Effect Of Metabolic Syndrome On The Safety And Postoperative Lower Urinary Tract Symptoms Of Transurethral Bipolar Plasma Kinetic Prostatectomy

Objective:This study aims to retrospectively analyze the case data of patients with benign prostatic hyperplasia(BPH)who underwent transurethral bipolar plasma kinetic prostatectomy(TUPKP)by a single operator in our hospital,and then investigate the effect of metabolic syndrome(MS)on the safety and postoperative lower urinary tract symptoms(LUTS)of patients with BPH undergoing TUPKP,so as to more accurately assess the surgical risk and prognosis of patients with MS combined with BPH undergoing TUPKP,and take appropriate preventive measures to improve the safety of the procedure,while relatively lowering the expectations of patients and facilitating patient-physician harmony.Methods:Patients with BPH who underwent TUPKP by a single operator from June 2019 to June 2022 in the Department of Urology,Affiliated Hospital of Chengde Medical university,were used as the study population,and the clinical data of the patients were collected retrospectively,including body mass index(BMI),blood pressure level,fasting Blood glucose level,fasting triglyceride(TG)level,high-density lipoprotein cholesterol(HDL-C)content,previous hypertension,diabetes history and other MS-related metabolic indicators,surgery time,bleeding volume,bladder flushing time,postoperative tube placement time,postoperative hospitalization time,postoperative complications and other TUPKP safety indexes.The patients were also followed up with the international prostate symptom score(IPSS)and quality of life index score(QOL)and other LUTS-related indexes at 6months after surgery.The patients were divided into two groups according to whether they had combined MS or not,and analyzed whether there were any differences in surgical safety indexes and postoperative IPSS scores and QOL scores between the two groups.Binary logistic regression analysis was used to clarify the independent risk factors for postoperative LUTS progression in patients.Results:The inclusion and exclusion criteria were met by 109 individuals in total,including 32 patients with BPH combined with MS and 77 patients with BPH alone.No significant difference was found in age(P> 0.05).There were significant differences between the two groups in the preoperative related metabolic indexes except systolic blood pressure.Among them,BMI,diastolic blood pressure,fasting blood glucose level and TG level in MS group were significantly higher than those in non-MS group(P<0.05),while HDL-C level was significantly lower than that in non-MS group(P<0.05).The safety indicators of TUPKP surgery(operation time,blood loss,bladder flushing time,postoperative catheterization time,postoperative hospital stay,postoperative complications)were not significantly different between the two groups(P>0.05).The postoperative IPSS score and QOL score were significantly different(P<0.05),and the IPSS score and QOL score in the MS group were significantly higher than those in the non-MS group.The IPSS score ≤7 was classified as mild LUTS,IPSS score 8～19 as moderate LUTS,and IPSS score ≥20 as severe LUTS.since there was only one patient with severe LUTS in this study,the patients were divided into two groups,mild LUTS and moderate-severe LUTS,and univariate and multifactorial binary logistic regression analyses were performed,respectively.the results confirmed that BMI,having hypertension and time to surgery were independent risk factors for LUTS progression after TUPKP(P<0.05).Conclusions:1.Whether BPH patients have combined MS or not has no significant effect on the surgical safety of TUPKP,and TUPKP is a safe and effective surgical modality for MS combined with BPH patients.2.LUTS was more severe after TUPKP in patients with MS combined with BPH than in patients with BPH alone.Among the MS components,obesity and hypertension were independent risk factors for the progression of LUTS symptoms in patients after surgery.