Predictors of reoperation after transurethral resection of the prostate in a diverse, urban academic centre

Abstract

To evaluate predictors of reoperation after transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) in a diverse patient population. A retrospective chart review was performed on men who underwent TURP between 2013 and 2016 at our institution with follow-up data post-operatively. Variables collected included patient demographics and clinical characteristics. Primary outcomes included whether the patient underwent repeat TURP and months elapsed since initial TURP. A total of 304 men underwent TURP during the study period. Thirty men (10%) underwent repeat TURP at a mean interval of 26 months. Reoperation after TURP was not associated with race, body mass index (BMI), 5-alpha-reductase inhibitor (5-ARI) use, or pre-operative prostate volume. An elevated pre-operative haemoglobin A1c (HbA1c) was associated with both reoperation (odds ratio (OR) = 1.32, 95% confidence interval (CI): 1.03–1.69), 30 day readmission (OR = 1.96, 95% CI: 1.17–3.28) and 30-day hematuria (OR: 2.37, 95% CI: 1.29–4.38). Pre-operative prostate specific antigen (PSA) levels > 4 and hydronephrosis on imaging were also associated with a higher risk of reoperation. Reoperation after TURP occurred in 10% of our study cohort at a median of 26 months after surgery. Elevated HbA1c prior to surgery was associated with reoperation, 30-day readmission and 30-day hematuria. Higher risk of post-operative complications in patients with poorly controlled diabetes should be communicated at the time of decision for surgery. Future studies should evaluate whether optimising diabetes control prior to TURP reduces risk of reoperation or whether this risk is non-modifiable due to permanent changes in the lower urinary tract due to chronic hyperglycaemia. III