Effect of bladder outlet procedures on urodynamic assessments in men with an acontractile or underactive detrusor: A systematic review and meta-analysis

ObjectiveTo review the effect of bladder outlet procedures on urodynamic outcomes and symptom scores in males with detrusor underactivity (DU) or acontractile detrusors (AD). Materials and MethodsWe performed a systematic review and meta-analysis of research publications derived from PubMed, Embase, Web of Science, and Ovid Medline to identify clinical studies of adult men with non-neurogenic DU or AD who underwent any bladder outlet procedure. Outcomes comprised the detrusor pressure at maximum flow (P(det)Q(max)), maximum flow rate (Q(max)), international prostate symptom score (IPSS), and quality of life (QoL). This study is registered under PROSPERO CRD42020215832. ResultsWe included 13 studies of bladder outlet procedures, of which 6 reported decreased and 7 reported improved P(det)Q(max) after the procedure. Meta-analysis revealed an increase in the pooled mean P(det)Q(max) of 5.99 cmH(2)0 after surgery (95% CI: 0.59-11.40; p = 0.03; I-2 95%). Notably, the P(det)Q(max) improved in all subgroups with a preoperative bladder contractility index (BCI) <50 and decreased in all subgroups with a BCI & GE;50. All studies reported an improved Q(max) after surgery, with a pooled mean difference of 5.87 mL/s (95% CI: 4.25-7.49; I-2 93%). Only three studies reported QoL, but pooling suggested significant improvements after surgery (mean, -2.41 points; 95% CI: -2.81 to -2.01; p = 0.007). All seven studies reporting IPSS demonstrated improvement (mean, -12.82; 95% CI: -14.76 to -10.88; p < 0.001). ConclusionsThis review shows that P(det)Q(max) and Q(max) increases after surgical bladder outlet procedures in men with DU and AD. Bladder outlet procedures should be discussed as part of the shared decision-making process for this group. The evidence was of low to very low certainty.