Hypothesis / aims of study
Elderly men are liable to have bladder outlet obstruction (BOO) due to enlarged prostate (EP). Comorbidities like diabetes mellitus (DM), cerebral strokes (CS) and Parkinson’s disease (PD) are common at that age. Till now there is no sure method including the urodynamics that can predict the prognosis in patients with CS and PD after surgery. Some investigators do not feel that urodynamics provide information about prediction of surgical outcome. We aimed to investigate which comorbidity has a more deleterious effect on the lower urinary tract (LUT) that may guide us in selecting patients for surgery.
Study design, materials and methods
We reviewed the urodynamics of 173 male patients older than 60 years with BOO. Patients were classified into 5 groups. G1 (62 patients) without co-morbidity, G2 (45 patients) with DM, G3 (34 patients) with CS, G4 (19 patients) with DM plus CS and G5 (13 patients) with PD.
Interpretation of results
Detrusor overactivity were reported in the literature to occur in about 55% of patients with diabetic cystopathy, underactive bladder in 23%, Hyper-reflexic bladder in 10% and 11% had intermediate results. In G2, DO was observed in 62.2% and BCI <100 was observed in 42.2%. Both values were higher than reported values which may be due to the effect of aging and BOO besides DM.
In cerebrovascular accidents, small bladder capacity and DO are common after recovery of the shock stage. DO was reported in the literature to be present in 50% of the patients. In our study DO was noticed in 82.4% in G3 and 94.7% in G4 which is high than reported and may be due to association of BOO in both groups and DM in addition to BOO in G4.
There was no significant difference between G4 and G1. It is probably that the effects of DM (tendency to large capacity and normal or high compliance) counteract the effects of CS (tendency to small capacity and low compliance) regarding bladder storage function.
In PD, DO was reported in the publications in 36-81% and detrusor underactivity in 40-53% of patients. Bladder capacity and volume at first sensation are reduced. In our study, DO and BCI <100 were observed in 92.3% of our patients with PD.
G3 and G5 showed significant difference from G1, which is more in the storage function in G3 and in the emptying function in G5.