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Lombardo R, Ghezzo N, Sarcinelli L, Turchi B, Zammitti F, Franco A, Nacchia A, Cicione A, Tema G, Pastore AL, Guarnotta G, Fuschi A, Al Salhi Y, Tubaro A, De Nunzio C. Post-Voided Residual Ratio Does Not Predict Trifecta Outcome after Transurethral Resection of Prostate. Life (Basel) 2024; 14:445. [PMID: 38672716 PMCID: PMC11051523 DOI: 10.3390/life14040445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
The purpose of this study was to assess the importance of the post-void residual (PVR) ratio (PVR ratio) in achieving a favorable trifecta outcome for patients suffering from lower urinary tract symptoms and benign prostatic enlargement (LUTS-BPE) who undergo transurethral resection of the prostate (TURP). Starting from 2015, a series of patients with LUTS-BPE who underwent TURP were included in a forward-looking study. These patients were assessed using the international prostate symptom score (IPSS) screening tool, uroflowmetry, and a transrectal ultrasound to measure prostate volume (TRUS). Both the PVR urine volume and the PVR ratio (PVR-R), which is the PVR as a percentage of total bladder volume (voided volume + PVR), were measured. The assessment of outcomes was based on the trifecta favorable outcome, defined as meeting all of the following criteria: (1) absence of perioperative complications, (2) a postoperative IPSS of less than eight, and (3) a postoperative maximum urinary flow rate (Qmax) greater than 15 mL/s. A total of 143 patients were included, with a median age of 70 years (interquartile range 65-73). Of these, 58% (83/143) achieved a positive trifecta outcome. Upon conducting a multivariate analysis, both IPSS and Qmax were identified as predictors of a positive trifecta outcome, whereas the PVR-R did not prove to be an independent predictor. In summary, it was found that preoperative IPSS and Qmax are indicative of a trifecta outcome following TURP, whereas PVR-R is not.
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Affiliation(s)
- Riccardo Lombardo
- Department of Urology, Sapienza University of Rome, 00185 Rome, Italy; (N.G.); (L.S.); (B.T.); (F.Z.); (A.F.); (A.N.); (A.C.); (G.T.); (A.L.P.); (G.G.); (A.F.); (Y.A.S.); (A.T.); (C.D.N.)
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van Merode NAM, Nijholt IM, Heesakkers JP, van Koeveringe GA, Steffens MG, Witte LPW. Effect of bladder outlet procedures on urodynamic assessments in men with an acontractile or underactive detrusor: A systematic review and meta-analysis. Neurourol Urodyn 2023; 42:1822-1838. [PMID: 37498009 DOI: 10.1002/nau.25253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To review the effect of bladder outlet procedures on urodynamic outcomes and symptom scores in males with detrusor underactivity (DU) or acontractile detrusors (AD). MATERIALS AND METHODS We performed a systematic review and meta-analysis of research publications derived from PubMed, Embase, Web of Science, and Ovid Medline to identify clinical studies of adult men with non-neurogenic DU or AD who underwent any bladder outlet procedure. Outcomes comprised the detrusor pressure at maximum flow (Pdet Qmax ), maximum flow rate (Qmax ), international prostate symptom score (IPSS), and quality of life (QoL). This study is registered under PROSPERO CRD42020215832. RESULTS We included 13 studies of bladder outlet procedures, of which 6 reported decreased and 7 reported improved Pdet Qmax after the procedure. Meta-analysis revealed an increase in the pooled mean Pdet Qmax of 5.99 cmH2 0 after surgery (95% CI: 0.59-11.40; p = 0.03; I2 95%). Notably, the Pdet Qmax improved in all subgroups with a preoperative bladder contractility index (BCI) <50 and decreased in all subgroups with a BCI ≥50. All studies reported an improved Qmax after surgery, with a pooled mean difference of 5.87 mL/s (95% CI: 4.25-7.49; I2 93%). Only three studies reported QoL, but pooling suggested significant improvements after surgery (mean, -2.41 points; 95% CI: -2.81 to -2.01; p = 0.007). All seven studies reporting IPSS demonstrated improvement (mean, -12.82; 95% CI: -14.76 to -10.88; p < 0.001). CONCLUSIONS This review shows that Pdet Qmax and Qmax increases after surgical bladder outlet procedures in men with DU and AD. Bladder outlet procedures should be discussed as part of the shared decision-making process for this group. The evidence was of low to very low certainty.
