Effectiveness of treatment of detrusor over activity after transuretral resection of benign prostate hyperplasia

Abstract

BACKGROUND: In a significant number of patients with benign prostatic hyperplasia who underwent transurethral resection (TURP), micturition disorders are detected in the late postoperative period. The issues of drug treatment of overactive bladder are widely covered in the literature and clinical guidelines. However, the number of studies on the treatment of patients with detrusor overactivity after TURP is relatively small.
 AIM: The aim of the study is to increase the effectiveness of treatment of patients with detrusor overactivity after TURP in the late postoperative period.
 MATERIALS AND METHODS: We treated 51 patients with urodynamically confirmed detrusor overactivity after TURP aged 56 to 87 years (mean 71.5 8.4 years). Taking into account the comorbid background, concomitant therapy, age characteristics and the presence of contraindications, 8 patients were prescribed solifenacin, 9 trospium chloride, 34 mirabegron. Appointment of anticholinergic therapy for 1 month in 7 patients was ineffective, they were prescribed mirabegron. Drug treatment lasted 3 months. With insufficient effectiveness of drug therapy, combined treatment with mirabegron was performed in combination with extracorporeal magnetic stimulation (ECMS) for 1 month (12 sessions of ECMS in total). When the combination of ECMS and mirabegron was ineffective, intravesical botulinum therapy was performed. The effectiveness of treatment was assessed by subjective assessment by patients, the results of patients filling out IPSS questionnaires, urination diaries, ultrasound results and uroflowmetry.
 RESULTS: After the end of drug therapy 17 (33.3%) patients subjectively rated the result of treatment as excellent, 15 (29.4%) patients as good. In 19 (37.3%) patients the effectiveness of drug therapy was regarded as insufficient and they underwent combined therapy with mirabegron and ECMS. As a successful combination therapy was recognized in 10 (52.6%) patients. Botulinum therapy was performed in 6 patients with ineffectiveness of the previous stages of treatment with a positive effect in 5 (83.3%) of them. Tolerability of treatment was satisfactory. Based on the results of the study, an algorithm for the treatment of detrusor overactivity in patients with urination disorders in the late postoperative period after TURP was proposed.
 CONCLUSIONS: The applied treatment regimen for patients with detrusor overactivity after TURP is effective and can be recommended for use in clinical practice.