A. Tubaro

THE DIAGNOSIS OF BLADDER OUTLET OBSTRUCTION IN MEN BY ULTRASOUND MEASUREMENT OF BLADDER WALL THICKNESS

PURPOSEnThe objective of the study was to investigate specificity and sensitivity of bladder wall thickness in the diagnosis of bladder outlet obstruction.nnnMATERIALS AND METHODSnThe study included 174 patients referred to our prostate centers for lower urinary tract symptoms. Free uroflowmetry and pressure-flow studies were performed in duplicate as part of the diagnostic evaluation. After the 2 voiding studies were done the bladder was filled to 150 ml. and wall thickness was measured via suprapubic ultrasound. Bladder outlet obstruction was diagnosed and graded according to the Abrams-Griffiths and Schäfer nomogram as well as to the group specific urethral resistance algorithm.nnnRESULTSnA significant correlation (r > 0.6, p < or = 0.007) was found between bladder wall thickness and all parameters of the pressure-flow study. A bladder wall thickness of 5 mm. appeared to be the best cutoff point to diagnose bladder outlet obstruction, since 63.3% of patients with bladder wall thickness less than 5 mm. were unobstructed while 87.5% of those with a bladder wall thickness 5 mm. or greater were obstructed. Bladder wall thickness out performed uroflowmetry in terms of specificity and sensitivity in the diagnosis of outlet obstruction as demonstrated by an area under curve value of 0.860 versus 0.688 in the receiver operator characteristics analysis.nnnCONCLUSIONSnMeasurement of bladder wall thickness appears to be a useful predictor of outlet obstruction with a diagnostic value exceeding free uroflowmetry although it does not represent a substitution to invasive urodynamics. These data support the hypothesis that the relationships between morphology and function are of clinical importance.

The Prediction of Clinical Outcome from Transurethral Microwave Thermotherapy by Pressure-Flow Analysis: A European Multicenter Study

A total of 100 patients treated with a single session of microwave thermotherapy at 4 European centers was stratified according to 2 different types of obstruction (constrictive and compressive) and compared to clinical outcome at 6 months. Patients had a Madsen-Iversen score of 8 or more, maximum flow rate of 15 ml. per second or less and residual urine volume of 300 ml. or less at entry. The change in Madsen-Iversen score was the same in the 2 groups. Maximum flow rate increased from 8.71 +/- 2.62 to 14.73 +/- 4.04 ml. per second in the constrictive group, and from 8.54 +/- 2.26 to 10.41 +/- 4.52 in the compressive group (p < or = 0.0001). Residual urine decreased from 96.00 +/- 72.85 to 40.34 +/- 56.33 ml. in the constrictive group and from 109.86 +/- 67.09 to 84.65 +/- 81.45 ml. in the compressive group (p < or = 0.0001). Success, as defined by an increase of 50% or more in maximum flow rate and Madsen-Iversen score, was noted in 68% of the constrictive but only 15% of the compressive groups (p < or = 0.0001 chi-square test for trend). Selection by pressure-flow criteria for patients being considered for thermotherapy should improve the overall clinical results.

Responders and Nonresponders to Transurethral Microwave Thermotherapy: A Multicenter Retrospective Analysis

PURPOSEnWe attempted to identify any parameter that could possibly lead to a successful treatment outcome after transurethral microwave thermotherapy.nnnMATERIALS AND METHODSnClinical parameters and treatment profiles of 292 patients were analyzed in a retrospective multicenter manner. Responder and nonresponder groups were identified according to a given definition.nnnRESULTSnNo statistically significant differences in baseline characteristics were found. Responders showed a 76% symptomatic improvement rate compared to 27% in nonresponders, and an 82% improvement rate in peak flow compared to a 5% decrease in nonresponders. Responders also showed a significantly greater increase in posttreatment PSA level and a significantly greater amount of energy released during treatment.nnnCONCLUSIONSnNo baseline clinical parameter is capable of predicting treatment outcome.

Transurethral microwave thermotherapy : past, present and future

ConclusionThe findings of improved clinical results in certain patient groups in some studies suggest that the full clinical benefit of TUMT has been under-reported. The objective must be to find the thermal dose, which will maintain a clinically significant reduction in symptoms with objective evidence of improved urinary flow and reduction in obstruction, while causing minimal post-treatment morbidity and still not necessitating anaesthesia. The maximum benefit of TUMT will be obtained only by selection of individual patients for specific therapeutic protocols.