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Affiliation(s)
- Nadine A M van Merode
- Department of Urology, Isala Hospital, Zwolle, The Netherlands
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ingrid M Nijholt
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands
- Department of Innovation and Science, Isala Hospital, Zwolle, The Netherlands
| | - John P Heesakkers
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Sze C, Zhang TR, Dreyfuss L, DeMeo G, Thorogood SL, Chughtai B, Te AE, Lee RK, Hu JC. US patterns of care for urodynamic evaluation for BPH. Neurourol Urodyn 2023; 42:1563-1568. [PMID: 37395472 DOI: 10.1002/nau.25239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/07/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Practice patterns around the use of urodynamic evaluation (UDS) for benign prostatic hyperplasia (BPH) surgery are largely undefined. As such, we investigated factors associated with the use of UDS for BPH. METHODS We used American Board of Urology case log data from 2008 to 2020, to compare patient- and surgeon-sided factors associated with UDS utilization and BPH surgeries. We performed logistic regression models to identify factors independently associated with UDS usage for BPH. RESULTS Among urologists performing UDS, the majority (80%) self-identified as general urologists and practiced in a private practice group (69%). Compared with urologists who performed no UDS, urologists who performed any UDS for BPH were more likely to be from the Mid-Atlantic (20.3% vs. 10.6%, p < 0.01) and practice in regions with populations of >1 000 000 (34.7% vs. 28.5%, p < 0.01). Overall, UDS utilization declined over time (odds ratio [OR]: 0.95 year-to-year, 95% confidence interval [CI]: 0.91-0.99). In adjusted analyses, the odds of performing UDS was higher among male (OR: 2.19, 95% CI: 1.17-4.09), older (OR: 1.05, 95% CI: 1.03-1.06), and female pelvic medicine and reconstructive surgery subspecialty (OR: 3.23, 95% CI: 2.01-5.2) urologists. Additionally, performing UDS for BPH was associated with higher BPH surgical case volume (OR: 1.004, 95% CI: 1.001-1.008). CONCLUSION There is a significant practice variation in use of UDS for BPH. Although overall BPH surgeries are increasing, urologists are increasingly less likely to perform UDS for BPH. Specifically, urologists who perform UDS have significantly higher BPH case volume than those who do not perform UDS, suggesting that UDS usage may not factor into BPH surgery decision-making.
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Affiliation(s)
- Christina Sze
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Tenny R Zhang
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Leo Dreyfuss
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Gina DeMeo
- Department of Medical Eduation, Touro University California College of Osteopathic Medicine, Vallejo, California, USA
| | - Samantha L Thorogood
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Bilal Chughtai
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Alexis E Te
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Richard K Lee
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Jim C Hu
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
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Lebani BR, Barcelos ADS, Gouveia DSES, Girotti ME, Remaille EP, Skaff M, Almeida FG. The role of transurethral resection of prostate (TURP) in patients with underactive bladder: 12 months follow-up in different grades of detrusor contractility. Prostate 2023; 83:857-862. [PMID: 36945749 DOI: 10.1002/pros.24526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/12/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION AND OBJECTIVE Male detrusor underactivity (DUA) definition remains controversial and no effective treatment is consolidated. Transurethral resection of the prostate (TURP) is one of the cornerstones surgical treatments recommended in bladder outlet obstruction (BOO). However, the role of prostatic surgery in male DUA is not clear. The primary endpoint was the clinical and voiding improvement based on IPSS and the maximum flow rate in uroflowmetry (Qmax) within 12 months. MATERIALS AND METHODS We analyzed an ongoing prospective database that embraces benign prostata hyperplasia (BPH) male patients with lower urinary tract symptoms who have undergone to TURP. All patients were evaluated pre and postoperatively based on IPSS questionnaires, prostate volume measured by ultrasound, postvoid residual urine volume (PVR), Prostate Specific Antigen measurement and urodynamic study (UDS) before the procedure. After surgery, all patients were evaluated at 1-, 3-, 6- and 12-months. Patients were categorized in 3 groups: Group 1-Detrusor Underactive (Bladder Contractility Index (BCI) [BCI] < 100 and BOO index [BOOI] < 40); Group 2-Detrusor Underactive and BOO (BCI < 100 and BOOI ≥ 40); Group 3-BOO (BCI ≥ 100 and BOOI ≥ 0). RESULTS It was included 158 patients underwent monopolar or bipolar TURP since November 2015 to March 2021. According to UDS, patients were categorized in: group 1 (n = 39 patients); group 2 (n = 41 patients); group 3 (n = 77 patients). Preoperative IPSS was similar between groups (group 1-24.9 ± 6.33; group 2-24.8 ± 7.33; group 3-24.5 ± 6.23). Qmax was statistically lower in the group 2 (group 1-5.43 ± 3.69; group 2-3.91 ± 2.08; group 3-6.3 ± 3.18) as well as greater PVR. The 3 groups presented similar outcomes regard to IPSS score during the follow-up. There was a significant increase in Qmax in the 3 groups. However, group 1 presented the lowest Qmax improvement. CONCLUSION There were different objective outcomes depending on the degree of DUA at 12 months follow-up. Patients with DUA had similar IPSS improvement. However, DUA patients had worst Qmax improvement than men with normal bladder contraction.
