術前排尿功效可預估經尿道攝護腺刮除術後甲型阻斷劑使用與否
許哲維1、程威銘1,2、張彰琦1,2、黃建勳1,2、邱逸淳1,2、洪士奇1、邱文祥1,2
1台北市立聯合醫院忠孝院區外科部泌尿科； 2國立陽明大學醫學院泌尿學科
Preoperative voiding efficacy could predict postoperative alpha blocker usage after transurethral resection of the prostate
Che-Wei Hsu1, Wei-Ming Cheng1,2, Chang-Chi Chang1,2, Ken-J Chien-Hsun Huang1,2, Yi-Chun Chiu1,2, Shih-Chi Hong1, Allen Chiu1,2
1Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
2Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Purpose:
Some patients with benign prostatic enlargement (BPE) have to take alpha blockers to control their lower urinary tract symptoms after transurethral resection of the prostate (TURP). In the present study, we tried to find out non-invasive predictors of postoperative alpha blocker usage after TURP.
Materials and Methods:
From January 1st, 2011 to December 31st, 2016, patients who received TURP for BPE in our community-based hospital were included. Those who didn’t have complete preoperative evaluation, lost follow-up postoperatively, or received palliative TURP for prostate cancer were excluded. Preoperative voiding efficacy, defined as voided volume on uroflowmetry divided by total volume (voided volume on uroflowmetry plus residual urine on bladder ultrasound), as well as maximum flow rate (Qmax), mean flow rate (Qmean) on uroflowmetry, serum prostatic specific antigen (PSA), prostate size estimated by transrectal ultrasound and weight of resected prostatic tissue were compared between patients who needed alpha blockers for more than three months postoperatively and those who didn’t. Fisher exact test, Mann-Whitney U test, multiple regression analysis and receiver operating characteristic (ROC) curve were used for statistical analysis.
Results:
There were 41 patients included for analysis, and 19 patients (46.3%) had to take alpha blockers after TURP. The demographic data were shown in the Table. Patients who needed postoperative alpha blockers tended to be older (p < 0.01) and had worse preoperative voiding efficacy (61.7% vs. 74.6%, p = 0.02). There were no statistical differences when it comes to voided volume, Qmax, Qmean, serum PSA level, prostate size and weight of resected prostatic tissue. Voiding efficacy remained significant after multivariate analysis (p = 0.028). A cutoff level of voiding efficacy to predict postoperative alpha blockers usage was less than 63.3% (AUC = 0.713, p = 0.01, sensitivity 81.82%, and specificity = 52.63%).
Conclusion:
Preoperative voiding efficacy less than 63.3% could predict post-TURP alpha blockers usage. It could help patient counseling before TURP.