MP48: Treatment outcome of patients with CNS disorders and voiding dysfunction after bladder outlet surgery (TUIP.TURP.TUIBN)
  • 52 views,
  • 06-11,
  • 上傳者: TUA人資客服組,
  •  0
慢性腦部病變合併排尿障礙病患接受膀胱出口手術之預後分析
張天霖、陳聖復、郭漢崇
佛教慈濟醫療財團法人花蓮慈濟醫院 泌尿部
Treatment outcome of patients with CNS disorders and voiding dysfunction after bladder outlet surgery (TUIP.TURP.TUIBN)
Tien-Lin Chang, Sheng-Fu Chen, Hann-Chorng Kuo
Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
 
Purpose: CNS lesions have an impact on micturition, typically result in involuntary bladder contractions with coordinated sphincter function. Sensation and voluntary striated sphincter function are usually preserved, but sensation may be deficient or delayed. Detrusor areflexia may occur either initially or as a permanent dysfunction. Urinary incontinence may occur owing to the detrusor overactivity. Bladder outlet surgeries are treatment options for voiding dysfunction secondary to bladder outlet obstruction or bladder neck dysfunction. However, LUTS may persist after these surgeries. This study focused on the therapeutic outcomes of patient with CNS lesion and voiding dysfunction who received bladder outlet surgeries and identified the predictor of satisfactory outcomes.
Materials and Methods: This study is a retrospective survey on 51 men and 9 women who had CNS lesions and symptoms of voiding dysfunction following bladder outlet surgery, which were proved by video-urodynamic study. Pre-operative VUDS parameters and post-operative VUDS parameters or uroflowmetry parameters at baseline and follow-up were analysed. Clinical outcomes were assessed by comparing pre-operative and post-operative LUTS including storage and voiding symptoms. Patients with urethral stricture, history of prostate cancer were excluded from the study. Patient characteristics and baseline urodynamic parameters were analysed for factors predictive of outcomes.
Results: The mean age of the patients was 77.1 ± 9.8 years (range 41-87). In total CNS group, symptoms including frequency and urinary retention have improved after surgery. About the uroflowmetry parameter, cQmax, PVR and VE have significantly improved after surgery. Control group has better improvement in cQmax, In BPO group, control group has better outcome in frequency, urgency and CBC. No other significant difference between two groups. In non-BPO group, control group has better outcome in urinary retention, cQmax, PVR and VE. In patient with DO, CNS group has better outcome in frequency and urinary retention. Between three CNS lesion groups, Parkinson’s disease has better outcome in CBC, cQmax , PVR and PE. And CVA group has significant improved in frequency, urinary retention, PVR and VE. There is no predictive factor of success found in current baseline characteristics.
Conclusions: Bladder outlet surgeries are effective to both CNS and non-CNS patients with voiding dysfunction. In DO group, CNS group has less effect on bladder outlet surgeries. TURP is a better surgical intervention than TUI-P in both BPO and non BPO group. CVA and Parkinson’s disease have better outcome than dementia group.
 
 
Total
DO
CNS(n=51)
Control(=33)
P-value
CNS(n=31)
Control(n=7)
P-value
Age
71.06±9.829
69.91±9.204
0.593
71.61±10.362
77.43±8.52
0.176
Storage
Frequency
Baseline
15(29.4%)
27(81.8%)
0.000
13(41.9%)
5(71.4%)
0.011
Follow-up
4(7.8%)
6(18.2%)
0.599
4(12.9%)
0(0%)
0.000
P
0.006
0.000
 
0.021
 
 
Urgency
Baseline
15(29.4%)
23(69.7%)
0.000
12(38.7%)
3(42.9%)
0.001
Follow-up
8(15.7%)
7(21.2%)
0.612
7(22.6%)
1(14.3%)
0.001
P
0.146
0.000
 
0.344
0.500
 
Nocturia
Baseline
11(21.6%)
16(48.5%)
0.010
9(29%)
2(28.6%)
0.000
Follow-up
7(13.7%)
10(30.3%)
0.534
6(19.4%)
1(14.3%)
0.001
P
0.375
0.109
 
0.625
1.000
 
UUI
Baseline
13(25.5%)
5(15.2%)
0.259
10(32.3%)
3(42.9%)
0.000
Follow-up
9(17.6%)
10(30.3%)
0.979
7(22.6%)
4(57.1%)
0.031
P
0.508
0.125
 
0.687
1.000
 
Voiding
Dysuria
Baseline
15(29.4%)
30(90.9%)
0.000
11(35.5%)
6(85.7%)
0.009
Follow-up
11(21.6%)
9(27.3%)
0.424
4(12.9%)
2(28.6%)
0.001
P
0.754
0.000
 
