The role of intra-operative void score during transurethral resection of prostate as a marker of efficacy: a feasibility study.
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ABSTRACT: Background
To assess the feasibility of a novel intra-operative void scoring technique. To determine if intra-operative void score (VS) could act as a marker for post-operative success following TURP.Methods
Fifteen patients undergoing TURP were included in this single-centre feasibility study. All patients had indwelling urinary catheters for recurrent retention due to benign prostatic hyperplasia (BPH). In theatre, immediately before- and after TURP, an intra-operative VS was measured and graded 0-5. Primary outcomes were the feasibility of measuring intra-operative VS and its accuracy in predicting surgical outcome.Results
A combined pre- and post-score with a threshold ≥6 correctly predicted 82% of those who were catheter free (sensitivity) and 100% of those who were not catheter free (specificity) at follow up and the positive predictive value was 100% and negative predictive value 60%.Conclusion
Intra-operative void score during TURP is simple, reproducible, fast and requires minimal resources. In TURP it may predict successful outcomes by identifying patients who will be catheter free post-operatively as opposed to those who will be catheter dependent despite the procedure.
SUBMITTER: Robinson C
PROVIDER: S-EPMC9314725 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Patient follow-up after transurethral resection of the prostate (TURP) is crucial to evaluate treatment-related outcomes and potential adverse events. We sought to determine the rate of, and factors associated with, patient nonadherence to follow-up after TURP. Data from 180 patients who underwent TURP were analysed. Patient counselling and follow-up were standardized among the cohort. Patients were considered lost to follow-up (LTF) if they were at least 30 days from their first scheduled follow-up appointment. Descriptive statistics and logistic regression analyses were performed to determine the impact of predictors on the rate of compliance with prescribed follow-up. Of 180 patients, 55 (30.5%) were LTF. LTF patients were younger (p?<?0.001), had lower educational status (p?=?0.007) and were more frequently single (p?=?0.03) than those who were not LTF. Importantly, patients who experienced a postoperative-related event (PRE) were more likely to follow-up (p?=?0.04). Multivariable analysis revealed that younger age (p?<?0.001) and low educational status (p?<?0.001) were independent predictors of being LTF. One out of three men submitted to TURP is lost to follow-up in the real-life setting. Noncompliance to follow-up was more frequent among young, single patients with low educational status. On the contrary, patients who experienced a PRE were more likely to follow-up.
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Project description:BackgroundTransurethral resection of the prostate (TURP) is the standard operation for benign prostatic obstruction. Thulium laser transurethral vaporesection of the prostate (ThuVARP) is a technique with suggested advantages over TURP, including reduced complications and hospital stay. We aimed to investigate TURP versus ThuVARP in men with lower urinary tract symptoms or urinary retention secondary to benign prostatic obstruction.MethodsIn this randomised, blinded, parallel-group, pragmatic equivalence trial, men in seven UK hospitals with bothersome lower urinary tract symptoms or urinary retention secondary to benign prostatic obstruction were randomly assigned (1:1) at the point of surgery to receive ThuVARP or TURP. Patients were masked until follow-up completion. Centres used their usual TURP procedure (monopolar or bipolar). All trial surgeons underwent training on the ThuVARP technique. Co-primary outcomes were maximum urinary flow rate (Qmax) and International Prostate Symptom Score (IPSS) at 12-months post-surgery. Equivalence was defined as a difference of 2·5 points or less for IPSS and 4 mL per s or less for Qmax. Analysis was done according to the intention-to-treat principle. The trial is registered with the ISRCTN Registry, ISRCTN00788389.FindingsBetween July 23, 2014, and Dec 30, 2016, 410 men were randomly assigned to ThuVARP or TURP, 205 per study group. TURP was superior for Qmax (mean 23·2 mL per s for TURP and 20·2 mL per s for ThuVARP; adjusted difference in means -3·12, 95% CI -5·79 to -0·45). Equivalence was shown for IPSS (mean 6·3 for TURP and 6·4 for ThuVARP; adjusted difference in means 0·28, -0·92 to 1·49). Mean hospital stay was 48 h in both study groups. 91 (45%) of 204 patients in the TURP group and 96 (47%) of 203 patients in the ThuVARP group had at least one complication.InterpretationTURP and ThuVARP were equivalent for urinary symptom improvement (IPSS) 12-months post-surgery, and TURP was superior for Qmax. Anticipated laser benefits for ThuVARP of reduced hospital stay and complications were not observed.FundingUK National Institute for Health Research Health Technology Assessment Programme.
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