Transurethral resection of the prostate for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia: how much should be resected?
Abstract:Objective: To assess the impact of the percent of resected tissue on the improvement of urinary symptoms.
Materials and Methods:The study included a prospective analysis of 88 men with benign prostatic hyperplasia. Patients were divided in three groups according to the percent of resected tissue: Group 1 < 30%; Group 2, 30% to 50%; and Group 3, > 50%. Each patient was re-evaluated 3 months after surgery. We assessed the international prostatic symptom score, nocturia and serum prostate specific antigen levels.… Show more
“…Although surgical or interventional therapy is not indicated for nocturia, transurethral resection of the prostate (TURP) appears to confer a greater improvement in BPH symptoms including nocturia, and several studies reported a decrease in the mean number of nocturia episodes after TURP [35,36]. The mechanism of improvement in symptoms after TURP is not clear.…”
Nocturia is usually considered to be just one of the symptoms included with lower urinary tract symptoms (LUTS) and is treated with therapy based on LUTS. Recent research suggests, however, that nocturia is not merely a simple symptom of LUTS but is a multifactorial condition with many contributing etiological factors. The causes of nocturia can be classified into bladder storage problems, increased urine output, sleep disturbance problems, and other potential diseases. The frequency-volume chart (FVC) is very important in evaluating and diagnosing nocturia. Patients usually record the volume and timing of voids for a period of 1 to 3 days on the FVC. The FVC data can provide information on voiding patterns and clues about the etiology and treatment of nocturia. It is doubtful that alpha-blockers will have clinical significance for treatment because the difference in nocturia episodes between treatment with alpha-blockers and placebo is too small. Antimuscarinics also exert no effect on nocturnal polyuria, and the evidence supporting the efficacy of antimuscarinics for the treatment of nocturia is limited. However, several randomized placebo-controlled trials have shown the efficacy of oral desmopressin in the treatment of adults with nocturia. Short-acting hypnotics may be helpful for patients with sleep disturbances. Although surgical or interventional therapy is not indicated for nocturia, transurethral resection of the prostate appears to confer a greater improvement in benign prostatic hyperplasia symptoms including nocturia. The management of nocturia may require a team approach by making optimal use of multidisciplinary expertise.
“…Although surgical or interventional therapy is not indicated for nocturia, transurethral resection of the prostate (TURP) appears to confer a greater improvement in BPH symptoms including nocturia, and several studies reported a decrease in the mean number of nocturia episodes after TURP [35,36]. The mechanism of improvement in symptoms after TURP is not clear.…”
Nocturia is usually considered to be just one of the symptoms included with lower urinary tract symptoms (LUTS) and is treated with therapy based on LUTS. Recent research suggests, however, that nocturia is not merely a simple symptom of LUTS but is a multifactorial condition with many contributing etiological factors. The causes of nocturia can be classified into bladder storage problems, increased urine output, sleep disturbance problems, and other potential diseases. The frequency-volume chart (FVC) is very important in evaluating and diagnosing nocturia. Patients usually record the volume and timing of voids for a period of 1 to 3 days on the FVC. The FVC data can provide information on voiding patterns and clues about the etiology and treatment of nocturia. It is doubtful that alpha-blockers will have clinical significance for treatment because the difference in nocturia episodes between treatment with alpha-blockers and placebo is too small. Antimuscarinics also exert no effect on nocturnal polyuria, and the evidence supporting the efficacy of antimuscarinics for the treatment of nocturia is limited. However, several randomized placebo-controlled trials have shown the efficacy of oral desmopressin in the treatment of adults with nocturia. Short-acting hypnotics may be helpful for patients with sleep disturbances. Although surgical or interventional therapy is not indicated for nocturia, transurethral resection of the prostate appears to confer a greater improvement in benign prostatic hyperplasia symptoms including nocturia. The management of nocturia may require a team approach by making optimal use of multidisciplinary expertise.
“…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. 23 However prolonged TURP in medically compromised patients with large prostate may be associated with increased bleeding and TUR syndrome development. 23 We found the significant difference in preoperative QoL in patients having smaller prostate in comparison to that of patient group having large (> 80 grams) prostate size.…”
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confidence: 99%
“…23 However prolonged TURP in medically compromised patients with large prostate may be associated with increased bleeding and TUR syndrome development. 23 We found the significant difference in preoperative QoL in patients having smaller prostate in comparison to that of patient group having large (> 80 grams) prostate size. However after complete resection of adenomatous tissue in both groups, the QoL score after TURP shows no difference between both groups.…”
“…10 Prostatectomy (transurethral or open surgical way) is the gold standard treatment of BPO when medical treatments are ineffective or responsible for side effects, depending on the patientʼs general status and the severity of the symptoms. A large number of studies [11][12][13][14] have shown an improvement of nocturia after outlet reduction surgeries in pure F I G U R E 1 Causative factors of nocturia S112 | groups of patients with BPO-induced nocturia. However, in some cases, symptoms persist or de novo symptoms appear.…”
Aims: Male lower urinary tract symptoms (LUTS) are common and bothersome symptoms in the aging population, of which the etiology is multifactorial.Prostatic surgery may be considered to alleviate some of these LUTS, especially in patients in which benign prostatic obstruction is believed to be the underlying cause. The aim of this paper is to discuss underlying pathophysiology, signs, and conditions that may lead to success or failure after prostatic surgery in male patients with LUTS. Methods: The paper is a report of presentations and subsequent discussions at the annual International Consultation on Incontinence Research Society, in June 2018 in Bristol.Results and conclusions: Unfavorable outcomes after prostatic surgery are reported in 25% to 30% of the patients. This may be due to persistent or de novo symptoms, related to the multifactorial origin of symptoms. Specific underlying conditions such as with detrusor overactivity, detrusor underactivity, and nocturnal polyuria are discussed in their relationship with prostatic surgery.Knowledge gaps are addressed and specific research questions proposed.
K E Y W O R D Sdetrusor overactivity, detrusor under activity, male lower urinary tract symptoms, nocturia, overactive bladder, prostatic surgery, urodynamics
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