Prognosis Of Bladder Outlet Obstruction With Detrusor Underactivity After Surgery

Objective: To explore the efficacy of surgical treatment for patients with BOO and DU induced by prostate hyperplasia and the risk factors affecting prognosis.We screened the commonly used clinical data in elder LUTS patients,taking the invasive pressure-flow study measurement as the “gold standard” for diagnosis,analyzing these clinical data with statistical methods,so as to provide valuable evidence for clinical.Patients and methods: In this study,we retrospectively analyzed the the clinical data(age,history of hypertension,diabetes,smoking,drinking,lumbar injury,creatinine,urea,fPSA,tPSA,fPSA/tPSA,prostate volume,etc.)of 147 BPH patients diagnosed in the first affiliated hospital of Dalian Medical University,from July 2017 to November 2018.We used international prostate symptom scale(IPSS),quality of life score(QOL)as the questionnaire,and recorded the preoperative IPSS,QOL score,urodynamic results,1 month and 3 months IPSS and QOL score after surgery.(1)To reveal the clinical characteristics,risk factors and urodynamic characteristics of DU by comparing the preoperative clinical data and urodynamic results between DU(-)group and DU(+)group.(2)To investigate the effect of TURP on the prognosis of BOO patients with DU by comparing the preoperative,postoperative IPSS and QOL scores between DU(-)group and DU(+)group.(3)To analyze whether the factors(smoking,drinking,hypertension,diabetes,whether or not the prostate protrude into bladder cavity,and different degrees of bladder outlet obstruction)would affect the prognosis of DU patients by comparing the postoperative IPSS and QOL scores of patients in the DU(+)group.Results: There were no significant differences in creatinine,urea,fPSA,tPSA,fPSA/tPSA and prostate volume between DU(-)and DU(+)group before surgery,and no significant differences in smoking,drinking,hypertension,diabetes.In DU(+)patients,Qmax,bladder emptying rate and Pdet@Qmax decreased,while age,PVR and bladder volume increased.The comparison of IPSS and QOL scores of the patients before and 1 month and 3 months after surgery showed that both the DU(-)group(p<0.001)and the DU(+)group(p<0.001)were significantly improved compared with the clinical data before surgery.One month after surgery,IPSS score of patients in the DU(-)group was significantly improved compared with that in the DU(+)group(p<0.001),and VW group in the DU(+)group was significantly different from that in the W+ and W-groups(p=0.04).Three months after surgery,there was no significant difference in IPSS score(p=0.054)and QOL score(p=0.055)between the DU(-)group and the DU(+)group,and there was no significant difference within the DU(+)group(p=0.085).There was no significant difference in IPSS and QOL between the DU(+)patients(smoking,drinking,hypertension,diabetes,whether or not the prostate protrude into bladder cavity,and different degrees of obstruction).Conclusion: Whether BOO patients are combined with DU or not,the postoperative symptoms of BOO patients are significantly improved compared with those before surgery.For patients with BOO combined with DU,TURP is still a feasible treatment method,while for patients with severe detrusor dysfunction,surgical treatment should be carefully considered.