Detrusor instability with equivocal obstruction: A predictor of unfavorable symptomatic outcomes after transurethral prostatectomy

Machino, Rintaro; Κakizaki, Hidehiro; Ameda, Kaname; Sawada, Takashi; Tanaka, Hiroshi; Matsuura, Shinobu; Koyanagi, Tomohiko

doi:10.1002/nau.10057

Cited by 74 publications

(74 citation statements)

References 20 publications

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“…The results indicate that the complicated cases (presence of equivocal obstruction, DO or underactive/acontractile detrusor, with/without neurological diseases) are prone to unsuccessful treatment outcome. This is in line with the previous reports that unfavorable symptomatic outcomes after TUR-P are closely associated with the presence of DO and absence of BOO [6], and post-operative incontinence is common in patients with DO [33]. Thus, careful selection of the typical BPH patients seems necessary to maximize therapeutic benefit.…”

Section: Neurological Disorders In Patients With Bphsupporting

confidence: 76%

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Do BPH Patients Have Neurogenic Detrusor Dysfunction? A Uro-Neurological Assessment

Sakakibara¹,

Hamano

Uchiyama³

et al. 2005

Urol Int

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Introduction: Most men with benign prostatic hyperplasia (BPH) are middle- aged and elderly. Neurogenic detrusor dysfunction (NDD) may also occur in these populations. We made an uro-neurological assessment in such patients in order to investigate the possibility of a concurrent NDD in patients diagnosed with BPH, and to correlate the presence of NDD with treatment outcome. Materials and Methods: 28 men, mean age 66.4 years, referred by urologists at the outpatient clinic as BPH (initial diagnosis: BPH alone, 24, BPH and NDD, 4) with regards to digital examination and lower urinary tract symptoms, underwent urodynamic study and neurological examination. MRI scans were performed to confirm the diagnosis. Results: Urodynamic study (except for 2, acontractile detrusor (AD)) showed equivocal obstruction (EO), 6; underactive detrusor (UD), 9 (voiding phase); detrusor overactivity (DO), 12; urethral relaxation, 1, and reduced sensation, 5 (filling phase). EO correlated with the presence of UD (p = 0.03). DO did not correlate with the prostate size or urodynamically-defined outlet obstruction. Reduced sensation was common in patients >65 years of age (p = 0.05). Neurological examination/imaging showed exaggerated reflexes, 1; decreased reflexes, 6; multiple cerebral infarction, 8; cervical spondylosis, 1 (in patients with DO); lumbar spondylosis, 5 (in patients with AD/UD), and the final diagnosis was made: definite BPH, 6; probable BPH, 9; BPH and NDD, 13, and NDD were common in the patients aged >65 years (p = 0.015). Transurethral prostatectomy and α-blocker were mostly successful, but the failure rate was reported in definite BPH, none, probable BPH, 29%, and BPH and NDD, 33%. Conclusions: BPH patients, particularly those >65 years of age, commonly have NDD. Multiple cerebral infarction (upper neuron disorder) and lumbar spondylosis (lower neuron disorder) might contribute to DO and UD, respectively. A uro-neurological assessment is important to select typical BPH patients for maximizing therapeutic benefit.

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Section: Neurological Disorders In Patients With Bphsupporting

confidence: 76%

“…A pressure-flow study has also revealed that patients with BOO not only have a strong detrusor, but also an underactive detrusor [6]. Although many theories have been proposed to explain the development of detrusor dysfunction in BOO, their pathogenesis remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Do BPH Patients Have Neurogenic Detrusor Dysfunction? A Uro-Neurological Assessment

Sakakibara¹,

Hamano

Uchiyama³

et al. 2005

Urol Int

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“…One study in 62 BPE patients concluded that symptomatic and overall outcomes were significantly worse in patients who did not have BOO but had detrusor overactivity-related symptoms [19]. In addition, the development of new storage symptoms (OAB) during an extended follow-up was reported in a few men in whom no OAB-related symptoms had been recognized preoperatively [20].…”

Section: Discussionmentioning

confidence: 99%

Prediction of Persistent Storage Symptoms after Transurethral Resection of the Prostate in Patients with Benign Prostatic Enlargement

et al. 2014

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Objective: To identify the prognostic factors causing persistent storage symptoms following transurethral resection of the prostate in patients with benign prostatic enlargement (BPE). Methods: A total of 116 men with symptomatic BPE requiring surgery were enrolled in the study between January 2011 and December 2012. The patients underwent basic clinical evaluations including transrectal ultrasound, International Prostate Symptom Score and urodynamic study. After 6 months, International Prostate Symptom Score and uroflowmetry were rechecked. The definition of persistent storage symptoms was patients with storage scores >7 points. Logistic regression analysis and receiver operating characteristic analysis were conducted. Results: The 116 patients were divided into a persistent storage symptom-positive group (n = 33) and a storage symptom-negative group (n = 83). Multivariate analysis showed that the degrees of worse initial storage symptoms (odds ratio [OR] = 8.32), small bladder capacity (OR = 4.31), impaired detrusor contractility (OR = 2.96) and age (OR = 1.05) were consistently associated with persistent storage symptoms. Conclusions: This short-term study confirms the positive and consistent correlations between the baseline degree of worse initial storage symptoms, bladder capacity, detrusor contractility and age and the improvement in storage symptoms.

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“…In this situation, it was suggested that persistent DO might be the principal cause of the unfavorable outcomes. 7 In a more recent investigation, higher baseline levels of DO also had a negative effect on outcomes in men with postoperative improvement in their prostate symptom score. 8 These anatomic and functional observations are clinically meaningful; they indicate why medical or surgical therapies targeting the prostate do not always alleviate storage symptoms 1 and emphasize the major contribution to LUTS and OAB symptom generation of afferent signaling arising outside the prostate.…”

Section: Overactive Bladdermentioning

confidence: 97%

Lower urinary tract symptoms (LUTS) and bladder afferent activity

Yoshimura

2007

Neurourol. Urodyn.

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Detrusor instability with equivocal obstruction: A predictor of unfavorable symptomatic outcomes after transurethral prostatectomy

Abstract: Preoperative evaluation of DI is of benefit because it enhances predictive value of the PFS.

Cited by 74 publications

References 20 publications

Do BPH Patients Have Neurogenic Detrusor Dysfunction? A Uro-Neurological Assessment

Do BPH Patients Have Neurogenic Detrusor Dysfunction? A Uro-Neurological Assessment

Prediction of Persistent Storage Symptoms after Transurethral Resection of the Prostate in Patients with Benign Prostatic Enlargement

Lower urinary tract symptoms (LUTS) and bladder afferent activity

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