Benign prostatic hyperplasia : Part 1- diagnosis

Peer reviewedPublisher PD

Advances in Assistive Electronic Device Solutions for Urology

Recent technology advances have led urology to become one of the leading specialities to utilise novel electronic systems to manage urological ailments. Contemporary bladder management strategies such as urinary catheters can provide a solution but leave the user mentally and physically debilitated. The unique properties of modern electronic devices, i.e., flexibility, stretchability, and biocompatibility, have allowed a plethora of new technologies to emerge. Many novel electronic device solutions in urology have been developed for treating impaired bladder disorders. These disorders include overactive bladder (OAB), underactive bladder (UAB) and other-urinary-affecting disorders (OUAD). This paper reviews common causes and conservative treatment strategies for OAB, UAB and OUAD, discussing the challenges and drawbacks of such treatments. Subsequently, this paper gives insight into clinically approved and research-based electronic advances in urology. Advances in this area cover bladder-stimulation and -monitoring devices, robot-assistive surgery, and bladder and sphincter prosthesis. This study aims to introduce the latest advances in electronic solutions for urology, comparing their advantages and disadvantages, and concluding with open problems for future urological device solutions

Role of Transition Zone Index in Assessing Bladder Outflow Obstruction due to Benign Prostatic Hyperplasia

INTRODUCTION AND AIM: Benign prostatic hyperplasia is a pathological process which contributes to, but is not the sole cause of lower urinary tract symptoms. The aim of our study was to evaluate the role of transition zone index in assessing bladder outflow obstruction due to benign prostatic hyperplasia. The secondary objective was to determine correlation of transition zone index with IPSS score, Abrams-Griffith number and urinary flow rates. MATERIALS AND METHODS: A prospective study of 50 men with lower urinary tract symptoms due to benign prostatic hyperplasia was done between August 2011 and February 2012.The IPSS score, peak flow rate, residual urine and pressure flow studies was estimated. All patients underwent transrectal ultrasound of prostate with calculation of prostate and transition zone volume. The transition zone index was computed as TZV/TPV. RESULTS: The mean age of patients was 63.78 years and mean IPSS score was 14.98. There were 22 patients in the obstructed group (AG > 40) and 28 patients had an AG number 40 (p-value < 0.001) and had 100% sensitivity, 75% specificity,76% positive predictive value for diagnosing bladder outlet obstruction. CONCLUSION: Transition zone index is a good non invasive tool to assess bladder outlet obstruction in men with BPH. Using a Transition Zone index cut off of > 0.45, can identify outlet obstruction with 100% sensitivity, 75% specificity and 76% positive predictive value

The value of home urodiagnostics in the assessment of men with lower urinary tract symptoms

PhD ThesisA third of all men experience unpleasant lower urinary tract symptoms (LUTS) such as a poor stream and being unable to postpone urination, usually later in life. Two important investigations for these men are: a one-o clinic-based measurement of urine ow rate, and the patient's hand written record of volumes passed over the course of several days. Well acknowledged deficiencies in these tests have spurred research into home-based alternatives. `Home urodiagnostic' devices have been developed that obtain multiple measurements of flow rate and an electronic voiding diary. However, little conclusive evidence exists as to their clinical utility. The aim of this thesis is to investigate the value of home urodiagnostics in the assessment of men with LUTS. First, the improvement in clinical performance of an average rather than single flow rate measurement is calculated based upon the theory of combining variance, predicting benefit for thousands of men per year. Next, finding existing devices deficient, the characteristics and technical performance of a novel device are presented. Despite its low cost, it is found to meet the required standard. In a study of conventional versus home urodiagnostics in men with LUTS, the latter is better tolerated, less likely to fail and gave more reliable measurement of flow rate. A study in which home urodiagnostics was performed before and after prostate surgery reveals large variation in the response of flow rate to surgery. Subtle changes within an individual are demonstrable. Finally, home urodiagnostics is piloted within primary care, where the resulting data suggests benefit from a change in the management strategy of over a third of patients studied. In conclusion, home urodiagnostics shows promise for improving the assessment of men with LUTS. The next step is to evaluate the effect on patient reported outcomes in a large scale trial.The Wellcome Trust

Protocol for PRImary care Management of lower Urinary tract Symptoms in men:Protocol for development and validation of a diagnostic and clinical decision support tool (The PriMUS Study)

