Residual Lower Urinary Tract Symptoms (LUTS) after Transurethral Resection of Prostate (TURP): The Urodynamic Studies in Chiangmai University Hospital
Keywords:
persistent or residual symptoms, post TURP, urodynamic studiesAbstract
Background: TURP has been the gold standard in the treatment of BPH since the beginning of the endoscopic era. However, many patients are unable to urinate and the same symptoms persist after this operation. Identifying the causes of symptoms after TURP in BPH patients are necessary for planning and proper management.
Materials and Methods: The retrospective data of 77 post-TURP patients (age 72.66 ± 9.68) having BPH and Lower Urinary Tract Symptoms (LUTS) persisting for at least 2 months were collected from 1988-2004. The number of TURP of each patient was 1-4 times. The underlying causes of LUTS detected by us were interstitial cystitis (IC) in 2 cases, eosinophilic cystitis (EOC) in 1 case, spinal stenosis (Neurogenic Lower Urinary Tract Dysfunction / NLUTD) in 10 cases, and 65 cases only had BPH with LUTS. All were referred to our urodynamic unit for searching for the causes of residual lower urinary tract symptoms. The Cysto-Pressure-Flow studies with fluoroscopy or video-urodynamics were performed in at least 2 successive micturition cycles of each patient in upright position. Male voiding dysfunction classified by Blaivas' criteria was used for interpretation. For statistical analysis of urodynamic variables, SPSS v.2 was used.
Results: There were 32 (41.56%) cases of impaired detrusor contractility (ImC) and of these 7 had NLUTD and 1 had EOC. Sixteen (20.78%) cases had detrusor overactivity (DO) and of these one had IC. Two (2.6%) cases had only bladder outlet obstruction (BOO). Eighteen (23.38%) cases had two conditions, 9 (11.67%) of these had DO + ImC (4 had sphincter weakness incontinence (SWI) due to TURP and 2 of these had NLUTD), and other 9 (11.67%) cases had DO + BOO. Six (7.79%) cases had normal study. Two of these had sphincter weakness (damage) due to TURP. Two (2.6%) cases had incomplete study because they could not urinate during studies. One (1.3%) case was in equivocal group.
Conclusions: All cases of BPH are not necessary causing LUTS. Most post-TURP patients with residual or persistent LU'TS have impaired detrusor contractility (ImC). The second cause of the symptoms is DO. The third is the combination of DO and BOO or ImC. Only 2.6% have BOO alone. Obviously, repeated TURP should not be considered if meticulous physical examination and investigations are not performed because many patients do not have BOO.
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