Impact of detrusor underactivity on the postoperative outcomes after benign prostatic enlargement surgery

Plata, Mauricio; Santander, Jessica; Trujillo, Carlos Gustavo; Bravo‐Balado, Alejandra; Robledo, Daniela; Higuera, Tatiana; Caicedo, Juan Ignacio

doi:10.1002/nau.24637

Cited by 8 publications

(9 citation statements)

References 26 publications

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“…The full texts of the remaining 103 studies were screened and 87 papers were further excluded for lack of specificity of data or duplicate studies. Finally, 17 studies were accepted and included for meta‐analysis 9–25 . Figure 1 shows the PRISMA flow diagram.…”

Section: Resultsmentioning

confidence: 99%

“…Finally, 17 studies were accepted and included for meta-analysis. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Figure 1 shows the PRISMA flow diagram.…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 shows characteristics of the included studies. There were 5 prospective nonrandomized studies 14,17,18,22,25 and 12 retrospective studies, [9][10][11][12][13]15,16,[19][20][21]23,24 including 1701 DUA and 1993 NC patients. Regarding surgical procedures and in accordance with the ICS (International Continence Society) report on the terminology for male lower urinary tract surgery, 26 there were eight TURP studies, four GreenLight PVP (photoselective vaporization of the prostate; also known as GreenLight laser vaporization of the prostate) studies, two HoLEP studies, one GreenLight PVP/HoLEP study, one Holmium laser incision of the prostate study, and one study did not report the type of surgery.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

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Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta‐analysis

Wroclawski,

Takemura,

Santos

et al. 2023

Neurourology and Urodynamics

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IntroductionMen with detrusor underactivity (DUA) and concomitant bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) may present poorer functional outcomes after surgical desobstruction. This study aimed to evaluate the safety and efficacy of BPE surgery in men with DUA compared with those with normal detrusor contractility (NC).Materials and MethodsThis review was performed according to the 2020 PRISMA framework. A comprehensive literature search was performed until May 7, 2023, using MEDLINE, EMBASE, and Cochrane Database. No date limits were imposed. Only comparative studies were accepted. The primary endpoint was to assess if there was any difference in short‐ and long‐term functional outcomes after BPE surgery in men with DUA and NC. The secondary endpoint was to evaluate the differences in perioperative outcomes and postoperative complications between the two groups. Meta‐analysis was performed using Review Manager (RevMan) software.ResultsThere were 5 prospective nonrandomized studies and 12 retrospective studies, including 1701 DUA and 1993 NC patients. Regarding surgical procedures, there were eight TURP (transurethral resection of the prostate) studies, four GreenLight PVP (photoselective vaporization of the prostate) studies, two HoLEP (Holmium laser enucleation of the prostate) studies, one GreenLight PVP/HoLEP study, one Holmium laser incision of the prostate study, and one study did not report the type of surgery. We did not find a statistically significant difference between the two groups in terms of perioperative outcomes, including postoperative catheterization time, hospitalization time, urinary retention, need to recatheterization, transfusion rate, or urinary tract infections. Also, we found no significant differences in long‐term complications, such as bladder neck stenosis or urethral stenosis. Posttreatment bladder recatheterization and retreatment rate for BPE regrowth could not be evaluated properly, because only one study reported these findings. When we analyzed functional outcomes at 3 months, those with NC had lower International Prostatic Symptom Score (IPSS), lower quality‐of‐life (QoL) score, better maximum flow rate (Qmax), and lower post‐voiding residual (PVR) of urine. These results were maintained at 6 months postoperatively, with exception of PVR that showed no difference. However, at 12 and more than 12 months the functional outcomes became similar regarding IPSS and QoL. There were few data about Qmax and PVR at longer follow‐up.ConclusionIn this meta‐analysis, data suggest that BOO surgical treatment in patients with concomitant BPE and DUA appears to be safe. Despite patients with DUA may present worse functional outcomes in the short postoperative term compared with the NC population, IPSS and QoL scores become comparable again after a longer follow‐up period after surgery.

