Patients presenting with lower urinary tract symptoms who most deserve to be investigated for primary bladder neck obstruction

Abstract We aimed to investigate clinical features potentially useful in primary bladder neck obstruction (PBNO) diagnosis in men presenting with lower urinary tract symptoms (LUTS). Data from 1229 men presenting for LUTS as their primary complaint at a single centre were retrospectively analysed. A...

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Autores principales:	Nicolò Schifano, Paolo Capogrosso, Rayan Matloob, Luca Boeri, Luigi Candela, Giuseppe Fallara, Antonio Costa, Edoardo Pozzi, Federico Belladelli, Walter Cazzaniga, Costantino Abbate, Francesco Montorsi, Andrea Salonia
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/4b1dc5f1245e4024bfca06b31bcf33bb
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spelling	oai:doaj.org-article:4b1dc5f1245e4024bfca06b31bcf33bb2021-12-02T10:54:15ZPatients presenting with lower urinary tract symptoms who most deserve to be investigated for primary bladder neck obstruction10.1038/s41598-021-83672-52045-2322https://doaj.org/article/4b1dc5f1245e4024bfca06b31bcf33bb2021-02-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-83672-5https://doaj.org/toc/2045-2322Abstract We aimed to investigate clinical features potentially useful in primary bladder neck obstruction (PBNO) diagnosis in men presenting with lower urinary tract symptoms (LUTS). Data from 1229 men presenting for LUTS as their primary complaint at a single centre were retrospectively analysed. All patients underwent a comprehensive medical and physical assessment, and completed the International Prostate Symptoms Score. All patients were investigated with uroflowmetry, and trans-rectal ultrasound imaging to define prostate volume. Urodynamic evaluation was performed when the diagnosis of benign prostatic enlargement was not confirmed and the patient presented a significant chance of detrusor overactivity or underactivity. As per our internal protocol, patients < 60 years old with bothersome LUTS and > 60 years with a prostate volume (PV) < 40 mL were also investigated with urethrocystoscopy to rule out urethral stricture. Logistic regression analysis tested clinical predictors of possible PBNO. Of 1229 patients, 136 (11%) featured a clinical profile which was consistent with PBNO. Overall, these patients were younger (p < 0.0001), had lower BMI (p < 0.0001), less comorbidities (p = 0.004) and lower PSA values (p < 0.0001), but worse IPSS scores (p = 0.01) and lower PV values (p < 0.0001) compared to patients with other-aetiology LUTS. At multivariable analysis, younger age (OR 0.90; p = 0.003) and higher IPSS scores (OR 1.12; p = 0.01) were more likely to be associated with this subset of patients, after accounting for other clinical variables. One out of ten young/middle-aged men presenting for LUTS may be affected from PBNO. Younger patients with more severe LUTS systematically deserve an extensive assessment to rule out PBNO, thus including urethrocystoscopy and urodynamics with voiding-cysto-urethrogram.Nicolò SchifanoPaolo CapogrossoRayan MatloobLuca BoeriLuigi CandelaGiuseppe FallaraAntonio CostaEdoardo PozziFederico BelladelliWalter CazzanigaCostantino AbbateFrancesco MontorsiAndrea SaloniaNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Nicolò Schifano Paolo Capogrosso Rayan Matloob Luca Boeri Luigi Candela Giuseppe Fallara Antonio Costa Edoardo Pozzi Federico Belladelli Walter Cazzaniga Costantino Abbate Francesco Montorsi Andrea Salonia Patients presenting with lower urinary tract symptoms who most deserve to be investigated for primary bladder neck obstruction
description	Abstract We aimed to investigate clinical features potentially useful in primary bladder neck obstruction (PBNO) diagnosis in men presenting with lower urinary tract symptoms (LUTS). Data from 1229 men presenting for LUTS as their primary complaint at a single centre were retrospectively analysed. All patients underwent a comprehensive medical and physical assessment, and completed the International Prostate Symptoms Score. All patients were investigated with uroflowmetry, and trans-rectal ultrasound imaging to define prostate volume. Urodynamic evaluation was performed when the diagnosis of benign prostatic enlargement was not confirmed and the patient presented a significant chance of detrusor overactivity or underactivity. As per our internal protocol, patients < 60 years old with bothersome LUTS and > 60 years with a prostate volume (PV) < 40 mL were also investigated with urethrocystoscopy to rule out urethral stricture. Logistic regression analysis tested clinical predictors of possible PBNO. Of 1229 patients, 136 (11%) featured a clinical profile which was consistent with PBNO. Overall, these patients were younger (p < 0.0001), had lower BMI (p < 0.0001), less comorbidities (p = 0.004) and lower PSA values (p < 0.0001), but worse IPSS scores (p = 0.01) and lower PV values (p < 0.0001) compared to patients with other-aetiology LUTS. At multivariable analysis, younger age (OR 0.90; p = 0.003) and higher IPSS scores (OR 1.12; p = 0.01) were more likely to be associated with this subset of patients, after accounting for other clinical variables. One out of ten young/middle-aged men presenting for LUTS may be affected from PBNO. Younger patients with more severe LUTS systematically deserve an extensive assessment to rule out PBNO, thus including urethrocystoscopy and urodynamics with voiding-cysto-urethrogram.
format	article
author	Nicolò Schifano Paolo Capogrosso Rayan Matloob Luca Boeri Luigi Candela Giuseppe Fallara Antonio Costa Edoardo Pozzi Federico Belladelli Walter Cazzaniga Costantino Abbate Francesco Montorsi Andrea Salonia
author_facet	Nicolò Schifano Paolo Capogrosso Rayan Matloob Luca Boeri Luigi Candela Giuseppe Fallara Antonio Costa Edoardo Pozzi Federico Belladelli Walter Cazzaniga Costantino Abbate Francesco Montorsi Andrea Salonia
author_sort	Nicolò Schifano
title	Patients presenting with lower urinary tract symptoms who most deserve to be investigated for primary bladder neck obstruction
title_short	Patients presenting with lower urinary tract symptoms who most deserve to be investigated for primary bladder neck obstruction
title_full	Patients presenting with lower urinary tract symptoms who most deserve to be investigated for primary bladder neck obstruction
title_fullStr	Patients presenting with lower urinary tract symptoms who most deserve to be investigated for primary bladder neck obstruction
title_full_unstemmed	Patients presenting with lower urinary tract symptoms who most deserve to be investigated for primary bladder neck obstruction
title_sort	patients presenting with lower urinary tract symptoms who most deserve to be investigated for primary bladder neck obstruction
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/4b1dc5f1245e4024bfca06b31bcf33bb
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Patients presenting with lower urinary tract symptoms who most deserve to be investigated for primary bladder neck obstruction

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