Abstract
Background: Diabetics have significantly greater BPH severity of symptoms when compared with the healthy controls. This study aims to evaluate which diabetic patient with lower urinary tract symptoms due to BPH will benefit from trasurethral resection of prostate (TURP).
Patients & Methods: A cohort study of 40 male diabetic patients presented with lower urinary tract symptoms (LUTS) and diagnosed to have benign prostatic hyperplasia (BPH) by ultrasound in the period between May 2021 and November 2022. All of them had post voiding residual urine(PVR) more than 300 cc, international prostate symptom score (IPSS) more than 8, and prostate volume less than 80 gm. We also excluded patients with other neurological diseases, stroke or history of endoscopic or surgical treatment of BPH. All patients were preoperatively evaluated by carful history taking to detect IPSS, quality of life ( Qol), preoperative abdomen-pelvic ultrasound, residual urine (PVR), urine, flowmetry and urodynamic study in all patients. Mono-polar transurethral resection of prostate (TURP) with spinal anesthesia was done in all patients by the same team. We monitored postoperative improvement by follow up the patients after 2 weeks, one month, three months, and one year. Filling cystometry and pressure flow study was done three months postoperatively.
Results: The mean age was 66.1 ±7.4 years old. Twenty patients presented with refractory urine retention with the use of alpha blocker. The mean prostate volume by abdominal ultrasound was 69.3 ±8.9 with the mean residual urine 373.2 ±41.2. There was postoperative significant improvement in maximum flow (Q max), residual urine (PVRU), quality of life, IPSS and bladder contractility index (BCI).
Correlation of these parameters improvement and preoperative factors showed significant correlation between this improvement and preoperative BCI, age, duration of diabetes, HbA1c, PVR, infected urine culture, preoperative IPSS and bladder capacity (P values ≤0.0001). No significant correlation with bladder capacity, prostate volume, sensations and detrusor over activities.
Conclusions: TURP is safe and effective in treatment of obstructive urinary symptoms in BPH uncontrolled diabetic patients with large PVRU. Patients age, duration of diabetes, HbA1c, urinary infection, preoperative BCI and IPSS have a great effect on postoperative improvement.