20Jul 2017

RELATION BETWEEN BLADDER OUTLET OBSTRUCTION AND SYSTEMIC VASCULAR ENDOTHELIAL DYSFUNCTION IN THE MALE. A PRELIMINARY STUDY.

  • First Department of Urology, Aristotle University of Thessaloniki, General Hospital ?G. Gennimatas?.
  • Department of Urology, Victoria Hospital, Kirkcaldy, NHS, UK.
  • Department of Urology, AMC University Hospital, Amsterdam, The Netherlands.
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Hypothesis / aims of study: It is well recognized that endothelial dysfunction is strongly related to lower urogenital problems such as erectile dysfunction, which shortly precedes clinical coronary arterial occlusion. The study aims to investigate the potential correlation of systemic vascular endothelial dysfunction and coronary artery disease (CAD) with bladder outlet obstruction (BOO). Study design, materials and methods: Thirty men age 50 years and older (mean=62.7 years ?14.6) with mild to severe LUTS were enrolled and gave written consent. All patients underwent pressure flow study and simultaneous non-invasive recording of detrusor tissue oxygenation and hemodynamics with Near Infrared Spectroscopy (NIRS). Systemic endothelial integrity was assessed by measurement of inflammatory and endothelial-prothrombotic markers such as Endothelin-1 (ET-1), Interleukin-6 (IL-6), Asymmetric Dimethylarginine (ADMA) and N-terminal C-type natriuretic peptide (NT-pro CNP). CAD, defined as occlusion of coronary arteries, was also recorded. IBM-SPSS ver. 22 was used for the statistical analysis. Results:- Logistic regression model was applied to examine whether BOO ? as diagnosed properly with the standard Pressure Flow study and also by estimation of detrusor muscle oxygenation with the NIRS technique ? correlates with vascular lesions. Elevated values of ΕΤ-1 and IL-6 were found, but they were not statistically significant. NIRS showed a specificity of 88% and a sensitivity of 79% in diagnosing BOO. Also, a sevenfold increase was found in the likelihood of BOO in patients with CAD. Interpretation of Results: Elevated biochemical markers of endothelial dysfunction such as ΕΤ-1, and IL-6 as well as by the sevenfold increase in the likelihood of BOO in coronary patients suggest that there may be a correlation between lower urinary tract dysfunction and vascular occlusion. With the limitation of the small sample size, a common pathophysiological background may exist such as impaired blood perfusion of the bladder and/or prostate. This is also supported by the use of NIRS that assesses obstruction through detrusor oxygenation impairment. Concluding Message: Bladder outlet obstruction may be related to endothelial dysfunction and coronary artery disease. Also, NIRS may be a good alternative for non-invasive urodynamic studies in the assessment of bladder outlet obstruction.

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[Anastasios Anastasiadis A A, George Dimitriadis G D, Konstantinos Gkagkalidis K G, Steve Leung S L, Ioannis Vakalopoulos I V and Jean de la Rosette J D. (2017); RELATION BETWEEN BLADDER OUTLET OBSTRUCTION AND SYSTEMIC VASCULAR ENDOTHELIAL DYSFUNCTION IN THE MALE. A PRELIMINARY STUDY. Int. J. of Adv. Res. 5 (Jul). 1053-1060] (ISSN 2320-5407). www.journalijar.com

Konstantinos Gkagkalidis

DOI:

Article DOI: 10.21474/IJAR01/4814      
DOI URL: http://dx.doi.org/10.21474/IJAR01/4814

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