Evaluation and Management of Lower Urinary Tract Symptoms After Outlet Surgery for Benign Prostatic Hyperplasia

Overview

Journal Curr Bladder Dysfunct Rep

Publisher Springer

Date 2020 May 5

PMID 32362986

Citations 3

Authors

Nirmish Singla

Ajay K Singla

Affiliations

Soon will be listed here.

Abstract

There are many options available in the surgical treatment of outlet obstruction secondary to benign prostatic hyperplasia (BPH). While most patients exhibit improvement in their lower urinary tract symptoms (LUTS) following intervention, up to 35 % of patients may exhibit persistent or recurrent LUTS. In the present review, we discuss the patho-physiology of LUTS after bladder outlet surgery and discuss considerations in evaluating and managing such patients. We highlight the crucial role of thorough evaluation with complete urodynamics testing, as pure obstruction only accounts for a minority of post-operative LUTS. Hence, detrusor contractility, detrusor overactivity, urethral sphincter function, and urinary incontinence must be assessed to appropriately guide subsequent therapy and improve patients' quality of life.

Citing Articles

Review of simultaneous treatment with intradetrusor onabotulinumtoxinA injections during transurethral prostate surgery for men with bladder outlet obstruction and overactive bladder.

Hsu C, Young W, Wu S Tzu Chi Med J. 2025; 37(1):42-48.

PMID: 39850386 PMC: 11753517. DOI: 10.4103/tcmj.tcmj_180_24.

Risk factors associated with the severity of overactive bladder among Syrian patients with type 2 diabetes.

Khadour F, Khadour Y, Alhatem W, Barroush D Sci Rep. 2024; 14(1):16547.

PMID: 39020001 PMC: 11255225. DOI: 10.1038/s41598-024-67326-w.

Treating overactive bladder symptoms after transurethral prostatic surgery for benign prostatic hyperplasia - Which medication to choose?.

Lee C, Kuo H Tzu Chi Med J. 2023; 35(4):312-316.

PMID: 38035054 PMC: 10683516. DOI: 10.4103/tcmj.tcmj_123_23.

The relationship between bladder storage function and frequent micturition after TURP.

Wang J, Yang B, Zhang W, Sun S, Wang J, Zhang Y World J Urol. 2022; 40(8):2055-2062.

PMID: 35778576 DOI: 10.1007/s00345-022-04079-z.

References

Steers W, Ciambotti J, Etzel B, Erdman S, de Groat W . Alterations in afferent pathways from the urinary bladder of the rat in response to partial urethral obstruction. J Comp Neurol. 1991; 310(3):401-10. DOI: 10.1002/cne.903100309. View

Serretta V, Morgia G, Fondacaro L, Curto G, Lo Bianco A, Pirritano D . Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions. Urology. 2002; 60(4):623-7. DOI: 10.1016/s0090-4295(02)01860-5. View

Kageyama S, Watanabe T, Kurita Y, Ushiyama T, Suzuki K, Fujita K . Can persisting detrusor hyperreflexia be predicted after transurethral prostatectomy for benign prostatic hypertrophy?. Neurourol Urodyn. 2000; 19(3):233-40. DOI: 10.1002/(sici)1520-6777(2000)19:3<233::aid-nau4>3.0.co;2-m. View

Kuo H . Analysis of the pathophysiology of lower urinary tract symptoms in patients after prostatectomy. Urol Int. 2002; 68(2):99-104. DOI: 10.1159/000048427. View

Elmansy H, Kotb A, Elhilali M . Is there a way to predict stress urinary incontinence after holmium laser enucleation of the prostate?. J Urol. 2011; 186(5):1977-81. DOI: 10.1016/j.juro.2011.06.063. View

Wei J, Calhoun E, Jacobsen S . Urologic diseases in america project: benign prostatic hyperplasia. J Urol. 2008; 179(5 Suppl):S75-80. PMC: 11160437. DOI: 10.1016/j.juro.2008.03.141. View

Nitti V, Kim Y, Combs A . Voiding dysfunction following transurethral resection of the prostate: symptoms and urodynamic findings. J Urol. 1997; 157(2):600-3. View

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U . The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003; 61(1):37-49. DOI: 10.1016/s0090-4295(02)02243-4. View

Gormley E, Lightner D, Faraday M, Vasavada S . Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015; 193(5):1572-80. DOI: 10.1016/j.juro.2015.01.087. View

10.

Machino R, Kakizaki H, Ameda K, Shibata T, Tanaka H, Matsuura S . Detrusor instability with equivocal obstruction: A predictor of unfavorable symptomatic outcomes after transurethral prostatectomy. Neurourol Urodyn. 2002; 21(5):444-9. DOI: 10.1002/nau.10057. View

11.

Han H, Ko W, Yoo T, Oh T, Kim D, Kwon D . Factors associated with continuing medical therapy after transurethral resection of prostate. Urology. 2014; 84(3):675-80. DOI: 10.1016/j.urology.2014.04.027. View

12.

Bruskewitz R, Larsen E, Madsen P, Dorflinger T . 3-year followup of urinary symptoms after transurethral resection of the prostate. J Urol. 1986; 136(3):613-5. DOI: 10.1016/s0022-5347(17)44991-3. View

13.

Speakman M, Brading A, Gilpin C, Dixon J, Gilpin S, Gosling J . Bladder outflow obstruction--a cause of denervation supersensitivity. J Urol. 1987; 138(6):1461-6. DOI: 10.1016/s0022-5347(17)43675-5. View

14.

Madersbacher S, Marberger M . Is transurethral resection of the prostate still justified?. BJU Int. 1999; 83(3):227-37. DOI: 10.1046/j.1464-410x.1999.00908.x. View

15.

Javle P, Jenkins S, West C, Parsons K . Quantification of voiding dysfunction in patients awaiting transurethral prostatectomy. J Urol. 1996; 156(3):1014-8; discussion 1018-9. View

16.

Boyle P, Robertson C, Mazzetta C, KEECH M, Hobbs F, Fourcade R . The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study. BJU Int. 2003; 92(4):409-14. DOI: 10.1046/j.1464-410x.2003.04369.x. View

17.

Seaman E, Jacobs B, Blaivas J, Kaplan S . Persistence or recurrence of symptoms after transurethral resection of the prostate: a urodynamic assessment. J Urol. 1994; 152(3):935-7. DOI: 10.1016/s0022-5347(17)32614-9. View

18.

Tkocz M, Prajsner A . Comparison of long-term results of transurethral incision of the prostate with transurethral resection of the prostate, in patients with benign prostatic hypertrophy. Neurourol Urodyn. 2002; 21(2):112-6. DOI: 10.1002/nau.10013. View

19.

Abrams P, Farrar D, Turner-Warwick R, Whiteside C, Feneley R . The results of prostatectomy: a symptomatic and urodynamic analysis of 152 patients. J Urol. 1979; 121(5):640-2. DOI: 10.1016/s0022-5347(17)56918-9. View

20.

Abrams P . Investigation of postprostatectomy problems. Urology. 1980; 15(2):209-12. DOI: 10.1016/0090-4295(80)90424-0. View