ABSTRACT
Objective:
To establish the
urodynamic classification of middle-
aged and
elderly men with benign prostatic obstruction(BPO), and to analyze the
efficacy of transurethral resection of the
prostate(
TURP) on various types of
patients.
Methods:
A retrospective
analysis of middle-
aged and
elderly male patients with non-neurogenic
lower urinary tract symptoms(LUTS)
who underwent
urodynamic tests from January 2010 to December 2018, including 793
patients with BPO.
Urodynamics examination of detrusor without contraction
needs to complete
cystoscopy to
diagnose BPO. During
urodynamic examination, the detrusor uninhibited contraction induced by spontaneous or stimulation during the
bladder filling period is diagnosed as overactivity of the
bladder detrusor(DO), and the LinPURR chart indicates the
detrusor underactivity(DU). Based on the persistence of BPO leading to DO, DU, and decreased
bladder compliance, 793
male patients with BPO with LUTS were divided into four types, including type Ⅰ(BPO n=164, 20.7%), type Ⅱ(BPO combined with DO n=333, 42.00%), type Ⅲ(BPO combined with DU n=267, 33.7%), type Ⅳ(BPO combined with decreased
bladder compliance n=29, 3.7%). The preoperative comparison between groups showed that the age of type Ⅰ-Ⅳ gradually increased, and the age of type Ⅰ was significantly smaller than other types [(67.3±8.2)years, (69.7±7.7)years, (71.5±7.9)years, (72.4±7.1)years, P<0.05]. Compared with other types, the type Ⅰ’s IPSS-S[(9.1±3.6)points vs.(10.4±3.1) points, (9.2±3.3) points, (10.4±3.1)points, P<0.05], IPSS-V[(13.5±3.4) points vs. (14.2±3.5)points, (14.0±3.5)points, (14.2±2.9)points, P<0.05], IPSS scores[(22.6±5.4)points, (24.7±4.9)points, (23.1±5.3)points, (24.6±4.7)points, P<0.05] were significantly lower than other groups, the maximum
bladder capacity [(332.6±83.2)ml vs.(221.4±80.8)ml, (286.7±108.2)ml, (242.3±103.4)ml, P<0.05], the functional
bladder capacity was significantly higher than other types[(215.2±90.0)ml, (148.5±76.0)ml, (154.9±87.2)ml, (121.2±72.9)ml, P<0.05]. Type Ⅱ’s IPSS-S[(10.4±3.1)points vs.(9.1±3.6)points, (9.2±3.3)points, P<0.05],
nocturia frequency[(3.7±1.8)times vs.(3.2±1.8)times, (3.2±1.6)times, P<0.05], IPSS score[(24.7±4.9)points vs.(22.6±5.4)points, (23.1±5.3)points, P<0.05],
quality of life scores [(4.9±0.9) points, (4.6±0.9)points, (4.6±0.9)points, P<0.05] was significantly higher than type Ⅰ and type Ⅲ ( P<0.05). Type Ⅲ and Ⅳ had higher residual
urine than type Ⅱ[(121.3±96.4)ml, (121.3±96.4)ml vs.(71.2±73.5)ml, P<0.05]. Type Ⅳ’s IPSS-S[(10.4±3.1)points vs. (9.1±3.6)points, (9.2±3.3)points, P<0.05], IPSS-V[(14.2±2.9) points vs.(13.5±3.4)points, (14.0±3.5)points, P<0.05], the frequency of
nocturia[(3.8±1.9)times vs.(3.2±1.8)times, (3.2±1.6)times, P<0.05] was significantly higher than that of type Ⅰ and type Ⅲ, and the
quality of life score was higher than type Ⅰ and type Ⅲ[(4.3±0.8)points vs.(4.7±0.9)points, (4.6±0.9)points, P<0.05]. type Ⅱ and type Ⅳ’s
bladder compliance[(21.4±24.2)ml/cmH 2O, (11.0±11.4)ml/cmH 2O vs.(33.9±23.7)ml/cmH 2O, (33.1±32.7)ml/cmH 2O, P<0.05], maximum
bladder capacity[(221.4±80.8)ml, (242.3±103.4)ml vs.(332.6±83.2)ml, (286.7±108.2)ml, P<0.05], functional
bladder capacity[(148.5±76.0)ml, (121.2±72.9)ml vs.(215.2±90.0)ml, (154.9±87.2)ml, P<0.05] were significantly less than type Ⅰ and type Ⅲ( P<0.05). From November 2016 to November 2018, 60 middle-
aged and
elderly male patients with confirmed BPO and
TURP were selected, including type Ⅰ( n=17, 28.3%), type Ⅱ ( n=23, 38.3%), and Ⅲ type ( n=11, 18.3%), Ⅳ type( n=9, 15.1%). Type IV
patients are significantly older than other types ( P<0.05),
bladder compliance is significantly worse than other types( P<0.05), the maximum
bladder capacity is smaller than other types( P<0.05). The follow-up started 3 months after the operation. The content of the follow-up included IPSS, IPSS-S, IPSS-V,
nocturia frequency, undisturbed
sleep time,
nocturia quality of life score, and
life quality score.
Results:
The IPSS scores of type Ⅰ, type Ⅱ, and type Ⅲ after
TURP were significantly improved compared with preoperative(19.8±6.2 vs.3.4±1.8; 21.9±5.2 vs.4.6±2.6; 21.5±6.2 vs.5.7±4.6, P<0.05), type Ⅳ
urine storage symptom score (9.1±4.1 vs.4.3±3.7),
nocturia frequency(3.6±1.5vs.2.3±1.6),
nocturia quality of life score (25.3±6.9 vs.31.4±13.7) Compared with preoperatively, there was no significant improvement( P>0.05). The
quality of life score improvement of type Ⅳ
patients was significantly lower than that of type Ⅰ, type Ⅱ, and type Ⅲ (10.9±9.1 vs.12.2±9.0, 14.4±5.7, 12.7±5.8, P<0.05). The IPSS score of type Ⅳ
patients was significantly higher than that of type Ⅰ(7.0±5.8 vs.3.4±1.8), and the
nocturia quality of life score was significantly lower than that of each group (31.4±13.7 vs.37.5±4.2, 38.7±3.5, 37.8±3.8, P<0.05).
Conclusions:
For middle-
aged and
elderly men with BPO, we divide them into four types based on the results of
urodynamic examinations, type Ⅰ(simple BPO), type Ⅱ(BPO combined with DO), type Ⅲ(BPO combined with DU), type Ⅳ(BPO combined with
bladder compliance decline). Type Ⅰ
patients have the best
bladder function, and
TURP has the best effect; type Ⅱ has a high symptom score and poor
quality of life, and can benefit after
TURP; type Ⅲ
bladder function is poor, and
surgery should be performed as soon as possible to prevent further deterioration of
bladder function; type Ⅳ
bladder function is the best poor, IPSS score and
quality of life score are high,
TURP surgery is not effective.