How complete is a transurethral resection of the prostate?

Correlation of Postoperative Outcomes According to the Amount of Prostatic Tissue Removed in Patients Undergoing Transurethral Resection of the Prostate

OBJECTIVE

The present study assesses the effect of the proportion of tissue resected during transurethral resections of the prostate (TUR-P) on lower urinary tract symptoms (LUTS) and other parameters in patients with a benign prostatic obstruction (BPO).

MATERIALS AND METHODS

Forty-three patients who underwent TUR-P between 2018 and 2021 were assessed prospectively. The patients were divided into two groups according to the percentage of tissue removed (group 1 <30%, group 2 >30% resection). Age, prostate volume, amount of resected tissue, operative time, length of hospital stay, duration of catheterization, International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum urinary flow rate (Qmax), and serum prostate-specific antigen (PSA) (ng/dl) at preoperative and postoperative three months were recorded.

RESULTS

The percentage of tissue removed was 22.2% vs. 48.4% (p = 0.001), IPSS reduction was 77.7% vs. 83.3% (p = 0.048), QoL improvement was 77.2% vs. 84.8% (p = 0.133), Qmax increase was 171.3% vs. 193.5% (p = 0.032), and serum PSA decrease was 56.4% vs. 69.2% (p = 0.049) in groups 1 and 2, respectively. In addition, the operative time was 38.5 vs. 53.6 min (p = 0.001), the length of hospital stay was 2.0 vs. 2.4 days (p = 0.001), and the duration of catheterization average was 4.1 vs. 4.9 days (p = 0.002).

CONCLUSION

Resections of at least 30% of prostatic tissue can provide a significant improvement in the symptoms and parameters related to benign prostatic obstruction, while resections of less than 30% of prostatic tissue can effectively reduce urinary symptoms and improve the quality of life in older adult patients with comorbidities who require shorter operating times.

Investigation of parameters related to treatment efficiency in patients undergoing transurethral prostate resection for benign prostatic hyperplasia

Aim: Evaluation of the postoperative benefit rates and various parameters that may be associated with the postoperative benefit in patients who underwent transurethral resection of the prostate due to benign prostate enlargement and the treatment efficacy of transurethral resection of the prostate and to investigate whether the parameters that can predict this can be achieved. Materials and Methods: 100 patients who underwent transurethral resection of the prostate in our clinic between 2015-2016 July were evaluated retrospectively. Preoperative estimated prostate weight, international prostate symptom score , maximum flow rate, postvoid residual urine volume , and resected prostate tissue weights were recorded. In the postoperative six weeks to six months, the data of the patients were re-recorded and statistical analyzes were performed. Results: It was determined that the decrease in IPSS was 11.40 (53.4%), the increase in Qmax was 11.10 ml/s (110%) and the decrease in PVR was 59.60 ml (59%). The decrease in IPSS was found to be statistically significantly higher in those with preoperative IPSS ≥ 20, preoperative Qmax ≤ 10 ml/sec, and PVR >100 ml (p100 ml (p=0.012, p 50 g and RDA / TPA ≤ 0.3 (p=0.027 and p=0.008, respectively). Conclusion: We think that obtaining clearer data that may be related to the efficacy of transurethral resection of the prostate can guide clinicians in patient follow-up and treatment selection, and more studies are needed on this subject.

Are all procedures for benign prostatic hyperplasia created equal? A systematic review on post-procedural PSA dynamics and its correlation with relief of bladder outlet obstruction

PURPOSE

To evaluate and provide a comprehensive literature review of Prostate specific antigen (PSA) dynamics after various surgical procedures for benign prostatic hyperplasia (BPH).

METHODS

A thorough PubMed database search was performed over last 30 years including terms "PSA" and various surgical procedures for BPH. PSA nadir after various procedure was evaluated. The post-operative improvement in International Prostate Symptom Score, maximum void rates and post-void residue after surgeries were recorded. An indirect correlation was made between PSA nadir and outcome of various BPH surgical procedures.

RESULTS

Enucleation procedures like simple prostatectomy and endoscopic enucleation of prostate (EEP) produced maximum drop in PSA level after surgery and were associated with the highest improvement in post-operative parameters. The PSA nadir following resection techniques like transurethral resection of prostate and Holmium laser resection of prostate and vaporization technique was variable and less robust when compared to EEP. Newer techniques like Aquablation, Rezum, Urolift, Prostate artery embolization and Temporary implantable nitinol devices (iTIND) produce relatively less reduction in PSA and lesser percentile improvement in post-operative parameters.

