Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Bladder Dysfunction Reports
Published in: Current Bladder Dysfunction Reports 3/2016

01-09-2016 | Inflammatory/Infectious Bladder Disorders (MS Mourad, Section Editor)

Evaluation and Management of Lower Urinary Tract Symptoms After Outlet Surgery for Benign Prostatic Hyperplasia

Authors: Nirmish Singla, Ajay K. Singla

Published in: Current Bladder Dysfunction Reports | Issue 3/2016

Login to get access

Abstract

There are many options available in the surgical treatment of outlet obstruction secondary to benign prostatic hyperplasia (BPH). While most patients exhibit improvement in their lower urinary tract symptoms (LUTS) following intervention, up to 35 % of patients may exhibit persistent or recurrent LUTS. In the present review, we discuss the pathophysiology of LUTS after bladder outlet surgery and discuss considerations in evaluating and managing such patients. We highlight the crucial role of thorough evaluation with complete urodynamics testing, as pure obstruction only accounts for a minority of post-operative LUTS. Hence, detrusor contractility, detrusor overactivity, urethral sphincter function, and urinary incontinence must be assessed to appropriately guide subsequent therapy and improve patients’ quality of life.
Literature
1.
Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol. 2008;179:S75.CrossRefPubMed
2.
Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61:37.CrossRefPubMed
3.
Boyle P, Robertson C, Mazzetta C, et al. The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study. BJU Int. 2003;92:409.CrossRefPubMed
4.
Kupelian V, Wei JT, O’Leary MP, et al. Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) Survey. Arch Intern Med. 2006;166:2381.CrossRefPubMed
5.
Reynard JM. Does anticholinergic medication have a role for men with lower urinary tract symptoms/benign prostatic hyperplasia either alone or in combination with other agents? Curr Opin Urol. 2004;14:13.CrossRefPubMed
6.
7.
Abrams PH, Farrar DJ, Turner-Warwick RT, et al. The results of prostatectomy: a symptomatic and urodynamic analysis of 152 patients. J Urol. 1979;121:640.PubMed
8.
Bruskewitz RC, Larsen EH, Madsen PO, et al. 3-year followup of urinary symptoms after transurethral resection of the prostate. J Urol. 1986;136:613.PubMed
9.
Madersbacher S, Marberger M. Is transurethral resection of the prostate still justified? BJU Int. 1999;83:227.CrossRefPubMed
10.••
Nitti VW, Kim Y, Combs AJ. Voiding dysfunction following transurethral resection of the prostate: symptoms and urodynamic findings. J Urol. 1997;157:600. This is an earlier study that highlights the unpredictable nature of voiding dysfunction patterns following TURP and the poor correlation between subjective complaints and UDS findings. This study helps demonstrate the importance of conducting multichannel UDS in evaluating LUTS after BOO surgery prior to management. CrossRefPubMed
11.
Tkocz M, Prajsner A. Comparison of long-term results of transurethral incision of the prostate with transurethral resection of the prostate, in patients with benign prostatic hypertrophy. Neurourol Urodyn. 2002;21:112.CrossRefPubMed
12.
13.•
Mirone V, Imbimbo C, Longo N, et al. The detrusor muscle: an innocent victim of bladder outlet obstruction. Eur Urol. 2007;51:57. This literature review nicely captures a number of both in vivo and in vitro studies on human tissue and animal models to demonstrate the physiologic changes in bladder structure and function that evolve in the setting of BOO. These changes are important to understand the processes driving LUTS after surgery to relieve long-standing BOO. CrossRefPubMed
14.
Speakman MJ, Brading AF, Gilpin CJ, et al. Bladder outflow obstruction—a cause of denervation supersensitivity. J Urol. 1987;138:1461.PubMed
15.
16.
Steers WD, Ciambotti J, Etzel B, et al. Alterations in afferent pathways from the urinary bladder of the rat in response to partial urethral obstruction. J Comp Neurol. 1991;310:401.CrossRefPubMed
17.
Steers WD, Kolbeck S, Creedon D, et al. Nerve growth factor in the urinary bladder of the adult regulates neuronal form and function. J Clin Invest. 1991;88:1709.CrossRefPubMedPubMedCentral
18.
