The Significance of the Influence of Aging and Infravesical Obstruction Caused by Benign Prostatic Enlargement on Detrusor Impairment
Damir Aganovic, Osman Hadziosmanovic, Alden Prcic, Benjamin Kulovac
Med Arh. 2012; 66(3): 185-189
Objective: to analyze the influence of aging and infravesical obstruction on cystometric characteristics of patients with lower urinary tract symptoms (LUTS) and proven benign prostatic enlargement (BPE). Methodology: A retrospective analysis was performed of basic characteristics of randomly chosen 213 patients with LUTS caused by BPE and urodynamic findings made in period 2005-2009 at the Urology Department of the Sarajevo University Clinical Center. The patients were divided into groups based on their age (<60 years/46 patients, 60-69 years /95 pat., and >70 years /72 pat.), and the degree of bladder compliance loss (<20 ml/cmH2O-76 patients, 20-40 ml/cmH2O-57 pat., and >40 ml/cmH2O-80 pat.). All patients had International Prostate Symptom Score (IPS-S) completed, prostate volume measured transabdominally, free uroflowmetry, as well as complete urodynamic study (UDS) findings – cystometry and pressure/flow studies (PFS). The PFS data were plotted on L-PURR, URA and ICS nomogram, bladder contractility index (BCI) and obstruction coefficient (OCO) were calculated for each patient. Results: There was no statistically significant difference of IPS-S, prostate volume and postvoid residual urine among the age groups. Qmax (ml/sec.) declines significantly with age (mean 11.9 vs. 10.3 vs. 7.9, ANOVA p< 0.001), along with statistically significant decrease of cystometric capacity (mean 331ml vs. 293 ml vs. 264 ml, p=0.001), bladder compliance (BC-ml/cmH2O) (mean 35.3 vs. 31 vs. 26.5, p=0.013), with increased incidence of detrusor overactivity (DO) (21.7% vs. 32.6% vs. 45.8%, chi2 test for trend p=0.006), followed by a higher incidence of obstruction (URA≥29 cmH2O) (37% patients vs. 61% patients vs. 72.2% patients Chi2 for trend=13.8; p=0.0002), along with noticeable reduction of BCI (117 vs. 121 vs. 106; p=0.02). Patients with severe BC damage (<20 ml/cmH2O) showed a difference with respect to the degree of obstruction and age, along with decreased cystometric capacity and higher incidence of DO, while the difference in IPP-S was insignificant. OCO with cut-off point of 1 showed significant difference with regard to age (66.3 vs. 66.6 years, T test, p=0.015), prostate volume (45 cc vs. 51.8 cc, p=0.007) and incidence of DO (26% vs. 43.4%, p=0.02). Conclusion: the degree of bladder compliance loss and incidence of obstruction increase with age, as reflected in decreased bladder capacity, decreased urine voided volume and increased incidence of DO, along with noticeably impaired detrusor contractility.
1. Briganti A, Capitanio U, Suardi N, et al. Benign prostatic hyperplasia and its aetiologies. Eur Urol Suppl. 2009; 8: 865-871.
2. Abrams P. Cystometry. In: Urodynamics, edited by Abrams P, Springer – Verlag, London, second edition, (Ch 3), 2000: 39-76.
3. Abrams P, Griffiths D, Hofner K, et al. The urodynamics of LUTS. In: Chatelain C, Denis L, Foo KT, et al. editors. Benign prostatic hyperplasia. Plymouth, UK: Health Publications; 2001: 227-281.
4. Abram P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society. Neurourol Urodyn 2002; 21: 167-78
5. Schaefer W. Basic principles and clinical application of advanced analysis of bladder voiding function. Urol Clin North N Am. 1990; 17: 553-566.
6. Abrams P. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding dysfunction, BJU Inter. 1999, 84, 14-15.
7. Hald T, Brading AF, Elbadawi A and al: Pathophysiology of the urinary bladder in obstruction and ageing: The 4rd International Consultation on Benign Prostatic Hyperplasia, Proceedings, Paris, Edited by S.C.I, (Ch 4), 1997: 131-178.
8. Levin RM, Longhurst PA, Barasha B and al. Studies on experimental bladder outlet obstruction in the cat: Long-term functional effects, J Urology. 1992, 148: 939-943.
9. Levin RM, Haugaard N, O’Connor Laura and al. Obstructive response of human bladder to BPH vs. rabbit bladder response to partial outlet obstruction: A direct comparison, Neurol Urodynam. 2000; 19: 609-629.
10. Madersbacher S, Klingler HC, Schatzl G and al: Age related urodynamic changes in patients with benign prostatic hyperplasia, J Urol. 1996; 156: 1662-1667.
11. Liao L, Schaefer W. Cross-sectional and longitudinal studies on interaction between bladder compliance and outflow obstruction in men with benign prostatic hyperplasia, Asian J Androl. 2007; 9(1): 51-56.
12. Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJMCH. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol. 2004; 46: 547-554.
13. Griffiths DJ, McCracen PN, Harrison GM and al. Characteristic of urinary incontinence in elderly patients studied by 24-houred monitoring and urodynamic testing, Age Ageing, 1992; 21: 195-201.
14. Madersbacher S, Pycha A, Klingler HC and al. Interrelationships of bladder compliance with age, detrusor instability and obstruction in elderly men with lower urinary tract symptoms, Neurol Urodynam. 1999; 18: 3-15.
15. Ameda K, Sullivan Maryrose, Bae RJ and Yalla SV. Urodynamic characterization of nonobstructive voiding dysfunction in symptomatic elderly men, J Urology. 1999; 162(1): 142-149.