Effect of urodynamic preoperative detrusor overactivity on the outcomes of transurethral surgery in patients with male bladder outlet obstruction: a systematic review and meta-analysis

Kim, Myong; Jeong, Chang Wook; Oh, Seung June

doi:10.1007/s00345-018-2402-8

Cited by 15 publications

(12 citation statements)

References 31 publications

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“…Liu et al [ 22 ] and the present findings indicate that preoperative DO is a positive prognostic factor in patients with DU undergoing bladder outlet surgery. In contrast, a recent meta-analysis found no correlation between preoperative DO and surgical outcomes in male patients with BOO [ 23 ]. Moreover, a large-scale study demonstrated that both age and BOO are independently associated with the presence of DO [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes and Predictive Factors in Patients With Detrusor Underactivity Undergoing Bladder Outlet Obstruction Surgery

Chuang,

Ou,

Cheng

et al. 2024

Int Neurourol J

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Purpose: This study was conducted to evaluate the efficacy of bladder outlet surgery in patients with detrusor underactivity (DU) and to identify factors associated with successful outcomes.Methods: We conducted a retrospective review of men diagnosed with DU in urodynamic studies who underwent bladder outlet surgery for lower urinary tract symptoms between May 2018 and April 2023. The International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry (UFM), and multichannel urodynamic studies were administered. Successful treatment outcomes were defined as either an IPSS improvement of at least 50% or the regaining of spontaneous voiding in patients urethral catheterization prior to surgery.Results: The study included 93 male patients. Men diagnosed with significant or equivocal bladder outlet obstruction (BOO) experienced significant postoperative improvements in IPSS (from 20.6 to 6.0 and from 17.4 to 6.5, respectively), maximum urine flow rate (from 5.0 mL/sec to 14.4 mL/sec and from 8.8 mL/sec to 12.2 mL/sec, respectively) and voiding efficiency (from 48.8% to 86.0% and from 61.2% to 85.1%, respectively). However, in the group without obstruction, the improvements in IPSS and UFM results were not significant. The presence of detrusor overactivity (odds ratio [OR], 3.152; P=0.025) and preoperative urinary catheterization (OR, 2.756; P=0.040) were associated with favorable treatment outcomes. Conversely, an unobstructed bladder outlet was identified as a negative prognostic factor.Conclusions: In men with DU accompanied by equivocal or significant BOO, surgical intervention to alleviate the obstruction may enhance the IPSS, quality of life, and UFM results. However, those with DU and an unobstructed bladder outlet face a comparatively high risk of treatment failure. Preoperative detrusor overactivity and urinary catheterization are associated with more favorable surgical outcomes. Consequently, active deobstructive surgery should be considered for patients with DU who are experiencing urinary retention.

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Section: Discussionmentioning

confidence: 99%

Surgical Outcomes and Predictive Factors in Patients With Detrusor Underactivity Undergoing Bladder Outlet Obstruction Surgery

Chuang,

Ou,

Cheng

et al. 2024

Int Neurourol J

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“…Two recent meta-analyses have been published by Kim et al in which the authors evaluated the impact of preoperative DUA or DO in LUTS/BPH patients undergoing deobstructive surgery, based on results from comparative studies [29,30]. The authors found that preoperative DUA was significantly associated with poorer degrees of IPSS and Qmax improvements, as well as a poorer tendency (although not statistically significant) toward IPSS-QoL and PVR improvements.…”

Section: Discussionmentioning

confidence: 99%

“…The authors found that preoperative DUA was significantly associated with poorer degrees of IPSS and Qmax improvements, as well as a poorer tendency (although not statistically significant) toward IPSS-QoL and PVR improvements. On the other hand, improvements in the total IPSS, IPSS-QoL, Qmax, and PVR were similar between patients with and without preoperative DO [29,30]. Although several studies on the subject have been published, the exact role of DUA and DO before surgical intervention is still to be determined [27,28,[31][32][33][34][35][36][37].…”

Section: Discussionmentioning

confidence: 99%

Post-Voided Residual Ratio Does Not Predict Trifecta Outcome after Transurethral Resection of Prostate

Lombardo,

Ghezzo,

Sarcinelli

et al. 2024

Life

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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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“…Although it is controversial that UDS may not change the management of lower urinary tract symptom (LUTS), it nonetheless plays an important role in prognostication and expectation management before urologic procedures—both important aspects in patients’ perceived effectiveness and impact on quality of life 3 . Furthermore, recent randomized control trials and meta‐analyses demonstrate limited utility in performing UDS for the treatment of BOO, and that performing UDS does not reduce surgery rates 4,5 . Moreover, current guidelines do not recommend UDS in preoperative evaluation for male LUTS, unless there is diagnostic uncertainty 6,7 …”

Section: Introductionmentioning

confidence: 99%

“…3 Furthermore, recent randomized control trials and meta-analyses demonstrate limited utility in performing UDS for the treatment of BOO, and that performing UDS does not reduce surgery rates. 4,5 Moreover, current guidelines do not recommend UDS in preoperative evaluation for male LUTS, unless there is diagnostic uncertainty. 6,7 Given the controversy surrounding UDS and BPH, we hypothesized that there is significant practice variation and we sought to leverage American Board of Urology (ABU) case log data to evaluate practice patterns to discern factors associated with performing UDS for BPH.…”

Section: Introductionmentioning

confidence: 99%

US patterns of care for urodynamic evaluation for BPH

Sze

Zhang

Dreyfuss

et al. 2023

Neurourology and Urodynamics

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IntroductionPractice 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.MethodsWe 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.ResultsAmong 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).ConclusionThere 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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Effect of urodynamic preoperative detrusor overactivity on the outcomes of transurethral surgery in patients with male bladder outlet obstruction: a systematic review and meta-analysis

Abstract: Our meta-analysis results demonstrated that preoperative urodynamic DO has no diagnostic role in the prediction of surgical outcomes in patients with male BOO.

Cited by 15 publications

References 31 publications

Surgical Outcomes and Predictive Factors in Patients With Detrusor Underactivity Undergoing Bladder Outlet Obstruction Surgery

Surgical Outcomes and Predictive Factors in Patients With Detrusor Underactivity Undergoing Bladder Outlet Obstruction Surgery

Post-Voided Residual Ratio Does Not Predict Trifecta Outcome after Transurethral Resection of Prostate

US patterns of care for urodynamic evaluation for BPH

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