nach oben

Current Urology Reports

Erschienen in:

01.10.2018 | Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)

Lower Urinary Tract Symptoms Following Transurethral Resection of Prostate

verfasst von: Soo Jeong Kim, Omar Al Hussein Alawamlh, Bilal Chughtai, Richard K. Lee

Erschienen in: Current Urology Reports | Ausgabe 10/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Transurethral resection of the prostate (TURP) is the standard surgical therapy for lower urinary tract symptoms (LUTS) due to prostatic enlargement. Following TURP, LUTS may persist in a proportion of patients. Persistent LUTS necessitates proper evaluation and management. In this review, we sought to describe the prevalence, pathophysiology, and predictors of LUTS following TURP, as well as the recommended evaluation and management.

Recent Findings

Among the different techniques utilized for TURP, the prevalence of postoperative LUTS is similar. The chronically obstructed bladder has been shown to vary in its expression of collagen, tissue factors, and receptors when compared to the normal bladder which could contribute to the pathophysiology of LUTS after TURP. Although androgen receptors exist in the urinary epithelium, the role of sex hormones in LUTS remains obscure. GreenLight laser can lead to postoperative irritative voiding symptoms as a result of tissue necrosis.

Summary

A large proportion of patients have persistent LUTS following TURP, with similar incidences between different techniques that can be used to perform TURP. LUTS after TURP should be evaluated with a thorough history and physical, including International Prostate Symptom Score, and urine culture to rule out infection. Noninvasive uroflow, post-void residuals, and subsequent urodynamic study or cystoscopy can be utilized as needed. Further research is necessary to be able to more precisely predict the patients who will experience no improvement in or worsening of LUTS following TURP.

Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984;132:474–9.CrossRefPubMed

Lee C, Kozlowski JM, Grayhack JT. Intrinsic and extrinsic factors controlling benign prostatic growth. Prostate. 1997;31:131–8.CrossRefPubMed

Thorpe A, Neal D. Benign prostatic hyperplasia. Lancet. 2003;361:1359–67.CrossRefPubMed

American Urological Association - Management of Benign Prostatic Hyperplasia [Internet]. [cited 2018 Jun 7]. Available from: http://www.auanet.org/benign-prostatic-hyperplasia-(2010-reviewed-and-validity-confirmed-2014)

Sarma AV, Wei JT. Clinical practice. Benign prostatic hyperplasia and lower urinary tract symptoms. N Engl J Med. 2012;367:248–57.CrossRefPubMed

Zhao Y-R, Liu W-Z, Guralnick M, Niu W-J, Wang Y, Sun G, et al. Predictors of short-term overactive bladder symptom improvement after transurethral resection of prostate in men with benign prostatic obstruction. Int J Urol. 2014;21:1035–40.CrossRefPubMed

Nitti VW, Kim Y, Combs AJ. Voiding dysfunction following transurethral resection of the prostate: symptoms and urodynamic findings. J Urol. 1997;157:600–3.CrossRefPubMed

Bruskewitz RC, Larsen EH, Madsen PO, Dørflinger T. 3-year followup of urinary symptoms after transurethral resection of the prostate. J Urol. 1986;136:613–5.CrossRefPubMed

Doll HA, Black NA, McPherson K, Flood AB, Williams GB, Smith JC. Mortality, morbidity and complications following transurethral resection of the prostate for benign prostatic hypertrophy. J Urol. 1992;147:1566–73.CrossRefPubMed

10.

Cho MC, Kim HS, Lee CJ, Ku JH, Kim SW, Paick J-S. Influence of detrusor overactivity on storage symptoms following potassium-titanyl-phosphate photoselective vaporization of the prostate. Urology. 2010;75:1460–6.CrossRefPubMed

11.

Al-Rawashdah SF, Pastore AL, Salhi YA, Fuschi A, Petrozza V, Maurizi A, et al. Prospective randomized study comparing monopolar with bipolar transurethral resection of prostate in benign prostatic obstruction: 36-month outcomes. World J Urol. 2017;35:1595–601.CrossRefPubMed

12.

