Association Between Lower Urinary Tract Symptoms And Residual Urine And Chronic Kidney Disease In Benign Prostatic Hyperplasia

BackgroundBoth benign prostatic hyperplasia(BPH)and chronic kidney disease(CKD)are both important public health problems in the world,which can seriously affect the quality of human’s life.With the improvement of people’s life and the increase of age,the incidence of BPH has gradually increased to make it one of the most common diseases in the urinary system of elderly men.Previous studies have shown that men with BPH who do not undergo treatment eventually develop renal dysfunction.In this way,studies have shown that CKD develops as a complication of BPH/LUTS,but the mechanism still remains unknown.Some studies have found that the decline of maximum urinary flow rate(Qmax)due to BPH has some certain relationship with renal impairment.Whether LUTS or PVR can harm renal function still remains rare and inconclusive.Therefore,it is still necessary to explore the relationship between LUTS or PVR and CKD.Objection1、The study aims to find out the distribution characteristics of LUTS in the adult male patients with BPH.Then we explore the relationship between different clinical factors and LUTS and find out how they affect the patient’s quality of life.Finally we find out the relationship between LUTS and CKD and determine whether the severity of LUTS is an independent risk factor for CKD and provide guidance for clinical work.2、We first analyze the clinical characteristics of PVR in BPH patients.Then we explore the differences of eGFR in different PVR groups.Finally we explore the relationship between PVR and CKD,and determine whether PVR serves as a risk factor for CKD.Methods and materials1.In this retrospective study,we collected 705 male patients aged 42-97 years who were diagnosed with BPH and treated with transurethral resection of the prostate(TURP)in Nanfang Hospital between October 2012 and October 2016.We excluded those men according to our strict inclusion criteria and exclusion criteria.Then the baseline characteristics of the patients were collected and analysed.Firstly we analyzed the distribution characteristics of age,LUTS,QOL and CKD.Then,we investigated the relationship between different groups of PV,BMI,tPSA,f/t PSA and LUTS,and finally we explore the association between LUTS and CKD and determined whether LUTS serves as a risk factor for CKD.2.In the second part,a total of 314 patients were taken out of the 705 patients who have been tested PVR.Then the baseline characteristics of the patients were collected and analysed.All patients were divided into different groups according to PVR and we analyzed the characteristics of eGFR in different groups.Then,we investigated the relationship between eGFR and different groups of PVR and finally determined whether PVR serves as a risk factor for CKD.Results1.In the first part,among the 705 BPH patients included,the analysis found that with the increase of age,PV and tPSA,the higher the IPSS and QOL score patients got and the differences were statistically significant(P<0.001).However,there was no statistically significant difference in IPSS and QOL score in patients with different BMI and f/t PSA.IPSS was positively correlated with CKD stages.Besides,a higher severity of LUTS led to the decline of eGFR and the fitting curve found IPSS was negatively related with eGFR.Univariate and multivariate logistics regression analysis found that IPSS was an independent risk factor of CKD when adjusted for age,UTI,hypertension and DM.2.In the 314 patients with BPH included in the second part,the PVR of CKD group was significantly higher than that in the non-CKD group(205.45±210.63mL VS 79.06±113.88mL,F=38.292,P<0.001).With the increase of CKD stage,the more PVR patients had and the difference was statistically significant(P<0.001).The comparison of eGFR between different PVR groups revealed that the more PVR patients had,the poorer the renal function was.Univariate and multivariate logistics regression analysis found that PVR(≥100mL)and IPSS werre independent risk factors of CKD when adjusted for age,UTI,hypertension and DM.ConclusionThis study shows that in addition to the common cause for CKD such as age,hypertension,diabetes mellitus,and urinary tract infections,LUTS and PVR due to BPH are also independent risk factors that can lead to kidney damage and promote the incidence of CKD.Therefore,when faced with BPH patients with obvious LUTS or residual urine,Treatments should be adopted timely to improve the patient’s symptoms and reduce the amount of residual urine,which can prevent kidney damage so as to prevent the happening of the CKD.