- •Preface and Acknowledgments
- •Contents
- •Contributors
- •1: Embryology for Urologists
- •Introduction
- •Renal Development
- •Pronephros
- •Mesonephros
- •Metanephros
- •Development of the Collecting System
- •Critical Steps in Further Development
- •Anomalies of the Kidney
- •Renal Agenesis
- •Renal Aplasia
- •Renal Hypoplasia
- •Renal Ectopia
- •Renal Fusion
- •Ureteral Development
- •Anomalies of Origin
- •Anomalies of Number
- •Incomplete Ureteral Duplication
- •Complete Ureteral Duplication
- •Ureteral Ectopia
- •Embryology of Ectopia
- •Clinical Correlation
- •Location of Ectopic Ureteral Orifices – Male (in Descending Order According to Incidence)
- •Symptoms
- •Ureteroceles
- •Congenital Ureteral Obstruction
- •Pipestem Ureter
- •Megaureter-Megacystis Syndrome
- •Prune Belly Syndrome
- •Vascular Ureteral Obstructions
- •Division of the Urogenital Sinus
- •Bladder Development
- •Urachal Anomalies
- •Cloacal Duct Anomalies
- •Other Bladder Anomalies
- •Bladder Diverticula
- •Bladder Extrophy
- •Gonadal Development
- •Testicular Differentiation
- •Ovarian Differentiation
- •Gonadal Anomalies
- •Genital Duct System
- •Disorders of Testicular Function
- •Female Ductal Development
- •Prostatic Urethral Valves
- •Gonadal Duct Anomalies
- •External Genital Development
- •Male External Genital Development
- •Female External Genital Development
- •Anomalies of the External Genitalia
- •References
- •2: Gross and Laparoscopic Anatomy of the Upper Urinary Tract and Retroperitoneum
- •Overview
- •The Kidneys
- •The Renal Vasculature
- •The Renal Collecting System
- •The Ureters
- •Retroperitoneal Lymphatics
- •Retroperitoneal Nerves
- •The Adrenal Glands
- •References
- •3: Gross and Laparoscopic Anatomy of the Lower Urinary Tract and Pelvis
- •Introduction
- •Female Pelvis
- •Male Pelvis
- •Pelvic Floor
- •Urinary Bladder
- •Urethra
- •Male Urethra
- •Female Urethra
- •Sphincter Mechanisms
- •The Bladder Neck Component
- •The Urethral Wall Component
- •The External Urethral Sphincter
- •Summary
- •References
- •4: Anatomy of the Male Reproductive System
- •Testis and Scrotum
- •Spermatogenesis
- •Hormonal Regulation of Spermatogenesis
- •Genetic Regulation of Spermatogenesis
- •Epididymis and Ductus Deferens
- •Accessory Sex Glands
- •Prostate
- •Seminal Vesicles
- •Bulbourethral Glands
- •Penis
- •Erection and Ejaculation
- •References
- •5: Imaging of the Upper Tracts
- •Anatomy of the Upper Tracts and Introduction to Imaging Modalities
- •Introduction
- •Renal Upper Tract Basic Anatomy
- •Modalities Used for Imaging the Upper Tracts
- •Ultrasound
- •Radiation Issues
- •Contrast Issues
- •Renal and Upper Tract Tumors
- •Benign Renal Tumors
- •Transitional Cell Carcinoma
- •Renal Mass Biopsy
- •Renal Stone Disease
- •Ultrasound
- •Plain Radiographs and IVU
- •Renal Cystic Disease
- •Benign Renal Cysts
- •Hereditary Renal Cystic Disease
- •Complex Renal Cysts
- •Renal Trauma
- •References
- •Introduction
- •Pathophysiology
- •Susceptibility and Resistance
- •Epidemiological Breakpoints
- •Clinical Breakpoints
- •Pharmacodynamic Parameters
- •Pharmacokinetic Parameters
- •Fosfomycin
- •Nitrofurantoin
- •Pivmecillinam
- •b-Lactam-Antibiotics
- •Penicillins
- •Cephalosporins
- •Carbapenems
- •Aminoglycosides
- •Fluoroquinolones
- •Trimethoprim, Cotrimoxazole
- •Glycopeptides
- •Linezolid
- •Conclusion
- •References
- •7: An Overview of Renal Physiology
- •Introduction
- •Body Fluid Compartments
- •Regulation of Potassium Balance
- •Regulation of Acid–Base Balance
- •Diuretics
- •Suggested Reading
- •8: Ureteral Physiology and Pharmacology
- •Ureteral Anatomy
- •Modulation of Peristalsis
- •Ureteral Pharmacology
- •Conclusion
- •References
- •Introduction
- •Afferent Signaling Pathways
- •Efferent Signaling
- •Parasympathetic Nerves
- •Sympathetic Nerves
- •Vesico-Spinal-Vesical Micturition Reflex
- •Peripheral Targets
- •Afferent Signaling Mechanisms
- •Urothelium
- •Myocytes
- •Cholinergic Receptors
- •Muscarinic Receptors
- •Nicotinic Receptors
- •Adrenergic Receptors (ARs)
- •a-Adrenoceptors
- •b-Adrenoceptors
- •Transient Receptor Potential (TRP) Receptors
- •Phosphodiesterases (PDEs)
- •CNS Targets
- •Opioid Receptors
- •Serotonin (5-HT) Mechanisms
- •g-Amino Butyric Acid (GABA) Mechanisms
- •Gabapentin
- •Neurokinin and Neurokinin Receptors
- •Summary
- •References
- •10: Pharmacology of Sexual Function
- •Introduction
- •Sexual Desire/Arousal
- •Endocrinology
- •Steroids in the Male
- •Steroids in the Female
- •Neurohormones
- •Neurotransmitters
- •Dopamine
- •Serotonin
- •Pharmacological Strategies
- •CNS Drugs
- •Enzyme-inducing Antiepileptic Drugs
- •Erectile Function
- •Ejaculatory Function
- •Premature Ejaculation
- •Abnormal Ejaculation
- •Conclusions
- •References
- •Epidemiology
- •Calcium-Based Urolithiasis
- •Uric Acid Urolithiasis
- •Infectious Urolithiasis
- •Cystine-Based Urolithiasis
- •Aims
- •Who Deserves Metabolic Evaluation?
