Transüretral Prostat Rezeksiyonu Sonrası Medikal Tedaviye Devam Durumunun Öngörülmesinde Preoperatif Prostat Boyutu Belirleyici midir?

Öz

GİRİŞ ve AMAÇ: Benign prostat hiperplazisi (BPH) nedeniyle TURP uygulanan hastaların küçük de olsa bir bölümünde postoperatif alt üriner sistem semptomları (AÜSS) devam etmekte ve bu hastalarda medikal tedaviye devam edilmektedir. Biz de çalışmamızda, TURP uygulanan hastalarda prostat boyutu ile postoperatif ek girişim oranları ve AÜSS nedeniyle medikal tedaviye devam edilme oranları arasında ilişki olup olmadığını araştırdık.
YÖNTEM ve GEREÇLER: Preoperatif prostat boyutlarına göre hastalar Grup 1 (prostat hacmi ≥80 ml) ve Grup 2 (prostat hacmi <80 ml) olarak iki gruba ayrıldı. Gruplar; preoperatif PSA değerleri ve prostat volümü, eşlik eden ko-morbiditeler, postoperatif ek sistoskopi ve sistometri yapılıp yapılmadığı, postoperatif medikal tedavi kullanımı açısından karşılaştırıldı.
BULGULAR: Çalışmaya toplam 87 hasta dahil edildi. Grup 1’deki 26 hastada prostat boyutu ≥80 ml iken, grup 2’deki 61 hastada prostat boyutu <80 ml idi. 87 hastanın 19’una (%22), postoperatif dönemde AÜSS’nin devam etmesi nedeniyle, sistoskopi veya sistometri yapıldı ya da medikal tedavi yeniden başlandı. İstatistiksel olarak anlamlı olmasa da, 80 ml altında prostat hacmi olup, TURP uygulanan hastalarda, postoperatif AÜSS’nin daha sık görüldüğü gözlendi.
TARTIŞMA ve SONUÇ: Her ne kadar TURP sonrası işeme bozukluklarını ve risk faktörlerini belirlemek için prospektif ve geniş serili çalışmalara ihtiyaç olsa da, elde ettiğimiz veriler büyük prostatlarda TURP’nin cerrahi sonuçlarının daha yüz güldürücü olabileceğine işaret etmektedir.

Türkçe Kısa Başlık: Prostat Hacmi ve Tedaviye Devam Durumu

Anahtar Kelimeler

• TURP,Alt üriner sistem semptomları (AÜSS),prostat boyutu,sistoskopi,sistometri

Does Preoperative Prostate Volume Predictive For Medical Therapy Continuation After Transurethral Prostate Resection?

Abstract

INTRODUCTION: A small proportion of patients who underwent TURP for benign prostate hyperplasia suffer from persistent lower urinary tract symptoms and needs continuing medical treatment. In our study, we aimed to evaluate whether or not is there any relationship between preoperative prostate volume and postoperative persistent LUTS and medical treatment continuation.
METHODS: The patients were divided into two groups (group 1: prostate volume ≥80 ml, and group 2: prostate volume <80 ml) according to prostate volume. Preoperative PSA levels, prostate volume, comorbidities, the necessity of postoperative cystoscopy and cystometry and postoperative medical therapy continuation were evaluated and compared between groups.
RESULTS: A total of 87 patients included to the study. Prostate volume was ≥80 ml in 26 patients (group1), and <80 ml in 61 patients (Group 2). Of 87 patients 19 (22%) had persistent LUTS and underwent cystoscopy, cystometry or were restarted medical therapy. Despite there were no statistical significance, LUTS were seen more frequently in patients who had prostate volume less than 80 ml.
DISCUSSION AND CONCLUSION: Despite high volume and prospective studies are warranted for determining the risk factors for postoperative LUTS following TURP operations, our study demonstrates that TURP operations may have better outcomes in larger prostates.

İngilizce Kısa Başlık: Prostate Volume and Therapy Continuation

Keywords

• TURP,lower urinary tract symptoms,prostate volume,cystoscopy,cystometry

Kaynakça

1. 1. Abrams P, Chpple C, Khoury S, Roehrborn C, de La Rosette J. International scientific committee. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol 2009; 81: 1779-1787.
2. 2. S. Gravas, T. Bach, A. Bachmann, et al. EAU 2015 guidelines on the management of non-neurogenic male lower urinary tract tymptoms (LUTS), incl. Benign Prostatic Obstruction (BPO).
3. 3. Reich O, Gratzke C, Stief CG. Techniques and long-term results of surgical procedures for BPH. Eur Urol 2006;49(6):970-978.
4. 4. Joshi HN, De Jong IJ, Karmacharya RM, Shrestha B, Shrestha R. Outcomes of transurethral resection of the prostate in benign prostatic hyperplasia comparing prostate size of more than 80 grams to prostate size less than 80 grams. Kathmandu Univ Med J 2014;12(47):163-167.
5. 5. Han HH, Ko WJ, Yoo TK, et al. Factors associated with continuing medical therapy after transurethral resection of prostate. Urology 2014;84(3):675-680.
6. 6. Park HK, Paick SH, Lho YS, Jun KK, Kim HG. Effect of the ratio of resected tissue in comparison with the prostate transitional zone volume on voiding function improvement after transurethral resection of prostate. Urology 2012;79(1):202-206.
7. 7. Bruskewitz RC, Larsen EH, Madsen PO, Dørflinger T. 3-year follow up of urinary symptoms after transurethral resection of the prostate. J Urol 1986;136(3):613-615.
8. 8. Kakizaki H, Machino R, Koyanagi T. Clinical experience in lower urinary tract symptoms. BJU Int 2001;88:23-26.

9. 9. Thomas AW, Cannon A, Bartlett E, et al. The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic followup of transurethral resection of prostate for bladder outlet obstruction. J Urol 2005;174:1887-1891.
10. 10. Hakenberg OW, Pinnock CB, Marshall VR. Preoperative urodynamic and symptom evaluation of patients undergoing transurethral prostatectomy: analysis of variables relevant for outcome. BJU Int. 2003;91(4):375-9.
11. 11. Seaman EK, Jacobs BZ, Blaivas JG, Kaplan SA. Persistence or recurrence of symptoms after transurethral resection of the prostate: a urodynamic assessment. J Urol. 1994;152(3):935-7.
12. 12. Lin YH, Hou CP, Chen TH, Juang HH, Chang PL, Yang PS, Lin YS, Chen CL, Tsui KH. Is diabetes mellitus associated with clinical outcomes in aging males treated with transurethral resection of prostate for bladder outlet obstruction: implications from Taiwan Nationwide Population-Based Cohort Study. Clin Interv Aging. 2017;12:535-541.
13. 13. Ransmayr GN1, Holliger S, Schletterer K, Heidler H, Deibl M, Poewe W, Madersbacher H, Kiss G. Lower urinary tract symptoms in dementia with Lewy bodies, Parkinson disease, and Alzheimer disease. Neurology. 200822;70(4):299-303.
14. 14. Ellenberg MAX. Development of urinary bladder dysfunction in diabetes mellitus. Ann Intern Med 1980;92:321-323.
15. 15. Yoshimura N, Chancellor MB, Andersson K, et al. Recent advances in understanding the biology of diabetes-associated bladder complications and novel therapy. BJU Int 2005;95:733-738.
16. 16. Kaplan SA. Re: Factors Associated with Continuing Medical Therapy after Transurethral Resection of Prostate. J Urol. 2015;194(2):482.
17. 17. Oelke M, Baard J, Wijkstra H, et al. Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia. Eur Urol. 2008;54:419-426