RESEARCH ARTICLE


Elevated Tumor Necrosis Factor-α and Transforming Growth Factor-β in Prostatic Tissue are Risk Factors for Lower Urinary Tract Symptoms after Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Patients with Urinary Retention



Gede W.K. Duarsa1, *, Anak A. G. Oka1, Sri Maliawan2, Doddy M. Soebadi3, Putu Astawa2, Made Bakta2, Dewa M. Sukrama2, Ida B. P. Manuaba4, Nyoman M. Astawa5
1 Urology Department, Medical Faculty of Udayana University, Sanglah Hospital Denpasar, Bali, Indonesia
2 Medical Faculty of Udayana University, Sanglah Hospital Denpasar, Bali, Indonesia
3 Urology Department, Medical Faculty of Airlangga University, Surabaya, Indonesia
4 Department of Biomedical Science, Udayana University, Bali, Indonesia
5 Department of Veterinary, Udayana University, Bali, Indonesia


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© 2018 Duarsa et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Urology Department, Medical Faculty of Udayana University, Sanglah Hospital Denpasar, Bali, Indonesia; Tel: +628155753377; E-mail: gwkduarsa@yahoo.com


Abstract

Background:

Lower Urinary Tract Symptoms (LUTS) after Transurethral Resection of the Prostate (TURP) occur in one-third of Benign Prostatic Hyperplasia (BPH) patients, may be caused by persistent prostatic inflammation and fibrosis.

Objective:

This study aims to evaluate the role of inflammation and fibrosis in pathological mechanism of LUTS among patients with BPH who underwent TURP by assessing their PSA, TNF-α, and TGF-β level.

Design, Setting, and Participant:

Data in this study were analyzed with the 2-way hypothesis. The study used odds ratio to define the risk factors of LUTS after TURP. The samples of the study are BPH patients after TURP aged 50-80 years old.

Interventions:

No intervention(s).

Outcome Measurements and Statistical Analysis:

The data analyzed using SPSS version 21.0 for Windows.

Results and Limitations:

There were 34 cases of LUTS and 42 controls without LUTS. We found that there were an increased levels of TNF-α (> 46.95 pg/ml) (OR 55.6, 95% Confidence Interval [CI] 11.1-278.4, p=0.00) and TGF-β (> 207.63 pg/ml) (OR 16.7, 95%CI 5.3-52.8, p=0.00). The result of multiple linear logistic regression analysis obtained equation Y= 0.033 x TNF-α + 0.031 x TGF-β. Population Attributable Risk (PAR) % TNF-α is 60%, PAR % TGF-β is 53%.

Conclusion:

Combination of elevated levels of TNF-α (>46.95 pg/ml) and TGF-β (>207.63) in prostate tissue is the risk factors for the occurrence of LUTS after TURP.

Patient Summary:

In this study, we enrolled 76 patients who were diagnosed with BPH and urinary retention. After TURP, there were 34 cases of LUTS and 42 controls without LUTS. We found that the levels of TNF-α and TGF-β between cases and controls were significantly different. We conclude that the combination of elevated levels of TNF-α and TGF-β in prostate tissue is the risk factors for the occurrence of LUTS after TURP.

Keywords: PSA, TNF-α, TGF-β, LUTS, TURP, Urinary retention.