- •Metabolic Workup for Stone Producers
- •Medical History and Physical Examination
- •Stone Analysis
- •Serum Chemistry
- •Urine Evaluation
- •Urine Cultures
- •Urinalysis
- •Twenty-Four Hour Urine Collections
- •Radiologic Imaging
- •Medical Management
- •Conservative Management
- •Increased Fluid Intake
- •Citrus Juices
- •Dietary Restrictions
- •Restricted Oxalate Diet
- •Conservative Measures
- •Selective Medical Therapy
- •Absorptive Hypercalciuria
- •Thiazide
- •Orthophosphate
- •Renal Hypercalciuria
- •Primary Hyperparathyroidism
- •Hyperuricosuric Calcium Oxalate Nephrolithiasis
- •Enteric Hyperoxaluria
- •Hypocitraturic Calcium Oxalate Nephrolithiasis
- •Distal Renal Tubular Acidosis
- •Chronic Diarrheal States
- •Thiazide-Induced Hypocitraturia
- •Idiopathic Hypocitraturic Calcium Oxalate Nephrolithiasis
- •Hypomagnesiuric Calcium Nephrolithiasis
- •Gouty Diathesis
- •Cystinuria
- •Infection Lithiasis
- •Summary
- •References
- •12: Molecular Biology for Urologists
- •Introduction
- •Inherited Changes in Cancer Cells
- •VEGR and Cell Signaling
- •Targeting mTOR
- •Conclusion
- •References
- •13: Chemotherapeutic Agents for Urologic Oncology
- •Introduction
- •Bladder Cancer
- •Muscle Invasive Bladder Cancer
- •Metastatic Bladder Cancer
- •Conclusion
- •Prostate Cancer
- •Other Chemotherapeutic Drugs or Combinations for Treating HRPC
- •Conclusion
- •Renal Cell Carcinoma
- •Chemotherapy
- •Immunotherapy
- •Angiogenesis Inhibitor Drugs
- •Conclusion
- •Testicular Cancer
- •Stage I Seminoma
- •Stage I non-seminomatous Germ Cell Tumours (NSGCT)
- •Metastatic Germ Cell Tumours
- •Low-Volume Metastatic Disease (Stage II A/B)
- •Advanced Metastatic Disease
- •Salvage Chemotherapy for Relapsed or Refractory Disease
- •Conclusion
- •Penile Cancer
- •Side Effects of Chemotherapy
- •Conclusion
- •References
- •14: Tumor and Transplant Immunology
- •Antibodies
- •Cytotoxic and T-helper Cells
- •Immunosuppression
- •Induction Therapy
- •Maintenance Therapy
- •Rejection
- •Posttransplant Lymphoproliferative Disease
- •Summary
- •References
- •15: Pathophysiology of Renal Obstruction
- •Causes of Renal Obstruction
- •Effects on Prenatal Development
- •Prenatal Hydronephrosis
- •Spectrum of Renal Abnormalities
- •Renal Functional Changes
- •Renal Growth/Counterbalance
- •Vascular Changes
- •Inflammatory Mediators
- •Glomerular Development Changes
- •Mechanical Stretch of Renal Tubules
- •Unilateral Versus Bilateral
- •Limitations of Animal Models
- •Future Research
- •Issues in Patient Management
- •Diagnostic Imaging
- •Ultrasound
- •Intravenous Urography
- •Antegrade Urography and the Whitaker Test
- •Nuclear Renography
- •Computed Tomography
- •Magnetic Resonance Urography
- •Hypertension
- •Postobstructive Diuresis
- •References
- •Introduction
- •The Normal Lower Urinary Tract
- •Anatomy
- •Storage Function
- •Voiding Function
- •Neural Control
- •Symptoms
- •Flow Rate and Post-void Residual
- •Voiding Cystometry
- •Male
- •Female
- •Neurourology
- •Conclusions
- •References
- •17: Urologic Endocrinology
- •The Testis
- •Normal Androgen Metabolism
- •Epidemiological Aspects
- •Prostate
- •Brain
- •Muscle Mass and Adipose Tissue
- •Bones
- •Ematopoiesis
- •Metabolism
- •Cardiovascular System
- •Clinical Assessment
- •Biochemical Assessment
- •Treatment Modalities
- •Oral Preparations
- •Parenteral Preparations
- •Transdermal Preparations
- •Side Effects and Treatment Monitoring
- •Body Composition
- •Cognitive Decline
- •Bone Metabolism
- •The Kidneys
- •Endocrine Functions of the Kidney
- •Erythropoietin
- •Calcitriol
- •Renin
- •Paraneoplastic Syndromes
- •Hypercalcemia
- •Hypertension
- •Polycythemia
- •Other Endocrine Abnormalities
- •References
- •General Physiology
- •Prostate Innervation
- •Summary
- •References
- •Wound Healing
- •Inflammation
- •Proliferation
- •Remodeling
- •Principles of Plastic Surgery
- •Tissue Characteristics
- •Grafts
- •Flap
- •References
- •Lower Urinary Tract Symptoms
- •Storage Phase
- •Voiding Phase
- •Return to Storage Phase
- •Urodynamic Parameters
- •Urodynamic Techniques
- •Volume Voided Charts
- •Pad Testing
- •Typical Test Schedule
- •Uroflowmetry
- •Post Voiding Residual
- •Further Diagnostic Evaluation of Patients
- •Cystometry with or Without Video
- •Cystometry
