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The natural history of lower urinary tract dysfunction in men: minimum 10‐year urodynamic follow‐up of untreated detrusor underactivity
Author(s) -
Thomas Alun W.,
Can Andrea,
Bartlett Esther,
EllisJones Julie,
Abrams Paul
Publication year - 2005
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2005.05891.x
Subject(s) - natural history , medicine , lower urinary tract symptoms , urodynamic studies , bladder outlet obstruction , urinary system , urology , gynecology , prostate , cancer
There are two papers from Bristol on the natural history of lower urinary tract dysfunction in men, in both cases with a minimum 10‐year follow‐up. The first of these is a urodynamic study of neurologically untreated men with untreated detrusor underactivity, most of whom remained untreated with a mean follow‐up of 13.6 years. The results provide important information on the natural history of this condition, and show that there are minimal symptomatic and urodynamic changes with time. In the second of these papers the natural history of untreated BOO in men is described. The authors showed that patients with untreated BOO show no significant urodynamic deterioration in the long‐term, with only a minority having worsening of their symptoms. OBJECTIVES To assess the long‐term symptomatic and urodynamic outcomes of men with untreated detrusor underactivity (DUA) as there has been little long‐term follow‐up information on men with DUA, a cause of lower urinary tract symptoms (LUTS) in a significant minority of men. PATIENTS AND METHODS Neurologically intact men aged > 18 years who were investigated in our department between 1972 and 1986, diagnosed with DUA, and who initially opted for no specific treatment were invited for a repeat symptomatic and urodynamic evaluation. Identical methods of assessment were used, allowing results to be compared directly. RESULTS In all, 224 men were initially diagnosed with DUA; 87 (39%) of these died. Of the 69 men who initially opted for a conservative approach and attended for repeat assessment, 58 (84%) remained untreated, with a mean follow‐up of 13.6 years. There were no significant changes in symptoms over the follow‐up. The only significant urodynamic finding was an increase in the proportion of patients with detrusor overactivity, but with no apparent worsening of chronic retention. Of the 11 men in who failed the conservative approach , eight proceeded to surgery for LUTS, and three for acute urinary retention. CONCLUSIONS These results provide important information on the natural history of DUA. In men with DUA presenting with LUTS there are few symptomatic and urodynamic changes with time.