Evaluating the Role of Intraoperative Voiding Score in Prognostication Following Transurethral Resection of the Prostate.

INTRODUCTION

Transurethral resection of the prostate (TURP) is an established treatment option for benign prostatic hyperplasia (BPH) with bladder outlet obstruction. Recently, the intra-operative void score (IVS) has emerged as a potential objective tool for assessing TURP efficacy by evaluating irrigating fluid flow. This study aimed to investigate IVS's role in predicting outcomes of TURP.

METHODOLOGY

This prospective observational study was conducted at the Institute of Kidney Diseases, Peshawar, Pakistan, from January to March 2025. Forty male patients aged ≥50 years with BPH underwent TURP. IVS was assessed by emptying the bladder, instilling 300 mL of glycine irrigation solution, and applying a standardized 50 newton force to the suprapubic area and the Void score was calculated both pre-resection and post-resection. Patients were stratified into two groups based on combined IVS (high vs low combined IVS) and based on post-resection IVS (high vs low post-resection IVS) and compared for outcomes. Our primary outcomes included a successful trial without catheter (STWOC) and catheter-free follow-up (CFF). Univariate and multivariable analyses were conducted with a significance level set at p<0.05.

RESULTS

This study examined 40 subjects who underwent TURP during the study period. The mean ± SD age was 63.8 ± 8.9 years, and the average prostate size was 70.5 ± 14.3 grams. Sixteen patients had a low combined IVS score, and 24 had a high combined IVS score. A total of 14 patients had a low post-resection IVS, and 26 had a high post-resection IVS. Among these groups, the study population demonstrated balanced baseline characteristics and similar comorbidity profiles (all p>0.05). Multivariable regression analysis demonstrated that high combined IVS had 3.2-fold greater odds of STWOC (aOR=3.2, 95% CI:1.6-6.4, p=0.001) and 3.9-fold greater odds of CFF at six weeks (adjusted odds ratio (aOR)=3.9, 95% CI:1.7-8.9, p=0.002). Similarly, high post-resection IVS was independently associated with improved outcomes, including 2.8-fold greater odds of STWOC (aOR=2.8, 95% CI:1.3-6.0, p=0.008), 3.1-fold greater odds of CFF (aOR=3.1, 95% CI:1.2-8.0, p=0.02).

CONCLUSION

IVS represents a promising tool for real-time assessment of TURP efficacy and prediction of postoperative outcomes. Higher combined and post-resection IVS were associated with significantly higher odds of STWOC and CFF, representing much better outcomes. This simple scoring system could potentially improve surgical decision-making and patient counseling regarding expected outcomes following TURP.