Introduction

The age of patients undergoing renal transplantation has increased in the past decades. Symptoms of benign prostate hyperplasia (BPH) are rare in dialysis patients due to low urine excretion. As BPH is very prevalent in elderly men, urologists often have to address unexpectedly symptomatic patients after their kidneys recover function. The aim of this study is to compare urological outcomes and morbidity related to transurethral resection (TURP) or incision of the prostate (TUIP) performed in either the early or the late post-transplant period.

Methods

Between 1998 and 2016, 3145 renal allograft transplantations were performed in our institution. Fifty patients developed severe prostatic symptoms with no response to drug treatment after recovery of renal function. The patients were divided into two groups in accordance with the time between transplantation and the prostate procedure and were prospectively studied: group I – 18 patients in which TURP/TUIP was performed less than 90 days after transplantation; and group II – 32 patients in which the prostate procedure was performed more than 90 days after transplantation. Urologic parameters analyzed were International Prostate Symptom Score (IPSS), Prostate Specific Antigen (PSA), prostate measurements and PVR (post void residual urine) before and 6 months after surgery. The morbidity was compared based on need of transfusion, presence of urinary tract infection (UTI), time to home discharge and loss of renal function (elevation of creatinine levels).

Results

Both groups were comparable in terms of age (59.8 ± 8.6 vs. 58.5 ± 9.3, p=0.744), but not in prostate measurement (55.3 ± 37.5 vs. 37.0 ± 12.7, p=0,001). Furthermore, time of home discharge (9.4 ± 8.5 vs. 4.1 ± 4.5, p=0.026), the UTI incidence (55.6% vs. 18.8%, p<0,017), and loss of renal function (elevation of creatinine levels - p<0,001) were significantly higher in group I. However, there were no differences between the groups in terms of IPSS in the 6 months (5.9 ± 4.3 vs. 5.1 ± 3,8, p=0.560), decrease PSA levels (p=0.568), and PVR in the 6 months (14,2 ± 35,3 ml vs. 26,3 ± 41,4 ml, p=0.309). No patients need receive transfusions.

Conclusions

Despite the fact that there was no difference in effectiveness, TURP and TUIP should be avoided in the early post transplantation period due to the increasing risk of infection, the loss of graft function and higher time of home discharge.

Funding

None