Effect of transurethral resection of the prostate on detrusor instability and urge incontinence in elderly males

Abstract

Detrusor instability is common in men with evidence of outflow obstruction due to benign prostatic hypertrophy and typically reverses in about two thirds of patients after transurethral resection of the prostate (TURP). It is also common among the elderly without outflow obstruction and may lead to urge incontinence. To determine whether TURP has an effect on detrusor instability and urge incontinence in elderly men, or whether these abnormalities are due to other age-associated changes, 12 males (mean age 80 years) with urge incontinence or frequency and urgency of micturition, and symptomatic benign prostatic hypertrophy, were studied by 24-hour monitoring of incontinence and videourodynamic examination, before and after TURP; 7/12 patients were significantly cognitively impaired. Preoperatively, all patients showed detrusor instability, which reversed postoperatively in only one patient, a significantly smaller proportion than that consistently reported in younger patients. Preoperatively, 11/12 patients were incontinent. After TURP, 8/11 patients had an improvement in the amount of incontinence, by up to 458 g in 24 hours. Those who improved had been urodynamically more severely obstructed preoperatively. Those with the most improvement were also cognitively impaired. We conclude that, in the geriatric population, detrusor instability and urge incontinence may be the result of age-associated changes and not secondary to obstruction. Detrusor instability is likely to persist following TURP. Preoperative urodynamic assessment of obstruction in the incontinent male with benign prostatic hypertrophy may be useful since the severity of incontinence responds well to TURP if there is marked obstruction. Cognitive impairment should not be a deterrent to operation.

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

“…Further, persistence of storage symptoms following TURP has been reported more frequently in men >80 years of age [3]. In another study of 100 consecutive patients who underwent TURP, a high proportion of patients reported increasing urine leakage with increasing age [9].…”

“…However, a large proportion of patients complain of persistent storage symptoms following TURP [3]. Such storage symptoms as urgency, frequency and nocturia can be well controlled by medication, but there is little information regarding the associated factors that predict storage-related symptomatic outcome following TURP.…”

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

“…The term idiopathic DO is also used if there is no definite cause for DO, although neurological signs are not uncommon in patients with idiopathic DO [12]. Previous studies have described that even after the surgical relief of BOO, DO persists in 25-93% of patients with DO [4,13], the figures increasing with age [13]. In the present study, DO was not related with the size of prostatic enlargement or BOO as seen in Rosier's study [14], but DO tended to increase with age.…”

Characterization of men with lower urinary tract dysfunction after surgical management of benign prostatic obstruction

“…Age alone can be a secondary cause of LUTS, independent of past TURP interventions. Increasing LUTS could be attributed to increased prevalence of detrusor over activity at older ages [4]; although, contradicting evidence argues that age is not a risk factor for failed-TURPs or detrusor over activity [5,10]. The cohort average age is comparable to the national average age of patients undergoing TURP at 69 years old, suggesting these patients are not at a higher risk of recurrent symptoms or failed procedure [11].…”

“…Established risk factors for TURP complications include increasing age, prostate size greater than 31 cc, medical history of urinary retention requiring catheterization, and pre-operative PVR [3][4][5]. Few studies have examined this population; therefore, we characterized men with recurrent lower urinary tract dysfunction after a surgical resection of the prostate.…”