[Consequences of prostatic obstruction on bladder function, impact of removal, and management of recurrence after surgery].

Autor:	de la Taille A; Service de chirurgie urologique, CHU Henri-Mondor, AP-HP, 94000 Créteil, France. Electronic address: adelataille@hotmail.com., Robert G; Service d'urologie, CHU de Bordeaux, 30000 Bordeaux, France., Descazeaud A; Service d'urologie, CHU de Limoges, 87042 Limoges, France.
Jazyk:	francouzština
Zdroj:	Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie [Prog Urol] 2018 Nov; Vol. 28 (15), pp. 813-820. Date of Electronic Publication: 2018 Sep 24.
DOI:	10.1016/j.purol.2018.08.013
Abstrakt:	Objective: Our objective was to evaluate bladder outlet obstruction (BOO) consequences on the detrusor activity, to analyze the impact of medical and surgical treatments, and to study the reasons for recurrence of urinary symptoms after surgical treatment. Method: A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications between 2000 and July 2018 with the keywords: BPH, bladder obstruction, bladder instability, surgery, and reoperation. A first research was crossed with the results of the reviews of literature already published and was enriched by the contributions of the various authors. A synthesis has been proposed. Results: The consequences of bladder outlet obstruction (BOO) on the detrusor may be detrusor overactivity (DOA) or detrusor hypocontractility. DOA is found in about 50% of patients at the time of their surgery and its evolution is most often favorable after surgical treatment (resolved or reduced in 2/3 of cases). Bladder hypocontractility is responsible for acute or chronic urinary retention. It can be the cause for poor postoperative micturition recovery requiring self-catheterization which the patient must have been informed before surgical treatment. Surgery reduces urinary symptoms with a low but significant surgical revision rate (10 to 30% depending on the surgical technique). The less efficient technique with regard to surgical revision rates are prostatic radiofrequency or cervico-prostatic incision, followed by laser vaporization techniques, TURP and adenomectomy (surgical or endoscopic). Adenomectomy is the surgical technique that has the lowest recurrence rate. The identified risk factors for surgical revision are the surgeon's experience, the power of the laser (in case of photovaporization), the surgical technique employed, the length of operative time, the low or excessive volume of the prostate, the significant pre-operative post-void residual volume, and the slight decrease of postoperative PSA level. Prior to any surgical revision for recurrence of urinary symptoms, the assessment should include the review of previous surgical report, the evaluation of the resected prostatic volume and the residual prostatic volume, the IPSS score, the calendar of micturition, the urethrocystoscopy and the urodynamic assessment. Conclusion: BOO can lead to bladder dysfunction such as DOA or detrusor hypocontractility. Resolution of BOO by a suitable surgical treatment allows, in the majority of the cases, to resolve bladder dysfunctioning. In case of failure, the assessment must be complete to define the causes and to find the most suitable solution. (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)
Databáze:	MEDLINE
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