BERKELEY, CA (UroToday.com) - Benign prostatic hyperplasia (BPH) is a very prevalent disease among males over 50. The main treatment strategies consist of watchful waiting, drugs, and surgeries. Although transurethral resection of the prostate (TURP) is considered as the gold standard treatment for managing lower urinary tract symptoms caused by BPH, it has been found to be associated with some complications, including postoperative bleeding, urinary retention, transurethral resection syndrome, infection, bladder pain, urinary storage symptoms, and decreased health-related quality of life. These adverse events may be attributable to non-prostatic conditions leading to the development of urinary symptoms as a result of detrusor overactivity or dysfunction of detrusor contractility. Moreover, these symptoms might be as a result of increased sensitivity of muscarinic receptors in the bladder smooth muscle, contrary to a prostatic pathology leading to overactive bladder symptoms (i.e., storage symptoms) following TURP. Given these points and the fact that these symptoms are similar to that of overactive bladder disease, we sought to determine the effect of tolterodine as an anticholinergic on urinary symptoms following TURP. In our prospective randomized trial we demonstrated the impact of 2 mg of tolterodine twice daily on reducing the urinary storage symptoms following catheter removal after TURP compared with placebo.
All patients over 55 undergoing TURP with negative urine culture were entered into the study. Factors interfering with the lower urinary tract symptoms and postvoid residual urine (PVR) higher than 70 mL were considered as exclusion criteria. According to the guidelines, establishing an exact PVR value is not possible to implement the treatment, and on the other hand, a PVR volume of 50 to 100 mL among elderly is generally considered normal value. It has also been demonstrated that patients with small PV and lower weight of resected prostate during TURP will experience persistent urinary symptoms after TURP. In our study tolterodine-treated patients had higher PV compared with that of placebo-treated ones, hence, the impact of tolterodine may have increased by the effect of preoperative PV, and improving storage symptoms may not be only caused by the tolterodine effect, as well. Consequently, we think that preoperatively considering urodynamic study can be of great benefit for excluding patients suffering from lower urinary tract symptoms caused by other factors rather than TURP.
Written by:
Yousef Rezaei as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
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