Prospective study of effects of turp on outcome, morbidity, mortality in patients with non dialysis requiring renal insufficiency.

INTRODUCTION : Benign Prostate Hyperplasia (BPH) is a common disease in adult men and its incidence is age related. Prevalence of BPH is approximately 25% in men aged 40 to 49 years, 50% in men aged 50 to 59 years and 80% in men aged 70 to 79 years. Renal failure and symptomatic benign prostatic hyperplasia (BPH) are two common health problems, they usually co-exist in 5.9–13.6% of the male population over 50 years of age. Actually going by the natural history of the disease and its progression with relation to Benign prostatic hyperplasia and its complications, it is noted that 13.6% of patients who presented to undergo Transurethral resection were in renal failure. It is usually not clear in this group of patients whether the reason for renal insufficiency is or is not Benign prostatic hyperplasia. However, it has been reported in some studies that the incidence of diabetes mellitus and hypertension is higher in patients with renal failure (RF) and lower urinary tract symptoms (LUTS) due to Benign prostatic hyperplasia. On the other hand, it is known that due to chronic urinary obstruction, BPH can lead to renal failure and even death occasionally. AIMS AND OBJECTIVES : To study the prevalence of co-morbid factors in patients with Benign prostatic hyperplasia and non dialysis requiring renal insufficiency. Study of treatment outcome following the surgical management of BPH with non dialysis requiring renal failure. Study of complications associated with operative management in these patients. MATERIALS AND METHODS : This is a clinical study of 40 cases of Benign prostatic hyperplasia in normal and in patients with non dialysis requiring renal failure who underwent surgical therapy-TURP. Inclusion Criteria: All patients with Non dialysis requiring Renal Dysfunction associated with Benign Enlargement of Prostate in the Department of Urology in our institute. Exclusion Criteria: Histologically proven malignant prostatomegaly. Patients undergoing open prostatectomy. Patients with end stage renal disease requiring hemodialysis. CONCLUSION : The incidence of renal failure associated with benign prostatic hyperplasia in our study was about 12.5%. After excluding patients with prostatic malignancy, patients needing dialysis, the study group constituted 5%. The age of presentation was around 64-65 years, which also coincided with increased prevalence of chronic kidney disease in elderly population, who also present with benign hyperplasia of prostate. There was no significant variation in preoperative and postoperative levels of serum sodium, potassium levels in patients with nondialysis requiring renal failure (S.creatinine less than 3), when compared to normal patients. Complications of transurethral resection in patients who had nondialysis requiring renal failure, was on the higher side. Bleeding as a complication requiring blood transfusion was noted in 20% of patients compared to normal patients. But overall complication rate was not statistically significant. This can be attributed either small sample size. Improvement in instruments like bipolar resection, use of non hemolytic irrigation solutions, continuous flow resectoscopes, better anesthetic care can be a factor. The outcome following TURP was successful with restoration in normal renal function and normal voiding pattern in majority of patients and it was further noted that the successful outcome of TURP in these patients were influenced by various factors such as age, duration of symptoms, severity of lower urinary tract symptoms, severity of renal failure at the time of presentation, The size of Prostate gland had no correlation with the final outcome