Transurethral resection of the prostate (TURP) in males with detrusor underactivity (DU) and bladder outlet obstruction (BOO) is debated.1,2  
Aim of the study was to evaluate outcomes in males with detrusor underactivity (DU) underwent transurethral resection of the prostate (TURP).

We prospectively evaluated 51 patients underwent TURP for lower urinary tract symptoms with urodynamics (UD) diagnosis of DU. All males were stratified in two cohorts: one with bladder outlet obstruction (BOO), and a second one without BOO. UD was performed according to Good Urodynamic Practice. DU was defined as BCI weak class and Schaefer nomograms contractility classes Very Weak or Weak. BOO was defined as International Continence Society (ICS) nomograms class obstructed and Schaefer nomograms obstruction classes III-VI. Follow-up was performed considering International Prostate Symptom Score (IPSS), uroflowmetry (UF), post-void residual urine (PVR) and PVR ratio obtained from the ratio of PVR to bladder volume (BV: voided volume + PVR). IPSS was also stratified in three classes of LUTS severity: 0-7 moderate, 8-19 fair, 20-35 severe. Patients’ satisfaction was measured by VAS and a simple question. Q-square and T-Student tests were used for statistical analysis.

IPSS’ class showed improvement in both groups, higher when BOO was associated to DU (p=0.037). In both groups no statistical difference was documented regarding improvement of IPSS median score (p=0.68), median peak flow (p=0.052), and PVR/PVR ratio (p=0.49). Subjective satisfaction was high in both groups. Patients’ characteristic and outcomes are reported in Table 1 and 2.

TURP in patients with detrusor underactivity lead to a significant improvement in all functional outcomes. Significant improvements were achieved in both obstructed and unobstructed males, and patients with DU and BOO had better results but with no statistical difference.
Moreover, subjective satisfaction was high in both populations.

This study shows that the lack of BOO in patients with detrusor underactivity should not be excluding from surgical indications.

Gani J, Hennessey D: The underactive bladder: diagnosis and surgical treatment options. Transl Androl Urol, 2017 Jul;6(Suppl 2): S 186-195.
Kim M, Jeong CW et al: Effect of Preoperative Urodynamic Detrusor Underactivity on Transurethral Surgery for Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis. J Urol, 2018 Jan;199(1):237-244.