Transurethral resection of the prostate for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia: how much should be resected?

Abstract

Objective: To assess the impact of the percent of resected tissue on the improvement of urinary symptoms. Materials and Methods:The study included a prospective analysis of 88 men with benign prostatic hyperplasia. Patients were divided in three groups according to the percent of resected tissue: Group 1 < 30%; Group 2, 30% to 50%; and Group 3, > 50%. Each patient was re-evaluated 3 months after surgery. We assessed the international prostatic symptom score, nocturia and serum prostate specific antigen levels. Results: All patients presented a significant decrease on mean International Prostate System Score (IPSS) (23 to 5.9), Quality of Life (QoL) (4.9 to 1.0) and nocturia (3.2 to 1.9). Variation in the IPSS was 16.7, 16.6 and 18.4 for patients from Group 1, 2 and 3 respectively (P = 0.504). Although the three groups presented a significant decrease in QoL, patients in Group 3 presented a significantly greater decrease when compared to Group 1. Variation in QoL was 3.1, 3.9 and 4.2 for patients from Group 1, 2 and 3 respectively (p = 0.046). There was no significant difference in nocturia variation according to the percent of resected tissue (p = 0.504). Median pre and postoperative PSA value was 3.7 and 1.9 ng/mL respectively. Patients from Group 1 did not show a significant variation (p = 0.694). Blood transfusions were not required in any group. Conclusions: Resection of less than 30% of prostatic tissue seems to be sufficient to alleviate lower urinary tract symptoms related to benign prostate hyperplasia. However, these patients may not show a significant decrease in serum PSA level.

Current Evaluation and Treatment of Nocturia

“…Although surgical or interventional therapy is not indicated for nocturia, transurethral resection of the prostate (TURP) appears to confer a greater improvement in BPH symptoms including nocturia, and several studies reported a decrease in the mean number of nocturia episodes after TURP [35,36]. The mechanism of improvement in symptoms after TURP is not clear.…”

Outcomes of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Comparing Prostate Size of more than 80 Grams to Prostate Size less than 80 Grams

“…21,22 The recommended TURP technique consists of a complete resection of adenomatous tissue inside the surgical capsule for better result in terms of quality of life and symptom improvement. 23 However prolonged TURP in medically compromised patients with large prostate may be associated with increased bleeding and TUR syndrome development. 23 We found the significant difference in preoperative QoL in patients having smaller prostate in comparison to that of patient group having large (> 80 grams) prostate size.…”

“…23 However prolonged TURP in medically compromised patients with large prostate may be associated with increased bleeding and TUR syndrome development. 23 We found the significant difference in preoperative QoL in patients having smaller prostate in comparison to that of patient group having large (> 80 grams) prostate size. However after complete resection of adenomatous tissue in both groups, the QoL score after TURP shows no difference between both groups.…”

Can we predict the success of prostatic surgery for male lower urinary tract symptoms: ICI‐RS 2018?

“…10 Prostatectomy (transurethral or open surgical way) is the gold standard treatment of BPO when medical treatments are ineffective or responsible for side effects, depending on the patientʼs general status and the severity of the symptoms. A large number of studies [11][12][13][14] have shown an improvement of nocturia after outlet reduction surgeries in pure F I G U R E 1 Causative factors of nocturia S112 | groups of patients with BPO-induced nocturia. However, in some cases, symptoms persist or de novo symptoms appear.…”