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.
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.