Lower Urinary Tract Symptoms Clinical Trial
Official title:
Contractility: Cuff Versus Urodynamics Testing In Males With Voiding Lower Urinary Tract Symptoms
A number of men will experience bothersome urinary symptoms, which become more common as they
age. A number of conditions can cause these symptoms, and general practitioners may refer men
to their local hospital for further assessment and treatment. Symptoms can include poor flow
of urine, the need to pass urine more frequently, or the sensation that the bladder is not
completely emptying. This can be due to an enlargement of the prostate gland. These symptoms
can also be caused when the bladder muscle is not able to contract (squeeze) as well as it
previously has to empty the bladder. This is known as underactive bladder (UAB).
It is important to distinguish between the two conditions as a cause for these symptoms, to
prevent side effects from unnecessary medications or operations. Currently, men would need to
undergo a bladder pressure test (urodynamics). This involves inserting a catheter via the
penis into the bladder, through which the bladder is filled with fluid and pressure is
measured. A separate second small tube is inserted into the rectum to measure the pressure in
the abdomen. The pressure changes are observed as the bladder is filled, and then urine is
passed around the catheter.
A second technique for measuring bladder pressure is the use of a small inflatable cuff which
is placed around the penis (penile cuff test). The bladder pressure can then be determined by
inflating the cuff and interrupting the flow of urine. The bladder can be filled naturally
before the test, which means a bladder catheter tube is not required. This study is designed
to find out ways that the penile cuff test can be made more accurate. It will compare the
cuff results to those obtained from a bladder pressure test, and will take x-ray pictures of
the urinary tract during the test.
The investigators intend to refine the procedural steps of the cuff test to improve the
measurement and reduce variability with pves.isv, therefore giving a more reproducible test.
By improving the penile cuff test, the investigators can then go on to assess how our
non-invasive measurements correlate with urodynamically derived indices of contractility, and
use data from this pilot to help construct methodology of future cuff research. The current
hypotheses are that; 1) accuracy of the cuff interruption pressure (pcuff.int) can be
improved by modification of penile cuff test factors, 2) the number of valid inflations
obtained per patient will increase with the modifications, and 3) that this non-invasive
measure of contractility will correlate with pre-existing invasive indices.
The research protocol also gives the opportunity to explore correlation between commonly used
symptom scores, and accuracy in the assessment of ultrasound residual urine volume
measurement.
The primary objectives are therefore:
- To modify procedural steps of the penile cuff test that may reduce the previously
observed variability and perform a pilot study to assess a reduction in variance
- To identify behaviour of the urethra during penile cuff inflation, by performing x-ray
screening during the penile cuff test, and assess whether this is another source of
inaccuracy
- To test the basic assumption of the penile cuff test that the bladder neck remains open
during flow interruption
Secondary objectives of the study include the following:
- To compare non-invasive measurements from the penile cuff test against invasive indices
of contractility
- To compare 2 different symptom scores for men with voiding lower urinary tract symptoms
(LUTS)
- To assess accuracy and inter-observer variability of ultrasound residual measurement
against a known volume.
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