Transurethral prostate surgery as a preventive method against progression of chronic kidney disease in patients with uro
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ORIGINAL ARTICLE
Transurethral prostate surgery as a preventive method against progression of chronic kidney disease in patients with urodynamically proven bladder outlet obstruction Dong Sup Lee1 · Hyung Wook Kim2 · Seung‑ju Lee1 Received: 14 June 2019 / Accepted: 25 November 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Objective The present study was aimed to investigate (1) whether urodynamic factors are responsible for kidney damage in patients with bladder outlet obstruction (BOO) and (2) whether transurethral prostate surgery for BOO can alleviate the damage to the kidneys. Methods This prospective observational study involved men aged 50–80 years. Prostate size and urodynamic test were performed during screening period. Laboratory tests to measure the glomerular filtration rate, the urinary protein to creatinine ratio and dipstick urinalysis were performed before and 6 months after the transurethral prostate surgery. Results Sixty-seven patients completed the laboratory study among a hundred enrolled patients with urodynamically proven BOO. Among the urodynamic parameters, only low bladder compliance (lower than 60 mL/cmH2O) was associated with clinically significant proteinuria (p 60 mL/min/1.73m2, the annual mortality was increased 1.6–2.1 fold in patients with mild proteinuria and 2.5–2.8 fold in those with severe proteinuria compared to healthy group. Considering that the pernicious symptoms associated with CKD usually go unrecognized by individuals [6], especially in early CKD, the investigation and monitoring for kidney damage in risky patients are absolutely required in terms of prevention. Brown and O’Reilly emphasized that the prevalence of renal impairment due to benign prostate hyperplasia (BPH) is often underestimated in the general community [7]. Several clinical studies have investigated whether BPH-related factors pose risks of CKD [8, 9], and the authors of those studies suggest that bladder outlet obstruction (BOO) can be a risk factor of CKD. Although most of the studies tried to find an association between CKD and BPH (or BOO), there is a lack of community-based observational study that quantitatively describe proteinuria (kidney damage) in patients with BPH with GFR > 60 mL/min/1.73m2. Therefore, investigating the association between proteinuria and BPH-related factor(s) is important because aging itself exposes one to the risks of CKD. Assuming that the findings of previous research studies [8, 9] are true, we sought to identify the potential urological risk factor(s) of kidney damage in urodynamically proven BOO in BPH patients. Thus, we hypothesized that BOO related urological factor(s) could be a risk factor of kidney damage in BPH patients. Furthermore, we hypothesized that if any BOO related factors were associated with kidney damage, transurethral prostate surgery could mitigate the condition (kidney damage).
Materials and methods Patient selection The present study is a prospective observational study involving consecutive patients diagnosed w
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