REVIEW   Free access

Minerva Urology and Nephrology 2021 February;73(1):59-71

DOI: 10.23736/S2724-6051.20.03678-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Detrusor overactivity and underactivity: implication for lower urinary tract symptoms related to benign prostate hyperplasia diagnosis and treatment

Massimiliano CRETA ¹, Claudia COLLÀ RUVOLO ¹, Nicola LONGO ¹, Francesco MANGIAPIA ¹, Davide ARCANIOLO ², Marco DE SIO ², Cosimo DE NUNZIO ³, Ciro IMBIMBO ¹, Vincenzo MIRONE ¹, Ferdinando FUSCO ¹ ✉

¹ Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy; ² Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy; ³ Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy

INTRODUCTION: Detrusor underactivity (DUA) and detrusor overactivity (DO) have potential impact on the outcomes of surgery for lower urinary tract symptoms related to benign prostate hyperplasia (LUTS/BPH).
EVIDENCE ACQUISITION: We performed a literature search including studies on humans enrolling patients with preoperative urodynamic evidence of DO and/or DUA undergoing LUTS/BPH surgery. Factors that may influence the outcomes of surgery in these patients were evaluated.
EVIDENCE SYNTHESIS: In patients with DUA mean bladder contractility index improved from +4 to +44.6, mean total International Prostate Symptom Score (IPSS) improved from -3 to -19.5 points, mean maximum urinary flow (Qmax) improved from +1.4 to +11.7 mL/s, and mean postvoid residual volume (PVR) improved from -16.5 to -736 mL. Older age, lack of obstruction, concomitant DO, lower detrusor contractility and use of transurethral resection of the prostate (TURP) or photovaporization (PV) instead of Holmium laser enucleation of the prostate (HoLEP) were associated with worse outcomes. In patients with DO, the percentage of DO resolution ranged from 57.1% to 83.3%. Mean total IPSS, Qmax, and PVR variations ranged from +0.9 to -15.7 points, from -0.2 mL/s to +14 mL/s, and from -19.6 to -202.5 mL, respectively. Older age, lack of obstruction, terminal DO, low maximum cystometric capacity, early and high amplitude DO, and use of transurethral prostate incision instead of TURP or open adenomectomy were associated with worse outcomes.
CONCLUSIONS: In patients with DUA or DO, surgery for LUTS/BPH provides overall good results. However, a number of factors can affect these outcomes.

KEY WORDS: Urinary bladder, overactive; Urinary bladder, underactive; Lower urinary tract symptoms; Surgery