經尿道前列腺切除與保守藥物治療比較起來對於良性前列腺肥大造成之尿滯留會有較佳的臨床預後
侯鎮邦、林友翔、曹書翰、張慧朗、陳建綸、侯俊名、楊珮珊、崔克宏
長庚醫療財團法人林口長庚紀念醫院 泌尿外科
Compared to conservative medical treatment transurethral resection of the prostate achieves better clinical outcomes in patients with urinary retention due to benign prostate obstruction
Chen-Pang Hou, Yu-Hsiang Lin, Shu-Han Tsao, Phei-Lang Chang, Chien-Lun Chen, Chun-Ming Hou, Pei-Shan Yang, Ke-Hung Tsui.
Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Purpose: To evaluate the surgical outcomes of patients with urinary retention due to benign prostatic obstruction (BPO) who underwent transurethral resection of the prostate (TURP) and compare the outcomes with those who received medication treatment without surgical intervention.
Materials and Methods: This retrospective cohort study analyzed claims data collected during the period of 1997–2012 from Taiwan National Health Insurance Research Database. Our study targets were patients diagnosed with symptomatic BPH and suffered from urinary retention during this period. The excluding criteria were those with concomitant prostate cancer, bladder cancer, long-term urinary catheter indwelling, and those who did not receiveαblocker medication regularly. The patients of age < 40 or >90 were also excluded in our study. They were categorized into a TURP (n = 1218) and medication only (n = 795) group. After 1:1 matching with propensity score, the patient characteristics, postoperative clinical outcomes, and geriatric related adverse events were recorded and compared.
Results: After 1:1 matching with propensity score there was no significant difference in patient baseline data between the two groups. Compared to the medication group, the TURP cohort had a lower incidence of urinary tract infection (UTI) and urinary retention (UR) during the post-op 2 months to 3 years (20.7% vs. 28.9% and 12.5% vs. 27.6%, respectively, p <0.001). The life-long bone fracture incidence was also lower in the TURP cohort (7.9% vs. 9.2%, p=0.048). The patients receiving TURP had a better bone fracture-free survival (HR 95% CI=0.58, p=0.016). The mortality rate of any cause during the study period was also lower in the TURP group (31.7% vs.46.5%, p <0.001). Nevertheless, there was no difference between the two groups in regards to the incidence of an inguinal hernia, hemorrhoids, cerebral vascular accident, and acute myocardial infarction during the postop follow-up years.
Conclusions: Our large-scale data study reveals that, compared to conservative treatment, TURP achieves better clinical outcomes in patients with UR due to BPH. Thus, early surgical intervention should be considered in such patients.