Analysis of Treatment Outcome (Visual Laser Assisted Prostatectomy) According to the Types of Bladder Outlet Obstructive Pattern in BPH

Park, Sung Tae; Lee, Jeong Gu

Abstract

Patients with symptomatic BPH have different patterns of obstruction: compressive (difficulty in opening the urethra) and constrictive (decreasing elasticity of urethra) obstruction. 26 patients with symptomatic BPH were classified into two different groups according to the types of obstruction as shown by pressure/flow study and clinical outcomes were compared between these groups. There were no differences in the mean age and weight of the prostate at presentation between two groups. Of the 26 patients, 16 had compressive, and 10 had constrictive obstruction. Amount of postvoiding residual urine (PVR), maximal detrusor contraction pressure (Pdet. max.), detrusor maximal flow pressure (Pdet. Qmax.), and minimal urethral opening pressure (Pmuo) were significantly higher in compressive obstruction group than in constrictive obstruction group as shown by analysis of the urodynamic parameters before treatment. Patients were treated with VLAP followed by TURP for obstructing prostate tissues to facilitate early voiding after catheter removal. Postoperative results were evaluated using the parameters such as peak flow rate (Qmax.), amount of PVR and AUA symptom score. Significant increases in Qmax, decreases of symptom score and amount of PVR were evident for both groups of obstruction after treatment. Improvements of the clinical parameters were substantially better in constrictive,than compressive obstruction groups, but without statistically significant differences.