Detrusor Overactivity in Patients with Benign Prostatic Obstruction: The Clinical and Urodynamic Characteristic

Choi, Hyung Joon; Lee, Kyu Sung

Abstract

Purpose
Benign prostatic obstruction (BPO) and detrusor overactivity (DO) are the major factors that cause lower urinary tract symptoms (LUTS) in men, but they usually coexist. Therefore, the clinical and urodynamic characteristics of BPO with DO were reviewed.
Materials and Methods
One hundred nineteen patients, aged over 50 years and diagnosed as the bladder outlet obstruction (BOO) on urodynamic study, were included. Patients with a neurological history that might affect their bladder function were excluded. All patients were systemically examined, with digital rectal examination, transrectal ultrasound, s-PSA and an urodynamic study, and IPS-score and ICS male questionnaires also completed. After a pressure-flow study, BOO was defined based on the Abrams- Griffiths number (>or=20). Patients were divided into the pure BOO and those combined with idiopathic detrusor overactivity (IDO) groups, and their clinical and urodynamic variables compared.
Results
Of the 119 BPO men, 57 (48%) were combined with IDO. The patients with combined IDO were older (68+/-9.8 vs. 60+/-8.9 years, p<0.05), had a lower maximal cystometric capacity (321+/-94 vs. 429+/-113 ml, p<0.05) and more obstructed (AG number: 44 21.6 vs. 35.6+/-13.5, p<0.01) than the pure BPO patients. The incidence of IDO increased with obstruction grade, from 40% in the AG number 20-40 group to 52 and 75% in the 40-60 and the more than 60 groups, respectively (p<.05). The older patients had a higher incidence of IDO on an age based comparison (50-60 years: 24%, 60-70 years: 44%, >or=70 years: 83%, p<0.05). In the comparison of the symptoms questionnaires, the BPO combined with IDO group was found to have higher scores than the pure BPO group for irritative symptoms (IPS-score: 9.09+/-3.83 vs. 11.27+/-3.12, ICS male questionnaires: 17.44+/-3.66 vs. 20.37+/-4.56, p<0.05).
Conclusions
These data indicate that BPO with IDO is considered to be a more progressed disease, and a more pronounced obstruction and older age were also noted than with pure BOO. The incidence of BPO with IDO would also increase as irritative symptom score increased.