Korean J Urol.  2010 Oct;51(10):700-703.

Analysis of the Factors Causing Bladder Irritation after Transurethral Resection of the Prostate

• Kim TI
• Song JM
• Chung HC

Abstract

PURPOSE
Approximately 20% to 30% of patients with benign prostatic hyperplasia (BPH) require medication or supplementary treatment for their continuous irritative bladder symptoms after transurethral resection of the prostate (TURP). The purpose of this study was to identify any factors related to continuous bladder irritation in patients after TURP.
MATERIALS AND METHODS
Of all patients who underwent TURP from January 2000 to December 2007, 160 who underwent long-term follow-up were selected for this study. The International Prostate Symptom Score (IPSS) was assessed 12 months after TURP, and the patients were divided into two groups: one group with an irritative bladder symptom score on the IPSS of 7 or less (non-irritative group) and another group with an irritative bladder symptom score on the IPSS of 8 or greater (irritative group). Preoperative urodynamic study variables, preoperative and postoperative IPSS, and the shape of the prostate upon transrectal ultrasonography (TRUS) were analyzed.
RESULTS
Of the 160 patients, 93 patients were assigned to the non-irritative group, and 67 were assigned to the irritative group. Initial irritative bladder symptoms were significantly different between the two groups (p<0.05). Also, a retrourethral enlarged prostate was more frequently observed upon TRUS in the irritative group. Symptoms of urinary frequency, incontinence, and urgency were significantly greater in the irritative group. Although there was no significant difference in the preoperative quality of life between the two groups, postoperative quality of life was significantly worse in the irritative group.
CONCLUSIONS
The shape of the prostate and the preoperative irritation score correlated significantly with the postoperative severity of irritative bladder symptoms. Therefore, physicians should be cautious when performing TURP in patients with a retrourethral enlarged prostate and severe irritative symptoms.

Keyword

Prostatic hyperplasia; Transurethral resection of prostate; Treatment

MeSH Terms

Follow-Up Studies
Humans
Prostate
Prostatic Hyperplasia
Quality of Life
Transurethral Resection of Prostate
Urinary Bladder
Urodynamics

Figure

• 

  FIG. 1 Change in IPSS according to prostate shape. Type I is a hyperplasia limited to the transition zone only and having no retrourethral enlargement. Type II is a retrourethral enlarged prostate. Both types showed a decrease in IPSS score postoperatively, but the degree of change was smaller in Type I. IPSS: International Prostate Symptom Score, op: operation.

Reference

1. Thorpe A, Neal D. Benign prostatic hyperplasia. Lancet. 2003. 361:1359–1367.

2. Kim HH, Kwak C, Seo SI, Chung H, Lee ES, Lee CW. The effects and complications of transurethral resection for benign prostatic hyperplasia: results of long-term follow-up. Korean J Urol. 1996. 37:268–280.

3. Rasweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol. 2006. 50:969–979.

4. Han KS, Hong SJ, Chung BH. Changing trends in the management of benign prostatic hyperplasia during recent 5 years. Korean J Urol. 2005. 46:458–462.

5. Doll HA, Black NA, McPherson K, Flood AB, Williams GB, Smith JC. Mortality, morbidity and complications following transurethral resection of the prostate for benign prostatic hypertrophy. J Urol. 1992. 147:1566–1573.

6. Uchida T, Ohori M, Soh S, Sato T, Iwamura M, Ao T, et al. Factors influencing morbidity in patients undergoing transurethral resection of the prostate. Urology. 1999. 53:98–105.

7. Nam JG, Choi NG. Evaluation of persistent lower urinary tract symptoms after transurethral resection of prostate. Korean J Urol. 2003. 44:540–544.

8. Wasserman NF. Benign prostatic hyperplasia: a review and ultrasound classification. Radiol Clin North Am. 2006. 44:689–710.

9. Tubaro A, Carter S, Hind A, Vicentini C, Miano L. A prospective study of the safety and efficacy of suprapubic transvesical prostatectomy in patients with benign prostatic hyperplasia. J Urol. 2001. 166:172–176.

10. Steers WD, Ciambotti J, Etzel B, Erdman S, de Groat WC. Alterations in afferent pathways from the urinary bladder of the rat in response to partial urethral obstruction. J Comp Neurol. 1991. 310:401–410.

11. Dinis P, Silva J, Ribeiro MJ, Avelino A, Reis M, Cruz F. Bladder C-fiber desensitization induces a long-lasting improvement of BPH-associated storage LUTS: a pilot study. Eur Urol. 2004. 46:88–93.

12. Kojima M, Inui E, Ochiai A, Naya Y, Kamoi K, Ukimura O, et al. Reversible change of bladder hypertrophy due to benign prostatic hyperplasia after surgical relief of obstruction. J Urol. 1997. 158:89–93.

13. Cote RJ, Bruke H, Schoenberg HW. Prediction of unusual postoperative results by urodynamic testing in benign prostatic hyperplasia. J Urol. 1981. 125:690–692.

14. Seki N, Yuki K, Takei M, Yamaguchi A, Naito S. Analysis of the prognostic factors for overactive bladder symptoms following surgical treatment in patients with benign prostatic obstruction. Neurourol Urodyn. 2009. 28:197–201.

15. Chung HY, Han DS, Jang YS, Song KH. The influences of bladder outlet obstruction on improvement of storage symptoms in patients who underwent transurethral resection of prostate. Korean J Urol. 2008. 49:912–916.

16. Lee HS, Ihm DH, Chung HC, Song JM. The outcome of TURP on lower urinary tract symptoms according to shape of prostate. Korean J Urol. 2008. 49:Suppl 1. 66.

17. Housami F, Abrams P. Persistent detrusor overactivity after transurethral resection of the prostate. Curr Urol Rep. 2008. 9:284–290.