Predictors Of Postoperative Lower Urinary Tract Symptoms Improvements In Patient With Small-Volume Prostate And Bladder Outlet Obstruction

Figures & data

Figure 1 Flow diagram of this study.

Table 1 Criteria For Determining The Efficacy Of Individual Domains (IPSS, IPSS-S, IPSS-V And Function) And Proportion Of Patients For Each Efficacy Grade

	Postoperative 3 Months			Postoperative 12 Months
Symptom			Proportion Of Patients, n			Proportion Of Patients, n
IPSS	Efficacy	Post/pre ratio of IPSS		Efficacy	Post/pre ratio of IPSS
	Excellent	≤0.25	98	Excellent	≤0.25	82
	Good	≤0.50	70	Good	≤0.50	52
	Fair	≤0.75	50	Fair	≤0.75	40
	Poor	>0.75	39	Poor	>0.75	29
IPSS-v	Efficacy	Post/pre ratio of IPSS-S		Efficacy	Post/pre ratio of IPSS-S
	Excellent	≤0.25	99	Excellent	≤0.25	80
	Good	≤0.50	55	Good	≤0.50	45
	Fair	≤0.75	50	Fair	≤0.75	45
	Poor	>0.75	53	Poor	>0.75	33
IPSS-s	Efficacy	Post/pre ratio of IPSS-V		Efficacy	Post/pre ratio of IPSS-V
	Excellent	≤0.25	97	Excellent	≤0.25	86
	Good	≤0.50	80	Good	≤0.50	53
	Fair	≤0.75	44	Fair	≤0.75	39
	Poor	>0.75	46	Poor	>0.75	25
Function (Qmax)	Efficacy	Post-pre of Qmax		Efficacy	Post-pre of Qmax
	Excellent	≥10ml/s	90	Excellent	≥10ml/s	75
	Good	≥5ml/s	80	Good	≥5ml/s	58
	Fair	≥2.5ml/s	52	Fair	≥2.5ml/s	42
	Poor	<2.5ml/s	35	Poor	<2.5ml/s	28

Abbreviations: IPSS, International Prostate Symptom Score; IPSS-v, IPSS voiding subscore; IPSS-s, IPSS storage subscore; Qmax, maximum urinary flow rate.

Table 2 Univariate Analysis Of Risk Factors For Postoperative Outcomes In Patients With Small-Volume Prostate

