圍術期抗精神病藥物暴露增加經尿道前列腺手術後尿滯留之風險：一項真實世界世代研究

鄭宛妤¹、高士凱²、黃聖淇³、曾文歆^1,4、黃冠華¹

¹臺南永康奇美醫院,外科部,泌尿科；²臺北榮民總醫院,精神醫學部；³臺南永康奇美醫院,教學部,一般科；⁴ 國立中山大學生物醫學研究所

Perioperative Antipsychotic Exposure Increases the Risk of Postoperative Urinary Retention Following Transurethral Prostate Surgery: A Real-World Cohort Study

Wan-Yu Cheng¹、Shih-Kai Kao²、Sheng-Chi Huang³、Wen-Hsin Tseng^1,4、Steven K. Huang¹

¹ Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; ² Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; ³ Department of General Medicine, Chi Mei Medical Center, Tainan, Taiwan; ⁴ Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan;

Purpose: To evaluate the association between perioperative antipsychotic exposure and the risks of postoperative urinary retention (POUR) and urologic complications following transurethral prostate surgery, emphasizing age, timing, and surgical type-specific effects.

Materials and Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, identifying men aged ≥ 40 years undergoing transurethral prostate surgery between 2010 and 2025. Propensity score matching (1:1) balanced baseline characteristics. The primary outcome was POUR within 30 days; secondary outcomes included urinary tract infection (UTI) and obstructive uropathy.

Results: After matching (n=6,627 per group), antipsychotic exposure was associated with significantly higher risks of POUR (16.7% v.s. 13.1%; HR, 1.28; p<0.001), UTI (HR, 1.36; p<0.001), and obstructive uropathy (HR, 1.24; p<0.001). The risk of POUR was more pronounced in patients aged ≥ 75 years (HR, 1.26; p<0.001) and those undergoing transurethral enucleation (TUEP: HR, 1.26, p=0.001 vs. TURP: p=0.246). Notably, preoperative exposure yielded the highest risk (HR, 1.65; p<0.001). Both first-generation (HR, 1.30; p<0.001) and second-generation (HR, 1.31; p=0.002) antipsychotics showed consistent risks.

Conclusion: Perioperative antipsychotic exposure is a significant modifiable risk factor for POUR and related complications following transurethral prostate surgery, particularly with preoperative use and in elderly patients. These findings underscore the necessity of comprehensive perioperative medication review and multidisciplinary management to optimize postoperative bladder outcomes.