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Urodynamic Evaluation of Bladder Neck Obstruction in Chronic Prostatitis
URODYNAMICS, PHYSIOLOGY AND EMBRYOLOGY
and requires no complex acid or alcohol extraction steps. Disadvantages include the cost in terms of time and material, and that the test cannot confirm azoospermia because the method also measures DNA in leukocytes. However, azoospermia can be determined with a simple test. M. G. F. 2 figures, 3 references
PEDIATRIC UROLOGY Varicocele and Puberty-The Critical Factor? G. G. WYLLIE, Department of Surgery, Adelaide Children's Hospital, North Adelaide, Australia
637
The authors conclude "the studies have provided urodynamic evidence that bladder neck obstruction could be a significant though not a predominant factor in the aetiology of the clinical syndrome of chronic prostatitis". They also state that "the studies have not provided clear urodynamic evidence in favor of bladder neck obstruction as the significant or predominant factor in the aetiology of the clinical syndrome of chronic prostatitis. It could be argued that this small series does present some evidence in support of the separation of prostatitis into predominantly motor dysfunction (prostatodynia) compared with a predominant sensory causation (prostatosis) but with a significant inflammatory basis which is shared by both groups". A. J. W. 6 tables, 4 references
Brit. J. Urol., 57: 194-196 (Apr.) 1985 The author treated 10 boys with a left varicocele by ligation of branches of the spermatic vein above the internal inguinal ring. In 9 boys the left testis was smaller than the right testis and it was softer than normal. In 3 cases followed for 15 to 24 months postoperatively the testes were essentially equal in size. Previous studies in infertile men have reported that the testis on the side of a varicocele was smaller and softer than normal, whereas the opposite testis was normal in size but softer than normal. Testicular biopsies in infertile men with varicocele have revealed bilateral pathological changes, more advanced on the varicocele side. Similar changes have been demonstrated in 12 to 16-year-old boys with varicocele. The development of an immature testis may be affected adversely when there is increased blood flow in the vicinity. That the varicocele could develop before puberty may lead to subsequent infertility. Prevention of infertility associated with varicocele depends upon early surgical correction before puberty. M. G. F. 1 figure, 1 table, 12 references
URODYNAMICS, PHYSIOLOGY AND EMBRYOLOGY Urodynamic Evaluation of Bladder Neck Obstruction in Chronic Prostatitis
G. F. MURNAGHAN AND R. J. MILLARD, Department of Surgery, Prince Henry Hospital, Sydney, Australia Brit. J. Urol., 56: 713-716 (Dec.) 1984 The authors report the results of urodynamic assessment (synchronous video-pressure-flow cystourethrography) in 50 male patients whom they believed had chronic prostatitis and whose symptoms commonly suggested outflow obstruction. They report their results in nonmutually exclusive categories as follows. Of the patients 23 had involuntary bladder contractions, an approximately equal number with and without obstruction. Bladder outlet obstruction was demonstrated in 30 patients, and was localized to the area of the bladder neck in 24 and prostate in 6. A sensory problem on testing occurred in 13 of 30 patients with and 13 of 20 without outflow obstruction. Posterior urethritis was found (diagnosed visually) at endoscopy in 28 of 36 patients. Endoscopy suggested obstruction in 20 of 21 patients with and 8 of 15 without urodynamic evidence of outflow obstruction.
Female Chronic Urinary Retention
A.
M. DEANE AND
P.H. L. WORTH, Institute of Urology,
London, England Brit. J. Urol., 57: 24-26 (Feb.) 1985 The authors define chronic urinary retention as painless retention of urine with a residual volume exceeding the normal capacity. This condition generally is associated with frequent voiding, overflow incontinence and recurrent infection but upper tract deterioration in the female patient is rare, since detrusor pressure usually is low. On a urodynamic basis, the condition usually is due to detrusor failure in the female patient. The authors studied 37 patients 18 to 77 years old who fell into this category. No patient has had significant upper urinary tract deterioration. Video urodynamic studies demonstrated detrusor failure with no detrusor activity on voiding. Neurological disease was present in 13 cases but none had a lesion amenable to an operation. The neurological diagnoses were multiple sclerosis in 7 patients, diabetes in 2, post-rectal excision in 2, vitamin B12 deficiency in 1 and spina bifida in 1. The possible etiologic factors present in 24 patients with idiopathic detrusor failure were anxiety or depressive illness in 11, hysteria in 2, post-hysterectomy in 5, suprapubic repair in 3 and vaginal repair in 2. The patients were initially taught to perform clean intermittent self-catheterization. Most of them were able to perform this function adequately but there was a high degree of patient resistance and several either stopped or requested alternative treatment. Pharmacological therapy was not helpful. Procedures to lower outlet resistance were tried in 32 cases. Satisfactory voiding ensued after Otis urethrotomy and overdilation in 8 of 19 patients, and after bladder neck incision in 6 of 13. Only 1 of the 6 patients complained of urinary stress incontinence. 3 tables, 12 references
Abstracter's comment. The authors believe that although chronic urinary retention in the female patient almost invariably is accompanied by detrusor failure absence of outlet coordination must also have a role. They note that many female patients are able to void satisfactorily without any evidence of detrusor activity on voiding cystography, and suggest that neurogenic dysfunction could prevent pelvic floor relaxation, and that this failure of pelvic floor relaxation might also occur in the idiopathic cases. The easiest and probably the best course of management is intermittent self-catheterization. Many patients will be resistant to this therapy and will go elsewhere for
