Effect Of DU On The Efficacy Of TURP In Patients With BPH Under Different Degrees Of Bladder Outlet Obstruction

Objective: Through study the subjective and objective evalution indicators of benign prostatic hyperplasia(BPH)patients before and after operation,to investigate the effect of detrusor underactivity(DU)on the outcomes of transurethral resection on prostate(TURP)in BPH patients with different degrees,so as to enhance the the understanding on DU and guide the selection of treatment methods and improve the quality of life of patients with DU.Methods: A retrospective study was conducted in 369 patients with benign prostatic hyperplasia who underwent surgical treatment between January of 2013 and September of 2018.All patients with complete follow up data in hospitals(Second Hospital of Tianjin Medical University and Characteristic Medical Center of Chinese People's Armed Police Forces).Urinary flow rate and imaging examination were performed in all patients before surgery,and f Qmax and PVR were recorded.All patients underwent urodynamic study before surgery,and BCI and BOOI were recorded.And all patients had completed the international prostate symptom score(IPSS)and quality of life questionnaires before surgery.The patients were divided into two groups according to BCI.The DU group was defined BCI<100.And the non-DU group was defined BCI?100.According to BOOI,the patients were divided into three groups: BOOI <20 group,20?BOOI <40 group and BOOI?40group.IPSS,IPSS-S,IPSS-V and f Qmax,PVR were used as subjective and objective evaluation indicators to evaluate the surgical effect.Successful improvement was regarded as?50% improvement for IPSS,IPSS-S,IPSS-V;?3 scores reduction for QOL,and ?5ml/s improvement for f Qmax.Receiver operating characteristic(ROC)curves was used to calculate the optimal cut-off point of DU in different bladder outlet obstruction groups.According the optimal cut-off point,DU patients were categorized into mild DU and severe DU group in different bladder outlet obstruction groups,and the improvement of subjective and objective indexes was compared between the mild DU and severe DU group.Results:1.According to BCI < 100 as the diagnostic criteria of DU,there were 150 patients in DU group and 219 patients in non-DU group.There were significant differences in PV,f Qmax,Pdet Qmax,Pdetmax,MCC,BCI,BOOI and PVR between the two groups(P < 0.05).According to BOOI,the patients were divided into three groups: BOOI < 20 group(n = 19),20 ? BOOI < 40 group(n = 57)and BOOI ?40 group(n = 293).There were significant differences in PV,f Qmax,Pdet Qmax,Pdetmax,MCC,BCI,BOOI and PVR among the three groups(P < 0.05).2.There were significant differences in IPSS,IPSS-S,IPSS-V,QOL,f Qmax and PVR between BOOI < 20 group,20 ? BOOI < 40 group and BOOI ? 40 group after TURP(P < 0.05).There were significant differences in IPSS,IPSS-S,IPSS-V,QOL and f Qmax among the three groups except f Qmax(P < 0.05).There were significant differences in the success rates of IPSS,IPSS-S,IPSS-V,QOL and f Qmax among the three groups(P < 0.05).3.In BOOI < 20 group,there were significant differences in the success rates of IPSS,IPSS-S,IPSS-V,QOL and f Qmax between DU group(n = 14)and non-DU group(n= 5)(p < 0.05).In 20 ? BOOI < 40 group,there were significant differences in the success rates of IPSS,IPSS-S,IPSS-V,QOL and f Qmax between DU group(n = 46)and non-DU group(n = 11)(p < 0.05).In BOOI ? 40 group,there were significant differences in the success rate of IPSS,IPSS-S,IPSS-V,QOL and f Qmax between DU group(n = 90)and non-DU group(n = 203)(p < 0.05).4.In BOOI < 20 group,DU patients were divided into two groups with preoperative BCI equal to 63 as the optimal cut-off point.There were significant differences in the success rates of IPSS between the mild DU group(n = 8)and the severe DU group(n= 6)(P < 0.05).In 20 ? BOOI < 40 group,DU patients were divided into two groups with preoperative BCI equal to 76 as the optimal cut-off point.There were significant differences in the success rate of IPSS and IPSS-V between the mild DU group(n = 19)and the severe DU group(n = 27)(P < 0.05).In BOOI ? 40 group,DU patients were divided into two groups with preoperative BCI equal to 82 as the optimal cut-off point.There were significant differences in the success rate of IPSS,IPSS-V and f Qmax between the mild DU group(57 cases)and the severe DU group(33 cases)(P < 0.05).Conclusion: 1.Patients with different degrees of bladder outlet obstruction can benefit from TURP surgery.However,DU patients with BOOI<20 group had lower success rate after operation,so TURP surgery may have limited benefit.Because the number of patients in BOOI < 20 group is small and there may be bias,it is necessary to increase the sample size in future studies to draw reliable conclusions.2.The improvement of TURP in DU patients under different degrees of bladder outlet obstruction were worse than that in non-DU patients.3.The severity of DU under different bladder outlet obstructions has different effects on the efficacy of TURP.The success rate of postoperative in patients with BOOI<40 combined with severe DU is not high.Therefore,adequate communication with patients with BOOI < 40 combined with severe DU before TURP is necessary to clearly inform patients of surgical expectations.