Hypothesis / aims of study
We assumed that the larger the difference in daily temperature, the worse the symptoms of benign prostatic hyperplasia (BPH) patients would be. Therefore, we investigated the symptom deterioration of patients with BPH according to the daily temperature difference.
Study design, materials and methods
From the National Health Insurance Service database, we collected and analyzed data on patients with benign prostatic hyperplasia patients in six major metropolitan areas in Korea between January 2008 and December 2017. We identified diagnoses using the International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Patients were treated with α-blocker, 5α-reductase inhibitor (5ARI) for more than three months due to prostate hypertrophy. Data for day daily temperature differences over 10 years were collected in the data base of the Korea Meteorological Administration. We investigated the rate occurrence of emergency room visit, rate of urethral catheter insertion, rate of hospitalization, and rate of BPH surgery due to aggravation of low urinary tract symptoms (LUTS) according to daily temperature difference. BPH surgery included transurethral resection of prostate, laser prostatectomy, prostatic urethral lift procedure. The number of BPH surgeries was analyzed for 3, 6, and 9 months after emergency room visit with worsening LUTS. Categorical variables were analyzed by the ratio of events (%). Student t-test, chi-square test and Fisher's exact were used to compare the postoperative outcomes. Multivariate analysis was performed using logistic regression. Statistical significance was defined as a p-value ≤0.05.
A total of 1,446,465 patients were enrolled in this study. The distribution of patients according to the residence area was 715709 (49.5%) in Seoul, 217815 (15.1%) in Busan, 174398 (12.1%) in Daegu, 130402 (9.0%) in Incheon, 107506 (7.4%) in Daejeon and 100635 (7.0%) in Gwangju. In 10 years. the number of BPH patients in 6 cities increased 3.3 times from 75,204 in 2008 to 250,265 in 2017. As the number of patients visiting the emergency room due to aggravation of the LUTS due to the difference of daily temperature in each region for 10 years, The larger the daily temperature difference, the more severe the LUTS. The larger the daily difference, the more patients who visit the emergency room, and the more patients who have inserted the urethral catheter. And the number of hospitalized patients also increases. 7955 patients visited the emergency room when the daily temperature difference was below 4 degrees. And 38985 patients visited the emergency room when the daily temperature difference was more than 10 degrees. When the daily temperature difference was more than 10 degrees, about 4.9 times more patients visited the emergency room than when the daily temperature difference was below 4 degrees. After visiting the emergency room, there were 3,309 patients who inserted the catheter due to worsening LUTS at the daily temperature difference below 4 degrees. When the daily temperature difference was more than 10 degrees, the number of catheter insertion cases was 16,303, which was 4.9 times higher than that of below 4 degrees. The number of patients hospitalized after visiting the emergency room is 3857 at the daily temperature difference of less than 4 degrees. When the daily temperature difference was more than 10 degrees, the number of hospitalized patients was 19736, which was 5.1 times higher than when the temperature was less than 4 degrees. The greater the daily temperature difference, the greater the number of patients undergoing BPH surgery after visiting the emergency room. By time, surgery was most frequently performed within three months after visiting the emergency room.
Interpretation of results
The greater the difference in temperature, the worse the LUTS symptoms of BPH patients, which significantly increases the number of emergency room visits, catheter insertion, hospitalization, and BPH surgical patients.