Abstract
ObjectiveTo analyze the underlying lower urinary tract dysfunctions by video-urodynamic studies in men who have persistent storage symptoms after initial drug therapy for lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).MethodsThe medical records of 614 men ≥40 years of age with LUTS and an International Prostate Symptom Score of ≥8 were retrospectively analyzed. All patients had persistent storage symptoms after medical treatment for at least 6 months. A video-urodynamic study was done to investigate the underlying bladder or bladder outlet dysfunction. Predictors of bladder outlet obstruction (BOO) by baseline urine flow metrics and prostate parameters were investigated.ResultsThe final results revealed bladder neck dysfunction (BND) in 137/614 (22.3%), benign prostatic obstruction (BPO) in 246/614 (40.1%), detrusor overactivity (DO) in 193/614 (31.4%), and DO with detrusor underactivity (DO+DU) in 38/614 (6.2%) patients. Among the patients, 221/281 (78.6%) with a total prostatic volume (TPV) ≥40 ml had BOO, including 43/281 (15.3%) with BND and 178/281 (63.3%) with BPO. If we combined TPV ≥40 ml and Qmax <12 ml/s as predictors of BOO, BOO was found in 176/215 (81.8%) patients including 34/215 (15.8%) with BND and 142/215 (66.0%) with BPO. BOO was also found in 48.8% of men with a TPV <40ml, and in 36.3% of men with TPV< 40 ml and Qmax ≥ 12 ml/s. In 102 men with TPV <40 ml and Qmax ≥12 ml/s, 64 (62.7%) had DO.ConclusionBOO, including BND and BPO, comprise 62.4% (383/614) of men with persistent storage symptoms after initial medical treatment for LUTS/BPH. In men who have persistent storage symptoms after medical treatment for LUTS/BPH, BOO should be carefully investigated and appropriate management being given to improve LUTS.
Highlights
Lower urinary tract symptoms (LUTS) are highly prevalent in aged men [1]
If we combined total prostate volume (TPV) !40 ml and Qmax
The initial medical treatment with a combination of an alpha-blocker and an antimuscarinic or beta-3 adrenoceptor agonist has been recommended in treating men with LUTS suggestive of benign prostatic hyperplasia (LUTS/ BPH) with predominantly storage symptoms [6,7]
Summary
AUA and EAU guidelines recommend to treat LUTS in men with an alpha-blocker alone or in combination with an alpha-reductase inhibitor when the total prostate volume (TPV) is greater than 30–40 mL [2,3]. About three-quarters of men with symptomatic bladder outlet obstruction (BOO) have LUTS improved with alpha-blocker monotherapy. The residual storage LUTS after alpha-blocker treatment is usually attributable to bladder dysfunction such as detrusor overactivity (DO) and an antimuscarinic is advised to add [2,4]. The initial medical treatment with a combination of an alpha-blocker and an antimuscarinic or beta-3 adrenoceptor agonist has been recommended in treating men with LUTS suggestive of benign prostatic hyperplasia (LUTS/ BPH) with predominantly storage symptoms [6,7]. It is likely that storage symptoms may exist primarily or secondarily to BPH or BOO; combined treatment is beneficial and can relieve LUTS after the initial medical treatment [4,8]
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