Prognostic Value of Pressure-flow Study and Clinical Parameters in the Outcome Measurement after Transurethral Prostatectomy in Patients with BPH

Jung, Phil Bum; Lee, Jeong Gu

Abstract

PURPOSE: We performed this study to elucidate whether patient`s satisfaction and improvement of clinical parameters after transurethral resection of prostate(TURP) correlate with the degree of preoperative obstruction. We investigated the role of urodynamic studies as a predictor of outcome after TURP.
MATERIALS AND METHODS
Parameters including pre-operative symptom scores(IPSS), uroflow rate, prostate volume and urodynamic studies, were assessed in 27 patients undergoing TURP due to BPH. Bladder outlet obstruction was assessed by pressure-flow study(PFS). Post-operative evaluation was performed with IPSS and uroflowmetry 3 months after surgery. Post-operative patient`s satisfaction was determined by subjective responses to the questionnaires. The subjective responses, clinical and urodynamic parameters were compared and statistically analyzed.
RESULTS
Eighteen patients(67%) had preoperative bladder outlet obstruction(BOO; defined as L-PURR> or =3), while 14(52%) demonstrated associated detrusor instability(DI). Significant improvements in IPSS, quality of life, peak flow rate and residual urine were noted in all patients post-operatively(p<0.05). Significant improvements in voiding symptom scores were demonstrated in patients with good results(p<0.05). Good results(16 patients) were more frequently noted in the patients with BOO than those without BOO. 60% of the patients who showed only DI had poor results. The positive predictive value for the good and poor results were 76.9%(L-PURR> or =3) and 91%(L-PURR<3).
CONCLUSIONS
No differences in the improvements of clinical parameters except voiding symptom scores were noted between obstructive and non-obstructive BPH. However, patient`s satisfaction after surgery was higher for patients in whom preoperative pressure-flow study confirmed obstruction. Also, obstructive parameters such as L-PURR or URA may be useful in predicting postoperative results.