Age Related Urodynamic Changes in Patients with Benign Prostatic Hyperplasia

No AccessJournal of UrologyClinical Urology: Original Article1 Nov 1996Age Related Urodynamic Changes in Patients with Benign Prostatic Hyperplasia Stephan Madersbacher, H. Christoph Klingler, Georg Schatzl, Thomas Stulnig, Christian P. Schmidbauer, and Michael Marberger Stephan MadersbacherStephan Madersbacher , H. Christoph KlinglerH. Christoph Klingler , Georg SchatzlGeorg Schatzl , Thomas StulnigThomas Stulnig , Christian P. SchmidbauerChristian P. Schmidbauer , and Michael MarbergerMichael Marberger View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)65478-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determined age related urodynamic changes in patients with untreated symptomatic benign prostatic hyperplasia (BPH). Materials and Methods: A total of 222 patients (mean age 67.3 years, range 45 to 90) with the clinical diagnosis of symptomatic BPH was entered into a prospective protocol evaluating the international prostate symptom score (I-PSS), prostate volume, noninvasive uroflowmetry, residual volume and a pressure-flow study. To obtain a homogeneous study population only patients with a noninvasive maximum flow rate of 15 ml. per second or less and an I-PSS of 7 or more were eligible. Results: There was no correlation between age and I-PSS (p greater than 0.05) but there was a statistically significant decrease in maximum flow rate (p = 0.045) and voided volume (p = 0.0013) with age. Prostate volume increased constantly from 31.3 to 64.4 ml. in patients 45 to 50 and older than 80 years, respectively (p less than 0.0001). Pressure-flow studies revealed an age related decrease in cystometric bladder capacity (p = 0.0003) and invasive maximum flow rate (p = 0.0057) but no changes in detrusor pressure at maximum flow rate (p greater than 0.05), maximum detrusor pressure (p greater than 0.05) and linear passive urethral resistance relation (p greater than 0.05). The incidence of urodynamically proved bladder instability increased from 20 to 47 percent in men 45 to 50 and older than 80 years, respectively. Conclusions: The well established age related decrease in maximum flow rate and voided volume in patients with prostatism cannot be attributed to an increase in bladder outflow obstruction or impaired detrusor function. Because 60 percent of all men older than 80 years did not have urodynamic obstruction despite a decreased maximum flow rate of 10 to 15 ml. per second, all patients meeting these criteria and having symptoms bothersome enough to justify surgery should undergo pressure-flow studies before surgical intervention. References 1 : Community-based population studies on the natural history of prostatism. Curr. Opin. Urol.1995; 5: 13. Google Scholar 2 : The development of human benign prostatic hyperplasia with age. J. Urol.1984; 132: 474. Link, Google Scholar 3 : High prevalence of benign prostatic hypertrophy in the community. Lancet1991; 338: 469. Google Scholar 4 : Similar levels of urological symptoms have similar impact on Scottish and American men--although Scots report less symptoms. J. Urol., part 21993; 150: 1701. Abstract, Google Scholar 5 : Epidemiology of bladder emptying symptoms in elderly men. J. Urol.1992; 148: 1817. Link, Google Scholar 6 : Natural history of prostatism: urinary flow rates in a community-based study. J. Urol.1993; 150: 887. Link, Google Scholar 7 : Uroflowmetry in asymptomatic elderly males. Brit. J. Urol.1986; 58: 390. Google Scholar 8 : In support of pressure-flow studies for evaluating men with lower urinary tract symptoms. Urology1994; 44: 153. Google Scholar 9 : The role of urodynamic investigation in the assessment of benign prostatic hypertrophy. J. Urol.1992; 148: 1133. Link, Google Scholar 10 : Analysis of bladder-outlet function with the linearized passive urethral resistance relation, linPURR, and a disease-specific approach for grading obstruction: from complex to simple. World J. Urol.1995; 13: 47. Google Scholar 11 : Improved indication and followup in transurethral resection of the prostate using the computer program CLIM: a prospective study. J. Urol.1992; 148: 111. Link, Google Scholar 12 : Bladder outlet obstruction versus impaired detrusor contractility: the role of uroflow. J. Urol.1991; 145: 810. Link, Google Scholar 13 : Urodynamic factors in relation to outcome of prostatectomy. Urology1986; 28: 256. Google Scholar 14 : The prevalence of prostatism: a population-based survey of urinary symptoms. J. Urol.1993; 150: 85. Link, Google Scholar 15 : Natural course of human benign prostatic hyperplasia with relation to urinary disturbance. Prostate1994; 24: 279. Google Scholar 16 : Prostatic enlargement, symptomatology and pressure/flow evaluation: interrelations in patients with symptomatic BPH. Scand. J. Urol. Nephrol.1994; 157: 67. Google Scholar 17 : Is there a correlation between prostate size and bladder-outlet