Modelized analysis of pressure-flow studies of patients with lower urinary tract symptoms due to benign prostatic enlargement

Aims: To gain insight from an adaptable computer model of micturition into the pathophysiological phenomena occurring during voiding in men with lower urinary tract symptoms due to benign prostatic enlargement (BPE). Methods: By using the Valentini-Besson-Nelson (VBN) micturition model, we proceeded with an in-depth and systematic analysis of the pressure-flow studies of 71 patients (119 tracings) provided by three different institutions. Results: The modelized analysis identified and quantified several pathophysiological phenomena during voiding: compressive obstruction, variations in detrusor contraction force (enhanced or reduced), progressive relaxation of the prostatic fossa, occasional detrusor-bladder neck coupling, and sphincteric control dysfunctions. Once these phenomena were taken into account by using a set of new parameters, the computed flow rate and detrusor pressure curves became very similar to the recorded ones. Conclusions: The accuracy of this sophisticated analysis allows us to separate and to study during each voiding the phenomena belonging to the urethra, the detrusor, the bladder neck, the prostate, and their neurologic coordination in BPE patients.