CONCLUSIONS

Various surgical procedures for BPH result in varying PSA nadirs level. Enucleation procedures and simple prostatectomy produce the most drastic and sustained decrease in PSA. There is a possible indirect evidence suggesting that the level of PSA nadir corresponds closely with the degree of post-operative improvement and durability of the procedure. Establishing the new PSA nadir at 3-6 months after the procedure is recommended as a part of routine surveillance for prostate cancer in eligible patients.

Changes in S-PSA after transurethral resection of prostate and its correlation to postoperative outcome

PURPOSE

Although different factors may affect prostate-specific antigen (PSA) reduction after transurethral resection of prostate, an approximate 70 % decrease from baseline is expected. We hereby undertook a prospective study to analyze changes in serum PSA (S-PSA) after transurethral resection of the prostate (TURP) and its correlation with the residual prostatic weight and clinical symptom score improvement.

METHODS

Seventy patients who underwent TURP for bladder outlet obstruction were included in the study. Patient's evaluation included history, International Prostate Symptom Score (IPSS), S-PSA, Qmax, post-void residual urine and prostate size. On follow-up, trans-rectal ultrasonography, S-PSA and IPSS score were calculated. Patients were analyzed in three groups based on the amount of tissue resected: less than 40, 40-60 and more than 60 % tissue resected.

RESULTS

Preoperative prostate size, IPSS, Qmax and S-PSA were 62.56 ml, 23.84, 11.68 ml/sec and 3.3 ng/ml. There was a significant decrease in the IPSS score, prostate size and S-PSA levels after TURP in all the three groups. There was a significant positive correlation of the amount of tissue resected with change in S-PSA levels, change in IPSS score and postoperative IPSS score. Reduction in IPSS score significantly correlated with patient's satisfaction.

CONCLUSIONS

The amount of tissue resected in TURP has a direct bearing on the S-PSA levels, change in symptom score and residual prostate volume. It is the percentage change in IPSS score and not the absolute value of IPSS, which has a direct bearing with the patient satisfaction and with the amount of tissue resected. Percentage fall in S-PSA by 70 % was found to be predictor of more than 60 % resection.

The one year outcome after KTP laser vaporization of the prostate according to the calculated vaporized volume

The aim of this study was to develop a new simple method for measuring the vaporized volume and to evaluate the outcome of high-power potassium-titanyl-phosphate (KTP) photoselective laser vaporization. A total of 65 patients, with a mean age of 67.7 yr (range 53 to 85), were included in the primary analysis. The vaporized volume was calculated as the pre-operative volume minus the immediate post-operative volume plus the volume of the defect. For all patients, the subjective and objective parameters improved significantly after surgery. Six and 12 months after surgery, the group with a smaller vaporized volume (<15 g) had a lower reduction of the mean International Prostate Symptom Score (P=0.006 and P=0.004) and quality of life index (P=0.006 and P=0.004) when compared to the group with a greater vaporized volume (>or=15 g). There were no differences in the change of the maximum flow rate and post-void residual based on the vaporized volume. Our findings suggest that the subjective improvement, after a high-power KTP laser vaporization, may be dependent on the vaporized volume obtained after the procedure.

Interstitial laser coagulation versus transurethral resection of the prostate for benign prostatic enlargement--a prospective randomized study

OBJECTIVE

Interstitial laser coagulation (ILC) of the prostate is a minimally invasive method for treating symptomatic benign prostatic enlargement (BPE). We performed a prospective randomized study to compare the clinical outcomes of ILC and transurethral resection of the prostate (TURP).

MATERIAL AND METHODS

Between December 1997 and February 2000, 38 patients with moderate-to-severe symptomatic BPE were included in the study. Seven were subsequently excluded due to intercurrent disease or protocol violation and the remaining 31 were randomized to either TURP (n=11) or ILC (n=20). A suprapubic tube was inserted in all ILC-treated patients, and ILC was performed as an outpatient procedure when feasible. Data were recorded preoperatively and at 3-month and 1-year follow-up. The assessment parameters were International Prostate Symptom Score (IPSS), uroflow, prostate volume determined by means of transrectal ultrasound and postvoid residue.

