ABSTRACT
Benign prostatic hyperplasia (BPH) may lead to benign prostatic obstruction (BPO), which may result in bladder dysfunction. Based on the urodynamic analysis of bladder function of 793 BPO patients, bladder function could be classified into 3 stages and 6 types. Detrusor overactivity with impaired contractility (DHIC) is the transitional period of bladder function from compensation to decompensation. The indications of surgical therapy of bladder outlet obstruction (BOO) in different guidelines do not consider the bladder function. This paper emphasizes the importance of bladder function in the surgical choices for BOO, in order to select targeted and individualized surgical methods, and discusses the choice of surgical treatment for BPO from the perspective of bladder function.
ABSTRACT
The number of benign prostatic obstruction (BPO) patients in China is increasing, and patients tend to be younger and younger. The former "gold standard" scheme of transurethral resection of the prostate (TURP) is more suitable for patients with prostate volume ranging from 40 mL to 80 mL, which may lead to excessive resection in patients with small prostate volume and low efficiency in patients with large prostate volume. New minimally invasive techniques have been introduced,including prostate artery embolization, laser surgery (such as holmium, green, diode, and thulium), minimally invasive simple prostatectomy, transperineal laser ablation, prostatic urethral lift,and robot-assisted water jet ablation of the prostate. These methods are alternatives to TURP and increasingly used in the treatment of BPO. This article reviewed the advances in minimally invasive treatment of BPO.
ABSTRACT
Benign prostatic hyperplasia (BPH) is a slowly progressing benign disease. Some patients still have to receive operation. If surgical treatement time is not proper, it may increase the risk of operation and reduce therapeutic effect. However, there is still lack an effective method to evaluate the optimal timing of BPH surgery. The large-scale, multi-center, high-quality clinical trials are needed to clarify the reasonable solutions.
ABSTRACT
Objective:To establish the urodynamic classification of middle-aged and elderly men with benign prostatic obstruction(BPO), and to analyze the efficacy of transurethral resection of the prostate(TURP) on various types of patients.Methods:A retrospective analysis of middle-aged and elderly male patients with non-neurogenic lower urinary tract symptoms(LUTS) who underwent urodynamic tests from January 2010 to December 2018, including 793 patients with BPO. Urodynamics examination of detrusor without contraction needs to complete cystoscopy to diagnose BPO. During urodynamic examination, the detrusor uninhibited contraction induced by spontaneous or stimulation during the bladder filling period is diagnosed as overactivity of the bladder detrusor(DO), and the LinPURR chart indicates the detrusor underactivity(DU). Based on the persistence of BPO leading to DO, DU, and decreased bladder compliance, 793 male patients with BPO with LUTS were divided into four types, including type Ⅰ(BPO: n=164, 20.7%), type Ⅱ(BPO combined with DO: n=333, 42.00%), type Ⅲ(BPO combined with DU: n=267, 33.7%), type Ⅳ(BPO combined with decreased bladder compliance: n=29, 3.7%). The preoperative comparison between groups showed that the age of type Ⅰ-Ⅳ gradually increased, and the age of type Ⅰ was significantly smaller than other types [(67.3±8.2)years, (69.7±7.7)years, (71.5±7.9)years, (72.4±7.1)years, P<0.05]. Compared with other types, the type Ⅰ’s IPSS-S[(9.1±3.6)points vs.(10.4±3.1) points, (9.2±3.3) points, (10.4±3.1)points, P<0.05], IPSS-V[(13.5±3.4) points vs. (14.2±3.5)points, (14.0±3.5)points, (14.2±2.9)points, P<0.05], IPSS scores[(22.6±5.4)points, (24.7±4.9)points, (23.1±5.3)points, (24.6±4.7)points, P<0.05] were significantly lower than other groups, the maximum bladder capacity [(332.6±83.2)ml vs.(221.4±80.8)ml, (286.7±108.2)ml, (242.3±103.4)ml, P<0.05], the functional bladder capacity was significantly higher than other types[(215.2±90.0)ml, (148.5±76.0)ml, (154.9±87.2)ml, (121.2±72.9)ml, P<0.05]. Type Ⅱ’s IPSS-S[(10.4±3.1)points vs.