Diabetes mellitus patients require higher rates of continuing medication after transurethral resection of prostate: implications from taiwan nationwide population-based cohort study
糖尿病患在攝護腺刮除後有高比例地需要持續使用藥物控制: 全民健康保險研究資料庫研究
Chih-Te Lin1 ,Chen-Pang Hou1,2,Yu-Hsiang Lin1,2.4, Tien-Hsing Chen2.5., Horng-Heng Juang3, Phei-Lang Chang1,2, Pei-Shan Yang1,2, Yu-Sheng Lin2,6, Chien-lun Chen1,2, Ke-Hung Tsui1,2
林志德、侯鎮邦、林友翔、陳添興、莊宏亨、張慧朗、楊佩珊、林祐賸、陳建綸、崔克宏
- Department of Urology, Chang Gung Memorial Hospital at linkou, Taiwan, Republic of China
林口長庚紀念醫院 外科部 泌尿科
- School of Medicine, Chang Gung University, Taiwan, Republic of China
長庚大學醫學院
- Department of Anatomy, School of Medicine, Chang Gung University, Kwei-shan, Tao-Yuan, Taiwan, Republic of China
長庚大學醫學院 解剖學系
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan, Republic of China
- 醫學研究所
- Division of Cardiology, Department of Internal medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
林口長庚紀念醫院 內科部 心臟科
6. Division of Cardiology, Department of Internal medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China
嘉義長庚紀念醫院 內科部 心臟科
Objective
The relationship between Benign prostate hyperplasia (BPH) and diabetes mellitus (DM) have been well-discussed in the literature. However, very few studies have focused on the treatment results of DM patients who have undergone transurethral resection of the prostate (TUR-P).
Objective:
The aim of this study was to compare the clinical outcomes between diabetic patients and non-diabetic patients receiving TUR-P
Design, Setting, and Participants :
This analysis was a retrospective cohort study using 13 years (2000-2012) of claims data from Taiwan’s National Health Insurance Research Database (NHIRD). A total of 4887 patients who had persistent lower urinary tract symptoms (LUTS) and underwent TUR-P for BPH were enrolled and divided into two groups: DM and Non-DM group.
Outcome Measurements and Statistical Analysis :
The patients’ characteristics, post-operative clinical outcomes, and the medication records after TUR-P were compared. Chi-square test was used for categorical variables and independent sample t-test for continuous variables. Multivariable logistic regression analysis was used to compare the risk of postoperative outcomes. Finally, estimations of the medication-free survival rate after TUR-P using Kaplan-Meier method were compared between study groups using log-rank test.
Results and Limitations
DM group patients had a higher prevalence of comorbidities. Post-operatively, the DM group had lower rates of UTI (OR, 0.78; p=0.009) and higher rates of urinary retention requiring catheterization (OR, 1.35; p=0.01) within 1 month after TUR-P. A higher proportion of patients with DM took anti-muscarinics (OR, 1.23; P = 0.032) within the first 3 months and α-blockers (OR, 1.18; P = 0.049) during 3-12 months after receiving TUR-P. Overall, the DM group patients had a worse post-operative medication-free survival compared to that of non-DM group patients (95% CI=1.14; p=0.005). The main limitation of this study inherited from the data structure of NHIRD. This database did not contain enough personal information which may be confounding variables influencing urinary tract symptoms.
Conclusions:
Diabetes Mellitus patients require higher rates of continuing medication after TUR-P, especially anti-muscarinics in three months post-op and alpha-blocker after three months post-op. Diabetes Mellitus patients also had higher incidence of urine retention after surgery.
Patient Summary:
DM patients had relatively poor treatment outcomes compared to DM-free patients