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The mechanical stop test and isovolumetric detrusor contractile reserve are associated with immediate spontaneous voiding after transurethral resection of prostate

Abstract

Purpose

To identify urodynamic factors associated with the mechanical stop test and immediate spontaneous voiding following transurethral resection of prostate (TURP).

Methods

We identified 90 men who underwent TURP over a 12-month period. Forty-three (mean age 68 years) underwent urodynamic evaluation prior to TURP. Isovolumetric detrusor contractile pressure (Piso) was obtained using the mechanical stop test during the voiding phase, and used to calculate detrusor contractile reserve (Pres = PisoPdet@Qmax). Primary outcome was spontaneous voiding after TURP.

Results

Preoperative catheter-free spontaneous voiding was present in 63% of men (27/43) with a urodynamic (mean ± SD): Qmax 6.2 ± 2.7 mL/s, Pdet@Qmax 102 ± 47 cmH2O, Piso 124 ± 49 cmH2O, Pres 22 ± 16 cmH2O, bladder outlet obstruction index (BOOI) 90 ± 49, and bladder contractility index (BCI) 132 ± 44. The remaining 16 catheter-dependent men demonstrated a urodynamic (mean ± SD): Qmax 3.6 ± 3.3 mL/s, Pdet@Qmax 87 ± 38 cmH2O, Piso 99 ± 51 cmH2O, Pres 10 ± 18 cmH2O, BOOI 82 ± 36, and BCI 106 ± 48. Following TURP, 67% of men voided spontaneously with their first void trial, and in receiver operator analysis of urodynamic measures (Pdet@Qmax, Piso, Pres, BOOI and BCI), only Pres was significantly associated with immediate spontaneous voiding after TURP (threshold Pres ≥ 9 cmH2O, AUC = 0.681, p = 0.035).

Conclusions

In men who underwent TURP, a Pres ≥ 9 cmH2O was associated with immediate spontaneous voiding and may be easily incorporated into the postoperative pathway.

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Abbreviations

BCI:

Bladder contractility index (BCI = Pdet@Qmax + 5 × Qmax)

BOOI:

Bladder outlet obstruction index (BOOI = Pdet@Qmax − 2 × Qmax)

Pdet@Qmax :

Detrusor pressure at maximum flow

P iso :

Isovolumetric detrusor contraction pressure

P res :

Detrusor contractile reserve pressure (Pres = PisoPdet@Qmax)

PVR:

Post-void residual

Q max :

Maximum flow rate

TURP:

Transurethral electrosurgical resection of prostate

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Funding

This study was funded by author (ADD) support from the KL2 component of the Stanford Clinical Translational Science Award to Spectrum (NIH 5KL2TR001083-05) and NIH Extramural Loan Repayment Program for Clinical Researchers (NIH 1L30DK115056-01).

Author information

ADD: Protocol/project development, data collection, data analysis, manuscript writing/editing; XZ: Manuscript writing/editing; CVC: Protocol/project development, manuscript writing/editing.

Correspondence to Amy D. Dobberfuhl.

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Conflicts of interest

Dr. Dobberfuhl has received research grants from the National Institutes of Health, SUFU Foundation Study of Chemodenervation, and Stanford Women’s Health & Sex Differences in Medicine. Dr. Comiter has received research grants from the SUFU Foundation Study of Chemodenervation and is a consultant for Neuspera Medical Systems. The authors declare that they have no conflicts of interest in relation to the content of the manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Dobberfuhl, A.D., Zhang, X. & Comiter, C.V. The mechanical stop test and isovolumetric detrusor contractile reserve are associated with immediate spontaneous voiding after transurethral resection of prostate. Int Urol Nephrol 52, 239–246 (2020). https://doi.org/10.1007/s11255-019-02322-y

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Keywords

  • Follow-up studies
  • Male
  • Muscle contraction
  • Prostatic hyperplasia
  • Urologic surgical procedures