To explore urodynamic characteristics and their clinical value in pelvic lipomatosis (PL) patients.
We reviewed the clinical information of 84 PL patients. A voiding pressure-flow study was used to classify patients into nonoutlet obstruction (NOO), latter-half-section obstruction (LHSO), or whole-section bladder outlet obstruction (BOO) groups. Urinary morphologic features were measured by imaging examination and cystoscopy.
A unique LHSO that presented as sudden increasing detrusor pressure (Pdet) and decreasing flow rate in the latter half of voiding was observed for 52.4% (44 of 84) patients. Overall, 27.4% (23 of 84 patients) were diagnosed with BOO with whole-section increasing Pdet and decreasing flow rate. According to the morphologic feature analyses, the NOO patients had the largest angle of anteroposterior vesical walls (P < 0.001) and the least severe thickened bladder trigone (P = 0.015). The external compression at the bladder neck and thickened bladder trigone caused a prolonged and strictured bladder outlet tract (see the Supplementary video). There were 0, 5, and 4 urinary diversions performed in the NOO, LHSO, and BOO groups at diagnosis (P = 0.055). No patients in the NOO group, seven in the LHSO group, and two patients in the BOO group had disease progression at follow-up. Two LHSO patients and one BOO patients without hydronephrosis at diagnosis developed to hydronephrosis during follow-up.
Morphologic alterations of the urinary system of PL patients lead to unique LHSO or BOO on UDS. The presences of LHSO and BOO are associated with disease severity and progression.
Neurourology and urodynamics. 2017 Aug 01 [Epub ahead of print]
Yuke Chen, Yang Yang, Wei Yu, Yunxiang Xiao, Yu Fan, Jihong Duan, Yuan Tang, Jie Jin, Huihui Wang, He Wang, Sainan Zhu, Zhijun Xi, Shiliang Wu
Department of Urology, Peking University First Hospital, Beijing, China., Department of Radiology, Peking University First Hospital, Beijing, China., Department of Medical Statistics, Peking University First Hospital, Beijing, China.