The role of urodynamics study in prediction of short term outcome of prostatectomy in patients with chronic urinary retention

Abstract

Benign prostatic enlargement or BPE is a common condition to the extent that at the age of 55, approximately 25% of men report obstructive voiding symptoms. At the age of 75, 50 % of men complain of decreased force and caliber of their urinary stream, long standing outflow obstruction predispose to hypocontractile bladder and subsequently CUR, ICS defines DU as "a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span. DU was present in 28% of men <50 years of age increasing up to 48% in men >70 years of age. Chronic urinary retention was defined as the persistent inability to completely evacuate the bladder despite maintaining the ability to void, raising PVR. PVRU value required to diagnose CUR is debated, but most research settings suggested the value of 300 ml as the minimum volume required to diagnose CUR. Review of the literature showed diverse recommendations about the value of preoperative UDS in patients with chronic urinary retention, papers either recommend, recommend with restrictions or doesn’t recommend at all. Sample of 30 patients were included in our study diagnosed with BPE and complicated with chronic urinary retention were evaluated by preoperative UDS,underwent prostatectomy by either (TURP, transvesical approach or laser prostatetctomy), then patients had postoperative symptoms assessment, PVRU and uroflowmetry. We also assessed the predictive value of multiple parameters such as age, duration of the complaint, recurrent attacks of AUR, chronic indwelling catheter, diabetes mellitus (DM), maturation symptoms (as quantified by the IPSS, QOLI), PVR measured in(cm³) and prostate size. Preoperative UDS results were correlated with postoperative results whether success or failure according to four parameters (IPSS, QOLI, PVRU and Q-max), aiming to define certain UDS criteria upon which we can rely to properly select patients with favorable postoperative outcome and warn those expected to have postoperative complications or failure. According to our study we have found that normal bladder sensitivity, average compliance, obstructed patients according to AG and LinPURRnomogramswere strong predictor of operative success in patients with chronic urinary retention. We have to say that there were few obstacles which may limit the application of our results, for example short postoperative follow up duration, small sample size and multiple prostatectomy techniques done by more than one surgeon. So we recommend for further studies to have larger sample size, longer duration for postoperative follow up, using single prostatectomy technique done by only one surgeon.