Incidence and Risk Factors of Post-Operative Depression in Patients Undergoing Transurethral Resection of Prostate for Benign Prostatic Hyperplasia

Figures & data

Table 1 Frequency of Depression and Erectile Dysfunction in Relation to Baseline Characteristics of 611 Patients

	Total N=611	Without Depression		With Depression		P*	Erectile Dysfunction		P*
		N=459	%	N=152	%		N=421	%
Age (years)						0.463			0.000^‡
≤ 60	72	54	75.0	18	25.0		38	52.8
61–80	479	356	74.3	123	25.7		323	67.4
> 80	60	49	81.7	11	18.3		60	100
^aDuration of BPH (years)						0.016^‡			0.448
< 1	97	76	78.4	21	21.6		64	66.0
1–3	104	85	81.7	19	18.3		66	63.5
3–5	167	132	79.0	35	21.0		119	71.3
> 5	243	166	68.3	77	31.7		172	70.8
Marital status						0.032^‡			0.001^‡
Married	351	275	78.3	76	21.7		223	63.0
Widowed/single	260	184	70.8	76	29.2		198	76.2
Education						0.000^‡			0.158
> 9 years	325	264	81.2	61	18.8		232	71.4
≤ 9 years	286	195	68.2	91	31.8		189	66.1
Occupation						0.986			0.942
Retired/unemployed	575	432	75.1	143	24.9		396	68.9
Employed	36	27	75.0	9	25.0		25	69.4
^bIncome						0.260			0.074
Insufficient	218	158	72.5	60	27.5		160	73.4
Sufficient	393	301	76.6	92	23.4		261	66.4
^cNutritional status						0.198			0.000^‡
BMI < 24	404	310	76.7	94	23.3		238	58.9
BMI ≥ 24	207	149	72.0	58	28.0		183	88.4
Physical activity						0.478			0.000^‡
< 30 min/day	420	312	74.3	108	25.7		312	74.3
≥ 30 min/day	191	147	77.0	44	23.0		109	57.1
^dCigarette smoking						0.001^‡			0.000^‡
Currently	333	230	69.1	103	30.9		259	77.8
Ever	208	172	82.7	36	17.3		119	57.2
Never	70	57	81.4	13	18.6		43	61.4
Alcohol consumption						0.025^‡			0.017^‡
Frequently (≥ 3 per week)	133	88	66.2	45	33.8		104	78.2
Seldom	348	269	77.3	79	22.7		236	67.8
Never	130	102	78.5	28	21.5		81	62.3

Notes: ^aDuration of BPH was defined as the time from LUTS onset to the operation date. ^bInsufficient income was defined as patients reported difficulty to make both ends meet; ^cAccording to Chinese standards, BMI ≥ 24 was defined as overweight; ^dFailure to quit smoking was defined as currently, former smokers was defined as ever; Never smoking was defined as never. *Difference between two subgroups was assessed by Chi-square test. ^‡The difference was statistically significant.

Abbreviations: BPH, benign prostatic hyperplasia; BMI, body mass index (kg/m²); LUTS, lower urinary tract symptoms.

Figure 1 Flow chart of participant enrolment.

Table 2 Severity of LUTS, Coexisting Diseases, Erectile Function and Depression in Patients with BPH at 6 Months After TURP

	Total N=611	Without Depression		With Depression		P*	Erectile Dysfunction		P*
		N=459	%	N=152	%		N=421	%
Severity of LUTS currently						0.000^‡			0.000^‡
Mild	409	330	80.7	79	19.3		239	58.4
Moderate	137	89	65.0	48	35.0		121	88.3
Severe	65	40	61.5	25	38.5		61	93.8
Comorbidities
Coronary artery disease	216	156	72.2	60	27.8	0.220	165	76.4	0.003^‡
Diabetes	179	123	68.7	56	31.3	0.018^‡	151	84.4	0.000^‡
Hypertension	492	364	74.0	128	26.0	0.185	340	69.1	0.826
Dyslipidaemia	233	164	70.4	69	29.6	0.033^‡	182	78.1	0.000^‡
Bladder stone	67	43	64.2	24	35.8	0.028^‡	45	67.2	0.744
Erectile function [pts.]						0.013^‡			NA
IIEF-5 <22	421	304	72.2	117	27.8		–	–
IIEF-5 ≥22	190	155	81.6	35	18.4		–	–
Urinary incontinence						0.001^‡			0.331
Yes	5	0	0	5	100		5	100
No	606	459	75.7	147	24.3		416	68.6
Depression symptoms						NA			0.000^‡
No symptoms	459	459	100	-	-		304	66.2
Mild	128	–	–	128	84.2		94	73.4
Moderate	20	–	–	20	13.2		19	95.0
Severe	4	–	–	4	2.6		4	100

Notes: *Difference between two subgroups was assessed by Chi-square test. ^‡The difference was statistically significant.

Abbreviations: LUTS, lower urinary tract symptoms; BPH, benign prostatic hyperplasia; TURP, transurethral resection of the prostate; IIEF-5, International Index of Erectile Function questionnaire-5.

Table 3 Risk Factors Revealed by Multiple Logistic Regression for Severity of Depression Symptoms

Risk Factors	Subgroup	Depression Symptoms		OR (95% CI)	Significance*
		Mild N (%)	Moderate or Severe N (%)
Marital status	Married	71 (93.4)	5 (6.6)	1.00	0.004^‡
	Widowed/single	57 (75.0)	19 (25.0)	4.73 (1.67–13.46)
Education	> 9 years	81 (89.0)	10 (11.0)	1.00	0.052
	≤ 9 years	47 (77.0)	14 (23.0)	0.41 (0.17–1.01)
Cigarette smoking	Ever/Never	44 (89.8)	5 (10.2)	1.00	0.199
	Currently	84 (81.6)	19 (18.4)	1.99 (0.70–5.69)
Alcohol consumption	Seldom/Never	98 (91.6)	9 (8.4)	1.00	0.000^‡
	Frequently	30 (66.7)	15 (33.3)	5.44 (2.17–13.68)
Severity of LUTS	Mild	72 (91.1)	7 (8.9)	1.00	0.018^‡
	Moderate/Severe	56 (76.7)	17 (23.3)	3.12 (1.21–8.05)
Duration of BPH	≤ 5 years	69 (92.0)	6 (8.0)	1.00	0.013^‡
	> 5 years	59 (76.6)	18 (23.4)	3.51 (1.31–9.42)
Erectile function	IIEF-5 ≥ 22	34 (97.1)	1 (2.9)	1.00	0.042^‡
	IIEF-5 < 22	94 (80.3)	23 (19.7)	8.32 (1.08–63.99)
Urinary incontinence	No	127	20	1.00	0.002^‡
	Yes	1	4	5.88 (3.23–10.70)
Diabetes	No	86 (89.6)	10 (10.4)	1.00	0.021^‡
	Yes	42 (75.0)	14 (25.0)	2.87 (1.18–6.99)
Dyslipidaemia	No	71 (85.5)	12 (14.5)	1.00	0.622
	Yes	57 (82.6)	12 (17.4)	1.25 (0.52–2.98)
Bladder stone	No	113 (88.3)	15 (11.7)	1.00	0.003^‡
	Yes	15 (62.5)	9 (37.5)	4.52 (1.69–12.12)

Notes: *Difference between two subgroups was assessed by logistic regression analysis. ^‡Statistical significant after logistic regression analyses.

Abbreviations: LUTS, lower urinary tract symptoms; BPH, benign prostatic hyperplasia; IIEF-5, International Index of Erectile Function questionnaire-5; OR, odds ratio; CI, confidence interval.