Absence of metabolic syndrome, preoperative urinary symptoms and flow predict positive trifecta outcome after transurethral resection of prostate: development of a clinical nomogram

De Nunzio C1, Cancrini F1, Lobardo R1, Sica A1, Tema G1, D'Annunzio S1, Baldassarre V1, Tubaro A1

Research Type


Abstract Category

Prostate Clinical / Surgical

Abstract 168
E-Poster 1
Scientific Open Discussion ePoster Session 7
Wednesday 4th September 2019
13:10 - 13:15 (ePoster Station 10)
Exhibition Hall
Benign Prostatic Hyperplasia (BPH) Surgery Male
1.Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy,

Fabiana Cancrini




Hypothesis / aims of study
Recently, trifecta outcome has been proposed to evaluate transurethral resection of prostate outcome. Aim of our study was to evaluate the risk factors for favourable trifecta outcome in patients with lower urinary tract symptoms and benign prostatic enlargement (LUTS-BPE) undergoing transurethral resection of prostate (TURP).
Study design, materials and methods
From 2015 onward, a consecutive series of patients with LUTS-BPE undergoing transurethral resection of prostate were propectively enrolled. Patients were evaluated using the International Prostate Symptom Score (IPSS), uroflowmetry and transrectal ultrasound prostate volume assessment (TRUS). Metabolic syndrome (MetS) was defined according to Adult Treatment Panel III (ATP III). Outcomes were evaluated considering the trifecta favourable outcome which was defined as a combination of the following items: (1) no perioperative complications, (2) postoperative IPSS <8, and (3) postoperative Qmax >15 ml/s. Based on the logistic regression analysis a nomogram was generated. Discrimination, calibration and net benefit was assessed using LROC, calibration plots and decision curve analysis.
143 patients were enrolled with a median age of 70 years (IQR 65/73), a median BMI of 25 kg/m2 (IQR: 24/28) and a median PSA of 4 ng/ml (IQR 3/8).  Preoperatively, median Qmax was 8 (6/10) ml/s, median IPSS was 17 (IQR 13/23) and median TRUS was 60 ml (IQR: 49/82). Overall 83/143 (58%) presented a positive trifecta outcome. Overall 55/143 (38%) patients presented the MetS and out of them 22/55 (40%) a positive trifecta outcome (p=0.001).
Interpretation of results
On multivariate analysis preoperative low IPSS, preoperative high Qmax and absence of MetS were independent predictors of trifecta. The predicted accuracy of the model was 0,76. Calibration of the model was excellent (p=0.91). A net benefit was recorded in the range of probabilities between 35 and 95%.
Concluding message
In our study absence of  Metabolic Syndrome, symptoms and uninary flow are predictors of favourable trifecta outcome. If externally validated our nomogram may help in the preoperative counseling of patients.
Figure 1
Funding None Clinical Trial No Subjects Human Ethics Committee Sant'Andrea Hospital Helsinki Yes Informed Consent Yes