Patients with larger prostate are more likely to be cather-free following TURP.
TRUS allows more accurate estimation of the prostatic volume, but this will not predict the effect of TURP on chronic retention. If you are in doubt of the benefit of TURP for a patient, you may choose to do complete urodynamic assessment including pressure flow study to confirm the presence of obstruction rather than atonic bladder.
Insertion of a temporary endourethral stent could serve as a test before performing TURP especialy in elderly comorbid patients. However, the availability of these stents is restricted
Do you mean such outcome as postoperative residual urine? In a case of future prognosis for bladder capacity, instead of Trus, you can try simplier, so-called "artificial uroflowmetry". Using urethral catheter or cystostomic tube (if exists), you can place distal end of the catheter on 80 cm above from the level of bladder and ask patient to void. If patient can void with sufficient Q and without significant volume of residual urine, then prognosis can be estimated as good. If patient is not able to void sufficiently on this height, you can reduce it to 60 cm, then 40 and finally to 20 cm. As lower is a level of distal end of catheter, as poorer is prognosis for post-operatve voiding. This technique is pretty cheap and simple. It was developed by our specialists and we use it in our everyday practice. 80cm of water column within the 24 Fr tube was estimated to be equal to normal urethral resistance.
TRUS estimation of prostate size is an operator-dependant procedure and it does not predict the outcomes of TURP in chronic retention. The functional outcomes of these patients depend mostly on the detrusor muscle status, which could be evaluated by UDS. However, even with cases with detrusor underactivity, removal of obstruction would partially improve the detrusor contraction in a subgroup of patients. Therefore, some surgeons prefer to proceed for TURP without UDS as surgery considers being the only acceptable option for these patients.
It is à misconception that removal of thé obstruction Will improve detrusor contractility. It would certainly avoid any further deterioration but it would't improve thé contraction of the detrusor. Thus, Pressure flow studies are needed but you can also rely on non invasive procedures
But it is really true that removal of obstruction would improve detrusor activity in some patients.
It depends on duration of an obstruction. Trabeculations of the detrusor and existence of bladder diverticula seen on conventional suprapubic US are also findings reducing the chance of good prognosis. In some cases open surgery can be an option.
Along the same lines. The only predictor is bladder contractility, which goes along with bladder compliance. If the bladder is hypercompliant, ie hyperdistended the prognosis is worse. Difficult to predict though but important in terms of patient counselling.
If TURP is correctly performed,the results depend only by the time of obstruction and so on by the conditions of the bladder
Do not forget about diabetic cystopathy and neuroegic bladder ;-)
Statde that TRUS allows more accurate estimation of the prostatic volume rather then sovrapubic. Intravescical Prostatic Protrusion (IPP) is a new parameter to be considered consdered and validated by recent studies. IPP is correlated to BOO (cut-off 12mm). IPP is a measurement of the median lobe. When prostatic volume is less than 35 cc and IPP
In elderly male patients with signs or symptoms of lower urinary tract dysfunction PVR may be observed and 'chronic urinary retention' may be diagnosed. However the diagnosis 'chronic urinary retention' is not perfectly defined. If the prostate is large, the likelihood of BOO increases with the prostate size, the maximum of flow decreases and the likelihood of postvoid residual increases. The development of postvoid residual is usually a slow proces, as the prostate is slowly increasing in size. and flowrate slowly decreasing. The bladder gets used to this -small in the beginning and slowly incremental- post void urine volume and the patient remains unaware of this. Also usually the bladder can cope with this and contracton remains. It is not easy to predict in general who will develop underactivity. If the PVR is not too large and the prostate is relatively large TURP will do good. Precise limits are unavailable. However If the prostate is not large- in case of large PVR- underactivity is more likely and the patient will be unable to 'open his prostate- scar' after TURP (of a small prostate that is likely not obstructing), and PVR nor voiding will improve much. But remember. PVR must only be done after a voiding (flowrate) in the patient's usual position and after the patient has mentioned that the voiding has been (almost) as usual.
The only way to evaluate bladder function ist doing UDS with pressure/ flow measurement - everything else is for the individual speculation.
prostate volume predicts the likelyhood of bladder outflow obstruction, but detrusor underactivity plays a role in the outcome of surgery, but there is no evidence that I am aware of that shows how precise this 'role' is.
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