Predictors of reoperation after transurethral resection of the prostate in a diverse,urban academic centre

Abstract

Objective:

To evaluate predictors of reoperation after transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) in a diverse patient population.

Materials and methods:

A retrospective chart review was performed on men who underwent TURP between 2013 and 2016 at our institution with follow-up data post-operatively. Variables collected included patient demographics and clinical characteristics. Primary outcomes included whether the patient underwent repeat TURP and months elapsed since initial TURP.

Results:

A total of 304 men underwent TURP during the study period. Thirty men (10%) underwent repeat TURP at a mean interval of 26 months. Reoperation after TURP was not associated with race, body mass index (BMI), 5-alpha-reductase inhibitor (5-ARI) use, or pre-operative prostate volume. An elevated pre-operative haemoglobin A1c (HbA1c) was associated with both reoperation (odds ratio (OR) = 1.32, 95% confidence interval (CI): 1.03–1.69), 30 day readmission (OR = 1.96, 95% CI: 1.17–3.28) and 30-day hematuria (OR: 2.37, 95% CI: 1.29–4.38). Pre-operative prostate specific antigen (PSA) levels > 4 and hydronephrosis on imaging were also associated with a higher risk of reoperation.

Conclusions:

Reoperation after TURP occurred in 10% of our study cohort at a median of 26 months after surgery. Elevated HbA1c prior to surgery was associated with reoperation, 30-day readmission and 30-day hematuria. Higher risk of post-operative complications in patients with poorly controlled diabetes should be communicated at the time of decision for surgery. Future studies should evaluate whether optimising diabetes control prior to TURP reduces risk of reoperation or whether this risk is non-modifiable due to permanent changes in the lower urinary tract due to chronic hyperglycaemia.

Level of evidence:

III

Keywords

Benign prostatic hypertrophy transurethral resection of prostate reoperation diabetes

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References

Crawford

Wilson

McConnell

, et al. Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. J Urol 2006; 175(4): 1422–1426; discussion1426.

Alcaraz

Carballido-Rodriguez

Unda-Urzaiz

, et al. Quality of life in patients with lower urinary tract symptoms associated with BPH: change over time in real-life practice according to treatment—the QUALIPROST study. Int Urol Nephrol 2016; 48(5): 645–656.

Bertaccini

Vassallo

Martino

, et al. Symptoms, bothersomeness and quality of life in patients with LUTS suggestive of BPH. Eur Urol 2001; 40(Suppl. 1): 13–18.

Mayer

Kroeze

Chopra

, et al. Examining the ‘gold standard’: a comparative critical analysis of three consecutive decades of monopolar transurethral resection of the prostate (TURP) outcomes. BJU Int 2012; 110(11): 1595–1601.

Madersbacher

Oelke

Hocker

, et al. Sophisticated surgical management of distinctive patients with benign prostatic hyperplasia (BPH). Urologe A 2020; 59(10): 1168–1176.

Eredics

Wachabauer

Rothlin

, et al. Reoperation rates and mortality after transurethral and open prostatectomy in a long-term nationwide analysis: have we improved over a decade. Urology 2018; 118: 152–157.

Madersbacher

Lackner

Brossner

, et al. Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases. Eur Urol 2005; 47(4): 499–504.

Varkarakis

Bartsch

Horninger

Long-term morbidity and mortality of transurethral prostatectomy: a 10-year follow-up. Prostate 2004; 58(3): 248–251.

Varma

Morgan

JM.

The weight of the prostate gland is an excellent surrogate for gland volume. Histopathology 2010; 57(1): 55–58.

10.

Hammarsten

Hogstedt

Hyperinsulinaemia as a risk factor for developing benign prostatic hyperplasia. Eur Urol 2001; 39(2): 151–158.

11.

Sarma

Parsons

McVary

, et al. Diabetes and benign prostatic hyperplasia/lower urinary tract symptoms–what do we know. J Urol 2009; 182(6 Suppl.): S32–7.

12.

Michel

Mehlburger

Schumacher

, et al. Effect of diabetes on lower urinary tract symptoms in patients with benign prostatic hyperplasia. J Urol 2000; 163(6): 1725–1729.

13.

Sasaki

Yoshimura

Chancellor

MB.

Implications of diabetes mellitus in urology. Urol Clin North Am 2003; 30(1): 1–12.

14.

Breyer

Sarma

AV.

Hyperglycemia and insulin resistance and the risk of BPH/LUTS: an update of recent literature. Curr Urol Rep 2014; 15(12): 462.

15.

Soleimani

Hoseini

Aliasgari

, et al. Long-term outcome of trans urethral prostatectomy in benign prostatic hyperplasia patients with and without diabetes mellitus. J Pak Med Assoc 2010; 60(2): 109–112.

16.

Lin

Hou

Chen

, et al. Is diabetes mellitus associated with clinical outcomes in aging males treated with transurethral resection of prostate for bladder outlet obstruction: implications from Taiwan Nationwide Population-Based Cohort Study. Clin Interv Aging 2017; 12: 535–541.

17.

De Nunzio

Franco

Lombardo

, et al. Phamacological treatment of persistant lower urinary tract symptoms after a transurethral resection of the prostate is predictive of a new surgical treatment: 10 years follow-up study. Neurourol Urodyn 2021; 40(2): 722–727.

18.

Ibrahim

el-Malik

Ghali

, et al. Effect of age, comorbidity and type of surgery on perioperative complications and mortality of prostatectomy. Br J Urol 1995; 76(3): 341–345.

19.

Malaeb

McBean

, et al. National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000-2008). Urology 2012; 79(5): 1111–1116.

20.

McBean

Caldwell

DS.

Unequal use of new technologies by race: the use of new prostate surgeries (transurethral needle ablation, transurethral microwave therapy and laser) among elderly Medicare beneficiaries. J Urol 2006; 175(5): 1830–1835; discussion1835.

21.

Pastore

Mariani

Barrese

, et al. Transurethral resection of prostate and the role of pharmacological treatment with dutasteride in decreasing surgical blood loss. J Endourol 2013; 27(1): 68–70.

22.

Rassweiler

Teber

Kuntz

, et al. Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol 2006; 50(5): 969–979; discussion980.

23.

Sagen

Nelzon

Peeker

Transurethral resection of the prostate: fate of the non-responders. Scand J Urol 2020; 54(5): 443–448.

24.

Frendl

Chen

Chang

, et al. A claims based assessment of reoperation and acute urinary retention after ambulatory transurethral surgery for benign prostatic hyperplasia. J Urol 2021; 205(2): 532–538.