and requires no complex acid or alcohol extraction steps. Disadvantages include the cost in terms of time and material, and that the test cannot confirm azoospermia because the method also measures DNA in leukocytes. However, azoospermia can be determined with a simple test. M. G. F. 2 figures, 3 references
PEDIATRIC UROLOGY Varicocele and Puberty-The Critical Factor? G. G. WYLLIE, Department of Surgery, Adelaide Children's Hospital, North Adelaide, Australia
637
The authors conclude "the studies have provided urodynamic evidence that bladder neck obstruction could be a significant though not a predominant factor in the aetiology of the clinical syndrome of chronic prostatitis". They also state that "the studies have not provided clear urodynamic evidence in favor of bladder neck obstruction as the significant or predominant factor in the aetiology of the clinical syndrome of chronic prostatitis. It could be argued that this small series does present some evidence in support of the separation of prostatitis into predominantly motor dysfunction (prostatodynia) compared with a predominant sensory causation (prostatosis) but with a significant inflammatory basis which is shared by both groups". A. J. W. 6 tables, 4 references
Brit. J. Urol., 57: 194-196 (Apr.) 1985 The author treated 10 boys with a left varicocele by ligation of branches of the spermatic vein above the internal inguinal ring. In 9 boys the left testis was smaller than the right testis and it was softer than normal. In 3 cases followed for 15 to 24 months postoperatively the testes were essentially equal in size. Previous studies in infertile men have reported that the testis on the side of a varicocele was smaller and softer than normal, whereas the opposite testis was normal in size but softer than normal. Testicular biopsies in infertile men with varicocele have revealed bilateral pathological changes, more advanced on the varicocele side. Similar changes have been demonstrated in 12 to 16-year-old boys with varicocele. The development of an immature testis may be affected adversely when there is increased blood flow in the vicinity. That the varicocele could develop before puberty may lead to subsequent infertility. Prevention of infertility associated with varicocele depends upon early surgical correction before puberty. M. G. F. 1 figure, 1 table, 12 references
URODYNAMICS, PHYSIOLOGY AND EMBRYOLOGY Urodynamic Evaluation of Bladder Neck Obstruction in Chronic Prostatitis
G. F. MURNAGHAN AND R. J. MILLARD, Department of Surgery, Prince Henry Hospital, Sydney, Australia Brit. J. Urol., 56: 713-716 (Dec.) 1984 The authors report the results of urodynamic assessment (synchronous video-pressure-flow cystourethrography) in 50 male patients whom they believed had chronic prostatitis and whose symptoms commonly suggested outflow obstruction. They report their results in nonmutually exclusive categories as follows. Of the patients 23 had involuntary bladder contractions, an approximately equal number with and without obstruction. Bladder outlet obstruction was demonstrated in 30 patients, and was localized to the area of the bladder neck in 24 and prostate in 6. A sensory problem on testing occurred in 13 of 30 patients with and 13 of 20 without outflow obstruction. Posterior urethritis was found (diagnosed visually) at endoscopy in 28 of 36 patients. Endoscopy suggested obstruction in 20 of 21 patients with and 8 of 15 without urodynamic evidence of outflow obstruction.
Female Chronic Urinary Retention
A.
M. DEANE AND
P.H. L. WORTH, Institute of Urology,
London, England Brit. J. Urol., 57: 24-26 (Feb.) 1985 The authors define chronic urinary retention as painless retention of urine with a residual volume exceeding the normal capacity. This condition generally is associated with frequent voiding, overflow incontinence and recurrent infection but upper tract deterioration in the female patient is rare, since detrusor pressure usually is low. On a urodynamic basis, the condition usually is due to detrusor failure in the female patient. The authors studied 37 patients 18 to 77 years old who fell into this category. No patient has had significant upper urinary tract deterioration. Video urodynamic studies demonstrated detrusor failure with no detrusor activity on voiding. Neurological disease was present in 13 cases but none had a lesion amenable to an operation. The neurological diagnoses were multiple sclerosis in 7 patients, diabetes in 2, post-rectal excision in 2, vitamin B12 deficiency in 1 and spina bifida in 1. The possible etiologic factors present in 24 patients with idiopathic detrusor failure were anxiety or depressive illness in 11, hysteria in 2, post-hysterectomy in 5, suprapubic repair in 3 and vaginal repair in 2. The patients were initially taught to perform clean intermittent self-catheterization. Most of them were able to perform this function adequately but there was a high degree of patient resistance and several either stopped or requested alternative treatment. Pharmacological therapy was not helpful. Procedures to lower outlet resistance were tried in 32 cases. Satisfactory voiding ensued after Otis urethrotomy and overdilation in 8 of 19 patients, and after bladder neck incision in 6 of 13. Only 1 of the 6 patients complained of urinary stress incontinence. 3 tables, 12 references
Abstracter's comment. The authors believe that although chronic urinary retention in the female patient almost invariably is accompanied by detrusor failure absence of outlet coordination must also have a role. They note that many female patients are able to void satisfactorily without any evidence of detrusor activity on voiding cystography, and suggest that neurogenic dysfunction could prevent pelvic floor relaxation, and that this failure of pelvic floor relaxation might also occur in the idiopathic cases. The easiest and probably the best course of management is intermittent self-catheterization. Many patients will be resistant to this therapy and will go elsewhere for