Transüretral Prostat Rezeksiyonu, Prostat Enükleasyonu veya Açık Prostatektomi Uygulanan Benign Prostat Hiperplazisi Hastalarının Patoloji Sonuçlarının Retrospektif Karşılaştırması

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Tarih
2025-02-17Yazar
Kısıklı, Alp
Ambargo Süresi
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ABSTRACT
Aim: Our study aims to reveal the incidental oncological diagnosis rates of patients who
underwent HoLEP, open prostatectomy and TUR-P and which clinical parameters this may be
related to.
Materials and Methods: A total of 771 patients who were treated at the Hacettepe University
Urology Department between January 2021 and October 2023, who were given a surgical
indication due to BPH despite medical treatment, and who underwent Open Prostatectomy,
TUR-P or HoLEP surgeries were included in our study. Patients diagnosed with prostate
cancer before surgery were excluded from the study. The patients' age, pre-operative PSA
values, prostate volumes and prostate specimen volumes included in the study by Pathology
were taken as parameters and compared between the surgery groups. In addition, PSA
densities, resected prostate volumes and pre-operative and post-operative IPSS scores were
also included in the comparison.
Results: 310 HoLEP, 106 SPTV-P and 355 TUR-P patients were included in the study. When
the homogeneity between the groups was examined for comparison, it was understood that the
SPTV-P group was statistically significantly higher than the other two groups with a mean of
70.1 in terms of age; however, in the eta squared evaluation made for statistical power, this
difference was understood to be below moderate significance. In the comparison made in
terms of PSA and pre-operative prostate volume, the SPTV-P group was found to be
statistically significantly different, and it was found to be compatible with our clinical
practice, together with the frequent referral of patients with larger prostates (>100 g) to SPTV-
P during pre-operative patient evaluation. PSA density between the groups was compared and
no significant difference was found. In the correlation analyses between the groups, a strong
correlation was found between PSA and prostate volume in the total cohort and in the internal
examination of all three groups; it was seen that the trend arising from this correlation
disappeared in patients diagnosed with malignancy. In the comparison made between the
groups, incidental prostate cancer was detected in 6.6% of the total cohort. In multiple and
binary analyses between the groups, it was observed that there was no statistically significant
difference in terms of iPca detection rates. iPca was detected in 5.5% of patients in the
HoLEP group, 3.8% in the SPTV-P group, and 7.9% in the TUR-P group. When the
significance level of the parameters in terms of iPca detection was examined, it was calculated
that age and the specimen volume included in the study by Pathology created statistically
significant results. It was found that the PSAd value of the patient group diagnosed with iPca
was 0.13 on average, and the PSAd average of the patients diagnosed benign was 0.06; the
difference between them was found to be statistically significant. In addition, analysis was
performed for patients whose IPSS scores were determined pre-operatively and at the 3rd
month post-operatively within the three surgery groups, and it was determined that there was
a statistically significant improvement in IPSS for all three surgery types; and no superiority
between the three groups.
Conclusion: According to our results, HoLEP surgery is reliable in oncological terms, despite
offering different specimen morphology. iPca detection rates are mainly related to patient age
and prostate specimen volume examined by Pathology.
Keywords: Prostate, Holmium laser prostate enucleation, open prostatectomy, incidental
prostate cancer, prostate volume
Bağlantı
https://hdl.handle.net/11655/36676Koleksiyonlar
Künye
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