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Affiliation(s)
- Bruno Rodrigues Lebani
- Department of Surgery, Division of Urology, Voiding Dysfunction Section, São Paulo Hospital-Federal University of São Paulo, São Paulo, Brazil
| | - André da Silva Barcelos
- Department of Surgery, Division of Urology, Voiding Dysfunction Section, São Paulo Hospital-Federal University of São Paulo, São Paulo, Brazil
| | - Denise Sbrissia E Silva Gouveia
- Department of Surgery, Division of Urology, Voiding Dysfunction Section, São Paulo Hospital-Federal University of São Paulo, São Paulo, Brazil
| | - Marcia Eli Girotti
- Department of Surgery, Division of Urology, Voiding Dysfunction Section, São Paulo Hospital-Federal University of São Paulo, São Paulo, Brazil
| | - Eduardo Pinto Remaille
- Department of Surgery, Division of Urology, Voiding Dysfunction Section, São Paulo Hospital-Federal University of São Paulo, São Paulo, Brazil
| | - Milton Skaff
- Department of Surgery, Division of Urology, Voiding Dysfunction Section, São Paulo Hospital-Federal University of São Paulo, São Paulo, Brazil
| | - Fernando Gonçalves Almeida
- Department of Surgery, Chief of Division of Urology and Voiding Dysfunction Section, São Paulo Hospital-Federal University of São Paulo, São Paulo, Brazil
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Robinson C, Hepburn A, Turner RM, Zarrabi AD. The role of intra‐operative void score during transurethral resection of prostate as a marker of efficacy: a feasibility study. ANZ J Surg 2022; 92:1492-1497. [PMID: 35486002 PMCID: PMC9314725 DOI: 10.1111/ans.17664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/25/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
Background To assess the feasibility of a novel intra‐operative void scoring technique. To determine if intra‐operative void score (VS) could act as a marker for post‐operative success following TURP. Methods Fifteen patients undergoing TURP were included in this single‐centre feasibility study. All patients had indwelling urinary catheters for recurrent retention due to benign prostatic hyperplasia (BPH). In theatre, immediately before‐ and after TURP, an intra‐operative VS was measured and graded 0–5. Primary outcomes were the feasibility of measuring intra‐operative VS and its accuracy in predicting surgical outcome. Results A combined pre‐ and post‐score with a threshold ≥6 correctly predicted 82% of those who were catheter free (sensitivity) and 100% of those who were not catheter free (specificity) at follow up and the positive predictive value was 100% and negative predictive value 60%. Conclusion Intra‐operative void score during TURP is simple, reproducible, fast and requires minimal resources. In TURP it may predict successful outcomes by identifying patients who will be catheter free post‐operatively as opposed to those who will be catheter dependent despite the procedure.
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Affiliation(s)
| | - Alastair Hepburn
- Dunedin Hospital Southern District Health Board Dunedin New Zealand
| | - Robin M. Turner
- Biostatistics Centre, Division of Health Sciences University of Otago Dunedin New Zealand
| | - Amir D. Zarrabi
- Department of Surgery University of Otago Dunedin New Zealand
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Abuelnaga M, Sharaf A, Armitage J. Efficacy of Holmium laser enucleation of the prostate in men with impaired bladder contractility: A review. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211062468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Since Holmium laser enucleation of the prostate (HoLEP) was introduced in the 1990s as an endoscopic deobstructing modality for benign prostatic hyperplasia (BPH), several reports have concluded that HoLEP has compared favourably to transurethral resection of prostate (TURP) in relieving Bladder Outlet Obstruction (BOO). However, there has been no consensus regarding the efficacy of surgical management of men with Detrusor Underactivity (DU) and BOO. Methods: We performed a literature search of PubMed, Google Scholar, Scopus, and Web of Science databases. All studies that provided data on the effectiveness of HoLEP in men with BOO and DU were assessed. Data collected included the number of patients, median follow-up, International Prostate Symptom Score (IPSS), Qmax, post-void residual (PVR) and catheter dependency pre- and post-intervention. Results: Nine studies were identified in the literature with a follow-up range between 6 and 60 months. Only one prospective study was identified where investigators performed urodynamic studies (UDSs) before and after the intervention. In addition to a significant improvement of voiding parameters, they reported partial recovery of detrusor muscle contractility in approximately 80% of patients. Furthermore, all other studies reported an improvement in all outcome parameters and proved the efficacy of HoLEP in patients with DU and BOO. Conclusion: The current literature underpins the efficacy of HoLEP in patients with impaired bladder contractility. However, current research is limited and the majority of the published data are retrospective in nature. Therefore, more well-conducted prospective randomised studies are needed to reinforce high-level evidence for this hypothesis. Level of evidence: Not applicable.
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Does detrusor underactivity affect the results of transurethral resection of prostate? Int Urol Nephrol 2020; 53:199-204. [PMID: 33074461 DOI: 10.1007/s11255-020-02669-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
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.
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Chen SF, Peng CH, Kuo HC. Will detrusor acontractility recover after medical or surgical treatment? A longitudinal long-term urodynamic follow-up. Neurourol Urodyn 2020; 40:228-236. [PMID: 33053242 DOI: 10.1002/nau.24540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
AIMS Patients with urinary retention due to detrusor acontractility (DA) might regain voiding efficiency (VE) after treatment. This study investigated the long-term outcomes and predictors of recovery following treatment. METHODS A total of 32 patients with DA were retrospectively identified and enrolled. DA was defined by Pdet .Qmax = 0 cmH2 O and postvoid residual (PVR) > 300 ml determined through videourodynamic study (VUDS). All patients received medical or surgical treatment and were followed up for at least 3 months, during which repeat VUDS was conducted. Detrusor contractility recovery was confirmed when patients were able to void with a Pdet .Qmax ≥ 10 cmH2 O after treatment. RESULTS Our patients comprised 22 women and 10 men (mean age, 73.2 ± 9.7 years; mean follow-up duration, 1.6 ± 1.8 [0.3-7.4] years). Follow-up VUDS revealed that 14 (43.9%) patients recovered from detrusor contractility, with five patients recovering within 1 year and nine after 1 year. Pdet .Qmax , voided volume, PVR, maximum flow rate, and VE significantly improved in both the recovery and nonrecovery groups. The recovery group had significantly better VE (p = .039) and significantly lower bladder compliance (74.2 ± 83.2 vs. 119 ± 82.6; p = .007) than the nonrecovery group. Receiver operating characteristic (ROC) analysis revealed an optimum bladder compliance cutoff value of <80 ml/cmH2 O for predicting detrusor contractility recovery with an area under the ROC curve of 0.780. CONCLUSIONS Among the included patients with DA, 43.9% had detrusor contractility recovery after treatment, with bladder compliance of <80 ml/cmH2 O predicting bladder function recovery.
