[Surgery (TUR-P) as a recommended initial treatment modality for the presented case]

Area of Science:

• Urology
• Lower Urinary Tract Dysfunction (LUTD)
• Benign Prostatic Hyperplasia (BPH)

Context:

• Lower urinary tract dysfunction encompasses voiding dysfunction and overactive bladder.
• Potential causes of voiding dysfunction include bladder outlet obstruction from benign prostatic hyperplasia (BPH) or detrusor underactivity.
• This case highlights the complex interplay of BPH and overactive bladder symptoms.

Purpose:

• To compare the prospective efficacies of pharmacological and surgical treatments for lower urinary tract dysfunction.
• To evaluate treatment options for a patient presenting with significant voiding dysfunction and overactive bladder.
• To provide a literature-based recommendation for the optimal therapeutic strategy.

Summary:

• Pharmacological treatments like alpha-1 blockers offer limited improvement in objective measures for BPH and detrusor underactivity.
• Anticholinergics are contraindicated in patients with significant residual urine due to severe voiding dysfunction.
• Transurethral resection of the prostate (TUR-P) is presented as a gold-standard surgical treatment, demonstrating significant improvements in voiding and storage symptoms, flow rate, and reduced residual urine.

Impact:

• TUR-P effectively resolves urge incontinence and uninhibited detrusor contractions in a majority of BPH patients.
• Surgery provides superior outcomes for both subjective symptoms and objective measures in patients with BPH and coexisting detrusor underactivity.
• The literature review supports recommending surgery as the standard initial therapy for patients with significant voiding dysfunction, as exemplified by the presented case (Qmax 9.4 ml/s, residual urine 72 ml).