[show abstract][hide abstract] ABSTRACT: Bladder emptying in crouching position is a conventional way in many eastern countries. Our aim was to evaluate uroflowmetry parameters as an index of obstruction severity in standing and crouching positions and comparison of them in patients with bladder outlet obstruction symptoms.
Uroflowmetry in standing and crouching positions was done in 83 patients with bladder outlet obstruction symptoms due to benign prostatic hyperplasia (BPH). The patients were 50 years old or older and their maximum flow rate in standing position was less than 15 mL/s. The maximum flow rate, average flow rate, maximum flow time, and postvoid residual urine volume were measured and recorded. The results in standing and crouching positions were compared.
The mean maximum flow rate and mean average flow rate in crouching position increased 86% and 51%, respectively (P < .001; P = .012), while mean maximum flow time and postvoid residual volume decreased 40% and 46%, respectively (P < .001; P < .001). These changes were also significant in patients with maximum flow rates of less than 10 mL/s and 10 mL/s to 15 mL/s in standing position, except for the maximum flow time in the latter group.
A more complete emptying of bladder in crouching position in patients with BPH can be attributed to the increased bladder pressure due to a good transmission of intra-abdominal pressure and a complete and coordinated relaxation of pelvic floor muscles. This position can help improve patients' symptoms.
[show abstract][hide abstract] ABSTRACT: To evaluate the effect of intravenous thyrotropin releasing hormone (TRH) on the urethral closure pressure (UCP).
Twenty-two female patients with either bladder outlet obstruction (BOO) or detrusor under activity were included in this study. They divided into two study and control groups randomly. Twelve patients in study group received 200 microgr of TRH intravenously and patients in control group received intravenous normal saline as placebo. Standard urethral pressure profilometry was performed before injection and after injection at 5, 10, 20 and 30 minutes. Functional profile length (FPL), maximum urethral closure pressure (MUCP), and urethral closure pressure at the proximal quarter of the FPL (1/4 FLP) and at the distal quarter of FPL (3/4 FLP) were measured in both groups.
The mean age of the study and control groups were 41.61+/-21.7 years and 43.59+/-19 years respectively .The study and control groups included 5 BOO and 6 detrusor under activity and 4 BOO and 5 detrusor under activity respectively. The mean peak flow rate was 5.69+/-8.4 ml/s in the study group and 6.31+/-81 ml/s in control group. There wasn't significant difference between two groups. Mean maximum urethral closure pressure demonstrated no significant difference in two groups before and after TRH injection, but a marked reduction in 3/4 UCP and 3/4 FPL in patients after TRH injection was seen.
TRH injection significantly reduces the distal urethral pressure.
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