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Refractory lower urinary tract symptoms in patients with lumbar disc hernia relieved by non-surgical treatment

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Abstract

Purpose

Refractory lower urinary tract symptoms (LUTS) coexisting with lumbar disc hernia (LDH) have been shown to resolve following LDH surgery, implying that LDH causes these LUTS. The purpose of this study was to report outcomes in patients with refractory LUTS and LDH following non-surgical treatment targeting LDH.

Methods

A retrospective cohort study was conducted using outpatient data collected at Tongji Hospital, China, between 2016 and 2018. This study included 131 adult patients with refractory LUTS and LDH. Patients were stratified into two groups. Group A underwent non-surgical treatment for LDH plus pharmacological treatment for LUTS. Group B underwent only pharmacological treatment for LUTS. The International Prostate Symptom Score (IPSS), the IPSS quality of life (QoL) score, and uroflowmetry were used to evaluate outcomes.

Results

In group A, following treatment, the maximum flow rate (Qmax) increased by 3.92 ml/s (p < 0.001), the IPSS reduced by 5.99 points (p < 0.001), and the QoL score decreased by 1.51 points (p < 0.001). In group B, the Qmax increased by 0.09 ml/s (p = 0.833), the IPSS reduced by 0.72 points (p = 0.163), and the QoL score decreased by 0.07 points (p = 0.784).

Conclusions

LUTS can be relieved by a combination of pharmacological treatment for LUTS and non-surgical treatment for LDH in some refractory LUTS patients with LDH. MRI is recommended for these patients.

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If requested, the corresponding author will provide the data or will cooperate fully in obtaining and providing the data on which the manuscript is based for examination by the editors or their assignees.

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Acknowledgements

This study was supported partly by a Translation Medicine Grant from Tongji Hospital, Huazhong University of Science and Technology (2016ZHYX27, to Guanghui Du).

Funding

This study was supported partly by a Translation Medicine Grant from Tongji Hospital, Huazhong University of Science and Technology (2016ZHYX27, to Guanghui Du).

Author information

Authors and Affiliations

  1. Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People’s Republic of China

    Lei Xu, Lina Li, Qing Ling, Shengfei Xu, Libo Liu, Peng Cao & Guanghui Du

  2. Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People’s Republic of China

    Yong Zhang

  3. Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People’s Republic of China

    Xiangde Min & Liang Wang

  4. Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People’s Republic of China

    Lei Xu & Jianming Wang

Authors
  1. Lei Xu
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  5. Qing Ling
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  11. Guanghui Du
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Contributions

The authors listed below have made substantial contributions to the intellectual content of the paper in the various sections described below. GD, LX, YZ, LW, and JW: protocol/project development. LX, YZ, LL, QL, SX, LL, and PC: data collection or management. GD, LX, and YZ: data analysis. GD and LX: manuscript writing/editing. GD: funding acquisition.

Corresponding author

Correspondence to Guanghui Du.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Consent to participate

Verbal informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding the publication of their data and photographs.

Ethics approval

The study protocol was performed in line with the principles of the Declaration of Helsinki, and approved by the Tongji Hospital Research Ethics Committee and the Institutional Review Board.

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Electronic supplementary material

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345_2020_3330_MOESM1_ESM.docx

Supplementary file1 (DOCX 11495 kb) Fig. S1 (a) Lumbar disc hernia (LDH) (sagittal T2-weighted image): high signal intensity in the annulus fibrosus of the L4/L5 disc is suggestive of annular fissure with herniation of disc material into the spinal canal (solid red arrow); (b) Multiple-disc LDH (sagittal T2-weighted image): herniated discs at L4/L5 and L5/S1, with the L4/L5 disc slightly compressing the dural sac; (c) Central LDH (axial T1-weighted image): herniated disc compresses the dural sac and results in secondary spinal and lumbar foraminal stenosis; (d) Central LDH (axial T1-weighted image): herniated disc slightly compresses the dural sac without obvious compression of the nerve root; (e) Single-disc LDH (sagittal T2-weighted image): herniated disc at L5/S1 without obvious compression of the dural sac; (f) Focal LDH (axial T1-weighted image): herniation is less than 180° of the disc circumference, and the herniated disc slightly compresses the dural sac without obvious compression of the nerve root; (g) Disc bulge (axial T1-weighted image): herniation is greater than 180° of the disc circumference, and there is narrowing of the spinal canal and both lateral recesses with compression of the exiting nerve roots; (h) LDH (sagittal T2-weighted image): herniated discs compress the dural sac and cauda equina

345_2020_3330_MOESM2_ESM.docx

Supplementary file2 (DOCX 1971 kb) Fig. S2 (a) Uroflowmetry improved in a 56-year-old woman from baseline to post-treatment: the maximum uroflowmetry rate (Qmax) is increased from 14.1 ml/s (total 414.7 ml) to 22.2 ml/s (total 396.4 ml), average urinary flow is increased from 7.3 ml/s to 11.9 ml/s, and voiding time is decreased from 65.0 s to 34.5 s; (b) The urine flow curve pattern is improved in a 53-year-old woman from baseline to post-treatment: the curve is changed from an abdominal pressure void curve to a detrusor void curve

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Xu, L., Zhang, Y., Min, X. et al. Refractory lower urinary tract symptoms in patients with lumbar disc hernia relieved by non-surgical treatment. World J Urol 39, 1597–1605 (2021). https://doi.org/10.1007/s00345-020-03330-9

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