Effect of urodynamic preoperative detrusor overactivity on the outcomes of transurethral surgery in patients with male bladder outlet obstruction: a systematic review and meta-analysis
To investigate the effect of urodynamic detrusor overactivity (DO) on the outcomes of transurethral surgery in patients with male bladder outlet obstruction (BOO).
Materials and methods
We systematically searched the PubMed, Embase, and Cochrane Library databases for articles published between January 1989 and June 2017. All results of eligible studies were synthesized.
Nine articles met the eligibility criteria. These studies included a total of 932 patients with a median number of 92 patients per study (range 40–190). Of the nine studies, the conventional transurethral prostatectomy was adopted in four studies, photoselective vaporization of prostate in three studies, and other surgical modalities in two studies. In patients with DO positive, the pooled mean difference (MD) was not significant for a better or poorer improvement in the International Prostate Symptom Score [pooled MD, − 0.27; 95% confidence interval (CI), − 1.75 to 1.22; studies, 9; participants, 827], quality-of-life score (pooled MD, − 0.14; 95% CI, − 0.46 to 0.18; studies, 7; participants, 734), maximal flow rate (pooled MD, 0.79; 95% CI, − 1.57 to 3.14; studies, 8; participants, 781), and post-void residual volume (pooled MD, 2.81; 95% CI, − 4.70 to 10.32; studies, 6; participants, 509) compared to patients with DO negative. Some comparisons showed between-study heterogeneity despite the strict criteria of the eligible studies. However, there was no clear evidence of publication bias in the funnel plots.
Our meta-analysis results demonstrated that preoperative urodynamic DO has no diagnostic role in the prediction of surgical outcomes in patients with male BOO.
KeywordsBenign prostatic hyperplasia Bladder outlet obstruction Transurethral surgery Treatment outcome Urodynamic study Detrusor overactivity
The authors are indebted to Jung-Yun Lee (E-mail: email@example.com), Assistant Professor, Department of Obstetrics and Gynecology, Yonsei University College of Medicine for his pro bono technical advice about our meta-analysis.
MK data collection, data analysis, and manuscript writing; CWJ data collection, data analysis, and manuscript editing; SJO project development, data collection, data analysis, and manuscript editing.
Compliance with ethical standards
Conflict of interest
This study was supported by Grant no. 23-2015-0050 from the Seoul National University Hospital Research Fund. The authors have declared that no competing interests exist.
Research involving human participants or animals
This study did not involve human participants or animals.
- 4.Gravas S, Bachmann A, Descazeaud A, Drake M, Gratzke C, Madersbacher S et al (2014) EAU guidelines on the management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). Available at: https://uroweb.org/wp-content/uploads/Non-Neurogenic-Male-LUTS_2705.pdf. Accessed Dec 2017
- 5.McVary K, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF et al (2010) American urological association guideline: management of benign prostatic hyperplasia (BPH). Available at: https://www.auanet.org/benign-prostatic-hyperplasia-(2010-reviewed-and-validity-confirmed-2014). Accessed Dec 2017
- 20.Tanaka Y, Masumori N, Itoh N, Furuya S, Ogura H, Tsukamoto T (2006) Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity? Int J Urol 13:1398–1404CrossRefPubMedGoogle Scholar
- 23.Masumori N, Furuya R, Tanaka Y, Furuya S, Ogura H, Tsukamoto T (2010) The 12-year symptomatic outcome of transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction compared to the urodynamic findings before surgery. BJU Int 105:1429–1433CrossRefPubMedGoogle Scholar
- 28.Agarwal A, Rathi S, Patnaik P, Shaw D, Jain M, Trivedi S et al (2014) Does preoperative urodynamic testing improve surgical outcomes in patients undergoing the transobturator tape procedure for stress urinary incontinence? A prospective randomized trial. Korean J Urol 55:821–827CrossRefPubMedPubMedCentralGoogle Scholar