The efficacy of pyridostigmine therapy after transurethral resection of prostate in cases with underactive urinary bladder

Underactive bladder is a decrease in detrusor contraction and/or shortening of the contraction time, resulting in an incomplete and/or prolongation of the bladder emptying within the normal time frame. Prolonged bladder outlet obstruction due to prostatic enlargment one of the main causes of bladder hypocontractility. To make a diagnosis, it is necessary to perform a pressure-flow study. Decrease in maximum urine flow rate related to bladder outlet obstruction or poor contractility can be distinguished by pressure-flow study.

parasympathomimetics (cholinergic receptor stimulating agents) could be beneficial for patients with underactive bladder. However, no systematic review with meta-analysis addressing potential benefits or adverse effects exists. Pyridostigmine is a medication used to treat myasthenia gravis and underactive bladder as well.

Patients with underactive bladder after transurethral resection of prostate may still complain of recurrent attacks of obstructive lower urinary tract symptoms.

Inclusion Criteria:

• Patients who are not younger than 45 or older than 75 years.
• Patients with benign prostatic hyperplasia who are eligible for transurethral resection of prostate.
• Patients who has decreased bladder contractility confirmed by urodynamic study (pressure flow study) and plotted on international continence society (ICS) nomogram.

Exclusion Criteria:

• Patients younger than 45 or older than 75 years.
• Patients who have diabetes.
• Patients with a history of neurological diseases.
• patients with a previous history of pelvic surgery.