Is There a Relationship between the Amount of Tissue Removed at Transurethral Resection of the Prostate and Clinical Improvement in Benign Prostatic Hyperplasia

Abstract

Objective: To assess in a prospective trial the influence of the amount of tissue resected at transurethral resection of the prostate (TURP) for benign prostatic enlargement on the symptom improvement as assessed by symptom scores. Methods: Between December 1996 and August 1998 a total of 138 men (mean age 68.2, range 53–89) with symptomatic benign prostatic enlargement who underwent TURP participated in this prospective study. Patients were assessed preoperatively with the International Prostate Symptom Score (IPSS), the American Urological Association Bother Score (AUA–BS) and the Benign Prostatic Hyperplasia Impact Index (BPH–II) as well as urinary flow rate measurements (Q_max) and prostate volume (PV) and residual urine determination by ultrasound. The amount of tissue resected was weighed. Patients were followed with reevaluation of Q_max, residual urine and the symptom and bother scores at 3 and 6 months. Results: A close correlation between preoperative PV (mean 49.0 ml, SD 22.0, range 13–140) and the resected tissue weight (RTW, mean 24.7 g, SD 18.0, range 6–128) was seen (r = 0.75, p<0.001). Age was correlated with preoperative PV (r = 0.23, p<0.05). While significant mean improvements in Q_max, residual volume and IPSS, AUA–BS and BPH–II were found 3 and 6 months postoperatively, a negative correlation was seen between the RTW and the IPSS, the AUA–BS and the BPH–II 3 months after TURP (r = –0.23, p<0.024; r = –0.23, p<0.025; r = –0.20, p = 0.05). No statistically significant correlation was seen between symptom change and the percentage of PV removed or the residual prostatic weight. Classification of the patients into groups depending on preoperative PV (<30, 31–50, 51–70 and >70 ml) showed a tendency for patients with larger PV to gain more symptom improvement postoperatively. Conclusions: Early symptom improvement after TURP will depend on the amount of tissue removed but the relationship is weak and affected by several other confounding factors. Apparently, the symptomatic improvement after TURP is not primarily dependent on the relative completeness of the resection. Patients with larger prostates and larger RTW tend to gain more symptomatic benefit from TURP than do patients with smaller prostates.

Transurethral resection of the prostate for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia: how much should be resected?

“…While some authors have suggested that better clinical results after TURP may correlate with the completeness of the resection of the obstructing adenoma (9,10), others have shown that partial resection produces short-term functional results comparable to those of standard TURP (11,12). The aim of this study was to evaluate the impact of the percent of resected tissue (PRT) during TURP on the short-term clinical outcome of patients with LUTS due to BPH.…”

Outcomes of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Comparing Prostate Size of more than 80 Grams to Prostate Size less than 80 Grams

“…Some studies suggested complete resection should be performed for better result. 19,20 while others have suggested that a partial resection is adequate for short term functional results. 21,22 The recommended TURP technique consists of a complete resection of adenomatous tissue inside the surgical capsule for better result in terms of quality of life and symptom improvement.…”

Validación de la versión española del Cuestionario Benign Prostatic Hyperplasia Impact Index: "Estudio Validart"

“…Hakenberg O et al 2001 30 también utilizaron el cuestionario BII, entre otras medidas, para evaluar el grado de mejoría de los síntomas de la HBP en pacientes en los que se había practicado una resección transuretral de próstata. Concretamente el BII se administró antes y después de la intervención a los 3 y 6 meses.…”