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URODYNAMIC ASSESSMENT OF PATIENTS WITH ACUTE URINARY RETENTION: IS TREATMENT FAILURE AFTER PROSTATECTOMY PREDICTABLE?

1997; Lippincott Williams & Wilkins; Volume: 158; Issue: 5 Linguagem: Inglês

10.1016/s0022-5347(01)64139-9

1527-3792

Bob Djavan, S. Madersbacher, Christoph Klingler, Michael Marberger,

Prostate Cancer Diagnosis and Treatment

No AccessJournal of UrologyClinical Urology: Original Articles1 Nov 1997URODYNAMIC ASSESSMENT OF PATIENTS WITH ACUTE URINARY RETENTION: IS TREATMENT FAILURE AFTER PROSTATECTOMY PREDICTABLE? Bob Djavan, Stefan Madersbacher, Christoph Klingler, and Michael Marberger Bob DjavanBob Djavan , Stefan MadersbacherStefan Madersbacher , Christoph KlinglerChristoph Klingler , and Michael MarbergerMichael Marberger View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64139-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Some patients with acute urinary retention due to benign prostatic hyperplasia do not have successful outcome after prostatectomy and require either a chronic indwelling urethral catheter or clean intermittent catheterization. Urodynamic and clinical parameters were examined preoperatively in 81 men 56 to 93 years old (mean age 72 years) in search of an outcome predictor after prostatectomy. Materials and Methods: International Prostate Symptom Score, prostate volume, retention episodes, retention volume and urodynamic parameters from a multichannel pressure-flow study were analyzed preoperatively and postoperatively. All patients underwent transurethral prostatectomy and were reexamined 2, 4, 12 and 24 weeks after surgery. A multichannel pressure-flow study was performed preoperatively and 12 weeks postoperatively. Results: At 24 weeks postoperatively 11 patients (13%) were unable to void and therefore classified as treatment failures while the remaining patients voided spontaneously and were classified as treatment successes. There were statistically significant differences (p <0.005) between treatment failure and treatment success regarding age (83.5 +/− 7 versus 70.1 +/− 8 years), preoperative volume of retention (1,780 versus 1,080 ml.), and maximal detrusor pressure (24.4 versus 73.5 cm. water), but not to International Prostate Symptom Score, episodes of retention and prostate volume. The ability to void during preoperative pressure flow study and the presence of detrusor instability predicted good outcome. In treatment success patients postoperative urodynamic data showed significant decrease in detrusor pressure at maximum flow rate (from 80.8 +/− 33 to 34.6 +/− 10 cm. water). Those with treatment failure had an increase in maximal detrusor pressure (from 26 +/− 12 to 42.6 +/− 13 cm. water), suggesting detrusor recovery. Conclusions: Patients with acute urinary retention, age 80 years or older, with retention volume greater than 1,500 ml., no evidence of instability and maximal detrusor pressure less than 28 cm. water are at high risk of treatment failure. However, despite treatment failure the detrusor may recover in patients younger than 80. Therefore, prostatectomy should still be performed in this group (less than 80 years old) even if preoperative urodynamics suggest an unfavorable outcome. References 1 : Postoperative retention of urine: a prospective urodynamic study. Brit. Med. J.1991; 302: 894. Google Scholar 2 : Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients. J. Urol.1989; 141: 243. Link, Google Scholar 3 : Acute urinary retention in men: a comparison of voiding and nonvoiding patients after prostatectomy. J. Urol.1995; 153: 685. 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Google Scholar From the Department of Urology, University of Vienna, Vienna, Austria.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byAntunes A, Iscaife A, Reis S, Albertini A, Nunes M, Lucon A, Nahas W and Srougi M (2015) Can We Predict Which Patients will Experience Resolution of Detrusor Overactivity after Transurethral Resection of the Prostate?Journal of Urology, VOL. 193, NO. 6, (2028-2032), Online publication date: 1-Jun-2015.Blatt A, Brammah S, Tse V and Chan L (2012) Transurethral Prostate Resection in Patients with Hypocontractile Detrusor—What is the Predictive Value of Ultrastructural Detrusor Changes?Journal of Urology, VOL. 188, NO. 6, (2294-2299), Online publication date: 1-Dec-2012.Mariappan P, Brown D and McNeill A (2007) Intravesical Prostatic Protrusion is Better Than Prostate Volume in Predicting the Outcome of Trial Without Catheter in White Men Presenting With Acute Urinary Retention: A Prospective Clinical StudyJournal of Urology, VOL. 178, NO. 2, (573-577), Online publication date: 1-Aug-2007.TAN Y and FOO K (2018) Intravesical Prostatic Protrusion Predicts the Outcome of a Trial Without Catheter Following Acute Urine RetentionJournal of Urology, VOL. 170, NO. 6, (2339-2341), Online publication date: 1-Dec-2003.Holm N, Horn T, Smedts F, Nordling J and Rossette J (2018) Does Ultrastructural Morphology Of Human Detrusor Smooth Muscle Cells Characterize Acute Urinary Retention?Journal of Urology, VOL. 167, NO. 4, (1705-1709), Online publication date: 1-Apr-2002.FLORATOS D, SONKE G, FRANCISCA E, KIEMENEY L, KORTMANN B, DEBRUYNE F and de la ROSETTE J (2018) HIGH ENERGY TRANSURETHRAL MICROWAVE THERMOTHERAPY FOR THE TREATMENT OF PATIENTS IN URINARY RETENTIONJournal of Urology, VOL. 163, NO. 5, (1457-1460), Online publication date: 1-May-2000.DJAVAN B, FAKHARI M, SHARIAT S, GHAWIDEL K and MARBERGER M (2018) A NOVEL INTRAURETHRAL PROSTATIC BRIDGE CATHETER FOR PREVENTION OF TEMPORARY PROSTATIC OBSTRUCTION FOLLOWING HIGH ENERGY TRANSURETHRAL MICROWAVE THERMOTHERAPY IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIAJournal of Urology, VOL. 161, NO. 1, (144-151), Online publication date: 1-Jan-1999.DJAVAN B, ROEHRBORN C, SHARIAT S, GHAWIDEL K and MARBERGER M (2018) PROSPECTIVE RANDOMIZED COMPARISON OF HIGH ENERGY TRANSURETHRAL MICROWAVE THERMOTHERAPY VERSUS alpha-BLOCKER TREATMENT OF PATIENTS WITH BENIGN PROSTATIC HYPERPLASIAJournal of Urology, VOL. 161, NO. 1, (139-143), Online publication date: 1-Jan-1999. Volume 158Issue 5November 1997Page: 1829-1833 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information Bob Djavan More articles by this author Stefan Madersbacher More articles by this author Christoph Klingler More articles by this author Michael Marberger More articles by this author Expand All Advertisement PDF downloadLoading ...