title: The evolution of detrusor overactivity after watchful waiting, medical therapy and surgery in patients with bladder outlet obstruction.
abstract: OBJECTIVE
  We analyzed the evolution of detrusor overactivity in patients with bladder outlet obstruction treated with either medical or surgical therapy or watchful waiting.
  
  
  METHODS
  Of 255 patients with symptomatic benign prostatic enlargement who completed the International Prostate Symptom Score and underwent full urodynamic investigation 161 presented with bladder outlet obstruction. Of the 161 men 101 were reevaluated with a second clinical evaluation and urodynamics 1 to 5 years (mean 2) after watchful waiting in 20, medical treatment (alfuzosin 20 and finasteride 16) in 36 and surgery (transurethral incision of the prostate 13 and prostatectomy 32) in 45. For statistical analysis Wilcoxon matched paired data and Kruskal Wallis tests were used as appropriate.
  
  
  RESULTS
  Overall detrusor overactivity was present in 53 patients (52%) at baseline and 41 (40%) at followup. Detrusor overactivity was present in 9 patients (45%) at baseline and 11 (55%) at followup in the watchful waiting group (p = 0.17); 7 (35%) at baseline and 6 (30%) at followup in the alfuzosin group (p = 0.37); 10 (62.5%) at baseline and 10 at followup in the finasteride group (p = 1); 6 (46%) at baseline and 4 (30%) at followup in the transurethral prostate incision group (p = 0.48); and 21 (68%) at baseline and 10 (31%) at followup in the prostatectomy group (p = 0.02).
  
  
  CONCLUSIONS
  Detrusor overactivity is highly prevalent (52%) in patients with bladder outlet obstruction, and appears to persist for long periods when obstruction is left untreated or treated only with medical therapy. However, surgical treatment of bladder outlet obstruction, prostatectomy in particular, significantly reduces the incidence of detrusor overactivity and lessens the chance of its de novo appearance for up to 5 years.
authors.affiliation: U. Bracci Department of Urology, La Sapienza University of Rome, Rome, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: de Nunzio
authors.forename: Giorgio
authors.initials: G
authors.lastname: Franco
authors.forename: Andrea
authors.initials: A
authors.lastname: Rocchegiani
authors.forename: Francesco
authors.initials: F
authors.lastname: Iori
authors.forename: Costantino
authors.initials: C
authors.lastname: Leonardo
authors.forename: Cesare
authors.initials: C
authors.lastname: Laurenti
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000503:physiopathology; D011470:Prostatic Hyperplasia / Q000150:complications; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*