1
|
Oszczudlowski M, Cymbalista G, Bilski K, Dobruch J. Detrusor underactivity after radical prostatectomy: A prospective observational study. Neurourol Urodyn 2024; 43:638-645. [PMID: 38273775 DOI: 10.1002/nau.25396] [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: 11/09/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE To evaluate the impact of radical prostatectomy (RP) on bladder function with special interest in detrusor underactivity (DU) and to appraise clinical significance of DU in postprostatectomy patients. MATERIAL AND METHODS This was a prospective, observational study conducted on male patients subjected to laparoscopic RP (LPR). Urodynamic studies were performed at the day before surgery (visit 1), 3-6 months postoperatively (visit 2) and more than 12 months after surgery (visit 3). Incidence of DU that occurred after LPR (de novo DU), incidence of persisting de novo DU after 12 months, clinical relevance of DU after LPR and predictive factors of de novo DU were assessed. RESULTS 99 of 100 patients underwent preoperative urodynamic study (visit 1) and those were included in further analysis. 84 and 76 patients were available for follow-up at second and third visit respectively. De novo DU occurred after LPR in 25 (29.7%) patients at visit 2 (p < 0.001). Sixteen from 24 patients (66,7%) who developed de novo DU after RP (visit 2) continued to have DU 1 year after surgery (visit 3) (p = 0.04). On the multivariate analysis, urinary incontinence requiring more than 1 pad per day (odds ratio [OR] 5.11; confidence interval [CI] 1.69-17.19; p = 0.005) and preoperative IPSS storage sub-score (OR 1.25; CI 1.03-1.63; p = 0.030) were significantly associated with de novo DU. Postprostatectomy patients with DU had significantly lower Urinary Assessment of the Expanded Prostate Cancer Index Composite (EPIC) total score (819 vs. 911, p = 0.02), EPIC Function domain score (300 vs. 357, p = 0.002) and EPIC Urinary incontinence domain (137 vs. 224, p = 0.002) when compared to their counterparts without DU. CONCLUSIONS RP substantially influences bladder function, causing de novo DU, which persists in substantial number of patients 1 year postoperatively. Furthermore, significant correlation between DU and postprostatectomy urinary incontinence may play a role when anti-incontinence surgery is considered.
Collapse
Affiliation(s)
| | - Grzegorz Cymbalista
- Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Konrad Bilski
- Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jakub Dobruch
- Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| |
Collapse
|
2
|
Wroclawski ML, Takemura LS, Santos HOD, Heldwein FL, Gauhar V, Lim EJ, Law YXT, Teoh JYC, Herrmann TRW, Castellani D. Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta-analysis. Neurourol Urodyn 2024; 43:126-143. [PMID: 38010924 DOI: 10.1002/nau.25336] [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: 06/19/2023] [Revised: 08/22/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Men 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 METHODS This 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. RESULTS There 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. CONCLUSION In 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.
Collapse
Affiliation(s)
- Marcelo Langer Wroclawski
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Urology, Hospital Beneficencia Portuguesa de Sao Paulo, São Paulo, Brazil
- Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | | | - Flavio Lobo Heldwein
- Department of Urology, Universidade Federal de Santa Catarina, Florianopolis, Brazil
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore
- Department of Urology, National University Hospital, Singapore
| | - Ee Jean Lim
- Department of Urology, National University Hospital, Singapore
| | | | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Daniele Castellani
- Urology Unit, Azienda Ospedaliera-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| |
Collapse
|
3
|
Takeshima Y, Yamada Y, Takemura K, Kimura N, Hakozaki Y, Miyakawa J, Taguchi S, Akiyama Y, Sato Y, Kawai T, Yamada D, Fujimura T, Kume H. The association between the parameters of uroflowmetry and lower urinary tract symptoms in prostate cancer patients after robot-assisted radical prostatectomy. PLoS One 2022; 17:e0275069. [PMID: 36201466 PMCID: PMC9536545 DOI: 10.1371/journal.pone.0275069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/09/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To investigate changes in uroflowmetry parameters in men undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer. MATERIALS AND METHODS Four hundred and twenty-eight patients received uroflowmetry testing before and after RARP from November 2011 to December 2018. Clinicopathological data, including age, initial prostate-specific antigen (PSA), prostate volume, clinical stage, body mass index (BMI), uroflowmetry parameters, and core lower urinary tract symptom scores (CLSS) were retrospectively obtained from clinical records. Changes in uroflowmetry parameters were analyzed for statistical predictors and effects on post-operative outcomes. RESULTS A significant increase in maximum flow rate (MFR) and decreases in voided volume (VV) and post-void residual urine (PVR) were seen. In multivariate analysis, age was a negative predictor of MFR increase, while prostate volume was a positive predictor of PVR decrease and MFR increase. VV decrease led to worse incontinence symptoms, while PVR decrease and MFR increase led to improvement in voiding symptoms such as slow stream and straining. Continence recovery curves showed that VV decrease were associated with a delay in continence recovery. CONCLUSIONS Significant changes were seen in uroflowmetry results after RARP, each parameter directly related to urinary symptoms. In particular, VV decrease was associated with a worsening of incontinence symptoms and continence recovery.
