Abstract
Objective: To investigate the relationship between preoperative Neutrophil to lymphocyte ratio (NLR) and Platelet to Lymphocyte ratio (PLR) values and post TURP strictures.
Patients and Methods: A retrospective review of data regarding preoperative absolute neutrophil, lymphocyte and platelet count were recorded for all patients who underwent TURP for benign prostatic hyperplasia in Urology Department from January 2017 to December 2017. Patients who had posterior urethral strictures, documented active infection at the time of TURP, surgery for any other urethral pathology and previous or ongoing treatment for any cancer and hematologic disorders were excluded. Study group comprised of 285 cases. NLR and PLR were calculated. Diagnosis of urethral stricture was suspected when uroflowmetry showed a maximum flow rate of less than 10 mL per second and was confirmed by both urethrogram and cystoscopyin each stricture patient. Receiver operating characteristic (ROC) curve was drawn to determine the cut off value of PLR and NLR for predicting stricture.
Results: Statistically significant differences were observed between the groups in terms of prostate volume, operating time, NLR and PLR. For predicting urethral stricture, the optimal cut-off value of PLR was 111.895, (sensitivity: 1, specificity: 1; AUC=1) and NLR was 2.33 [sensitivity: 0.82; specificity:0.6; AUC=0.721 (0.637 - 0.805)].
Conclusion: There is a definite correlation between inflammatory markers and urethral stricture formation. Both PLR and NLR can be used to determine the probability of development of urethral stricture in patients after TURP.
Keywords: Inflammatory markers, Neutrophil to lymphocyte ratio (NLR), Platelet to Lymphocyte ratio (PLR), Post-TURP stricture.
References
- Stormont TJ, Suman VJ, Oesterling JE. Newly diagnosed bulbar urethral strictures: etiology and outcome of various treatments. J Urol 1993;150:1725-8.
- Kashefi C, Messer K, Barden R, Sexton C, Parsons JK. Incidence and prevention of iatrogenic urethral injuries. J Urol 2008;179:2254-8.
- Jordan GH, McCammonn KA. Surgery of the penis and urethra. Campbell-Walsh Urology. – 10th ed. / editor-in-chief, Alan J. Wein ; editors, Louis R. Kavoussi et al.: Saunders; 2012. p. 967-83.
- Lentz HC, Mebust WK, Foret JD, Melchior J. Urethral stricture following transurethral prostatectomy. Review of 2223 resections. J Urol 1977;117:194-6.
- Feng JF, Huang Y, Chen QX. Preoperative platelet lymphocyte ratio (PLR) is superior to neutrophil lymphocyte ratio (NLR) as a predictive factor in patients with esophageal squamous cell carcinoma. World J Surg Oncol 2014;12:5
- Stucki P, Marini L, Mattei A, Xafis K, Boldini M, Danuser H. Bipolar versus monopolar transurethral resection of the prostate: a prospective randomized trial focusing on bleeding complications. J Urol 2015;193:1371-1375.
- Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol 2006;50:969-80.
- Komura K, Inamoto T, Takai T, Uchimoto T, Saito K, Tanda N, Minami K, Oide R, Uehara H, Takahara K, Hirano H, Nomi H, Kiyama S, Watsuji T, Azuma H. Incidence of urethral stricture after bipolar transurethral resection of the prostate using turis: results from a randomised trial. BJU Int 2015;115:644-652.
- Hart AJL, and Fowler JW: Incidence of urethral stricture after transurethral resection of prostate. Urology 18:588–591, 1981.
- Hammarsten J, Lindqvist K, and Sunzel H: Urethral strictures following transurethral resection of the prostate: the role of the catheter. BJU Int 63: 397–400, 1989.
- Hoffmann r. Transurethraleresektion (TUrP) und transurethraleinzision (TUiP) der Prostata. in: Hoffmann r (editor). endoskopischeUrologie. Heidelberg: Springer; 2005. p. 50-84.
- Hartung r, May F. Die transurethral eelektro resektion der Prostata. BJU int 2006;98(4):921-934.
- García P, Schroede M, Soler M, Mendoza F. Risk factors for developing urethral stricture in patients that underwent transurethral resection of the prostate. Rev Mex Urol. 2013;73(4):166–174
- Nielsen KK, and Nordling J: Urethral stricture following transurethral prostatectomy. Urology 34: 18–24, 1990.
- Chambers RM, Baitera B. The anatomy of the urethral stricture. Br J Urol 1977; 49: 545–51
- Mundy AR, Andrich DE. Urethral strictures. BJU Int 2011;107:6-26
- Nielsen KK, and Nordling J: Urethral stricture following transurethral prostatectomy. Urology 34: 18–24, 1990.
- Cavalcanti AG, Costa WS, Baskin LS, McAninch JA, Sampaio FJ. A morphometric analysis of bulbar urethral strictures. BJU Int 2007;100:397-402.
- Alessandro Sciarra, Stefano Salciccia, Luca Albanesi, Antonio Cardi, Giuseppe D’Eramo and Franco Di Silverio, Use of cyclooxygenase-2 inhibitor for prevention of urethral strictures secondary to transurethral resection of the prostate, Urology, 66, 6, (1218), (2005)
- Sharpe JR, and Finney RP: Urethral strictures: treatment with intralesional steroids. J Urol 116: 440–448, 1976.
- Kirschenbaum A, Klaisner AP, Lee R, et al: Expression of cyclooxygenase 1 and 2 in the human prostate. Urology 56: 671–676, 2000.
- Tsujii M, and Du Bois RN: Alterations in cellular adhesion and apoptosis in epithelial cells overexpressing prostaglandin endoperoxide synthase 2. Cell 83: 493–501, 1995.
- Kim HS, Ku JH. Systemic Inflammatory Response Based on Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker in Bladder Cancer. Dis Markers. 2016; 2016:8345286.
- Sidaway P. Prostate cancer: Platelet-to-lymphocyte ratio predicts prostate cancer prognosis. Nat Rev Urol 2015;12:238
- Yamagata M, Mikami T, Tsuruta T, Yokoyama K, Sada M, Kobayashi K, et al. Submucosal fibrosis and basic-fibroblast growth factor-positive neutrophils correlate with colonic stenosis in cases of ulcerative colitis. Digestion. Karger Publishers; 2011;84: 12–21.
- Werner S, Grose R. Regulation of wound healing by growth factors and cytokines. Physiol Rev 2003;83:835-70.
- El-Sakka AI, Hassoba HM, Pillarisetty RJ, Dahiya R, Lue TF. Peyronie’s disease is associated with an increase in transforming growth factor-beta protein expression. J Urol 1997;158:1391-4.
- Kamath VV, Krishnamurthy S, Satelur KP, Rajkumar K. Transforming growth factor-β1 and TGF-β2 act synergistically in the fibrotic pathway in oral submucous fibrosis: An immunohistochemical observation. Indian J Med Paediatr Oncol 2015;36:1116.
- Sangkum P, Gokce A, Tan RB, Bouljihad M, Kim H, Mandava SH, et al. Transforming Growth Factor-β1 Induced Urethral Fibrosis in a Rat Model. J Urol 2015;194:820-7
- Shen L, Smith JM, Shen Z, Eriksson M, Sentman C, Wira CR. Inhibition of human neutrophil degranulation by transforming growth factor-beta1. Clin Exp Immunol. 2007;149(1):155-61.
Corresponding Author
Shanmugha Das K.V
Department of Urology, Government Medical College, Kozhikode, Kerala University of Health Sciences
DOI: https://dx.doi.org/10.18535/jmscr/v7i9.116
