In a nutshell
This study looked at the occurrence of lower urinary tract symptoms (LUTS) after prostate surgery. This study concluded that the occurrence of LUTS after prostate removal was affected by certain factors.
Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland. An enlarged prostate can affect bladder function and have a negative impact on quality of life. BPH can cause LUTS to occur. LUTS can include: how often someone urinates, inability to delay urinating, trouble beginning or maintaining a urine stream, nocturia (frequent urination during the night) and retaining urine. Treatments for BPH may include medication or surgery. Medications for BPH often result in many side effects while surgery can lead to complications.
A common surgery to relieve BPH is transurethral resection of the prostate (TURP). TURP involves removing pieces of excess prostate tissue.
Sometimes, even after surgery to remove part of the prostate, LUTS can persist. This study reviews the factors that can contribute to the continuation of LUTS after prostate surgery.
Methods & findings
The occurrence of LUTS was examined in BPH patients who had TURP. Occurrence of LUTS after TURP is 20-50%. Urethral stricture (narrowing of the tube carrying urine out of the body) and more severe LUTS have been observed after TURP.
The cause of the LUTS after TURP is believed to be from a loss of flexibility in the muscles which make up the bladder. This loss of muscle makes the bladder less flexible and it cannot hold as much urine. The loss of flexibility is believed to be caused by a re-shaping of the muscle. This shape change occurs after a long period of the enlarged prostate blocking the urine flow.
There are possible factors that may predict LUTS after TURP. These include: age, the shape of the enlarged prostate and the presence of certain naturally occurring chemicals in the body. Older patients have already lost some flexibility of the bladder muscles. This may be worsened by TURP. BPH patients who have an enlarged middle area of their prostate may not suffer with LUTS after TURP. The presence of the substance, nerve growth factor (NGF), has also been connected to LUTS after TURP.
Evaluation of LUTS after TURP should be carried out with a patient history and a physical exam. Other tests should include: assessment of urinary symptoms and tests for urinary infection.
LUTS can be managed with pelvic floor muscle exercises, medication or surgery. Pelvic floor muscle exercises train the muscles of the pelvic floor to contract. This causes the muscles of the bladder to relax. Medications can include anti-inflammatories (should there be an infection) or muscle relaxants to try and relax the urinary muscles. Surgery can be used to try and remove the blockage that it causing the LUTS. If pelvic floor exercises, medication or surgery do not work to relieve the LUTS, then catheterization must be considered.
The bottom line
This study concluded that LUTS after TURP is a common occurrence. Certain factors can affect LUTS occurrence after TURP. LUTS must be evaluated and managed by a doctor.
The fine print
The authors note that more research is needed in the area of LUTS after TURP.
If you are concerned about LUTS after TURP surgery, talk to your doctor.
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Current urology reports
Aug 20, 2018
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