Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2019 May;82(5):381-384. doi: 10.1097/JCMA.0000000000000088.
Some patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms hesitate to undergo surgical treatment until acute urinary retention (AUR) occurs. Some of these patients have been found to have hydronephrosis or even renal insufficiency. This study aimed to analyze the risk factors for hydronephrosis in patients with AUR who needed to receive transurethral resection of the prostate (TURP).
We retrospectively analyzed 91 patients from January 2014 to June 2015, who had BPH and received TURP for AUR. Patients with urolithiasis, prostate cancer, bladder cancer, gross hematuria, previous bladder radiation therapy, or urinary tract surgery were excluded. Parameters of intravesical prostatic protrusion (IPP), serum prostatic specific antigen (PSA), total prostate volume (PV), age, body mass index (BMI), hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), and serum creatinine (Cr) were compared between the hydronephrosis and non-hydronephrosis groups.
There were significant differences in IPP (p < 0.001) and Serum Cr (p < 0.001) between the hydronephrosis and non-hydronephrosis groups. For IPP, the cut-off values of the highest risk of hydronephrosis was 1.95 cm. There were no significant differences in age, BMI, DM, HTN, CAD, total PV, and PSA between the two groups. IPP was not correlated with total PV (p = 0.423). Most of the patients with hydronephrosis had renal function improvement after TURP.
IPP was a significant risk factor for hydronephrosis in BPH patients. If the patients' IPP exceeded 1.95 cm, they had a higher risk of having hydronephrosis when AUR occurred. Hydronephrosis is a risk factor for renal insufficiency, and Serum Cr levels decreased significantly in the patients of our study.
一些患有良性前列腺增生（BPH）和下尿路症状的患者直到发生急性尿潴留（AUR）才会接受手术治疗。其中一些患者已经发现有肾积水甚至肾功能不全。本研究旨在分析需要接受经尿道前列腺切除术（TURP）的 AUR 患者发生肾积水的危险因素。
我们回顾性分析了 2014 年 1 月至 2015 年 6 月期间 91 例因 BPH 接受 TURP 治疗 AUR 的患者。排除有尿路结石、前列腺癌、膀胱癌、肉眼血尿、既往膀胱放射治疗或尿路手术的患者。比较肾积水组和非肾积水组患者的膀胱内前列腺突入（IPP）、前列腺特异性抗原（PSA）、前列腺总体积（PV）、年龄、体重指数（BMI）、高血压（HTN）、糖尿病（DM）、冠心病（CAD）和血清肌酐（Cr）等参数。
肾积水组和非肾积水组的 IPP（p<0.001）和血清 Cr（p<0.001）有显著差异。对于 IPP，肾积水的最高风险截断值为 1.95cm。两组间年龄、BMI、DM、HTN、CAD、总 PV 和 PSA 无显著差异。IPP 与总 PV 无相关性（p=0.423）。大多数肾积水患者在 TURP 后肾功能得到改善。
IPP 是 BPH 患者肾积水的显著危险因素。如果患者的 IPP 超过 1.95cm，发生 AUR 时发生肾积水的风险更高。肾积水是肾功能不全的危险因素，本研究患者的血清 Cr 水平显著下降。
