| BackgroundBenign prostatic hyperplasia(BPH)is one of the most common causes of lower urinary tract symptoms(LUTS)in elderly men.The incidence of BPH increases rapidly after the age of 40,and even reaches about 100%at the age of 90,which has a significant impact on the quality of life of patients.According to the current guidelines for the diagnosis and treatment of urological diseases,surgery is still the standard and the most effective method for the treatment of BPH when it is difficult to treat LUTS.For several decades,transurethral resection of the prostate(TURP)and open prostatectomy(OP)have been considered as reference criteria for the treatment of prostates smaller than and larger than 80ml,respectively.However,TURP has many complications,such as high risk of bleeding during and after operation,incomplete resection and so on.For open prostate surgery,this is the most invasive method for the treatment of BPH,OP is usually associated with serious perioperative complications,including longer intubation time and hospital stay.Therefore,a variety of minimally invasive surgical techniques emerge as the times require,transurethral enucleation and resection of the prostate(TUERP)combined with the advantages of TURP and OP,has been widely used and recognized in clinic.It has the advantages of less bleeding during and after operation,complete resection of hyperplastic glands,and rapid recovery after operation and so on.Early removal of catheter after operation is an important process of rapid recovery after operation.Whether the catheter can be successfully removed within 48 hours is affected by many factors.At present,it is not clear which factors will affect the removal of catheter within 48 hours after operation.ObjectiveWith the increasing number of BPH patients in China year by year and the gradual popularization of the concept of enhanced recovery after surgery(ERAS),whether the catheter can be removed in the early postoperative period has become a problem that urologists need to face.In this study,the correlation between the clinical data of patients and the failure of catheter removal within 48 hours after operation was comprehensively analyzed,and the risk factors that may affect the prognosis were screened out,which has certain reference significance for guiding clinicians to remove the catheter within 48 hours after surgery.Materials and Methods1.According to the inclusion criteria and exclusion criteria,the clinical data of 357 patients with BPH treated by TUERP from January 2015 to July 2018 were collected.All of these patients stopped continuous bladder irrigation and removed the catheter within 48 hours after operation.According to whether the removal of the catheter was successful,they were divided into group A(successful extubation)and group B(extubation failure).By comparing the clinical data of the two groups of patients,the threshold effect and saturation effect were analyzed by R software to screen out the risk factors that could affect the removal of urinary catheter within 48 hours after operation.2.Using Logistic regression analysis,taking the failure of catheter removal as dependent variable and clinical data as independent variable,univariate analysis and multivariate analysis were carried out,the prediction model was established,the regression equation was constructed.The Receiver Operating Characteristic(ROC)curve was constructed by SPSS software,and the area under the curve and the value of cut-off were calculated.Results1.A total of 357 patients were included in this study,including 305 patients in group A and 52 patients in group B.By comparing the clinical data between the two groups,the study showed that there was no correlation between age and failure to remove catheter within 48 hours after operation(P>0.05).With the increase of IPP,IPSS and QoL,the risk of urethral extubation within 48 hours after operation increased,and the difference was statistically significant(P<0.05).With the increase of prostate volume,the risk of urethral extubation within 48 hours after operation decreased,the difference was statistically significant(P<0.05).2.Logistic multivariate regression analysis showed that IPSS,QoL,preoperative drug treatment,history of acute urinary retention,prostate volume and IPP were independent influencing factors of urethral removal within 48 hours after operation.Through Logistic regression analysis,the prediction model was established.The regression equation:logit(P)=10.862+1.376x(IPSS)-1.185×(QoL)-1.062x(preoperative drug therapy)+1.079 x(history of acute urinary retention)+0.030 x(prostate volume)-0.867x(IPP),The area under the ROC curve was 0.860,the cut-off value of the diagnostic model was 1.7725,the sensitivity and specificity of predictive model were 74.1%and 84.6%,respectively.ConclusionsThis study showed that the success rate of extubation within 48 hours ater TUERP was 85.4%.In order to improve the success rate of extubation,reduce the economic burden of patients and the risk of nosocomial infection,and improve the utilization rate of medical resources,It was found that with the increase of IPP,IPSS and QoL,the risk of failure of extubation within 48 hours increased,while with the increase of prostate volume,the risk of failure of extubation decreased.The predictive model constructed by Logistic regression analysis can help clinicians evaluate whether the patients can remove the catheter within 48 hours after transurethral enucleation of the prostate,which has a good reference value in clinical practice. |
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