MP74-15 BLADDER OUTLET PROCEDURES ARE AN EFFECTIVE TREATMENT OPTION FOR PATIENTS WITH URODYNAMICALLY-CONFIRMED DETRUSOR UNDERACTIVITY WITHOUT BLADDER OUTLET OBSTRUCTION

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I1 Apr 2016MP74-15 BLADDER OUTLET PROCEDURES ARE AN EFFECTIVE TREATMENT OPTION FOR PATIENTS WITH URODYNAMICALLY-CONFIRMED DETRUSOR UNDERACTIVITY WITHOUT BLADDER OUTLET OBSTRUCTION Bradley Potts, Michael Belsante, Andrew Peterson, and Ngoc-Bich Le Bradley PottsBradley Potts More articles by this author , Michael BelsanteMichael Belsante More articles by this author , Andrew PetersonAndrew Peterson More articles by this author , and Ngoc-Bich LeNgoc-Bich Le More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1712AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detrusor underactivity (DU) is an important cause of bladder emptying dysfunction, and it is only distinguished from bladder outlet obstruction (BOO) with pressure-flow urodynamic studies (UDS). Because sparse published information exists regarding the management of DU patients without associated BOO, we set out to investigate the surgical procedures that have been used for such patients and their associated outcomes. METHODS We performed an IRB approved retrospective review of patients who underwent UDS at our institution (1996-2014). We included males age >18 years with emptying symptoms, bladder contractility index <100, and BOO index <40. We excluded the following known causes of DU: concomitant BOO on UDS, diabetes, pelvic radiation, and neuropathology (stroke, congenital/degenerative disease, trauma/surgery). We defined success as no future retention or symptoms requiring urinary catheterization/subsequent operations. RESULTS We identified 139 patients with median follow-up (FU) of 10 mos. (IQR = 1-36) after UDS diagnosis. Most patients were managed with either medication alone (37%) or urinary catheterization +/- medication (30%). Only 21 patients (15%) received bladder outlet surgery (14 TURPs, 6 KTPLAPs, and 1 bladder-neck incision). Types of DU in this group included detrusor hyperactivity with impaired contractility (10, 48%), isolated DU (6, 29%), and acontractile bladder (AB) (5, 24%). Success was achieved in 18 (86%) of patients undergoing bladder outlet procedures with postoperative FU of 6 mos. (IQR = 1-18). Failure occurred in 3 cases: 1) an isolated DU patient with UTI and retention 10 days postop; 2) an AB patient with UTI and retention 15 days postop; and 3) an isolated DU patient with fecal impaction and retention 3 mos. postoperatively. In the latter 2 cases, patients resumed volitional voiding without further difficulty. Using the same methods, we also identified 5 patients with DU who then had radical prostatectomy for prostate cancer. In this group, success occurred in all 5 (100%) cases with FU 45 mos. (IQR = 6-81). CONCLUSIONS Though infrequently used, bladder outlet procedures are an effective treatment option for patients with UDS-diagnosed DU without BOO. We recommend considering the procedure in all patients with medication-refractory DU. Our post-prostatectomy results may be considered when discussing treatment options with prostate cancer patients who also have DU. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e975 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Bradley Potts More articles by this author Michael Belsante More articles by this author Andrew Peterson More articles by this author Ngoc-Bich Le More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...