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



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.

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  1. 1.

    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

    Google Scholar 

  2. 2.

    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

    CAS  PubMed  Google Scholar 

  3. 3.

    Saweirs WW, Coddard J (2007) What are the best treatments for early chronic kidney disease? Nephrol Dial Transplant 22(Suppl 9):ix31–ix38

    PubMed  Google Scholar 

  4. 4.

    Levey AS, Stevens LA, Coresh J (2009) Conceptual model of CKD: applications and implications. Am J Kidney Dis 53(3 Suppl 3):S4–16

    PubMed  Google Scholar 

  5. 5.

    Hemmelgarn BR, Manns BJ, Lloyd A et al (2010) Relation between kidney function, proteinuria, and adverse outcomes. JAMA 303(5):423–429

    CAS  PubMed  Google Scholar 

  6. 6.

    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

    Google Scholar 

  7. 7.

    Brown SC, O'Reilly PH (1995) Glomerular filtration rate measurement: a neglected test in urological practice. Br J Urol 75(3):296–300

    CAS  PubMed  Google Scholar 

  8. 8.

    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

    PubMed  Google Scholar 

  9. 9.

    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

    PubMed  Google Scholar 

  10. 10.

    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

    PubMed  Google Scholar 

  11. 11.

    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

    CAS  PubMed  PubMed Central  Google Scholar 

  12. 12.

    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

    CAS  PubMed  Google Scholar 

  13. 13.

    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

    CAS  PubMed  PubMed Central  Google Scholar 

  14. 14.

    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

    CAS  PubMed  Google Scholar 

  15. 15.

    Stevens LA, Levey AS (2009) Measured GFR as a confirmatory test for estimated GFR. J Am Soc Nephrol 20(11):2305–2313

    PubMed  Google Scholar 

  16. 16.

    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

    Google Scholar 

  17. 17.

    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

    CAS  PubMed  Google Scholar 

  18. 18.

    Levey AS, Inker LA (2016) GFR as the "gold standard": estimated, measured, and true. Am J Kidney Dis 67(1):9–12

    PubMed  Google Scholar 

  19. 19.

    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

    PubMed  PubMed Central  Google Scholar 

  20. 20.

    Summary of recommendation statements (2013) Kidney Int Suppl (2011) 3(3):5–14

  21. 21.

    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

    CAS  PubMed  Google Scholar 

  22. 22.

    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

    Google Scholar 

  23. 23.

    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

    CAS  PubMed  Google Scholar 

  24. 24.

    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

    PubMed  Google Scholar 

  25. 25.

    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

    CAS  PubMed  Google Scholar 

  26. 26.

    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

    CAS  PubMed  Google Scholar 

  27. 27.

    Rivera ME, Lingeman JE, Krambeck AE (2018) Holmium laser enucleation of the prostate. J Endourol 32(S1):S7–S9

    PubMed  Google Scholar 

  28. 28.

    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

    CAS  PubMed  Google Scholar 

  29. 29.

    Rule AD, Lieber MM, Jacobsen SJ (2005) Is benign prostatic hyperplasia a risk factor for chronic renal failure? J Urol 173:691–696

    PubMed  Google Scholar 

  30. 30.

    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

    CAS  PubMed  Google Scholar 

  31. 31.

    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

    PubMed  Google Scholar 

  32. 32.

    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

    CAS  PubMed  Google Scholar 

  33. 33.

    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

    PubMed  Google Scholar 

  34. 34.

    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

    PubMed  Google Scholar 

  35. 35.

    Penna FJ, Elder JS (2011) CKD and bladder problems in children. Adv Chronic Kidney Dis 18(5):362–369

    PubMed  Google Scholar 

  36. 36.

    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

    CAS  PubMed  Google Scholar 

  37. 37.

    Taylor A (1999) Radionuclide renography: a personal approach. Semin Nucl Med 29(2):102–127

    CAS  PubMed  Google Scholar 

  38. 38.

    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

    CAS  PubMed  PubMed Central  Google Scholar 

  39. 39.

    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

    CAS  PubMed  Google Scholar 

  40. 40.

    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

    PubMed  Google Scholar 

  41. 41.

    Simerville JA, Maxted WC, Pahira JJ (2005) Urinalysis: a comprehensive review. Am Fam Physician 71(6):1153–1162

    PubMed  Google Scholar 

  42. 42.

    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

    PubMed  Google Scholar 

  43. 43.

    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

    CAS  PubMed  Google Scholar 

  44. 44.

    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

    CAS  PubMed  Google Scholar 

  45. 45.

    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

    PubMed  Google Scholar 

  46. 46.

    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

    PubMed  Google Scholar 

  47. 47.

    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

    PubMed  Google Scholar 

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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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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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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 (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).

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