Association of High Bladder Neck Elevation With Urodynamic Bladder Outlet Obstruction in Patients With Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia

• Published in: Urology (Ridgewood, N.J.) Vol. 84; no. 6; pp. 1461 - 1466
• Main Authors: Kang, Minyong, Kim, Myong, Choo, Min Soo, Bae, Jungbum, Ku, Ja Hyeon, Yoo, Changwon, Oh, Seung-June
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2014; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cohort Studies; Comorbidity; Cystoscopy - methods; Follow-Up Studies; Humans; Lower Urinary Tract Symptoms - diagnosis; Lower Urinary Tract Symptoms - epidemiology; Male; Medical sciences; Middle Aged; Multivariate Analysis; Nephrology. Urinary tract diseases; Predictive Value of Tests; Prostatic Hyperplasia - diagnosis; Prostatic Hyperplasia - epidemiology; Republic of Korea; Retrospective Studies; Risk Assessment; Severity of Illness Index; Tumors of the urinary system; Ureteroscopy - methods; Urinary Bladder - physiopathology; Urinary Bladder Neck Obstruction - diagnosis; Urinary Bladder Neck Obstruction - epidemiology; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urodynamics; Urology; Republic of Korea; High; Human; Nephrology; Urinary system disease; Prostate disease; Urinary tract disease; Urology; Urodynamics; Voiding dysfunction; Association; Benign prostatic hyperplasia; Bladder disease; Bladder neck; Bladder neck obstruction; Benign neoplasm; Male genital diseases; Lower urinary tract symptoms
• ISSN: 0090-4295; 1527-9995; 1527-9995
• DOI: 10.1016/j.urology.2014.08.037

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). 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. 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. 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.