Does urodynamics predict voiding after benign prostatic hyperplasia surgery in patients with detrusor underactivity?

doi:10.1016/j.ajur.2018.12.005

Asian Journal of Urology, 2019, 6 (3): 264-269 doi: 10.1016/j.ajur.2018.12.005

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Does urodynamics predict voiding after benign prostatic hyperplasia surgery in patients with detrusor underactivity?

Dominique Thomas^a,1,Kevin C. Zorn^b,1,Nadir Zaidi^a,Stephanie Ashley Chen^a,Yiye Zhang^c,Alexis Te^a,Bilal Chughtai^a,*(

)

^aDepartment of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
^bSection of Urology, Department of Surgery, University of Montreal Hospital Center, Montreal, QC, Canada
^cDepartment of Healthcare Policy and Research, Weill Cornell Medical College/New York Presbyterian, NY, USA

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Abstract

Objective: We sought to determine if urodynamic study (UDS) predicted voiding outcomes in men with detrusor underactivity (DU) and benign prostatic enlargement (BPE) who underwent photovaporization of the prostate (PVP). Methods: Between September 2010 and July 2015, 106 male patients with BPE and DU were identified. All patients underwent PVP. Urinary retention was noted by the preoperative necessity for an indwelling or intermittent catheter. Data collection included comorbidities, quality of life (QoL) scores, prostate volume, prostate-specific antigen (PSA), UDS and perioperative outcomes. UDS parameters included volume at first desire to void, volume at first urge to void, volume of severe urge, volume at capacity, compliance, detrusor contractions, maximum urinary flow rate (Q_max), and postvoid residual (PVR). Results: A total of 106 men were included in this analysis, who had urinary retention with a Foley catheter or clean intermittent catheterization (CIC) at the time of surgery. At baseline we found patients who voided had a detrusor pressure at Q_max (P_det@Q_max) of 10.05 ± 6.45 cmH₂O compared to 16.78 ± 12.17 cmH₂O in those who did not void (p = 0.071). Postoperatively, 96 (90.6%, mean age 76.9 ± 26.2 years) of patients voided successfully while 10 (9.4%, mean age 80.52 ± 9.61 years) of patients remained in urinary retention. Mean baseline Q_max was 4.895 ± 5.452 mL/s and 2.900 ± 3.356 mL/s (p = 0.087) in those who voided and did not respectively. PVR was 319.23 ± 330.62 mL in those who voided and 276.88 ± 263.27 mL (p = 0.344) in those who did not void. No UDS parameter predicted who would void postoperatively or improvements in QoL. Conclusions: The patients with DU and BPE might be able to successfully void after undergoing PVP regardless of UDS findings. All men who voided had improved international prostate symptom score and QoL scores compared to baseline and these parameters were durable up to 12 months.

Key words： Benign prostatic enlargement Detrusor underactivity Follow-up Photovaporization of the prostate Urodynamic study

Received: 06 June 2018 Available online: 18 December 2018

Corresponding Authors: Bilal Chughtai E-mail: bic9008@med.cornell.edu

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	Dominique Thomas
	Kevin C. Zorn
	Nadir Zaidi
	Stephanie Ashley Chen
	Yiye Zhang
	Alexis Te
	Bilal Chughtai

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Cite this article:

Dominique Thomas,Kevin C. Zorn,Nadir Zaidi, et al. Does urodynamics predict voiding after benign prostatic hyperplasia surgery in patients with detrusor underactivity?[J]. Asian Journal of Urology, 2019, 6(3): 264-269.

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http://www.ajurology.com/EN/10.1016/j.ajur.2018.12.005 OR http://www.ajurology.com/EN/Y2019/V6/I3/264

All patient baseline characteristics.

UDS parameters for all patients prior to surgery.

Previous medical history and surgical characteristics.

Postoperative characteristics for voiding patients.

[1]	Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U , 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; 21:167-78.
[2]	Oelke M, Baard J, Wijkstra H, de la Rosette JJ, Jonas U, Hofner K . Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia. Eur Urol 2008; 54:419-26.
[3]	Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C , et al. EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2015; 67:1099-109.
[4]	Jeong SJ, Kim HJ, Lee YJ, Lee JK, Lee BK, Choo YM , et al. Prevalence and clinical features of detrusor underactivity among elderly with lower urinary tract symptoms: a comparison between men and women. Korean J Urol 2012; 53:342-8.
[5]	Schafer W, Abrams P, Liao L, Mattiasson A, Pesce F, Spangberg A , et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 2002; 21:261-74.
[6]	Nager CW, Brubaker L, Litman HJ, Zyczynski HM, Varner RE, Amundsen C , et al. A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med 2012; 366:1987-97.
[7]	Porru D, Madeddu G, Campus G, Montisci I, Scarpa RM, Usai E . Evaluation of morbidity of multi-channel pressure-flow studies. Neurourol Urodyn 1999; 18:647-52.
[8]	Paick JS, Um JM, Kwak C, Kim SW, Ku JH . Influence of bladder contractility on short-term outcomes of high-power potassium- titanyl-phosphate photoselective vaporization of the prostate. Urology 2007; 69:859-63.
[9]	Masumori N, Furuya R, Tanaka Y, Furuya S, Ogura H, Tsukamoto T . The 12-year symptomatic outcome of transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction compared to the urodynamic findings before surgery. BJU Int 2009; 105:1429-33.
[10]	Jamzadeh AE, Xie D, Laudano M, Seklehner S, Elterman DS, Shtromvaser L , et al. Urodynamic characterization of lower urinary tract symptoms in men less than 40 years of age. World J Urol 2013; 32:469-73.
[11]	Valdivieso R, Meyer CP, Hueber PA, Meskawi M, Alenizi AM, Azizi M , et al. Assessment of energy density usage during 180W lithium triborate laser photoselective vaporization of the prostate for benign prostatic hyperplasia. Is there an optimum amount of kilo-Joules per gram of prostate? BJU Int 2016; 118:633-40.
[12]	McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF , et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 2011; 185:1793-803.
[13]	Cho MC, Ha SB, Park J, Son H, Oh SJ, Kim SW , et al. Impact of detrusor underactivity on surgical outcomes of laser prostatectomy: comparison in serial 12-month follow-up outcomes between potassium-titanyl-phosphate photoselective vaporization of the prostate (PVP) and holmium laser enucleation of the prostate (HoLEP). Urology 2016; 91:158-66.
[14]	Cho MC, Park J, Kim JK, Cho SY, Jeong H, Oh SJ , et al. Can preoperative detrusor underactivity influence surgical outcomes of 120 W HPS vaporization of the prostate (PVP) or holmium laser enucleation of the prostate (HoLEP)? A serial 3- year follow-up study. Neurourol Urodyn 2018; 37:407-16.
[15]	Ryoo HS, Suh YS, Kim TH, Sung HH, Jeong J, Lee KS . Efficacy of holmium laser enucleation of the prostate based on patient preoperative characteristics. Int Neurourol J 2015; 19:278-85.
[16]	Javle P, Jenkins SA, Machin DG, Parsons KF . Grading of benign prostatic obstruction can predict the outcome of transurethral prostatectomy. J Urol 1998; 160:1713-7.
[17]	Gotoh M, Yoshikawa Y, Kondo AS, Kondo A, Ono Y, Ohshima S . Prognostic value of pressure-flow study in surgical treatment of benign prostatic obstruction. World J Urol 1999; 17:274-8.
[18]	Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P . The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10- year urodynamic follow-up. BJU Int 2004; 93:745-50.