title: The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic followup of transurethral resection of prostate for bladder outlet obstruction.
abstract: OBJECTIVE
  Despite long-term symptomatic and uroflowmetry studies following transurethral prostate resection (TURP) there are sparse pressure flow data. Consequently there is minimal information to account for the long-term symptomatic failure and flow rate decrease seen with time following early improvements after surgery.
  
  
  METHODS
  Men older than 45 years who were investigated at our department between 1972 and 1986, diagnosed with bladder outlet obstruction and elected surgical intervention were invited for repeat symptomatic and urodynamic assessment. Identical methods were used, allowing direct comparison of results.
  
  
  RESULTS
  A total of 1,068 men were initially diagnosed with bladder outlet obstruction, of whom 428 (40%) died in the interim. Of the men who were followed 217 underwent TURP with a mean followup since surgery of 13.0 years. A significant, sustained decrease in the majority of symptoms and improvements of urodynamic parameters was seen. Long-term symptomatic failure and decreased flow rate were principally associated with detrusor under activity (DUA) rather than obstruction. Presentation predictive factors for the future development of DUA were decreased detrusor contractility and a lesser degree of obstruction.
  
  
  CONCLUSIONS
  This unique long-term study provides valuable information on surgically treated bladder outlet obstruction. The association of long-term failure following surgery with DUA emphasizes the importance of pressure flow studies before repeat surgery. However, our faith in the long-term efficacy of TURP is justified.
authors.affiliation: Bristol Urological Institute, Bristol, United Kingdom. alun.thomas@which.net
authors.forename: Alun W
authors.initials: AW
authors.lastname: Thomas
authors.forename: Andrea
authors.initials: A
authors.lastname: Cannon
authors.forename: Esther
authors.initials: E
authors.lastname: Bartlett
authors.forename: Julie
authors.initials: J
authors.lastname: Ellis-Jones
authors.forename: Paul
authors.initials: P
authors.lastname: Abrams
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011336:Probability; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016055:Urinary Retention / Q000175:diagnosis* / Q000453:epidemiology; D014563:Urodynamics / Q000502:physiology