糖尿病與高齡男性接受微創手術治療後臨床結果之相關性

徐志豪、楊宇祥

台北市立萬芳醫院-委託臺北醫學大學辦理 泌尿科

Association Between Diabetes Mellitus and Clinical Outcomes in Aging Males Undergoing Minimally Invasive Surgical Therapies

Chih-Hao Hsu, Yu-Hsiang Yang

Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.

Purpose:

Previous evidence suggests that diabetes mellitus (DM) is associated with suboptimal outcomes in patients undergoing conventional transurethral resection of the prostate (TUR-P). Recently, minimally invasive surgical therapies (MISTs), including UroLift and Rezūm, have emerged as alternative treatment options for benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTSs), particularly in patients with multiple comorbidities. This study aimed to compare LUTS-related and clinical outcomes between patients with and without DM undergoing UroLift or Rezūm.

Materials and Methods:

In this retrospective cohort study, data were extracted from the TriNetX database, including 5,158 patients with persistent LUTSs who underwent UroLift or Rezūm for benign prostatic enlargement (BPE). Patients were stratified into DM and non-DM groups. To minimize confounding due to baseline differences, 1:1 propensity score matching was performed based on key prognostic variables to generate well-balanced cohorts.

Results:

Following surgery, patients with DM demonstrated a modestly increased risk of urinary tract infection (UTI) compared to non-DM patients (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.013–1.293). However, no statistically significant differences were observed between the groups in terms of acute urinary retention (AUR) (HR 0.90, 95% CI 0.771–1.069), ejaculatory function (HR 1.15, 95% CI 0.69–1.90), sexual dysfunction (HR 0.91, 95% CI 0.76–1.10), reintervention rate (HR 1.02, 95% CI 0.84–1.26), or postoperative medication-free status (HR 0.98, 95% CI 0.77–1.26).

Conclusion:

Although DM was associated with a slightly increased risk of postoperative UTI following UroLift or Rezūm, no significant differences were identified in AUR, reintervention, sexual outcomes, or medication-free rates compared to non-DM patients. Given prior evidence of poorer outcomes with TUR-P in patients with DM, MISTs may serve as a feasible and effective alternative for managing BPH-related LUTSs in this population.