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Year : 2012  |  Volume : 28  |  Issue : 2  |  Page : 235-236
 

Incomplete prostate adenoma resection does not affect the outcome after transurethral resection of prostate -A fact or a myth?


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Date of Web Publication13-Jul-2012

Correspondence Address:
Amit Kumar
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How to cite this article:
Kumar A. Incomplete prostate adenoma resection does not affect the outcome after transurethral resection of prostate -A fact or a myth?. Indian J Urol 2012;28:235-6

How to cite this URL:
Kumar A. Incomplete prostate adenoma resection does not affect the outcome after transurethral resection of prostate -A fact or a myth?. Indian J Urol [serial online] 2012 [cited 2019 Nov 13];28:235-6. Available from: http://www.indianjurol.com/text.asp?2012/28/2/235/98482

Park HK, Paick SH, Lho YS, Jun KK, Kim HG. Effectof the ratio of resected tissue in comparison with the prostate transitional zone volume on voiding function improvement after transurethral resection of prostate. Urology2012;79:202-6.



   Summary Top


Transurethral resection of the prostate (TURP) is the 'gold standard' therapy for treatment of benign prostatic hyperplasia (BPH), however, symptomatic improvement is not seen in 5 - 35% of the patients. [1] Studies have been conducted to identify factors that can predict post-TURP success. The extent of tissue resected is considered to be one such factor and the same factor is related to the perioperative morbidity of TURP, specifically blood loss and the transurethral resection (TUR) syndrome. In this retrospective study, the author has tried to evaluate whether the resection weight or ratio of resected prostatic tissue volume to the volume of prostate transitional zone has any effect on the success of TURP.

Transurethral resections of the prostate were performed by several surgeons who had more than '10 years' of experience, using either a 24- or 27-Fr bipolar resectoscope. The patients were stratified into two groups according to the resection ratio (volume of resected tissue / prostate transitional zone) as measured by the preoperative transrectal ultrasound (TRUS). Group A included individuals with a resection ratio < 50% and group B included individuals with a resection ratio more than or equal to 50%. These groups were then compared with regard to prostate volume (PV), transitional zone volume (TZV), preoperative and postoperative International Prostate Symptom Score (IPSS), quality of life (QoL), peak flow rate (Qmax), and post void residual volume (PVR).

There were no statistically significant differences in age, PV, TZV, IPSS or prostate-specific antigen (PSA) levels between groups A and B before surgery. However, group B were found to have a significantly higher mean resected tissue weight compared to that of group A (24.4 g vs. 11.2 g) and significantly higher resection ratios (78.5 vs. 34.1%). After TURP no significant difference in absolute value or any change from baseline for IPSS, QoL, Qmax or PVR was observed between the groups. Also, the resection ratio did not have a significant effect on any postoperative symptoms, bother score, Qmax or post void residual in the small prostate (< 40 g) and large prostate (> 40 g) subgroups, respectively. The authors thus concluded that the resection ratio had no effect on post-TURP clinical improvement, even after stratification, according to prostate size, and suggested that complete prostate adenoma resection may not be essential during TURP.


   Comments Top


Conventional TURP recommends complete removal of all adenomatous prostatic tissue, however, in practice; the extent of tissue actually removed varies greatly because of differences in individual surgical estimations and is responsible for significant differences in the postoperative outcome. Outcomes between photo-selective vaporization of the prostate (PVP laser), where complete adenoma removal is not possible in contrast to conventional TURP or Holmium Laser Enucleation of the Prostate (HoLEP), where complete removal of adenoma is generally performed, have not been found to vary significantly. In fact, several studies have recently suggested that, while the mean difference in pre- and post-PVP volumes is significantly smaller than that associated with traditional TURP, the degree of overall clinical improvement does not vary between the approaches. [2],[3] This finding also supports the fact that complete resection of adenomatous lesions may not be necessary for achievement of symptom improvement in TURP.

In the present study, after stratifying subjects according to preoperative prostate volume into less than or greater than 40 g, the resection weight was found to be lower in the small prostate group, but the resection ratio was similar in both the small and large prostate groups. Thus, the resection ratio was a significant determinant of post-TURP success and not the preoperative prostate volume. However, in a different study, after three months of follow-up, improvement in the IPSS and Q max was more in large prostate group than in the small prostate group, but when they were followed for one year, these parameters were found to be better in small prostate group. [2]

The conclusion that complete prostate adenoma resection may not be needed during TURP raises a question regarding the well-established belief of complete adenoma excision during TURP. We feel that the biggest problem with this conclusion is the extremely short follow-up duration of only six months. [4] The authors need to address the implications of this conclusion. Do they recommend incomplete resection for treatment of prostate adenoma to avoid complications? [4] As TURP is a common procedure, we should be extremely cautious before drawing such conclusions. We fear that the rate of re-resection will rise rapidly if this approach is followed, as patients with a small resection ratio might show prostatic tissue regrowth more rapidly than those with a large resection ratio. The present re-treatment rate is 3 to 14.5% after a five-year follow-up. [5] Long-term prospective studies, with a larger sample size, are required, to further analyze this phenomenon.

 
   References Top

1.Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: Minimum 10-year urodynamic follow up of transurethral resection of prostate for bladder outlet obstruction. J Urol 2005;174:1887-91.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Park JS, Min GE, You CH. Comparison of treatment outcomes between photoselectivevaporization and transurethral resection of the prostate for benign prostatic hyperplasia. Korean J Urol 2007;48:297- 303.  Back to cited text no. 2
    
3.Bachmann A, Schürch L, Ruszat R, Wyler SF, Seifert HH, Müller A,et al. Photoselective vaporization (PVP) versus transurethralresection of the prostate (TURP): A prospective bicentre study of perioperative morbidity functional outcome. EurUrol 2005;48:965-71.  Back to cited text no. 3
    
4.Park HK, Paick SH, Lho YS, Jun KK, Kim HG. Effect ofthe ratio of resected tissue in comparison with the prostate transitional zone volume on voiding function improvement after transurethral resection of prostate. Urology2012;79:202-6.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP) - incidence, management and prevention. EurUrol 2006;50:969-80.  Back to cited text no. 5
    




 

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