Risk Factors of Emergency Room Visits for Bleeding Complications Following Transurethral Procedures in the Treatment of Benign Prostatic Hyperplasia: A Retrospective Cohort Study

Figures & data

Table 1 Patient Characteristics

Variables		Mean/Number (N=665)	SD	Range/Percentage
General parameter
Age		71	8	64–76	Year-old
CCI categorized	0	243		36.5%
	≥ 1	422		63.5%
IPSS		24	5	21–27
Recurrent BPH/LUTS	Yes	71		10.7%
	No	594		89.3%
Antiplatelet	Yes	93		14.0%
	No	572		86.0%
Anticoagulant	Yes	17		2.6%
	No	648		97.4%
5-ARIs	Yes	105		16.7%
	No	523		83.3%
Admission with Foley	Yes	124		18.7%
	No	540		81.3%
PSA		7.18	7	2.73–9.01	ng/mL
Prostate volume		59.66	26	42.41–72.99	gm
Platelet		216.0	60	175–245	1000ul
INR		1.0	0.1	1–1.1
aPTT		28.2	2.3	26.8–29.3
Length of stay		3.5	3.3	3.0–4.0	Days
Operation
Procedures
	ThuVARP	171		25.7%
	ThuLEP	118		17.7%
	PVP	125		18.8%
	M-TURP	70		10.6%
	B-TURP	181		27.3%
Seniority of urologist		18.0	7	10–20	Years
First OP	Yes	234		35.2%
	No	431		64.8%
Last OP	Yes	117		17.6%
	No	548		82.4%
OP started in the afternoon	Yes	291		43.8%
	No	374		56.2%
Weight of resected prostate		24.89	23	8.4–32.4	gm
Percent of resected prostate		34	2	19–47	%
Foley Traction immediate after OP	Yes	430		64.7%
	No	235		35.3%
Repeated Foley Traction after release	Yes	4		0.6%
	No	660		99.4%
Manual irrigation	≧ 2	9		1.4%
	< 2	656		98.6%
Catheterization time		2.6	4.6	1.1–2.0	Days
ER visits for gross hematuria within 3 months	Yes	39		5.9%
	No	626		94.1%
ER visits for clot retention within 3 months	Yes	22		3.3%
	No	643		96.7%

Abbreviations: CCI, Charlson Comorbidity Index; IPSS, International Prostate Symptom Score; TURP, transurethral resection of the prostate; 5-ARI, 5α-reductase inhibitors; PSA, prostate specific antigen; INR, international normalized ratio; M-TURP, monopolar transurethral resection of the prostate; B-TURP, bipolar transurethral resection of the prostate; Green, greenlight photoselective vaporization of the prostate; ThuLEP, thulium laser enucleation of the prostate; ThuVARP, thulium laser transurethral vaporesection of the prostate; First OP, first operation of the day; Last OP, last operation of the day.

Figure 1 Trend of ER visits for hematuria and clot retention within six months following operation.

Table 2 Analysis of Predictors of ER Visits for Gross Hematuria Within Three Months

		Univariate Analysis			Multi-Variate Analysis
		Exp(B)	95% CI for Exp(B)	p-value	Exp(B)	95% CI for Exp(B)	p-value
General parameter
Age		1.00	0.96–1.04	0.926
CCI categorized
	CCI = 0	1.00
	CCI ≥ 1	0.92	0.47–1.78	0.797
IPSS		1.04	0.97–1.11	0.283
Recurrent BPH/LUTS		0.95	0.33–2.77	0.930
Antiplatelet		0.90	0.34–2.36	0.829
Anticoagulant		1.00	0.13–7.77	0.997
5-ARIs		0.93	0.38–2.28	0.874
Admission with Foley		0.95	0.41–2.21	0.905
PSA		1.00	0.95–1.04	0.875
Prostate volume		1.00	0.99–1.02	0.664
Platelet		1.00	1.00–1.01	0.772
INR		7.21	0.24–215.45	0.255
aPTT		1.05	0.92–1.20	0.436
Length of stay (days)		0.93	0.74–1.16	0.522
Operation
Procedures
	ThuVARP	1.00			1.00
	ThuLEP	0.61	0.24–1.54	0.294	0.85	0.30–2.43	0.760
	PVP	0.24	0.07–0.84	0.025*	0.45	0.19–1.08	0.072
	M-TURP	0.84	0.29–2.38	0.736	0.65	0.26–1.63	0.355
	B-TURP	0.45	0.19–1.08	0.072	0.30	0.09–1.01	0.051
Seniority of urologist		1.00	0.96–1.05	0.979
First OP		0.54	0.25–1.15	0.108
Last OP		0.84	0.35–2.06	0.709
OP started in the afternoon		1.38	0.72–2.64	0.331
Weight of resected prostate		0.99	0.98–1.01	0.380
Percent of resected prostate		0.89	0.17–4.70	0.891
Foley Traction immediate after OP		1.25	0.62–2.51	0.539
Repeated Foley Traction after release		5.46	0.55–53.70	0.146
Manual irrigation ≧ 2		4.78	0.96–23.82	0.056	4.09	0.79–21.06	0.092
Catheterization time		1.02	0.96–1.07	0.591

