VOIDING DYSFUNCTION FOLLOWING TRANSURETHRAL RESECTION OF THE PROSTATE- SYMPTOMS AND URODYNAMIC FINDINGS

Purpose: Persistent voiding dysfunction following transurethral resect ion of the prostate is not uncommon. We determined the correlation, if any, between the subjective complaints in men with voiding dysfunctio n after transurethral resection of the prostate and the urodynamic fin dings. Materials and Methods: A total of 50 consecutive men with voidi ng dysfunction following transurethral resection of the prostate was e valuated with the American Urological Association symptom index and mu ltichannel urodynamics. Patients with urethral stricture, urinary rete ntion or prostate cancer were excluded from the study. Urodynamic para meters assessed included detrusor instability, bladder capacity, sphin cteric insufficiency using the Valsalva leak point pressure, voiding p ressure-flow studies as determined by the Abrams-Griffiths nomogram (o bstructed, unobstructed or equivocal) and post-void residual. Results: Mean patient age was 71 years and mean interval from last transurethr al resection of the prostate was 58 months (range 2 to 252). Mean tota l, obstructive and irritative symptom scores were 16.3, 5.8 and 10.5, respectively. A total of 20 patients (40%) complained of incontinence (14 urge and 6 stress). According to the Abrams-Griffiths nomogram 62% of the cases were unobstructed, 16% obstructed and 22% equivocal. Uro dynamic abnormalities were demonstrated in 43 patients (86%), and incl uded detrusor instability (54%), obstruction with or without detrusor instability (16%), sphincteric insufficiency (8%), detrusor hypocontra ctility (4%) and sensory urgency (4%). There was no difference in the total, irritative or obstructive scores among obstructed, unobstructed or equivocal cases. Similarly there was no difference in scores among patients with and without detrusor instability. Age, number of transu rethral resections and interval since last transurethral resection wer e unrelated to pressure-flow results or detrusor instability. Post-voi d residual was significantly greater in obstructed cases and bladder c apacity was significantly less in those with detrusor instability. The cause of incontinence was demonstrated in 19 of 20 patients (95%): 4 (20%) had sphincteric insufficiency and 15 (75%) had detrusor instabil ity. Conclusions: Symptoms are unreliable in predicting urodynamic fin dings with respect to obstruction and detrusor instability. There is a high incidence of detrusor instability in patients with voiding dysfu nction after transurethral resection of the prostate. Urodynamic obstr uction is a less likely occurrence.