Bladder mucosal cell abnormalities and symptomatic outcome after transurethral resection of the prostate

Objectives. To identify predictors of poor symptomatic improvement after tr ansurethral resection of the prostate (TURP), we investigated mucosal cell abnormalities in men about to undergo this procedure, and any association b etween these abnormalities and pre- and postoperative urinary tract symptom s. Methods. Bladder lavages were obtained from patients undergoing TURF for ou tflow obstruction during 1995 to 1996 at the Repatriation General Hospital. Pressure flow studies were obtained preoperatively, and International Pros tate Symptom Scores and flow rates were obtained preoperatively and 3 month s and 2 years postoperatively. Cells from bladder washings were examined fl ow-cytometrically for Tn antigen expression and DNA cell cycle parameters. Results. Of 192 patients recruited, 145 met the inclusion criteria. The fre quency of Tn antigen expression, aneuploidy, and tetraploid aneuploidy in b ladder mucosal cell washings in this group was comparable to a previous stu dy. Weak, statistically significant associations were found between S-phase fraction and the initial International Prostate Symptom Score irrespective of whether total S-phase fraction cell numbers or categories were used. Th e trend of each of these associations was consistent (ie, patients with hig her S-phase fraction values had more severe symptoms, poorer quality of lif e, and lower flow rates). The association was maintained at 3 months postop eratively but not at 2 years. Potential confounding factors did not explain the association. Conclusions. Bladder mucosal cell abnormalities can be found in men selecte d to undergo TURF to relieve obstruction and are associated with poor short -term symptomatic outcome. Further studies are needed to confirm these find ings, in particular any association between higher mucosal cell proliferati on rates and the presence of lower urinary tract symptoms. UROLOGY 54: 834- 838, 1999. (C) 1999, Elsevier Science Inc.