Functional outcomes of surgical treatment of patients with benign prostatic hyperplasia

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

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).

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

References

  1. Korneyev I. et al. [Prevalence of lower urinary tract symptoms among male population in Russian Federation: analysis of population study results]. Georgian Med News. 2015;241:7–14.
  2. Logie J., Clifford G.M., Farmer R.D.T. Incidence, prevalence and management of lower urinary tract symptoms in men in the UK. BJU Int. 2005;95(4):557–562.
  3. Parsons J.K. et al. Prevalence and Characteristics of Lower Urinary Tract Symptoms in Men Aged ≥80 Years. Urology. 2008;72(2):318–321.
  4. Enikeev D. et al. Randomized prospective trial of the severity of irritative symptoms after HoLEP vs ThuFLEP. World J Urol. 2022;40(8):2047–2053.
  5. Elsaqa M. et al. Predictors of postoperative urinary tract infection following holmium laser enucleation of prostate. Canadian Urological Association Journal. 2023;17(11).
  6. Kyono Y. et al. Positive urine culture under indwelling urethral catheterization is a risk factor for febrile complications after holmium laser enucleation of the prostate (HoLEP). LUTS: Lower Urinary Tract Symptoms. 2021;13(3):377–382.
  7. Capogrosso P. et al. Rates and predictors of postoperative complications after Holmium laser enucleation of the prostate (HoLEP) at a high-volume center. Minerva Urology and Nephrology. 2022;74(4).
  8. Romero-Otero J. et al. Factors Influencing Intraoperative Blood Loss in Patients Undergoing Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia: A Large Multicenter Analysis. Urology. 2019;132:177–182.
  9. Sun F. et al. The Efficacy and Safety of HoLEP for Benign Prostatic Hyperplasia With Large Volume: A Systematic Review and Meta-Analysis. Am J Mens Health. 2022;16(4):155798832211132.
  10. Yan P. et al. Intraoperative and postoperative outcomes of thulium laser enucleation versus bipolar resection in the transurethral treatment of benign prostatic hyperplasia: a meta-analysis. Lasers Med Sci. 2022;37(5):2517–2525.
  11. Wang Y.-B. et al. Comparison on the Efficacy and Safety of Different Surgical Treatments for Benign Prostatic Hyperplasia With Volume >60 mL: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials. Am J Mens Health. 2021;15(6):155798832110670.
  12. Chehonackii I.A.C. et al. Intravesical prostatic protrusion as a predictor of the functional outcome of surgical treatment of benign prostatic hyperplasia. Urologiia. 2022;3:58–62.
  13. Oelke M. et al. Age and Bladder Outlet Obstruction Are Independently Associated with Detrusor Overactivity in Patients with Benign Prostatic Hyperplasia. Eur Urol. 2008;54(2):419–426.
  14. Gadzhieva Z.K. Urodynamic studies in the diagnosis and treatment of urinary disorders. Abstract of the dissertation. ...Doctor of Medical Sciences, Moscow, 2009. Russian (Гаджиева З.К. Уродинамические исследования в диагностике и лечении нарушений мочеиспускания. Автореферат дис. …док. мед. наук. М., 2009).
  15. Coman R.A. et al. Predictive Factors of Transient Urinary Incontinence Following Holmium Laser Enucleation of the Prostate (HoLEP): Single-Center Experience. Medicina (B Aires). 2024;60(9):1460.
  16. Martov A.G. et al. Bipolar and laser endoscopic enucleation for large benign prostatic hyperplasia. Urologiia. 2020;1:59–63.
  17. Kotov S.V. et al. The problem of antibiotic resistance in patients with urinary tract infection. Urologiia. 2021;1:5–12.
  18. Kotov S.V. et al. Efficacy of Phlogenzyme® in men following transurethral laser enucleation of prostate hyperplasia: results of a randomized trial. Urology Herald. 2024;12(2):43–57.
  19. Pirola G.M. et al. Urethral stricture following endoscopic prostate surgery: a systematic review and meta-analysis of prospective, randomized trials. World J Urol. 2022;40(6):1391–1411.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
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.

Download (84KB)
Indexing metadata
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.

Download (71KB)
Indexing metadata
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.

Download (75KB)
Indexing metadata
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.

Download (69KB)
Indexing metadata
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

Download (66KB)
Indexing metadata
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

Download (129KB)
Indexing metadata

Согласие на обработку персональных данных с помощью сервиса «Яндекс.Метрика»

1. Я (далее – «Пользователь» или «Субъект персональных данных»), осуществляя использование сайта https://journals.rcsi.science/ (далее – «Сайт»), подтверждая свою полную дееспособность даю согласие на обработку персональных данных с использованием средств автоматизации Оператору - федеральному государственному бюджетному учреждению «Российский центр научной информации» (РЦНИ), далее – «Оператор», расположенному по адресу: 119991, г. Москва, Ленинский просп., д.32А, со следующими условиями.

2. Категории обрабатываемых данных: файлы «cookies» (куки-файлы). Файлы «cookie» – это небольшой текстовый файл, который веб-сервер может хранить в браузере Пользователя. Данные файлы веб-сервер загружает на устройство Пользователя при посещении им Сайта. При каждом следующем посещении Пользователем Сайта «cookie» файлы отправляются на Сайт Оператора. Данные файлы позволяют Сайту распознавать устройство Пользователя. Содержимое такого файла может как относиться, так и не относиться к персональным данным, в зависимости от того, содержит ли такой файл персональные данные или содержит обезличенные технические данные.

3. Цель обработки персональных данных: анализ пользовательской активности с помощью сервиса «Яндекс.Метрика».

4. Категории субъектов персональных данных: все Пользователи Сайта, которые дали согласие на обработку файлов «cookie».

5. Способы обработки: сбор, запись, систематизация, накопление, хранение, уточнение (обновление, изменение), извлечение, использование, передача (доступ, предоставление), блокирование, удаление, уничтожение персональных данных.

6. Срок обработки и хранения: до получения от Субъекта персональных данных требования о прекращении обработки/отзыва согласия.

7. Способ отзыва: заявление об отзыве в письменном виде путём его направления на адрес электронной почты Оператора: info@rcsi.science или путем письменного обращения по юридическому адресу: 119991, г. Москва, Ленинский просп., д.32А

8. Субъект персональных данных вправе запретить своему оборудованию прием этих данных или ограничить прием этих данных. При отказе от получения таких данных или при ограничении приема данных некоторые функции Сайта могут работать некорректно. Субъект персональных данных обязуется сам настроить свое оборудование таким способом, чтобы оно обеспечивало адекватный его желаниям режим работы и уровень защиты данных файлов «cookie», Оператор не предоставляет технологических и правовых консультаций на темы подобного характера.

9. Порядок уничтожения персональных данных при достижении цели их обработки или при наступлении иных законных оснований определяется Оператором в соответствии с законодательством Российской Федерации.

10. Я согласен/согласна квалифицировать в качестве своей простой электронной подписи под настоящим Согласием и под Политикой обработки персональных данных выполнение мною следующего действия на сайте: https://journals.rcsi.science/ нажатие мною на интерфейсе с текстом: «Сайт использует сервис «Яндекс.Метрика» (который использует файлы «cookie») на элемент с текстом «Принять и продолжить».