Clinical Outcome of Immediate Transurethral Surgery for Benign Prostate Obstruction Patients with Acute Urinary Retention: More Radical Resection Resulted in Better Voiding Function

Continuation of Selective Alpha Blocker After Transurethral Resection of the Prostate Is Associated with a Decreased Risk of Hip Fractures in Elderly Patients Diagnosed with Benign Prostate Hyperplasia

Hip fractures significantly affect mortality and quality of life in the elderly population. Although alpha-blockers are commonly prescribed for lower urinary tract symptoms after transurethral resection of the prostate (TURP), their long-term safety regarding fracture risk remains controversial. This study aimed to investigate whether long-term alpha-blocker use after TURP affects the risk of hip fractures requiring surgery in elderly men. This study included 6853 male patients aged ≥50 years who underwent TURP between 2000 and 2018. The alpha-blocker group (n = 1371) included patients who continued alpha-blocker treatment after TURP, while the control group (n = 5482) included those who had discontinued the medication. The primary outcome was hip fracture requiring surgical intervention. During follow-up (3.80 ± 1.64 years), hip fracture occurred in 4.2% of the alpha-blocker group versus 5.6% of controls. After adjusting for baseline characteristics and competing risk analysis, alpha-blocker use was associated with a significantly lower risk of hip fracture (p = 0.005). Subgroup analysis revealed particularly strong protective effects in patients with diabetes. Long-term use of alpha-blockers after TURP was associated with reduced hip fracture risk, particularly in patients with diabetes. These findings suggest the safety of continued alpha-blocker therapy after TURP in these patients.

Comparison of Complications and Outcomes Following Transurethral Resection of the Prostate in Patients Presenting With and Without Acute Urinary Retention

OBJECTIVE

The objective of this study is to evaluate the outcomes and complications of transurethral resection of the prostate (TURP) in patients with and without acute urinary retention (AUR).

METHODOLOGY

This descriptive study was conducted in the Urology Department of the Institute of Kidney Diseases (IKD), Hayatabad Medical Complex (HMC), Peshawar, from 11th August 2023 to 11th February 2024. A total of 127 male patients aged over 40 years with prostate sizes between 40 and 80 grams on ultrasonography were included. Patients with a history of prostate cancer or prior prostate surgery were excluded. All participants underwent TURP, and postoperative complications, such as urinary tract infections (UTIs), hematuria, lower urinary tract symptoms (LUTS), recatheterization, and hospital stay length, were documented. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States) to compare outcomes between the AUR and non-AUR groups.

RESULTS

The study included 127 patients with a mean age of 64.92 ± 3.8 years. The incidence of AUR was 63(49.6%). Postoperative complications such as UTIs (p=0.39), hematuria (p value= 0.06), LUTS (p=0.27), recatheterization (0.52), and sepsis (0.20) were more common in the AUR group, though these differences were not statistically significant. The need for blood transfusions was also higher in the AUR group (P=0.09). Hospital stay duration and symptom resolution were comparable between the AUR and non-AUR groups.

CONCLUSION

AUR in benign prostatic hyperplasia patients was associated with more severe symptoms and an increased frequency of certain postoperative complications, including UTIs, hematuria, and the need for blood transfusions. However, most differences between the AUR and non-AUR groups were not statistically significant.

Safety and Clinical Efficacy of Prostatic Artery Embolization in Patients with Indwelling Urinary Catheter for Benign Hyperplasia-A Multicenter Study

