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

Objective: To 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 methods: We 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.

Results: We 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 cmH₂ 0 after surgery (95% CI: 0.59-11.40; p = 0.03; I² 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 ≥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; I² 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).

Conclusions: This 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.