[Male cervico-urethral obstruction of organic cause: transrectal prostatic ultrasonography versus permicturition and urethral ultrasonography].

AIM

This paper reports personal experience relating to the use of "static" and "permicturition" prostatic transrectal ultrasonography and urethral ultrasonography in the imaging diagnosis of obstructed patients.

METHODS

Between January 1996 and January 1998 we selected 96 consecutive patients aged between 25 and 73 years old (mean 54 years) with symptoms of obstructive dysuria with pathological uroflowmetry and pressure/flow rates (Qmax ranging between 5-12 ml/sec and URA between 34-81). Eighteen of the patients selected had previously undergone prostate surgery for benign pathologies. All patients underwent a standard and permicturition transrectal ultrasonography and urethral ultrasonography using a retrograde approach. The results were compared with those obtained by retrograde urethrocystography and urethrocystoscopy, regarded as the "gold standard" for the diagnosis of urethral obstruction.

RESULTS

Sixty-three (65.5%) patients were able to execute the permicturition phase, but only 54 (56.2%) reported that the test was indicative of "real urination", whereas retrograde urethral ultrasonography was well tolerated in all cases and easy to accomplish. In 19 (20%) patients (6 of whom had undergone prostate surgery and 13 were suffering from urethral stenosis), "major" organic alterations responsible for urethral obstruction were observed with the combined use of these ultrasonographic methods. These were not evident using static transrectal ultrasonography and increased the diagnostic sensitivity from 80 to 98%.

CONCLUSIONS

We feel that an increasingly complete ultrasonographic study of the lower urinary tract is necessary, above all in obstructed patients. This can be achieved using permicturition and urethral transrectal ultrasonography, ensuring an accurate diagnosis and optimising health expenditure.