Functional outcomes of surgical treatment of patients with benign prostatic hyperplasia

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Abstract

Aim. To compare the functional outcomes of various surgical procedures, to assess the rate of complications and urination disorders after surgery, and to identify possible risk factors and predictors of unsatisfactory treatment outcomes.

Materials and methods. The functional outcomes of surgical treatment were evaluated in 398 patients with benign prostatic hyperplasia (BPH). Patients were divided into 3 groups depending on the surgical method: bipolar transurethral resection of the prostate, laser enucleation of the prostate, and laparoscopic simple prostatectomy. The groups were comparable in age, comorbidities, and maximum urinary flow rate (Qmax). Prostate volume, total PSA level, and IPSS score differed between groups. They were higher in the group of simple prostatectomy.

Results. Before surgical treatment, 192 (48.2%) patients underwent urodynamic studies including "filling cystometry" and "pressure-flow", to determine the bladder outlet obstruction index (BOOI) and detrusor overactivity (DO), which was confirmed in 82.8% of cases. The mean BOOI value was 72.1.

Functional outcomes did not statistically differ between groups at all follow-up points during the first year. After 12 months, the mean Qmax across all groups was 22.3±6.4 ml/s, the median IPSS value after the transurethral resection and simple prostatectomy was 3.0 points, while in the enucleation group it was 4.0 points.

Transient urinary incontinence after catheter removal was recorded in 46 (11.6%) patients. By 3 months of follow-up, 10 (2.5%) patients had urge urinary incontinence on urodynamic study, requiring conservative therapy with M-anticholinergics or β3-adrenomimetics. De novo stress urinary incontinence was confirmed in 1 (0.3%) patient after transurethral enucleation.

Infectious complications (prostatitis, orchiepididymitis) requiring antibiotic therapy occurred in 61 (15.3%) patients. The risk of infectious complications was higher in those with longer operative time (p=0.004), diabetes mellitus (p=0.006), and bacteriuria (p=0.019).

All strictures were identified after transurethral procedures, including transurethral resection (1.1%) and transurethral enucleation (6.8%). Patients with urethral strictures more often developed postoperative infectious complications (p=0.008). It was noted that patients with cystostomy tube had a lower frequency of strictures (p=0.076).

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About the authors

Sergey V. Kotov

FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia; Pirogov City Clinical Hospital No.1; «Kommunarka» Moscow Multidisciplinary Clinical Center of Moscow Health Department

Email: urokotov@mail.ru
ORCID iD: 0000-0003-3764-6131

Ph.D., MD, professor, Head of the Department of Urology and Andrology named after Academician N.A. Lopatkin of FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia; Urologist at the Urologic Department of the Pirogov City Clinical Hospital No.1; Head of University Clinic of Urology, Oncourology and Andrology, «Kommunarka» Moscow Multidisciplinary Clinical Center of Moscow Health Department

Russian Federation, 117997, Russia Moscow, st. Ostrovityanova, 1; 119049, Moscow, Leninsky Prospekt, 8; 108814, Moscow, Sosenskoye village, Kommunarka village, st. Sosensky Stan, 8

Daniil A. Bogdanov

FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia; «Kommunarka» Moscow Multidisciplinary Clinical Center of Moscow Health Department

Author for correspondence.
Email: dancjaaa@gmail.com
ORCID iD: 0000-0001-6847-5684
SPIN-code: 2280-7170

Ph.D. student at the Department of Urology and Andrology named after Academician N.A. Lopatkin of FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia; Urologist at the «Kommunarka» Moscow Multidisciplinary Clinical Center of Moscow Health Department

Russian Federation, 117997, Russia Moscow, st. Ostrovityanova, 1; 108814, Moscow, Sosenskoye village, Kommunarka village, st. Sosensky Stan, 8

Anvar G. Yusufov

FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia; «Kommunarka» Moscow Multidisciplinary Clinical Center of Moscow Health Department

Email: anvar.yusufov@mail.ru
ORCID iD: 0000-0001-8202-3844

Ph.D., associate professor at the Department of Urology and Andrology named after Academician N.A. Lopatkin of FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia; Head of the Urologic Department of «Kommunarka» Moscow Multidisciplinary Clinical Center of Moscow Health Department

Russian Federation, 117997, Russia Moscow, st. Ostrovityanova, 1; 108814, Moscow, Sosenskoye village, Kommunarka village, st. Sosensky Stan, 8

Renat I. Guspanov

FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia; Pirogov City Clinical Hospital No.1; «Kommunarka» Moscow Multidisciplinary Clinical Center of Moscow Health Department

Email: uroguspanov@yandex.ru
ORCID iD: 0000-0002-2944-2668

Ph.D., associate professor at the Department of Urology and Andrology named after Academician N.A. Lopatkin of FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia; Urologist at the Urologic Department of the Pirogov City Clinical Hospital No.1; Oncologist, 4th Oncology Department (Oncourology) of «Kommunarka» Moscow Multidisciplinary Clinical Center of Moscow Health Department

Russian Federation, 117997, Russia Moscow, st. Ostrovityanova, 1; 119049, Moscow, Leninsky Prospekt, 8; 108814, Moscow, Sosenskoye village, Kommunarka village, st. Sosensky Stan, 8

Georgy V. Badakva

Pirogov City Clinical Hospital No.1

Email: stubbz909@gmail.com
ORCID iD: 0000-0001-6450-0571
SPIN-code: 8792-7493

Ph.D. student at the Department of Urology and Andrology named after Academician N.A. Lopatkin of FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia; Urologist at the Urologic Department of the Pirogov City Clinical Hospital No.1

Russian Federation, 119049, Moscow, Leninsky Prospekt, 8

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2. Fig. 1. Dynamics of changes in the maximum urine flow rate (Qmax) after surgery (TURBT - transurethral resection of the prostate; HoLEP - holmium enucleation of the prostate; ThuLEP - thulium enucleation of the prostate; AE - adenomectomy). Vertical bars: 95% confidence interval.

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3. Fig. 2. Dynamics of changes in the average IPSS score after surgery (TURP — transurethral resection of the prostate; HoLEP — holmium enucleation of the prostate; ThuLEP — thulium enucleation of the prostate; AE — adenomectomy). Vertical columns: 95% confidence interval.

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4. Fig. 3. Dynamics of changes in nocturia after surgery depending on the presence of detrusor overactivity (DO). Vertical columns: 95% confidence interval. P=0.105.

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5. Fig. 4. Dynamics of changes in the maximum urine flow rate (Qmax) after surgery depending on the presence of infectious complications (IC). Vertical columns: 95% confidence interval. P=0.375.

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6. Fig. 5. Dynamics of changes in the average IPSS score after surgery (depending on the presence of infectious complications (IC). Vertical columns: 95% confidence interval. P=0.031

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7. Fig. 6. Dynamics of changes in the average IPSS score (A) and the flow rate of urination Qmax (B) after surgery depending on the presence of cicatricial complications. Vertical columns: 95% confidence interval. A: p=0.003; B: p=0.000

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