Note: *Correlation is significant at the 0.05 level (two-tailed).

Figure 2 Incidence of ER visits for hematuria within three months for different methods.

Table 3 Analysis of Predictors of ER Visits for Clot Retention Within Three Months

		Univariate Analysis			Multi-Variate Analysis
		Exp(B)	95% CI for Exp(B)	p-value	Exp(B)	95% CI for Exp(B)	p-value
General parameter
Age		0.98	0.93–1.04	0.529
CCI categorized
	CCI = 0	1.00
	CCI ≥ 1	0.68	0.29–1.60	0.380
IPSS		0.96	0.88–1.04	0.315
Recurrent BPH/LUTS		0.83	0.19–3.64	0.807
Antiplatelet		0.97	0.28–3.35	0.962
Anticoagulant		1.87	0.24–14.74	0.554
5-ARIs		1.11	0.37–3.35	0.852
Admission with Foley		0.43	0.10–1.85	0.255
PSA		0.97	0.90–1.05	0.493
Prostate volume		1.00	0.99–1.02	0.849
Platelet		1.00	0.99–1.01	0.837
INR		14.91	0.26–844.56	0.190
aPTT		1.10	0.94–1.28	0.249
Length of stay (days)		0.91	0.67–1.25	0.570
Operation
Procedures
	ThuVARP	1.00			1.00
	ThuLEP	0.71	0.24–2.14	0.546	0.67	0.20–2.24	0.519
	PVP	0.26	0.06–1.22	0.087	0.30	0.06–1.41	0.126
	M-TURP	0.81	0.21–3.03	0.748	0.83	0.22–3.19	0.792
	B-TURP	0.18	0.04–0.83	0.028*	0.18	0.04–0.82	0.027*
Seniority of urologist		1.01	0.95–1.07	0.734
First OP		0.53	0.19–1.46	0.220
Last OP		0.46	0.11–1.99	0.298
OP started in the afternoon		1.07	0.46–2.52	0.871
Weight of resected prostate		0.99	0.97–1.01	0.445
Percent of resected prostate		1.58	0.20–12.68	0.665
Foley Traction immediate after OP		1.18	0.47–2.93	0.726
Repeated Foley Traction after release		10.14	1.01–101.63	0.049*	9.08	0.77–107.75	0.080
Manual irrigation ≧ 2		9.09	1.77–46.53	0.008*	9.51	1.66–54.43	0.011*
Catheterization time		1.03	0.98–1.09	0.262

Note: *Correlation is significant at the 0.05 level (two-tailed).

Figure 3 Incidence of ER visits for clot retention within three months for different methods.

Table 4 Early Postoperative Complications Within 30-Day

Complications	The Clavien-Dindo Classification Grade	Numbers (Percentage)
Gross hematuria (N=208)
	Grade I	208(31.8)
Clot retention (N=21)
	Grade III	21(3.2)
Urinary tract infection (N=201)
	Grade II	201(30.7)
Acute urinary retention (N=50)
	Grade III	50(7.6)
Urge urinary incontinence (N=76)
	Grade I	76(11.6)
Stroke (N=0)
	All grade	0(0)
Acute myocardial infarction (N=0)
	All grade	0(0)