The predictive value of platelet to lymphocyte and neutrophil to lymphocyte ratio in determining urethral stricture after transurethral resection of prostate

Abstract

Objective: The pathology of urethral stricture disease is still unclear however progressive inflammation may contribute to the development of urethral stricture. The platelet-to-lymphocyte ratio (PLR) is a new and simple marker that indicates inflammation. In this study we aimed to investigate the predictive value of neutrophil to lymphocyte ratio (NLR) and PLR in patients with urethral stricture who underwent transurethral resection of prostate (TURP). Material and methods:A total of 208 patients who underwent bipolar-TURP were included in this study. Patients who had previously undergone surgery due to any urethral pathology, posterior urethral strictures, previous or ongoing treatment for any cancer, hematologic disorders, presence of an active infection at the time of surgical intervention, and prior blood transfusion were excluded. PLR, NLR and red cell distribution width (RDW) levels were measured. In order to investigate the predictive values of NLR and PLR variables, binary logistic regression analysis was performed. Results:No statistically significant differences were observed between the groups in terms of age, NLR, RDW, prostate size and operative times. Statistically significant differences were presented only in the median PLR-values. For predicting urethral stricture, the optimal cut-off value was 112.5, (sensitivity: 0.84, specificity: 0.64; AUC= 0.762, 95% CI 0.684-0.84). Conclusion:In this study we showed that PLR can be used to determine urethral stricture as a cost-effective, common, and simple biomarker in patients after TURP.Keywords: Inflammation; neutrophil to lymphocyte ratio; platelet to lymphocyte ratio; urethral stricture.Cite this article as: Gül M, Altıntaş E, Kaynar M, Buğday MS, Göktaş S. The predictive value of platelet to lymphocyte and neutrophil to lymphocyte ratio in determining urethral stricture after transurethral resection of prostate. Turk J Urol 2017; 43: 325-9

Hematologic parameters and Neutrophil / Lymphocyte ratio in the prediction of urethroplasty success

“…As such, the NLR has been reported to be a significant marker for patient counseling and clinical trial design (21). In a related study of 208 patients with a history of urethral stricture after transurethral resection of the prostate from our country, it was shown that the NLR was relatively higher in relapsed patients but not significant (9). In our study, there were no statistically significant differences between neutrophils, lymphocytes, NLR, and patients with and without stricture recurrence after urethroplasty.…”

“…When urethral strictures are considered, fibroblasts are probably responsible for the development of the urethral stricture; however, the reason for the urethral stricture is related to the urinary extravasation into the subepithelial space causing increased inflammation and subsequent scar formation. With this knowledge, many authors have used colchicine, mitomycin-C, triamcinolone, corticosteroids, and anti-inflammatory drugs locally or systemically to reduce urethral stricture after urethral procedures (9). In this context, urethral stricture is a result of inflammatory changes in the epithelium of the urethra and can be treated by interfering with the inflammatory process.…”

The contribution of the immune system to genitourinary fibrosis

“…NLR and PLR are inconsistent in their ability to predict urethral stricture behavior but given the ease of collection of these markers, further evaluation may be warranted. 58,60 In addition, degree of pelvic trauma is not consistently associated with urethral stricture formation. 47 Further investigation is needed, given the potential for bladder dysfunction and subsequent renal failure as well as the patient morbidity associated with repeated surgeries following failure of initial management.…”

“…The plasma neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are nonspecific markers of systemic inflammation. [58][59][60] Given that platelet, neutrophil, and lymphocyte counts are often included as routine lab work for patients, there has been significant interest in evaluating these markers in the setting of urethral strictures. 58,60 One study demonstrated higher absolute neutrophil count and NLR in subjects with recurrent urethral stricture after undergoing DVIU, suggesting that chronic inflammation may contribute to stricture recurrence.…”

“…[58][59][60] Given that platelet, neutrophil, and lymphocyte counts are often included as routine lab work for patients, there has been significant interest in evaluating these markers in the setting of urethral strictures. 58,60 One study demonstrated higher absolute neutrophil count and NLR in subjects with recurrent urethral stricture after undergoing DVIU, suggesting that chronic inflammation may contribute to stricture recurrence. 60 PLR, but not NLR, was predictive of stricture development in individuals undergoing transurethral resection of the prostate (TURP), a common procedure for management of benign prostatic hyperplasia that carries a small risk of associated urethral strictures.…”