The Research Of Treatment Options And Prognosis's Significance Of Urinary ATP Quantification And Urodynamic Testing In Patients With BPH And OAB

Objective: The aim of this study was to investigate the significance of Urinary ATP quantification and urodynamic testing in the patients with BPH combined with OAB.Methods: The patients were divided into there groups, pure BPH group(58 men), BPH+OAB group(55 men), normal group(12 men). Patients with a history that might affect their bladder function were excluded. We identified differences of the age, IPSS and the volumn of prostate between the patients with pure BPH and the ones with BPH+OAB. We used the urodynamic testing to observe whether detrusor overactive(DO) existed and identify differences of maximum detrusor pressure(Pdetmax), bladder compliance, maximum cystometric capacity(MCC), maximum flow rate(Qmax), post void residual(PVR), detrusor contractility,volumn at first desire to void(FD) between pure BPH group and BPH+OAB group. The urodynamic testing was also applied in patients after treatments. Detrusor histopathological changes were measured by HE stain. Meanwhile, 34 men in BPH+OAB group were treated with surgical operations(group of operations),and 21 men in BPH+OAB group were treated with solifenacin and tamsulosin hydrochloride (group of drug treatment). All of the pure BPH patients were treated with surgical operations. The urine ATP were measured by chemiluminescence method both pretherapy and post-treatment.Results: The patients with BPH+OAB were older, had a higher IPSS and bigger volumn of prostate. The percentage of DO in BPH+OAB group was 52.9%, and the percentage of DO in pure BPH group was 13.8%. In the BPH+OAB group, FD and MCC was smaller, bladder compliance was lesser, decrease of detrusor contractility was more obvious compared to pure BPH group (P<0.05). The urine ATP before treatment in BPH+OAB group were lower than the pure BPH group (P<0.05). The result of HE stain displayed that detrusor of BPH+OAB group was obviously incrassate and muscle fiber was in irregular arrangement. Two months after treatment, the urine ATP were decreased, Qmax were increased, and PVR were decreased both in BPH+OAB group and pure BPH group(P<0.05).In the 22 patients who had DO before surgical operations, there were 3 men(13.6%) were rid of DO and 19 men(86.4%) were found the DO was remittence. all of patients who had DO before drug treatment were found the DO was remittence. Meanwhile, all the patients who had DO before surgical operations in pure BPH group were rid of DO. In the group of operations, the percentage of patients who still had urgency and frequency of micturition was 64.7%(22 men); the percentage of patients who felt remittence was 35.3%(12 men). All of above patients were given solifenacin and tamsulosin hydrochloride, we found symptoms of urgency and frequency of micturition were obviously improved. In the group of drug treatment, the percentage of patients who felt symptoms of OAB were obviously improved was 90.5%(19 men), the percentage of patients who felt symptoms of OAB were slightly improved was 9.5%(2 men). In the control group, only 8.6% still had symptoms of urgency and frequency of micturition, and the rest patients were well.Conclusion:The detrusors of the patients with BPH and OAB are impaired more seriously than the ones of patients with simple BPH, and the reduced level of detrusor contractibility is positively correlated with the decrease of urinary ATP. Urinary ATP quantification and urodynamic testing are significant to patients with BPH and OAB, which can be used as a marker of bladder function and have important reference to treatment options and prognosis. Drug treatment is good for the patients with BPH and OAB who have lesser obstruction, higher urinary ATP and less impaired detrusor, but simple surgical operation can not relieve the symptoms of OAB effectively.