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.
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.
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 < 0.001). Transurethral prostate surgery significantly improved proteinuria (p = 0.007), especially in patients with low bladder compliance (p = 0.004), and subsequently decreased the risk grade of CKD progression (p < 0.001).
Low bladder compliance in patients with BOO may be a risk factor for kidney damage. Transurethral prostate surgery to relieve BOO could be a preventive method against CKD progression in patients with low bladder compliance.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39(2 Suppl 1):S1–266
Andrassy KM (2013) Comments on 'KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease'. Kidney Int 84(3):622–623
Saweirs WW, Coddard J (2007) What are the best treatments for early chronic kidney disease? Nephrol Dial Transplant 22(Suppl 9):ix31–ix38
Levey AS, Stevens LA, Coresh J (2009) Conceptual model of CKD: applications and implications. Am J Kidney Dis 53(3 Suppl 3):S4–16
Hemmelgarn BR, Manns BJ, Lloyd A et al (2010) Relation between kidney function, proteinuria, and adverse outcomes. JAMA 303(5):423–429
Johnson DW, Atai E, Chan M et al (2013) KHA-CARI guideline: early chronic kidney disease: detection, prevention and management. Nephrology (Carlton) 18(5):340–350
Brown SC, O'Reilly PH (1995) Glomerular filtration rate measurement: a neglected test in urological practice. Br J Urol 75(3):296–300
Rule AD, Jacobson DJ, Roberts RO et al (2005) The association between benign prostatic hyperplasia and chronic kidney disease in community-dwelling men. Kidney Int 67(6):2376–2382
Kwon YM, Cho B, Son KY, Choi HC, Park SG, Park JH (2012) Lower urinary tract symptoms have negative associations with glomerular filtration rate irrespective of prostate volume in Korean men. Urology 79(1):182–187
Carter JL, Tomson CR, Stevens PE, Lamb EJ (2006) Does urinary tract infection cause proteinuria or microalbuminuria? A systematic review. Nephrol Dial Transplant 21(11):3031–3037
Kassaian SE, Goodarzynejad H, Boroumand MA, Salarifar M, Masoudkabir F, Mohajeri-Tehrani MR et al (2012) Glycosylated hemoglobin (HbA1c) levels and clinical outcomes in diabetic patients following coronary artery stenting. Cardiovasc Diabetol 11:82
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J et al (2014) 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint national committee (JNC 8). JAMA 311(5):507–520
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med 130(6):461–470
Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S et al (2006) Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 145(4):247–254
Stevens LA, Levey AS (2009) Measured GFR as a confirmatory test for estimated GFR. J Am Soc Nephrol 20(11):2305–2313
Smith HW (1951) Measurement of the filtration rate. The kidney: structure and function in health and disease. Oxford University Press, New York, pp 39–62
Seegmiller JC, Burns BE, Fauq AH, Mukhtar N, Lieske JC, Larson TS (2010) Iothalamate quantification by tandem mass spectrometry to measure glomerular filtration rate. Clin Chem 56(4):568–574
Levey AS, Inker LA (2016) GFR as the "gold standard": estimated, measured, and true. Am J Kidney Dis 67(1):9–12
Halkar R, Taylor A, Manatunga A, Issa MM, Myrick SE, Grant S, Shenvi NV (2007) Monitoring renal function: a prospective study comparing camera-based technetium-99m mercaptoacetyltriglycine clearance and creatinine clearance. Urology 69(3):426–430
Summary of recommendation statements (2013) Kidney Int Suppl (2011) 3(3):5–14
Fisher H, Hsu CY, Vittinghoff E, Lin F, Bansal N (2013) Comparison of associations of urine protein-creatinine ratio versus albumin-creatinine ratio with complications of CKD: a cross-sectional analysis. Am J Kidney Dis 62(6):1102–1108
Burden R (2005) Tomson C (2005) Identification, management and referral of adults with chronic kidney disease: concise guidelines. Clin Med (Lond) 5(6):635–642
Yamamoto H, Yamamoto K, Yoshida K, Shindoh C, Takeda K, Monden M et al (2015) Modified cut-off value of the urine protein-to-creatinine ratio is helpful for identifying patients at high risk for chronic kidney disease: validation of the revised Japanese guideline. Tohoku J Exp Med 237(3):201–207
White SL, Yu R, Craig JC, Polkinghorne KR, Atkins RC, Chadban SJ (2011) Diagnostic accuracy of urine dipsticks for detection of albuminuria in the general community. Am J Kidney Dis 58(1):19–28
Abrams P (1999) Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int 84(1):14–15
Matsuoka K, Iida S, Tomiyasu K, Shimada A, Suekane S, Noda S (1998) Holmium laser resection of the prostate. J Endourol 12(3):279–282
Rivera ME, Lingeman JE, Krambeck AE (2018) Holmium laser enucleation of the prostate. J Endourol 32(S1):S7–S9
Mustonen S, Ala-Houhala IO, Tammela TL (2001) Long-term renal dysfunction in patients with acute urinary retention. Scand J Urol Nephrol 35(1):44–48
