Patients undergoing TURP for moderate to severe lower urinary tract symptoms. (LUTS) secondary to benign enlargement of prostate were included. Patients ...
JSSN 2014; 17 (1)
Original Article
Change in Storage Symptoms after Transurethral Resection of Prostate: A Prospective Observational Study Luitel BR, Gupta DK, Chalise PR, Subedi P, Chapagain S, Sharma UK, Gyawali PR, Shrestha GK, Joshi BR 8URORJ\8QLW'HSDUWPHQWRI6XUJHU\7ULEKXYDQ8QLYHUVLW\7HDFKLQJ+RVSLWDO0DKDUDMJXQM.DWKPDQGX1HSDO Corresponding author:'U%KRM5DM/XLWHO/HFWXUHU 8URORJ\ 8URORJ\8QLW787HDFKLQJ+RVSLWDOGUEKRMUDM#JPDLOFRP
Abstract Introduction 3DWLHQWV ZLWK HQODUJHG SURVWDWH JHQHUDOO\ UDWH WKHLU VWRUDJH V\PSWRPV IUHTXHQF\ XUJHQF\DQGQRFWXULD DVWKHPRVWERWKHUVRPHDVWKHVHV\PSWRPVLQWHUIHUHPRUHZLWKGDLO\DFWLYLWLHV DQG KDYH KXJH LPSDFW RQ TXDOLW\ RI OLIH (IIHFW RI WUDQVXUHWKUDO UHVHFWLRQ RI SURVWDWH 7853 RQ VWRUDJHV\PSWRPVLVXQNQRZQ Objective 7RDVVHVVWKHFKDQJHLQVWRUDJHV\PSWRPVLQSDWLHQWVXQGHUJRLQJ7853 Methods $SURVSHFWLYHREVHUYDWLRQDOVWXG\ZDVFRQGXFWHGDWWKHDXWKRU¶VLQVWLWXWHIURP$XJXVW WR-XO\3DWLHQWVXQGHUJRLQJ7853IRUPRGHUDWHWRVHYHUHORZHUXULQDU\WUDFWV\PSWRPV /876 VHFRQGDU\ WR EHQLJQ HQODUJHPHQW RI SURVWDWH ZHUH LQFOXGHG 3DWLHQWV ZHUH HYDOXDWHG E\ ,QWHUQDWLRQDOSURVWDWHV\PSWRPVFRUH ,366 TXHVWLRQQDLUHV. 7KHTXHVWLRQQXPEHUDQGRIWKH,366 TXHVWLRQQDLUHJDYHWKHVWRUDJHV\PSWRPVXEVFRUH $IWHULQLWLDOHYDOXDWLRQVWKHSDWLHQWVXQGHUZHQW 7853$IWHUPRQWKVWKH,366ZDVUHHYDOXDWHGDQGWKHFKDQJHLQVWRUDJHV\PSWRPZDVDQDO\]HG Results $ WRWDO RI SDWLHQWV ZKR KDG XQGHUJRQH 7853 ZHUH HOLJLEOH IRU ¿QDO GDWD DQDO\VLV 0DMRULW\RIWKHSDWLHQWVKDGVHYHUHERWKHUVRPH/876ZLWKPHDQ,366VFRUHRI7KHEDVHOLQH VWRUDJHV\PSWRPVXEVFRUHZDV$IWHUPRQWKVRIIROORZXSWKHUHZDVVLJQL¿FDQWGHFUHDVH LQWRWDO,366VFRUHDQGERWKRILWVVXEVFRUHV2QFRPSDULQJWKHPHDQFKDQJHLQVWRUDJHDQGYRLGLQJ VXEVFRUHWKHUHZDVOHVVGHFUHPHQWLQVWRUDJHVXEVFRUHZKLFKZDVVWDWLVWLFDOO\VLJQL¿FDQW S Conclusions: 7KLV VWXG\ VKRZHG WKDW DIWHU 7853 FKDQJH LQ YRLGLQJ VXEVFRUH RFFXUV PRUH WKDQ VWRUDJHVXEVFRUHDQGVWRUDJHV\PSWRPVPD\QRWUHYHUWWRQRUPDO Key Words: IUHTXHQF\QRFWXULDVWRUDJHV\PSWRPV7853XUJHQF\
