Chronic kidney disease, preoperative use of antispasmodics and lower resected prostate volume ratios are risk factors for postoperative use of adrenergic Alpha-blockers and antispasmodics

PLOS ONE RESEARCH ARTICLE Chronic kidney disease, preoperative use of antispasmodics and lower resected prostate volume ratios are risk factors for postoperative use of adrenergic Alphablockers and antispasmodics Chen-Hsun Hsueh1, Li-Wen Chang1, Kun-Yuan Chiu1,2, Sheng-Chun Hung1, JunPeng Chen3, Jian-Ri Li ID1,2,4,5* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan, 2 School of Medicine, National Chung Hsing University, Taichung, Taiwan, 3 Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan, 4 Department of Intensive Care, Division of Surgical Intensive Care Unit, Taichung Veterans General Hospital, Taichung, Taiwan, 5 Department of Nursing, Hungkuang University, Taichung, Taiwan * OPEN ACCESS Citation: Hsueh C-H, Chang L-W, Chiu K-Y, Hung S-C, Chen J-P, Li J-R (2023) Chronic kidney disease, preoperative use of antispasmodics and lower resected prostate volume ratios are risk factors for postoperative use of adrenergic Alphablockers and antispasmodics. PLoS ONE 18(3): e0282745. https://doi.org/10.1371/journal. pone.0282745 Editor: Mohammad Saleem, King Abdulaziz University, UNITED STATES Received: September 20, 2022 Accepted: February 21, 2023 Published: March 9, 2023 Copyright: © 2023 Hsueh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Abstract Objectives Transurethral resection of prostate (TURP) and laser prostate surgery are common surgeries for benign prostate hyperplasia (BPH). We conducted an investigation using hospital database to evaluate the clinical factors associated with post-operative usage of alphablockers and antispasmodics. Methods This study was conducted using retrospective clinical data from the hospital database, which contained newly diagnosed BPH patients between January 2007 and December 2012 who subsequently received prostate surgery. The study end-point was the use of alpha-blockers or antispasmodics for at least 3 months duration after 1 month of surgery. The exclusion criteria was prostate cancer diagnosed before or after the surgery, recent transurethral surgeries, history of open prostatectomy, and history of spinal cord injury. Clinical parameters, including age, body mass index, preoperative prostate specific antigen value, comorbidities, preoperative usage of alpha-blockers, anstispasmodics and 5-alpha reductase inhibitors, surgical methods, resected prostate volume ratios, and preoperative urine flow test results, were evaluated. Results A total of 250 patients receiving prostate surgery in the database and confirmed pathologically benign were included. There was significant association between chronic kidney disease (CKD) and the usage of alpha-blockers after prostate surgery (OR = 1.93, 95% CI PLOS ONE | https://doi.org/10.1371/journal.pone.0282745 March 9, 2023 1 / 12 PLOS ONE Factors related to LUTS medications after TURP 1.04–3.56, p = 0.036). Postoperative antispasmodics usage was significantly associated with preoperative usage of antispasmodics (OR = 2.33, 95% CI 1.02–5.36, p = 0.046) and resected prostate volume ratio (OR = 0.12, 95% CI 0.02–0.63, p = 0.013). Conclusions BPH patients with underlying CKD were more likely to require alpha-blockers after surgery. In the meantime, BPH patients who required antispasmodics before surgery and who received lower prostate volume resection ratio were more liable to antispasmodics after prostate surgery. Introduction Benign prostate hyperplasia (BPH) is a common problem in elder patients, with a prevalence of over 50% in male population aged over 50 years [1]. BPH may lead to prostate enlargement that obstructs bladder neck, which further causes lower urinary tract symptoms (LUTS). Symptomatic LUTS can be manifested as storage symptoms and voiding symptoms, and may result in decreased quality of life as well as various complications [2]. Treatment of BPHinduced LUTS is indicated to relieve symptoms and prevent complications. The treatment begins with lifestyle modification and medical treatment, and may proceed to surgical intervention if initial treatments fail. Most patients present with general improved LUTS symptoms after surgery [3,4]. However, some patients still require medical treatment, especially adrenergic alpha-blockers and antispasmodics, after surgery due to recurrent BPH or persistent LUTS symptoms [5,6]. Obviously, there may be some different characteristics in this patient group that hinder the effects of surgical interventions. Further investigation of this patient group is essential to provide better treatment suggestion in advance. In this study, we aim to identify BPH patients who require adrenergic alpha-blockers and antispasmodics for at least three months after receiving surgery using preoperative and perioperative data. Methods Database Our database was a web-based system that recorded clinical information of patients receiving medical care in Taichung Veterans General Hospital (VGHTC) since January 2000. It included diagnosis, operation notes, results of examinations from outpatient departments, emergency departments and hospitalizations, as well as records of prescribed medicine. The patient data was de-identified before our analysis for privacy concern. Patient selection and treatments Patients who were newly diagnosed BPH between January 2007 and December 2012, and subsequently received prostate surgery were included. The ICD code for BPH was ICD-9-CM 600. The exclusion criteria included prostate cancer diagnosed before or after surgery, transurethral incision or resection within a year before surgery, history of open prostatectomy, and history of spinal cord injury. History of prostate cancer was identified by medical records, preoperative transurethral biopsy results, and biopsy retrieved peri-operatively. All patients included were followed up to December 2021 for last hospital visit or death. PLOS ONE | https://doi.org/10.1371/journal.pone.0282745 March 9, 2023 2 / 12 PLOS ONE Factors related to LUTS medications after TURP Study process This study was conducted using retrospective clinical data from VGHTC database, and was approved by institutional review board with No. CE21221A. The study endpoints included the usage of adrenergic alpha-blockers and antispasmodics after surgery for at least three months. Most patients returned back to the outpatient clinic one week after discharge and were followed up every three months afterward. The cut-off of minimum three m (...truncated)