The Influences of Bladder Outlet Obstruction on Improvement of Storage Symptoms in Patients Who Underwent Transurethral Resection of Prostate

Ho Young Chung; Dong Seok Han; Young Seop Jang; Ki Hak Song

doi:10.4111/kju.2008.49.10.912

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Chung, Han, Jang, and Song: The Influences of Bladder Outlet Obstruction on Improvement of Storage Symptoms in Patients Who Underwent Transurethral Resection of Prostate

Original Article

Korean J Urol 2008;49(10):912-916.

Published online: 20 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.10.912

The Influences of Bladder Outlet Obstruction on Improvement of Storage Symptoms in Patients Who Underwent Transurethral Resection of Prostate

Ho Young Chung, Dong Seok Han, Young Seop Jang, Ki Hak Song

From the Department of Urology, Konyang University College of Medicine, Daejeon, Korea

Received 18 June 2008 Revised 25 August 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the influences of preoperative bladder outlet obstruction(BOO) to be adjusted by age and prostate volume on improvement of storage symptoms in patients who underwent transurethral resection of prostate (TURP) in a long term follow up.

Materials and Methods

We performed retrospective study of 75 patients with benign prostatic hyperplasia (BPH) who had undergone TURP and preoperative urodynamics from July 2004 to December 2006. 18 patients of them were lost follow up in this period, so we analyzed 57 patients in this study. The degrees of BOO were measured by the Abrams-Griffiths (AG) number calculated according to the preoperative urodynamic data. International Prostate Symptom Score (IPSS) questionnaire were used to evaluate improvement of symptoms. Especially IPSS questions number 2, 4 and 7 were used to evaluate storage symptoms. Partial correlation analysis was done between the AG numbers and the degree of storage symptoms improvement, adjusted by the age and the prostate volume.

Results

There were significant decreases of the IPSS (p=0.029), storage symptom score (p=0.024) and frequency score (p=0.017) in BOO group compared to the non-BOO group. The changes of IPSS (γ=−0.338, p=0.012), storage symptoms score (γ=−0.292, p=0.031) and frequency symptom score (γ=−0.305, p=0.023) were significantly correlated with AG number.

Conclusions

These results suggested that the preoperative AG number derived from urodynamics was an important factor in predicting the postoperative results. It would be expected that the patients with high AG numbers might be more improved storage symptom after TURP.

Keywords: Prostatic hyperplasia, Urodynamics, Urinary bladder neck obstruction, Transurethral resection of prostate

References

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Fig. 1.

Comparison of the changes of symptom scores before and after TURP between the patients with and without bladder outlet obstruction. The patients with bladder outlet obstruction showed significant decrease of IPSS, storge symptom score and frequency score after TURP comparing with the patients without bladder outlet obstruction (p＜0.05). Each bar is mean±SE. AG number: Abrams-Griffith number, TURP: transurethral resection of the prostate, BOO: bladder outlet obstruction.

Table 1.

Comparison of the preoperative clinical findings

Parameters	BOO (n=40)	ⁿon-BOO (n=17)	p-value
Age	71.4±1.0	71.5±1.6	0.930
Follow up (months)	13.8±1.4	17.1±2.3	0.190
Prostate volume on TRUS (cc)	81.6±5.2	61.1±4.2	0.004
PSA (ng/ml)	9.3±1.6	4.2±0.9	0.007
IPSS
Total symptom score	27.2±0.9	24.6±2.2	0.300
Storage symptom score	11.4±0.5	10.1±0.9	0.170
Frequency score	4.1±0.5	3.2±0.4	0.070
Urgency score	3.8±0.2	3.3±0.5	0.260
Nocturia score	3.6±0.2	3.5±0.3	0.910
QoL score	5.3±0.2	5.0±0.3	0.490

Statistical significance test was done by Student's t-test, BOO: bladder outlet obstruction, TRUS: transrectal ultrasonography, PSA: prostate-specific antigen, IPSS: International Prostate Symptom Score, QoL: quality of life, Each value is mean±SE

Table 2.

Comparison of the changes of the symptom scores before and after TURP between the patients with and without bladder outlet obstruction

Parameters	BOO (n=40)	Non-BOO (n=17)	p-value
IPSS
Total symptom score	−16.3±1.2	−10.6±2.6	0.029
Voiding symptom score	−10.6±0.9	−7.1±0.9	0.023
Storage symptom score	−5.7±0.5	−3.4±1.0	0.024
Frequency score	−1.7±0.3	−0.3±0.5	0.017
Urgency score	−3.1±0.3	−2.5±0.5	0.282
Nocturia score	−1.1±0.3	−0.6±0.3	0.289
QoL score	−2.9±0.3	−2.2±0.5	0.243

Statistical significance test was done by Student's t-test, TURP: transurethral resection of prostate, BOO: bladder outlet obstruction, IPSS: International Prostate Symptom Score, QoL: quality of life, Each value is mean±SE

Table 3.

Partial correlation between AG numbers and changes of symptom scores before and after TURP adjusted by age & prostate volume

Parameters	AG number
Parameters	Partial correlation coefficient (γ)	p-value
IPSS
Total symptom score	−0.338	0.012
Storage symptom score	−0.292	0.031
Frequency score	−0.305	0.023
Urgency score	−0.149	0.277
Nocturia score	−0.100	0.470
QoL score	−0.295	0.029

AG: Abrams-Griffith, IPSS: International Prostate Symptom Score, QoL: quality of life

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