To Evaluate Usefulness of Ultrasound Cystodynamogram in Evaluation of Bladder Outlet Obstruction: An Institutional Based Study

Abstract

Background: Bladder outlet obstruction (BOO) is a urological condition where the urine flow from the urinary bladder through the urethra is impeded. The present study was conducted to assess usefulness of ultrasound cystdynamogram in evaluation of bladder outlet obstruction. Materials and Methods: The 51 patients for this prospective observational study of bladder outlet obstruction were selected from the cases admitted to surgical wards of Saraswathi Institute of Medical Sciences, Hapur, Anwarpur, Uttar Pradesh (India) during Feb 2019 to Feb 2020. All the patients included in this study were subjected to standard diagnostic criteria including detailed history, International prostatic symptom score (IPSS), physical examination, digital rectal examination (DRE), Complete blood counts (CBC), renal biochemistry, complete urine analysis, culture and sensitivity (C/S), uroflowmetry and ultrasonography. The results were correlated with each other and subjected to statistical analysis. Chi square test was applied to calculate the p values for the associations between the variables studied. Results: The present study showed that the age distribution in our study ranged from 40 to 92yrs with peak prevalence in 7th and 8th decade of life. Maximum no. of patients in our study were farmers. The most commonly reported symptom was frequency of micturition, found in 47 patients. Nocturia was the second most common LUTS subtype. 94.2% of the patients had an International prostate symptom score of more than 7. Physical examination in all the cases of our study group did not reveal any significant finding. Except for the digital rectal examination which gave useful information about the approximate prostate size. DRE showed significant correlation (p= 0.008), when was compared with the different IPSS scores. Digitally evaluated size of the prostate also did correlate well with the size of prostate assessed on USG. 17.6% of the patients of our study turned out to be diabetic. USG gave a fair evidence about: Prostate size – 40 cases (78.4%) had the prostate of more than 30gms, Intravesical protrusion of prostate – 31.4% had median lobe protrusion into the bladder Presence of bladder calculus - 2 patients had bladder calculus, Presence of diverticula –only 1 out of 51 had bladder diverticulum while 2 had trabeculations visible on USG, Bladder wall thickness - most of the patients had the thickness of 6mm or 5.5mm, 39.2% and 35.3% respectively, Post void residual – 54.9% of cases had significant amount of post void residual. Conclusion: The present study concluded that however, ultrasound cystodynamogram cannot replace pressure flow studies in the diagnosis of Bladder Outlet Obstruction, but it can provide a valuable improvement over symptom score and simple uroflowmetry in the diagnosing the cause of lower urinary tract dysfunction.