范玉華、鍾孝仁、黃逸修、林登龍、陳光國

台北榮民總醫院 泌尿部；書田泌尿科學研究中心；國立陽明大學泌尿學科

Yu-Hua Fan, Hsiao-Jen Chung, Eric Yi-Hsiu Huang, Alex T. L. Lin, Kuang-Kuo Chen

Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan

Shu-Tien Urological Research Center, Taipei, Taiwan

School of Medicine, National Yang-Ming University, Taipei, Taiwan

 

Purpose: Patients with benign prostatic obstruction may need to strain to void and this effort over time may have a direct impact on the abdominal wall contributing to the development of inguinal hernia (IH). Furthermore, the published data showed that patients with IH present higher intensity of lower urinary tract symptoms. It is interesting to know whether transurethral prostatectomy for benign prostatic hyperplasia (BPH) could reduce the incidence of IH.

Materials and Methods: We recruited male patients who were newly diagnosed with BPH and aged 50 years or older from a urology dataset including 3,431,366 individuals selected from the National Health Insurance Research Database for the year 2006 to 2010. According to treatment strategies, patients were assigned to one of the following categories: transurethral resection of prostate (TURP), α-1 blockers only, 5α-reductase inhibitors ± α-1 blockers. All subjects were followed up to the end of 2010 or the development of IH. Patients were excluded if they had prostatic cancer, constipation, chronic obstructive pulmonary disease, or IH developed within 6 months of diagnosis of BPH. The age-adjusted cox time-dependent model was used to calculate the risk of IH between different treatment groups.

Results: We identified 171965 incident male patients with newly diagnosed BPH. Of the BPH patients, 8294 (4.82 %) underwent TURP (TURP group), 151753 (88.25%) received α-1 blockers only (AB group), 11918 (6.93%) received 5α-reductase inhibitors plus α-1 blockers or not (5ARI group). The incidences of IH in different treatment group were as follows: 93 (1.12%) in TURP group, 2334 (1.54%) in AB group, 147 (1.23%) in 5ARI group. The incidence of IH in either TURP group or 5ARI group was significantly lower than that in AB group (both p < 0.001). There was no difference in incidence rates of IH between TURP and 5ARI group. We further subdivided the TURP group into two subgroups according the weight of resected specimens and these were < 15 gm and ≥ 15 gm. There was no difference in incidence rates of IH between the two subgroups of TURP. No matter what the weight of the resected specimens, significantly lower incidence rates of IH than AB group  were noted. Additionally, there was no difference in incidence rates of IH between TURP < 15gm or > 15gm and 5ARI group.

Conclusions: Regardless of the prostate size, TURP could significantly reduce the incidence of inguinal hernia in BPH patients compared with pharmacological treatment with α-1 blockers only. Nevertheless, combination therapy with 5α-reductase inhibitors could provide the similar effect against IH.