Presentation Authors: So Inamura*, Hisato Kobayashi, Makoto Tanio, Manami Tsutsumiuchi, Minekatsu Taga, Katsuki Tsuchiyama, Yosuke Matsuta, Yoshitaka Aoki, Hideaki Ito, Osamu Yokoyama, Fukui, Japan
Introduction: Surgical therapy is an important therapeutic strategy for benign prostatic hyperplasia (BPH). However, the degree of improvement in postoperative clinical parameters can often vary depending on the case. Here, we assessed factors influencing postoperative clinical parameters in patients with transurethral prostatic surgery.
Methods: 96 patients who underwent transurethral resection of prostate (TURP), or holmium laser enucleation of prostate (HoLEP), and had measured total prostatic volume and volume of the transitional zone by transrectal ultrasound (TRUS) from 2006â€“2016 were assessed for ratio of prostatic resection and clinical parameters (i.e., preoperative and postoperative IPSS, OABSS, uroflowmetry, pressure flow study, and the magnitude of prostatic inflammation). Ratio of prostatic resection was calculated using the following formula: the weight of prostatic resection / the preoperative volume of transitional zone. A ratio of more than 0.8 prostatic resection was defined as â€œcomplete resectionâ€. Chronic prostatic inflammation was assessed by the grade (lymphocyte density), extent (lymphocyte distribution) and location of inflammation.
Results: Ratio of prostatic resection was negatively correlated with the rate of change in the intermittency and straining (IPSS) score and post-voiding residual, and positively correlated with Qmax. The factors affecting the rate of change in postoperative parameters were further examined in only the complete-resection group (46 cases). The rate of change in Qmax and Voided volume showed a strong positive correlation with the magnitude of inflammation.
Conclusions: In BPH surgery, urologists must conduct complete resections, because a higher ratio of prostatic resection contributes to the degree of improvement in postoperative clinical parameters. The degree of improvement in patients with stronger chronic prostatic inflammation was dramatic. In such cases, functional obstruction due to inflammation exists in addition to mechanical obstruction. Thus, removal of inflamed sites by transurethral surgery of prostate simultaneously improves the lower urinary tract symptoms caused by mechanical obstruction, and the functional obstruction in patients with strong inflammation. This result indicated that prostatic inflammation had a significant impact in exacerbating male LUTS.