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Speaker: Dr. Prasant Pattnaik, India
Important Takeaways
1. OAB affects about 30% of patients post-TURP, with half showing symptom resolution within four weeks.
2. Factors like pre-existing bladder issues, stimulant consumption, and low bladder compliance increase the risk of post-TURP OAB.
3. A detailed diagnosis using clinical history, bladder diaries, and urodynamic studies is essential for proper management.
4. Initial treatment focuses on lifestyle changes, pelvic floor exercises, and pharmacological therapy with antimuscarinics or beta-agonists.
5. Minimally invasive options, including botulinum toxin injections and neuromodulation, are effective in refractory cases.
Key Highlights
Incidence and Predisposing Factors:
OAB symptoms, including urgency, frequency, and nocturia, are common after TURP, with an incidence of around 30%. Patients with pre-existing detrusor overactivity, poor bladder perfusion, or frequent stimulant use (e.g., caffeine) are at higher risk for developing post-TURP OAB.
Diagnostic Tools and Assessments:
Accurate diagnosis involves questionnaires such as IPSS and OABSS, detailed clinical assessments, bladder diaries, and post-void residual measurements. In complex cases, urodynamic studies help evaluate bladder function and predict postoperative outcomes.
Management Approaches:
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Conservative management is the first step, including behavioural therapy, fluid optimization, and pelvic floor exercises. Pharmacological treatment with antimuscarinics (e.g., solifenacin) and beta-agonists (e.g., mirabegron) is often used, with antidepressants and desmopressin for specific symptoms.
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Minimally Invasive Treatments
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For refractory OAB, botulinum toxin injections offer symptom relief but may need repetition after two years. Sacral neuromodulation and intramuscular stimulation (IMS) are promising alternatives, especially when combined with pharmacological treatments.
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Preventive Strategies and Surgical Considerations
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Preoperative counselling, lifestyle adjustments, and treating infections before surgery help minimise OAB symptoms. Enucleation techniques, such as HoLEP, reduce the risk of postoperative complications compared to traditional TURP. Careful surgical techniques, including low intravesical pressure and precise dissection, further decrease complications.
Considerations for Pre-Operative Bladder Function Assessment:
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Bladder Function Evaluation: Assess bladder compliance, detrusor activity, and storage function preoperatively to guide treatment decisions.
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Watchful Waiting: Consider delaying intervention in mild cases to observe if symptoms resolve without treatment.
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Risk-Benefit Analysis: Balance the benefits of treating overactive bladder (OAB) against potential side effects of antimuscarinic medications, such as dry mouth and constipation.
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Personalised Treatment: Tailor management to the patient’s individual characteristics, comorbidities, and treatment preferences.
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Alternative Surgical Options: Explore minimally invasive surgical treatments (MIST) that reduce the risk of complications associated with traditional TURP.
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Minimally Invasive Techniques: Techniques like HoLEP and MIST minimise trauma, preserving bladder function and reducing post-surgical OAB incidence.
Société Internationale d'Urologie Congress, 23-26 October 2024, New Delhi, India.
