Preoperative clinical and urodynamic factors influencing the short-term outcome of transurethral resection of the prostate for benign prostatic hyperplasia: a prospective observational study

Apoorva Saxena; Sudipta Saha; Om Prakash Pathania; Nain Singh

doi:10.18203/2349-2902.isj20263845

Authors

Apoorva Saxena Department of General Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
Sudipta Saha Department of General Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
Om Prakash Pathania Department of General Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
Nain Singh Department of General Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India

DOI:

https://doi.org/10.18203/2349-2902.isj20263845

Keywords:

Treatment outcome, Detrusor pressure, Bladder compliance, Urodynamics, Benign prostatic hyperplasia, Transurethral resection of prostate

Abstract

Background. Although transurethral resection of the prostate remains the surgical mainstay for benign prostatic hyperplasia, a substantial minority of patients report an unsatisfactory result. This prospective observational study evaluated which preoperative clinical and urodynamic parameters influenced the short-term outcome of the procedure.

Methods. Thirty-five men with lower urinary tract symptoms due to benign prostatic hyperplasia, an International Prostate Symptom Score above 13, a maximum urinary flow rate below 15 mL/s and at least one absolute indication for surgery underwent monopolar transurethral resection of the prostate at a tertiary-care teaching hospital. Preoperative prostate volume, post-void residual urine, serum prostate-specific antigen, duration of catheterisation, uroflowmetry and multichannel urodynamics were recorded. The outcome at one month was graded by the International Prostate Symptom Score, the quality-of-life score and the maximum urinary flow rate, and was classified as effective or non-effective.

Results. The outcome was effective in 27 patients (77.1%) and non-effective in 8 (22.9%). A smaller prostate (43.3±8.4 versus 54.6±11.0 ml), catheterisation exceeding six weeks, a lower maximum detrusor pressure (30.0±19.2 versus 60.4±46.1 cm H₂O) and a lower bladder compliance (13.5±12.0 versus 37.7±29.7 ml/cm H₂O) were significantly associated with a non-effective outcome. Age, serum prostate-specific antigen, the presence of refractory retention and post-void residual urine showed no significant association.

Conclusions. A small prostate, prolonged preoperative catheterisation, a low detrusor pressure and poor bladder compliance predicted a less favourable short-term outcome. Preoperative urodynamic assessment is advisable in men with a small gland or prolonged retention, both to refine the indication for surgery and to counsel patients about the likely benefit.

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