Comparison Of Two Numerical Parameters To Assess Detrusor Contractility In Patients Receiving Transurethral Resection Of The Proatate

Objective: Through collecting the clinical and urodynamic data,and the efficacy parameters postoperatively among patients receiving TURP,we compared BCI(Bladder contractility index,BCI)and WFmax(maximum watts factor,WFmax)in diagnosing DU(Detrusor underactivity,DU)among these patients,and both on the impact of TURP efficacy.Analysis based above,the better parameter and its cutoff value with TURP efficacy were expected to find out and applied in clinical practice.Methods: A retrospective study was carried out in 241 benign prostatic hyperplasia(BPH)patients treated with TURP and with complete follow up data in hospitals(Affliated Hospital of Logistics University of Chinese People's Armed Police Forces,Second Hospital of Tianjin Medical University.)from January 2013 to October 2017.We recorded maximum cystometric capacity(MCC),maximum detrusor pressure invoiding(Pdetmax),bladder outletobstruction index(BOOI),detrusor contractility category in Lin PURR nomogram,BCI,WFmax.3months postoperatively,IPSS,IPSS-S,IPSS-V,Qo L,f Qmax and PVR were reassessed as subjecticve and objective efficacy parameters,respectively.Successful improvement was regarded as?50% improvement for IPSS,IPSS-S,IPSS-V;?3 scores reduction for Qo L,and ?5ml/s improvement for f Qmax.According to Lin PURR,patients in or below and above W+ were grouped to DU,and non-DU.By reference to Lin PURR,receiver operating characteristic curves(ROC)were plotted to find out the optimum values of BCI and WFmax in diagnosing DU.According to the values,patients were grouped to weak and strong BCI,weak and strong WFmax,respectively.Preoperative clinical and urodynamic parameters were compared between DU and no-DU,weak and strong BCI,weak and strong WFmax groups,respectively.At the optimum values we compared the accuracy and area under the ROC curves(AUC)between BCI and WFmax.The optimum values of BCI and WFmax in prognosing symptomatic improvement were obtained through ROC analysis and patients were divided to low and high BCI,low and high WFmax groups,respectively.The subjective and objective parameters postoperatively,and successful improvement rates were compared between low and high detrusor contractility groups.The prognostic accuracy and AUC were compared between the BCI and WFmax.Results: 1.By reference to Lin PURR nomogram,BCI and WFmax equaled to 103 and 10.5W/m2 respectively When the maximum diagnostic values obtained.There were 78,84,90 patients in DU,weak BCI,weak WFmax groups;and 163,157,151 patiens in strong detrusor contractility groups.There were no significant differences in preoperative IPSS,IPSS-S,IPSS-V,Qo L,PVR between DU and no-DU groups,weak and strong BCI groups,weak and strong WFmax groups,but significant differences in MCC,Pdetmax,Pdet Qmax,BOOI,BCI,WFmax.Significant differences were found in age and PV between DU and no-DU groups,PSA and f Qmax between weak and strong BCI groups,PV between weak and strong WFmax groups.2.By reference to Lin PURR,the accuracy of BCI and WFmax were 95.85% and 82.57%,and the AUC were 0.981 and 0.844,both with significant differences.3.The optimum values of BCI and WFmax in prognosing symptomatic outcome were 98.7 and 10.27W/m2.There were 78,71,86 patients in DU,low BCI,low WFmax groups;and 163,170,155 patiens in high detrusor contractility groups.Significant improvement were found in efficacy parameters of DU,low BCI and low WFmax groups,while the postoperative improvement degrees and successful improvement rates were significantly less than high detrusror contractility groups.4.The accuracy of BCI and WFmax in predicting successful and unsuccessful improvement of IPSS were 74.27% and 71.37%,respectively;while the AUC were 0.716 and 0.750,with no significant differences.Conclusion: There were no significant differences in LUTS and f Qmax between DU and no-DU patients with BPH,and it is hard to distinguish them without urodynamics.Both BCI and WFmax had highly signicant associations with Lin PURR,but the former more highly than the latter.To some extent,both methods could predict the TURP efficacy and had equivalent value in prognosing symptomatic outcome.10.27W/m2 perhaps could be a threshold value for DU;and for BCI,the current threshold value is appropriate to diagnose DU.In view of the comparability and convenience,BCI is more appropriate in clinical practice.