{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T04:53:19Z","timestamp":1784177599206,"version":"3.55.0"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T00:00:00Z","timestamp":1621814400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["I01 BX003454-01"],"award-info":[{"award-number":["I01 BX003454-01"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Lower urinary tract symptoms (LUTS) in aging men are commonly attributed to bladder outlet obstruction from benign prostatic hyperplasia (BPH) but BPH\/LUTS often reflects a confluence of many factors. We performed a hierarchical cluster analysis using four objective patient characteristics (age, HTN, DM, and BMI), and five pre-operative urodynamic variables (volume at first uninhibited detrusor contraction, number of uninhibited contractions, Bladder Outlet Obstruction Index (BOOI), Bladder Contractility Index (BCI) and Bladder Power at Qmax) to identify meaningful subgroups within a cohort of 94 men undergoing surgery for BPH\/LUTS. Two meaningful subgroups (clusters) were identified. Significant differences between the two clusters included Prostate Volume (95 vs 53 cc; p-value = 0.001), BOOI (mean 70 vs 49; p-value = 0.001), BCI (mean 129 vs 83; p-value &lt;0.001), Power (689 vs 236; p-value &lt;0.001), Qmax (8.3 vs 4.9 cc\/sec; p-value &lt;0.001) and post-void residual (106 vs 250 cc; p-value = 0.001). One cluster is distinguished by larger prostate volume, greater outlet resistance and better bladder contractility. The other is distinguished by smaller prostate volume, lower outlet resistance and worse bladder contractility. Remarkably, the second cluster exhibited greater impairment of urine flow and bladder emptying. Surgery improved flow and emptying for patients in both clusters. These findings reveal important roles for both outlet obstruction and diminished detrusor function in development of diminished urine flow and impaired bladder emptying in patients with BPH\/LUTS.<\/jats:p>","DOI":"10.1371\/journal.pone.0251721","type":"journal-article","created":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T17:29:24Z","timestamp":1621877364000},"page":"e0251721","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Cluster analysis of men undergoing surgery for BPH\/LUTS reveals prominent roles of both bladder outlet obstruction and diminished bladder contractility"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3111-0216","authenticated-orcid":true,"given":"Andrew J.","family":"Schneider","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Grimes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Will","family":"Lyon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Kemper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijian","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wade","family":"Bushman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,5,24]]},"reference":[{"key":"pone.0251721.ref001","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1016\/S0022-5347(05)64473-4","article-title":"Urodynamic patterns of normal male micturition: influence of water consumption on urine production and detrusor function","volume":"168","author":"F Schmidt","year":"2002","journal-title":"J Urol"},{"key":"pone.0251721.ref002","doi-asserted-by":"crossref","first-page":"840","DOI":"10.4111\/kju.2013.54.12.840","article-title":"Effect of transurethral resection of the prostate based on the degree of obstruction seen in urodynamic study","volume":"54","author":"DS Min","year":"2013","journal-title":"Korean J Urol"},{"key":"pone.0251721.ref003","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1080\/03008880410015147","article-title":"Alteration of contractile and regulatory proteins following partial bladder outlet obstruction","volume":"215","author":"S Chacko","year":"2004","journal-title":"Scand J Urol Nephrol Suppl"},{"key":"pone.0251721.ref004","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1111\/bju.12687","article-title":"Effect of partial bladder outlet obstruction and reversal on rabbit bladder physiology and biochemistry: duration of recovery period and severity of function","volume":"114","author":"M Jock","year":"2014","journal-title":"BJU Int"},{"key":"pone.0251721.ref005","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1111\/j.1464-410X.2005.05891.x","article-title":"The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated detrusor underactivity","volume":"96","author":"AW Thomas","year":"2005","journal-title":"BJU Int"},{"key":"pone.0251721.ref006","first-page":"315","article-title":"Age dependence of urinary bladder contractility","volume":"11","author":"R Van Mastrigt","year":"1992","journal-title":"Neurourol Urodyn"},{"key":"pone.0251721.ref007","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1007\/s00345-014-1358-6","article-title":"Detrusor contraction power parameters (BCI and W max) rise with increasing bladder outlet obstruction grade in men with lower urinary tract symptoms: results from a urodynamic database analysis","volume":"32","author":"M Oelke","year":"2014","journal-title":"World J Urol"},{"key":"pone.0251721.ref008","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1111\/j.1464-410X.2003.04719.x","article-title":"The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up","volume":"93","author":"AW Thomas","year":"2004","journal-title":"BJU Int"},{"key":"pone.0251721.ref009","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1097\/01.ju.0000176740.76061.24","article-title":"The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow up of transurethral resection of prostate for bladder outlet obstruction","volume":"174","author":"AW Thomas","year":"2005","journal-title":"J Urol"},{"key":"pone.0251721.ref010","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1590\/s1677-5538.ibju.2016.0405","article-title":"Surgical treatment of detrusor underactivity: a short term proof of concept study","volume":"43","author":"JG Blaivas","year":"2017","journal-title":"Int Braz J Urol"},{"key":"pone.0251721.ref011","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1111\/j.1442-2042.2006.01589.x","article-title":"Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity?","volume":"13","author":"Y Tanaka","year":"2006","journal-title":"Int J Urol"},{"key":"pone.0251721.ref012","doi-asserted-by":"crossref","first-page":"E34","DOI":"10.1111\/bju.14661","article-title":"Effect of preoperative detrusor underactivity on long-term surgical outcomes of photovaporization and holmium laser enucleation in men with benign prostatic hyperplasia: a lesson from 5-year serial follow-up data","volume":"123","author":"MC Cho","year":"2019","journal-title":"BJU Int"},{"key":"pone.0251721.ref013","first-page":"106","article-title":"Afterload reduction and cardiac performance. Physiologic basis of systemic vasodilators as a new approach in treatment of congestive heart failure","volume":"65","author":"DT Mason","year":"1978","journal-title":"Am J Med"},{"key":"pone.0251721.ref014","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/0002-9149(87)90376-6","article-title":"Effects of afterload reduction (diuretics and vasodilators) on left ventricular volume and mitral regurgitation in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy","volume":"60","author":"LW Stevenson","year":"1987","journal-title":"J Cardiol"},{"key":"pone.0251721.ref015","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1111\/j.1464-410X.2005.05815.x","article-title":"The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction","volume":"96","author":"AW Thomas","year":"2005","journal-title":"BJU Int"},{"key":"pone.0251721.ref016","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1002\/nau.10084","article-title":"Urodynamic evaluation of the human bladder response to an increase in outlet resistance","volume":"21","author":"JD Engel","year":"2002","journal-title":"Neurourol Urodyn"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0251721","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T17:29:33Z","timestamp":1621877373000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0251721"}},"subtitle":[],"editor":[{"given":"Georgios","family":"Gakis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,5,24]]},"references-count":16,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0251721","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,24]]}}}