Background/Objectives: This multicentric study aimed to evaluate the efficacy and safety of prostatic artery embolization (PAE) to remove indwelling urinary catheter (IUC) in patients with symptomatic benign prostatic hyperplasia (BPH). Secondary objectives were to identify features associated with post-PAE catheter-free survival (PCFS). Methods: All consecutive patients who underwent PAE for IUC related to BPH with a follow-up of at least 2 years (except for early death) in 6 French University Hospitals were retrospectively included. Clinical efficacy was defined as the removal of the IUC after PAE (through a trial without catheter [TWOC]) and evaluated at regular intervals. Chi-square tests, Wilcoxon tests and multivariable binary logistic regressions were utilized to investigate predictors of TWOC success. Univariable and multivariable Cox regressions were utilized to investigate predictors of PCFS in patients with TWOC success. Results: 140 men with IUC (median age: 82.5 years, interquartile range [IQR] = 73-88.2 years, range: 46-100) who underwent PAE between January 2017 and March 2021 were included. Initial successful catheter removal (TWOC success) following PAE occurred in 113/140 (80.7%) patients, and 3/140 (2.1%) patients encountered major complications. In patients with TWOC success, PCFS at 6 months, 1 year and 2 years were 87.5% (95%CI: 81.4-94.1), 84.4% (95%CI: 77.7-91.7) and 79% (71.3-87.4), respectively. No independent predictive factors for TWOC success and PCFS were identified. Conclusions: PAE should be considered as a safe option with good clinical efficacy in the short and long term for elderly and inoperable patients with IUC due to symptomatic BPH.

Analysis of urinary retention after endoscopic prostate enucleation and its subsequent impact on surgical outcomes

PURPOSE

Postoperative urinary retention (PUR) is a common complication after prostate enucleation, which leads to an increased length of hospital stay and decreased postoperative satisfaction. This study determined the predictive factors of postoperative urine retention within 1 month after prostate enucleation and investigated whether PUR influences surgical outcomes at the 2-week, 3-month, and 6-month follow-up time points.

METHODS

Data were collected from the electronic medical records of 191 patients with benign prostatic obstruction (BPO) during October 2018 to September 2021. Of them, 180 patients who underwent thulium laser or plasma kinetic enucleation of the prostate (ThuLEP, PKEP) were separated into the PUR group (n = 24) and the non-PUR (NPUR) group (n = 156). Uroflowmetry and the International Prostate Symptom Score (IPSS) questionnaire were followed up at 2 weeks, 3 months, and 6 months postoperatively.

RESULTS

The PUR group had a significantly higher percentage of patients with type 2 diabetes mellitus (DM) than the NPUR group. Postoperatively, compared with the NPUR group, the PUR group had significantly less improvement in changes in the IPSS Quality of Life scores at 2 weeks, the total IPSS(International Prostate Symptom Score) at all follow-up times, the IPSS-S(IPSS storage subscores) at 2 weeks and 3 months, and the IPSS-V(IPSS voiding subscores) at all follow-up times. Predictive factors for PUR include lower preoperative maximum urinary flow (Qmax), lower preoperative total IPSS, and higher operation time.

CONCLUSION

Lower preoperative Qmax, lower IPSS scores, and longer operation time were risk factors for PUR. Furthermore, PUR could be a prognostic factor for prostatic enucleation surgical outcomes.

Outcomes of Aquablation in Men With Acute and Chronic Urinary Retention

OBJECTIVE

To compare outcomes of Aquablation in men with acute and chronic urinary retention.

METHODS

We conducted a retrospective review of all men undergoing Aquablation resection of the prostate between May 2021 and August 2022. Men were classified as having acute urinary retention if they required either intermittent or indwelling catheter and chronic urinary retention if they had a postvoid residual >300 mL prior to surgery. We compared success rates and time to passage of trial without catheter as well as complication rates to those with no retention.

RESULTS

A total of 113 men underwent Aquablation including 28 with acute retention and 16 with chronic retention. Failure of initial void trial was significantly higher in patients with preoperative urinary retention (40%) and chronic retention with postvoid residual >300 mL (12.5%) compared to those with no retention (7.2%, P < .001). Among men with acute and chronic retention 98% were voiding spontaneously at a mean 5months follow-up. There was no difference in utilization of postoperative prostate medications, complications, International Prostate Symptom Score or uroflowmetry among men with acute, chronic, or no retention.

CONCLUSION

Aquablation is an effective method for treatment of men with urinary retention, with 98% achieving spontaneous voiding regardless of preoperative urodynamic findings. Men in acute retention prior to surgery were more likely to fail their initial void trial, which may support the recommendation for a delayed trial without catheter.

