Clinical Characteristics And Outcomes After TURP For Detrusor Underactivity In Benign Prostatic Obstruction Men

Objective: To analyze differences in clinical factors and urine dynamics parameters between benign prostatic obstruction combined with detrusor underactivity and those without DU, and, to explore the efficiency of TURP for them.Methods: A retrospective study was conducted in 110 cases of BPO patients confirmed by urodynamic examination in our hospital from February 2013 to December 2014, and the clinical parameters of all cases had been recorded in date base, including International Prostate Symptom Score(IPSS), Quality of Life(QOL) scores(QOL question of the IPSS) and Overactive Bladder Symptom Score(OABSS) questionnaires and the outcomes of Urine dynamics examination, free urine flow rate and residual urine. Then, a follow-up was conducted after 3 mouth since TURP in items including above questionnaires, free urine flow rate and PVR. BCI is determined by the formula Pdet Qmax +5Qmax, DU is a BCI of less than 100. An analysis between DU and non-DU groups was undergone to explore the characteristics of DU; another research on efficiency of TURP treatment for BPO combined with DU was conducted by comparison of follow-ups at same time.Results: A total of 110 patients with complete clinical data were included in this study. In univariate analysis, men with DU were significantly less obstructed, had less prostates volume and lower serum PSA. Age had no correlation with bladder contractility index(BCI), maximum Watt factor(WFmax) and detrusor contractility(DC). Meanwhile, neither IPSS nor OABSS, including the subscores in these two questionnaires, had a difference between DU and non-DU groups.In urodynamic examination, men with DU had significantly less BOO grade(from Lin PURR), larger MCC and urgency urinate capacity, had less maximum pressure and lower flow rate. BOO grade had a positive correlation with bladder detrusor capacity items. Multivariate analysis showed that WFmax and DC subgroup were independently associated with DU. ROC curve analysis demonstrated WFmax less than 11 and DC W + or less had a better sensitivity and specificity when BCI < 10 was made for golden diagnostic standard of DU.All patients had a significant improvement in IPSS,irritative and obstructive IPSSsubscores, QOL and OABSS. Whereas, patients with DU had a less alleviation rate for IPSS、irritative and obstructive IPSS subscores and QOL in comparison with those without DU.A analyses for symptomatic alleviation rate(with an improvement of good or very good) according to different BOO grades from Lin PURR scale and different BCI groups(BCI:82-100,BCI:<82) was conducted. The alleviation rate of IPSS and obstructive IPSS subscores from BCI:82-100 group were significantly higher than BCI less than 82, totally or only when BOO grade was mild(Ⅱ、Ⅲ)。Furthermore, different BOO groups all had a good alleviation rate of IPSS and QOL whatever BCI was.TURP could obviously improve Qmax and Qave of whom had non DU.Conclusion:1. DU is not independently associated with age in BPO men. 2. Detrusor contraction power parameters rise with increasing bladder outlet obstruction grade in BPO men. 3. Neither IPSS nor OABSS scores, including the subscores in those questionnaires, had a difference between cases with BPO alone and those with DU. 4. TURP can achieve a good efficiency in symptomatic alleviation and objective indicators(Qmax and PVR) in BPO patients with DU or not. Patients with DU had a less alleviation rate for IPSS, irritative and obstructive subscores and QOL scores compared with non-DU. TURP could obviously improve Qmax and Qave of whom had no DU. 5. The alleviation rate of IPSS and obstructive IPSS subscores from BCI:82-100 group were significantly higher than BCI less than 82 when BOO grade was mild(Ⅱ、Ⅲ).