الفهرس 
Benign Prostate HyperplasiaOnly 14 pages are availabe for public view
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Abstract
Benign prostatic hyperplasia (BPH) is commonly found in the aging male, beginning at 40–45 years old and becoming 60% at 60 and 80% at 80 years old. A longitudinal study suggesting a prostate growth rate of 2.0%–2.5% per year in older men. Treatments of choice for BPH are non-surgical and surgical intervention. Alpha-blocker and 5α-Reductase inhibitors are the most common combination pharmacological therapy of options. In the past decades, there was a shift in managing BPH patients from surgical treatment to medical treatment.
Approximately 25–30% of patients with BPH have detrusor underactivity (DUA). It makes surgical failure, such as minor improvement of International Prostate Symptoms Score (IPSS) and imperfect improvement of flow rate in the BPH with DUA patients.
Bladder outlet obstruction (BOO), clinically defined as high-pressure/low-flow micturition pattern at urodynamic investigations, is a common urological condition in humans with benign prostatic obstruction (BPO) being the most frequent causative factor. It represents a key pathophysiological link between benign prostate enlargement (BPE) and lower urinary tract symptoms (LUTS). Besides symptoms, BOO can also lead to progressive tissue remodeling of the bladder and of the upper urinary tract with subsequent serious functional impairments.
The aim of this study was to evaluate the outcome of detrusor muscle function in patients with underactive bladder due to benign prostate enlargement after treatment with prostatectomy. This progressive study was conducted on 50 patients at Urology Department Menoufia University during the period from July 2020 to October 2021. These patients were less than 70 years of age in men who scheduled for prostatectomy with post voiding residual urine more than 150 ml.
All patients were selected according to the inclusion and exclusion criteria:
Inclusion criterion: These patients were less than 70 years of age in men who scheduled for prostatectomy with post voiding residual urine more than 150 ml.
Exclusion criteria: Relevant neurological disease, such as a stroke, multiple sclerosis, Parkinson’s disease, or Spina bifida, Men with bladder stones, Previous prostate surgery, Not medically fit for surgery, or unable to complete outcome assessments.
For every patient the following was done: Patient’s consent was taken for radiological examination, detailed medical history including: Weight, height, BMI, HTN, DM, Full physical examination, Routine lab evaluations including: Complete urine analysis and culture, PSA (free and total), Bl. urea and S. creatine, audiological investigation
Results of the current study were summarized as follows:
The age of the present study ranged between 56.0–70.0 with mean of 65.24 ± 4.95 years. The Weight of the present study ranged between 63.0–120.0 with mean of 88.54 ± 12.81 kg. The Height of the present study ranged between 159.0–188.0 with mean of 175.10 ± 7.27 cm. The BMI of the present study ranged between 19.44–39.64 with mean of 28.88 ± 3.80 kg/m2. Regarding HTN (mmHg) and DM, 60.0 % was HTN and 54.0 % was DM.
Summary
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Post voiding residual urine Pre-operative was 180.0 (153.0–600.0) ml range. U/S Abdomen Pre -operative showed, Bilateral HUN Was found in 6.0 % and absent in 94.0 %.
Post voiding residual urine post-operative was 35.0(10.0-230.0) ml range.
Regarding Bladder wall thickness, most become Normal (84.0 %) Post-operative
IPSS pre-operative ranged between 18.0 – 32.0 with mean 26.24 ± 3.20, and Quality of life score pre-operative ranged between 3.0–6.0 with median 5.0.
IPSS Post-operative ranged between 9.0 – 26.0 with mean 17.28 ± 4.80, and Quality of life score post-operative ranged between 1.0–5.0 with median 3.0.
Pre-operative, Pdet Qmax ranged between 10.0 – 145.0 and median was 58.50 cm H2O. Q max ranged between 1.90 – 22.0 and median was 5.90 ml/s, and Average flow rate ranged between 0.20 – 10.0 and median was 3.0 ml.
Post-operative, Pdet Qmax ranged between 50.0–90.0 and median was 75.0 cm H2O, Q max ranged between 3.30–18.0 and median mean was 13.30 ml, Average flow rate ranged between 1.90–19.10 and median was 14.0 ml.
BCI pre-operative, it ranged between 35.0 – 165.0 and median was 89.50. 34 (68.0%) patients showed weak detrusor contractility (BCI <100), 13 (26.0%) patients showed normal detrusor contractility (BCI 100–150), and 3 (6.0%) patients showed strong detrusor contractility (BCI >150).
BCI post-operative, it ranged between 76.0–180.0 and median was 145.0. 8 (18.6%) patients showed weak detrusor contractility (BCI <100), 25 (58.1%) patients showed normal detrusor contractility (BCI 100–150), and 10 (23.3%) patients showed strong detrusor contractility (BCI >150).
Regarding Pdet Qmax, there was a statistically significant difference between Pdet Qmax (pre and Post-operative) (p=0.004*). Post-operative, Pdet Qmax was a higher than pre-operative.
Regarding Q max, there was a statistically significant difference between Q max (pre and Post-operative) (p<0.001*). Post-operative, Q max was a higher than pre-operative.
Regarding BCI, there was a statistically significant difference between BCI (pre and Post-operative) (p<0.001*).
Regarding average flow rate, there was a statistically significant difference between average flow rate (pre and Post-operative) (p<0.001*). Post-operative, Average flow rate was a higher than pre-operative.