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The effect of complete transurethral resection of the prostate on symptoms, quality of life, and voiding function improvement.

Milonas D, Verikaite J, Jievaltas M - Cent European J Urol (2015)

Bottom Line: According to Qmax, the treatment was effective in 74.2%, according to IPSS, in 91%, and according to QoL, in 74.2% of patients.The ROC analysis demonstrated that RPTW/TZV and RPTW/TPV ratios were the most significant predictors of obtaining favorable results.Survival analysis (life table) shows that in order to achieve 50% improvement on Qmax, QoL, and IPSS, more than 30-35% of TPV and more than 60% of the TZV should be removed.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Lithuanian University of Health Sciences, Medical Academy, Kaunas, Lithuania.

ABSTRACT

Introduction: Transurethral resection of the prostate (TURP) still remains the most popular surgical treatment for patients with lower urinary tract symptoms. However, in some patients, the improvement of symptoms after TURP is insufficient. The aim of our study was to evaluate the impact of the resected prostate tissue weight (RPTW) on the improvement of symptoms (IPSS), quality of life (QoL), and voiding function after TURP.

Material and methods: The study included 89 men who had undergone TURP in our institution. IPSS, QoL, post-voiding residual urine volume (PVR) and Qmax were recorded before the operation and six months after TURP. The total prostate volume (TPV) and transition zone volume (TZV) were measured before the operation by transrectal ultrasound. The impact of RPTW, RPTW/TZV ratio, and RPTW/TPV ratio were analyzed according to the efficacy of TURP.

Results: The mean Qmax after TURP increased by 10.15 mL/s, IPSS decreased by 16.7 points, QoL increased by 3.57 points, and PVR decreased by 95.3 mL. According to Qmax, the treatment was effective in 74.2%, according to IPSS, in 91%, and according to QoL, in 74.2% of patients. The ROC analysis demonstrated that RPTW/TZV and RPTW/TPV ratios were the most significant predictors of obtaining favorable results. Survival analysis (life table) shows that in order to achieve 50% improvement on Qmax, QoL, and IPSS, more than 30-35% of TPV and more than 60% of the TZV should be removed.

Conclusions: The efficacy of the TURP at short term follow-up depends on the completeness of the resection.

No MeSH data available.


Related in: MedlinePlus

ROC curve analysis for the influence of intra–operative parameters on the evaluated parameters and the overall effectiveness.RPTW – resected prostate tissue weight: area under the curve – 0.572, p = 0.303, RPTW/TZV – ratio of the resected prostate tissue weight and the transition zone volume: area under the curve – 0.691, p = 0.007; RPTW/TPV – ratio of the resected prostate tissue weight and the total prostate volume: area under the curve – 0.699, p = 0.005
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Figure 0001: ROC curve analysis for the influence of intra–operative parameters on the evaluated parameters and the overall effectiveness.RPTW – resected prostate tissue weight: area under the curve – 0.572, p = 0.303, RPTW/TZV – ratio of the resected prostate tissue weight and the transition zone volume: area under the curve – 0.691, p = 0.007; RPTW/TPV – ratio of the resected prostate tissue weight and the total prostate volume: area under the curve – 0.699, p = 0.005

Mentions: In total, 89 patients were involved in this prospective case report study. The patients’ preoperative data are shown in Table 1. Moderate symptoms (up to 18 IPSS points) were observed in 30.2% and severe (19 and more IPSS points) symptoms in 69.8% of the patients. All the evaluated parameters (Qmax, QoL, PVR, and IPSS) changed significantly at 6 months after TURP (Table 1). The difference between pre– and postoperative data varied from 75% (IPSS and PVR) to 120% (Qmax). The treatment was effective according to Qmax (improvement >50% or ≥10 mL/s) in 74.2% of the patients, according to IPSS (improvement >50% or ≥10 points) in 91%, and according to QoL (improvement >50% or ≥3 points) in 74.2% of the patients. According to our definition of efficacy, the treatment was effective in 74.2% (excellent – 71.9% and good – 2.2%) of the patients, while in 25.8% (fair – 6.7% and ineffective – 19.1%) of the patients TURP was ineffective 6 months after the operation. The mean RTW was 23.6 gr. (SD ±14.43, range 5–66). The mean RPTW/TPV ratio was 0.48 (SD ±0.17, range 0.13–0.89), and the mean RPTW/TZV ratio was 0.91 (SD ±0.29, range 0.42–1.98). The mean TPV at the 6 month follow–up was 25.8 mL (SD ±15.44). A very strong correlation between RPTW and the difference of TPV before and after TURP was found (r = 0.869, p < 0.001). All pre– and intraoperative parameters were evaluated with respect to the treatment efficacy. The decrease in PVR was similar between the groups, and therefore, an increase in Qmax and QoL, as well as the reduction in the IPSS score, were significantly higher when TURP was effective (Table 2). There was no difference in RPTW, but the resected tissue ratio with TZV and TPV was higher when the treatment was effective (Table 2). The ROC curve analysis was performed for each of the intraoperative parameters to evaluate their influence on treatment outcomes. The most significant predictors for obtaining favorable results were RPTW/TZV and RPTW/TPV ratios. The data is shown in Table 3 and Figure 1. Survival analysis (life tables) shows that in order to achieve 50% improvement in Qmax, QoL, and IPSS (Table 4), more than 30–35% of all prostate tissue (the cut–off value of the RPTW/TPV ratio was 0.30–0.35) and more than 60% of the transition zone tissue (the cut–off value of RPTW/TZV ratio was 0.60) should be removed.