RESULTS

At 1-year follow-up, uroflowmetry indicated a more pronounced increase in peak urinary flow rate (Qmax) in the TURP patients than in the ILC subjects (p<0.02). Differences in postvoid residue, IPSS and prostate volume between the two treatments could not be evaluated due to the small number of patients in each group. Postoperative urinary tract infections occurred in 13 ILC patients but in only one TURP subject, and catheterization was done for 24 days after ILC and for 2 days after TURP. The study was ended prematurely due to the prolonged postoperative catheterization and the high rate of urinary tract infections in the ILC patients.

CONCLUSIONS

At 1-year follow-up, the increase in Qmax was smaller in the ILC subjects than in the TURP patients. The ILC subjects had comparatively more postoperative urinary tract infections and more prolonged postoperative catheterization than the TURP patients.

Completeness and efficiency of prostate tissue removal: loop resection compared with a new operative technique of transurethral electrovaporization

OBJECTIVE

To compare the completeness and efficiency of the removal of prostatic adenomatous tissue between transurethral resection (TURP) and a new operative technique of electrovaporization (TUEVAP) using a modified roller electrode.

PATIENTS AND METHODS

In a prospective double-blind study, patients with moderate to severe lower urinary tract symptoms and objective evidence of obstruction, were randomized to undergo either TURP (using a standard cutting-wire loop) or TUEVAP (performed with a new operative technique and the spiked-bar electrode). The prostate volume measured using transrectal ultrasonography (TRUS-PV) was used to assess the completeness of tissue clearance after treatment. Results were compared using group median values. For the TURP group, the TRUS-PV estimate of tissue removed was divided by the dry resected weight to derive a correction factor for any discrepancy between the values. This factor was applied to the TRUS-PV reduction in the TUEVAP group (where there was no tissue to be weighed) to estimate the actual tissue removal in this group. The efficiency of tissue removal for each treatment modality was derived by dividing the amount of tissue removed by the operative duration.

RESULTS

There was no difference in the reduction in TRUS-PV at 3 months (23.9 cm3 vs 21.45 cm3, P<0.9), or in the operative duration (45 min vs 52.5 min, P<0.2), between TURP and TUEVAP, respectively. The TRUS-PV of tissue removed exceeded the actual dry resected weight after TURP (15 g) by a factor of 1.59. After applying this factor to the TRUS-PV reduction for the TUEVAP group, the calculated dry weight of tissue removed for this group was 13.49 g (P<0.55); the difference in tissue removal rate by TRUS criteria was 0.48 cm3/min vs 0.37 cm3/min (P<0.15).

CONCLUSIONS

These data suggest an equivalent completeness of removal of adenomatous prostate tissue between TURP and TUEVAP. The efficiency of tissue removal for TUEVAP was slightly less than that of regular loop resection, but this difference was not statistically significant. These results are specific to the combination of electrode, electrosurgical unit and operative technique used in this study, and may differ if any of these variables are altered.

A prospective randomized controlled trial of hybrid laser treatment or transurethral resection of the prostate, with a 1-year follow-up

OBJECTIVE

To compare the clinical outcome after hybrid laser treatment of the prostate, combining potassium titanyl phosphate (KTP) and Nd:YAG lasers, with transurethral resection of the prostate (TURP).

PATIENTS AND METHODS

A prospective randomized trial was conducted to compare laser treatment and TURP. The hybrid laser treatment technique involved performing initial 30 W KTP vaporizing bladder neck incisions and prostatotomies followed by a 'free-paint' application of 60 W Nd:YAG coagulation energy. Patients were re-assessed after 6 weeks, 6 months and 1 year, using the International Prostate Symptom Score (IPSS) and uroflowmetry. TURP was conducted using conventional methods.

RESULTS

In all, 204 patients were randomized into the study; at 6 weeks there were significant differences between the groups for the IPSS (12.4 vs 9.1, P=0.001) and maximum urinary flow rates (16.1 vs 20.8 mL/S, P<0. 001) in favour of the TURP group. At 6 months and one year this difference had disappeared. Similar numbers of patients in each group complained of bothersome postoperative urinary symptoms (23% vs 19%). Blood transfusions (5% vs none) and urethral strictures (9% vs 2%) were more common after TURP, whereas more early infective complications occurred after hybrid laser treatment (24% vs 5%). Only one patient in each group required re-operation because of poor resolution of symptoms.

CONCLUSIONS

At one year, hybrid KTP/Nd:YAG laser treatment of the prostate was equivalent to TURP in the improvements in IPSS, maximum urinary flow rate and post-void residual urine.