The relation between the storage symptoms before and after transurethral resection of the prostate, analysis of the risk factors and the prevention of the symptoms with solifenacin

ABSTRACT Objective and Hypothesis We aimed to investigate the reasons of storage symptoms ( SS) after transurethral resection of the prostate (TURP). The hypothesis was that a positive correlation would be identified between preoperative and postoperative SS in patients with undergoing TURP and starting early solifenacin treatment in patients with high preoperative SS would be reasonable. In addition, we aimed to analyze multiple other risk factors for post-TURP SS. Materials and Methods A total of 160 patients undergoing TURP were prospectively evaluated and divided into two groups according to their OABS. Those with a score of ≥10 points were Group 1 (G1), and those with <10 points Group 2 (G2). In addition, patients in each group were randomly further divided into two subgroups: those who were started on 5 mg solifenacin succinate in the early postoperative period (G1/G2 A) and those who were not (G1/G2 B). In additions to SS Preop, perop and at the 3rd-month of postoperatively 14 variable were evaluated. The effects of these factors, surgery and the efficacy of an early medical treatment on the postoperative SS were investigated. LUTS were assessed by International Prostate Symptom Score (IPSS) and SS were assessed by sum of IPSS 2, 4 and 7 questionnaires (Storage, S- IPSS). Results Preoperative IPSS and S-IPSS were significantly higher in G1 (p<0.001); there was a significant improvement at IPSS, S-IPSS, QoL score, Qmax, and PVR for all groups after surgery. Only preoperative S-IPSS was found to have significant effect on postoperative SS (p<0.001). There was a significant difference between G1A and G1B but no significant difference between G2A and G2B in terms of SS at postoperatively. In addition to this, prostatic volume was found smaller than non-symptomatic patients in de novo SS patients. Conclusion TURP provides significant improvement in both storage and voiding symptoms. The predictive value of the preoperative S-IPSS on postop SS is significant. These results suggest that 5 mg solifenacin succinate treatment in the early postoperative period may be beneficial for patients with high preoperative SS and may not be beneficial in others. Small prostatic volume may bode ill for postoperative SS in the patients with de novo SS.

摘要
研究目的与假说：本研究旨在探讨经尿道前列腺切除术（transurethral resection of the prostate, TURP）后储尿期症状（storage symptoms, SS）的发生原因。本研究提出假说：接受TURP的患者术前与术后储尿期症状存在正相关，且对于术前储尿期症状评分较高的患者，术后早期启用琥珀酸索利那新（solifenacin succinate）治疗具有合理性。此外，本研究还旨在分析TURP术后储尿期症状的其他多项危险因素。
材料与方法：本研究前瞻性评估了共计160例行TURP的患者，并依据其OABS评分分为两组：评分≥10分者为1组（G1组），评分<10分者为2组（G2组）。随后，每组患者再随机分为两个亚组：术后早期予以5mg琥珀酸索利那新治疗的亚组（G1/G2 A组）与未予以该治疗的亚组（G1/G2 B组）。除术前、围术期及术后3个月的储尿期症状外，本研究还评估了14项变量，并探讨了上述因素、手术操作以及早期药物治疗的疗效对术后储尿期症状的影响。下尿路症状（lower urinary tract symptoms, LUTS）采用国际前列腺症状评分（International Prostate Symptom Score, IPSS）进行评估，储尿期症状则通过IPSS第2、4、7项问卷得分之和进行量化（储尿期IPSS，S-IPSS）。
结果：G1组患者的术前IPSS及S-IPSS评分均显著高于G2组（p<0.001）；术后所有组别的IPSS、S-IPSS、生活质量（quality of life, QoL）评分、最大尿流率（Qmax）及残余尿量（post-void residual urine volume, PVR）均得到显著改善。仅术前S-IPSS评分被证实对术后储尿期症状具有显著影响（p<0.001）。术后储尿期症状方面，G1A组与G1B组间存在显著差异，但G2A组与G2B组间无显著差异。此外，新发储尿期症状患者的前列腺体积较无症状患者更小。
结论：TURP可显著改善储尿期与排尿期症状。术前S-IPSS评分对术后储尿期症状具有显著的预测价值。上述结果提示，术后早期予以5mg琥珀酸索利那新治疗，对于术前储尿期症状评分较高的患者可能具有获益，而对其他患者则未必有益。对于新发储尿期症状的患者，较小的前列腺体积可能预示术后储尿期症状预后不良。