The effect of complete transurethral resection of the prostate on symptoms, quality of life, and voiding function improvement.

Milonas D, Verikaite J, Jievaltas M - Cent European J Urol (2015)

ROC curve analysis for the influence of intra–operative parameters on the evaluated parameters and the overall effectiveness.RPTW – resected prostate tissue weight: area under the curve – 0.572, p = 0.303, RPTW/TZV – ratio of the resected prostate tissue weight and the transition zone volume: area under the curve – 0.691, p = 0.007; RPTW/TPV – ratio of the resected prostate tissue weight and the total prostate volume: area under the curve – 0.699, p = 0.005
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526604&req=5

Figure 0001: ROC curve analysis for the influence of intra–operative parameters on the evaluated parameters and the overall effectiveness.RPTW – resected prostate tissue weight: area under the curve – 0.572, p = 0.303, RPTW/TZV – ratio of the resected prostate tissue weight and the transition zone volume: area under the curve – 0.691, p = 0.007; RPTW/TPV – ratio of the resected prostate tissue weight and the total prostate volume: area under the curve – 0.699, p = 0.005
Mentions: In total, 89 patients were involved in this prospective case report study. The patients’ preoperative data are shown in Table 1. Moderate symptoms (up to 18 IPSS points) were observed in 30.2% and severe (19 and more IPSS points) symptoms in 69.8% of the patients. All the evaluated parameters (Qmax, QoL, PVR, and IPSS) changed significantly at 6 months after TURP (Table 1). The difference between pre– and postoperative data varied from 75% (IPSS and PVR) to 120% (Qmax). The treatment was effective according to Qmax (improvement >50% or ≥10 mL/s) in 74.2% of the patients, according to IPSS (improvement >50% or ≥10 points) in 91%, and according to QoL (improvement >50% or ≥3 points) in 74.2% of the patients. According to our definition of efficacy, the treatment was effective in 74.2% (excellent – 71.9% and good – 2.2%) of the patients, while in 25.8% (fair – 6.7% and ineffective – 19.1%) of the patients TURP was ineffective 6 months after the operation. The mean RTW was 23.6 gr. (SD ±14.43, range 5–66). The mean RPTW/TPV ratio was 0.48 (SD ±0.17, range 0.13–0.89), and the mean RPTW/TZV ratio was 0.91 (SD ±0.29, range 0.42–1.98). The mean TPV at the 6 month follow–up was 25.8 mL (SD ±15.44). A very strong correlation between RPTW and the difference of TPV before and after TURP was found (r = 0.869, p < 0.001). All pre– and intraoperative parameters were evaluated with respect to the treatment efficacy. The decrease in PVR was similar between the groups, and therefore, an increase in Qmax and QoL, as well as the reduction in the IPSS score, were significantly higher when TURP was effective (Table 2). There was no difference in RPTW, but the resected tissue ratio with TZV and TPV was higher when the treatment was effective (Table 2). The ROC curve analysis was performed for each of the intraoperative parameters to evaluate their influence on treatment outcomes. The most significant predictors for obtaining favorable results were RPTW/TZV and RPTW/TPV ratios. The data is shown in Table 3 and Figure 1. Survival analysis (life tables) shows that in order to achieve 50% improvement in Qmax, QoL, and IPSS (Table 4), more than 30–35% of all prostate tissue (the cut–off value of the RPTW/TPV ratio was 0.30–0.35) and more than 60% of the transition zone tissue (the cut–off value of RPTW/TZV ratio was 0.60) should be removed.

Bottom Line: According to Qmax, the treatment was effective in 74.2%, according to IPSS, in 91%, and according to QoL, in 74.2% of patients.The ROC analysis demonstrated that RPTW/TZV and RPTW/TPV ratios were the most significant predictors of obtaining favorable results.Survival analysis (life table) shows that in order to achieve 50% improvement on Qmax, QoL, and IPSS, more than 30-35% of TPV and more than 60% of the TZV should be removed.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Lithuanian University of Health Sciences, Medical Academy, Kaunas, Lithuania.

ABSTRACT

Introduction: Transurethral resection of the prostate (TURP) still remains the most popular surgical treatment for patients with lower urinary tract symptoms. However, in some patients, the improvement of symptoms after TURP is insufficient. The aim of our study was to evaluate the impact of the resected prostate tissue weight (RPTW) on the improvement of symptoms (IPSS), quality of life (QoL), and voiding function after TURP.

Material and methods: The study included 89 men who had undergone TURP in our institution. IPSS, QoL, post-voiding residual urine volume (PVR) and Qmax were recorded before the operation and six months after TURP. The total prostate volume (TPV) and transition zone volume (TZV) were measured before the operation by transrectal ultrasound. The impact of RPTW, RPTW/TZV ratio, and RPTW/TPV ratio were analyzed according to the efficacy of TURP.

Results: The mean Qmax after TURP increased by 10.15 mL/s, IPSS decreased by 16.7 points, QoL increased by 3.57 points, and PVR decreased by 95.3 mL. According to Qmax, the treatment was effective in 74.2%, according to IPSS, in 91%, and according to QoL, in 74.2% of patients. The ROC analysis demonstrated that RPTW/TZV and RPTW/TPV ratios were the most significant predictors of obtaining favorable results. Survival analysis (life table) shows that in order to achieve 50% improvement on Qmax, QoL, and IPSS, more than 30-35% of TPV and more than 60% of the TZV should be removed.

Conclusions: The efficacy of the TURP at short term follow-up depends on the completeness of the resection.

No MeSH data available.


Related in: MedlinePlus