經尿道前列腺切除術／經尿道前列腺剜除術圍手術期口服類固醇暴露與術後膀胱頸攣縮後續介入治療之關聯：一項 TriNetX 探索性世代研究

曾華緯、曾文歆、黃冠華

奇美醫學中心 外科部 泌尿科

Perioperative Oral Steroid Exposure and Subsequent Intervention for Bladder Neck Contracture After TURP/TUEP: A TriNetX Exploratory Cohort Study

Hua-Wei Tseng, Wen-Hsin Tseng, Steven K. Huang

Divisions of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

Purpose: Bladder neck contracture (BNC) is an uncommon but clinically significant late complication after transurethral surgery for benign prostatic obstruction. Previous studies reported that adjuvant oral deflazacort after optical internal urethrotomy was associated with reduced urethral stricture recurrence and improved postoperative flow rates, suggesting a potential anti-inflammatory and anti-scarring role for oral steroids. Based on this concept, we evaluated whether perioperative oral steroid exposure is associated with subsequent intervention for BNC after TURP/TUEP.

Materials and Methods: This retrospective exploratory cohort study used the TriNetX Global Collaborative Network. Patients undergoing TURP/TUEP were identified by procedure codes. Perioperative oral steroid exposure was defined as deflazacort, cortisone, prednisolone, or prednisone within 7 days before to 14 days after surgery; patients without such exposure served as controls. The outcome was subsequent BNC-related intervention, defined by specific bladder neck procedure codes. Outcome analysis began 30 days after surgery, and patients with outcomes before the time window were excluded. Propensity score matching was performed for baseline characteristics.

Results: Before matching, 3,113 patients were identified in the steroid cohort and 160,038 in the control cohort. After matching, 3,082 patients remained in each cohort. Following exclusion of patients with outcomes before the analysis window, 3,020 steroid-exposed and 3,039 controls were included in risk analysis. BNC-related intervention occurred in 26 patients in each group (0.9% vs 0.9%). No significant difference was found in risk difference, risk ratio, or odds ratio. Kaplan-Meier analysis also showed no significant difference (log-rank p=0.787; HR 1.078, 95% CI 0.626–1.857).

Conclusions: Perioperative oral steroid exposure was not associated with a significant difference in subsequent intervention for BNC after TURP/TUEP. Given the low event count, these findings should be considered exploratory. Further studies with larger sample sizes are needed.