Top

Published in:

Open Access 03-10-2023 | Transurethral Prostate Resection | Original Article

Effects of resection volume on postoperative micturition symptoms and retreatment after transurethral resection of the prostate

Authors: Seung Han Shin, Kwang Suk Lee, Kyo Chul Koo, Kang Su Cho, Chang Hee Hong, Byung Ha Chung, Hyun Soo Ryoo, Jae Hyun Ryu, Yun Beom Kim, Seung Ok Yang, Jeong Kee Lee, Tae Young Jung, Jeong Woo Yoo

Published in: World Journal of Urology | Issue 11/2023

Abstract

Purpose

Despite advances in technology, such as advent of laser enucleation and minimally invasive surgical therapies, transurethral resection of the prostate (TURP) remains the most widely performed surgical technique for benign prostatic hyperplasia (BPH). We evaluated resection volume (RV)-derived parameters and analyzed the effect of RV on post-TURP outcomes.

Methods

This observational study used data from patients who underwent TURP at two institutions between January 2011 and December 2021 Data from patients with previous BPH surgical treatment, incomplete data, and underlying disease affecting voiding function were excluded. The collected data included age, prostate-specific antigen, transrectal ultrasound (TRUS)- and uroflowmetry-derived parameters, RV, perioperative laboratory values, perioperative International Prostatic Symptom Score (IPSS), follow-up period, retreatment requirements and interval between the first TURP and retreatment.

Results

In 268 patients without prior BPH medication, there were no differences in prostate volume (PV), transitional zone volume (TZV), or RV according to IPSS. A total of 60 patients started retreatment, including medical or surgical treatment, within the follow-up period. There was a significant difference in RV/PV between the groups without and with retreatment respectively (0.56 and 0.37; p = 0.008). However, preoperative TRUS- and uroflowmetry-derived parameters did not differ between the two groups. Multiple linear regression analysis showed that RV (p = 0.003) and RV/TZV (p = 0.006) were significantly associated with differences in perioperative IPSS. In the multivariate logistic regression analysis, only RV/PV was correlated with retreatment (p = 0.010).

Conclusion

Maximal TURP leads to improved postoperative outcomes and reduced retreatment rate, it may gradually become a requirement rather than an option.

Yang CY, Chen GM, Wu YX, Zhang WJ, Wang J, Chen PP, Lou ZY (2023) Clinical efficacy and complications of transurethral resection of the prostate versus plasmakinetic enucleation of the prostate. Eur J Med Res 28:83CrossRefPubMedPubMedCentral

Gittelman M, Ramsdell J, Young J, McNicholas T (2006) Dutasteride improves objective and subjective disease measures in men with benign prostatic hyperplasia and modest or severe prostate enlargement. J Urol 176:1045–1050CrossRefPubMed

Chung BH, Lee SH, Roehrborn CG, Siami PF, Major-Walker K, Wilson TH, Montorsi F, Group CS (2012) Comparison of the response to treatment between Asian and Caucasian men with benign prostatic hyperplasia: long-term results from the combination of dutasteride and tamsulosin study. Int J Urol 19:1031–1035CrossRefPubMed

Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I, Morrill BB, Gagnier RP, Montorsi F, Groeup CS (2010) The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol 57:123–131CrossRefPubMed

Roehrborn CG, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, Brown BT, McVary KT, Te AE, Gholami SS (2013) The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the LIFT Study. J Urol 190:2161–2167CrossRefPubMed

Pisco JM, Bilhim T, Pinheiro LC, Fernandes L, Pereira J, Costa NV, Duarte M, Oliveira AG (2016) Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol 27:1115–1122CrossRefPubMed

Lai S, Peng P, Diao T, Hou H, Wang X, Zhang W, Liu M, Zhang Y, Seery S, Wang J (2019) Comparison of photoselective green light laser vaporisation versus traditional transurethral resection for benign prostate hyperplasia: an updated systematic review and meta-analysis of randomised controlled trials and prospective studies. BMJ Open 9:e028855CrossRefPubMedPubMedCentral

Huang S-W, Tsai C-Y, Tseng C-S, Shih M-C, Yeh Y-C, Chien K-L, Pu Y-S, Tu Y-K (2019) Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis. BMJ 367:5919CrossRef

Aagaard J, Jonler M, Fuglsig S, Christensen LL, Jorgensen HS, Norgaard JP (1994) Total transurethral resection versus minimal transurethral resection of the prostate–a 10-year follow-up study of urinary symptoms, uroflowmetry and residual volume. Br J Urol 74:333–336CrossRefPubMed

10.

Park HK, Paick SH, Lho YS, Jun KK, Kim HG (2012) Effect of the ratio of resected tissue in comparison with the prostate transitional zone volume on voiding function improvement after transurethral resection of prostate. Urology 79:202–206CrossRefPubMed

11.

Aprikian S, Luz M, Brimo F, Scarlata E, Hamel L, Cury FL, Tanguay S, Aprikian AG, Kassouf W, Chevalier S (2019) Improving ultrasound-based prostate volume estimation. BMC Urol 19:1–8CrossRef

12.

