Comparative outcomes of transurethral resection of the prostate in benign prostatic hyperplasia patients with and without upper urinary tract dilatation: a propensity score matching analysis

Abstract

Background

Upper urinary system dilation appears to be a precursor to the progression to renal failure as a result of benign prostatic hyperplasia (BPH). This study aimed to compare the outcomes of transurethral resection of the prostate (TUR-P) between BPH patients who develop upper urinary tract dilation (UUTD) and those in the normal group.

Materials and methods

Patients who underwent TUR-P for BPH diagnosis between 2019 and 2024 were included in the study. A propensity score matching was applied based on parameters such as age, International Prostate Symptom Score, prostate-specific antigen, prostate volume, serum creatinine, preoperative hemoglobin value, and presence of transurethral catheter. After the formation of the normal and UUTD patient groups, demographic and clinical data were compared. TUR-P outcomes, including International Prostate Symptom Score, clot retention, reoperation rates, blood transfusion rates, urinary retention rates, postoperative uroflow values, urodynamic requirements, and results were compared between the groups.

Results

After propensity score matching, a total of 128 patients who underwent TUR-P due to BPH, comprising 64 patients with UUTD and 64 patients with normal findings, were retrospectively reviewed. Mean hemoglobin level after TUR-P for UUTD group was 12.7 ± 1.9 g/dl, and for the normal group, it was 13.2 ± 2.1 g/dl. Postoperative clot retention rate UUTD and normal group was 4.7% and 3.1%, respectively. Blood transfusion rate for the UUTD group was 4.7%, and for the normal group, it was 1.6%. Postoperative urinary retention rate was higher in the UUTD group (18.7 vs. 9.4, P < 0.05). Reoperation rate was 14% in the UUTD group and 7.8% in the normal group, with no statistically significant difference (P > 0.05).

Conclusions

Although the rate of postoperative urinary retention is higher in patients with UUTD, which can lead to impaired kidney function during the course of BPH, TUR-P can be effectively performed without causing a significant increase in early or long-term complications.