Retention and UAB: Plenary Session spills insights
Led by Prof. Cosimo De Nunzio (IT) and Prof. Kari Tikkinen (FI), the Plenary Session “Lights on urinary retention and underactive bladder in BPO patients” comprised State-of-the-art lectures, case presentations, live interviews, and riveting debates. This article features the two State-of-the-art lectures in the session.
During his lecture “Detrusor underactivity and underactive bladder: Definition and clinical implication”, Prof. Tufan Tarcan (TR) defined underactive bladder (UAB) as a symptomatic definition that is not necessarily associated with detrusor underactivity (DU) or impaired bladder tissue contractility.
Prof. Tarcan also discussed the challenges from the co-existence of UAB/DU with other types of lower urinary tract dysfunction (LUTD). Regarding male lower urinary tract symptoms (LUTS), benign prostatic obstruction (BPO) and DU are the main reasons for prostatectomy failures. He added that detrusor overactivity and DU are associated with poor outcomes of prostatectomy, especially with urinary incontinence (UI).
Citing “Summary paper on underactive bladder from the European Association of Urology Guidelines on non-neurogenic male lower urinary tract symptoms” (M. Baboudjian, et al), Prof. Tarcan also discussed the recommendations for the surgical treatment, and the conservative and pharmacological management of underactive bladder.
Prof. Tarcan stated that the management of UAB/DU depends on the phenotype, bother, and aetiology. He added that relief of bladder outflow obstruction can be achieved through bladder re-education and pelvic floor muscle exercises (PFME); clean intermittent catheterisation (CIC); neuromodulation; and relief of bladder outlet obstruction (BOO).
There is no medical treatment yet for DU.
Operating patients with retention
In his State-of-the-art lecture “Should you operate every patient with retention?”, Prof. Enrico Finazzi Agrò (IT) defined acute urinary retention (AUR) as when a patient is unable to pass urine despite having a full bladder, and chronic urinary retention is when there is chronic high post-void residual volume (PVR) where the patient experiences slow flow and incomplete bladder emptying.
Should one operate on every patient with retention? Prof. Finazzi Agrò answered “no” to chronic urinary retention, and “yes” to AUR. However if DU is present in the latter, the EAU Guidelines recommend counselling patients about the potential subjective and objective benefits of benign prostatic surgery.
Prof. Finazzi Agrò enumerated the absolute indications for surgery, such as:
- Recurrent or refractory urinary retention
- Overflow incontinence
- Recurrent urinary tract infections (UTIs)
- Bladder stone or diverticula
- Treatment-resistant macroscopic haematuria due to benign prostatic hyperplasia (BPH)/benign prostate enlargement (BPE)
- Dilatation of the upper urinary tract due to BPO, with or without renal insufficiency
Prof. Finazzi Agrò cited the study “Detrusor underactivity influences the efficacy of TURP in patients with BPO” (Yan Zhu, et al) which showed the improved success rates of postoperative parameters among the severe (approximately 90%), mild (around 60%), and non-DU patients (about 40%).
Regarding BPO surgery for AUR patients, Prof. Finazzi Agrò cited the study “Efficacy and safety of surgery for benign prostatic obstruction in patients with preoperative urinary catheter” (B. Gondran-Tellier, et al). It concluded that the overall success rate of BPO surgery was 70.8% after a one-year follow-up. Compared with transurethral resection of the prostate (TURP), enucleation methods and photoselective vaporisation of the prostate (PVP) were associated with better catheter-free survival, whereas prostate artery embolization (PAE) was associated with higher risk of AUR recurrence.
Are there AUR patients who should not be surgically treated? According to the aforementioned study, patients who failed to remain without catheter despite surgery were most likely to be frail-patients (older; with more comorbidities, including cardiovascular diseases).
He underlined that all these findings may be obtained only after invasive urodynamics. “Without this information, we may not have all the information we need to give good counselling and prediction of the results,” said Prof. Finazzi Agrò.
Learn more about the rest of the expert insights shared during the State-of-the-art lectures by (re)viewing their full presentations as webcasts on the EAU26 Resource Centre.