Skolarikos A, Rassweiler J, de la Rosette JJ, Alivizatos G, Scoffone C, Scarpa RM, et al. Safety and efficacy of bipolar versus monopolar transurethral resection of the prostate in patients with large prostates or severe lower urinary tract symptoms: post hoc analysis of a European multicenter randomized controlled trial. J Urol. 2016;195:677–84.CrossRefPubMed

13.

Lukacs B, Loeffler J, Bruyère F, Blanchet P, Gelet A, Coloby P, et al. Photoselective vaporization of the prostate with GreenLight 120-W laser compared with monopolar transurethral resection of the prostate: a multicenter randomized controlled trial. Eur Urol. 2012;61:1165–73.CrossRefPubMed

14.

•• Thomas JA, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, et al. A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH study. Eur Urol. 2016;69:94–102. This randomized non-inferiority trial compared GreenLight laser vaporization of the prostate to standard TURP, and showed that at 24 months of follow-up, the long-term effectiveness and safety of the two modalities are similar. CrossRefPubMed

15.

Mordasini L, Di Bona C, Klein J, Mattei A, Wirth GJ, Iselin CE. 80-W GreenLight laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic obstruction: 5-year outcomes of a single-center prospective randomized trial. Urology. 2018;116:144–9.CrossRefPubMed

16.

Pereira-Correia JA, de Moraes Sousa KD, Santos JBP, de Morais PD, Lopes-da-Silva LF, Krambeck RL, et al. GreenLight HPS™120-W laser vaporization vs transurethral resection of the prostate (<60 mL): a 2-year randomized double-blind prospective urodynamic investigation. BJU Int. 2012;110:1184–9.CrossRefPubMed

17.

Bae J, Kang HW, Lee HW, Lee KS, Cho MC. Predictors of de novo urge urinary incontinence after photoselective vaporization of the prostate. World J Urol. 2016;34:413–8.CrossRefPubMed

18.

Mirone V, Imbimbo C, Longo N, Fusco F. The detrusor muscle: an innocent victim of bladder outlet obstruction. Eur Urol. 2007;51:57–66.CrossRefPubMed

19.

Ponholzer A, Temml C, Wehrberger C, Marszalek M, Madersbacher S. The association between vascular risk factors and lower urinary tract symptoms in both sexes. Eur Urol. 2006;50:581–6.CrossRefPubMed

20.

Wada N, Watanabe M, Kita M, Matsumoto S, Kakizaki H. Analysis of bladder vascular resistance before and after prostatic surgery in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. Neurourol Urodyn. 2012;31:659–63.CrossRefPubMed

21.

Pinggera G-M, Mitterberger M, Pallwein L, Schuster A, Herwig R, Frauscher F, et al. Alpha-blockers improve chronic ischaemia of the lower urinary tract in patients with lower urinary tract symptoms. BJU Int. 2008;101:319–24.CrossRefPubMed

22.

Lin Y-H, Hou C-P, Chen T-H, Juang H-H, Chang P-L, Yang P-S, et al. Is diabetes mellitus associated with clinical outcomes in aging males treated with transurethral resection of prostate for bladder outlet obstruction: implications from Taiwan nationwide population-based cohort study. Clin Interv Aging. 2017;12:535–41.CrossRefPubMedPubMedCentral

23.

Barbosa JABA, Reis ST, Nunes M, Ferreira YA, Leite KR, Nahas WC, et al. The obstructed bladder: expression of collagen, matrix metalloproteinases, muscarinic receptors, and angiogenic and neurotrophic factors in patients with benign prostatic hyperplasia. Urology. 2017;106:167–72.CrossRefPubMed

24.

Kohnen PW, Drach GW. Patterns of inflammation in prostatic hyperplasia: a histologic and bacteriologic study. J Urol. 1979;121:755–60.CrossRefPubMed

25.

Wu Y, Pan H, Wang W-M, Xu D, Zhang L, Gu Z-Q, et al. A possible relationship between serum sex hormones and benign prostatic hyperplasia/lower urinary tract symptoms in men who underwent transurethral prostate resection. Asian J Androl. 2017;19:230–3.CrossRefPubMed

26.

