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

Abstract

OBJECTIVESTo assess the long-term outcome of the efficacy of transurethral resection of the prostate (TURP) in men with detrusor underactivity (DUA), a cause of lower urinary tract symptoms (LUTS) in a significant minority of men. PATIENTS AND METHODSNeurologically intact men with LUTS, who were investigated in our department between 1972 and 1986, diagnosed with DUA and who underwent surgical intervention, were invited for a repeat symptomatic and urodynamic assessment. Identical methods were used, allowing direct comparison of the results. RESULTSIn all, 224 men were initially diagnosed with DUA; 87 (39%) of these died in the interim and 22 followed had a TURP, with a mean follow-up since surgery of 11.3 years. There were no significantly sustained reductions in any symptoms. There was a small but significant reduction of questionable clinical significance in the bladder outlet obstruction index, but this did not translate into an improved flow rate. Comparison with 58 agematched patients with DUA who remained untreated showed no significant advantage of surgical intervention in the long-term; on the contrary, there was more chronic retention in those who had had surgery. CONCLUSIONSThere are no long-term symptomatic or urodynamic gains from TURP in men shown to have DUA. The results of TURP in men with DUA are important, as urologists who surgically treat patients based on the symptoms and uroflowmetry alone will do so in a significant minority of men with DUA. These results strengthen the argument for a routine preoperative urodynamic assessment. Authors from Leicester assessed the prevalence and incidence rates for urinary incontinence and storage disorder in the UK over a 1-year period, finding that this constituted a major public health problem, with consequent effects on services and funding.

Optimizing individual treatment outcomes in men with lower urinary tract symptoms using storage subscale score/total International Prostate Symptom Score (IPSS) as a new IPSS ratio

“…Although antimuscarinics reduce DO and are indicated for the treatment of OAB, until recently, many men have been only prescribed antimuscarinics for persistent OAB symptoms following prostatic surgery (8). Antimuscarinic therapy in men with LUTS has traditionally been avoided due to an increased risk of acute urinary retention in BOO cases.…”

“…Although DO and OAB symptoms may develop secondary to BOO in men, they also may occur independently (7,8). Determination of the dominating pathology in the clinical scenario of patients with LUTS is a major concern in opting for medical therapy.…”

Photoselective Vaporization of the Prostate and Simultaneous Suprapubic Cystostomy for the Treatment of Benign Prostatic Hyperplasia in Patients with Mild to Severe Detrusor Underactivity

“…The diagnostic approaches are mostly based on the urodynamics tests and clinical manifestations. DU is characterized by a low pressure, poorly sustained or wave-like detrusor contraction with an associated poor flow rate [9]. DU has various, but not typical, clinical manifestations or symptoms being indistinguishable from those seen in detrusor overactivity, BPH and urinary tract infection.…”

“…From June 2012 to May 2014, a total of 78 patients diagnosed with BPH accompanied by DU from our hospital were included in this study. The diagnosis of DU was based on urodynamic examination findings [9] and clinical manifestation. The definition of DU used here was a detrusor pressure at Q max (Pdet max ) of <40 cm H 2 O and detrusor contraction of inadequate duration and/or wave-like detrusor contraction with a Q max of <10 ml/s.…”

“…BPH patients may develop DU due to the failure of medical treatment of BOO in a timely manner and the overstretched detrusor. Some researchers reported that restoration of detrusor function cannot be achieved after the application of simple prostatectomy in men with BPH and DU [8,9] and suprapubic cystostomy should be performed, while others suggested that surgical resolution of obstruction is an appropriate therapeutic method regardless of the existence of DU according to urodynamics assessment and does not impact the improvement of the quality of life (QoL) after the operation [10]. The authors in the present study found that patients with BPH and DU will experience a obvious decrease in the quality of life and increase in risk of bladder infection if they receive simple cystostomy and will not achieve good postoperative results if they receive simple prostatectomy because they may still experience dysuresia or upper urinary tract deterioration.…”