Predictors of Overactive Bladder Symptoms Regarding the Short-term Outcome of TURP in Patients with Benign Prostatic Obstruction
|School||Tianjin Medical University|
|Keywords||Benign prostatic hyperplasia Bladder outlet obstruction Overactivebladder Detrusor overactivity Urodynamic|
Objective:The aim of this study was to investigate whether the urodynamic parameters and the severity of OAB symptoms affected the improvement of OAB symptoms following a TURP in patients with BPO, to find the perfect prediction parameters, which can suitably guide the selection of cases suitable for surgical intervenetion on the clinical.Methods:A retrospective study was conducted in BPH patients with BOO or suspicious BOO confirmed by urodynamic examination who had undergone TURP in our hospital, and all patients’LUTS must meet the OAB symptoms. All patients had completed the preoperative evaluations including the IPSS, QOL, OABSS, PSA, prostate volume and full urodynamics. Filling cystometry were performed to determine DO, which was comprised PDO and TDO before TURP, and was defined according to the ICS (2002). The degree of obstructions to all of the patients were LinPURR scores of II above, and the patients were divided into mild obstruction(Ⅱ-Ⅲ) and severe obstruction(Ⅳ-Ⅵ) groups. The patients were divided into weak (VW,W-,W+) and normal/strong (N-,N+,ST) groups according to the strength of detrusor contraction. It was divided into mild, moderate and severe groups according to the severity of OAB symptoms. The OAB was divided into OAB wet and OAB dry according to whether associated with incontinence. The efficacy of TURP was determined at3months after surgery using the IPSS, QOL, OABSS, Qmax and PVR. The improvement of OAB symptoms was defined as a reduction of≥50%in the subtotal storage symptom scores or the OABSS. Statistical analysis was conducted on the data between the different groups.Results:136patients were enrolled in this study, the mean age of all patients was70.5years (range50-87years). The average prostate volume was97.72ml (range21.0-388.8ml).24patients with double hydronephrosis returned into normal postoperative. Not only subjective symptoms such as the IPSS (the subtotal storage and obstructive symptom scores), OABSS and QOL index but also objective parameters such as Qmax and PVR were significantly improved3months after TURP.30(22.06%) patients still had OAB symptoms postoperative.90(66.2%) patients showed OAB wet preoperatively, and13(14.4%) patients continued to be showed OAB wet postoperatively, but had improved in OAB symptoms after operation.On preoperative urodynamics,48(35.29%) patients showed DO, which were comprised of PDO27(19.85%) cases and TDO21(15.44%) cases. There was no significant difference in the preoperative subtotal storage symptom scores and OABSS between the presence and absence of DO. Three months postoperatively, men without preoperative DO had a significantly lower subtotal storage symptom scores and OABSS than those with preoperative DO (P<0.05). The scores of PDO patients were significantly lower in the two scoring systems compared with TDO patients before and after the operation (P<0.01). Interestingly, there was no significant difference between the preoperative and postoperative subtotal storage symptom scores and OABSS at the absence DO and presence PDO. The scores of TDO patients were significantly higher compared with non-TDO patients before and after the operation in the two scoring systems (P<0.05). There was no significant difference in D-value among groups above, but all groups had improved in OAB symptoms after operation.In the success rate of OAB symptoms improvement, the rate of DO patients (85.4%,75.0%) was lower than non-DO patients (96.6%,90.9%), and the rate of TDO patients (76.2%,57.1%) was lower compared with non-TDO patients (95.7%,90.4%)(P<0.05). In patients with OAB wet before operation,8of29(27.6%) of patients with DO and5of61(8.2%) of patients without DO still showed OAB wet after surgery, and there statistical significance (P=0.034). Meanwhile,7of15(46.7%) of patients with preoperative TDO and1of14(7.1%) of patients with PDO continued to be showed OAB wet postoperatively (P=0.013).There was no significant difference in the two scores between mild obstruction (35) and severe obstruction (101) at preoperation or postoperation. The detrusor weak group (49) had no significant difference in the two scores with detrusor normal/strong group (87) at preoperation or postoperation. When the subtotal storage symptom scores of IPSS was the evaluation criteria,85(97.7%) cases in detrusor normal/strong group to improve the success was significantly higher than41(83.7%) cases in detrusor weak group in OAB symptoms after surgery(P=0.008).It was divided into three groups according to the severity of OAB symptoms,10cases in mild group,94cases in moderate group and32cases in severe group. In the comparison among the three groups, men with mild OAB symptoms preoperatively had a significantly lower subtotal storage symptom scores and OABSS than those with moderate and severe OAB symptoms after operation (P<0.05).Conclusion:1. Compared with the patients with PDO or without DO, the patients with TDO will be poor in the improvement of OAB symptoms, and the patients’OAB symptoms of the PDO, TDO and non-DO groups had significantly improved after operation.2. There was no significant difference in the improvement of OAB symptoms between mild obstruction and severe obstruction patients. The cases with detrusor normal/strong and detrusor weak were also no difference.3. Men with mild OAB symptoms preoperatively had a better improvement in the OAB symptoms than those with moderate and severe OAB symptoms.