The Long-term Outcome Of OAB Symptom Improvement In Patients With Benign Prostatic Obstruction After TURP

Objective:To investigate whether preoperative overactive bladder symptoms and urodynamic parameters affect the improvement of overactive bladder symptoms following transurethral resection of the prostate.Methods:A retrospective study was conducted in BPH patients with 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 age, IPSS, OABSS, QOL, PSA, prostate volume and full urodynamics. And these parameters were recorded after surgery3,6,12months. Statistical analysis was conducted among the different groups. The improvement of OAB symptoms was defined as a reduction of≥50% in the IPSS-S or the OABSS. The groups were divided according to the age、the presence and pattern of DO> the degree of BOO and the severity of OAB symptoms.Results:153patients completed the whole12months study, the mean age of all patients was70.8±7.5years. The average prostate volume was75.3±60.8ml. No matter the subtotal storage or obstructive symptom were significantly improved after TURP (P<0.001). The rate of overall OAB treatment success after surgery3、6、12months were respective IPSS-S(135/153、139/153、136/153)、 OABSS (125/153、136/153、142/153)In the results of preoperative urodynamics,42patients with DO, which were comprised of PDO22cases and TDO20cases. There was no significant difference in the preoperative subtotal storage symptom scores and OABSS between the presence and absence of DO. But three months later, men with preoperative DO had a significantly higher IPSS-S and OABSS than those without preoperative DO (P<0.05). The scores of PDO patients were significantly lower in IPSS-S and OABSS compared with TDO patients before and after the operation (P<0.01). The same situation was discovered between the Non-TDO and TDO groups. The rate of OAB treatment success after surgery3months showed the TDO group was lower than the Non-TDO group IPSS(121/133vs14/20), OABSS (114/133vsl1/20)(P<0.05).But the differences were disappeared after6and12months.There was no significant difference in IPSS-S and OABSS between mild obstruction (41) and severe obstruction (112) at preoperation or postoperation. Nor the detrusor weak group (51) with detrusor normal/strong group (102). But in IPSS-S, the rate of OAB treatment success in detrusor normal/strong group was higher than the detrusor weak group (though there was no significant difference).It was divided into three groups according to the severity of OAB symptoms,29cases in mild group,100cases in moderate group and24cases in severe group. In the comparison among the three groups, men with severe OAB symptoms preoperatively had a significantly higher IPSS-S and OABSS than those with mild and moderate OAB symptoms after operation (P<0.05). And the difference was still existed after surgery3months, it was disappeared after6and12months. The rate of OAB treatment success was no difference in three stages among groups.Multivariate analysis after TURP3months showed TDO (OR=0.17, P=0.02)、 DC (OR=5.77, P=0.01) had an independent prognostic impact on the outcome of OAB related symptoms in IPSS-S; meanwhile in OABSS, TDO (OR=0.20, P=0.002) had an independent prognostic impact on the outcome of OAB related symptoms.Conclusion:1.TURP is an effective method treating BPO, most patients have improvement in their symptoms. Patients with TDO have a more serious OAB symptoms both in preoperative and postoperative; TDO has an independent prognostic impact on the short-term outcome of OAB related symptoms, but no impact on long-term prognosis.2. There was no significant difference between the groups BOO severity and DC severity in preoperative and postoperative, but DC may have an independent prognostic impact on the outcome of OAB related symptoms.3. The patients with severe OAB symptoms have a reduced improvement than mild and moderate groups in short-term, but no difference in long-term.4. The patients with TDO and weak detrusor contractility may have a worse improvement in urgency in short-term.