Kasım Emre ERGÜN, Serdar KALEMCİ, Tuncer BAHÇECİ, Fuat KIZILAY, Mehmet Ceyhun ÖZYURT

Benign prostat hiperplazisi nedeniyle transüretral prostat rezeksiyonu uygulanan hastalarda tedavi etkinliği ile ilişkili parametrelerin araştırılması

Amaç: Benign prostat büyümesi nedeniyle transüretral prostat rezeksiyonu yapılan hastalarda postoperatif yarar oranlarını ve postoperatif yararla ilişkili olabilecek çeşitli parametreleri değerlendirerek, transüretral prostat rezeksiyonunun tedavi etkinliğini değerlendirmeyi ve bunu öngörebilecek parametrelere ulaşılıp ulaşılamayacağını araştırmayı amaçladık. Gereç ve Yöntem: 2015-2016 Temmuz tarihleri arasında kliniğimizde transüretral prostat rezeksiyonu yapılan 100 hasta retrospektif olarak değerlendirildi. Preoperatif tahmini prostat ağırlığı (TPA), uluslararası prostat semptom skoru (IPSS), maksimum akım hızı (Qmax) ve işeme sonrası rezidü idrar hacmi (PVR) değerleri ve rezeke edilen prostat dokusu ağırlıkları (RDA) kaydedildi. Postoperatif altı hafta ile altı ay arası dönemde hastaların verileri tekrar kaydedilip istatistiksel analizler yapıldı. Bulgular: Uluslararası prostat semptom skorundaki azalmanın 11,40 (%53,4), Qmax’taki artışın 11,10 ml/sn (%110) ve PVR’deki azalmanın 59,60 ml (%59) olduğu tespit edildi. IPSS’deki düşüş, preoperatif IPSS ≥ 20 olanlarda, preoperatif Qmax ≤ 10 ml/sn olanlarda ve PVR >100 ml olanlarda istatistiksel anlamlı olarak daha fazla saptandı (sırasıyla p 100 ml olan hastalarda Qmax’daki artış ve PVR’deki azalma istatistiksel anlamlı olarak daha fazla bulundu (sırasıyla p=0,012, p 50 gr olan hastalarda ve RDA / TPA ≤ 0,3 olan hastalarda PVR azalması istatistiksel anlamlı olarak daha fazla bulundu (sırasıyla p=0,027 ve p=0,008) Sonuç: Transüretral prostat rezeksiyonu tedavi etkinliği ile ilişkili olabilecek daha net verilere ulaşılmasının hasta takibi ve tedavi seçimi konusunda klinisyenleri yönlendirebileceğini ve bu konuda daha fazla çalışma yapılması gerektiğini düşünmekteyiz.

Investigation of parameters related to treatment efficiency in patients undergoing transurethral prostate resection for benign prostatic hyperplasia

Aim: Evaluation of the postoperative benefit rates and various parameters that may be associated with the postoperative benefit in patients who underwent transurethral resection of the prostate due to benign prostate enlargement and the treatment efficacy of transurethral resection of the prostate and to investigate whether the parameters that can predict this can be achieved. Materials and Methods: 100 patients who underwent transurethral resection of the prostate in our clinic between 2015-2016 Julys were evaluated retrospectively. Preoperative estimated prostate weight, international prostate symptom score, maximum flow rate, post void residual urine volume, and resected prostate tissue weights were recorded. In the postoperative six weeks to six months, the data of the patients were re-recorded and statistical analyzes were performed. Results: It was determined that the decrease in IPSS was 11.40 (53.4%), the increase in Qmax was 11.10 ml/s (110%) and the decrease in PVR was 59.60 ml (59%). The decrease in IPSS was found to be statistically significantly higher in those with preoperative IPSS ≥ 20, preoperative Qmax ≤ 10 ml/sec, and PVR >100 ml (p100 ml (p=0.012, p 50 g and RDA / TPA ≤ 0.3 (p=0.027 and p=0.008, respectively). Conclusion: We think that obtaining clearer data that may be related to the efficacy of transurethral resection of the prostate can guide clinicians in patient follow-up and treatment selection, and more studies are needed on this subject.

