Effectiveness of treatment of detrusor overactivity after transurethral resection of benign prostate hyperplasia

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.

Keywords

benign prostatic hyperplasia / bladder outlet obstruction / lower urinary tract symptoms / transurethral resection of the prostate / extracorporeal magnetic stimulation / detrusor overactivity / overactive bladder

References

[1] 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

[2] Раснер П.И., Сивков А.В., Харчилава Р.Р. Российские клинические рекомендации. Доброкачественная гиперплазия предстательной железы. Общероссийская общественная организация «Российское общество урологов». Москва, 2022.

[3] 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.)

[4] Амдий Р.Э. Диагностическое и прогностическое значение уродинамических исследований нижних мочевых путей у больных с инфравезикальной обструкцией и нарушением сократимости детрузора: автореф. дис. … д-ра мед. наук. Санкт-Петербург, 2007. 24 с.

[5] 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

[6] Sokhal A.K., Sinha R.J., Purkait B., Singh V. Transurethral resection of prostate in benign prostatic enlargement with underactive bladder: A retrospective outcome analysis // Urol Ann. 2017. Vol. 9, No. 2. P. 131–135. DOI: 10.4103/UA.UA_115_16

[7] 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

[8] Аль-Шукри С.Х., Гиоргобиани Т.Г., Амдий Р.Э., Аль-Шукри А.С. Нарушения мочеиспускания у больных с неудовлетворительными результатами хирургического лечения доброкачественной гиперплазии предстательной железы // Вестник хирургии им. И.И. Грекова. 2017. Т. 176, № 6. С. 66–70. DOI: 10.24884/0042-4625-2017-176-6-66-70

[9] 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.)

[10] Тарасов Н.И., Иващенко В.А. Лечение расстройств мочеиспускания после трансуретральной резекции предстательной железы // Экспериментальная и клиническая урология. 2016. № 1. C. 98–105.

[11] 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

[12] Campbell R.A., Gill B.C. Medication Discontinuation Following Transurethral Prostatectomy: an Unrecognized Effectiveness Measure? // Current Urology Reports. 2020. Vol. 21, No. 12. P. 61. DOI: 10.1007/s11934-020-01015-9

[13] 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

[14] Аль-Шукри С.Х., Амдий Р.Э., Кузьмин И.В. Снижение сократимости мочевого пузыря у больных доброкачественной гиперплазией предстательной железы // Урологические ведомости. 2011. Т. 1, № 1. С. 3–8. DOI: 10.17816/uroved.11

[15] 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

[16] Cornu J.N., 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

[17] 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

[18] Zhao Y.R., Liu W.Z., 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. Vol. 21, No. 10. P. 1035–1040. DOI: 10.1111/iju.12482

[19] 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

[20] Кузьмин И.В. Эпидемиологические аспекты гиперактивного мочевого пузыря и ургентного недержания мочи // Урологические ведомости. 2015. Т. 5, № 3. C. 30–34.

[21] 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

[22] Chapple C.R., 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. Vol. 6, No. 3. P. 522–530. DOI: 10.1016/j.euf.2019.09.020

[23] 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

[24] Кузьмин И.В., Кузьмина С.В. Антихолинергическая терапия гиперактивного мочевого пузыря: практические аспекты // РМЖ. Медицинское обозрение. 2021. Т. 5, № 5. С. 273–279. DOI: 10.32364/2587-6821-2021-5-5-273-279

[25] 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

[26] Аль-Шукри С.Х., Ананий И.А., Амдий Р.Э., Кузьмин И.В. Электростимуляция мышц тазового дна в лечении больных с недержанием мочи после радикальной простатэктомии // Урологические ведомости. 2016. Т. 6, № 4. С. 10–13. DOI: 10.17816/uroved6410-13

[27] 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

[28] Apostolidis A., Averbeck M.A., 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. Vol. 36, No. 4. P. 882–893. DOI: 10.1002/nau.23170

[29] 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

[30] Nunzio C.D., Brucker B., Bschleipfer T., et al. Beyond Antimuscarinics: A Review of Pharmacological and Interventional Options for Overactive Bladder Management in Men // European Urology. 2021. Vol. 79, No. 4. P. 492–504. DOI: 10.1016/j.eururo.2020.12.032

[31] 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.)

[32] Ткачева О.Н., Недогода С.В., Арутюнов Г.П., и др. Фармакотерапия у лиц пожилого и старческого возраста. Методическое руководство МЗ РФ. Москва, 2018. 87 c.

[33] 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.)

[34] Ткачева О.Н., Яхно Н.Н., Незнанов Н.Г., и др. Российские клинические рекомендации «Когнитивные расстройства у лиц пожилого и старческого возраста». Общественная организация «Российское общество психиатров», Общероссийская общественная организация «Российская ассоциация геронтологов и гериатров». Москва, 2020. 317 c.

[35] 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

[36] 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. Vol. 38, No. 2. P. 433–477. DOI: 10.1002/nau.23897

[37] 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

[38] Кузьмин И.В., Слесаревская М.Н. Антихолинергическая терапия гиперактивного мочевого пузыря: геронтологические аспекты // Клиническая геронтология. 2021. Т. 27, № 11–12. С. 21–34. DOI: 10.26347/1607-2499202111-12021-034

[39] 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

[40] Амдий Р.Э., Аль-Шукри С.Х., Кузьмин И.В., и др. Экстракорпоральная магнитная стимуляция в урологии // Урологические ведомости. 2021. Т. 11, № 4. С. 345–353. DOI: 10.17816/uroved84474

[41] 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

[42] Jayadevappa R., Chhatre S., Newman D.K., et al. Association between overactive bladder treatment and falls among older adults // Neurourol Urodyn. 2018. Vol. 37, No. 8. P. 2688–2694. DOI: 10.1002/nau.23719

[43] 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

[44] Аль-Шукри С.Х., Кузьмин И.В. Качество жизни больных с гиперактивностью мочевого пузыря // Урологические ведомости. 2011. Т. 1, № 1. C. 21–22. DOI: 10.17816/uroved57653

RIGHTS & PERMISSIONS

Eco-Vector