Evaluation and Management of Lower Urinary Tract Symptoms After Outlet Surgery for Benign Prostatic Hyperplasia

Abstract

There are many options available in the surgical treatment of outlet obstruction secondary to benign prostatic hyperplasia (BPH). While most patients exhibit improvement in their lower urinary tract symptoms (LUTS) following intervention, up to 35 % of patients may exhibit persistent or recurrent LUTS. In the present review, we discuss the patho-physiology of LUTS after bladder outlet surgery and discuss considerations in evaluating and managing such patients. We highlight the crucial role of thorough evaluation with complete urodynamics testing, as pure obstruction only accounts for a minority of post-operative LUTS. Hence, detrusor contractility, detrusor overactivity, urethral sphincter function, and urinary incontinence must be assessed to appropriately guide subsequent therapy and improve patients' quality of life.

Keywords: Benign prostatic hyperplasia; Bladder outlet obstruction; Lower urinary tract symptoms; Transurethral resection of prostate.

Fig. 1

A simplified proposed algorithm in evaluating and managing LUTS after BOO surgery based on UDS findings (shown in red text). Abbreviations: LUTS lower urinary tract symptoms, BOO bladder outlet obstruction, H&P history and physical examination, AUA-SI American Urological Association symptom index, UDS urodynamics study, TRUS transrectal ultrasound, RUG retrograde urethrography, 5-ARI 5 α-reductase inhibitor, DO detrusor overactivity, DU detrusor underactivity, BNC bladder neck contracture, UTI urinary tract infection, CIC clean intermittent catheterization, SPT suprapubic tube