Functional outcomes of surgical treatment of patients with benign prostatic hyperplasia

Kotov S.V., Bogdanov D.A., Yusufov A.G., Guspanov R.I., Badakva G.V.

1) 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, Moscow, Russia; 2) Pirogov City Clinical Hospital No.1, Moscow, Russia; 3) «Kommunarka» Moscow Multidisciplinary Clinical Center of Moscow Health Department, Moscow, Russia

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

Corresponding author: D.A. Bogdanov – 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, Moscow, Russia; e-mail: dancjaaa@gmail.com

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