A Urodynamic View of Prostatic Obstruction and the Results of Prostatectomy

Abstract

Summary The responses of the detrusor to obstruction are discussed. Detrusor instability has been a frequent finding and if it persists it appears to be responsible for a considerable proportion of postprostatectomy symptoms. A post‐voiding residual urine is a clear indication of detrusor decompensation; severe outflow obstruction with high pressure detrusor instability may occur before the detrusor finally decompensates and residual urine develops. The function of isolated sphincter mechanisms is analysed, and a technique for the preservation of the distal sphincter mechanism during enucleation prostatectomy considered. If further studies prove that detrusor complications, particularly instability, increase as a result of delaying the resolution of a significant outflow obstruction, there are good urodynamic reasons for avoiding them by advising a relatively early resolution of outflow obstruction.