Is there a relationship between the amount of tissue removed at transurethral resection of the prostate and clinical improvement in benign prostatic hyperplasia

Objective: To assess in a prospective trial the influence of the amount of tissue resected at transurethral resection of the prostate (TURP) for benig n prostatic enlargement on the symptom improvement as assessed by symptom s cores. Methods: Between December 1996 and August 1998 a total of 138 men (mean age 68.2, range 53-89) with symptomatic benign prostatic enlargement who under went TURF participated in this prospective study. Patients were assessed pr eoperatively with the international Prostate Symptom Score (IPSS), the Amer ican Urological Association Bother Score (AUA-BS) and the Benign Prostatic Hyperplasia Impact Index (BPH-II) as well as urinary flow rate measurements (Q(max)) and prostate volume (PV) and residual urine determination by ultr asound. The amount of tissue resected was weighed. Patients were followed w ith reevaluation of Q(max), residual urine and the symptom and bother score s at 3 and 6 months. Results: A close correlation between preoperative PV (mean 49.0 mi, SD 22.0 , range 13-140) and the resected tissue weight (RTW, mean 24.7 g, SD 18.0, range 6-128) was seen (r = 0.75, p <0.001). Age was correlated with preoper ative PV (r = 0.23, p <0.05). While significant mean improvements in Q(max) , residual volume and IPSS, AUA-BS and BPH-II were found 3 and 6 months pos toperatively, a negative correlation was seen between the RTW and the IPSS, the AUA-BS and the BPH-II 3 months after TURF (r = -0.23, p <0.024; F = -0 .23, p <0.025; r = -0.20, p = 0.05). No statistically significant correlati on was seen between symptom change and the percentage of PV removed or the residual prostatic weight. Classification of the patients into groups depen ding on preoperative PV (< 30, 31-50, 51-70 and > 70 mi) showed a tendency for patients with larger PV to gain more symptom improvement postoperativel y. Conclusions: Early symptom improvement after TURF will depend on the amount of tissue removed but the relationship is weak and affected by several oth er confounding factors. Apparentry, the symptomatic improvement after TU RP is not primarily dependent on the relative completeness of the resection, Patients with larger prostates and larger RTW tend to gain more symptomatic benefit from TURF than do patients with smaller prostates. Copyright (C) 2 001 S. Karger AG. Basel.