Email this article Effectiveness of treatment of detrusor overactivity after transurethral resection of benign prostate hyperplasia
- Authors: Simanov R.N.1,2, Amdiy R.E.3, Al-Shukri S.K.3, Kuzmin I.V.3, Barysheva O.Y.1,2
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Affiliations:
- Petrozavodsk State University
- V.A. Baranov Republican Hospital
- Academician I.P. Pavlov First St. Petersburg State Medical University
- Issue: Vol 13, No 1 (2023)
- Pages: 5-13
- Section: Original articles
- URL: https://bakhtiniada.ru/uroved/article/view/134239
- DOI: https://doi.org/10.17816/uroved192493
- ID: 134239
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Abstract
BACKGROUND: In a significant number of patients with benign prostatic hyperplasia who underwent transurethral resection (TURP), micturition disorders are detected in the late postoperative period. The issues of drug treatment of overactive bladder are widely covered in the literature and clinical guidelines. However, the number of studies on the treatment of patients with detrusor overactivity after TURP is relatively small.
AIM: The aim of the study is to increase the effectiveness of treatment of patients with detrusor overactivity after TURP in the late postoperative period.
MATERIALS AND METHODS: We treated 51 patients with urodynamically confirmed detrusor overactivity after TURP aged 56 to 87 years (mean 71.5 ± 8.4 years). Taking into account the comorbid background, concomitant therapy, age characteristics and the presence of contraindications, 8 patients were prescribed solifenacin, 9 — trospium chloride, 34 — mirabegron. Appointment of anticholinergic therapy for 1 month in 7 patients was ineffective, they were prescribed mirabegron. Drug treatment lasted 3 months. With insufficient effectiveness of drug therapy, combined treatment with mirabegron was performed in combination with extracorporeal magnetic stimulation (ECMS) for 1 month (12 sessions of ECMS in total). When the combination of ECMS and mirabegron was ineffective, intravesical botulinum therapy was performed. The effectiveness of treatment was assessed by subjective assessment by patients, the results of patients filling out IPSS questionnaires, urination diaries, ultrasound results and uroflowmetry.
RESULTS: After the end of drug therapy 17 (33.3%) patients subjectively rated the result of treatment as “excellent”, 15 (29.4%) patients as “good”. In 19 (37.3%) patients the effectiveness of drug therapy was regarded as insufficient and they underwent combined therapy with mirabegron and ECMS. As a successful combination therapy was recognized in 10 (52.6%) patients. Botulinum therapy was performed in 6 patients with ineffectiveness of the previous stages of treatment with a positive effect in 5 (83.3%) of them. Tolerability of treatment was satisfactory. Based on the results of the study, an algorithm for the treatment of detrusor overactivity in patients with urination disorders in the late postoperative period after TURP was proposed.
CONCLUSIONS: The applied treatment regimen for patients with detrusor overactivity after TURP is effective and can be recommended for use in clinical practice.
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##article.viewOnOriginalSite##About the authors
Ruslan N. Simanov
Petrozavodsk State University; V.A. Baranov Republican Hospital
Author for correspondence.
Email: ruslansimanov@yandex.ru
ORCID iD: 0000-0003-1246-7233
SPIN-code: 3747-8245
chief lecturer in the Department of Hospital Surgery, ENT, Ophthalmology, Dentistry, Oncology and Urology, urologist
Russian Federation, Petrozavodsk; PetrozavodskRefat E. Amdiy
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: r.e.amdiy@mail.ru
ORCID iD: 0000-0003-1305-5791
SPIN-code: 2399-7041
Scopus Author ID: 6506347944
Dr. Sci. (Med.), professor of the Department of Urology
Russian Federation, Saint PetersburgSalman Kh. Al-Shukri
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: alshukri@mail.ru
ORCID iD: 0000-0002-4857-0542
SPIN-code: 2041-8837
Scopus Author ID: 6506423220
Dr. Sci. (Med.), Professor, head of the Department of Urology
Russian Federation, Saint PetersburgIgor V. Kuzmin
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: kuzminigor@mail.ru
ORCID iD: 0000-0002-7724-7832
SPIN-code: 2684-4070
Scopus Author ID: 56878681300
Dr. Sci. (Med.), professor of the Department of Urology
Russian Federation, Saint PetersburgOlga Yu. Barysheva
Petrozavodsk State University; V.A. Baranov Republican Hospital
Email: hosptherapy@mail.ru
ORCID iD: 0000-0002-2133-4849
SPIN-code: 4896-5434
Dr. Sci. (Med.), professor of the Department of Hospital Therapy of the Medical Institute, head of the Nephrology Department
Russian Federation, Petrozavodsk; PetrozavodskReferences
- Rasner PI, Sivkov AV, Harchilava RR. Rossiiskie klinicheskie rekomendatsii. Dobrokachestvennaya giperplaziya predstatelnoi zhelezy. Obshcherossiiskaya obshchestvennaya organizatsiya. Rossiiskoe Obshchestvo Urologov. Moscow, 2022. (In Russ.) Available from: https://cr.minzdrav.gov.ru/schema/6_1
- Amdiy RE. Diagnosticheskoe i prognosticheskoe znachenie urodinamicheskikh issledovanii nizhnikh mochevykh putei u bolnykh s infravezikalnoi obstruktsiei i narusheniem sokratimosti detruzora [dissertation abstract]. Saint Petersburg; 2007. 24 p. (In Russ.)
