Diagnosis and Treatment of Catheter-Dependent Men After Transurethral Resection of the Prostate and Laser Failures
Urinary retention and incomplete bladder emptying after transurethral resection of the prostate (TURP) and laser failures are caused by persistent urethral obstruction and/or impaired detrusor contractility. The aim of this study is to compare urodynamic findings and surgical outcomes of TURP and KTP laser prostate ablation (KTPLAP) in catheter-dependent men who were advised that they were no longer surgical candidates by their prior urologists, but subsequently underwent surgery at our institution.
This is a retrospective observational study of catheter-dependent men due to urinary retention thought to be unsuitable for surgery after failing TURP or KTPLAP. A database was searched for catheter-dependent men who underwent urodynamics after failed TURP or KTPLAP. Exclusion criteria were neurogenic bladder and temporary catheterization. All patients underwent routine assessment including cystoscopy and videourodynamics (VUDS) and were divided into 3 groups based on the bladder outlet obstruction index (BOOI) and bladder contractility index (BCI): 1) detrusor underactivity (DU), 2) bladder outlet obstruction (BOO), and 3) detrusor acontractility (DA). See table 1 for definitions. The primary outcome measures were the Patient Global Impression of Improvement (PGII) and catheter independence. Secondary outcomes were uroflow and post void residual urine. Mann-Whitney and Pearson chi-squared tests were utilized.
95 catheter-dependent men were identified and 29 excluded. 24 declined surgery and 42 elected surgery of whom 71% had pure DU, 21% had pure BOO, and 40% had both. Mean follow up time was 25 months (median= 20 months, range= 1 month-11 years). At minimum follow up of one year, 36/42 patients had a successful outcome based on the PGII and 88% were rendered catheter free (see table). There was no difference in any preoperative characteristics between men who underwent surgery and those who declined.
In this series, catheter-dependent men after failed TURP or KTPLAP, thought to be poor surgical candidates, had a high success rate after prostate surgery despite 3/4 having DU. The role of DU as a prognostic factor for prostate surgery should be reevaluated.
Funding: Institute for Bladder and Prostate Research