The Effect of Transurethral Resection of the Prostate in Detrusor Underactivity

Yong Sang Jeong; Sung-Won Lee; Kyu-Sung Lee

doi:10.4111/kju.2006.47.7.740

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Jeong, Lee, and Lee: The Effect of Transurethral Resection of the Prostate in Detrusor Underactivity

Original Article

Korean Journal of Urology

Korean Journal of Urology 2006; 47(7): 740-746.

Published online: 31 July 2006

DOI: https://doi.org/10.4111/kju.2006.47.7.740

The Effect of Transurethral Resection of the Prostate in Detrusor Underactivity

Yong Sang Jeong, Sung-Won Lee, Kyu-Sung Lee

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (LKS@smc.samsung.co.kr)

Received 27 March 2006 Accepted 20 May 2006

Abstract

Purpose

We evaluated the effect of transurethral resection of the prostate (TUR-P) in men with detrusor underactivity (DUA) who do not respond to conservative medical treatment.

Materials and Methods

Of the patients who underwent TUR-P for LUTS at our institution, we reviewed the records of 71 patients who had undergone preoperative urodynamic study. According to the bladder outlet obstruction index and the bladder contractility index, the patients were divided into two groups: group A (25 patients) with unobstructed and underactive detrusor function, and group B (46 patients) with obstructed and/or normal detrusor contractility. We evaluated the difference of International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), post void residual (PVR) volume and the subjective satisfaction after TUR-P.

Results

There were no significant differences preoperatively between the groups for age, Qmax and PVR. The total IPSS/QoL score was higher and the prostatic size was smaller in group A. After TUR-P in group A, the IPSS/QoL score and PVR were significantly improved; the Qmax was also improved, but this was not significant. There were significant improvements in all parameters in group B. Patients in group B showed the more significant improvement rate of the IPSS score and they were more satisfied after TUR-P than those in group A.

Conclusions

Patients with DUA had less improvement in their symptom score and operative satisfaction than those with obstructed and/or normal detrusor contractility after TUR-P. However, there was significant improvement in IPSS/QoL and PVR after TUR-P in former group and 64% of these patients were satisfied. Therefore, TUR-P is thought to be an optional surgical procedure for treating the men with DUA who do not respond to conservative medical treatment.

Keywords: Urinary tract, Symptoms, Urodynamics, Transurethral resection of prostate

Figures and Tables

Fig. 1

Comparisons of pre- and post-operative IPSS (A: Total, B: Voiding, C: Storage, D: QoL) in the two groups; p^*: comparisons of the variables before and after TUR-P, p^†: comparisons of the rates of improvement of the variables after TUR-P between the two groups. IPSS: International Prostate Symptom Score, QoL: quality of life, TUR-P: transurethral resection of the prostate.

Fig. 2

Comparisons of pre- and post-operative Qmax and PVR in the two groups; p^*: comparisons of the variables before and after TUR-P, p^†: comparisons of the rates of improvement of the variables after TUR-P between the two groups. Qmax: maximum flow rate, PVR: post void residual, TUR-P: transurethral resection of the prostate.

Fig. 3

Subjective satisfaction rates after TUR-P of group A (A) and group B (B). TUR-P: transurethral resection of the prostate.

Fig. 4

A composite nomogram of the ICS nomogram and Schäfer's nomogram allows categorization of patients into nine classes, according to three obstruction and three contractility categories. There is a spectrum of patients, ranging from group 1 (no obstruction and good contractility) to group 9 (obstruction with weak contractility). A shaded area represents an unobstructed bladder outlet combined with weak bladder contractility group (Group A in this study). ICS: International Continence Society, PdetQ_max: detrusor pressure at maximal flow, Q_max: maximum flow rate.

Table 1

Preoperative patient characteristics (mean±SD)

PSA: prostate-specific antigen, IPSS: International Prostate Symptom Score, QoL: quality of life, Qmax: maximum flow rate, PVR: post void residual

Table 2

Comparison of clinical parameters at pre-operation and post-operation between the two groups (mean±SD)

^*: changes from pre-operation to post-operation between group A and group B. IPSS: International Prostate Symptom Score, QoL: quality of life, Qmax: maximum flow rate, PVR: post void residual

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