Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.
World J Urol. 2024 May 19;42(1):337. doi: 10.1007/s00345-024-05039-5.
To assess the impact of kidney function in patients with BPH undergoing surgery prior to Transurethral resection of prostate (TURP), Laser enucleation of the prostate (LEP), and Laser Vaporization of the prostate (LVP) on operative and post-operative outcomes using the ACS-NSQIP database.
The ACS-NSQIP database was reviewed for patients that underwent TURP, LEP and LVP for treatment of patients with BPH between the years of 2008 and 2021. Demographics, comorbidities, bleeding disorders, operative time, and surgical procedure performed were collected for comparison between Kidney function groups: G1, normal/high function; G2-G3, mild/moderate kidney disease; and G4-G5, severe kidney disease. The 30-day peri-operative complications were measured and a multivariate logistic regression analysis was performed while adjusting for all confounding variables. Propensity score matching was performed between the G1 and G4-G5 cohorts.
A total of 83,020 patients were included. On multivariable regression, in the G2-G3 cohort, patients were at significantly increased risk for renal complications with OR = 2.43[1.56-3.79]. After propensity score matching, the G4-G5 cohort showed increased odds of pneumonia OR = 4.02[1.343-12.056], renal complications with OR = 7.62[2.283-25.411], cardiac complications OR = 4.53[1.531-13.411], and sepsis/septic shock OR = 1.76[1.091-2.834]. They also had a higher need for blood transfusion OR = 3.58[2.242-5.714], and prolonged hospital stay with OR = 1.49[1.296-1.723].
Pre-operative kidney disease may pose an increased risk of complications for patients undergoing endoscopic BPH surgery. The literature lacks information on the effect of pre-operative kidney disease on endoscopic BPH surgeries. Further studies are required to compare post-operative outcomes of LEP and LVP as compared to TURP across kidney function status.
为了评估在接受经尿道前列腺切除术（TURP）、前列腺激光剜除术（LEP）和前列腺激光汽化术（LVP）之前的前列腺增生（BPH）患者的肾功能对手术和术后结果的影响，我们使用了美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库。
我们回顾了 ACS-NSQIP 数据库中 2008 年至 2021 年间接受 TURP、LEP 和 LVP 治疗 BPH 患者的资料。收集患者的人口统计学、合并症、出血性疾病、手术时间和手术方式等数据，比较肾功能组：G1 为正常/高功能；G2-G3 为轻度/中度肾功能障碍；G4-G5 为严重肾功能障碍。测量了 30 天围手术期并发症，并进行了多变量逻辑回归分析，同时调整了所有混杂变量。对 G1 和 G4-G5 两组进行了倾向评分匹配。
共纳入 83020 例患者。多变量回归分析显示，G2-G3 组患者的肾并发症风险显著增加，OR=2.43[1.56-3.79]。经过倾向评分匹配后，G4-G5 组患者肺炎的发生几率增加，OR=4.02[1.343-12.056]；肾并发症的发生几率增加，OR=7.62[2.283-25.411]；心脏并发症的发生几率增加，OR=4.53[1.531-13.411]；脓毒症/感染性休克的发生几率增加，OR=1.76[1.091-2.834]。同时，他们需要输血的几率增加，OR=3.58[2.242-5.714]；住院时间延长，OR=1.49[1.296-1.723]。
术前肾功能障碍可能会增加接受内镜 BPH 手术患者发生并发症的风险。目前文献缺乏关于术前肾功能障碍对内镜 BPH 手术影响的信息。需要进一步研究比较 LEP 和 LVP 与 TURP 术后在不同肾功能状态下的术后结果。