Clinical Outcome of Endoscopic Enucleation of the Prostate Compared With Robotic-Assisted Simple Prostatectomy for Prostates Larger Than 80 cm3 in Aging Male

This study investigated and compared the surgical outcomes of using endoscopic enucleation (thulium: YAG laser and bipolar plasma; ThuLEP) with robotic-assisted simple prostatectomy (RASP) in the treatment of prostates larger than 80 cm3. Records were obtained for the period from January 2014 to December 2020 for selected patients with BPO who underwent RASP, ThuLEP, or bipolar transurethral enucleation of the prostate (B-TUEP). Patients were excluded if they had active malignant disease, neurogenic bladder, lower urinary tract syndrome for reasons other than BPO, and a history of prostate surgery. Data of 396 patients who underwent B-TUEP, ThuLEP, and RASP were examined. A total of 112 patients met the including criteria, 85 of whom (B-TUEP: 29; ThuLEP: 41; RASP: 15) completed the final visit. The mean operation time and duration of postoperative hospital stays in the RASP group were significantly longer than those of the B-TUEP and ThuLEP groups. Only 1 patient in the RASP group required blood transfusion. The RASP group was superior to the other groups in voiding improvement including Qmax and IPSS voiding score. The pain score of the ThuLEP group after surgery was significantly lower than that of the other two groups during hospitalization, whereas the QoL scores were identical between the three groups at 2 weeks, 3 months, and 6 months post operation. The rates of returning to ER within the first postoperative month did not differ significantly between the three groups, and all the reasons for return involved minor complications that required no additional invasive treatment. These three surgical methods (B-TUEP, ThuLEP, and RASP) are all effective and safe for treating prostates larger than 80 cm3, with each having its particular advantages. B-TUEP requires the shortest operation time, ThuLEP causes the lowest postoperative pain, and RASP results in superior voiding function improvement.

Monopolar Transurethral Resection of Prostate for Benign Prostatic Hyperplasia in Patients With and Without Preoperative Urinary Catheterization: A Prospective Comparative Study

Background

A significant proportion of patients undergo surgery for benign prostatic hyperplasia following acute urinary retention. Studies have reported conflicting results of improvement following transurethral surgery in these patients.

Objective

To compare perioperative complications and postoperative voiding parameters in patients undergoing monopolar transurethral resection of prostate with and without preoperative Foley catheterization.

Methods

A prospective non-randomized study was conducted in patients undergoing monopolar transurethral resection of prostate for symptomatic benign prostatic hyperplasia. Patients were divided into those with Foley catheterization preoperatively (n=52), and those without catheters (n=90). Change in hemoglobin level, the resected volume of prostate, complications and the need for postoperative catheterization were compared. Postoperative symptoms score using International Prostate Symptom Score, maximum flow rate and post-void residual volume were assessed at three months follow up.

Results

The mean operative duration, length of stay and resected volume were higher in those patients with catheters; however, no significant differences were noted for mean hemoglobin level change and need for postoperative recatheterization. Three patients in each group required recatheterization and, all were catheter-free at one week postoperatively. Complications developed in 16.1% (n=23) with most of them being Clavien I. Patients with catheters had a lower postoperative maximum flow rate than those without it (16.90 vs 19.75 mL/sec). Patients with catheters had a significantly better postoperative quality of life and symptom score.

Conclusion

Monopolar transurethral resection of prostate in patients with preoperative per-urethral Foley catheter for acute urinary retention had similar postoperative voiding parameters with comparable complication rates to those without a catheter.

Postoperative medical treatment of lower urinary tract symptoms after benign prostatic hyperplasia surgery. Are we underestimating the problem?

PURPOSE OF REVIEW

The aim of this study was to determine whether well timed start of medical and surgical treatment of benign prostatic obstruction (BPO) influences the treatment's effectiveness and thus the patients' overall functional outcomes and quality of life.

RECENT FINDINGS

Pharmacological therapy even in high-volume (>80 cm3) BPH typically begins with α-blockers sole and only subsequently are 5ARI added. Several studies showed that acute urinary retention (AUR) developed more frequently in men who suffered severe lower urinary tract symptoms (LUTS) and who did not start combination therapy immediately. Moreover, there are no strict criteria which determine the right time for performing surgery in patients with mild and moderate LUTS, especially when pharmacological therapy fails. However, sometimes, the surgery does not eliminate all the symptoms, as it deals effectively with BPO, but does not treat an overactive bladder. Also, data show that surgery should be performed as soon as possible and be more radical after the first episode of AUR.

