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BLADDER OUTLET OBSTRUCTION IN MALES WITH NEUROGENIC DYSFUNCTION TREATED BY SURGICAL MANAGEMENT-A SYSTEMIC REVIEW STUDY

Sajid Fouad ALNugali1 , Amal Mohammed Alsomali2 , Hanan Mohammed Alghamdi3 , Khalid Abdullah Abualnassr4 , Zahra Ali abdullah Alrebh5 , ABDULAZIZ MOHAMMED R ALMASOUD6 , Alia Mahmoud Baqais7 , Muteb Ayedh Alotaibi8 , Mohammed Ahmad Alghamdi9 , Abdulrahim Abdullah Alshehri10, Talal Mohammed Alsharari11

Background:In terms of Surgical management of bladder outlet obstruction may result in urinary incontinence (UI). Management by surgery of bladder outlet obstruction especially anatomic type (BOO) indicated in males with neurogenic bladder dysfunction. A noticeable complication after surgery. The aim:To know the best practice in the surgical treatment of bladder outlet obstruction in males with neurogenic bladder dysfunction, due to multiple sclerosis, Parkinson disease, spinal cord injury (SCI) or cerebrovascular accident (CVA) or spina bifida. Evidence acquisition: We have started a systematic review and we searched on Medline, Embase, Cochrane controlled trial databases, Web of Science, and Google Scholar were searched for publications until august 2018. Evidence synthesis: A total of 850 abstracts were screened. Ten studies were included. The types of anatomic BOO discussed were benign prostate obstruction, urethral stricture, and bladder neck sclerosis. The identified surgical treatments were trans- urethral resection of the prostate (TURP) in patients with Parkinson, CVA or SCI, endoscopic treatment of urethral stricture by laser ablation or urethrotomy (mainly in SCI patients), and bladder neck resection (BNR) in SCI patients. The outcome of TURP may be highly variable, and includes persistent or de novo urinary incontinence, regained normal micturition control, and urinary continence. Good results were seen in BNR and endoscopic urethrotomy studies. Laser ablation and cold knife urethrotomy resulted in restarting intermittent catheterization or adequate voiding. Overall, a high risk of bias was found. Conclusions: This systematic review provides an overview of the current literature on the outcome of several surgical approaches of different types of anatomic BOO in males with neurogenic bladder dysfunction. Identifying the optimal practice was impossible due to limited availability of high-quality studies.

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