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World Journal of Urology

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01-04-2011 | Topic Paper

The role of invasive and non-invasive urodynamics in male voiding lower urinary tract symptoms

Authors: Brian A. Parsons, Elizabeth Bright, Ahmed M. Shaban, Anne Whitehouse, Marcus J. Drake

Published in: World Journal of Urology | Issue 2/2011

Abstract

Introduction

Troublesome voiding lower urinary tract symptoms (LUTS) are a common problem in men, particularly with ageing. Implicitly, management of voiding LUTS can be guided by accurate determination of underlying mechanisms, distinguishing men with voiding symptoms caused by outlet obstruction from those with reduced bladder contractility.

Methods

A PubMed search of the published literature on invasive and non-invasive methods used to assess lower urinary tract function was carried out.

Results

A multitude of methods have been applied to assess LUTS. Multichannel pressure flow studies (PFS) are the standard for diagnosing bladder outlet obstruction and underlying mechanisms of LUTS, though their invasive nature can be difficult to tolerate, and improved prediction of treatment outcome is disputed. Uroflowmetry and post void residual measurement are insufficient to make a definitive diagnosis. Ultrasound-derived measurements of bladder wall thickness and estimated bladder weight offer a potential non-invasive alternative to PFS, but their diagnostic parameters are still under evaluation. Non-invasive methods that measure isovolumetric bladder pressure by interrupting the urinary stream can reproducibly measure pressure and urinary flow, but are unable to determine the effects of abdominal straining during voiding and give no insight into urine storage symptoms. Doppler ultrasound during urethral flow is informative, but it is an expensive approach whose clinical utility has yet to be established.

Conclusion

A variety of non-invasive urodynamic and non-urodynamic techniques have been used to evaluate LUTS and some show great promise. However, there is as yet, insufficient evidence to justify replacement of invasive voiding cystometry by these investigational approaches.

Irwin DE et al (2006) Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 50(6):1306–1314 discussion 1314–1315PubMedCrossRef

Abrams P et al (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21(2):167–178PubMedCrossRef

de la Rosette JJ et al (1998) Relationships between lower urinary tract symptoms and bladder outlet obstruction: results from the ICS-“BPH” study. Neurourol Urodyn 17(2):99–108PubMedCrossRef

Emberton M et al (1996) The effect of prostatectomy on symptom severity and quality of life. Br J Urol 77(2):233–247PubMed

Belal M, Abrams P (2006) Noninvasive methods of diagnosing bladder outlet obstruction in men. Part 1: Nonurodynamic approach. J Urol 176(1):22–28PubMedCrossRef

Abrams PH, Griffiths DJ (1979) The assessment of prostatic obstruction from urodynamic measurements and from residual urine. Br J Urol 51(2):129–134PubMedCrossRef

Bruskewitz RC, Iversen P, Madsen PO (1982) Value of postvoid residual urine determination in evaluation of prostatism. Urology 20(6):602–604PubMedCrossRef

Kranse R, van Mastrigt R (2003) Weak correlation between bladder outlet obstruction and probability to void to completion. Urology 62(4):667–671PubMedCrossRef

Bosch JL et al (1995) Reasons for the weak correlation between prostate volume and urethral resistance parameters in patients with prostatism. J Urol 153(3 Pt 1):689–693PubMed

10.

Mochtar CA et al (2005) Prognostic role of prostate-specific antigen and prostate volume for the risk of invasive therapy in patients with benign prostatic hyperplasia initially managed with alpha1-blockers and watchful waiting. Urology 65(2):300–305PubMedCrossRef

11.

Witjes WP et al (1997) The correlation between prostate volume, transition zone volume, transition zone index and clinical and urodynamic investigations in patients with lower urinary tract symptoms. Br J Urol 80(1):84–90PubMed

12.

Kojima M et al (1997) The American Urological Association symptom index for benign prostatic hyperplasia as a function of age, volume and ultrasonic appearance of the prostate. J Urol 157(6):2160–2165PubMedCrossRef

13.

Kojima M et al (1997) Correlation of presumed circle area ratio with infravesical obstruction in men with lower urinary tract symptoms. Urology 50(4):548–555PubMedCrossRef

14.

St Sauver JL et al (2009) Presumed circle area ratio of the prostate in a community-based group of men. BJU Int 104(1):58–62PubMedCrossRef

15.

Lim KB et al (2006) Comparison of intravesical prostatic protrusion, prostate volume and serum prostatic-specific antigen in the evaluation of bladder outlet obstruction. Int J Urol 13(12):1509–1513PubMedCrossRef

16.

