良性攝護腺肥大病人發生術後血尿之術前危險因子探討

曹書瀚、王敘涵、朱聖賢、陳孝文、王大民、江仰仁、劉冠麟、林國仁

林口長庚紀念醫院 泌尿科

Evaluating the risk factors of postoperative hematuria in patients receiving TURP or laser prostatectomy

Shu-Han Tsao, Hsu-Han Wang, Sheng-Hsien Chu, Hsiao-Wen Chen, Ta-Min Wang,Yang-Jen Chiang, Kuan-Lin Liu, Kuo-Jen Lin

Department of Urology, Chang Gung Memorial Hospital, Taipei, Taiwan


Purpose: We aim to find out the risk factors of postoperative hematuria in patients receiving transurethral resection of prostate or laser prostatectomy.

Materials and Methods: Study population consisted of 713 patients undergoing surgical intervention for benign prostatic hyperplasia at a single medical center from 2016/01 to 2016/12. Severe postoperative hematuria was defined as hematuria requiring emergency department visit or transurethral check bleeding in a follow-up of 1 month. Exposures of interest included age, BMI, preoperative indwelling catheter, prostate volume, preoperative diagnosis of pyuria, operative duration, operative procedures, and use of oral antiplatelet therapy or 5 alpha reductase inhibitors.

Results: Among 713 patients, 388 patients are available with data of preoperative transrectal ultrasonography within one year before operation. We further choose 1 from 2 randomly and made our control group as 194 patients. Severe postoperative hematuria occurred in 41 patients during a follow-up of 1 month. 16 patients underwent bipolar TURP. 21 patients underwent Thulium laser prostatectomy, and 4 patients underwent green light laser prostatectomy. No statistical significance was found between different operative procedures or shape of prostate gland. Multivariate analysis revealed that the odds of postoperative hematuria increased with prostate volume (OR 1.03, 1.00–1.05), preoperative blood WBC (OR 1.23, 1.02–1.47), preoperative prothrombin time (OR 1.77, 1.19–2.61) and preoperative diagnosis of pyuria (OR 6.58, 1.20–36.10).

Conclusions: Larger prostate size, higher preoperative blood WBC, higher preoperative prothrombin time and preoperative diagnosis of pyuria were associated with a higher risk of postoperative hematuria requiring emergency department visit or transurethral check bleeding.