Transurethral prostate surgery as a preventive method against progression of chronic kidney disease in patients with urodynamically proven bladder outlet obstruction

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 < 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).

Conclusions

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.

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Acknowledgement

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.

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Authors

Contributions

DSL: protocol development, manuscript writing, data collection, data analysis; HWK: manuscript editing, data analysis; SJL: protocol development, manuscript editing.

Corresponding author

Correspondence to Seung-ju Lee.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

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Informed consent was obtained from all individual participants in the study.

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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

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Keywords

  • Benign prostate hyperplasia
  • Urinary bladder
  • Compliance
  • Proteinuria
  • Chronic kidney disease