Establishment and value assessment of efficacy prediction model about transurethral prostatectomy

Abstract

Abbreviations & Acronyms AUC = area under the curve AUR = acute urinary retention BCI = bladder contractility index BOO = bladder outlet obstruction BOOI = bladder outlet obstruction index BWT = bladder wall thickness DO = detrusor overactivity DWT = detrusor wall thickness IPP = intravesical prostatic protrusion IPSS = International Prostate Symptom Score IPSS -s = storage score IPSS -v = voiding score LUTS/BPO = lower urinary tract symptoms suggestive of benign prostatic obstruction MODS = multiple organ dysfunction symptom m P ura = maximum pressure of urethra NPV = negative predictive value P det Q max = pressure of detrusor at maximum flow rate PPV = positive predictive value PSA = prostate-specific antigen PVR = post-voiding residue Q max = maximum flow rate QoL = quality of life RI = resistive index ROC = receiver operating characteristic R res = weight ratio of resection R s/v = ratio of IPSS -s and IPSS -v TPV = total prostate volume T res = time of resection TURP = transurethral prostatectomy TURS = TUR syndrome TZV = transitional zone volume UDS = urodynamics UEBW = ultrasonic estimation of bladder weight US = ultrasonography UTI = urinary tract infection UUI = urge urinary incontinence W res = tissue weight of resection Objectives: To establish and to evaluate discriminant models to predict the outcomes of transurethral prostatectomy. Methods: Clinical data of patients treated with transurethral prostatectomy between January and December 2013 were collected, including medical history, symptoms, biochemical tests, ultrasonography and urodynamics. Surgical efficacy was evaluated at 6-month follow up. Predictive models were constructed by logistic regression. Receiver operating characteristic curve and diagnostic tests were used to test the accuracy of models before the predictive value between models was compared. Results: A total of 182 patients were included, with 73.6% having an effective outcome. History of recurrent urinary tract infection (OR 1.33), score of storage phase (OR 2.58), maximum flow rate (OR 2.11) and detrusor overactivity (OR 3.13) were found to be risk factors. International Prostate Symptom Score (OR 0.13), transitional zone index (OR 0.58), resistive index of prostatic artery (OR 0.46), bladder wall thickness (OR 0.78), ultrasonic estimation of bladder weight (OR 0.28), bladder outlet obstruction index (OR 0.20) and bladder contractility index (OR 0.83) were found to be protective factors. The areas under the curve of models using factors from ultrasonography and urodynamics were 0.792 and 0.829 respectively, with no significant difference being found between them (P = 0.348). Conclusions: Surgical efficacy of transurethral prostatectomy is positively correlated to severe voiding phase symptoms, outlet obstruction and better detrusor contractility, and negative correlated with urinary infection, severe storage phase symptoms and excessive detrusor contractibility. Ultrasonography might replace urodynamics in selecting patients for whom transurethral prostatectomy is more likely t...

Significance of a decrease in the proportion of detrusor muscle to bladder wall for non-invasive diagnosis of detrusor underactivity in men with lower urinary tract symptoms

“…However acceptable tools for noninvasively distinguishing BOO from DU have yet to be identified 8 , 28 . Huang et al 29 analyzed that increased BWT was associated with ineffective recovery of IPSS, QoL score and Qmax after surgery (OR 0.78, 95% CI 0.72–0.84). The DMT was analyzed as an independent predictor of surgical efficacy of IPSS, QoL score and Qmax (OR 2.05, p = 0.036; AUC 0.762, cutoff value 15 mm at the bladder volume of 250 mL) 30 .…”

Modified Bladder Outlet Obstruction Index for Powerful Efficacy Prediction of Transurethral Resection of Prostate with Benign Prostatic Hyperplasia

“…In a study by Seki et al, multiple logistic regression analysis indicated that a higher baseline level of BOOI was associated with greater improvements in IPSS and QoL. Huang et al conducted a study to establish an e cacy prediction model for transurethral prostatectomy, and found that there was a positive correlation between surgical e cacy with a higher degree of BOO and secondary detrusor cell hypertrophy [17]. Similarly, previous studies have shown that patients with de nite BOO derive greater bene t from TURP surgery than those with equivocal and unobstruction [18,19].…”

Modified bladder outlet obstruction index for powerful efficacy prediction of transurethral resection of prostate with benign prostatic hyperplasia

“…In a study by Seki et al, multiple logistic regression analysis indicated that a higher baseline level of BOOI was associated with greater improvements in IPSS and QoL. Huang et al conducted a study to establish an efficacy prediction model for transurethral prostatectomy, and found that there was a positive correlation between surgical efficacy with a higher degree of BOO and secondary detrusor cell hypertrophy [ 19 ]. Similarly, previous studies have shown that patients with definite BOO derive greater benefit from TURP surgery than those with equivocal and unobstruction [ 20 , 21 ].…”