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. 2021 Mar;40(3):868-875.
doi: 10.1002/nau.24637. Epub 2021 Mar 1.

Impact of detrusor underactivity on the postoperative outcomes after benign prostatic enlargement surgery

Mauricio Plata  1 , Jessica Santander  1 , Carlos Gustavo Trujillo  1 , Alejandra Bravo-Balado  1 , Daniela Robledo  1 , Tatiana Higuera  1 , Juan Ignacio Caicedo  1
Affiliations

Impact of detrusor underactivity on the postoperative outcomes after benign prostatic enlargement surgery

Mauricio Plata et al. Neurourol Urodyn. 2021 Mar.

Abstract

Introduction and objective: Previous studies suggest that men with detrusor underactivity (DUA) have less symptomatic improvement after prostate surgery than those with normal contractility, but the available data is controversial. We aim to determine the differences in functional outcomes of patients with or without DUA who underwent photovaporization of the prostate (PVP) with GreenLight™180 W XPS.

Methods: A cohort of patients with lower urinary tract symptoms (LUTS) who underwent PVP between 2012 and 2019 was evaluated. Patients were stratified according to bladder contractility index (BCI). DUA was defined as BCI < 100. Those with normal contractility (BCI = 100-150) were included in Group 1, and those with DUA (BCI < 100) in Group 2. Primary outcomes were symptomatic improvement defined as a reduction ≥ 4 points in the international prostate symptom score (IPSS) and a reduction of at least 1 point in the quality of life (IPSS-QoL). Complications according to the Clavien-Dindo classification were also recorded.

Results: A total of 271 patients who underwent PVP with GreenLight™ and met the inclusion criteria were assessed. Group 1 included 158 patients, while Group 2 included 113 patients. Mean follow-up was 24 months. Patients with normal contractility had a median reduction of 11 points (18.9 ± 8.0 to 7.1 ± 7.0) while patients with DUA had a median reduction of 10 points (19.3 ± 6.9 to 8.6 ± 8.4) in IPSS score; these differences were not statistically significant (p = .20). Patients in Group 1 had a 1.92 higher chance of QoL improvement (OR, 1.92; 90% CI, 1.10-3.37), compared to those in Group 2. Failure to void after PVP was most frequently reported in DUA patients (OR, 2.36; 90% CI, 1.26-4.43). Sociodemographic characteristics, intraoperative complications, conversion rates, hospital stay, and urinary catheterization time were similar between groups.

Conclusions: Patients with LUTS, regardless of their BCI, improved their symptoms after PVP according to the IPSS. However, patients with DUA were more likely not to improve their QoL after the procedure and had a higher chance of failure to void in the immediate postoperative period. An appropriate counseling process with the patient discussing possible outcomes based on these findings should be encouraged.

Keywords: detrusor underactivity; lower urinary tract symptoms; photovaporization of the prostate.

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REFERENCES

    1. D'Ancona C, Haylen B, Oelke M, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019;38(2):433-477. https://doi.org/10.1002/nau.23897
    1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167-178. https://doi.org/10.1002/nau.10052
    1. Gratzke C, Bachmann A, Descazeaud A, et al. EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2015;67(6):1099-1109. https://doi.org/10.1016/j.eururo.2014.12.038
    1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37-49.
    1. Osman NI, Esperto F, Chapple CR. Detrusor underactivity and the underactive bladder: a systematic review of preclinical and clinical studies. Eur Urol. 2018;74(5):633-643. https://doi.org/10.1016/j.eururo.2018.07.037

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