魏子鈞1,2 林子平1,2 林登龍1,2 鍾孝仁1,2 黃逸修1,2 陳光國1,2
國立陽明大學 醫學院 泌尿學科 及 書田泌尿科學研究中心2
For smaller weight transurethral resection of prostate, combined transurethral incision of bladder neck is an independent factor for less urinary retention rate. --- A nation-wide database study
Tzu-Chun Wei1,2, Tzu-Ping Lin1,2, Alex T. L. Lin1,2, Hsiao-Jen Chung1,2, Eric YH Huang1,2, Kuang-Kuo Chen1,2
Department of Urology1, Taipei Veterans General Hospital, Taiwan
Department of Urology, School of Medicine, and Shu-Tien Urological Institute2, National Yang Ming University, Taipei, Taiwan
Purpose: If the resection weight of transurethral resection of prostate (TURP) is smaller, acute urinary retention (AUR) after the operation may be a complication of great concern, especially for those without Foley indwelled previously. However, whether combined transurethral incision of bladder neck (TUIBN) may reduce AUR rates after the operation is still a question. Therefore, this article is aimed to analyze AUR rates after smaller resection weight of TURP in Taiwan according to the claims of the National Health Insurance (NHI) program.
Materials and Methods: From the NHI Research Database of Taiwan, we applied for the all the claims of patients who ever visited urology clinic during 2006 to 2010. We received all the records of both admission and ambulatory clinics. In Taiwan, the NHI divides TURPs into four categories according to the resection weight (<5g, ≧5~15g, ≧15~50g, and ≧50g, respectively), and the first group (<5g) was defined as “smaller weight TURP”. AUR was defined as any kind of indwelling catheterization within 2 weeks after TURP with or without TUIBN. Patients younger than 40 years old were excluded. Patients who received TUIBN or optic or otis urethrotomy within 1 year before TURP and 2 months after were excluded, as well as those who had TURPs within 2 months between each surgery or long admission period (14 dats) after TURP. Patients who had diagnosis of prostate or bladder cancer within 3 months peri-operatively were excluded. ICD-9 codes for hypertension (HTN), diabetes mellitus (DM), cerebral vascular disease (CVA), spinal stenosis (SS), and herniated intervertebral disc (HIVD) were used for disease confirmation only when the diagnoses existed at least one year before TURP. Descriptive and comparative analyses were performed.
Results: There were 2597 TURPs analyzed, including 2497 TURPs only (group A) and 100 TURPs with combined with TUIBN (group B). The hospitalization days mainly ranged from 3 to 5 days. The mean age was 72.45, with 72.69 and 71.86 in group A and B respectively. Among all patients included, 245 of them were associated with AUR (9.43%), with 9.69% and 3.00% in group A and B (P=0.022). Patient who had previous AUR episodes within 2 months before TURP was of 23.64%, but pre-OP AUR was not significantly associated with higher post-OP AUR rate (11.24%) than no AUR before TURP (8.88%) (P=0.083). About co-morbidities, HTN, DM, CVA, SS, and HIVD were not significant risk factors for AUR after TURP (P=0.934, 0.426, 0.111, 0.976, and 0.362 respectively). In multivariate analysis, combined TUIBN and younger age are the only two significant factors associated with less AUR rates after smaller weight TURPs. (P=0.041 and 0.028 respectively)
Conclusion: In Taiwan, most patients treated with smaller weight TURP without combined TUIBN. However, AUR rate is significantly lower in patients receiving combined TURP with TUIBN, regardless of pre-OP Foley indwelling or other co-morbidities. Although further randomized clinical trials are still necessary, it implies that for patients with bladder outlet obstruction treated with smaller resection weight of TURP, combined TUIBN may be beneficial, especially regarding the post-OP AUR episodes.