obstruction? World. J. Urol.1995; 13: 9. Google Scholar 18 : International prostate symptom score and quality of life assessment versus urodynamic parameters in men with benign prostatic hyperplasia symptoms. J. Urol.1995; 153: 1516. Link, Google Scholar 19 : Correlation of the AUA symptom index with urodynamics in patients with suspected benign prostatic hyperplasia. Neurourol. Urodynam.1994; 13: 521. Google Scholar 20 : Correlation between the international prostatic symptom score and a pressure-flow study in the evaluation of symptomatic benign prostatic hyperplasia. J. Urol.1996; 155: 200. Link, Google Scholar 21 : Do reported micturition symptoms on the American Urological Association questionnaire correlate with 24-hour home uroflowmetry recordings?. J. Urol.1996; 155: 197. Link, Google Scholar 22 : The relevance of preoperative cystometrography in patients with benign prostatic hyperplasia: correlating the findings with clinical features and outcome after prostatectomy. J. Urol.1994; 152: 443. Abstract, Google Scholar 23 : Is detrusor instability in elderly males related to the grade of obstruction? Neurourol. Urodynam.1995; 14: 625. Google Scholar 24 : Why pressure-flow studies should be optional and not mandatory studies for evaluating men with benign prostatic hyperplasia. Urology1994; 44: 156. Google Scholar 25 : Age dependence of urinary bladder contractility. Neurourol. Urodynam.1992; 11: 315. Google Scholar 26 : Age as a prognostic variable in patients undergoing transurethral prostatectomy. Scand. J. Urol. Nephrol.1993; 27: 225. Google Scholar 27 : Prostatectomy in the over 80-year-old. Brit. J. Urol.1989; 64: 417. Google Scholar Departments of Urology and Internal Medicine III, University of Vienna, Vienna, Austria.© 1996 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byAzadzoi K, Chen B, Radisavljevic Z and Siroky M (2018) Molecular Reactions and Ultrastructural Damage in the Chronically Ischemic BladderJournal of Urology, VOL. 186, NO. 5, (2115-2122), Online publication date: 1-Nov-2011.RULE A, JACOBSON D, McGREE M, GIRMAN C, LIEBER M and JACOBSEN S (2018) LONGITUDINAL CHANGES IN POST-VOID RESIDUAL AND VOIDED VOLUME AMONG COMMUNITY DWELLING MENJournal of Urology, VOL. 174, NO. 4 Part 1, (1317-1322), Online publication date: 1-Oct-2005.AZADZOI K, BABAYAN R, KOZLOWSKI R and SIROKY M (2018) Chronic Ischemia Increases Prostatic Smooth Muscle Contraction in the RabbitJournal of Urology, VOL. 170, NO. 2, (659-663), Online publication date: 1-Aug-2003.ATHANASOPOULOS A, GYFTOPOULOS K, GIANNITSAS K, FISFIS J, PERIMENIS P and BARBALIAS G (2018) Combination Treatment With an α-Blocker Plus an Anticholinergic for Bladder Outlet Obstruction: A Prospective, Randomized, Controlled StudyJournal of Urology, VOL. 169, NO. 6, (2253-2256), Online publication date: 1-Jun-2003.AIKAWA K, LEGGETT R and LEVIN R (2018) Effect of Age on Hydrogen Peroxide Mediated Contraction Damage in the Male Rat BladderJournal of Urology, VOL. 170, NO. 5, (2082-2085), Online publication date: 1-Nov-2003.KOZLOWSKI R, KERSHEN R, SIROKY M, KRANE R and AZADZOI K (2018) CHRONIC ISCHEMIA ALTERS PROSTATE STRUCTURE AND REACTIVITY IN RABBITSJournal of Urology, VOL. 165, NO. 3, (1019-1026), Online publication date: 1-Mar-2001.RODRIGUES P, LUCON A, FREIRE G and ARAP S (2018) URODYNAMIC PRESSURE FLOW STUDIES CAN PREDICT THE CLINICAL OUTCOME AFTER TRANSURETHRAL PROSTATIC RESECTIONJournal of Urology, VOL. 165, NO. 2, (499-502), Online publication date: 1-Feb-2001.MICHEL M, MEHLBURGER L, SCHUMACHER H, BRESSEL H and GOEPEL M (2018) EFFECT OF DIABETES ON LOWER URINARY TRACT SYMPTOMS IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIAJournal of Urology, VOL. 163, NO. 6, (1725-1729), Online publication date: 1-Jun-2000.AZADZOI K, TARCAN T, SIROKY M and KRANE R (2018) ATHEROSCLEROSIS-INDUCED CHRONIC ISCHEMIA CAUSES BLADDER FIBROSIS AND NON-COMPLIANCE IN THE RABBITJournal of Urology, VOL. 161, NO. 5, (1626-1635), Online publication date: 1-May-1999.Schatzl G, Madersbacher S, Lang T and Marberger M (2018) The Early Postoperative Morbidity of Transurethral Resection of the Prostate and oF 4 Minimally Invasive Treatment AlternativesJournal of Urology, VOL. 158, NO. 1, (105-111), Online publication date: 1-Jul-1997.Yu H, Levin R, Longhurst P and Damaser M (2018) Effect of Age and Outlet Resistance on Rabbit Urinary Bladder EmptyingJournal of Urology, VOL. 158, NO. 3, (924-930), Online publication date: 1-Sep-1997. Volume 156Issue 5November 1996Page: 1662-1667 Advertisement Copyright & Permissions© 1996 by American Urological Association, Inc.MetricsAuthor Information Stephan Madersbacher More articles by this author H. Christoph Klingler More articles by this author Georg Schatzl More articles by this author Thomas Stulnig More articles by this author Christian P. Schmidbauer More articles by this author Michael Marberger More articles by this author Expand All Advertisement PDF downloadLoading ...