Association of high bladder neck elevation with urodynamic bladder outlet obstruction in patients with lower urinary tract symptoms and benign prostatic hyperplasia

Urology. 2014 Dec;84(6):1461-6. doi: 10.1016/j.urology.2014.08.037.

Abstract

Objective: To ascertain the association of cystourethroscopic findings of bladder neck elevation with urodynamic bladder outlet obstruction (BOO) in patients with lower urinary tract symptoms and benign prostatic hyperplasia (LUTS-BPH).

Materials and methods: Study subjects were 646 consecutive men aged >40 years diagnosed with LUTS-BPH at Seoul National University Hospital from December 2005 through January 2012. We collected the International Prostatic Symptom Score, serum prostate-specific antigen levels, prostate volume measured by transrectal ultrasonography, uroflowmetry with postvoid residual volume, and urodynamics with a pressure flow study. We examined the degree of lateral lobe protrusion of prostate, bladder neck elevation degree (BNE-D), and bladder neck elevation angle (BNE-A) under a cystourethroscopic examination.

Results: When we examined BNE by cystourethroscope, the mean BNE-A was 26.1°. Higher BNE-D was strongly positively correlated with BNE-A, but neither was associated with the degree of lateral lobe protrusion of prostate. Patients with higher BNE-A (≥ 35°) had higher BOO index and more obstructed voiding patterns than those with lower BNE-A (<35°). BNE-A was positively correlated with BOO index (r = 0.186). However, we identified only total prostate volume (odds ratio [OR], 1.036), maximal flow rate (Qmax; OR, 0.843), and detrusor pressure at Qmax (PdetQmax; OR, 1.278) as significant predictors of BOO in the multivariate analysis.

Conclusion: In sum, patients with higher BNE-A (≥ 35°) by cystourethroscope had higher BOO index and more obstructed voiding patterns than those with lower BNE-A (<35°). Moreover, both BNE-D and BNE-A were positively correlated with BOO index. Thus, cystourethroscopic findings of BNE status can be helpful to predict urodynamic BOO in the patients with LUTS-BPH.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Comorbidity
  • Cystoscopy / methods
  • Follow-Up Studies
  • Humans
  • Lower Urinary Tract Symptoms / diagnosis
  • Lower Urinary Tract Symptoms / epidemiology*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Prostatic Hyperplasia / diagnosis
  • Prostatic Hyperplasia / epidemiology*
  • Republic of Korea
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Ureteroscopy / methods
  • Urinary Bladder / physiopathology*
  • Urinary Bladder Neck Obstruction / diagnosis
  • Urinary Bladder Neck Obstruction / epidemiology*
  • Urodynamics