Surgical treatment of detrusor underactivity: a short term proof of concept study

Abstract

Objectives To compare the surgical outcomes of men with bladder outlet obstruction (BOO) due to benign prostatic obstruction (BPO) to those with detrusor underactivity (DU) or acontractile detrusor (DA).Materials and Methods This retrospective, IRB approved study included men who underwent BPO surgery for refractory LUTS or urinary retention. Patients were grouped based on videourodynamic (VUDS) findings: 1) men with BOO, 2) men with DU and 3) men with DA. The primary outcome measure was the Patient Global Impression of Improvement (PGII). Secondary outcome measures included uroflow (Qmax), post-void residual volume (PVR) and the need for clean intermittent catheterization (CIC).Results One hundred and nineteen patients were evaluated: 1) 34 with BOO, 2) 62 with DU and 3) 23 with DA. Subjective success rate (PGII) was highest in the BOO group (97%) and those with DU (98%), while DA patients had a PGII success of 26%, (p<0.0001). After surgery, patients with BOO had the lowest PVR (68.5mL). Fifty-six patients (47%) performed CIC pre-operatively (47% of BOO, 32% of DU and 87% of DA patients). None of the patients in the BOO and DU groups required CIC post operatively compared to16/23 (69%) of patients in the DA group (p<0.0001).Conclusions BPO surgery is a viable treatment option in men with presumed BOO and DU while DA is a poor prognostic sign in men who do not void spontaneously pre-operatively.

Cluster analysis of men undergoing surgery for BPH/LUTS reveals prominent roles of both bladder outlet obstruction and diminished bladder contractility

“…Thomas et al [ 8 , 9 ] observed no long-term symptomatic nor urodynamic benefits from TURP in patients with impaired contractility without obstruction. In contrast, Blaivas and colleagues [ 10 ] reported that surgery afforded significant improvement in symptoms and bladder emptying in men with impaired contractility. Good outcomes have also been reported by Tanaka et al [ 11 ].…”

Therapeutic outcome of active management in male patients with detrusor underactivity based on clinical diagnosis and videourodynamic classification

“…Even in patients with DA, BOO surgery still provided improved treatment outcome for 58.8% of the DU patients. Recent studies have shown that patients with DU with or without BOO can still benefit from transurethral prostatic surgeries and have improvement of LUTS after surgery 18 , 19 . However, patients with DA might need CIC after prostatic surgery 19 , and patients with DU are more likely to have a lower quality of life and failure to voiding in the immediate postoperative period 20 .…”

Post-void residual urine ratio: A novel clinical approach to the post-void residual urine in the assessment of males with lower urinary tract symptoms

“…Data of a recent Cochrane and meta-analysis and of the RCT UPSTREAM study did not demonstrate the usefulness of preoperative urodynamics (UD) in these candidates to surgery [ 16 17 ]. However, several studies have shown that males with DUA, associated or not to BOO, had satisfactory results at short-time follow-up after surgery, but not long lasting-time [ 18 19 20 21 22 23 ]. Moreover, poorer surgical outcomes have been reported in underactive males than in non-underactive obstructed patients.…”