Elderly patients with bladder outlet obstruction and associated neurological comorbidities: Can urodynamics be of help in selecting patients for surgery.

Abulseoud A1, Ali G1

Research Type

Clinical

Abstract Category

Urodynamics

Abstract 170
Open Discussion ePosters
Scientific Open Discussion Session 7
Wednesday 29th August 2018
12:15 - 12:20 (ePoster Station 11)
Exhibition Hall
Bladder Outlet Obstruction Neuropathies: Central Neuropathies: Peripheral Surgery
1. Alexandria University
Presenter
A

Amr Abulseoud

Links

Abstract

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.
Results
All groups were similar regarding their mean age. On comparing each group with G1, G2 had significantly high volume at 1st sensation and cystometric capacity (p=0.027, p=0.005) while no significant difference with G4 (Table 1). G3 and G5 had significantly low cystometric capacity (p=0.003, p=0.037) (Table 1). Bladder compliance was significantly low in G3 (p=0.049) (Table 1). Voided volume was significantly low in G3 (p=0.001) and G5 (p=0.040) (Table 2). G5 had significantly low Pdet at Qmax (p=0.006), BCI (p= 0.039) and higher incidence of BCI <100 ( p=0.001) (Table 2).
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.
Concluding message
CS patients had poor storage function while PD patients had poor emptying function. We assume that CS patients with marked storage dysfunction are at high risk of urinary incontinence, while PD patients with marked emptying dysfunction are at high risk of retention and both may not be good candidates for surgery.
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Disclosures
Funding None Clinical Trial Yes Public Registry No RCT No Subjects Human Ethics Committee Alexandria University Helsinki Yes Informed Consent Yes
28/03/2024 06:47:18