PRESSURE-FLOW STUDIES PREOPERATIVELY AND POSTOPERATIVELY IN PATIENTS WITH BENIGN PROSTATIC HYPERTROPHY - ESTIMATION OF THE URETHRAL PRESSURE-FLOW RELATION AND URETHRAL ELASTICITY

• Pressure/flow studies were performed in 28 men with benign prostatic hypertrophy. Twenty-three of the men were also studied postoperatively. Urethral function during micturition was quantified by the urethral pressure/flow relation, P(det) = P(mo) + L(m) Q(m), where P(det) is detrusor pressure, P(mo) is minimal opening pressure, Q is flow rate, and m and L(m) are parameters. Using this method to quantify urethral function, three urodynamically different types of obstruction can be defined. In the first of these, P(mo) is elevated corresponding to Schafer’s compressive obstruction. The second is a constrictive type of obstruction in which m greater-than-or-equal-to 4/3 and L(m) is elevated and the third is a low-compliant type of obstruction in which m less-than-or-equal-to 1 and L(m) is elevated. The two latter types of obstruction may be combined with a compressive obstruction. The preoperative pressure/flow relations were mostly characterized by a very high P(mo), a moderately elevated L(m), and a low m. Thus the majority of patients had a combination of compressive and low-compliant obstruction. Postoperatively, micturitions were much improved and the pressure/flow relations often had an even lower P(mo) than normal, a normal L(m), and a high m. From the pressure/flow relations, the elasticity of the flow-controlling zone can be estimated and described by the urethral pressure/area relation, p(A) = P(mo) + K(n) A(n), where p(A) is the intrinsic urethral pressure, A is the cross-sectional area of the flow-controlling zone and K(n) and n are parameters describing the distensibility of the flow-controlling zone. Preoperatively, the flow-controlling zone had a low distensibility. The shape of the curve suggested that the urethra could have been distended further by higher pressure. Postoperatively, the urethra was distended to larger cross-sectional areas, but in many cases the shape of the curve suggested that distension was restricted by fibrosis. Median and range values for the model parameters as well as discriminating limits between the preoperative micturitions and micturitions in elderly men without voiding problems are presented. The exponent m is not perfectly reproducible but tends to be the same if a person performs several micturitions. The residual sum of squares is often increased more than 100% if an exponent m value other than the optimal one is used for curve fitting. Results when the micturitions were analysed with Schafer’s model and classified using the maximum flow/pressure at maximum flow diagram recommended by the International Continence Society are also shown.

Ämnesord

TEKNIK OCH TEKNOLOGIER  -- Maskinteknik -- Strömningsmekanik och akustik (hsv//swe)

ENGINEERING AND TECHNOLOGY  -- Mechanical Engineering -- Fluid Mechanics and Acoustics (hsv//eng)

Nyckelord

BIOMECHANICAL MODEL; PRESSURE AREA RELATION; BLADDER OUTLET OBSTRUCTION; URETHRAL RESISTANCE

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