Litman HJ, Bhasin S, O’Leary MP, Link CL, McKinlay JB. BACH Survey Investigators. An investigation of the relationship between sex-steroid levels and urological symptoms: results from the Boston Area Community Health survey. BJU Int. 2007;100:321–6.CrossRefPubMed

27.

Huet R, Mathieu R, Rohou T, Peyronnet B, Manunta A, Verhoest G, et al. MRI assessment of tissue effects after 180-W XPS greenlight laser vaporization of the prostate. Lasers Surg Med. 2017;49:577–81.CrossRefPubMed

28.

• Antunes AA, Iscaife A, Reis ST, Albertini A, Nunes MA, Lucon AM, et al. Can we predict which patients will experience resolution of detrusor overactivity after transurethral resection of the prostate? J Urol. 2015;193:2028–32. This study examined clinical and urodynamic variables as potential predictors for persistent LUTS at 12 months following TURP. Older age, lower cystometric capacity, and higher detrusor overactivity amplitude were predictive of persistent detrusor overactivity following TURP. CrossRefPubMed

29.

Choi H, Kim JH, Shim JS, Park JY, Kang SH, Moon DG, et al. Prediction of persistent storage symptoms after transurethral resection of the prostate in patients with benign prostatic enlargement. Urol Int. 2014;93:425–30.CrossRefPubMed

30.

Gormley EA, Griffiths DJ, McCracken PN, Harrison GM, McPhee MS. Effect of transurethral resection of the prostate on detrusor instability and urge incontinence in elderly males. Neurourol Urodyn. 1993;12:445–53.CrossRefPubMed

31.

Seki N, Yuki K, Takei M, Yamaguchi A, Naito S. Analysis of the prognostic factors for overactive bladder symptoms following surgical treatment in patients with benign prostatic obstruction. Neurourol Urodyn. 2009;28:197–201.CrossRefPubMed

32.

Kim MS, Park KK, Chung BH, Lee SH. Effect of photoselective vaporization prostatectomy on lower urinary tract symptoms in benign prostatic hyperplasia with or without intravesical prostatic protrusion. Korean J Urol. 2013;54:36–41.CrossRefPubMedPubMedCentral

33.

Guerios SD, Wang Z-Y, Boldon K, Bushman W, Bjorling DE. Blockade of NGF and trk receptors inhibits increased peripheral mechanical sensitivity accompanying cystitis in rats. Am J Phys Regul Integr Comp Phys. 2008;295:R111–22.

34.

Liu B, Zheng B, Zhou Z, Xu Z, Cai S. Change of nerve growth factor mRNA in human detrusor in bladder outlet obstruction with benign prostatic hyperplasia and their implication. Zhonghua Wai Ke Za Zhi. 2004;42:874–6.PubMed

35.

• Hu H, Zhang W, Liu X, Wang H, Fang Z, Liang C, et al. Nerve growth factor levels are associated with overactive bladder symptoms and long-term treatment outcome after transurethral resection of the prostate in patients with benign prostate hyperplasia. J Urol. 2018; This paper demonstrated that nerve growth factor levels can be used as a biomarker to predict the likelihood of having persistent LUTS following TURP.

36.

Fujita K, Kimura T, Saito K, Kitagawa M, Furuhata T, Uyama K, et al. Epididymitis after transurethral prostatectomy. Clin Ther. 1988;10 Spec No:56–9.PubMed

37.

Chughtai B, Simma-Chiang V, Kaplan SA. Evaluation and management of post-transurethral resection of the prostate lower urinary tract symptoms. Curr Urol Rep. 2014;15:434.CrossRefPubMed

38.

Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol. 2006;50:969–79. discussion 980CrossRefPubMed

39.

Kuo H-C. Analysis of the pathophysiology of lower urinary tract symptoms in patients after prostatectomy. Urol Int. 2002;68:99–104.CrossRefPubMed

40.

