Asociación entre las trabéculas vesicales severas y la realización de prostatectomía en pacientes con síntomatología urinaria asociada a hiperplasia prostática, atendidos en Uromédica entre los años 2007 y 2017

Abstract

Introduction: The presence of severe trabeculae in patients with prostatic hyperplasia (BPH) and urinary symptomatology supposes an anatomical and functional deterioration of the bladder wall. This deterioration leads to a greater probability of failure in pharmacological management, but there are few investigations in this regard. In this study, we determined the association between the presence of severe trabeculae and the risk of prostatectomy in patients with BPH. Methods: In this retrospective survival study, we analyzed the medical records of 234 patients with BPH attended at Uromédica in Bucaramanga, Colombia, who were medically managed after a cystoscopy. The cystoscopies were performed between 2007 and 2012, and the time of follow-up and the fact of having been operated was recorded in each patient. Those patients who were not operated were considered censored. Values of the following independent variables were recorded: degree of bladder trabeculation, age, prostate volume, presence of middle lobe, presence of bladder neck hyperplasia, postvoid residual, bladder capacity. Considering the surgery / follow-up time as a dependent variable, a bivariate analysis was made with each of the independent variables. A Cox regression was made with the variables that were significant in the bivariate analysis.We made different regression models including interaction between the different independent variables. Additionally, different regression models analyzed the existence of confounding factors of the association between bladder trabeculation and the dependent variable. Results: The median follow-up time was 25.1 months. 81 patients (34.6%) underwent surgery. The bivariate analysis showed that the independent variables associated with an increased risk of surgery are severe trabeculae, age, PSA, middle lobe, postvoid residual and prostatic volume. The median surgery free survival was 77.4 months for patients with mild trabeculae and 36.1 months for patients with severe trabeculae (p <0.001). The multivariate analysis showed that the variables associated with surgery risk were the presence of bladder trabeculation (p <0.001, HR = 3.83) and PSA (p = 0.002, HR = 1.09). No interactions were found between the independent variables. The only independent variable that acted as a confounder of the association between the trabeculae and the risk of surgery was the PSA level. Conclusion: There is an association between the presence of severe bladder trabeculation and the risk of prostatectomy in patients with urinary symptoms secondary to BPH.