Chia SJ et al (2003) Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU Int 91(4):371–374PubMedCrossRef

17.

Reis LO et al (2008) Intravesical protrusion of the prostate as a predictive method of bladder outlet obstruction. Int Braz J Urol 34(5):627–633 discussion 634–637PubMedCrossRef

18.

Kojima M et al (1997) Noninvasive quantitative estimation of infravesical obstruction using ultrasonic measurement of bladder weight. J Urol 157(2):476–479PubMedCrossRef

19.

Oelke M et al (2007) Diagnostic accuracy of noninvasive tests to evaluate bladder outlet obstruction in men: detrusor wall thickness, uroflowmetry, postvoid residual urine, and prostate volume. Eur Urol 52(3):827–834PubMedCrossRef

20.

Manieri C et al (1998) The diagnosis of bladder outlet obstruction in men by ultrasound measurement of bladder wall thickness. J Urol 159(3):761–765PubMedCrossRef

21.

Hakenberg OW et al (2000) Bladder wall thickness in normal adults and men with mild lower urinary tract symptoms and benign prostatic enlargement. Neurourol Urodyn 19(5):585–593PubMedCrossRef

22.

Oelke M et al (2006) Ultrasound measurement of detrusor wall thickness in healthy adults. Neurourol Urodyn 25(4):308–317 (discussion 318)PubMedCrossRef

23.

Kojima M et al (1996) Ultrasonic estimation of bladder weight as a measure of bladder hypertrophy in men with infravesical obstruction: a preliminary report. Urology 47(6):942–947PubMedCrossRef

24.

Kojima M et al (1997) Reversible change of bladder hypertrophy due to benign prostatic hyperplasia after surgical relief of obstruction. J Urol 158(1):89–93PubMedCrossRef

25.

Egilmez T et al (2006) Effects of selective alpha-1-adrenergic receptor blockers on bladder weight. Urol Int 76(1):42–50PubMedCrossRef

26.

Reynard JM et al (1998) The ICS-‘BPH’ Study: uroflowmetry, lower urinary tract symptoms and bladder outlet obstruction. Br J Urol 82(5):619–623PubMed

27.

Chancellor MB et al (1991) Bladder outlet obstruction versus impaired detrusor contractility: the role of uroflow. J Urol 145(4):810–812PubMed

28.

Abrams P (2006) Urodynamics. Springer, London, p 161

29.

Reynard JM et al (1996) The value of multiple free-flow studies in men with lower urinary tract symptoms. Br J Urol 77(6):813–818PubMed

30.

Siroky MB, Olsson CA, Krane RJ (1979) The flow rate nomogram: I. Development. J Urol 122(5):665–668PubMed

31.

Haylen BT et al (1989) Maximum and average urine flow rates in normal male and female populations—the Liverpool nomograms. Br J Urol 64(1):30–38PubMedCrossRef

32.

Kadow C et al (1985) A flow rate nomogram for normal males over the age of 50. In: Proceedings of ICS 15th Annual Meeting, London

33.

Sullivan MP, Yalla SV (2000) Penile urethral compression-release maneuver as a non-invasive screening test for diagnosing prostatic obstruction. Neurourol Urodyn 19(6):657–669PubMedCrossRef

34.

Blake C, Abrams P (2004) Noninvasive techniques for the measurement of isovolumetric bladder pressure. J Urol 171(1):12–19PubMedCrossRef

35.

Van Mastrigt R, Pel JJ (1999) Towards a noninvasive urodynamic diagnosis of infravesical obstruction. BJU Int 84(2):195–203PubMedCrossRef

36.

van Mastrigt R et al (2009) Development and application of the condom catheter method for non-invasive measurement of bladder pressure. Indian J Urol 25(1):99–104PubMedCrossRef

37.

Pel JJ, van Mastrigt R (1999) Non-invasive measurement of bladder pressure using an external catheter. Neurourol Urodyn 18(5):455–469 (discussion 469–475)PubMedCrossRef

38.

Pel JJ et al (2002) Development of a non-invasive strategy to classify bladder outlet obstruction in male patients with LUTS. Neurourol Urodyn 21(2):117–125PubMedCrossRef

39.

Pel JJ, van Mastrigt R (2003) A flow rate cut-off value as a criterion for the accurate non-invasive measurement of bladder pressure using a condom-type catheter. Urol Res 31(3):177–182PubMedCrossRef

40.

Van Mastrigt R (1995) Non invasive bladder pressure measurement—methodology and reproducibility. Neurourol Urodyn 14:2

41.