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Affiliation(s)
- Sheng-Fu Chen
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chung-Hsin Peng
- Department of Urology, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Sagen E, Nelzén O, Peeker R. Transurethral resection of the prostate: fate of the non-responders. Scand J Urol 2020; 54:443-448. [PMID: 32885703 DOI: 10.1080/21681805.2020.1812712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) has been the standard method of surgical management of benign prostatic enlargement for decades. Some patients experience significant voiding dysfunction and discomfort postoperatively, without any apparent clinical complications from the procedure. Furthermore, a significant proportion of men still require postoperative catheterisation. This study analysed patients defined as non-responders after TURP with the principal aim to reveal their fate. METHODS A prospectively recruited cohort of 355 men, who underwent TURP during 2010-2012, was investigated. Non-responders were identified as still requiring catheterisation postoperatively and/or exhibiting all of the following voiding outcomes based on the de Wildt criteria: IPSS > 7, bother score > 2, Qmax < 15 mL/s and PVR > 100 mL. The non-responders were followed for a maximum period of three years using retrospective chart reviews. RESULTS Thirty-five men were defined as non-responders. Of these, 26 men were operated on due to urinary retention and nine men due to bothersome symptoms. The non-responders were followed for a mean time of 72 months. Seven men underwent a redo-TURP and two men a bladder neck incision. Eleven of the 35 men were finally judged as having satisfactory voiding parameters. Sixteen men used CISC. Eleven men reduced the frequency of CISC to a minimum. Seven men had to use an indwelling catheter indefinitely. CONCLUSION Men with preoperative urinary retention constituted the vast majority of non-responders. The use of postoperative urodynamic studies was remarkably low. Almost one in three non-responders finally had a satisfactory outcome with or without re-intervention.
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Affiliation(s)
- Erik Sagen
- Research and Development Centre, NU Hospital Group, Uddevalla, Sweden.,Research and Development Centre, Hospital of Skaraborg, Skövde, Sweden.,Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Olle Nelzén
- Research and Development Centre, Hospital of Skaraborg, Skövde, Sweden
| | - Ralph Peeker
- Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy, Gothenburg, Sweden
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Rubilotta E, Balzarro M, Gubbiotti M, Antonelli A. Outcomes of transurethral resection of the prostate in unobstructed patients with concomitant detrusor underactivity. Neurourol Urodyn 2020; 39:2179-2185. [PMID: 32720738 DOI: 10.1002/nau.24470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/19/2020] [Indexed: 11/10/2022]
Abstract
AIMS The aim of the study was to evaluate the transurethral resection of the prostate (TURP) outcomes of unobstructed patients with detrusor underactivity (DUA), comparing the surgical results between obstructed and unobstructed males with concomitant DUA, at midterm follow-up. METHODS This was an observational, prospective, comparative, nonrandomized study. Candidates to TURP underwent preoperative urodynamics (UD), with a diagnosis of DUA, were divided in two cohorts: Group A unobstructed men, group B males with bladder outlet obstruction (BOO). Males were evaluated yearly with uroflowmetry (UF), post-void residual (PVR), and bladder voiding efficiency (BVE), International Prostate Symptom Score (IPSS) questionnaire, visual analogic scale (VAS) for subjective assessment of the quality of life. The degree of the variation of maximum flow rate (Qmax), PVR, BVE, IPSS, VAS between baseline and follow-up (Δ) was evaluated. RESULTS Patients in group A were 28 and in group B 23. Overall patient's mean ± SD age was 63.37 ± 12.41 years. Preoperative urodynamics characteristics: mean bladder contractility index (BCI) of 61.15 and 76.25 in group A and B, respectively; mean bladder outlet obstruction index (BOOI) of 17.25 and 50.15 in group A and group B, respectively. After surgery, overall patient group, group A, and group B showed a statistical improvement in IPSS score (P < .0001), Qmax (P < .0001), PVR (P < .0008), BVE (P < .03) and VAS (P < .0001). CONCLUSIONS BOO had an important impact on the degree of improvement of Qmax and PVR/BVE, while had a poor influence on lower urinary tract symptoms amelioration. The most relevant outcomes were found when BOO was associated with DUA, which was not a contraindication to surgery.
