Is benign prostatic obstruction surgery indicated for improving overactive bladder symptoms in men with lower urinary tract symptoms?

Abstract

OAB is a common clinical feature in a population of male LUTS, often concomitant with voiding symptoms. Although detrusor overactivity is found in some patients with OAB and BPO, there is no absolute correspondence between clinical symptoms and urodynamic findings. In the context of BPO, OAB pathophysiology implicates nitric oxide pathway, bladder ischemia, ageing of the urinary tract, and calcium-activated potassium channels activity. BPO relief can be followed in the medium term by persistence of OAB symptoms, and preoperative detrusor overactivity has been identified as the main predictive factor. However, preoperative urodynamics remain only indicated in specific cases, when it could directly influence clinical decision-making. Antimuscarinics may be the treatment of choice for persistent symptoms after surgery, but there is no firm recommendation in this clinical setting.

Persistent storage symptoms after TURP can be predicted with a nomogram derived from the ice water test

“…The presence of DO is even higher as 50% in patients who have urge urinary incontinence. After TURP, storage symptoms including urge incontinence persist in a considerable number of patients, and preoperative DO has been identified as the main predictive factor . Older data suggests that about 20% of patients have persistent storage symptoms following TURP .…”

Syndrome clinique d’hyperactivité vésicale non neurologique de l’homme

“…D'autre part, le SCHV peut se développer secondairement à l'OSV [18]. Sur le plan physiopathologique, sont observés des changements dans la paroi de la vessie, non seulement caractérisés par une hypertrophie musculaire du détrusor, mais aussi par des modifications de l'urothélium [19], de la voie de transduction du signal du monoxyde d'azote, des phénomènes d'ischémie et des modifications des canaux calciques et des voies neuronales [20].…”