Benign Prostatic Hyperplasia Surgical Scoring (BPHSS) - Beyond the Abstract

Benign prostatic hyperplasia (BPH), the progressive hyperplasia of prostatic glandular and stromal tissues, is quite common in aging males. The main treatments include surgical treatment and medicine treatment. Surgery is the most efficient treatment for BPH especially for the relief of the symptoms of bladder outflow obstruction. Transurethral enucleation of the prostate (TUEP) is currently considered as an efficient treatment for BPH patients, and holmium laser enucleation of the prostate (HoLEP), in particular, is one of the most popular among them.

Arguments still exist about what is the ‘gold standard’ for the BPH surgical treatment and the merits of HoLEP cannot be ignored compared with the transurethral resection of the prostate (TURP). Thus, there still lacks a scoring system and standardized methods to measure and predict the difficulties during HoLEP, which may contribute a lot to the standardization of this surgical procedure. In order to develop a standardized scoring system, we developed the BPH surgical scoring (BPHSS) system, to quantify the ability to predict the perioperative outcomes resulting from an enlarged prostate. 

The following factors were included to measure the perioperative outcomes: the basic patient preoperative characteristics, operation time (OT), pre- and post- surgery hemoglobin decrease, Na+ variation, hospital stay duration, duration of bladder irrigation, catheterization time, and hospitalization time. All the influencing data included the following: prostatic volume (PV), prostate-specific antigen (PSA), bladder stones, intravesical prostatic protrusion (IPP), and metabolic syndrome (MetS), which consist the BPHSS. In this study, both retrospective and prospective observational studies were done for the examination of the influencing factors mentioned above. 

BPHSS is suitable to predict the perioperative outcomes in patients undergoing HoLEP. It may help urologist to prepare more before surgery to treat the enlarged prostates. It is demonstrated that the BPHSS can predict the risk of the HoLEP surgical procedure. It may help urologist to prepare more preoperatively for the enlarged prostates in the aspect of surgery arrangement and the treatment procedure. Further studies are needed to validate this scoring system in more BPH patients of multiple medical centers.

Written by:

Huan Xu, MD Department of Urology, Shanghai Ninth People’s Hospital, Shanghai Jiao tong University School of Medicine, Shanghai, China

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