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Affiliation(s)
| | | | - Marilena Gubbiotti
- Department of Urology, San Donato Hospital, Arezzo, Italy.,Serafico Institute of Assisi, Research Centre "InVita", Assisi, Perugia, Italy
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Jiang YH, Chen SF, Kuo HC. Role of videourodynamic study in precision diagnosis and treatment for lower urinary tract dysfunction. Tzu Chi Med J 2020; 32:121-130. [PMID: 32269943 PMCID: PMC7137365 DOI: 10.4103/tcmj.tcmj_178_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/20/2019] [Accepted: 10/03/2019] [Indexed: 11/15/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) are complicated and cannot be used alone to diagnose lower urinary tract dysfunctions (LUTDs) and guide treatment. Patients with bladder outlet obstruction (BOO), impaired detrusor contractility, and hypersensitive bladder might present with voiding predominant symptoms, whereas patients with detrusor overactivity (DO), dysfunctional voiding, or BOO might also present with storage symptoms. To clearly identify the pathophysiology of LUTD, a comprehensive urodynamic study (UDS) including pressure flow and image during the storage and emptying phases, naming videourodynamic study (VUDS), is necessary. This study is especially mandatory in the diagnosis of (1) male LUTS refractory to medical treatment for benign prostatic hyperplasia, (2) female voiding dysfunction and urinary retention, (3) diagnosis of overactive bladder syndrome refractory to first-line medication, (4) management of female stress urinary incontinence and postoperative LUTS, (5) diagnosis and management of neurogenic LUTD, (6) pediatric urinary incontinence and enuresis, (7) geriatric urinary incontinence, and (8) recurrent bacterial cystitis. Although VUDS should not be used as a screening test for any LUTS, it should be considered when the initial management cannot relieve LUTS, or when invasive surgical procedure is planning to undertake for patients with refractory LUTS. VUDS should be recommended as the second-line investigation when the initial diagnosis and treatment based on the symptoms alone or noninvasive tests fail to improve LUTS.
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Affiliation(s)
- Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Sheng-Fu Chen
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Creta M, Collà Ruvolo C, Longo N, Mangiapia F, Arcaniolo D, DE Sio M, DE Nunzio C, Imbimbo C, Mirone V, Fusco F. Detrusor overactivity and underactivity: implication for lower urinary tract symptoms related to benign prostate hyperplasia diagnosis and treatment. Minerva Urol Nephrol 2020; 73:59-71. [PMID: 32026666 DOI: 10.23736/s2724-6051.20.03678-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Detrusor underactivity (DUA) and detrusor overactivity (DO) have potential impact on the outcomes of surgery for lower urinary tract symptoms related to benign prostate hyperplasia (LUTS/BPH). EVIDENCE ACQUISITION We performed a literature search including studies on humans enrolling patients with preoperative urodynamic evidence of DO and/or DUA undergoing LUTS/BPH surgery. Factors that may influence the outcomes of surgery in these patients were evaluated. EVIDENCE SYNTHESIS In patients with DUA mean bladder contractility index improved from +4 to +44.6, mean total International Prostate Symptom Score (IPSS) improved from -3 to -19.5 points, mean maximum urinary flow (Q<inf>max</inf>) improved from +1.4 to +11.7 mL/s, and mean postvoid residual volume (PVR) improved from -16.5 to -736 mL. Older age, lack of obstruction, concomitant DO, lower detrusor contractility and use of transurethral resection of the prostate (TURP) or photovaporization (PV) instead of Holmium laser enucleation of the prostate (HoLEP) were associated with worse outcomes. In patients with DO, the percentage of DO resolution ranged from 57.1% to 83.3%. Mean total IPSS, Q<inf>max</inf>, and PVR variations ranged from +0.9 to -15.7 points, from -0.2 mL/s to +14 mL/s, and from -19.6 to -202.5 mL, respectively. Older age, lack of obstruction, terminal DO, low maximum cystometric capacity, early and high amplitude DO, and use of transurethral prostate incision instead of TURP or open adenomectomy were associated with worse outcomes. CONCLUSIONS In patients with DUA or DO, surgery for LUTS/BPH provides overall good results. However, a number of factors can affect these outcomes.
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Affiliation(s)
- Massimiliano Creta
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Claudia Collà Ruvolo
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Nicola Longo
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Francesco Mangiapia
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Davide Arcaniolo
- Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Marco DE Sio
- Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Cosimo DE Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Ciro Imbimbo
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Vincenzo Mirone
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Ferdinando Fusco
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy -
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Wu SY, Kuo HC. Predictive factors for recovery of voiding function after transurethral prostate surgery in men with small prostate volume and very low detrusor contractility. Low Urin Tract Symptoms 2019; 12:41-46. [PMID: 31430060 DOI: 10.1111/luts.12282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/18/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Detrusor underactivity (DU) is a common but poorly understood clinical problem. The diagnosis and treatment are difficult and full of uncertainties. There are many overlaps between DU and bladder outlet obstruction (BOO) in men. Prostatic surgery might improve voiding efficiency (VE). This study aims to investigate effectiveness and predictors of voiding function recovery after prostate surgery in patients with DU. METHODS Male patients with DU and small total prostate volume (TPV, <40 mL) who had undergone transurethral prostate surgery were retrospectively reviewed over the past two decades. Video-urodynamic studies were performed before and after the operation. The urodynamic parameters were recorded, and change of VE was used to determine treatment outcome. A postoperative VE of ≥50% was considered successful. RESULTS A total of 48 patients were included, with a mean age of 74.4 ± 10.0 years. The mean follow-up period was 24.9 ± 30.5 months. At the most recent follow-up, 29 (60.4%) patients had positive results. Among them, 21 (72.4%) patients recovered within 1 month, and only one recovered later than 6 months after the operation. After surgery, the maximum flow rate, voided volume, postvoid residual urine, and VE all showed improvement. Patients with successful outcome had a higher baseline detrusor pressure (p = .029) and greater maximum flow rate (p = .034) than the nonrecovery group. The age and other parameters were not significantly different between recovery and nonrecovery group. CONCLUSIONS Patients with DU and small TPV might also benefit from prostatic surgery if they had a higher detrusor pressure and maximum flow rate at baseline.
