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Modified transurethral resection of the prostate (TURP) for men with moderate lower urinary tract symptoms (LUTS) before brachytherapy is safe and feasible.
BJU Int. 2015 Apr; 115(4):580-6.BI

Abstract

OBJECTIVE

To report the urinary toxicity outcomes for patients at greater risk of voiding symptoms and retention who received a modified limited transurethral resection of the prostate (TURP) before low-dose rate (LDR) brachytherapy.

PATIENTS AND METHOD

Data were analysed from patients receiving the above procedures between 2006 to present, taken from the prospective brachytherapy database of 2000 patients at the St. Luke's Cancer Centre. The limited TURP (TURP(BXT)) was performed at a median (range) of 64 (25-205) days before seed implantation with a median resection weight of 1.15 g. Selection criteria were based on patients with moderate lower urinary tract symptoms, poor flow or post-void residual urine volume (PVR), or a prominent middle lobe or high bladder neck on transrectal ultrasonography. Baseline prostate cancer characteristics, uroflowmetry, International Prostate Symptom Score (IPSS) and quality-of-life QoL scores were collected and compared with follow-up IPSS and QoL scores.

RESULTS

Data for 112 patients was gathered from the database. The TURP(BXT) resulted in statistically significant improvements before LDR brachytherapy in maximum urinary flow rate (Qmax) and PVR, IPSS and QoL scores (the mean Qmax before vs after the TURP(BXT) was 11.3 vs 16.7 mL/s). The IPSS and QoL scores at 6 months after seed implantation were increased compared with baseline values before the TURP(BXT) (mean IPSS at 6 months 11.7 vs 9.2 before TURP(BXT)), but no difference at 1 year (mean IPSS 9), and improved scores at 2, 3, 4 and 5 years follow-up (mean IPSS of 7.9, 5.6, 5.3 and 7.4, respectively).

CONCLUSION

The present study suggests patients at increased risk of deteriorating voiding symptoms, including urinary retention, are no longer contraindicated against LDR brachytherapy if they receive a modified TURP before seed implantation. This procedure does not appear to carry the risk of urinary incontinence thought to be associated with a conventional TURP before LDR brachytherapy.

Authors+Show Affiliations

St. Luke's Cancer Centre, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24802744

Citation

Brousil, Philip, et al. "Modified Transurethral Resection of the Prostate (TURP) for Men With Moderate Lower Urinary Tract Symptoms (LUTS) Before Brachytherapy Is Safe and Feasible." BJU International, vol. 115, no. 4, 2015, pp. 580-6.
Brousil P, Hussain M, Lynch M, et al. Modified transurethral resection of the prostate (TURP) for men with moderate lower urinary tract symptoms (LUTS) before brachytherapy is safe and feasible. BJU Int. 2015;115(4):580-6.
Brousil, P., Hussain, M., Lynch, M., Laing, R. W., & Langley, S. E. (2015). Modified transurethral resection of the prostate (TURP) for men with moderate lower urinary tract symptoms (LUTS) before brachytherapy is safe and feasible. BJU International, 115(4), 580-6. https://doi.org/10.1111/bju.12798
Brousil P, et al. Modified Transurethral Resection of the Prostate (TURP) for Men With Moderate Lower Urinary Tract Symptoms (LUTS) Before Brachytherapy Is Safe and Feasible. BJU Int. 2015;115(4):580-6. PubMed PMID: 24802744.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modified transurethral resection of the prostate (TURP) for men with moderate lower urinary tract symptoms (LUTS) before brachytherapy is safe and feasible. AU - Brousil,Philip, AU - Hussain,Muddassar, AU - Lynch,Mark, AU - Laing,Robert W, AU - Langley,Stephen E M, Y1 - 2014/12/15/ PY - 2014/5/8/entrez PY - 2014/5/8/pubmed PY - 2015/6/2/medline KW - LUTS KW - TURP KW - brachytherapy KW - prostate KW - urinary toxicity SP - 580 EP - 6 JF - BJU international JO - BJU Int VL - 115 IS - 4 N2 - OBJECTIVE: To report the urinary toxicity outcomes for patients at greater risk of voiding symptoms and retention who received a modified limited transurethral resection of the prostate (TURP) before low-dose rate (LDR) brachytherapy. PATIENTS AND METHOD: Data were analysed from patients receiving the above procedures between 2006 to present, taken from the prospective brachytherapy database of 2000 patients at the St. Luke's Cancer Centre. The limited TURP (TURP(BXT)) was performed at a median (range) of 64 (25-205) days before seed implantation with a median resection weight of 1.15 g. Selection criteria were based on patients with moderate lower urinary tract symptoms, poor flow or post-void residual urine volume (PVR), or a prominent middle lobe or high bladder neck on transrectal ultrasonography. Baseline prostate cancer characteristics, uroflowmetry, International Prostate Symptom Score (IPSS) and quality-of-life QoL scores were collected and compared with follow-up IPSS and QoL scores. RESULTS: Data for 112 patients was gathered from the database. The TURP(BXT) resulted in statistically significant improvements before LDR brachytherapy in maximum urinary flow rate (Qmax) and PVR, IPSS and QoL scores (the mean Qmax before vs after the TURP(BXT) was 11.3 vs 16.7 mL/s). The IPSS and QoL scores at 6 months after seed implantation were increased compared with baseline values before the TURP(BXT) (mean IPSS at 6 months 11.7 vs 9.2 before TURP(BXT)), but no difference at 1 year (mean IPSS 9), and improved scores at 2, 3, 4 and 5 years follow-up (mean IPSS of 7.9, 5.6, 5.3 and 7.4, respectively). CONCLUSION: The present study suggests patients at increased risk of deteriorating voiding symptoms, including urinary retention, are no longer contraindicated against LDR brachytherapy if they receive a modified TURP before seed implantation. This procedure does not appear to carry the risk of urinary incontinence thought to be associated with a conventional TURP before LDR brachytherapy. SN - 1464-410X UR - https://www.unboundmedicine.com/medline/citation/24802744/Modified_transurethral_resection_of_the_prostate__TURP__for_men_with_moderate_lower_urinary_tract_symptoms__LUTS__before_brachytherapy_is_safe_and_feasible_ L2 - https://doi.org/10.1111/bju.12798 DB - PRIME DP - Unbound Medicine ER -