Nose H, Foo KT, Lim KB, Yokoyama T, Ozawa H, Kumon H (2005) Accuracy of two noninvasive methods of diagnosing bladder outlet obstruction using ultrasonography: intravesical prostatic protrusion and velocity-flow video urodynamics. Urology 65:493–497CrossRefPubMed

13.

Ku JH, Ko DW, Cho JY, Oh SJ (2010) Correlation between prostatic urethral angle and bladder outlet obstruction index in patients with lower urinary tract symptoms. Urology 75:1467–1471CrossRefPubMed

14.

Kim BS, Ko YH, Song PH, Kim TH, Kim KH, Kim BH (2019) Prostatic urethral length as a predictive factor for surgical treatment of benign prostatic hyperplasia: a prospective, multiinstitutional study. Prostate Int 7:30–34CrossRefPubMed

15.

Stormont G, Chargui S (2020) Transurethral resection of the prostate.

16.

Demirel I, Ozer AB, Bayar MK, Erhan OL (2012) TURP syndrome and severe hyponatremia under general anaesthesia. Case Rep. https://doi.org/10.1136/bcr-2012-006899CrossRef

17.

Castellani D, Rubilotta E, Fabiani A, Maggi M, Wroclawski ML, Teoh JY-C, Pirola GM, Gubbiotti M, Pavia MP, Gomez-Sancha F (2022) Correlation between transurethral interventions and their influence on type and duration of postoperative urinary incontinence: Results from a systematic review and meta-analysis of comparative studies. J Endourol 36:1331–1347CrossRefPubMed

18.

Garza-Montúfar ME, Cobos-Aguilar H, Treviño-Baez JD, Pérez-Cortéz P (2021) Factors associated with urethral and bladder neck stricture after transurethral resection of the prostate. J Endourol 35:1400–1404CrossRefPubMed

19.

Alexander CE, Scullion MM, Omar MI, Yuan Y, Mamoulakis C, N’Dow JM, Chen C, Lam TB (2019) Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. Cochrane Database Syst Rev 12:CD009629PubMed

20.

Sonksen J, Barber NJ, Speakman MJ, Berges R, Wetterauer U, Greene D, Sievert KD, Chapple CR, Montorsi F, Patterson JM, Fahrenkrug L, Schoenthaler M, Gratzke C (2015) Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur Urol 68:643–652CrossRefPubMed

21.

Raizenne BL, Zheng X, Oumedjbeur K, Mao J, Zorn KC, Elterman D, Bhojani N, McClure T, Te A, Kaplan S, Sedrakyan A, Chughtai B (2023) Prostatic artery embolization compared to transurethral resection of the prostate and prostatic urethral lift: a real-world population-based study. World J Urol 41:179–188CrossRefPubMed

22.

Dahm P, MacDonald R, McKenzie L, Jung JH, Greer N, Wilt T (2021) Newer minimally invasive treatment modalities to treat lower urinary tract symptoms attributed to benign prostatic hyperplasia. Eur Urol Open Sci 26:72–82CrossRefPubMedPubMedCentral

23.

Tamalunas A, Schott M, Keller P, Atzler M, Ebner B, Buchner A, Stief CG, Magistro G (2022) How does symptom severity impact clinical outcomes of men with lower urinary tract symptoms after holmium laser enucleation or transurethral resection of the prostate? Cent Eur J Urol 75:387–394

24.

Yan J, Gao L, Xu G, Zhang J (2022) The effectiveness and safety of three surgical procedures for the treatment for benign prostatic hyperplasia: a network meta-analysis. Heliyon 8:e10884CrossRefPubMedPubMedCentral

25.

Suzuki Y, Toyama Y, Nakayama S, Nomura S, Minowa T, Tanabe K, Kondo Y (2017) Treatment results of transurethral resection of the prostate by non-Japanese board-certified urologists for benign prostate hyperplasia: analysis by resection volume. J Nippon Med Sch 84:73–78CrossRefPubMed

Title: Effects of resection volume on postoperative micturition symptoms and retreatment after transurethral resection of the prostate
Authors: Seung Han Shin
Kwang Suk Lee
Kyo Chul Koo
Kang Su Cho
Chang Hee Hong
Byung Ha Chung
Hyun Soo Ryoo
Jae Hyun Ryu
Yun Beom Kim
Seung Ok Yang
Jeong Kee Lee
Tae Young Jung
Jeong Woo Yoo
Publication date: 03-10-2023
Publisher: Springer Berlin Heidelberg
Keywords: Transurethral Prostate Resection
Benign Prostatic Hypertrophy
Benign Prostatic Hypertrophy
Published in: World Journal of Urology / Issue 11/2023
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04628-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of resection volume on postoperative micturition symptoms and retreatment after transurethral resection of the prostate

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2023

Change in renal blood flow in response to intrarenal pressure alterations induced by ureteroscopy in an in-vivo porcine model

Technological innovations and evolving trends in endourological management for urolithiasis and benign prostatic hypertrophy

Intrarenal pressure study using 7.5 French flexible ureteroscope with or without ureteral access sheath in an ex-vivo porcine kidney model

Follow-up for the upper urinary tract in patients with high-risk neurogenic lower urinary tract dysfunction

The diagnostic accuracy of micro-ultrasound for prostate cancer diagnosis: a review

A scoping review of office-based prostatic stents: past, present, and future of true minimally invasive treatment of benign prostatic hyperplasia