Imaging assessment of uncomplicated bladder outflow obstruction

To assess the impact of the use of plain X-ray films and ultrasound examina tions on clinical decision-making in patients referred with symptoms of bla dder outflow obstruction. Patients with symptoms of bladder outflow obstruc tion were recruited prospectively. After clinical assessment they underwent standard investigations of plain X-ray of the kidneys, ureters and bladder , and upper and fewer urinary tract ultrasound. A management decision was m ade on the basis of all results. These decisions were then reviewed with sp ecific reference to radiological findings to assess the role of imaging in the decision-making process. A total of 320 men were recruited for the stud y. X-ray of the kidneys, ureters and bladder detected 10 upper tract calcul i, none of which has required active intervention to date. Four bladder cal culi were detected. Two of these were also seen on ultrasound scan: one was small and insignificant, the other had caused microscopic haematuria, nece ssitating cystoscopy regardless of the X-ray findings. Upper tract ultrasou nd revealed abnormalities and anatomical variants which did not affect mana gement. Four patients had upper tract dilatation but these had already had surgery planned on the basis of other investigations, including residual ur ine volume determination by lower tract ultrasound. Lower urinary tract ult rasound should be the only routine imaging used in the initial assessment o f patients with bladder outflow obstruction, with consequent implications o f reduced patient stress and reduced investigation cost.