Voiding urethrocystoscopy: A new concept for benign prostatic obstruction characterization

Area of Science:

• Urology
• Medical Imaging
• Surgical Techniques

Background:

• Benign prostatic obstruction (BPO) significantly impacts male lower urinary tract symptoms.
• Understanding the dynamic mechanical behavior of prostatic lobes during voiding is crucial for effective BPO management.
• Current diagnostic methods may not fully capture the dynamic nature of prostatic obstruction.

Purpose of the Study:

• To evaluate the feasibility of performing voiding urethrocystoscopy (VUC) in male patients.
• To characterize the dynamic movements of prostatic lobes during the micturition process.
• To explore a novel approach for understanding the biomechanics of BPO.

Main Methods:

• A prospective evaluation of patients undergoing benign prostatic obstruction relief.
• Flexible urethrocystoscopy was performed with the bladder filled to the point of desire to void.
• Patients were instructed to void with the endoscope in place, allowing for video-recording and categorization of prostatic lobe dynamics.

Main Results:

• VUC was successfully performed in 161 out of 192 (84%) male patients.
• Prostatic lobe dynamics during micturition were categorized into distinct types, including 'closed' (coalescent) and various degrees of lateral lobe opening.
• Specific patterns observed included fixed posterior bladder necks and mobile median lobes with a 'rolling ball' effect.

Conclusions:

• Voiding urethrocystoscopy (VUC) is a feasible diagnostic tool in males.
• The study provides the first detailed description of prostatic lobe dynamics during micturition.
• These findings may pave the way for a new mechanical understanding of benign prostatic obstruction.