Urodynamics in patients with pheochromocytoma: A peri‐operative study of 10 cases

• Published in: World journal of surgery 1992-07, Vol.16 (4), p.676-679
• Main Authors: Carnaille, B. M., Rigot, J. M., Bailleul, J. P., Quievreux, J. L., Wemeau, J. L., Proye, C. A.
• Format: Article
• Language: English
• Subjects: Adrenal Gland Neoplasms - metabolism; Adrenal Gland Neoplasms - physiopathology; Adrenal Gland Neoplasms - surgery; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adrenergic alpha-Antagonists - pharmacology; Adult; Aged; Biological and medical sciences; Bladder Neck; Como; Endocrinopathies; Epinephrine - metabolism; Female; Humans; International Continence Society; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Norepinephrine - metabolism; Pheochromocytoma - metabolism; Pheochromocytoma - physiopathology; Pheochromocytoma - surgery; Postoperative Period; Preoperative Care; Urethral Pressure; Urodynamic Study; Urodynamics - drug effects
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/BF02067353

Alpha receptors have been demonstrated in the bladder neck, and urinary retention may be the presenting symptom in an occasional pheochromocytoma patient. This prompted us to definie the urodynamic profile in pheochromocytoma patients. Ten patients were studied. Except for 2 patients, all tumors secreted norepinephrine either alone (n=4) or mixed (n=4). Urodynamic studies (uroflowmetry, cystometry, profilometry, response to alpha‐adrenergic agents) were performed with Urodyn 5000 chain (DANTEC) connected to a water perfused Bohler's catheter. Profilometry was done according to the Brown and Wickham technique. Normal values were those of the International Continence Society. Alpha blocker test was done by intravenous injection of thymoxamine (0.5 mg/kg) and was considered as positive if urethral closure pressure (UCP) decrease was >30% after 10 minutes. Ten patients had a pre‐operative study, omitting alpha‐blocker test in 1 patient; 5 patients consented a postoperative study. Pre‐operatively we could demonstrate: 1) Increased UCP in 8 of 10 patients, regardless of the secretory pattern; 2) Response to alpha‐adrenolytic agents in 7 of 9 patients; and postoperatively: 3) Good correlation between a positive alpha‐blocker test and a decrease in urethral pressure in 3 of 5 patients. Urodynamics in pheochromocytoma patients show a typical alpha‐adrenergic pattern and may explain bladder dysfunction as a presenting symptom. Résumé Il existe des récepteurs Alpha‐adrénergiques dans le col vésical et la rétention d'urine peut parfois être le symptome initial d'un phéochromocytome. Ceci nous a conduit à définir le profil urodynamique des porteurs de phéochromocytome. L'étude a concerné 10 patients (9 hommes, 1 femme; âge moyen 45 ans, extrèmes 35–71 ans). Chacun était porteur de phéochromocytome à sécrétion exclusive soit de Noradrénaline (NA) dans 3 cas, ou d'Adrénaline (A) dans 2 cas, à sécrétion mixte de NA + A dans 3 cas et de NA + A + Dopamine dans 2 cas. Les études urodynamiques (débitmétrie, cystométrie, profil urètral, test aux Alpha‐bloquants) ont été réalisées avec une chaine Urodyn 5000 (Dantec), capteurs de pression à eau. Le profil urètral est réalisé selon la technique de Brown et Wickham. Les valeurs normales sont celles de l'International Continence Society. Le test aux Alpha‐Bloquants est réalisé par injection intra‐veineuse de Chlorydrate de Moxysilite (0,5 mg/kg) et est considéré comme positif pour une chute de pression de clôture d'au moins 30% en