- •Videocystometrography (Cystometry + Cystourethrography)
- •Cystometric Findings
- •Comment:
- •Measurements During the Storage Phase:
- •Measurements During the Voiding Phase:
- •Abnormal Function
- •Disorders of Sensation
- •Causes of Hypersensitive Bladder Sensation
- •Causes of Hyposensitive Bladder Sensation
- •Disorders of Detrusor Motor Function
- •Bladder Outflow Tract Dysfunction
- •Detrusor–Urethral Dyssynergia
- •Detrusor–Bladder Neck Dyssynergia
- •Detrusor–Sphincter Dyssynergia
- •Complex Urodynamic Investigation
- •Urethral Pressure Measurement
- •Technique
- •Neurophysiological Evaluation
- •Conclusion
- •References
- •Endoscopy
- •Cystourethroscopy
- •Ureteroscopy and Ureteropyeloscopy
- •Nephroscopy
- •Virtual Reality Simulators
- •Lasers
- •Clinical Application of Lasers
- •Condylomata Acuminata
- •Urolithiasis
- •Benign Prostatic Hyperplasia
- •Ureteral and Urethral Strictures
- •Conclusion
- •References
- •Introduction
- •The Prostatitis Syndromes
- •The Scope of the Problem
- •Category III CP/CPPS
- •The Goal of Treatment
- •Conservative Management
- •Drug Therapy
- •Antibiotics
- •Anti-inflammatories
- •Alpha blockers
- •Hormone Therapies
- •Phytotherapies
- •Analgesics, muscle relaxants and neuromodulators
- •Surgery
- •A Practical Management Plan
- •References
- •Orchitis
- •Definition and Etiology
- •Clinical Signs and Symptoms
- •Diagnostic Evaluation
- •Treatment of Infectious Orchitis
- •Epididymitis
- •Definition and Etiology
- •Clinical Signs and Symptoms
- •Diagnostic Evaluation of Epididymitis
- •Treatment of Acute Epididymitis
- •Treatment of Chronic Epididymitis
- •Treatment of Spermatic Cord Torsion
- •Fournier’s Gangrene
- •Definition and Etiology
- •Risk Factors
- •Clinical Signs and Symptoms
- •Diagnostic Evaluation
- •Treatment
- •References
- •Fungal Infections
- •Candidiasis
- •Aspergillosis
- •Cryptococcosis
- •Blastomycosis
- •Coccidioidomycosis
- •Histoplasmosis
- •Radiographic Findings
- •Treatment
- •Tuberculosis
- •Clinical Manifestations
- •Diagnosis
- •Treatment
- •Schistosomiasis
- •Clinical Manifestations
- •Diagnosis
- •Treatment
- •Filariasis
- •Clinical Manifestations
- •Diagnosis
- •Treatment
- •Onchocerciasis
- •References
- •25: Sexually Transmitted Infections
- •Introduction
- •STIs Associated with Genital Ulcers
- •Herpes Simplex Virus
- •Diagnosis
- •Treatment
- •Chancroid
- •Diagnosis
- •Treatment
- •Syphilis
- •Diagnosis
- •Treatment
- •Lymphogranuloma Venereum
- •Diagnosis
- •Treatment
- •Chlamydia
- •Diagnosis
- •Treatment
- •Gonorrhea
- •Diagnosis
- •Treatment
- •Trichomoniasis
- •Diagnosis
- •Treatment
- •Human Papilloma Virus
- •Diagnosis
- •Treatment
- •Scabies
- •Diagnosis
- •Treatment
- •References
- •26: Hematuria: Evaluation and Management
- •Introduction
- •Classification of Hematuria
- •Macroscopic Hematuria
- •Microscopic Hematuria
- •Dipstick Hematuria
- •Pseudohematuria
- •Factitious Hematuria
- •Menstruation
- •Aetiology
- •Malignancy
- •Urinary Calculi
- •Infection and Inflammation
- •Benign Prostatic Hyperplasia
- •Trauma
- •Drugs
- •Nephrological Causes
- •Assessment
- •History
- •Examination
- •Investigations
- •Dipstick Urinalysis
- •Cytology
- •Molecular Tests
- •Blood Tests
- •Flexible Cystoscopy
- •Upper Urinary Tract Evaluation
- •Renal USS
- •KUB Abdominal X-Ray
- •Intravenous Urography (IVU)
- •Computed Tomography (CT)
- •Retrograde Urogram Studies
- •Magnetic Resonance Imaging (MRI)
- •Additional Tests and Renal Biopsy
- •Intractable Hematuria
- •Loin Pain Hematuria Syndrome
- •References
- •27: Benign Prostatic Hyperplasia (BPH)
- •Historical Background
- •Pathophysiology
- •Patient Assessment
- •Treatment of BPH
- •Watchful Waiting
- •Drug Therapy
- •Interventional Therapies
- •Conclusions
- •References
- •28: Practical Guidelines for the Treatment of Erectile Dysfunction and Peyronie´s Disease
- •Erectile Dysfunction
- •Introduction
- •Diagnosis
- •Basic Evaluation
- •Cardiovascular System and Sexual Activity
- •Optional Tests
- •Treatment
- •Medical Treatment
- •Oral Agents
- •Phosphodiesterase Type 5 (PDE 5) Inhibitors
- •Nonresponders to PDE5 Inhibitors
- •Apomorphine SL
- •Yohimbine
- •Intracavernosal and Intraurethral Therapy
- •Intracavernosal Injection (ICI) Therapy
- •Intraurethral Therapy
- •Vacuum Constriction Devices
