Evaluation of detrusor function in patients with large and giant benign prostatic hyperplasia pre- and post-laparoscopic transvesical adenomectomy

Introduction. Laparoscopic transvesical adenomectomy (LTA) is the method of choice for managing large and giant BPH. This method is characterised by effective correction of bladder outlet obstruction, low incidence of hemorrhagic complications and incontinence, reduction of postoperative recovery time, as well as improvement of patients' quality of life.

Objective. To determine the functional state of the detrusor pre- and post-LTA in patients with large and giant BPH.

Materials & Methods. This retrospective study is based on the results of treatment of 36 patients who underwent LTA for BPH. Inclusion criteria: prostate volume over 80 cc, maximum urine flow rate (Qmax) below 15 ml/sec, no history of lower urinary tract infection and neurogenic urination disorders; no history of transurethral surgery. All patients underwent filling and voiding cystometry immediately before surgery and again 3 to 6 months postoperatively.

Results. The mean age of the patients was 65.8 ± 4.21 years. The average prostate volume was 148.5 ± 17.9 cc, and the mean total IPSS score before treatment was 19.4 ± 2.3 points. Qmax ranged from 3.2 to 11.3 ml/s, with a mean value of 6.2 ± 1.6 ml/s. No patients experienced complications greater Clavien-Dindo I in the early postoperative period. Postoperatively, there was a statistically significant decrease in detrusor pressure from 20.29 (± 2.9) to 11.24 (± 2.9) cm H₂O, as well as an increase in Qmax from 6.24 (± 1.61) to 25.1 (± 5.05) ml/s.

Conclusions. LTA is an effective and safe method of surgical treatment of BPH both from the perspective of common complications and from the perspective of functional detrusor disorders.

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