Erythrocyte Sedimentation Rate (ESR) is an acute phase reactant and an indirect measure of inflammation inside the body. It increases as a response to acute conditions such as infection, injury, tissue destruction, some cancers, burns, surgery, or trauma. Transurethral electrosurgical Resection of the Prostate (TURP) is the current gold standard for management of patients with bladder outlet obstruction secondary to benign prostatic enlargement or BPH. The success of operation is determined when after resection of the prostate following removal of indwelling catheter several days post-operative, the patient is able to void freely without catheter. It is not mentioned whether the edema of the post-operative site or the persistent inflammation of the prostate after resection may cause the failure of TWOC. The primary objective of this study is to determine if ESR can be a reliable predictor of success of TWOC in patients who underwent TURP for Benign Prostatic Hyperplasia (BPH). Also, this study determines the relationship between ESR and success rate of TWOC and to explore the different factors that may affect success rate of TWOC.
On the day of planned catheter removal, 4 milliliters of blood is extracted from the patient, placed in an Ethylenediaminetetraacetic acid (EDTA) tube and sent to laboratory for ESR determination. One milliliter of EDTA-anticoagulated blood is placed in the Westergren tube. After 60 minutes, measurements were taken of the distance the red cells traveled to settle at the bottom of the tube. After catheter removal, patients were observed whether they can void freely without catheter or not. Patients that did not able to void within 4 to 6 hours were re-catheterized. Results were recorded.
A total of 135 patients with BPH who underwent TURP were included in the analysis. Success of trial voiding without catheter was observed on 117 of 135 patients (87%). Patients’ age varied from 49 to 80 years, overall median age at 67 years. Among these patients, the average ESR was significantly lower (48 mm versus 56 mm, range = 17-109 mm; p=0.012). Presence of urinary retention (61%), history of cigarette smoking (56%), hypertension (61%), diabetes mellitus (50%), trabeculations in cystoscopy and prostate size less than 20 grams (17%) were more common among patients with unsuccessful TWOC.ESR (p=0.012) was an independent significant predictor of TWOC. Based on univariate analysis, Diabetes Mellitus (DM) (p=0.003), trabeculations in cystoscopy (p=0.000) and UTI (p=0.000) were also significantly associated with TWOC. Among the significant independent covariates, DM was a significant factor affecting the success rate of TWOC (p=0.005) based on multivariate analysis. Patients without DM were about 16 times more likely to have a successful TWOC (OR=15.750, 95% CI=2.335, 106.227).
ESR was significantly lower in patients with success of trial voiding without catheter. ESR can be a reliable predictor of success of TWOC in patients who underwent TURP for BPH.