- •Surgical Therapy
- •Conclusion
- •Peyronie´s Disease (PD)
- •Introduction
- •Oral Drug Therapy
- •Intralesional Drug Therapy
- •Iontophoresis
- •Radiation Therapy
- •Surgical Therapy
- •References
- •29: Premature Ejaculation
- •Introduction
- •Epidemiology
- •Defining Premature Ejaculation
- •Voluntary Control
- •Sexual Satisfaction
- •Distress
- •Psychosexual Counseling
- •Pharmacological Treatment
- •On-Demand Treatment with Tramadol
- •Topical Anesthetics
- •Phosphodiesterase Inhibitors
- •Surgery
- •Conclusion
- •References
- •30: The Role of Interventional Management for Urinary Tract Calculi
- •Contraindications to ESWL
- •Complications of ESWL
- •PCNL Access
- •Instrumentation for PCNL
- •Nephrostomy Drains Post PCNL
- •Contraindications to PCNL
- •Complications of PCNL
- •Semirigid Ureteroscopy
- •Flexible Ureteroscopy
- •Electrohydraulic Lithotripsy (EHL)
- •Ultrasound
- •Ballistic Lithotripsy
- •Laser Lithotripsy
- •Ureteric Stents
- •Staghorn Calculi
- •Lower Pole Stones
- •Horseshoe Kidneys and Stones
- •Calyceal Diverticula Stones
- •Stones and PUJ Obstruction
- •Treatment of Ureteric Colic
- •Medical Expulsive Therapy (MET)
- •Intervention for Ureteric Stones
- •Stones in Pregnancy
- •Morbid Obesity
- •References
- •Anatomy and Function
- •Pathophysiology
- •Management
- •Optical Urethrotomy/Dilatation
- •Urethral Stents
- •Preoperative Assessment
- •Urethroplasty
- •Anastomotic Urethroplasty
- •Substitution Urethroplasty
- •Grafts Versus Flaps
- •Oral Mucosal Grafts
- •Tissue Engineering
- •Graft Position
- •Conclusion
- •References
- •32: Urinary Incontinence
- •Epidemiology and Risk Factors
- •Pathophysiology
- •Urge Incontinence
- •Conservative Treatments
- •Pharmacotherapy
- •Invasive/ Surgical Therapies
- •Stress Urinary Incontinence
- •Male SUI Therapies
- •Female SUI Therapies
- •Mixed Urinary Incontinence
- •Conclusions
- •References
- •33: Neurogenic Bladder
- •Introduction
- •Examination and Diagnostic Tests
- •History and Physical Examination
- •Imaging
- •Urodynamics (UDS)
- •Evoked Potentials
- •Classifications
- •Somatic Pathways
- •Brain Lesions
- •Cerebrovascular Accident (CVA)
- •Parkinson’s Disease (PD)
- •Multiple Sclerosis
- •Huntington’s Disease
- •Dementias
- •Normal Pressure Hydrocephalus (NPH)
- •Tumors
- •Psychiatric Disorders
- •Spinal Lesions and Pathology
- •Intervertebral Disk Prolapse
- •Spinal Cord Injury (SCI)
- •Transverse Myelitis
- •Peripheral Neuropathies
- •Metabolic Neuropathies
- •Pelvic Surgery
- •Treatment
- •Summary
- •References
- •34: Pelvic Prolapse
- •Introduction
- •Epidemiology
- •Anatomy and Pathophysiology
- •Evaluation and Diagnosis
- •Outcome Measures
- •Imaging
- •Urodynamics
- •Indications for Management
- •Biosynthetics
- •Surgical Management
- •Anterior Compartment Repair
- •Uterine/Apical Prolapse
- •Enterocele Repair
- •Conclusion
- •References
- •35: Urinary Tract Fistula
- •Introduction
- •Urogynecologic Fistula
- •Vesicovaginal Fistula
- •Etiology and Risk Factors
- •Clinical Factors
- •Evaluation and Diagnosis
- •Pelvic Examination
- •Cystoscopy
- •Imaging
- •Treatment
- •Conservative Management
- •Surgical Management
- •Urethrovaginal Fistula
- •Etiology and Presentation
- •Diagnosis and Management
- •Ureterovaginal Fistula
- •Etiology and Presentation
- •Diagnosis and Management
- •Vesicouterine Fistula
- •Etiology and Presentation
- •Diagnosis and Management
- •Uro-Enteric Fistula
- •Vesicoenteric Fistula
- •Pyeloenteric Fistula
- •Urethrorectal Fistula
- •References
- •36: Urologic Trauma
- •Introduction
- •Kidney
- •Expectant Management
- •Endovascular Therapy
- •Operative Intervention
- •Operative Management: Follow-up
- •Reno-Vascular Injuries
- •Pediatric Renal Injuries
- •Adrenal
- •Ureter
- •Diagnosis
- •Treatment
- •Delayed Diagnosis
- •Bladder and Posterior Urethra
- •Bladder Injuries: Initial Management
- •Bladder Injuries: Formal Repair
- •Anterior Urethral Trauma
- •Fractured Penis
- •Penile Amputation
- •Scrotal and Testicular Trauma
- •Imaging
- •CT-IVP (CT with Delayed Images)
- •Technique
- •Cystogram
- •Technique
- •Retrograde Urethrogram (RUG)
- •Technique
- •Retrograde Pyelogram (RPG)
- •Technique
- •One-Shot IVP
- •Technique
- •References
- •37: Bladder Cancer
- •Who Should Be Investigated?