Introduction ERWKHUVRPH DV WKHVH V\PSWRPV LQWHUIHUH PRUH ZLWK GDLO\ activities and have greatest negative impact on the patient’s TXDOLW\RIOLIH2XWRIWKHVHV\PSWRPVQRFWXULDLVWKHPRVW ERWKHUVRPH2 7UDQVXUHWKUDOUHVHFWLRQRISURVWDWH 7853 IRU V\PSWRPDWLF %(3 RIWHQ LPSURYHV YRLGLQJ V\PSWRPV DOWKRXJKLWVHIIHFWRQVWRUDJHV\PSWRPVLVYDULDEOHDQGQR 3DWLHQWV ZLWK EHQLJQ HQODUJHPHQW RI SURVWDWH %(3 FRQVLVWHQWGDWDLVDYDLODEOH generally rate their storage symptoms as the most )UHTXHQF\XUJHQF\QRFWXULDDQGXUJHQF\LQFRQWLQHQFHDUH WKHVWRUDJHV\PSWRPVDVVRFLDWHGZLWKEHQLJQHQODUJHPHQW RI SURVWDWH 3UHYLRXVO\ WKHVH V\PSWRPV ZHUH NQRZQ DV LUULWDWLYH V\PSWRPV DQG RIWHQ DWWULEXWHG WR GHWUXVRU RYHUDFWLYLW\RURYHUDFWLYHEODGGHUV\PSWRPV1
JSSN
Journal of Society of Surgeons of Nepal
JSSN 2014; 17 (1)
&XUUHQWWKHUDSLHVIRUV\PSWRPDWLF%(3IRFXVRQUHOLHYLQJ Results WKHXULQDU\REVWUXFWLRQ7KHLUHIIHFWRQVWRUDJHV\PSWRPV LVXQNQRZQ7KLVVWXG\ZDVFRQGXFWHGZLWKWKHREMHFWLYH $ WRWDO RI SDWLHQWV ZKR KDG XQGHUJRQH 7853 ZHUH RI DVVHVVLQJ WKH FKDQJH LQ VWRUDJH V\PSWRPV ǻ 6WRUDJH HOLJLEOH IRU ¿QDO GDWD DQDO\VLV7KH SDWLHQW GHPRJUDSKLFV DUHVKRZQLQ7DEOH0DMRULW\RIWKHSDWLHQWVKDGVHYHUH V\PSWRPVXEVFRUH LQ3DWLHQWVXQGHUJRLQJ7853 ERWKHUVRPH /876 ZLWK PHDQ ,366 6&25( 2) 7KHEDVHOLQHVWRUDJHV\PSWRPVXEVFRUHZDV$IWHU Methods PRQWKV RI IROORZ XS WKHUH ZDV VLJQL¿FDQW GHFUHDVH LQ $ SURVSHFWLYH REVHUYDWLRQDO VWXG\ ZDV FRQGXFWHG DW WRWDO ,366 VFRUH DQG ERWK RI LWV VXEVFRUHV VWRUDJH DQG XURORJ\XQLW'HSDUWPHQWRI6XUJHU\ 7ULEKXYDQ8QLYHUVLW\ YRLGLQJGRPDLQ ZKLFKZDVVWDWLVWLFDOO\VLJQL¿FDQW 7DEOH 7HDFKLQJ+RVSLWDO.DWKPDQGX RYHUDSHULRGRIRQH\HDU On comparing the mean change in storage and voiding $XJXVWWR-XO\ ,QIRUPHGFRQVHQWZDVWDNHQ VXEVFRUH WKHUH ZDV OHVV GHFUHPHQW LQ VWRUDJH VXEVFRUH IURP WKH SDWLHQWV DQG HWKLFDO FOHDUDQFH ZDV WDNHQ IURP ZKLFKZDVVWDWLVWLFDOO\VLJQL¿FDQW S 7DEOH 7KLV ,QVWLWXWLRQDOUHYLHZERDUG3DWLHQWVXQGHUJRLQJ7853IRU ¿QGLQJSURYHVWKDWSRVW7853FKDQJHLQYRLGLQJVXEVFRUH PRGHUDWHWRVHYHUH/876VHFRQGDU\WR%(3DQGWKRVHZKR