Elevated PSA, infection are most predictive of AUR

Ankara, Turkey-Elevated PSA levels and the presence of urinary tract infection are the symptomatic parameters that are most predictive of acute urine retention in men with BPH, according to a group of Turkish researchers. Their data also suggest that plasmakinetic resection of the prostate may provide 1-year outcomes similar to those of open prostatectomy in BPH patients who do not have retention.

Plasmakinetic resection of the prostate was the surgical method used in 37 men, 14 of whom (38%) had urinary retention. The other 34 patients underwent open prostatectomy and, from those, 20 (59%) were found to have acute retention.

Dr. Ayyildiz and colleagues evaluated several parameters in each patient, including International Prostate Symptom Score, uroflowmetry results, prostate size, cystoscopic findings, and free and total PSA. Prior to surgery, a general assessment, history, physical examination, rectal examination, and transrectal ultrasound were performed, and urea and creatinine levels, drug history, and residual urine volume were measured, among other screening procedures.

PSA value exhibited a significantly higher predictive rate for AUR than did other parameters (p<.0001). Similarly, urinary tract infection was significantly more frequent in men with acute retention than in those without it.

"Despite the significantly higher risk of AUR among patients treated with open surgery, we found no difference in surgical success rates between men with or without AUR at 1-year follow-up, regardless of the surgical technique used," Dr. Ayyildiz said.

The researchers concluded that men with prostates less than 80 cc in volume without a history of acute retention probably would be better treated with plasmakinetic resection than with open surgery. Dr. Ayyildiz added that he and his colleagues "cannot yet make any comment on the postoperative effect of plasmakinetic resection of the prostate on AUR."

Ankara Training and Research Hospital is one of Turkey's largest state hospitals, and its Second Urology Clinic takes referrals from across the country, which gives Dr. Ayyildiz's team a large BPH population from which to draw. The group, which also includes Turgay Akgül, MD, Baris Nuhoglu, MD, Emre Huri, MD, and Cankon Germiyanoglu, MD, has previously published data on plasmakinetic resection and other methods of prostatic surgery (Int J Urol 2006; 13:21-4; J Endourol 2005; 19:79-82).