Diabetes mellitus patients require higher rates of continuing medication after transurethral resection of prostate: Implications from Taiwan nationwide population-based cohort study

Purpose: The aim of this study was to compare the clinical outcomes between diabetic patients and non-diabetic patients receiving transurethral resection of prostate (TUR-P).

Materials and Methods: This analysis was a retrospective cohort study using 13 years (2000–2012) of claims data from Taiwan’s National Health Insurance Research Database (NHIRD). A total of 4887 patients who had persistent lower urinary tract symptoms (LUTS) and underwent TUR-P for benign prostate hyperplasia (BPH) were enrolled and divided into two groups: Diabetes mellitus (DM) group and Non-DM group. The patients’ characteristics, post-operative clinical outcomes, and the medication records after TUR-P were compared.

Results: There was no difference between the two groups in regards to age, ratio of urinary tract infection (UTI) and urinary retention before surgery. The pre-operative medication statuses were also similar between the two groups. However, DM group patients had a higher prevalence of comorbidities. Post-operatively, the DM group had lower rates of UTI (OR, 0.78; p=0.009) and higher rates of urinary retention requiring catheterization (OR, 1.35; p=0.01) within 1 month after TUR-P. Both of the proportions became insignificantly different during the 1 month to 1 year post-operative period. A higher proportion of patients with DM took anti-muscarinics (OR, 1.23; P = 0.032) within the first 3 months and α-blockers (OR, 1.18; P = 0.049) during 3–12 months after receiving TUR-P. Overall, the DM group patients had a worse post-operative medication-free survival compared to that of non-DM group patients (95% CI=1.14; p=0.005).

Conclusion: Diabetes Mellitus patients require higher rates of continuing medication after TUR-P, especially anti-muscarinics in three months post-op and alpha-blocker after three months post-op. Diabetes Mellitus patients also had higher incidence of urine retention after surgery.