Abstract:

Objective： To evaluate the efficacy and outcome of palliative transurethral resection of the prostate (pTURP) in patients with server bladder outlet obstruction (BOO) due to prostatic obstruction induced by advanced prostate cancer.Methods:All the 16 patients who had a pTURP between November 2007 and January 2015 due to BOO (high residual urine volume combined with hydronephrosis or urinary retention refractory to medical treatment ) at our institution were retrospectively assessed. All the patients were diagnosed with advanced prostate cancer (Ⅲ stage or Ⅳ stage). The clinical data, functional and oncological follow-up results were evaluated. The cancer specific survivals were estimated by Kaplan-Meier analysis.Results:The mean age of the patients was 73.8 years (63－81 years). Five  cases were graded in stage Ⅲ of prostate cancer and 11  in stage Ⅳ. The indications for pTURP were refractory urinary retention in 12 cases, and high residual urine volume with hydronephrosis in 4 cases. The mean prostate volume at pTURP was 43.2 mL (28－78 mL) and the mean PSA (prostate specific antigen) level before pTURP was 48.2 μg/L (2－107 μg/L). The patients had mean residual urine volume 166.4 mL (50－450 mL) and mean urinary flow rate 3.6 mL/s(0－6 mL/s, n=7) before pTURP. It took mean 62.9min (35－94 min) in pTURP with mean estimated blood loss 126.9 mL (30－263 mL) and mean resected tissue 14.1 g (10－22 g). There were no transfusion cases. Postoperative mean serum PSA 20.5 μg/L (1－41 μg/L), residual urine volume 43.4 mL (0－400 mL) and urinary flow rate 10.1 mL/s (7-16 mL/s, n=7) were shown in these cases. A patient encountered persistent hematuria needing irrigation. Compared with preoperation, the patients had significantly lower serum PSA level (P<0.001), less residual urine volume (P<0.001) and more urinary flow rate (P=0.001) after pTURP. The mean follow-up after pTURP was 36 months (1－86 months). In addition, 2 patients received repeated pTURP. At the time of the latest analysis, 3 patients died from prostate cancer progression. As estimated by KaplanMeier analysis, the 2-, 3- and 5-year cancer specific survival rates after pTURP were 91%, 78% and 58%, respectively.Conclusion:Despite less resected tissue, greater delay in urination and reoperation rates, pTURP is a fairly effective procedure in patients with server BOO . Although a potential negative impact of pTURP on survival cannot be excluded, the estimated 3 and 5year cancer specific survival rates in this series seem to justify this intervention.

Key words: Prostatic neoplasms, Urinary bladder neck obstruction, Transurethral resection of prostate