- •Epidemiology
- •Risk Factors
- •Role of Screening
- •Signs and Symptoms
- •Imaging
- •Cystoscopy
- •Urine Tests
- •PDD-Assisted TUR
- •Pathology
- •NMIBC and Risk Groups
- •Intravesical Chemotherapy
- •Intravesical Immunotherapy
- •Immediate Cystectomy and CIS
- •Radical Cystectomy with Pelvic Lymph Node Dissection
- •sexual function-preserving techniques
- •Bladder-Preservation Treatments
- •Neoadjuvant Chemotherapy
- •Adjuvant Chemotherapy
- •Preoperative Radiotherapy
- •Follow-up After TUR in NMIBC
- •References
- •38: Prostate Cancer
- •Introduction
- •Epidemiology
- •Race
- •Geographic Variation
- •Risk Factors and Prevention
- •Family History
- •Diet and Lifestyle
- •Prevention
- •Screening and Diagnosis
- •Current Screening Recommendations
- •Biopsy
- •Pathology
- •Prognosis
- •Treatment of Prostate Cancer
- •Treatment for Localized Prostate Cancer (T1, T2)
- •Radical Prostatectomy
- •EBRT
- •IMRT
- •Brachytherapy
- •Treatment for Locally Advanced Prostate Cancer (T3, T4)
- •EBRT with ADT
- •Radical Prostatectomy
- •Androgen-Deprivation Therapy
- •Summary
- •References
- •39: The Management of Testis Cancer
- •Presentation and Diagnosis
- •Serum Tumor Markers
- •Primary Surgery
- •Testis Preserving Surgery
- •Risk Stratification
- •Surveillance Versus Primary RPLND
- •Primary RPLND
- •Adjuvant Treatment for High Risk
- •Clinical Stage 1 Seminoma
- •Risk-Stratified Adjuvant Treatment
- •Adjuvant Radiotherapy
- •Adjuvant Low Dose Chemotherapy
- •Primary Combination Chemotherapy
- •Late Toxicity
- •Salvage Strategies
- •Conclusion
- •References
- •Index
215
PathoPhysiology of lowEr Urinary tract obstrUction
Figure 16.4. two women with an intermittent urinary stream. in the top panel, a neurologically normal woman with dysfunctional voiding and outlet obstruction due to fowler’s syndrome. Lower panel;voiding cystometrogram from a female patient with multiple
occur as a consequence of problems in the sacral part of the spinal cord causing tonic contraction.81 It is also seen when there is loss of communication between the brainstem and the lower urinary tract, which results in detrusor sphincter dyssynergia (DSD).82 DSD is common in high spinal cord injury and also occurs in advanced multiple sclerosis. It gives rise to a characteristically intermittent flow rate, and post-void residuals tend to be significant. Because of the high pressures generated during voiding, upper urinary tract function
sclerosis.the trace shows a wandering, poorly sustained detrusor contraction, resulting in an intermittent and very poor flow, with incomplete emptying. it would be extremely hard to ascertain whether outlet obstruction is also present in this patient.
can be impaired, leading to hydronephrosis and renal failure.83 When examined endoscopically, the bladder neck of these patients is often hypertrophied, and the bladder wall itself is trabeculated and diverticulated.
