The P.R.OS.T.A.T.E Nomogram for the Preoperative Prediction of Clinical Efficacy of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Patients

Abstract

Transurethral resection of the prostate (TURP) is often indicated for benign prostatic hyperplasia (BPH). Some patients, however, fail to adequately respond to these interventions. Accordingly, a powerful prediction model for TURP efficacy is warranted. This study aimed to create a nomogram with preoperative parameters for the prediction of individual TURP efficacy. Methods: Clinical data from 356 BPH subjects who underwent TURP were retrospectively collected between November 2015 and June 2021 for nomogram development. The prediction model was developed using multivariable logistic regression analysis and presented as a nomogram. Nomogram performance was assessed through calibration curves and the concordance index (C-index). An independent validation cohort containing 177 consecutive patients in the corresponding period was used for external validation. The optimal cutoff value was determined through receiver operating characteristic curve (ROC) analysis by maximizing the Youden index, and its accuracy was assessed through sensitivity, specificity and predictive values. Results: In multivariate analysis of the primary cohort, the independent factors for TURP efficacy were age, International Prostate Symptom Score (IPSS), intravesical prostatic protrusion (IPP), bladder wall thickness (BWT), peripheral zone thickness (PT) and transitional zone thickness (TT), all of which were included in the nomogram. The calibration curve for survival probability showed good agreement between the nomogram predictions and actual observations. The C-index for predicting TURP efficacy was 0.860 (95% confidence interval [CI], 0.808-0.911). The optimal cutoff total nomogram score was 177, with a maximum Youden index of 0.643. The sensitivity, specificity, positive predictive value, and negative predictive value for predicting TURP efficacy were 70.6%, 75.6%, 90.6%, and 43.7% in the validation cohort, respectively. Logistic regression analysis in the validation cohort demonstrated that the area under the curve (AUC) was 0.806 (95% CI, 0.733-0.879). Conclusion: The P.R.OS.T.A.T.E nomogram objectively and accurately predicted TURP efficacy, thereby facilitating the clinical decision-making process.

A preoperative noninvasive index prediction model for TURP surgical outcomes in patients with benign prostatic hyperplasia

“…Tian et al [24]combined age, IPSS, IPP, bladder wall thickness, peripheral prostatic belt thickness, and migratory zone thickness to construct a prediction model for predicting post-TURP outcomes in patients with BPH, which had an AUC = 0.806 (95% CI 0.733-0.879); however, it is worth noting that the researchers did not analyze the model with clinical decision curves and that most of the predictive factors were obtained by ultrasonography. factors were overwhelmingly obtained from ultrasound, resulting in a greater degree of possible measurement bias.…”

The influence of preoperative urodynamic parameters on clinical results in patients with benign prostatic hyperplasia after transurethral resection of the prostate

“…For example, Li et al [ 22 ] found that patient age, BMI, duration of history of LUTS, and prostate volume were independent influences for postoperative urge incontinence through logistic regression models. Ye Tian et al [ 23 ] reported that the P.R.OS.T.A.T.E. regression model could predict the outcome of BPH surgery in 2022.…”

Can we predict and manage persistent storage and voiding LUTS following bladder outflow resistance reduction surgery in men? ICI‐RS 2023

“…49 Tian et al have developed a nomogram to predict the efficacy of TURP, but this mainly addresses the success of improving the flow rate and does not address the development or persistence of storage OAB/LUTS. 50 As can be seen from the above, storage and/or voiding LUTS can either persist or develop after TURP surgery and urodynamics is key to the assessment of these patients with bothersome LUTS following surgery. However, further research with large clinical trials is needed where urodynamics is utilized before TURP and then repeated post-TURP to be able to understand the pathophysiology of LUTS postsurgery, allowing better counseling of patients before surgery.…”

“…Tian et al have developed a nomogram to predict the efficacy of TURP, but this mainly addresses the success of improving the flow rate and does not address the development or persistence of storage OAB/LUTS 50 …”