Urodynamic and clinical effects of transurethral resection of the prostate in patients with benign prostatic enlargement associated with detrusor underactivity: a retrospective study

Domenico Prezioso1, Nicola Russo1, Antonio Ruffo1, Giuseppe Romeo1, Fabrizio Iacono1, Ester Illiano1
  • 1 Università Federico II - Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche (Napoli)

Objective

Detrusor underactivity (DU) is defined as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span. It is a common lower urinary tract dysfunction that is poorly understood and underresearched.The clinical features that result from DU are often indistinguishable from other lower urinary tract dysfunctions,
in particular hesitancy, weak stream, intermittency, and straining that are all common symptoms seen in
patients with bladder outflow obstruction(BOO).Benign prostatic hyperplasia (BPH) is a condition often associated with lower urinary tract symptoms (LUTS).LUTS,especially the bother symtoms have a negative impact on health-related quality of life. The aim of this study is to investigate the effectiveness of transurethral resection of the prostate in treating men with non neurogenic DU and BPH.

Methods and results

A retrospective study .Between September 2012 and September 2013 male patients presenting LUTS symptoms were evaluated at baseline. Baseline evaluation included: medical and pharmacological history, physical examination, laboratory investigations( total PSA ) uroflowmetry, urinary system ultrasonography and post-void residual (PVR) urine measurement, lumbo-sacral MRI. Patients completed a self-administered IQoL (International quality of life questionnaire) questionnaire and an IPSS (International Prostate Symptom Score) was determined for male patients. A urodynamic exam was also performed (Menfis, Pro-2000). A total of 34 patients with a mean age of 52 years were chosen to be enrolled in the study. Inclusion criteria included: Maximum Flow Rate (Qmax) 50 ml; Bladder Outlet Obstruction Index (BOOI) > 40; Bladder Contractility Index (BCI) < 100.Patients with possible neurogenic voiding dysfunction or urethral stricture, bladder calculi, bladder tumour, prostate tumour, urethral diverticulum, were excluded. After baseline evaluation, enrolled patients undergone monopolar transurethral resection of the prostate(TURP). Patients were requested to return at months 3 for an evaluation of symptoms, total PSA, , urinary system ultrasonography with PVR urine measurement, completed self-administered IQoL and IPSS questionnaire. Finally, patients undergone a second urodynamic exam, uroflowmetry.
Once data was collected and recorded, we evaluated the following:
1. Qmax at baseline compared with Qmax after 3 months after TURP
2. Detrusor Pressure (Pdet) at Qmax at baseline compared with PdetQmax after 3 months after TURP
3. PVR at baseline compared with PVR after 3 months after TURP
4. IQoL. at baseline compared with IPSS after 3 months after TURP
5. IPSS at baseline compared with IPSS after 3 months after TURP
An improvement in symptom score, storage symptom score, Qmax, PVR, voiding efficiency, IPSS, IQoL questionnaire was observed in all patients, and a good therapeutic response with improved voiding symptoms was observed in 62,7% of the patients.At visit total PSA is 2.5 ±3.9 ng/ml (0.4-6.4 ng/ml), prostate volume is 45 ±23 ml (23-90ml), Qmax 5.7±4.1, PVR 60±254,IPSS 22.3± 6.5, QoL 4.69±0.61.After 3months after the TURP Qmax is 16.4±7.3, PVR 30±73,IPSS 8.9 ± 3.5, QoL 1.5±0.5. No increase of Pdet at maximum flow rate after 3 months after TURP

Discussion

Our study suggests that in selected patients with benign prostatic enlargement associated with detrusor underactivity the transurethral resection of the prostate improves voiding symptoms, Qmax, PVR, and all 2 questionnaire scores, however an increase in Pdet at maximum flow rate after 3 months was not observed.Current treatment options for male detrusor underactivity are limited,like intermittent
catheterization, however long-term use of indwelling catheters can be associated with a high risk of complications, including UTIs, meatal erosions in men, so they are methods that adversely affect the quality patient' life.Transurethral resection of the prostate is an effective surgical procedure for treatment of LUTS/BPH, especially for patients with BOO, nevertheless DU may not be a contraindication for TURP. .

References

• Taylor JA III, Kuchel GA. Detrusor underactivity: Clinical features and pathogenesis of an underdiagnosed geriatric condition. J. Am. Geriatr. Soc. 2006; 54: 1920–32.
• Seki N1, Kai N, Seguchi H, Takei M. Predictives regarding outcome after transurethral resection for prostatic adenoma associated with detrusor underactivity. Urology. 2006 Feb;67(2):306-10.
• Thomas AW1, Cannon A, Bartlett E, Ellis-Jones J, Abrams P.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. BJU Int. 2004 Apr;93(6):745-50.

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