Study of Detrusor Dysfunction Due to Outlet Obstruction: Link Between Analysis of Uroflows of Men with Benign Prostatic Hyperplasia and Animal Studies

  • Françoise A. Valentini
  • Robert M. Levin
  • Gilbert R. Besson
  • Pierre P. Nelson


Bladder dysfunction secondary to benign prostatic hyperplasia (BPH) is a major affliction of aging men. BPH can initiate both irritative lower urinary tract symptoms (urgency, frequency, and nocturia), and obstructive symptoms (reduced flow rate, increased micturition pressure, increased duration of micturition, and incomplete emptying). Although these symptoms are related to the effect of the enlarging prostate and subsequent urethral obstruction, there appears to be no direct relationship between prostate size or composition and severity of symptoms.3,13,17,19,23 In addition, the results of standard urodynamic evaluations do not correlate well with the severity of patient symptoms; standard urodynamics cannot accurately predict either level of bladder pathology or potential for recovery following surgery.3,13,17,19,23 One major problem is that current methods of urodynamic analysis, including pressure measurements, are indirect assessments of detrusor power or contractile function.


Benign Prostatic Hyperplasia Flow Curve Outlet Obstruction International Prostate Symptom Score Bladder Outlet Obstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Brackman F, Autet W: Once and twice daily dosage regimens of Pygeum africanum extract (PA): a double blind study in patients with benign prostatic hyperplasia. J Urol, 161(Suppl 4):361, 1999.CrossRefGoogle Scholar
  2. 2.
    Gosling JA, Gilpin SA, Dixon JS, Gilpin CJ: Decrease in the autonomic innervation of human detrusor muscle in outflow obstruction. J Urol, 136(2):501, 1986.PubMedGoogle Scholar
  3. 3.
    Ichiyanagi O, Nakada T: Correlations between parameters in pressure-flow analysis and histological compositions in prostate in patients with benign prostatic hyperplasia. Urol Int, 59(3):154, 1997.PubMedCrossRefGoogle Scholar
  4. 4.
    Jørgensen JB, Jensen KM-E: Uroflowmetry. Urol Clin North America, 23(2):237, 1996.CrossRefGoogle Scholar
  5. 5.
    Levin RM, Longhurst PA, Monson FC, Kato K, Wein AJ: Effect of bladder outlet obstruction on the morphology, physiology and pharmacology of the bladder. Prostate, 3(Suppl):9, 1990.PubMedCrossRefGoogle Scholar
  6. 6.
    Levin RM, Longhurst PA, Monson FC, Haugaard N, Wein AJ: Experimental studies on bladder outlet obstruction. In: Lepor H, Lawson RK, editors. Prostate Diseases. Philadelphia: WB Saunders Company, p. 119–130, 1993.Google Scholar
  7. 7.
    Levin RM, Levin SS, Zderic SA, Yoon JY, Wein AJ: Effect of partial outlet obstruction of the rabbit urinary bladder on ryanodine binding to microsomal membranes. Gen Pharmacol, 25(3):421, 1994.PubMedCrossRefGoogle Scholar
  8. 8.
    Levin RM, Zderic SA, Yoon JY, Sillen U, Wein AJ: Effect of ryanodine on the contractile response of the normal and hypertrophied rabbit urinary bladder to field stimulation. Pharmacology, 47(4):244, 1993.PubMedCrossRefGoogle Scholar
  9. 9.
    Levin RM, Riffaud J-P, Bellamy F, Rohrmann D, Habib M, Krasnopolsky L, et al: Protective effect of Tadenan on bladder function secondary to partial outlet obstruction. J Urol, 155:1466, 1996.PubMedCrossRefGoogle Scholar
  10. 10.
    Levin RM, Riffaud J-P, Bellamy F, Rohrmann D, Krasnopolsky L, Haugaard N, et al: Effects of Tadenan pretreatment on bladder physiology and biochemistry following partial outlet obstruction. J Urol, 156:2084, 1996.PubMedCrossRefGoogle Scholar
