MP89-18 TURP/KTPLAP: AN EFFECTIVE TREATMENT FOR MEN WITH DETRUSOR UNDERACTIVITY (DU) & BLADDER OUTLET OBSTRUCTION (BOO)

Abstract

INTRODUCTION AND OBJECTIVES: In this study, we report outcomes of men with detrusor underactivity (DU) & bladder outlet obstruction (BOO) treated with KTP laser ablation (KTPLAP) or transurethral resection of the prostate (TURP). METHODS: This is a retrospective study of consecutive patients with DU (defined by a bladder contractility index (BCI) < 100) who underwent KTPLAP or TURP because of presumed BOO (PBOO). Presumed BOO was diagnosed when the product of detrusor contraction time and a Qavg of 12 mL/S was bladder capacity. The rationale for this is that if the bladder contracted long enough to empty at a normal flow, reducing outlet resistance by surgery would improve voiding dynamics; ie, there is a relative BOO. Men with DU & PBOO were compared with a matched cohort of those with BOO only. A subset analysis was also performed of patients with DU due to an acontractile bladder comparing those with and without the ability to void during clean intermittent catheterization (CIC) regimen. Pre and post-operative urodynamic parameters were measured along with need for CIC. The primary outcome measure was the Patient Global Impression of Improvement (PG-II). Success was defined as a PG-II score of 1-3. Comparisons were made using a two-sided t-test. RESULTS: The results of outlet reducing surgery are equal with respect to both subjective and objective outcomes in men with DU & PBOO and BOO. However, only 1/8 patients with an acontractile detrusor had a successful outcome, independent of whether they were able to void spontaneously while on preoperative CIC. See tables 1 and 2 for complete comparison of data. CONCLUSIONS: TURP or KTPLAP area equally effective in men with BOO and those with detrusor underactivity and presumed BOO. However, an acontractile detrusor is a poor prognostic sign.