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Affiliation(s)
- Shu-Yu Wu
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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14
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Yao W, Wu F, Zhang D, Zheng X, Xu H, Zhou X, Wan W, Chen S. Impacts of preoperative maximum detrusor pressure on minimally invasive surgery effect on patients with benign prostatic hyperplasia. MINERVA CHIR 2019; 75:25-29. [PMID: 30600962 DOI: 10.23736/s0026-4733.18.07880-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aims to investigate the impacts of preoperative maximum detrusor pressure (Pdet.max) on minimally invasive surgery effect on patients with benign prostatic hyperplasia. METHODS The clinical data of a total of 156 patients receiving minimally invasive surgery for benign prostatic hyperplasia in Hospital of Nanchang Institute of Medical Sciences from August 2014 to June 2017 were retrospectively reviewed and summarized. The patients were divided into three groups according to different Pdet.max in the urodynamic examination results before the surgery, namely, group A (Pdet.max <50 cmH2O), group B (50≤ Pdet.max <90 cmH2O) and group C (Pdet.max ≥90 cmH2O). The International Prostate Symptom Score (IPSS) and Quality-of-Life score (QOLS) were compared. RESULTS Compared with those in group A, the IPSS and QOLS of the patients in group B and group C at 1 month, 3 months and 12 months after the surgery were decreased notably (all P<0.05). Moreover, the IPSS and QOLS of the patients in group C were obviously lower than those in group B (all P<0.05). CONCLUSIONS The results indicated that as the preoperative Pdet.max was increased, the symptoms of the patients receiving minimally invasive surgery for benign prostatic hyperplasia were ameliorated more significantly, and the patients had higher quality of life. The preoperative Pdet.max can judge the treatment effect of minimally invasive surgery on the patients with benign prostatic hyperplasia and help to guide the patients' prognosis. The greater the preoperative Pdet.max is, the better the treatment effect of the patients after the surgery will be, and the higher the quality of life will be.
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Affiliation(s)
- Wenliang Yao
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China
| | - Feihua Wu
- Department of Gynecology, Jiangxi Provincial Hospital of traditional Chinese Medicine, Nanchang, China
| | - Duanjun Zhang
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China
| | - Xiaoting Zheng
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China
| | - Heping Xu
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China
| | - Xiaopi Zhou
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China
| | - Wenyuan Wan
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China
| | - Shenghui Chen
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China -
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15
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Recovery of Voiding Efficiency and Bladder Function in Male Patients With Non-neurogenic Detrusor Underactivity After Transurethral Bladder Outlet Surgery. Urology 2019; 123:235-241. [DOI: 10.1016/j.urology.2018.09.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 01/22/2023]
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16
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Wu SY, Jiang YH, Kuo HC. Detrusor Underactivity and Bladder Outlet Procedures in Men. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0491-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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17
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Jiang YH, Lee CL, Jhang JF, Kuo HC. Current pharmacological and surgical treatment of underactive bladder. Tzu Chi Med J 2018; 29:187-191. [PMID: 29296045 PMCID: PMC5740689 DOI: 10.4103/tcmj.tcmj_122_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Underactive bladder (UAB) or detrusor underactivity (DU) is a common yet still poorly understood urological problem. In addition to true detrusor failure and neuropathy, the inhibitory effects of detrusor contraction by the striated urethral sphincter and the bladder neck through alpha-adrenergic activity may also play a role in the development of UAB or DU. Treatment of UAB or DU aims to reduce the postvoid residual (PVR) urine volume and increase voiding efficiency, either by spontaneous voiding or abdominal straining. Pharmacotherapy with parasympathomimetics or cholinesterase inhibitors might be tried, and benefits can be achieved in combination with alpha-blockers. Bladder outlet surgeries, including urethral onabotulinumtoxinA injection, transurethral incision of the bladder neck, and transurethral incision or resection of the prostate can effectively improve voiding efficiency and decrease the PVR in most patients with DU. The mechanisms have not been well elucidated. It is likely that ablation of the bladder neck or prostatic urethra might not only decrease bladder outlet resistance but also abolish the sympathetic hyperactivity which inhibits detrusor contractility in patients with idiopathic UAB or DU.
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Affiliation(s)
- Yuan-Hong Jiang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Cheng-Ling Lee
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Jia-Fong Jhang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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18
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Ko KJ, Lee CU, Lee KS. Clinical implications of underactive bladder. Investig Clin Urol 2017; 58:S75-S81. [PMID: 29279879 PMCID: PMC5740033 DOI: 10.4111/icu.2017.58.s2.s75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022] Open
Abstract
Underactive bladder (UAB) is a common urologic condition but a complex disease that causes troublesome lower urinary tract symptoms. Currently, management of UAB remains unsatisfactory. Also, many urological diseases can be combined with UAB. In these combined cases, the treatment results may be affected by UAB component. This review focuses on the clinical implications of UAB in patients with common urologic conditions, including bladder outlet obstruction, overactive bladder syndrome and stress urinary incontinence.
