Ultrasound for diagnosis bladder neck motility in men with lower urinary tract symptoms - pilot prospective study

Bubnov R1, Spivak M2

Research Type

Clinical

Abstract Category

Male Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 291
E-Poster 2
Scientific Open Discussion ePoster Session 18
Thursday 5th September 2019
13:10 - 13:15 (ePoster Station 1)
Exhibition Hall
Benign Prostatic Hyperplasia (BPH) Imaging Prolapse Symptoms Pelvic Floor
1.Clinical Hospital “Pheophania“ of State Affairs Department, 2.Zabolotny Institute of Microbiology and Virology of the National Academy of Sciences of Ukraine
Presenter
R

Rostyslav Bubnov

Links

Poster

Abstract

Hypothesis / aims of study
Lower urinary tract symptoms (LUTS) is a functional unit with the multifactorial aetiology is a widespread problem in men with a major impact on quality of life (QoL) [1]. 
Benign prostatic hyperplasia (BPH) might not play a crucial role in particular group of patients. 
Myofascial trigger points might associated with generalized pelvic pain and LUTS. 
Bladder neck hypermotility and pelvic floor dysfunction is well studied in female, but rather underestimated in adult men.
Ultrasound (US) has strong potential for diagnosis of pelvic floor disorders and treatment of pelvic muscles dysfunction [2,3], however many methodological differences and limitations still exist that induce confounders in the studies. 
Development of valid screening and diagnostic method is highly recommended for holistic management of LUTS and suggesting treatment options [3]. 
Hypothesis:
Transaddominal ultrasound is effective for diagnosis bladder neck motility in men with lower urinary tract symptoms irrelevant to prostate hyperplasia. 
The aim was to evaluate the feasibility and reliability of transabdominal US for screening of bladder neck motility in men with LUTS in association with BPH.
Study design, materials and methods
We included 112 patients, males (38–92 years, 65±8 yo), suffering from LUTS. Male patients of group 2 (n = 30) had no LUTS were the controls. All patients underwent general examination, transabdominal pelvic ultrasound for evaluation bladder neck motility and prostate volume. Transabdominal US measurements of bladder neck rotation in a postero-inferior direction at rest and on maximal Valsalva was performed to all patients. Measurements were taken at rest and on maximal Valsalva, and the difference yields a numerical value for bladder neck (prostate) descent (probe position over the pubic bone in vertical / sagittal orientation using M-mode, figure 1). Among patients with LUTS we distinguished patients, who demostrated increasing deviation at maximal Valsalva over the threshold (empirically considered at level of 45 mm) - group 1a (n =30); rest was included to 1b group. 
All patients were also assessed for central and peripheral myofascial trigger points in pelvic and low back muscles physically and on extensive neuromuscular US using M-mode to evaluate muscles thickness, structure and motion in intervetrebral spaces, pelvis, gluteal region.
Results
On transabdominal US on maximal Valsalva, the proximal urethra (prostate) was visualized to rotate in a posteroinferior direction and was measured in group 1a as high as 86±17 mm (65-120 mm), significantly higher vs group 1b and controls (37 ± 12 mm and 27 ± 8 mm respectively, p<0.05 for both). 
In 40% of patients of group 1a (12/30) no signs of BPH were diagnosed. 
The median prostate volume in group 1a was 49.6±25 cm3 (12-130 mm), significantly lower vs group 1b (67.6±21 cm3; 47-190 mm, p<0.05) in and had no significant difference vs controls (p>0.05). 
Transabdominal ultrasound data had poor negative correlation with prostate volume (r=-0.1).
US signs of chronic prostatitis were detected in 8 patients of group 1a, in 27 patients of group 1b, and in 7 patients in group 2.
In 16 patients of group 1a (53%) the myofascial trigger points in pelvic muscles were diagnosed. Additionally 9 patients of group 1a were assessed for myofascial trigger points in pelvic and low back muscles by physical exam and on US.
Interpretation of results
Transabdomibal US is feasible and reliable method for assessment bladder neck motility in men with LUTS. The bladder neck hypermotility was diagnosed in 27 % patients with LUTS, had negative correlation with prostate volume, and can be considered significant cause of LUTS in men often irrelevant to BPH.
Concluding message
Relevant US imaging techniques for assessment interaction of internal genitalia with pelvic floor muscles, resulting bladder neck hypermotility and evoking urogenital symptoms by validated questionnaires conjoined with specific background analysis are essential for personalized management of pelvic floor dysfunction. 
Integrative evaluating of postural im/balance is essential to local detection of muscle dystonia,  weakness and spasticity associated with pelvic dysorders. Further studies to establish causality in regards to BPH, chronic prostatitis and myofascial trigger points and other conditions are required.
Figure 1 Transabdominal ultrasound data had poor negative correlation with prostate volume (r=-0.1).
Figure 2 Transabdominal US measurements (sagittal ultrasound scan) of bladder neck rotation in a posteroinferior direction at rest and on maximal Valsalva
References
  1. Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, Oelke M, Tikkinen KA, Gravas S. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol. 2015 Jun;67(6):1099-109. doi: 10.1016/j.eururo.2014.12.038.
  2. Dietz HP: Pelvic floor ultrasound: a review. Am J Obstet Gynecol. 2010 Apr;202(4):321-34. doi: 10.1016/j.ajog.2009.08.018.
  3. Bubnov RV: Unremovable idiopathic pelvic pain treatment by a novel ultrasound guided technique. European Journal of Neurology. 2012, 19 (Suppl. 1), 586.
Disclosures
Funding personal Clinical Trial No Subjects Human Ethics Committee The ethics committee of institutional review board and Special Academic Council on Doctoral Thesis of D.K. Zabolotny Institute of Microbiology and Virology of the National Academy of Sciences of Ukraine (protocol N 7 issued 03.07.2018). Helsinki Yes Informed Consent Yes