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Objective: To analyze the clinical and urodynamic efficacy of treatment with doxazosin during 6 months for voiding phase disorders in patients with BPH., Methods: A prospective clinical and urodynamic study (before and after treatment) was performed in 65 consecutive male patients with BPH, aged 54-79 years (mean 66.7), to evaluate the results of treatment with doxazosin 4 mg/day during 6 months. Clinical evaluation included patient history and the International Prostatic Symptom Score (IPSS) and urodynamic evaluation included uroflowmetry with post-void residual data and pressure-flow test. A static urethral pressure profile was associated with the urodynamic voiding study., Results: The IPSS score improved significantly from 19.8 +/- 4.8 before treatment to 11.9 +/- 4.6 after treatment (p < 0.001). Urinary symptoms improved significantly more markedly after treatment (coeff. -0.45939) in patients with a lower IPSS score. The symptomatic improvement demonstrated by the IPSS did not correlate with the DRE or the transabdominal US prostatic volume. Mean maximum flow rate before treatment was 9.13 ml/sec and increased to 16.23 ml/sec after treatment (p < 0.01). Postvoid residual dropped from 21.7% to 12.5% (p < 0.01). In the pressure-flow test, foot-point PURR dropped significantly from 69 cms H2O to 45.9 cms H2O (p < 0.001). The PURR curvature diminished from 0.27416 to 0.15964 cms H2O (ml/sec2) (p < 0.01). A statistically significant improvement of the compressive (p < 0.001) and constrictive (p < 0.05) elements of lower urinary tract obstruction was observed. The urethral functional length of the urethral profile showed a significant reduction (pre-treatment: 5.56 cms; post-treatment 4.31 cms) (p < 0.05). A statistical correlation was found between the urethral functional length and the foot-point PURR post-treatment., Conclusions: Adrenergic blockade with doxazosin reduces both the compressive and constrictive elements of lower urinary tract obstruction in the voiding phase in patients with BPH, although no statistical correlation with the IPSS could be demonstrated.

Objectives: The present study compared the results of the different urodynamic methods utilized in the diagnosis of urinary obstruction., Methods: A urodynamic study was performed in 105 patients with prostatism; mean age 66.19 years. The following five urodynamic methods were utilized: maximum pressure/maximum flow rate (Pmax/Fmax), pressure/flow nomogram, pressure/flow curve, Schaefer's PURR and the resistance square., Results: The Pmax/Fmax method showed the lowest percentage of obstruction (61%), 48% of the nomograms were inconclusive, the pressure/flow curve diagnosed obstruction in 88%, Schaefer's PURR diagnosed obstruction in 77% and the resistance square diagnosed obstruction in 78% of the cases. When the nomogram findings were diagnostic, no significant differences between the other methods were observed. The Pmax/Fmax, pressure/flow curve and the PURR methods proved to be independent methods, while the resistance square showed no significant differences with Schaefer's PURR. An irregular bladder at cystography was associated with a significantly higher percentage of obstruction (72% vs 92%). Lengthening and compression of the prostatic urethra demonstrable on cystourethrography was associated with the diagnosis of obstruction on all the methods used. A diminished segment of the urethral lumen was associated with a high percentage of obstruction on all methods, the PURR showing the highest (100%). However, the diagnosis of constrictive obstruction was found in only 30% of the cases.

Objective: The present study was conducted to determine the correlation between the urinary symptoms and lower urinary tract dynamics in patients with prostatism., Methods: 105 males with prostatism (mean 66.19 years) were evaluated clinically, urodynamically and radiologically by PURR (passive urethral resistance ratio) determination., Results: The intensity of the irritative symptoms was slightly higher (21%) when bladder instability was associated. The obstructive symptoms were associated with diminished urinary flow rate and could be observed in bladder outlet obstruction (81%) or diminished bladder contractility (79%). Both conditions were found in 49% of the cases. The postvoiding urine depended on diminished bladder contractility (37%), but not on bladder outlet obstruction. Bladder instability did not depend on obstruction, although 88% of the patients with unstable bladder were obstructed. Compressive obstruction was associated with a lesser degree of diminished contractility (55%) than the other forms of obstruction. Prostatism was associated with diminished contractility without bladder outlet obstruction in 15% of the cases. The irregular bladder was more frequent in bladder outlet obstruction (92%) and bladder diverticula were more frequent in bladder instability (36%). In all the cases with compression and lengthening of the prostatic urethra, the diagnosis was compressive obstruction. In all the cases with segmental, diminished urethral diameter, the diagnosis was obstruction, although only 30% were diagnosed as constrictive compression. No pathological urethral changes were demonstrable on cystourethrography in 33% of the cases with obstruction., Conclusions: Urinary symptoms correlate poorly with lower urinary tract dynamics. PURR determination is a very reliable method of diagnosis in urinary obstruction, for both segmentally diminished and more extensive involvement (elongation and compression of the prostatic urethra) of the urethral lumen.

Most of the urodynamic studies are conducted in the laboratory during a brief recording time and under nonphysiological conditions and, thus, may fail to unfold the nature of existing pathological conditions of the lower urinary tract; false positives and false negatives are possible. To overcome some of the difficulties associated with conventional P/F studies we have developed, with the cooperation of Medical Measurement System company, Entschede, The Netherlands, a portable system (UDS 2000) for ambulatory monitoring of intravesical pressure, abdominal pressure and EMG connectable with a weight transducer flowmeter that permits performing Holter P/F measurements. We compared the results obtained with conventional P/F studies and with the Holter P/F studies in 58 BPH patients. During the filling phase we observed a slightly increased number of stable detrusors with Holter P/F recording (46 vs 42); conversely, the number of patients suffering from urge incontinence was the same (7 pts). During the voiding phase, out of 45 patients considered obstructed at conventional P/F study, only 42 were really urodynamically obstructed (93.3%), while 3 other patients had borderline obstruction. Four patients with borderline obstruction at conventional P/F study were considered nonobstructed after Holter P/F.

A retrospective study was conducted in 27 patients with posterior urethral valves that had been treated between 1978 and 1991 in order to determine the prognostic factors of renal function. Patient age ranged from 12 days to 12 years. The mean follow-up was 5 years. Urinary infection was the most common symptom. We used micturating cystography, intravenous urography, US, urodynamics and cystoscopy for the diagnosis. Renal function was evaluated by serum creatinine. All the valves were treated endoscopically by transurethral fulguration. Nineteen patients also underwent ureteral reimplantations. There were 5 nephrectomies and 12 upper tract diversions. There was a strong correlation between serum creatinine at the beginning and after a year and the final renal function (p > 0.001 and p = 0.030, respectively). The correlation between the age and initial serum creatinine was almost significant (p = 0.065). There was no significant correlation between the age at diagnosis, the reflux and the final renal function.