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

## TL;DR

This study shows that the intraoperative voiding score can predict successful outcomes after prostate surgery, helping surgeons make better decisions.

## Contribution

The study introduces the intraoperative voiding score as a novel predictor of TURP outcomes in real-time surgical settings.

## Key findings

- High combined IVS was associated with 3.2-fold greater odds of successful trial without catheter.
- High post-resection IVS was linked to 3.1-fold greater odds of catheter-free follow-up at six weeks.
- IVS is a promising real-time tool for assessing TURP efficacy and predicting postoperative outcomes.

## Abstract

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.