- Sokhal AK, Sinha RJ, Purkait B, Singh V. Transurethral resection of prostate in benign prostatic enlargement with underactive bladder: A retrospective outcome analysis. Urol Ann. 2017;9(2):131–135. doi: 10.4103/UA.UA_115_16
- Al-Shukri SK, Giorgobiani TG, Amdiy RE, Al-Shukri AS. Urinary dysfunction in patients with unsatisfactory results of surgical treatment of benign prostatic hyperplasia. Grekov’s Bulletin of Surgery. 2017;176(6): 66–70. (In Russ.) doi: 10.24884/0042-4625-2017-176-6-66-70
- Tarasov NI, Ivashchenko VA. Treatment of urinary disorders after transurethral resection of benign prostatic hyperplasia depending on their causes. Experimental and Clinical Urology. 2016;(1):98–105. (In Russ.)
- Campbell RA, Gill BC. Medication Discontinuation Following Transurethral Prostatectomy: an Unrecognized Effectiveness Measure? Current Urology Reports. 2020;21(12):61. doi: 10.1007/s11934-020-01015-9
- Al-Shukri SKh, Amdiy RE, Kuzmin IV. Decrease of urinary bladder contractility in patients with benign prostate hyperplasia. Urologicheskie vedomosti. 2011;1(1):3–8. (In Russ.) doi: 10.17816/uroved.11
- Cornu JN, Ahyai S, Bachmann A, et al. A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. European Urology. 2015;67(6):1066–1096. doi: 10.1016/j.eururo.2014.06.017
- Zhao YR, Liu WZ, Guralnick M, et al. Predictors of short-term overactive bladder symptom improvement after transurethral resection of prostate in men with benign prostatic obstruction. Int J Urol. 2014;21(10):1035–1040. doi: 10.1111/iju.12482
- Kuzmin IV. Epidemiological aspects of overactive bladder and urge urinary incontinence. Urologicheskie vedomosti. 2015;5(3): 30–34. (In Russ.) doi: 10.17816/uroved5330–3
- Chapple CR, Mironska E, Wagg A, et al. Multicriteria decision analysis applied to the clinical use of pharmacotherapy for overactive bladder symptom complex. Eur Urol Focus. 2020;6(3):522–530. doi: 10.1016/j.euf.2019.09.020
- Kuzmin IV, Kuzmina SV. Anticholinergic therapy of an overactive bladder: clinical practice aspects. Russian Medical Inquiry. 2021;5(5): 273–279. (In Russ.) doi: 10.32364/2587-6821-2021-5-5-273-279
- Al-Shukri SK, Ananiy IA, Amdiy RE, Kuzmin IV. Electrical stimulation of the pelvic floor in the treatment of patients with urinary incontinence after radical prostatectomy. Urologicheskie vedomosti. 2016;6(4):10–13. (In Russ.) doi: 10.17816/uroved6410-13
- Apostolidis A, Averbeck MA, Sahai A, et al. Can we create a valid treatment algorithm for patients with drug resistant overactive bladder (OAB) syndrome or detrusor overactivity (DO)? Results from a think tank (ICI-RS2015). Neurourol Urodyn. 2017;36(4):882–893. doi: 10.1002/nau.23170
- Nunzio CD, Brucker B, Bschleipfer T, et al. Beyond Antimuscarinics: A Review of Pharmacological and Interventional Options for Overactive Bladder Management in Men. European Urology 2021;79(4):492–504. doi: 10.1016/j.eururo.2020.12.032
- Tkacheva ON, Nedogoda SV, Arutyunov GP, et al. Farmakoterapiya u lits pozhilogo i starcheskogo vozrasta. Metodicheskoe rukovodstvo. MZ RF. Moscow; 2018. 87 p. (In Russ.)
- Tkacheva ON, Yakhno NN, Neznanov NG, et al. Rossiiskie klinicheskie rekomendatsii “Kognitivnye rasstroistva u lits pozhilogo i starcheskogo vozrasta”. Obshchestvennaya organizatsiya “Rossiiskoe obshchestvo psikhiatrov”, Оbshcherossiiskaya obshchestvennaya organizatsiya. Rossiiskaya assotsiatsiya gerontologov i geriatrov. Moscow; 2020. 317 p. (In Russ.)
- D’Ancona C, Haylen B, Oelke M, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019;38(2):433–477. doi: 10.1002/nau.23897
- Kuzmin IV, Slesarevskaya MN. Anticholinergic bladder therapy: geriatric aspects. Clin Gerontol. 2021;27(11–12):21–34. (In Russ.) doi: 10.26347/1607-2499202111-12021-034
- Amdiy RE, Al-Shukri SK, Kuzmin IV, et al. Extracorporeal magnetic stimulation in urology. Urology reports (St. Petersburg). 2021;11(4):345–353. doi: 10.17816/uroved84474
- Jayadevappa R, Chhatre S, Newman DK, et al. Association between overactive bladder treatment and falls among older adults. Neurourol Urodyn. 2018;37(8):2688–2694. doi: 10.1002/nau.23719
- Al-Shukri SK, Kuzmin IV. Quality of life in patients with overactive bladder. Urologicheskie vedomosti. 2011;1(1):21–26 (In Russ.) doi: 10.17816/uroved57653
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