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Outcomes of KTPLAP and TURP in Patients with Impaired Detrusor Contractility

Daniel A. Thorner, Fernando Cabrera, Jerry G. Blaivas, Johnson Tsui, Dmitry Volkin, Jeffrey P. Weiss
SUNY Downstate, Brooklyn, NY

We report outcomes in men with impaired detrusor contractility (IDC) treated with KTP laser ablation (KTPLAP) or transurethral resection of the prostate (TURP).
Materials & Methods:
This was a retrospective study of consecutive patients with IDC who underwent KTPLAP or TURP. IDC was defined as bladder contractility index <100 or detrusor contraction of insufficient duration to empty bladder. Pre-operative uroflow(Qmax), post-void residual volume(PVR), videourodynamics, and cystoscopy were obtained. Post-operative Qmax, PVR, clean intermittent catheterization(CIC) need, and Patient Global Impression of Improvement(PGII) score were obtained.
56 men aged 29-91 years (mean=67) were included. Mean preop BCI, BOOI, and PVR for entire cohort was 51(SD=30), 31(SD=30), and 670(SD=559) respectively. Mean preop IPSS and bladder capacity for the entire cohort was 14(SD=8) and 904mL (SD=605mL) respectively. 5(96%) subjects were available at 1 year follow-up and 53/56(95%) subjects completed PGII. 41(73%) had successful outcomes (PGII score=1 in 20, 2 in 21). 6(11%) had little to no improvement (PGII score=3 in 2, 4 in 4), 6(11%) were worse (PGII score=5 in 1, 6 in 3, 7 in 2) and 11 still required CIC. Pre- and postop data is shown below.
80% of patients with IDC who underwent KTPLAP/TURP had excellent outcomes based upon PGII and Objective improvement in PVR, Qmax, and need for CIC. TURP/KTPLAP is viable for properly selected patients with IDC.

Table 1: Pre and Post-op Data
Mean Qmax, mL/sec (SD)Median Qmax, mL/sec
Mean PVR mL (SD)Median
PVR, mL (range)
# on CIC
670 (559)547 (0-2500)27
17 (10)15 (0-44)144 (249)51 (0-1200)11

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