title: Acute urinary retention increases the risk of complications after transurethral resection of the prostate: a population-based study.
abstract: Study Type--Prognosis (cohort) Level of Evidence 2a. What's known on the subject? and What does the study add? Higher mortality and morbidity rates in men presenting with AUR have been reported in previous studies. This study has comprehensive comparisons of post-TURP complications between patients with and without AUR. Furthermore, it shows that AUR is associated with increased risk of complications after TURP.
  
  
  OBJECTIVE
  • To assess the association between a history of acute urinary retention (AUR) and complications after transurethral resection of prostate (TURP).
  
  
  METHODS
  • We conducted a retrospective, national, population-based study using Taiwan's National Health Insurance Research Database. • We included men > 50 years old, diagnosed with benign prostatic hyperplasia (BPH) and divided these into two groups: an AUR(+) group--those with AUR who underwent TURP between 2002 and 2004; and an AUR(-) group--those without AUR who underwent TURP between those dates. • Prostate cancer, Parkinsonism and multiple sclerosis were exclusion criteria. • Postoperative complications, e.g. re-catheterization, haematuria or urinary tract infection (UTI), were compared using crude odds ratios (ORs), 95% confidence intervals (CIs), and Student's t-test. • A chi-squared test was used for potential confounding factors: preoperative UTI and anticoagulant use. • Univariate and multivariate analysis on medical expenses were conducted.
  
  
  RESULTS
  • The AUR(+) group contained 3305 men; the AUR(-) group contained 1062. • Re-catheterization (13.8%), septicaemia (1.1%) and shock (0.3%) were found only in the AUR(+) group. • The AUR(+) group had more UTIs (18.9% vs. 15.6%, OR: 1.26, 95% CI: 1.05-1.52), more lower urinary tract symptoms (22.8% vs. 16.9%, OR: 1.45, 95% CI: 1.21-1.73), fewer blood transfusions (3.2% vs. 1.5%, OR: 2.19, 95% CI: 1.29-3.72) and higher medical expenses. • There were no significant differences in haematuria, lower urinary tract stricture, or re-surgical intervention of the prostate and second-line antibiotic use.
  
  
  CONCLUSIONS
  • Patients in Taiwan with BPH with AUR who were treated by TURP were associated with a higher risk of complications, longer hospital stay and more comorbidities than those without AUR and a preoperative warning is warranted for these patients.
authors.affiliation: Department of Urology, Medical College and Hospital, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Jeng-Sheng
authors.initials: JS
authors.lastname: Chen
authors.forename: Chia-Hsien
authors.initials: CH
authors.lastname: Chang
authors.forename: Wen-Horng
authors.initials: WH
authors.lastname: Yang
authors.forename: Yea-Huei
authors.initials: YH
authors.lastname: Kao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D020728:Transurethral Resection of Prostate / Q000009:adverse effects*; D016055:Urinary Retention / Q000150:complications* / Q000503:physiopathology; D014563:Urodynamics