Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,a...Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].展开更多
Background Pressure-flow study combined with cystourethroscopy were used as the major method to define female bladder neck obstruction in China. However, the definition of urodynamics for female bladder outlet obstruc...Background Pressure-flow study combined with cystourethroscopy were used as the major method to define female bladder neck obstruction in China. However, the definition of urodynamics for female bladder outlet obstruction （BOO） is not clear so far. Video-urodynamic study （VUDS） would provide more information to define the female BOO, but it is not used commonly due to the limitation of video-urodynamic equipment in China. We attempted to find a better way for diagnosis of female BOO by performing VUDS. Methods VUDS and cystourethroscopy were performed in 38 women with signs and symptoms of difficult voiding from March 2008 to April 2010 in Beijing Chao-Yang Hospital. Bladder neck obstruction was defined by radiological evidence of narrowing bladder neck, voiding pressure greater than 20 cmH2O and maximum flow rate （Qmax） less than 12 ml/s. Transurethral incision of bladder neck was then performed on those patients. Follow-up examination （Qmax and residual urine） was recorded 3 months after operation. Results The mean time from its onset to diagnosis was （18.1±9.1） months in 38 patients. Average patient age was 36.1 years （range from 19 to 79 years）. The mean Qrnax was （10.6±4.7） ml/s and residual urine was （81.5±42.4） ml. Three out of 38 patients had obvious distal urethral stricture, eight of them suffered from definitely bladder neck contracture and the remaining 27 patients did not show obvious abnormalities measured by cystourethroscopy examination. For the 35 patients without urethral stricture, the most frequent findings of VUDS were high-voiding pressure plus low-flow rate and narrow bladder neck during voiding on simultaneous fluoroscopy examination. With video-urodynamics definition, 32 patients were diagnosed as bladder neck obstruction with mean Qmax of （10.8±3.7） ml/s, residual urine of （76.9±32.7） ml and detrusor pressure at maximum flow （Pdet Qmax） of （50.7±19.1） cmH20. Other three patients were suffered from detrusor hypocontractility. All 32 patients including eight with definitely bladder neck contracture and 24 with primary bladder neck obstruction received transurethral bladder neck incision. The symptom of difficult voiding was relieved. The postoperative follow-up showed that Qrnax was （21.7±7.6） ml/s （P 〈0.01） and the residual urine was （23.2±17.6） ml （P 〈0.01）. Conclusions The real cause of the obstruction for female patient with difficult voiding might be various. A full VUDS would give us valuable information for correct diagnosis in female patients with bladder neck obstruction.展开更多
The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in par...The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in particular any possible effect on the risk of prostate cancer have prompted further research in this regard. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms （LUTS） in patients treated with testosterone. The exact mechanism of this improvement is still debated but may have a close relationship to metabolic syndrome. For the clinician, the results of these studies are promising but do not constitute high levels of evidence. A thorough clinical examination （including history, examination and laboratory testing of testosterone） should be undertaken before considering the diagnosis of late-onset hypogonadism or instigating treatment for it. Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients.展开更多
文摘Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].
文摘Background Pressure-flow study combined with cystourethroscopy were used as the major method to define female bladder neck obstruction in China. However, the definition of urodynamics for female bladder outlet obstruction （BOO） is not clear so far. Video-urodynamic study （VUDS） would provide more information to define the female BOO, but it is not used commonly due to the limitation of video-urodynamic equipment in China. We attempted to find a better way for diagnosis of female BOO by performing VUDS. Methods VUDS and cystourethroscopy were performed in 38 women with signs and symptoms of difficult voiding from March 2008 to April 2010 in Beijing Chao-Yang Hospital. Bladder neck obstruction was defined by radiological evidence of narrowing bladder neck, voiding pressure greater than 20 cmH2O and maximum flow rate （Qmax） less than 12 ml/s. Transurethral incision of bladder neck was then performed on those patients. Follow-up examination （Qmax and residual urine） was recorded 3 months after operation. Results The mean time from its onset to diagnosis was （18.1±9.1） months in 38 patients. Average patient age was 36.1 years （range from 19 to 79 years）. The mean Qrnax was （10.6±4.7） ml/s and residual urine was （81.5±42.4） ml. Three out of 38 patients had obvious distal urethral stricture, eight of them suffered from definitely bladder neck contracture and the remaining 27 patients did not show obvious abnormalities measured by cystourethroscopy examination. For the 35 patients without urethral stricture, the most frequent findings of VUDS were high-voiding pressure plus low-flow rate and narrow bladder neck during voiding on simultaneous fluoroscopy examination. With video-urodynamics definition, 32 patients were diagnosed as bladder neck obstruction with mean Qmax of （10.8±3.7） ml/s, residual urine of （76.9±32.7） ml and detrusor pressure at maximum flow （Pdet Qmax） of （50.7±19.1） cmH20. Other three patients were suffered from detrusor hypocontractility. All 32 patients including eight with definitely bladder neck contracture and 24 with primary bladder neck obstruction received transurethral bladder neck incision. The symptom of difficult voiding was relieved. The postoperative follow-up showed that Qrnax was （21.7±7.6） ml/s （P 〈0.01） and the residual urine was （23.2±17.6） ml （P 〈0.01）. Conclusions The real cause of the obstruction for female patient with difficult voiding might be various. A full VUDS would give us valuable information for correct diagnosis in female patients with bladder neck obstruction.
文摘The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in particular any possible effect on the risk of prostate cancer have prompted further research in this regard. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms （LUTS） in patients treated with testosterone. The exact mechanism of this improvement is still debated but may have a close relationship to metabolic syndrome. For the clinician, the results of these studies are promising but do not constitute high levels of evidence. A thorough clinical examination （including history, examination and laboratory testing of testosterone） should be undertaken before considering the diagnosis of late-onset hypogonadism or instigating treatment for it. Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients.
