The Application Of Urodynamic Study On 251 Aged Men With Benign Prostatic Hyperplasia

Background and objectiveBenign prostatic hyperplasia (BPH) is a common, bothersome problem in aged men, characterized by lower urinary tract symptoms (LUTS) and sometimes associated with urinary incontinence and sexual dysfunction. Men with LUTS suggestive of BPH have impaired health-related quality of life and create a significant economic burden to society. But many men in middle age were diagnosed with BPH in the last years. However, seldom culture about the difference of the bladder function of patients with BPH between aged and middle age men were found, especially evaluate it by urodynamics. The traditional examination for BPH can't evaluate the bladder function objectively, due to it's morphological detection, such as B-ultrasound, digital rectal examination and endoscopy. Then some patients with LUTS mainly resulted from dysfunction of bladder, such as Detrusor Underactivety (DUA), will feel no improved after operation. Meanwhile, BPH is related with age and it's prevalence increase with age, but other intercurrent illness increase too, such as cerebrovascular disease and diabetes, and which can cause detrsour dysfunction too. The traditional examination can't evaluate it. Contrarily the urodynamic studies (UDS) can do it. But debates are still existing about the UDS for BPH because of it's invasive injury.The main objective of this study is to investigate clinical and urodynamical character of the BPH patients by analysising the clinical and urodynamic data of 251 BPH patients with LUTS who were performed UDS from April 2003 to October 2005, and to investigate the difference of the bladder function between aged and middle age men, and to investigate the value and necessity of UDS in these patients, especially in elder patients.Materials and methodsTwo hundred and fifty patients with BPH and LUTS were included in this study, who were perfermed UDS at urodynamic center in the First Affiliated Hospital of Zhengzhou University from April 2003 to October 2005. All of them with BPH were confirmed by B-ultrasound, and PSA<4ng/ml. A total of 251 patients were divided into group A (≧65 y, 176 cases) and group B (< 65 y, 75 cases) according to age, group A age ranged from 65 to 88 year-old (74.3±5.2y), group B from 41 to 64 year-old (56.1±6.2y). Register the patients with diabetes, cerebrovascular disease, Parkinson's disease in group A and group B; Then excluding these patients, 149 patients without these diseases from group A and group B were divided into two sub-groups: group A₁(≧ 65 y, 85 cases) and group B₁ ( < 65 y, 64 cases) respectively. UDS examination was performed in accordance to International Continence Society (ICS) by using Dantec DUET Logic uroflowmeter. Recorder the Max Free Flow Rate in Uroflowmetry; Post Void Residul, the Compliance of bladder and with or without Detrusor Overactivity (DOA) in FCMG; the Max Pressure of Detrusor (MaxPdet) and with or without Detruor Underactivity (DUA) in Pressure-Flow studies; the Max Urethral Pressure (MUP), the Max Urethral Close Pressure (MUCP) and Urethral Functional Length (UFL) in Urethral Pressure Profile (UPP) respectively. DUA was defined as the detrusor pressure less than 40cmH2O at Max Flow Rate (MFR), and MFR less than 15ml/s in Pressure-Flow studies. Data were analyzed using SPSS 11.0 software, and p<0.05 is considered significant. Results1. A total of 91 (51.7% ) patients with intercurrent illness were founded in group A, included cerebrovascular disease, diabetes, both of cerebrovascular disease and diabetes, encephalatrophy and Parkinson's disease, and the number were 50 (28.4%), 25 (14.2%), 7 (3.98%), 6 (3.4%) and 3 (1.7%) respectively. Comparatively, only a total of 11 patients with intercurrent illness were founded in group B, included cerebrovascular disease, diabetes and both of cerebrovascular disease and diabetes, the number were 6 (8.0%), 3 (4.0%) and 2 (2.67%) respectively. Significant difference between group A and B were founded (p < 0.05).2. The incidence of catheterization or cystostomy because of acute urinary retention between group A1 (34.12%) and B1 (12.50%)was significant different(P<0.05).3. The significant difference of MFFR of the patients whose voiding volume were more than 150ml in group A₁( 9±4ml/s) and B₁ (13±5ml/s) were founded in Uroflowmetry(P<0.05).4. In Pressure-Flow studies, the incidence of DUA between group A1 (25.88 %)and B1 (7. 81%) is significant different (P<0. 05).5. In UPP, the difference of MUP, MUCP and UFL between group A1(93±30cmH2O, 81±27cmH2O, 68±16mm,) and B1 (107±32 cmH2O, 99±31cmH2O , 59±13mm)was significant (P<0. 05).Conclusion1. Aged patients with BPH are likely to suffer from illness which can cause bladder dysfunction, such as cerebrovascular disease and diabetes, and easy to occur acute urinary retention.2. In aged patients with BPH, the MFFR decreased significantly, but the incidence of DUA and the resistant force of urethra increased.3. To aged patients with BPH, urodynamic studies can help to identify the cause of bladder dysfunction and increase the accuracy of diagnosis before surgery.