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Affiliation(s)
- Kwang Jin Ko
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
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19
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Blaivas JG, Forde JC, Davila JL, Policastro L, Tyler M, Aizen J, Badri A, Purohit RS, Weiss JP. Surgical treatment of detrusor underactivity: a short term proof of concept study. Int Braz J Urol 2017; 43:540-548. [PMID: 28266820 PMCID: PMC5462147 DOI: 10.1590/s1677-5538.ibju.2016.0405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/25/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To compare the surgical outcomes of men with bladder outlet obstruction (BOO) due to benign prostatic obstruction (BPO) to those with detrusor underactivity (DU) or acontractile detrusor (DA). MATERIALS AND METHODS This retrospective, IRB approved study included men who underwent BPO surgery for refractory LUTS or urinary retention. Patients were grouped based on videourodynamic (VUDS) findings: 1) men with BOO, 2) men with DU and 3) men with DA. The primary outcome measure was the Patient Global Impression of Improvement (PGII). Secondary outcome measures included uroflow (Qmax), post-void residual volume (PVR) and the need for clean intermittent catheterization (CIC). RESULTS One hundred and nineteen patients were evaluated: 1) 34 with BOO, 2) 62 with DU and 3) 23 with DA. Subjective success rate (PGII) was highest in the BOO group (97%) and those with DU (98%), while DA patients had a PGII success of 26%, (p<0.0001). After surgery, patients with BOO had the lowest PVR (68.5mL). Fifty-six patients (47%) performed CIC pre-operatively (47% of BOO, 32% of DU and 87% of DA patients). None of the patients in the BOO and DU groups required CIC post operatively compared to16/23 (69%) of patients in the DA group (p<0.0001). CONCLUSIONS BPO surgery is a viable treatment option in men with presumed BOO and DU while DA is a poor prognostic sign in men who do not void spontaneously pre-operatively.
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Affiliation(s)
- Jerry G Blaivas
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.,Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - James C Forde
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Jonathan L Davila
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Lucas Policastro
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Michael Tyler
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Joshua Aizen
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Anand Badri
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Rajveer S Purohit
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.,Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
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20
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Pyun JH, Kang SG, Kang SH, Cheon J, Kim JJ, Lee JG. Efficacy of holmium laser enucleation of the prostate (HoLEP) in men with bladder outlet obstruction (BOO) and non-neurogenic bladder dysfunction. Kaohsiung J Med Sci 2017; 33:458-463. [DOI: 10.1016/j.kjms.2017.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/25/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022] Open
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21
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Sokhal AK, Sinha RJ, Purkait B, Singh V. Transurethral resection of prostate in benign prostatic enlargement with underactive bladder: A retrospective outcome analysis. Urol Ann 2017; 9:131-135. [PMID: 28479762 PMCID: PMC5405654 DOI: 10.4103/ua.ua_115_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate the clinical outcome and efficacy of transurethral resection of the prostate in patients of benign prostatic enlargement (BPE) with underactive bladder. Materials and Methods: Retrospective study of 174 patients, who underwent transurethral resection of prostate (TURP) between 2008 and 2015, for lower urinary tract symptoms with BPE with bladder underactivity. Clinical history, physical examination, renal function test, urinalysis, cystourethroscopy, transabdominal or transrectal ultrasonography, and urodynamic study were recorded. Patients having a history of neurologic conditions, spinal trauma or surgery, pelvic trauma or surgery, diabetes mellitus with end organ damage, urethral pathology or surgery, and prostatic cancer were excluded from the study. Results: The mean follow-up period was 22.4 ± 6.2 months. Mean prostate volume was 42.8 ± 6.4 ml and mean serum prostate-specific antigen was 2.3 ± 1.8 ng/ml. The International Prostate Symptom Score changed from 24.6 ± 4.2 preoperatively to 10.8 ± 5.8 postoperatively which was found statistically significant. Quality of life (QOL) score changed from 4.8 ± 1.2 to 2.6 ± 0.4. Twenty-two patients out of 174 remained on a per-urethral catheter or clean intermittent catheterization due to voiding failure after TURP beyond 1 month. Conclusions: TURP should be considered a viable treatment option in men with enlarged prostate with underactive detrusor who had poor response to medical treatment. Preoperative counseling and postoperative follow-up are crucial in the management of such patients.
