ABSTRACT
Objective To analyze the impact of detrusor underactivity (DU) on the outcomes of transurethral resection of prostate (TURP) in patients with benign prostatic obstruction (BPO).Methods A retrospective study was conducted in 157 BPO patients who underwent TURP from January 2013 to December 2016.Their ages ranged from 48 to 86 years with a mean age of 70 years.All patients underwent urodynamic study before surgery,bladder contraction index(BCI) ranged from 49.3 to 208.6,with a mean of 120.1.The patients were divided into two groups according to BCI.DU group (BCI ＜ 100) consisted of 47 patients,non-DU group (BCI ≥ 100) 110patients.Before surgery,there were no significant differences in International Prostate Symptom Score (IPSS),storage and voiding symptom scores of IPSS (IPSS-S,IPSS-V),quality of life (QOL),maximum free flow rate (fQmax),post-voided residual urine volume (PVR) between the two groups[(21.5 ±7.0)vs.(21.5 ±6.2),(9.5 ±3.6)vs.(9.8 ±3.5),(12.0 ± 4.9)vs.(11.8±4.2),(5.1 ±0.8)vs.(5.3 ±0.7),(6.5±3.5)ml/s vs.(7.6±5.0)ml/s,(137.4± 146.2)ml vs.(105.2 ± 135.9)ml] (P ＞ 0.05 for each).The outcomes of TURP were assessed by the above mentioned parameters at 3 months postoperatively;IPSS、IPSS-S、IPSS-V were regarded as successful if they improved more than 50％,QOL was successful if it was improved more than 3,fQmax successful if it was improved 5ml/s.The change and successful improvement rates of the above mentioned parameters were compared between DU and non-DU group.Through receiver operating characteristic curve(ROC) analysis,patients were categorized into mild DU and severe DU group and compared the successful improvement rates between the two groups.Results Both DU group and non-DU group improved significantly in IPSS,IPSS-S,IPSS-V,QOL,fQmax,PVR at 3 months postoperatively (P ＜ 0.05)and the two groups differed significantly in those parameters [(8.6 ± 7.3) vs.(4.4 ±4.5),(5.0 ± 3.5) vs.(3.6 ±2.8),(3.6 ±5.1)vs.(0.9 ± 2.3),(2.3 ±1.5) vs.(1.5 ± 1.0),(11.5 ±6.9) ml/s vs.(16.3 ± 6.9) ml/s,(48.4 ± 65.6) ml vs.(23.6 ± 25.6) ml] (P ＜ 0.05 for each).In regard to the successful improvement rates of IPSS,IPSS-S,IPSS-V,QOL,fQ DU group was less successful than non-DU group [70.2％ (33/47)vs.90.9％ (100/110),51.1％ (24/47)vs.73.6％ (81/110),74.5％ (35/47)vs.93.6％ (103/110),59.6％ (28/47)vs.83.6％ (92/110),42.6％ (20/47)vs.81.8％ (90/110),P ＜0.05 for each].Youden index was maximum when BCI equaled to 82.There were significant differences in the successful improvement rates of IPSS and IPSS-V between mild DU (82 ≤ BCI ＜ 100) and severe DU (BCI ＜ 82) group [82.8％ (24/29) vs.50.0％ (9/18),86.2％ (25/29) vs.55.6％ (10/18),P ＜ 0.05 for each),no significant differences in IPSS-S and fQmax [58.6％ (17/29) vs.38.9％ (7/18),48.3％ (14/29) vs.33.3％ (6/18),P ＞ 0.05 for each].Conclusions Benign prostatic obstruction patients with DU can achieve improvement in both subjective and objective parameters after TURP,but patients without DU can get more improvement.BPO patients with severe DU patients show a worse improvement of the voiding symptom.Surgeons should have adequate communication with the patients and inform them of appropriate expectations.