McRae LP, Bottaccini MR, Gleason DM (1995) Noninvasive quantitative method for measuring isovolumetric bladder pressure and urethral resistance in the male: I. Experimental validation of the theory. Neurourol Urodyn 14(2):101–114PubMedCrossRef

42.

Griffiths C et al (1999) A new method for non-invasive assessment of bladder pressure during voiding compared with simultaneous invasive urodynamics. Neurourol Urodyn 18(4):2

43.

Griffiths CJ et al (2002) Noninvasive measurement of bladder pressure by controlled inflation of a penile cuff. J Urol 167(3):1344–1347PubMedCrossRef

44.

McIntosh SL et al (2003) Noninvasive measurement of bladder pressure. Does mechanical interruption of the urinary stream inhibit detrusor contraction? J Urol 169(3):1003–1006PubMedCrossRef

45.

Griffiths CJ et al (2005) A nomogram to classify men with lower urinary tract symptoms using urine flow and noninvasive measurement of bladder pressure. J Urol 174(4 Pt 1):1323–1326 (discussion 1326; author reply 1326)PubMedCrossRef

46.

Harding C et al (2007) Predicting the outcome of prostatectomy using noninvasive bladder pressure and urine flow measurements. Eur Urol 52(1):186–192PubMedCrossRef

47.

Drinnan MJ et al (2003) Inter-observer agreement in the estimation of bladder pressure using a penile cuff. Neurourol Urodyn 22(4):296–300PubMedCrossRef

48.

Belal M, Abrams P (2006) Noninvasive methods of diagnosing bladder outlet obstruction in men. Part 2: Noninvasive urodynamics and combination of measures. J Urol 176(1):29–35PubMedCrossRef

49.

Ozawa H et al (1998) Development of noninvasive velocity flow video urodynamics using Doppler sonography. Part I: Experimental urethra. J Urol 160(5):1787–1791PubMedCrossRef

50.

Ozawa H et al (1998) Development of noninvasive velocity flow video urodynamics using Doppler sonography. Part II: Clinical application in bladder outlet obstruction. J Urol 160(5):1792–1796PubMedCrossRef

51.

Ozawa H et al (2000) Noninvasive urodynamic evaluation of bladder outlet obstruction using Doppler ultrasonography. Urology 56(3):408–412PubMedCrossRef

52.

Ding YY et al (2000) Reliability of color Doppler ultrasound urodynamics in the evaluation of bladder outlet obstruction. Urology 56(6):967–971PubMedCrossRef

53.

Unsal A, Cimentepe E (2004) Effect of voiding position on uroflowmetric parameters and post-void residual urine volume in patients with benign prostatic hyperplasia. Scand J Urol Nephrol 38(3):240–242PubMedCrossRef

54.

Ozawa H et al (2009) Use of Doppler ultrasound for non-invasive urodynamic diagnosis. Indian J Urol 25(1):110–115PubMedCrossRef

55.

Griffiths DJ (1980) Urodynamics: the mechanics and hydrodynamics of the lower urinary tract. Adam Hilger, Bristol

56.

Schafer W (1985) Urethral resistance? Urodynamic concepts of physiological and pathological bladder outlet function during voiding. Neurourol Urodyn 4:161–201

57.

Nitti VW (2005) Pressure flow urodynamic studies: the gold standard for diagnosing bladder outlet obstruction. Rev Urol 7(Suppl 6):S14–S21PubMed

58.

Griffiths D et al (1997) Standardization of terminology of lower urinary tract function: pressure-flow studies of voiding, urethral resistance, and urethral obstruction. International Continence Society Subcommittee on Standardization of Terminology of Pressure-Flow Studies. Neurourol Urodyn 16(1):1–18PubMedCrossRef

59.

Rosario DJ et al (1999) A comparison of ambulatory and conventional urodynamic studies in men with borderline outlet obstruction. BJU Int 83(4):400–409PubMedCrossRef

60.

Sonke GS et al (2000) Variability of pressure-flow studies in men with lower urinary tract symptoms. Neurourol Urodyn 19(6):637–651 (discussion 651–656)PubMedCrossRef

61.

McConnell J et al (eds) (2006) Male lower urinary tract dysfunction: evaluation and management. Health Publications, Paris

Title: The role of invasive and non-invasive urodynamics in male voiding lower urinary tract symptoms
Authors: Brian A. Parsons
Elizabeth Bright
Ahmed M. Shaban
Anne Whitehouse
Marcus J. Drake
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 2/2011
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-009-0488-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The role of invasive and non-invasive urodynamics in male voiding lower urinary tract symptoms

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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