RESULTS OF URODYNAMIC ASSESSMENT FOR DETRUSOR UNDERACTIVITY IN INDIVIDUALS UNDERGOING TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)

Abstract

Background: Benign prostatic enlargement (BPE) is a prevalent cause of bladder outlet obstruction (BOO) in aging males, often presenting with lower urinary tract symptoms (LUTS). Transurethral resection of the prostate (TURP) remains the gold standard for managing BOO. However, in patients with detrusor underactivity (DU), a condition characterized by impaired bladder muscle contractility, surgical outcomes are less predictable. Limited data exist regarding TURP efficacy in patients with concurrent BPE and DU, necessitating further investigation into its clinical utility.

Objective: To evaluate the effectiveness of TURP in men diagnosed with DU and BPE by comparing preoperative and postoperative urodynamic parameters and quality-of-life outcomes.

Methods: This prospective observational study was conducted at the Institute of Kidney Diseases, Peshawar, from June 2023 to September 2024. Sixty male patients with LUTS due to BPE and confirmed DU (bladder contractility index [BCI] <100) were enrolled following ethical approval. All patients underwent clinical evaluation, ultrasonography, and urodynamic testing including detrusor pressure at maximum flow (pdetQmax), maximum flow rate (Qmax), post-void residual volume (PVR), and BCI. TURP was performed under spinal anesthesia, and follow-up assessments were conducted at 3 months postoperatively. Data were analyzed using SPSS version 23, with statistical significance set at P ≤ 0.05.

Results: The mean age of participants was 61.4 ± 9.6 years. Preoperative values included pdetQmax of 27.2 ± 6.0 cm H₂O, Qmax of 11.9 ± 3.8 ml/s, BCI of 86.8 ± 22.9, and PVR of 210.8 ± 63.5 ml. Postoperatively, pdetQmax rose to 30.6 ± 6.8 cm H₂O (p=0.08), Qmax increased to 16.0 ± 4.5 ml/s (p=0.002), BCI improved to 110.8 ± 26.8 (p=0.2), and PVR decreased to 102.6 ± 44.0 ml (p=0.01). Clean intermittent catheterization was required in 23.3% (n=14) of patients due to persistent elevated PVR.

Conclusion: TURP is a viable treatment option in patients with DU and coexisting BOO. Although improvement in bladder contractility is not guaranteed, significant symptomatic relief and better voiding parameters can still be achieved with careful patient selection.