Introduction Lower urinary tract symptoms (LUTS) is a bothersome condition affecting older men which can lead to poor quality of life. General practitioners (GPs) currently have no easily available assessment tools to help effectively diagnose causes of LUTS and aid discussion of treatment with patients. Men are frequently referred to urology specialists who often recommend treatments that could have been initiated in primary care. GP access to simple, accurate tests and clinician decision tools are needed to facilitate accurate and effective patient management of LUTS in primary care. Methods and analysis PRImary care Management of lower Urinary tract Symptoms (PriMUS) is a prospective diagnostic accuracy study based in primary care. The study will determine which of a number of index tests used in combination best predict three urodynamic observations in men who present to their GP with LUTS. These are detrusor overactivity, bladder outlet obstruction and/or detrusor underactivity. Two cohorts of participants, one for development of the prototype diagnostic tool and other for validation, will undergo a series of simple index tests and the invasive reference standard (invasive urodynamics). We will develop and validate three diagnostic prediction models based on each condition and then combine them with management recommendations to form a clinical decision support tool. Ethics and dissemination Ethics approval is from the Wales Research Ethics Committee 6. Findings will be disseminated through peer-reviewed journals and conferences, and results will be of interest to professional and patient stakeholders

Mathematical modelling and analysis on male urine flow rate

Troublesome voiding lower urinary tract symptoms (LUTS) are a common problem in men, particularly with ageing. Management of voiding LUTS can be guided by accurate determination of underlying mechanisms, distinguishing men with voiding symptoms caused by outlet obstruction from those with reduced bladder contractility. The aim of this dissertation is by analysing measured data to establish proper characteristic vector and model sets to provide quantitative interpretation of the male urine flow rate (UFR) in order to assist medical diagnosis and prediction non-invasively. The methods we propose have not been described before, so this work is clearly novel.This study initially demonstrates a critical review of urine flow shape and current non-invasive urodynamic methods on diagnosing Bladder outlet obstruction (BOO) and Detrusor underactivity (DU), along with diagnosing accuracy and limitations of each method. Furthermore, a urodynamic model using first order discrete transfer function has been designed initially to lay down a fundamental assessment of whole urine flow shape. However, in follow up research this model shows limited diagnosing power for differentiation. To view the possible frequency difference between two groups, a simple Butterworth filter with two different cut-off values is designed and adapted to separate the frequency components caused by abdominal straining and detrusor contraction. Continuously to quantify the difference of frequency range in BOO and DU flow curve, an elliptic filter has been developed and adapted for UFR curve and fast Fourier transform is employed to derive median power frequency. Additionally, the diagnosing utility of flow template is assessed and mathematical criteria of intermittent shape is proposed

To Investigate the role of Urinary Brain Derived Neurotrophic Factor (BDNF) Measurement in the Assessment of Lower Urinary Tract Symptoms in Women

Interest in urinary biomarkers has increased over the last few years. Work on urinary neurotrophic factors, particularly nerve growth factor (NGF) has been investigated in lower urinary tract symptoms (LUTS). Urinary brain derived neurotrophic factor (BDNF) is thought to be even more specific than NGF, as a marker of certain lower urinary tract conditions such as overactive bladder (OAB), stress urinary incontinence (SUI) or bladder pain syndrome/interstitial cystitis (BPS/IC). It has been proposed that measurement of urinary BNDF in LUTS is even better at discriminating between different conditions and can also give an indication of disease severity and treatment response. There are limited studies published looking at the role of urinary BDNF measurement in LUTS. The initial part of this thesis provides an overview of the basic science behind BDNF, the published data so far surrounding BDNF, a review of the anatomy and physiology of the lower urinary tract and an overview of methods used to assess LUTS in current clinical practice. The remainder of the thesis aims to determine whether urinary BDNF measurement is of any use in assessing women with LUTS initially determining the test-retest reliability of the measurement technique. I then go on to determine whether it is comparable to other assessment methods including patient centred questionnaires, 3-day bladder diaries and urodynamics. Furthermore, urinary BDNF levels are assessed conditions including overactive bladder, stress incontinence, bladder pain and prolapse. In the last section, the relevance of the study findings is discussed, and the data is pooled with published data for a meta-analysis of BDNF in lower urinary tract symptoms. Final conclusions are made and suggestions for future research considered.Open Acces