الفهرس 
Benign Prostatic HyperplasiaOnly 14 pages are availabe for public view
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Abstract
In this study, we aimed to determine the prevalence of BOO in diabetic patients with LUTS and enlarged prostate. We also wanted to assess the predictive value of less invasive methods such as the International Prostate Symptoms Score (IPSS), maximum flow rate (Q max), postvoiding residual urine (PVRU) and prostate volume (PV) for the diagnosis of BOO in this group of patients and also to predict the outcome of TURP in diabetic and non diabetic patients.
In order To reach our aim of work, we conducted 2 different studies.
Study (І): 30 diabetic patients over the age of 50 years complaining of lower urinary tract symptoms (LUTS), enlarged prostates, were evaluated by UDS.
Study (П): 63 patients (diabetic & non diabetic) evaluated pre & post TURP in order to compare the outcome after surgery.
As regards study І, the final urodynamic diagnosis demonstrated abnormalities in the vast majority of the patients. (BOO: bladder outlet obstruction, DH: detrusor hypocontractility, RS: reduced sensation, DO: detrusor overactivity, DSD: detrusor sphincteric dyssenergia), and according to the urodynamics, patients were divided into 2 groups: obstructed (60% BOO) and non obstructed group (40% without BOO).
There were no big differences between both groups in respect to age, time since onset of diabetes, IPSS, prostate volume. Also as regarding uroflowmetry, no big differences in the Q max (p=0.409) or the voided volume (p=0.235), but as regarding the PVRU, there was a significant difference between both groups (p=0.030), higher amounts of PVRU were found in the group without BOO.
As regarding UDS, the non obstructed group showed higher MCC than the obstructed ones representing a significant difference (p=0.016), also the detrusor pressure at MCC was much lower in the non obstructed group representing another significant difference between them (p=0.039).
There was significant difference between both groups in the bladder compliance, but the detrusor pressure at maximum flow was significantly higher in the obstructed group than the non obstructed ones (p=0.032).
Detrusor overactivity was found in 61% of the obstructed group and was not found in the no obstructed ones.
Detrusor hypocontractility was found in 83% of the patients without BOO and 11.11% in those with BOO.
As regards study П, we observed that there were no significant differences between the diabetic & non diabetic group in the IPSS, IPSS Qol, prostate size as compared to each other pre or postoperative.
Co-morbidities were found more in the diabetic patients.
Preoperative Urinary retention is an important factor especially chronic urinary retention when found in diabetic patient, it may indicate bladder decompensation, eventually the patient may not benefit from the operation as found in one of our diabetic patients who responded well to cholinomimetic therapy, so preoperative UDS would have been valuable in this patient.
Early postoperative complications were found more in the diabetic group especially UTI.
There was no significant difference between both groups in the preoperative Q max, but 6 months after TURP, Q max was much improved in the non diabetic patients than that of the diabetic ones. (p=0.036).
Also there was much improvement in the voided volume in the non diabetic group post TURP as compared to that of the diabetic ones. (p=0.019).
There was no difference between both groups in the PVRU as compared to each other pre & postoperative, but when comparing the results post TURP with the preoperative score for each group separately, there would be a significant improvement after the operation for both groups, as shown in our study. (p=0.007).
So this study demonstrates that there is a high prevalence of other abnormalities that can explain the presence of LUTS such as reduced sensitivity and detrusor hypocontractility in diabetic patients with LUTS and enlarged prostate other than BOO. Non-invasive tests such as IPSS, free uroflowmetry and PVRU have low sensitivity and specificity for BOO diagnosis in this population.
Our data suggest that urodynamic evaluation should be systematically indicated for diabetic patients with BPH and LUTS when considering surgical treatment of BPH.
Although the comparative study showed that most of the diabetic patients with BPH & LUTS will benefit from TURP (but not as the non diabetic ones) but at least to predict the outcome of the operation & comparing it with the risks of surgery & whether the patients are going to need an additional cholinomimetic therapy or CIC postoperative or not.