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

Open Access
Publisher Website
Google Scholar
Abstract
In the first paper in this section the authors from the Bristol Urological Institute investigated 224 men with detrusor underactivity, and evaluated the effect of this condition on the outcome of TURP. This quite unique study found that TURP is not helpful in this condition. They underscored their view that reliance on symptoms and uroflowmetry is not enough when patients are being considered for TURP, and recommended routine preoperative urodynamic assessment. There is an updated meta‐analysis of clinical trials of Permixon in the treatment of symptomatic BPH presented in this section. The authors review all clinical trial data from 14 randomized and 3 open‐label trials. Although the trials varied widely in methods the meta‐analysis showed a significant improvement in symptoms and flow rates in patients treated with this compound. Authors from Leicester assessed the prevalence and incidence rates for urinary incontinence and storage disorder in the UK over a 1‐year period, finding that this constituted a major public health problem, with consequent effects on services and funding. OBJECTIVES To assess the long‐term outcome of the efficacy of transurethral resection of the prostate (TURP) in men with detrusor underactivity (DUA), a cause of lower urinary tract symptoms (LUTS) in a significant minority of men. PATIENTS AND METHODS Neurologically intact men with LUTS, who were investigated in our department between 1972 and 1986, diagnosed with DUA and who underwent surgical intervention, were invited for a repeat symptomatic and urodynamic assessment. Identical methods were used, allowing direct comparison of the results. RESULTS In all, 224 men were initially diagnosed with DUA; 87 (39%) of these died in the interim and 22 followed had a TURP, with a mean follow‐up since surgery of 11.3 years. There were no significantly sustained reductions in any symptoms. There was a small but significant reduction of questionable clinical significance in the bladder outlet obstruction index, but this did not translate into an improved flow rate. Comparison with 58 age‐matched patients with DUA who remained untreated showed no significant advantage of surgical intervention in the long‐term; on the contrary, there was more chronic retention in those who had had surgery. CONCLUSIONS There are no long‐term symptomatic or urodynamic gains from TURP in men shown to have DUA. The results of TURP in men with DUA are important, as urologists who surgically treat patients based on the symptoms and uroflowmetry alone will do so in a significant minority of men with DUA. These results strengthen the argument for a routine preoperative urodynamic assessment.