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1. AUA Practice Guidelines Committee. AUA Guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol. 2003; 170: 530-47.
2. Rassweiler J, Teber D, Kuntz R ve ark. Complications of transurethral resection of the prostate (TURP)- incidence, management and prevention. Eur Urol. 2006; 50: 969-79.
3. 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;174:1887-91.
4. Reynard JM, et al. The ICS-’BPH’ Study: uroflowmetry, lower urinary tract symptoms and bladder outlet obstruction. Br J Urol, 1998. 82(5): p. 619-23.
5. McLoughlin MG, Kinahan TJ. Transurethral resection of the prostate in the outpatient setting. J Urol. 1990 May;143(5):951-2.
6. Bosch JL, Hop WC, Kirkels WJ, Schröder FH. The International Prostate Symptom Score in a community-based sample of men between 55 and 74 years of age: prevalence and correlation of symptoms with age, prostate volume, flow rate and residual urine volume. Br J Urol. 1995 May;75(5):622-30.
7. Reynard JM, et al. The ICS-’BPH’ Study: uroflowmetry, lower urinary tract symptoms and bladder outlet obstruction. Br J Urol, 1998. 82(5): p. 619-23.
8. McConnell JD. Benign prostatic hyperplasia: treatment guidelines and patient classification. Br J Urol. 1995 Jul;76 Suppl 1:29-46.
9. Barry MJ, Cockett AT, Holtgrewe HL, McConnell JD, Sihelnik SA, Winfield HN. Relationship of symptoms of prostatism to commonly used physiological and anatomical measures of the severity of benign prostatic hyperplasia. J Urol. 1993 Aug;150(2 Pt 1):351-8.
10. Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, et al. Meta–analysis of functional outcomes and complications following transurethral procedures for lower urinary symptoms resulting from benign prostatic enlargement. Eur Urol. 2010; 58: 384–97.
11. Reich O, Gratzke C, Bachmann A, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 2008;180:246–9.
12. Schatzl G, Madersbacher S, Djavan B, Lang T, Marberger M. Twoyear results of transurethral resection of the prostate versus four ‘less invasive’ treatment options. Eur Urol 2000;37:695–701.
13. Madersbacher S. et al. Is transurethral resection of the prostate stil justified? BJU Int. 1999.83:227.
14. Marszalek M,Ponholzer A,Pusman M,Berger I,Madersbacher S. Transurethral Resection of the Prostate. Eur Urol 2009:504–12.
15. Tascı AI, Ilbey YO, Tugcu V, Cicekler O, Cevik C, Zoroglu F. Transurethral resection of the prostate with monopolar resectoscope: single-surgeon experience and long-term results of after 3589 procedures. Urology. 2011 Nov;78(5):1151-5.
16. Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, et al. EAU guidelines on the treatment and follow–up of non–neurogenic male lower tract symptoms including benign prostatic obstruction. Eur Urol. 2013; 64: 118–40.
17. Antunes AA, Srougi M, Coelho RF, Leite KR, Freire CG. Transurethral resection of the prostate for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia: how much should be resected? Int Braz J Urol. 2009; 35: 683–9.
18. Hakenberg OW, Helke C, Manseck A, Wirth MP. Is There a Relationship between the Amount of Tissue Removed at Transurethral Resection of the Prostate and Clinical Improvement in Benign Prostatic Hyperplasia. Eur Urol. 2001; 39: 412–7.
19. Aagaard J, Jonler M, Fuglsig S, Christensen LL, Jorgensen HS, Norgaard JP: Total transurethral resection versus minimal transurethral resection of the prostate--a 10-year follow-up study of urinary symptoms, uroflowmetry and residual volume. Br J Urol. 1994;74: 333-6.
20. Green JS, Bose P, Thomas DP, Thomas K, Clements R, Peeling WB, et al.: How complete is a transurethral resection of the prostate? Br J Urol. 1996; 77: 398-400.
21. Chen SS, Hong JG, Hsiao YJ, Chang LS: The correlation between clinical outcome and residual prostatic weight ratio after transurethral resection of the prostate for benign prostatic hyperplasia. BJU Int. 2000; 85:79-82.
22. Agrawal MS, Aron M, Goel R: Hemiresection of the prostate: short-term randomized comparison with standard transurethral resection. J Endourol. 2005;19: 868-72.
23. Milonas D, Verikaite J, Jievaltas M. The effect of the completeness of transurethral resection of the prostate on symptoms, quality of life, and voiding function improvement. Cent European J Urol. 2015; 68: 169-74.
24. 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: 202–6.