Rule AD, Lieber MM, Jacobsen SJ (2005) Is benign prostatic hyperplasia a risk factor for chronic renal failure? J Urol 173:691–696
Nissenkorn I, Savion M, Servadio C (1988) Renal and bladder function recovery after prostatectomy in patients with a chronic residual urine of above 1,000 ml. Eur Urol 14(6):434–436
Negro CL, Muir GH (2012) Chronic urinary retention in men: how we define it, and how does it affect treatment outcome. BJU Int 110(11):1590–1594
Schwertner-Tiepelmann N, Hagedorn-Wiesner A, Erschig C, Beilecke K, Schwab F, Tunn R (2017) Clinical relevance of neurological evaluation in patients suffering urinary retention in the absence of subvesical obstruction. Arch Gynecol Obstet 296(5):1017–1025
Ahmed AF, Bedewi M (2016) Can bladder and prostate sonomorphology be used for detecting bladder outlet obstruction in patients with symptomatic benign prostatic hyperplasia? Urology 98:126–131
Silva JA, Gonsalves MC, de Melo RT, Carrerette FB, Damiao R (2015) Association between the bladder wall thickness and urodynamic findings in patients with spinal cord injury. World J Urol 33(1):131–135
Penna FJ, Elder JS (2011) CKD and bladder problems in children. Adv Chronic Kidney Dis 18(5):362–369
Rossleigh MA, Thomas MY, Moase AL (1994) Determination of the normal range of furosemide half-clearance time when using Tc-99m MAG3. Clin Nucl Med 19(10):880–882
Taylor A (1999) Radionuclide renography: a personal approach. Semin Nucl Med 29(2):102–127
McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW, Lepor H, McVary KT, Nyberg LM Jr, Clarke HS, Crawford ED, Diokno A, Foley JP, Foster HE, Jacobs SC, Kaplan SA, Kreder KJ, Lieber MM, Lucia MS, Miller GJ, Menon M, Milam DF, Ramsdell JW, Schenkman NS, Slawin KM, Smith JA, Medical Therapy of Prostatic Symptoms (MTOPS) Research Group (2003) The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 349(25):2387–2398
Roehrborn CG, Siami P, Barkin J, Damião R, Becher E, Miñana B, Mirone V, Castro R, Wilson T, Montorsi F, CombAT Study Group (2009) The influence of baseline parameters on changes in international prostate symptom score with dutasteride, tamsulosin, and combination therapy among men with symptomatic benign prostatic hyperplasia and an enlarged prostate: 2-year data from the CombAT study. Eur Urol 55(2):461–471
Gilling PJ, Aho TF, Frampton CM, King CJ, Fraundorfer MR (2008) Holmium laser enucleation of the prostate: results at 6 years. Eur Urol 53(4):744–749
Simerville JA, Maxted WC, Pahira JJ (2005) Urinalysis: a comprehensive review. Am Fam Physician 71(6):1153–1162
Elihimas UF, Elihimas HC, Lemos VM et al (2014) Smoking as risk factor for chronic kidney disease: systematic review. J Bras Nefrol 36(4):519–528
Hong SK, Lee ST, Jeong SJ et al (2010) Chronic kidney disease among men with lower urinary tract symptoms due to benign prostatic hyperplasia. BJU Int 105(10):1424–1428
Gerridzen RG, Thijssen AM, Dehoux E (1992) Risk factors for upper tract deterioration in chronic spinal cord injury patients. J Urol 147(2):416–418
Tkocz M, Prajsner A (2002) Comparison of long-term results of transurethral incision of the prostate with transurethral resection of the prostate, in patients with benign prostatic hypertrophy. Neurourol Urodyn 21(2):112–116
de la Taille A, Robert G, Descazeaud A (2018) Consequences of prostatic obstruction on bladder function, impact of removal, and management of recurrence after surgery. Prog Urol 28(15):813–820
Cho MC, Ha SB, Park J et al (2016) Impact of detrusor underactivity on surgical outcomes of laser prostatectomy: comparison in serial 12-month follow-up outcomes between potassium-titanyl-phosphate photoselective vaporization of the prostate (PVP) and holmium laser enucleation of the prostate (HoLEP). Urology 91:158–166
The authors wish to acknowledge the financial support from the Catholic Medical Center Research Foundation in the program year of 2016. We are particularly grateful to Inae Park (Department of Urology, St. Vincent’s Hospital) for assisting with data processing.
Conflict of interest
The authors declare that they have no conflict of interest.
The institutional review board approved the observational study design and access to the patients’ medical records (approval number: VC13OISI0222, date of approval: February 26th, 2014). Additionally, this project was registered at ClinicalTrials.gov (Register no: L201401N1). This study was performed in accordance with the Declaration of Helsinki. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Lee, D.S., Kim, H.W. & Lee, Sj. Transurethral prostate surgery as a preventive method against progression of chronic kidney disease in patients with urodynamically proven bladder outlet obstruction. World J Urol 38, 2583–2593 (2020). https://doi.org/10.1007/s00345-019-03041-w
- Benign prostate hyperplasia
- Urinary bladder
- Chronic kidney disease