Conclusions
Both men and women are at risk of BOO, but the more homogenous nature of BOO in men has
216 Practical Urology: EssEntial PrinciPlEs and PracticE
allowed a standard approach to diagnosis,which |
13. |
Andersson KE. Detrusor contraction – focus on mus- |
||
is lacking in women.Anatomical constriction or |
|
carinic receptors. Scand J Urol Nephrol Suppl. 2004; |
||
distortion (or direct blockage from a foreign |
|
215:54-57 |
||
14. |
Drake MJ. The integrative physiology of the bladder. |
|||
body) result in BOO. In addition, excessive |
||||
|
Ann R Coll Surg Engl. 2007;89:580-585 |
|||
sphincter activity, as a result of neurological |
|
|||
15. |
Ho KM, McMurray G, Brading AF, Noble JG, Ny L, |
|||
disease of the CNS, or idiopathic overactivity of |
|
Andersson KE. Nitric oxide synthase in the heteroge- |
||
the sphincter muscles themselves, is an unusual |
|
neous population of intramural striated muscle fibres of |
||
but important patient group. Diagnosis cannot |
|
the human membranous urethral sphincter. J Urol. |
||
rely on symptoms alone, and an overall impres- |
|
1998;159:1091-1096 |
||
16. |
Ho KM, Ny L, McMurray G, Andersson KE, Brading AF, |
|||
sion, using symptoms, flow rate testing, cys- |
||||
|
Noble JG. Co-localization of carbon monoxide and nitric |
|||
tometrogram, and imaging all have a part to |
|
|||
|
oxide synthesizing enzymes in the human urethral |
|||
play. |
|
sphincter. J Urol. 1999;161:1968-1972 |
||
|
|
17. |
Abrams P, Cardozo L, Fall M, et al. The standardisation of |
|
|
|
|
terminology of lower urinary tract function: report from |
|
|
|
|
the Standardisation Sub-committee of the International |
|
References |
|
Continence Society. Neurourol Urodyn. 2002; 21:167-178 |
||
18. |
Abrams P, Cardozo L, Fall M, et al. The standardisation |
|||
|
|
|
of terminology of lower urinary tract function: report |
|
1. |
Yucel S, Baskin LS. An anatomical description of the |
|
from the Standardisation Sub-committee of the Inte- |
|
|
male and female urethral sphincter complex. J Urol. |
|
rnational Continence Society. Am J Obstet Gynecol. |
|
|
171:1890-1897 |
|
2002;187:116-126 |
|
2. |
Wallner C, Dabhoiwala NF, Deruiter MC, Lamers WH. |
19. |
de la Rosette JJ,Witjes WP, Schafer W, et al. Relationships |
|
|
The anatomical components of urinary continence. Eur |
|
between lower urinary tract symptoms and bladder out- |
|
|
Urol. 2009;55(4):932-943 |
|
let obstruction: results from the ICS-“BPH” study. |
|
3. |
Ashton-Miller JA, DeLancey JO. Functional anatomy of |
|
Neurourol Urodyn. 1998;17:99-108 |
|
|
the female pelvic floor. Ann NY Acad Sci. 2007;1101: 266- |
20. |
Pandita RK, Fujiwara M, Alm P, Andersson KE. |
|
|
296 |
|
Cystometric evaluation of bladder function in non- |
|
4. |
DeLancey JO. Structural support of the urethra as it |
|
anesthetized mice with and without bladder outlet |
|
|
relates to stress urinary incontinence: the hammock |
|
obstruction. J Urol. 2000;164:1385-1389 |
|
|
hypothesis. Am J Obstet Gynecol. 1994;170:1713-1720. |
21. |
Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams |
|
|
discussion 20–3 |
|
P. The natural history of lower urinary tract dysfunction |
|
5. |
Brading AF. Spontaneous activity of lower urinary tract |
|
in men: minimum 10-year urodynamic followup of |
|
|
smooth muscles: correlation between ion channels and |
|
transurethral resection of prostate for bladder outlet |
|
|
tissue function. J Physiol. 2006;570:13-22 |
|
obstruction. J Urol. 2005;174:1887-1991 |
|
6. |
Brown M, Wickham JE. The urethral pressure profile. |
22. |
Haylen BT, Ashby D, Sutherst JR, Frazer MI, West CR. |
|
|
Br J Urol. 1969;41:211-217 |
|
Maximum and average urine flow rates in normal male |
|
7. |
Bolton JF, Whittlestone TH, Sibley GN. Comparisons of |
|
and female populations – the Liverpool nomograms. |
|
|
the responses of anterior and posterior human adult |
|
Br J Urol. 1989;64:30-38 |
|
|
male bladder neck smooth muscle to in vitro stimula- |
23. |
Siroky MB, Olsson CA, Krane RJ. The flow rate nom- |
|
|
tion. BJU Int. 2008;102:1737-1742 |
|
ogram: I. Development. J Urol. 1979;122:665-668 |
|
8. |
Sergeant GP, Thornbury KD, McHale NG, Hollywood |
24. |
Siroky MB, Olsson CA, Krane RJ. The flow rate nomo- |
|
|
MA. Interstitial cells of Cajal in the urethra. J Cell Mol |
|
gram: II. Clinical correlation. J Urol. 1980;123: 208-210 |
|
|
Med. 2006;10:280-291 |
25. |
Reynard JM, Yang Q, Donovan JL, et al. The ICS-“BPH” |
|
9. |
Ichiyanagi O, Sasagawa I, Suzuki Y, Ishigooka M, Nakada |
|
study: uroflowmetry, lower urinary tract symptoms and |
|
|
T. Relation between urethral elasticity and bladder out- |
|
bladder outlet obstruction. Br J Urol. 1998;82: 619-623 |
|
|
let obstruction and histologic composition of the pros- |
26. |
Pernkopf D, Plas E, Lang T, et al. Uroflow nomogram for |
|
|
tate in patients with benign prostatic hyperplasia. |
|
male adolescents. J Urol. 2005;174:1436-1439. discussion 9 |
