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Modified transurethral resection of the prostate for the management of BPH-related refractory lower urinary tract symptoms in patients with a history of pelvic fracture urethral injury reconstruction

  • Kirtishri Mishra
  • Cristina Baeza
  • Laura Bukavina
  • Reynaldo G. GómezEmail author
Urology - Original Paper

Abstract

Introduction

To evaluate the impact of a modified transurethral resection of prostate (mTURP) in patients with a history of pelvic fracture urethral injury (PFUI) status post-urethroplasty, and subsequent lower urinary tract symptoms (LUTS) refractory to medical therapy caused by benign prostatic hyperplasia (BPH).

Methods

Five patients were identified with a history of PFUI and a successful reconstruction of the urethra, who developed severe LUTS. After maximal medical therapy failed, these patients underwent a mTURP. Their continence status and voiding parameters were recorded before and after surgery.

Results

Significant improvements in both post-void residual (172 ± 137.36 mL vs. 26.6 ± 24.44 mL), p = 0.026, and International Prostatic Symptom Score (23.6 ± 4.82 vs. 7.6 ± 4.30), p = 0.002 were observed in the study. Although maximum flow rate was not statistically significant, there was an overall improvement in Qmax in all patients (8.92 ± 3.71 vs. 16.78 ± 6.44 mL/sec). Furthermore, all patients remained continent after this modified intervention.

Conclusion

Our modified TURP provides an adjunctive option in the management of severe LUTS secondary to BPH in patients with a history of PFUI urethroplasty who are refractory to medical management. In our experience, the patients experienced a lasting response with no incontinence.

Keywords

Pelvic fracture urethral injury Bladder outlet obstruction Transurethral resection of bladder neck Reconstructive urology 

Abbreviations

PFUI

Pelvic fracture urethral injury

BPH

Benign prostatic hyperplasia

mTURP

Modified transurethral resection of prostate

LUTS

Lower urinary tract symptoms

PVR

Post-void residual

IPSS

International Prostate Symptom Score

TRUS

Transrectal ultrasound

IPP

Intravesical prostatic protrusion

TURP

Transurethral resection of prostate

Notes

Author contributions

Mishra: data analysis, manuscript writing/editing, Cristina Baeza: data analysis, protocol/project management, Laura Bukavina: data analysis, manuscript writing/editing, Reynaldo G. Gómez: protocol/project management, data analysis, manuscript writing/editing.

Funding

None

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Urology InstituteUniversity Hospitals, Cleveland Medical CenterClevelandUSA
  2. 2.Case Western Reserve University School of MedicineClevelandUSA
  3. 3.Urology ServiceHospital del TrabajadorSantiagoChile
  4. 4.Universidad Andres Bello School of MedicineSantiagoChile

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