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Abstract
Purpose
We evaluated the efficacy of bipolar transurethral resection of the prostate (TURP) in patients with large prostates (＞80g) and determined the postoperative results based on the transitional zone resection ratio.
Materials and Methods
Thirty patients with benign prostatic hyperplasia (BPH)＞80g (group 1) and 76 patients with BPH between 30g and 80g (group 2) were evaluated. The evaluation before TURP included the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual urine (PVR), and transrectal ultrasonography. The operative time, weight of resected tissue, change in serum hemoglobin, and complications were noted. After TURP, patients were reassessed for the IPSS, Qmax, and PVR at 6 months. In group 1, subgroup analysis of the postoperative symptom scores was performed based on the ratio of the resection volume (RV) to the transitional zone volume (TZV).
Results
In patients with large prostates, the operative times were prolonged, and the weights of resected tissues were higher. However, there were no statistically significant differences between the two groups with respect to hemoglobin changes, postoperative hospital stays, or complications. The postoperative clinical parameters were markedly improved in both groups. Severe bleeding necessitated blood transfusion, and the TURP syndrome did not occur in any patients. The symptom score improved more as the RV/TZV increased.
Conclusions
Bipolar TURP is an effective and safe surgical treatment method, even in patients with large prostates. Considering that the complications associated with bipolar TURP are very rare, surgeons should aim to perform a complete resection of the enlarged transitional zone to ensure a good postoperative result.
References
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Fig. 1.
Symptom score improvement based on resected tissue volume per transition zone volume in group 1. TZV: transition zone volume, IPSS: International Prostate Symptom Score, IPSS_FS: IPSS filling subscore, IPSS_VS: IPSS voiding subscore. Asterisk indicates a p＜0.05.
Table 1.
Preoperative characteristics of the patients
Table 2.
Indication for operation
| No. of patients (%) | ||
|---|---|---|
| Group 1 | Group 2 | |
| Voiding difficulty | 14 (47) | 45 (59) |
| Acute urinary retention∗ | 14 (47) | 25 (33) |
| Bladder stone | 2 (6) | 3 (4) |
| Recurrent hematuria | 0 | 3 (4) |
| Total | 30 (100) | 76 (100) |
Table 3.
Correlation coefficient among different parameters
Table 4.
Surgical outcomes of the patients
| Group 1 | Group 2 | p-value | |||
|---|---|---|---|---|---|
| Operative time∗ (min.) | 97.3±31.7 | 60.1±22.9 | ＜0.01 | ||
| Weight of resected tissue∗ (g) | 40.0±17.2 | 16.0±9.1 | ＜0.01 | ||
| Resected tissue per min.∗ (g/min.) | 0.41±0.08 | 0.27±0.05 | ＜0.01 | ||
| Resected tissue volume/TZV (%) | 61.3±21.5 | 61.2±27.8 | 0.98 | ||
| Change of hemoglobin (g/dl) | 1.74±0.9 | 1.39±2.3 | 0.43 | ||
| Postoperative hospital stay (days) | 5.1±1.4 | 4.8±1.4 | 0.12 | ||
| Transfusion | None | None | |||
| Symptoms of TUR syndrome | None | None | |||
| Complications | |||||
| Transient urinary retention (%) | 6.7 | 6.6 | |||
| Transient dysuria (%) | 6.7 | 5.3 | |||
| Stricture (%) | 0 | 0 | |||
| Incontinence (%) | 0 | 0 | |||
| Surgical revision (%) | 0 | 0 | |||
| Clinical parameters | Preoperative | Postoperative | Preoperative | Postoperative | |
| IPSS∗ | 19.6±10.0 | 5.3±4.3 | 20.8±6.9 | 9.3±6.3 | 0.03 |
| IPSS_FS | 8.9±4.1 | 3.7±3.2 | 9.2±3.1 | 5.1±3.7 | 0.22 |
| IPSS_VS∗ | 10.7±6.6 | 1.6±1.8 | 11.6±4.6 | 4.3±3.7 | ＜0.01 |
| QoL | 4.2±1.1 | 1.6±1.0 | 4.5±1.0 | 2.5±1.6 | 0.05 |
| Qmax (ml/sec) | 7.9±3.4 | 20.4±9.9 | 8.1±3.7 | 16.7±8.0 | 0.11 |
| PVR (ml) | 75.3±67.0 | 36.8±33.2 | 94.3±53.6 | 42.5±60.8 | 0.71 |
Table 5.
Standardized coefficients (β) and p-values after stepwise multiple linear regression analysis in group 1
| Variables | IPSS improvement | IPSS_FS improvement | IPSS_VS improvement | |||
|---|---|---|---|---|---|---|
| p-value | β | p-value | β | p-value | β | |
| Constant | 0.04∗ | − | 0.15 | − | 0.006∗ | − |
| PSA | −† | −† | −† | −† | −† | −† |
| TPV | −† | −† | −† | −† | −† | −† |
| TZV | 0.02∗ | 0.77 | 0.10 | 0.60 | 0.002∗ | 0.92 |
| Resected tissue volume/TZV | 0.02∗ | 0.82 | 0.06 | 0.71 | 0.003∗ | 0.87 |
| Sig. | 0.03∗ | 0.12 | 0.004∗ | |||
| R2 | 0.50 | 0.27 | 0.70 | |||
In the regression analysis symptomscore improvement was taken as the dependent variable and PSA, TV, TZ, and TZRR were taken as independent variables. Each symptom score improvement was calculated as the value of postoperative symptom score minus preoperative symptomscore. TZV: transition zone volume, TUR: transurethral resection, IPSS: International Prostate Symptom Score, IPSS_FS: IPSS filling subscore, IPSS_VS: IPSS voiding subscore
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