The resolution of detrusor over activity after medical and surgical treatment in patients with bladder outlet obstruction

Abstract

Objective: This study was design to evaluate the efficacy of transurethral resection of prostate (TURP) compared to alpha-adrenoceptor antagonists (Alfuzosin SR) for the treatment of patients with benign prostatic hyperplasia BPH concomitant with detrusor overactivity (DO). Material and Method: The patients presenting with lower urinary tract symptoms (LUTS), due to benign prostatic enlargement were invited into the present study. These patients completed the International Prostatic Symptom Score (IPSS), the Quality of Life score (QoL), and underwent urodynamic investigation. Twenty-five patients with urodynamics proving bladder outlet obstruction and concomitant detrusor overactivity were allocated into two groups. Group 1 was treated by TURP (surgical treatment group) and group 2 was treated with Alfuzosin SR (medical treatment group). Twelve patients were allocated to group 1 and the remainder 13 to group 2. Reassessment was performed after three months when the patients completed the International Prostatic Symptom Score (IPSS), Quality of Life score (QoL), and urodynamics study. Results: Mean patient age was compared for both groups (70 ± 2.5 years in group 1 and 70.7 ± 1.8 in group 2, p = 0.84). There were no statistically significant differences between baseline clinical and urodynamic characteristics of patients in the different treatment groups. IPSS and QoL scores improved significantly after treatment in each group. A statistically significant difference after treatment was noted in group 1 for the obstruction urodynamic parameters (Qmax, PdetQmax, Bladder outlet obstruction index). In group 2, a significant improvement was found in PdetQmax and Bladder outlet obstruction index, but not in Qmax. Detrusor overactivity persisted in three patients of group 1 (75% resolution), while two patients in group 2 were free from detrusor overactivity (15% resolution) (Chi-square = 0.001). Conclusion: Surgical treatment of benign prostatic hyperplasia, particularly TURP, significantly reduces the incidence of detrusor overactivity concurrent with bladder outlet obstruction, when compared with the use of alpha-adrenoceptor antagonists alone.