BPH OR NEUROGENIC BLADDER: CLINICAL CORRELATION IS MORE IMPORTANT THAN MERE URODYNAMIC STUDY BEFORE DECIDING FOR PROSTATECTOMY

A 55 year old patient came with history of retention and was on catheter for 4 months.He had a history of stroke and was on clopitab and antihypertensives. The urologists had seen him and because of the underlying   

neurological disorders; he was counselled against the surgery and was kept on continuous indwelling catheter. The catheter was changed every 3 weeks.

We evaluated him here; his focussed neurological examination was normal.His TRUS revealed 40 gm prostate and Serum PSA values was normal.

We took him up for urodynamic evaluation.His bladder capacity was small and had unstable

detrusor contractions but he voided with poor flow with adequate bladder contractions. 

The patient was taken up for LASER prostatectomy and post-operative he started voiding well.

We stress upon doing Urodynamic evaluation in all cases of so called " neurogenic bladder" as many times two pathologies- Bladder outlet obstruction(BOO) and neurological disorder can co-exist and not treating underlying BOO can keep patient on long term indwelling catheter and its complications like repeated infections or compel them to go for self catheterisation.

This can be avoided by doing UDS. The UDS should not be read technically by graphs and AG values etc. It should be correlated with clinical scenario.Sometimes there can be equivocal obstruction or sub-optimal detrusor with poor flow. The UDS should be read in the light of patients problems.An episode of retention; we always think that the obstructive element is overwhelming. In all such cases with retention and equivocal obstructions on UDS ; We have got good results with LASER prostatectomy.