title: Role of Bladder Dysfunction in Men with Lower Urinary Tract Symptoms Refractory to Alpha-blocker Therapy: A Video-urodynamic Analysis.
abstract: OBJECTIVE
  Lower urinary tract symptoms (LUTS) in men result from a complex interplay of pathophysiology, including bladder and bladder outlet dysfunction. This study retrospectively analyzed bladder dysfunction in men with LUTS based on the results of video-urodynamic studies (VUDS).
  
  
  METHODS
  Male patients (aged ≥40 years), with LUTS and an International Prostate Symptom Score of 8 or more, who were refractory to alpha-blocker treatment were retrospectively recruited and evaluated with VUDS and total prostate volume (TPV). Patients were further divided into subgroups of bladder dysfunction and bladder outlet dysfunction according to characteristic VUDS findings. Age, TPV and VUDS findings were compared among different subgroups.
  
  
  RESULTS
  After VUDS, bladder outlet obstruction (BOO) was only noted in 48.6% of men. Of patients, 919 of 2991 (30.7%) had bladder dysfunction including detrusor underactivity (DU, 5.1%), detrusor overactivity and inadequate contractility (DHIC, 5.3%), detrusor overactivity (DO, 17%) and hypersensitive bladder (HSB, 3.3%). In addition, 1941 (64.9%) had bladder outlet dysfunction including BOO + DO (33.8%), BOO alone (14.8%), and poor urethral sphincter relaxation (PRES, 16.3%). Among the 1519 patients with DO, 66.6% (1012) had BOO while, among 1454 patients with BOO, 69.5% (1010) had DO. Patients with DHIC, DU and DO were 5 years older than patients with HSB and normal men. TPV was significantly smaller in patients with DHIC, DU and DO as compared with BOO + DO.
  
  
  CONCLUSIONS
  Approximately one-third of male LUTS was due to bladder dysfunction. A man older than 70 years with LUTS and TPV less than 30 mL usually indicates the presence of bladder dysfunction rather than BOO.
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Yuan-Hong
authors.initials: YH
authors.lastname: Jiang
authors.affiliation: Department of Urology, Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei, Taiwan.
authors.forename: Chun-Hou
authors.initials: CH
authors.lastname: Liao
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Hann-Chorng
authors.initials: HC
authors.lastname: Kuo
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D009126:Muscle Relaxation; D009130:Muscle, Smooth / Q000503:physiopathology; D009929:Organ Size; D011467:Prostate / Q000473:pathology*; D012189:Retrospective Studies; D017211:Treatment Failure; D014521:Urethra / Q000503:physiopathology; D001743:Urinary Bladder / Q000503:physiopathology*; D001748:Urinary Bladder Neck Obstruction / Q000503:physiopathology*; D014563:Urodynamics; D014741:Video Recording
chemical_list: D000317:Adrenergic alpha-Antagonists
keywords: bladder; incontinence; lower urinary tract symptoms; urodynamics