Age-associated determinants decompensation of the bladder in the conditions of prostate hyperplasia

Introduction. In conditions of long-term infravesical obstruction caused by prostate hyperplasia (РН), 15-30% of patients eventually experience decompensation of detrusor function. At the same time, the details of the adaptive transformation of the vascular bed of the bladder, as well as its correlation with the structural remodeling of this organ, which determine the decompensation of the lower urinary tract in conditions of chronic urinary retention, are still unclear. Aim. To study the role of vascular and age-related factors in the depletion of the compensatory reserve of detrusor in long-term РН in elderly and senile people. Material and methods. Autopsy material from 25 men who did not have urological pathology, from 25 men who had РН without signs of decompensation of the bladder and biopsy material from 25 patients operated on for РН in the decompensation stage were examined. The age of all persons ranged from 60 to 80 years. Control – 10 men aged 20-30 years, who died as a result of injuries. Histological sections of the areas of the bladder were stained with hematoxylin-eosin, according to Mason and Hart. Results. In conditions of long-term РН, the functioning of a locally hypertrophic detrusor occurs against the background of age-related atrophic-sclerotic changes in it, the cause of which is: atherosclerosis of large arteries, as well as hyalinosis of small arteries and arterioles, characteristic of arterial hypertension. The «working capacity» of the bladder under these conditions is provided by the activity of regulatory muscle formations in the arterial and venous basins, with the help of which the necessary level of oxygenation is achieved. However, progressive age-related changes in the cardiovascular system over time lead to an increase in chronic ischemia. Sclerotic changes develop in the regulatory structures of the arteries and veins. As a result, there is a gross diffuse sclerosis of the detrusor with atrophy of the muscle fibers. Conclusions. Decompensation of detrusor in РН is a consequence of earlier vascular decompensation, the morphological markers of which are: arteriosclerosis, phlebosclerosis and sclerosis of regulatory structures.

Objectification of the evaluation of a pharmacological test with alpha-adrenergic blocking agents during uroflowmetry

The tactics of treating dysuric disorders are largely determined by the pathophysiological and morpho-clinical basis: infravesical obstruction, impaired bladder contractility, complex neurogenic urination disorders, etc. Among the diseases that most often cause infravesical obstruction in men, the most common pathologies are benign prostatic hyperplasia, prostate cancer, prostate sclerosis, obstructive processes of the bladder neck (contractures, fibrosis), urethral strictures of various etiologies. The use of a comprehensive urodynamic study makes it possible to differentiate the causes of urinary disorders. One of the most common and non-invasive methods used in the urologist’s clinical practice is uroflowmetry. The use of the fuzzy logic algorithm described in the article for making a decision on the presence of obstructive urination allows one to assess the urodynamic situation using the home uroflow monitoring technique. Analytical urodynamics in conjunction with the fuzzy logic block increases the accuracy of describing the examination results, and the introduction of the proposed model into the software simplifies the work with diagnostic urological equipment and increases the efficiency of the examination.

Diagnosis of Urination Disorders in Young Patients with Lower Urinary Tract Symptoms of Uncertain Origin

Lower urinary tract symptoms (LUTS) are not uncommon in young men. The etiology of LUTS in men aged up to 50 years is diverse. According to various authors, it is recommended to use a complex urodynamics tests (CUT) to assess LUTS in young men. However, even in modern urological practice, many such patients continue to be treated empirically, and the use of urodynamic studies is still not widely practiced for this group. The objective: assess the clinical significance of CUT in men with LUTS under the age of 50 years. Materials and methods. The results of CUM in patients with LUTS under the age of 50 were evaluated. 87 patients aged 18 to 43 years with LUTS of uncertain origin were examined. Results. The leading diagnoses, with which patients were referred, were chronic prostatitis and neurogenic bladder, which were found in 28 (32.2%) and 22 (25.3%) patients, respectively. 21 (24.1%) patients admitted to the clinic had no primary diagnosis. As a result of the examination, infravesical obstruction (IVO) was found in 32 (36.8%) men, hyperactive bladder in 24 (27.6%), hypoactive bladder in 9 (10.3%) patients, non-neurogenic neurogenic bladder – in 7 (8.0%) and 15 (17.2%) men urological pathology was not detected. Conclusions. We have shown the effectiveness of CUT to clarify the diagnosis in young men under the age of 50 with LUTS. Diagnosed with a significant proportion of patients, urinary disorders have characteristic differences, reflecting the abnormalities found when using CUT. In most patients, the clinical diagnosis was changed after performing CUT. Thus, the use of CUT in young men with LUTS is crucial for a more accurate diagnosis and, therefore, for adequate therapy.

