Outcomes of transurethral resection of prostate for benign prostatic obstruction stratified as per duration of prior medical therapy

Introduction/Aims of study

This original work done in patients with Benign Prostatic Obstruction aims to find out the impact of duration of medication therapy on the outcomes of TURP. Medical management of BPO is recommended as the first line of treatment and surgery is usually reserved for those who have failure of medical management and/or complications of BPO (refractory retention, vesical calculus, recurrent UTI or hematuria). However, there is some pointing evidence that delay in the surgery may affect the overall outcomes of transurethral resection of prostate (TURP) [1, 2] Presently, there is a lacuna on the impact of delay in surgery owing to prolonged duration of preoperative medical therapy on the outcomes of surgery. We aimed to find this impact with the hypothesis that patients who are on long term medication therapy have less improvement in their subjective symptoms and objective bladder function parameters compared to patients who undergo surgery earlier.

Methods

An observational prospective cohort study was conducted to evaluate the outcomes after TURP with respect to prior duration of pre operative medical management as < 3, 3–12 and > 12 months. Baseline characteristics (age, comorbidities, ASA grade, duration and type of medical therapy, indication of surgery, serum PSA, IPSS, Ultrasound imaging with post-void residual urine , UDS storage and voiding pressures) were collected for all patients undergoing TURP. Operative details (surgical time, resected prostate weight) and post-operative outcomes (post-operative stay, catheter duration and Clavien-Dindo grade of complications) were noted. Follow up was done at 6 weeks, 3 months and 6 months with IPSS, PVR and UDS storage/voiding pressures. Primary outcome was patient-reported outcome measure (PROM) of IPSS based improvement of symptoms at 3 months. Secondary outcome measures included PROM at 6 weeks and 6 months, complete emptying of bladder (as measured by Ultrasound based PVR), Urodynamics Storage and Voiding pressures and comparison between patients who received only alpha blockers and those who also received 5-alpha reductase inhibitors. One way ANOVA was used for testing of mean between three independent groups whereas Repeat measure ANOVA was used for repeated observations. A p-value of < 0.05 was considered statistically significant. All analysis was done using SPSS software, version 25.0.

Results

87 men undergoing TURP from Jan 2022-Dec 2023 were divided into three groups based on duration of preoperative medical therapy - <3 months (n = 24), 3–12 months (n = 27) and > 12 months (n = 36). Baseline parameters including age, co-morbidities, prostate size, ASA grade, serum PSA, resection time, resected prostate weight, post-operative stay, catheter duration and post-operative complications were found to be similar across all three groups. However, the patients in > 12 months group had poorer percent reduction in IPSS [30 ± 14.3 vs. 42.4 ± 10.3 vs. 39.1 ± 15.9, p = 0.002], PVR [40.8 ± 16.6 vs. 48.9 ± 20.6 vs. 63.3 ± 14, p < 0.001], and UDS storage [14.8 ± 12.4 vs. 16.7 ± 18.1 vs. 32.1 ± 21, p = 0.002] and voiding pressures [9.2 ± 11.4 vs. 19.7 ± 12.6 vs. 18.8 ± 13.1, p = 0.005] compared to the other group of patients. This difference in outcomes was consistent irrespective of the type of medication therapy (alpha blockers vs. combination therapy). There was a significant negative correlation between duration of medical therapy and IPSS reduction [r (86):-0.25, p = 0.008].

Conclusion

The delay in surgery due to prolonged preoperative medical therapy is associated with poorer IPSS, PVR, Urodynamic storage and voiding pressure improvements.

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