Bladder outlet obstruction (BOO) in men with castration‐resistant prostate cancer. (2nd December 2013)

• Record Type: Journal Article
• Authors: Rom, Maximilian; Waldert, Matthias; Schatzl, Georg; Swietek, Natalia; Shariat, Shahrokh F.; Klatte, Tobias
• Is Part Of: BJU international. Volume 114:Number 1(2014:Jul.)
• Page Start: 62
• Page End: 66
• Publication Date: 2013-12-02
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12438
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12438-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju12438-list-0001" list-type="bullet"> <list-item> <p>To evaluate the frequency of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in patients with castration‐resistant prostate cancer (CRPC) and lower urinary tract symptoms (LUTS).</p> </list-item> </list> </p> </sec> <sec id="bju12438-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12438-list-0002" list-type="bullet"> <list-item> <p>Our prospective urodynamics database was queried.</p> </list-item> <list-item> <p>Inclusion criteria were CRPC and an International Prostate Symptom Score (IPSS) ≥ 20.</p> </list-item> <list-item> <p>Exclusion criteria were previous local therapy to the prostate gland, known urethral stricture disease, and a neurological component of LUTS.</p> </list-item> <list-item> <p>Twenty‐one patients were identified.</p> </list-item> <list-item> <p>Urodynamic findings were analysed and compared with those of a matched cohort of 42 patients with benign prostatic enlargement (BPE).</p> </list-item> </list> </p> </sec> <sec id="bju12438-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12438-list-0003" list-type="bullet"> <list-item> <p>The median age of patients in the CRPC group was 74 years, and the median prostate‐specific antigen (PSA) level at the time of the urodynamic study was 90 ng/mL.</p> </list-item> <list-item> <p>According to the BOO index, three patients (14%) were obstructed, three were equivocally obstructed (14%) and 15 were unobstructed.</p> </list-item> <list-item> <p>DO was seen in 12 patients (57%).</p> </list-item> <list-item> <p>Compared with the BPE group, patients with CRPC had lower cystometric bladder capacities (<italic>P</italic> = 0.003), were less likely to have BOO (14 vs 43%, <italic>P</italic> = 0.009) and more likely to have DO (57 vs 29%, <italic>P</italic> = 0.028).</p> </list-item> </list> </p> </sec> <sec id="bju12438-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12438-list-0004" list-type="bullet"> <list-item> <p>This study generates the hypothesis that only a minority of CRPC patients with LUTS have BOO, and that more than half of patients have DO.</p> </list-item> <list-item> <p>LUTS in CRPC may therefore be seldom attributable to BOO, but are, at least in part, related to DO and reduced cystometric capacity.</p> </list-item> <list-item> <p>A urodynamic investigation may be necessary before palliative transurethral resection of the prostate to select appropriate candidates.</p> </list-item> <list-item> <p>Larger prospective studies are needed to confirm our findings.</p> </list-item> </list> </p> </sec> </abstract>