PD38-06: TURPUDU Trial- A prospective study evaluating the effect of transurethral resection of prostate on urodynamic parameters in patients of benign enlargement of prostate with upper urinary tracts dilatation

Shantanu Tyagi*, Kalpesh parmar, Shrawan Singh, Chandigarh, India

Introduction: Pressure-flow changes after transurethral resection of prostate (TURP) for benign prostatic enlargement (BPE) with lower urinary tract symptoms have been well described in the literature. But, till date no study has evaluated the post-TURP urodynamic changes in patients with BPE with upper urinary tract dilatation (UTD). With this background, we evaluated the urodynamic outcomes of TURP in patients of BPE with UTD and correlate with International Prostate Symptoms Score (IPSS).

Methods: In this prospective study (TURPUDU stands for - TURP for Upper tract Dilatation and Urodynamic changes), patients of BPE with UTD from July 2017 to Jan 2021 were enrolled. Study protocol was registered and cleared with Institutional review board (NK/3880/MS/148). Detailed IPSS score, ultrasonography abdomen, serum creatinine, and serum PSA were recorded. All the patients were catheterised and observed for post-obstructive diuresis. At 4 weeks, repeat ultrasound and serum creatinine were recorded. Urodynamic study (UDS) was performed after ensuring sterile urine culture. Patients underwent TURP as per standard technique. A repeat UDS was performed after 3 months and analyses were done.

Results: Ninety-five patients were enrolled of which data of 90 patients were analysed. In the filling phase of the UDS study, there was a significant decrease in detrusor pressure at the end filling phase from 29 cm H2O to 8 cm H2O post-TURP. Maximum cystometric capacity (MCC) [409ml to 485ml(p-value <0.001)] and bladder compliance [10 ml/cm of H2O to 33 ml/cm of H2O (p-value <0.001)] significantly improved at 3 months following surgery. In the voiding phase, peak flow rate showed a significant increase [5 ml/sec to 16 ml/sec (p-value <0.001)], post-void residual urine volume significantly decreased [460 ml to 30 ml (p value <0.001)] and peak detrusor pressure marginally decreased following TURP. Detrusor contractility index also improved significantly at 3 months post TURP [53 to 108;(p-value <0.05)]. Among 78 patients with a weak bladder (BCI <100) before surgery, BCI improved in 55% of patients following TURP (n=43). The IPSS score decreased from 21 ± 6 to 4 ± 2 following TURP.

Conclusions: This is the first study evaluating the effect of TURP on urodynamic parameters in patients of BPE with upper tract changes. Changes in the bladder dynamics and resolution of hydroureteronephrosis following TURP reflected in the changes in urodynamic parameters and International prostate symptom score.

Source of Funding: none