(9.1±3.6)points, (9.2±3.3)points, P<0.05], nocturia frequency[(3.7±1.8)times vs.(3.2±1.8)times, (3.2±1.6)times, P<0.05], IPSS score[(24.7±4.9)points vs.(22.6±5.4)points, (23.1±5.3)points, P<0.05], quality of life scores [(4.9±0.9) points, (4.6±0.9)points, (4.6±0.9)points, P<0.05] was significantly higher than type Ⅰ and type Ⅲ ( P<0.05). Type Ⅲ and Ⅳ had higher residual urine than type Ⅱ[(121.3±96.4)ml, (121.3±96.4)ml vs.(71.2±73.5)ml, P<0.05]. Type Ⅳ’s IPSS-S[(10.4±3.1)points vs. (9.1±3.6)points, (9.2±3.3)points, P<0.05], IPSS-V[(14.2±2.9) points vs.(13.5±3.4)points, (14.0±3.5)points, P<0.05], the frequency of nocturia[(3.8±1.9)times vs.(3.2±1.8)times, (3.2±1.6)times, P<0.05] was significantly higher than that of type Ⅰ and type Ⅲ, and the quality of life score was higher than type Ⅰ and type Ⅲ[(4.3±0.8)points vs.(4.7±0.9)points, (4.6±0.9)points, P<0.05]. type Ⅱ and type Ⅳ’s bladder compliance[(21.4±24.2)ml/cmH 2O, (11.0±11.4)ml/cmH 2O vs.(33.9±23.7)ml/cmH 2O, (33.1±32.7)ml/cmH 2O, P<0.05], maximum bladder capacity[(221.4±80.8)ml, (242.3±103.4)ml vs.(332.6±83.2)ml, (286.7±108.2)ml, P<0.05], functional bladder capacity[(148.5±76.0)ml, (121.2±72.9)ml vs.(215.2±90.0)ml, (154.9±87.2)ml, P<0.05] were significantly less than type Ⅰ and type Ⅲ( P<0.05). From November 2016 to November 2018, 60 middle-aged and elderly male patients with confirmed BPO and TURP were selected, including type Ⅰ( n=17, 28.3%), type Ⅱ ( n=23, 38.3%), and Ⅲ type ( n=11, 18.3%), Ⅳ type( n=9, 15.1%). Type IV patients are significantly older than other types ( P<0.05), bladder compliance is significantly worse than other types( P<0.05), the maximum bladder capacity is smaller than other types( P<0.05). The follow-up started 3 months after the operation. The content of the follow-up included IPSS, IPSS-S, IPSS-V, nocturia frequency, undisturbed sleep time, nocturia quality of life score, and life quality score. Results:The IPSS scores of type Ⅰ, type Ⅱ, and type Ⅲ after TURP were significantly improved compared with preoperative(19.8±6.2 vs.3.4±1.8; 21.9±5.2 vs.4.6±2.6; 21.5±6.2 vs.5.7±4.6, P<0.05), type Ⅳ urine storage symptom score (9.1±4.1 vs.4.3±3.7), nocturia frequency(3.6±1.5vs.2.3±1.6), nocturia quality of life score (25.3±6.9 vs.31.4±13.7) Compared with preoperatively, there was no significant improvement( P>0.05). The quality of life score improvement of type Ⅳ patients was significantly lower than that of type Ⅰ, type Ⅱ, and type Ⅲ (10.9±9.1 vs.12.2±9.0, 14.4±5.7, 12.7±5.8, P<0.05). The IPSS score of type Ⅳ patients was significantly higher than that of type Ⅰ(7.0±5.8 vs.3.4±1.8), and the nocturia quality of life score was significantly lower than that of each group (31.4±13.7 vs.37.5±4.2, 38.7±3.5, 37.8±3.8, P<0.05). Conclusions:For middle-aged and elderly men with BPO, we divide them into four types based on the results of urodynamic examinations, type Ⅰ(simple BPO), type Ⅱ(BPO combined with DO), type Ⅲ(BPO combined with DU), type Ⅳ(BPO combined with bladder compliance decline). Type Ⅰ patients have the best bladder function, and TURP has the best effect; type Ⅱ has a high symptom score and poor quality of life, and can benefit after TURP; type Ⅲ bladder function is poor, and surgery should be performed as soon as possible to prevent further deterioration of bladder function; type Ⅳ bladder function is the best poor, IPSS score and quality of life score are high, TURP surgery is not effective.
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.
ABSTRACT
Lower urinary tract symptoms (LUTS),consisting storage,voiding and postmicturition symptoms,is a comprehensive definition involving multiple organs.There has been an increasing emphasis on the integrated management of non-neurogenic male lower urinary tract symptoms.Instead of focusing on the enlarged prostate,the current treatment has paid more attention on the entire urinary tract as well as multiple organ factors.Therefore,we provided a literature review and summarized the key points during the management of male LUTS as 3B,namely beyond prostate,beyond surgery and beyond urology.