Transrectal ultrasound with separate measurement of the transition zone volume predicts the short-term outcome after transurethral resection of the prostate

Objectives. To determine whether the volume of prostatic adenomas as assess ed by transrectal ultrasound (TRUS) influenced the outcome after transureth ral resection of the prostate (TURP). Methods. TRUS with total prostate and transition zone (TZ) volume determina tions was performed preoperatively in 298 consecutive patients undergoing T URP for benign prostatic hyperplasia without prior urodynamic evaluation. P ostoperatively, the outcome of surgery was stated as excellent (no or minor remaining symptoms), improved (but with some remaining symptoms), or failu re (the same or aggravated symptoms) according to a patient-administered qu estionnaire. Six possible risk factors were evaluated: TZ volume 20 cc or l ess, neurologic disorders, previous TURP/transurethral incision of the pros tate (TUIP), diabetes, indwelling catheter, and age older than 80 years. Results. Thirty patients (10.1%) had treatment failure, 45 (15.1%) improvem ent, and 223 (74.8%) had excellent outcome. After subdivision into preopera tive TZ volume of 20 cc or less and greater than 20 cc, it was found that t he outcomes of 20.9% (n = 19) were failures if the TZ volume was 20 cc or l ess but only 5.3% (n = 11) if the TZ volume was greater than 20 cc. Additio nal independent risk factors for failure were neurologic disorders and prev ious TURP/TUIP. When all patients with risk factors were excluded (TZ volum e 20 cc or less, neurologic disorders, previous transurethral surgery, and diabetes), the risk of failure was 3.3%. Conclusions, Patients with a preoperative TZ volume greater than 20 cc and no history of neurologic disorders, previous TURP/TUIP, or diabetes had a v ery high chance of favorable outcome after TURP, even though no pressure/fl ow evaluation had been performed preoperatively. UROLOGY 53: 926-930, 1999. (C) 1999, Elsevier Science Inc. All rights reserved.