BPH 03. Effect of timing of surgery for BPH in the overall symptom improvement

Introduction and Objective: While there are definite indications of surgery for BPH, these indications are mostly for severe cases where further medical treatment is unfeasible. In general the transition of medical to surgical treatment, if at all, is highly dependent on local medical economics and patient or physician preference. The present study proposes to identify difference in treatment outcomes for patients with delayed surgical treatment with immediate surgical treatment.

Methods: Medical records of patients treated with TURP or PVP were retrospectively reviewed for initial pretreatment, preoperative and post operative IPSS Voiding, storage symptom scores and quality of life scores, and maximum urine flow rate (Q_max). These factors were analyzed against duration of medical treatment with alpha blockers. For the purpose of analysis, patients who had received combination therapy were excluded from the study. Linear regression analysis of absolute change in individual factors. A general linear model for repeated measures was constructed and compensated for initial prostate volume.

Results: The linear regression model showed the highest association with changes in IPSS storage symptom scores increasing despite surgical treatment as the delay to surgical treatment was prolonged (P=0.016, R=0.712). A general linear model for initial, preoperative and post operative IPSS subdomains and maximal flow rate was constructed with contrasting groups divided by medical treatment duration of 1 year, and a covariate of initial prostate volume. While the overall multivariate analysis was not significant between the two groups, univariate analysis of IPSS storage symptoms scores showed significant between groups changes with the delayed surgical treatment group showing lower improvement following surgery (P=0.042).

Conclutions: While overall outcome of delayed versus immediate surgical treatment showed no significant difference, linear regression and general linear models showed poorer response for IPSS storage symptom scores. This may be due to significant worsening of storage symptoms following secondary bladder change.