RFFXUVPRUHWKDQVWRUDJHVXEVFRUHDQGVWRUDJHV\PSWRPV ZHUH DEOH WR FRPPXQLFDWH XQGHUVWDQG DQG FRPSO\ ZLWK may not revert to normal. VWXG\TXHVWLRQQDLUHVZHUHLQFOXGHG7KHIROORZLQJSDWLHQWV ZHUH H[FOXGHG IURP WKH VWXG\ SDWLHQWV ZLWK QHXURJHQLF Table 1: Patient Demographics EODGGHUSURVWDWHFDQFHUEODGGHUWXPRUEODGGHUVWRQHDQG Mean±SD XUHWKUDOVWULFWXUHLQGZHOOLQJFDWKHWHUIRU!PRQWKDQGD Variable KLVWRU\RISURVWDWLFDQGRUXUHWKUDOVXUJHU\ $JH 3DWLHQWVZHUHHYDOXDWHGE\,QWHUQDWLRQDO3URVWDWH6\PSWRP 6FRUH ,366 TXHVWLRQQDLUHV3 DQG XURÀRZPHWU\ 7KH TXHVWLRQ QXPEHU DQG RI WKH ,366 TXHVWLRQQDLUH JDYH WKH VWRUDJH V\PSWRP VXEVFRUH (Fig 1) 7UDQVDEGRPLQDO XOWUDVRQRJUDSK\ 7$86 ZDV XVHG WR measure size of the prostate, intravesical protrusion of SURVWDWH ,33 DQG3RVWYRLGUHVLGXDOXULQH 3958 $IWHU the initial evaluations, the patients had undergone standard PRQRSRODU7853$IWHUPRQWKVWKH,366ZDVUHHYDOXDWHG (hospital visit or over telephone) and the change in storage symptom was analyzed.
IPSS total
6WRUDJHV\PSWRPVXEVFRUH
9RLGLQJV\PSWRPVXEVFRUH
42/
Size of the prostate(gm)
IPP(mm)
3958 PO
4PD[ POVHF
IPSS Score (0-35)
Table 2: Outcomes after 3 months of TURP Voiding symptom Subscore (0-20) Storage symptom Subscore (0-15) Incomplete emptying (0-5)
Frequency (0-5)
Straining (0-5)
Urgency (0-5)
Intermittency (0-5)
Nocturia (0-5)
Weak Stream (0-5)
Fig. 1: International Prostate Symptom Score (IPSS) Subscores 4 The paired t -test was used to compare the IPSS, storage VXEVFRUHYRLGLQJVXEVFRUHDQGTXDOLW\RIOLIH 42/ EHIRUH DQG PRQWKV DIWHU 7853 2QH6DPSOH .ROPRJRURY Smirnov Test was used to compare the change in storage DQG YRLGLQJ VXEVFRUHV ǻ 6WDWLVWLFDO SDFNDJH IRU VRFLDO VFLHQFHV 6366 YHUVLRQZDVXVHGIRUWKHGDWDDQDO\VLV 3YDOXHEHORZZDVFRQVLGHUHGVWDWLVWLFDOO\VLJQL¿FDQW JSSN
Variable
Baseline
After 3 months
Mean p-value* &KDQJH ǻ
IPSS(Total)
Storage symptom VXEVFRUH 9RLGLQJ symptom VXEVFRUH 42/
)UHTXHQF\
8UJHQF\
Nocturia
Journal of Society of Surgeons of Nepal
JSSN 2014; 17 (1)
