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The resected prostate weight matters in transurethral resection of the prostate in men with benign prostatic
Kekeli Kodjo Adanu1,2, Mawuenyo Attawa Oyortey3,4, James Edward Mensah5,6
1Department of Surgery, School of Medicine, University of Health and Allied Sciences, Ho, Ghana. kadan@uhas.edu.gh.
Background:
Although a notable proportion of patients report improvement in clinical outcomes following transurethral resection of the prostate (TURP), symptoms persist in about 25% of cases, resulting in dissatisfaction with the treatment. Due to this dissatisfaction, several studies have been conducted to determine the parameters that can predict outcomes. These parameters include the resected weight and the resected weight fraction. However, there is ambiguity as to what constitutes an adequate resection. Even more, the effect of the resected weight on clinical outcomes in African men with benign prostatic hyperplasia (BPH) is limited. Relevant data is needed to improve clinical practice. This study aims to determine the effect of the resected prostate weight on clinical outcomes in men with BPH at the Korle Bu Teaching Hospital (KBTH).
Methods:
This study uses the International Prostate Symptom Score (IPSS), Quality of Life (QoL), International Index of Erectile Function-5 (IIEF-5) questionnaires, Peak Flow Rate (PFR) and Post Void Residual (PVR) urine volume to assess the clinical outcomes among men with BPH undergoing TURP at the KBTH. A cross-tabulation analysis evaluated the impact of the resected weight on the clinical outcome variables. Pearson and Spearman correlation methods ascertained the correlation between the post-operative PFR and the prostate weights, while receiver operator characteristic models interrogated the relationship between resected weight models and the clinical outcome variables. A total of 52 patients were recruited with an average of 5 recruited per month, using consecutive sampling.
Results:
The mean age was 66.83 ± 8.67 and failed medical therapy was the main indication for surgery (65%). The mean resected weight was 10.53 ± 6.98 g and the average resection speed was 0.13 g/minute. Resected weights, 20% or less of the prostate volume were much less effective. As the resected fraction doubles, the improvement in the peak flow rate also doubles. Although the resected weight and the resected weight fraction curve models were both effective in predicting voiding outcomes, the resected weight fraction had a better predictive value.
Conclusion:
The improvement in voiding function following TURP is dependent on the resected weight as it doubles the improvement in voiding function. Resections greater than 30% of the prostate weight are sufficient to restore normal voiding function.