Giant urinoma in a newborn boy with a posterior urethral valve: A сase report and review

Posterior urethral valve is the most common cause of infravesical obstruction in male newborns. Spontaneous rupture of the urinary collecting system with urine extravasation is a rare complication in this group of children. We present a case of urinoma in a patient with a posterior urethral valve at 4 weeks of age with renal insufficiency. The transurethral destruction of the valve and evacuation of the urinoma contributed to the restoration of the urodynamics and recovery of renal function. Urinoma is a rare manifestation of this defect, and its significance for predicting the preservation of renal function has not been fully determined yet. Reports about the occurrence of urine extravasation in the posterior urethral valve and studying kidney function in the long-term period can clarify the significance of this spontaneous mechanism of urinary tract decompression.

Remodeling of the bladder and its vascular bad in the elderly and old age patients under infravesical obstruction caused by prostate hyperplasia

Introduction. It is known that prolonged bladder obstruction caused by prostatic hypertrophy leads to serious structural changes in the bladder wall. However the detailed morphogenesis of this process, the features of the compensatory-adaptive reactions of the its vascular bed and the role of existing background diseases in this process, as well as age-related changes are still unclear. Aim of our study was to discover the features of the structural rearrangement of the bladder and its vasculature in elderly and senile people with BPH. Materials and methods. Autopsy material from 25 men 60-80 years old who had no urological pathology and from 25 men of the same age who had BPH without signs of urinary bladder decompensation was studied. There were 10 men aged 20-30 who died as a result of injuries in control group. Results. Histological and immunohistochemical studies revealed a pronounced structural reorganization of the bladder wall and its vasculature in patients with BPH. This process is superimposed on the already existing involutive changes in the detrusor such as its atrophy, sclerosis of the intermuscular stroma and neurodegenerative changes. The compensatory hypertrophy of detrusor and changes in its vasculature to regulate the local hemodynamics develop in men with ifravesical obstruction. Such changes in the arterial bed include bundles of intimate muscles, muscular-elastic sphincters and polypoid pillows formations. They provide a normal blood supply of the intact parts of the detrusor at the cost of deterioration the blood supply of its areas with atrophic and sclerotic changes. Regulatory changes such as muscle "couplings", muscle rollers and valves were also revealed in the veins. The contraction of this musculature imparts an impulse to the movement of venous blood to the heart and relaxation promotes its deposition. The valves are able to prevent the development of blood regurgitation. Conclusions. Рrostatic hyperplasia and infravesical obstruction cause the functional load on the detrusor increases, which leads to its local hypertrophy. This process occurs against the background of age-related changes. There is also a structural reorganization of the vascular bed of the bladder, the role of which is to redistribute blood flow in favor of detrusor sites that are subjected to greater functional load.

Decrease of urinary bladder contractility in patients with benign prostate hyperplasia

Aim of the study.Estimation of the decrease of urinary bladder contractility in patients with benign prostate hyperplasia (BPH). Patients and methods.In 146 BPH patients (mean age 62,1 0,8) urodynamic investigation including uroflowmetry and pressure-flow study was performed. The results of miction cystometry were evaluated using Shafer nomogram, the emptying idex was calculated as relation of voiding volume to maximal cystometric capacity. Results.56,2% BPH patients showed the decreased detrusor contractility. The results of urinary bladder contractility estimation by Shafer nomogram are dependent on the degree of infravesical obstruction (IVO). The emptying index is not related to the presence and degree of IVO and characterizes the degree of urinary bladder emptying as well as contraction duration. Concomitant lumbar osteochondrosis and diabetes detoriates urinary bladder emptying. Reliable contractility estimation may only be performed based on urodynamic study since basic BPH patients examination is not sufficient. Conclusion.In has to be considered during treatment strategy planning that in many BPH patients low urinary truct disfunction is determined by the decrease of urinary bladder contractility and not by IVO.

Asymptomatic Uncountable Urinary Bladder Stones Removal: Play the Winner

Urinary bladder stones are a common condition in elderly males, and they are usually related to infravesical obstruction secondary to prostate enlargement. Endoscopic management of bladder stone is the gold standard treatment; yet, in some cases, return to conventional open surgery is necessary. In our article, we reported the case of a 73-year-old male patient with accidentally discovered multiple urinary bladder stones. Cystolithotomy was the treatment of choice which went uneventfully with a smooth postoperative course.