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Section: Resultsmentioning

confidence: 99%

“…Finally, 17 studies were accepted and included for meta-analysis. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Figure 1 shows the PRISMA flow diagram.…”

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

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Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta‐analysis

Wroclawski,

Takemura,

Santos

et al. 2023

Neurourology and Urodynamics

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“…Recent studies have shown that patients with DU with or without BOO can still benefit from transurethral prostatic surgeries and have improvement of LUTS after surgery 18 , 19 . However, patients with DA might need CIC after prostatic surgery 19 , and patients with DU are more likely to have a lower quality of life and failure to voiding in the immediate postoperative period 20 .…”

Section: Discussionmentioning

confidence: 99%

Therapeutic outcome of active management in male patients with detrusor underactivity based on clinical diagnosis and videourodynamic classification

Lee

Jhang

et al. 2022

Sci Rep

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Detrusor underactivity (DU) could be resulted from many different etiologies. Patients with DU might have reduced bladder sensation, low detrusor contractility, and large post-void residual volume. This study analyzed therapeutic outcome of active management for male DU patients, based on clinical and urodynamic characteristics. Male DU patients aged > 18 years old were retrospectively reviewed from the videourodynamic study (VUDS) records in recent 10 years. The patients’ demographics, VUDS results, treatment modalities, and treatment outcome were analyzed. The treatment outcomes were compared among patients with different DU subgroups, clinical diagnosis and treatment modalities. Patients with voiding efficiency of > 66.7% were considered having a successful treatment outcome. For comparison, 30 men with normal VUDS finding served as the control arm. Most of the DU patients had reduced bladder sensation. The reduced bladder sensation is closely associated with low detrusor contractility. After active treatment, a successful outcome was achieved in 68.4% of patients after bladder outlet surgery, 59.1% after urethral botulinum toxin A injection, and 57.6% after medical treatment, but only 18.2% after conservative treatment. A successful treatment outcome was achieved in patients with an intact detrusor contractility, either low (69.2%) or normal voiding pressure (81.8%), and in patients with a normal or increased bladder sensation (78.1%). However, patients with detrusor acontractile (41.3%) or absent bladder sensation (17.9%) had less favorable treatment outcome after any kind of urological management. This study revealed that active management can effectively improve voiding efficiency in patients with DU. The normal bladder sensation, presence of adequate detrusor contractility, and bladder outlet narrowing during VUDS provide effective treatment strategy for DU patients. Among all management, BOO surgery provides the best treatment outcome.

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“…Patients with DU had a higher incidence rate of temporary acute urinary retention after removing the urethral catheter postoperatively. Although IPSS score improvements were similar between groups, BOO with DU patients experienced less improvement in QoL [ 74 ].…”

Section: Predictors For a Successful Boo Surgery For Dumentioning

confidence: 99%

Detrusor Underactivity in Men with Bladder Outlet Obstruction

2022

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Detrusor underactivity (DU) and bladder outlet obstruction (BOO) are both common troublesome causes of lower urinary tract symptoms (LUTS) and often impact on quality of life simultaneously in men. This article aims to focus on DU with BOO in male patients. Methods: Original articles concerning DU with BOO were identified through literature research from PubMed and EMBASE database. We selected 38 articles in our review, including those concerning pathophysiology, evaluation, treatment and predictors for a successful BOO surgery for DU. Results: DU from BOO can result from several pathophysiological mechanisms. Although urodynamic study (UDS) is considered as a precise method to diagnose DU and BOO, there are some previous studies which proposed a non-invasive method to identify DU related to BOO. The treatment goal of DU is restoring bladder contractility using medication or surgery. Releasing outlet obstruction and resistance is the main strategy to restore bladder contractility when medication to directly increase bladder contractility has had limited efficacy. Conclusions: DU from BOO is poorly understood and is largely under-researched. The etiology and pathophysiology still need to be evaluated. Effective and safe medication to restore bladder contractility is also lacking. It remains valuable to perform further research to reveal the unknown aspects of DU.

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Impact of detrusor underactivity on the postoperative outcomes after benign prostatic enlargement surgery

Cited by 8 publications

References 26 publications

Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta‐analysis

Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta‐analysis

Therapeutic outcome of active management in male patients with detrusor underactivity based on clinical diagnosis and videourodynamic classification

Detrusor Underactivity in Men with Bladder Outlet Obstruction

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