Abstract
OBJECTIVE. The aim of this prospective study was to establish the influence of operative parameters on outcomes after transurethral resection of the prostate. MATERIALS AND METHODS. In this prospective case series study, 89 patients underwent transurethral resection of the prostate. The standardized protocol was used to investigate the impact of operative parameters (resected tissue weight, residual prostate weight, and residual prostatic weight ratio [total prostate volume - resected tissue weight / total prostate volume]) on outcomes after six months following transurethral resection of the prostate. The evaluation of treatment efficacy was done using the criteria of the Second International Consultation on Benign Prostatic Hyperplasia. All postoperative results were categorized as excellent, good, fair, or none. Treatment was considered effective when the postoperative results were excellent and good, and ineffective when results were fair and none. RESULTS. Treatment was effective for 85.4% and ineffective for 14.6% of the patients. The univariate analysis of operative parameters detected the residual prostatic weight ratio (cutoff value, 0.71; P<0.001; sensitivity, 0.62; specificity, 0.96; OR, 39.47) as the strongest independent predictor of ineffective outcome. Logistic regression analysis revealed two important parameters of unfavorable outcomes: residual prostatic weight ratio (cutoff value, 0.71; P<0.001; OR, 62.16) and residual prostate weight (cutoff value, 26.6 mL; P=0.013; OR, 9.98). When the values of both these parameters were lower than their cutoff values, the probability of an ineffective outcome was reduced to 3%; however, when they were higher, the probability of an unfavorable outcome was increased to 95%. CONCLUSIONS. Residual prostatic weight ratio and residual prostatic weight are significant operative parameters for the prediction of outcomes after transurethral resection of the prostate.
Highlights
Benign prostate hyperplasia (BPH) is a common troublesome condition for elderly men
When the values of both these parameters were lower than their cutoff values, the probability of an ineffective outcome was reduced to 3%; when they were higher, the probability of an unfavorable outcome was increased to 95%
total prostate volume (TPV) and transition zone volume (TZV) significantly correlated with the duration of the procedure (r=0.58, P
Summary
Medical therapy has recently become more popular, the functional results of BPH treatment are still much better after surgery. The improvement in the results of separate functions does not always imply that the treatment is beneficial because up to 20% of the patients had unfavorable results after transurethral resection of the prostate (TURP) [3, 4]. There are a few ways to lower the percentage of unfavorable results after TURP: better selection of patients and an understanding of how complete the resection should be. There are numerous discussions and investigations regarding the effort to find optimal preoperative parameters for a better selection of patients for TURP, very few studies evaluated the effect of operative parameters on outcomes. Comparing all BPH interventional treatment modalities, functional results are the best after an open operation [1, 5]. There are certain limitations for transurethral resection that do not allow removing the same amount
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