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

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

doi:10.1007/s00345-023-04628-0

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

World J Urol. 2023 Nov;41(11):3065-3074. doi: 10.1007/s00345-023-04628-0. Epub 2023 Oct 3.

Authors

Affiliations

¹ Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea.
² Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
³ Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea. yoo8318@naver.com.

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.

Keywords: Benign prostatic hyperplasia; International prostatic symptom score; Resection volume; Transurethral resection of the prostate.

Publication types

Observational Study

MeSH terms

Humans
Male
Prostate / diagnostic imaging
Prostate / surgery
Prostatic Hyperplasia* / complications
Retreatment
Transurethral Resection of Prostate* / methods
Treatment Outcome
Urination