title: Is diabetes mellitus associated with clinical outcomes in aging males treated with transurethral resection of prostate for bladder outlet obstruction: implications from Taiwan Nationwide Population-Based Cohort Study.
abstract: OBJECTIVE
  We assessed the lower urinary tract symptoms (LUTSs) and clinical outcomes between diabetes mellitus (DM) patients and non-diabetic (non-DM) patients receiving transurethral resection of prostate (TUR-P).
  
  
  METHODS
  This analysis was a retrospective cohort study using 13 years (2000-2012) of claims data from Taiwan's National Health Insurance Research Database (NHIRD). A total of 4,887 patients who had persistent LUTSs and underwent TUR-P for prostate enlargement (benign prostate enlargement [BPE]) were enrolled and divided into two groups: DM and non-DM groups. The patients' characteristics, postoperative clinical outcomes, and the medication records after TUR-P were compared. Chi-square test was used for categorical variables and independent samplest-test for continuous variables. Multivariable logistic regression analysis was used to compare the risk of postoperative outcomes. Finally, we estimated the medication-free survival rate after TUR-P using Kaplan-Meier method and compared it between study groups using log-rank test.
  
  
  RESULTS
  DM group patients had a higher prevalence of comorbidities. Postoperatively, the DM group had lower rates of urinary tract infection (UTI; odds ratio [OR], 0.78;P=0.009) and higher rates of urinary retention requiring catheterization (OR, 1.35;P=0.01) within 1 month after TUR-P. A higher proportion of patients with DM took anti-muscarinics (OR, 1.23;P=0.032) within the first 3 months and α-blockers (OR, 1.18;P=0.049) during 3-12 months after receiving TUR-P. Overall, the DM group patients had a worse postoperative medication-free survival compared to that of non-DM group patients (95% confidence interval [95% CI], 1.14;P=0.005).
  
  
  CONCLUSIONS
  DM patients require higher rates of continuing medication after TUR-P, especially anti-muscarinics in 3 months postoperatively and alpha-blocker after 3 months postoperatively. DM patients also had higher incidence of urine retention after surgery. DM patients had relatively poor treatment outcomes compared to DM-free patients.
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital - Linkou; School of Medicine; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital - Linkou; School of Medicine.
authors.forename: Chen-Pang
authors.initials: CP
authors.lastname: Hou
authors.affiliation: School of Medicine; Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung.
authors.forename: Tien-Hsing
authors.initials: TH
authors.lastname: Chen
authors.affiliation: Department of Anatomy, School of Medicine, Chang Gung University, Kwei-shan, Tao-Yuan.
authors.forename: Horng-Heng
authors.initials: HH
authors.lastname: Juang
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital - Linkou; School of Medicine.
authors.forename: Phei-Lang
authors.initials: PL
authors.lastname: Chang
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital - Linkou; School of Medicine.
authors.forename: Pei-Shan
authors.initials: PS
authors.lastname: Yang
authors.affiliation: School of Medicine; Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China.
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Lin
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital - Linkou; School of Medicine.
authors.forename: Chien-Lun
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital - Linkou; School of Medicine.
authors.forename: Ke-Hung
authors.initials: KH
authors.lastname: Tsui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007345:Insurance Claim Review; D059411:Lower Urinary Tract Symptoms; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D020728:Transurethral Resection of Prostate / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery*
keywords: benign prostate hyperplasia; infection; lower urinary tract symptoms; overactive bladder; prostatectomy; urinary tract infection