Analysis of Risk Factors and Outcome of Renal Failure in Benign Prostatic Hyperplasia PC01-PC03
Dr. Ramreddy Chilumula,
Professor and Head, Department of Urology, 6th Floor, Speciality Block, Nizam's Institute of Medical Sciences,
Punjagutta, Hyderabad-50082, Telangana, India.
Introduction: Benign Prostatic Hyperplasia (BPH) is one of the most common diseases of aging men, affecting 50% by 60 years of age and increasing to 90% by ninth decade of life. A small percentage of men with obstruction secondary to BPH have azotemia, some of whom progress to irreversible renal failure, while others recover remarkably well.
Aim: To assess the risk factors and outcome of renal failure in patients of BPH in comparison to those patients without renal failure.
Materials and Methods: This was a retrospective study of 60 patients with a diagnosis of BPH with and without renal failure who underwent treatment in the Department of Urology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India, between January 2015 to December 2016. All patients were evaluated with clinical history and physical examination including Digital Rectal Examination (DRE) and appropriate laboratory examination. Uroflowmetry followed by ultrasound abdomen was done. All patients underwent transurethral resection of prostate, postoperatively uroflowmetry and Ultrasonography (USG) of abdomen for post void residual volume were done at the time of discharge and at one, three months follow up. Results evaluated with student t-test, fisher’s-exact test and Chi-square test.
Results: Obstructive voiding symptoms mean International Prostate Symptoms (IPSS) score, comorbidity factors like diabetes and hypertension (24), Urinary retention (24), Urinary Tract Infections (UTIs) (16) and median lobe enlargement (19) were more common in patients with renal failure. Weight of the gland resected and mean operative time were similar in patients with or without renal failure. Once obstruction was relieved 23 patients had normal serum creatinine. Seven patients had renal failure at one month follow up after Transurethral Resection of the Prostate (TURP). All these patients had either diabetes mellitus (1) or hypertension (2) or both (4).
Conclusion: Men with large residual urine volumes with retention and concurrent UTIs are at higher risk for renal failure. Renal failure in the presence of comorbid illnesses, such as diabetes mellitus and hypertension, may be augmented by BPH and also have an impact on the recovery of renal function after relieving the obstruction.