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Urodynamic risk factors for renal dysfunction in men with obstructive and nonobstructive voiding dysfunction

C V Comiter1, M P Sullivan, R S Schacterle

  • 1Division of Urology, Surgical Service, West Roxbury Veterans Affairs Medical Center, Massachusetts, USA.

The Journal of Urology
|July 1, 1997
PubMed
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In men with lower urinary tract symptoms, bladder outlet obstruction and detrusor instability alone do not increase kidney dysfunction risk. However, combined with diminished bladder compliance, the risk of renal dysfunction significantly rises.

Area of Science:

  • Urology
  • Nephrology
  • Medical Diagnostics

Background:

  • Lower urinary tract symptoms (LUTS) in men are often linked to benign prostatic hyperplasia (BPH).
  • Urodynamic investigation frequently identifies bladder outlet obstruction, detrusor instability, and diminished bladder compliance in these patients.
  • The impact of these urodynamic findings on renal function requires clarification.

Purpose of the Study:

  • To determine if urodynamic abnormalities, including bladder outlet obstruction, detrusor instability, and diminished bladder compliance, contribute to renal dysfunction in men with LUTS.
  • To assess the independent and combined effects of these abnormalities on renal function markers.

Main Methods:

  • 161 men with LUTS underwent urodynamic evaluation.
  • Bladder outlet obstruction, detrusor instability, and decreased bladder compliance (≤30 ml/cm H2O) were recorded.

Related Experiment Videos

  • Serum blood urea nitrogen (BUN) and creatinine levels were measured and compared across diagnostic groups.

    • Main Results:

    • 34% of men had elevated BUN, and 12% had elevated creatinine.
    • No significant correlation was observed between obstruction severity and BUN or creatinine levels.
    • A significantly higher incidence of azotemia (kidney dysfunction) was found in patients with both outlet obstruction and detrusor instability when diminished bladder compliance was present (78%) compared to those with normal compliance (36%).

    Conclusions:

    • Outlet obstruction, with or without detrusor instability, is not a significant risk factor for elevated BUN and creatinine in men with nonneurogenic voiding dysfunction.
    • The combination of outlet obstruction, detrusor instability, and diminished bladder compliance substantially increases the risk of renal dysfunction (azotemia).
    • Diminished bladder compliance is a critical factor in the development of renal dysfunction when associated with other urodynamic abnormalities.