*Paired t-test Table 3: Comparison of Change in storage and voiding symptom subscore Variable ǻ6WRUDJHV\PSWRPVXEVFRUH ǻYRLGLQJV\PSWRPVXEVFRUH 6WRUDJHVXEVFRUHDIWHUPRQWKV 9RLGLQJVXEVFRUHDIWHUPRQWKV
Mean 1.9
Kolmogorov Smirnov Z 2.1 2.3
** One-Sample Kolmogorov-Smirnov Test
Discussion 7KLV LV RQH RI WKH ¿UVW VWXGLHV GHGLFDWHG WR VWRUDJH V\PSWRPV DIWHU 7853 &KDQJHV WKDW RFFXU RQ EODGGHU GXHWREHQLJQSURVWDWLFREVWUXFWLRQPD\QRWUHYHUWGHVSLWH UHPRYDORIREVWUXFWLRQ2XUVWXG\VKRZVWKDWPDMRULW\RI SDWLHQWVXQGHUJRLQJ7853DUHLQWKHVHYHQWKGHFDGHZLWK VHYHUH/876ZLWKSRRUTXDOLW\RIOLIHGXHWRERWKHUVRPH symptoms. Mean size of the prostate in patients who had XQGHUJRQH7853ZDVJP,QPRVWRIWKHUHFHQWVHULHV the average size of prostate in man who had undergone 7853 ZDV JP WR JP The mean age of the SDWLHQWV ZKR KDG XQGHUJRQH 7853 LV DOVR VLPLODU WR WKH ¿QGLQJV RI *DFFL HW DO ZLWK PHDQ DJH RI \HDUV This ¿QGLQJ UHDI¿UPV WKDW EHQLJQ HQODUJHPHQW RI SURVWDWH LV disease of the elderly male.
p-value**
E\*DFFLHWDOIURP,WDO\WKHSUHRSHUDWLYH,366DQG42/ VFRUHZHUH DQGUHVSHFWLYHO\7KLV¿QGLQJVKRZV WKDWLQRXUSRSXODWLRQWKHSUHRSHUDWLYH,366DQG42/DUH higher than those in the patients from the western world. 7KHUHDVRQEHKLQGWKLVPLJKWEHWKHGHOD\HGSUHVHQWDWLRQ RIRXUSDWLHQWVRQO\DIWHUWKHV\PSWRPVEHFRPHVHYHUHDQG 42/ZRUVHQV6RPHRIRXUSDWLHQWHYHQWKLQNWKDW/876LV SDUWRIROGDJHDQGQHYHUWKLQNRIVHHNLQJPHGLFDODGYLFH for treatment for many years.
/RZHUXULQDU\WUDFWV\PSWRPVPD\EHFODVVL¿HGLQWRYRLGLQJ REVWUXFWLYH DQGVWRUDJH LUULWDWLYH V\PSWRPV The cause RI%(3LQGXFHGVWRUDJHV\PSWRPVLVPXOWLIDFWRULDO%ODGGHU RXWOHW REVWUXFWLRQ %22 LQGXFHV GHWUXVRU G\VIXQFWLRQ E\ VPRRWK PXVFOH FHOO K\SHUWURSK\ FROODJHQ GHSRVLWLRQ EODGGHU LVFKHPLD DQG UHSHUIXVLRQ LQMXU\12 There are PDQ\ H[SODQDWLRQV RI GHWUXVRU RYHUDFWLYLW\ LQ %(3 VXFK as increase in sympathetic stimulation, supersensitivity to acetylcholine, increase in nerve growth factor and Benign enlargement of prostate is a common condition in local changes producing segmental contractions.12 %(3 middle-aged and elderly men causing urinary symptoms RIWHQ UHVXOWV LQ D UHGXFHG IXQFWLRQDO EODGGHU FDSDFLW\ ZLWK