|
|
Urology. 1999;53:1149-1153 |
27. |
Idzenga T, Pel JJ, van Mastrigt R. Accuracy of maximum |
|
10. |
Mitterberger M, Pinggera GM, Neuwirt H, et al. Three- |
|
flow rate for diagnosing bladder outlet obstruction can |
|
|
dimensional ultrasonography of the urinary bladder: |
|
be estimated from the ICS nomogram. Neurourol |
|
|
preliminary experience of assessment in patients with |
|
Urodyn. 2008;27:97-98 |
|
|
haematuria. BJU Int. 2007;99:111-116 |
28. |
Abrams PH, Griffiths DJ. The assessment of prostatic |
|
11. |
Sebe P, Fritsch H, Oswald J, et al. Fetal development of |
|
obstruction from urodynamic measurements and from |
|
|
the female external urinary sphincter complex: an ana- |
|
residual urine. Br J Urol. 1979;51:129-134 |
|
|
tomical and histological study. J Urol. 2005;173:1738- |
29. |
Abrams P, Blaivas JG, Stanton SL, Andersen JT. The stan- |
|
|
1742. discussion 42 |
|
dardisation of terminology of lower urinary tract func- |
|
12. |
Petros PE, Woodman PJ. The integral theory of conti- |
|
tion. The International Continence Society Committee |
|
|
nence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19: |
|
on Standardisation of Terminology. Scand J Urol Nephrol |
|
|
35-40 |
|
Suppl. 1988;114:5-19 |
217
PathoPhysiology of lowEr Urinary tract obstrUction
30.Belal M, Abrams P. Noninvasive methods of diagnosing bladder outlet obstruction in men. Part 2: noninvasive urodynamics and combination of measures. J Urol. 2006;176:29-35
31.Belal M, Abrams P. Noninvasive methods of diagnosing bladder outlet obstruction in men. Part 1: nonurodynamic approach. J Urol. 2006;176:22-28
32.Harding CK, Robson W, Drinnan MJ, Griffiths CJ, Ramsden PD, Pickard RS.An automated penile compression release maneuver as a noninvasive test for diagnosis of bladder outlet obstruction. J Urol. 2004;172: 2312-2315
33.Griffiths CJ, Harding C, Blake C, et al. A nomogram to classify men with lower urinary tract symptoms using urine flow and noninvasive measurement of bladder pressure.J Urol.2005;174:1323-1326.discussion 6; author reply 6
34.Pel JJ, van Mastrigt R. A flow rate cut-off value as a criterion for the accurate non-invasive measurement of bladder pressure using a condom-type catheter. Urol Res. 2003;31:177-182
35.Oelke M, Hofner K, Jonas U, de la Rosette JJ, Ubbink DT, Wijkstra H. Diagnostic accuracy of noninvasive tests to evaluate bladder outlet obstruction in men: detrusor wall thickness, uroflowmetry, postvoid residual urine, and prostate volume. Eur Urol. 2007;52:827-834
36.Oelke M, Hofner K, Wiese B, Grunewald V, Jonas U. Increase in detrusor wall thickness indicates bladder outlet obstruction (BOO) in men. World J Urol. 2002;19: 443-452
37.Akikwala TV, Fleischman N, Nitti VW. Comparison of diagnostic criteria for female bladder outlet obstruction. J Urol. 2006;176:2093-2097
38.Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19:553-564
39.Di Grazia E, Troyo Sanroman R, Aceves JG. Proposed urodynamic pressure-flow nomogram to diagnose female bladder outlet obstruction. Arch Ital Urol Androl. 2004;76:59-65
40.Gravina GL, Costa AM, Ronchi P, Galatioto GP, Luana G, Vicentini C. Bladder outlet obstruction index and maximal flow rate during urodynamic study as powerful predictors for the detection of urodynamic obstruction in women. Neurourol Urodyn. 2007;26:247-253
41.Kuo HC. Urodynamic parameters for the diagnosis of bladder outlet obstruction in women. Urol Int. 2004;72: 46-51
42.Chassagne S, Bernier PA, Haab F, Roehrborn CG, Reisch JS, Zimmern PE. Proposed cutoff values to define bladder outlet obstruction in women. Urology. 1998;51: 408-411
43.Lemack GE, Zimmern PE. Pressure flow analysis may aid in identifying women with outflow obstruction. J Urol. 2000;163:1823-1828
44.Defreitas GA, Zimmern PE, Lemack GE, Shariat SF. Refining diagnosis of anatomic female bladder outlet obstruction: comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls. Urology. 2004;64:675-679. discussion 9–81
45.Nitti VW, Tu LM, Gitlin J. Diagnosing bladder outlet obstruction in women. J Urol. 1999;161:1535-1540
46.Cormier L, Ferchaud J, Galas JM, Guillemin F, Mangin P. Diagnosis of female bladder outlet obstruction and relevance of the parameter area under the curve of detrusor pressure during voiding: preliminary results. J Urol. 2002;167:2083-2087
47.Klijer R, Bar K, Bialek W. Bladder outlet obstruction in women: difficulties in the diagnosis. Urol Int. 2004;73: 6-10
48.Abrams P. LUTS, BPH, BPE, BPO: a plea for the logical use of correct terms. Rev Urol. 1999 Spring;1:65
49.Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984;132:474-479
50.Parsons JK, Bergstrom J, Silberstein J, Barrett-Connor E. Prevalence and characteristics of lower urinary tract symptoms in men aged > or = 80 years. Urology. 2008;72:318-321
51.McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 18, 2003;349: 2387-2398