Kageyama S, Watanabe T, Kurita Y, et al. Can persisting detrusor hyperreflexia be predicted after transurethral prostatectomy for benign prostatic hypertrophy? Neurourol Urodyn. 2000;19:233.CrossRefPubMed
19.
Machino R, Kakizaki H, Ameda K, et al. Detrusor instability with equivocal obstruction: a predictor of unfavorable symptomatic outcomes after transurethral prostatectomy. Neurourol Urodyn. 2002;21:444.CrossRefPubMed
20.
Mitterberger M, Pallwein L, Gradl J, et al. Persistent detrusor overactivity after transurethral resection of the prostate is associated with reduced perfusion of the urinary bladder. BJU Int. 2007;99:831.CrossRefPubMed
21.
Javle P, Jenkins SA, West C, et al. Quantification of voiding dysfunction in patients awaiting transurethral prostatectomy. J Urol. 1996;156:1014.CrossRefPubMed
22.
Kuo HC. Analysis of the pathophysiology of lower urinary tract symptoms in patients after prostatectomy. Urol Int. 2002;68:99.CrossRefPubMed
23.
Seaman EK, Jacobs BZ, Blaivas JG, et al. Persistence or recurrence of symptoms after transurethral resection of the prostate: a urodynamic assessment. J Urol. 1994;152:935.PubMed
24.
Han HH, Ko WJ, Yoo TK, et al. Factors associated with continuing medical therapy after transurethral resection of prostate. Urology. 2014;84:675.CrossRefPubMed
25.
Roos NP, Wennberg JE, Malenka DJ, et al. Mortality and reoperation after open and transurethral resection of the prostate for benign prostatic hyperplasia. N Engl J Med. 1989;320:1120.CrossRefPubMed
26.
Kuntz RM, Lehrich K. Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm.:: a randomized prospective trial of 120 patients. J Urol. 2002;168:1465.CrossRefPubMed
27.
Chughtai B, Simma-Chiang V, Kaplan SA. Evaluation and management of post-transurethral resection of the prostate lower urinary tract symptoms. Curr Urol Rep. 2014;15:434.CrossRefPubMed
28.••
McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185:1793. This reference reflects the most updated consensus put forth by the AUA on the management of BPH based on a systematic review and sythesis of the literature. This guideline should be familiar to all urologists. CrossRefPubMed
29.
Gormley EA, Lightner DJ, Faraday M, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015;193:1572.CrossRefPubMed
30.
Thomas AW, Cannon A, Bartlett E, et al. The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up. BJU Int. 2004;93:745.CrossRefPubMed
31.
Arai Y, Kaiho Y, Takei M, et al. Burden of male stress urinary incontinence: a survey among urologists in Japan. Int J Urol. 2009;16:915.CrossRefPubMed
32.
Helfand B, Mouli S, Dedhia R, et al. Management of lower urinary tract symptoms secondary to benign prostatic hyperplasia with open prostatectomy: results of a contemporary series. J Urol. 2006;176:2557.CrossRefPubMed
33.
Serretta V, Morgia G, Fondacaro L, et al. Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions. Urology. 2002;60:623.CrossRefPubMed
34.
Elmansy HM, Kotb A, Elhilali MM. Is there a way to predict stress urinary incontinence after holmium laser enucleation of the prostate? J Urol. 2011;186:1977.CrossRefPubMed
Metadata
Title
Evaluation and Management of Lower Urinary Tract Symptoms After Outlet Surgery for Benign Prostatic Hyperplasia
Authors
Nirmish Singla
Ajay K. Singla
Publication date
01-09-2016
Publisher
Springer US
Published in
Current Bladder Dysfunction Reports / Issue 3/2016
Print ISSN: 1931-7212
Electronic ISSN: 1931-7220
DOI
https://doi.org/10.1007/s11884-016-0376-1

Other articles of this Issue 3/2016

Current Bladder Dysfunction Reports 3/2016 Go to the issue

Post-Prostatectomy and Acquired Voiding Dysfunction (V Tse, Section Editor)

Ketamine-Associated Uropathy: From Presentation to Management

Post-Prostatectomy and Acquired Voiding Dysfunction (V Tse, Section Editor)

Psychotropic Drugs and Their Effects on Lower Urinary Tract Function: an Update

Voiding Dysfunction Evaluation (C Gomez, Section Editor)

Optimizing Outcomes of Sacral Neuromodulation for the Treatment of Urinary Retention

Pediatric Bladder Dysfunction (SJ Hodges, Section Editor)

Pediatric Bladder Reconstruction

Inflammatory/Infectious Bladder Disorders (MS Mourad, Section Editor)

Vulvodynia: Current Etiology, Diagnosis, and Treatment

Inflammatory/Infectious Bladder Disorders (MS Mourad, Section Editor)

Diagnosis and Management of Male Genital Lichen Sclerosus