Effects of TORS-OSA Surgery on Lower Urinary Tract Symptoms, Overactive Bladder Symptoms, and Nocturia in Male Patients with Obstructive Sleep Apnea/Hypopnea Syndrome

摘要

Yao-Chi Chuang,1,2 Pei-Wen Lin,2– 4 Hsin-Ching Lin,2,4– 6 Chun-Tuan Chang,6 Michael Friedman,7,8 Anna M Salapatas,8 Chih-Yun Lin9 1Division of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 2College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Division of Glaucoma, Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 4Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 5Department of Otolaryngology, Robotic Surgery Center and Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 6Department of Business Management, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung, Taiwan; 7Department of Otolaryngology, Division of Sleep Surgery, Rush University Medical Center, Chicago, IL, USA; 8Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; 9Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, TaiwanCorrespondence: Hsin-Ching Lin, Department of Otolaryngology, Sleep and Robotic Surgery Center, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, 833, Taiwan, Tel +886-7-7317123 ext.2533, Fax +886-7-7313855, Email hclin@adm.cgmh.org.tw; enthclin@aol.comObjective: To determine the presence of lower urinary tract symptoms (LUTS), and overactive bladder (OAB) symptoms in men with obstructive sleep apnea/hypopnea syndrome (OSA) and the effects of transoral robotic surgery (TORS) for the treatment of OSA on these conditions.Materials and Methods: One hundred twenty-three patients with a diagnosis of OSA were prospectively enrolled. The evaluations of LUTS and OAB symptoms were based on self-administered questionnaires containing international prostate symptom score (IPSS) and OAB symptom score (OABSS), respectively. Men with an OABSS urgency score of ≥ 2 and sum score of ≥ 3 were considered to have OAB. The therapeutic outcomes were assessed at baseline, and 12 weeks after TORS-OSA Surgery.Results: There were significant differences in IPSS, and OABSS according to OSA severity. After TORS-OSA surgery, significant improvements on OSA severity, daytime quality of life (QoL) and nighttime sleep quality were observed. TORS-OSA surgery was also associated with a statistically significant improvement of LUTS, LUTS QoL score, and OAB symptoms (IPSS 22.1% decrease; IPSS QoL score 21.1% decrease; OABSS17.4% decrease) at post-operative 3 months’ follow-up. The presence of OAB, and severe nocturia was significantly reduced from 22.8% to 11.4% (p=0.001), 5.7% to 0.8% (p=0.031) after TORS-OSA surgery. There were no patients who had acute airway compromise or massive bleeding peri- or post-operatively.Conclusion: TORS upper airway surgery could improve LUTS and OAB symptoms on male patients with OSA in addition to improvement of major parameters of sleep study and sleep-related QoL.Keywords: snoring, obstructive sleep apnea, lower urinary tract symptoms, overactive bladder symptoms, OSA surgery, transoral robotic surgery