Outcome of surgery for benign prostatic hyperplasia-is it predictable?

AIM The study was done to evaluate the pre-operative and intra operative factors which influence the post-operative outcome in patients undergoing surgery for Benign Prostatic Hyperplasia (BPH). SETTING AND DESIGN It was carried out prospectively at a university college hospital in northern India. MATERIAL & METHODS The study was carried out prospectively in 31 patients who underwent surgery for BPH (TURP - 50, Open Prostatectomy - 10). Various pre-operative and intra-operative parameters were studied by means of a detailed history and examination, IPS score, urodynamic evaluation & cystoscopic examination. Their effect on post-operative outcome was evaluated by measuring changes in IPSS, maximum and average flow rates, and fall in PSA values. STATISTICAL ANALYSIS Repeated measure ANNOVA was applied to calculate the significance of preoperative factors on post operative outcome (IPSS, Q max and Q av). RESULTS All parameters studied in the patients improved significantly following surgery. Patients who had pre-operative urinary retention and catheter at the time of surgery had significant improvement in both subjective (IPSS ,p=.oo4) and objective (maximum & average flow rates p=.04) parameters studied. Patients with larger prostrate had a significantly better maximum flow rate (p=.03) and IPSS at 3 months post-operatively. Similarly, patients with larger bladder capacity (more than 150 ml), better compliance (more than 6 ml per cm of water) and lower post-voidal residue (less than 60ml) had better post-operative outcome. CONCLUSION Patients with pre-operative urinary retention, shorter duration of bladder catheterization, lower post voidal residue, high IPSS score, larger prostrate, larger bladder capacity and compliance had a significantly better outcome following surgery for BPH as assessed by various parameters studied.