Elevated Tumor Necrosis Factor-α and Transforming Growth Factor-β in Prostatic Tissue are Risk Factors for Lower Urinary Tract Symptoms after Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Patients with Urinary Retention

Abstract

Background: Lower Urinary Tract Symptoms (LUTS) after Transurethral Resection of the Prostate (TURP) occur in one-third of Benign Prostatic Hyperplasia (BPH) patients, may be caused by persistent prostatic inflammation and fibrosis. Objective: This study aims to evaluate the role of inflammation and fibrosis in pathological mechanism of LUTS among patients with BPH who underwent TURP by assessing their PSA, TNF-α, and TGF-β level. Design, Setting, and Participant: Data in this study were analyzed with the 2-way hypothesis. The study used odds ratio to define the risk factors of LUTS after TURP. The samples of the study are BPH patients after TURP aged 50-80 years old. Interventions: No intervention(s). Outcome Measurements and Statistical Analysis: The data analyzed using SPSS version 21.0 for Windows. Results and Limitations: There were 34 cases of LUTS and 42 controls without LUTS. We found that there were an increased levels of TNF-α (> 46.95 pg/ml) (OR 55.6, 95% Confidence Interval [CI] 11.1-278.4, p=0.00) and TGF-β (> 207.63 pg/ml) (OR 16.7, 95%CI 5.3-52.8, p=0.00). The result of multiple linear logistic regression analysis obtained equation Y= 0.033 x TNF-α + 0.031 x TGF-β. Population Attributable Risk (PAR) % TNF-α is 60%, PAR % TGF-β is 53%. Conclusion: Combination of elevated levels of TNF-α (>46.95 pg/ml) and TGF-β (>207.63) in prostate tissue is the risk factors for the occurrence of LUTS after TURP. Patient Summary: In this study, we enrolled 76 patients who were diagnosed with BPH and urinary retention. After TURP, there were 34 cases of LUTS and 42 controls without LUTS. We found that the levels of TNF-α and TGF-β between cases and controls were significantly different. We conclude that the combination of elevated levels of TNF-α and TGF-β in prostate tissue is the risk factors for the occurrence of LUTS after TURP.

<p>Risk Factors for Prostate Volume Progression After Prostate-Transurethral Resection</p>

“…Milonas et al 17 reported that the growth of the prostate gland could be predicted based on the PSA level. Duarsa et al 6 previously found that high PSA level (>4 ng/mL) promoted LUTS and prostate volume.…”

“…The active form of this hormone, dihydrotestosterone, activated androgen receptor, and promoted prostate development. 6 Prostate-specific antigen (PSA), as a marker produced by prostate's epithelial cells, should be strongly related to the increased volume of BPH. Aging showed an increasing transitional volume of the prostate with an unknown direct mechanism.…”

Serum testosterone and prostate-specific antigen levels are major risk factors for prostatic volume increase among benign prostatic hyperplasia patients

“…Previous study conducted by Duarsa et al. [ 39 ] in 2018 showed a significant difference of TNF-α expression in LUTS patients after being performed a TURP compared to non-LUTS patients. In this study, we examine the association of the cytokine with prostate volume resulting in a Bivariate analysis (r=−0.089; p =0.423) and total effect analysis (r=0.010; p =0.942).…”

“…The same study conducted by Duarsa et al. [ 39 ] also evaluated the association of TGF-β which is shown to be significantly higher on BPH patients with LUTS after TURP. In the human body, TGF-β is able to induce proliferation in prostatic stromal cells, however it is also responsible in the pathway of growth arrest of the cells.…”

Prospective cohort study comparison of bipolar and monopolar transurethral resection of prostate for benign prostatic hyperplasia: haemoglobin, sodium levels, and urethral catheter traction application

“…7 Nevertheless, 33-35% of patients with benign prostate enlargement with retention, have a chance to LUTS after TURP surgery, especially 2-6 weeks after surgery. 8 Several techniques have been developed, including the use of bipolar TURP (B-TURP) which is a rival to monopolar TURP (M-TURP) as conventional ones as well as the gold standard of prostate surgery therapy. In a multicenter study in Canada, which compared the impact of B-TURP and M-TURP, there were no significant differences in terms of duration of surgery and length of resection, where "functional outcome" increased significantly in both types of action.…”