Symptom	IPSS			IPSS-v			IPSS-s			Function (Qmax)
	Success (Excellent Or Good)	Failure (Fair Or Poor)	P	Success (Excellent Or Good)	Failure (Fair Or Poor)	P	Success (Excellent Or Good)	Failure (Fair Or Poor)	P	Success (Excellent Or Good)	Failure (Fair Or Poor)	P
Postoperative 3 Months
Age(years)	70.38±11.49	69.70±12.84	0.666	69.97±11.55	70.39±12.58	0.786	70.42±11.67	69.51±12.61	0.573	70.67±11.50	69.10±12.79	0.321
BMI	21.51±0.88	21.45±0.85	0.648	21.48±0.88	21.50±0.85	0.895	21.54±0.86	21.38±0.87	0.161	21.50±0.89	21.48±0.83	0.872
PSA(ng/mL)	3.00±1.19	2.97±1.06	0.801	3.03±1.15	2.93±1.14	0.461	3.03±1.16	2.89±1.10	0.367	3.03±1.14	2.91±1.15	0.407
TPV(mL)	25.15±2.99	25.13±2.67	0.967	25.01±3.04	25.34±2.63	0.373	25.21±2.92	24.98±2.81	0.542	25.22±2.90	25.00±2.84	0.577
TZV(mL)	10.59±1.90	10.64±1.96	0.831	10.74±1.92	10.42±1.91	0.018*	10.71±1.93	10.37±1.87	0.183	10.64±1.90	10.55±1.97	0.742
TZI	0.43±0.08	0.42±0.07	0.896	0.43±0.08	0.41±0.07	0.036*	0.43±0.08	0.42±0.07	0.253	0.43±0.08	0.42±0.07	0.853
IPP(mm)	10.68±3.65	5.67±2.46	<0.001*	10.13±3.83	7.19±3.76	<0.001*	9.29±4.05	8.20±3.99	0.047*	9.96±3.96	6.98±3.49	<0.001*
PUA(°)	44(31–59)	31(19–51)	<0.001*	43(23–59)	35(19–58)	<0.001*	41(21–58)	39(19–59)	0.571	43(22–59)	33(19–59)	<0.001*
PrePCB(mm)	9.7(0.9–28.9)	12.8(0.7–23.8)	0.015*	10.8(0.9–28.9)	10.9(0.7–23.8)	0.232	9.9(0.9–28.9)	11.9(0.7–23.8)	0.049*	10.9(0.9–28.9)	10.9(0.7–23.8)	0.541
PostPCB(mm)	2.7(0.1–14.3)	7.5(0.5–14.9)	<0.001*	3.6(0.1–14.3)	5.1(0.2–14.9)	0.091	3.0(0.1–14.9)	6.9(0.4–14.6)	<0.001*	3.5(0.1–14.6)	5.7(0.5–14.9)	0.001*
Operation			0.045*			0.246			0.004*			0.239
TURP	65	46		62	49		66	45		69	42
PKEP	103	43		92	54		111	35		101	45
Pre-PVR			0.408			0.946			0.2			0.464
Yes	23	9		19	13		19	13	15	23	9
No	145	80		135	90		158	67		147	78
Postoperative 12 Months
Age(years)	70.02±11.52	69.49±12.99	0.072	69.29±11.54	70.73±12.75	0.143	70.06±11.74	69.38±12.65	0.224	70.12±11.60	69.31±12.82	0.094
BMI	21.52±0.89	21.45±0.86	0.698	21.50±0.88	21.49±0.88	0.871	21.53±0.88	21.41±0.89	0.540	21.48±0.90	21.53±0.85	0.324
PSA(ng/mL)	3.02±1.20	3.05±1.00	0.012*	3.07±1.17	2.96±1.08	0.309	3.04±1.18	3.00±1.05	0.103	3.06±1.16	2.98±1.09	0.470
TPV(mL)	25.19±3.06	25.10±2.76	0.103	25.08±3.10	25.30±2.72	0.086	25.22±3.00	25.04±2.88	0.379	25.30±2.96	24.90±2.95	0.552
TZV(mL)	10.47±1.93	10.40±2.09	0.449	10.66±1.99	10.10±1.93	0.850	10.64±2.00	10.02±1.88	0.996	10.54±1.99	10.26±1.97	0.907
TZI	0.42±0.08	0.41±0.07	0.064	0.43±0.08	0.40±0.07	0.367	0.43±0.08	0.40±0.07	0.117	0.42±0.08	0.41±0.07	0.501
IPP(mm)	10.55±3.68	5.99±2.52	<0.001*	10.06±3.80	7.31±3.66	0.097	9.38±4.01	8.15±3.78	0.079	9.86±3.91	7.37±3.57	0.019*
PUA(°)	44(31–58)	30(24–35)	<0.001*	44(26–58)	42(24–50)	<0.001*	44(24–58)	42.5(26–53)	0.470	44(30–58)	38(24–47)	<0.001*
PrePCB(mm)	10.10(0.9–28.9)	8.3(2.1–16.2)	0.009*	10.5(1.2–28.9)	5.8(0.9–19.1)	0.553	9.2(0.9–28.9)	10.4(3.0–18.1)	0.039*	10.4(0.9–28.9)	7.8(1.1–19.2)	0.923
PostPCB(mm)	2.6(0.1–14.3)	4.7(1.7–8.0)	<0.001*	3.4(0.1–14.3)	0.9(0.3–5.9)	0.223	2.75(0.1–14.3)	4.35(0.4–14.3)	<0.001*	2.7(0.1–14.3)	4.0(0.9–13.7)	0.006*
Operation			0.042*			0.248			0.007*			0.483
TURP	50	36		49	37		50	36		54	32
PKEP	84	33		76	41		89	28		79	38
Pre-PVR			0.607			0.790			0.046*			0.893
Yes	19	8		16	11		14	13		18	9
No	115	61		109	67		125	51		115	61

Note: *P<0.05.

Abbreviations: TPV, total prostate volume; TZV, transitional zone volume; TZI, transition zone index=TZV/TPV; IPP, Intravesical prostatic protrusion; PCB, Prostatic calculi burden; pre-PVR, preoperative-Post voided residual; TURP, transurethral resection of the prostate; PKEP, plasmakinetic enucleation of the prostate.

Figure 2 ROC curve of improved postoperative IPSS (A), IPSS-v (B), IPSS-s (C) and Qmax (D) in patients followed up for 3 months postoperatively.

Figure 3 ROC curve of improved postoperative IPSS (A), IPSS-v (B), IPSS-s (C) and Qmax (D) in patients followed up for 12 months postoperatively.

Figure 4 Zonal classification of the prostate and prostatic calculi.

Abbreviations: AFS, anterior fibromuscular stroma; TZ, transitional zone; CZ, central zone; PZ, peripheral zone.

Figure 5 Prostate calculi between the adenoma and the surgical capsule were removed using electrocution during PKEP. (A) Prostatic calculi at 5-o’clock position (B) Prostatic calculi at 7-o’clock position. a: prostatic calculi; b: surgical capsule; c: electric cut loops; d: 5-o’clock position of hyperplasia gland lobe in prostate apex; e: 7-o’clock position of hyperplasia gland lobe in prostate apex.

