Preoperative clinical and urodynamic factors influencing the short-term outcome of transurethral resection of the prostate for benign prostatic hyperplasia: a prospective observational study

Background. Although transurethral resection of the prostate remains the surgical mainstay for benign prostatic hyperplasia, a substantial minority of patients report an unsatisfactory result. This prospective observational study evaluated which preoperative clinical and urodynamic parameters influenced the short-term outcome of the procedure. Methods. Thirty-five men with lower urinary tract symptoms due to benign prostatic hyperplasia, an International Prostate Symptom Score above 13, a maximum urinary flow rate below 15 mL/s and at least one absolute indication for surgery underwent monopolar transurethral resection of the prostate at a tertiary-care teaching hospital. Preoperative prostate volume, post-void residual urine, serum prostate-specific antigen, duration of catheterisation, uroflowmetry and multichannel urodynamics were recorded. The outcome at one month was graded by the International Prostate Symptom Score, the quality-of-life score and the maximum urinary flow rate, and was classified as effective or non-effective. Results. The outcome was effective in 27 patients (77.1%) and non-effective in 8 (22.9%). A smaller prostate (43.3±8.4 versus 54.6±11.0 ml), catheterisation exceeding six weeks, a lower maximum detrusor pressure (30.0±19.2 versus 60.4±46.1 cm H₂O) and a lower bladder compliance (13.5±12.0 versus 37.7±29.7 ml/cm H₂O) were significantly associated with a non-effective outcome. Age, serum prostate-specific antigen, the presence of refractory retention and post-void residual urine showed no significant association. Conclusions. A small prostate, prolonged preoperative catheterisation, a low detrusor pressure and poor bladder compliance predicted a less favourable short-term outcome. Preoperative urodynamic assessment is advisable in men with a small gland or prolonged retention, both to refine the indication for surgery and to counsel patients about the likely benefit.