ICS 2018: Evaluation of Transurethral Resection of the Prostate in Men with Detrusor Underactivity: Is it a Viable Treatment Option?

Philadelphia, PA (UroToday.com) A pressure-flow study is the only method to distinguish between BPO and DU. In patients with BPO, transurethral resection of the prostate (TURP) is performed, but many urologists hesitate to perform a TURP in patients with DU since clinical improvement may be poor and surgery bears considerable risks. The question is: is this hesitation justified? The aim of this study was to compare clinical outcomes after TURP in men with and without DU using the Hannover-Maastricht (HM)-nomogram, a BOO-dependent bladder contractility nomogram. The authors claimed that this is the first clinical report of men with and without DU treated with TURP using the HM-nomogram for categorization of bladder contractility.

Dr. Witte and team conducted a  retrospective analysis and studied men treated with TURP for refractory voiding symptoms between 2010 and 2016. A total of 394 of these men underwent a preoperative pressure-flow study (PFS). They included patients with a reliable preoperative PFS, a pre- and postoperative maximum flow rate (Qmax) and pre- and postoperatively measurement of post-void residual (PVR) (n=80). Bladder outlet obstruction index (BOOI) and maximum Watt factor (Wmax) were calculated by the software (MMS) of the PFS . Patients were plotted in the HM-nomogram and categorized in the group with DU (<25th percentile group) and without DU (the >25th percentile group). Clinical outcomes were measured by comparing pre- and postoperative Qmax and PVR. Catheterization rates were calculated pre- and postoperatively in both groups, but irrespective of the method of catheterization.

Different TURP methods used in our hospital included: GreenLight™ laser vaporization, 980-nm diode laser vaporization and electrosurgical TURP. The choice for electrosurgical TURP was the inability to visualize the ureteral orifices. Patients with the presence of a large prostatic midlobe were mostly treated with 980-nm diode laser vaporization. All other patients were treated with GreenLight™ laser vaporization. Statistical analysis was performed using a Mann-Whitney U test and Chi-square test using SPSS version 23.

The authors found that postoperative Qmax increased dramatically after TURP in men with and without DU, but was not significantly affected by the method of TURP (p=0.36). However, patients who underwent a 980-nm diode laser vaporization had a significantly higher postoperative PVR (33ml (10-70)) than GreenLight™ laser vaporization (11ml (0-40)) and electrosurgical TURP (0ml (0-42)) (p=0.02).

The authors concluded that TURP for refractory voiding symptoms leads to improvement of the Qmax, reduction of the PVR and the catheterization rate in patients with and without detrusor underactivity. Therefore TURP should also be considered as a viable treatment option in patients with detrusor underactivity

Presented by: Selma Palthe, Isala Clinics, Zwolle/Meppel, the Netherlands
Co-Authors: Steffens M, Kums J, Bout C, Witte L, Isala Clinics, Zwolle/Meppel, the Netherlands

Written by: Bilal Farhan, MD; Clinical Instructor, Female Pelvic Medicine and Reconstructive Surgery, University of California, Irvine Medical Center, Twitter: @Bilalfarhan79 at the 2018 ICS International Continence Society Meeting - August 28 - 31, 2018 – Philadelphia, PA USA