Table 3 Multivariate Analysis Of Risk Factors For Successful Treatment In Patients With Small-Volume Prostate

Treatment Success	IPSS		IPSS-v		IPSS-s		Function (Qmax)
	P	95% CI	P	95% CI	P	95% CI	P	95% CI
Postoperative 3 Months
TZV	/	/	0.647	0.837–1.333	/	/	/	/
TZI	/	/	0.001*	1.073(1.029–1.118)	/	/	/	/
IPP	<0.001*	1.751(1.399–2.191)	0.001*	1.147(1.056–1.247)	0.776	1.011(0.938–1.090)	0.001*	1.154(1.058–1.259)
PUA	<0.001*	1.266(1.172–1.367)	<0.001*	1.123(1.077–1.172)	/	/	<0.001*	1.084(1.043–1.127)
PrePCB	0.229	1.007(0.996–1.018)	/	/	0.065	1.007(1.000–1.013)	/	/
PostPCB	<0.001*	0.966(0.950–0.982)	/	/	<0.001*	0.975(0.965–0.985)	0.588	0.998(0.980–1.006)
Operation			/	/			/	/
TURP	0.103	2.279(0.847–6.8133)			0.035*	1.865(1.046–3.323)
PKEP
Postoperative 12 Months
PSA	0.365	1.243(0.776–1.989)
TZV	/	/	/	/	/	/	/	/
TZI	/	/	/	/	/	/	/	/
IPP	<0.001*	1.611(1.288–2.014)	/	/	/	/	0.009*	1.132(1.031–1.243)
PUA	<0.001*	1.255(1.158–1.360)	<0.001*	1.102(1.058–1.147)	/	/	0.001*	1.072(1.028–1.117)
PrePCB	0.206	1.079(0.959–1.2115)	/	/	0.091	1.072(0.989–1.162)	/	/
PostPCB	<0.001*	0.708(0.596–0.841)	/	/	<0.001*	0.744(0.660–0.838)	0.606	0.978(0.899–1.064)
Operation			/	/			/	/
TURP	0.168	2.096(0.732–5.996)			0.066	1.874(0.959–3.661)
PKEP
Pre-PVR	/	/					/	/
Yes					0.054	0.394(0.153–1.014)
No

Note: *P<0.05.

Table 4 Evaluation The Utility Of Different Variables For Predicting Treatment Success Using Receiver Operating Curve (ROC) Analysis

	IPSS	IPSS-v	IPSS-s	Function (Qmax)
Postoperative 3 Months
TZI	/	0.567(0.497–0.638)	/	/
IPP	0.865(0.820–0.909)	0.721(0.657–0.785)	/	0.717(0.652–0.782)
PUA	0.888(0.842–0.934)	0.758(0.694–0.822)	/	0.737(0.664–0.810)
PostPCB	0.785 (0.725–0.845)	/	0.717(0.658–0.771)	/
Postoperative 12 Months
IPP	0.830(0.774–0.886)	/	/	0.676(0.600–0.752)
PUA	0.870(0.813–0.926)	0.706(0.627–0.785)	/	0.698(0.611–0.784)
PostPCB	0.798(0.736–0.860)	/	0.740(0.666–0.817)	/

Table 5 Comparison Of Clinical Parameters Between The Two Surgical Procedures

Operation	Postoperative 3 Months			Postoperative 12 Months
	PKEP	TURP	P	PKEP	TURP	P
Age(year)	59.54±11.84	60.93±12.12	0.358	68.73±11.87	71.36±12.11	0.873
BMI	21.58±0.89	21.36±0.83	0.052	21.62±0.90	21.32±0.82	0.176
PSA(ng/mL)	2.93(1.03–5.00)	2.93(1.06–4.99)	0.844	3.20(1.07–5.00)	3.30(1.10–4.91)	0.613
TPV (mL)	25.03±2.91	25.29±2.84	0.481	25.15±2.99	25.17±2.93	0.534
TZV (mL)	10.49±1.80	10.77±2.06	0.241	10.41±1.81	10.50±2.20	0.051
TZI(TZV/TPV)	0.42±0.07	0.43±0.08	0.446	0.42±0.07	0.42±0.08	0.082
IPP(mm)	7.81±3.51	8.20±3.82	0.397	9.21±3.95	8.73±4.01	0.899
PUA(°)	37.74(19.42–59.60)	38.21(21.22–58.79)	0.484	43.00(26.00–54.00)	44.00(24.00–58.00)	0.228
PrePCB	106.82(8.90–288.73)	108.50(7.40–235.40)	0.811	10.50(1.20–28.90)	8.50(0.90–19.30)	0.287
PostPCB	29.60(1.00–146.20)	37.20(3.30–149.20)	0.042*	2.60(0.10–14.30)	3.00(0.40–13.70)	0.019*
Stone free rate(%)	64.72(0.00–99.29)	55.39(2.13–96.86)	0.003*	76.38(1.67–99.29)	59.79(10.51–88.32)	0.007*
Pre-PVR			0.487			0.814
Yes	20	12		15	12
No	126	99		102	74
Clavien grading system			0.660			0.562
I	13	18		7	9
II	4	3		3	1
III-a	1	3		1	2
III-b	2	1		0	0
IV-a	0	0		0	0
IV-b	0	0		0	0
V	0	0		0	0

Notes: Stone free rate=(1-PostPCB/PrePCB)×100; *P<0.05.