Collapse
Affiliation(s)
- Yuta Takeshima
- Division of Innovative Cancer Therapy, Advanced Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Kotaro Takemura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoki Kimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuji Hakozaki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jimpei Miyakawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
4
|
De Novo Detrusor Underactivity and Other Urodynamic Findings after Radical Prostatectomy: A Systematic Review. Medicina (B Aires) 2022; 58:medicina58030381. [PMID: 35334557 PMCID: PMC8949898 DOI: 10.3390/medicina58030381] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background and objectives: The aim of this systematic review is to evaluate the impact of radical prostatectomy (RP) on bladder function, with special attention towards detrusor underactivity investigated with the means of urodynamic evaluation. Materials and Methods: The review was performed in accordance with the PRISMA statement and was registered in the PROSPERO (ID#: CRD42020223480). The studied population was limited to men with prostate cancer who underwent urodynamic study prior to and after radical prostatectomy. Eight hundred twenty-seven studies were screened, with twenty-five finally included. A qualitative analysis was performed. Rates of detrusor underactivity (DU) before surgery were reported in eight studies and ranged from 1.6% to 75% (median of 40.8%). DU occurred de novo after RP in 9.1% to 37% of patients (median of 29.1%). On the other hand, preexisting DU resolved in 7% to 35.5% of affected men. Detrusor overactivity (DO) was the most frequently reported outcome, being assessed in 23 studies. The rate of DO preoperatively was from 5% to 76% (median of 25%). De novo was reported in 2.3–54.4% of patients (median of 15%) and resolved after RP in 19.6% to 87.5% (median of 33%) of affected patients. Baseline rates of bladder outlet obstruction (BOO) varied between studies from 19% to 59.3%, with a median of 27.8%. The most pronounced change after surgery was the resolution of BOO in 88% to 93.8% (median of 92%) of affected patients. Results: Rates of de novo impaired bladder compliance (IBC) varied from 3.2% to 41.3% (median of 13.3%), whereas the resolution of IBC was reported with rates ranging from 0% to 47% (median of 4.8%). Conclusions: BOO, DO, and DU are frequently diagnosed in men scheduled for RP. BOO is improved after RP in most patients; however, there is still a substantial rate of patients with de novo DU as well as DO which may impair functional outcomes and quality of life.
Collapse
|
5
|
Hata J, Onagi A, Tanji R, Honda-Takinami R, Matsuoka K, Hoshi S, Sato Y, Ogawa S, Kataoka M, Haga N, Kojima Y. Prevalence and predictors of postoperative detrusor underactivity after robot-assisted radical prostatectomy: A prospective observational study. Int J Urol 2021; 28:734-740. [PMID: 33745187 DOI: 10.1111/iju.14549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify the prevalence and predictors of postoperative detrusor underactivity during the early postoperative period after robot-assisted radical prostatectomy. METHODS We carried out a prospective observational study of 64 patients scheduled for robot-assisted radical prostatectomy using urodynamic study before and 1 month after robot-assisted radical prostatectomy. Detrusor underactivity was defined as maximum flow rate ≤15 mL/s and detrusor pressure at maximum flow rate ≤25 cmH2 O during voiding. Incidences of pre- and postoperative detrusor underactivity were assessed, and predictors of postoperative detrusor underactivity were determined using uni- and multivariate logistic regression analyses. Factors comprised patient characteristics (age, prostate weight etc.), operative factors (surgical duration, nerve sparing etc.) and preoperative urodynamic study parameters (maximum flow rate, bladder contractile index etc.). RESULTS Pre- and postoperative detrusor underactivity at 1 month after robot-assisted radical prostatectomy were detected in one patient (1.6%) and 24 patients (37.5%), respectively. Univariate analysis selected preoperative maximum flow rate (P = 0.02), detrusor pressure at maximum flow rate (P = 0.04) and bladder contractile index (P < 0.01) as predictors of postoperative detrusor underactivity (odds ratio 0.83, 0.97 and 0.94, respectively). On multivariate analyses, only preoperative bladder contractile index was associated with postoperative detrusor underactivity (P < 0.01; odds ratio 0.94). A cut-off of 102.8 offered optimal accuracy in receiver operating characteristic analysis. Patient characteristics and operative factors were not significantly associated with postoperative detrusor underactivity. CONCLUSIONS A comparatively high prevalence of postoperative detrusor underactivity is observed in patients at 1 month after robot-assisted radical prostatectomy. Patients with preoperative low bladder contractile index have a higher probability of developing early postoperative detrusor underactivity after robot-assisted radical prostatectomy.