0.063
0.125
 
Self voiding
Baseline
11(33.3%)
10(19.6%)
1.000
14(45.2%)
7(100%)
 
Follow-up
25(49%)
33(100%)
0.000
8(25.8%)
1(14.3%)
0.002
P
0.000
 
 
 
 
 
Retention
Baseline
18(35.3%)
6(18.2%)
0.090
12(38.7%)
2(28.6%)
0.000
Follow-up
4(7.8%)
0(0%)
0.030
2(6.5%)
0(0%)
0.000
P
0.007
 
 
0.039
 
 
CIC/Foley/cystostomy
Baseline
2(3.9%)
0(0%)
0.250
1(3.2%)
0(0%)
0.000
Follow-up
1(3%)
6(11.8%)
0.007
3(9.7%)
0(0%)
0.000
P
0.289
 
 
0.625
 
 
Sensation
FSF(Baseline)
139.54±83.237
155.77±65.778
0.363
114.97±67.075
155.20±90.467
0.243
FS(Baseline)
206±130.916
238.5±84.418
0.184
162.50±101.324
181.50±108.491
0.681
US(Baseline)
229.35±138.194
298.82±121.373
0.022
177.81±102.236
171.57±106.680
0.886
Storage
CBC
Baseline
284.57±208.996
338.52±126.321
0.144
268.58±219.06
188.29106127
0.355
Follow-up
266.14±158.405
300.39±193.010
0.377
218.42±131.397
162.14±58.159
0.279
P
0.067
0.024
 
0.288
0.298
 
Δ
-18.02±229.547
-38.12±184.519
 
-50.16±232.170
-26.14±94.626
0.791
Voiding
cQmax
Baseline
0.378±0.3874
0.354±0.1991
0.710
0.467±0.39
0.326±0.2308
0.369
Follow-up
0.552±0.4628
0.812±0.3176
0.003
0.688±0.4485
0.759±0.2041
0.688
P
0.039
0.016
 
0.845
0.401
 
Δ
0.1517±0.50044
0.4584±0.29669
0.002
0.2221±0.60522
0.4329±0.24316
0.375
Volume
Baseline
115.21±110.444
243.76±132.381
0.000
136.87±118.517
148.29±101.421
0.815
Follow-up
139.44±137.110
261.7±186.462
0.001
150.39±136.910
117.57±47.229
0.539
P
0.538
0.009
 
0.181
0.521
 
Δ
29.64±165.025
17.94±173.786
0.758
13.52±164.078
-30.71±98.449
0.500
PVR
Baseline
191.13±224.948
97.72±114.692
0.018
136.10±214.226
46.67±52.78
0.322
Follow-up
130.25±144.420
38.70±68.079
0.000
68.03±81.883
52.00±70.2
0.486
P
0.024
0.548
 
0.620
0.639
 
Δ
-47.66±234.774
-56.06±125.485
0.833
-63.68±220.018
4.57±70.116
0.427
VE
Baseline
0.4771±0.42234
0.7324±0.303
0.000
0.5952±0.3934
0.77551±0.35921
0.274
Follow-up
0.5704±0.36353
0.8639±0.19973
0.000
0.6965±0.308
0.7657±0.284
0.590
P
0.004
0.002
 
0.077
0.890
 
Δ
0.0756±0.41475
0.1321±0.30460
0.054
0.1013±0.41428
-0.0071±0.29618
0.518
Pdet(Baseline)
40.13±31.897
40.78±22.638
0.915
49.97±30.158
46.43±32.098
0.784
BOOI(Baseline)
26.08±31.588
0.73±0.303
0.000
34.94±33.480
0.78±0.359
0.000
Contractility
BCI(Baseline)
64.235±46.151
71.409±26.252
0.367
81.903±38.8170
69.286±25.4540
0.420
 
 
 
 
BPO
Non-BPO
CNS(n=18)
Control(n=11)
P-value
CNS(n=27)
Control(n=22)
P-value
Age
67.45±6.817
73.72±7.683
0.035
68.71±10.907
71.14±10.110
0.425
Storage
Frequency
Baseline
8(44.4%)
9(81.8%)
0.047
7(25%)
18(81.8%)
0.000
Follow-up
2(11.1%)
1(9.1%)
0.534
2(7.1%)
5(22.7%)
0.336
P
0.063
0.008
 
0.125
0.000
 
Urgency
Baseline
8(44.4%)
9(81.8%)
0.047
7(25%)
14(63.6%)
0.006
Follow-up
6(33.3%)
2(18.2%)
0.076
2(7.1%)
5(22.7%)
0.336
P
1.000
0.016
 
