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Is isolated bladder outlet obstruction associated with hydronephrosis? A database analysis
Author(s) -
Sinha Sanjay,
Matai Lavina
Publication year - 2020
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.24495
Subject(s) - medicine , hydronephrosis , abnormality , bladder outlet obstruction , odds ratio , urology , confidence interval , retrospective cohort study , urinary system , urinary tract obstruction , prostate , cancer , psychiatry
Aims To examine whether isolated bladder outlet obstruction in the absence of associated lower urinary tract abnormality results in hydronephrosis. Isolated obstruction causes a brief rise in bladder pressure that might not trigger hydronephrosis. Methods Data included adult men who underwent urodynamics for refractory non‐neurogenic lower tract symptoms between 2011 and 2020. International Continence Society indices for obstruction (bladder outlet obstruction index [BOOI] ≥ 40) and underactivity (bladder contractility index [BCI] < 100) were calculated. Storage abnormality was defined as detrusor overactivity (DO) or poor compliance (<20 ml/cm H 2 0). Isolated obstruction was defined as BOOI ≥ 40, BCI ≥ 100 and no storage abnormality. Nonparametric tests using R program (3.5.0) applied ( p < .05 significant). Logistic regression analyses were performed to study the relationships of hydronephrosis with lower urinary tract function. Results A total 1596 men (range, 18–91 years; median, 51.0 years; Q3, 64.0 years; Q1, 34.0 years) were eligible. Hydronephrosis was noted in 274 (17.2%). A total of 45.4% were obstructed, 52.3% were underactive and 41.7% had storage abnormality. Storage abnormality (odds ratios [OR], 2.05; 95% confidence interval [CI]: 1.56, 2.69; p < .001) and bladder contractility (OR, 1.68; 95% CI, 1.25–2.26; p < .001) but not obstruction (OR, 1.07; 95% CI, 0.80–1.44; p = .634) was associated with hydronephrosis. Of eight possible combinations, men with BOO ≥ 40, BCI ≥ 100 and storage abnormality had highest probability of hydronephrosis (OR, 0.29; 95% CI, 0.24–0.33). Subanalysis showed that poor compliance (OR, 3.39; 95% CI, 2.49–4.60; p < .001) but not DO was associated with hydronephrosis. Younger age and higher postvoid residual urine were also associated with hydronephrosis. Conclusions In adult men with refractory non‐neurogenic lower urinary tract symptoms, isolated bladder outlet obstruction is not associated with hydronephrosis.