Analysis Of Influencing Factors Of Early Lower Urinary Tract Symptoms After Transurethral Enucleation Of The Prostate

Background:Benign Prostatic Hyperplasia(BPH)is a common and frequentlyoccurring disease in elderly men,which can cause Lower Urinary Tract Symptoms(LUTS),such as frequent urination,urination hesitation,thinning of urine flow,strenuous urination and inexhaustible urination.In recent years,Transurethral Resection of the Prostate(TURP)and Holmium Laser Enucleation of the Prostate(Ho LEP),represented by transurethral minimally invasive surgery of the prostate,can effectively improve bladder outlet obstruction and relieve lower urinary tract symptoms.However,although the obstruction is relieved by surgery,there are still more than half of the patients with poor improvement of LUTS in the early stage after operation,which seriously affects the effect of operation and the quality of life of patients,and even makes patients doubt the effect of treatment.Therefore,to explore the influencing factors of early LUTS after prostatectomy is necessary to improve the postoperative effect.Objective: To explore the influencing factors of early occurrence of LUTS after transurethral enucleation of the prostate,so as to provide basis for effectively preventing and improving the severity and duration of early postoperative LUTS symptoms,improving the effect of operation and improving the quality of life of patients after operation.Methods: According to the inclusion and exclusion criteria,the clinical data of104 patients who underwent prostatectomy in the Department of Urology of the sixth6 affiliated Hospital of Guangzhou Medical University from December 2021 to December 2022 were analyzed retrospectively,and the influencing factors of postoperative LUTS were analyzed.Collect relevant clinical indicators and data before,during and after operation,including age and Body Mass Index(BMI),history of smoking,complication of hypertension,diabetes,coronary heart disease,chronic obstructive pulmonary disease,personal history of stroke,history of complaints related to BPH for more than 3 years,medication for treatment of BPH in the short term,gross hematuria before operation,short-term urinary retention and indwelling catheter time,International Prostate Symptom Score(IPSS)and Quality of Life score(Qo L),preoperative creatinine,preoperative urinary sediment test and urine culture results,Prostate Specific Antigen(PSA),prostate volume,preoperative urodynamic index,enucleation procedure,total operation time,operative blood loss,urine sediment and urine culture results within 1 week after operation,postoperative indwelling catheter time,postoperative flushing time.Postoperative LUTS and urinary incontinence were followed up 1 month after operation.The above data were collected and analyzed,and the postoperative LUTS and urinary incontinence were counted.Univariate analysis screened out the factors that may be related to the occurrence of postoperative LUTS,and then multivariate analysis was conducted to further verify the relevant influencing factors.Results: Among the 104 patients in this study,91 patients still had varying degrees of LUTS one month after operation,accounting for 87.50%,of which the incidence of moderate and severe LUTS was 59.60%,and the incidence of postoperative urinary incontinence was 37.50%.Among the patients with postoperative LUTS,the ratio of voiding symptoms to storage symptoms(IPSS-V/S)< 1 accounted for as high as94.51%,indicating that postoperative LUTS was dominated by urine storage symptoms.According to the duration of postoperative LUTS,104 patients were divided into two groups: non-LUTS group and LUTS group.Univariate analysis showed that the time of postoperative indwelling catheter in the two groups was 5.00(3.00～7.00)day and 4.00(3.00～4.00)day respectively,P=0.004,the difference was statistically significant,and the incidence of postoperative LUTS was 74.07% and 92.21% respectively in patients with a history of BPH less than 3 years and more than 3 years,P=0.036,the difference was statistically significant.It was found that the incidence of postoperative LUTS in patients who took BPH for more than one week and those who did not take it was 66.67% and 91.01% respectively,P=0.020,with a statistically significant difference.Further multivariate analysis showed that the duration of postoperative indwelling catheter(P=0.036,OR=2.839,95%CI:1.072～7.522)and the history of complaint of BPH more than 3 years(P=0.033,OR=9.502,95%CI:1.206～74.899)were risk factors for persistent LUTS after operation.The drugs used to treat BPH within a short period of time were used for more than one week(P=0.018,OR=0.045,95%CI:0.003～0.580)is the protective factor of LUTS.According to the duration of postoperative LUTS,the patients were divided into non-LUTS and mild LUTS group and moderate to severe LUTS group to explore the influencing factors leading to moderate and severe LUTS.Univariate analysis showed that the incidence of moderate and severe LUTS in patients aged 50-69 and 70-90 was47.73% and 68.33% respectively,P=0.034,and the difference was statistically significant.The incidence of moderate and severe LUTS in patients with BMI < 24kg/and BMI ≥ 24kg/ was 48.08% and 71.43% respectively,P=0.017,and the difference was statistically significant.The incidence of moderate and severe LUTS in patients with hypertension and without hypertension was 76.47% and 51.43% respectively,P=0.015,and the difference was statistically significant,while the incidence of moderate to severe LUTS in patients with Chronic Obstructive Pulmonary Disease(COPD)and without COPD was 0.040,P=0.015,and the difference was statistically significant.The postoperative flushing time of the two groups was 2.00(1.00～2.25)day and 2.00(1.00 ～ 2.00)days respectively,P=0.037,and the difference was statistically significant.Further multivariate analysis of the above factors found that overweight was a risk factor for moderate and severe LUTS after operation(P=0.022,OR=2.804,95%CI:1.164～6.755),and no statistical significance was found in the multivariate analysis of other indicators.Conclusion: First,the main symptom of postoperative LUTS was urine storage period.Second,postoperative indwelling catheter time,BPH-related medical history more than3 years and short-term use of BPH-related drugs for more than 1 week are all factors affecting the incidence of postoperative LUTS.Third,being overweight may lead to more severe LUTS.