A Comparative Study Between Early Endoscopic Intervention and Medical Treatment in Case of Mild Bladder Outlet Obstruction (BOO) with Benign Prostatic Hyperplasia (BPH) in Diabetic Patients

Abstract

Background: Bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) is common in diabetic patients, necessitating an evaluation of early endoscopic intervention versus medical management. Objective: To compare the effectiveness of early endoscopic intervention and medical treatment for mild BOO in diabetic patients with BPH, assessing symptom relief, urinary flow improvement, and complications. Methods: A multicenter, prospective study was conducted at the Department of Urology, Pabna Medical College, Bangladesh, from June 2019 to December 2021. Two hundred forty-four diabetic male patients with mild BOO were randomized into either early endoscopic intervention (TURP/TULP) or medical management (alpha-blockers, 5-alpha-reductase inhibitors). Primary outcomes included symptom relief, urinary flow rate, and quality of life. Secondary outcomes included complications and follow-up over 12 months. Results: The early endoscopic intervention group showed a 75% improvement in symptoms, while the medical group showed 52% (p < 0.05). Urinary flow rate increased by 40% in the endoscopic group, compared to 23% in the medical group (p < 0.01). Standard deviation of symptom improvement in the endoscopic group was 3.2 (95% CI: 2.8-3.7) and 4.5 in the medical group (95% CI: 4.1-4.9). The p-value for symptom improvement between groups was 0.03. The complication rate was 10% for the endoscopic group and 5% for the medical group (p < 0.05). Additionally, quality of life improvement was significantly higher in the endoscopic group (85%) versus 55% in the medical group (p < 0.001). Conclusion: Early endoscopic intervention significantly outperforms medical treatment in improving symptoms, urinary flow, and quality of life in diabetic patients with mild BOO and BPH