0.125
0.004
 
Nocturia
Baseline
6(33.3%)
2(18.2%)
0.376
5(17.9%)
14(63.6%)
0.001
Follow-up
3(16.7%)
0(0%)
0.062
4(14.3%)
10(45.5%)
0.125
P
0.500
 
 
1.000
0.289
 
UUI
Baseline
6(33.3%)
1(9.1%)
0.319
7(25%)
4(18.2%)
0.563
Follow-up
4(22.2%)
3(27.3%)
0.647
5(17.9%)
7(31.8%)
0.781
P
1.000
0.500
 
0.687
0.375
 
Voiding
Dysuria
Baseline
4(22.2%)
10(90.9%)
0.000
11(39.3%)
20(90.9%)
0.000
Follow-up
2(11.1%)
0(0%)
0.138
8(28.6%)
9(40.9%)
0.882
P
1.000
 
 
0.687
0.001
 
Self voiding
Baseline
11(61.1%)
 
 
13(46.4%)
22(100%)
 
Follow-up
3(16.7%)
 
 
7(25%)
6(27.3%)
0.435
P
 
 
 
0.070
 
 
Retention
Baseline
0(0%)
9(50%)
0.005
9(32.1%)
6(27.3%)
0.709
Follow-up
2(11.1%)
0(0%)
0.138
1(3.6%)
0(0%)
0.263
P
0.063
 
 
0.039
 
 
CIC/Foley/cystostomy
Baseline
0(0%)
0(0%)
 
2(7.1%)
0(0%)
0.201
Follow-up
2(11.1%)
0(0%)
0.138
2(7.1%)
0(0%)
0.109
P
 
 
 
1.000
X
 
Sensation
FSF
116.94±94.666
148.64±60.333
0.331
154.96±76.244
159.70±69.787
0.827
FS
160.71±104.768
234.18±73.130
0.053
232.25±141.772
240.76±91.413
0.800
US
190.33±101.467
303.36±115.216
0.010
251.71±155.561
296.55±126.926
0.279
Storage
CBC
Baseline
293.94±255.550
358.64±112.008
0.436
306.57±169.013
328.45±134.251
0.612
Follow-up
268.78±145.573
400±235.864
0.118
252.96±160.255
250.59±149.932
0.958
P
0.524
0.001
 
0.012
0.627
 
Δ
-25.17±273.003
41.36±150.823
0.466
-54.15±172.967
-77.86±189.962
0.650
Voiding
cQmax
Baseline
0.457±0.45
0.322±0.154
0.350
0.365±0.359
0.369±0.2199
0.965
Follow-up
0.457±0.45
0.801±0.216
0.315
0.526±0.436
0.817±0.362
0.015
P
0.647
0.340
 
0.022
0.043
 
Δ
0.2069±0.63181
0.4790±0.22181
0.182
0.1647±0.43685
0.4481±0.33222
0.016
Volume
Baseline
134.44±99.031
281.36±137.353
 
99.71±120.08
224.95±128.87
 
Follow-up
144.17±89.383
353.27±253.681
 
145.82±162.306
215.91±125.483
 
P
0.106
0.212
 
0.860
0.034
 
Δ
9.72±104.084
71.91±233.912
0.421
50.85±200.647
-9.05±132.960
0.236
PVR
Baseline
168.88±268.305
77.27±120.589
0.299
206.86±203.616
108.43±112.995
0.037
Follow-up
124.61±150.733
46.73±57.498
0.061
107.14±109.031
34.68±73.739
0.007
P
0.496
0.505
 
0.005
0.729
 
Δ
-34.89±277.661
-30.55±121.324
0.961
-105.00±175.169
-68.82±128.351
0.423
VE
Baseline
0.618±0.423
0.8051±0.29
0.171
0.427±0.412
0.696±0.309
0.011
Follow-up
0.628±0.334
0.826±0.249
0.104
0.583±0.363
0.883±0.173
0.000
P
0.076
0.510
 
0.019
0.120
 
Δ
0.0106±0.41175
0.0227±0.32821
0.934
0.1737±0.40813
0.1868±0.28404
0.899
Pdet
50.88±32.415
55.64±23.653
0.679
32.86±31.219
33.00±18.158
0.985
BOOI
34.83±31.945
0.81±0.291
0.000
22.43±32.468
0.7±0.309
0.001
Contractility
BCI
81.11±51.029
86.091±27.29
0.765
58.929±40.014
64.068±22.935
0.571
 
TURP success
5(83.3%)
 
 
8(88.9%)
 
 
 
TUIP success
1(16.7%)
 
 
1(11.1%)
 
 
 
