Benefits and Harms of Benign Prostatic Obstruction Treatments in Renal Transplanted Patients.

In an increasingly ageing transplant population, timely management of benign prostatic obstruction (BPO) is key to preventing complications that result in graft dysfunction or compromise survival.

To evaluate benefits/harms of BPO treatments in transplant patients by reviewing current literature.

A computerised bibliographic search of Medline, Embase, and Cochrane databases was performed for studies reporting outcomes on BPO treatments in transplanted patients.

A total of 5021 renal transplants (RTs) performed between 1990 and 2016 were evaluated. BPO incidence was 1.61 per 1000 population per year. Overall, 264 men underwent intervention. The mean age was 58.4 yr (27-73 yr). In all, 169 patients underwent surgery (n = 114 transurethral resection of the prostate [TURP]/n = 55 transurethral incision of the prostate [TUIP]) and 95 were treated with an un-named alpha-blocker (n = 46) or doxazosin (n = 49). There was no correlation between prostate volume and treatment modality (mean prostate size = 26 cc in the surgical group where reported and 48 cc in the medical group). The mean follow-up was 31.2 mo (2-192 mo). The time from RT to BPO treatment was reported in six studies (mean: 15.4 mo, range: 0-156 mo). The time on dialysis before RT was recorded in only three studies (mean: 47.3 mo, range: 0-288 mo). There was a mean improvement in creatinine after intervention from 2.17 to 1.77 mg/dl. A total of 157 men showed an improvement in the International Prostate Symptom Score (from 18.26 to 6.89), and there was a significant reduction in postvoid residual volume in 199 (mean fall 90.6 ml). Flow improved by a mean of 10 ml/s following intervention in 199 patients. Complications included acute urinary retention (4.1%), urinary tract infections (8.4%), bladder neck contracture (2.2%), and urethral strictures (6.9%). The mean reoperation rate was 1.4%.

Current literature is heterogeneous and of low-level evidence. Despite this, alpha-blockers, TUIP, and TURP showed a beneficial increase in the peak urinary flow and reduced symptoms in transplants patients with BPO. Improvement in the mean graft creatinine was noted after intervention. Complications were under-reported. A multicentre comparative cohort study is needed to draw firm conclusions about the ideal treatment for BPO in RT patients.

In this report, we looked at the outcomes for transplant patients undergoing medical or surgical management of benign prostatic obstruction. Although the literature was very heterogeneous, we found that medical management and surgery with transurethral resection/incision of the prostate are beneficial for improving urinary flow and bothersome symptoms. We conclude that further prospective studies are required for better clarity about timing and modality of intervention in transplant patients.

European urology focus. 2023 Aug 16 [Epub ahead of print]

Rhana Hassan Zakri, Vital Hevia, Romain Bossier, Oscar Rodriguez-Faba, Enrique Lledo Garcia, Klemens Budde, Alberto Breda, Jonathon Olsburgh, Arnaldo Figueiredo

Department of Transplantation, Renal & Urology, Guy's and St Thomas' Hospital, London, UK. Electronic address: ., Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain., Aix-Marseille University, Marseille, France; Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique, Marseille, France., Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain., Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany., Department of Transplantation, Renal & Urology, Guy's and St Thomas' Hospital, London, UK., Department of Urology and Renal Transplantation, Coimbra University Hospital, Coimbra, Portugal.