Correlation Between Improvement Of Lower Urinary Tract Symptoms And Metabolic Syndrome After Transurethral Resection Of Prostate

Background Transurethral resection of the prostate(TURP)is the gold standard for the treatment of benign prostatic hyperplasia(BPH)with moderate to severe lower urinary tract symptoms(LUTS).However,there are differences in the postoperative benefits of patients,and some patients have no obvious improvement in postoperative symptoms.Analyzing the reasons,domestic and foreign studies have pointed out that the lower urinary tract symptoms of patients before TURP are related to metabolic syndrome.A small number of foreign literature have concluded that the improvement of symptoms after TURP is also related to metabolic syndrome.However,there is no large-scale center report on the correlation between postoperative lower urinary tract symptom improvement and metabolic syndrome in China.We want to determine the risk factors affecting the improvement of lower urinary tract symptoms by analyzing the correlation between the improvement of the lower urinary tract and the metabolic syndrome in our hospital patients six months after TURP.This has important guiding significance for predicting the postoperative treatment effect and improving patients’ quality of life after surgery.Objective To analyze the correlation between preoperative and postoperative lower urinary tract symptoms(LUTS)and metabolic syndrome(MS)in patients with benign prostatic hyperplasia(BPH)requiring surgery;To predict the improvement of lower urinary tract symptoms after transurethral resection of the prostate(TURP)in benign prostatic hyperplasia patients with metabolic syndrome.Methods A retrospective analysis of the clinical data of 270 patients who underwent transurethral resection of the prostate for benign prostatic hyperplasia in Henan Provincial People’s Hospital from January 2020 to December 2020.According to the definition of metabolic syndrome,the included patients were divided into the MS group(129 cases)and the non-MS group(141 cases).The basic information of patients,preoperative height,weight and abdominal circumference,history of hypertension and diabetes and another past medical history,history of lipid-lowering drug use,history of smoking and drinking,urinary system color Doppler ultrasound,biochemical blood indicators,Urodynamics,international prostate symptom score(IPSS score)and quality of life index score(QOL score);and urinary color Doppler ultrasound,urodynamics,IPSS score,and QOL score at six months after the operation.I used SPSS21.0 software to analyze whether the clinical data of the MS group and the non-MS group were significantly different.Results(1)There was no difference in age,drinking history,prostate volume,residual urine volume,total cholesterol,low-density lipoprotein,serum uric acid,serum creatinine and PSA between the MS group and the non-MS group(P>0.05);There were differences in BMI,triglyceride,high density and low protein,QOL score,IPSS score,urine storage period score,and voiding period score between the two groups of patients(P<0.05),and the mean data of patients in the MS group were significantly different higher than those in the non-MS group;the MS group’s maximum urinary flow rate(Qmax),the bladder capacity at the initial feeling of urge to urinate and the bladder capacity at the time of solid urge to urinate were smaller than those in the non-MS group(P<0.05).(2)MS includes abdominal obesity,hyperglycemia,hypertension,hypertriglyceridemia,and low-density lipoproteinemia.Spearman rank correlation analysis was used to calculate the number of MS subgroups and preoperative IPSS score,storage.The correlation coefficients(r)of urinary stage score and voiding stage score were 0.495,0.448,and 0.370,respectively,and the P values were all <0.001,indicating that the more MS subgroups,the higher the corresponding lower urinary tract symptom score.(3)The P values of the five subgroups of MS and the three stages of IPSS(<25 points,26-30 points,and 31-35 points)were <0.001,0.007,<0.001,<0.001,and <0.001,indicating each subgroup of metabolic syndrome was an independent risk factor for lower urinary tract symptoms in patients with benign prostatic hyperplasia.(4)The correlation P values of the prostate volume(<25ml,25-50 ml,50-75 ml,>75ml)between the five subgroups of MS and the four groups were 0.013,0.003,0.089,0.813,and 0.078,respectively;combined abdominal obesity,hyperglycemia The prostate volume increased significantly(P<0.05),and the combination of hypertension,hypertriglyceridemia,and low-density lipoproteinemia had no significant correlation with the increase in prostate volume(P>0.05).(5)The postoperative IPSS score,storage stage score,voiding stage score,Qmax,QOL score and residual urine volume of the two groups of patients were significantly improved compared with those before surgery(P<0.05).And the score of lower urinary tract symptoms in the MS group was higher than that in the non-MS group(P < 0.05).The improvement of postoperative IPSS score and urine storage score in the MS group was better than that in the non-MS group(P<0.05),but the improvement of QOL score in the MS group was inferior to that in the non-MS group(P<0.05).There was no difference in the improvement and residual urine volume improvement(P>0.05).(6)Logistic regression was used to analyze the effect of five MS subgroups on improving lower urinary tract symptoms.The impact of different MS subgroups on the improvement of lower urinary tract symptoms was inconsistent;among them,abdominal obesity,hyperglycemia,and hypertriglyceridemia had impact on the improvement of IPSS and QOL(P<0.05);hypertension and LDL-C affected the improvement of IPSS(P<0.05).(7)Simple linear regression was used to analyze the influence of different variables on the improvement of total IPSS after surgery.The preoperative IPSS score,the patients with metabolic syndrome,the number of MS-free subgroups and the number of MS subgroups influenced the improvement of postoperative IPSS(P< 0.05).The multiple linear regression analysis results indicated that the preoperative IPSS score and the number of MS and MS subgroups were independent predictors of postoperative improvement in total IPSS(P<0.05).Conclusion(1)Metabolic syndrome and its subgroups were closely related to prostate volume,and LUTS/BPH;(2)Compared with the MS group,postoperative lower urinary tract symptoms improved better in non-MS patients;(3)The number of metabolic syndrome and its subgroups is an independent risk factor for the improvement of lower urinary tract symptoms after TURP,and can predict the effect of postoperative LUTS treatment;(4)During the treatment of BPH patients,patients should be actively guided to control the metabolic level,increase the amount of exercise or take related hypoglycemic and lipid-lowering drugs.To improve patients’ quality of life with benign prostatic hyperplasia after surgery.