Elsevier

Urology

Volume 86, Issue 3, September 2015, Pages 581-586
Urology

Prostatic Diseases and Male Voiding Dysfunction
Does Postoperative Leukocyturia Influence Treatment Outcomes After Photoselective Vaporization of the Prostate (PVP)? A Prospective Short-Term Serial Follow-Up Study

https://doi.org/10.1016/j.urology.2015.06.024Get rights and content

Objective

To identify serial changes in the incidence of leukocyturia after photoselective laser-vaporization of the prostate (PVP), to determine whether postoperative leukocyturia could be associated with surgical outcomes, and to identify predictors of persistent leukocyturia after PVP.

Patients and Methods

A total of 102 men without leukocyturia on baseline urinalysis but underwent PVP were included in this prospective study. Treatment outcomes were assessed at 1 week, and 1, 3, 6, and 12 months postoperatively using International Prostate Symptom Score, Overactive Bladder Symptom Score (OABSS), uroflowmetry, postvoid residual, urinalysis, urine culture, and serum prostate-specific antigen (PSA).

Results

The incidences of leukocyturia and dysuria at 1 week, and 1, 3, and 6 months postoperatively were 100.0%, 51.0%, 19.6%, and 0.0% and 30.3%, 25.4%, 5.9%, and 0.0%, respectively. Only one case of bacteriuria occurred throughout the entire follow-up period. At 1 month postoperatively, decrease in subtotal storage symptoms score, quality-of-life index, and total OABSS in patients without leukocyturia were significantly greater than in those with leukocyturia. At 3 months postoperatively, patients without leukocyturia showed greater improvement in subtotal storage symptoms score, total OABSS, quality-of-life index, bladder voiding efficiency, and postvoid residual compared with those with leukocyturia. On logistic regression analysis, age, PSA, prostate size, and amount of energy utilized were independent predictors of persistent leukocyturia 3 months after surgery.

Conclusion

Leukocyturia is observed in all patients immediately after PVP, but its incidence decreases with time. It may have adverse effects on treatment outcomes. Also, older age, higher serum PSA, larger prostate size, and greater amount of energy utilized may be risk factors of persistent leukocyturia.

Section snippets

Patients and Methods

This study was approved by the Institutional Review Board of our hospital. A total of 102 eligible men, who underwent PVP using an 80 W potassium–titanyl-phosphate (KTP) laser (n = 90) or a 120 W high-performance system (HPS) laser (n = 12) for LUTS and/or BPH refractory to medical treatment between March 2010 and January 2014, were included in this prospective study. The inclusion criteria were: (1) no leukocyturia on baseline urinalysis and (2) sterile urine culture before surgery. Patients

Results

The baseline characteristics of the patients are shown in Table 1. Total IPSS, subtotal voiding symptom score, and the QOL index decreased significantly beginning 1 week after surgery compared with those at baseline, whereas the subtotal storage symptom score and total OABSS score decreased significantly beginning 3 months after surgery (Fig. 1). Maximum flow rate, PVR, and BVE improved significantly beginning 1 week after surgery, compared with those values at baseline (Fig. 1). The mean

Comment

Postoperative leukocyturia is a relatively common finding during the early postoperative period after transurethral BPH surgery. Some patients complain of bothersome LUTS, including dysuria and storage symptoms after PVP. Cho et al suggested that the duration of leukocyturia after TURP is significantly associated with the duration of postoperative LUTS, such as dysuria or storage symptoms.2 It has been presumed that leukocyturia after TURP is associated with exudation of inflammatory cells from

Conclusions

Postoperative leukocyturia is observed in all patients immediately after PVP, but its incidence decreases with time. However, the postoperative leukocyturia and the related dysuria may have an adverse effect on treatment outcome during the early postoperative period after PVP. Also, our data suggest that preoperative older age, higher serum PSA level, larger prostate size, and a greater amount of energy utilized may be risk factors of persistent leukocyturia at 3 months after PVP. Further

Acknowledgments

This work was supported by the Dongguk University Research Fund of 2011.

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Financial Disclosure: The authors declare that they have no relevant financial interests.

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