SIGNIFICANCE OF URODYNAMIC INVESTIGATIONS FOR UNSATISFACTORY RESULTS OF OPERATIVE TREATMENT OF BENIGN PROSTATE HYPERPLASIA

THE AIM of the investigation was to detect causes of unsatisfactory results of operative treatment of patients with benign prostate hyperplasia (BPH). PATIENTS AND METHODS. Urodynamic examination was performed in 27 patients with unsatisfactory results of operative treatment. Complaints to day and night pollakiuria, feeling of incomplete emptying of the bladder, imperative urges to urination etc. remained in 18 patients. Postoperative urinary incontinence was also noted in 9 patients. The control group consisted of 17 patients with good results of operative treatment. RESULTS. Findings of urodynamic examination of patients showed that dysuria retained after operation was due to a pathology of detrusor: 16 (50.3%) patients had detrusor instability (DI) and 2 (7.4%) had impaired contractility of detrusor. Patients with urinary incontinence also had marked impairments of the detrusor function. The maximal cystometric capacity of the bladder in these patients proved to be as little as 300.1± 30.7 ml (p< 0.05), and DI was diagnosed in 55.6% of patients. At the same time, patients with urinary incontinence had sharply decreased indicators of profilemetry of the urethra characterizing the blood sphincter function of the bladder  the functional length of the urethra, maximal urethral pressure and maximal pressure of urethra closing (p<0.001). The urodynamic examination diagnosed veritable caused by stress urinary incontinence due to a damage of the urinary bladder sphincter in 4 patients. Five patients had mixed character of incontinence of urine due to both a damage of the sphincter and to dysfunction of detrusor (mixed urinary incontinence). CONCLUSION. The urodynamic examination of patients for unsatisfactory results of operative treatment allowed determining the cause of dysuria, urinary incontinence included. Exact diagnosis of specific features and causes of impaired function of the lower urinary pathways in such patients helps to choose adequate policy of treatment.

1. Rodrigues P, Lucon AM, Campos Freire G, Arap S. Urodynamic pressureflow studies can predict the clinical outcome after transurethral prostatic resection. J Urol 2001; 165: 499502

2. Homma Y. Pressureflow studies in benign prostatic hyperplasia: to do or not to do for the patient? BJU Int 2001; 87: 1923

3. Nitti VW, Kim Y, Combs AJ. Voiding dysfunction following transurethral resection of the prostate: symptoms and urodynamic findings. J Urol 1997: 157 (2): 600603

4. Foote J, Yun SK, Leach GE. Postprostatectomy incontinence: Pathophysiology, evaluation and management. Urol Clin North Am 1991 (18): 229241

5. Abrams P, Blaivas JG, Stanton SL, Anderson JT. Standardization of terminology of lower urinary tract. Neurourol Urodynam 1988; 7: 403427

6. Blaivas JG, Appel RA, Leach G et al. Definition and classification of urinary incontinence: Recommendations of the Urodynamic Society. Neurourol Urodynam 1997; 16: 149151

7. Халимов ЗМ. Клинико-уродинамическая характеристика расстройств мочеиспускания у больных, перенесших оперативное лечение аденомы предстательной железы. Ав тореф. дис. ... канд. мед. наук. М., 1995; 15

8. Porru D, Jallous H, Cavalli V et al. Prognostic value of a combination of IPSS, flow rate and residual urine volume compared to pressureflow studies in the preoperative evaluation of symptomatic BPH. Eur Urol 2002; 41 (3): 246249

9. Mashino R, Kakizaki H, Ameda K et al. Detrusor instability with equivocal obstruction: A predictor of unforable symptomatic outcomes after transurethral prostatectomy. Neurourol Urodynam 2002; 21 (5): 444-449