Collapse
Affiliation(s)
- Junya Hata
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akifumi Onagi
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ryo Tanji
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ruriko Honda-Takinami
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kanako Matsuoka
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Seiji Hoshi
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuichi Sato
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Soichiro Ogawa
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masao Kataoka
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Nobuhiro Haga
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| |
Collapse
|
6
|
Liu D, Chen M, Han X, Li Y. Comparative study of the maximum Watts factor and Schafer contractility grade, bladder contractility index in male patients with lower urinary tract symptoms. Medicine (Baltimore) 2018; 97:e13101. [PMID: 30383695 PMCID: PMC6221659 DOI: 10.1097/md.0000000000013101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To investigate whether the maximum Watts factor (WF) is 1 parameter of describing detrusor contraction in male patients with lower urinary tract symptoms (LUTS).We retrospectively reviewed urodynamic data of male subjects with LUTS. Data on age, maximum flow rate (Qmax), post-void residual (PVR), detrusor pressure at maximum flow rate (PdetQmax), maximum Watts factor (WFmax), and Schafer contractility grades were collected. First, all patients were divided into 6 groups according to Schafer contractility grade. The urodynamic parameters include WFmax and bladder contractility index (BCI) were compared and analyzed among the 6 groups by using Kruskal-Wallis test statistically. The box plot of Schafer contractility grade with WFmax or BCI were plotted and analyzed. Second, the correlation scatter diagram between WFmax and BCI was plotted and analyzed. Spearman's correlation test was performed. Third, we drew the Receiver Operating Characteristic (ROC) curve and confirmed the area under the curve, the Optimal Operating Point (OOP) and corresponding sensitivity and specificity for WFmax by the reference standard of Schafer contractility grade and BCI respectively.A total of 455 men were included. The mean age of patients was 57 ± 17.9 years, ranging from 18 to 87 years. Median of WFmax increased from 5.8 W/m in very week (VW) group to 19.5 W/m in strong (ST) group, while BCI rose from 70 to 170. The box plot of Schafer contractility grade with WFmax or BCI showed that both WFmax and BCI were positively correlated with Schafer contractility grade. Kruskal-Wallis test among the 6 groups showed statistically significant difference (P <.001). The correlation scatter diagram showed that WFmax increased significantly with BCI (), the linear regression equation being Y = 3.33 + 0.07X, R2 = 0.298. Spearman's correlation test revealed that WFmax and BCI were positively correlated, with the correlation coefficient being 0.616 (P <.001). The WFmax area under ROC curve by Schafer contractility grade was 0.894 and WFmax OOP was interpreted at 11.1 W/m. In addition, the area under ROC curve by BCI was 0.802 and WFmax OOP was interpreted at 9.8 W/m.Our findings suggestted that WFmax was a good parameter of evaluating detrusor contraction as well as Schafer contractility grade and BCI, which should be widely used in clinical.
Collapse
|
7
|
Jiang YH, Kuo HC. Recent research on the role of urodynamic study in the diagnosis and treatment of male lower urinary tract symptoms and urinary incontinence. CI JI YI XUE ZA ZHI = TZU-CHI MEDICAL JOURNAL 2017; 29:72-78. [PMID: 28757770 PMCID: PMC5509199 DOI: 10.4103/tcmj.tcmj_19_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although evidence shows that urodynamic study may not improve outcomes, it can be used to evaluate men with lower urinary tract symptoms (LUTSs) which have not been adequately delineated and treated. In young men with LUTS not responding to treatment based on clinical examination, or elderly men with LUTS and incontinence, a complete urodynamic evaluation is mandatory to understand the pathophysiology underlying LUTS, such as bladder outlet obstruction (BOO), detrusor overactivity, and detrusor underactivity. Preoperative urodynamic study-proven BOO is a predictor of a successful surgical outcome. An urodynamic study should be performed when patients with LUTS are planning to undergo surgical treatment for benign prostatic obstruction.
Collapse
Affiliation(s)
- Yuan-Hong Jiang
- 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
| |
Collapse
|
8
|
Kitta T, Kanno Y, Chiba H, Moriya K, Maruyama S, Abe T, Shinohara N. Radical prostatectomy restores detrusor contraction pattern according to pressure flow parameters. Int J Urol 2017; 24:301-307. [DOI: 10.1111/iju.13295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 12/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Takeya Kitta
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
| | - Yukiko Kanno
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
| | - Hiroki Chiba
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
| | - Satoru Maruyama
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
| |
Collapse
|