Treatment outcome of patients with CNS disorders and voiding dysfunction after bladder outlet surgery (TUIP, TURP, TUIBN)

Chang T1, Chen S1, Lee C1, Jhang J1, Jiang Y1, Kuo H1

Research Type

Clinical

Abstract Category

Male Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 406
Male Voiding Dysfunction and LUTS 2
Scientific Podium Short Oral Session 26
Friday 20th November 2020
15:37 - 15:45
Pavilion 9
Neuropathies: Central Surgery Outcomes Research Methods
1. Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
Presenter
T

Tien-Lin Chang

Links

Abstract

Hypothesis / aims of study
CNS lesions have an impact on micturition, typically result in involuntary bladder contractions with coordinated sphincter function. Sensation and voluntary striated sphincter function are usually preserved, but sensation may be deficient or delayed. Urinary incontinence may occur owing to the detrusor overactivity. Bladder outlet surgeries are treatment options for voiding dysfunction secondary to bladder outlet obstruction or bladder neck dysfunction. However, LUTS may persist after these surgeries. This study focused on the therapeutic outcomes of patient with CNS lesion and voiding dysfunction who received bladder outlet surgeries and identified the predictor of satisfactory outcomes.
Study design, materials and methods
This study is a single-center, retrospective review of VUDS database and chart review of clinical symptoms of patients from 1997 to 2019, including 51 men and 9 women who had CNS disorders and symptoms of voiding dysfunction following bladder outlet surgery(TUR-P, TUI-P or TUI-BN). Patients with urethral stricture, history of prostate cancer, spinal cord injury or other neurological diseases were excluded. 33 patients in control group without known brain insult were enrolled. Pre-operative VUDS parameters and post-operative uroflowmetry parameters were collected. Storage and voiding symptoms were recorded by chart review. Patients’ characteristics and baseline urodynamic parameters were analysed for predictive factor of outcomes.
Results
The mean age of the patients was 71.06 ± 9.82 years old (range 41-87). Between three CNS groups, Parkinson’s disease has better outcome in cQmax , PVR and VE. CVA group has significant improvement in frequency, PVR and VE while patients with dementia has no significant difference. Pdet is lower in dementia group while comparing to other two groups (Table.1). In total CNS group, symptoms including frequency and urinary retention have improved after surgery. About the uroflowmetry parameter, cQmax, PVR and VE have significantly improved. In patients with BPH, there is significantly improvement in frequency, urgency in control group. The similar outcomes are noted in patients without BPH (Table.2). There is no predictive factor of success found in current baseline characteristics.
Interpretation of results
Bladder outlet surgeries are effective in improving the voiding symptoms in patients with or without CNS disorder. However, there is no obvious improvement in storage symptoms in patients with CNS disorder. There is no obvious improvement in patients with dementia compare to other two groups. It may be due to that patients with dementia usually have detrusor underactivity.
Concluding message
Bladder outlet surgeries are effective to relieve voiding symptoms but not storage symptoms in patients with CNS lesions. We should have precise diagnosis before surgical intervention for the patients with CNS disorders and voiding dysfunction.
Figure 1 Table.1. Changes of subjective and VUDS parameters between CNS and control group, and comparison among CNS disorder groups
Figure 2 Table.2 Changes of subjective and VUDS parameters in patients with and without BPH
Disclosures
Funding None Clinical Trial Yes Public Registry No RCT No Subjects Human Ethics Committee Research Ethics Committee, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation Helsinki Yes Informed Consent Yes