Outcomes of reduction cystoplasty in men with impaired detrusor contractility

摘要

Objective To report surgical outcomes in patients with impaired detrusor contractility (IDC) treated with reduction cystoplasty (RC). Methods This was a retrospective study of consecutive patients with IDC who underwent RC. IDC was defined as a bladder contractility index of 100 and/or a detrusor contraction of insufficient duration resulting in a postvoid residual volume (PVR) 600 mL. Bladder outlet obstruction was defined by a bladder outlet obstruction index (BOOI) 40. All patients had preoperative International Prostate Symptom Score, maximum uroflow (Qmax), PVR, bladder diary, videourodynamics, and cystoscopy. Patients with prostatic obstruction underwent synchronous open prostatectomy. Postoperative Qmax, PVR, need for clean intermittent catheterization (CIC), and Patient Global Impression of Improvement (PGII) score were obtained. Follow-up was at 3 months, 1 year, and yearly thereafter. Results Eight men met inclusion criteria (mean age, 60; range, 43-75 years). Preoperatively, 3 of 8 patients (37.5%) had moderate-sized bladder diverticula, 4 of 8 (50%) had a bladder contractility index 100, and 6 of 8 (75%) had a BOOI 40. Two patients (25%) fulfilled criteria for bladder outlet obstruction (BOOI, 67 and 72). Three (37.5%) underwent synchronous bladder diverticulectomy, and 3 (37.5%) underwent suprapubic prostatectomy. All patients were available for follow-up at 1 year. Seven of 8 (88%) had a successful outcome (PGII ≤2). One patient was unchanged (PGII, 4) and still needed CIC. Conclusion All but 1 patient who met specific criteria for RC had excellent outcomes after surgery based on the PGII, PVR, Q max, and need for CIC. RC is a viable option for properly selected patients with IDC.