title: Association of high bladder neck elevation with urodynamic bladder outlet obstruction in patients with lower urinary tract symptoms and benign prostatic hyperplasia.
abstract: OBJECTIVE
  To ascertain the association of cystourethroscopic findings of bladder neck elevation with urodynamic bladder outlet obstruction (BOO) in patients with lower urinary tract symptoms and benign prostatic hyperplasia (LUTS-BPH).
  
  
  METHODS
  Study subjects were 646 consecutive men aged >40 years diagnosed with LUTS-BPH at Seoul National University Hospital from December 2005 through January 2012. We collected the International Prostatic Symptom Score, serum prostate-specific antigen levels, prostate volume measured by transrectal ultrasonography, uroflowmetry with postvoid residual volume, and urodynamics with a pressure flow study. We examined the degree of lateral lobe protrusion of prostate, bladder neck elevation degree (BNE-D), and bladder neck elevation angle (BNE-A) under a cystourethroscopic examination.
  
  
  RESULTS
  When we examined BNE by cystourethroscope, the mean BNE-A was 26.1°. Higher BNE-D was strongly positively correlated with BNE-A, but neither was associated with the degree of lateral lobe protrusion of prostate. Patients with higher BNE-A (≥ 35°) had higher BOO index and more obstructed voiding patterns than those with lower BNE-A (<35°). BNE-A was positively correlated with BOO index (r = 0.186). However, we identified only total prostate volume (odds ratio [OR], 1.036), maximal flow rate (Qmax; OR, 0.843), and detrusor pressure at Qmax (PdetQmax; OR, 1.278) as significant predictors of BOO in the multivariate analysis.
  
  
  CONCLUSIONS
  In sum, patients with higher BNE-A (≥ 35°) by cystourethroscope had higher BOO index and more obstructed voiding patterns than those with lower BNE-A (<35°). Moreover, both BNE-D and BNE-A were positively correlated with BOO index. Thus, cystourethroscopic findings of BNE status can be helpful to predict urodynamic BOO in the patients with LUTS-BPH.
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Minyong
authors.initials: M
authors.lastname: Kang
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Myong
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Urology, Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea.
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Choo
authors.affiliation: Department of Urology, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Jungbum
authors.initials: J
authors.lastname: Bae
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
authors.affiliation: Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL.
authors.forename: Changwon
authors.initials: C
authors.lastname: Yoo
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: sjo@snu.ac.kr.
authors.forename: Seung-June
authors.initials: SJ
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003558:Cystoscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000453:epidemiology*; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018666:Ureteroscopy / Q000379:methods; D001743:Urinary Bladder / Q000503:physiopathology*; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis / Q000453:epidemiology*; D014563:Urodynamics