Indian Journal of Urology
ORIGINAL ARTICLE
Year
: 2000  |  Volume : 16  |  Issue : 2  |  Page : 116--117

Recurrent bladder outlet obstruction and urodynamics


Altaf H Syed, Mohd N Akhter, Lawrence H Stewart 
 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

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.



How to cite this article:
Syed AH, Akhter MN, Stewart LH. Recurrent bladder outlet obstruction and urodynamics.Indian J Urol 2000;16:116-117


How to cite this URL:
Syed AH, Akhter MN, Stewart LH. Recurrent bladder outlet obstruction and urodynamics. Indian J Urol [serial online] 2000 [cited 2022 Jan 29 ];16:116-117
Available from: https://www.indianjurol.com/text.asp?2000/16/2/116/22208


Full Text

 Introduction



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



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 ( [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

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2Enhorning 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.
3Mayo 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.
4Shah PJR. The assessment of patients with a view to urodynamics. In: Urodynamics:Principles, Practice and Application. Edinburgh. Churchill Livingstone. 1994: 85-94.
5Schaffer W. Urodynamics of micturation. Current Opin Urol 1992: 2: 252.
6Nitti VW. Kim Y. Combs AJ. Voiding dysfunction following transurethral resection of the prostate: symptoms and urodynamic findings. J Urol 1997: 157: 600-603.