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ORIGINAL ARTICLE
Year : 2000  |  Volume : 16  |  Issue : 2  |  Page : 116-117
 

Recurrent bladder outlet obstruction and urodynamics


Western General Hospital NHS Trust, Edinburgh, United Kingdom

Correspondence Address:
Altaf H Syed
Western General Hospital NHS Trust, Crewe Road, Edinburgh, EH4-2JJ
United Kingdom
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Source of Support: None, Conflict of Interest: None


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   Abstract 

A 66-year-old man underwent transurethral bladder outlet surgery over 6 years on five occasions without im­provement and without any pressure flow studies. To un­derstand fully the aetiology of post-transurethral resection voiding problems and symptoms, a proper urodynamie evaluation is mandatory.


Keywords: Voiding Problems; Urodynamics; Transurethral Surgery.


How to cite this article:
Syed AH, Akhter MN, Stewart LH. Recurrent bladder outlet obstruction and urodynamics. Indian J Urol 2000;16:116-7

How to cite this URL:
Syed AH, Akhter MN, Stewart LH. Recurrent bladder outlet obstruction and urodynamics. Indian J Urol [serial online] 2000 [cited 2019 Aug 24];16:116-7. Available from: http://www.indianjurol.com/text.asp?2000/16/2/116/22208



   Introduction Top


The incidence of voiding dysfunction and associated symptoms after transurethral resection of prostate for be­nign disease has been reported to be 5 to 35%. [3],[6] The causes of symptoms that can be identified urodynamically include persistent or recurrent bladder outlet obstruction, detrusor hypocontractility, persistent or de-novo detrusor instabil­ity and sensory urgency. Hence prior pressure flow stud­ies can avoid unnecessary re-operation rate in selected cases. [1]


   Case Report Top


A 66-year-old man presented to hospital with acute uri­nary retention for which he was catheterised. His prostate felt small and benign and the investigations (haematocrit, urea & electrolytes and prostate specific antigen) were normal. He had a successful trial without catheter but re­mained symptomatic with frequency, nocturia, hesitancy and slow flow. He was prescribed Indoramin (an alpha­blocker) which did not improve his symptoms. Two months later cystoscopy showed gross bladder neck stenosis and resection of the bladder neck and prostate was performed. The postoperative flow-rate was good (Q max. 15.3 mls/s), with no residue. Review three months later showed a poor flow (Q max. 2.7 mls/s) and subsequent cystoscopy con­firmed recurrent bladder neck stenosis apparently nar­rowed down to size 12 Fr. A second bladder neck resection was performed and the flow study thereafter was excel­lent (Q max. 20.1 mls/s) with no residual urine. Three months later the patient was again symptomatic with irri­tative and obstructive urinary symptoms. Cystoscopy once again showed recurrent bladder neck stenosis and a blad­der neck incision was carried out on this occasion. Postoperatively urine flow was good (Q max. 16.7 mls/s) with no residue and therefore, as there were no further problems, the patient was discharged.

Four years later he was referred back with obstructive urinary symptoms which were confirmed by a flow-rate (Q max 6.1 mls/s) with large post-void residues (210 mls). Subsequently at cystoscopy bladder outlet obstruction was noted and so transurethral resection of prostate was per­formed. Postoperative flow rate was satisfactory (Q max. 14.7 mls/s) with no residue, hence the patient was dis­charged.

Six years later he went into acute retention again. Cys­toscopy again showed bladder neck stenosis and repeat resection was performed. The postoperative flow-rate was excellent (Q max. 23.9 mls/s) with no residue. However 3 months later the patient was voiding small volumes (<100 mls) frequently and the residual urine was 410 mls. Video­urodynamics were carried out which showed an acontrac­tile bladder [Figure 1]. An indwelling catheter was left in-situ for three months and afterwards he practised intermittent self-catheterisation.


   Comments Top


Urodynamic studies have been available for more than 30 years [2] but their value is often ignored. The indications for the tests are well documented [4],[5] and this case high­lights the necessity of performing urodynamics in patients presenting with recurrent voiding problems rather than simply proceeding blindly to perform unnecessary surgery.

 
   References Top

1.Blaives JG. Urodynamic diagnosis of primary bladder neck obstruc­tion. World J Urol 1984: 2: 191.  Back to cited text no. 1    
2.Enhorning G. Miller ER. Hinman F Jr. Urethral closure studied with cine-roentgenography and simultaneous bladder-urethral pressure recording. Surg Gynecol Obstet 1964: 118: 507-516.  Back to cited text no. 2    
3.Mayo ME. Evaluation and management of symptoms after prosta­tectomy. In: Benign prostatic hypertrophy. Hinman F Jr. Boyarsky SHAH eds. New York. Springer-Verlag. 1983: 957-970.  Back to cited text no. 3    
4.Shah PJR. The assessment of patients with a view to urodynamics. In: Urodynamics:Principles, Practice and Application. Edinburgh. Churchill Livingstone. 1994: 85-94.  Back to cited text no. 4    
5.Schaffer W. Urodynamics of micturation. Current Opin Urol 1992: 2: 252.  Back to cited text no. 5    
6.Nitti VW. Kim Y. Combs AJ. Voiding dysfunction following transurethral resection of the prostate: symptoms and urodynamic findings. J Urol 1997: 157: 600-603.  Back to cited text no. 6    


    Figures

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    Abstract
    Introduction
    Case Report
    Comments
    References
    Article Figures

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