52.Roehrborn CG. BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int. 2008;101(Suppl 3):17-21
53.Shirakawa T, Okada H, Acharya B, et al. Messenger RNA levels and enzyme activities of 5 alpha-reductase types 1 and 2 in human benign prostatic hyperplasia (BPH) tissue. Prostate. 1, 2004;58:33-40
54.Maruyama K, Fukutomi J, Chiba T, et al. Two district alpha(1)-adrenoceptor subtypes in the human prostate: assessment by radioligand binding assay using 3H-prazosin. Gen Pharmacol. 1996;27:1377-1381
55.Garg G, Singh D, Saraf S. Management of benign prostate hyperplasia: an overview of alpha-adrenergic antagonist. Biol Pharm Bull. 2006;29:1554-1558
56.Girman CJ, Jacobsen SJ, Guess HA, et al. Natural history of prostatism: relationship among symptoms, prostate volume and peak urinary flow rate. J Urol. 1995;153: 1510-1515
57.Lepor H, Williford WO, Barry MJ, Haakenson C, Jones K. The impact of medical therapy on bother due to symptoms, quality of life and global outcome, and factors predicting response. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. J Urol. 1998;160:1358-1367
58.Ilie CP, Chancellor MB. Perspective of botox for treatment of male lower urinary tract symptoms. Curr Opin Urol. 2009;19:20-25
59.Housami F, Abrams P. Persistent detrusor overactivity after transurethral resection of the prostate. Curr Urol Rep. 2008;9:284-290
60.Cranston D, Davies AH, Smith JC. Cobb’s collar – a forgotten entity. Br J Urol. 1990;66:294-296
61.Kajbafzadeh A. Congenital urethral anomalies in boys. Part I: posterior urethral valves. Urol J. Spring 2005;2: 59-78
62.Kajbafzadeh A. Congenital urethral anomalies in boys. Part II. Urol J. Summer 2005;2:125-131
218
Practical Urology: EssEntial PrinciPlEs and PracticE
63.Kim ED, Moty A, Wilson DD, Zeagler D. Treatment of a complete lower urinary tract obstruction secondary to an expandable foam sealant. Urology. 2002;60:164
64.Shetty BP, John SD, Swischuk LE,Angel CA. Bladder neck obstruction caused by a large simple ureterocele in a young male. Pediatr Radiol. 1995;25:460-461
65.Groutz A, Blaivas JG, Pies C, Sassone AM. Learned voiding dysfunction (non-neurogenic, neurogenic bladder) among adults. Neurourol Urodyn. 2001;20:259-268
66.Attaran M, Rome E, Gidwani GP. Unusual presentation of lichen sclerosuis in an adolescent. J Pediatr Adolesc Gynecol. 2000;13:99
67.Chou CP, Levenson RB, Elsayes KM, et al. Imaging of female urethral diverticulum: an update. Radiographics. 2008;28:1917-1930
68.Keegan KA, Nanigian DK, Stone AR. Female urethral stricture disease. Curr Urol Rep. 2008;9:419-423
69.Novi JM, Shaunik A, Mulvihill BH, Morgan MA. Acute urinary retention caused by a uterine leiomyoma: a case report. J Reprod Med. 2004;49:131-132
70.Advincula AP, Hernandez JC. Acute urinary retention caused by a large peritoneal inclusion cyst: a case report. J Reprod Med. 2006;51:202-204
71.Merlini E, Lelli Chiesa P. Obstructive ureterocele – an ongoing challenge. World J Urol. 2004;22:107-114
72.Romanzi LJ, Chaikin DC, Blaivas JG. The effect of genital prolapse on voiding. J Urol. February 1999;161:581-586
73.Mueller ER, Kenton K, Mahajan S, FitzGerald MP, Brubaker L. Urodynamic prolapse reduction alters urethral pressure but not filling or pressure flow parameters. J Urol. 2007;177:600-603
74.Ordorica R, Rodriguez AR, Coste-Delvecchio F, Hoffman M, Lockhart J. Disabling complications with slings for
managing female stress urinary incontinence. BJU Int. 2008;102:333-336
75.Hilton P. A clinical and urodynamic study comparing the Stamey bladder neck suspension and suburethral sling procedures in the treatment of genuine stress incontinence. Br J Obstet Gynaecol. 1989;96:213-220
76.Wang AC, Chen MC. Comparison of tension-free vaginal taping versus modified Burch colposuspension on urethral obstruction: a randomized controlled trial. Neurourol Urodyn. 2003;22:185-190
77.Wang AC. Burch colposuspension vs. Stamey bladder neck suspension. A comparison of complications with special emphasis on detrusor instability and voiding dysfunction. J Reprod Med. 1996;41:529-533
78.Goldman HB, Zimmern PE. The treatment of female bladder outlet obstruction. BJU Int. 2006;98:359-366
79.Bael A, Lax H, de Jong TP, et al. The relevance of urodynamic studies for urge syndrome and dysfunctional voiding: a multicenter controlled trial in children. J Urol. 2008;180:1486-1493. discussion 94–5
80.Swinn MJ, Fowler CJ. Isolated urinary retention in young women, or Fowler’s syndrome. Clin Auton Res. 2001;11:309-311
81.Sakakibara R, Hattori T, Uchiyama T, Yamanishi T, Ito H, Ito K. Neurogenic failures of the external urethral sphincter closure and relaxation; a videourodynamic study. Auton Neurosci. 14, 2001;86:208-215
82.Karsenty G, Reitz A, Wefer B, Boy S, Schurch B. Understanding detrusor sphincter dyssynergia – significance of chronology. Urology. 2005;66:763-768
83.Ahmed HU, Shergill IS,Arya M, Shah PJ. Management of detrusor-external sphincter dyssynergia. Nat Clin Pract Urol. July 2006;3:368-380