Efficacy of Transurethral Resection of the Prostate in Male Patients With Impaired Detrusor Contractile Function and Urinary Retention

TL;DR

This study shows that TURP can help some older men with bladder issues stop using catheters, though success varies based on prostate size and other factors.

Contribution

The study evaluates TURP efficacy in male patients with impaired detrusor function, a less understood surgical scenario.

Findings

37 out of 67 patients became catheter-free within 3 months after TURP.

Higher prostate volume was an independent predictor of surgical failure.

Treatment failure was linked to more frequent urinary tract infections and hospitalizations.

Abstract

Detrusor underactivity (DUA) increasingly affects aging male patients with voiding symptoms, while its management remains challenging, with less favorable surgical outcomes compared to bladder outlet obstruction. Our aim was to evaluate the efficacy of TURP in male patients with urinary retention and unfavorable urodynamic findings.

This retrospective, single‐center study included 67 male patients undergoing TURP between September 2021 and September 2024 after a failed trial of voiding. Patients were divided into three groups labeled as detrusor acontractility (DA, n = 18, voided without detrusor contraction), DUA (n = 19, voided with BCI < 100 and BOOI < 20), or non‐voiders (n = 30, failed to urinate and lacked measurable detrusor contractions on pressure‐flow study). Surgical success was defined as successful voiding with post‐void residual (PVR) < 150 mL at 3 months. Baseline parameters (PSA, prostate volume, cystoscopy and urodynamic findings), rate of surgical success, Patient Global Impression of Improvement (PGI‐I) score and adverse events (subsequent surgeries and urinary tract infection) were registered and analyzed.

Overall 37 (55.2%) patients became catheter‐free within 3 months. The mean follow‐up duration was 25.4 ± 9.6 months. Surgical success was achieved in DA, DUA, and non‐voider groups in 6 (33%), 13 (68.4%), and 18 (60%) cases, respectively, and a PGI‐I score greater than 4 was reported by 35 (52.2%) patients. Multivariate analysis showed higher prostate volume as an independent predictor for failure (OR: 1.7; 95% CI: 1.010–2.940; p = 0.046). Two patients developed stress urinary incontinence, and three required additional surgical intervention due to urethral stricture. Urinary tract infections occurred more frequently in the treatment failure group: Nine patients (30%) were hospitalized, and 16 (53%) required more than two antibiotic prescriptions within a 6‐month period. In contrast, among the success group, only two patients (5.4%) were hospitalized, and none required frequent antibiotic therapy.

TURP offers a reasonable chance for catheter discontinuation in case of unfavorable urodynamic parameters. With careful patient selection in mind, surgery remains a viable option even in this patient population.

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