• Gravas S, Tzortzis V, Melekos MD. Translation of benign prostatic hyperplasia guidelines into clinical practice. Curr Opin Urol 2008;18: 56-60.
• Porru D, Madeddu G, Campus G, Montisci I, Scarpa RM, Usai E. Evaluation of morbidity of multi-channel pressure- flow studies. Neurourol Urodyn 1999; 18: 647-652.
• Kortmann BB, Sonke GS, D'ancona FC, Floratos DL, De- bruyne FM, De La Rosette JJ. The tolerability of urody- namic studies and flexible cysto-urethroscopy used in the assessment of men with lower urinary tract symptoms. BJU Int 1999; 84: 449-453.
• Tsuru N, Kurita Y, Masuda H, Suzuki K, Fujita K. Role of Doppler ultrasound and resistive index in benign prostatic hypertrophy. Int J Urol 2002; 9: 427-430.
• Kaplan SA, Te AE, Pressler LB, Olsson CA. Transition zone index as a method of assessing benign prostatic hy- perplasia: correlation with symptoms, urine flow and de- trusor pressure. J Urol 1995; 154: 1764-1769.
• Franciosi M, Koff WJ, Rhoden EL. Correlation between the total volume, transitional zone volume of the prostate, transitional prostate zone index and lower urinary tract symptoms (LUTS). Int Urol Nephrol 2007; 39: 871-877.
• Ezz el Din K, Kiemeney LA, de Wildt MJ, Debruyne FM, de la Rosette JJ. Correlation between uroflowmetry, pros- tate volume, postvoid residue, and lower urinary tract symptoms as measured by the International Prostate Symptom Score. Urology 1996; 48: 393-397.
• Ochiai A, Kojima M. Correlation of ultrasound-estimated bladder weight with ultrasound appearance of the prostate and postvoid residual urine in men with lower urinary tract symptoms. Urology 1998; 51: 722-729.
• Miyashita H, Kojima M, Miki T. Ultrasonic measurement of bladder weight as a possible predictor of acute urinary retention in men with lower urinary tract symptoms sug- gestive of benign Prostatic hyperplasia. Ultrasound Med Biol 2002; 28: 985-990.
• Işikay L, Turgay Akgül K, Nuhoğlu B, et al. Lower uri- nary tract symptoms, prostate volume, uroflowmetry, re- sidual urine volume and bladder wall thickness in Turkish men: a comparative analysis. Int Urol Nephrol 2007; 39: 1131-1135.
• Lepor H. Pathophysiology of lower urinary tract symp- toms in the aging male population. Rev Urol 2005;7: 3-11.
• Jensen KM, Jorgensen JB, Mogensen P. Urodynamics in prostatism. I. Prognostic value of uroflowmetry. Scand J Urol Nephrol 1988; 22: 109-117.
• Aganovic D. The role of uroflowmetry in diagnosis of in- fravesical obstruction in the patients with benign prostatic enlargement. Med Arh 2004; 58: 109-111.
• Ather MH, Memon A. Uroflowmetry and evaluation of voiding disorders. Tech Urol 1998; 4: 111-117.
• Abrams PH. Benign prostatic hypertrophy In: Himman F Jr, ed. Urodynamic results of surgery, New York: Spring- Verlag, 1983, 843-956.
• Nitti VW. Pressure flow urodynamic studies: the gold standard for diagnosing bladder outlet obstruction. Rev Urol 2005;7 : 14-21.
• Walker RMH, Patel A, Carter SC. Is there a clinically sig- nificant change in pressure-flow study values after urethral instrumentation in patients with lower urinary tract symp- toms? Brit J Urol 1998; 81: 206-210.
• Bruskewitz RC, Iversen P, Madsen PO. Value of post void residual urine determination in eva-luation of prostatism. Urology 1982; 20: 602.
• Akino H, Maekawa M, Nakai M et al. Ultrasound- estimated bladder weight predicts risk of surgery for be- nign Prostatic hyperplasia in men using alpha- adrenoceptor blocker for LUTS. Urology 2008; 72: 817- 820.
• Oelke M, Höfner K, Wiese B, Grünewald V, Jonas U. In- crease in detrusor wall thickness indicates bladder outlet obstruction (BOO) in men. World J Urol 2002; 19: 443- 452.