Do high residual volumes predict successful outcomes after Transurethral Resection of Prostate for Chronic Urinary Retention?

Sinha A1, Thakare N1, El Sheikh S1, Singh P1, Mishra V1

Research Type

Clinical

Abstract Category

Male Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 559
E-Poster 3
Scientific Open Discussion Session 31
Friday 6th September 2019
13:40 - 13:45 (ePoster Station 1)
Exhibition Hall
Voiding Dysfunction Bladder Outlet Obstruction Surgery Male Underactive Bladder
1.Royal Free London NHS Foundation Trust
Presenter
V

Vibhash Mishra

Links

Poster

Abstract

Hypothesis / aims of study
ICS defines Chronic Urinary Retention (CUR) as non-painful bladder, where there is a chronic high Post-Void Residual (PVR). There are no strict criteria for high PVR. Although some investigators consider >300-400 mls as a high residual, the definition of high PVR is subjective. Moreover, there is a lack of clear guidelines on the management of CUR resulting in an inconsistency in the approach towards offering bladder outflow surgery to these patients. It is postulated that high residual volumes with weak detrusor function result in poor surgical outcomes. Pre-operative utilisation of urodynamic studies (UDS) is also variable among clinicians ranging from strict adherence to complete omission. The aim of this retrospective electronic patient record (EPR) based study was to evaluate a correlation between high post-void bladder residuals and successful voiding after Transurethral resection of prostate (TURP) in patients with chronic urinary retention (CUR).
Study design, materials and methods
A database of all patients having undergone TURP in our hospital between March 2012 and December 2018 was obtained from the histopathology department. Their EPRs were studied to identify patients with CUR defined as any combination of enlarged non-painful bladder along with large residual volume on initial catheterisation, impaired renal function and upper tract dilatation on radiological imaging. Data on basic demographics, relevant comorbidities, residual volumes, pre-operative UDS and surgical outcomes were extracted. A successful outcome was defined as complete freedom from catheter. Based on this defintion, the dataset was divided into two groups - ‘success’ and ‘failure’. Statistical analysis was carried out using SPSS software to obtain the results.
Results
Out of a total of 685 patients who underwent TURP, 93 men with a mean age of 73 years (range = 51 - 95 years) were identified to have a pre-operative diagnosis of CUR. Forty-nine (52.6%) of these got rid of their catheters while 44 continued to use it post-operatively in some form or the other. The mean age of those with a successful outcome was 70 years while the mean of those with an unsuccessful outcome was 75 years. This difference was statistically significant (p-value < 0.05). The mean residual volumes in the ‘success’ and ‘failure’ groups were 1.4 L (range = 0.6 L– 4 L) and 1.2 L (range = 0.4 L – 3 L) respectively and the difference was not statistically significant. The outcomes of those with PVR =>1.5 L were no different from those with PVR <1.5 L. Pre-operative UDS was carried out on 46 of the 93 patients. Of these, 40 (87%) were found to have urodynamic bladder outflow obstruction (BOO) while the other 6 had detrusor hypocontractility. Twenty nine of 46 (63%) patients in the UDS group had successful outcomes while 17 (37%) including 14 with proven BOO continued to use catheters. Post-operative UDS was not carried out in this group to rule out persistent BOO. Of the 47 who did not have pre-operative UDS, 15 (32%) had a successful outcome. With regards to relevant co-morbidities contributing to poor outcomes, the ‘success’ and ‘failure’ groups were not statistically different (Chi-square test; p-value > 0.05).
Interpretation of results
Our results indicate that age has a bearing on predicting outcomes of TURP for CUR, whilst post-void residual volumes and comorbidities do not have any such correlation. One of the reasons for initial failure of outflow surgery could be incomplete relief of obstruction. Routine use of pre-operative Urodynamics could have resulted in avoidance of TURP. Among those who did not have pre-operative UDS only one-third of patients had a successful outcome.
Concluding message
Within the limitations of a small retrospective study, we can say that outcomes of TURP in patients with CUR are not dependent on residual volume and co-morbidities. Pre-operative Urodynamics should be used routinely to select patients for surgery. In those with unsuccessful outcomes from surgery, post-operative UDS should be carried out to exclude persistent obstruction.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics not Req'd Retrospective Data collection Helsinki Yes Informed Consent No
28/03/2024 10:02:49