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

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.