 
CVA
PD
Dementia
P-value
 
Case
36
8
7
 
 
Age
69.42±9.967
72.75±9.161
77.57±7.635
0.115
 
Surgery
TUR-P
19(52.8%)
5(62.5%)
4(57.1%)
0.875
 
TUI-P
7(19.4%)
1(12.5%)
1(14.3%)
0.869
 
TUI-BN
10(27.8%)
2(25%)
2(28.6%)
0.985
 
Storage
Frequency
Baseline
12(33.3%)
2(25%)
1(14.3%)
0.573
 
Follow-up
3(8.3%)
1(12.5%)
0(0%)
0.405
 
P-value
0.021
1.000
 
 
 
Urgency
Baseline
10(27.8%)
2(25%)
1(14.3%)
0.694
 
Follow-up
5(13.9%)
3(37.5%)
0(0%)
0.006
PD v.s. Dementia
PD v.s. CVA
P-value
0.298
 
 
 
 
Nocturia
Baseline
9(25%)
1(12.5%)
1(14.3%)
0.651
 
Follow-up
6(16.7%)
1(12.5%)
0(0%)
0.391
 
P-value
0.625
1.000
 
 
 
UUI
Baseline
7(19.4%)
3(37.5%)
3(42.9%)
0.299
 
Follow-up
6(16.7%)
3(37.5%)
0(0%)
0.010
PD v.s. Dementia
P-value
1.000
 
 
 
 
Voiding
Dysuria
Baseline
11(30.6%)
2(25%)
2(28.6%)
0.951
 
Follow-up
7(19.4%)
1(12.5%)
3(42.9%)
0.494
 
P-value
0.687
1.000
1.000
 
 
Retention/AUR
Baseline
16(44.4%)
0(0%)
2(28.6%)
0.054
 
Follow-up
2(5.6%)
0(0%)
2(28.6%)
0.144
 
P-value
0.003
 
1.000
 
 
CIC/Foley/cystostomy
Baseline
2(5.6%)
0(0%)
0(0%)
0.648
 
Follow-up
4(11.1%)
0(0%)
2(28.6%)
0.360
 
P-value
0.687
 
 
 
 
TPV
32.387±16.4182
56.167±20.056
49.833±27.4886
0.082
 
Resect(%)
34.53%
30.14%
23.9%
 
 
DO
25(69.4%)
5(62.5%)
1(14.3%)
0.019
CVA v.s. Dementia
Sensation
FSF
145.15±76.047
91±37
168.57±132.411
0.156
 
FS
213.41±115.532
127±82.077
262.43±205.545
0.114
 
US
240.76±125.770
139.63±102.217
278.14±197.020
0.106
 
Storage
CBC
Baseline
298.78±222.749
190.75±122.746
318.71±206.584
0.382
 
Follow-up
271.25±160.3
224.13±127.075
287.86±193.150
0.702
 
P-value
0.470
0.002
0.190
 
 
Δ
-27.53±257.739
33.38±54.116
-29.50±205.516
0.794
 
Voiding
cQmax
Baseline
0.379±0.3945
0.523±0.43
0.204±0.253
0.289
 
Follow-up
0.567±0.445
0.684±0.535
0.204±0.253
0.313
 
P-value
0.615
0.022
0.207
 
 
Δ
0.1535±0.55088
0.1609±0.33272
0.1287±0.41752
0.992
 
Volume
Baseline
129.24±119.784
108.5±83.635
56.71±75.703
0.289
 
Follow-up
158.2.4±151.753
117.13±82.072
76.29±96.531
0.371
 
P-value
0.974
0.166
0.987
 
 
Δ
33.17±185.712
8.62±79.390
36.50±125.644
0.928
 
PVR
Baseline
202.84±233.832
107±162.096
262±261.587
0.270
 
Follow-up
107.44±118.024
82.25±111.946
211.57±170.037
0.274
 
P-value
0.048
0.005
0.068
 
 
Δ
-60.69±262.509
24.75±84.297
-66.00±194.484
0.644
 
VE
Baseline
0.4694±0.4176
0.6±0.43
0.376±0.469
0.588
 
Follow-up
0.61±0.35891
0.6125±0.33213
0.3186±0.368
0.588
 
P-value
0.004
0.040
0.140
 
 
Δ
0.1033±0.44558
0.0138±0.29698
-0.0083±0.39035
0.754
P=0.592
Pdet
40.47±28.764
54.38±40.507
22.29±31.122
0.151
 
BOOI
24.53±28.821
40.88±45.74
17.14±25.083
0.307
 
Contractility
BCI
64.583±45.42
88.125±39.11
35.143±46.65
0.083
 
附件
訪客如要回應,請先 登入
    資料夾 :
    發表時間 :
    2020-06-11 11:22:32
    觀看數 :
    52
    發表人 :
    TUA人資客服組
    部門 :
    台灣泌尿科醫學會
    QR Code :