Giulioni Carlo, Palantrani Vanessa, De Stefano Virgilio, Cicconofri Andrea, Antezza Angelo, Beltrami Mattia, Milanese Giulio, Ranghino Andrea, Gauhar Vineet, Castellani Daniele, Galosi Andrea Benedetto
Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy.
Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy.
J Endourol. 2023 Oct;37(10):1129-1138. doi: 10.1089/end.2023.0224. Epub 2023 Aug 31.
Patients who have undergone renal transplant may have a concomitant benign prostatic hyperplasia (BPH), a condition that can potentially hinder the recovery of the renal graft and necessitate surgical intervention. However, endoscopic treatment of BPH should be performed carefully because of the associated perioperative risks. We aimed to systematically assess the factors affecting surgical indications and perioperative outcomes of BPH surgical treatment in renal transplantation (RT) recipients. A systematic literature search was performed on January 28, 2023, using Scopus, PubMed, and EMBASE with no date limit. Preclinical and animal studies, reviews, letters to the editor, case reports, and meeting abstracts were excluded. Eighteen articles were accepted and included. Clinical BPH has a high incidence rate after RT, particularly in elderly men. Secondary events associated with BPH, such as acute urinary retention and urinary tract infections, can lead to a gradual decline of renal graft function and patient survival. BPH procedure can prevent these events and guarantee improvements in serum creatinine levels, voiding parameters, and lower urinary tract symptoms. When the urine culture is negative, the endoscopic procedure of the prostate may be performed within 1 month of the initial procedure, particularly in older patients, more prone to develop voiding dysfunction. Alternatively, a transurethral incision of the prostate may be recommended for patients with smaller prostates who wish to preserve ejaculatory function. Data on comparative BPH surgical procedures are lacking. BPH procedure should be offered in RT recipients who develop bladder outlet obstruction owing to BPH. Endoscopic treatment should be performed after a few weeks from RT to avoid further graft deterioration.
接受肾移植的患者可能同时患有良性前列腺增生（BPH），这种情况可能会阻碍肾移植的恢复，并需要进行手术干预。然而，由于围手术期风险，BPH的内镜治疗应谨慎进行。我们旨在系统评估影响肾移植（RT）受者BPH手术治疗手术指征和围手术期结果的因素。2023年1月28日，使用Scopus、PubMed和EMBASE进行了系统的文献检索，无日期限制。排除临床前和动物研究、综述、致编辑的信、病例报告和会议摘要。共纳入18篇文章。临床BPH在RT后发病率较高，尤其是老年男性。与BPH相关的继发事件，如急性尿潴留和尿路感染，可导致肾移植功能逐渐下降和患者生存率降低。BPH手术可以预防这些事件，并保证血清肌酐水平、排尿参数和下尿路症状得到改善。当尿培养阴性时，前列腺内镜手术可在初次手术后1个月内进行，尤其是老年患者，他们更容易出现排尿功能障碍。另外，对于希望保留射精功能的前列腺较小的患者，可推荐经尿道前列腺切开术。缺乏关于BPH手术比较的数据。对于因BPH导致膀胱出口梗阻的RT受者，应提供BPH手术。内镜治疗应在RT后几周进行，以避免移植肾功能进一步恶化。
