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ORIGINAL ARTICLE |
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| Year : 2000 | Volume
: 16
| Issue : 2 | Page : 116-117 |
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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
 Source of Support: None, Conflict of Interest: None  | Check |
 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 |
| 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 (<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 | | |
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 | | |
| 1. | Blaives JG. Urodynamic diagnosis of primary bladder neck obstruction. World J Urol 1984: 2: 191.  |
| 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. |
| 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. |
| 4. | Shah PJR. The assessment of patients with a view to urodynamics. In: Urodynamics:Principles, Practice and Application. Edinburgh. Churchill Livingstone. 1994: 85-94. |
| 5. | Schaffer W. Urodynamics of micturation. Current Opin Urol 1992: 2: 252. |
| 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. |
[Figure 1]
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