V5-02: Voiding urethrocystoscopy: a new concept for benign prostatic obstruction characterization.
The role of urethrocystoscopy (UC) in male lower urinary tract symptoms (LUTS) assessment regarding benign prostatic obstruction (BPO) is unclear. However, the last EAU guidelines advise to perform an UC prior to minimally invasive/surgical therapies if the findings may change treatment. We assessed the feasibility of voiding urethrocystoscopy (VUC) in males with (LUTS) and describe the characteristics of dynamic movements of the prostatic lobes during micturition, with further implications for surgical approach such as preservation ejaculatory function.
All consecutive patients with LUTS and willing to preserve their ejaculatory function scheduled for BPO relief surgery in a tertiary reference center were included in this prospective evaluation. After emptying the bladder, an UC with a 16-Fr flexible endoscope was performed and the bladder was filled up to 500mL to generate a desire to void. The patient was asked to void once the tip of the endoscope facing the veru montanum. Movements of the prostatic lobes during micturition were characterized. Endoscopic movements of the prostatic lobes were video-recorded, and categorized based on the dynamics of the lateral lobes, the posterior lobe and the bladder neck.
192 procedures were conducted. In 161 cases (84%), the patient was able to void. Among these patients, 126 cases were stated as “closed” (coalescent), without opening of the initial part of the urethra and the bladder neck. In 38 cases, there was no opening of the lateral lobes (type 1A), and in 47 cases a partial opening of the distal parts of the lateral lobes was seen (type 1B). In 31 cases, a fixed posterior bladder neck was seen (type 2A) and in 10 cases a mobile median lobe, with a rolling ball effect, was seen (type 2B). In 25 cases, the lumen was completely open and equivocal in 10 cases.
This study demonstrates the feasibility of VUC and describes for the first time the dynamics of prostatic lobes during micturition. This functional description may be useful to evaluate preoperatively the possibility of partial surgery, meaning removal of the only visually obstructive responsible structure to restore correct urinary flow, and subsequently preservation of ejaculatory function. In this study, 70% of patients could benefit of such surgery since the obstruction was partial (types 1B, 2A and 2B).