Effects of Transurethral Prostate Resection and Transurethral Laser Prostatectomy on Plasma Hormone Levels

Abstract

Objective: The short and long-term effects of two common transurethral procedures (TURP and TULP, transurethral prostatic resection and laser prostatectomy, respectively) on plasma hormone levels in patients with benign prostatic hyperplasia (BPH) have been evaluated. Patients and Methods: Totally 57 patients with histologically proven BPH (age range 54–81 years, mean 62.5 years) were included into the study program. Of these 57 patients, 44 underwent TURP and 13 underwent TULP for treatment of their bladder outlet obstructions. 20 patients with bladder cancer undergoing transurethral resection (n = 15) and those undergoing transurethral laser ablation (n = 5) constituted the control group. Plasma luteinizing hormone (LH), prolactin (PRL), follicle-stimulating hormone (FSH), adrenocorticotrophic hormone (ACTH), cortisol, aldosterone, dihydroepiandrosterone sulfate (DHEA-S) and testosterone levels were assessed in all patients before and after 3 weeks and 3 months following the aforementioned procedures. Comparative evaluation of the results with respect to the effect of different procedures have been made between study and control groups. Results: Preoperatively, we were not able to demonstrate any significant difference with respect to all but plasma prolactin levels (p < 0.05) between the study and control groups. Prolactin levels were found to be significantly higher in BPH patients. In BPH patients undergoing TURP, while LH levels were significantly higher during the 3 weeks’ evaluation (p < 0.001) no significant difference could be shown during the 3 months’ examination (p > 0.05). Again, prolactin levels did significantly decline (p < 0.05) in patients undergoing TURP during the 3 weeks’ follow-up evaluation, no difference was present 3 months postprocedure. On the other hand, in patients undergoing TULP, while we were not able to show any significant difference with respect to plasma prolactin levels (p > 0.05) pre- and postoperatively, plasma LH levels were significantly increased during the 3-month evaluation (p < 0.05). Conclusions: Alterations in the plasma levels of LH and prolactin following prostatectomy during follow-up evaluation, led the physicians to consider possible effects of some factors released from resected prostate gland. Behavior of prolactin and LH after TURP and laser ablation is quite different in our study. It may be related to the higher amount of residual prostate tissue after TULP. On the other hand, normalization of hormone levels 3 months following TURP, led us to think about the activation of some factors responsible for hormonal regulation which in turn institutes a new hormonal balance.

Serum luteinizing hormone concentration is significantly associated with recovery of urinary function after radical prostatectomy

“…In patients undergoing TURP and transurethral laser prostatectomy, there was a significant increase in LH concentrations 3 weeks after the procedure. However, after 3 months' follow‐up, LH concentrations returned to the normal range, indicating a possible effect of the prostate gland on these hormones . The present study underscores the demonstration of negative feedback from the removal of the whole prostate gland on the hypothalamic–pituitary–testicular axis.…”

Endoscopic Enucleation of Prostate Could Increase Testosterone Levels in Hypotestosteronemic Patients with Bladder Outlet Obstruction

“…In the patients who received TULP, only the plasma LH levels were significantly increased at the 3-month time point relative to the preoperative time point. Therefore, Kadir Türkölmez et al, considered that some factors released from the resected prostate gland may have affected the evaluation results and that the differences may be related to a higher amount of residual prostate tissue after TULP [20]. Furthermore, previous observational studies have reported no changes in testosterone, LH, FSH, adrenocorticotropic hormone, or dehydroepiandrosterone sulfate levels at short-term (3 weeks) [21] and 3-month follow-up time points after surgery [20].…”

“…Therefore, Kadir Türkölmez et al, considered that some factors released from the resected prostate gland may have affected the evaluation results and that the differences may be related to a higher amount of residual prostate tissue after TULP [20]. Furthermore, previous observational studies have reported no changes in testosterone, LH, FSH, adrenocorticotropic hormone, or dehydroepiandrosterone sulfate levels at short-term (3 weeks) [21] and 3-month follow-up time points after surgery [20]. In the present study, we noted a significant difference between preoperative and postoperative testosterone levels in the low-testosterone group (p < 0.05).…”

Changes in sex hormone levels after radical prostatectomy: Results of a longitudinal cohort study

“…Certain studies have shown that there are no significant changes in these hormones following surgical treatment for benign prostatic hyperplasia (BPH) (12,16,17). Further investigations are required, but on the basis of these studies it appears that BPH does not significantly affect the hypothalamic-pituitary axis.…”