  11. 11.
    Levin RM, Das AK, Haugaard N, Novitsky Y, Horan P, Leggett RE, et al: Beneficial effects of Tadenan therapy after two weeks of partial obstruction in the rabbit. Neurourol urodyn, 16(6):583, 1997.PubMedCrossRefGoogle Scholar
  12. 12.
    Levin RM, Haugaard N, Hogavero L, Leggett RE, Das AK: Biochemical evaluation of obstructive bladder dysfunction in men secondary to BPH: a preliminary report. Urology, 53(2):446, 1999.PubMedCrossRefGoogle Scholar
  13. 13.
    Levin RM, Haugaard N, Hypolite JA, Wein AJ, Buttyan R: Metabolic factors influencing lower urinary tract function. Exp Physiol, 84(1):171, 1999.PubMedGoogle Scholar
  14. 14.
    Longhurst PA, Wein AJ, Levin RM: In-vitro models of bladder contraction and function. Neurourol. Urodyn, 10:97, 1991.CrossRefGoogle Scholar
  15. 15.
    Rohrmann D, Levin RM, Duckett JW, Zderic SA: The decompensated detrusor I: the effects of bladder outlet obstruction on the use of intracellular stores. J Urol, 156(2 Pt 2):578, 1996.PubMedCrossRefGoogle Scholar
  16. 16.
    Schäfer W: Principles and clinical application of advanced urodynamic analysis of voiding function. Urol Clin North America, 17(3):553, 1990.Google Scholar
  17. 17.
    Shapiro E, Lepor H: The pathophysiology of clinical BPH. Prog Clin Biol Res, 386:253, 1994.PubMedGoogle Scholar
  18. 18.
    Steers WD, De Groat WC: Effect of bladder outlet obstruction on micturition reflex pathways in the rat. J Urol, 140(4):864, 1988.PubMedGoogle Scholar
  19. 19.
    Terris MK, Afzal N, Kabalin JN: Correlation of transrectal ultrasound measurements of prostate and transition zone size with symptom score, bother score, urinary flow rate, and post-void residual volume. Urology, 52(3):462, 1998.PubMedCrossRefGoogle Scholar
  20. 20.
    Valentini FA, Nelson PP: A general model of skeletal muscular contraction Part II: Introduction of he activation parameter and the nervous control. Kybernetes, 14:241, 1985.CrossRefGoogle Scholar
  21. 21.
    Valentini F, Besson G, Malavaud B, Nelson P, Saby M-O, Sarramon J-P: A mathematical model of micturition applied to the interpretation of uroflowmetry curves of patients with benign prostatic hypertrophy. J Urol, 155(5):382A, 1996.Google Scholar
  22. 22.
    Valentini FA, Besson GR, Nelson PP, Zimmern PE: A mathematical micturition model to restore simple flow recordings in healthy and symptomatic individuals and enhance uroflow interpretation. Neurourol Urodyn, 19:153, 2000.PubMedCrossRefGoogle Scholar
  23. 23.
    Witjes WP, Aarnink RG, Ezz-el-Din K, Wijkstra H, Debruyne EM, de la Rosette JJ: The correlation between prostate volume, transition zone volume, transition zone index and clinical and urodynamic investigations in patients with lower urinary tract symptoms. Br J Urol, 80(1):84, 1997.PubMedCrossRefGoogle Scholar
  24. 24.
    Zderic SA, Rohrmann D, Gong C, Snyder HM, Duckett JW, Wein AJ, Levin RM: The decompensated detrusor II: evidence for loss of sarcoplasmic reticulum function after bladder outlet obstruction in the rabbit. J Urol, 156(2 Pt 2):587, 1996.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  • Françoise A. Valentini
    • 1
    • 2
  • Robert M. Levin
    • 3
  • Gilbert R. Besson
    • 1
  • Pierre P. Nelson
    • 1
  1. 1.Division of RehabilitationHôpital Jean RostandIvry-sur-SeineFrance
  2. 2.Université Pierre et Marie Curie (Paris 6)ParisFrance
  3. 3.Albany College of PharmacyAlbanyUSA

Personalised recommendations