SUMMARY

A combination of α-blockers and 5ARI makes for a good starting point where the treatment of high volume BPH is concerned. Ideally, surgery should be performed immediately or as soon as possible in patients with the first episode of AUR and 'anatomic' BPH tissue removal is preferable (dissection of tissue along the prostate capsule to remove its maximum volume).

Prioritisation of catheterised patients for elective bladder outflow obstruction surgery in the current coronavirus disease 2019 era to reduce catheter-associated morbidity

Objectives:

This study aimed to audit the waiting times for a transurethral resection of prostate (TURP) at our institution, and to evaluate the extent of catheter-associated morbidity in this population.

Methods:

This was a retrospective closed-loop audit, with cycle one between 1 January 2018 and 31 December 2018 and cycle two between 1 October 2019 and 29 February 2020. Data collected included patient demographics, catheter status, catheter-associated presentations to accident and emergency (A&E), admissions and waiting times for TURP. The waiting-list form now has a catheter box, and a goal of 30 days from waitlisting to operation was set for those catheterised.

Results:

In cycle 1, 36% of the 181 patients were catheterised, and waited a median of 119 days (interquartile range (IQR) 59–163 days) for their TURP, while those not catheterised waited a median of 118 days (IQR 57.75–188.25 days). Catheterised patients presented to A&E 93 times, resulting in 13 admissions, compared to two presentations and zero admissions for those not catheterised. The median time from catheter insertion to first A&E attendance was 20 days (IQR 2–101 days). In cycle 2, 33% of the 55 patients were catheterised, with the median waiting-list time falling to 32 days (IQR 22–46 days) in those catheterised and 33 days (IQR 20–49 days) in those not catheterised. All 11 A&E attendances were from catheterised patients, with no admissions. The median time from insertion to first A&E attendance was nine days (IQR 4–40 days). Eighty-eight per cent of the waiting-list forms had appropriately ticked the catheter box.

Conclusion:

Our study shows that catheterised patients awaiting a TURP are more likely to have complications necessitating A&E attendance. Prioritisation of these patients on the waiting list for bladder outflow obstruction surgery may help to reduce catheter-associated morbidity.

Level of evidence:

Level 2c.

Incidence and predictors of early and late hospital readmission after transurethral resection of the prostate: a population-based cohort study

OBJECTIVES

To evaluate the incidence and predictors of hospital readmission and emergency department (ED) visits in patients with benign prostatic hyperplasia treated by transurethral resection of the prostate (TURP).

PATIENTS AND METHODS

We conducted a retrospective cohort study using a linked administrative dataset from Calgary, Canada. Participants were men who underwent their first TURP procedure between 2015 and 2017. We examined patient demographics, and type of surgery (elective or urgent). Comorbidities were scored using the Charlson comorbidity index (CCI). The primary outcomes were unplanned hospital readmissions and ED visits at 30, 60 and 90 days after TURP. The secondary aim was to identify potential predictors across these groups.

RESULTS

We identified 3059 men, most of whom underwent elective TURP (83%). The mean (sd) patient age was 71.0 (10.0) years. A total of 224 patients (7.4%) were readmitted to the hospital within 30 days, 290 (9.5%) within 60 days, and 339 (11.1%) within 90 days of discharge. The frequency of return visits within 30, 60 and 90 days of TURP were 21.4%, 26% and 28.6%, respectively. The most responsible diagnoses for ED visit within 90 days were haematuria (15.4%) and retention of urine (12.8%). Multivariable analysis showed that age (odds ratio [OR] 1.61, P < 0.001), surgery type (OR 2.20, P < 0.001), and CCI score (OR 2.03, P < 0.001) were independently associated with odds of readmission and ED visits at all time points.

CONCLUSION

Older age, poorer health and urgent surgery predicted return to ED or readmission after TURP; efforts should be made to improve selection, counselling and preoperative optimization based on these risks.