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      Changes in Bladder Wall Thickness and Detrusor Wall Thickness After Surgical Treatment of Benign Prostatic Enlargement in Patients With Lower Urinary Tract Symptoms: A Preliminary Report

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          Abstract

          Purpose

          The purpose of the present study was to evaluate the perioperative changes in bladder wall thickness and detrusor wall thickness after transurethral prostatectomy.

          Materials and Methods

          Fifty-one men who were treated for benign prostatic hyperplasia/lower urinary tract symptoms with transurethral prostatectomy were prospectively analyzed from May 2012 to July 2013. Prostate size, detrusor wall thickness, and bladder wall thickness were assessed by transrectal and transabdominal ultrasonography perioperatively. All postoperative evaluations were performed 1 month after the surgery.

          Results

          The patients' mean age was 69.0 years, the mean prostate-specific antigen concentration was 8.1 ng/mL, and the mean prostate volume was 63.2 mL. The mean bladder wall thickness was 5.1 mm (standard deviation [SD], ±1.6), 5.1 mm (SD, ±1.6), and 5.0 mm (SD, ±1.4) preoperatively and 4.5 mm (SD, ±1.5), 4.5 mm (SD, ±1.3), and 4.6 mm (SD, ±1.2) postoperatively in the anterior wall, dome, and trigone, respectively (p=0.178, p=0.086, and p=0.339, respectively). The mean detrusor wall thickness was 0.9 mm (SD, ±0.4) preoperatively and 0.7 mm (SD, ±0.3) postoperatively (p=0.001). A subgroup analysis stratifying patients into a large prostate group (weight, ≥45 g) and a high Abrams-Griffiths number group (>30) showed a significant decrease in detrusor wall thickness (p=0.002, p=0.018).

          Conclusions

          There was a decrease in detrusor wall thickness after transurethral prostatectomy. The large prostate group and the high Abrams-Griffiths number group showed a significant decrease in detrusor wall thickness after surgery.

          Related collections

          Most cited references 18

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          Diagnostic accuracy of noninvasive tests to evaluate bladder outlet obstruction in men: detrusor wall thickness, uroflowmetry, postvoid residual urine, and prostate volume.

          The aim of this prospective study was to compare the diagnostic accuracy of detrusor wall thickness (DWT), free uroflowmetry, postvoid residual urine, and prostate volume (index tests) with pressure-flow studies (reference standard) to detect bladder outlet obstruction (BOO) in men. During a 2-yr period, men older than 40 yr with lower urinary tract symptoms and/or prostatic enlargement had the following tests: ultrasound measurements of DWT, free uroflowmetry (Q(max), Q(ave)), postvoid residual urine, and prostate volume. Pressure-flow studies were used to divide obstructed from nonobstructed bladders. One hundred sixty men between 40-89 yr of age (median: 62 yr) were included in the study; 75 patients (46.9%) had BOO according to pressure-flow studies. The results of all investigated index tests differed significantly between obstructed and nonobstructed men. DWT was the most accurate test to determine BOO: the positive predictive value was 94%, specificity 95%, and the area under the curve of ROC analysis 0.93. There was an agreement of 89% between the results of DWT measurement and pressure-flow studies. Measurements of DWT can detect BOO better than free uroflowmetry, postvoid residual urine, or prostate volume. In clinical routine, DWT measurements can be used to judge BOO noninvasively. European Association of Urology.
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            Pressure flow urodynamic studies: the gold standard for diagnosing bladder outlet obstruction.

             V W Nitti (2004)
            Bladder outlet obstruction (BOO) is a common cause of lower urinary tract symptoms (LUTS) in men and women. By definition, BOO is determined urodynamically, assessing the pressure-flow relation during voiding. Since the 1960s much work has been done to standardize the urodynamic definitions of obstruction in men and more recently women. Today, urodynamic testing voiding pressure-flow analysis remains the gold standard for the diagnosis of BOO and the etiology of LUTS. The pressure-flow relation is much better defined in men than in women, but recent work suggests that although the definition of obstruction may differ between men and women, the concept of the pressure-flow relation to diagnose obstruction holds true for both genders.
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              Increase in detrusor wall thickness indicates bladder outlet obstruction (BOO) in men.

              Detrusor wall thickness decreases continuously while the bladder fills to 50% of its capacity and then remains constant until 100%. Therefore, detrusor wall measurements were performed in patients when the bladder was filled to maximum capacity only. Mean detrusor wall thickness for unobstructed (n = 14), equivocal (n=23) and obstructed patients (n=33) were 1.33, 1.62 and 2.4 mm, respectively (P <0.001). With increasing CHESS letters and CHESS numbers, the thickness of the detrusor wall increased as well (P< 0.001). The positive predictive value of detrusor wall measurement (95.5% for a cut-off value greater than or equal to 2 mm) was superior to all other predictors investigated. The thickness of the detrusor wall increases depending on the extent of BOO. Both constrictive and compressive BOO lead to an increase in detrusor wall thickness. BOO is found in 95.5% of men with a detrusor wall thickness greater than or equal to 2 mm. Measuring the thickness of the detrusor wall can be used as a screening test to detect BOO.
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                Author and article information

                Journal
                Korean J Urol
                Korean J Urol
                KJU
                Korean Journal of Urology
                The Korean Urological Association
                2005-6737
                2005-6745
                January 2014
                15 January 2014
                : 55
                : 1
                : 47-51
                Affiliations
                Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea.
                Author notes
                Corresponding Author: Hwancheoul Son. Department of Urology, SMG-SNU Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707, Korea. TEL: +82-2-870-2391, FAX: +82-2-870-3863, volley@ 123456snu.ac.kr
                Article
                10.4111/kju.2014.55.1.47
                3897630
                © The Korean Urological Association, 2014

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Original Article
                Voiding Dysfunction

                Urology

                urinary bladder, lower urinary tract symptoms, prostate

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