Page 15 - CUAJOctober2022

RESEARCH LETTER

Early and late outcomes of transurethral prostatectomy in men with

significant postvoid residual volumes and mild or no lower urinary

tract symptoms

Snir Dekalo , Blayne Welk 1,3
1,2
2
1 Division of Urology, Department of Surgery, Western University, London, ON, Canada; Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Epidemiology & Biostatistics, Western
3
University, London, ON, Canada
Cite as: Dekalo S, Welk B. Early and late outcomes of transurethral prostatectomy in men with
significant postvoid residual volumes and mild or no lower urinary tract symptoms. Can Urol Assoc criteria were: men with at least two consecutive documented
J 2022;16(10):317-9. http://dx.doi.org/10.5489/cuaj.7937 elevated PVRs (defined as >500 ml on bladder scan or cath-
eterization) who were voiding spontaneously and did not
have neurological disease; mild or no LUTS (international
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Published online July 21, 2022 prostate symptom score [IPSS] <8); no evidence of obstruct-
ive uropathy (based on serum creatinine or hydronephrosis);
no prior prostate surgery; and finally, no significant history of
Introduction overflow incontinence or urinary infections. All patients had
their elevated PVRs discovered incidentally.
We created an electronic data extraction template and
Non-neurogenic chronic urinary retention is defined as used all available clinical records to ensure maximal data
a postvoid residual (PVR) >300 mL that persists on two accuracy. PVR and maximal flow rate (Qmax) based on
measurements for at least six months. When patients have noninvasive uroflowmetry voided volume >150 mL were
1
hydronephrosis, acute kidney injury, chronic urinary tract reviewed. The study was approved by the Western University
infections (UTIs), urinary incontinence, or symptomatic Ethics Committee (120709).
retention, active management with surgical intervention or
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intermittent catheterization is appropriate; however, the Statistical analysis
most challenging patients are those with elevated postvoid
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residual volumes (often discovered incidentally) who experi- Continuous variables are presented as median and inter- - -
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ence no or mild urinary symptoms. The American Urological quartile range (IQR). Categorical variables are presented
Association whitepaper suggests that these patients under- as number (%). Continuous parameters were compared by
go no treatment due to lack of knowledge about effective- Wilcoxon’s signed-rank test for paired data. All statistical
ness of interventions at reducing future complications. analyses were two-sided, and significance was defined as
1
Interventions such as intermittent catheterization can cause p<0.05. R Statistical Software (version 3.5.1; R Foundation
UTIs, urethral trauma, and reduce a person’s quality of life, for Statistical Computing, Vienna, Austria) was used.
3
and transurethral prostatectomy (TURP) is associated with
defined complications, such as stricture and incontinence. It Results
4
is also possible, however, that reducing any degree of outlet
obstruction will help prevent progression to complications, We identified 14 men who met our inclusion criteria. The
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1
or “high-risk” chronic urinary retention. Our objective was median age at TURP was 65 (IQR 61–70). Preoperatively,
to examine the outcomes of men with elevated PVRs and median Qmax was 8 ml/sec (IQR 6–13) and PVR was 820
mild or no lower urinary tract symptoms (LUTS) who, after ml (IQR 691–985). The median IPSS prior to surgery was 5
shared decision-making, elected to undergo a TURP. (IQR 4–7). Sonographic evaluation of the pre-TURP prostates
demonstrated a median volume of 38 mL (IQR 29–46). Five
Methods men underwent urodynamic studies (UDS) before surgery
and had a median bladder outlet obstruction index (BOOI)
This is a retrospective case-series study. We used electronic of 56 (IQR 50–74), with all results in the obstructed range.
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office billing records to identify all men who underwent a The median bladder volume at permission to void during
TURP by a single urologist from 2011–2020. Our inclusion these UDS was 960 ml (IQR 700–1350). There were no pos-
CUAJ • October 2022 • Volume 16, Issue 10 317
© 2022 Canadian Urological Association