The Resolution of Detrusor Over Activity after Medical and Surgical Treatment in Patients with Bladder Outlet Obstruction
Supon Sriplakich MD*, Kritsana Promwatcharanon MD*
Affiliation : * Division of Urology, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai
Objective : This study was design to evaluate the efficacy of transurethral resection of prostate (TURP) com-
pared to alpha-adrenoceptor antagonists (Alfuzosin SR) for the treatment of patients with benign prostatic
hyperplasia BPH concomitant with detrusor overactivity (DO).
Materials and Methods : 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.
Keywords : Detrusor overactivity, Benign prostatic hyperplasia
