Can persisting detrusor hyperreflexia be predicted after transurethral prostatectomy for benign prostatic...

Area of Science:

• Urology
• Neurourology

Background:

• Detrusor hyperreflexia (DH) is common in benign prostatic hypertrophy (BPH) patients.
• DH persists post-surgery in 30-50% of patients after transurethral prostatectomy (TUR-P) or surgical enucleation.
• Identifying patients at risk for persistent post-operative urinary irritation and DH is clinically important.

Purpose of the Study:

• To evaluate pre-operative cystometry patterns and single-photon emission computed tomography (SPECT) findings for predicting post-operative detrusor hyperreflexia (DH) in benign prostatic hypertrophy (BPH) patients.
• To correlate pre-operative DH patterns with post-operative outcomes.

Main Methods:

• Twenty-three patients with pre-operative DH (19 due to BPH, 4 neurogenic) were studied.
• BPH patients were classified into three cystometry patterns based on DH onset and bladder volume.
• Pre-operative SPECT was performed on 14 patients; post-operative cystometry was compared with pre-operative findings.

Main Results:

• Patients with pattern 1 DH (continual sporadic onset) and neurogenic bladder showed persistent DH post-surgery.
• Patients with pattern 2 (early onset) and pattern 3 (late onset) DH had significantly reduced or absent DH post-surgery.
• Abnormal frontal lobe cerebral blood flow on SPECT correlated with persistent DH, while normal SPECT indicated resolution of DH.

Conclusions:

• Pre-operative cystometry patterns, particularly pattern 1, and abnormal SPECT findings predict persistent detrusor hyperreflexia (DH) after surgery for benign prostatic hypertrophy (BPH).
• Combining cystometry and SPECT can improve prediction of post-operative DH and urinary irritation symptoms.
• This allows for better patient selection and management strategies.