D VXEMHFWLYH GHFUHDVH LQ TXDOLW\ RI OLIH8 Surgical EHFDXVH RI EODGGHU RXWOHW REVWUXFWLRQ LQGXFHG GHWUXVRU treatment is indicated for severe lower urinary tract RYHUDFWLYLW\ LQYROXQWDU\ GHWUXVRU FRQWUDFWLRQV RU KLJK V\PSWRPV ,366! ZLWK SRRU TXDOLW\ RI OLIH IDLOXUH RI SRVWYRLGUHVLGXDOV 395 13 These factors ultimately lead medical treatment, refractory retention, chronic retention, WRIUHTXHQF\XUJHQF\DQGQRFWXULDZLWKRUZLWKRXWXUJHQF\ EDFN SUHVVXUH FKDQJHV ZLWK IXQFWLRQDO UHQDO LPSDLUPHQW LQFRQWLQHQFH ZKLFK DUH FROOHFWLYHO\ NQRZQ DV VWRUDJH KHPDWXULD DQG FRPSOLFDWLRQV OLNH VWRQHV GLYHUWLFXOL RU symptoms. recurrent infection.9$LPRIWKHVXUJHU\LVWRUHGXFHXULQDU\ V\PSWRPVWKXVUHVWRULQJDJRRGTXDOLW\RIOLIH'XULQJWKH ,QRXUVWXG\WKHEDVHOLQHVWRUDJHV\PSWRPVFRUHZDV ODVW\HDUV7853KDVEHHQWKHUHIHUHQFHVWDQGDUGIRUWKH ZKLFK PRQWKV DIWHU7853 UHGXFHG WR ZLWK QHW VXUJLFDOWUHDWPHQWRI%3+XSWRWKHVL]HRIPO FKDQJHRI'HVSLWHWKLVWKHGHFUHPHQWLQVWRUDJH VXEVFRUHZDVOHVVWKDQWKHGHFUHPHQWLQYRLGLQJVXEVFRUH The common clinical methods used for evaluating men for 7KLV ¿QGLQJ VKRZV WKDW SRVW7853 FKDQJH LQ YRLGLQJ WKHVXUJLFDOWUHDWPHQWRI%3+LQFOXGHXOWUDVRQRJUDSK\DQG VXEVFRUH RFFXUV PRUH WKDQ VWRUDJH VXEVFRUH DQG VWRUDJH XURÀRZPHWU\HJPD[LPXPÀRZUDWH 4PD[ ,QDGGLWLRQ V\PSWRPVPD\QRWUHYHUWWRQRUPDO7KLV¿QGLQJLVVXSSRUWHG ,366DVHOIDGPLQLVWHUHGTXHVWLRQQDLUH11 LVDOVRDYDOXDEOH E\WKHDYDLODEOHOLWHUDWXUHV,QWKHVWXG\GRQHE\*DFFLHW WRROIRUWKHFOLQLFDOGHFLVLRQPDNLQJZKLFKDVVHVVHVORZHU al SURVWDWHFWRP\ UHVXOWHG LQ D VLJQL¿FDQW LPSURYHPHQW XULQDU\WUDFWV\PSWRPV /876 DQGTXDOLW\RIOLIH 42/ LQREVWUXFWLYH PHDQ WR DQGLUULWDWLYHV\PSWRP EHIRUHDQGDIWHUWUHDWPHQW,QRXUVWXG\WKHWRWDO,366EHIRUH WR $IWHU VXUJHU\ WKH ,366 VFRUH VKRZHG 7853ZDVZLWK42/VFRUHRI ,QWKHVWXG\ VLJQL¿FDQW LPSURYHPHQWV LQ XULQDU\ V\PSWRPV ZLWK WKH GRQHE\&KDOLVHHWDOWKHSUHRSHUDWLYH,366DQG42/VFRUH ,366 VKRZLQJ PRUH VLJQL¿FDQW FKDQJHV IRU REVWUXFWLYH ZHUHDQGUHVSHFWLYHO\6LPLODUO\LQWKHVWXG\GRQH
JSSN
Journal of Society of Surgeons of Nepal
JSSN 2014; 17 (1)
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