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Affiliation(s)
- Ashok Kumar Sokhal
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rahul Janak Sinha
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bimalesh Purkait
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vishwajeet Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
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22
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Long-term follow up and predictive factors for successful outcome of transurethral incision of the bladder neck in women with detrusor underactivity. J Formos Med Assoc 2016; 115:807-13. [DOI: 10.1016/j.jfma.2015.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/07/2015] [Accepted: 08/10/2015] [Indexed: 11/22/2022] Open
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23
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Thulium Laser Prostate Enucleation in Refractory Urinary Retention: Operative and Functional Outcomes in a Large Cohort of Patients. Urology 2016; 93:152-7. [DOI: 10.1016/j.urology.2016.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/08/2016] [Accepted: 02/12/2016] [Indexed: 11/21/2022]
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24
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Welk B. Picking your prostates. Can Urol Assoc J 2016; 9:379-80. [PMID: 26834889 DOI: 10.5489/cuaj.3478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Blayne Welk
- Department of Surgery & Epidemiology and Biostatistics, Western University, London, Canada
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25
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Role of Urodynamics in the Evaluation of Elderly Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0261-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Kimata R, Nemoto K, Tomita Y, Takahashi R, Hamasaki T, Kondo Y. Efficacy of a thermoexpandable metallic prostate stent (Memokath) in elderly patients with urethral obstruction requiring long-term management with urethral Foley catheters. Geriatr Gerontol Int 2014; 15:553-8. [PMID: 24852087 DOI: 10.1111/ggi.12309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2014] [Indexed: 11/30/2022]
Abstract
AIM To investigate whether the insertion of a thermoexpandable metallic prostate stent (Memokath) facilitates the removal of Foley catheters in elderly patients ineligible for urethral obstruction surgery because of the potential complications involved in long-term catheter management. METHODS A total of 37 male patients (mean age 79.8 ± 6.2 years) ineligible for surgery under general anesthesia because of advanced age, the presence of post-cerebrovascular disorders or anticoagulant therapy use and who subsequently had a Memokath stent inserted between June 2007 and November 2009 were enrolled in the present study. Patients with spinal injury were excluded. We compared the correlation between prostatic urethral length and total prostate volume (TPV). We also evaluated the postoperative postvoid residual (PVR) and presence of pyuria, and reviewed postoperative complications and unassisted urination ability. RESULTS We found a positive correlation between prostatic urethral length and TPV. After the insertion of the Memokath stent, the catheters were removed from all patients who could urinate unassisted. The PVR was <50 mL in 76.4% patients, and there was a 52% improvement in pyuria after insertion of the Memokath stent. The mean postoperative follow-up duration was 33.2 ± 16.7 months. A total of 21 patients (56.7%) were able to urinate unassisted after receiving the Memokath stent. Unassisted urination was difficult in patients with poor performance status. No serious complications were observed after insertion of the Memokath stent. CONCLUSIONS The Memokath stent was safe and useful for elderly patients with urethral obstruction and good performance status requiring long-term management with urethral Foley catheters.
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Affiliation(s)
- Ryoji Kimata
- Department of Urology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan; Department of Urology, Kitamurayama Hospital, Yamagata, Japan
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27
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Rom M, Waldert M, Schatzl G, Swietek N, Shariat SF, Klatte T. Bladder outlet obstruction (BOO) in men with castration-resistant prostate cancer. BJU Int 2013; 114:62-6. [DOI: 10.1111/bju.12438] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Maximilian Rom
- Department of Urology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - Matthias Waldert
- Department of Urology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - Georg Schatzl
- Department of Urology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - Natalia Swietek
- Department of Urology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - Shahrokh F. Shariat
- Department of Urology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - Tobias Klatte
- Department of Urology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
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Mitchell CR, Mynderse LA, Lightner DJ, Husmann DA, Krambeck AE. Efficacy of holmium laser enucleation of the prostate in patients with non-neurogenic impaired bladder contractility: results of a prospective trial. Urology 2013; 83:428-32. [PMID: 24231217 DOI: 10.1016/j.urology.2013.09.035] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/26/2013] [Accepted: 09/30/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the outcomes of men with detrusor underactivity or acontractility undergoing holmium laser enucleation of the prostate (HoLEP). METHODS A prospective case series between 2009 and 2012 was performed to examine short-term outcomes of men with urodynamic evidence of detrusor hypocontractility or acontractility because of a non-neurogenic etiology and concurrent benign prostatic obstruction (BPO), undergoing HoLEP. RESULTS Fourteen patients with detrusor hypocontractility and 19 patients with acontractility and evidence of BPO underwent HoLEP during the study period. Median age was 71.5 and 75 years, respectively. Preoperatively, 5 (35.7%) men with hypocontractility and 19 (100%) men with acontractility had catheter-dependent urinary retention for a median of 3 and 9 months, respectively. At a median follow-up of 24.7 months, all 5 (100%) men with hypocontractility and 18 of 19 (94.7%) men with acontractility were voiding spontaneously without the need for intermittent catheterization. Individuals with hypocontratile bladders had statistically significant improvements in American Urological Association Symptom Index (21.5 vs 3; P = .014), maximum urine flow (Qmax, 10 vs 21 mL/s; P = .001), and postvoid residual (250 vs 53 mL; P = .007) from baseline to postoperative assessments. In patients with an acontractile bladder, 15 of 19 (78.9%) displayed significant return of detrusor contractility, whereas 4 of 19 (21.1%) were voiding exclusively by Valsalva effort on follow-up urodynamic study. Postoperatively, patient satisfaction, as ascertained by American Urological Association Symptom Index, was high for both groups. CONCLUSION Intermediate follow-up results indicate that HoLEP is a viable management option for men with BPO and detrusor hypocontractility. Furthermore, detrusor acontractility does not appear to adversely affect postoperative results, with return of spontaneous urination and demonstration of detrusor contractility allowing for efficient voiding, in over 95% of patients.
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