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International Urology and Nephrology
Published in: International Urology and Nephrology 10/2022

11-07-2022 | Dementia | Urology - Original Paper

Surgical outcome of male patients with chronic central nervous system disorders and voiding dysfunction due to bladder outlet obstruction

Authors: Tien-Lin Chang, Sheng-Fu Chen, Hann-Chorng Kuo

Published in: International Urology and Nephrology | Issue 10/2022

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Abstract

Purpose

Voiding dysfunction is common in patients with chronic central nervous system (CNS) diseases and has great impact on quality of life. Patients with chronic CNS disorders might have concomitant detrusor overactivity, detrusor underactivity, and voiding dysfunction. Although bladder outlet surgeries could relieve bladder outlet obstruction (BOO), patients might have persistent or exacerbated storage symptoms. This study investigated surgical outcome of patients with chronic CNS disorders after bladder outlet surgery.

Methods

A total of 63 male patients with cerebrovascular accident (CVA, n = 44), Parkinson’s disease (PD, n = 11), and early-stage dementia (n = 8), had received bladder outlet surgery after videourodynamic proven BOO refractory to medical treatment. The preoperative and postoperative lower urinary tract symptoms (LUTS) and uroflowmetry parameters were assessed. If the storage symptom subscore decreased or increased by 1, the outcome was considered improved or exacerbated after treatment. When patients had improvement in maximum flow rate (Qmax) and voiding efficiency (VE) and decreased voiding symptom subscore, they were considered having improvement of voiding dysfunction.

Results

The mean age was 71.1 ± 9.8 years and mean duration from diagnosis of BOO to surgical intervention was 15.1 ± 25.0 months. Overall, there was significant improvement in voiding LUTS and urinary retention after surgery. The post-void residual volume (PVR), corrected Qmax (cQmax), and VE significantly improved after surgery. In subgroup analysis, although voiding symptoms improved in CVA patients, urgency and exacerbated urgency incontinence persisted after surgery. In PD patients, there was improvement in voiding condition such as PVR, cQmax and VE, but the storage symptoms did not change after surgery. Patients with dementia had no improvement both in storage and voiding symptoms.

Conclusions

Bladder outlet surgeries are effective to relieve voiding dysfunction in patients with CVA and PD, but have little effect on storage LUTS in patients with chronic brain lesions.
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Metadata
Title
Surgical outcome of male patients with chronic central nervous system disorders and voiding dysfunction due to bladder outlet obstruction
Authors
Tien-Lin Chang
Sheng-Fu Chen
Hann-Chorng Kuo
Publication date
11-07-2022
Publisher
Springer Netherlands
Published in
International Urology and Nephrology / Issue 10/2022
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI
https://doi.org/10.1007/s11255-022-03285-3

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