The distressing lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) have a major negative influence on quality of life. Although patient response varies, transurethral resection of the prostate (TURP) is still the cornerstone for patients not responsive to medications. To help urologists with risk assessment and enhance patient counselling, this project intends to create and evaluate a predictive nomogram that integrates important preoperative clinical and diagnostic factors to estimate individualised TURP efficacy.

From December 2019 to January 2024, a retrospective study was carried out at the Department of Urology, SRIHER. 367 patients made up the primary cohort, and 177 patients made up the validation cohort of the 544 BPH patients receiving TURP that were examined. Exclusion criteria were previous urological procedures, urethral strictures, bladder calculi, neurogenic bladder, and prostate/bladder cancer; inclusion criteria included verified BPH cases undergoing TURP. Uroflowmetry, renal function assessment, digital rectal examination (DRE), International Prostate Symptom Score (IPSS), Quality of Life (QoL) index, and ultrasonographic parameters like dilatation of upper tracts, bladder wall thickness (BWT) and postvoid residual urine (PVR) were all part of the preoperative evaluation. Using uroflowmetry, USG KUB, IPSS, and improvements in quality of life, postoperative outcomes were evaluated at three to six months. When two or more postoperative indicators significantly improved, TURP efficacy was considered successful.

Significant improvements were seen in IPSS reduction (mean: 21.3 ± 5.6 to 7.8 ± 3.4, p<0.001), QoL index enhancement (mean: 5.2 ± 1.3 to 1.8 ± 0.9, p<0.001), and peak urinary flow rate (Qmax) increase (mean: 7.9 ± 3.1 mL/s to 18.2 ± 4.6 mL/s, p<0.001) after TURP, which was effective in 81.2% (n=289) of the primary cohort. Six independent indicators of TURP success were found using multivariate logistic regression: age, IPSS, intravesical extension of the prostate (IVEP), BWT, Society for Foetal Urology grade (SFU), and renal failure. Using the R rms package, a predictive nomogram called e-TURP was created and verified. It showed good calibration and differentiation (C-index: 0.860, 95% CI: 0.808–0.911). The model maintained strong predictive accuracy in the validation cohort, with an ideal cutoff score of 157 according to the Youden index (0.643). The model's dependability in clinical settings was highlighted by sensitivity and specificity evaluations, which showed an area under the ROC (receiver operating characteristic) curve of 0.875.

To improve decision-making and patient counselling, the e-TURP nomogram integrates six essential preoperative indicators to offer a feasible tool for preoperative risk classification in BPH patients undergoing TURP. Retrospective design, single-centre data, and possible variation in surgical procedures are among the drawbacks despite excellent validation.