Kahokehr A, Vather R, Nixon A, Hill AG. Non-steroidal anti-inflammatory drugs for lower urinary tract symptoms in benign prostatic hyperplasia: systematic review and meta-analysis of randomized controlled trials. BJU Int. 2013;111:304–11.CrossRefPubMed

41.

Kara C, Resorlu B, Cicekbilek I, Unsal A. Analgesic efficacy and safety of nonsteroidal anti-inflammatory drugs after transurethral resection of prostate. Int Braz J Urol. 2010;36:49–54.CrossRefPubMed

42.

Chughtai B, Thomas D, Kaplan S. α-blockers, 5-α-reductase inhibitors, acetylcholine, β3 agonists, and phosphodiesterase-5s in medical management of lower urinary tract symptoms/benign prostatic hyperplasia: how much do the different formulations actually matter in the classes? Urol Clin N Am. 2016;43:351–6.CrossRef

43.

Porru D, Campus G, Caria A, Madeddu G, Cucchi A, Rovereto B, et al. Impact of early pelvic floor rehabilitation after transurethral resection of the prostate. Neurourol Urodyn. 2001;20:53–9.CrossRefPubMed

44.

Hou C-P, Chen T-Y, Chang C-C, Lin Y-H, Chang P-L, Chen C-L, et al. Use of the SF-36 quality of life scale to assess the effect of pelvic floor muscle exercise on aging males who received transurethral prostate surgery. Clin Interv Aging. 2013;8:667–73.PubMedPubMedCentral

Titel: Lower Urinary Tract Symptoms Following Transurethral Resection of Prostate
verfasst von: Soo Jeong Kim
Omar Al Hussein Alawamlh
Bilal Chughtai
Richard K. Lee
Publikationsdatum: 01.10.2018
Verlag: Springer US
Erschienen in: Current Urology Reports / Ausgabe 10/2018
Print ISSN: 1527-2737
Elektronische ISSN: 1534-6285
DOI: https://doi.org/10.1007/s11934-018-0838-4

Neu im Fachgebiet Urologie

Adjuvante Immuntherapie verlängert Leben bei RCC

25.04.2024 Nierenkarzinom Nachrichten

Nun gibt es auch Resultate zum Gesamtüberleben: Eine adjuvante Pembrolizumab-Therapie konnte in einer Phase-3-Studie das Leben von Menschen mit Nierenzellkarzinom deutlich verlängern. Die Sterberate war im Vergleich zu Placebo um 38% geringer.

Bei Senioren mit Prostatakarzinom auf Anämie achten!

24.04.2024 DGIM 2024 Nachrichten

Patienten, die zur Behandlung ihres Prostatakarzinoms eine Androgendeprivationstherapie erhalten, entwickeln nicht selten eine Anämie. Wer ältere Patienten internistisch mitbetreut, sollte auf diese Nebenwirkung achten.

Stufenschema weist Prostatakarzinom zuverlässig nach

22.04.2024 Prostatakarzinom Nachrichten

Erst PSA-Test, dann Kallikrein-Score, schließlich MRT und Biopsie – ein vierstufiges Screening-Schema kann die Zahl der unnötigen Prostatabiopsien erheblich reduzieren: Die Hälfte der Männer, die in einer finnischen Studie eine Biopsie benötigten, hatte einen hochgradigen Tumor.

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

20.04.2024 EAU 2024 Kongressbericht

Beim chronischen Harnwegsinfekt bei Frauen wird bisher meist eine Antibiotikaprophylaxe eingesetzt. Angesichts der zunehmenden Antibiotikaresistenz erweist sich das Antiseptikum Methenamin-Hippurat als vielversprechende Alternative, so die Auswertung einer randomisierten kontrollierten Studie.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2018

Enhanced Endoscopy in Bladder Cancer

Approaches to Eliminate Radiation Exposure in the Management of Pediatric Urolithiasis

Contemporary Management of the Newly Diagnosed Prostate Cancer Patient with Metastatic Disease at Presentation

Laser Therapy for Genitourinary Syndrome of Menopause