Does detrusor underactivity affect the results of transurethral resection of prostate?
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UROLOGY - ORIGINAL PAPER
Does detrusor underactivity affect the results of transurethral resection of prostate? M. A. Abdelhakim1 · A. Rammah1 · A. H. Abozamel1 · M. G. El‑sheikh1 · M. S. Abdelazeem1 · S. M. Abdallah2 · A. Y. Abdelaziz1 Received: 11 July 2020 / Accepted: 25 September 2020 © Springer Nature B.V. 2020
Abstract Purpose We aimed to evaluate the outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and diagnosed to have weak detrusor contractility by urodynamic study. Methods A prospective study of 32 male patients had BPH candidate for TURP diagnosed to have impaired detrusor contractility by preoperative urodynamic study. We studied the postoperative outcome after TURP regarding international prostate symptoms score (IPSS), maximum flow rate (Qmax), post-voiding residual urine (PVR), the patients need for catheter, and urodynamic pressure flow study (PFS) parameters (maximum detrusor contractility, bladder contractility index (BCI), maximum bladder capacity and compliance) after 6 month follow-up. Results Twenty-one cases presented with urethral catheter because of chronic or refractory retention. Twenty patients voided preoperatively during PFS with mean detrusor pressure (Pdet) at Qmax 23.97 ± 25.54 cmH2O and the mean BCI was 51.04 ± 23.86, while twelve patients did not void with mean maximum Pdet 21.75 ± 7.34. After 6 month follow-up, there was significant improvement in IPSS, Qmax, and detrusor contractility (Pdet at Qmax and BCI) postoperatively in all patients, and there was no significant postoperative improvement of post-voiding residual urine (p value 0.92). Finally, 11 patients voided normally without RU, 7 patients needed timed triple voiding with crede maneuver and small RU, and 14 patients needed CIC. Conclusions There were significant improvements in IPSS, detrusor contractility, and urine flow after TURP in patients with BPH and weak bladder contractility, although the risk of postoperative urine retention in approximately 43% of cases and needed CIC. Keywords BPH · TURP · Detrusor under activity · Acontractile bladder
Introduction Lower urinary tract symptoms (LUTS) are considered to be a common complaint in adult men with a major impact on quality of life (QoL) [1]. LUTS have traditionally been related to bladder outlet obstruction (BOO), which is usually caused by benign prostatic enlargement (BPE). Bladder dysfunction may also cause LUTS, including detrusor overactivity/OAB, detrusor underactivity/underactive bladder [2].
* A. Y. Abdelaziz [email protected] 1
Urology Department, Faculty of Medicine, Cairo University, Giza 11562, Egypt
Pediatrics Department, Faculty of Medicine, Cairo University, Giza, Egypt
2
Impaired detrusor contractility in the form of detrusor underactivity (DU) or detrusor acontractility (DA) can cause LUTS and confound the diagnosis of BOO. The detrusor underactivity can only be diagnosed by detrusor pressureuroflow urodynamic studies [3]. When treating BPH, in addition to deter
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